A Case Study of A 66-Year Old Patient With Multiple Electrolyte Imbalances

A Case Study of a 66-year old Patient with Multiple Electrolyte Imbalances
BSN307- Group 2A
Group Members
MIRANDA, Noella Jeune Bienah T.
MOCORRO, Rommel
MONOSO, Johann
NAPULAN, Angemae Krizette
NUNEZ, Abegail Lene P.
PANTALEON, Alfred Jan S.
PASOLOHAN, Vanesa Mae L.
PONGASE, Joy Mae
QUESADA, Princess
II. DEMOGRAPHIC PROFILE
Name: RT
Address: Homeland, Brgy. Sauyo, Novaliches, Quezon City
Age: 66 Birth Date: January 27, 1955 Birth Place: N/A
Gender: Male
Religion: Born Again Race/Ethnic Origin: Filipino
Occupation: N/A Educational Attainment: N/A
Marital Status: Married Name of Spouse: Josefa
Number of Children: 3
Chief Complaints: Generalized body weakness
Date of Admission: August 29, 2021
Room & Bed Number: ER & 150
Attending / Admitting Physician: Dr. Pineda & Dr. Acuna
Admitting/Final Diagnosis: Multiple Electrolyte Imbalance
Medical Insurance: Phil health

III. NURSING HEALTH HISTORY
A. History of Present Illness
2 days prior to consultation, the patient stated that he experienced weakness on his lower
extremities which resulted in him having difficulties in moving. Client also stated that he
experienced drowsiness, chest pain and he also had a fever. Upon experiencing these, the client
decided to go to the hospital to seek medical care.
B. Past Health History
Since June 14, 2021, client was re-examined for his chest and showed streaky and ill-
defined densities in both lower lungs which suggests bilateral interstitial pneumonia and/or
fibrosis. The result also showed that the heart remained enlarged with left ventricular prominence.
The nodulo hazed densities in the right upper lobe are now more apparent which suggests
pulmonary tuberculosis vs neoplastic process. An interval blunting of the left costophrenic sulcus
suggests minimal pleural effusion. The rest of the chest findings did not change which includes
atheromatous, tortuous aorta and osteodegenerative changes. Client had a status post of
myocardial infarction and had undergone angiogram during the year of 2017. He stated that he
has hypertension for the past 20 years and also has diabetes mellitus for 5 years. For the
heredofamilial disease, his father has diabetes and his mother is hypertensive. The client also
indicated that he had been completely vaccinated. Client had no other major travel history. Lastly,
the client confirmed that he has no allergies to any food and drugs.
GENOGRAM
IV. GORDON’S ASSESSMENT
A. HEALTH PERCEPTION/ HEALTH MANAGEMENT
The patient was admitted on August 28, 2021, a 66-year-old male who came in due to
generalized body weakness. Upon asking the client regarding his health, he describes his health
as physically tired. He also stated that he cannot perform regular exercise due to his age and
ability. R.Tandoc thinks that the cause of his body weakness is because of too much intake of
salty and fatty food. He had a hard time following the suggestion of not eating too many salty and
fatty foods.
Interpretation: Deviation from Normal
Analysis: Generalized body weakness is most often related to fatigue. Salty and foods
high in saturated fats can increase blood pressure. Too much salt can put a person at risk for
heart disease. It can also affect our sleep. According to Dr. Darling, “Eating a meal that’s high in
sodium at dinnertime can contribute to sleep disturbances, in part due to an increase in blood
pressure and fluid retention” With too much salt in your bloodstream you may not sleep well that
night and feel tired the next day.”. According to a study by Yingting Cao, “Fat overload can cause
your gut to produce neurohormones that make your brain react more slowly” This makes you feel
sluggish and fatigued after eating it.
Reference:
Kathryn Teng, M. D. (2020, September 4). Too much salt is bad - for your heart and
your sleep. Cleveland Clinic. Retrieved September 21, 2021, from
https://health.clevelandclinic.org/salt-and-sleep/.
Malia, M. (2019, February 25). Find it hard to keep your eyes open after meals? read
this. Men's Health. Retrieved September 21, 2021, from
https://www.menshealth.com/health/a19521568/fat-and-sleepiness-risk/.
A. NUTRITIONAL METABOLIC
Nutritional - Before During Analysis Interpretation

Metabolic Hospitalization Hospitalization
Pattern
08/28/21
08/25/21 -Based on the Before
2 pcs of ham and 1 Was put on Low intake of the Hospitalization
Breakfast (8 cup of rice; 1 glass Salt Low Fat Diet patient before
am) of water hospitalization, it Deviation From
shows that he Normal
consumed too
Breakfast (7:30 much salt.
am) Ingesting too
Garlic Butter much salt can During
Shrimp (half a kilo) 1 pc of banana; 1 have unpleasant Hospitalization
Lunch 1 cup of rice; 2 pc of fish
(12:30 pm) effects, both in the - NORMAL
glasses of water short and long
08/29/21
1 cup of instant term. It can cause
pudding Was put on nothing water retention,
per orem rise in blood
2 pcs fried chicken pressure, intense
Snack (3:30 09/01/21
pm) and 1 cup of rice; 1 thirst, and
glass of water increase stomach
Diet shifted to
cancer risk, risk of
General Liquid Diet
heart disease.
Dinner (8
pm) Breakfast (7:30
Reference: Petre,
am)
A. (2020, July 9).
Sausage
(processed) and 1 1 cup of hot cereal What happens if
cup of rice; 1 glass (like Cream of you eat too much
of water Wheat) thinned salt? Healthline.
08/26/21 with whole milk; 1/2 Retrieved
cup fruit juice September 21,
Breakfast
Beef short ribs and 2021, from
(7:30 am) Lunch (noon)
1 cup of rice; 1 glass https://www.healt
of water hline.com/nutrition
2 cups of soup
/what-happens-if-
1/2 cup tomato you-eat-too-
1 pc burger and 1 juice much-
Lunch (1 pm) glass of water salt#overdose.
1 cup chocolate
pudding -Also, it consists of
Crunchy pork rinds too many
(skin) and 1 cup of Snack (3:30 pm) saturated fats in
Snack (4
rice; 1 glass of your diet can raise
pm) 1/2 cup
water "bad" LDL
supplement
cholesterol in your
beverage
blood, which can
Dinner (8:30 Sausage, bacon, 1/2 cup fruit juice increase the risk
pm) and salt pork; 1 of heart disease
glass of coffee and stroke. In
1 pc fried chicken addition, it also
Dinner (7:30 pm) causes you to
and soup; 1 glass of
water 2 cups soup become
08/27/21 overweight or
obese, this raises
Breakfast 1/2 to 1 cup your risk of
(7:45 am) blended oatmeal endometrial,
3 pcs of sliced pizza
thinned with milk breast, prostate,
and 1 low-fat yogurt
and colorectal
Lunch (1 pm) 1/2 cup lemonade cancers.
Frozen meat and 1 Reference: NHS.

cup of rice; 1 glass (n.d.). NHS
of water 09/02/21
choices. Retrieved
Snack (4 Diet shifted to Soft September 21,
pm) Low Salt Low Fat 2021, from
Diet https://www.nhs.u
k/live-well/eat-
Breakfast (7:30 well/different-fats-
Dinner (8 pm
am) nutrition/#:~:text=
)
Eating%20too%2
1 medium pear; 1
0much%20saturat
slice of toast; 2
ed%20fats,liver%
boiled eggs; 1
2C%20where%20
apple
it's%20disposed%
Lunch (12 pm) 20of.
5 ounces of grilled A low-sodium,

fish; 2 sweet low-fat diet could
potatoes; ¼ cup of benefit those who
olives are genetically
predisposed to
Dinner (7 pm) cardiovascular
problems. If you
Spinach salad; 1
have high blood
banana
pressure, elevated
cholesterol, or
heart disease, it's
even more
important to tweak
your eating habits.
As the Harvard
T.H. Chan School
of Public Health
notes, African
Americans and
people over age
50 as well as
those with
hypertension or
diabetes are at
higher risk of
developing health
problems due to
excess sodium
consumption.
Reference: Leaf
Group. (n.d.). List
of low-fat, low Salt
& Low
Cholesterol
Foods.
LIVESTRONG.C
OM. Retrieved
September 21,
2021, from
https://www.livestr
ong.com/article/2
40022-list-of-low-
fat-low-salt-low-
cholesterol-
foods/.
NPO is usually
prescribed as a
safety precaution.
Without it, you
could become
nauseous once
contrast or
sedation is
administered
because you have
something in your
stomach. This can
lead to aspiration
meaning you
might uptake your
stomach contents
into your lungs.
Aspiration can
lead to pneumonia
and other health
issues.
Reference:
Speicher, A.
(2019, December
19). NPO, or
nothing by mouth:
3 things you need
to know. UVA
Radiology and
Medical Imaging
Blog for Patients.
Retrieved
September 21,
2021, from
https://blog.radiol
ogy.virginia.edu/n
po-definition/.
B. ELIMINATION
R. Tandoc sometimes experiences trouble when defecating and urinating. The patient
does not defecate sometimes for 2 to 3 days. The characteristic of the stool of the patient
upon hospitalization is a black, tarry stool. The patient urinates thrice a day since the
patient does not meet the required water intake for his age. The characteristic of his urine
is dark yellow in color.
Gordon’s Before After Analysis Interpretation

Assessment Hospitalization Hospitalization
Day 1 August 25, 2021 September 1, Before
(Wednesday): 2021 Hospitalization:
(Wednesday):
Constipati - Deviation
on can be from normal
The patient was attributed to the
able to defecate The patient lack of exercise
and urinate. did not able to and movement,
defecate. inadequate fluid
intake, and not
After
eating regular or
Hospitalization:
balanced meals.
Urinary - Deviation
incontinence is from normal
common among
the older adults.
Often elderlies
purposely drink
insufficient fluids
to prevent
urination (Medline
Plus, 2021).
(Thursday): 2021 (Thursday): Hospitalization:
The patient was The patient did not Constipati - Deviation

not able to defecate but was on can be from normal
defecate. The able to urinate. attributed to the
patient urinated The characteristic lack of exercise
thrice today. The of the urine was and movement,
characteristic of dark yellow. inadequate fluid
the urine was intake, and not
After
dark yellow in eating regular or
Hospitalization:
color. balanced meals.
Urinary - Normal
incontinence is
common among
the older adults.
Often elderlies
purposely drink
insufficient fluids
to prevent
urination. When a
patient is
dehydrated, the
kidneys attempt
to conserve as
much water as
possible, making
the urine more
concentrated and
darker in color
(Medline Plus,
2021).
(Friday): 2021 (Friday): Hospitalization:
A problem in the
Patient was not The patient was upper digestive - Deviation
able to defecate able to defecate tract is indicated from normal
but was able to after 2 days. by black or tarry
urinate. The Characteristic of feces with a foul
characteristic of the stool was black odor. It usually
the urine was and tarry implies that there
yellow in color. is bleeding in the
After
right side of the
Hospitalization:
colon, stomach,
or small intestine. - Deviation
Melena is a term from normal
used to
characterize this
finding (Medline
Plus, 2021).
(Saturday): 2021 (Saturday): Hospitalization:
A characteristic
The patient was of a urine like - Normal
able to defecate The patient was yellow in color
and urinate. The able to defecate (due to
characteristic of and urinate. The urochrome, a bile
the stool was characteristic of breakdown
brown in color. the stool was product) is
After
The brown in color. The commonly termed
Hospitalization:
characteristic of characteristic of as “amber” or
the urine was the urine was pale “straw.” Urine that - Normal
pale yellow in yellow in color. has been
color. concentrated is a
darker yellow
(amber) than
urine that has
been diluted
(BrainKart, 2017).
Brown or any
shades of brown
stool is a sign of a
healthy bowel
movement. The
brown color
comes from a
pigment called
bilirubin, which is
formed when red
blood cells start
breaking down
(Biggers, 2020).
Day 5 August 29, 2021 September 5, Before Before
(Sunday): 2021 (Sunday): Hospitalization: Hospitalization:
Patient was not The patient was Constipation can - Deviation

able to defecate able to defecate be attributed to from normal
but was able to and urinate. The the lack of
urinate. The characteristic of exercise and
characteristic of the stool was movement,
the urine was brown in color. The inadequate fluid
dark yellow in characteristic of intake, and not
After
color. the urine was pale eating regular or
Hospitalization:
yellow in color. balanced meals.
Urinary - Normal
incontinence is
common among
the older adults.
Often elderlies
purposely drink
insufficient fluids
to prevent
urination (Medline
Plus, 2021).
After
Hospitalization:
A characteristic
of a urine like
yellow in color
(due to
urochrome, a bile
breakdown
product) is
commonly termed
as “amber” or
“straw.” Urine that
has been
concentrated is a
darker yellow
(amber) than
urine that has
been diluted
(BrainKart, 2017).
Brown or any
shades of brown
healthy bowel
movement. The
brown color
comes from a
pigment called
bilirubin, which is
formed when red
blood cells start
breaking down
(Biggers, 2020).
(Monday): 2021 (Monday): Hospitalization: Hospitalization:
Patient was able The patient was A problem in the - Deviation

to defecate and able to defecate upper digestive from normal
urinate. The and urinate. The tract is indicated
characteristics of characteristic of by black or tarry
the stool was the stool was feces with a foul
black, tarry stool. brown in color. The odor. It usually
The characteristic of implies that there
After
characteristic of the urine was pale is bleeding in the
Hospitalization:
the urine was yellow in color. right side of the
pale yellow. colon, stomach, - Normal
or small intestine.
Melena is a term
used to
characterize this
finding (Medline
Plus, 2021).
After
Hospitalization:
A characteristic
of a urine like
yellow in color
(due to
urochrome, a bile
breakdown
product) is
commonly termed
as “amber” or
has been
concentrated is a
darker yellow
(amber) than
urine that has
been diluted
(BrainKart, 2017).
Brown or any
shades of brown
healthy bowel
movement. The
brown color
comes from a
pigment called
bilirubin, which is
formed when red
blood cells start
breaking down
(Biggers, 2020).
(Tuesday): 2021 (Tuesday): Hospitalization: Hospitalization:
- Deviation
from normal
The patient did The patient was Constipation can
not defecate but able to defecate be attributed to
was able to and urinate. The the lack of
urinate when he characteristic of exercise and
got to the the stool was movement,
hospital. brown in color. The inadequate fluid After
characteristic of intake, and not Hospitalization:
the urine was pale eating regular or
- Normal
yellow in color. balanced meals
(Medline Plus,
2021).
After
Hospitalization:
A characteristic
of a urine like
yellow in color
(due to
urochrome, a bile
breakdown
product) is
commonly termed
as “amber” or
has been
concentrated is a
darker yellow
(amber) than
urine that has
been diluted
(BrainKart, 2017).
Brown or any
shades of brown
healthy bowel
movement. The
brown color
comes from a
pigment called
bilirubin, which is
formed when red
blood cells start
breaking down
(Biggers, 2020).
References:
(2021, September 1). Retrieved from Medline Plus:

https://medlineplus.gov/ency/article/003130.htm
(2017, July 22). Retrieved from BrainKart:

https://www.brainkart.com/article/Characteristics-of-Urine_18829/
Biggers, A. (2020, January 2). Retrieved from Medical News Today:

https://www.medicalnewstoday.com/articles/320938#normal-poop
C. ACTIVITY-EXERCISE
Due to old age, R. Tandoc is advised by his family to not go outside often thus his daily
exercise only consists of doing chores and watching television. The patient takes his daily naps
in the afternoon to compensate for his lack of sleep during the night. The patient usually does the
same thing every week, only when during the weekend he gets to spend more time with his
children and grandchildren. During his hospitalization, the patient is not able to do any exercise
due to his bed rest and weakness in the lower extremities of the body.
Analysis: Studies show that older individuals who engaged in at least 150 minutes of moderate
to vigorous physical activity per week were 67% less likely to suffer from any cause of death than
those less inactive. Furthermore, each 30-minute session of low-intensity daily activity such as
leisure strolls or housework, was linked to a 20% reduction in the chance of mortality (Snead,
2020).
Interpretation: Normal
References:
Snead, F. (2020, October 16). Retrieved from iNews:

https://inews.co.uk/news/science/household-chores-physical-activity-health-exercise-405395
D. COGNITIVE-PERCEPTUAL
Patient R.T has been wearing eyeglasses due to his old age, he has been going to optical
shops when he reached his 40s since reading small letters or signage far from him is difficult at
his age. Prior to hospitalization, he has been having a hard time recognizing or remembering
small details which is understandable at age 66. The companion of Patient R.T added that he can
still recall major events in his life which means it is not a chronic problem. Although, days before
hospitalization, he admits that he had a hard time focusing on tasks which require long-hours of
attention.
INTERPRETATION: Deviation from Normal
Analysis: Changes in vision with adults begin at the age of 40 to elderly stage. Furthermore, other
senses such as hearing acuity, speech and memory. (Potter, et.al 2018). According to Harvard
Medical School, as the brain changes with age decline, other physiologic factors may also
contribute to decreased cognitive ability such as medications, poor vision and hearing as well as
sleep deprivation.
References:
● Harvard Medical School. (2017, August 30). How memory and thinking ability
change with age. Harvard Health. https://www.health.harvard.edu/mind-and-
mood/how-memory-and-thinking-ability-change-with-age
● Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2018). Fundamentals of
Nursing. Singapore: Elsevier. p.1244
E. SLEEP-REST
R. Tandoc has his usual routine every day. The patient is easily woken up by the noise outside
their house thus he wakes up early and does his usual activities every morning. R. Tandoc goes
to bed early with his wife to attain 7 to 8 hours of sleep but is unable to due to his insomnia. The
patient would sometimes wake up around 2:00 to 4:00 AM but go back to sleep after a couple of
minutes. The patient does not have any work thus in the afternoon he takes his naps to make up
for his lack of sleep after watching television and wakes up before dinner time.
Date Sleep Rest
Day 1: - Patient went to bed - Patient was able to

at 9:30 PM but was take a nap at around
August 25, 2021 able to sleep at 2:00 PM until 4:00
10:00 PM. PM while watching
(Wednesday) television.
- Patient experienced
sleep interruption
at around 2:30 AM
but went back to
sleep immediately.
- Patient has woken

up at 5:00 AM.
at 9:30 PM but was take a nap from 2:00
August 26, 2021 able to sleep at PM until 4:00 PM
12:00 AM. while watching
(Thursday) television.
- Patient experienced
sleep interruption
at around 2:30 AM
but went back to
sleep immediately.
- Patient has woken

up at 5:00 AM.
Day 3: - Patient went to - Patient was able to

bed at 9:30 PM but take a nap at around
August 27, 2021 was able to sleep 2:00 PM until 4:00
at 12:00 AM. PM while watching
(Friday) television.
- Patient
experienced sleep
interruption at
around 3:30 AM
but went back to
sleep immediately.
- Patient has woken

up at 5:00 AM.
Day 4: - Patient went to - Patient was able

bed at around to rest at around 3:00
August 28, 2021 10:00 PM but was PM until 5:00 PM
able to sleep at after playing with his
(Saturday) 11:30 PM. grandchildren and
watching television.
- Patient
experienced sleep
interruption at 4
AM thus unable to
go back to sleep.
at 10:00 PM but rest at around 3:00
August 29, 2021 went to sleep at PM until 5:00 PM
around 12:00 AM. after playing with his
(Sunday) grandchildren and
- Patient did not watching television.
experience any
sleep interruption
- Patient woke up
before 6AM.
Day 6: - Patient went to - Patient was able to

bed at 11:30 PM take a nap at around
August 30, 2021 but was able to 2:00 PM until 4:00
sleep at 12:30 PM. PM while watching
(Monday) television.
- Patient
experienced sleep
interruption at
around 2:30 AM
but went back to
sleep immediately.
- Patient has woken

up at 5:00 AM.
Day 7: - Patient went to - Patient was not able to
bed at 9:30 PM but have his rest due to
August 31, 2021 was able to sleep him going to the
at 1:00 AM. hospital for health
(Tuesday) concerns
- Patient did not
experience any
sleep interruption
- Patient has woken

up at 7:00 AM but
was feeling
generally weak.
Analysis: The recommended amount of sleep for adults 65 years and above is 7 to 8
hours. However, insomnia and aging may sometimes coincide. Many elderlies have sleep issues
as a result of natural changes in their sleep-wake cycle and circadian rhythm. Insomnia consists
of difficulty in falling asleep or being asleep, multiple situations of waking up in the middle of the
night, etc. Daytime sleepiness and fatigue are also indications of insomnia in older adults (Fry,
2020).
Interpretation: Deviation from normal
References:
Fry, A. (2020, September 18). Retrieved from Sleep Foundation:

https://www.sleepfoundation.org/insomnia/older-adults
F. SELF-CONCEPT/SELF-PERCEPTION
The patient stated that he feels too old already at 66 years because of being physically tired
and weak. His age and condition issues affect his ability to feel confident in performing his daily
exercise. In terms of examination, the patient is nervous because of his condition. He is also being
passive because the patient is not communicating that much and letting others take responsibility
or make some decisions.
Interpretation: Deviation from Normal
Analysis: According to a study by Dietz B.E., “Findings indicate those over age sixty-five
experience heightened levels of self-esteem, especially on self-efficacy. However, through the
intervening variable of role accumulation, older age is associated with decreases in self-esteem.”
A negative self-perception of aging is an indicator of risk for future disability in ADL. Factors such
as low economic status, living alone, multiple chronic medical conditions, and depressive feelings
contribute to a negative self-perception of aging but do not explain the relationship with incident
activities of daily living disability.
Reference:
Dietz BE. The relationship of aging to self-esteem: the relative effects of maturation and
role accumulation. Int J Aging Hum Dev. 1996;43(3):249-66. DOI: 10.2190/BHXN-XQM2-RMAB-
HD4P. PMID: 9031008
Moser, C., Spagnoli, J., & Santos-Eggimann, B. (2011, July 20). Self-perception of aging
and vulnerability to adverse outcomes at the age of 65–70 years. OUP Academic. Retrieved
September 21, 2021, from
https://academic.oup.com/psychsocgerontology/article/66B/6/675/588906.
G. ROLE-RELATIONSHIP
R. Tandoc lives with his wife, one of his children, and grandchildren. The patient does not
feel lonely or stressed when his grandchildren are at school because he is accompanied by his
wife and daughter-in-law. Every weekend R. Tandoc regularly plays with his children after lunch
to have some quality time with his family. When allowed outside of his home, he visits his friends
or vice versa for a quick conversation. He does household chores to relieve some boredom and
to not feel as a burden because of his old age. However, when the patient is admitted to the
hospital, he is unable to be with his family due to the restriction of the hospital.
Analysis: It is critical for the mental and emotional well-being of elderlies to maintain relationships
and spend time with others. It can aid in the prevention of depression, which is common among
older adults. According to research, 20% of people over the age of 60 suffer from depression.
There are numerous causes to this, but one of the primary reasons is that people who were
formerly active in their younger years are suddenly spending much of their time alone (Lifeline,
2020).
References
(2020). Retrieved from Lifeline: https://www.lifeline.ca/en/blog-article/make-social-interaction-a-

priority-for-seniors/
H. SEXUALITY-REPRODUCTIVE
R. Tandoc has experienced minimal interest in being sexually active and stated a definite loss
of libido however he did indicate his sexual needs were abundantly met. In terms of discussing
his sexual issues, he showed no embarrassment in opening the topic. He did not even have a
difficult time talking about sex with his sons and daughters.
Analysis: It is common to lose interest in sex from time to time, and libido levels vary through life.
It’s also normal for your interest not to match your partner’s at times. On the other hand,
testosterone levels also factor into your sex drive. Adult men are considered to have low
testosterone, when their levels fall below 300 nanograms per deciliter (ng/dL), according to
guidelines from the American Urological Association (AUA). When your testosterone levels
decrease, your desire for sex also decreases.
Reference:
Feintuch, S. (2019, April 1). Common causes of low libido and no sex drive in men. Healthline.
Retrieved September 21, 2021, from https://www.healthline.com/health/low-
testosterone/conditions-that-cause-low-libido#low-t.
I. COPING/STRESS TOLERANCE
Patient R.T is a father who works in an office and misses going to work. As he has retired
from the corporate job, he has been looking for ways to keep himself occupied by tending to his
grandchildren which he says fulfills him and alleviates his stress in daily life. As he stated
“Ngayong tumanda na ako, nagiging mahina narin ako sa usually na ginagawa ko kaya
naghahanap nalang ako ng stress-reliever” , Before hospitalization, he has been fond of watching
action movies in the television and sometimes plays with his grandchildren.
INTERPRETATION: NORMAL
Analysis: As stated from Amanda Senior Care (2021), Stress levels vary from individuals.
Especially older adults, as their physiological aspects change, finding ways of not being stressed-
out from doing mundane day-to-day activities, especially as working adults, may help find
meaning through finding purpose such as being a grandfather can be a positive aspect of the
person handling retirement phase.
References:
The effects of stress on older adults. (2021, April 12). Amada Senior Care.
https://www.amadaseniorcare.com/2020/01/the-effects-of-stress-on-older-adults/
J. VALUE-BELIEF
Patient R.T is a Born Again Christian and is actively and devoted to making it part of their
lifestyle as a family.
INTERPRETATION: NORMAL
Analysis: According to the Ministry of Business, Innovation and Employment (2019), the value-
belief system of a person is crucially important since it serves as a guide in how people live their
lives and accord in their choices. Having personal commitment especially when sharing with a
family shapes the person and makes their life significant.
Reference:
Ministry of Business, Innovation, and Employment. (2019). Personal beliefs,
values, attitudes and behaviour. Retrieved from
https://www.iaa.govt.nz/foradvisers/adviser-tools/ethics-toolkit/personal-beliefs-values-
attitudes-andbehaviour/
V. PHYSICAL ASSESSMENT
ASSESSMENT
METHOD USED BODY PART NORMAL FINDINGS ACTUAL FINDINGS ANALYSIS &
(CEPHALO – INTERPRETATION (with
CAUDAL) reference)
Inspect and Head Head size and shape The client’s head is NORMAL
palpate the Head vary, especially in normocephalic and
accord with ethnicity. symmetric. The head is
normally hard and there’s no
Head size may vary in presence of lesions.
shape and ethnicity.
The head must be
symmetric, round,
erect, and in midline
proportion to body
size. (Normocephalic).
The head is normally
hard and smooth with
no lesions present.
Inspect and Face Face is normally The client's face is normally NORMAL
palpate the face proportionate and proportionate and
symmetric. symmetric. The movements
Movements are equal of clients are equally
bilaterally. Parotid bilateral. The parotid glands
glands are normal size. are normal size.
The face is symmetric The client’s face is

and proportionate; symmetrical and
movements are proportionate; movements
equally bilateral; are equally bilateral. Parotid
Normal size parotid glands are in normal size.
glands.
Weber, J. R., & Kelley, J. H. (2018).Assessing Children and Adolescents. In J. R. Weber, & J. H. Kelley, Health Assessment in
Nursing Sixth Edition (p. 794). Wolters Kluwer Publications .
Weber, J. R., & Kelley, J. H. (2018). Assessing Head and Neck. In J. R. Weber, & J. H. Kelley, Health Assessment in Nursing Sixth
Edition (p. 289). Wolters Kluwer Publications .
ASSESSMENT BODY PART NORMAL ACTUAL FINDINGS ANALYSIS &

METHOD USED (CEPHALO – FINDINGS INTERPRETATION (with
CAUDAL) reference)
Observe skin color, SKIN The skin color is The skin color of the DEVIATION FROM NORMAL
odor and lesions pale white, with patient has a dark
yellow, brown, or discoloration on the Since the client has hematemesis,
olive, or pink perianal area. it results in perianal hematoma - a
tones to dark collection of blood that leaked
brown and black. from the burst blood vessel in the
No presence of anus. The piled up blood
strong odor, and surrounds the outside area of the
the skin has no blood vessel below the skin -
lesions. causing a dark blue discoloration.
Perianal hematoma (anal
thrombosis) may be small or
large, and are sensitive to
pressure. The larger the size, the
more painful they become. The
duration of pain typically lasts
from 1-2 weeks ,and it may take
approximately 3 months for the
lump to fully recover. (Dresden,
2020)
Reference: Dresden, D. (2020,

November 16). Perianal
hematoma: Causes, symptoms,
and treatment. Medical News
Today. Retrieved September 18,
2021, from
https://www.medicalnewstoday.c
om/articles/perianal-hematoma.
Palpate for texture, SKIN The skin is soft, The client’s NORMAL
temperature, moisture, warm, slightly temperature is warm,
turgor, and edema. moist, with good soft, and has good
skin turgor. No skin turgor. The client
presence of showed no signs of
edema. edema.
Inspect and palpate HAIR The hair is silky, The client’s hair is NORMAL
hair strong, and silky, strong, and
elastic, and has elastic. The client
fine downy hair has fine down hair
that covers the covering the rest of
body. the body.
Inspect and Palpate NAILS .The nails should The client’s nails are NORMAL
nails. be groomed. clean and well-
There must be groomed. The nails
pink undertones return back to its pink
present. color upon release
after pressing.
Weber, J. R., & Kelley, J. H. (2018).Assessing Children and Adolescents. In J. R. Weber, & J. H. Kelley, Health Assessment in
Nursing Sixth Edition (p. 793-794). Wolters Kluwer Publications .
Weber, J. R., & Kelley, J. H. (2018). Assessing Skin, Hair, and Nails. In J. R. Weber, & J. H. Kelley, Health Assessment in
Nursing Sixth Edition (p. 265). Wolters Kluwer Publications .
ASSESSMENT BODY PART NORMAL ACTUAL ANALYSIS & INTERPRETATION
METHOD USED (CEPHALO – FINDINGS FINDINGS (with reference)
CAUDAL)
Inspect and observe EYE Inner canthus The client’s inner NORMAL
the external eye distance is canthus is
approximately 2.5 approximately at
cm, horizontal slant, 2.5 cm, horizontal
no epicanthal folds. slant, no epicanthal
The outer canthus folds. The outer
is directly aligned canthus of the
with the tips of the client is directly
pinnas. aligned with the tip
of the pinnas.
No swelling,
discharge, The client has no
presence of lesion presence of
in the eyelids. swelling, discharge
or lesions in the
eyelids.
The sclera and

conjunctiva are
clear and free of The client’s sclera
discharge, no and conjunctiva
presence of lesions, are clear and free
redness or from discharge, no
lacerations. presence of
lesions, redness or
lacerations.
Pupils are equal,

round, and reactive
to light and The client’s pupils
accommodation are equal, round,
(PERRLA). reactive to light and
accommodation
(PERRLA).
Inspect the internal EYE The red reflex is The client has a NORMAL
eye present. red reflex.
Perform extraocular EYE The light reflects The client’s eyes NORMAL
muscle test symmetrically in the remained still and
center of both focused during the
pupils using the assessment of the
hirschberg test. Hirschberg test as
the light reflected
symmetrically on
both pupils.
Weber, J. R., & Kelley, J. H. (2018).Assessing Children and Adolescence. In J. R. Weber, & J. H. Kelley, Health Assessment
in Nursing Sixth Edition (p. 796-798). Wolters Kluwer Publications .
ASSESSMENT BODY PART NORMAL ACTUAL ANALYSIS &

METHOD USED (CEPHALO FINDINGS FINDINGS INTERPRETATION (with
– CAUDAL) reference)
Inspect the Lips. MOUTH The lips are smooth The client’s lips NORMAL
Observe lip and moist with no are smooth and
consistency and presence of lesions moist; no
color. or swelling. presence of
lesions or swelling
Inspect the Teeth MOUTH There are a total of The client has a NORMAL
thirty-two pearly total of 26 pale
whitish teeth with yellow teeth with
smooth edges. smooth gums.
Inspect and palpate MOUTH The tongue is pink, The client’s tongue NORMAL
the tongue moist, moderate is pink, moist,
size with papillae; no moderate size; no
presence of lesions. presence of
lesions.
Inspect the posterior MOUTH The tonsils may be The client’s client’s NORMAL
pharyngeal wall and present or absent. tonsils are
tonsils They are present. The color
symmetrical, pink, is pink,
and may be symmetrical and
enlarged (+1) to no signs of lesions
healthy clients. No or swelling.
presence of
exudate, swelling, or
lesions.
Palpate the sinuses NOSE Upon palpation, the The client’s frontal NORMAL
frontal and maxillary and maxillary
sinuses are non- sinuses are non-
tender; no presence tender upon
of crepitus. palpation with no
signs of crepitus.
Weber, J. R., & Kelley, J. H. (2018).Assessing Mouth, Throat,Nose,Sinuses. In J. R. Weber, & J. H. Kelley, Health Assessment
in Nursing Sixth Edition (p. 367-374). Wolters Kluwer Publications .

METHOD USED (CEPHALO – FINDINGS FINDINGS INTERPRETATION (with
CAUDAL) reference)
Inspect the external EAR There is a small The client’s ear NORMAL
auditory canal amount of has a small
odorless earwax amount of earwax
which is a normal which appears
discharge. The yellow in color. The
cerument color consistency of the
may be yellow, cerumen is flaky.
red, orange, gray,
brown, and black.
The consistency
may be soft,
moist, dry, flaky,
or hard.
Inspect the auricle, EAR The ears are The client’s ears NORMAL
tragus, and lobule equally bilateral. are equally
The auricle aligns bilateral. The
with each corner auricle aligns with
within a 10- each corner of the
degree angle of eye within 10-
the vertical degree angle of
position. The the vertical
earlobes may be position.
attached, free, or
soldered.
Weber, J. R., & Kelley, J. H. (2018).Assessing Ears. In J. R. Weber, & J. H. Kelley, Health Assessment in Nursing Sixth Edition
(p. 347). Wolters Kluwer Publications .
Weber, J. R., & Kelley, J. H. (2018).Assessing Head and Neck. In J. R. Weber, & J. H. Kelley, Health Assessment in Nursing
Sixth Edition (p. 295). Wolters Kluwer Publications .
ASSESSMENT BODY PART NORMAL ACTUAL FINDINGS ANALYSIS &
METHOD USED (CEPHALO – FINDINGS INTERPRETATION (with
CAUDAL) reference)
Palpation of the ABDOMEN Unblemished skin, Upon palpation, the NORMAL

Abdominal Area uniform in color, client’s abdomen is
symmetric globular, soft, non-
contour, not tender
distended.
Symmetrical
movements
caused by
respirations.
Assessment of ABDOMEN Normal poop must The client has black, DEVIATION FROM
Stool Character be brown, soft to dry, tarry stools, and NORMAL
firm texture has not had bowel
movement for 2 Black or tarry stools with
days. foul smell may be a sign of
problem in the upper
digestive tract. This may
indicate bleeding in the
stomach, small intestine,
and/or right side of the
colon. Moreover, peptic
ulcers are a common
cause of upper
gastrointestinal bleeding. It
occurs due to abnormal
blood vessels, lesions on
the esophagus from
vomiting, cut-off blood
supply to the intestines,
inflammation, trauma, or
cancer. (Chaptini & Peikin,
2019)
Reference: Chaptini L,
Peikin S. Gastrointestinal
bleeding. In: Parrillo JE,
Dellinger RP, eds. Critical
Care Medicine: Principles
of Diagnosis and
Management in the Adult.
5th ed. Philadelphia, PA:
Elsevier; 2019:chap 72.
Weber, J. R., & Kelley, J. H. (2018).Assessing Thorax and Lungs. In J. R. Weber, & J. H. Kelley, Health Assessment in Nursing

CAUDAL) reference)
Observe use of POSTERIOR The client does not The client did not NORMAL
accessory muscles THORAX use accessory use any accessory
(trapezius/shoulder muscles to assist
) muscles to assist breathing; the client
breathing; used his diaphragm
diaphragm is the as his lower chest
major muscle at expanded during
work as evidenced inspiration.
by expansion of the
lower chest during
inspiration.
Auscultate for POSTERIOR There are three The client has NORMAL
breath sounds THORAX types of normal vesicular breath
breath sounds that sounds.
may be
auscultated;
bronchial,
bronchovesicular
and vesicular.
Auscultate for POSTERIOR There are no Upon auscultation, NORMAL
adventitious THORAX adventitious the client has no
sounds sounds present adventitious sound
such as crackles such as crackles or
(discrete and wheezes.
discontinuous
sounds) or
wheezes (musical
and continuous)
are auscultated.

CAUDAL) reference)
Observe for use of ANTERIOR Use of accessory Use of accessory NORMAL

accessory muscles THORAX muscles muscle is not seen
(sternomastoid and with normal
rectus abdominis) is respiratory effort
not seen with normal by the client.
respiratory effort.
BODY PART BODY PART NORMAL FINDINGS ACTUAL ANALYSIS &

(CEPHALO – (CEPHALO – FINDINGS INTERPRETATION (with
CAUDAL) CAUDAL) reference)
Assessment of MUSCULOSK Performs well and The client has DEVIATION FROM
range of motion on ELETAL has done it without generalized body NORMAL
extremities any difficulties weakness (ROM
of lower Upon observation, the client
extremities) has complained of
generalized body weakness
that is probably due to
multiple electrolyte
imbalances amongst his
other complications. ROM is
used to measure
musculoskeletal health. Any
abnormalities that are
present in the ROM can
affect level of performance. If
the upper extremities are
affected, it can prevent the
client from performing daily
errands, while the affected
lower extremities can have
an impact on the distribution
of energy within the spine
and lower extremities. (Abu
El Kasem, et al., 2020)
Reference: Abu El Kasem,
S.T., Aly, S.M., Kamel, E.M.
et al. Normal active range of
motion of lower extremity
joints of the healthy young
adults in Cairo, Egypt. Bull
Fac Phys Ther 25, 2 (2020).
https://doi.org/10.1186/s431
61-020-00005-9
Weber, J. R., & Kelley, J. H. (2018).Assessing Musculoskeletal System. In J. R. Weber, & J. H. Kelley, Health Assessment in Nursing
VI. LABORATORY/ DIAGNOSTIC RESULTS AND COMPARISON
TEST NORMAL RESULT CLINICAL

VALUES INTERPRETATION
Date: Aug.29,2021
BUN 6-23 mg/dl No data A BUN test, also known as a

blood urea nitrogen test, can
provide important information
about your kidney function. Your
kidneys' primary function is to
remove waste and excess fluid
from your body. If you have
kidney disease, this waste
material can accumulate in your
blood, causing serious health
issues such as high blood
pressure, anemia, and heart
disease.
Reference: Medline Health.

(n.d). BUN (Blood Urea
Nitrogen). Retrieved from
https://medlineplus.gov/lab-
tests/bun-blood-urea-nitrogen/
Date: Aug.29,2021
SGPT 7-56 U/L No data Serum Glutamic Pyruvic

Transaminase (SGPT) is an
abbreviation for Serum Glutamic
Pyruvic Transaminase. This test
determines the level of
Glutamate Pyruvate
Transaminase (GPT) in blood
serum. GPT is an enzyme that
can be found in heart cells,
kidneys, muscles, and the liver.
Reference: Indus Health Plus.

(n.d). Monitor Your Liver Health
with Regular SGPT Blood Test.
retrieved from
https://www.indushealthplus.co
m/sgpt-blood-test.html
Date: Aug.29,2021
ABG pH: 7.35-7.45 pH: 7: 490 An arterial blood gases (ABG)

paCO2: 35-45 pCO2: 19.0 test determines the acidity (pH)
mmHg HCO3:14.5 and levels of oxygen and carbon
HCO3: 22-26 meq/l pO2:144 dioxide in artery blood. This test
paO2: 85-100 SaO2: 99% determines how well your lungs
SaO2: 95-100% can move oxygen into your
blood and remove carbon
dioxide from your blood.
Interpretation:
pH is higher than 7.45: alkaline
(basic). Alkalosis
HCO3 is lower than normal:
metabolic acidosis
SaO2 is normal
Deviation from normal:
A pH of less than 7.35 indicates

acidosis and a pH greater than
7.45 indicates alkalosis.
A low level of bicarbonate in

your blood may result in
metabolic acidosis or an excess
of acid in the body. Metabolic
acidosis can be caused by a
variety of conditions, including
diarrhea, kidney disease and
liver failure.
References:
University of Michigan Health.
(n.d). Arterial Blood Gases
(ABG) Test. Retrieved from
https://www.uofmhealth.org/hea
lth-library/hw2343
The Pharmaceutical Journal.

(n.d). How to interpret arterial
blood gas results. Retrieved
from https://pharmaceutical-
journal.com/article/ld/how-to-
interpret-arterial-blood-gas-
results
University Rochester University.

(n.d). Bicarbonate. Retrieved
from
https://www.urmc.rochester.edu
/encyclopedia/content.aspx?co
ntenttypeid=167&contentid=bic
arbonate
Date: Aug.29,2021
ECG Heart rate: 60- QRS: 0.08/sec An electrocardiogram (EKG) is a

100bpm Q-T: 0.36/sec quick and painless procedure
PR interval: 0.12- that measures electrical signals
0.20 s Atrial fibrillation with in your heart. When your heart
QRS interval: ≤ rapid ventricular beats, an electrical signal
0.12s response travels through it. An EKG can
QT interval: < half determine whether or not your
RR interval (males < heart is beating at a normal rate
0.40 s; females < and strength. It also aids in
0.44 s) determining the size and
P wave amplitude (in location of your heart's
lead II): ≤3 mV (mm) chambers. An abnormal EKG
P wave terminal may indicate heart disease or
negative deflection damage.
(in lead V1:≤ 1 mV
(mm) Interpretation:
Q wave: < 0.04 s(1 Irregular heartbeat
mm) and < ,/3 of R
wave amplitude in Deviation from normal:
the same lead An irregular heartbeat is
referred to as atrial fibrillation
with a rapid ventricular
response. Some symptoms of
AFib With RVR are a fast
heartbeat, chest pain, dizziness,
faintness, shortness of breath,
tiredness and weakness.
Reference:
Medline Plus. (n.d).
Electrocardiogram. Retrieved
from
tests/electrocardiogram/
Watson, S., (2020). AFib With

Rapid Ventricular Response
(RVR). Retrieved from
https://www.webmd.com/heart-
Date: Aug.29,2021
TPAG Total Protein: 60-80 No data The total protein, Albumin-

g/L Globulin (A/G) Ratio
Al Is done to determine the
Albumin: 39-51 g/L amount of protein in your body.
Globulin” 23-35 g/L The majority of the proteins
found in your blood are
produced by your liver. Albumin
is one of the most common
types of protein. Albumin
transports a variety of other
substances throughout your
body, including medications and
products produced by your
body. Another type of protein
known as globulin performs
additional functions in your
body.
This test provides information

about the amount of albumin
you have compared with
globulin. This comparison is
called the A/G ratio. This test is
useful when your healthcare
provider suspects you have liver
or kidney disease.
Reference: University
Rochester University.
(n.d).Total Protein and A/G
Ratio. Retrieved from
https://www.urmc.rochester.edu
/encyclopedia/content.aspx?co
ntenttypeid=167&contentid=tota
l_protein_ag_ratio
Date: Aug.29,2021
Ionized calcium 4.4 - 5.2mg/dL No data An ionized calcium test is

ordered to check the patient’s
blood calcium levels if it
indicates symptoms of kidney
disease or problems with the
parathyroid gland. It also
determines if the patient is
receiving a blood transfusion
and abnormal levels of blood
proteins.
Reference: Healthline. (n.d).

Ionized Calcium Test. Retrieved
from
https://www.healthline.com/heal
th/calcium-ionized#uses
Date: Aug.29,2021
Phosphorus 2.8 - 4.5 mg/dL No data A phosphate in blood test
measures the amount of
phosphate in your blood.
Normally, the kidneys filter and
remove excess phosphate from
the blood. If phosphate levels in
your blood are too high or too
low, it can be a sign of kidney
disease or other serious
disorders.
Reference: Medline Plus.

(n.d).Phosphate in Blood.
Retrieved from
tests/phosphate-in-blood/
Date: Aug.29,2021
60-70 seconds Prothrombin time (PT) is a blood
No Data test that measures the time it
DpT/PTT takes for the liquid portion
(plasma) of your blood to clot.
Reference: Medline Plus. (n.d). Prothrombin

time (PT). Retrieved from
https://medlineplus.gov/ency/article/003652.
htm
Date: Aug.29,2021
12 to 300 ng/mL - The ferritin test uses venous
males No Data blood to measure ferritin levels.
Serum ferritin The test is sometimes ordered
12 to 150 ng/mL - together with other tests to help
females evaluate the body's iron stores,
such as an iron level or a total
iron-binding capacity (TIBC)
test.
Reference: Medicinenet. (2021).

Ferritin Blood Test: Results of
High, Low, and Normal Levels.
Retrieved from
https://www.medicinenet.com/fe
rritin_blood_test/article.htm
Date: Aug.29,2021
240 to 450 mcg/dL Total iron binding capacity
or 42.96 to 80.55 No Data (TIBC) is a blood test to see if
TIBC micromol/L you have too much or too little
iron in your blood. Iron moves
through the blood attached to a
protein called transferrin. This
test helps your health care
provider know how well that
protein can carry iron in your
blood.
Reference: UCSFHealth. (n.d).

Total Iron Binding Capacity.
Retrieved from
https://www.ucsfhealth.org/med
ical-tests/total-iron-binding-
capacity
Date: Aug.29,2021
Reticulocytes are immature red
0.5% to 1.5% No Data blood cells. A reticulocyte count
Reticulocyte Count is a test your doctor can use to
measure the level of
reticulocytes in your blood. It’s
also known as a retic count,
corrected reticulocyte count, or
reticulocyte index.
Reference: Healthline. (n.d).

Reticulocyte Count: Purpose,
Procedure, and Results.
Retrieved from
https://www.healthline.com/heal
th/reticulocyte-count
Date: Aug.29,2021
Urine pH is 6.0, but it The pH is the measurement of
can range from 4.5 No Data how acidic or alkaline a person’s
Urinalysis to 8.0 urine is. Doctors often test the
urine pH, and they may perform
other diagnostic tests, when a
person has symptoms that may
be related to a problem in the
urinary tract.
Reference: MedicalNewsToday.
(n.d). What is the normal pH
range for urine?. Retrieved from
https://www.medicalnewstoday.
com/articles/323957
Date: Aug.29,2021
0 to 22 mm/hr for
men and 0 to 29 No Data Sed rate, or erythrocyte
ESR mm/hr for women sedimentation rate (ESR), is a
blood test that can reveal
inflammatory activity in your
body. A sed rate test isn't a
stand-alone diagnostic tool, but
it can help your doctor diagnose
or monitor the progress of an
inflammatory disease.
Reference: Mayoclinic. (n.d).

Sed rate (erythrocyte
sedimentation rate). Retrieved
from
https://www.mayoclinic.org/test
s-procedures/sed-
rate/about/pac-20384797
Date: Aug.29,2021
adults and children Procalcitonin is a substance
older than 72 No Data produced by many types of
Procalcitonin hours is 0.15 cells in the body, often in
ng/mL or less response to bacterial
infections but also in
response to tissue injury. The
level of procalcitonin in the
blood can increase
significantly in systemic
bacterial infections and
sepsis. This test measures
the level of procalcitonin in
the blood.
Reference: LabTestsOnline. (2020).
Procalcitonin. Retrieved from
https://labtestsonline.org/tests/procalcitonin
VII. DRUG STUDY
Reference: FA Davis, 2019 Drug Handbook
1) Ferrous sulfate 1 tab 2x a day
Name of Indication Contraindicati Mechanism of Side Effect Nursing Responsibilities

Drug on Actions
Generic PO: Hemochroma An essential mineral CNS: IM, IV— Assessment
Name Prevention/trea tosis, found in SEIZURES,
tment of iron- hemosiderosi hemoglobin, dizziness, ● Assess nutritional status and
Ferrous deficiency s, or other myoglobin, headache, syncope. dietary history to determine
Sulfate anemia evidence of possible cause of anemia and
iron overload; and many enzymes. need for patient
Brand Anemias not Enters the
Name: bloodstream and is CV: IM, IV— teaching.
due to iron hypotension,
Feratab deficiency; transported to the hypertension, ● Assess bowel function for
Some organs of the tachycardia. GI: constipation or diarrhea.
products reticuloendothelial nausea; PO,
Classific
contain system (liver, constipation, dark
ation: Notify health care professional
alcohol, spleen, bone stools, diarrhea, and use appropriate
marrow), where it is epigastric pain,
Therape tartrazine, or separated
utic: sulfites and nursing measures should these
antiane occur
should be out and becomes
mics avoided in part of iron stores. GI bleeding; IM, IV,
patients Lab Test Considerations:
Pharma taste disorder, Monitor hemoglobin,
cologic: vomiting. hematocrit, and reticulocyte
with known
Iron intolerance or values prior to and every 3 wk
supplem Therapeutic during the first 2 mo of therapy
hypersensitivi
ents ty and periodically thereafter.
Effects: Derm: IM, IV— Serum ferritin and iron levels
Dosage Prevention/treatme flushing, urticaria. may also be monitored to
nt of iron deficiency. assess effectiveness of
1 tab – therapy.
twice a
day Resp: IV— cough,
dyspnea.
Route: Potential Nursing Diagnoses
Local: pain at IM Activity intolerance
PO site (iron dextran), (Indications)
(Adults) phlebitis at IV site,
: 120- skin staining at IM
240 site (iron dextran).
mg/day Implementation ● Discontinue
divided oral iron preparations prior to
2. Losartan 500 mg/tab once a day
Name of Indication Contraindication Mechanism of Side Effect Nursing Responsibilities

Drug Actions
Generic Alone or Hypersensitivity; Blocks CNS: dizziness, Assessment
Name with other Concurrent use vasoconstrictor anxiety,
agents in with aliskiren in and aldosterone- depression, fatigue, ● Assess BP (lying, sitting,
Losartan the patients with producing effects headache, standing) and pulse
managem diabetes or of angiotensin II at insomnia, periodically during therapy.
Brand Name: ent of moderate-to- receptor sites, weakness. Notify health care
hypertensi severe renal including vascular professional
on. impairment with
Cozaar Treatment known smooth muscle of significant changes.
of diabetic intolerance or and the adrenal CV: hypotension,
Classification nephropat hypersensitivity glands.
: chest pain, edema, ● Monitor frequency of
hy in tachycardia. prescription refills to
patients
Therapeutic: determine adherence.
with type 2
antihyperten diabetes Use Cautiously Therapeutic ● Assess patient for signs of
sives and in:
hypertensi Derm: rashes. angioedema (dyspnea, facial
Pharmacolog on Effects: swelling). May rarely cause
Volume- or angioedema.
ic: (irbesartan
and
losartan salt-depleted EENT: nasal ● HF: Monitor daily weight
angiotensin patients or
only). Lowering of BP. congestion, and assess patient routinely
patients Slowed pharyngitis, rhinitis, for resolution of fluid
II receptor receiving high progression of sinusitis. overload (peripheral
antagonists doses diabetic
edema, rales/crackles,
Dosage of diuretics dyspnea, weight gain, jugular
nephropathy
(irbesartan and GI: abdominal pain,
500mg –
losartan only) diarrhea, drug- venous distention).
once a day
induced hepatitis,
dyspepsia, nausea,
Route:
vomiting.
Decreased risk of Lab Test Considerations:
PO (Adults):
stroke in patients Monitor renal function
Hypertension with hypertension
—50 mg
and left ventricular GU: impaired renal and electrolyte levels
once daily hypertrophy
initially function. periodically. Serum
(effect may be potassium,
(range 25–
less in black
100 mg/day
patients) (losartan BUN, and serum creatinine
as a single
3.) Clopidogrel 75 mg/tab once a day
Name of Drug Indication Contraindication Mechanism of Side Effect Nursing Responsibilities

Actions
Generic Name Acute Contraindicated Inhibits platelet Incidence of Assessment
coronary in: aggregation by adverse reactions
Clopidogrel syndrome Hypersensitivity irreversibly similar to that of ● Assess patient for
(ST- to clopidogrel or inhibiting aspirin. symptoms of stroke,
Brand Name: segment prasugrel; peripheral
elevation Pathologic the binding of ATP
MI, non- bleeding (peptic to platelet vascular disease, or MI
Plavix
ST- ulcer, receptors. CNS: depression, periodically during therapy.
segment intracranial dizziness, fatigue,
Classification: elevation hemorrhage); headache. EENT: ● Monitor patient for signs
MI, or Concurrent use epistaxis.
Therapeutic: of thrombotic thrombocytic
unstable of omeprazole or
antiplatelet Therapeutic purpura
angina). esomeprazole
agents (thrombocytopenia,
Patients
with Effects: Reduction microangiopathic
Pharmacologi establishe in risk of MI and Resp: cough,
c: platelet d stroke dyspnea, hemolytic anemia,
Use Cautiously eosinophilic neurologic findings, renal
aggregation peripheral in: Patients at
inhibitors arterial pneumonia. dysfunction, fever). May
risk for bleeding rarely occur, even after
disease,
recent MI, Absorption: short
Dosage (trauma,
or recent
surgery, or other exposure (
stroke. Well absorbed CV: chest pain,
75 mg– once a pathologic
day following oral edema,
conditions); 2 wk). Requires
History of GI administration; hypertension.
rapidly prompt treatment.
Route: bleeding/ulcer
disease; Severe metabolized to an
hepatic active antiplatelet
Recent MI,
Stroke, or impairment; GI: GI BLEEDING,
Peripheral compound. Parent abdominal pain,
Arterial drug has no diarrhea,
antiplatelet activity dyspepsia, Lab Test Considerations:
gastritis.
Disease
PO (Adults):
75 mg once ONSET Monitor bleeding time
daily Derm: ACUTE
within 24 hr GENERALIZED during therapy. Prolonged
EXANTHEMATOU bleeding time, which is
S PUSTULOSIS,
4.) Rosuvastatin 10mg/tab
Name of Drug Indication Contraindicatio Mechanism of Side Effect Nursing Responsibilities

n Actions
Generic Name Rosuvastati Hypersensitivity Inhibit an enzyme, CNS: amnesia, Assessment

n: Slow ; Active liver 3-hydroxy-3- confusion,
Rosuvastatin progression disease or methylglutaryl- dizziness, ● Obtain a dietary history,
of coronary unexplained coenzyme A headache, especially with regard to
Brand Name: atherosclero persistent in (HMG-CoA) insomnia, memory fat
sis. AST or ALT reductase, which loss, weakness.
Rosuvastati is responsible for consumption.
Crestor n: Primary
prevention catalyzing an
Classification: of Use Cautiously early step in the CV: chest pain,
5.) Pantoptazole 40 mg/tab
cardiovascul in: synthesis of peripheral edema.
Therapeutic: ar disease ● Lab Test
cholesterol.
lipid-lowering (reduces Considerations: Evaluate
agents — serum cholesterol and
Name of Indicationrisk of Contraindication Mechanism of Side Effect Nursing Responsibilities
stroke, triglyceride levels before
Drug Actions
Pharmacologic: myocardial patients with EENT: rhinitis; initiating, after
Asian ancestry Therapeutic lovastatin, blurred
HMG-CoA infarction,
(may have Effects: Lowers vision. 4– 6 wk of therapy, and
reductase and
blood levels and total and LDL periodically thereafter.
inhibitors revasculariz
risk of cholesterol and
ation) in
rhabdomyolysis triglycerides.
Dosage patients
without ) Slightly increase
Resp: bronchitis.
HDL
clinically ● Monitor liver function
10 mg- tab
evident tests, including AST and
once a day
coronary ALT,
heart —Concurrent GI: abdominal
Route: disease but Absorption:
use of cramps, before initiating therapy
with an gemfibrozil,
PO (Adults): increased constipation, and if signs of liver injury
azole —20% absorbed diarrhea, flatus,
10 mg once risk of antifungals, following oral
daily initially cardiovascul heartburn, altered (fatigue, anorexia, right
protease administration; taste, drug-induced
(range 5– 20 ar disease upper abdominal
inhibitors,
Generic Erosive Binds to an CNS: headache. Assessment
Name esophagitis enzyme in the
associated with Contraindicated presence of GI: CLOSTRIDIUM ● Assess patient
pantopraz GERD. in: acidic gastric DIFFICILE- routinely for epigastric or
ole Hypersensitivity pH, preventing ASSOCIATED abdominal
to rabeprazole or the final DIARRHEA
Brand related drugs transport of (CDAD), abdominal pain and for frank or
Name: Maintenance (benzimidazoles hydrogen ions pain, diarrhea, occult blood in stool,
) into the gastric eructation, emesis,
lumen. flatulence.
Protonix of healing of
Therapeutic
erosive or gastric aspirate.
Effects:
Classificat esophagitis.
Diminished
ion: Pathologic
accumulation of
gastric Derm: cutaneous
acid in the
Therapeut hypersecretory lupus Lab Test
gastric lumen,
ic: conditions. with lessened erythematosus. Considerations: May
antiulcer acid reflux. cause abnormal
agents Healing of
duodenal ulcers liver function tests,
Pharmaco Unlabeled Use: and Endo: includingqAST, ALT,
logic: Adjunctive esophagitis. hyperglycemia. alkaline
proton- Decreased acid
pump treatment of secretion in phosphatase, and
inhibitors duodenal ulcers hypersecretory bilirubin.
associated with conditions. F and E:
Dosage Helicobacter hypomagnesemia ● May cause
pylori. (especially if hypomagnesemia.
40 mg- treatment duration 3 Monitor serum
tab once a Absorption: mo). magnesium prior to and
day Tablet is periodically during
enteric-coated; therapy.
Route: absorption
occurs only GU: acute
after tablet interstitial nephritis.
PO
leaves the
(Adults): Potential Nursing
stomach.
Short- Diagnoses
term
treatment Hemat: vitamin B12 Acute pain (Indications)
of erosive deficiency.
6.) Vitamin C + Zinc
Name of Indication Contraindication Mechanism of Side Effect Nursing Responsibilities

Drug Actions
Side effects on
Generic Serve as ONSET: Vitamins are Assessment
Name components of rarely
enzyme systems Hypersensitivity N/a experienced. ● Assess patient for signs
Vitamin C + that catalyze to additives, of vitamin deficiency
numerous varied These may
zinc preservatives, include: before and periodically
metabolic or colorants throughout therapy.
Brand reactions. -Presence of high
PEAK:
Name: Necessary for oxalic acid in ● Assess nutritional
homeostasis. Urine status through 24-hr diet
Water-soluble N/a
Classificati Precautions: recall. Determine
vitamins (B- -Drovwsiness frequency of
on: vitamins and
Dose should be consumption of vitamin-
vitamin C) rarely -Diffulty in rich foods.
General cause toxicity. adjusted to DURATION sleeping
Use avoid
toxicity,especiall -Low energy Potential Nursing
Fat-soluble n/a Diagnoses
Used in the y for fat-soluble
vitamins -Redness of Face
prevention (vitamins D and vitamins
and and Neck ● Imbalanced nutrition:
E) may
treatment less than body
accumulate and -Headache
of vitamin cause toxicity requirements
deficiencie -Nausea and (Indications).
s and as heartburn
supplemen ● Deficient knowledge,
ts in related to disease
various process and medication
regimen
metabolic
disorders.
Dosage (Patient/Family
Teaching).
40 mg- tab
once a day Implementation
daily. ● Because of infrequency

of single vitamin
deficiencies,
combinations are
commonly administered.
Patient/Family Teaching
● Encourage patients to
comply with diet
recommendations of
physician or other health
care
professional. Explain that

the best source of
vitamins is a well-
balanced diet with foods
from
the four basic food

groups.
● Patients self-
medicating with vitamin
supplements should be
cautioned not to exceed
RDAs.
The effectiveness of
megadoses for treatment
of various medical
conditions is unproved
and
may cause side effects

and toxicity.
Evaluation/Desired
Outcomes
● Prevention of, or
decrease in, the
symptoms of vitamin
deficiencies.
7. Azithromycin 500mg/tab
Name of Indication Contraindicat Mechanism of Side Effect Nursing

Drug ion Actions Responsibilities
Generic -used for the -Serious -In order to -nausea -Monitor patient for
Name: treatment of cases of replicate, superinfection.
Azithromy patients with mild allergic bacteria may -diarrhea
cin to moderate reactions. require a specific
infections caused process of -abdominal pain vAlert: Monitor patient for
Brand by susceptible protein CDAD, which may range
Name: -headache in severity from mild
strains of the synthesis,
microorganisms. - enabled by diarrhea to fatal colitis.
Zithromax Contraindicate -vomiting
ribosomal
d in patients proteins. vAlert: Consider full risk
Classifica hypersensitive profile when choosing
tion: to appropriate antibiotic
macrolide azithromycin. therapy
antibiotic
Dosage:
-Do not use -Monitor patient for
500 mg of oral drug in allergic and skin
tablet once patients with reactions.
a day pneumonia or
in those with
moderate to
severe illness. -Monitor patient for
Route: jaundice, hepatoxicity,
and hepatitis.
P.O. (Oral)
-use
cautiously in vAlert: Exacerbation and
patients with new onset of myasthenia
impaired gravis have occurred
hepatic with azithromycin use.
function or
myasthenia
gravis
8. Cefuroxime 2g intravenously
Name of Indication Contraindicat Mechanism of Side Effect Nursing

Drug ion Actions Responsibilities
Generic -For the treatment - -It binds to a -Nausea -Monitor patient for signs
Name: of many different contraindicate specific and symptoms of
Cefuroxime types of bacterial d in patients penicillin-binding -diarrhea superinfection and
infections such as hypersensitive proteins (PBPs) diarrhea and treat
Brand bronchitis, to drug or located inside -strange taste appropriately.
Name: sinusitis, tonsillitis, other the bacterial cell in mouth
Ceftin ear infections, skin cephalosporin wall, it inhibits
-vomiting
infections, s. the third and last
gonorrhea, and stage of bacterial -Drug may increase INR
urinary tract cell wall and risk of bleeding.
Classificat vAlert: Drug Monitor patient.
infections. synthesis.
ion: may cause
CDAD and
Cephalosp
pseudomembr
orin -Advise patient receiving
anous colitis
antibiotic drug IV to report
ranging from
discomfort at IV insertion
mild to life-
site.
threatening,
Dosage: which can
occur even 2
2g twice a months after
day therapy
Route:
intravenous
9. Ceftriaxone 2g intravenously
Name of Indication Contraindi Mechanism of Side Effect Nursing
Drug cation Actions Responsibilities
Generic -used for treatment of - -works by -black, tarry -Monitor patients for
Name: the infections caused contraindica inhibiting the stools signs and symptoms
Ceftriaxo by susceptible ted in mucopeptide of superinfection,
ne organisms. patients synthesis in the -sore throat diarrhea, and anemia
sodium hypersensiti bacterial cell and treat
ve to or wall. The beta- -swollen glands appropriately.
Brand other lactam moiety of
Name: -chest pain
cephalospor ceftriaxone
ins. binds to -shortness of
Classifica carboxypeptida -Tell patient to report
tion: breath adverse reactions
ses.
Rocephin promptly.
-unusual
-use
Classific weakness or
cautiously in
ation: tiredness
patients
hypersensiti -Monitor PT and INR
Cephalos ve to in patients with
porin penicillin. impaired vitamin K
antibiotic synthesis or low
vitamin K sores.
vAlert: may
cause
Dosage:
superinfecti
-Instruct patients to
2g twice a on and mild
report discomfort at IV
day to fatal
insertion site.
CDAD.
vAlert: May
Route: cause
hemolytic
anemia,
which can
Intraveno be fatal.
us
-Use
cautiously in
patients
with history
of colitis,
renal
insufficiency
, or GI or
gallbladder
disease.
10. Cilostazol 100mg/tab
Name of Indication Contraindic Mechanism of Side Effect Nursing

Drug ation Actions Responsibilities
-Monitor patients for
Generic -indicated for the - -Cilostazol and -nausea development of a new
Name: alleviation of Contraindicat several of its systolic murmur or
Cilostazol symptoms of ed in patients metabolites are -stomach cardiac signs or
intermittent hypersensitiv cyclic AMP pain symptoms after drug
Brand claudication (pain in e to drug or (cAMP) initiation.
Name: the legs that occurs its phosphodiestera -heartburn
with walking and components. se activity and vAlert: CV risk is
Pletal -diarrhea
disappears with rest). suppressing unknown in patients who
cAMP -headache use drug on long-term
degradation with basis and in those with
- a resultant
Classificat -dizziness severe underlying heart
Contraindicat increase in
ion: disease.
ed in patients cAMP in -muscle pain
with HF of platelets and
Platelet-
any severity. blood vessels, -Dosage can be reduced
aggregatio
n inhibitor leading to or stopped without such
(antiplatele inhibition of rebound effects as
t) - platelet platelet hyper
Contraindicat aggregation and aggregation.
ed in patients vasodilation.
with
Dosage:
hemostatic -if aspirin is added to
100 mg/tab disorders or drug therapy, monitor
once a day active patient for aspirin-
bleeding. related adverse
reactions.
Route: -instruct patient to take

-Left
drug on an empty
P.O. (Oral) ventricular
stomach, at least 30
outflow tract minutes before or 2
obstruction hours after breakfast
has been and dinner.
reported in
patients with
sigmoid-
shaped -advise patient to avoid
interventricul drinking grapefruit juice
ar septum. during drug therapy.
11. Citicoline 1g/tab
Name of Indication Contraindica Mechanism of Side Effect Nursing

Drug tion Actions Responsibilities
Generic -CVA in acute and -hypertonia of -derivative of -insomnia -Monitor blood pressure,
Name: recovery phase. the choline and heart rate, and pulse
Symptoms and signs parasympath cytidine involved -stomach rate.
Citicoline of cerebral etic nervous in the pain
insufficiency i.e., system. biosynthesis of
dizziness, headache, lecithin. It is -chest pain
poor concentration, claimed to -Monitor for adverse
Brand -nausea effect
memory loss, increase blood
Name:
disorientation, flow and oxygen -headache
Acholine Recent cranial consumption in
trauma, and their the brain. -diarrhea -Instruct patient to report
sequence. immediately if she
-constipation develops chest
Classificat tightness, tingling in
ion: mouth and throat,
headache, diarrhea, and
Oral
blurring of vision
nutritional
supplement
s
Dosage:
1g twice a
day
Route:
P.O. (Oral)
12. Diphenhydramine chloride 25 mg intravenously

Name of Indication Contraindicatio Mechanism Side Effect Nursing
Drug n of Actions Responsibilities
Generic -Relief of allergic -Contraindicated -Antagonize -dry mouth, -Stop drug 4 days before
Name: symptoms caused in patients the effects of nose, and diagnostic skin testing.
by histamine hypersensitive histamine vat throat
Diphenhydra release including to drug. H1-receptor
mine anaphylaxis, sites; does -vomiting
hydrochlorid seasonal and not bind to or -Injection form is for IV or
e perennial allergic inactive -loss of IM administration only.
rhinitis, allergic -Avoid use in histamine. appetite
Brand dermatoses, patients taking Significant
Name: MAO inhibitors. -constipation
Parkinson’s CNS -Dizziness, excessive
disease, and depressant -increased sedation, syncope,
Banophen,
dystonic reactions and chest toxicity, paradoxical
Benadryl,
from medications, -Children anticholinergi congestion stimulation, and
Sominex
mild nighttime younger than c properties. hypotension are more
sedation, age 12 use drug -drowsiness likely to occur in elderly
prevention of only as directed patients.
Classificatio motion sickness. by prescriber. -dizziness
n:
Antihistamin
e
Dosage:
25mg thru
intravenous
Route:
Intravenous
13. Furosemide 40 mg intravenously

Name of Indication Contraindicatio Mechanism of Side Effect Nursing
Drug n Actions Responsibilities
vAlert: Monitor weight,
Generic -indicated for the -contraindicated -promotes -Diarrhea BP, and pulse rate
Name: treatment of in patients diuresis by routinely with long-term
edema associated hypersensitive blocking - use.
Furosemide with congestive to drug and in tubular constipatio
heart failure, those with reabsorption of n
cirrhosis of the anuria. sodium and -Monitor fluid intake and
liver, and renal chloride in the -nausea or output and electrolyte,
Brand vomiting
disease, including proximal and BUN, and carbon dioxide
Name: vAlert: drug may
the nephrotic distal tubules, levels frequently.
cause tinnitus -dizziness
Lasix syndrome, in as well as in
adults and and reversible or the thick -blurred
pediatric patients. irreversible ascending vision -Watch for signs of
hearing loss. loop of Henle.
Classificati hypokalemia, such as
-itching or
on: muscle weakness and
rash
-intravenous -Drug may cramps.
Diuretics furosemide is exacerbate or -vertigo
indicated as activate SLE.
adjunctive therapy -stomach
in acute -Consult prescriber and
cramps
Dosage: pulmonary edema dietitian about a high-
when a rapid onset - potassium diet or
20 mg thru constipatio potassium supplements.
of diuresis is
intravenous n
desired.
-Monitor elderly patients,

Route: who are especially
susceptible to excessive
Intravenous diuresis.
14. Ketoanalogue 600mg/tab
Name of Drug Indication Contraindicati Mechanism of Side Effect Nursing Responsibilities

on Actions
Generic Chronic renal Hypercalcemia Following May cause Give enough calories to
Name insufficiency with , amino acid ingestion, the hypercalcemi the patient. Concomitant
the following metabolism ketoanalogues a. use with other calcium-
Ketoanalogue conditions: given disorder. are containing drugs must be
with high calorie, transaminated given with attention, as it
Brand Name low protein food by taking may cause hypercalcemia.
≤40 g daily; nitrogen from
Ketosteril compensated or non- essential Serum calcium levels must
decompensated amino acids, be monitored periodically.
Classification retention; thereby Not to be given along with
glomerular filtration decreasing the drugs that are slightly
Therapeutic: rate of 5-50 formation of soluble in calcium
Supplements mL/minute. urea by re-using
the amino Before:
Pharmacologi group. The 1. Assess electrolyte
c: Nutrition levels of levels
therapy in accumulating 2. Explain the therapeutic
chronic kidney uremic toxins value of drug
disease. are decreased. 3. Assess allergy to the
Keto- and/or drug
Dosage hydroxy-acids 4. Caution patient of the
do not elicit different side effects
600 mg/tab 3x hyperfiltration of 5. Assess vital signs
a day residual 6. Proper preparation of
nephrons. the drug
Route
In normal During:
PO individuals, 1. Verify patient’s identity
there is an 2. Administer with food to
increase in the prevent GI upset
plasma level of 3. Administer drug at right
ketoanalogues, time, route, and dosage
10 min after oral 4. Advise swallowing the
ingestion. tablet whole
Peak levels are 5. Monitor vital signs
reached within
20-60 mins and After:
normal levels 1. Document
are reached administration of the drug
again after 90 2. Instruct patient to report
mins immediately if symptoms
of hypercalcemia occur
like muscle weakness,
constipation
3. Monitor calcium levels.
4. Monitor for signs of
hypercalcemia and
electrolyte levels.
5. Monitor vital signs
especially cardiac
changes.
15. Rebamipide 100mg/tab
Name of Indication Contraindicati Mechanism of Side Effect Nursing

Drug on Actions Responsibilities
Generic Rebamipide is Rebamipide is Rebamipide is Significant: Administer the drug
Name prescribed for the contraindicated postulated to before meals.
treatment of with patients increase Dizziness,
Rebamipide peptic ulcers, who are prostaglandin drowsiness, Check the BP after
gastroduodenal hypersensitive E2 in gastric thrombocytope giving the medication
Brand Name ulcers, and gastric to the drug, mucosa and nia, leucopenia,
disorders lactating, elevate gastric hypersensitivity Let the patient verbalize
Mucosta pregnant, and mucous, , and discomfort after
It is indicated children gastric anaphylactoid administration
Classificatio during bleeding, mucosal blood reactions (e.g.
n erosion, redness, flow and hives, rash, Monitor any signs of
and edema that secretion of itching, adverse reaction.
Therapeutic: occur in acute gastric eczema),
Antiulcerant; gastritis and acute alkaline. It also shock, Special care is required
Antacids exacerbation of stimulates jaundice. in elderly patients to
chronic gastritis. gastric Rarely, liver minimize the risk of
Dosage mucosal cell dysfunction. gastrointestinal
growth and disorders because
100mg/tab decreases Gastrointestinal these patients may be
1 tab thrice a gastric mucosa disorders: physiologically more
day injury. sensitive to Mucosta
Constipation, than younger patients.
Route Absorption: dry mouth,
Time to peak diarrhea, Monitor for any adverse
PO plasma nausea, reactions
concentration: vomiting,
2 hours. heartburn, Inform patient that drug
abdominal pain, may be taken with or
Distribution: belching, the without food
Plasma protein sensation of Mucosta should be
binding: 98.4- abdominal administered to
98.6%. enlargement, pregnant or possibly
taste pregnant women only if
Excretion: Via abnormality. the anticipated
urine therapeutic benefit is
Others: thought to outweigh any
Cold sweat, potential risk.
difficulty
breathing. If abnormal findings are
observed, Mucosta
should be discontinued
and appropriate
measures are taken.
16. Acetaminophen 300 mg
Name of Drug Indication Contraindication Mechanism Side Effect Nursing

of Actions Responsibilities
Generic Name Used for the Hypersensitivity. Appears to
Hypersensitivit Assessment
treatment of Severe hepatic inhibit y reaction. - If given for analgesia,
Acetaminophe mild to impairment or prostaglandin assess onset, type,
n moderate pain active liver disease synthesis in
Early Signs of location, duration of pain
and reduction (IV). the CNS and, Acetaminophe -Assess for fever.
Brand Name of fever to a lesser n Toxicity:
extent, block Anorexia, Intervention/evaluation
Tylenol pain impulses nausea, -Assess for clinical
through diaphoresis, improvement and relief of
Classification peripheral fatigue within pain, fever
action. Actsfirst 12–24 hrs.
Therapeutic: centrally on Patient/family teaching\
Analgesics hypothalamic Later Signs of - Consult physician for
heat- Toxicity: use in children younger
CLINICAL: regulating Vomiting, right than 2 yrs
Non-narcotic center, upper -Severe/recurrent pain or
analgesic, producing quadrant high/continuous fever
antipyretic. peripheral tenderness, may indicate serious
Dosage vasodilation elevated LFTs illness.
300 mg within 48–72 -Do not take more than 4
Onset: less hrs after g/day
than 60mins ingestion.
Route Peak: 1-3hrs
Intravenously Duration: 4-6
hrs
17. Lactulose
Name of Indication Contraindication Mechanism Side Effect Nursing Responsibilities

Drug of Actions
Generic Hypersensitivit Patients on low- Inhibits Occasional: Assessment
Name y to lactulose. galactose diets. diffusion of Abdominal Question usual stool
Lactulose Pts requiring a NH3 into cramping, pattern, frequency,
low- galactose Use Cautiously in: blood by flatulence, characteristics. Conduct
Brand diet. Diabetes mellitus; converting increased neurological exam in pts
Name Excessive or NH3 to NH4 + thirst, with elevated serum
Constulose, prolonged use (may abdominal ammonia levels
Enulose, lead to Enhances discomfort.
Generlac, dependence); diffusion of Intervention/evaluation
Kristalose Lactation: Safety NH3 from Rare: Nausea, Encourage adequate fluid
not established in blood to gut, vomiting. intake. Assess bowel
Classificati breastfeeding. where it is sounds for peristalsis.
on converted to Monitor daily pattern of
PHARMAC NH4 + ; bowel activity, stool
OTHERAP consistency; record time of
EUTIC: Produces evacuation.
Lactose osmotic effect
derivative. in colon Patient/family teaching
CLINICAL: • Evacuation occurs in 24–
Hyperosmo 48 hrs of initial dose. •
tic laxative, Institute measures to
ammonia promote defecation
detoxicant. • Drink plenty of fluids.
Dosage
15–30 mL
(10–20
g)/day, up
to 60 mL
(40 g)/day
Route
PO
18. Calcium Gluconate

Generic Hypocalcemia Hypersensiti Essential for function, CNS: tingling Assessment

Name vity to integrity of nervous, sensations, sense Assess B/P, EKG and
Adjunctive calcium muscular, skeletal of oppression or cardiac rhythm, renal
Calcium treatment of formulation.. systems. Plays an heat waves with function, serum
Gluconate magnesium important role in IV use, syncope magnesium, phosphate,
intoxication normal cardiac/renal with rapid IV calcium, ionized calcium.
Brand function, respiration, use.
Name During blood coagulation, Intervention/evaluation
exchange cell membrane and CV: bradycardia, Monitor serum BMP,
transfusions capillary permeability. arrhythmias, calcium, ionized calcium,
Classificati cardiac arrest with magnesium, phosphate;
on Hyperphosphate rapid IV use, mild B/P,
mia drop in BP, cardiac rhythm, renal
PHARMAC vasodilation. function. Monitor for
OTHERAPE Dietary signs of hypercalcemia
UTIC: supplement GI: constipation, .
Electrolyte irritation, chalky Patient/family teaching
replenisher. Hyperkalemia taste, hemorrhage, • Do not take within 1–2
with secondary nausea, vomiting, hrs of other oral
CLINICAL: cardiac toxicity thirst, medications, fiber-
Antacid. abdominal pain. containing foods.
• Avoid excessive use of
Dosage GU: polyuria, renal alcohol, tobacco, and
(Mild): 1–2 g calculi. caffeine.
over 2 hrs
; Metabolic:
(Moderate to hypercalcemia.
severe,
asymptomati
c): 4 g over 4
hrs;
(Severe,
symptomatic
): 1–2
g over 10
min;
Route
IV
19. Acetylcysteine

Generic PO: Antidote for Hypersensiti Mucolytic splits CNS: drowsiness. Intervention/evaluation
Name the vity linkage of
management of mucoproteins, CV: vasodilation. If bronchospasm
acetylcystein potentially Cautions: reducing viscosity of occurs, discontinue
e hepatotoxic Pts with pulmonary EENT: rhinorrhea. treatment, notify
overdosage of bronchial secretions. physician;
Brand acetaminophen asthma; Acetaminophen Resp: bronchodilator
Name debilitated toxicity: bronchospasm, may be added to
Acetadote IV: Antidote for pts with Hepatoprotective by bronchial/tracheal therapy. Monitor rate,
Cetylev the severe restoring hepatic irritation, chest depth, rhythm, type of
Mucomyst management of respiratory glutathione and tightness, increased respiration
Parvolex potentially insufficiency enhancing nontoxic secretions. (abdominal, thoracic).
hepatotoxic conjugation of Observe sputum for
Classificati overdosage of acetaminophen. GI: nausea, color, consistency,
on acetaminophen vomiting, stomatitis. amount.
Therapeutic
Therapeutic: Effect: Facilitates Derm: Patient/family teaching
antidotes, removal of pulmonary rash, clamminess,
mucolytic secretions by pruritus, urticaria. • Slight, disagreeable
coughing, postural sulfuric odor from
Dosage drainage, mechanical Misc: allergic solution may be
ADULTS, 3– means. Protects reactions (primarily noticed during initial
5 mL (20% against with IV), including administration but
solution) 3–4 acetaminophen ANAPHYLAXIS, disappears quickly.
times/day or overdose-induced ANGIOEDEMA, • Adequate hydration is
6–10 mL hepatotoxicity. chills, fever. important part of
(10% therapy.
solution) 3–4 • Follow guidelines for
times/day. proper coughing and
deep breathing
Route techniques.
PO • Auscultate lung
sounds.
I V Medication Infusion Blood Other Fluids
Transfusion Treatment
D5NSS 60cc/hr
(Dextrose 5% in 0.9% NaCL)
Dextrose 5 in .9 Sodium Chloride is

a prescription medicine used to treat
the symptoms of Hypoglycemia.
Dextrose 5 in .9 Sodium Chloride

belongs to a class of drugs called
Glucose-Elevating Agents;
Metabolic and Endocrine,
May cause serious side effects

including
● abnormal heart rate,

● low blood pressure,
● fatigue,
● weakness,
● muscle cramps, and
● constipation
Most common side effects

● fever,
● infections at the site of injection,
● blood clot or inflammation
surround the site of injection,
● leakage of fluid into the
surrounding tissues
(extravasation), and
● too much fluid in the blood
(hypervolemia)
DESCRIPTION
Dextrose and Sodium Chloride

Injection, USP (dextrose and sodium
chloride inj) is a sterile,
nonpyrogenic solution for fluid and
electrolyte replenishment and
caloric supply in single dose
containers for intravenous
administration.
Dosage is dependent upon the age,

weight, and clinical condition of the
patient as well as laboratory
determinations.
Parenteral drug products should be

inspected visually for particulate
matter and discoloration prior to
VIII . ECOLOGIC MODEL
A. Hypothesis
The electrolyte imbalance is not only caused by one factor but a chained causation. The
chained causation are the different predisposing factor that has a lot of contribution on the
patient’s condition. This condition might come from the patient’s physical activity and nutrition.
B. Predisposing Factors
1. Agent
Nutritive: A patient’s electrolyte must play each role in his body that should be fairly
consistent. These electrolytes are; sodium, chloride, potassium, magnesium, calcium, phosphate,
and carbonate. Imbalance of electrolytes may occur when the patient’s body creates too many or
not enough materials or electrolytes.
Physical: The patient is experiencing vomiting wherein it is one of the factors that can
cause electrolyte imbalance. More than that, excessive exercise or physical activity, usage of
alcohol and drugs, eating disorders, medications, burns, kidney disease, and heart failure may
also cause electrolyte imbalance.
2. Host
A. Age: 66
B. Sex / Gender: Male
C. Religion: Born Again
D. Ethnic/ Race: Filipino
E. Family size: Nuclear Family
C. Ecologic Model
The Ecologic model that was used is the web model. This model illustrates well the
predisposing factors of multiple electrolyte imbalance. Also, it illustrates that a certain effect never
depends on a single cause. In the illustration above, it shows that the factors of having imbalance
electrolytes are caused by the different factors such as physical and nutritive factors.
D. Analysis
AGENT
According to Healthline (2018), fluids in our body contains cells, glucose and electrolytes.
Electrolytes are from the foods and liquids that a patient’s consume. In addition, electrolytes has
a very important role in our body as it enables to conduct electricity to move electrical charges in
our body (Morris, S., 2019). More than that, electrolytes has many components such as sodium,
chloride, potassium, magnesium, calcium, phosphate, and carbonate. Every component has
different role to play in our body. Sodium helps to control fluids in the body, chloride balances
acidity and alkalinity, potassium regulates your heart and blood pressure, calcium contributes to
blood clotting etc. These are just examples of electrolytes that if it works too much or not enough
in our body, it occurs multiple electrolyte imbalance (Morris, S., 2019). Furthermore, physical
activities may also be the cause of electrolyte imbalance such as excessive exercise, heavy
physical activity, usage of drugs and alcohol, and eating disorder (Morris, S., 2019). Other than
that, present or past illnesses may also occur electrolyte imbalance such as burns, heart failure,
vomiting, medications, and kidney disease (Morris, S., 2019).
HOST
The client is a 66 year-old, male that is married and has a nuclear family. The client came
to hospital with a chief complaint of generalized body weaknesses and was admitted. His
diagnosis is multiple electrolyte imbalance wherein the patient might lost a lot of body fluid from
prolonged vomiting, inadequate diet and lack of vitamins, illnesses, malabsorption, etc.
(Chemocare, n.d.).
E. Conclusion and Recommendation
The patient is a 66-year old, male that came to hospital due to generalized body
weaknesses and was diagnosed with multiple electrolyte imbalance. Therefore, it is concluded
that the stated predisposing factors and the web model that was used maybe the highest possible
cause of his electrolyte imbalance. Moreover, it is highly recommended to treat the patient
immediately by increasing or decreasing the fluid intake depends on the problem of the fluid of
the patient. Providing proper diet meal, certain IV and oral medications. Furthermore, promoting
health teaching will also be affective to the patient to prevent electrolyte imbalance.
References:
Morris, S. (2019). How to prevent an electrolyte imbalance. Retrieved from

https://www.healthline.com/health/food-nutrition/how-to-prevent-an-electrolyte-imbalance
Holland, K. (2019). All about electrolyte disorders. Retrieved from
https://www.healthline.com/health/electrolyte-disorders
Chemocare (n.d.). Electrolyte imbalance. Retrieved from

https://chemocare.com/chemotherapy/side-effects/electrolyte-
imbalance.aspx#:~:text=There%20are%20many%20causes%20for,lack%20of%20vitami
ns%20from%20food
Felman, A. (2017). Everything you need to know about electrolytes. Retrieved from
https://www.medicalnewstoday.com/articles/153188#treatment-and-prevention
XI. PATHOPHYSIOLOGY
Anatomy and physiology
Half of our body is made up of water – stored and restricted to various spaces in which we
call fluid compartments. There are three compartments: fluid inside cells, fluid in spaces around
cells, and blood. Our cells contain 60% water in the human body, while the remaining percentage
surrounding the cells. Our organs such as the brain and kidney – contain the highest percentage
of water, whereas the bones and teeth possess the lowest amount of water. Regardless, it is
crucial to keep them functioning properly by maintaining fluid levels at an adequate level; not too
much or not too low. Electrolytes are considered minerals that carry electrical charge when they
get dissolved in blood. Thus, we now have electrolytes - sodium, chloride, potassium, and
bicarbonate. The human body consists of electrolytes that interact with cells in the tissues,
muscles, and nerves. Balanced electrolyte substances indicate a sign of a normal function of the
body, which is essential for us to survive. Those common electrolytes include – sodium, calcium,
potassium, bicarbonate, magnesium, chloride, and phosphate. Their main function is to maintain
homeostasis inside the body through regulating neurological and muscle function, fluid balance,
delivery of oxygen, acid-base balance, and water balance. For instance, sodium regulates normal
fluid levels in the fluid compartments because the fluid inside the compartment depends on the
electrolyte concentration. High electrolyte concentration leads the fluid into the compartment,
while low electrolyte concentration moves the fluid out of the compartment – this is a process
called osmosis. The kidneys contribute to maintaining electrolyte balance through filtering water
and electrolytes from the blood – excreting them into the urine. So, if electrolyte imbalance occurs,
disorders can possibly develop in the body.
Overview of the Disease
Imbalances in the body will ultimately result in different complications in the body like
generalized body weakness. Precedently, these complications arise from the preexisting
conditions in the body, particularly in the liver. Our liver, in its very essence, targets the process
of maintaining homeostasis regarding the fluids in our body. It secretes bile that aids with digestion
and excretion of waste including the maintenance of fluid balance in the body (Johns Hopkins
Medicine, n.d.). If the liver is impaired, it could cause an imbalance in our digestive system.
External factors like our lifestyle could directly impact our liver like alcohol abuse. If left
unobserved, it could lead to a range of diseases that could potentially end with cirrhosis, which is
very deadly. In relation to alcohol abuse, it affects the liver in such a way that the liver fails to
regenerate on its own and function the way it is supposed to (Dunn & Shah, 2016). Alcohol and
aldehyde damages the hepatocytes, which aids in metabolic, endocrine and secretory functions
of the body; this is where bile comes from.
Even though immune cells in the body start to reverse those damages, the liver won’t be
able to reproduce more hepatocytes leading to the disruption of metabolic, endocrine, and
secretory functions. Consequently, those immune responses of the body will now be interrupted,
causing other natural body defenses. Splanchnic vasodilatation will occur as part of the body’s
natural responses through the production of renin-angiotensin-aldosterone system (RAAS)
(Shabir, 2021). Moreover, RAAS is part of the neurohumoral systems that acts up when the body
is in distress. Neurohumoral systems work by maintaining arterial and circulatory balance in our
bodies (Colucci, 2020). However, all of those natural responses of the body result in water
retention and sodium retention and those two are correlated with each other; making those
imbalances in the body to cause and manifest symptoms that should be managed.
Symptoms of electrolyte imbalance include irregular heartbeat, weakness, bone disorders,
changes in blood pressure, seizures, nervous system disorders, and muscle spasms. This occurs
when a harmful concentration of electrolyte substances are at a high or low level. Causes may
vary from different disorders such as kidney disease, dehydration, prolonged vomiting/diarrhea,
poor diet, congestive heart failure, cancer, drug effects, bulimia, or influence of age as kidneys of
older adults become less functioning.
Contextual Mapping/ Schematic Diagram
Multiple Electrolyte Imbalances
Etiology
Predisposing factors
Alcohol use disorder
Modifiable Old age (66 years old) Non-modifiable
Alcohol use disorder Old age (66 years old)
Alcohol, acetaldehyde Alcohol & acetaldehyde damages

Liver is now impaired hepatocytes and prevents the liver to
heal and function
Metabolic, endocrine &

secretory functions are Liver can’t produce Immune cells kick in to
disrupted enough hepatocytes prevent further damage
Splanchnic/ systemic reduction in the effective neurohumoral systems

vasodilatation arterial blood volume are activated
Electrolyte imbalance would result

to different clinical manifestations: Water retention
Hyponatremia
Generalized body
weakness (lethargy)
Hypervolemia
Sodium retention
Diagnostic tests Confirmation
CBC, serum sodium, To confirm, blood and electrolyte levels
Potassium, Creatinine, BUN, are checked; compared and contrasted
SGPT, TPAG, ionized calcium, with each other. Additionally, signs and
phosphorus, TIBC, reticulocyte symptoms manifested by the patient are
count, urinalysis, ESR, CRP, also considered.
LDH, procalcitonin, D-D
In dealing with these complications, common options that could be implemented are fluid and
sodium restrictions for the patient. Usually, by closely monitoring the intake and output of the
patient and replacing electrolytes would be sufficient enough to treat patients with multiple
electrolyte imbalance. This is done through utilization of intravenous fluids plus the alteration of
the patient’s diet (ChemoCare, n.d.). If those aren’t sufficient enough, pharmaceuticals could be
introduced to the patient, particularly diuretics, in order for health professionals to control the fluid
and electrolytes levels of the patient (Ellis, 2019). These methods of treating the mentioned
condition are all more commonly utilized in patients involved in different kinds of surgeries,
geriatric patients, and people with preexisting diseases. Furthermore, nursing interventions
should be focused on the nutritional status of the client. Other interventions might be regarding
the edematous state of the client like repositioning, movement of the extremities, or compressions
(Mayo Clinic Staff, 2020).
References:
Johns Hopkins Medicine. (n.d.). Liver: Anatomy and Functions. Retrieved from
https://www.hopkinsmedicine.org/health/conditions-and-diseases/liver-anatomy-and-functions
Lewis III, J. L., MD. (2020, April). Electrolyte Balance | Boundless Anatomy and Physiology. MSD
Manual: Consumer Version. https://courses.lumenlearning.com/boundless-
ap/chapter/electrolyte-balance/
Sissons, C. (2020, May 27). What is the average percentage of water in the human body?
MEDICAL NEWS TODAY. https://www.medicalnewstoday.com/articles/what-percentage-of-the-
human-body-is-water
Shabir, O., PhD. (2021, March 4). What is the Renin-Angiotensin-Aldosterone System? News-
Medical.Net. https://www.news-medical.net/health/What-is-the-Renin-Angiotensin-Aldosterone-
System.aspx
Dunn, W., & Shah, V. H. (2016). Pathogenesis of Alcoholic Liver Disease. Clinics in Liver Disease,
20(3), 445–456. https://doi.org/10.1016/j.cld.2016.02.004
Colucci, W. S., MD. (2020, July 23). Pathophysiology of heart failure: Neurohumoral
adaptations. UpToDate Website. https://www.uptodate.com/contents/pathophysiology-of-heart-
failure-neurohumoral-adaptations
X. PROBLEM IDENTIFICATION AND PRIORITIZATION
Problem Inference Problem Priority Cues Rank Justification

Identification: Statement: Problem
Cues with Cues
Electrolyte Low oxygen Electrolytes Low Subjective Aside from being an

imbalance RT saturation must be kept in oxygen Cues 1 actual problem, this
Hypervolemic (93%) a balanced saturation problem is the first
Hyponatremia The patient priority as based on
BP: 130/70
state in order (93%) verbalized
AEB altered for your body to BP: 130/70 Maslow’s Hierarchy of
electrolytes “Hinang hina Needs, electrolyte
and lethargy Presence of function ako parang di imbalance falls on the
lethargy correctly. Vital Presence ko na yata category of physiologic
body systems of lethargy kaya.” needs which is a basic
Hypertensive may be
Hypertensi need. Moreover,
harmed if this Objective symptoms of
ve Cues
does not electrolyte imbalance
happen. Low oxygen vary depending on
Severe saturation which electrolytes are
electrolyte (93%) most affected.
imbalances Common symptoms
can lead to BP: 130/70 include
nausea,lethargy and
unconsciousne Presence of fluid retention. Hence,
ss, lethargy addressing the
convulsions, electrolyte imbalance
and cardiac Hypertensive by providing optimal
arrest, among management,
other things. clinicians should be
knowledgeable about
fluid and electrolyte
homeostasis and the
underlying
pathophysiology of the
respective disorders.
References:
Morris, S. (n.d). How to Prevent an

Electrolyte Imbalance. Retrieved from
https://www.healthline.com/health/food-
nutrition/how-to-prevent-an-electrolyte-
imbalance#prevention
Lee, J. (2010). Fluid and Electrolyte

Disturbances in Critically Ill Patients.
Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC3043756/
Fluid Volume Presence of Maintaining a Presence Subjective This problem affects

Deficit RT dry black healthy fluid of dry Cues: 2 the toileting activity of
Upper stools balance is black the patient. It falls
Gastrointestin stools The patient under the physiological
Vomiting of essential for stated
al Bleeding needs in Maslow’s
Blood good health. Vomiting verbatim,
probably Hierarchy of Needs,
secondary to
Dehydration of Blood “Parang ano therefore, this problem
BPUD AEB can be caused po eh gusto should also be a
Hematemesis by insufficient ko nalang priority. Moreover,Fluid
, Melena, and fluid intake or matulog lagi Volume Deficit refers to
Lethargy. excessive fluid kasi dehydration, water
loss, which can nanghihina loss alone without
impair cardiac po ako. change in sodium.
and renal Tapos hirap Hence, it could be
rin ako addressed by
function as well
dumumi eh recognizing and
as electrolyte kahit anong addressing factors
control. pilit ko.” contributing to
Volume deficient fluid volume
overload, renal Objective such as diarrhea,
failure, and Cues: vomiting, fever,
electrolyte diuretic therapy, or
Presence of
toxicity can all uncontrolled diabetes
dry black
result from stools mellitus. Administer
insufficient medications such as
urine output. Vomiting of antidiarrheals and
Blood antiemetics as
appropriate.
Presence of
Reference: Nursing Fundamentals. (n.d).
body 15.6 APPLYING THE NURSING
PROCESS. Retrieve from
weakness https://wtcs.pressbooks.pub/nursingfunda
mentals/chapter/15-6-applying-the-
nursing-process/
Upper Vesicular Bacteria, Objective This problem is the

gastrointestin breath sounds viruses, and Cues: 3 third priority as this
al infection parasites can all problem falls under the
RT cause Blood physiological needs.
hematemesis gastrointestinal Pressure: Gastrointestinal
AEB episode illnesses. The 70/40 infections are
of melena infection will infections caused by
usually clear up RR: 36 viruses, bacteria, or
in a few days. parasites that cause
Staying gastroenteritis, which
hydrated is the Temperatur is an inflammation of
most essential e: 36.4 the gastrointestinal
self-care tract involving both the
treatment for Vesicular stomach and the small
adults and breath intestine. Hence,it
children with a sounds could be addressed by
GI illness. identifying infected
patients as soon as
possible to implement
extended infection
control.
Reference: Biomerieux. (n.d).
Gastrointestinal Infections. Retrieved from
https://www.biomerieux-
diagnostics.com/gastrointestinal-
infections
Decreased Hypertension: The quantity of BP: 130/70 Subjective This problem falls
Cardiac blood pumped Cues: 4 under the physiological
Output RT -BP: 130/70 by the heart per needs in Maslow’s
Increased -Pallor minute is Patient Hierarchy of Needs.
vascular -Chest pain referred to as verbalized Decreased cardiac
resistance -Generalized cardiac output “nanghihina output may result in
AEB Elevated body (CO), and it is talaga ako insufficient blood
Blood weakness the method nung isang supply and
Pressure -Drowsiness through which araw pa at compromise vital
_Low blood circulates laging reactions, that caused
Hemoglobin throughout the inaantok, conditions like
Result: 121.0 body, sumasakit din myocardial infarction,
g/L particularly to yung dibdib hypertension, valvular
-ECG result the brain and ko…” heart disease,
with RVR other critical congenital heart
organs. Objective disease,
Cues: cardiomyopathy, heart
-BP: 130/70 failure, pulmonary
-Pallor disease, arrhythmias,
-Chest pain drug effects, fluid
-Generalized overload, decreased
body fluid volume, and
weakness electrolyte imbalance
-Drowsiness is common causes of
_Low decreased cardiac
Hemoglobin output.
Result: 121.0
g/L
-ECG result References:
with RVR Simple Nursing. (n.d). Decreased Cardiac

Output. Retrieved from
https://simplenursing.ph/decreased-
cardiac-output-nursing-diagnosis/
Nurseslabs. (2021). Decreased Cardiac

Output Nursing Care Plan. Retrieved from
https://nurseslabs.com/decreased-
cardiac-output/
Activity -Type-II Improve the Patient Subjective This problem is the last
Intolerance -Diabetes patient's ability verbalized Cues: 5 priority as this problem
RT decreased Mellitus to perform daily “Hinang- falls under the
hemoglobin -Hypervolemic hina po Patient physiological needs.
activities verbalized
level AEB -Hyperosmolar ako at Activity intolerance is a
without feeling “Hinang-hina
generalized -Hyponatremia hirap sa common side effect of
body
excessive pakiramda po ako at heart failure and can
weakness fatigue; m” hirap sa be related to
Improve the pakiramdam” generalized weakness
patient's and difficulty resting
physiological Objective and sleeping, it caused
health over Cues: by coronary disease,
time; Improve -Type-II decreased cardiac
the patient's Diabetes output, hypertension,
ability to use Mellitus congenital problems,
energy - congestive heart
conservation Hypervolemi failure, cardiac
c arrhythmias/dysrhythm
and
- ias, structural
management abnormalities, and
techniques; Hyperosmola
r myocardial ischemia
and. Maintain and myocardial
-
the patient's infarction.
Hyponatremi
respiratory and a
cardiovascular
functions CR: 105bpm Reference:
during RR: 36cpm
Simple Nursing. (n.d). Activity Intolerance.
activities. Temp: 36.4 Retrieved from
https://simplenursing.ph/nursing-
SpO2 sat: intervention-for-activity-intolerance/
98%
Problem and Cues Rank Justification
Electrolyte imbalance RT Aside from being an actual problem, this problem is the
Hypervolemic Hyponatremia first priority as based on Maslow’s Hierarchy of Needs,
AEB altered electrolytes and 1 electrolyte imbalance falls on the category of
lethargy physiologic needs which is a basic need. Moreover,
symptoms of electrolyte imbalance vary depending on
Subjective Cues which electrolytes are most affected. Common
symptoms include nausea,lethargy and fluid retention.
Hence, addressing the electrolyte imbalance by
providing optimal management, clinicians should be
The patient verbalized “Hinang knowledgeable about fluid and electrolyte homeostasis
hina ako parang di ko na yata and the underlying pathophysiology of the respective
kaya.” disorders.
References:
Objective Cues Morris, S. (n.d). How to Prevent an Electrolyte Imbalance. Retrieved from
https://www.healthline.com/health/food-nutrition/how-to-prevent-an-electrolyte-imbalance#prevention
Low oxygen saturation (93%) Lee, J. (2010). Fluid and Electrolyte Disturbances in Critically Ill Patients. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043756/
BP: 130/70
Presence of lethargy
Hypertensive
Fluid Volume Deficit RT Upper This problem affects the toileting activity of the patient.
Gastrointestinal Bleeding It falls under the physiological needs in Maslow’s
probably secondary to BPUD 2 Hierarchy of Needs, therefore, this problem should also
AEB Hematemesis, Melena, and be a priority. Moreover,Fluid Volume Deficit refers to
Lethargy. dehydration, water loss alone without change in sodium.
Hence, it could be addressed by recognizing and
Subjective Cues: addressing factors contributing to deficient fluid volume
such as diarrhea, vomiting, fever, diuretic therapy, or
The patient stated verbatim, uncontrolled diabetes mellitus. Administer medications
“Parang ano po eh gusto ko such as antidiarrheals and antiemetics as appropriate.
nalang matulog lagi kasi
Reference:
nanghihina po ako. Tapos hirap Nursing Fundamentals. (n.d). 15.6 APPLYING THE NURSING PROCESS. Retrieve from
rin ako dumumi eh kahit anong https://wtcs.pressbooks.pub/nursingfundamentals/chapter/15-6-applying-the-nursing-process/
pilit ko.”
Objective Cues:
Presence of dry black stools
Vomiting of Blood
Presence of body weakness
Upper gastrointestinal infection This problem is the third priority as this problem falls
RT hematemesis AEB episode under the physiological needs. Gastrointestinal
of melena 3 infections are infections caused by viruses, bacteria, or
parasites that cause gastroenteritis, which is an
Objective Cues: inflammation of the gastrointestinal tract involving both
the stomach and the small intestine. Hence,it could be
Blood Pressure: addressed by identifying infected patients as soon as
70/40 possible to implement extended infection control.
Reference: Biomerieux. (n.d). Gastrointestinal Infections. Retrieved from
RR: 36 https://www.biomerieux-diagnostics.com/gastrointestinal-infections
Temperature: 36.4
Vesicular breath sounds

Decreased Cardiac Output RT This problem falls under the physiological needs in
Increased vascular resistance Maslow’s Hierarchy of Needs. Decreased cardiac
AEB Elevated Blood Pressure 4 output may result in insufficient blood supply and
compromise vital reactions, that caused conditions like
Subjective Cues: myocardial infarction, hypertension, valvular heart
disease, congenital heart disease, cardiomyopathy,
Patient verbalized “nanghihina heart failure, pulmonary disease, arrhythmias, drug
talaga ako nung isang araw pa at effects, fluid overload, decreased fluid volume, and
laging inaantok, sumasakit din electrolyte imbalance is common causes of decreased
yung dib-dib ko…” cardiac output.
Objective Cues:
-BP: 130/70 References:
-Pallor Simple Nursing. (n.d). Decreased Cardiac Output. Retrieved from https://simplenursing.ph/decreased-
cardiac-output-nursing-diagnosis/
-Chest pain
-Generalized body weakness Nurseslabs. (2021). Decreased Cardiac Output Nursing Care Plan. Retrieved from
-Drowsiness https://nurseslabs.com/decreased-cardiac-output/
_Low Hemoglobin Result: 121.0

g/L
-ECG result: Afib with RVR
Activity Intolerance RT This problem is the last priority as this problem falls
decreased hemoglobin level under the physiological needs. Activity intolerance is a
AEB generalized body weakness 5 common side effect of heart failure and can be related
to generalized weakness and difficulty resting and
Subjective Cues: sleeping, it caused by coronary disease, decreased
cardiac output, hypertension, congenital problems,
Patient verbalized “Hinang-hina congestive heart failure, cardiac
po ako at hirap sa pakiramdam” arrhythmias/dysrhythmias, structural abnormalities, and
myocardial ischemia and myocardial infarction.
Objective Cues:
-Type-ii Diabetes Mellitus

-Hypervolemic Reference:
-Hyperosmolar Simple Nursing. (n.d). Activity Intolerance. Retrieved from https://simplenursing.ph/nursing-

-Hyponatremia intervention-for-activity-intolerance/
CR: 105bpm
RR: 36cpm
Temp: 36.4
SpO2 sat: 98%
XI. NURSING CARE PLAN
Cues Nursing Dx Analysis Goals and Implement Rationale Evaluation

Objectives ation
Subjective Cues Electrolyte Scientific Short-term The patient will have a

The patient
imbalance Analysis: goal: balanced intake and
verbalized “Hinang
RT Hypervolemic After output within the next 24
hina ako parang di
Hypervolemi hyponatremia implementi hours.
ko na yata kaya.”
c is a condition ng all the
Hyponatrem where there’s nursing
ia AEB an abnormal intervention
Objective Cues
altered amount of s,
● Low oxygen
saturation electrolytes fluid buildup the patient
(93%) and lethargy in the body in will have a
● BP: 130/70
● Presence of comparison balanced
lethargy to sodium intake and
● Hypertensive
levels. The output
usual cause within the
of fluid next 24
retention in hours
Effectiveness:
the body is Objectives Did the client exhibit
signs of improvement?
from :
✓ MET
preexisting The patient ● Limiting ● Sodium ____UNMET
Efficiency &
complications will be able sodium causes
Appropriateness:
of the kidney, to follow the intake thirst, Was the intervention
successfully
in some intervention and fluid which
implemented for the
cases, heart- s and restrictio then whole day?
✓ MET
related consequent n will be causes
____UNMET
complications ly exhibit impleme an impair Adequacy &
Acceptability:
, possible signs of nted; in the
cirrhosis, and improveme diuretics kidney to Was the client satisfied
after the intervention?
pregnancy nt in if metaboli
_✓_MET
could be a hydration. necessar ze ____UNMET
cause, too y excess
(WebMD ● Monitorin water
Editorial g I&O ● Monitorin
Contributors periodica g I&O to
& Brennan, lly. ensure
2021). Those stable
complications fluid; if
will result in not,
altered electrolyt
electrolytes es or IV
Effectiveness:
that The patient fluids will
Was the client able to
consequently will express ● The be express his comfort
levels?
results in comfortabili nurse will introduce
_✓_MET
lethargy. ty once the evaluate d (Cirino ____UNMET
Efficiency &
Situational intervention the &
Appropriateness:
Analysis: has been patient’s Stephens Was the intervention
implemented within 5
In this case, implemente comforta , 2017)
minutes?
the patient is d. bility _✓__MET
____UNMET
an old male through
(66-year-old) the pain Adequacy &
Acceptability:
who’s had a scale of
Was the client active
chief 1-10. and positive during the
actual evaluation?
complaint of
_✓_MET
generalized ____UNMET
body
Effectiveness:
weakness. Was the client able to
elaborate the
This is due to
appropriate measures
hypervolemic to prevent hypervolemia
hyponatremia?
hyponatremia
_✓_MET
that needs ____UNMET
intervention
Efficiency &
through
Appropriateness:
properly The patient Was the intervention
successfully discussed
providing the will ● Health ● Rating
within 20 minutes?
right amount elaborate teaching pain _✓_MET
____UNMET
and quality of the will be scale, in
diet and appropriate utilized. this case, Adequacy &
Acceptability:
fluids. measures the
Was the client active
to prevent absence and positive during the
actual discussion?
hypervolem of it, is
_✓_MET
ia essential ____UNMET
hyponatrem to
The patient’s family will
ia evaluate
learn how to properly
if the
manage the patient’s
patient
condition at home.
responds
to the
interventi
on being
made
(Wayne,
2020)
Long term
goal: ● Family ● Health
The teaching teaching
patient’s will be needs to
family will impleme be used
learn how nted. for
to manage explainin
fluid and g the
diet importan
restrictions ce of
for the keeping
patient. track of
fluids,
sodium
intake,
amongst
other
things.
(The
Nurse’s
Role in
Patient
Education,
2018)
Reference:
● WebMD Editorial Contributors, & Brennan, D., MD. (2021, May 11). What Is Fluid
Overload? WebMD. Retrieved from https://www.webmd.com/a-to-z-guides/what-is-fluid-
overload
● Cirino, E., & Stephens, C., RN, CCRN, CPN. (2017, June 28). Hypervolemia (Fluid
Overload). Healthline. Retrieved from https://www.healthline.com/health/hypervolemia
● Wayne, G. B., BSN, RN. (2020, September 8). Fluid Volume Excess Nursing Care Plan.
Nurseslabs. Retrieved from https://nurseslabs.com/excess-fluid-volume/
● The Nurse’s Role in Patient Education. (2018, March 22). Arkansas State University
Online. Retrieved from https://degree.astate.edu/articles/nursing/nurses-role-patient-
education.aspx
XII. DISCHARGE PLAN
DISCHARGE PLAN
MEDICINES ● Pantoprazole - Take Pantoprazole

40 mg or 1 tablet once a day for 2
weeks to treat erosive esophagitis
(damage to the esophagus from
stomach acid caused by
gastroesophageal reflux disease,
or GERD).
● Rebamipide - Take Rebamipide

100 mg or 1 tablet thrice a day for
1 week to prevent mucosal erosion
and damage. The drug augments
gastric blood flow, reduces free
oxygen radicals mediated oxidative
stress and lipid peroxidation, and
promotes prostaglandin
biosynthesis in the duodenal wall.
● Metoprolol - Take Metoprolol 500

mg or 1 tablet twice a day to treat
angina (chest pain) and
hypertension (high blood
pressure).
● Rosuvastatin - Take Rosuvastatin

10 mg or 1 tablet at bedtime to
prevent heart and blood vessel
disease, heart attacks, and strokes.
It's used to lower cholesterol if you
have been diagnosed with high
cholesterol.
● Trimetazidine - Take
Trimetazidine 35 mg or 1 tablet
twice a day to prevent and treat the
symptoms of angina (chest pain).
Angina is caused by a lack of blood
supply and oxygen to your heart.
Trimetazidine helps to maintain the
energy metabolism of heart muscle
cells, protecting them from the
effects of reduced oxygen supply.
● Citicoline - Take Citicoline 1 mg or

1 tablet twice a day to help memory
loss due to aging, improve vision in
people with glaucoma, and help
with recovery in stroke patients.
● Cefixime - Take Cefixime 400 mg

or 1 tablet once a day for 7 days to
treat many different types of
infections caused by bacteria.
● Vitamin E and Zinc - Take Vitamin

E and Zinc 1 tablet once a day.
Vitamin E prevents coronary heart
disease, supports immune
function, prevents inflammation,
promotes eye health, and lowers
the risk of cancer while zinc helps
your immune system and
metabolism function.
EXERCISE / ENVIRONMENT ● 2 Weeks After Discharge

Encourage the patient to take plenty of rest
to build up strength and stamina, but do not
stay in bed all day. Try taking short regular
walks for 10-15 minutes.
● 3 Weeks After Discharge

Encourage the patient to continue to take
short walks. The patient may also perform
light chores such as dusting the windows
or cooking light meals.
● 4-6 Weeks after Discharge

Encourage the patient to take a 40-minute
walk. Intense activities are prohibited.
TREATMENT Instruct the client to continue the Doctor’s

order of medications to continue at home
such as:
● Pantoprazole 40 mg/tab, 1 tab

once a day for 2 weeks
● Rebamipide 100 mg/tab,1 tablet
thrice a day for 1 week
● Metoprolol 500 mg/tab, 1 tablet
twice a day
● Rosuvastatin 10 mg/ tab,1 tablet at
bedtime
● Trimetazidine 35 mg/tab, 1 tablet
twice a day
● Citicoline 1 mg/tab, 1 tablet twice a
day
● Cefixime 400 mg/tab, 1 tablet once
a day for 7 days
● Vitamin E and Zinc 1 tablet once a
day
HEALTH TEACHINGS ● Educate the patient for the signs of

hypernatremia (too much salt
levels) and how to prevent it
● Review the medications of the

patient and instruct dosages and
when to take it.
● Discuss to the patient and his

family the significance of any fluid
or diet restrictions such as low salt
low fat diet.
● Educate and explain to the patient

to move cautiously when changing
positions (e.g., from supine position
to a standing or sitting position).
● Inform clients about any expected
side effects of prescribed
medications and how to handle
them.
● Educate and provide the rationale
to the client and family on when
to contact a healthcare
professional.
OUTPATIENT FOLLOW UP Instruct the patient to attend follow-up

consultations scheduled by the Physician.
If you have any of the following, call your

physician or rush to the emergency room:
● abdominal pain
● fatigue
● recurrence of vomiting
● weakness
● high fever
DIET
● Increase fluid intake, especially
water to stay hydrated.
● Milk, orange juice, coconut water,

soy milk, tomato juice, and sports
drinks.
● Increase solid intake that contains

high in electrolytes
● Fruits: banana, avocado, dried

apricots
● Vegetables: sweet potato, squash,

leafy green vegetables
● Dairy products: yogurt and cheese
● Salt: food that has table salt that

only contains 40% sodium and
60% chloride, olives and pickles.
SPIRITUAL
● Advice to continue praying and
building relationships with God, do
meditations and attend worship
seminars.
● Encourage the client to avoid

negative attitude and thoughts and
always be open with his feelings
especially to his family and friends.
Advice to seek emotional support if
having uncontrollable emotions.
● Provide the patient with the right

amount of knowledge for the
reoccurrence of the disease in
order to avoid fear and anxieties.
EVIDENCE BASED NURSING
1. General Question
Oral rehydration therapy (ORT) or intravenous therapy (IVT) Which intervention is better for
geriatric patients?
2. Reconstruction of General Question related to client’s problem identified in the RLE.

In a geriatric patient with multiple electrolyte imbalances, is utilizing oral rehydration therapy
(ORT) more effective and practical for treating his condition as opposed to using intravenous
therapy (IVT)?
A. COPES (Client-Oriented Practical Evidence Search)
Client type & What you might do Alternate course of What you want to
problem action accomplish
If a geriatric patient Are given oral rehydration or intravenous fluid Which would be better
who has multiple therapy (ORS) therapy (IVT) for the geriatric patient to
electrolyte imbalances improve his electrolyte
imbalances?
B. PICOM (Patient Focus Population, Intervention, Comparison, Outcome,

Measurement)
Patient/ Intervention Comparison Outcome Measurement

Focus population
The focus The World Oral Rehydration Oral rehydration The efficacy of the
population in the Health Therapy (ORT) therapy is a interventions will be
study included the Organization which is used to standard determined through
older adult (WHO) treat intestinal medication for utilizing research
population (56 years recommends volume losses geriatric patients studies related to the
old- older). Geriatric oral rehydration from diarrhea, with intestinal clinical problem.
patients are more therapy (ORT) short bowel volume losses. Moreover,
likely to experience for diarrheal syndromes, and However, it may observation to the
electrolyte illness inflammatory be client will be done by
imbalance and are dehydration and bowel disease in contraindicated monitoring electrolyte
highly required for involves the use older patients will to certain imbalance.
maintaining the fluid of oral be compared to situations such
levels in the body. rehydration IV therapy. Oral as excessive
solutions (ORS), Rehydration vomiting despite
including the Therapy (ORT) a small diet,
recommended is highly effective worsening
WHO and lifesaving in diarrhea, and
formulation adults, as well as intestinal ileus.
consisting of the children. It is a According to
oral rehydration practical and Sheikh, MD. et
glucose-salt safe alternative al. (2016) the risk
formula. ORT to IV therapy. of aspiration is
can reduce the more likely to be
need for IV caused by ORS
hydration administration to
therapy, thereby older patients
avoiding such due to higher
serious osmolarity and
complications. lower electrolyte
content.
Meanwhile, the
use of
intravenous fluid
therapy is safe
and applicable to
older patients
with severe
conditions as
they show signs
of rapid
breathing,
lethargy, and
presence of
shock.
Critical Review
An article about ORT VS IVT written by Sheikh, F., Colburn, J., Shapiro, A., and
Greenough III, W. entitled “Oral Rehydration Therapy as an Alternative to Intravenous Therapy in
Dehydrated Older People” is about dehydration that can be treated by ORT or IVT. Oral
rehydration therapy is recommended by the World Health Organization (WHO) for rehydration
which has become the standard treatment for children experiencing different illnesses such as
diarrhea. However, there is still lack of evidence and evaluations whether the ORT will be effective
to older populations. Through this research, the case of a 68-year old man suffering from
dehydration that was treated by ORT will be further evaluated by analyzing the; patients included,
comparing the intervention, and monitoring the outcome.
The case reported focused on comparing the risks and benefits of Oral Rehydration
Therapy versus Intravenous Therapy among elderly geriatric patients above 56 years old. As a
scenario, this focused on a case of a 68-year old man suffering from dehydration and is at high
risk of IV fluid overload which was successfully treated via Oral rehydration therapy. The case
stemmed from the issue of prolonged periods of ileostomies or colostomies in the United States
which was explored as the basis of which is more effective and causes less risk to these geriatric
patients. Based on the article, its intervention recommends the use of oral rehydration therapy
(ORT) for diarrheal illness dehydration and involves the use of oral rehydration solutions (ORS).
ORT can reduce the need for IV hydration therapy, thereby avoiding such serious complications.
On the other hand, our case intervention for multiple electrolyte imbalances is done through
utilization of intravenous fluids plus the alteration of the patient’s diet. It focuses on the nutritional
status of the client.
The patient, two weeks after hospitalization, was able to tolerate ORT, food, and getting
TPN at night. Shortly after, the patient was put on a complete oral diet and continued with ORT
to restore ileostomy losses, which had dropped to between 800 ml and 1L per day. While taking
ORT, electrolytes of the patient became stable, apart from a reduction in magnesium to 1.4
mEq/L, which was returned to normal with the use of supplementation. Rehabilitation and physical
therapy helped improve his condition thus he was discharged from the hospital. The patient was
able to take his prescriptions and through the mouth after discharge. Over the course of 35 days,
the patient was completely sustained on ORT as he started to eat and withdrew off of TPN and
supplemental IV fluids.
The study focuses on comparing Oral Rehydration Therapy and Intravenous Therapy
among older people. It is important to discuss and review this kind of research because it might
be beneficial in the future for our healthcare workers. The study evaluated if Oral Rehydration
Therapy is a better option than Intravenous Therapy because it suggests it may be a safer and
less costly way to replace volume losses in older individuals, as it has proven to be in children.
SUMMARY OF LITERATURES
A study regarding the use of Oral Rehydration Therapy as an alternative to Intravenous

Therapy was conducted by Sheikh, F., Colburn, J., Shapiro, A., and Greenough III, W. in order to
evaluate the treatment efficacy of ORT among elderly geriatric patients who suffer from
dehydration. In this research, a case of a 68-year old man with dehydration was reported to have
successfully been treated with ORT. Further discussion tells that during the 1970s, the studies
made on cholera have shown that ORT was highly effective and was considered a lifesaver in
adults as well as in children. Researchers suggest that the continued use of ORT among geriatric
patients reduces the demand for IV Therapy along with parenteral nutrition and other
complications accompanying them. Researchers indicated that ORT is a practical and a safe
alternative to IV Therapy as presented in the clinical case. Furthermore, the study recommends
translating ORT from pediatric into geriatric practice to avert volume depletion with the associated
hazards of hospitalization as it may be an inexpensive and highly effective means. In addition to
that, the proponents have concluded that the scientific and educational challenge is to test in a
reasonable and effective manner whether the implementation of ORT for widespread use in
elderly patients can help improve or enhance the outcomes and lessen morbidity and mortality.
References:
Sheikh, F., Colburn, J., Shapiro, A., and Greenough III, W. (2016). Oral Rehydration Therapy as
an Alternative to Intravenous Therapy in Dehydrated older people.

A Case Study of A 66-Year Old Patient With Multiple Electrolyte Imbalances

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

A Case Study of A 66-Year Old Patient With Multiple Electrolyte Imbalances

Uploaded by

Copyright:

Available Formats

A Case Study of a 66-year old Patient with Multiple Electrolyte Imbalances

MIRANDA, Noella Jeune Bienah T.

NAPULAN, Angemae Krizette

NUNEZ, Abegail Lene P.

PANTALEON, Alfred Jan S.

PASOLOHAN, Vanesa Mae L.

PONGASE, Joy Mae

Address: Homeland, Brgy. Sauyo, Novaliches, Quezon City

Age: 66 Birth Date: January 27, 1955 Birth Place: N/A

Religion: Born Again Race/Ethnic Origin: Filipino

Occupation: N/A Educational Attainment: N/A

Marital Status: Married Name of Spouse: Josefa

Chief Complaints: Generalized body weakness

Date of Admission: August 29, 2021

Room & Bed Number: ER & 150

Attending / Admitting Physician: Dr. Pineda & Dr. Acuna

Admitting/Final Diagnosis: Multiple Electrolyte Imbalance

Medical Insurance: Phil health

A. History of Present Illness

B. Past Health History

A. HEALTH PERCEPTION/ HEALTH MANAGEMENT

Interpretation: Deviation from Normal

Nutritional - Before During Analysis Interpretation

Frozen meat and 1 Reference: NHS.

5 ounces of grilled A low-sodium,

Gordon’s Before After Analysis Interpretation

The patient was The patient did not Constipati - Deviation

Patient was not The patient was Constipation can - Deviation

Patient was able The patient was A problem in the - Deviation

(2021, September 1). Retrieved from Medline Plus:

(2017, July 22). Retrieved from BrainKart:

Biggers, A. (2020, January 2). Retrieved from Medical News Today:

Snead, F. (2020, October 16). Retrieved from iNews:

INTERPRETATION: Deviation from Normal

Date Sleep Rest

Day 1: - Patient went to bed - Patient was able to

- Patient has woken

- Patient has woken

Day 3: - Patient went to - Patient was able to

- Patient has woken

Day 4: - Patient went to - Patient was able

Day 6: - Patient went to - Patient was able to

- Patient has woken

- Patient has woken

Interpretation: Deviation from normal

Fry, A. (2020, September 18). Retrieved from Sleep Foundation:

Interpretation: Deviation from Normal

(2020). Retrieved from Lifeline: https://www.lifeline.ca/en/blog-article/make-social-interaction-a-

The face is symmetric The client’s face is

ASSESSMENT BODY PART NORMAL ACTUAL FINDINGS ANALYSIS &

Reference: Dresden, D. (2020,

The sclera and

Pupils are equal,

ASSESSMENT BODY PART NORMAL ACTUAL ANALYSIS &

ASSESSMENT BODY PART NORMAL ACTUAL ANALYSIS &

Palpation of the ABDOMEN Unblemished skin, Upon palpation, the NORMAL

ASSESSMENT BODY PART NORMAL ACTUAL ANALYSIS &

ASSESSMENT BODY PART NORMAL ACTUAL ANALYSIS &

Observe for use of ANTERIOR Use of accessory Use of accessory NORMAL

BODY PART BODY PART NORMAL FINDINGS ACTUAL ANALYSIS &

TEST NORMAL RESULT CLINICAL

BUN 6-23 mg/dl No data A BUN test, also known as a

Reference: Medline Health.