Far Eastern University NRMF: Case Study

Far Eastern University NRMF
Case Study
INTRODUCTION
Perhaps, one of the major problems that the world is

facing through the years is the health of every individual. In
fact, every nation around the world always gives an immediate
action to develop ways of having a perfect health care system
for the benefit of every citizen within their territory. The health
care system is recognized as the key element in ensuring the
health of the people. Thus, more and more experts and policy
makers are continuously making an effort to improve the
existing health care system. More and more countries are
producing policies and orders to change and develop their
health care system to meet the demands of their people.
These countries tends to reconstruct their entire health care
system which they perceived as one of the best ways in order
to achieve their primary goal of giving better health service
and meet the demands of their people.
Hypertensive cardiovascular disease also known as hypertensive heart
disease occurs due to the complication of hypertension or high blood pressure.
In this condition the workload of the heart is increased manifold and with time
this causes the heart muscles to thicken. The heart continues pumping blood
against this increased pressure and over a period of time the left ventricle of
the heart enlarges and this in turn causes the blood pumped by heart to
reduce. If proper treatment is not taken at this stage then symptoms of congestive heart failure may be observed.
Symptoms
It usually takes some time for the problem of high blood pressure to eventually lead to hypertensive cardiovascular disease and
therefore high blood pressure is often called the silent killer. Eventually hypertensive heart disease can also lead to congestive
heart failure. Some symptoms of hypertension and the eventual congestive heart failure include arrhythmias, shortness of
breath, weakness and fatigue, swelling in lower extremities and greater frequency of urination during the night. Hypertensive
cardiovascular disease may also result in ischemic heart condition and in this case there might be chest pain, sweating and
dizziness, nausea and shortness of breath. Hypertrophic cardiomyopathy could also be a result of hypertensive heart disease.
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Tests
Usually the first signal is elevated blood pressure together with a possibility of enlargement of the heart. Fluid within the lungs
may also be found in preliminary examination by using the stethoscope and some abnormal heart sounds may also be detected.
ECG is ordinarily done and this may show abnormal results in those who have possible hypertensive cardiovascular disease.
Evidence of ischemia which is the lack of oxygen in the heart muscle may also be detected. Some other tests ordinarily
conducted may include a chest X ray, a CT scan of the chest, echocardiogram and coronary angiogram.
Treatment
The primary aim of any treatment in hypertensive cardiovascular disease is reduction of blood pressure and then eventual
control of the heart disease. The line of treatment will ordinarily depend on the condition such as whether there is angina or
acute myocardial infarction. The line of treatment may include beta blockers, angiotensin converting enzyme inhibitors (ACE),
calcium channel blockers, diuretics etc depending upon particulars of each individual case. The blood pressure is consistently
required to be checked and kept under control in this condition.
OBJECTIVES
Our main objective with the situation is to reduce client’s pain and provide care.
HCVD is new to our group that’s why we chose this case. We did this case study for us to enhance our
knowledge and to understand more information about the importance of nursing care plan included the drug study,
laboratory results and many more, thus to give us an idea of how we could give proper nursing care for our clients
with such condition, so that we could apply them on our future exposures as students and eventually as nurses.
We also did this case study as a part of our requirement in our clinical exposure.
I. BIOGRAPHIC DATA
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The client is G.P a male who is currently residing at Quezon City. He is 77 years old who is born on May 9,
1933 in Bataan. He is a Born Again Christian and is a retired government employee. He is living with his wife,
grandchild and youngest son. He came to the institution with a chief complaint of Difficulty of Breathing, admitted
for the 1st time to FEU-NRMF Medical Center last January 5,2011.
II. NURSING HISTORY
A. PAST HEALTH HISTORY
The patient can’t recall any childhood diseases such as chicken pox, mumps and measles. He is non-
hypertensive, non-diabetic and non-asthmatic. He has no history of accident, trauma, major operation, blood
transfusion or allergy to foods or drugs.
B. HISTORY OF PRESENT ILLNESS

The present illness started one month prior to admission when the patient suddenly experienced generalized
body malaise. It was later accompanied by easy fatigability of breathing. No other associated signs and symptoms
were noted such as fever, chest pain and shortness of breath. He was brought to a nearby private clinic where he
was admitted for one week and was given Digoxin 0.25 mg/tab;et, one tablet once a day and unrecalled
medications. The diagnosis then was also unrecalled. He improved and was discharged.
One week prior to admission, the patient experienced generalized body malaise, easy fatigability, and difficulty
of breathing. He was brought to a government hospital where he was given the following medications, Digoxin 0.25
mg/tablet, OD, Coumadin with unrecalled dosage and some unrecalled medications. The client wasn’t also able to
recall the diagnosis.
Few hours prior to admission, the above symptoms persisted. They were later associated with shortness of
breath. He was brought to the institution and was admitted.
C. FAMILY HISTORY
The client has a paternal history of breast cancer and a maternal history of hypertension, asthma and heart
disease. No other heredo-familial diseases were noted such as diabetes Mellitus, liver or kidney disease.
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III. PATTERNS OF FUNCTIONING
A. PSYCHOLOGICAL HEALTH
1. Coping Patterns
When the client has problem, he usually tells it to his wife specially when it is about his work. His
wife also said that back on his adulthood the client was a little hot tempered but he usually watches TV
to divert his anger. His wife also said that he is the best husband and father to his children. They don’t
have problems financially because the client is an architect, he designs ships.
Interpretation: Client diverts his problems by engaging in recreational activities. He is more

emotionally vocal with his problems to family specifically to his wife. He is the type of guy that reasons
out and fights for what he thinks is right but in a calm manner.
Analysis: Coping mechanism can be viewed as an active method of problem solving developed to
meet life’s challenges. Cooperative or friendly, expressive feelings appropriate to the situation,
verbalizes positive things regarding others and the future express positive coping mechanism.
Source: Fundamentals of Nursing, 7th Edition by: Barbara Kozier, Glenora Erb, Audrey Berman & Shirlee
Snyder, page 193
2. Interaction Patterns
The client has no problems with interacting to other people, especially with the kind of job he
has. His wife said that the client is a sociable person and that he can interact with other people easily.
His wife added “Palangiti yan lagi kaya madaming kaibigan, at sa trabaho niya pa lang kailangan niya
talagang maging approachable. He designs ships for the past presidents.” They usually eat out every
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time he has free time. He has a happy relationship with his wife they just had celebrated their 50th
anniversary.
Interpretation: Client does not have any social interaction problems. He can easily adjust to people
and friendly. He is sociable and can easily interact with different types of people. He is also very vocal
and very smart speaker according to his wife.
Analysis: The effectiveness of communication determines the ability to function as a cooperative,

growth-producing unit. Messages are constantly being communicated both verbally and non-verbally.
The information-transmitted influences how members work together fulfil their assigned roles;
incorporate values and developed skills to function in society. Communication plays a significant role in
the development of self-esteem, which is necessary for the growth of the personality.
Source: Fundamentals of Nursing, 7th Edition by: Barbara Kozier, Glenora Erb, Audrey Berman &
Shirlee Snyder, and
page 193
3. Cognitive Patterns
The client is a college graduate. His wife proudly said “Nako he is an engineer and an architect,
he graduated from a known university in Manila. He works for the government” His wife also said that
he is very focused on his works because he is also the one who estimates the whole project aside from
planning it. She also added that her husband is really a smart and handsome guy.
Interpretation: The client is smart and has no difficulties in doing architectural plans back in his days.
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Analysis: Cognitivism depicts learning as a complex cognitive activity. In other words, learning is
largely a mental or intellectual or thinking process. Perceptions are selectively chosen by the individual
and personal characteristics are an impact on how a cue is perceived. Cognitivists also emphasize the
importance of social, emotional, and physical context in which learning occurs.
Intelligence is the measurable product of intellectual functioning, which consists of memory,

comprehension and concentration. Person that integrates information obtained through vision, hearing,
touching, taste and/or smell with past experiences to understand or make sense of environment.
Snyder, page 448
Nurses Handbook of Health Assessment, Janet Weber, page 513
4. Self-Concept
According to his wife, the client is determined and hardworking. She also described him as the
best husband and father because he had provided them all the things that a family needs. She said
“Alam naman niya sa sarili niya na mabait siya and he has been the best husband to me and the best
father to his children. Wala siyang doubt sa sarili niya, kapag sinabi niya nagagawin niya magagawa
niya. Ang hirap kaya nung ginagawa niya kasi he’ll plan for the ship and then siya pa ang
mageestimate.”
Interpretation: The client is aware os his self and has agreed to what his wife is saying. He has a
positive concept for himself and in life.
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Analysis: A positive self-concept is essential to a person’s mental and physical health. Individuals with
a positive self-concept are better able to develop and maintain interpersonal relationships and resist
psychologic and physical illness. Self-awareness refers to the relationship between one’s perception of
himself or herself and other’s perception as well. One important component of this process is
introspection when one considers his own beliefs, attitudes, motivations, strengths and limitation.
Snyder, page 1003
Donnely, 2004
5. Emotional and Family Coping Patterns
The client is emotionally vocal to his wife. He tells her everything and when he gets angry he
usually diverts it to watching TV or they just go out. The client doesn’t smoke nor drink when he has
problems. His wife added “Nung bata pa siya mejo maiinitin ang ulo lalo na kapag tungkol sa trabaho
alam mo na.”
Interpretation: Client is very emotional to his wife with all his feelings. But he diverts his feelings and
he knows to control it by diverting to other activities. His usual problem is his work. However, their
family talk about certain family issues together.
Analysis: The basic developmental task is establishing his self integrity. Establishing a firm sense of
self, and then reaching to others..
Snyder, page 394
Coping mechanisms are behaviours use to decrease stress and anxiety. Many coping behaviours are
learned based on one’s family, past experiences and socio-cultural influences and expectations.
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Coping is a process that a person uses to manage events that he or she perceives and interprets as
stressful. Successful coping requires adjusting to circumstances, environmental demands and
challenges. Coping can be adaptive producing relief from stress and even growth. It can be
maladaptive, leading to further disintegration and disorganization .
Source: Fundamentals of Nursing, 5th Edition by: Carol Taylor, Carol Lillis, & Priscilla LeMone, page 855
Fundamentals of Nursing.4th Edition by Craven and Hirnle. pp. 405
B. SOCIO-CULTURAL PATTERNS
1. Cultural Patterns
The client practices cultural traditions particularly during celebrating birthdays. His wife said that
the client is a family type of person he values his family very much because that is what he learned
from his parents, coming from a large family who has practiced the shared traditions from other
culture. The client’s wife said that they don’t believe on albularyos instead they always consult the
nearest medical facility like the nearby private clinic where he was brought to prior to his admission.
His wife also added “Hindi siya naniniwala sa mga religions, ang sabi niya isa lang naman ang DIyos
pero nung nabinyagan siyang Roman Catholic. Kaya nga nung 50th anniversary naming walang pari, we
just celebrated by gathering here and eating.”
Interpretation: Client is still practicing his family tradition but not all. He doesn’t practice going to
church but he believes in God. With regards to health beliefs, their family only consult health care
providers.
Analysis: Culture may be defined as a shared system of beliefs, values, and behavioral expectations
that provides social structure for daily living. Culture defines roles and interactions with others as well
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as with families and communities. The attitudes and institutions are unique to particular group. Culture
includes the beliefs, habits, likes and dislikes and customs and rituals learned from ones family.
Source: Fundamentals of Nursing, 5th Edition by: Carol Taylor, Carol Lillis, & Priscilla LeMone, pp. 40,
791
2. Significant Relationships
The client is married for 50 years. He has 5 children and his wife, all are very supportive and
visits him from time to time. The client is emotionally vocal to his wife. He tells her everything and
when. He has a good relationship with all his children and considers his family his treasure as
verbalized by his wife. Arguments come and go but they just talk to it with all of the persons involved.
Interpretation: Client had good marriage life. He has a good relationship with the opposite sex and
he values his family his like his treasure.
Analysis: Family influences on health care because health is defined uniquely by each client culture
the nurse must assess the family’s health definition and beliefs. Family is often major caregivers of
their relatives. Lack of social support from family or significant others result in psychological and
spiritual isolation, which negatively impacts a person’s physiological state.
Source: Rick Daniels. Nursing Fundamentals Caring and Clinical Decision Making 2004 page 849-851
3. Recreation Patterns
The client’s wife said that the client usually watches TV, “Minsan lumalabas kami dati nung kaya
niya pa. Nakapagout of the country na rin kami, sabi ko nga we had everything in the world that a
couple wishes from our children to the luxuries in life.” She added.
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Interpretation: Client engages in recreational activity. He is an outoing person because of his jobs
but sees to it to have time for his family.
Analysis: Consider recreational facilities in the community and outside the community. Theaters and
movie houses, numbers and types of church and religious services. Number and utilization of
Playgrounds, pools, parks and sport facilities. Level of participation in various church programs number
and types of social communities, organizations and clubs available
Snyder, page 201
4. Environment
The client lives in Quezon City. His wife stated that their house is a bungalow type, well lit and
well ventilated. She also added that their drinking water is purified and that the garbage is collected
twice a week.
Interpretation: The client’s place has good ventilation and source of lighting. They also have good
source of drinking water.
Analysis: The environment should meet the client’s needs for physical and emotional, comfort and
safety. Noise, temperature extremes, destructions, and lack of privacy or space may create confusion
tension and discomfort. Environmental Destructions are common in Health Care settings and can
interfere with messages sent between people, so nurses must try to control the environment as much
as possible to create favorable conditions for effective communication.
Source: Fundamentals of Nursing, 5th Edition by: Patricia A. Potter & Anne Griffin Perry, page 449
5. Economic
The economic pattern was not assessed due to time constraints.

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C. SPIRITUAL PATTERNS
1. Religious Beliefs and Practices
The client believes in God. His wife said “Hindi siya naniniwala sa mga religions, ang sabi niya isa
lang naman ang DIyos pero nung nabinyagan siyang Roman Catholic. Kaya nga nung 50th anniversary
naming walang pari, we just celebrated by gathering here and eating.”
Interpretation: Client is a believer of God but he doesn’t pratice religious activities.
Analysis: By identifying the patient’s spiritual beliefs in the nursing history, the nurse can support the
patient’s spiritual needs through acceptance, participation in prayer or other rituals, or referral to a
spiritual leader. Faith in a higher being provides support and helps to reduce fears in many people.
Source: Fundamentals of Nursing, 5th Edition by Taylor et al, pp. 790-791
2. Values and Valuing
His wife said that he believes that one should respect others to be respected.
Interpretation: The client maintains good values in life which are staying to be humble and giving
respect to others.
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Analysis: Values are enduring beliefs or attitudes about the worth of a person, object, idea, or action.
Beliefs are interpretations or conclusions that people accept as true. Although people derive values
from society and their individual subgroups, they internalize some or all of these values and perceive
them as personal values
Source: Fundamentals of Nursing by Kozier, 8th ed, vol. 1 page 80
IV. Activities of Daily Living
ADL Before During Analysis and Interpretation

Hospitalization Hospitalization
Nutrition According to the The client is in OF Analysis:

client, his typical and SDAP. He is
foods before he got required to consume • Importance of a well-balanced diet
hospitalized were 1600 kcal low salt low with fewer calories to accommodate
foods with less salt fat + 8 egg whites lower metabolic rate and decreased
and less fat. He divided by 6 servings physical activity.
prefers vegetables per day. • Importance of sufficient amounts of
and fruits than pork. vitamin D and calcium to prevent
He drinks osteoporosis.
approximately 2, 000
ml of water daily. • An 1,800 calorie diet and should be
adapted to the individual needs of
each elderly patient. It encourages
older adults to choose foods high in
fiber to avoid constipation, to drink
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plenty of fluids to maintain

hydration, reduce salt intake, and
use fish, nuts and liquid oils instead
of saturated fats. Practical
suggestions to remain active include
going for walks, working in a garden,
taking an exercise class at a
community center or gym, and
playing with pets.
(Kozier et.al, Fundamentals of Nursing 8th

edition, vol. 1, page 423)
Interpretation:
The client does not have sufficient iron

intake daily. Leafy vegetables are rich in
iron. The clients’ diet is not sufficient for
his age. But it is administered via OF
every 4 hours. Thus, it supports the slow
metabolic needs of the client.
Eliminati During Client’s fecal elimination:

on hospitalization, The
Analysis:
client usually
defecates at least • Patterns of defecation vary in
every other day. His frequency, quantity, and
output averages of consistency. Color: Brown;
30cc/hour. Consistency: Formed, soft,
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4pm- 100cc semisolid, moist

5pm- 30cc (Kozier et.al, Fundamentals of Nursing 8th
6pm- 20cc edition, vol. 2, page 1325-1326)
7pm- 25cc
8pm 25cc
Interpretation:
The client’s fecal elimination is normal

due to his diet.
Analysis:
Client’s urinary elimination
• Amount: 1,200-1,500 mL.; Color:

Straw, Amber, transparent
Interpretation:
The client’s urinary elimination is also

within normal. His average urine output is
within normal range.
Sleep His sleeping pattern Analysis:

and Rest is irregular and
usually disturbed due • A common mistaken belief is that
to pain he is feeling the need for sleep decreases with
in his abdomen or age. In fact, the elderly adult needs
back. about the same amount of sleep as
he did as a young person and in
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middle age. The majority of older

adults need between six and 10
hours of sleep each night. Research
shows that less than four or more
than eight hours of sleep is
associated with mortality rates that
are higher than those of persons
sleeping eight hours

Interpretation:
Due to his pain the client has disturbed

sleep but in a day he sleeps
approximately 8 hours in total.
Exercise According to the As observed, the Analysis:

client’s wife, he client has only limited
doesn’t engage activity. He only lies • Exercises that exercise large muscle
groups rhythmically, such as
himself to physical on his bed.
walking, are good.
activities.
• Exercise factors may lead to
cardiovascular disease
• Importance of 30 minutes of
moderate physical activity daily, 20
minutes of vigorous physical activity
3 times per week.
(Pellitteri A., Maternal and Child Health
Nursing 5th edition, vol.1, page 276)
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Interpretation:
The client has doesn’t engage himself

through such activities. Thus wasting
some muscles and tissues.
Hygiene He takes a bath He is ordered to Analysis:

once or twice daily have a bactidol
and brushes his swab once a day • If a person is due to go into hospital,
sometimes that person becomes
teeth after meals. for his oral hygiene
very aware of their hygiene. The
and bed bathing is thought of being vulnerable and
adviced to the exposed to strangers can cause the
relatives. person to become very strict on their
hygiene needs.
(http://www.hygieneexpert.co.uk/)
Interpretation:
The client is immobile and has difficulty in

achieving proper hygiene.
Substanc His wife said that The same with his Analysis:
e Abuse the client is not a past ADL, the
smoker nor a client doesn’t • If a person is due to go into hospital,
sometimes that person becomes
alcohol drinker. smoke and doesn’t
very aware of their hygiene. The
drink. thought of being vulnerable and
exposed to strangers can cause the
person to become very strict on their
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hygiene needs.
(http://www.hygieneexpert.co.uk/)
Interpretation:
The client is immobile and has difficulty in

achieving proper hygiene.
V. PHYSICAL ASSESSMENT
GENERAL SURVEY
Body Part Normal Findings Actual Findings Interpretation/Anal

Examined ysis
Body built, height, Proportionate, varies with lifestyle Bed Ridden Deviated
and weight in
relation to age,
lifestyle and health
Overall hygiene and Clean, neat, good grooming Appears clean but appears Client is weakened
grooming weak due to her disease
condition thus
making her ADL
altered which
includes grooming
Body and breath No foul odor, no halitosis Minimal odor noted Client is weakened
odor due to her disease
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condition thus
making her ADL
altered which
includes grooming
Signs of distress No distress noted appears distressed He appears distress

due to his pain.
Obvious signs of Healthy appearance Appears restless and weak, Due to pain brought
health or illness guarding behaviour noted, by his condition
verbalizes pain upon palpation
of abdomen and upon
movement
Attitude Cooperative Cooperative Normal
Mood and Affect Appropriate to situation Appropriate to situation, he Normal

smiles
Quantity and Quality Understandable, moderate pace, Not understandable, his wife Client can’t speak
of speech exhibits thought association answers every question asked clearly but nods his
head everytime he is
asked
Relevance and Logical sequence, make sense, has Not appropriate N/A
organization of sense of reality
thoughts
Skin Lesions Freckles, some birth marks, some (+) bed sore on buttocks Due to prolonged
flat and raised nevi; no abrasions or pressure of lying in
other lesions (size, shape lesion) his bed
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Skin Moisture Moisture in the skin folds and the Skin is a little dry, Due to inadequate
axillae (varies with environmental intake of liquids
temperature and humidity, body
temperature, and activity)
Skin Temperature Uniform temperature; with normal Uniform temperature; with Normal
range normal range
Skin Turgor When pinched, skin springs back to Skin springs back slower Due to inadequate
previous state; may be slower in intake of liquids
elders
Fingernail and Highly vascular and pink in light- Pale Decreased circulation
toenail bed color skinned clients; dark-skinned clients
may have brown or black
pigmentation in longitudinal steaks
Blanch Test Prompt return of pink or usual color Returns more than 4 seconds, Decreased circulation
Capillary refill (generally less than four seconds) 5 seconds to be exact
Lips Soft, moist, smooth texture dry Due to inadequate

intake of liquids
TEETH Smooth, white, shiny tooth enamel No teeth Due to age
(number, color,
alignment)
Reference: Fundamental of Nursing
8th edition Volume one by KOZIER
and ERB copyright 2008
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VI. Laboratory and Diagnostic findings
1/05/11
Electrolytes Result Reference Range Analysis/Interpretat
ion
Sodium 157.6 135-148 mmol/ Slightly High. Sodium is

the most abundant cation
(pronounced cat-ion) in
the blood and its chief
base. It functions in the
body to maintain osmotic
pressure, acid-base
balance and to transmit
nerve impulses. A
increased concentration
of sodium
(hypernatremia) occurs
whenever there is a
relative increase in the
amount of body water
relative to sodium. This
happens with some
diseases of the liver and
kidney, in patients
with congestive heart
failure, inburn victims,
and in numerous other
conditions.
Potassium 3.33 3.50-5.30 mmol/L Low. Potassium is the
major intracellular cation.
Hypokalemia, or
decreased potassium, can
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arise due to kidney

diseases; excessive loss
due to heavy
sweating, vomiting,
or diarrhea, eating
disorders, certain
medications, or other
causes.
Roentgenographic Report
01/05/11
Chest 2:
Re-examination since August 20, 2010 shows progression in the previously mentioned nodulohazed densities in the right
upper lobe and no significant interval change in the nodular density in the left parahilar area. The hemidiagraphragm and
costophrenic angle remain obscured. Heart is still enlarged. The rest of the chest findings are unchanged.
Interpretation:
Chest radiographs are used to diagnose many conditions involving the chest wall, bones of the thorax, and structures
contained within the thoracic cavity including the lungs, heart, and great vessels. Pneumonia and congestive heart failure are
very commonly diagnosed by chest radiograph. Chest radiographs are used to screen for job-related lung disease in
industries such as mining where workers are exposed to dust.
Chest 3(S/P CVP Insertation)

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Follow up film after 7 hours shows no significant interval change in the previously noted nodulohazed densities as well as the
left sided pleural effusiin. Heart is enlarge. Chest leads noted. CVP line is not visualized. The rest of the chest findings are
unchanged.
Interpretation:
Chest radiographs are used to diagnose many conditions involving the chest wall, bones of the thorax, and structures
contained within the thoracic cavity including the lungs, heart, and great vessels. Pneumonia and congestive heart failure are
very commonly diagnosed by chest radiograph. Chest radiographs are used to screen for job-related lung disease in
industries such as mining where workers are exposed to dust.
01/06/11
Liver Profile Result Reference Range Analysis/Interpretat
ion
Albumin 24 35-50 g/L Low albumin levels can

reflect diseases in which
the kidneys cannot
prevent albumin from
leaking from the blood
into the urine and being
lost. In this case, the
amount of albumin or
protein in the urine also
may be measured
01/08/11

ion

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Hypokalemia, or
arise due to kidney
due to heavy
sweating, vomiting,
or diarrhea, eating
disorders, certain
causes.
Hematology Result Normal Values Interpretation
Hemoglobin 10.0 M: 16 Hemoglobin is the protein molecule in red blood cells that
carries oxygen from the lungs to the body's tissues and returns carbon
dioxide from the tissues to the lungs.
A low hemoglobin is referred to as anemia. There are many reasons for
anemia.
Some of the more common causes are:
- loss of blood (traumatic injury, surgery, bleeding colon
cancer or stomach ulcer),
- nutritional deficiency (iron, vitamin B12, folate),
- bone marrow problems (replacement of bone marrow by cancer),
- suppression by chemotherapy drugs,
- kidney failure, and
- abnormal hemoglobin (sickle cell anemia).
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Hematocrit 0.31 M: 0.42-0.54 A low hematocrit is referred to as being anemic. Some of the more
common causes are:
- loss of blood
- nutritional deficiency
- bone marrow problems
- abnormal hemoglobin
WBC 12.03 A high number of WBCs is called leukocytosis. It may be due to:
- Anemia
- Infectious diseases
- Inflammatory disease (such as rheumatoid arthritis or allergy)
- Leukemia
- Severe emotional or physical stress
- Tissue damage (for example, burns)
Platelet 60 160-380X10 9 Decreased in platelet indicates increased bleeding time.
Ultrasonograhic Report
01/16/11

ion
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the kidneys cannot
may be measured.
01/18/11
Hematolo0 ^gy Result Normal Values Interpretation
RBC 2.57x10 5.5-6.5 x 10 Decreased in RBC indicates anemia.

12 /L ^12/L
Hemoglobin 8.7g?dl M: 16 Hemoglobin is the protein molecule in red blood cells that
carries oxygen from the lungs to the body's tissues and returns carbon
dioxide from the tissues to the lungs.
A low hemoglobin is referred to as anemia. There are many reasons for
anemia.
Some of the more common causes are:
- loss of blood (traumatic injury, surgery, bleeding colon
cancer or stomach ulcer),
- nutritional deficiency (iron, vitamin B12, folate),
- bone marrow problems (replacement of bone marrow by cancer),
- abnormal hemoglobin (sickle cell anemia).
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Hematocrit 0.26 M: 0.42-0.54 A low hematocrit is referred to as being anemic. Some of the more
common causes are:
- loss of blood
- nutritional deficiency
- bone marrow problems
- abnormal hemoglobin
WBC 14.16 5-10 A high number of WBCs is called leukocytosis. It may be due to:
- Anemia
- Infectious diseases
- Inflammatory disease (such as rheumatoid arthritis or allergy)
- Leukemia
- Severe emotional or physical stress
- Tissue damage (for example, burns)
01/19/11
KUB ultrasound
Indication: Sepsis scrotal edema
Right kidney= 11.4 x 7.3 x 7.2 cm
Left kidney=11.1 x 5.7 x 6.1 cm

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Both kidneys are normal in sizes with increased parenchymal echogenicity and poor cortico medullary differentiation. A 7.2 x
8.2 x 6.0 cm (volume 187 cc) cystic structure is seen almost occupying the entire right kidney. Likewise, a 2.4 x 3.2cm
septated cyst is noted at the lower pole of the left kidney. No lithiasis or hydrone
phrosis noted.
The urinary bladder is moderately distended with thin walls. No abdominal intraluminal echoes seen.
Volume= 336 cc
Post void determination not assesses since the patient is unable to urine.
The prostate gland is normal in size measuring 2.4 x 2.6 x 3.3 cm with an estimated weight of 11 grams.
Note of mild to moderate ascites.
Scrotal ultrasound
Left testis= 2.3 x 1.9 x 1.6 cm
Right testis= 2.5 x 1.7 x 1.8 cm
There is visualization of echogenic structure in both inguinal canals with patent tunica vaginalis, no flow seen on Doppler
studies.
Minimal bilateral hydrocoele is seen (right>left)
There is edematous fluid collection within the subcutaneous region of the scrotum bilaterally.
Case Study
Impression:
• Bilateral renal parenchymal disease with cortical cyst, as described.

• Mild to moderate ascites.
• Consider bilateral omentocoele.
• Minimal bilateral hydrocoele.
• Anasarcus changes, both scrotal areas
• Normal sonogramof the urinary bladder, prostate gland and both testes.
Interpretation:
Despite its name, a KUB is not typically used to investigate pathology of the kidneys, ureters, or bladder, since
these structures are difficult to assess (for example, the kidneys may not be visible due to overlying bowel gas.) In
order to assess these structures with X-ray, a technique called an intravenous pyelogram is utilized.
KUB is typically used to investigate gastrointestinal conditions such as a bowel obstruction and gallstones, and can
detect the presence of kidney stones. The KUB is often used to diagnose constipation as stool can be seen readily.
The KUB is also used to assess positioning of indwelling devices such as ureteric stents and nasogastric tubes. KUB
is also done as a scout film for other procedures such as barium enemas.
01/22/11
Ultrasound guided cystoscopy with suprapubic tube insertion
Examination of the lower abdomen using 4 MHz curvilinear probe shows well distended urinary bladder measuring 7.6 x 6.0 x
4.6 cm with an estimated volume of 112 cc. Walls are thickened, suggestive of cystitis.
Case Study
Ultrasound guided cystoscopy with suprapubic tube insertion was done after securing a written consent, aseptic technique
and instillation of anesthesia. A gauge 18 spinal needle was inserted into the suprapubic area with the skin depth to superior
urinary bladder wall approximately 1.7 cm. Urethral foley catheter was also inserted two balloon catheter were noted in the
urinary bladder.
Patient tolerated the procedure wall and was transferred to recovery room in a stable condition.
Interpretation:
Cystoscopy is a test that allows your doctor to look at the inside of the bladder and the urethra using a thin, lighted
instrument called a cystoscope The cystoscope is inserted into your urethra and slowly advanced into the bladder.
Cystoscopy allows your doctor to look at areas of your bladder and urethra that usually do not show up well on X-rays. Tiny
surgical instruments can be inserted through the cystoscope that allow your doctor to remove samples of tissue (biopsy) or
samples of urine. Small bladder stones and some small growths can be removed during cystoscopy. This may eliminate the
need for more extensive surgery
Dissection at the base of the bladder to reach the anterior vaginal wall and uterine cervix creates edema, interrupts the small
nerve pathways, and thereby sets up the physiologic changes that produce urinary bladder atony. Therefore, catheter
drainage of the urinary bladder is an essential feature of many pelvic surgical procedures. Fortunately, in most cases, these
conditions reverse themselves in 3-5 days, and catheter drainage is no longer needed. The operation provides drainage of
the urinary bladder through a clean surgical incision and ensures that the catheter does not slip out of the patient or become
dislodged within the abdominal wall. The procedure reduces edema at the base of the bladder, allowing the return of normal
vesical function.
Prothombin Time Result Reference Range Analysis/Interpretat

ion
Case Study
Test 14.7 sec 51.5% activity 11 to 13.5 seconds

Increased PT may be due
to: Bile duct obstruction;
Cirrhosis ; Disseminated
intravascular coagulation;
Hepatitis ; Liver disease;
Malabsorption ; Vitamin K
deficiency ; Coumadin
(warfarin) therapy ; Factor
VII deficiency ;Factor X
deficiency ; Factor II
(prothrombin) deficiency;
Factor V deficiency ;Factor
I (fibrinogen) deficiency
Control 11.90
INR 1.29 0.8–1.2

A high INR level such as
INR=5 indicates that
there is a high chance of
bleeding, whereas if the
INR=0.5 then there is a
high chance of having a
clot. Normal range for a
healthy person is 0.9–1.3,
and for people on
warfarin therapy, 2.0–3.0,
although the target INR
may be higher in
particular situations, such
as for those with a
mechanical heart valve,
or bridging warfarin with
a low-molecular weight
Case Study
heparin (such as
enoxaparin)
perioperatively.
Activated Partial Result Reference Range Analysis/Interpretat

Thromboplastin Time ion
Test 44.0 sec The period required for

clot formation in
recalcified blood plasma
after contact activation
and the addition of
platelet substitutes; used
to address the intrinsic
and common pathways of
coagulation.
Values below 25 seconds

or over 39 s (depending
on local normal ranges)
are generally abnormal.
Shortening of the PTT has
little clinical relevance.
Normal PTT times require
the presence of the
following coagulation
factors: I, II, V, VIII, IX, X,
XI, & XII. Notably,
deficiencies in factors VII
or XIII will not be detected
Case Study
with the PTT test.

Prolonged APTT may
indicate: use of heparin
(or contamination of the
sample); antiphospholipid
antibody (especially lupus
anticoagulant, which
paradoxically increases
propensity to
thrombosis); coagulation
factor deficiency (e.g.
hemophilia)
Control 35.8 sec
01/24/11
Routine test Result Reference Range Analysis/Interpretat

ion
Creatinine 60.30 63.60 - 110.50 umol/L Decrease in creatinine

level suggest decrease in
glomerular filtration
Clinical Chemistry Center
01/28/11
Case Study

ion

the kidneys cannot
may be measured

ion

Hypokalemia, or
arise due to kidney
due to heavy
sweating, vomiting,
or diarrhea, eating
disorders, certain
causes.
Prothombin Time Result Reference Range Analysis/Interpretat

Case Study
ion
Test 26.3 sec 16.8% activity

Increased PT may be due
to: Bile duct obstruction;
Cirrhosis ; Disseminated
intravascular coagulation;
Hepatitis ; Liver disease;
Malabsorption ; Vitamin K
deficiency ; Coumadin
(warfarin) therapy ; Factor
VII deficiency ;Factor X
deficiency ; Factor II
(prothrombin) deficiency;
Factor V deficiency ;Factor
I (fibrinogen) deficiency
Control 11.90
INR 2.61 A high INR level such as

INR=5 indicates that
there is a high chance of
bleeding, whereas if the
INR=0.5 then there is a
high chance of having a
clot. Normal range for a
healthy person is 0.9–1.3,
and for people on
warfarin therapy, 2.0–3.0,
although the target INR
may be higher in
particular situations, such
as for those with a
Case Study
mechanical heart valve,

or bridging warfarin with
a low-molecular weight
heparin (such as
enoxaparin)
perioperatively
VII. Medications
DRUG ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS NURSING CONSIDERATIONS

1. Digoxin binds to a site on • it is prescribed in the Ventricular
(Lanoxin) the extracellular treatment of fibrillation, ventricular CNS: fatigue, • Assess apical pulse
aspect of the α- congestive heart tachycardia, or headache, asthenia regularly for 1 full minute. If
Dose: 0.25/mg subunit of failure and certain known rate is less than 60
1 tab OD the Na+/K+ ATPas cardiac arrhythmias. hypersensitivity to CV: bradycardia, beats/minute, withhold dose
e pump in this drug prohibits its ECG and notify prescriber.
Pharmacologic the membranes o use. changes, arrhythmia • Monitor for signs and
Class: Cardiac f heart cells s symptoms of drug toxicity
Glycoside (myocytes) and Hypersensitivity to (such as nausea, vomiting,
decreases its drug EENT: blurred or visual disturbances,
Therapeutic function. • Uncontrolled yellow vision arrhythmias, and altered
Class: Increases force ventricular mental status). Be aware that
Cardiovascular and velocity of arrhythmias GI: nausea, vomiting, therapeutic digoxin levels
Agent, Inotropic, myocardial • AV block diarrhea range from 0.5 to 2 ng/ml.
antiarrhythmic contraction and • Idiopathic • Monitor ECG and blood
prolongs hypertrophic levels of digoxin, potassium,
GU: gynecomastia
refractory period subaortic stenosis magnesium, calcium, and
of atrioventricular • Constrictive creatinine.
(AV) node by pericarditis Hematologic:
• Stay alert for hypocalcemia.
increasing thrombocytopenia
Know that this condition may
calcium entry into predispose patient to digoxin
myocardial cells. Other: decreased toxicity and may decrease
Slows conduction appetite digoxin efficacy.
Case Study
through sinoatrial
and AV nodes ☞ Watch closely for
and produces hypokalemia and
antiarrhythmic hypomagnesemia. Know that
effect. digoxin toxicity may occur
with these conditions despite
digoxin blood levels below 2
ng/ml.
Patient teaching
• Advise patient to check
pulse rate regularly. If it's
below 60 or above 110
beats/minute, tell him to
withhold dose and notify
prescriber.
• Instruct patient not to take
over-the-counter drugs
without prescriber's approval.
• Teach patient how to
recognize and report signs
and symptoms of digoxin
toxicity.
• Stress importance of follow-
up testing as directed by
prescriber.
• As appropriate, review all
other significant and life-
threatening adverse reactions
and interactions, especially
those related to the drugs,
tests, foods, and herbs
mentioned above.
Case Study
DRUG ACTION Far E a sINDICATION
t e r n U n i v e r sCi ONTRAINDICATION
ty NRMF ADVERSE EFFECTS NURSING CONSIDERATIONS
Trimetazidine counteracting all • Long-term treatmentC a s e S t u dshould
This drug y • stop taking drug and
the major of angina pectoris. never be used in CNS: dizziness, contact prescriber if he
Dose: 35mg/tab metabolic • treatment of tinnitus, patients who are headache, experiences signs or
1 tab BID disorders vertigo or dizziness, hypersensitive to any insomnia, seizures symptoms of hypersensitivity
occurring within and for the treatment of its constituents reaction (rash, hives, or
Pharmacologic the ischemic cell. of visual problems CV: chest pain, other skin reactions) or
Class: metabolic limitation of thought to have a palpitations, severe diarrhea (which may
drugs intracellular circulatory basis hypotension indicate pseudomembranous
acidosis, colitis).
Therapeutic correction of EENT: photophobia, • Instruct patient not to take
Class: Anti- disturbances of sinusitis, pharyngitis with milk, yogurt,
anginal transmembrane multivitamins containing zinc
ion exchanges, GI: nausea, vomiting, or iron, or antacids
and prevention of diarrhea, containing aluminum or
excessive constipation, magnesium.
production of free abdominal pain, • Teach patient proper use of
radicals. dyspepsia, eye drops. Tell him to avoid
flatulence, pseudome touching applicator tip to
mbranous colitis eye, finger, or any other
object.
• Caution patient to avoid
GU: vaginitis
driving and other activities
that require mental alertness
Hematologic: until CNS effects of drug are
lymphocytopenia known.
• As appropriate, review all
Metabolic: hyperglyc other significant and life-
emia, hypoglycemia threatening adverse
reactions and interactions,
Musculoskeletal: ba especially those related to
ck pain, tendon the drugs, tests, foods,
rupture, tendinitis herbs, and behaviors
mentioned above.
Skin: photosensitivity
Other: altered taste,

reaction and pain at
I.V. site,
hypersensitivity
reactions
including Stevens-
Johnson syndrome
Case Study

Moriamin Forte Moriamin is an • Malnutrition, protein contraindicated for • Assess patient for signs of
antidepressant and vitamin patient’s with Hypervitaminosis vitamin deficiency before and
Dose: 1 tab TID and antipsychotic deficiencies, malabsorption (large doses) periodically throughout
drug which anemia, syndrome therapy.
Pharmacologic blocked the convalescence, • Assess nutritional status
Class: Water- prostaglandin to • Restoration and through 24 h diet recall.
soluble vitamin produce maintenance of body • Determine frequency
norepinephrine. resistance, of consumption of vit rich
Therapeutic pregnancy and foods
Class: lactation,
Multivitamin & • Adjuvant in the
Multimineral therapy of peptic
ulcer and TB.
Case Study
Captopril prevents the Hypertension contraindicated in CNS: dizziness. • captopril therapy should be
conversion of Heart Failure: patients who are initiated under close medical
Dose: angiotensin I to Left Ventricular hypersensitive to this GI: Nausea and supervision
25mg/tab angiotensin II by Dysfunction After product or any other vomiting, diarrhea. When necessitated by the
¼ tab BID inhibition of ACE, Myocardial Infarction angiotensin- patient's clinical condition,
a converting enzyme Skin: rash the daily dose of captopril
Pharmacologic peptidyldipeptide inhibitor may be increased every 24
Class: ACE carboxy hours or less under
Inhibitor hydrolase.. continuous medical
supervision until a
Therapeutic satisfactory blood pressure
Class: ACE response is obtained or the
Inhibitor/Thiazide maximum dose of captopril is
Combination reached.
Captopril should generally be
used in conjunction with a
diuretic and digitalis.
Carvedilol CNS: dizziness, fatig
Blocks • Hypertension • History of serious Instruct patient to take
ue, weakness,
stimulation Of F a r E a s t e r n U n i v e r shypersensitivity
ity NRMF medication as directed, at
Dose: 6.25mg/tab • CHF (ischemic or anxiety, depression,
beta1 reaction (Stevens- the same time each day,
1tab BID (hold for
(myocardial) and cardiomyopathic) C a s e S t u d y drowsiness,
BP <90/60) Johnson insomnia, memory even if feeling well. Do not
beta2 (pulmonary with digoxin,
syndrome, loss, mental status skip or double up on
,vascular, and diuretics, and ACE
Pharmacologic angioedema, changes, missed doses. Take
uterine)adrenergi inhibitors
Class: anaphylaxis) nervousness, missed doses as soon as
c receptor sites • Left ventricular
Alpha/Beta- nightmares. possible up to 4 hr before
• Pulmonary edema
DRUG
Adrenergic • AlsoAhas
CTION INDICATION
dysfunction after CONTRAINDICATION ADVERSE EFFECTS NURSING
next dose. Abrupt
CONSIDERATIONS
Potassium
Blocker Maintains acid-
alpha1 blocking Formyocardial
use as an infarction • Hypersensitivity
Cardiogenic shock to EENT: blurred vision, • Instruct patient
withdrawal may to mix and
Chloride(Kalium base balance,
activity, which electrolyte replenisher tartrazine or alcohol dry eyes,
CNS: nasal
confusion, dissolve powder
precipitate life- completely
Durule)
Therapeutic isotonicity,
may resultandin and in the treatment of •(with
Bradycardia, heart
some products) stuffiness.
unusual fatigue, in 3 to 8 oz of water
threatening or juice.
arrhythmias,
Class: electrophysiologic
orthostatic hypokalemia. block or sick
• Acute dehydrationsinus • Tell patient to swallow
restlessness, hypertension, or
Dose: 1 tab QID
Cardiovascular balance
hypotension syndrome
• Heat cramps (unless Resp: bronchospasm
asthenia, flaccid extended-release capsules
myocardial ischemia
Agent throughout body • Hyperkalemia is in
a pacemaker , wheezing.
paralysis, whole without crushing or
Pharmacologic tissues; crucial to place)
• Hyperkalemic paresthesia, absent • Advise patient
chewing them. to make sure
Class: Mineral, nerve impulse familial periodic
• Uncompensated CV: BRADYCARDIA,
reflexes enoughpatient
• Instruct medicationto take is oral
electrolyte transmission and paralysis
CHF requiring IV CHF, PULMONARY form available
with or for
justweekends,
after a meal,
contraction of • Severe renal EDEMA.
CV: ECG changes, with a glass and
holidays, of water or fruitA
vacations.
inotropic agents
Therapeutic cardiac, skeletal, impairment hypotension, arrhyth juice.
written prescription may
(wean before
Class: Electrolyte and smooth • Severe hemolytic GI: diarrhea,
mias, heart block, • Tell patient
be kept to sip diluted
in wallet in case of
starting carvedilol)
replacement, muscle. Also reactions constipation,
cardiac arrestnausea. liquid form
emergency over 5 to 10
nutritional essential for • Severe tissue
hepatic minutes.
supplement normal renal trauma
impairment GU: erectile vomiting, •• Advise
Teach patient
patient to and family
report
GI: nausea,
function and • Untreated Addison's dysfunction, ↓ libido. how tovomiting,
nausea, check pulse and
confusion,
•disease
Asthma or other diarrhea, abdominal
carbohydrate blood pressure.
numbness and tingling, Instruct
discomfort, flatulence
metabolism. bronchospastic
• Esophageal Derm: STEVENS- them to
unusual checkorpulse
fatigue daily
weakness,
disorders caused
compression JOHNSON or and blood
a heavy pressure
feeling in legs.
Metabolic:
by enlarged left SYNDROME,
hyperkalemia TOXIC • Tell patientAdvise
biweekly. to minimize patient GIto
atrium (with wax EPIDERMAL upset
holdby eating
dose andfrequent,
contact
matrix forms) NECROLYSIS, small servings
health of food and if
care professional
Musculoskeletal: we
• Concurrent use of itching, rashes, drinking plenty
pulse is <50 bpmof fluids.
or blood
akness and
potassium-sparing urticaria. • Inform patient
pressure that although
changes
heaviness of legs
diuretics, wax matrix form may appear
significantly
angiotensin-enzyme Endo: hyperglycemia in stool, drug has already
converting (ACE) Respiratory:
, hypoglycemia. • Mayabsorbed.
been cause drowsiness or
inhibitors, or salt respiratory paralysis dizziness.
• Advise Caution
patient not to use
substitutes containing MS: arthralgia, back saltpatients to avoid driving or
substitutes.
potassium Other: irritation
pain, muscle at I.V.
cramps. • As appropriate,
other activities review
that requireall
site other significant
alertness untiland life- to
response
Neuro: paresthesia. threatening
the drug isadverse
known
Misc: ANAPHYLAXI •especially
Advise patient
those to change
related to
S, ANGIOEDEMA, thepositions slowly
drugs, tests, to and
foods,
drug-induced lupus minimize
herbs orthostatic
mentioned above.
Furosemide Thought to inhibit • It is prescribed in the 1. Anuria, • Know that I.V. or I.M.
sodium and treatment of edema pregnancy, lactation, CNS: dizziness, injection is given when
Dose: 20mg TV chloride Far E a s t ebyr n U n i v eelectrolyte
caused rsity N RMF
depletion, headache, vertigo, patient requires rapid onset
after Albumin reabsorption from congestive heart C a s or
e known
Study weakness, lethargy, of diuresis or can't receive
infusion ascending loop of failure, renal failure, hypersensitivity to this paresthesia, oral doses.
Henle and distal or liver failure and drug or other drowsiness, • Be aware that I.V. dose
Pharmacologic renal tubules. alone or in sulfonylureas restlessness, light- may be given by direct
Class: Diuretic, Increases combination for the prohibits its use. headedness injection over 1 to 2 minutes.
Loop potassium treatment of • For I.V. infusion, dilute in
excretion and hypertension. CV: hypotension, dextrose 5% in water, normal
Therapeutic plasma volume, orthostatic saline solution, or lactated
Class: promoting renal hypotension, Ringer's solution.
Cardiovascular excretion of tachycardia, volume ☞ Don't infuse more than 4
Agent. water, sodium, depletion, necrotizin mg/minute.
chloride, g angiitis, • Give oral doses in morning
magnesium, thrombophlebitis, with food. If second dose is
hydrogen, and arrhythmias prescribed, give in afternoon.
calcium.
EENT: blurred vision,
xanthopsia, hearing Patient monitoring
loss, tinnitus
• Watch for signs and
GI: nausea, vomiting, symptoms of ototoxicity.
diarrhea, ☞ Assess for other evidence
constipation, of drug toxicity (arrhythmias,
dyspepsia, oral and renal dysfunction, abdominal
gastric irritation, pain, sore throat, fever).
cramping, anorexia, • Monitor CBC, BUN, and
dry mouth, acute electrolyte, uric acid, and
pancreatitis CO2 levels.
• Monitor blood pressure,
GU: excessive and pulse, fluid intake and
frequent urination, output, and weight.
nocturia, glycosuria, • Assess blood glucose
bladder levels in patients with
spasm, oliguria, diabetes mellitus.
interstitial nephritis • Monitor dietary potassium
intake. Watch for signs and
Hematologic: anemi symptoms of hypokalemia.
a,
purpura, leukopenia, Patient teaching
thrombocytopenia,
hemolytic anemia • Instruct patient to take in
morning with food (and
Hepatic: jaundice second dose, if prescribed,
Case Study
RUG ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS NURSING CONSIDERATIONS
Omeprazole Suppresses Treatment and Diarrhea; headache, The concurrent use of
(Omepren) gastric acid prevention of ulcers in Do not use in Severe allergic clopidogrel and omeprazole
secretion by F a rtheEstomach
a s t e rand
n U n i v epatients
upper r s i t y hypersensitiv
NRMF reactions (rash; should be avoided. Patients
Dose: 40mg/tab specific inhibition intestines Case e (allergic)
Study to it. hives; itching; receiving clopidogrel for MI
1 tab OD of the hydrogen– difficulty breathing; or stroke may not receive the
potassium Do not use in tightness in the expected antiplatelet activity
Pharmacologic adenosinetriphos pregnant or nursing chest; swelling of the if omeprazole is used
Class: Proton phatase (H +, K +- animals. mouth, face, lips, or concurrently.
pump inhibitor ATPase) enzyme tongue; unusual
system found at Use with caution in hoarseness); chest Separating the time of
Therapeutic the secretory animals pain; dark urine; fast administration of clopidogrel
Class: surface of parietal with liver disease. or irregular heartbeat; and omeprazole does not
Antiulcer drug cells fever, chills, or sore reduce the chance of the
Antisecretory 2. throat; red, swollen, interaction.
drug Inhibits the final blistered, or peeling
transport of skin; seizures; Concurrent use of
hydrogen ions swelling of the hands, cimetidine, esomeprazole,
(via exchange ankles, or feet; etravirine, felbamate,
with potassium unusual bruising or fluconazole, fluvoxamine,
ions) into the bleeding; unusual or fluoxetine, ketoconazole,
gastric sudden weight voriconazole and ticlopidine
lumen. Since the increase; unusual should also be avoided
H +, K +-ATPase tiredness; vision because they may also
enzyme system is changes; yellowing of reduce clopidogrel's
regarded as the the eyes or skin. antiplatelet activity.
acid (proton)
pump of the The FDA does not have
gastric mucosa, sufficient drug interaction
omeprazole is information to provide
known as a recommendations for
gastric acid pump concurrent use of other PPIs.
inhibitor. The
inhibitory effect is
There is no evidence that
dose-related.
H2 antagonists (other than
Omeprazole
cimetidine) interfere with
inhibits both basal
antiplatelet activity of
and stimulated
clopidogrel.
acid secretion
irrespective of the
stimulus. Both cimetidine and
omeprazole are available in
nonprescription (OTC) forms
and patients should be
educated to avoid these
drugs if receiving clopidogrel.
Case Study

Warfarin inhibits the ndicated for the 1. • • Tell patient he may take
effective prophylaxis and/ or Hypersensitivity to CNS: headache, oral drug with or without
Dose: 1mg/tab synthesis of treatment of venous drug or its agitation, anxiety food. Advise him to take
½ tab OD @ H.S biologically active thrombosis and its components once-daily prescription drug
forms of the extension, and pul- • contraindicated in GI: nausea, vomiting, at bedtime.
Pharmacologic vitamin K- monary embolism. pregnancy diarrhea, • Instruct patient to dissolve
Class: coumarins dependent constipation, EFFER dose in 6 to 8 oz of
Therapeutic clotting factors: II, indicated for the abdominal discomfort water before taking.
Class: VII, IX and X, as prophylaxis and/ or or pain • Caution patient to avoid
anticoagulants well as the treatment of the driving and other hazardous
regulatory factors thromboembolic Hematologic: reversi activities until he knows how
protein C, protein complications ble granulocytopenia drug affects concentration
S and protein Z. associated with atrial and thrombocytopeni and alertness.
Other proteins not fibrillation and/ or a • Tell patient smoking may
involved in blood cardiac valve decrease drug effects.
clotting, such as replacement.. Hepatic: hepatitis • As appropriate, review all
osteocalcin, may other significant and life-
also be affected. threatening adverse
Skin: rash
especially those related to
Other: pain at I.M. the drugs, tests, herbs, and
injection site, burning behaviors mentioned above.
or itching at I.V. site,
hypersensitivity
reaction
Case Study
DRUG ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS NURSING

CONSIDERATIONS
Ceftriaxone works by • Meningitis in 2. •
inhibiting the neonates, Cephalosporin Local (4.3%): • avoid alcohol while taking
Dose: 2mg TIV OD mucopeptide children, and hypersensitivity Injection site this drug and for 3 days after
synthesis in the adults (except inflammation with IV because severe reactions
Pharmacologic bacterial cell wall. pseudomonas administration. Pain, often occur
Class: 3rd The beta-lactam infections). induration, and
Generation moiety of • Multiresistant tenderness after IM •report severe diarrhea,
Cephalosporin Ceftriaxone binds Gram-negative injection. difficulty breathing, unusual
to infections, in tiredness or fatigue, pain at
Therapeutic carboxypeptidase particular Hypersensitivity injection site
Class: s, caused by (2.4%): Rash,
Antibiotic endopeptidases, enterobacters. pruritus, fever,
and • Gonorrhoea ca eosinophilia and less
transpeptidases used by ß- frequently urticaria
in the bacterial lactamase and anaphylaxis.
cytoplasmic producing
membrane. gonococci Gastrointestinal
These enzymes (single dose of (1.4%): Colitis,
are involved in 250 mg i.m.). diarrhea, nausea,
cell-wall • Osteomyelitis c and vomiting.
synthesis and cell aused
division. By by Staphylococ Symptoms of
binding to these cus aureus. pseudomembranous
enzymes, • Disseminated colitis can appear
Ceftriaxone and persisting during or after
results in the forms of Lyme antibiotic treatment.
formation of of disease.
defective cell
Nausea and vomiting
walls and cell
have been reported
death.
rarely.
Case Study
Less frequent
adverse reactions
(less than 1%) are:
Cardiovascular
System: Potentially
life-threatening
arrhythmias following
rapid (less than 60
seconds) bolus
administration via
central venous
catheter have been
observed.
Hematologic System:
Neutropenia,
transient leukopenia,
eosinophilia,
thrombocytopenia
and agranulocytosis
have been reported.
Some individuals
have developed
positive direct
Coombs Tests during
treatment with
CLAFORAN and
other cephalosporin
antibiotics. Rare
cases of hemolytic
anemia have been
reported.
Case Study
Genitourinary
System: Moniliasis,
vaginitis.
Central Nervous
System: Headache.
Liver: Transient
elevations in SGOT,
SGPT, serum LDH,
and serum alkaline
phosphatase levels
have been reported.
Kidney: As with some

other cephalosporins,
interstitial nephritis
and transient
elevations of BUN
and creatinine have
been occasionally
observed with
CLAFORAN.
Cutaneous: As with
other cephalosporins,
isolated cases of
erythema multiforme,
Stevens-Johnson
syndrome, and toxic
epidermal necrolysis
have been reported.
Case Study

Albumin CNS: headache. Prior to administration,
Provides colloidal Hypoalbuminemia • Allergic reactions to
Dose: 25% TIV q oncotic albumin CV: PULMONARY parenteral drug products
pressure, Hypovolemia
12 • Severe anemia EDEMA, fluid should be inspected visually
which serves overload,
to mobilize Prevention of Central • CHF for turbidity and
Pharmacologic Volume hypertension,
Class: Blood fluid from hypotension, discoloration, whenever
Depletion after • Normal or increased
volume expander extravascular intravascular tachycardia. solution and container
Paracentesis
tissues back volume permit.
due to Cirrhotic
Therapeutic into the Ascites GI: increased
Class: intravascular (Treatment salivation, nausea,
3. Do not dilute with sterile
antihyperbilirubin space Adjunct) vomiting.
emic water for injection.
• Requires Derm: rash, urticaria.
Ovarian
concurrent
Hyperstimulatio Do not use solutions of
administration MS: back pain.
n Syndrome Albumin (Human) 20% which
of appropriate (OHSS)
crystalloid Misc: chills, fever, are cloudy or have deposits.
Adult Respiratory flushing. Once the infusion container
Distress
has been opened the
Syndrome
Case Study
contents should be used

(ARDS)
(Treatment immediately. Discard the
Adjunct) unused portion. Filtration of
Acute Nephrosis Albumin (Human) 20% is not
(Treatment required.
Adjunct)
The infusion rate should be
Hemolytic Disease of
the Newborn adjusted according to the
(HDN) individual circumstances and
the indication. In plasma
exchange during
paracentesis, the infusion
rate may be higher and
should be adjusted to the
rate of removal.
If large volumes (greater

than 1500 ml) are
administered, the product
should be warmed to room
temperature before use.

Case Study
Triflusal blocks Secondary prevention Dyspepsia, • Monitor CBC with

active, antecedent or
after a first coronary or headache, abdominal
cyclooxygenase complicated peptic Differential
Dose: 300mg/cap cerebrovascular pain, nausea,
ulcer. Pathological
1cap OD inhibiting ischemic event of MI, vomiting, flatulence, periodically during
bleeding.
stable and unstable anorexia
thromboxane A2, Hypersensitivity to therapy
Pharmacologic angina, non-
salicylates.
Class: platelet preventing hemorrhagic strokeor » May cause ↑ AST, ALT,
aggregation transient ischemic alkaline phosphatase,
aggregation 4. and bilirubin
inhibitor. attack and reduction of
Therapeutic vein graft occlusion » May cause serum gastrin
Class: preserves after coronary bypass concentrations to ↑ during
Antitubercular first 1–2 wk of therapy.
vascular
Levels return to normal
prostacyclin, thus after discontinuation of
promoting anti- omeprazole
aggregant effect » Monitor INR and
prothrombin time in
patients taking warfarin
blocks
.
phosphodiesteras
e thereby
increasing cAMP
concentration,
thereby
promoting anti-
aggregant effect
due to inhibition
of calcium
mobilization
Case Study

Bethanechol Stimulates It is prescribed in the 5. Hypersensitiv
parasympathetic treatment of fecal and ity to drug CNS: headache, • Patient monitoring
Dose: 1 tab BID nervous system urinary retention and • GI or GU tract malaise
PO and cholinergic neurogenic atony of obstruction • Monitor blood pressure.
receptors, the bladder. • Hyperthyroidism CV: bradycardia, Be aware that hypertensive
Pharmacologic leading to • Active or latent hypotension, heart patients may experience
Class: increased asthma block, syncope sudden blood pressure
Cholinergic muscle tone in • Bradycardia with cardiac arrest drop.
Therapeutic bladder and • Hypotension • Stay alert for orthostatic
Class: increased • Hypertension EENT: excessive hypotension, a common
Urinary frequency of • Atrioventricular lacrimation, miosis adverse effect.
Antispasmodic ureteral conduction defects • Monitor vital signs and
peristaltic • Coronary artery GI: nausea, respiration for 30 to 60
waves. Also disease vomiting, diarrhea, minutes after subcutaneous
stimulates • Seizure disorders abdominal injection.
gastric motility, • Parkinsonism discomfort, belching • Monitor fluid intake and
increases gastric • Peptic ulcer output and residual urine
tone, and disease. GU: urinary urgency volume.
restores
rhythmic GI Respiratory: increa Patient teaching
peristalsis. sed bronchial
secretions, broncho • Tell patient that drug is
spasm usually effective within 90
minutes of administration.
Skin: diaphoresis, • Advise patient to take oral
flushing dose on empty stomach 1
hour before or 2 hours after
Other: hypothermia a meal to avoid GI upset.
• Instruct patient to move
slowly when sitting up or
Case Study
standing, to avoid dizziness

or light-headedness from
blood pressure decrease.
VIII. Pathophysiology
Predisposing factors: HCVD; Precipitating factors:

heredo-familial diseases fond of eating sweets;
(Hypertension; heart disease); coffee drinker; no regular
mild stroke; 77 y/o;male exercise
Damage to coronary Deposits of fats Atherosclerosi

artery s
Case Study
HD
Blood
Necrosis Ischemia O2 delivery LUMEN
flow LDL
Heart
failure Lack
Dysp Swel Arrhyt Asci of Anemi
nea Fatigue ling Decre hmia Persi tes appe a
Wei
and ased stent ght tite Infecti
Kidney weakne alertn coug gai on
damage ss ess h n
Neuropathy
Urosepsis Urinary
retention
Decubitus
Ulcer
Hypoalbuminem
ia IX. Ecologic Model
A) Hypothesis
Scrotal
The patient acquired hypertension through heredity that led to the development of CAD (Coronary Artery Disease). His
edema
mother has a history of hypertension, asthma and heart disease while his father has a history of breast cancer.
B) Predisposing Factors
• HCVD (hypertensive cardiovascular disease) occurs due to the complication of hypertension or high blood pressure and
is also a contributing factor to the eventual thickening of walls of blood vessels.
• Heredo-familial diseases (Hypertension; heart disease); the patient inherited hypertension from her mother that
eventually led to CAD and complicated to other diseases also
• mild stroke causes the affected part of the brain to unable to function and may immunocompromise the patient.
• 77 y/o;male, age plays a vital role in the development of diseases.
Case Study
• Fond of eating sweets, coffee drinker: Excessive coffee drinking is often thought to lead to higher blood pressure. It's
been shown that drinking 4-5 cups of coffee can raise your blood pressure by 5 points, compared to having only 1 cup.
This isn't a huge amount, but the consequences over the years can lead to heart attacks and strokes. Coffee also may
raise homocysteine levels in the blood, which is considered a risk factor for heart attacks. Sugar may, under some
circumstances for some people, increase heart rate.
• No regular exercise: Inactivity is one of the major risk factors for heart disease. However, exercise helps improve heart
health, and can even reverse some heart disease
C) ECOLOGIC MODEL
Urinary
retention Mild stroke
No regular HCVD
exercise
CAD Coffee drinker/

Fond of eating sweets
Hypertension
Heredo-familial
disease
Scrotal edema Age:77y/o
hypoalbumine
Case Study
D) Analysis
CAD is the end result of the accumulation of atheromatous plaques within the walls of the coronary arteries that
supply the myocardium (the muscle of the heart) with oxygen and nutrients. In the case of the patient it was predisposed
by inheritance and precipitated by his lifestyle.
E) Conclusion
The patient acquired CAD primarily due to inheritance and his lifestyle. Aside from his age, he has no regular exercise
that eventually affected the function of his heart. He is compromised even more because he already experienced mild
stroke. His disease even complicated to other cases like scrotal edema, hypoalbuminemia and urinary retention.
F) Management
Medical Management
Treatment of coronary artery disease is aimed at controlling symptoms and slowing or stopping the progression of
disease. The method of treatment is based on many factors determined by your symptoms, a physical exam, and
diagnostic testing. In many cases, if the blockage is less than 70 percent and not severely limiting blood flow, medications
may be the first line of treatment.
These help define your basic likelihood for developing heart disease. If you have any non-modifiable risk factors, it is
even more important to work on the risk factors you can change:
Modifiable risk factors
• Stop cigarette smoking and the use of tobacco products
• Control high blood pressure
• Lower high blood cholesterol
• Maintain tight diabetes control
• Follow a regular exercise plan
• Achieve and maintain your ideal body weight
• Control Stress and Anger
• Eat a diet low in saturated fat and cholesterol
• Cardiac Rehabilitation
Nursing Management
1. Relieve/control pain.
2. Prevent/minimize development of myocardial complications.
3. Provide information about disease process/prognosis and treatment.
4. Support patient/SO in initiating necessary lifestyle/behavioral changes.
Case Study
Health Promotion and Education
• Acute Needs
• Assessment: of pain, history, activity
• Pain: deep or superficial? Diffuse or well located?
• Care during anginal attack:
• O2 therapy
• Vitals, ECG
• Pain relief with Nitrate (& narcotic analgesic if ordered)
• Assessment of heart and breath sounds
– Patient comfort
– Assessment of patient response to therapy
X. Problem Prioritization
Nursing Diagnosis Priority Justification
Acute Pain related to High Priority This is an actual problem

suprapubic because pain causes change’s to the client’s
catheterization homeostasis and can
affect the treatment and cooperation of the
cues
patient. This must be addressed first before proceeding
>facial grimace to other problems.
>making sounds
>nodded when ask if

painful
Impaired Skin Integrity Medium Priority This is an actual problem but it is not life threatening.
related to physical Interventions needed to address this problem are to
immobility as prevent further impairment to the client’s current
Case Study
manifested by bed sores condition.
cues
>sumasakit yun
catheter niya kapag
gumgalaw siya.
>sores on the buttocks
Risk for Aspiration Low priority This problem is not an actual problem continuous
assessment should be done to prevent this.
cues
>nasogastric tube
feeding.
Risk for infection Low priority This is not an actual problem at the moment but it may
move to another level if left unchecked.
cues
>suprapubic catheter
XI. NURSING CARE PLAN
ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION

DIAGNOSIS
Subjective: Acute pain After 8 hours

related to of nursing
Case Study
“ sumasakit Suprapubic interventions, Goal met.

yun catheter catheterization the patient will
nia kapag.” As be able to
stated by the report reduced
wife PAIN: pain from the
pain scale of 7 Independent: After 8 hours of
Nods when ask An unpleasant to the scale of nursing
if painful. sensory 3. interventions,
Objective: experience - Assess pain, noting > Useful in monitoring of the patient was
arising from location, characteristics, changes in patient and able to report
Facial grimace potential 1. To evaluate frequency, quality, intensity effectiveness of medication reduced pain
tissue client’s and severity. Investigate and progression of healing. from the pain
Expressive damage. It is scale of 7 to
behavior such response to and report changes in pain
a subjective pain. as appropriate. Reassess the scale of 3.
as moaning, state in which
restlessness each pain is reported.
a person
and irritable. demonstrates
> Help to determine intensity,
discomfort
- Acknowledge the pain quality and severity of pain,
verbally or non
experienced and convey thus proper intervention is
verbally or
acceptance of client’s given.
both. Pain
reaction is response to pain.
what the
individual
feels, thinks - Observe non verbal cues >Pain is a subjective
and does or pain behaviors. experience.
about the
perceived
pain. Pain
-Monitor skin color, > During the phase of acute
interferes with
Case Study
a person’s temperature and vital signs. pain, these findings are

ability to rest, altered; this will then prompt
concentrate, for interventions.
and perform - Determine client’s
normal acceptable level of pain.
activites. > Pain is subjective and it
varies with the individual and
- Determine factors in situation.
client’s lifestyle that can
affect responses to
treatment. > To determine proper and
effective treatment regimen
for the client.
- Provide comfort measures,
quiet environment and calm
activities. > To promote non
pharmacological pain
- Instruct the use of management.
relaxation techniques such
as focused breathing
exercises and encourage
diversional activities. > To promote relaxation,
distract attention and reduce
pain.
2. To assist - Review procedures and

client to expectations; tell client
explore when treatment may cause
methods of pain. > To reduce tension of the
alleviation and unknown and reduce muscle
Case Study
control of pain. tension.
- Encourage verbalization of
feelings about pain.
> Timely interventions are
more likely to be successful in
alleviation of pain.
Collaborative:
- Administer analgesics as
indicated.
> To maintain acceptable

level of pain. Relief of pain
facilitates cooperation with
other therapeutic
interventions.
Note: Notify physician if

- Evaluate client’s response regimen is inadequate to
to analgesia, and assist in meet pain control goals.
transitioning drug regimen
based on individual needs.
> To help in management of
pain.
Case Study
Discharge Plan
Medicatio • Keeping your blood pressure under control protects your heart, lungs, brain, kidneys, and other organs.
ns • Take medicines regularly. The medications should be taken with the right dose and right time as prescribed by the
physician.
• Do not stop taking them without talking to your physician.
Exercises • Exercise regularly. Exercise for 30 minutes on most days of the week. Exercise may decrease your blood
pressure. This may also help you decrease or maintain a healthy body weight.
• Ask physician or caregiver for the types of exercise that are best for you. Talk to them if you need to lose weight,
and make a plan to lose it.
Treatment • More than one type of blood pressure medicine will be prescribed. If another illness is causing your high blood
pressure, that illness will also be treated. Instruct on indications for, frequency, and side effects of medications.
• Maintain a quiet, pleasant environment to promote relaxation.
• Provide clean and comfortable environment.
• Remind to comply to follow up check-up.
Health • Lifestyle changes may help decrease your blood pressure, and prevent or delay the onset of hypertension.
Teaching These changes can decrease the amount of medicine that you need to take and decrease your risk of having a
cardiovascular disease.
• Reduce Stress. Learn new ways to relax, such as deep breathing, meditation, and listening to music. Learn to
control anger and find ways of healthy ways of releasing your emotions.
• Report immediately any unusual that is felt, such as the following:
– very bad headache, dizziness, trouble thinking clearly (confusion), or problems talking or
understanding things.
– chest pain or discomfort that spreads to your arms, jaw, or back.
– lips or nail beds turned blue or white in color.
– nausea (upset stomach), sweating, or trouble breathing.
– not able to see out of one or both of your eyes.
Case Study
– unusual, sudden back pain.

– weakness or numbness in your arm, leg, or face. This may happen on only one side of your body.
Out- • Patient will be advised to go back in the hospital in a specific date to have a follow-up check up after discharge.
Patient • Contact your physician immediately if BP readings higher than normal that does not go down, even after taking
your medicines exactly as you have been told to.
• Contact your physician if more questions or concerns about your condition, medicine, or care are needed.
• Consult doctor for are any problems or complications encountered.
Diet • Decrease the amount of salt you use when cooking and eating.
• Limit the amount of packaged foods you eat that have high salt content, such as canned or frozen meals.
• A healthy diet rich in fruits, vegetables, and low -fat dairy products may decrease your blood pressure. Learn
about the fat content in foods and reduce the amount of saturated and total fat in your diet.
• Ask your physician or caregiver if you need to be on a special diet.
Spiritual • Support patient’s religious practices by encouraging him to attend Sunday masses to pray for faster recovery.
Advise • God has not called us to immortality but to holiness. Sir’h 3:18

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Far Eastern University NRMF

Perhaps, one of the major problems that the world is

II. NURSING HISTORY

A. PAST HEALTH HISTORY

B. HISTORY OF PRESENT ILLNESS

III. PATTERNS OF FUNCTIONING

Interpretation: Client diverts his problems by engaging in recreational activities. He is more

Analysis: The effectiveness of communication determines the ability to function as a cooperative,

Intelligence is the measurable product of intellectual functioning, which consists of memory,

Nurses Handbook of Health Assessment, Janet Weber, page 513

5. Emotional and Family Coping Patterns

Fundamentals of Nursing.4th Edition by Craven and Hirnle. pp. 405

The economic pattern was not assessed due to time constraints.

1. Religious Beliefs and Practices

Interpretation: Client is a believer of God but he doesn’t pratice religious activities.

Source: Fundamentals of Nursing, 5th Edition by Taylor et al, pp. 790-791

2. Values and Valuing

Source: Fundamentals of Nursing by Kozier, 8th ed, vol. 1 page 80

IV. Activities of Daily Living

ADL Before During Analysis and Interpretation

Nutrition According to the The client is in OF Analysis:

plenty of fluids to maintain

(Kozier et.al, Fundamentals of Nursing 8th

The client does not have sufficient iron

Eliminati During Client’s fecal elimination:

4pm- 100cc semisolid, moist

The client’s fecal elimination is normal

Client’s urinary elimination

• Amount: 1,200-1,500 mL.; Color:

The client’s urinary elimination is also

Sleep His sleeping pattern Analysis:

middle age. The majority of older

(Kozier et.al, Fundamentals of Nursing 8th

Due to his pain the client has disturbed

Exercise According to the As observed, the Analysis:

The client has doesn’t engage himself

Hygiene He takes a bath He is ordered to Analysis:

The client is immobile and has difficulty in

The client is immobile and has difficulty in

Body Part Normal Findings Actual Findings Interpretation/Anal

Signs of distress No distress noted appears distressed He appears distress

Attitude Cooperative Cooperative Normal

Mood and Affect Appropriate to situation Appropriate to situation, he Normal

Lips Soft, moist, smooth texture dry Due to inadequate

TEETH Smooth, white, shiny tooth enamel No teeth Due to age

VI. Laboratory and Diagnostic findings

Sodium 157.6 135-148 mmol/ Slightly High. Sodium is

arise due to kidney

Chest 3(S/P CVP Insertation)

Albumin 24 35-50 g/L Low albumin levels can

Electrolytes Result Reference Range Analysis/Interpretat

Potassium 2.54 3.50-5.30 mmol/L Low. Potassium is the

Hematology Result Normal Values Interpretation

Liver Profile Result Reference Range Analysis/Interpretat

Albumin 19 35-50 g/L Low albumin levels can

Hematolo0 ^gy Result Normal Values Interpretation

RBC 2.57x10 5.5-6.5 x 10 Decreased in RBC indicates anemia.

Indication: Sepsis scrotal edema

Right kidney= 11.4 x 7.3 x 7.2 cm