CP Acute Renal Failure chap7

7/31/2019 CP Acute Renal Failure chap7

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CHAPTER VII

MEDICAL AND NURSING MANAGEMENT

This chapter presents the laboratory tests of the patient and the interpretation of

the results. It also includes the laboratory results, discharge planning, drug studies,

health teachings, prognosis, problem list, Gordons functional health patterns,

prioritization of nursing diagnoses and nursing care plans.

IDEAL MEDICAL AND NURSING MANAGEMENT

a. Medical Management

Laboratory and Diagnostics Examinations:

o

Serum creatinine

An increase in the amount of creatinine in the blood (serum

creatinine) is usually the first sign of acute renal failure.

Repeated tests of serum creatinine can help monitor the

progress of renal failure and can help determine whether

treatment has been successful.

o Blood urea nitrogen (BUN)

BUN measures the amount of nitrogen in your blood that

comes from the waste product urea. If your kidneys are not

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able to remove urea from the blood normally, your BUN level

increases.

o Blood electrolyte tests, such as calcium, phosphate (phosphorus),

potassium, and sodium.

Potassium testing is used to detect concentrations that are too

high or too low. While calcium test aids in the diagnosis of

neuromuscular, skeletal, and endocrine disorders; arrhythmias;

blood-clotting deficiencies; and acid-base imbalance.

o Complete blood count (CBC)

A CBC provides important information about the red blood

cells, white blood cells, and platelets. It can be used to check

for diseases or infections that could be causing renal failure.

o Erythrocyte sedimentation rate (ESR, or sed rate) or antinuclear

antibodies (ANA) test

These may be used to screen for infection, autoimmune

disease, and other disorders, if your medical history and

symptoms suggest that one of these conditions might be

present.

o Urinalysis

Examines a sample of your urine. The results can provide

information about urine sediment, which is useful for evaluating

kidney damage (intrinsic acute renal failure).

It also looks for:

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Surgical relief of obstruction.

Correction of underlying fluid excess or deficits.

Correction and control of biochemical imbalances such as in:

HYPERKALEMIA give glucose and insulin to shift

potassium into cells; cation exchange resin orally or by

enema to promote rectal excretion of potassium.

ACIDOSIS give sodium bicarbonate; be prepared for

mechanical ventilation.

Restoration and maintenance of blood pressure through IV

fluids and vasopressors.

Maintenance of adequate nutrition Low protein diet with

supplemental amino acids and vitamins.

Administration of a low protein diet to delay inevitable renal

replacement therapy or to lengthen the interval between

sessions is physiologically unsound.

Initiation of hemodialysis, peritoneal dialysis or continuous renal

replacement therapy for patients with progressive azotemia and

other life threatening complications.

Dialysis as needed to control hyperkalemia, pulmonary edema,

metabolic acidosis, and uremic symptoms

Adjustment of drug regimen.

b. Nursing Management

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Assessment

During the Oliguric anuric phase: Assess urine volume less than 400

mL per 24 hours; increase in serum creatinine, urea, uric acid, organic

acids, potassium and magnesium; lasts 3 to 5 days if infants and

children, 10 to 14 days in adolescents and adults.

During the Diuretic phase: Assess when it begins with urine output

exceeds 500 mL per 24 hours and ends when BUN and creatinine

levels stop rising; length is variable.

Recovery Phase: asymptomatic; lasts several months to 1 year.

In Pre renal disease: Decrease tissue turgor, dryness of mucous

membranes, weight loss, flat neck veins, hypotension and tachycardia.

In Intra renal disease: presentation usually varies; usually have edema,

may have fever, skin rash.

Assess for nausea, vomiting, diarrhea and lethargy.

Diagnosis

Disturbed thought processes

Excess fluid volume

Imbalanced Nutrition: Less than body Requirements

Risk for infection

Planning

The goals are to attain optimal level of nutrition, maintenance of F&E

balance, maintenance of optimal tissue healing and avoidance of

complications.

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Nursing Interventions

MONITORING

Monitor 24- hour urine volumes to follow clinical course of the

disease.

Monitor BUN, creatinine and electrolytes.

Monitor signs and symptoms of hypovolemia or hypervolemia

because regulating capacity of kidneys is in adequate.

Monitor urine specific gravity; measure and record intake and

output, including urine gastric suction, stools, wound drainage,

perspiration. Specific gravity fixed at 1.010 indicates kidneys

inability to concentrate urine.

Monitor electrocardiogram for dysrhythmias and changes

associated with electrolyte imbalance, and report signs and

symptoms of hyperkalemia.

Monitor ABG levels as necessary to evaluate acid- base

balance.

Weigh the patient daily to provide an index of fluid balance.

Measure blood pressure at various times during the day with

patients in supine, sitting and standing positions.

Monitor for signs of infection.

Watch and report mental status changes, including lassitude,

lethargy and fatigue progressing to irritability, disorientation,

twitching and seizures.

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SUPPORTIVE CARE

Adjust fluid intake to avoid volume overload and dehydration.

a. Fluid restriction is not usually initiated until renal function is

quite low.

b. Give only enough fluids to replace losses during oliguric

anuric phase.

c. Fluid allowance should be distributed throughout the day.

d. Restrict sodium and water intake if there is evidence of

extracellular excess.

Watch for cardiac dysrhythmias and heart failure from

hyperkalemia, electrolyte imbalance or fluid overload. Have

resuscitation equipment available in case of cardiac arrest.

Treat hyperkalemia as ordered: administer sodium bicarbonate

or glucose and insulin to drive potassium cells.

Watch for signs of urinary tract infection and remove bladder

catheter as soon as possible.

Work with the dietician to regulate protein intake according to

the type of renal impairment. Protein and potassium are usually

restricted.

Institute seizure precautions, provide padded side rails and

have airway and suction equipment at the bedside.

Encourage and assist the patient to turn and move because

drowsiness and lethargy may reduce activity.

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HEALTH TEACHINGS

Explain that the patient may experience residual defects in

kidney function for long time for acute illness.

Encourage the patient to report for routine urinalysis and follow

up examinations.

Advise patient to avoid any medication unless specifically

prescribed.

Recommend resuming activity gradually because muscle

weakness will be present from excessive catabolism.

Evaluation

Expected Patient Outcomes

Consumes a healthy and balance diet.

Maintains fluid balance.

Feels less anxious.

Acquires information about diagnosis, surgical procedure and self care

after discharge.

Express feelings and concerns about self.

Recovers without complications.

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ACTUAL MEDICAL AND NURSING MANAGEMENT

COMPLETE BLOOD COUNT

01/15/11

A complete blood count is a common blood test, providing information on the

general health status and is a tool for checking disorders such as anemia, infection and

thrombocytopenia. Complete blood count provides detailed information about three

types of cells: red blood cells, white blood cells and platelets.

PURPOSES:

To assess overall health.

To diagnose a medical condition.

To monitor medical treatment.

To monitor medical condition.

PREPARATION:

If blood sample is tested only for CBC, a person can eat and drink normally

before the test.

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If a person is having other/additional test at the same time, she may need to fast

for a certain amount of time before the test.

PROCEDURE:

A member of health care team specifically a Medical technologist takes a sample

of blood.

A needle is inserted into the nein in the arm.

The blood sample is brought/ sent to the laboratory for analysis.

NURSING RESPONSIBILITIES:

Explain to the patient the purpose of the test.

Tell the patient that a blood sample will be taken and that she may feel slight

discomfort from the tourniquet and needle puncture.

Use gloves when obtaining and handling all specimens.

Transport specimen to the laboratory as soon as possible.

Diagnostic/laboratory Date Result Normalvalues

Interpretation

WBC

Monocytes

01/15/11

19.17

0.05

5-10 x10 g/L

0.03-0.06 %

Increaseindicates

infection(urinarytractinfection)

Still withinthe normalrange.

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Eosinophil

Basophils

Neutrophils

Hemoglobin

Hematocrit

RBC

MCV

MCHC

MCH

Platelet

0.01

0.00

0.82

173.4

0.52

6.0

86

38.5

33.2

337

0.02-0.04 %

0.00-0.01 %

0.55-0.65 %

120-140 SIg/L

0.40-0.50 x10 ^12/ L

4.5-5.0u ^ 3

82-92u ^3

32- 36g/dl

27-31pg

150-350 x

Slightdecrease,nosignificancebut low

value mayindicateallergiesandendocrinedisorders

Withinnormalrange

Increaseindicates

infection. Increase

may occurdue todehydration.

Increasemay be duetodehydration/severalepisodes of

vomiting. Increase

may be duetodehydration.

Withinnormalrange

Increasemayindicate

anemia. Increase

mayindicateanemia(pernicious).

Withinnormal

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10^g/L

range

FECALYSIS

01/15/11

Fecalysis is also known as stool analysis. It refers to a series of laboratory tests

done on fecal samples to analyze the condition of a persons digestive tract in general.

Among other things, a fecalysis is performed to check for the presence of any reducing

substances such as white blood cells (WBCs), sugars, or bile and signs of poor

absorption as well as screen for colon cancer. Fecalysis is the basic examination of the

stool which includes the inspection of the consistency, color and testing for occult blood.

It is inexpensive and noninvasive that can be performed at home as well as at the

doctors office.

PREPARATION:

If he is taking any medications, these must be screened as some can affect test

results. A patient is usually discouraged as well from taking aspirin, alcohol,

vitamin C, ibuprofen and certain types of food if his fecal sample will be checked

for any sign of blood.

Recent travel and X-Ray tests can also affect the results of fecalysis.

PROCEDURE:

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The patient must urinate first to prevent any urine from mixing with his feces later

on.

He must also wear gloves when its time to handle stool and transfer it to a safer

container. Solid and liquid fecal samples are both acceptable as long as they do

not have urine or other foreign substances like soap, water, and toilet paper

mixed in them.

If the patient is suffering from diarrhea, placing a plastic wrap and securing it

under the toilet seat could facilitate the collection process.

Collected samples must be brought to the doctors office or laboratory as soon as

possible. Delays could compromise the quality of the sample. Volume or amount

is also important so the patient must be sure he has collected an adequate

amount of stool.

Diagnostic/laboratory

Date Result Normal values Interpretation

Consistency

Color

RBC

01/15/11 Watery

Yellow

0-1/HPF

Soft andbulky,smalland dry,depending onthe diet.

Brown

None

Mayindicatemetabolicproblems

Changein colordepends

on thekind of foodtaken.

MayindicateGIbleeding

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Pus cells

Remarks:intestinal ova

and parasitesseen.

0-2/HPF None Mayindicateinfection

CLINICAL CHEMISTRY SECTION

01/15/11

This test is used to measure serum levels of calcium, the most abundant mineral

in the body. More than 98% of the body's calcium is found in bones and teeth, but

relative concentrations in those structures may vary as the body maintains calcium

balance. The body excretes calcium daily, regular ingestion of calcium in food (at least 1

g/day) is necessary for normal calcium balance. It is used to detect concentrations that

are too high or too low.

Purpose

To aid diagnosis of neuromuscular, skeletal, and endocrine disorders;

arrhythmias; blood-clotting deficiencies; and acid-base imbalance.

Patient preparation

Explain to the patient that this test is used to determine blood calcium levels.

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Tell him that the test requires a blood sample. Explain who will perform the

venipuncture and when.

Explain that he may experience slight discomfort from the needle puncture and

the tourniquet but that collecting the sample usually take less than 3 minutes.

Inform him that he needn't restrict food or fluids before the test.

Procedure and posttest care

Perform a venipuncture (without a tourniquet if possible), and collect the sample

in a 7-ml red-top orred marble-top tube.

If a hematoma develops at the venipuncture site, apply warm soaks.



Potassium

Calcium

Sodium

01/15/11

4.3mmol/ L

3.05mmol/L

144

3.5- 5.1mmol/ L

2.10-2.54mmol/L

137-145

Stillwithinnormalrange.

Increasemay bedue toepisodesofvomiting.

Still

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Creatinine

mmol/L

2.2mg/dl

mmol/L

0.8- 1.5

withinnormalrange.

Increasemay be

due tdehydration andmayindicateimpairedkidneyfunction.

URINALYSIS

01/16/11

Urinalysis is a test that evaluates a sample of your urine. It is used to detect and

assess a wide range of disorders, including urinary tract infection, kidney disorders and

diabetes. Urinalysis involves examining the appearance, concentration and content of

urine. A laboratory technician will examine the urines appearance. Urinalysis is also

called the Dipstick test.

PURPOSE:

To assess your overall health.

To diagnose a medical condition.

To monitor a medical condition.

PREPARATION:

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If urine is tested only for urinalysis, a person can eat and drink normally before

the test.

If a person is having other/additional test at the same time, she may need to fast

for a certain amount of time before the test.

PROCEDURE:

A laboratory technician will examine the urines appearance.

Urine can be collected at home or at the doctors office.

A container will be given for the urine sample.

Ideally urine should be collected in the morning because at that time urine is

concentrated and abnormal results may be obvious.

The urine sample should be collected using a clean- catch method at least 15

mL.

Deliver the sample to the laboratory, if you cant deliver it within 30 minutes;

refrigerate the sample unless youve been instructed.

The urine sample is then tested by placing a dipstick in the urine.

NURSING RESPONSIBILITIES:

Explain how to collect a clean catch specimen of at least 15 mL.

Explain that there is no food or fluids restriction.

Obtain a first voided morning specimen if possible.

Medications may be restricted for it may affect laboratory results.

Diagnostic/Laboratory


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Color

Transparency

Reaction

Specificgravity

Sugar

Albumin

Crystals

Amorphousurates

Pus cell

01/16/11

Yellow

Hazy

5.0

1.020

Negative

Positive(3+)

None

Few

0-2/HPF

Strawyellow,

amber

Clear

4.5-8

1.002-1.030

Negative

Negative

None

None

Negative

Normal

Signifieshigh levelofsedimentmay bepresent incase of urinarytract

infectionand anindicatorof kidneydisorder.

Still withinnormalrange.

Still withinnormalrange

Normal

Largeamountsof proteinmayindicatekidneyproblem.

Normal

It mayindicateanykidneyproblems.

Pus cellsin theurine may

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Erythrocytes 10-15/HPF

Negative

indicateinfection.

Indicateskidneydisorder,

blooddisorderor bladdercancer.


01/17/11

This test is used to measure serum levels of calcium, the most abundant mineral

in the body. More than 98% of the body's calcium is found in bones and teeth, but

relative concentrations in those structures may vary as the body maintains calcium

balance. The body excretes calcium daily, regular ingestion of calcium in food (at least 1

g/day) is necessary for normal calcium balance.

Purpose

To aid diagnosis of neuromuscular, skeletal, and endocrine disorders;

arrhythmias; blood-clotting deficiencies; and acid-base imbalance.

Patient preparation

Explain to the patient that this test is used to determine blood calcium levels.

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Potassium

Calcium

Sodium

01/17/11

2.8

mmol/ L

1.37mmol/L

130

mmol/L

3.5- 5.1

mmol/ L

2.10-2.54mmol/L

137-145

mmol/L

Decrease

may bedue todehydration andvomiting.

Decreasemayindicatelowcardiacstatus.

Decreasemay becausedbyexcessivefluid losscausedby

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vomitinganddiarrhea.


POTASSIUM TEST

01/19/11

Potassium testing is frequently ordered along with other electrolytes, a part of

routine physical. It is used to detect concentrations that are too high or too low.

Potassium is a mineral vital to skeletal, cardiac and smooth muscle activity. It is

involved in maintaining acid- base balance and as well as contributes to the intracellular

enzyme reactions.

Purpose:

To aid in the diagnosis of skeletal and cardiac disorders as well as acid- base

imbalance.

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Patient preparation

Explain to the patient that this test is used to determine blood potassium levels.












Potassium

01/19/11

4.1mmol/ L

3.5- 5.1mmol/ L

Stillwithinnormalrange.

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ARTERIAL BLOOD GAS ANALYSIS

01/19/11

Arterial blood gas (ABG) analysis is used to measure the partial pressures of oxygen

(PaO2), carbon dioxide (pacO2), the pH of an arterial sample, Oxygen content (O2CT),

oxygen saturation (SaO2) and bicarbonate (RCO3 -) values. A blood sample for ABG

analysis may be drawn by percutaneous arterial puncture or from an arterial line.

Purpose

To evaluate gas exchange in the lungs.

To assess integrity of the ventilatory control system.

To determine the acid-base level of the blood.

To monitor respiratory therapy.

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Patient preparation

Explain to the patient that this test is used to evaluate how well the lungs are

delivering oxygen to blood and eliminating carbon dioxide.


arterial puncture and when and which site - radial, brachial, or femoral artery -

has been selected for the puncture.

Inform him that he needn't restrict food or fluids.

Instruct the patient to breathe normally during the test, and warn him that he may

experience a brief cramping or throbbing pain at the puncture site.


Perform an arterial puncture.

After applying pressure to the puncture site for 3 to 5 minutes, tape a gauze pad

firmly over it. (If the puncture site is on the arm, don't tape the entire

circumference; this may restrict circulation.)

If the patient is receiving anticoagulants or has a coagulopathy, hold the puncture

site longer than 5 minutes if necessary.

Monitor vital signs, and observe for signs of circulatory impairment, such as

swelling, discoloration, pain, numbness, and tingling in the bandaged arm or leg.

Watch for bleeding from the puncture site.



pH

01/19/11

7.190 7.35-7.45

Decreasemay

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PCO2

PO2

HCO3

BE

13.9

82

5.3

-23

35-45mmHg

80-105mmHg

22-26mmol/L

-2 to +3mmol/L

indicateacidity ofblood.

Decreasemay

resultfrom thedecreasepH or acidity ofthe blood.It servesas arespiratorcomponent of acid-

basedetermination.

Normal

Decreasemayresultfrom thedecreasepH or

acidityand mayindicatemetabolicacidosis.It servesas ametaboliccomponent of acid

base

balance. Decrease

may bedue toacidosisordecreasepH.

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SO2 93 95-98% Slight

decrease,nosignificance but

low mayindicateinadequateperfusion.

CHEST P.A

01/19/2011

The chest x-ray is the most commonly performed diagnostic x-ray examination.

Chest x-ray makes images of the heart, lungs, airways, blood vessels and the bones of

the spine and chest. An x-ray (radiograph) is a noninvasive medical test that helps

physicians diagnose and treat medical conditions. Imaging with x-rays involves

exposing a part of the body to a small dose of ionizing radiation to produce pictures of

the inside of the body. X-rays are the oldest and most frequently used form of medical

imaging.

PURPOSE: Chest X-ray can show:

The condition of the lungs.

Heart related lung problems.

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The size and outline of the heart.

Blood vessels.

Calcium deposits.

To help diagnose or monitor treatment for conditions

PREPARATION:

You may be asked to remove some or all of your clothes and to wear a gown

during the exam.

You may also be asked to remove jewelry, dentures, eye glasses and any metal

objects or clothing that might interfere with the x-ray images.

Women should inform the physician that they are pregnant. Many imaging tests

are not performed during pregnancy so as not to expose the fetus to radiation.

PROCEDURE:

A radiologist is the one who perform the procedure and analyzes the result.

During the procedure, the body is positioned between the X-ray camera and the

X-ray digital recorder. The person will be asked to move into different positions or

angles.

During the front view, the person stands against the plate that contains the X- ray

film or digital recorder. You hold arms up or to the sides and roll shoulders

forward, and then take a deep breath.

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During the side views, you turn and place one shoulder on the plate and raise

your hands over the head, and then take a deep breath again.

RADOLOGIC FINDINGS

RESULT:

Patch of heavy densities are seen in the right lower lung field. These are

questionable opacities in the right apex. Left lung is clear, heart is clear. Heart is not

enlarged, sulci are intact. Trachea is at the midline. Bony thoracic cage is intact. Rest of

the included structures is unremarkable.

IMPRESSION:

Pneumonia

Suggest Apico- lordotic view for further evaluation of the right apex.


CREATININE TEST

01/23/11

The creatinine test measures urine levels of creatinine, the chief metabolite of

creatine. Produced in amounts proportional to total body muscle mass, creatinine is

removed from the plasma primarily by glomerular filtration and is excreted in the urine.

Because the body doesn't recycle it, creatinine has a relatively high, constant clearance

rate, making it an efficient indicator of renal function. A standard method for determining

urine creatinine levels is based on Jaffe's reaction; in which creatinine treated with an

alkaline picrate solution yields a bright orange-red complex.

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Purpose

To help assess glomerular filtration.

To check the accuracy of 24-hour urine collection based on the relatively

constant levels of creatinine excretion.

Patient preparation

Explain to the patient that this test helps evaluate kidney function.

Inform him that he needn't restrict fluids but shouldn't eat an excessive amount of

meat before the test.

Advise him that he should avoid strenuous physical exercise during the collection

period.

Tell him the test usually requires urine collection over a 24-hour period and teach

him the proper collection technique.


Collect the patient's urine over a 24hour period. Use a specimen bottle that

contains a preservative to prevent the degradation of creatinine.

Resume administration of medications withheld during the test.

Tell the patient he may resume normal diet and activity.



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Creatinine

01/23/11

1.5mg/dl

0.7-1.5mg

Stillwithin thenormal

range.

DOCTORS ORDER

Date and Time Doctors Order Rationale

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11/15/ 11 Please admit underthe service of Dr.Espinosa- Baas.

Please secureconsent.

TPR q4.

Start IVF PLR1L to runfast drip 500 cc thenregulate at 40 gtts/min.

IVF to follow PNSS1 Lto run at 30 gtts/ min

For management ofpresent condition.

Done for legalpurposes and toensure clientsknowledge,understanding ofhis condition andcooperation to themanagement ofhis condition.

To assess, compareand monitor patients conditionand progress. Vital

signs are usuallyaltered when thereis uneasiness ordiscomfort felt.

Helps to expandintravascularvolume; correctsan underlyingimbalance in fluidsand electrolytes,

and compensatesthe loss in thebody.PLR is anisotonic solution inwhich is usuallyused for whenthere isdehydration andhypovolemia.

Helps to expandintravascular

volume; correctsan underlyingimbalance in fluidsand electrolytes,and compensatesthe loss in thebody. PNSS s anisotonic solution

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Laboratory Tests: Complete Blood

Count.

Urine Analysis

Serum Potassium

used when there ishyponatremia andshock.

A complete blood

count is a commonblood test,providinginformation on thegeneral healthstatus and is a toolfor checkingdisorders such asanemia, infectionandthrombocytopenia.

Complete bloodcount providesdetailedinformation aboutthree types of cells: red bloodcells, white bloodcells and platelets.

Urinalysis is a testthat evaluates asample of yoururine. It is used todetect and assessa wide range ofdisorders,including urinarytract infection,kidney disordersand diabetes.Urinalysis involvesexamining theappearance,

concentration andcontent of urine.

Potassium testing isfrequently orderedalong with otherelectrolytes, a partof routine physical.

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Sodium

Calcium.

Serum Creatinine.

It is used to detectconcentrations thatare too high or toolow. Potassium isa mineral vital to

skeletal, cardiacand smoothmuscle activity.

Sodium testing isfrequently orderedalong with otherelectrolytes, a partof routine physical.It is used to detectconcentrations thatare too high or toolow. Sodium is amineral vital torenal reabsorptionand excretion aswell as for transmittingimpulses andcontractingmuscles.

Done to measure

the serum level ofcalcium as well as toaid in the diagnosisof neuromuscular,skeletal, andendocrine disorders;arrhythmias; blood-clotting deficiencies;and acid-baseimbalance.

The creatinine test

measures urinelevels of creatinine, thechief metabolite ofcreatinine. It alsohelps in assessingthe glomerularfiltration capacity

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11/15/11

11 AM

(+) seizure forseconds.

Medications:

Plasil 1 amp IVTTnow then q8 run forcontinuity.

Risek 40 mg IVTTO.D

Metronidazole 500 mgTID P.O.

Refer labs to A.P.

Fast drip 300 cc IVFnow.

Serum electrolytes tolab now and refer toDr. Espinosa, once in.

Start dopamine drip

of the kidney.

Prior to admissionpatientexperiencedepisodes of nausea andvomiting. The drugwas given torelieve or preventvomiting.

Patient wasdiagnosed to havemetabolic acidosis,wherein the bodyproduces toomuch acid. Thedrug was given totreat hyperacidityanddecrease/preventgastric secretion.

The patient alsowas diagnosed tohave amoebiasis.This drug wasgiven to treatamoebiasis.

Done for furtherevaluation of thelaboratory result.

Intravenous fluidsmust be properlyregulated asordered by thedoctor. This is toensure balance ofthe intake andoutput as well asto prevent possiblecomplications.

Done for furtherexaminations andevaluation of results.

Based on the

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37/128

4:30 PM

Tachypneic,

Acidoticbreathing, sunkeneyeballs, 4x LBMsince this AM.

6:35 PM

(-) urine output

7:40 PM

BM- once, (-) urineoutput

Fast drip 200cc frompresent IVF.

NaHCO3 25 meq + 25cc IVF Slow IVTT.

Insert foley catheterand attach to urobag.

Intake and output qshift and record.

Fast drip 500 cc PLR

IVF: PLR 1 L x 3 0gtts/min

rate was done toimprove perfusionand also toimprove bloodpressure of the

patient.Intravenous fluids

must be properlyregulated asordered by thedoctor.

Patient wasdiagnosed to havemetabolic acidosisthat is why thedrug was given to

treat metabolicacidosis andreduce gastricsecretion it shouldbe given slowly toprevent irritation.

Done to facilitateurine eliminationas well as tomonitor the urineoutput of the

patient.Done to monitor and

check the balancebetween the totalamount taken andreleased/excreted.

Intravenous fluidsmust be properlyregulated asordered by the

doctor. PLR isusually used whenthere isdehydration andhypovolemia.

Helps to expandintravascularvolume; corrects

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7:50 PM

(+) back pain, (-)urine output

Fast drip 500 cc nowx 30 mins.

IVF to follow: PLR 1 L

x 8.

Refer if still withouturine output after 1hour.

Give tramadol 50 mgIVTT now.

PLR 1L, fast dripanother 500 cc x 2cycles 30 minutesapart.

an underlyingimbalance in fluidsand electrolytes,and compensatesthe loss in the

body. PLR isusually used whenthere isdehydration andhypovolemia.

Intravenous fluidsmust be properlyregulated asordered by thedoctor.

Helps to expand

intravascularvolume; correctsan underlyingimbalance in fluidsand electrolytes,and compensatesthe loss in thebody. PLR isusually used whenthere isdehydration and

hypovolemia.Done to monitor and

evaluate clientscondition and forthe doctor toattend the saidproblem.

Patient experiencedpain due toincrease gastricsecretion that is

why the drug wasgiven to relievepain felt.

Intravenous fluidsmust be properlyregulated asordered by thedoctor. PLR is

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9 PM

BM- twice, watery

9:50 PM

Give Loperamide 1

cap TID.

IVF to follow: PLR 1 Lx 8- 3 bottles.

Fast drip 500 cc nowx 2 cycles 30 minutesapart.

IVF to follow: Right D5NM 1L x 8- 2 bottles.

Fast drip PNSS 500cc now x 2 cycles 30minutes apart.

usually used whenthere isdehydration andhypovolemia.

Patient was

diagnosed to havegastrointestinalinfection, AcuteGastroenteritis and

Amoebiasis inwhich one of itsmanifestations isloose bowelmovement. Thedrug was given totreat diarrhea.

Helps to expandintravascularvolume; correctsan underlyingimbalance in fluidsand electrolytes,and compensatesthe loss in thebody. PLR isusually used whenthere is

dehydration andhypovolemia.

Intravenous fluidsmust be properlyregulated asordered by thedoctor.

Helps to expandintravascularvolume; correctsan underlying

imbalance in fluidsand electrolytes,and compensatesthe loss in thebody.

Intravenous fluidsmust be properlyregulated as

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1/16/11

6:20 AM

BP: palpatory

50 mmHg, (+) BM

Fast drip PLR 500 ccnow.

Run present IVF PLR

1 L x 8.

Start tazobactam(vigocid) 2.25 g qshift, ANST.

Loperamide 2

capsules TID.

To follow D5 NSS 1 Lat 120 cc/ hr.

ordered by thedoctor. PNSS isusually used whenthere ishyponatremia and

shock.Helps to expand

intravascularvolume; correctsan underlyingimbalance in fluidsand electrolytes,and compensatesthe loss in thebody. PLR isusually used when

there isdehydration andhypovolemia.

The patient wasdiagnosed to havePneumonia that swhy the drug wasgiven to treatPneumonia andcombat infection.

Patient was

diagnosed to havegastrointestinalinfection, AcuteGastroenteritis and

Amoebiasis inwhich one of itsmanifestations isloose bowelmovement. Thedrug was given totreat diarrhea.

Helps to expandintravascularvolume; correctsan underlyingimbalance in fluidsand electrolytes,and compensatesthe loss in the

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1:30 PM

BP: 70/40 mmHg Refer to DR. Dequina.

Start Dobutamine250mg /500 mL run at5gtts/min.

Decrease dopaminedrip at 10 gtts/min.

Continue vigocid,loperamide andmetronidazole.

Refer.

D5 LR 1 L at 160 cc/hour Left arm.

body. D5 NSS isusually used whenthere isdehydration, shockand circulatory

insufficiency.Done for further

evaluation andmanagement.

Based on theassessment,patients bloodpressure ispalpatory only to80 mmHg; thedrug was given to

improve cardiacoutput.Dopamine is

indicated toimprove perfusionof vital organs, thedosage wasslowed down orreduced since theperfusion andblood pressure is

improving.Vigocid is indicated

to treat metabolicacidosis;loperamide isindicated to treatdiarrhea andmetronidazole isindicated to treatamoebiasis. It isdone for continuity

of the progress oftreating underlyingconditions.

Done for furthervaluation andmanagement.

Helps to expandintravascular

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3:30 PM

Ketorolac 30 mg qshift IV PRN for pain.

ABG stat.

Serum Creatinine

Potassium

volume; correctsan underlyingimbalance in fluidsand electrolytes,and compensates

the loss in thebody.Patient experienced

pain due to theincrease gastricsecretion that iswhy the drug wasgiven to relievepain felt.

To measure thepartial pressures

of oxygen (PaO2),carbon dioxide(pacO2), the pH ofan arterial sample,Oxygen content(O2CT), oxygensaturation (SaO2)and bicarbonate(RCO3 -) values.

The creatinine testmeasures urine

levels of creatinine, thechief metabolite ofcreatine. It alsohelps in assessingthe glomerularfiltration capacityof the kidney.

Potassium testing isfrequently orderedalong with otherelectrolytes, a partof routine physical.It is used to detectconcentrations thatare too high or toolow. Potassium isa mineral vital to

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4:30 PM

C.C near, fainting,BP: palpatory 80mmHg, (-) urine

Calcium

Change D5 NM 1L toPNSS 1 L at 100 gtts/min.

Start Dobutamine 250mg on D5 W 250 cc at30 gtts/ min. now.

Complete bed rest.

IVF:I. Right

PLR 1 L x 70 gtts/min.

To follow:

skeletal, cardiacand smoothmuscle activity.

Done to measure theserum level ofcalcium as well asto aid in thediagnosis of neuromuscular,skeletal, andendocrinedisorders;arrhythmias;blood-clottingdeficiencies; andacid-baseimbalance.

Helps to expandintravascularvolume; correctsan underlyingimbalance in fluidsand electrolytes,and compensatesthe loss in thebody.

Based on theassessment,patients bloodpressure ispalpatory only to70/40 mmHg, thedrug was given toimprove cardiacoutput.

Ordered because ofthe possible injuryor fall due tohypotension andsome CNS sideeffects of thedrugs.


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output. PLR 1 L at 60gtts/min.

PLR 1 L at 50 gtts/min.

Remaining Dopamine,Please addfurosemide 20 mg runthis at 10 gtts /min.

To follow: Dopamine 200mg in

D5 W 250 cc pre-mixed + furosemide

20 mg at 10 gtts/min.

Dobutamine drip at 30gtts/min.

To follow:

an underlyingimbalance in fluidsand electrolytes,and compensatesthe loss in the

body. PLR isusually used whenthere isdehydration andhypovolemia.

Based on theassessment,patients latestblood pressure ispalpatory that iswhy the drug was

given to improveperfusion to vitalorgans and tocorrecthypotension.Furosemide isadded to treatedema.

Based on theassessment,patients latest

blood pressure ispalpatory that iswhy the drug wasgiven to improveperfusion to vitalorgans and tocorrecthypotension.Furosemide isadded to treatedema.

Based on theassessment,patients bloodpressure ispalpatory, the drugwas given toimprove cardiacoutput.

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46/128

Continue O2.

Citicholine 500 mg IVq 8.

Advised ICUadmission, will waitfor their decision.

For close watchplease.

Family was advised toboil drinking water.

Please patency offoley catheter.

Wife was taught onaspiration precaution.

Done to improvebreathing pattern.

Based onassessment,patients blood

pressure is verylow and he wasdiagnosed of having prolongedhypotension. Thisdrug was given toimprove perfusionof vital organs andto correcthypotension.

Patient is in severe

condition whichrequires closemonitoring andevaluation.

Patients condition isalready severewhich requiresclose monitoring inorder to attendimmediatelyproblems.

The cause of amoebiasis of theclient is due to thewater taken fromthe river that iswhy it should beboiled to ensuresafe and cleanwater.

Done to ensure thatthe catheter is still

functioning andalso to determineurine outputaccurately.

Done in order for thesignificant othersto attend needsand problems of

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12 MN

BP: 70/40 mmHg,BM: 3x- 1000 cc.

1/17/11

1:15 AM

Add 10 mg offurosemide onpresent Dopaminedrip then on theDopamine drip tofollow add 40 mgfurosemide instead of20 mg.

Fast drip 200 cc ofPNSS

IV to follow on the

Left, PNSS 1 L at 100gtts/min x 3 bottles.

Repeat serumcreatinine at 6 PM.

their patient aswell as to beinvolved in themanagement ofthe clients

condition.Based on

assessmentpatient has edemadue to 3rd spacefluid shfting. It wasgiven to treatedema as well asto improveperfusion to vitalorgans.

Intravenous fluidsmust be properlyregulated asordered by thedoctor. PNSS isusually used whenthere ishyponatremia andshock.

Helps to expand

intravascularvolume; correctsan underlyingimbalance in fluidsand electrolytes,and compensatesthe loss in thebody. PNSS isusually used whenthere ishyponatremia andshock.

Patient wasdiagnosed to haveacute renal failure.This is done toassess glomerularfiltration status thismay help in

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5:45 AM Give sodium

bicarbonate 1 ampvery slow IV push stat

for 15 minutes.

Repeat dose after 10minutes.

Put side drip at leftarm D5 W 200 cc + 2ampules of Na HCO3to run at 20 gtts/min.

Fast drip at Left armIV 200 cc.

IVF to follow:

Right arm, PLR 1 L x40 gtts/ min.

determining kidneyfunction.

Patient wasdiagnosed to havemetabolic acidosis

that is why thedrug was given totreat metabolicacidosis andreduce gastricsecretion it shouldbe given slowly toprevent irritation.

To continue theprogress of treating metabolic

acidosis.Patient was

diagnosed to havemetabolic acidosisthat is why thedrug was given totreat metabolicacidosis andreduce gastricsecretion. D5 W isusually used when

there is fluid loss.Intravenous fluids


Helps to expandintravascularvolume; correctsan underlyingimbalance in fluids

and electrolytes,and compensatesthe loss in thebody. PLR isusually used whenthere isdehydration andhypovolemia.

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7AM

Creatinine 5.8mg/dl, (-) urineoutput for morethan 48 .

11:45 AM

With urine output,active, HR:100bpm

Left arm, PNSS 1 L x120 gtts/min. x 2bottles.

Suggest referral to Dr.Torre because ofincreasing creatinine.

Please carry out orderof Dr. Dequina.

Repeat serumcreatinine in AM.

IVFRight:

Decrease dobutamineto 16 gtts/min. thenconsume to of BP is >90 systolic.


and electrolytes,and compensatesthe loss in thebody. PNSS isusually used whenthere ishyponatremia andshock.

Done for furtherexaminations andevaluation of

results.To update the nurse

and the clientabout hiscondition, for continuity of care.

Patient wasdiagnosed to haveacute renal failurewhich requiresclose monitoring of

creatinine, anindicator of kidneyfunction. Done toassess glomerularfiltration status thismay help indetermining kidneyfunction.

Based on the

assessment,patients bloodpressure is alreadystable that is whythe drug dosagewas reduced. Thiswas given toimprove cardiac

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12:20 PM

Decrease Dopamine-furosemide drip to 6gtts/min.

Mainline IVF to follow:

D5 NM 1 L x 6

D5 NSS 1 L x 6

D5 NM 1 L x 7

Left: NaHCO3 drip at 20

gtts/ min.

output.

Dopamine isindicated toimprove perfusionof vital organs, the

dosage wasslowed down orreduced since theperfusion andblood pressure isimproving.


and electrolytes,and compensatesthe loss in thebody.

Helps to expandintravascularvolume; correctsan underlyingimbalance in fluidsand electrolytes,and compensates

the loss in thebody. D5 NSS isusually used whenthere isdehydration, shockand circulatoryinsufficiency.

Helps to expandintravascularvolume; correctsan underlying

imbalance in fluidsand electrolytes,and compensatesthe loss in thebody.

Patient wasdiagnosed to havemetabolic acidosis

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Mainline PNSS 1 L at60 gtts/min. ThenPNSS 1 L at 60gtts/min.

Urine C&S please.

Citicholine IV up totomorrow AM only.

Please continue tomonitor VS q 1-2

that is why thedrug was given totreat metabolicacidosis andreduce gastric

secretion.Helps to expand

intravascularvolume; correctsan underlyingimbalance in fluidsand electrolytes,and compensatesthe loss in thebody. PNSS isusually used when

there ishyponatremia andshock.

Done to determinepresence of microorganism inthe urine as wellits type.

Based onassessment,patients blood

pressure is verylow and he wasdiagnosed of having prolongedhypotension. Thisdrug was given toimprove perfusionof vital organs andto correcthypotension. Itwas to be

consumed sincethe patients bloodpressure hadalready comeback.

Vital signs should bemonitoredfrequently because

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11:30 PM

UO: 250 cc, BP:120/90 mmHg

11:55 PM

K: 2.8, C: 1.37, Na:130.

and I&O q 4 andrefer accordingly.

Moderate fast drip theremaining 250 cc on

PNSS then IVF tofollow, PNSS 1 L at100 gtts/min. x 4bottles.

Calvit/ Caltrate Plus 1tab P.O now then 1tab 3x a day.

Please incorporate 40meqs KCl + presentIVF of D5 NSS andrun at 30 gtts/ min.

client ishypotensive andcertainmedications aregiven. I & O should

also be monitoredto ensure thebalance betweenthe total amounttaken andreleased/excreted.

Intravenous fluidsmust be properlyregulated asordered by the

doctor. PNSS isusually used whenthere ishyponatremia andshock.

Patient wasdiagnosed to havemetabolic acid andlow serum calciumlevel. This drugwas given to treat

hyperacidity aswell as tosupplementcalcium.

Patient wasdiagnosed also tohave hypokalemia,low serumpotassium levelthat is why KClwas given tosupplementpotassium in ourbody. D5 NSShelps to expandintravascularvolume; correctsan underlyingimbalance in fluids

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1/18/11

10:15 AM

Feeling betternow, regular rhythm, (-) rales,soft abdomen.

Start side drip D5 W500 cc + 2 ampulesCalcium carbonate at20 gtts/min.

IVF:Right: Mainline: Present: D5

NSS with KCl at 30gtts/min.

To follow:

D5 NM 1 L + 20 meqKCl at 26 gtts/ min.


Patient was

diagnosed to havemetabolic acid andlow serum calciumlevel. This drugwas given to treathyperacidity aswell as tosupplementcalcium. D5 W isusually used whenthere is fluid loss.

Patient wasdiagnosed also tohave hypokalemia,low serumpotassium levelthat is why KClwas given tosupplementpotassium in ourbody. D5 NSShelps to expand

intravascularvolume; correctsan underlyingimbalance in fluidsand electrolytes,and compensatesthe loss in thebody.

Patient wasdiagnosed also tohave hypokalemia,low serumpotassium levelthat is why KClwas given tosupplementpotassium in ourbody. D5 NSS

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D5 NM 1 L + 16 meqat 20 gtts/min.

Dopamine-Furosemide drip toconsume.

Calcium carbonatedrip to consume.

Left:

Mainline: Present:PNSS decrease to 50gtts/min.

helps to expandintravascularvolume; correctsan underlyingimbalance in fluids


Helps to expandintravascularvolume; correctsan underlyingimbalance in fluidsand electrolytes,and compensates

the loss in thebody.

Dopamine is used toimprove perfusionof vital organs andcorrecthypotension whileFurosemide isused to treatedema. Thesedrugs were about

to consume, sincethe patients vitalsigns was alreadystable.

Patient wasdiagnosed to havemetabolic acid andlow serum calciumlevel. This drugwas given to treathyperacidity as

well as tosupplementcalcium.

Intravenous fluidsmust be properlyregulated asordered by thedoctor. PNSS is an

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To follow: PNSS 1 L at 40

gtts/min. PNSS 1 L at 30

gtts/min.

NaHCO3 drip toconsume.

Please check everyhour that each IVF isflowing accordingly.

VS q 4.

Discontinue IVomeprazole shift toomeprazole 20 mg 1tab P.O BID.

isotonic solutionused when there ishyponatremia andshock.

Helps to expand

intravascularvolume; correctsan underlyingimbalance in fluidsand electrolytes,and compensatesthe loss in thebody. PNSS is anisotonic solutionused when there ishyponatremia and

shock.Patient was

diagnosed to havemetabolic acidosisthat is why thedrug was given totreat metabolicacidosis andreduce gastricsecretion.

Intravenous fluids


Vital signs should bemonitoredfrequently becauseclient ishypotensive.

Patient wasdiagnosed to have

metabolic acidosis.This drug wasgiven to decreasegastric secretion.

Done so that shockwill not beexperienced by thepatient that may

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1/19/11

9:15 AM

BP: 160/90 mmHg,(+) rales bothlungs, (+)congestion

11:50 AM

Impact of dyspnea, no afterformula 1.5 L.

Allow to sit.

Regulate IVF at rightarm to KVO.

Close IVF at left arm.

Furosemide 40 mgvery slow IVTT now.

Monitor VS every 15minutes until stable.

Refer for unusualities.

Transfer IV line fromright arm to left armand regulate to 15gtts/min.

cause suddendecrease of bloodpressure.

Intravenous fluidsmust be properly

regulated asordered by thedoctor.

This may be done todiscontinue IVF ordrugadministrationrequires it.

Based on theassessment done,patient has edema

due to 3rd

spacefluid shifting. Thisdrug was given totreat edema. Itshould be givenslowly to avoidirritation.

Vital signs should bemonitoredfrequently becauseclient is

hypotensive and itis usually alteredwhen there isdiscomfort andabnormalities felt.

For further management andto attend theproblemimmediately.

Intravenous fluids

must be properlyregulated asordered by thedoctor. It is donemay be becausethe site at the rightarm is not alreadypatent or good as

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1:40 PM

S/o: alert, lack BMwas 10 PM lastnight, labored andfast breathing,BP: 130/90 mmHg,HR: 80bpm, (-)rales, UO: 2,250

Repeat serumcreatinine- 1/221/11

Repeat serumpotassium today.

Give P.O. meds. Atleast 1 hour apart.

Decrease omeprazoleOD hours of sleep.

Request for:

Chest X- Ray, sitting.

well as to preventIV complications.

To assessglomerularfiltration status this

may help indetermining kidneyfunction.

It is used to detectconcentrations thatare too high or toolow. Potassium isa mineral vital toskeletal, cardiacand smoothmuscle activity.

This is to preventdrug-druginteractions as wellas promote properabsorption of drugs.

Patient wasdiagnosed to havemetabolic acidosis.This drug was

given to decreasegastric secretion.The drug dosageis reduced may bebecause there isalready lessgastric secretion.

Patient wasdiagnosed to havePneumonia and wassuspected to have

PTB, minimal. Tohelp diagnose ormonitor treatment forconditions, as wellas to assess lungcondition.

To measure the

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cc (time- 7 AM to1:40

PM).

2 PM

ABG this afternoon.

O2 PRN.

Please relay serum K

+

ASAP by sun call tome or Dr. Torre.

Discontinue Ercefuryl

DiscontinueLoperamide.

Discontinue Kitnos.

Suggest:

Consume present

stock of IVmetronidazole thenshift to flagyl 500 mg1 tab P.O TID aftermeals.

Carry out all to followD5 NM 1 L at 10- 12

partial pressuresof oxygen (PaO2),carbon dioxide(pacO2), the pH ofan arterial sample,

Oxygen content(O2CT), oxygensaturation (SaO2)and bicarbonate(RCO3 -) values.

Patient wasdiagnosed to havePneumonia, whichmay causedifficulty of

breathing that iswhy O2 was givento supportbreathing andimprove breathingpattern.

For further evaluation andmanagement.

Underlyingconditions treated

using thesemedicationsmaybe are alreadycured.

Patient wasdiagnosed to haveamoebiasis. Thisdrug was given totreat the saidcondition and to

combat infection.Done to update the

nurse and clientabout his conditionand the neworders made. Thisis also to ensurecontinuity of care.

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6:15 PMABG result

relayed;pH:7.190PCO2:13.9PO2:82HCO3: 5.3BE: (-23)SO2:93TCO2:6

1/20/1111 AMStill acidoticbreathing but lessthan yesterday,alert, coversant,last B was last

night formed.

gtts/min.

Hook to O2 with 2-3L/min via nasalcannula.

Give NaHCO3 1 ampslow IV push for 15minutes.

At the same time,hook to side drip, D5W 500 cc + 2 ampulesNaHCO3 to run at 20gtts/ min.

Please relay CXRresult.

NaHCO3 10 gms. 2tablets TID P.O start

today.

NaHCO3 drip to

Patient wasdiagnosed to havePneumonia, whichmay causedifficulty of

breathing that iswhy O2 was givento supportbreathing andimprove breathingpattern.


treat metabolicacidosis andreduce gastricsecretion. It shouldbe given slowly toprevent irritation.

To increaseeffectivity of thedrug as well as theprogress of treating metabolic

acidosis.For further

evaluation andmanagement.

Patient wasdiagnosed to havemetabolic acidosisthat is why thedrug was given totreat metabolicacidosis and

reduce gastricsecretion.

Patient wasdiagnosed to havemetabolic acidosisthat is why thedrug was given totreat metabolic

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61/128

4:00 PM

Creatinine: 2.1mg/dl, Patientseen.

1/22/11

12:20 PM

Continue bladdertraining once foleycatheter is removedtomorrow, pleaserefer urine retention.

IVF to follow, D5 NM 1L x 24.

Please carry outsuggestions of Dr.Dequina.

Repeat serumcreatinine on 1/ 23/11- AM.

IVF: Present D5 NM

to run at 6-8gtts/min.

this is to stimulateurination.


an underlyingimbalance in fluidsand electrolytes,and compensatesthe loss in thebody.

Done to update thenurse and clientabout his conditionand the neworders made. This

is also to ensurecontinuity of care.Patient was

diagnosed to haveacute renal failurewhich requires aclose monitoring ofcreatinine, oneindicator of kidneyfunction. Toassess glomerular

filtration status thismay help indetermining kidneyfunction.

Helps to expandintravascularvolume; correctsan underlyingimbalance in fluidsand electrolytes,

and compensatesthe loss in thebody.


147


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63/128


64/128

NaHCO3 10gms. #20 only

2 tabs P.O TID.

Zinnat toconsumepresent stock.

Omeprazole #61 tab P.O OD7AM.

Lasix 40 mg #1only tab P.OOD 7AM.

Check up with Dr.Baas and Espinosa.

Advised:

Be careful with waterand foods.

metabolic acidosisthat is why thedrug was given totreat metabolicacidosis and

reduce gastricsecretion.

Patient wasdiagnosed to haveinfections such aspneumonia,urinary tractinfection, acutegastroenteritis andGIT infections thatis why the drug

was given to treatinfection and it.

Patient wasdiagnosed to havemetabolic acidosisthat is why thedrug was given totreat metabolicacidosis andreduce gastricsecretion.

Based on theassessment done,patient has edemadue to 3rd spacefluid shifting. Thisdrug was given totreat edema.

For further evaluation.

Through these, the

patient could againhave amoebiasisand possiblyacquire infection,

To remove dirt andmicroorganism inour hands andprevent having

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Proper hand washing

Monitoring of serumcreatinine

infection.Patient was

diagnosed to haveacute renal failurewhich requires a

close monitoring ofcreatinine anindicator of kidneyfunction. Done toassess glomerularfiltration status thismay help indetermining kidneyfunction.

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PHARMACOLOGIC MANAGEMENT

January 15, 2011 Loperamide Metoclopramide

(Plasil)

1 cap TID

1 amp IVTT RN for vomiting q 8

January 16, 2011

Nifuroxazide(Ercefuryl)

Etofamide (Kitnos)

Citicholine

Piperacillin tazobactam(Vigocid)

1 cap P.O. TID

500 mg 1 tab P.O BID

500 mg IV q8

2.25 gm IVTT ANST (-)

q8

January 17, 2011 PotassiumChloride (Kalium)

2 tablets P.O TID

January 19, 2011 Metronidazole(Flagyl)

500 mg 1 tab P.O. BID

January 23, 2011 Ketorolac

Ciprofloxacin(Ciprobay XR)

NaHCO3

Cefuroxime axetil(Zinnat)

Calcium carbonate

(Calvit) Omeprazole

(Risek)

Furosemide (Lasix)

30 mg IVTT PRN for

pain q 8

500 mg 1 tab P.O. OD

2 tablets P.O. TID

500 mg 1 tab P.O. OD

1 tab P.O. OD

20 mg 1 tab P.O. HS

40 mg 1 tab

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Brand name: ZINNAT

Generic name: cefuroxime axetil

Classification: Anti-infectives- 2ND Genaration Cephalosporins

Indications:

Lower respiratory infections.

Infections of the urinary.

Uncomplicated UTIs.

Contraindications:

Patients hypersensitive to drug or other cephalosorins.

Patients hypersensitive to penicillin because of possibility of cross sensitivity with

other beta- lactam antibiotics.

Drug interaction: Aminoglycosides, Loop diuretics, Probenecid

Actual Dosage: 500 mg 1 tab P.O OD

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Mechanism of action: Second generation cephalosporin that inhibits cell wall

synthesis, promoting osmotic instability; usually bactericidal.

Adverse reactions:

CV: phlebitis and thrombophlebitis.

GI-:pseudomembranous colitis, anorexia, diarrhea, nausea and vomiting.

HEMATOLOGIC: transient neutropenia, eosinophilia, hemolytic anemia, and

thrombocytopenia.

SKIN: maculopapular and erythematous rashes, urticaria, pain, induration, strile

abscesses, temperature elevation, tissue sloughing at I. M injection site.

OTHER: hypersensitivity reactions, serum sickness and anaphylaxis.

Nursing responsibilities:

ASSESSMENT:

Assess for allergy to cephalosporin. If allergic to one type, the patient should not

receive any other type of cephalosporin.

Assess vital signs which include the elevated temperature.

Assess urine output which includes the decrease urine output. Report abnormal

findings.

Assess for the laboratory result specifically the white blood cell count.

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Assess for the degree or severity of infection by observing signs of infection and

laboratory results.

DIAGNOSIS:

Ineffective Protection r/t invasion of microorganisms as manifested by increased

white blood cell count- 19.17 x 10^g/L.

PLANNING:

Clients infection will be controlled and later eliminated.

IMPLEMENTATION:

Verify the Doctors order.

Perform skin testing.

Observe the 12 rights in medication.

Observe for signs of hypersensitivity.

Monitor vital signs, urine output and laboratory results.

Report for any abnormalities.

Explain to the patient that the drug may have a bitter taste.

Instruct the patient to take the drug as prescribed.

Observe and notify physician about loose stools and diarrhea.

Nursing Considerations:

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If patient is unable to swallow tablets, the drug may be crushed or dissolved in

small amounts of apple, orange or grape juice.

To enhance absorption, drug can be given with food.

Health Teachings:

Instruct client to take the complete course of medication when when symptoms of

infection have ceased.

Instruct patient in proper hygiene.

Instruct patient to report any side effects from use of oral cephalosporin drug

which may include anorexia, nausea and vomiting, headache, itching and rash,

Advise the patient to take medication with food if gastric irritation occurs.

EVALUATION:

Evaluate the effectiveness of the cephalosporin by determining if the infection

has ceased and no side effects.

Rationale: Patient was diagnosed to have different infections such as Pneumonia,

urinary tract infections, acute gastroenteritis and GIT infection. This drug was given to

treat and combat infection.

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Brand name: FLAGYL

Generic name: metronidazole

Classification: Antiamoebics / Other Antibiotics/ Antiprotozoal Agent

Indications:

Amoebiasis

anaerobic infection

Contraindications:

In patients hypersensitive to drug or other nitroimidazole derivatives.

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Use cautiously in patients with history of blood dyscrasias, CNS disorder or

visual field changes.

Patients who take hepatotoxic drugs or hepatic disease and alcoholism.

Drug interaction: Cimetidine, Lithium, oral anticoagulants and Phenobarbital.

Actual Dosage: 500 mg 1 tab P.O after meals x 3 days TID

Mechanism of action: Direct acting trichomonacide and amebicide that works inside

and outside the intestines. Its thought to enter the cells of

microorganisms that contain nitroreductase, forming unstable

compounds that bind to DNA and inhibit synthesis, causing

cell death.

Adverse reactions:

CNS: fever, vertigo, headace, ataxia, dizziness, syncope, incoordination,

confusion, irritability, depression, weakness, insomnia, seizures and peripheral

neuropathy.

CV: flattened T wave, edema, flushing, thrombophlebitis.

EENT: rhinitis, pharyngitis and sinusitis.

GI-: abdominal cramping or pain, stomatitis, epigastric distress, nausea and

vomiting, anorexia, diarrhea, constipation, dry mouth and metallic taste.

GU: darkened urin, polyuria, dysuria, cystitis, dyspareunia, dryness of vagina and

vulva, vaginitis and genital pruritus.

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Check and verify the Doctors order.

Observe the 12 rights in medication.


Monitor vital signs. Compare with baseline findings.

Give drug with meals to minimize GI irritation.

Explain to patient that he may experience a metallic taste and have dark or red

brown urine.

Monitor the clients urinary output.

Observe for side effects and adverse reactions such as nausea, vomiting and

headache.

Instruct the client to take the drug as prescribed.

Record number and characteristics of stools.


Observe patient for edema, because Flagyl may cause sodium retention.

Health Teachings:

Advice to avoid alcohol intake and drugs with alcohol content at least 3 days

after the treatment.

Instruct patient in proper hygiene.

Instruct to take drug with food to minimize gastric irritation.

Instruct to report immediately any neurologic symptoms such as seizures and

peripheral neuropathy.

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Instruct to report/ notify prescriber for unusual responses.

EVALUATION:

Evaluate the effectiveness of the drug by noting absence of the infection.

Rationale: patient was diagnosed to have amoebiasis manifested by loose bowel

movement. The drug was given to treat amoebiasis.

Brand name: CIPROBAY XR

Generic name: ciprofloxacin

Classification: Fluoroquinolones

Indications:

Infections of the respiratory tract.

Urinary tract infection.

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Septicemia, infections in patients w/ reduced host defenses.

Contraindications:

In patients hypersensitive to fluoroquinolones.

Use cautiously in patients with CNS disorders, such as seizure disorders. Drug

may cause CNS stimulation.

Drug interaction: Increased serum theophylline; NSAIDs; cyclosporine; warfarin.

Potentiate effect of glibenclamide. Probenecid increases

ciprofloxacin serum conc. Al- & Mg-containing antacids.

Actual Dosage: 500 mg 1 tab P.O OD

Mechanism of action: Inhibits bacterial DNA synthesis, mainly by blocking DNA gyrase

thus having bactericidal effect.

Adverse reactions:

CNS: headache, restlessness, tremor, dizziness, fatigue, drowsiness, insomnia,

depression, light- headedness, confusion, hallucinations, seizures and

paresthesia.

CV: thrombophlebitis, edema and chest pain.

GI: nauseas, diarrhea, vomiting, abdominal pain or discomfort, oral candidiasis,

pseudomembranous colitis, dyspepsia, flatulence and constipation.

GU: crystalluria, interstitial nephritis.

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HEMATOLOGIC: eosinophilia, leucopenia, neutropenia and thrombocytopenia.

MUSCULOSKELETAL: arthralgia, joint or back pain, joint inflammation, joint

stiffness, tendon rupture, aching and neck pain.

SKIN: rash, photosensitivity, exfoliative dermatitis, burning, pruritus and

erythema.

OTHER: hypersensitivity reactions


ASSESSMENT:

Assess vital signs and compare results with future vital signs.

Assess for allergy to fluoroquinolones. If allergic, the patient should not

receive it.

Assess vital signs which include the elevated temperature.

Assess urine output which includes the decrease urine output. Report

abnormal findings.

Assess for the laboratory result specifically the white blood cell count.

Assess for the degree or severity of infection by observing signs of

infection and laboratory results.

Assess the urine output; fluid intake should be at least 2 L/ day.

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Be aware of drug interactions, wait up to 6 hours before giving another drug to

avoid decreasing drugs effects.

Food does not affect absorption but may delay peak drug levels.

Health Teachings:

Instruct patient to avoid using quinolones and orange juice with calcium for this

can reduce gastric absorption of the drug.

Warn patient to avoid hazardous tasks that require alertness, until effects of drug

are known.

Instruct patient to avoid caffeine while taking drug because of potential for

increased caffeine effects.

Instruct to notify prescriber if unusual responses may occur.

Instruct patient to minimize sunlight contact for this can cause photosensitivity.

EVALUATION:

Evaluate the effectiveness of the drug by noting absence of the infection.

Rationale: Patient was diagnosed to have different infections such as Pneumonia,

urinary tract infections, acute gastroenteritis and GIT infection. This drug was given to

treat and combat infection.

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Brand Name:

Generic name: ketorolac tromethamine

Classification: Nonsteroidal Antiinflammatory Drug

Indications:

Short term management of moderate to severe acute post-operative pain.

Contraindications:

Contraindicated in patients hypersensitive to drug and in those with active peptic

ulcer disease, recent GI bleeding or perforation.

Use cautiously in patients who are elderly or have hepatic or renal impairment or

cardiac decompensation.

Actual Dosage: 30 mg IVTT PRN for pain q 8

Adverse Reactions:

CNS: drowsiness, sedation, dizziness and headache.

CV: edema, hypertension, palpitations and arrhythmias.

GI: nausea, dyspepsia, GI pain, diarrhea, peptic ulceration, vomiting,

constipation and stomatitis.

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HEMATOLOGIC: decreased platelet adhesion, purpura and prolonged bleeding

time.

SKIN: pruritus, rash and diaphoresis

Nursing Responsibilities:

ASSESSMENT:

Assess the clients history of allergy to NSAIDs.

Assess the client or gastrointestinal upset and peripheral edema.

Assess patients pain before and I hour after treatment: type, location, intensity,

and ROM.

Assess for nonverbal cues which may help determining the degree and severity

of pain felt.

Assess for signs of bleeding.

DIAGNOSIS:

Acute pain r/t increased gastric secretion secondary to metabolic acidosis as

manifested by autonomic response increased white blood cell count of 19.17 x

10 ^ g/L.

PLANNING:

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Brand name: RISEK

Generic name: omeprazole

Classification: Anti- ulcer Drugs- Proton Pump Inhibitor

Indications:

Hyperacidity

Contraindications:

Patient hypersensitive to drug and its components.

Use cautiously in patients with respiratory alkalosis and hypokalemia.

Drug interaction: Increased serum theophylline; NSAIDs; cyclosporine; warfarin.

Potentiate effect of glibenclamide. Probenecid increases

ciprofloxacin serum conc. Al- & Mg-containing antacids.

Actual Dosage: 20 mg 1 tab P.O HS

Mechanism of action: Inhibits activity of acid pump and binds to hydrogen- potassium

adenosine triphosphate at secretory surface of gastric parietal

cells to block formation of gastric acid.

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Adverse reactions:

CNS: headache, dizziness and asthenia.

GI: diarrhea, abdominal pain, nausea and vomiting, constipation, flatulence.

Musculoskeletal :back pain

Respiratory: cough, upper respiratory tract infection

Skin: rash


ASSESSMENT:

Assess gastrointestinal complaints.

Assess the patients pain including the type, duration, severity, frequency and

location.

Assess fluid and electrolyte imbalance, including intake and output.

Assess for the gastric pH.

DIAGNOSIS:



10 ^ g/L.

PLANNING:

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Client will no longer experience abdominal pain after the drug therapy.

IMPLEMENTATION:

Check and verify Doctors order.

Observe the 12 rights of Drug Administration.

Administer drug 30 minutes before meals.

Instruct to take the drug on an empty stomach at least 1 hour before meals.

Monitor vital signs.

Monitor the patients intake and output.

Monitor pain, including its frequency, duration, interval, characteristics and

severity.

Caution patient to avoid hazardous activities, if he gets dizzy.

Watch and report for unusual response.


Omeprazole increases its own bioavailability with repeated doses. Drug is labile

in gastric acid; less drug is lost to hydrolysis because drug increases gastric pH.

Health Teachings:

Instruct patient to swallow tablets or capsules whole and not to open, crush or

chew.

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Instruct patient to take drug 30 minutes before meals.

Teach patient some pain management such as deep breathing exercises due to

its side effect.

Instruct patient to increase fluid intake.

Teach deep breathing exercises, to decrease pan felt.

Teach some diversional activities such as listening to music to divert attention.

EVALUATION:

Determine the effectiveness of the drug therapy and the presence of any side

effects. The client should be free of pain.

Rationale: Patient was diagnosed to have metabolic acidosis, in which there is increase

gastric secretion thus causing irritation. The drug was given to treat metabolic acidosis

and to reduce gastric secretion.

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Drug interaction:

Atenolol, tetracyclines, cardiac glycosides, calcium channel blocker.

Actual Dosage: 1 tab P.O OD

Mechanism of action: Replaces calcium and maintains calcium level.

Adverse reactions:

CNS: tingling sensations, sense of oppression or heat waves, syncope.

CV: vasodilation, mild drop of blood pressure, vasodilation, bradycardia,

arrhythmias and cardiac arrest.

GI: irritation, constipation, abdominal pain, thirst, hemorrhage, chalky taste,

nausea and vomiting.

GU: polyuria, rna calculi.

Metabolic: Hypercalcemia

SKN: local reactions including burn, necrosis, tissue sloughing, cellulitis, soft

tissue calcification irritation and pain.


ASSESSMENT:

Assess the patients pain, incuding the type, duration, severity and frequency.

Assess the patients renal function.

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Assess for fluid and electrolyte imbalances, especially calcium levels.

Assess for the drug history or any drug-drug interactions.

Assess laboratory results such as the serum calcium level.

DIAGNOSIS:



10 ^ g/L.

PLANNING:

Client will be free of abdominal pain after the drug management.

IMPLEMENTATION:

Check and verify the Doctors order.

Observe 12 rights during drug administration.

Monitor for hypersensitivity reactions.

Use all calcium products with extreme caution in digitalized patients and patients

with renal and cardiac disease.


severity.

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To avoid constipation and bloating and to improve absorption, give calcium

carbonate in divided doses.

Check for signs and symptoms of severe hypercalcemia such as confusion,

delirium and coma. Signs and symptoms of mild hypercalcemia are nausea and

vomiting.

Report for abnormalities.


Use calcium carbonate with extreme caution in digitalized patient and patient with

renal and cardiac diseases.

Health Teachings:

Tell patient to take oral calcium 1 to 1 hours after meals if GI upset occurs.

Tell patient to take oral calcium with a full glass of water.

Advise patient not to take calcium carbonate indiscriminately or to switch

antacids without prescribers advice.

Tell patient who takes chewable tablets to chew thoroughly before swallowing

and to follow with a glass of water.

Instruct patient to take drug as prescribed.

EVALUATION:

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Determine the effectiveness of the anti- ulcer treatment and the presence of side


Rationale: Patient was diagnosed with metabolic acidosis, wherein there is increase

gastric secretion. The drug was given to treat hyperacidity and supplement calcium.

Brand name:

Generic name: sodium bicarbonate

Classification: Acidifiers and Alkalinizers

Indications:

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Metabolic acidosis

Antacid

Contraindications:

Patients with metabolic or respiratory alkalosis and in those with hypocalcemia in

which alkalosis may produce tetany.

Use caution in patients with renal insufficiency, heart failure and edematous.

Patients losing chloride because of vomiting.

Drug interaction:

Anorexiants, flecainide and tetracyclines.

Actual Dosage: 2 tablets P.O TID

Mechanism of action: Restores buffering capacity of the body and neutralizes excess

acid.

Adverse reactions:

CNS: tetany

CV: edema

GI: gastric distention, belching and flatulence

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METABOLIC: hypokalemia, hypernatremia, metabolic alkalosis, hyperosmolarity.


ASSESSMENT:

Assess the patients pain, including the type, duration, severity and frequency.

Assess the patients renal function.

Assess for fluid and electrolyte imbalances, especially sodium levels.

Assess for the drug history or any drug-drug interactions.

Assess laboratory results such as HCO3 and serum sodium levels.

DIAGNOSIS:



10 ^ g/L.

PLANNING:

Patient will be free of abdominal pain after the drug management.

IMPLEMENTATION:

Check and verify Doctors order.

Observe the12 rights of drug administration.


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Inform prescriber about the laboratory results.


severity.

Encourage the patient to drink 2 oz of water after antacid to ensure that the drug

reaches the stomach.

Administer antacid 1 to 3 hours after meals and at bedtime.

Instruct to take drug as prescribed.

Instruct the patient with the use of relaxation techniques.


Tell patient not to take drug with milk because doing so may cause high levels of

calcium in the blood, abnormally high alkalinity in tissues and fluids or kidney

stones.

Health Teachings:

Advise the client to avoid foods and liquids that can cause gastric secretion.

Explain to the client that stools may become speckled and white.

Instruct the client to report pain, coughing or vomiting of blood.

Teach patient some diversional activities such as listening to music and reading

newpapers to divert attention to pain felt.

Teach deep breathing exercises to reduce pain felt.

EVALUATION:

Determine the effectiveness of the anti- ulcer treatment and the presence of side


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Rationale: Patient was diagnosed with metabolic acidosis, wherein there is increase

gastric secretion. The drug was given to treat hyperacidity.

Brand name: LASIX

Generic name: furosemide

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Store tablets in light- resistant container to prevent discoloration.

Health Teachings:

Advise patient to take drug with food to prevent GI upset.

Advise to take drug in morning to prevent need to urinate at night. Inform patient

of possible need for potassium or magnesium supplements.

Instruct patient to stand slowly to prevent dizziness and to limit strenuous

exercise.

Advise patient to inform immediately ringing of ears, severe abdominal pain, sore

throat and fever.

Instruct to take drug as prescribed.

EVALUATION:

Evaluate the effectiveness

CP Acute Renal Failure chap7

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