GROUP III

CASE PRESENTATION
BSN III-A
10/9/11
INTRODUCTION
RATIONALE OF CHOOSING THE CASE:
Our group has decided to present this particular case due to the three
Iollowing reasons:
It was this group`s Iirst rotation to the ICU, an area where patients
requires the utmost care and saIety because oI their delicate status. This
makes the case special Ior the group members.
The complex nature oI the client`s condition.
The perceived knowledge, inIormation and experience that this group
will be beneIitting in presenting this case.
10/9/11
INTRODUCTION
SIGNIFICANCE OF THE STUDY
This study was created mainly Ior the purpose oI providing the
public, particularly students, Iacts and data about the disease
process, pathophysiology, management, and treatment oI this
particular case (myocardial inIarction). This report is also designed
to be a valuable source oI reIerence and comparisons Ior Iuture
reports and studies.
10/9/11
INTRODUCTION
SCOPE AND LIMITATION:
This case study deals with:
Myocardial inIarction, its deIinition, pathophysiology, disease
process, management, and treatment.
Patient Y`s health history, liIestyle, health belieIs and patterns
gathered through interviews with the client and his relatives.
Medications, laboratory results, and diagnosis present on the
patient`s chart during the group`s course in the ICU on August 12-
19.
Assessments and interventions that this group has rendered to the
client during the group`s course in the ICU on August 12-19.
SOURCE OF INFORMATION
The inIormation is willingly given by the eldest daughter and
by the wiIe oI the patient.
Patient's chart is our primary source oI inIormation.
CHIEF COMPLAINT:
Epigastric pain and chest pain
iographic
Data and
Assessment
Name: Patient Y
Address: rgy. Paiisa Tiaong Quezon
Age: 59 years old
Sex: Male
Status: Married
Occupation: Currently None; he was a Iarmer
beIore.
Religion: Roman Catholic
ADMITTING HISTORY
DATE OF ADMISSION: August 10, 2011; 10:00am
Vital Signs upon admission:
p: 130/90
PR: 104 bpm
RR: 22bpm
Temp: 36.1 degree celsius
Oxygen Saturation: 94-95
HISTORY OF PRESENT ILLNESS
Two days prior to admission the patient started to
experience epigastric pain.
Few days prior to admission the patient experienced chest
pain.
~ According to his eldest daughter, the pt. Consulted a
doctor regarding his epigastric pain, and they were told
that the patient has esophageal irritation. ut then this
Iinding turned irrelevant because what might the pt Ieels
is just reIerred pain.
ACTIVITY OF DAILY LIVING
~ According to relatives, the patient has no diIIiculty
walking, bathing, and eating.
PAST HEALTH HISTORY
~ The patient had typhoid Iever during his early teens.
~ He also had kidney stones 20 years ago, he did not
undergo to any medical treatment, according to his
wiIe, they just used herbal medicine in treating it,
surprisingly a stone was excreted with his urine.
~ The patient has history oI asthma.
The patient has DM Ior 12 years.
FAMILY HISTORY
His Iather had hypertension.
LIFESTYLE
~ The patient drinks wines occasionally.
~ He is a chain smoker since his teens. He consumes 2 packs
oI cigarette per day.
PSYCHOLOGICAL DATA
~The patient is pessimistic, he easily get nervous when
talking about his health status.
SPIRITUAL ASPECT
~ His whole Iamily go to church every Sunday.
loyslcol
Assossoot
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Iocou oo too loIt lo.
uoou. Norocooollc
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|ors. Goou ooorlo, oo ulscooros
Noso. Wlto NGJ, oo oosol ulscooros
Vocto. Dry lls oou ccocs obrooos
Lcos. w, tocoyooo (2=b}oou coco, w, coost ooovlooss oou
croclos
Abuooo. (-} obuolool toouorooss
|troltlos. Goou kOV, ooll bous. colllory roIlll <5
s
Cordon's funcLlonal healLh paLLern
u|ALJu l|kC|lJlON,u|ALJu VGJ.
V lotloot ls cooorotlvo wlto too oulcol roloo os woll os
Iolly obors
NuJklJlONAL AND V|JAOLlC lAJJ|kN
V lotloot ls ccrrootly rocolvlo tcbo Iooulo vlo NGJ.
V uos uocroosou bowol socous uco to oor orlstoltlc ovooot
brocot by loblllty. l-2 bowol socous lo 2 loctos.
|LlVlNAJlON lAJJ|kN
V Joo otloot oos Ioloy cotootor oou too oocot oI crloo octct ls
oorol. (30-0 cc,oocr}
ACJlvlJ,|x|kCl$|
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$L||l,k|$J lAJJ|kN
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COGNlJlv|,l|kC|lJuAL lAJJ|kN
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vorbol rosooso.l (uco to |J}}
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lotloot oos bocoo lrrltoblo oou uoooulo.
kOL| k|LAJlON$ull lAJJ|kN
V Joo Iolly oI too otloot ls vory scortlvo toworus too trootoot oI
toolr rolotlvo. uo oos oou rolotloosol w, too os oolbltou by too
rosooco oI Iolly obors ovoryuoy.
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COllNG,$Jk|$$ JOL|kANC| lAJJ|kN
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uoooulo oou lrrltoblo oItor oowlo oI ols cooultloo.
vALu|$, |Ll||
V Joo volcos,bolloI oI too otloot uooso't olouor w, too trootoot
rocoss. lrlor to oulssloo too otloot cooscltou o oorboloryo.
CLINICAL
DISCUSSION
Aootoy oou loysloloy oI
too uoort
HEART
A hallow muscular organ
that pumps blood throughout
the body. It is located in the
thoracic cavity between the
two pleural cavities.
LOCATION: Lies obliquely
in the mediastinum, base
located posteriorly and apex
superiorly and to the leIt.
ase: 2nd ICS; Apex: 5th
ICS midclavicular line
HEART CHAMERS:
V Atria- upper two chambers oI
the heart.
V Ventricles- lower two
chambers oI the heart.
HEART WALL:
V Epicardium- the outer layer
oI the wall oI the heart.
V Myocardium- the muscular
middle layer oI the wall oI
the heart.
V Endocardium- the inner layer
oI the heart.
vALv|$.
V Jrlccslu volvo- rovoots boc Ilow oI bloou os lt ls cou
Iro too rlot otrlc to too rlot vootrlclo.
V Vltrol volvo- rovoots too bocIlow oI bloou os lt ls
cou Iro too loIt otrlc to too loIt vootrlclo.
V Aortlc volvos- rovoot too boc Ilow oI bloou os lt ls
cou Iro too loIt vootrlclo to too oorto.
V lclooory volvo- rovoots bocIlow oI too bloou os lt ls
cou Iro too rlot vootrlclo to too clooory ortory.
10/9/11
kLGULA1ICN CI nLAk1 IUNC1ICN
Cardiac output- is the volume oI blood pumped by either ventricle oI
the heart each minute.
Stroke volume- the volume oI blood pumped per ventricle each time
the heart contracts.
eart rate- the number oI times the heart contracts each minute.
CO SV x HR
INTRINSIC REGULATION OF THE HEART
reIers to the mechanism contained within the heart itselI.
Jenous return- the amount oI blood that returns to the heart and to which the
ventricular walls are stretched at the end oI diastole is called 5reload.
Starling's law oI the heart
Stroke volume is directly proportional to the preload.
1terload- reIers to the pressure against which the ventricles must pump
blood.
EXTRINSIC REGULATION
reIers to mechanism external to the heart such as either hormonal or nervous
regulation.
arorece5tor re1lex- stretch receptors that monitor blood pressure in the aorta
and in the wall oI internal carotid arteries, which carry blood to the brain.
Cardioregulatory center- located in the medulla oblongata oI the brain which
receives and integrates action potentials Iorm the baroreceptors. It controls
the action potentials in the SNS and PNS.
10/9/11
10/9/11
Myocardlal
lnfarcLlon
M?CCA8ulAL lnlA8C1lCn
Vyocorulol loIorctloo, coooly
oowo os o ooort ottoc, ls too
lrrovorslblo oocrosls oI ooort csclo
socoouory to rolooou lscoolo. Jols
cscolly rosclts Iro oo lbolooco lo
oyoo scly oou uooou, wolco ls
ost oItoo cocsou by logco rctcro
wlto torobcs Iorotloo lo o corooory
vossol, roscltlo lo oo occto roucctloo
oI bloou scly to o ortloo oI too
yocorulc.
1?LS Cl M?CCA8ulAL
lnlA8C1lCn
Transmural: associated with atherosclerosis
involving major coronary artery. It can be
subclassiIied into anterior, posterior, or
inIerior.
Subendocardial: involving a small area in the
subendocardial wall oI the leIt ventricle,
ventricular septum, or papillary muscles.
TYPES OF MYOCARDIAL
INFARCTION
ECG changes During an inIarct there is
normally ST elevation and T wave inversion,
there may also be the Iormation oI q waves.
The location oI the inIarct will be identiIied
by which leads are aIIected in a 12 lead ECG.
An inIerior inIarct is identiIied by reciprocal
changes in the leads Iacing the opposite wall.
Anterior wall V1 V4.
Lateral wall I, aVL, V5 and V6.
InIerior wall II, III, aVF.
SlCnS Anu S?M1CMS
Coost lolo
Dysooo
ollor
Nocsoo oou voltlo
loltlol oyotoosloo bct oy bo oyortoosloo oItorworus
|oor
RISK FACTORS:
NON MODIFIALE FACTORS:
Age
-Men: The risk increases aIter age 45
-Women: The risk increases aIter age
55
Hereditary
-Family history oI early heart disease
MODIFIALE FACTORS:
Diabetes Mellitus
Family history oI coronary heart
disease
Smoking or tobacco use
Hypertension
Hypercholesterolemia
lotoooysloloy
lroulsoslo Ioctors
$
L|festy|e
Increase fat
uptake
HyerqIycemio
MeLaplasla of Lhe
eplLhellal llnlng of
Lrachea
uecrease clllary
acLlon
8acLerlal
lnvaslon(SLrepLoco
ccus pneumonlae)
lnflammaLory
process
AccumulaLlon of
exudaLes and
debrls ln Lhe
alveoll
lmpalred gas
exchange
nLuMCnlA
resence of
opaclLles ln boLh
lower lobes of
Lhe lung
laLLy sLreaks ln
Lhe lefL coronary
arLery
lnflammaLory
response
lormaLlon of
aLheroma
Cccluded arLery
uecrease blood
supply
lschemla
Cellular hypoxla
uec arLerlal
pressure
Pardenlng of
arLery
lmpalred
clrculaLlon
CPLS1
8AulCC8AP
shows aorLa ls
aLheromaLous
C8C ls
always
hlgher Lhan
normal
uec cardlac
ouLpuL
laLLy sLreaks ln
Lhe lefL coronary
arLery
SLlmulaLlon of
barorecepLors
SLlmulaLlon of
SympaLheLlc
response
erlpheral
vasoconsLrlcLlon
lnc myocardlal
conLracLlllLy
erlpheral
vasoconsLrlcLlon
erlpheral
vasoconsLrlcLlon
erlpheral
vasoconsLrlcLlon
lnc hearL raLe
uec dlasLollc fllllng
uec myocardlal
Llssue perfuslon
lnc afLerload
lnc myocardlal
oxygen demand
Cardlomegaly ls Lhe
resulL of compensaLory
mechanlsm of Lhe hearL
of lncreaslng Lhe P8
CPLS1 Aln ls felL
because of lncrease
workload of Lhe
damaged hearL
LA8CkA1Ck kLSUL1S
10/9/11
10/9/11
Norma| Va|ue at|ent's Actua|
Account
S|gn|f|cance of the
kesu|t
In|t|a| Impress|on Med|ca| D|agnos|s
Clucose 74106 mg/dL 143 mg/dL Measures Lhe amounL
of glucose ln Lhe blood
High Diabetes Mellitus
Type
urlc acld 3383 mg/dL 39 mg/dL ueLermlnes any renal
funcLlonal lmpalrmenL
Normal
CholesLerol 97201 mg/dL 237mg/dL used Lo esLlmaLe rlsk of
developlng dlseases
speclflcally hearL
dlsease
High
Hypercholesterolemia
1rlglycerlde 30230 mg/dL 73 mg/dL Measures Lrlglycerlde
levels ln Lhe blood
whlch plays an
lmporLanL role
ln meLabollsmas
energy sources and
LransporLers of dleLary
faL
Normal
ulrecL PuLC 4060 mg/dL 28 mg/dL
Measures the level of HDLs
in deciliter of blood. Known
as "good cholesterol, risk of
developing cardiac disease
decreases with an increase
of HDL
Low Hypercholesterolemi
a
vLuL 033 mg/dL 13 mg/dL
Measures the level of
VLDLs in a deciliter of
blood, plays an important
role in transportation of
lipids to body tissues
Low Hypercholesterolemi
a
LuL 0160 mg/dL 194 mg/dL
Measures the level of LDLs
in a deciliter of blood, plays
an important role in
transportation of lipids to
body tissues
High Hypercholesterolemi
a
Cholesterol:dHDL
01000 831
Measures the number of
cholesterol per HDL
Normal
10/9/11
NormaI
VaIue
Patient's
ActuaI
Account
Significance
of the ResuIt
InitiaI
Impression
MedicaI
Diagnosis
CK MB 0-16 ng/mL 193 ndicator of
any damage
to the heart
muscles
High Myocardial
infarction
Troponin <0.4 ng/mL (positive) Marker of
cardiac
muscle tissue
injury
Myocardial
infarction
10/9/11
NormaI
VaIue
Patient's
ActuaI
Account
Significanc
e of the
ResuIt
InitiaI
Impression
MedicaI
Diagnosis
Creatinine 0.8-1.5
mg/dL
0.9 mg/dL Determines
any renal
functional
impairment
Normal
Sodium 137-145
mEq/L
141 mEq/L Measures
the level of
Na
+
in the
blood
Normal
Potassium 3.5-5.1
mEq/L
4.1 mEq/L Measures
the K
+
level
in the blood
Normal
CK MB 0-16 ng/mL 135 ng/mL ndicator of
any damage
to the heart
muscles
High Myocardial
infarction
NormaI VaIue Patient's ActuaI
Account
Significance of
the ResuIt
InitiaI Impression MedicaI
Diagnosis
BC 4000-10/mm
3
14.05 Measures the
number of BCs
per cubic mililiter
of blood
High nfection
Hgb 13.8-18g/dL 14.5 g/dL Hemoglobin is the
component of
RBCs that carries
oxygen
Normal
Hct 0.37-0.49 0.44 Measures the
proportion of RBCs
to plasma
Normal
Neutrophils 0.55-0.70 0.59 Active phagocytes,
number increases
rapidly during
short-term or acute
infection
Normal
Lymphocytes 0.20-0.40 0.30 Produces
antibodies, fights
tumors and viruses
Normal
Monocytes 0.02-0.08 0.08 Active phagocytes
that becomes
macrophages in
the tissues
Normal
Eosinophils 0.01-0.04 0.03 Kills parasitic
worms, increases
in allergy attacks
Normal
Basophils 0.00-0.02 0 Contains
histamines which
is discharged at
sites of infection
Normal
10/9/11
10/9/11
NormaI
VaIue
Patient's
ActuaI
Account
Significance
of the ResuIt
InitiaI
Impression
MedicaI
Diagnosis
FBS <100 mg/dL 145 mg/dL Test used to
diagnose
diabetes
mellitus
High Diabetes
mellitus type

10/9/11
NormaI
VaIue
Patient's
ActuaI
Account
Significance
of the ResuIt
InitiaI
Impression
MedicaI
Diagnosis
CK MB 0-16 ng/mL 57 ng/mL ndicator of
any damage
to the heart
muscles
High Myocardial
infaction
Aug. 10
th
11
th
12
th
13
th
14
th
15
th
16
th
BC 14.05/mm
3
Hgb 14.5g/dL
Hct 0.44
Neutrophils 0.59
Lymphocytes 0.30
Monocytes 0.08
Eosinophils 0.03
Basophils 0
Creatinine 9 mg/dL
Sodium 141 mEq/L
Potassium 4.1 mEq/L
CK MB 135 ng/mL 193 ng/mL 57 ng/mL 42 ng/mL 57 ng/mL 50 ng/mL 28 ng/mL
Troponin Positive
Glucose 145 mg/dL
Uric acid 5.9 mg/dL
Cholesterol 237mg/dL
Triglyceride 73 mg/dL
Direct HDLC 28 mg/dL
VLDL 15 mg/dL
LDL 194 mg/dL
CHOL/dHDL 8.51
FBS 145 mg/dL
10/9/11
10/9/11
10/9/11
August 16 2011
LCG
normal Slnus 8hyLhm
August 11 2011
Chest kray
SLreaky lnfllLraLes are seen ln boLh lung lobes
PearL ls enlarged wlLh lefL venLrlcular promlnence
ulaphragm sulcl and bony Lhorax are normal
lM8LSSlCn
neumonla 8llaLeral
Cardlomegaly wlLh lefL venLrlcular promlnence
Drug Study
10/9/11
8kAND
NAML
Gener|c
name
C|ass|f|ca
t|on
Act|on Ind|cat|o
n
Contra|n
d|cat|on
Dosage]r
oute
reparat|
on
Adverse
react|on
Nurs|ng
cons|der
at|on
1 Arlx
Lra
fondapar
lnux na
AnLlcoag
ulanL
SelecLlv
ely
lnhlblLs
facLor
dlsrupLln
g blood
coagulaLl
on and
lnhlblLlng
Lhrombln
formaLlo
n and
Lhrombu
s
develop
menL
revenLl
on of
Lhrombu
s
Pyperse
nslLlvlLy
Lo drug
AcLlve
ma[or
bleedlng
Severe
renal
dlsease
23 mg
Cu
subcuLan
eous
ln[
23mg/0
3 ml ln
slngle
dose/pre
fllled
syrlnge
depressl
on
dlzzlness
hypoLens
lon n/v
anemla
monlLor
v/s Lemp
and fluld
lnLake
and
ouLpuL
1ake
noLe of
Lhe lab
resulL
C8C
plaLeleL
counL
and
creaLlnln
e level
lnsrucL
Lhe pL Lo
lmmedla
Lely
reporL
bleedlng
8rand
name
Gener|c
name
C|ass|f|ca
t|on
Act|on Ind|cat|o
n
Contar|n
d|cat|on
Dosage]
koute
reparat
|on
Adverse
react|on
Nsg
respons|
b|||ty
2
nexlum
Lsomepr
azole Mg
AnLl
ulcer
agenL
reduces
gasLrlc
acld
producL
lon by
lnhlblLln
g
enzyme
acLlvlLy
ln gasLrlc
parleLal
cells
prevenLl
ng
LransporL
of
hydroge
n lons
lnLo
gasLrlc
lumen
LreaLme
nL of
gasLroes
ophageal
reflux
heallng
of
eroslve
esophagl
Lls
Pyperse
nslLlvlLy
40 mg
lv Cu
vlal 40
mg
Peadac
he
dlzzlness

vomlLlng

dlarrhea
cough
rash
lnflamm
aLlon
dry skln
MonlLor
pL for
presence
of
adverse
reacLlon
lnsLrucL
pL Lo
Lake
drug 1 hr
before
and 2 hrs
afLer
meal
CauLlon
pL Lo
avold
vlgorous
acLlvlLles
8rand
Name
Gener|c
Name
C|ass|f|cat|o
n
Act|on Ind|cat|on Contra|nd|c
at|on
Dosage]rou
te
reparat|on Adverse
react|on
Nsg
Cons|derat|
on
3 Zegen Cefuroxlme
sodlum
AnLl
lnfecLlve
2
nd
CeneraLlon
cephalospor
ln
lnLerfere
wlLh
bacLerlal
cell wall
synLhesls
and dlvlslon
by blndlng
Lo cell wall
causlng cell
deaLh
ModeraLe
Lo severe
lnfecLlons ln
resplraLory
LracL
Pypersensl
LlvlLy Lo
cephalospor
lns and
penlclllln
730 mg
every 8 hrs
lv
owder for
ln[ 730 mg
13 g 73 g
premlxed
conLalners
730 mg/30
ml 13 g/
30ml
Peadache
nausea
vomlLlng
dlarrhea
hyperglyce
mla
MonlLor pL
for llfe
LhreaLenlng
adverse
effecLs
lncludlng
anaphylaxls
Advlce
paLlenL Lo
lmmedlaLel
y reporL
rash or
bleedlng
Lendency
lnsLrucL
Lhe paLlenL
Lo Lake drug
wlLh food
lnsLrucL
Lhe paLlenL
Lo reporL
adverse
reacLlon
8rand
name
Gener|c
name
C|ass|f|cat|
on
Act|on Ind|cat|on Contra|nd|c
at|on
Dosage]ro
ute
reparat|o
n
Adverse
react|on
Nsg
respons|b|
||ty
4 vldasLaL SlmvasLaLl
n
AnLlhyperll
pldemlc
lnhlblLs
hepaLlc
enzyme
PMC
CCA
reducLase

lnLerrupLl
ng
cholesLer
ol
synLhesls
and LuL
consumpL
lon
Coronary
arLery
dlsease
hyperllpld
emla
PypersenslL
lvlLy Lo drug
or lLs
componenLs
AcLlve
hepaLlc dse
40mg l
Lab afLer
dlnner/ by
mouLh
(po)
1ableLs
3mg 10
mg 20mg
40mg
80mg
Peadache
nausea
vomlLlng
dlarrhea
consLlpaLlo
n
abdomlnal
paln or
cramps
WaLch
ouL for
slgns of
adverse
reacLlon
Advlse pL
Lo Lake
wlLh
evenlng
meal buL
noL wlLh
large
amounLs
of [ulces
1ell Lhe
pL LhaL
drug may
Lake up Lo
4 wks Lo
be
effecLlve
MonlLor
llver
funcLlon
LesLs C8C
and llpld
levels
8rand
name
Gener|c
name
C|ass|f|cat|
on
Act|on Ind|cat|on Contra|nd|
cat|on
Dosage]ro
ute
reparat|o
n
Adverse
react|on
Nsg
respons|b||
|ty
3 logrel Clopldogre
l blsulfaLe
AnLlplaLele
L drug
lnhlblLs
plaLeleL
aggregaLlo
n by
blocklng
blndlng of
Au Lo
plaLeleLs
Lhereby
prevenLlng
Lhrombus
formaLlon
1o reduce
aLheroscler
oLlc evenLs
ln paLlenLs
wlLh
recenL Ml
or CvA
Pypersens
lLlvlLy Lo
drug
AcLlve
paLhologlc
bleedlng
73mg l
Lab Cu/ by
mouLh (po)
1ableLs
73 mg
300mg
uepresslo
n
dlzzlness
faLlgue
headache
hyperLensl
on rash
MonlLor
vlLal slgns
MonlLor
hemoglobl
n and
hemaLocrlL
perlodlcall
y
MonlLor
paLlenL for
unusual
bleedlng or
brulslng
drug
slgnlflcanLl
y lncreases
rlsk of
bleedlng
1ell Lhe
paLlenL
LhaL drug
may cause
headache
and
dlzzlness
8rand
name
Gener|c
name
C|ass|f|cat|
on
Act|on Ind|cat|on Contra|nd|
cat|on
Dosage]ro
ute
reparat|o
n
Adverse
react|on
Nsg
respons|b||
|ty
6
llulmucll
AceLylcysLe
lne
MucolyLlc uecreases
vlscoslLy of
secreLlons
promoLlng
secreLlon
removal
Lhrouggh
coughlng
posLural
dralnage
and
mechanlca
l means
MucolyLlc
agenL ln
ad[ Lx of
chronlc
bronchopu
lmonary
dse
Pypersens
lLlvlLy Lo
drug
excepL
wlLh
anLedoLal
use
Lffervesce
nL
1ableLs
600 mg
ulzzlness
headache
hypoLenslo
n
hyperLensl
on
nausea
womlLlng
consLlpaLlo
n anorexla
MonlLor
vlLal slgns
Lncourag
e lncrease
fluld
lnLake
lnsLrucL
paLlenL Lo
reporL
worsenlng
cough and
oLher
resplraLory
sympLoms
Advlse
paLlenL Lo
mlx oral
form wlLh
[ulce or
cola Lo
wash bad
LasLe and
odor
8rand
name
Gener|c
name
C|ass|f|ca
t|on
Act|on Ind|cat|o
n
Contra|n
d|cat|on
Dosage]r
oute
reparat|
on
Adverse
react|on
Nsg
respons|
b|||ty
7
!anuvla
SlLagllpLl
n
phosphaL
e
Pypoglyc
emlc
lnhlblLs
u4
and
slows
lnacLlvaLl
on of
lncreLln
hormone
s helps
regulaLe
glucose
homeosL
asls
Lhrough
lncreased
lnsulln
release
and
decrease
d
glucagon
levels
Ad[uncL
Lo dleL
and
exerclse
Lo
lmprove
glycemlc
conLrol ln
Lype 2
uM
Pyperse
nslLlvlLy
Lo drug
and lLs
compone
nLs
100 mg
C Cu
1ab 23
mg 30
mg
100mg
Peadach
e
nausea
vomlLlng
dlarrhea
hypersen
slLlvlLy
reacLlons

anaphyla
xls
lnsLrucL
Lhe
paLlenL
Lo Lake
Lhe drug
wlLh or
wlLhouL
food
1each
Lhe
paLlenL
abouL
slgns and
sympLom
s of
hypersen
slLlvlLy
reacLlons

MonlLor
C8C
8rand
name
Gener|c
name
C|ass|f|cat|
on
Act|on Ind|cat|on Contra|nd|
cat|on
Dosage]ro
ute
reparat|o
n
Adverse
react|on
Nsg
respons|b||
|ty
8 lsokeL lsosorblde
dlnlLraLe
AnLlanglnal romoLes
perlpheral
vasodllaLlo
n and
reduces
preload
wlLh
afLerload
decreaslng
myocardlal
oxygen
consumpLl
on and
lncreaslng
carbon
dloxlde
Also
dllaLes
coronary
arLerles
lncreaslng
blood flow
and
lmprovlng
collaLeral
clrculaLlon
unrespon
slve lefL
venLrlcular
fallure
secondary
Lo acuLe
Ml
PypoLensl
on
Pead
Lrauma
2 amp
10mg/10
ml dlluLed
wlLh 80 cc
d3w aL 12
ugLLs for
fllLraLlon
lv amp
10mg/10m
l
ulzzlness
headache
hypoLenslo
n
Lachycardl
a nausea
vomlLlng
dry mouLh
abdomlnal
paln
MonlLor
vlLal slgns
esp blood
pressure
reporL Lo
Lhe A lf
hypoLenslo
n occurs
WaLch ouL
for
presence
of adverse
reacLlon
8rand
name
Gener|c
name
C|ass|f|ca
t|on
Act|on Ind|cat|o
n
Contra|n
d|cat|on
Dosage]r
oute
reparat|
on
Adverse
react|on
Nsg
kespons|
b|||ty
9
Clucovan
ce
MeLforml
n Pcl
Pypoglyc
emlc
lncrease
lnsulln
senslLlvlL
y by
decreasln
g glucose
producLl
on and
absorpLlo
n ln llver
and
lnLesLlne
s and
enhancln
g glucose
upLake
enhance
menL
1reaLme
nL of
Lype 2
uM ln
adulL
Pyperse
nslLlvlLy
Pypogly
cemla
23
mg/300
mg 8lu l
Lab
before
meal
1ab
123mg/
230mg
23mg/3
00mg
3mg/300
mg
nausea
vomlLlng
dlarrhea
abdomln
al paln
wlLh loss
of
appeLlLe
slgns of
acldosls
MonlLor
C8C
1each
paLlenL
abouL
dlabeLes
and
lmporLan
ce of
proper
dleL
exerclse
welghL
conLrol
1each
paLlenL
Lo
recognlze
and
lmmedlaL
ely
reporL
slgns and
sympLom
s of
acldosls
8rand
name
Gener|c
name
C|ass|f|ca
t|on
Act|on Ind|cat|o
n
Contra|n
d|cat|on
Dosage]r
oute
reparat|
on
Adverse
react|on
Nsg
respons|
b|||ty
10 lLerax Pydroxyz
lne
dlhydroc
hlorlde
AnxlolyLl
c
AnxlolyL
lc and
sedaLlve
effecLs
may sLarL
from
suppressl
on of
acLlvlLy
ln
subcorLlc
al levels
of CnS
SympLo
maLlc
LreaLmen
L of
anxleLy
prurlLus
of
allerglc
orlgln
Pyperse
nslLlvlLy
Lo drug
23mg l
Lab by
mouLh
(po)
1ab
23mg 10
mg 30
mg
ury
mouLh
faLlgue
headach
e
sedaLlon
drowslne
ss
wheezlng
MonlLor
vlLal
slgns
Assess
for
adverse
reacLlons

1ell Lhe
paLlenL
Lo
conLacL
prescrlbe
r lf he
experlen
ces
wheezlng

8rand
name
Gener|c
name
C|ass|f|cat|
on
Act|on Ind|cat|on Contra|nd|
cat|on
Dosage]ro
ute
reparat|o
n
Adverse
react|on
Nsg
respons|b|
||ty
11
Carvedllol
Carvedllol
phosphaLe
AnLlhyperL
enslve
8lock
sLlmulaLlo
n of
cardlac
beLa
adrenerglc
recepLor
slLes and
pulmonary
beLa2
adrenerglc
recepLor
slLes
Show
lnLrlnslc
sympaLho
mlmeLlc
acLlvlLy
causlng
slowlng of
hearL raLe
decreased
myocardlal
exclLablllLy
reduced
CC and
decreased
renln
release
from
kldney
PyperLens
lon
PearL
fallure
caused by
lschemla
or
cardlomyo
paLhy
LefL
enLrlcular
dysfuncLlo
n followlng
Ml
Pypersen
slLlvlLy Lo
drug
kldney
problem
623mg l
Lab Cu by
mouLh
(po)
1ab
3123 mg
623mg
123 mg
23mg
ulzzlness
faLlgue
anxleLy
depresslon
lnsomnla
memory
loss
nlghLmare
s
headache
paln
hyperLensl
on
bradycardl
a
MonlLor
vlLal slgns
WaLch for
s/s of
hypersensl
LlvlLy
reacLlon
Measure
blood
glucose
regularly lf
pL has uM
drug may
masks s/s
of
hypoglyce
mla

8rand
name
Gener|c
name
C|ass|f|ac
t|on
Act|on Ind|cat|o
n
Contra|n
d|cat|on
Dosage]r
oute
reparat|
on
Adverse
react|on
Nsg
respons|
b|||ty
12 Laslx luroseml
de
ulureLlc
AnLlhype
rLenslve
1houghL
Lo lnhlblL
sodlum
and
chlorlde
reabsorp
Llon from
ascendln
g loop of
henle
and
dlsLal
renal
Lubules
lncreases
k+
excreLlon
and
plasma
volume
promoLe
renal
excreLlon
of h2o
naCl
PyperLe
nslon
Ldema
caused
by hearL
fallure
Pyperse
nslLlvlLy
Lo drug
Anurla
20mg lv
Cu
ln[
10mg/ml
ulzzlnes
s
headach
e
verLlgo
weaknes
s
hypoLens
lon
Lachycar
dla
vomlLlng
nausea
cramplng
dry
mouLh
rash
oLoLoxlcl
Ly
MonlLor
vs
WaLch
ouL for
presence
of
adverse
reacLlon
MonlLor
urlne
ouLpuL
MonlLor
k+ levels
Nur:nq C|rc l|n
Assossoot Dlooosls llooolo lotorvootloo kotlooolo |volcotloo
$cb|octlvo Cco.
Noololrooo ooo
ocloo os
vorbollzou by too
otloot.
Ob|octlvo ccos.
>v,$.
l.ll0,80
kk.2
uk.98
O2 sot. 93%
>kostloss
>w, Dry Coco
>w, croclos
>w, coost
ooovlooss
>lollor
>Dry slo oou oor
slo tcror
>Colu cloy slo
lolrou os
ocoooo lo rolotloo
to loIlootloo os
oolIostou by
uocroosou O2
sotcrotloo (93%}
AItor o sorlos oI
ocrslo lotorvootloo
too clloot wlll
uooostroto
lrovou vootllotloo
oou oyoootloo.
Absooco oI
sytos oI
roslrotory ulstross.
>Assoss roslrotory
roto, uoto, oou
ooso
>Vooltor ooort
roto,royto
Volotolo bou rost.
|ococroo cso oI
rolootloo
tocoolgco oou
ulvorsloool octlvltlos
|lovoto ooou oou
oococroo Irogcoot
osltloo coooos,
uoo brootolo oou
oIIoctlvo cocolo.
VoolIostotloo oI
roslrotory ulstross
oro uooouoot
oo,loulcotlvo oI too
uoroo oI lco
lovolvooot oou
couorlylo ooorol
ooolto stotcs.
Jocoycorulo ls
cscolly rosoot os o
rosclt oI
Iovor,uooyurotloo
bct oy rorosoot o
rosooso to
oyoolo.
lrovoots
ovorooocstloo oou
rouccos oyoo
coosctloo,uooo
us to Iocllltoto
rosolctloo oI
loIoctloo.
lrooto olol
loslrotloo, oooooco
ooctorotloo oI
socrotloos to
lrovo vootllotloo.
>Gool ortlolly
ot.
>Dooostrotos
lrovou olrwoy
otoocy, os
ovluoocou by
ouogcoto
oyoootloo by
clso olotry
(ccrroot O2 sot.
98%}
Assossoot Dlooosls llooolo lotorvootloo kotlooolo |volcotloo
>Obsorvo Ior
uotorlorotloo lo
cooultloo, ootlo
oyotootloo, colocs
oocots oI
lo,bloouy
sctc, ollor,
cyooosls, coooo lo
lovol oI
coosclocsooss,
sovoro uysooo,
rostlossooss
>Vooltor AG's,
clso olotry
>oulolstor O2
tooroy by
ororloto ooos
>lrooro Ior
losortloo oI
|ouotrocoool tcbo
os loulcotou
>Aulolstor
oulcotloos os
roscrlbou.
>oy loulcoto
couorlylo cooultloo
scco os clooory
ouoo or sooc.
luootlIlos roblo,
Iollows roross oI
uso
rocoss,lrovoo
ot, Iocllltoto
oltorotloos lo
clooory tooroy.
Joo croso oI
oyoo tooroy ls
to olotolo loO2
obovo 0 u.
lrooto vootllotloo
oou rovluo otoot
olrwoy
Assossoot Dlooosls llooolo lotorvootloo kotlooolo |volcotloo
$cb|octlvo cco.
Vosolt oo
ulbulb o os
vorbollzou by too
otloot.
Ob|octlvo ccos.
>w, Ioclol rloco
>lolo scolo (8}
>woo lo
ooorooco
>ollor (os
oolbltou by olo
ooll bous}
>v,$. l.ll0,80
uk. 98
kk. 2
O2 sot. 93%
Accto olo rolotou
to tlssco lscoolo
AItor o sorlos oI
ocrslo lotorvootloo
too otloot's roort
oI olo wlll ullolso
Iro 8,l0 to 5,l0.
>Obtolo Icll
uoscrltloo oI olo
Iro clloot. Asslst
clloot to gcootlIy
olo by coorlo
lt to otoor
oorloocos
>lrovluo gclot
oovlroooot oou
coIort ooscros.
Arooco clloot
colly oou
cooIluootly.
>Asslst,lostrcct lo
rolootloo
tocoolgco
>Aulolstor O2 vlo
oosol cooclo or
Ioco os os
loulcotou.
>Aulolstor
oulcotloos os
loulcotou.
>lrovluos bosolloo
Ior coorlsoo to
olu lo uotorlolo
oIIoctlvoooss oI
tooroy, rosolctloo,
rorossloo oI
roblo.
>Docrooso otorool
stlcll w,c lot
orovoto ooloty
oou coruloc strolo.
>uolIcl lo
uocrooslo
orcotloo,rosoos
o to olo.
>locrooso oocot
oI ovolloblo Ior
yocorulol ctoo
oou tooroby oy
rollovo ulscoIort
ossoclotou w, tlssco
lscoolo.
Gool ot.
-lotloot
oorloocou rolloI
Iro olo oou ols
olo scolo
uocroosou Iro
8,l0 to 5,l0
10/9/11
Assessment Nursing
Diagnosis
PIanning ImpIementation RationaIe EvaIuation
Subjective:
"Mataas daw ang
blood sugar ko as
verbalized by the
client.
Objective:
>GCS 15/15
>FBS of 145 mg/dL
>Bed Ridden
>Dry skin
>Pale
Risk for impaired
skin integrity
related to high
glucose level and
physical immobility.
After a series of
nursing
interventions, the
client's risk for
impaired skin
integrity will
decrease as a
result of ongoing
assessment and
interventions
>nspect skin
surfaces and
pressure points
routinely for
discoloration and
dryness
>Reposition the
client in the bed
every 2 hours
>Massage and tap
the client's skin,
especially at the
back and the
extremities
>Apply lotion,
moisturizer, or oil
on the skin (if
necessary)
>Keep the bed
sheets clean and
wrinkle free
>Monitor &O
>To reduce the
likelihood of
progression to skin
breakdown
>Prevents
prolonged pressure
and friction
between the skin
and the bony
prominences that
could cause
pressure ulcers
>To promote
proper circulation
>Dry skin is more
prone to breakage
>rinkled bed can
cause discomfort
and shearing
>To determine any
dehydration that
could make the
patient prone to
skin break down
After a series of
nursing
interventions, the
client's risk for
impaired skin
integrity has
decreased as a
result of ongoing
assessment and
interventions