Summitted By: Maria Teresa P.

Villanueva
MC- BSN IV
Coronary artery disease
• Coronary artery disease (CAD) is a chronic disease that globally affects morbidity and quality of life of all racial and
ethnic populations. Globally, 17.9 million people succumbed to CAD, accounting for 31% of deaths worldwide. More
than 75% of these deaths occur in low- and middle-income countries. Moreover, by 2025, 80–90% of people in low-
and middle-income countries are projected to die from CAD, making it one of the leading causes of death worldwide. 
• Cardiovascular diseases (CVDs) – or diseases of the heart and blood vessels – are responsible for a third of death in the
Philippines. CVDs are part of the larger group of noncommunicable diseases (NCDs), which account for 72% of deaths in
the country in 2021.
• In the Philippines, Cardiovascular diseases (CVDs) is the third leading cause of death from January to November last year.
Accounted for 91,152 or 18.5 percent of the deaths recorded. CVD accounts for approximately 20% of total deaths and
35% of premature deaths, affecting 1 in 6 Filipinos. Cardiovascular disease (CVD) accounts for approximately 20% of
deaths among Filipinos. Health habits such as alcohol consumption, smoking, and poor diet and nutrition have been
increasingly implicated in the high rates of CVD. (Philippine and Philippine-American Health Statistics, 2020)
• During the first nine months of 2022, ischemic heart diseases were the leading cause of death with 91,152 cases or 18.5
percent of the total deaths in the country. This indicated an increase of about 18.7 percent from the 76,783 deaths or 16.9
percent of the total deaths in the same period of 2020. (Philippine Statistic Authority, 2022)
Risk factors
• Modifiable • Non- Modifiable
• Poor Diet • Age
• Smoking • Heredity
• Alcohol • Gender
• Physical Inactivity • Ethnicity Race
• Obese
• Use of certain Medication
• Diabetic
• Hypertensive
• Dyslipidemia
Patient’s Profile
• PERSONAL DATA:
• Name : Patient X
• Age : 88
• Gender : Female
• Status : Married
• Cc : Cough
• Diagnosis : Community Acquired Pneumonia - Mitral Valve Regurgitation -
Coronary Artery Disease
• AP : Dra. Honesta Villaluna Pulmonologist
Dr. Villona ( Co-management) Cardiologist
History of present illness
• Patient is a diagnosed case of Hypertension (2002) and Coronary Artery
Disease (2010) with maintenance medications (Compliant) (Meds:
Bisoprolol, Aceclofenac, Multivitamins)
• Interim of easy fatigability in doing activities of daily living
• 4 days prior to admission, patient started to have cough with yellowish to
greenish colored phlegm and no fever
• 3 days prior to admission, noted with shortness of breath episodes
• Persistence of symptoms prompted to consult to AP, advised to admit.
Past medical history

• Gave birth to a two child via normal delivery

• No past surgery
• Admitted: Makati Med (2010) Diagnosed CAD
• Had a right shoulder injury due to fall in Canada (Dec. 2022)

Vaccine: Pfizer 1st and 2nd dose 2021(Canada)

Booster Pfizer 2021 (Canada)
Social history and genogram with legends)

FATHER
MOTHER
Diabetic: Died Chronic Kidney Disease
Died Cause of Heart Attack

PATIENT BROTHER SISTER

Diabetic Hypertensive
Hypertensive

SON DAUGHTER
 ASSESSMENT FINDINGS ASSESSMENT FINDINGS

GENERAL SURVEY HAIR & SCALP • With equally distributed hair

 Whitish in color
 Relaxed, erect posture, coordinated movement    No masses
 Clean, neat
 No lesion
 No body odor or minor body odor

EYES • Pupil equally rounded upon light

MENTAL STATUS  
accommodation Size of 2-3mm in
 Cooperative  
  diameter
 Understandable, has sense of reality 
 With pale conjunctivae
EARS • Without lesion & deformation
Integumentary    Not tender
 
Skin  Poor Skin Turgor MOUTH AND PHARYNX • The is lips pale and dry
 Pale skin • The tongue and mucous membrane are
pinkish, moist, and free of swelling and
 Dry skin
lesions
 Warm to touch • The gums is pink and smooth,
 With Ecchymosis noted on left and right arm • The uvula is centered and freely
movable,
HEAD Symmetrical • The tonsils are small, pink, and

symmetrical in size
 
RESPIRATORY • With occasional cough
 Centrally located • With yellowish to greenish phlegm
NECK TRACHEA AND
 Without masses • With episode of shortness of breath
THYROID GLAND No enlargement of lymph nose • Symmetrical chest expansion
 With Audible crackles
•
• with dullness sounds heard upon
percussion
NAILS   • with crackle heard on both lungs
 
  The nail base is firm

 Surrounding cuticles are smooth, intact and without
inflammation
 Delayed capillary refill (3-5 secs)
 ASSESSMENT FINDINGS

CARDIOVASCULAR • No chest pain

• NO murmur sound

GASTROINTESTINAL • With globular abdomen

• With positive borborygmic sounds dull
sounds heard a LUQ
• Tympany sounds hear in the lower quadrant
• With soft and non tender abdomen

GENITOURINARY • Voiding freely

• No vaginal discharges
• With active bowel movement

EXTRIMITIES • With active rom, muscle strength of arm

left 5/5 right 4/5, feet both 5/5
• With ankle edema
Anatomy and Physiology of Circulatory System
• The circulatory system is also called the cardiovascular system, where “cardi”
refers to the heart, and “vascular” refers to the blood vessels. So, these are the two
key parts: the heart, which pumps blood, and the blood vessels, which carry blood
to the body and return it back to the heart again
• The heart is about the size of a person’s fist, which makes sense: a bigger person
has a bigger fist and, therefore, a bigger heart and it’s shaped like a cone, and sits
slightly shifted over to the left side, in the mediastinum, which is the middle of the
chest cavity, or thorax. It sits on top of the diaphragm, which is the main muscle
that helps with breathing, behind the sternum, or breastbone, in front of the 
vertebral column, squished in between the two lungs, and protected by the ribs.
 Pericardium – a double-walled sac around the
heart composed of:
A superficial fibrous pericardium
Heart Layer A deep two-layer serous pericardium
The Function of the Pericardium:
Protects and anchors the heart
Prevents overfilling of the heart with blood
Myocardium – cardiac muscle layer forming the
bulk of the heart. Composed of cardiomyocytes
The Function:
Responsible for the contractile function of the cardiac pump
Fibrous skeleton of the heart – crisscrossing,
interlacing layer of connective tissue
The Function:
Provides electrical insulation at the atrioventricular level and
fibrous continuity for the leaflets of the mitral, aortic, and tricuspid
valves

Endocardium – endothelial layer of the inner

myocardial surface A tissue covering the inside of the heart
The Function:
keeps the blood flowing through the heart separate from the
myocardium, or cardiac muscles also  lines the valves, which open and
close to regulate blood flow through the chambers of the heart
 Systemic Circulation

Where the Bloods enter

INFERIOR
Reoxygenation
happens

Valves prevent the

backward flow of blood

Systemic Circulation
Sinus node generates an electrical stimulus regularly,
60 to 100 times per minute under normal conditions.
The atria are then activated. The electrical stimulus
travels down through the conduction pathways and
causes the heart's ventricles to contract and pump out
blood. The 2 upper chambers of the heart (atria) are
stimulated first and contract for a short period of time
before the 2 lower chambers of the heart (ventricles).
The electrical impulse travels from the sinus node to
the atrioventricular node (also called AV node). There,
impulses are slowed down for a very short period, then
continue down the conduction pathway via the bundle
of His into the ventricles. The bundle of His divides into
right and left pathways, called bundle branches, to
stimulate the right and left ventricles.
Normally at rest, as the electrical impulse moves
through the heart, the heart contracts about 60 to 100
times a minute, depending on a person's age.
Each contraction of the ventricles represents one
heartbeat. The atria contract a fraction of a second
before the ventricles so their blood empties into the
ventricles before the ventricles contract.
 HYPERTROPHY
Pathophysiology thickened heart
muscle
Making the heart to
pump hard to supply MEDICATIONS:
MODIFIABLE FACTORS the body demand Trimetazidine (angina)
Digoxin (Increase HR) CARDIOMEGALY
• DIET( Fatty foods) Enlargement of
• ALCOHOL (OCCASIONAL) heart muscle
Blood clot will
• HIGH CHOLESTEROL ARTERY (CAD)
accrue that will LABORATORY:
• LIMITED PHYSICAL ACTIVITY Become completely X-ray
narrow the blood MEDICATIONS:
• HYPERTENTION Clopidogrel (but dis. blocked
flow
MEDICATIONS: Because of
Antihypertensive ecchymosis)
medications
ISCHEMIA
BUILD UP OF PLAQUE Causes the lack of
This damage the oxygen supply in LABORATORY:
NON MODIFIABLE FACTORS Artery and narrow the the heart ECG
• AGE (88YRS OLD) pathway TROPONIN I
• HEREDITY (MOTHER) BNP
MYOCARDIAL CKMB
ATHEROSCELORIS
INFARCTION
thickening or
Heart attack
LABORATORY: hardening of the
X-ray arteries CORONARY
ARTERY DISEASE
Laboratory Result and Interpretation

Complete Blood Count Hemoglobin 13.0-18.0g/dL  

 
Date: March 11, 2023 Result: 10.90 Abnormal:: Decreased
March 15, 2023 Result: 10 • Decreased HGB. level suggest iron deficiency, excessive
blood loss, or over hydration
March 17, 2023 Result: 9.30
 
  Hematocrit 40-50% Abnormal:: Decreased
Date: March 11, 2023  Result: 33.80 • Decreased HCT suggest iron deficiency anemia,
March 15, 2023 Result: 32.30 excessive fluid intake, or blood loss
 Sx of low HCT:
March 17, 2023 Result: 29  Pale complexion, weakness, fatigue, low energy,
trouble breathing, irregular heart beat (manifested to
patient)
• Increased HCT suggests severe Dehydration and
polycythemia
 
 Red blood cell 4.0-5.4x10^12/L Abnormal:: Decreased
(erythrocytes)
• Decreased RBC indicate VIT. B6, B12 or Folate Deficiency,
Date: March 11, 2023 Result: 3.05 it also signifies internal bleeding, kidney disease, or
March 15, malnutrition
Result: 2.89
2023  
Result: 22.64
March 17,
2023
MCV 79.4-94.9fl Abnormal:: Elevated
(MEAN Is a measure of the average volume of red blood cells corpuscle
CORPUSCULAR
VOLUME) • Increased MCV indicate macrocytic anemia
Result: 110.80  
Date: March 11, 2023
March 15, 2023 Result: 111.80
March 17, 2023 Result: 109.80
 
MCH 25.6-32.2pg Abnormal:: Elevated
(MEAN    MCH is macrocytic anemia, which is a blood disorder in which
CORPUSCULAR HGB) Result: 35.7 the body fails to produce enough red blood cells.
Date: March 11, 2023 Result: 34.60
March 15, 2023 Result: 35.20
March 17, 2023
 
 
 MCHC 32.2-35.5gd/L
(MEAN CORPUSCULAR
HGB
CONCENTRATION)
Normal
Date: March 11, 2023
Result: 10.90  
March 15, 2023
March 17, 2023 Result: 32.20
Result: 32.10

RDW (red cell 11.7-14.4% Abnormal:: Slightly Decreased

distribution width)
Result: 14.40 • it could be an indication of a nutrient deficiency, such as a
Date: March 11, 2023 deficiency of iron, folate, or vitamin B-12
March 15, 2023 Result:14.80
March 17, 2023 Result: 14.50

White blood cell 4.0-10.0x10^9/L Abnormal:: Elevated

 Date: March 11, 2023 • Elevated WBC indicates infection, abnormal Bone marrow,
Result: 13.59
March 15, 2023 smoking, chronic lung disease, immune disorders,
March 17, 2023 Result: 20.79 inflammatory or allergic reactions or even physical and
emotional stress
Result: 21.60
 
 Neutrophil 55-65%
(Fight pyogenic infection)
Abnormal:: Elevated
Date: March 11, 2023
• Neutrophilia- indicates infection
March 15, 2023 • Low Neutrophil- Neutropenia- is a condition that means low
March 17, 2023 Result: 86 level neutrophils, may be due to an infection eg. (Bacterial
pneumonia)
Result: 92
   
Result: 93

Lymphocytes 25-35%
Date: March 11, 2023
Result: 3 Abnormal:: Slightly Decreased
March 15, 2023
Result: 5 • Lymphocytopenia – low lymphocytes indicate a possible
March 17, 2023 infection
Result: 3  
Monocytes 3-6% Abnormal:: Elevated
Date: March 11, 2023 • Often a response to stress, chronic infection or autoimmune
Result:11
March 15, 2023 disease
Result: 3
March 17, 2023
Result: 4
 
 MPV 9.4-12.3fl
(Mean Platelet Volume)
Date: March 11, 2023
Result: 10.80 Normal 
March 15, 2023
March 17, 2023 Result: 10.60
Result: 11
 

Platelet 150-450
 Date: March 11, 2023 Result: 169
March 15, 2023 Normal
Result: 200
March 17, 2023
Result: 216
Blood Chemistry Result Normal
Values
 Creatinine 0.52-1.04 • Abnormal:: Elevated
March 11, 2023 1.60 • An increased level of creatinine may be a sign of poor kidney
March 15, 2023 2.30 function
March 16, 2023
1.80
March 17, 2023
1.40
 Potassium 3.5-5.1
March 11, 2023 4.80 Normal
March 15, 2023 4.80

Sodium 137-145
March 11, 2023 139 Normal
March 15, 2023 145

Blood Uric Acid 2.5-6.2 Abnormal:: Elevated

March 11, 2023 8.3
High levels of uric acid may be related to many conditions,
including: Gout. Kidney disease. 
 Fasting Blood 74-106mg/ Abnormal:: Elevated
Sugar March 12, 2023 1168 dL an indicator of a higher risk to diabetes

 Cholesterol 0-200md/dL
March 12, 2023 111 Normal
Triglycerides 0-15mg/dL Abnormal:: Elevated
March 12, 2023 83
higher than normal may mean you have a higher risk of heart
disease, stroke, and other conditions that affect your arteries.
HDL 0-60mg/dL
March 12, 2023 50
Cholesterol Normal

VLDL March 12, 2023 16.60 0-65 Normal

LDL Cholesterol March 12, 2023 44.60 0-130 Normal

Creatinine Kinase March 13, 2023 23 0-16U/L Abnormal:: Elevated

MB mean you have an inflammation of the heart muscle or are having or
recently had a heart attack
HS- Troponin I March 13, 2023 90 0-9ng/L Abnormal:: Elevated
•  sign that a heart attack has occurred
Pro BNP March 13, 2023 16427 <450pg/ml Abnormal:: Elevated
• it probably means you have heart failure
March 12, 2023 March 11, 2023
Culture and Sensitivity: Sputum Arterial Blood Gas: NORMAL
RESULTS NORMAL RANGE
Normal Growth of Microflora
PH 7.38 7.35-7.45
March 11, 2023 PCO2 32 35-45
Chest X-ray: PO2 65 80-100mmHg
Pneumonia Bilateral HCO3 19 22-26meq/L

Cardiomegaly BE -7 +/-2
Total CO2 20
Atheromatous Aorta
02 SAT 95% 95-100

March 11, 2023 FiO2 21

March 13, 2023
Antigen Test: Negative ECG Readings:
March 13,2023 Arterial Fibrillation with rapid ventricular response (With
RT-PCR Test: Negative A-fib with RVR, your heart doesn't have a normal signaling
process telling your heart when to beat. Instead, signaling is
disorganized and the parts of your heart beat out of sync)
            
GENERIC NAME CLASSIFICATION/SPECIFIC INDICATION CONTRAINDICATION SIDE EFFECT NURSING RESPONSIBILITIES
BRAND NAME ACTION
DOSAGE
FREQUENCY

CEFTRIAXONE  Cephalosporin  Lower respiratory tract  diarrhea from an •  Black, tarry stools.  Observe site closely for
Viatrex antibiotics  Skin and skin structure infection with • chest pain. extravasation during
1gm q12 x 3  Works by stopping the  Bone and joint Clostridium difficile • shortness of breath. administration.
growth of bacteria.  Acute otitis media bacteria. • sore throat.  Observe for signs of
 UTIs  a type of blood disorder • sores, ulcers, or white
adverse effects.
Septicemia where the red blood spots on the lips or in the
 mouth.
 Pelvic inflammatory cells burst called  Monitor signs of
hemolytic anemia. • swollen glands. pseudomembranous
disease (PID) unusual tiredness or
liver problems. • colitis, including
 Intraabdominal  weakness.
infections disease of the diarrhea, abdominal

 Meningitis gallbladder. pain, fever, pus or
 Uncomplicated severe renal mucus in stools, and
 other severe or
gonorrhea impairment.
 Surgical prophylaxis prolonged GI problems
 yellowing of the skin in a (nausea, vomiting,
newborn child
heartburn).
CLARITHROMYCIN  Macrolide antibiotics • Bacterial infections, such • diarrhea from an infection • Feeling sick (nausea) Stick  Advise patient about the
Claritek  Works by killing as pneumonia with Clostridium difficile to simple meals and do likelihood of GI
500mg BID bacteria or preventing bacteria. not eat rich or spicy food reactions, including
their growth • low amount of magnesium while you're taking this nausea, diarrhea,
in the blood. medicine. indigestion, abnormal
• low amount of potassium • Being sick (vomiting) Try taste, and abdominal
in the blood. taking small, frequent sips pain.
• myasthenia gravis, a of water to avoid  Instruct patient to report
skeletal muscle disorder. dehydration. severe or prolonged GI
• coronary artery disease. • Diarrhoea. problems.
• rapid ventricular • Bloating and indigestion.
heartbeat. • Headaches.
• Difficulty sleeping
(insomnia)
  Mucolytics respiratory diseases
associated with excessive
patients suffering from
phenylketonuria due to the • nausea,   Should be monitored
 Breaks disulfide bridges
NAC of mucoprotein.. mucus. aspartame content. Children • vomiting, for vomiting, and the
dose should be repeated
Fluimucil
600mg
below 2 years of age. 
• diarrhea, if the patient vomits
• transient skin within 60 minutes after
any dose.
rash,  Patients receiving
• flushing, intravenous
acetylcysteine for liver
• epigastric pain, failure should be
• constipation. hospitalized in a critical
care unit
BISOPROLOL  Beta Blockers mild to moderate Abrupt discontinuation • Headaches  Make sure you rest and
Coseryl  works by relaxing blood hypertension Depression • Feeling dizzy or weak. drink plenty of fluids.
5mg ½ tab OD vessels and slowing Acute heart failure, AV block, • Cold hands or  If bisoprolol makes you
heart rate to improve bradycardia, cardiogenic feetFeeling or being sick feel dizzy or weak, stop
and decrease blood shock, pulmonary edema, (nausea or vomiting) what you're doing and sit
pressure sick sinus syndrome, • Diarrhoea. or lie down until you feel
ventricular dysfunction • Constipation better.
Cerebrovascular disease
Hyperthyroidism, thyroid
disease, thyrotoxicosis
Diabetes mellitus.
 OMEPRAZOLE  Proton Pump
(PROSEC) Inhibitors
20mg IV  Decrease the amount of
acid that the stomach
makes
METHYLPREDNICOLONE  Corticosteroids
(Mepreson)  works to treat people
16mg tab BID with low levels of
corticosteroids by
replacing steroids that
are normally produced
naturally by the body.
PERINDOPRIL  Angiotensin-converting
Coversyl enzyme (ACE) inhibitors.
5mg TAB OD  makes blood flow more
smoothly by preventing
the production of certain
natural chemicals that
tighten the blood vessels
o Heart Burn  Hypersensitivity to any
o Gastritis drug components.
o Hyper Acidity  Liver Problem
o GERD  Systemic lupus
erythematosus
o Inflammation active, untreated
tuberculosis.
inactive tuberculosis.
herpes simplex infection of
the eye.
an infection due to a fungus.
intestinal infection caused by
the roundworm
Strongyloidiasis.
a condition with low thyroid
hormone levels.
diabetes.
o Hypertension  patients known to be
hypersensitive (including
angioedema) to this
product or to any other
ACE inhibitor.
 hereditary or idiopathic
angioedema
 Headache  Checks the Doctors
 Dizziness Order
 ABD Pain  Assess Bowel sound,
 Fatigue ABD. For Pain
 Malaise  Advice Pt. not to take
any food and alcohol
before taking the meds.
 Watch out for any
allergic reactions side
effects.
 upset stomach.  Assess for potassium
 stomach irritation. depletion (fatigue, nausea,
 vomiting. vomiting, depression,
 headache. polyuria, dysrhythmia and
 dizziness. weakness).
 insomnia.  Assess for hypertension,
 restlessness. oedema and cardiac
 depression. symptoms.
 Assess for mental status.
 Rotate sites in IM injection
 Feeling dizzy or  Report low blood pressure
lightheaded, Headaches (hypotension), especially if
 Being sick. patient experiences
 Diarrhoea dizziness or syncope.
 Mild skin rash.  Monitor symptoms of high
 Blurred vision plasma potassium levels
 Muscle cramps (hyperkalemia), including
bradycardia, fatigue,
weakness, numbness, and
tingling.
            
GENERIC NAME CLASSIFICATION/SPECIFIC INDICATION CONTRAINDICATION SIDE EFFECT NURSING RESPONSIBILITIES
BRAND NAME ACTION
DOSAGE
FREQUENCY

DIGOXIN  Digitalis glycosides o mild to moderate heart Acute myocardial infarction.  Feeling confused, dizzy  Monitor BP periodically in
Lanoxin  used to improve the failure in adult patients Hypersensitivity to the drug. or generally unwell patients receiving IV
0.25mg ½ tab strength and efficiency Ventricular fibrillation.  Feeling or being sick digoxin.
of the heart, or to Myocarditis. (nausea or vomiting) and  Monitor ECG during IV
control the rate and Hypomagnesemia. loss of appetite administration and 6 hr
rhythm of the heartbeat Hypokalemia.  Diarrhoea after each dose. Notify
Wolf-Parkinson-White  Changes in your vision health care professional if
syndrome (including blurred vision bradycardia or new
and not being able to arrhythmias occur.
look at bright light)  Observe IV site for redness
 Skin rashes or infiltration;
extravasation can lead to
tissue irritation and
sloughing
FUROSEMIDE  Diuretics o Peripheral edema or  Anuria  Increased urination  Monitor BP and pulse
Lasix  Increase the excretion edema associated  Patients with known before and during
10mg iv q6  Thirst
of Na+ and water by with heart failure drug hypersensitivity administration
the kidneys by o Chronic lung disease  Electrolyte imbalance  Muscle cramps  Assess fluid status
inhibiting their (CLD)  Monitor daily weight,
reabsorption from the o Nephrotic syndrome  Itching rash intake and output
proximal and distal  Weakness  Ratios amount and
tubules, as well as the location of edema,
loop of Henle  Dizziness lung sounds, skin
 Spinning sensation turgor, and mucous
membranes.
 Diarrhea  Notify health care
professional if thirst,
 Stomach pain
dry mouth, lethargy,
 Constipation weakness,
hypotension, or
 
oliguria occurs
ATROVENT NEB  Anticholinergics,
PRN Respiratory
 relaxes muscles in the
airways and increases air
flow to the lungs.
control mild chronic closed angle glaucoma.
obstructive pulmonary blockage of the urinary
disease bladder.
enlarged prostate.
an inability to completely
empty the bladder.
 dizziness  Protect solution for
 nausea inhalation from lightUse
 heartburn nebulizer mouthpiece
 constipation instead of face mask to
 dry mouth avoid blurred vision or
 difficulty urinating aggravation of narrow-
 pain when urinating angle glaucoma.
 frequent need to urinate  Can mix albuterol in
nebulizer for up to 1 hr.
 Ensure adequate
hydration, control
environmental
temperature to prevent
hyperpyrexia.

ENOXAPARINE  Low Molecular o Pulmonary embolism  hypersensitivity to  Bleeding  Assess for signs of
Clexane Weight Heparins (PE) enoxaparin or any  Anemia (not having bleeding and
0.4ml SC q24hrs.  Binds to and o Deep venous heparin products. enough healthy red hemorrhage, including
potentiates o Acute coronary  Active major bleeding blood cells) bleeding gums,
antithrombin (a syndromes such as such as  Pain and bruising at nosebleeds, unusual
circulating ST-elevation gastrointestinal bleed. the site on your skin bruising, black/tarry
anticoagulant) to form myocardial infarction  Active gastric or where you give the stools, hematuria, and
a complex that o thrombosis (DVT) duodenal ulcers. injection a fall in hematocrit or
irreversibly inactivates treatment and  Hemorrhagic  Fever blood pressure.
clotting factor prophylaxis cerebrovascular  Swelling in your legs  Assess if the Pt. had
o Venous accident an artificial heart valve
 
thromboembolism and if you have or
secondary to have ever had kidney
malignancy disease, an infection
o   in your heart, a stroke,
a bleeding disorder,
ulcers, or a low
platelet count.
 Notify physician or
nursing staff
immediately if
enoxaparin causes
excessive
anticoagulation.
 FOLIC ACID  Vitamins, Water-Soluble  Folic Acid Deficiency  Hypersensitivity,
Hema rate  used as a nutritional conditions associated with
Tab OD supplement iron overload (e.g.
hemochromatosis,
hemosiderosis,
thalassemia).
ALLOPRINOL  Xanthine oxidase High Uric Acid • Serious rash
Alllurase inhibitors • Renal disease, renal
300mg tab OD  works by reducing the failure, renal impairment
production of uric acid in • Hepatic disease,
the body hepatotoxicity
• Anticoagulant therapy,
bone marrow suppression
• Driving or operating
machinery
• Pregnancy
• Breast-feeding.
 Feeling sick (nausea) Loss
of appetite.
 Bloating or wind.
 Ankle, knee, or great toe
joint pain.
 Joint stiffness or swelling
 rash
 rash with flat lesions or
small raised lesions on the
skin.
 Take folic acid with, or just
after, a meal or snack to
help with feeling sick.
 Eat when you'd usually
expect to be hungry.
 It might help to eat smaller
and more frequent meals,
eat and drink slowly, and
exercise regularly.
 Monitor intake and
output ratios frequently;
this drug is excreted in
the urine and decreased
kidney function can
cause drug accumulation
and toxic effects
 Continuously assess the
patient for rash or more
severe hypersensitivity
reactions
 Monitor continuously for
joint pain and swelling.
IVF prescribed
• March 11, 2023- PNSS 1L x KVO- to administer diluted medications,
and sustain patients through serious medical conditions
• March 13, 2023- PNSS 1L x KVO
• March 15, 2023- PNSS 1L x 20cc/hr- Decreases the regulation because
AP limited the water intake by the Patient because of elevated
creatitine
• March 17, 2023- PNSS 1L x 20cc/hr
 Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation

Assess heart rate and blood Compensatory tachycardia After of an hour of nursing
Subjective: Decrease After an hour of pressure. is a common response for intervention patient report
Cardiac output nursing patients with significantly
“Masakit ang demonstrate pain relief as
dibdib ko” as related to intervention, low blood pressure to evidenced by absence of
verbalized by the Alterations in patient will reduce cardiac output. 
pain behaviors and stable
patient rate, rhythm, demonstrate Check for peripheral pulses. Weak pulses are present in
vital signs.
pain relief Perform capillary refill test (CRT). reduced stroke volume and
electrical cardiac output
Objective cues:
conduction Monitor urine output. If the patient Reduced cardiac output
Facial grimace secondary to is acutely ill, measure hourly urine results in reduced perfusion V/S:
Guarding or enlargement output and note a decrease in of the kidneys, with a
BP: 120/80
protective of heart output. resulting decrease in urine
HR: 100
behavior output
muscle Upright position is RR:20
Positioning to Position patient in semi-Fowler’s to recommended to reduce O2 sat: 99%
ease pain high-Fowler’s preload and ventricular Temp: 36.4
filling when fluid overload
BP: 140/80 is the cause.
HR: 123 The failing heart may not
Rr: 24 Administer oxygen therapy as be able to respond to
prescribed. increased oxygen
02 sat:94 demands. 
Temp: 36.3 Digitalis therapy, diuretics,
vasodilator therapy,
Administer medications as antidysrhythmic,
prescribed, noting side effects and angiotensin-converting
toxicity enzyme inhibitors, and
inotropic agents. 
 Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation
Monitor urine output, noting amount Urine output may be scanty and concentrated
and color, as well as the time of day (especially during the day) because of reduced After an hour
Subjective: Excess fluid After an when diuresis occurs renal perfusion.  of nursing
volume related hour of Maintain chair or bed rest in semi- Recumbency increases glomerular filtration and
“Hinahapo intervention,
Ako” as to Changes in nursing Fowler’s position during an acute phase decreases the production of ADH, thereby patient
glomerular intervention enhancing diuresis
verbalized by Demonstrate
filtration rate, patient will Weigh the patient daily and compare to Bodyweight is a sensitive indicator of 
the patient stabilized fluid
Demonstrat the previous measurement fluid balance, and an increase indicates fluid
Secondary to Follow a low-sodium diet and/or fluid volume excess. volume with
Objective cues:
decrease cardiac e stabilized restriction The client senses thirst because the body senses  balanced 
Ankle edema output fluid volume
dehydration. Oral care can alleviate the intake and outp
Audible sensation without an increase in fluid intake. ut
crackles Provide small, frequent, easily Reduced gastric motility can adversely affect , breath sounds
Oliguria, digestible meals. digestion and absorption. Small, frequent meals clear/clearing,
edema, may enhance digestion/ prevent abdominal vital signs
Weight gain discomfort. within
Hypertension Change position frequently. Elevate Edema formation, slowed circulation, acceptable
Respiratory feet when sitting. Inspect skin altered nutritional intake, and prolonged range, stable
distress, surface, keep dry, and provide immobility (including bed rest) are
abnormal weight, and
breath sounds padding as indicated. cumulative stressors that affect skin absence of
integrity and require close supervision/ edema
BP: 140/80 preventive interventions. V/S:
HR: 123  Institute/instruct patient regarding This helps reduce extracellular volume. BP: 120/80
Rr: 24 fluid restrictions as appropriates HR: 100
02 sat:94 RR:20
Temp: 36.3
Administer medications as Medications for diuresis to eliminate O2 sat: 99%
indicated. excess fluid Temp: 36.4
 Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation
Assess patient pain for intensity using To identify intensity, precipitating factors,
a pain rating scale, location, and and location to assist in accurate diagnosis. After of an hour of
Subjective: Acute pain After an precipitating factors
nursing
related to hour of  Monitor vital signs, especially pulse Tachycardia and elevated blood pressure
“Masakit ang intervention
dibdib ko” as increase cardiac nursing and blood pressure, every 5 minutes usually occur with angina and reflect patient report
workload interventio until pain subsides compensatory mechanisms secondary to
verbalized by the demonstrate pain
secondary to n, patient sympathetic nervous system stimulation.
patient relief as evidenced
will
Systemic oxygen Assess results of cardiac markers— These enzymes elevate in the presence of by absence of pain
Objective cues: demonstr
demand creatinine phosphokinase, CK- MB, myocardial infarction at differing times behaviors and
Facial grimace ate pain total LDH, LDH-1, LDH-2, troponin, and assist in ruling out a myocardial stable vital signs.
Guarding or relief and myoglobin ordered by the infarction as the cause of chest pain.
protective physician.
behavior Elevate the head of the bed Elevation improves chest expansion and
oxygenation V/S:
Positioning to Teach the patient relaxation techniques Emotional stress that can be relieved by BP: 120/80
ease pain and how to use them to reduce stress non-pharmacological measures such as HR: 100
Pain scale of relaxation. RR:20
5/10 Administer or assist with self- It reduces the amount of blood returning to O2 sat: 99%
administration of vasodilators, as the heart decreasing preload, decreasing its Temp: 36.4
BP: 140/80 ordered. workload.
Implement individualized preoperative Provides knowledge base from which
HR: 123 teaching program patient can make informed therapy choices
Rr: 24 and consent for procedure, and presents
02 sat:94 opportunity to clarify misconceptions
Temp: 36.3
 ENVIRONMENT
MEDICATION • Limit the environment stimuli that an trigger
the complications
• BISOPROLOL Coseryl 5mg ½ tab • Advised to have a safe and well ventilate
Once a day surroundings
• FOLIC ACID Hema rate Tab Once
a day
• ALLOPRINOL Alllurase 300mg tab TREATMENT
Once a day
• DIGOXIN Lanoxin 0.25mg ½ tab • Medications
Once a day • Always make sure to drink the medication
properly as ordered
• Multivitamins
HEALTH TEACHING OUT PATIENT

• Encourage to do exercise if tolerated. • As directed by a doctor, regular follow-up

examinations should be strongly encouraged to
• Everyone benefits from leading a healthy lifestyle, which ensure that management treatment is ongoing.
includes getting regular exercise and eating a balanced
diet. Those with hypertension can better control their
diseases and avoid complications by leading a healthy
lifestyle.
• Regularly monitor the vitals signs
DIET
• Make an alarm for the proper timing on drinking the
medications
• Do not eat fatty and salty foods
• Eat food that is reach in iron
• Limit fluid intake to 1 liter

SIRITUALLY
• Motivate the patient's family to engage in spiritual activities like
attending church and praying, adoration and mass.
• Use of relaxation and meditation by listening to the worship songs.
Nursing Theory
• Dorothea Orem’s Self-care suggests patients are better able to recover when they maintain some independence over their own
self-care. Self-Care Deficit Theory focuses on each “individual’s ability to perform self-care, defined as ‘the practice of activities
that individuals initiate and perform on their own behalf in maintaining life, health, and well-being.'” The Self-Care or Self-Care
Deficit Theory of Nursing is composed of three interrelated theories: (1) the theory of self-care, (2) the self-care deficit
theory, and (3) the theory of nursing systems, which is further classified into wholly compensatory, partially compensatory and
supportive-educative. DNPs are well equipped to meet the various needs of patients demonstrating self-care deficits. Let’s
examine the methods nurses can follow to address certain issues.
• The act of assisting others in the provision and management of self-care to maintain or improve human functioning at the home
level of effectiveness.” It focuses on each individual’s ability to perform self-care, defined as “the practice of activities that
individuals initiate and perform on their own behalf in maintaining life, health, and well-being. “The condition that validates the
existence of a requirement for nursing in an adult is the absence of the ability to maintain continuously that amount and quality
of self-care which is therapeutic in sustaining life and health, in recovering from disease or injury, or in coping with their effects. 
• ● Hygiene — Nurses can help patients maintain their own personal hygiene by providing reminders and motivation for
self-care. This could include daily prompting for activities like bathing and washing up.
● Dressing/grooming — Nurses can help their patients by recommending clothing that is easy to put on and remove,
giving them privacy, and providing frequent motivation.
● Feeding — Nurses can help enable patients to feed themselves as soon as possible. By creating a conducive
environment to eating (positioning the patient, ensuring they have access to their dentures, etc.), patients can stay
independent throughout their meals.
● Toileting — Nurses should work to simplify toileting for patients. This can include using bedpans, suppositories, stool
softeners, or commodes. Nurses should also be nearby in case of any accidents or falls.
● Speech deficit — Nurses should work closely with speech pathologists to ensure that any type of speech deficit will not
interfere with communication about care.