RevisionLevel 3 SectionB MedSurge Case Study2

COLLEGE OF NURSING
UPPER GASTROINTESTINAL BLEEDING SEC TO DUODENAL ULCER;

ANEMIA SEVERE SEC TO #1 REFLUX ESOPHAGITIS GRADE A
April 22, 2021

Thursday
Level 3 - Section B
Demetria, Anne Christine G.

Dianon, Christopher John W.
Dinoy, Aira Jean Joy A.
Espelita, Ethyl Lorraine H.
Estrella, Mary Catherine P.
Estremos, Ledayne Kristine L.
Evangelista, Ledelyn Marie P.
Flores, Keziah Marie
Florita, Niño John S.
Gabiana, Audrey Nicole C.
Gabisay, Ayrcel Maye O.
Gargar, Franz Diane Shae R.
Lagahit, Cleiza Cake V.
Lozano, Princess Lyn P.
Melencion, Christian Van Joseph M.
Moliño, Niña Ley M.
Dr. Adriel Arman V. Pizarra, DCHM, MAN, RN
Clinical Instructor
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TABLE OF CONTENTS
Introduction (Anatomy and Physiology and Pathophysiology) 3
Goals 28
Objectives 28
Significance of the Study 29
Definition of Terms 30
Cephalo – Caudal Assessment 33
LABORATORY AND DIAGNOSTIC STUDIES
COVID – 19 Rapid antibody test 36
Urine Analysis 38
Sodium, Potassium, Creatinine, BUN, ALT 41
Clinical Chemistry 43
Hematology (CBC) 49
Immunology 54
Prothrombin Time 55
Blood Typing 58
Blood Glucose 60
X-Ray 62
ECG 66
Gastrocospy 68
DRUG STUDIES
Drug Study # 1 – Tranexamic Acid 74
Drug Study # 2 – Omeprazole 78
Drug Study # 3 – Clarithromycin 80
Drug Study # 4 – Rebamipide 82
Drug Study # 5 – Amoxicillin 84
Drug Study # 6 – Furosemide 87
Drug Study # 7 – Vitamin K 90
NURSING CARE PLANS
NCP # 1 92
NCP # 2 95
NCP # 3 100
Discharged Plan 105
Learning Outcomes 108
Conclusion 108
Recommendation 108
References 110
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INTRODUCTION
Upper Gastrointestinal Bleeding is known as blood loss from a gastrointestinal
source above the ligament of Treitz (the suspensory ligament of the
duodenum), in the esophagus, stomach, or duodenum. The bleeding starts in
the gastrointestinal tract, which extends from the mouth to the large bowel.
It is a potentially life-threatening condition that requires prompt and
appropriate management. Most upper GI bleeds are a direct result of peptic
ulcer erosion, stress related- mucosal disease, that may evidence as
superficial erosive gastric lesion to frank ulcerations, erosive gastritis
(secondary to use or abuse of NSAIDs, oral corticosteroids, or alcohol) or
esophageal varices (secondary to hepatic failure).
Upper Gastrointestinal Bleeding is a common medical condition with various

etiologies and presentations that is estimated to occur in 80 to 150 out of
100,000 people each year with a higher incidence in men than in women.
Mortality rates from UGIB are 6%-10% overall. This disease causes a major
number of hospital admissions in the United States, which is estimated at
300000 patients annually. Upper GI bleeding has an annual incidence that
ranges from 40-150 episodes per 100000 persons and a mortality rate of 11%
to 15%.
A common presentation in the emergency departments worldwide are the

upper gastrointestinal bleeding causing a great number of admissions in
hospitals which in third world countries causes a huge impact in economy and
becomes a big health issue. Due to the incidence of UGIB an initial
management should be fast, accurate and appropriate, management should
be from pharmacologic acid suppression, endoscopic hemostatic techniques
and recognition of Helicobacter pylori as an etiologic agent in peptic ulcer
disease. Bleeding from the upper GI tract is approximately 4 times more
common than bleeding from the lower GI tract and is a major cause of
morbidity and mortality.
Upper Gastrointestinal Bleeding is classified according to the type of bleeding

to occur:
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● Acute Upper Gastrointestinal Bleeding: is a common medical
emergency characterised by haematemesis and/or melena.
● Occult Upper Gastrointestinal Bleeding: a bleeding that is not visible
to the subject. It could manifest lightheadedness, difficulty breathing,
fainting, chest pain and abdominal pain.
● Obscure Upper Gastrointestinal Bleeding: is a persistent or
recurrent bleeding for which no definitive source has been identified by
an initial evaluation. This bleeding might show up as vomiting blood,
which might be red or might be dark brown and resemble coffee grounds
in texture, black, tarry stool, and rectal bleeding, usually in or with stool.
ASSESSMENT OF SIGNS AND SYMPTOMS

Upper Gastrointestinal Bleeding could signal a life-threatening condition.
When there is a significant blood loss over a short period of time, bleeding
may manifest as:
● Hematemesis (bright red emesis or coffee-ground emesis): is the

vomiting of blood. It indicates that the bleeding is from the upper
gastrointestinal tract, usually from the esophagus, stomach, or proximal
duodenum.
● Melena: is a black, tarry stool. It is the most common presenting
symptom of upper gastrointestinal bleeding.
● Hematochezia: is the passage of fresh blood per anus, usually in or with
stools. It is caused by bleeding in the colon, which is fairly close to the
anus.
As this may lead to symptoms that might indicate a need for immediate
medical attention which includes:
● Changes in level of consciousness

● Syncope
● Unresponsiveness
● Dizziness
● Respiratory or breathing problems such as shortness of breath, difficulty
breathing, labored breathing, wheezing, and apnea
● Malaise
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PREDISPOSING FACTORS
● Genes: Genetic polymorphisms associated with upper gastrointestinal
bleeding. It involved platelet activation and aggregation, angiogenesis,
inflammatory process, and drug metabolism were associated with risk
of UGIB.
● Older Age: The aging of the population is associated with the increased
risk of chronic diseases, and greater consumption of drugs used in their
treatment, which may lead towards gastrointestinal bleeding.
● Sex (most commonly male): Drinking excessive alcohol is evident in
male. With high alcohol consumption they are widely at risk for
gastrointestinal bleeding within the upper digestive tract, which can
result in death.
PRECIPITATING FACTORS
● Lifestyle (Smoking and Alcohol Drinking): Mechanistic studies have
shown that cigarette smoke and its active ingredients can cause mucosal
cell death, inhibit cell renewal, decrease blood flow in the GI mucosa
and interfere with the mucosal immune system. Drinking too much
alcohol can wreak havoc on the digestive tract. It tears away at the
tissue, causing it to become very sensitive. So sensitive, that the tissue
can tear. The tears are called Mallory-Weiss tears, and they can create
a substantial amount of bleeding.
● History of peptic ulcer disease: A peptic ulcer is a sore that develops on
the stomach lining inside of the stomach or small intestine.
● Infection (Helicobacter Pylori): Due to increasing antibiotic resistance
and incomplete adherence to antibiotic regimens, follow-up testing and
confirmation of eradication is recommended.
● Concomitant use of medications (NSAIDS, acetylsalicylic acid, or
thienopyridines): By blocking the Cox-1 enzyme and disrupting the
production of prostaglandins in the stomach, NSAIDs can cause ulcers
and bleeding.
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COMPLICATIONS
Failure to seek treatment can result in serious complications and permanent
damage such as:
● Shock: People go into shock when their blood pressure becomes so low
that the body's cells do not receive enough blood and therefore do not
receive enough oxygen and as a result, cells in numerous organs,
including the brain, kidneys, liver, and heart, stop functioning normally.
● Anemia: Due to excessive bleeding results when loss of red blood cells
exceeds production of new red blood cells and when blood loss is rapid,
blood pressure falls, and people may be dizzy.
● Death: If the bleeding isn’t stopped.
ASSESSMENT
● Assess hemodynamic status and need of resuscitation
● Monitor blood loss if possible
● Assess vital signs especially BP and PR
● Assess medical history
● Monitor for symptoms and watch closely for serious symptoms
● Perform physical examination (imaging tests such as CT Scan)
TREATMENT
Treatment for gastrointestinal bleeding varies depending on the condition and
the lifestyle of the patient.
● Quit habits of smoking and drinking alcohol - to allow the bleeding to
subside.
● Endoscopy - to help stop the bleeding.
● Medications (Antibiotic) - to alleviate inflammation.
Duodenal ulcer is a sore that forms in the lining of the duodenum. It refers to
the clinical presentation and disease state that occurs when there is a
disruption in the mucosal surface at the level of the stomach or first part of
the small intestine, the duodenum. Anatomically, duodenal surfaces contain
a defense system that includes pre-epithelial, epithelial, and subepithelial
elements. Duodenal ulcers are part of a broader disease state categorized as
peptic ulcer disease.
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According to the latest WHO data published peptic ulcer disease deaths in the
Philippines reached 6,283 or 1.03% of total deaths. The age adjusted death
rate is 9.69 per 100,000 of the population ranks Philippines number 18 in the
world. Almost 70% of UGIB are due to duodenal ulcers. Duodenal ulcer
disease represents a serious medical problem. Approximately 500,000 new
cases are reported each year, with 5 million people affected in the United
States alone. Interestingly, those at the highest risk of contracting peptic ulcer
disease are those generations born around the middle of the 20th century.
Other types of ulcers:

● Gastric Ulcers: ulcers that develop inside the stomach.
● EsophagealU Ulcers: ulcers that develop inside the esophagus.

Many people with duodenal ulcers don't even have symptoms. Mostly,
duodenal ulcers may cause signs or symptoms such as:
● Abdominal pain (a hunger-like feeling)

● Dyspepsia
● Feeling of fullness, bloating or belching
● Intolerance to fatty foods
● Heartburn
● Nausea
Less often, it may cause severe signs or symptoms such as

● Vomiting or Hematemesis
● May appear red or black, dark blood in stools, or stools that are black
or tarry
● Dyspnea
● Syncope
● Appetite changes
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PREDISPOSING FACTORS
● Sex (Male): In men, duodenal ulcers were more common than gastric
ulcers; in women, the converse was found to be true. Considering the
factors of they intake high amounts of alcohol.
● Older Age: Ulcer disease has become a disease predominantly affecting
the older population, with the peak incidence occurring between 55 and
65 years of age.
PRECIPITATING FACTORS
● Infection (Helicobacter pylori): H. pylori is the etiologic factor in most
patients with peptic ulcer disease and may predispose individuals to the
development of gastric carcinoma. H. pylori colonizes in the human
stomach.
● Regular use of certain pain medications (NSAIDS): A small but
important percentage of patients have adverse gastrointestinal events
associated with NSAID use that results in substantial morbidity and
mortality. Risk factors for the development of NSAID-associated gastric
and duodenal ulcers.
● Smoking: Smokers are about two times more likely to develop ulcer
disease than nonsmokers. Cigarette smoking and H. pylori are co-
factors for the formation of peptic ulcer disease. There is a strong
association between H. pylori infection and cigarette smoking in patients
with and without peptic ulcers. Cigarette smoking may increase
susceptibility, diminish the gastric mucosal defensive factors, or may
provide a more favorable milieu for H. pylori infection.
● Drinking alcohol and Diet: Alcohol and Diet: Although alcohol has been
shown to induce damage to the gastric mucosa in animals, it seems to
be related to the absolute ethanol administered (200 proof). Pure
ethanol is lipid soluble and results in frank, acute mucosal damage.
Because most humans do not drink absolute ethanol, it is unlikely there
is mucosal injury at ethanol concentrations of less than 10% (20 proof).
● Untreated stress: Some types of food and beverages are reported to
cause dyspepsia. There is no convincing evidence that indicates any
specific diet causes ulcer disease. Epidemiologic studies have failed to
reveal a correlation between caffeinated, decaffeinated, or cola-type
beverages, beer, or milk with an increased risk of ulcer disease.
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COMPLICATIONS
If left untreated, duodenal ulcers can result to:
● Internal bleeding: Bleeding can occur as slow blood loss that leads to
anemia or as severe blood loss that may require hospitalization or a
blood transfusion. Severe blood loss may cause black or bloody vomit
or black or bloody stools.
● Perforation in stomach wall: Peptic ulcers can eat a hole through
(perforate) the wall of your stomach or small intestine, putting you at
risk of serious infection of your abdominal cavity (peritonitis).
● Obstructions: Peptic ulcers can block passage of food through the
digestive tract, causing you to become full easily, to vomit and to lose
weight either through swelling from inflammation or through scarring.
● Gastric Cancer: Studies have shown that people infected with H. pylori
have an increased risk of gastric cancer.
ASSESSMENT
● Assess patient’s history
● Assess patient’s physical condition
● Perform physical examination (endoscopy or an X-Ray)
PREVENTION
It may also be helpful to:
● Protect self from infections. It's not clear just how H. pylori spreads, but
there's some evidence that it could be transmitted from person to
person or through food and water. To protect from infection, practice
washing your hands with soap and water and by eating foods that have
been cooked completely.
● Use caution with pain relievers.: Regular use of pain relievers increases
the risk of peptic ulcer, take steps to reduce your risk of stomach
problems. For instance, take medication with meals. Work with the
physician to find the lowest dose possible that still gives pain relief.
Avoid drinking alcohol when taking medication, since the two can
combine to increase your risk of stomach upset.
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TREATMENT
Treatment for duodenal ulcers depends on the causes and how severe your
symptoms are:
● Medications (H2Blockers or PPIs) - to reduce the amount of acid and
protect your stomach lining.
● Surgery - to fix the problem.
ANATOMY AND PHYSIOLOGY (DUODENAL ULCER)
Duodenum -is the first part of the small intestine. It is located between the
stomach and the middle part of the small intestine, or jejunum. After foods
mix with stomach acid, they move into the duodenum, where they mix with
bile from the gallbladder and digestive juices from the pancreas.
Duodenal ulcer -is an ulcer that occurs in the lining in the part of the small
intestine just beyond the stomach (the duodenum).
Esophagogastric junction -is a muscle, not a mucosal, junction. The
boundary of the esophagus is at the upper esophageal sphincter and lower
esophageal sphincter (LES) at the oral and anal ends, respectively.
Pylorus, cone-shaped constriction in the gastrointestinal tract that

demarcates the end of the stomach and the beginning of the small intestine.
The main functions of the pylorus are to prevent intestinal contents from
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reentering the stomach when the small intestine contracts and to limit the
passage of large food particles or undigested material into the intestine.
Stomach -is a muscular organ located on the left side of the upper abdomen.
The stomach receives food from the esophagus. The stomach secretes acid
and enzymes that digest food.
Ulcer -is a sore, which means it's an open, painful wound.
Peptic ulcers are ulcers that form in the stomach or the upper part of the small
intestine, called the duodenum.
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When H. pylori colonizes it leads to an increase of mucosal injury and will
result to gastric metaplasia inflammation. This is where duodenal ulceration
happens. If left untreated, complications will arise thus bleeding happens. This
can cause patient to be in severe condition and even death.
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ANEMIA SEVERE SEC TO #1
Anemia happens when you do not have enough red blood cells. The cells travel
with iron and hemoglobin, which is a protein that helps carry oxygen through
the bloodstream to your organs all through the body. When someone develops
anemia, they are said to be "anemic." Being anemic might mean that you feel
more tired or cold than you usually do, or if your skin seems too pale. This is
due to your organs not receiving the oxygen they need to do their jobs. Some
people find out they are low in iron when they go to donate blood.
ARE THERE DIFFERENT KINDS OF ANEMIA?

There are several different types of anemia, but each of them causes the
number of red blood cells in circulation to drop. Red blood cell levels are low
due to one of the following reasons:
• Your body cannot make enough hemoglobin (low hemoglobin).
• Your body makes hemoglobin, but the hemoglobin doesn't work
correctly.
• Your body does not make enough red blood cells.
• Your body breaks down red blood cells too quickly.
Iron deficiency anemia
This most common type of anemia is caused by a shortage of iron in your
body. Your bone marrow needs iron to make hemoglobin. Without adequate
iron, your body can't produce enough hemoglobin for red blood cells.
Pernicious anemia
In a strict sense, pernicious anemia happens when a person lacks something
called intrinsic factor, which lets them absorb vitamin B12. Without vitamin
B12, the body cannot develop healthy red blood cells. Other types of anemia
that involve lack of B vitamins, such as B9 (folic acid), are also often lumped
in as pernicious anemia. This name may refer to other conditions, including
folic acid deficiency anemia and Addison’s anemia, even though there is no
intrinsic factor deficiency.
Hemolytic anemia
This type of anemia can be caused by inherited or acquired diseases that cause
the body to make deformed red blood cells that die off too quickly. (An
acquired disease is one that you didn’t have when you were born.) If it is not
genetic, hemolytic anemia can be caused by harmful substances or reactions
to certain drugs.
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Sickle cell anemia
This genetic form of anemia happens because the shape of the red blood cells
is faulty. They are sickle shaped, which means that they can clog the blood
vessels and cause damage. The hemoglobin does not work correctly. This type
of anemia is most often, but not always, found in African Americans.
Aplastic anemia
This is a type of anemia in that is caused by damaged bone marrow which is
unable to make enough red blood cells. It also may be congenital or acquired.
Another name for aplastic anemia is bone marrow aplasia (failure). Some
people might think of this condition as cancer, but it is not.
There is something referred to by some people as myelodysplastic anemia.
However, myelodyplastic syndromes (MDS) refer to actual cancer and are a
result of abnormal cells in the bone marrow.
Thalassemia
Is an inherited blood disorder that causes your body to have less hemoglobin
than normal Hemoglobin enables red blood cells to carry oxygen. Thalassemia
can cause anemia, leaving you fatigued.
HOW COMMON IS ANEMIA?

Anemia affects more than two billion people globally, which is more than 30%
of the total population. It is especially common in countries with few
resources, but it also affects many people in the industrialized world. Within
the U.S., anemia is the most common blood condition. An estimated three
million Americans have the disorder.
Prevalence of anemia among non-pregnant women (% of women ages 15-49)

in Philippines was 14.90 as of 2016. Its highest value over the past 26 years
was 37.70 in 1990, while its lowest value was 14.90 in 2016.
Who is most likely to develop anemia?

Anyone can develop anemia, although the following groups have a higher risk:
• Women: Blood loss during monthly periods and childbirth can lead to
anemia. This is especially true if you have heavy periods or a condition
like fibroids.
• Children, ages 1 to 2: The body needs more iron during growth spurts.
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• Infants: Infants may get less iron when they are weaned from breast
milk or formula to solid food. Iron from solid food is not as easily taken
up by the body.
• People over 65: People over 65 are more likely to have iron-poor diets
and certain chronic diseases.
• People on blood thinners: These medications include drugs include

aspirin, clopidogrel (Plavix®), warfarin (Coumadin®), heparin products,
apixaban (Eliquis®), betrixaban (BevyxXa®), dabigatran (Pradaxa®),
edoxaban (Savaysa®) and rivaroxaban (Xarelto®).
CAUSES:
Anemia occurs when your blood doesn't have enough red blood cells.
This can happen if:
• Your body doesn't make enough red blood cells
• Bleeding causes you to lose red blood cells more quickly than they can be
replaced
• Your body destroys red blood cells
Anemia signs and symptoms vary depending on the cause. If the anemia is
caused by a chronic disease, the disease can mask them, so that the anemia
might be detected by tests for another condition.
Depending on the causes of your anemia, you might have no symptoms. Signs
and symptoms, if they do occur, might include:
• Fatigue
• Weakness
• Pale or yellowish skin
• Irregular heartbeats
• Shortness of breath
• Dizziness or lightheadedness
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• Chest pain
• Cold hands and feet
• Headaches
COMPLICATIONS:
Left untreated, anemia can cause many health problems, such as:
• Severe fatigue. Severe anemia can make you so tired that you can't
complete everyday tasks.
• Pregnancy complications. Pregnant women with folate deficiency

anemia may be more likely to have complications, such as premature
birth.
• Heart problems. Anemia can lead to a rapid or irregular heartbeat

(arrhythmia). When you're anemic your heart must pump more blood to
make up for the lack of oxygen in the blood. This can lead to an enlarged
heart or heart failure.
• Death. Some inherited anemia, such as sickle cell anemia, can lead to
life-threatening complications. Losing a lot of blood quickly results in
acute, severe anemia and can be fatal.
PREVENTION:
Many types of anemia can't be prevented. But you can avoid iron deficiency
anemia and vitamin deficiency anemia by eating a diet that includes a variety
of vitamins and minerals, including:
• Iron. Iron-rich foods include beef and other meats, beans, lentils, iron-
fortified cereals, dark green leafy vegetables, and dried fruit.
• Folate. This nutrient, and its synthetic form folic acid, can be found in
fruits and fruit juices, dark green leafy vegetables, green peas, kidney
beans, peanuts, and enriched grain products, such as bread, cereal, pasta
and rice.
• Vitamin B-12. Foods that are rich in vitamin B-12 include meat, dairy
products, and fortified cereal and soy products.
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• Vitamin C. Foods rich in vitamin C include citrus fruits and juices,
peppers, broccoli, tomatoes, melons and strawberries. These also help
increase iron absorption.
ANATOMY AND PHYSIOLOGY

Anemia Severe Secondary to Upper GI Bleeding
Anemia is characterized by decreased oxygen delivery to the tissues, muscle

tissue is particularly affected that is caused by the lower than usual number
of red blood cells. Decreased oxygen delivery to the tissues and organs is one
of the main effects of anemia on the circulatory system.
Circulatory system is made up of your heart and an intricate network of

blood vessels. The purpose of this system is to keep all the cells in your body
supplied with fresh oxygen and nutrients while removing carbon dioxide and
other waste products.
The Heart- About the size of two adult hands held together, the heart rests
near the center of the chest. Thanks to consistent pumping, the heart keeps
the circulatory system working at all times.
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Arteries- carry oxygen-rich blood away from the heart and where it needs to
go.
Veins- carry deoxygenated blood to the heart where it is directed to the lungs
to receive oxygen.
Capillaries- the smallest and most numerous of the blood vessels, form the
connection between the vessels that carry blood away from the heart
(arteries) and the vessels that return blood to the heart
(veins). Function of capillaries is to exchange materials between the blood
and tissue cells.
Blood-is the transport media of nearly everything within the body. It
transports hormones, nutrients, oxygen, antibodies, and other important
things needed to keep the body healthy.
Functions of the Different Systems Affected
Skeletal System- Bones also serve as a site for fat storage and blood cell
production. The unique connective tissue that fills the interior of most bones
is referred to as bone marrow. Red bone marrow is where the production of
blood cells (named hematopoiesis, hemato- = “blood”, -poiesis = “to make”)
takes place. Red blood cells, white blood cells, and platelets are all produced
in the red bone marrow.
Urinary System- Kidneys activate vitamin D, which helps to maintain strong
bones, and produce erythropoietin, a hormone that is vital for
the production of red blood cells.
Respiratory system- works directly with the circulatory system to provide
oxygen to the body. Oxygen taken in from the respiratory system moves into
blood vessels that then circulate oxygen-rich blood to tissues and cells.
Digestive System- Help in digestion and absorption of food high in Vit B12
and Iron rich foods which are essential for red blood cell production.
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REFLUX ESOPHAGITIS GRADE A
Reflux esophagitis is an esophageal mucosal injury that occurs secondary to
retrograde flux of gastric contents into the esophagus. Clinically, this is referred to
as gastroesophageal reflux disease (GERD). Typically, the reflux disease involves the
distal 8-10 cm of the esophagus and the gastroesophageal junction. The disease is
patchy in distribution.
Esophagitis is inflammation that may damage tissues of the esophagus, the

muscular tube that delivers food from your mouth to your stomach.
Esophagitis can cause painful, difficult swallowing and chest pain. Causes of
esophagitis include stomach acids backing up into the esophagus, infection,
oral medications and allergies.
ASSESSMENT OF SIGNS AND SYPMTOMS

Reflux esophagitis is primarily seen in patients who are immunocompromised.
The most common causes of infectious esophagitis are fungal and viral. A
history of immunosuppression, steroid therapy, recent antibiotic use, or
systemic illness supports the diagnosis.
COMMON SIGNS AND SYMPTOMS OF ESOPHAGITIS INCLUDE:
• Difficult swallowing
• Painful swallowing
• Chest pain, particularly behind the breastbone, that occurs with eating
• Swallowed food becoming stuck in the esophagus (food impaction)
• Heartburn
• Acid regurgitation
In infants and young children, particularly those too young to explain their
discomfort or pain, signs of esophagitis may include:
• Feeding difficulties
• Failure to thrive
PREDISPOSING FACTOR:
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Risk factors for developing esophagitis include:
• weakened immune system due to HIV or AIDS, diabetes, leukemia,

or lymphoma
• hiatal hernia (when the stomach pushes through the opening in the diaphragm
between the esophagus and stomach)
• chemotherapy
• radiation therapy of the chest
• surgery in the chest area
• medications to prevent organ transplant rejection
• immunosuppressive medications used to treat autoimmune diseases
• aspirin and anti-inflammatory medications
• chronic vomiting
• obesity
• alcohol and cigarette use
• a family history of allergies or esophagitis
Your chance of developing an infection of the esophagus is low if you have a

healthy immune system.
PRECIPITATING FACTOR:
• Eating immediately before going to bed.
• Dietary factors such as excess alcohol, caffeine, chocolate and mint-flavored

foods.
• Excessively large and fatty meals.
• Smoking.
COMPLICATION:
Left untreated, esophagitis can lead to changes in the structure of the

esophagus. Possible complications include:
• Scarring or narrowing (stricture) of the esophagus
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• Tearing of the esophagus lining tissue from retching (if food gets stuck) or during
endoscopy (due to inflammation)
• Barrett's esophagus, characterized by changes to the cells lining the esophagus,

increasing your risk of esophageal cancer
ANATOMY AND PHYSIOLOGY
TRACHEA - also known as the windpipe, is a cartilaginous tube that connects

the larynx to the bronchi of the lungs, allowing the passage of air,
ESOPHAGUS - a hollow muscular tube that transports saliva, liquids, and
foods from the mouth to the stomach.
UPPER ESOPHAGEAL SPHINTER - is a bundle of muscles at the top of
the esophagus. The muscles of the UES are under conscious control, used
when breathing, eating, belching, and vomiting.
LOWER ESOPHAGEAL SPHINTER - located at the distal end where it meets
the stomach, is composed of a bundle of smooth muscle and functions to
protect the reflux of gastric contents into the esophagus.
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DIAPHRAGM - is the major muscle of respiration. It is a large, dome-shaped
muscle located below the lungs that contracts rhythmically and continually,
and most of the time, involuntarily. Upon inhalation, the diaphragm contracts
and flattens and the chest cavity enlarges.
STOMACH - temporary storage for food, which passes from the esophagus to
the stomach. mixing and breakdown of food by contraction and relaxation of
the muscle layers in the stomach. digestion of food.
PYLORIC SPHINTER - is a band of smooth muscle at the junction between
the pylorus of the stomach and the duodenum of the small intestine. It plays
an important role in digestion, where it acts as a valve to controls the flow of
partially digested food from the stomach to the small intestine.
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GOALS
The goal of the case study is to describe the medical condition’s final diagnosis
process which are the Upper Gastrointestinal Bleeding Sec To Duodenal Ulcer;
Anemia Severe Sec To #1 Reflux Esophagitis Grade A. This will also come up
will the study with regards to the treatment or management provided on the
given case. Identify the nursing management that will correlate the illness.
Properly recognize the part of the body affected from the disease as well as
its function. Discuss the laboratory and diagnostic findings and the normal
level/result.
OBJECTIVES
A. General Objectives
After 3-4 days of exposure at Southwestern University Medical Center, being
aided with the concept of, Care of Clients with Problems in Nutrition and GI
Tract, Endocrine System, Perception and Coordination, the student nurses will
be able to demonstrate competencies in knowledge, skills, and attitudes of an
effective clinician in evaluating and caring for patients with Gastrointestinal
Bleeding, Anemia, and Reflux Esophagitis in the health care setting.
B. Specific Objectives
1. Apply the nationally recognized guidelines for screening and diagnosing

Gastrointestinal Bleeding, Anemia, and Reflux Esophagitis.
2. Apply the practice guidelines for the treatment of patients with

Gastrointestinal Bleeding, Anemia, and Reflux Esophagitis.
3. Identify appropriate elements of assessment and interventions with the

diseases.
4. Explain the anatomy and physiology of the organs or systems involved in

the disease.
5. Analyze and understand the pathophysiology of Gastrointestinal Bleeding,
Anemia, and Reflux Esophagitis.
6. Formulate management plans for the care of patients with Gastrointestinal

Bleeding, Anemia, and Reflux Esophagitis.
7. Discuss treatment plans with patients in an empathic, disclosed, and

respectful manner.
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8. Use information technology to access patient and family education
resources on Gastrointestinal Bleeding, Anemia, and Reflux Esophagitis.
9. Critically review and implement the medical literature regarding new

evidence-based clinical trials and their implication on current treatment
guidelines of Gastrointestinal Bleeding, Anemia, and Reflux Esophagitis.
10. Improve patient care outcomes through effective communication with

other health care staff/professionals, community resources, and government
agencies.
SIGNIFICANCE OF THE STUDY

This study aims to provide education on:
1. the definition of upper gastrointestinal bleeding sec to duodenal ulcer;
anemia severe sec to #1 reflux esophagitis grade a
2. the disease process and its possible causes;
3. provide information about the signs and symptoms;
4. the anatomy and physiology of the disease; and
5. its treatment.
This study can benefit to the following:
Patient. This study will help the patient to have knowledge about his
condition, to be educate and aware of themselves in knowing its causes, signs
and symptoms, and factors with these diseases.
Family/ Significant Others. This study will help them to gain insight about
the patient’s condition and become aware of the situation. In addition, it helps
them provide a support system for the patient.
Students. This study will give information and to gain insights towards
patients on how to handle and apply the information provided with regards to
these diseases. To promote and enhance understanding regarding these
diseases.
School. This study will help to give more ideas that can help to promote their
strategies on handling diseases. Provide information and helps in enhancing
their understanding towards the case.
29
Healthcare Workers. This study will provide further knowledge and discover
more concepts relating to the causes, complication, modifiable and non-
modifiable factors, nursing interventions and treatments.
Healthcare Industry. This study will have a profound opportunity for

healthcare industries to build new concepts and discoveries relating to the
diagnosis, prognostic factors, treatments, appropriate nursing interventions
and early detection on people who are at risk for such disorder.
DEFINITION OF TERMS
Acid reflux/regurgitation. Is a common condition that features a burning
pain, known as heartburn, in the lower chest area. It happens when stomach
acid flows back up into the esophagus.
Acute bleeding. Bleeding that is of recent duration, originates beyond the
ligament of Treitz, results in instability of vital signs, and is associated with
signs of anemia with or without the need for blood transfusion.
AIDS. Acquired immunodeficiency syndrome is a term that applies to the most
advanced stages of HIV infection.
Anemia. Is a condition in which the number of red blood cells or the
haemoglobin concentration within them is lower than normal.
Aplastic Anemia. Is a type of anemia that is caused by damaged bone
marrow which is unable to make enough red blood cells.
Barrett's esophagus. A condition in which the lining of the esophagus
changes, becoming more like the lining of the small intestine rather than the
esophagus. This occurs in the area where the esophagus is joined to the
stomach.
Bone marrow. Is the spongy or viscous tissue that fills the inside of the
bones. This includes red bone marrow (produces blood cells) and yellow bone
marrow (helps store fat).
Duodenal ulcer. Is a peptic ulcer that develops in the first part of the small
intestine (duodenum).
Duodenum. The first part of the small intestine immediately beyond the
stomach, leading to the jejunum.
Dyspepsia. A persistent or recurrent pain or discomfort in the upper
abdomen.
30
Esophageal varices. Are abnormal, enlarged veins in the tube that connects
the throat and stomach (esophagus). This condition occurs most often in
people with serious liver diseases. Esophageal varices develop when normal
blood flow to the liver is blocked by a clot or scar tissue in the liver.
Esophagitis. Is an inflammation that may damage the tissues of the
esophagus.
Folate. Also known as vitamin B9 and folacin, is one of the B vitamins.
GERD. Gastroesophageal reflux disease occurs when stomach acid frequently
flows back into the tube connecting your mouth and stomach (esophagus).
This backwash (acid reflux) can irritate the lining of your esophagus.
H.pylori. Helicobacter pylori, previously known as Campylobacter pylori, is a
gram-negative, microaerophilic, spiral bacterium usually found in the
stomach.
Heartburn. Is a burning pain in your chest, just behind your breastbone. The
pain is often worse after eating, in the evening, or when lying down or bending
over.
Hematemesis. Vomiting of blood.
Hematochezia. Refers to fresh, red blood in your stool. This blood might be
mixed in with your stool or come out separately.
Hemodynamics. Refers to basic measures of cardiovascular function, such
as arterial pressure or cardiac output. It deals with the circulation of the blood.
Hemoglobin. Is a protein in the red blood cells that carries oxygen to the
body's organs and tissues and transports carbon dioxide from the organs and
tissues back to your lungs.
Hemolytic Anemia. Is a disorder in which red blood cells are destroyed faster
than they can be made.
Hiatal hernia. An anatomical abnormality in which part of the stomach
protrudes up through the diaphragm into the chest.
HIV. Human immunodeficiency virus, a virus that attacks the body's immune
system.
Immunosuppressants. Are drugs or medicines that lower the body's ability
to reject a transplanted organ. Another term for these drugs is anti-rejection
drugs.
Internal bleeding. Or hemorrhaging is bleeding that occurs inside the body
when a blood vessel is damaged.
31
Iron. An important mineral the body needs to make hemoglobin, a substance
in the blood that carries oxygen from the lungs to tissues throughout the body.
Iron is also an important part of many other proteins and enzymes needed by
the body for normal growth and development.
Iron deficiency anemia. Is a common type of anemia in which the blood
lacks adequate healthy red blood cells. As the name implies, iron deficiency
anemia is due to insufficient iron.
Leukemia. Is cancer of the body's blood-forming tissues, including the bone
marrow and the lymphatic system. It usually involves the white blood cells.
Lymphoma. Is a cancer of the lymphatic system, which is part of the body's
germ-fighting network.
Mallory-weiss tears. Refers to a tear or laceration of the mucous membrane,
most commonly at the point where the esophagus and the stomach meet
(gastroesophageal junction).
Melena. Black, tarry stools.
Occult bleeding. A gastrointestinal bleeding that is not visible to the patient
or physician, resulting in either a positive fecal occult blood test, or iron
deficiency anemia with or without a positive fecal occult blood test.
Overt bleeding. Is visible bleeding such as hematemesis , hematochezia or
melena.
Perforation. A hole or break in the containing walls or membranes of an
organ or structure of the body. Perforation occurs when erosion, infection, or
other factors create a weak spot in the organ and internal pressure causes a
rupture. It also may result from a deep penetrating wound caused by trauma.
Peritonitis. Is an inflammation of the peritoneum — a silk-like membrane
that lines your inner abdominal wall and covers the organs within your
abdomen — that is usually due to a bacterial or fungal infection.
Pernicious Anemia. Is a type of vitamin B12 anemia.
Sickle cell Anemia. An inherited disease in which the red blood cells have
an abnormal crescent shape, block small blood vessels, and do not last as long
as normal red blood cells.
Shock. Is a life-threatening condition that occurs when the body is not getting
enough blood flow. Lack of blood flow means the cells and organs do not get
enough oxygen and nutrients to function properly.
Thalassemia. Is an inherited blood disorder that causes the body to have
less hemoglobin than normal.
32
Ulcerations. The formation of a break on the skin or on the surface of an
organ. An ulcer forms when the surface cells die and are cast off.
Upper Gastrointestinal Bleeding. A blood loss from a gastrointestinal
source above the ligament of Treitz (the suspensory ligament of the
duodenum), in the esophagus, stomach, or duodenum.
Vitamin C. Is an essential nutrient involved in the repair of tissue and the
enzymatic production of certain neurotransmitters.
Vitamin B12. Also known as cobalamin, is a water-soluble vitamin involved
in the metabolism of every cell of the human body.
CEPHALO-CAUDAL ASSESSMENT
NEUROLOGICAL
Upon assessment the patient was oriented to person, place, time and
event. He seems slightly agitated due to his condition. The patient reported
that he almost fainted because he felt weak and often felt dizziness. The
patient is responsive to touch and voice.
The patient verbalized that he experience a dull, gnawing, sharp,
sometimes burning pain in the right upper quadrant and it is often relieved by
eating or taking some antacids. The pain usually occurs before meals, or when
he is hungry. The patient is asked about the severity of the pain and he replied
that it is usually around 6 to 7 over 10 which 1 is the lowest and 10 is the
highest.
EYES
The patient’s pupils are equal, round, reactive to light, and
accommodated. But his eyes are sunken (signs of dehydration). The patient’s
eyebrow has evenly distributed hair with skin intact, symmetrically aligned
and has equal movement. Eyelashes have equally distributed hair and curled
slightly outward. Eyes are symmetrical and aligned in sockets. Eyelids are in
normal position with no abnormal widening or ptosis. Darkened periorbital
puffiness are visible. No redness, discharge, or crusting noted on lid margins.
SKIN, HAIR, NAILS
The patient’s skin is intact, pale, and has poor skin turgor but no scars
or any lesions are present. Patient has a proper haircut of black hair color
which is dry and with no evidence of alopecia. Hair is kempt. The scalp is clean
and dry without lesions, patches and dandruff. Nails are trimmed and no
clubbing seen, but capillary refill is more than 3 seconds.
33
CARDIOVASCULAR
The client’s heart has no palpable pulsation over the aortic, pulmonic,
and mitral valves. No noted abnormal heaves, and thrills felt over the apex
and no abnormal heart sounds and murmur. Heart rate is normal with 83 bpm.
Capillary refill is more than 3 seconds. Patient’s blood pressure is 120/60
mmhg and HR of 96 bpm.
CHEST
The patient is tachypneic with a respiratory rate of 21 cpm. Lung sounds
are clear, and no cough is present. Patient’s chest wall is intact, chest pain,
shortness of breath and cough is noted, chest expansion is present.
Adventitious breath sounds are heard during auscultation, crackles noted at
both lungs in the 3rd intercostal space, presence of dullness to percussion.
GASTROINTESTINAL
Mucous membrane is dry, pale, but no lesions or crusting present. Gums
are intact. The patient says that he experience heartburn (pyrosis) often
resulting to having esophagitis. The patient’s abdomen is distended and
tender on the right upper quadrant. There is presence of bowel sounds in all
four quadrants upon auscultation. The patient reports of having melena in the
stool.
MUSCULOSKELETAL
The patient’s musculoskeletal is remarkable. Hand grips are equal in
strength, as well as the foot pushes are equal in strength. The patient can
perform ADLs without assistance, he can turn himself, sits independently,
stand, and walks independently.
UPPER EXTREMITIES
Both extremities are equal in size, have the same contour with
prominences of joints, there is slight involuntary movement in the left arm.
Temperature is warm and even. Can perform complete range of motion on the
right arm but there is inability to rotate on the left arm.
LOWER EXTREMITIES
Both extremities are equal in size, have the same contour with prominences
of joints, no crepitus noted and can counter act gravity in resistance to ROM.
Toenails are trim and clean.
GENITALS
Patient voids more than 3 times a day, approximately 980 ml; pain and
burning sensation upon urination is not present. No signs of lesions,
34
inflammation, and swelling in the scrotum, penis has no unusual discharges,
swelling and lesions.
35
LABORATORY AND DIAGNOSTIC STUDIES
Diagnostic Procedure Indication or Purpose Result and/or Possible Result Normal Values Nursing Responsibilities
(Before, During and
After)
COVID-19 Rapid Antibody - The test detects the November 18, 2020; 5:37:56 PM IgG antibody - negative Before:
Test (Qualitative) presence of patient- Test Result IgM antibody - negative
generated IgG Negative 1. Use universal
antibodies against antibody precautions and use
SARS-CoV-2, the IgM Negative of PPE when about
virus which causes antibody to swab. Observe
the disease COVID- proper hand
19. hygiene.
- The test can detect Interpretation: Negative 2. Introduce yourself
two types of and Identify the pt.
antibody isotypes: Remarks: A negative test means the 3. Label the clinical
IgG and IgM. patient was not infected with COVID- specimen using two
19 virus identifiers.
4. Discuss the test to
be done to the pt.
5. Encourage patient
to ask for questions
when procedure is
not understood well.
During:
36
6. Prepare the patient
for the test and
encourage patient
to take deep
breaths.
7. Insert slowly and
gently the minitip
swab. Leave it for
seconds to absorb
secretions.
8. Slowly remove the
swab and place
swab into the tube
provided.
After:
9. Throw the PPE used
and perform proper
hand hygiene.
10. Deliver specimen to
the lab promptly.
11. Document the
findings
37
Diagnostic Procedure Indication or Purpose Result and/or Possible Normal Values Nursing Responsibilities
Result (Before, During and After)
November 18, 2020;
Urine Analysis - A urinalysis is used to 7:13:07 PM Before:
detect and manage a
wide range of MACROSCOPIC 1. Perform proper hand
disorders, such as EXAMINATION: hygiene
urinary tract Color: Yellow (light/pale to 2. Introduce yourself
infections, kidney Color: Light Yellow dark/deep amber) and identify the pt.
disease and diabetes. Volume: 40 mL Transparency: Clear 3. Provide patient a
- A urinalysis involves Transparency: Clear Specific gravity: 1.005- special kit to collect
checking the Specific Gravity: 1.015 1.025 the urine (It will
appearance, most likely have a
concentration and CHEMICAL EXAMINATION: cup with a lid and
content of urine. wipes)
Albumin: Negative Albumin: negative 4. Encourage patient to
pH: 5.0 pH: 4.5-8.0 ask for questions
Ketone: Negative Ketone: negative when procedure is
Blood: Negative Blood: negative not understood well.
Glucose: Negative Glucose: negative
Nitrite: Negative Nitrite: negative During:
Bilirubin: Negative Bilirubin: negative
Urobilinogen: Normal Urobilinogen: Normal 5. Instruct patient to
obtain a clean catch
MICROSCOPIC urine sample.
EXAMINATION: 6. For women,
encourage the
38
WBC: 0-1/HPF patient to clean
RBC: 0-1/HPF WBC: 0-5/hpf between the vagina
Epithelial cells: rare RBC: 0-3/hpf "lips" (labia) before
Mucus threads: rare Epithelial cells: rare urinating.
Bacteria: rare Mucus threads: rare For men, Clean the
Bacteria: rare head of the penis
Crystals: with a sterile wipe
Amorphous urates: Moderate before urinating.
Amorphous urates: rare 7. Advise patient to
urinate a small
amount in the toilet
then collect the
sample in the cup
provided.
8. Remind the patient
not to touch the
inside of the cup to
avoid transfer of
bacteria.
After:
9. Instruct the patient

to screw the lid
tightly on the cup.
39
Do not touch the
inside of the cup or
the lid.
10. Encourage the
patient to wash
hands after
collecting the urine.
11. Secure and deliver
specimen to the lab
promptly.
12. Document the
findings
40
Diagnostic Procedure Indication of Purpose Results and/or Normal Values Nursing Responsibilities for all blood
Possible Results tests (Before, After, During)
Sodium Test Measures how much Sodium- 140.0 mmol/L 136-145 mmol/L
sodium is in the blood. Interpretation: Low sodium Before:
It is used to detect an NORMAL indicates 1. Perform proper hand hygiene.
abnormal sodium level, Hyponatremia 2. Introduce yourself and identify the
including low sodium patient.
(hyponatremia) and High sodium 3. Label the clinical specimen using
high sodium indicates two identifiers.
(hypernatremia). It Hypernatremia 4. Explain the purpose of this test.
helps keep the amount 5. Encourage patient to ask for any
of fluid inside and questions that is not being understood
outside the body’s cells well with the procedure.
and electrolyte balance
of the body.
3.5-5.1 mmol/L
Potassium Test Measures the amount Potassium- 4.20 Low potassium During:
of potassium in the mmol/L indicates 6. Instruct patient to comfortably
blood.It is used to Interpretation: Hypokalemia seated in a chair.
detect abnormal NORMAL High potassium 7. Inspect for accessible veins.
potassium levels, indicates 8. Clean the skin where the needle
including high Hyperkalemia goes in.
41
potassium 9. Insert the needle into a vein of the
(hyperkalemia) and arm, elbow or back of the
low potassium hand.
(hypokalemia). 10. Once sample has obtained, they
Potassium is an remove the needle and cover the site
electrolyte that’s with gauze or bandage.
essential for proper

muscle and nerve
function.
After:
Creatinine Test Measures the level of Creatinine- 1.04 mg/dl 0.51-0.95 mg/dl 11. Dispose the needles to its
creatinine in the blood Interpretation: Above Low creatinine level designated trash bin properly.
to check kidney the normal range means that there is 12. Throw the gloves and wash hands
function. too little creatinine properly.
High levels of being produced in 13. Deliver the specimen to the lab and
creatinine can indicate the body document the findings.
that your kidneys High levels of

aren’t working well. creatinine usually
mean that there is
too much creatinine
in the body
42
Measures the amount
Blood Urea Nitrogen of nitrogen in your BUN- 7.893 mg/dl 6.0-20.0 mg/dl
(BUN) Test blood that comes from Interpretation: If your levels are off
the waste product NORMAL the normal range,
urea. this could mean
that either your
kidneys or your
liver may not be
working properly.
Measures the amount
of ALT in
ALT(SGPT) the blood. It is also a ALT- 17.66 U/L 0-41 U/L
type for Interpretation: High levels of ALT in
liver function test. NORMAL the blood can
indicate a liver
problem/damage.
Chemical Chemistry
43
Fasting Blood Sugar Measures the glucose FBS- 92.53 mg/dL
(FBS) Test levels in your blood. Interpretation: 70-100 mg/dL
This test is used to find NORMAL
out if your blood sugar
levels are in the
healthy range.
Cholesterol Measures the amount Cholesterol- 117.9 0-200 mg/dL

of each type of mg/dL
cholesterol and certain Interpretation:
fats in your blood. NORMAL
25-148 mg/dL
Triglycerides Measures the amount Triglycerides- 168.6

of triglycerides in your mg/dL
blood. Interpretation: Above
the normal range
Higher than normal

triglyceride levels may
put you at risk for
heart disease.
44
35-88 mg/dL
High density Measures the level of HDL- 41.87 mg/dL
lipoprotein (HDL) cholesterol. It is Interpretation:
sometimes called the NORMAL
"good" cholesterol
because it carries
cholesterol from other
parts of your body
back to your liver.
0-150 mg/dL
Low density lipoprotein Measures the level of LDL- 42.3 mg/dL
(LDL) cholesterol. It is Interpretation:
sometimes called the NORMAL
"bad" cholesterol
because a high LDL
level lead
to a buildup of
cholesterol in
your arteries.
45
0-42 mg/dL
Measures the amount VLDL- 33.7 mg/dL
Very low-density of very low-density Interpretation:
lipoprotein (VLDL) lipoprotein in your NORMAL
blood. VLDL cholesterol
is a type of blood fat.
It is considered one of
the “bad” forms of
cholesterol.
46
Diagnostic Indication or Result and or Normal Values Nursing
Procedure Purpose Possible Result Responsibilities
Creatinine A creatinine test is 0.93mg/dL 0.51-0.95mg/dL Before:
a measure of how Interpretation: 1. Verify doctor’s order for
well your kidneys Normal Low creatinine laboratory tests.
are performing their count means that 2. Discuss to the patient the
job of filtering there is too price, purpose of the test,
waste from your little creatine being procedures,and the normal
blood. produced in the and abnormal findings.
body. 3. Encourage patient to ask for
High serum any questions about the test.
creatinine levels in During:
the blood indicate 4. Instruct patient to be
that the kidneys comfortably seated in a chair.
aren’t functioning 5. Inspect for accessible vein.
properly. 6. Wipe with alcohol swab where
Potassium A potassium blood 3.70mmol/L 3.5-5.1mmol/L the needle goes in.
test is used to Interpretation: 7. Insert the needle into a vein of
detect abnormal Normal Low potassium the arm.
potassium levels, count indicates 8. Once appropriate amount of
including high hypokalemia, blood is obtained, remove the
47
potassium High potassium needle and cover the size with
(hyperkalemia) and count indicates gauze or bandage.
low potassium hyperkalemia. After:
(hypokalemia). It is 9. Dispose the needles to its
often used as part designated bin properly.
of an electrolyte 10. Throw the gloves and wash
panel or basic hands properly.
metabolic panel for 11. Deliver the specimen to the
a routine health lab.
exam. 12. Monitor the patient’s lab
results.
13. If results are available, refer
results to the physician.
48
Diagnostic Indication Result and or Possible Normal Values Nursing
Procedure or Purpose Result Responsibilities
Complete Blood Count The blood Before:
Result Unit Range
& Differential differential 1. Verify doctor’s order for
WBC 16.38 103 /𝑚𝑚3 WBC 4.4-11.
test can laboratory tests.
H!
(November 18, 2020 detect 2. Discuss to the patient the
Interpretation:
@ 6:04PM) abnormal or price, purpose of the test,
- A high white blood
immature procedures, and the normal
cell count may indicate that
cells. It can and abnormal findings.
the immune system is
also 3. Encourage patient to ask
working to destroy an
diagnose an for any questions about the
infection.
infection, test.
inflammatio During:
n, 4. Instruct patient to be
leukemia, Result Range comfortably seated in a chair.
or an % # % # 5. Inspect for accessible vein.
immune NEU 63.1 10.34 NEU 37.0- 1.8-7.8 6. Wipe with alcohol swab
system LYM 23.3 3.82 80.0 where the needle goes in.
disorder. MON 8.8 1.44 LYM 10.0- 1.0-4.8 7. Insert the needle into a
EOS 4.1 0.67 50.0 vein of the arm.
49
BAS 0.7 0.11 MON 0.0- 0.0-1.0 8. Once appropriate amount
12.0 of blood is obtained, remove
EOS 0.0-7.0 0.0-0.4 the needle and cover the size
BAS 0.0-2.5 0.0-0.2 with gauze or bandage.
Result Unit Range After:
RBC 1.70 106/𝑚𝑚3 RBC 4.5-5.9 9. Dispose the needles to its
HGB 5.7 L! G/dL HGB 14.0-17.5 designated bin properly.
HCT 15.8 L! % HCT 41.5-50.4 10. Throw the gloves and
Interpretation: wash hands properly.
- Low hemoglobin count 11. Deliver the specimen to
indicates anemia. the lab.
- Low hematocrit 12. Monitor the patient’s lab
count indicate an insufficient results.
supply of healthy 13. If results are available,
red blood cells (anemia). refer results to the physician.
Result Unit
MCV 93 fL Range
MCH 33.5 pg MCV 90-96
MCHC 36.2 G/dL MCH 27.5-33.0
50
RDW 15.7 H! % MCHC 32.0-36.0
Interpretation: RDW 11.6-14.8
Low RDW indicates that RBC
are uniform in size.
PLT 337 103 /𝑚𝑚3 Range

MPV 7.7 fL PLT 150-450
MPV 6.0-11.0
Diagnostic Procedure Indication Result and or Possible Normal Values Nursing

or Purpose Result Responsibilities
Complete Blood Count The blood Before:
& Differential differential Result Unit Range 14. Verify doctor’s order for
test can WBC 9.2 103 /𝑚𝑚3 WBC 4.4-11. laboratory tests.
(November 22, 2020 @ detect 15. Discuss to the patient the
Result Range
4:59AM) abnormal or price, purpose of the test,
% # % #
immature procedures, and the normal
NEU 65.2 6.01 NEU 37.0-80.0 1.8-7.8
cells. It can and abnormal findings.
LYM 12.7 1.17 LYM 10.0-50.0 1.0-4.8
also 16. Encourage patient to ask
51
diagnose an MON 14.6 H! 1.35 H! MON 0.0-12.0 0.0-1.0 for any questions about the
infection, EOS 7.0 0.65 EOS 0.0-7.0 0.0-0.4 test.
inflammatio BAS 0.5 0.05 BAS 0.0-2.5 0.0-0.2 During:
n, Interpretation: 17. Instruct patient to be
leukemia, Low monocyte counts can comfortably seated in a chair.
or an indicate: 18. Inspect for accessible
immune • Bone marrow damage vein.
system or failure 19. Wipe with alcohol swab
disorder. • Hairy cell leukemia where the needle goes in.
• Aplastic anemia 20. Insert the needle into a

vein of the arm.
Result Unit Range 21. Once appropriate amount
RBC 3.47 L! 106/𝑚𝑚3 RBC 4.5-5.9 of blood is obtained, remove
HGB 10.7 L! G/dL HGB 14.0-17.5 the needle and cover the size
HCT 31.4 L! % HCT 41.5-50.4 with gauze or bandage.
Interpretation:
- Low red blood count After:
indicates anemia that can 22. Dispose the needles to its
cause feelings of fatigue and designated bin properly.
weakness. 23. Throw the gloves and

wash hands properly.
52
- Low hemoglobin count 24. Deliver the specimen to
indicates anemia. the lab.
- Low hematocrit 25. Monitor the patient’s lab
count indicate an insufficient results.
supply of healthy If results are available, refer
red blood cells (anemia). results to the physician
Result Unit Range

MCV 90 fL MCV 90-96
MCH 31.0 pg MCH 27.5-33.0
MCHC 34.2 G/dL MCHC 32.0-36.0
RDW 15.4 H! % RDW 11.6-14.8
Interpretation:
- High RDW indicates mixed
population of small and
large RBCs.
Range
PLT 407 103 /𝑚𝑚3 PLT 150-450
MPV 8.0 fL MPV 6.0-11.0
53
Diagnostic Procedure Indication or Result and/or Possible Result Normal Values Nursing Responsibilities
Purpose (Before, During and After)
Immunology (Crossmatch) The purpose Recipient Blood Group: O, Rh: Compatible
Before:
of the Positive Incompatible
crossmatch is Donor Blood Group: O, Rh: 1. Do proper hand hygiene
to detect the Positive 2. Use universal precautions
presence of • Compatible 3. Introduce yourself and
antibodies in (November 19, 2020 @ 11:42:27 Identify the pt.
the recipient AM) 4. Label the clinical specimen
against the Recipient Blood Group: O, Rh: using two identifiers.
red blood Positive 5. Discuss the test to be done
cells of the Donor Blood Group: O, Rh: to the pt.
donor. Positive 6. Encourage pt to ask for
These • Compatible questions when procedure is

not understood well.
antibodies (November 19, 2020 @ 5:20:21
7. Instruct patient to avoid
attach to the PM)
fatty foods.
red blood
cells of the During:
donor after
transfusion. 8. Clean the skin where the
needle goes in.
An
9. Wrap a rubber strap around
incompatible
the upper arm -- this
transfusion
creates pressure to make
can result in
the veins swell with blood
54
a severe 10. Insert a thin needle into a
hemolytic vein, usually on the inside
anemia and of pt’s arm, elbow or in the
even death. back of the hand.

11. Draw the blood
12. Remove the rubber strap
and put a bandage on the
arm or hand.
After:
13. Dispose the needle properly

14. Throw the gloves used and
wash hands.
15. Deliver the specimen to the
lab promptly.
16. Document the findings.
Diagnostic Procedure Indication or Result and/or Possible Result Normal Values Nursing Responsibilities
Purpose (Before, During and After)
Prothrombin Time a test used to Test Result Unit Reference Range:
Before:
help detect Patient 11.9. Seconds 9.2 – 13.2
and diagnose Control 12.9 Seconds ---------- 1. Do proper hand hygiene
a bleeding INR 0.92. ---------- 0.84 – 1.11 2. Use universal precautions
55
disorder or % Activity 108.40 % 83 - 143 3. Introduce yourself and
excessive Identify the pt.
clotting 4. Label the clinical specimen
disorder using two identifiers.
5. Discuss the test to be done
to the pt.
6. Encourage pt to ask for
questions when procedure
is not understood well.
During:
7. Clean the skin where the

needle goes in.
8. Wrap a rubber strap around
the upper arm -- this
creates pressure to make
the veins swell with blood
9. Insert a thin needle into a
vein, usually on the inside
of pt’s arm, elbow or in the
back of the hand.
10. Draw the blood
11. Remove the rubber strap
and put a bandage on the
56
arm or hand.
After:
12. Dispose the needle properly

13. Throw the gloves used and
wash hands.
14. Deliver the specimen to the
lab promptly.
15. Document the findings.
57
Result (Before, During, After)
BLOOD TYPING ABO grouping and Rh typing Blood Type: O Blood Type: A, B, AB, or O BEFORE
(ABO Group and Rh Type) are performed on all donated Rh Type: (+) Positive Rh Type: (+) Positive or (-) 1. Verify physician’s
blood. They are also performed Negative order.
when people require blood 2. Identify the patient
transfusion. appropriately.
3. Inform the patient
Conditions or situations that about the
may warrant a transfusion procedure.
include: 4. Encourage the
1. Severe anemia and patient to verbalize
conditions causing questions or
anemia such as sickle concerns.
cell disease and 5. There are no food,
thalassemia fluid, activity, or
2. Bleeding during or after medication
surgery restrictions unless
3. Injury or trauma by medical
4. Excessive blood loss direction.
5. Cancer and the effects 6. Perform hand
of chemotherapy hygiene.
58
6. Bleeding disorders such 7. Label the clinical
as hemophilia specimen using two
identifiers.
DURING
8. Practice strict
aseptic technique.
9. Wear appropriate
PPE such as gloves.
10. Timely notification
to the requesting
health-care provider
(HCP) of any critical
findings and related
symptoms.
AFTER
11. Deliver the
specimen to the lab
promptly.
12. Document the
findings.
13. Perform hand
hygiene.
59
BLOOD GLUCOSE (HGT) To screen for and diagnose 11/18/2020 5:40PM Fasting Blood Glucose BEFORE
prediabetes and diabetes. HGT: 96mg/dL NORMAL: 70-99 mg/dL 1. Verify physician’s
Interpretation: Normal (3.9 to 5.5 mmol/L) order.
To detect high blood glucose 2. Identify the patient
(hyperglycemia) or low blood 11/19/2020 12AM PREDIABETES: 100-125 appropriately.
glucose (hypoglycemia). HGT: 82mg/dL mg/dL (5.6 to 6.9 mmol/L) 3. Inform the patient
Interpretation: Normal about the
To monitor blood glucose levels DIABETES: 126 mg/dL (7.0 procedure.
over time to determine 11/19/2020 2AM mmol/L) and above on more 4. Label the clinical
whether treatment has been HGT: 103mg/dL than one testing occasion specimen using two
effective in controlling your Interpretation: Prediabetes identifiers.
diabetes. 5. For fasting blood
11/19/2020 6AM glucose, instruct the
To evaluate disorders of HGT: 96mg/dL patient to fast for at
carbohydrate metabolism such Interpretation: Normal least 8 hr before
as malabsorption syndrome. specimen collection
11/19/2020 12NN for the fasting
Fasting blood glucose HGT: 97mg/dL glucose test and not
(commonly called fasting blood Interpretation: Normal to consume any
sugar)—this test measures the caffeinated products
level after a fast of at least 8 11/19/2020 6PM Random Blood Glucose or chew any type of
hours. HGT: 103mg/dL NORMAL: below 200 mg/dl gum before
Interpretation: Prediabetes (below 11.1 mmol/l) specimen collection.
Random blood glucose— DIABETES: 200 mg/dl or 6. For random blood
measured when you have not 11/20/2020 12AM more (11.1 mmol/l or more) glucose, there are
60
fasted (randomly). This may HGT: 104mg/dL no restrictions.
also be used to screen for Interpretation: Prediabetes 7. Perform hand
diabetes. However, if a random hygiene.
glucose result is abnormal, it is 11/20/2020 6AM
typically followed by a fasting HGT: 94mg/dL DURING
blood glucose test or a glucose Interpretation: Normal 8. Clean the skin
tolerance test (GTT) to where the needle
establish the diagnosis. 11/20/2020 12NN will be punctured in.
HGT: 126mg/dL 9. The patient may
Interpretation: Diabetic feel slight to
moderate pain
when the needle
goes in. Reassure
the patient that the
pain is temporary
and that the pain is
reduced by relaxing
the arm.
AFTER
10. Recognize
hypoglycemia or
hyperglycemia,
prediabetes or
diabetes.
11. Document the
61
findings.
12. Perform hand
hygiene.
Diagnostic Indication/ Results/ Normal Nursing Responsibilities

Procedure Purpose Possible Results Values (Before, During, After)
Chest X-Ray It is a radiology test that The lung fields are clear. Normal lung fields, cardiac Before:
involves exposing the chest Heart is not enlarged. The size, mediastinal structures, 1. The gown is worn
briefly to radiation to produce tracheal air column is at thoracic spine, ribs and and metal-containing
an image of the chest and the midline. Both diaphragm. materials are
internal organs of the chest. hemidiaphragms and removed from the
It can help your healthcare costophrenic sulci are body before an X-ray
provider see how well your intact. Osteophytes are is taken.
lungs and heart are working. seen arising in the lateral 2. Pregnant women
It produces a black and white articulating margins of the need to notify the
image that shows the organs thoracic. doctor and the
in your chest. technician as some or
Impression: all images may not
Clear lung fields. be taken in order to
Spondylosis of the thoracic avoid unnecessary X-
spine. ray radiation
exposure to the
62
fetus.
3. Precautions, such as
protective lead
covers may be placed
on the abdomen to
avoid radiation to the
fetus when an X-ray
is absolutely
necessary.
4. Instruct patient to
cooperate during the
procedure.
5. Fasting or medication
restriction is not
needed unless
directed by the
health care provider.
During:
1. The patient is then
2. asked by the
technician to stand in
front of a surface
adjacent to the film
that records the
63
images.
3. The front of the chest
is closest to the
surface.
4. When the positioning
is appropriate
(normal standing
position with arms on
the sides), the
technician may
advise the patient to
take a deep breath
and hold it and then
take the image by
activating the device
(similar to taking a
regular photograph).
5. The image is then
captured on the film
within a few seconds.
6. The film can be
developed within a
few minutes to be
reviewed by the
doctor.
64
7. In situations where
someone is unable to
stand (too weak,
disabled or
hospitalized), the
image can be taken
while laying down
with the recording
surface placed behind
the back.
After:
1. Document the
findings.
2. Note that no special
care is required
following the
procedure.
3. If the test is
facilitated at the
bedside, reposition
the patient properly.
65
Diagnostic Indication/ Results/ Normal Nursing Responsibilities
Procedure Purpose Possible Results Values (Before, During, After)
Echocardiogram It is also known as Vent. Rate (bpm): 86 1. P wave: Before:

echocardiography, or heart PR Intervals (ms): 178 ● upright in leads I, aVF and V3 - V6 1. Inform the patient
ultrasound is a noninvasive, QRS Duration (ms): 104 ● normal duration of less than or that
painless test that uses high- QT/QTc Interval (ms): equal to 0.11 seconds echocardiography is
frequency sound waves to 356/402 ● polarity is positive in leads I, II, used to evaluate the
visualize the shape, size, and P/QRS/T Axes (deg): aVF and V4 - V6; diphasic in size, shape, and
movement of the structures 64/45/8 leads motion of various
of the heart. V1 and V3; negative in aVR cardiac structures.
Interpretation: ● shape is generally smooth, not Tell who will perform
Inferior T wave notched or peaked the test, where it will
abnormality is non specific take place, and that
2. PR interval: it’s safe, painless,
Borderline ECG ● Normally between 0.12 and 0.20 and is noninvasive.
seconds. 2. Advise the patient
Unconfirmed Diagnosis ● Duration less than or equal to that there's no need
0.12 seconds, amplitude greater to restrict food and
than 0.5 mV in at least one fluids for the test.
standard lead, and greater than 1.0 3. Instruct patient to
mV in at least one precordial lead. void prior and to
Upper limit of normal amplitude is change into a gown.
2.5 - 3.0 mV. 4. Advise the patient to
remain still during
66
4. ST segment: the test because
● isoelectric, slanting upwards to movement may
the T wave in the normal ECG distort results. May
● can be slightly elevated (up to 2.0 also be asked to
mm in some precordial breathe in or out or
leads) to briefly hold his
● never normally depressed breath during the
greater exam.
than 0.5 mm in any lead 5. Explain the need to
5. T wave: darken the
● T wave deflection should be in examination field.
the same direction as the QRS 6. Explain that a
complex in at least 5 of the 6 limb vasodilator (amyl
leads nitrate) may be
● normally rounded and given.
asymmetrical, with a more gradual
ascent than descent During:
● should be upright in leads V2 - 1. Inform that a
V6, inverted in aVR conductive gel is
● amplitude of at least 0.2 mV in applied to the chest
leads V3 and V4 and at area.
least 0.1 2. Position the patient
mV in leads V5 and V6 on his left side.
● isolated T wave inversion in an
After:
67
asymptomatic adult is 1. When the procedure
generally a normal variant is completed, remove
6. QT interval: the gel from the
● Durations normally less than or patient’s chest wall.
equal to 0.40 seconds for males 2. Inform the patient
and 0.44 seconds for females. that the study will be
interpreted by the
physician.
resume regular diet
and activities.
Result (Before, During and
After)
GASTROSCOPY A gastroscopy RESULTS: BEFORE:
(examination of the 1. Sedating patients
stomach) can help Esophagus: - The esophagus is before procedures.
confirm or rule out the The esophagus was located posterior to 2. Keeping the patient
presence of medical distensible with air the trachea and informed throughout
conditions like gastritis insufflation and with good begins distal to the the duration of the
or peptic ulcers. peristalsis. The esophageal cricoid cartilage and procedure.
mucosa was smooth and ends at the cardiac 3. Preparing the
pinkish. The Z was orifice of the instruments,
68
obliterated due to mucosal stomach. It ranges in equipment, and
breaks. diameter from 4 to 6 supplies for the
mm and in length procedure.
from 9 to 10 cm in 4. Cleaning and
the term infant to sterilizing equipment
approximately 25 cm before use.
in the adult. The 5. Take a full medical
change in the mucosa history from the
color from pale- to patient.
reddish-pink marks 6. Explain the procedure
the transition from and gain informed
the esophagus and consent.
gastric epithelium (Z 7. Patient is nil by
line). mouth for four to six
hours before the
procedure.
Stomach: - The stomach is DURING:

The cardia was hugging the usually located 8. If sedated, monitor
scope on retroflexed view. beneath the the patient’s level of
The fundus and body had diaphragm and is consciousness.
normal looking mucosa. The approximately 40 cm 9. Monitor physiological
distal to the incisors signs such as heart
69
antrum was hyperemic. The in an adult. The area rate and oxygen
pylorus was incompetent. of the stomach where saturation.
the esophagus enters 10. Ensure oxygen and
is known as gastric suction is available at
cardia. The portion of all times.
the stomach above 11. Observe the patient’s
the junction of the tolerance of the
esophagus and procedure, for
stomach is known as example, pain,
fundus. It is visible in excessive choking or
a retroflexed wheezing.
endoscopic view. The 12. Watch out for
majority of the unexpected events,
stomach is known as such as vomiting,
stomach body. Along cardiorespiratory
the lesser curvature depression,
of the stomach is the vasovagal reactions.
incisura which divides 13. Document time,
the gastric body from dosage and route of
the antrum. all medications.
Endoscopically, the 14. Assess and document
transition from the patient’s status on
body to the antrum is completing the
from rugae to flat procedure.
mucosa. The pylorus
70
is the muscular AFTER:
opening between the 15. Assess and monitor
lower end of the the patient until he or
stomach and she is fully recovered.
duodenum bulb. 16. Document all care
given and any
unusual events that
Duodenum: - The duodenum occurred.
The 1st portion has two deep extends from the 17. Provide written
ulcers measuring 1cm each pylorus to the instructions regarding
with clean base. The 2nd duodenojejunal diet, medications,
portion was hyperemic. angle. The duodenum activity restrictions,
bulb is an expanded follow-up
region immediately appointments and
distal to the pylorus. complications.
The duodenum then 18. Make sure the
DIAGNOSIS: forms a C-shaped patient is
1. Duodenal Bulb Ulcers loop and accompanied home.
Forrest II endoscopically turns
2. Reflux Esophagitis posteriorly and to the
Grade A right for 2.5 cm, then
inferiorly for 7.5 to
10 cm (descending
portion), then
anteriorly and to the
71
left for approximately
2.5 cm, and finally
connects to the
jejunum at the level
of ligament of Treitz.
72
5 NURSING PROBLEM LIST
1. Acute Pain Related to Irritated Esophageal Mucosa as evidenced by
Regurgitation of Acid
2. Risk for Deficient Fluid Volume Related to Upper Gastrointestinal
Bleeding Secondary to Duodenal Ulcer
3. Risk for infection Related to Inadequate Secondary Defense as evidence
by decrease RBC and HGB
4. Activity Intolerance Related to Generalized weakness as evidence by
duodenal Ulcer
5. Imbalanced nutrition: less than body requirements related to Inability
to ingest food as evidence by Reflux Esophagitis
73
DRUG STUDIES
DRUG NAME MECHANISM OF INDICATION SIDE EFFECTS NURSING

ACTION RESPONSIBILITIES
GENERIC NAME: Tranexamic acid To reduce or prevent hemorrhage. GI: Nausea, Vomiting, Before:
Tranexamic Acid competitively inhibits Diarrhea 1. Monitor blood
BRAND NAME: activation of CVD: Hypotension pressure, pulse,
Lysteda® plasminogen thereby SKIN: Rash and respiratory
Cyklokapron® reducing conversion of status as
CLASSIFICATION: plasminogen to indicated by
Therapeutic: plasmin (fibrinolysin), severity of
CONTRAINDICATION ADVERSE EFFECTS
Hemostatic agents an enzyme that bleeding.
Tranexamic acid is contraindicated in patients CVD: Thromboembolic, e.g.,
Pharmacologic: degrades fibrin clots, 2. Monitor for overt
with: arterial, venous, embolic;
fibrinolysis inhibitors fibrinogen, and other bleeding every
CNS: Neurologic, e.g., visual
DOSAGE: plasma proteins, 15–30 min.
• hypersensitivity to tranexamic acid impairment, convulsions,
500 mg including the 3. Monitor
or any of the ingredients headache, mental status
ROUTES: procoagulant factors V neurologic status
• acquired defective color vision, changes; myoclonus
I.V and VIII. (pupils, level of
since this prohibits measuring one
consciousness,
endpoint that should be followed as
FREQUENCY: motor activity) in
a measure of toxicity
PRN then q6h patients with
• subarachnoid hemorrhage
TIMING: subarachnoid
• active intravascular clotting
8 am hemorrhage.
8-2-8 4. Assess for
thromboembolic
complications
(especially in
74
patients with
history). Notify
physician of
positive Homans’
sign, leg pain
hemorrhage,
edema,
hemoptysis,
dyspnea, or
chest pain.
5. Monitor platelet
count and
clotting factors
prior to and
periodically
throughout
therapy in
patients with
systemic
fibrinolysis.
6. Check patient
chart for doctor’s
order.
75
7. Check
medication
tickets.
8. Prepare
medications.
9. Check
medication for
leak and
expiration date.
10. Establish rapport
and explain the
purpose and side
effects of drugs.
During:
11. Stabilize IV
catheter to
minimize
thrombophlebitis.
12. Monitor site
closely.
After:
13. Monitor patient
for adverse
effects.
76
14. Instruct patient
to notify the
nurse
immediately if
bleeding recurs
or if
thromboembolic
symptoms
develop.
15. Caution patient
to make position
changes slowly
to avoid
orthostatic
hypotension.
77
NAME OF DRUG MECHANISM OF ACTION INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES
GENERIC NAME: Converted to active Short-term treatment (4–8 CNS: Headache, Dizziness BEFORE
OMEPRAZOLE metabolites that wks.) of erosive esophagitis GI: Diarrhea, abdominal 1. Baseline assessment
irreversibly bind to, inhibit (diagnosed by endoscopy), pain, nausea, vomiting, 2. Assess B/P, pulse, respirations
BRAND NAME: hydrogen-potassium Symptomatic vomiting, constipation immediately before
PRILOSEC adenosine triphosphatase, gastroesophageal reflux RESPIRATORY:, asthenia administration.
an enzyme Disease (GERD) poorly (loss 3. Give before meals
CLASSIFICATION: On the surface of gastric responsive to other Of strength, energy), DURING
Proton pump parietal cells. Inhibits treatment. H. pylori upper respiratory tract 1. Instruct the pt. to Swallow
inhibitor hydrogen ion transport into associated duodenal ulcer infection, cough. whole. Do not crush or chew
gastric lumen. Therapeutic (with amoxicillin and MS: back pain delayed-release forms
DOSAGE: Effect: Increase gastric pH, clarithromycin). Long-term SKIN: rash 2. Assess for therapeutic response
20 mg/day reduces gastric acid treatment of pathologic AFTER
production. hyper secretory con ditions; 1. Document the intervention.
ROUTE: Treatment of active duo 2. Patient/ family teaching.
PO denal ulcer or active benign 3. Evaluate for therapeutic
gastric ulcer. Maintenance response (relief
FREQUENCY: Healing of erosive 4. Of GI symptoms). Question if
TID esophagitis. OTC, short- GI discomfort,
term: Treatment of 5. Nausea, diarrhea occurs.
TIMING: frequent, uncomplicated 6. Report headache, onset of
8-1-6 heartburn occurring 2 or black, tarry
More days/wk. OFF-LABEL: 7. Stools, diarrhea, abdominal
Pre vention/ treatment of pain.
NSAID-induced ulcers, 8. Avoid alcohol.
78
stress ulcer prophylaxis in
critically ill pts.
None known. Cautions: CNS: hepatotoxicity

May increase risk of GI: Pancreatitis, ,
fractures, gastrointestinal OTHERS: interstitial
infections. Hepatic nephritis Occur rarely.
impairment, pts of Asian
descent.
79
GENERIC NAME: Binds to ribosomal Treatment of susceptible CNS: Headache, dyspepsia BEFORE
CLARITHROMYCIN receptor sites of infections due to C. GI: Diarrhea, nausea, 1. Baseline assessment
susceptible organisms, pneumoniae, H. influenza, altered taste, abdominal 2. Assess B/P, pulse, respirations
BRAND NAME: inhibiting protein synthesis H. para influenza, H. pylori, pain. immediately before
BIAXIN of bacterial cell wall. M. catarrhalis, M. avium, M. administration.
Therapeutic Effect: pneumoniae, S. aureus, S. 3. Question pt for allergies to
CLASSIFICATION: Bacteriostatic; may be pneumoniae, S. pyogenes, clarithromycin,erythromycins.
ANTIBIOTIC Bactericidal with high including bacterial 4. Biaxin may be taken without
dosages or very exacerbation of bronchitis, regard to food. Take Biaxin XL
DOSAGE: susceptible otitis media, acute maxillary with food.
250–500 mg microorganisms. sinusitis, Mycobacterium

DURING
avium complex (MAC),
1. Monitor CBC, BUN, serum
ROUTE: pharyngitis, tonsillitis, H.
creatinine.
PO pylori duodenal ulcer,
2. Be alert for superinfection:
community acquired
fever, vomiting, diarrhea,
FREQUENCY: pneumonia, skin and soft
anal/genital pruritus, oral
BID tissue infections. Prevention
mucosal changes (ulceration,
of MACdisease. OFF-LABEL:
pain, erythema).
TIMING: Prophylaxis of infective
3. Assess for therapeutic response
8-6 Endocarditis, pertussis.
AFTER
1. Document the intervention.
2. Patient/ family teaching.
80
3. Monitor daily pattern of bowel
activity,stool consistency. Mild
GI effects may betolerable, but
increasing severity may indicate
onset of antibiotic-associated
colitis.
4. Continue therapy for full length
of treatment.
5. Report severe diarrhea.
Contraindications: Antibiotic-associated
Hypersensitivity to colitis, other
Other macrolide antibiotics. superinfections
Use with ergot alkaloids. (abdominal cramps, severe
History of cholestatic watery diarrhea, fever)
jaundice or hepatic may result from
impairment with prior altered bacterial balance.
clarithromycin use. Hepatotoxicity,
Concomitant use with thrombocytopenia occur
colchicine. Cautions: rarely.
Hepatic/renal dysfunction,
Elderly with severe renal
impairment. Myasthenia
gravis, coronary artery
disease. May prolong QT
interval (rare).
81
GENERIC NAME: Rebamipide is a mucosal Treatment for peptic ulcer GI: Dry mouth, Before:
Rebamipide protective agent and disease constipation, nausea, 1. Assess history for allergy of
ispostulated to increase vomiting, abdominal pain rebamipide.
BRAND NAME: gastric blood flow, 2. Advise patient to always take
Mucosta prostaglandinbiosynthesis food high in fiber such as
and decrease free oxygen cereals, wholegrain bread, oats,
CLASSIFICATION: radicals. berries, pears, melon and
Antiulcerant; Antacids broccoli, carrots to avoid
constipation.
DOSAGE: History of drug Hypersensitivity: Rash,
100mg hypersensitivity pruritus. During:

3. Take an extra precaution
ROUTE: Gastrointestinal: Sensation (through making sure that the
PO of abdominal enlargement, patient is already taking a
diarrhea and belching may meal) for adult taking this
FREQUENCY: rarely occur. medication as it is prone to GI
TID complication(peptic ulcer,
Hematologic: Leukopenia abdominal pain, and
TIMING: may rarely occur. constipation) as through GI
8am-1pm-6pm system reduced blood flow and
Others: Menstrual disorder, decreased secretion.
dizziness. 4. Make sure not to give drugs
more than three tablets per day
to avoid drug overdose.
82
5. Ask the client to wear lip balm
or place a petroleum jelly on
the lips since the drug causes
dry lips.
6. Ask the client to increase fluid
to avoid lips from cracking.
7. Tell the client to verbalize the
relief and occurrence of
hyperacidity.
8. Watch out for abdominal
distention.
After:
9. Advise not to take alcohol when

discharge while taking this
medication.
10. Monitor the client for the
presence of rash.
11. Inform the client to experience
the drug’s side effect.
83
GENERIC NAME: A semisynthetic penicillin Indicated to treat susceptible GI: Diarrhea, nausea, Before:
Amoxicillin which acts by inhibiting the bacterial infections of the vomiting.
bacterial wall synthesis it is ear, nose, throat, 1. Administer medication after
BRAND NAME: a penicillate sensitive and is genitourinary tract, skin, Skin: Pruritus, urticaria, meal to avoid stomach
Amoxil, Trimox effective gram positive skin structure, and lower discomfort or nausea to the
(Enterococcus faecalis, respiratory tract. patient.
CLASSIFICATION: Staphylococcus spp., 2. Coordinate to laboratory to
Antibiotic Streptococcus pneumonia, culture infected area prior to
Streptococcus spp. (alpha treatment; reculture area if
DOSAGE: and beta-hemolytic) and response is not as expected.
500mg gram negative (Escherichia 3. Determine previous
coli, Haemophilus hypersensitivity reactions to
ROUTE: influenza, Helicobacter CONTRAINDICATION ADVERSE EFFECTS penicillins, cephalosporins, and
PO pylori, Proteus mirabilis) other allergens prior to therapy.
Asthma, diarrhea, GI GI: pseudo-membranous
microorganism. 4. Take drug around the clock, do
disease, inflammatory bowel colitis (rare).
FREQUENCY: not miss a dose, and continue
disease, Hematologic: Hemolytic
BID therapy until all medication is
anemia, agranulocytosis
taken, unless otherwise directed
TIMING: by physician.
Body as a whole:
8am-6pm 5. Always wash hands thoroughly
Hypersensitivity (rash,
and disinfect equipment
allergy), superinfection.
(whirlpools, electrotherapeutic
devices, treatment tables, and
84
so forth) to help prevent the
spread of infection.
6. Make sure to prepare the desired
dose given by the physician.
During:
7. Monitor for signs of

hypersensitivity (fever,
wheezing, generalized itching,
dyspnea) report if symptoms
persist.
8. Administer corticosteroids,
antihistamines for skin reactions
as prescribed.
9. Assess bowel sound (increased
(hyperactive) bowel sound
indicate diarrhea.
10. Tell patient to report unusual
bleeding or bruising, sore
throat, hives, difficulty
breathing.
11. Monitor laboratory results,
particularly WBC and
culture/sensitivity reports.
85
After:
12. Monitor for signs and symptoms

of an urticarial rash (usually
occurring within a few days after
start of drug) suggestive of a
hypersensitivity reaction.
13. Tell patient to report onset of
diarrhea (to rule out
pseudomembranous colitis) and
monitor possible symptoms of
superinfection (vaginitis).
14. Remind patient not to stop
medication if he/she feels better
unless directed by the physician
to avoid future antibiotic
resistance.
15. Tell patient not to self medicate
as this is not intended to treat
other infection.
86
NAME OF DRUG MECHAN INDICATION SIDE EFFECTS NURSING
ISM OF RESPONSIBILITIES
ACTION
GENERIC NAME Thought to For cute pulmonary edema, CNS: dizziness, headache, BEFORE
inhibit
edema caused by heart vertigo, weakness, lethargy, 1. Assess for allergy to
sodium and
chloride failure, paresthesia, drowsiness, furosemide,
Furosemide reabsorption
hepatic cirrhosis, or renal restlessness, light-headedness sulfonamides, tartrazine.
from
ascending disease, hypertension and GI: nausea, vomiting, diarrhea, 2. Do not expose to light,
loop of
hypercalcemia associated constipation, dyspepsia, oral which may discolour
Henle and
BRAND NAME distal renal with and gastric irritation, cramping, tablets or solution.
tubules.
cancer anorexia, dry mouth, acute 3. Give early in the day
Increases
potassium pancreatitis to not interrupt with
Lasix excretion
Musculoskeletal: sleeping pattern.
and
plasma muscle pain, muscle cramps 4. Educate the patient
volume,
Skin: photosensitivity, rash, about the purpose and
promoting
CLASSIFICATION renal diaphoresis, urticaria, pruritus, importance of the drug.
excretion
exfoliative dermatitis, erythema 5. Educate patient that
of water,
sodium, multiforme drug may cause serious
Diuretics, Antihypertensive chloride,
Other: fever, transient pain at interactions with many
magnesium,
hydrogen, I.M. injection site common drugs.
and calcium.
6. Instruct him to tell all
prescribers he‟s taking it.
DOSAGE
20 mg DURING
87
7.Check the patency of
the IV site and IV line.
8. Administer the right
ROUTE
dose at the
IV right time.
ADVERSE EFFECTS
9. Monitor blood
CONTRAINDICATION
pressure, pulse, fluid
intake and output, and
weight.
FREQUENCY CV: hypotension, orthostatic 10. Monitor dietary
Hypersensitivity to the drug
hypotension, tachycardia, volume potassium intake. Watch
or other sulfonamides.
BID depletion, necrotizing angiitis, for signs and symptoms
thrombophlebitis, arrhythmias of hypokalemia.
EENT: blurred vision, xanthopsia,
hearing loss, tinnitus
TIMING GU: excessive and frequent AFTER
6AM – 6PM urination, nocturia, glycosuria, 11. Monitor CBC, BUN,
bladder spasm, oliguria, interstitial and electrolyte, uric acid,
nephritis Hematologic: anemia, and CO2 levels.
12. Monitor glucose
levels.
13. Advise patient to
report signs and
symptoms of ototoxicity
(hearing loss, ringing in
88
ears, vertigo) and other
drug toxicities.
move slowly when rising,
to avoid dizziness from
sudden blood pressure
decrease.
15. Advise client to avoid
drinking alcohol and
herbs while taking this
drug.
16. Inform patient that
there would be a regular
blood testing during
therapy.
89
NAME OF DRUG MECHANISM OF INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES
ACTION
GENERIC NAME: Fat-soluble used to treat and prevent CNS:light-headed feeling BEFORE
Vitamin K naphthoquinone low levels of certain
substances (blood clotting  Assess the patient for any
derivative chemically GI: gastric upset
factors) that your body allergic reactions with Vitamin K.
BRAND NAME: identical to and with  Protect drug from direct
naturally produces. These
Respiratory: trouble breathing sunlight.
Phytonadione similar activity as substances help your blood  Monitor therapeutic
to thicken and stop effectiveness which is indicated
naturally occurring
bleeding normally (e.g., Skin: redness, itching,hard by shortened PT, INR, bleeding,
CLASSIFICATION: vitamin K. Vitamin K is after an accidental cut or and clotting times, as well as
lump, sweating,swelling
Antidote, Vitamin essential for hepatic injury). Low levels of blood decreased hemorrhagic
clotting factors increase the tendencies.
biosynthesis of blood Others: changes in taste,
risk for unusual bleeding
DOSAGE: clotting Factors II, VII, IX, DURING
20mg and X.
 Observe for signs of local
inflammation
 Apply pressure to the injection
ROUTE:
site to prevent further bleeding.
IV  Aspirate carefully to avoid
intravascular injection.
FREQUENCY: AFTER
PRN
 Observe for bleeding (usually
occurs in 2nd or 3rd day)
TIMING:  Document the giving of
medication to prevent doubling of
STAT the dose.
 Maintain consistency in diet
and avoid significant increases in
daily intake of vitamin K–rich
foods when drug regimen is
CONTRAINDICATION ADVERSE EFFECTS stabilized. Know sources rich in
90
Contraindicated for CNS: Headache (after oral vitamin K (Asparagus, broccoli,
cabbage, lettuce, turnip greens,
hypersensitivity to vitamin dose), brain damage, death.
pork or beef liver, green tea,
K GI: Gastric upset. spinach, watercress, and
tomatoes).
Hematologic: Paradoxic
 Monitor patient constantly.
hypoprothrombinemia Severe reactions, including
fatalities, have occurred during
(patients with severe liver
and immediately after IV
disease), severe hemolytic injection
anemia.
Metabolic: Hyperbilirubinemia,
kernicterus.
Respiratory: Bronchospasm,
dyspnea, sensation of chest
constriction, respiratory
arrest.
Skin: Pain at injection site,
hematoma, and nodule
formation, erythematous skin
eruptions (with repeated
injections).
Special Senses: Peculiar taste
sensation.
91
NURSING CARE PLAN
DEFINING DIAGNOSIS SCIENTIFIC GOAL OF CARE INTERVENTION RATIONALE EVALUATION
CHARACTERISTICS ANALYSIS
Subjctive: Deficient fluid A history of chronic Short term: Short term:
“Nalipong man ko volume related or severe NSAID After 8 hours of After 8 hours of
sir, nya naa pod to upper use, as well as a nursing nursing
dugo ako tae” as gastrointestinal diagnosis of H. intervention pt. will intervention pt. will
verbalized by bleeding pylori, are the two be able to: be able to:
Independent: 1. A decrease in BP
patient. secondary to main causes of A. Identify the signs and an increase in A. Identify the
1. Monitor the client’s
duodenal ulcer duodenal ulcers. and symptoms of GI vital signs, and HR with changes in signs and
Objective: The bacteria will bleeding as well as observe BP and HR for position is an early symptoms of GI
Melena inflame the lining of what is present in signs of orthostatic indicator of bleeding as well as
Dizziness your duodenum, the patient. changes. decreased what is present in
causing an ulcer to circulatory volume. the patient.
BP 90/60mmHg
develop.
2. The client with a -Goal was met
bleeding ulcer may
2. Assess for the signs vomit bright
A peptic ulcer that of hematemesis such red blood or coffee
arises in the first as bright red vomitus grounds emesis.
and melena such as Melena occurs
part of the small
black tarry stool. when there is
intestine is known
bleeding in the
as a duodenal ulcer
upper GI tract.
(duodenum). One
3. They may
of the most indicate an
common 3. Note patient’s
impending
individual
complications of hypovolemic shock.
physiological response
peptic ulcer disease to bleeding such as
is acute major restlessness,
duodenal bleeding. dizziness, weakness
Peptic ulcers cause and pallor.
significant bleeding 4. Effective
therapeutic listening 4. A trusting nurse-
in 10-15% of cases. patient relationship
by actively listening to
reduces patients'
patient’s need,
anxiety and stress.
92
Fluid volume deficit answering questions
or Hypovolemic and being honest.
shock, also known 5. Educate patient by
B. Develop trust 5. To prepare B. Develop trust
as hemorrhagic telling importance of
with the nurse. patient and help with the nurse.
nothing by mouth
shock , is a medical make sure that the -Goal was met
status prior laboratory
condition result is accurate.
test.
exacerbated by a 6. Inform patient and
drop in blood SO about the patient’s 6. In order to avoid
volume as a result dietary status such as confusion and to
of blood loss, nothing to eat by have support with
mouth the patient’s
resulting in
C. Comply to dietary dietary status. C. Comply to
decreased cardiac
status or restrictions Dependent: dietary status or
production and restrictions such as
such as NPO and soft 7. Inform patient 7. Preparation is
insufficient tissue diet important for the NPO and soft diet
about the laboratory
perfusion. Trauma, or diagnostic test such patient when -Goal was met
GI bleeding, or as rt-pcr test, blood undergoing lab or
organ or aneurysm typing, urinalysis, diagnostic test.
rupture are all cretinine, BUN, slt,
common causes. chest x-ray, and cbc.
Losing more than

D. Participate in D. Participate in
20% of the blood
diagnostic or diagnostic or
volume due to 8. Transfuse blood as 8. To restore laboratory tests
laboratory tests and
severe GI bleeding specific treatment ordered by following intravascular and specific
can lead to procedure. appropriate time or volume. treatment
hypovolemic shock. duration of procedure.
This can lead to administration such -Goal was met
as4 units, 4 hours
significant organ
duration with 4 hours
failure, which interval per unit.
includes the brain,
liver and kidneys,
as well as gangrene
of the limbs due to
93
lack of blood 9. Administer IV fluids 9. To restore
supply. as ordered (D5NSS, intravascular
1L, @30gtts/min) volume.
10. Administer drug 10. Pharmacologic

as ordered by intervention in vital
teaching proper as part of the
administration treatment.
(Omeprazole, 80mg,
E. Perform right way IVTT, now)(Amoxicillin E. Perform right
of taking medication 500mg, PO,BID) way of taking
including the route, medication
dosage, timing and including the route,
frequency. dosage, timing and
frequency.
-Goal was met
Long term goal: Long term goal:

After 3-4 days of Collaborative: After 3-4 days of
11 When bleeding nrsing intervention
nrsing intervention 11. Assess laboratory
patient will be able values by is not visible, patient will be able
to: collaborating with decreased Hgb and to:
laboratory department Hct levels may be F. Manifest
F. Manifest improve
to monitor hematocrit an early indicator of improve health
health status such as
(Hct) and hemoglobin status such as
laboratory result bleeding. To assess
(Hgb) and other laboratory result
within normal range. if there’s
laboratory values that within normal
may indicate normal improvement with range.
results and improve the treatment -Goal was partially
health status. provided. met since
treatment needs
days to be
achieved
94
DEFINING NURSI SCIENTIFIC GOAL OF CARE NURSING RATIONALE EVALUATION
CHARACTE NG ANALYSIS INTERVENTIONS
RISTICS DIAGN
OSIS
SUBJECTIVE: Acute pain Acute pain: The state in SHORT TERM Independent SHORT TERM
“sakit ako related to which an individual 1. Determine the client’s 1. In taking a pain
After 8 hours of nurse- perception of pain. history, provide After 8 hours of
tutunlan dae irritated experiences and reports
client an opportunity for nurse-client
unya maka feel esophage the presence of severe intervention/interaction, intervention/interac
the client to
pa jud ko sa al mucosa discomfort or an the patient will be able express in their tion, the patient will
acid.” as as uncomfortable sensation to: own words how be able to:
verbalized by evidenced lasting from 1 seconds to they view the pain
the pt. by <6 months. The - demonstrate relief and the situation - demonstrate
of pain as to gain an relief of pain
regurgitati continuous acid reflux may evidenced by a as evidenced
understanding of
on of acid. damage the esophageal pain score of 4- what the pain by a pain
OBJECTIVE: lining and may eventually 6/10. means to the score of 4-
cause inflammation. When client. 6/10. Pt.
PAIN – 8 /10 (1 the amount of gastric juice verbalized
pain 6/10.
being the lowest that refluxes into the (Goal was
and 10 being esophagus exceeds the met)
the highest) normal limit, causing
Restlessness symptoms with or without - demonstrate the - demonstrate
Facial Grimace associated esophageal use of appropriate the use of
Difficulty in mucosal irritation/injury. diversional appropriate
activities and 2. Some patients diversional
swallowing Regurgitation occurs with 2. Assess the patient’s
relaxation skills. may be hesitant activities
varying degrees of willingness or ability
to try the and
to explore a range of
severity in approximately effectiveness of relaxation
techniques aimed at
80% of GERD patients. nonpharmacologic skills. (Goal
controlling pain.
This symptom is usually al methods and was met)
may be willing to
described as a sour taste try traditional - uses
in the mouth or a sense of - uses pharmacolog
pharmacological
pharmacological ical and non
fluid moving up and down methods (i.e., use
and non pharmacolog
in the chest. of analgesics). A
pharmacological ical pain –
combination of
Approximately 13% of pain – relief relief
both therapies
GERD patients complain strategies. strategies.
may be more
of regurgitation at least 4 effective and the
95
days per week, which is a nurse has the (Goal was
frequency sufficient for duty to inform the met)
patient of the
causing a measurable - displays - displays
different methods
decrement in their quality improvement of improvemen
to manage pain.
of life. coping. t of coping.
In addition, certain (Goal was
met)
factors—such as eating
large meals, exercising, or
bending over after
eating—tend to compress
the stomach and trigger
3. Assess for heartburn. 3. Heartburn is the
regurgitation. It is also
thought that regurgitation most common
feature of GERD.
is more common in GERD
This becomes
patients with anatomically more severe with
disrupted esophagogastric vigorous exercise,
junctions, which bending, or
compromise the ability to lying down.
prevent reflux. LONG TERM
LONG TERM
After 4 days of
After 4 days of nursing
nursing intervention,
intervention, the pt will
the pt will display
display improved well –
improved well –
being and avoid food that
4. Carefully assess pain 4. Pain of
being and avoid
triggers the regurgitation
location and discern esophageal spasm food that triggers the
of acid.
pain from GERD and resulting from regurgitation of acid.
angina pectoris. reflux esophagitis
tends to be
chronic and may
mimic angina
pectoris: radiating
96
to the neck, jaws,
and arms.
5. To reduce the
5. Elevate the head of backwash of acid
the bed from the stomach
to the esophagus.
6. Evaluate the patient’s 6. It is essential to

response to pain and assist patients to
management express as
strategies. factually as
possible (i.e.,
without the effect
of mood, emotion,
or anxiety) the
effect of pain
relief measures.
97
7. Evaluate what the 7. The meaning of
pain suggests to the pain will directly
patient. determine the
patient’s
response.
8. Teach pt. to avoid 8. Food that can

foods that cause
cause pain or
pain/and or increase increase acid
acid secretions. secretion can
worsen
esophageal
erosion.
Dependent:
9. Antacids are
9. Administer prescribed
helpful in
medications.
neutralizing
98
stomach acid. H2
– receptor
blockers reduce
the production of
stomach acid.
Collaborative:
10.Perform UGI 10. To assess mucosal

endoscopy as per fold.
doctor’s order.
99
DEFINING NURSING SCIENTIFIC GOAL OF NURSING RATIONALE EVALUATION
CHARACTERISTICS DIAGNOSIS ANALYSIS CARE INTERVENTIONS
Short term: Independent: Short term:
Subjective: Infection is the After 8hours of After 8 hours of
“ Gikuhaan man ko ug Risk for invasion of a host nursing 1. Monitor and record 1. To have a nursing intervention
dugo gani na ge order ni intervention patients’ vital signs. baseline data patient was able to:
infection organism’s bodily
doc kay nag bleeding daw patient will be
Related to tissues by disease
ko”. As verbalized by the able to: A. Demonstrates
patient. Inadequate causing organism, appropriate hygienic
Secondary their multiplication, A. Demonstrates 2. Stress proper hand 2. it is a first line measures such as
washing technique from infection by
Defenses as and the reaction of
appropriate hand washing.
cross
Objective: hygienic - GOAL MET
evidence by host tissues to these contamination.
Vital signs measures such
Increase WBC
RR: 22 organisms and the as hand washing. B. Identifies
TEMP: 36.5 toxins they produce. symptoms of
3. to reduce or
- WBC 16.38 (normal 4.4 B. Identifies infection of which to
Infections are caused 3.Educate patient and eliminate germs
– 11.0) symptoms of be aware.
SO about appropriate
- Low RBC levels: 1.70 by microorganism infection of which reduces the - GOAL MET
methods for cleaning,
10 6/microliter (normal such as bacteria, to be aware. disinfecting, and likelihood of
levels 4.5 – 5.9) viruses, yeast, fungi, sterilizing items. transmission. C. Remain free from
-Low HGB levels: C. Remain free symptoms of
or other large
5.7 g /dL (normal from symptoms infection.
levels14.0 – 17.5) organisms like of infection. - GOAL MET
4. Assess patient’s 4. To take note of
-Low HCT levels: 15.8 % parasites. The effects general condition baseline date and
(normal levels 41.5 – of an infection, such especially signs and abnormal
50.4) Long term: symptoms of infection. findings. Long term:
as swelling or a runny
After 3-4 days of After 2-3 days of
nose, occur due to nursing nursing intervention
the immune system’s intervention 5. Educate the patient 5. To prevent patient was able to:
patient will. the signs and further
attempt to get rid of
symptoms of infection complications.
100
the invading and the need to notify C. Achieve timely
organism. D. Achieve timely the physician or nurse wound healing.
wound healing. - GOAL PARTIALY
MET
A wound fill with pus, 6. Assess for the
E. Patients WBC
for example, when count will return presence of local 6. these re classic E. Patients WBC
white blood cells rush to normal 4,500- infectious process in signs of infection count will return to
10,000 mm the skin such as normal 4,500-
to the site of an
redness, swelling, pain 10,000 mm
injury to combat or tenderness and
- GOAL PARTIALY
foreign bacteria. discharges form
MET
incision site.
Most infections cause

an increase in pulse 7. Monitor white blood 7. An increase of
rate and body cell (WBC) count WBC count
indicates body’s
temperature, but
effort to combat
others may not cause pathogens.
an increase in pulse Very low WBS
indicates severe
rate proportionate to
risk for infection
the degree of fever.
Hypotension can be
caused by 8. Encourage adequate 8. It can reduce
rest. stress and boost
hypovolemia, septic
the immune
shock, or toxic shock. system.
101
Hyperventilation and
respiratory alkalosis 9. Maintain a clean 9. Establish
and quiet mechanism to
are common
environment. prevent
complications. occurrence of
infection
10. Wear gloves 10.It prevents the

during any contact transfer of
with mucus, blood, microorganisms
and other body fluids. that are already
Use goggles when on the hands and
appropriate. to protect the
hands from
becoming
contaminated.
11. Encourage 11.Helps reduce
coughing and deep the stasis of
breathing exercises; secretions in the
frequent position lungs and
changes. bronchial tree.
When stasis
occurs, microbial
infection of the
respiratory
tract that may
lead to
pneumonia
102
12. Encourage a diet 12.A balanced
that meets nutritional intake of
omega 3 and
needs.
omega 6 fatty
acids, vitamins
A, C and E,
zinc, iron,
protein and
calorie in
reducing the
risk of infection
and wound
healing
Dependent:
13. Administer 13. Medication

medications as can help treat the
ordered. patient.
103
14. Turn patient to 14. This is to
change positions at avoid the adverse
least every 2 hours if
effects of external
ordered by physician.
mechanical forces
(pressure, friction,
and shear).
Collaborative:
15.To monitor
15. Monitor laboratory effectiveness of
studies such as therapy and
hemoglobin levels assess values to
indicate adequate
104
DISCHARGED PLAN
DISCHARGE PLANNING
Subjective Data “Wala nako naglibang og dugo og wala napud ko nag lipong lipong” as verbalized by the patient.
Objective Data Patient is conscious, coherent, alert, responsive, cooperative, afebrile, nondyspneic, (-) Chest pain,
(-) Dizziness, (-) Melena
Vital signs as follows: T- 36.0 °C, PR- 79bpm, RR- 20cpm, BP- 120/70mmHg
Interventions:
Analysis Upon admission, patient complaint of melena and dizziness. After having been diagnosed with UPPER GASTROINTESTINAL
BLEEDING SEC TO DOUDENAL ULCER; ANEMIA SEVERE SEC TO #1; REFLUX ESOPHAGITIS GRADE A, the patient has fully
recovered and is in normal state. The patient was well and no other complaints upon discharge. The patient was taught on
different techniques to maintain a healthy lifestyle such as eating a healthy and balanced diet, avoiding foods and fluids that
would aggravate the condition, importance of exercise, and adherence to the treatment regimen.
Planning After 15-20 minutes of health teaching, the patient will be able to enumerate activities that will enhance his independence in
regards to his ADLs, safety, adherence to medications, diet, and therapy (soft diet, exercise at least 5-10 minutes,
meditation and guided imagery).
Activity Instructed patient to have diversional activities such as music therapy or exercise and encouraged to have adequate rest
periods. Keep to regular routines and schedules as much as possible. Assisted patient in attaining his highest level of
mobility possible before discharge. Instruct patient to avoid strenous activities such as running, jogging, playing basketball
and swimming and advised to avoid straining and lifting heavy objects to prevent an increase of pressure in the abdomen.
Medications Instructed the patient about medications regarding their indication, dosage, timing, contraindications, side effects, and
adverse effects. The patient should report any signs and symptoms, adverse effects and abnormalities being noted. Advised
the patient to not discontinue medications without physician’s orders. Reminded patient to avoid NSAIDs in order to prevent
ulcer and GI bleeding. Emphasized not to take other medications without consulting with the physician to prevent harmful
drug-drug interactions. Instructed patient and family to comply strictly with the following prescribed medications:
105
1. Omeprazole (pantor) 40 mg / cap, 1 capsule orally 2x a day 30 mins before breakfast & 30 mins before dinner for 10
days
2. Omeprazole (pantor) 40mg/cap, 1 capsule orally once a day 30mins to 1 hour before breakfast for 2 months
3. Clarithromycin 500mc/cap, 1 capsule orally 2x a day after meals for 10 days
4. Amoxicillin 500mg/cap, 2 capsules orally 2x a day after meals x 10 days
5. Rebamippide (mucosta) 100mg/tab 1 tab orally 3x a day for 14 days
Environment Make sure that the environment is clean and must be a good place to stay. Environmental stressors should be eliminated
(e.g., noise, crowding). Maintain quiet, comfortable and stress-free environment. The patient’s environment should be
regularly cleaned, disinfected and free from pollution. Patient’s room should have at least one area for sunlight exposure for
a natural source of Vitamin D.
Treatment Encouraged patient to have a soft diet to prevent further complications and problems such as GI bleeding. Make sure that
the family and patient knows the purpose and action of their treatment. Emphasized the importance of home medications
prescribed by the physician. Advised to comply with the treatment regimen.
Health Teaching Instructed patient how to have a healthy lifestyle, right foods to eat and foods to avoid. Instructed the significant other how
to prepare soft diet. Encouraged both the patient and the SO to maintain safe environment. Significant other who is taking
care of the patient must practice proper hand hygiene. Advised to comply with the treatment regimen prescribed by the
physician. Avoid activities that can harm the patient. Instruct the SO to assess the client at home unless for check-ups and
hospital visits. Demonstrate relaxation techniques such as yoga and proper deep breathing exercises. Contact health care
provider if symptoms persist.
Outpatient Referral The patient must have available telephone numbers of referred physicians and agencies. A written discharge will be
provided. It will be reviewed and explained to the patient and family. Follow up care in Dr. Avila’s clinic in Adventist Hospital
(Miller Hospital) on December 2, 2020 with all repeat laboratory results. The patient will know time, date, and location of
appointments given by the physician.
Diet Instruct the patient to eat a soft diet like (e.g., boiled egg, mashed potatoes, banana, porridge) and exclude spices like
pepper, garlic, onion and tomatoes. Frequent small meals are advised to decrease workload of the stomach. Supplement
nutrients by providing an alternative diet like oatmeal, yogurt, and tofu. Reminded the patient to avoid caffeine, soda and
106
alcoholic drinks because it would increase gastric acid secretion. Advised not to consume fried or spicy foods such as bicol
express, spicy sisig, spicy fried chicken, etc. because that would lead to heartburn. Advised patient to avoid dairy products
like cheese, butter, yogurt and milk because these are hard to digest and may lead to an increase in the workload of the
stomach.
Spiritual Encouraged patient and family members to go to church every Sunday. Continue to seek God’s guidance and enlightenment.
Emphasized the importance of prayers in healing and to ask for divine assistance in everything. Encouraged to continue to
have a positive outlook in life and not to give up easily when hard time comes.
Evaluation Goal was met. The patient and the SO understood the instructions given by the nurse and shows positive attitude towards
health care providers.
107
LEARNING OUTCOMES
1. Identified history, onset, prognostic factors, and symptoms of Upper
Gastrointestinal Bleeding Sec to Duodenal Ulcer, Severe Anemia and Reflux
Esophagitis.
2. Recognized the signs and symptoms of this health problem.
3. Described major clinical, etiological, and epidemiological characteristics of
Gastrointestinal Bleeding Sec to Duodenal Ulcer, Severe Anemia and Reflux
Esophagitis problem
4. Assessed an individual patient’s potential risk for the condition.
5. Recognized the general medical conditions and substances commonly
associated with the current condition of the patient.
6. Explained the anatomy and physiology of the organs or systems involved
and the pathophysiology of the disorder.
7. Assessed a patient’s risk for the said condition and be able to appropriately
respond to high-risk patients.
8. Administered and monitored prescribed pharmacologic treatments used in
treating the condition of the patient
9. Implemented clinical prevention and health promotion interventions to
provide patient-centered care.
10. Developed appropriate health teaching and treatment plan for patient.
CONCLUSION
This case study provides appropriate interventions and information that serves
as a guide to the family, caregivers, medical students, medical professionals,
and health institutions for the treatment of the patient. The goal of medical
therapy in upper gastrointestinal (GI) bleeding (UGIB) is to correct shock and
coagulation abnormalities and to stabilize the patient so that further
evaluation and treatment can proceed. In addition to intravenous (IV) fluids,
patients may need transfusion of packed red blood cells. High doses of proton
pump inhibitors (PPIs) may reduce the need for endoscopic therapy.
RECOMMENDATION
Recommendations for the patient having problems involving Upper GI
Bleeding is having a soft balance diet to reduce stomach workload and for
optimal nutrition. Eat small meals more often to heal the digestive system.
Diet should be bland with no dark coloured foods to prevent irritation and to
monitor blood in the stools. Avoid foods that cause heartburn, nausea and
108
vomiting. For anemia, eat iron-rich foods such as (meat, chicken, fish, and
eggs) to increase the iron in the body. Sleep more at night and take naps
during the day, mild exercises are recommended to tone abdominal muscles.
Make time for activities that help the patient relax (meditation, reading,
talking or listening to music). Do not take NSAIDs because it can increase the
risk for ulcers and GI bleeding. Alcohol and smoking are strictly prohibited as
it can cause ulcers and esophageal varices and over time the blood vessels
become weak and may bleed. The patient may need to return for colonoscopy,
endoscopy or other tests. These tests can make sure that the patient do not
have more bleeding.
It is also recommended for this study to be significant for the patient in

order to have knowledge about this condition, to be educated and to have
awareness in knowing its causes, signs and symptoms and factors with these
diseases. For the family, this study will help them gain insight about the
patient’s condition and become aware of the situation to help in providing a
support system. For the students, this will give them information and to gain
insights towards handling patients in order to apply the information with
regards to these diseases. The school will be the outmost institution to give
more ideas that can help promote their strategies in handling diseases and
enhancing the understanding towards the case. For our respected healthcare
workers, this will provide further knowledge and discover more concepts
relating to the causes, complication, modifiable and non-modifiable factors
with nursing interventions and treatments. And lastly to the healthcare
industry, this will have a profound opportunity to build new concepts and
discoveries relating to the diagnosis, prognostic factors, treatments,
appropriate nursing interventions and early detection on people who are at
risk for such disorder.
109
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COLLEGE OF NURSING

UPPER GASTROINTESTINAL BLEEDING SEC TO DUODENAL ULCER;

April 22, 2021

Demetria, Anne Christine G.

Dr. Adriel Arman V. Pizarra, DCHM, MAN, RN

Upper Gastrointestinal Bleeding is a common medical condition with various

A common presentation in the emergency departments worldwide are the

Upper Gastrointestinal Bleeding is classified according to the type of bleeding

ASSESSMENT OF SIGNS AND SYMPTOMS

● Hematemesis (bright red emesis or coffee-ground emesis): is the

● Changes in level of consciousness

Other types of ulcers:

ASSESSMENT OF SIGNS AND SYMPTOMS

● Abdominal pain (a hunger-like feeling)

Less often, it may cause severe signs or symptoms such as

ANATOMY AND PHYSIOLOGY (DUODENAL ULCER)

Pylorus, cone-shaped constriction in the gastrointestinal tract that

ARE THERE DIFFERENT KINDS OF ANEMIA?

HOW COMMON IS ANEMIA?

Prevalence of anemia among non-pregnant women (% of women ages 15-49)

Who is most likely to develop anemia?

• People on blood thinners: These medications include drugs include

This can happen if:

• Your body doesn't make enough red blood cells

• Your body destroys red blood cells

ASSESSMENT OF SIGNS AND SYMPTOMS

• Pale or yellowish skin

• Cold hands and feet

• Pregnancy complications. Pregnant women with folate deficiency

• Heart problems. Anemia can lead to a rapid or irregular heartbeat

ANATOMY AND PHYSIOLOGY

Anemia is characterized by decreased oxygen delivery to the tissues, muscle

Circulatory system is made up of your heart and an intricate network of

Esophagitis is inflammation that may damage tissues of the esophagus, the

ASSESSMENT OF SIGNS AND SYPMTOMS

COMMON SIGNS AND SYMPTOMS OF ESOPHAGITIS INCLUDE:

• Swallowed food becoming stuck in the esophagus (food impaction)

• weakened immune system due to HIV or AIDS, diabetes, leukemia,

• radiation therapy of the chest

• surgery in the chest area

• medications to prevent organ transplant rejection

• immunosuppressive medications used to treat autoimmune diseases

• aspirin and anti-inflammatory medications

• alcohol and cigarette use

• a family history of allergies or esophagitis

Your chance of developing an infection of the esophagus is low if you have a

• Eating immediately before going to bed.

• Dietary factors such as excess alcohol, caffeine, chocolate and mint-flavored

Left untreated, esophagitis can lead to changes in the structure of the

• Scarring or narrowing (stricture) of the esophagus

• Barrett's esophagus, characterized by changes to the cells lining the esophagus,

ANATOMY AND PHYSIOLOGY

TRACHEA - also known as the windpipe, is a cartilaginous tube that connects

1. Apply the nationally recognized guidelines for screening and diagnosing

2. Apply the practice guidelines for the treatment of patients with

3. Identify appropriate elements of assessment and interventions with the

4. Explain the anatomy and physiology of the organs or systems involved in

6. Formulate management plans for the care of patients with Gastrointestinal

7. Discuss treatment plans with patients in an empathic, disclosed, and