Ncp and Drug Study for Case in Sle

24

XIII. NURSING CARE PLAN

Assessment Nursing diagnosis Rationale Desire outcome Nursing intervention Justification Evaluation

Abnormal cues:>Malar or "butterfly" rash on the face>Discoid skin rash on hands, thighs and scalp>Photosensitivity>oral mucous membrane ulcers>joint pain>Patient is not oriented to time and place, forgetful-sunken eyes-Fatigue and weakness-poor appetite -dependent in her ADL-presence of alopecia

Vital signs:RR=24 cpmTemp= 36.5˚C

Laboratory results:-Antinuclear Anti Body result is 7.-HGB, HCT, RBC, platelet are decreased-WBC is increased-serum sodium

Nursing diagnosis:

Impaired tissue integrity related to inflammation, altered circulation as evidence by malar rash on the face, discoid skin rashes on hands, scalp and thighs, oral mucous membrane ulcers and presence of alopecia.

Nanda definition: Damage to mucous membranes, corneal, integumentary or subcutaneous tissues

Source:

Doenges, et al. Nurse’s Pocket Guide (12 Ed.). F.A. Davis company. 2010

Predisposing Gender: Female Race: AsianPrecipitating Infection: UTI ,

Pneumonia

Unknown etiology

defective immune regulatory mechanism

Loss of immune tolerance

increase antigenic load

excess T cell, defective B cell suppression and

shifting of T helper 1 to Th2 immune

responses

b cell hyperactivity

production of pathogenic

autoantibodies

After 32 hours of nurse-client interaction the client will be able to:

1. Verbalize understanding of condition and causative factors.

2. Demonstrate progressive improvement in wound or lesion healing through behavior and lifestyle changes and prevent complications or recurrence

Independent:

1. a. identify underlying condition or pathology involved in tissue injury

b. note poor hygiene and health practices

2.a. Assess blood supply and sensation on affected area by checking the site for redness, discharges, temperature and doing sensory tests.

b. Note skin color, texture, and turgor

-serves as baseline data and will suggests treatment options, as well as client’s desire and ability to protect self, and potential for recurrence of tissue damage

- this could have an impact in tissue health

-to evaluate actual/or potential impairment in circulation

-determines the extent or

After 32 hours of nurse-client interaction the client will be able to:

1. Goal met. The patient was able to understand and identify her present condition.

2. Goal met. The patient takes medication to minimize itching. The patient also verbalizes “gakatol pa sa dyapon pero indi na grabe”.

25

slightly decreased

>history of Rheumatoid Arthritis (2004)>history of UTI (March2011)

Weakness:>Poor immune system>gender: female>poor hygiene>does not cooperate in treatment >does not exercise

Strengths/wellness:>strong support system>strong financial support

immune complexes complement activation

tissue injury and damage

Impaired tissue integrity related to

inflammation, altered circulation as

evidence by malar rash on the face,

discoid skin rashes on hands, scalp and thighs, oral mucous

membrane ulcers and presence of alopecia.

Source:Smeltzers S.C, et,al.

Brunner & Suddarth’s Textbook

of Medical – Surgical Nursing.

Lippincott Williams and Wilkins. 12th ed.

3. Maintain optimal nutrition and physical well-being.

and assess areas of pigmentation of color changes

c. inspect skin on daily basis, describing wound lesions and rashes characteristics observed

d. encourage adequate periods of rest and sleep

3.a. maintain appropriate moisture environment for particular wound

b. reposition client, involving client in reasons for and decisions about times and positions

c. encourage early ambulation or mobilization

involvement of injury

-promotes timely intervention and revision of plan of care

-to limit metabolic demands, maximize energy available for healing and meet comfort needs

-to minimize condition and promote healing

-to enhance understanding and cooperation

-promotes circulation and reduces risk associated with immobility and prevent excessive tissue pressure

3. Goal met. The patient cooperates measures to improve nutrition and physical well-being. At the first day, patient was observe to have poor appetite but during the fourth day patient can be seen eating her meals gradually with the help of her folks.

26

4. identify measure in preventing and treatment regimens to enhance healing

d. provide optimum nutrition and increased protein intake

4. a. emphasize importance of adequate nutritional and adequate fluid intake

b. assist client in understanding and following medical regimen and developing program of preventive care.

c. discuss importance of health as well as measures to maintain proper skin functioning

5. Review laboratory results pertinent to causative factors

Collaborative:

1. Monitor and administer medications as

-to provide a positive nitrogen balance to aid in skin and tissue healing and to maintain a general good health.

-to maintain general good health and skin turgor

-enhances cooperation and optimizing outcomes

- for changes indicative of healing or presence of infection, complications.

-to determine and assess the contributing factors

-to be aware of all the medication client is taking, noting possible interaction

4. Goal met. The patient was able to know the appropriate regimen and prevention with regards to her disease condition. Through incidental health teaching she was able to understand more about the treatment given to her especially the medications and procedures.

27

Ordered such as, Lasix, Predisone, Cozar, Norvasc, Merrem, Calvit and KCl.

3. Assist with diagnostic procedures

4. Assist in identifying ongoing treatment needs and rehabilitation for the individual like physical and occupational therapy.

Source:Doenges, et al. Nurse’s Pocket Guide (12 Ed.). F.A. Davis company. 2010

or cumulative effects

-May be necessary to determine extent of impairment.

-to maintain gains and continue of progress

Source:Doenges, et al. Nurse’s Pocket Guide (12 Ed.). F.A. Davis company. 2010

28

ASSESSMENT NURSING DIAGNOSIS

RATIONALE DESIRED OUTCOME/

NURSING GOALS

NURSING INTERVENTIONS

JUSTIFICATION EVALUATION

Actual Abnormal Cues: Appears very tired and

weak Lethargic Compromised

concentration and mentation changes like disorientation to place, incoherent responses, and focusing on the feelings of weakness of her whole body

Inability to perform activites of daily living independently

Poor muscle stregth Hgb result of 115 g/L

and 104 g/L (normal: 120-160 g/L) last November 15 and November 17 lab results

Hct result of 0.32 L/L and 0.30 L/L(normal: 0.40-0.54 L/L) on November 15 and 17 lab results repectively

Serum sodium results of 130 (normal: 137-143 mEq/dL) and serum potassium result of 2.60 (normal: 3.6-5.1 mg/dL) on

Fatigue related to immune system pathology as evidenced by patient’s appearance of weakness and tiredness, lethargy, inability to perform activities independently, poor muscle strength, Hgb result of 115 g/L and 104 g/L (normal: 120-160 g/L) last November 15 and November 17 lab result, Serum sodium results of 130 (normal: 137-143 mEq/dL) and serum potassium result of 2.60 (normal: 3.6-5.1 mg/dL) on November 15 lab result

Definition: An overwhelming sustained sense of exhaustion and decreased capacity for physical and

Predisposing Gender: Female Race: AsianPrecipitating Infection: UTI ,

Pneumonia

Unknown etiology

Female estrogen hormones

Manifestations of heightened levels of

estrogen during puberty and pregnancy

Unknown cause of estrogen influencing

the immune response of the HLA

system in chromosome 6

Human Leukocyte Antigen Class 1 and

After 32 hours of nursing interventions, the client will be able to:

1. Report improved sense of energy

Independent Nursing Interventions:

a. Note patient’s belief of what is causing the fatigue and what relieves it

b. Evaluate aspect of “learned helplessness” that may be manifested by giving up

c. Accept reality of patient’s report of fatigue and do not underestimate effect on the quality of life the client experiences

d. Instruct methods to conserve energy (e.g. plan steps of activity before beginning so that all

-to assess contributing factors

-can perpetuate a cycle of fatigue, impaired functioning, and increased anxiety and fatigue

-to assist patient in coping with fatigue

-to reduce energy expenditure

After 32 hours of nursing interventions, the client was able to:

1. Goal met. When asked if patient still feels extremely tired, she was able to claim, “kapoy e, pero lain gid ya sang sadto nga week”, comparing the fatigue she has felt last week, which was more severe. Practices to conserve energy were done through the help of her significant others by assisting her to do activities of daily living. She also sleeps most of the time on our duty hours to conserve energy. Then at the last day of duty, she was already able to stand and able to hold conversations longer than the conversations she had upon first admission.

29

November 15 lab result

Vebal reports of “Indi ko pagsamuka anay, nakapoy ko.”

With health history of easy fatigability and body weakness 7 months prior admission and with decreased Hgb, Hct, potassium and sodium results of lab tests after consultation to physician.

Risk Factors/Weaknesses:Poor appetite Episodes of joint pain Noncompliance to

some medical interventions and laboratory tests

Hospital environment (too warm and noisy)

Sleep deprivation Poor financial support Knowledge deficit of

disease process and treatment

Wellness/strengths: Good emotional support for the family Willingness to

mental work at usual work level

Source: Doenges, et al. Nurse’s Pocket Guide (9th ed.). F.A. Davis Company.2004. p 232.

2 in chromosome 6 possess multiple

genes influenced in acquiring SLE

Fewer or defective macrophages in the

body

Defective clearance of early apoptotic

cells

Secondary necrosis of the cells

Release of nuclear fragments as

potential autoantigens

Impaired membrane integrity of dendritic

cell

Induced maturation of dendritic cells

Various

2. Perform activities of daily living and desired activities at level of ability

3. Participate in recommended treatment program

needed materials are at hand)

e. Provide environment conducive to relief of fatigue ( e.g.provide electric fan, etc.)

f. Provide means to decrease environmental noise (e.g. earplugs, etc.)g. Provide diversional activities. Avoid overstimulation/understimulation (cognitive and sensory)

h. Discuss routines to promote restful sleep (e.g. uninterrupted periods of rest, longer sleep periods at night, etc.)

a. Determine ability to participate in activities/ level of mobility

b. Note daily energy

-temperature and level of humidity are known to affect exhaustion

-when sleep deprivation is present, it adds to fatigue-impaired concentration can limit ability to block competing stimuli/distractions

-to assist patient to establish a sleep pattern

-to provide baseline data for the nurses plan of activities

-helpful in

2. Goal partially met. Patient was able to perform her activities of daily living through the help of her significant others. The greatest feat that the patient made during our duty week was that she was able to stand on the last day, although her basic daily activities were still done with assistance.

3. Goal met. Patient was able

30

follow nursing interventions Have strong faith in God

autoantibody productions

Production of antinuclear antibody,

anti-phospholipid and other specific

autoantibodies

Anti-erythrocyte antibody activation

Formation of defective immune

complex

Hemolysis

Reduced RBC count

Decrease in oxygen available for cellular

uptake

Fatigue

Appearance of tiredness and

inability to perform

patterns

c. Interview significant others regarding specific changes observed on patient

d. Establish realistic activity goals with the patient

e. Plan care to allow adequate rest periods. Schedule activities for periods when patient has the most energy

f. Involve patient and significant others in schedule planning

g. Encourage to do whatever is possible (e.g.self-care, sit up, etc.)

h. Assist with self-care needs; keep bed in low position and

determining pattern/timing of activity

-to assess contributing factors

-enhances commitment to promoting optimal outcomes

-to maximize participation

-to increase awareness of the treatment and rehabilitation to patient and significant others

-to manage patient within their limits of ability

-to assist patient with limited mobility

to show participation through listening while the student nurse gives accidental and prepared health teachings about the disease and its treatment. Although they had troubles with their finances, most of the highly needed medical interventions were followed. Significant others also assisted with the patient as evidenced by their willingness to accept information given by the student nurse. They also able to give simple examples of how to conserve the patient’s energy like not disturbing her in her sleep and keeping their voices down to make her rest. They also did their part in assisting her with her activities of daily living.

31

activities of daily living independently

Source:Smeltzers S.C, et,al. Brunner & Suddarth’s Textbook of Medical – Surgical Nursing. Lippincott Williams and Wilkins. 12th ed.

assist in ambulation as indicated

a. Discuss the disease process relevant to patient

b. Discuss therapy regimen relating to individual causative factors

c. Assist patient and significant others to develop a plan of activity and exercise within the individual’s capability

d. Instruct patient in ways to monitor responses to activity and significant signs and symptoms

e. Promote overall health measures (e.g. nutrition(High CHO, Normal CHOn, low Fat), adequate fluid

-understanding the disease can help the client understand the treatment regimen

-to help patient and significant others understand the relationship of disease and treatment and to elicit their cooperation on the treatment regimen

-to encourage participation of patient and significant others in health management of patient

-indicates the need to alter the activity level

-presence of anemia/hypoxemia reduces oxygen for available cellular uptake and

32

intake of 1.5-2L/day, appropriate intake of vitamins and minerals as prescribed especially iron, etc.)

Collaborative interventions:

a. Administer medications related to patient’s condition (e.g. pain relievers, antimalarials, etc.)

b. Assist with medical procedures as indicated

c. Administer blood transfusions properly as indicated. Report any allergic reactions.

Source: Doenges, et al. Nurse’s Pocket Guide(9th ed.). F.A. Davis Company.2004. pp 232-234.

contributes to fatigue

-to promote wellness of patient

-to assist in measures to relieve patient’s condition

-to supplement blood components and increase oxygen for cellular uptake

33

RISK NCP

Assessment Nursing diagnosis Rationale Desire outcome Nursing intervention Justification Evaluation

Abnormal cues:>easy fatigability and weakness>Patient is not oriented to time and place, forgetful>Photosensitivity>presence of alopecia>Malar or "butterfly" rash on the face>Discoid skin rash on hands, thighs and scalp>oral mucous membrane ulcers>joint pain>sunken eyes>poor appetite>dependent in her ADL>poor muscle tone

Vital signs:RR=24 cpmTemp= 36.5˚C

Laboratory results:-Antinuclear Anti Body result is 7.-HGB, HCT, RBC, platelet are decreased-WBC is increased-serum sodium slightly decreased

Nursing diagnosis:

Risk for injury related to tissue damage, autoimmune dysfunction, abnormal blood profile , disorientation and altered mobility as evidence by malar rash on the face, discoid skin rashes on hands, scalp and thighs, oral mucous membrane ulcers and presence of alopecia, weakness, disoriented to time and place, photosensitivity.

Nanda definition:

At risk of injury as a result of environmental conditions interacting with the individual’s adaptive and defensive resources.

Predisposing Gender: Female Race: AsianPrecipitating Infection: UTI ,

Pneumonia

Unknown etiology

immune system activation

altered immune response

soluble mediators (cytokines)

Endothelial / cellular response

Autoimmunity

Tiisue or organ involvement

After 32 hours of nurse-client interaction the client will be able to:

1. Verbalize understanding of individual factors that contribute to possibility of injury

2. Modify environment as

Independent:

1. a. Perform thorough assessment regarding safety issues when planning for client care and/or preparing for discharge from care.

b. note client’s age, gender, developmental stage, decision making ability and level of cognition

c. assess client’s muscle strength, gross and fine motor coordination

2. a. provide healthcare within culture of safety

-failure to accurately assess and intervene or refer these issues can place the client at needles risk and creates negligence issues for the healthcare practitioner.

-affects client’s ability to protect self and/or others, and influences choice of interventions and teaching

-to identify risk for falls

-to prevent errors resulting in client injury, promote

After 32 hours of nurse-client interaction the client will be able to:

1. Goal met. The patient was able to gain information about factor that may contribute to place patient at risk for injury.

2. Goal met. The patient was able to encourage how to protect herself and

34

>history of Rheumatoid Arthritis (2004)>history of UTI (March2011)

Weakness:>Poor immune system>gender: female>lack of patient’s cooperation>poor hygiene>does not cooperate in treatment >does not exercise.poor environmental sanitation

Strengths/wellness:>strong support system>strong financial support >strong religious belief

Source:Doenges, et al. Nurse’s Pocket Guide (12 Ed.). F.A. Davis company. 2010

Risk for injury related to tissue

damage, autoimmune dysfunction,

abnormal blood profile ,

disorientation and altered mobility as evidence by malar

rash on the face, discoid skin rashes on hands, scalp and thighs, oral mucous

membrane ulcers and presence of alopecia,

weakness, disoriented to time

and place, photosensitivity.

Source:Smeltzers S.C, et,al.

Brunner & Suddarth’s Textbook

of Medical – Surgical Nursing.

Lippincott Williams and Wilkins. 12th ed.

indicated to enhance safety.

3. Display behaviors, lifestyle changes to reduce risk factors and protect self from injury.

b. monitor environment for potentially unsafe conditions and modify as needed. ty

c. inform client regarding all treatment and medication

d. encourage use of techniques to reduce or manage stress and vent emotions

3. a. encourage and assist in frequent range-of-motion exercises

b. check vital sign every 4 hours

c. position patient to a comfortable position and side rails up

client safety and model safety behaviors for patient.

-to assist patient to reduce or correct individual risk factors.

-in order for the patient to be aware of all the treatment that the patient is receiving and to gain patient’s cooperation

-to alleviate stress and anxiety in order to prevent further harm to patient.

-exercises promote good circulation to the body. Thus, improving the body to be more health and prevent from further injury-to monitor patients condition.

-to prevent patient from at risk for falls.

enhance her awareness and knowledge about safety things and necessary precaution to be done to prevent her to be at risk for injury.

3. Goal met. The patient demonstrate lifestyle changes such as having exercises even while in bed with assistance. Patient was able to be aware of safety precautions in order to protect herself.

35

d. stress importance of monitoring conditions and risk that may contribute to occurrence of injury

Collaborative:

1. Assist in treatments and provide information regarding client’s disease/condition.

2. Administer medications such as; Lasix, Predisone, Cozar, Norvasc, Merrem, Calvit and KCl as ordered using the “10 rights to medication”

Source:Doenges, et al. Nurse’s Pocket Guide (12 Ed.). F.A. Davis company. 2010

-in order that patient may be aware in that she may also be able to protect herself.

-to provide proper information about the disease and treatments that would help the client achieve independence as well being.

-to alleviate itchiness, and to correct fluid and electrolyte balance and also to regulate blood pressure.

Source:Doenges, et al. Nurse’s Pocket Guide (12 Ed.). F.A. Davis company. 2010

36

C H E C K

Generic Name: Amlodipine besylate

Brand Name: Norvasc

Classification: Cardiovascular agent; calcium channel blocker; antihypertensive agent

Inhibits calcium ion influx across cardiac and smooth muscle cells, thus decreasing myocardial contractility and oxygen demand; also dilates coronary arteries and arterioles.

Treat hypertension Not affected by meals. It is given once a day.

Tell patient to report significant swelling of face or extremities.

Report shortness of breath, palpitations, irregular heartbeat, nausea, or constipation to physician

Monitor for signs and symptoms of dose-related peripheral or facial edema that may not be accompanied by weight gain; rarely, severe edema may cause discontinuation of drug.

Monitor BP with postural changes. Report postural hypotension.

Monitor heart rate; dose-related palpitations (more common in women) may occur.

XIV. DRUG STUDY

37

C H E C K

Generic Name: Furosemide

Brand Name: Lasix

Classification: Loop diuretic

Inhibits sodium and chloride reabsorption at proximal and distal tubules and ascending loop of Henle. Promotes water and sodium excretion.

Treat hypertension Not affected by meals. It is given every twelve hours (q12h) IVTT.

Advise patient to stand slowly to prevent dizziness, not to drink alcohol and to minimize strenuous exercise in hot weather.

Instruct patient to report ringing in ears, severe abdominal pain or sore throat and fever because they may indicate toxicity.

Assess patient’s underlying condition before starting therapy.

Monitor weight, peripheral edema, breath sounds, blood pressure, fluid intake and output, and electrolyte, glucose, BUN, and carbon dioxide levels.

Monitor uric acid level, especially if patient has a history of gout.

Be alert to adverse reactions and drug interactions.

38

C H E C K

Generic name: Losartan potassium

Brand name: Cozaar

Classification: Anti-hypertensive drug

Inhibits vasoconstrictive and aldosterone-secreting acion of angiotensin II receptor on the surface of vascular smooth muscle and other tiaaue cells.

Lowers high blood pressure Not affected by meals. It is given once a day (OD).

Tell patient to avoid salt substitutes; these products may contain potassium, which can cause high potassium level.

Notify healthcare provider if these serious side effects occur: swelling of face, eyes, lips or tongue and difficulty of breathing.

Monitor patient’s blood pressure to evaluate effectives of drug therapy. When used alone, drug has less of an effect on blood pressure.

Assess patient’s renal function (BUN and creatinine levels) regularly.

Monitor for signs of allergic reaction.

Closely monitor patient especially during first few weeks of therapy.

39

Generic name: Prednisone

Brand name: Prelone

Classification: Corticosteroids

Decreases inflammation, mainly by stabilizing leukocyte lysosomal membranes; and influences protein, fat and carbohydrate metabolism.

Suppresses immune response; stimulates bone marrow

Given orally with food if possible to reduce GI irritation. It is given once a day every am and once every pm.

Tell patient to take drug with food or milk.

Teach patient signs and symptoms of adrenal insufficiency: fatigue, muscle weakness, joint pain, fever, anorexia, nausea, shortness of breath, dizziness, fainting.

Instruct patient not to stop drug abruptly or without prescriber’s consent.

Determine whether patient is sensitive to other corticosteroids.

Weigh patient daily; report sudden weight gain to prescriber.

Monitor for Cushingoid effects: moon face, buffalo hump, central obesity, thinning hair, hypertension and increased susceptibility to infection. Watch for depression or psychotic episodes.

40

C H E C K

Generic name: Meropenem

Brand name: Merrem IV

Classification: Miscellaneous anti-infectives

Inhibits cell wall synthesis in bacteria. It readily penetrates cell wall of most gram positive and gram negative bacteria to reach penicillin-binding protein targets.

Prevent complicated skin and skin structure infections

Not affected by meals. It is given every eight hours (Q8h).

Tell patient to report adverse effects if drug or signs and symptoms of superinfection.

Advise patient to report loose stools to prescriber.

Obtain specimen for culture and sensitivity before giving first dose.

Monitor patient for signs of superinfection. Drug may cause overgrowth of non susceptible bacteria or fungi. Periodic assessment of organ system functions including renal, hepatic and hematopoietic function is recommended.

41

Generic name: Tramadol + Paracetamol

Brand name: Ultram

Classification: Opioid analgesics; central nervous system drugs

Centrally acting synthetic analgesic compound not chemically related to opioids. Thought to bind to opiate receptors and inhibit reuptake of norepinephrine and serotonin levels.

Relieve moderate to moderately severe pain

Not affected by meals. It is given thrice a day (TID).

Tell patient to avoid driving or other hazardous activities that require mental alertness until drugs CNS effects are known.

Advise patient to check with prescriber before taking OTC drugs because drug interactions can occur.

Instruct patient not to stop drug abruptly or without prescriber’s consent.

Reassess patient’s level of pain at least 30 minutes after administration.

Monitor patient’s cardiovascular and respiratory status. Withhold dose and notify prescriber if respiration is below 12cpm. Monitor bowel and bladder function. Anticipate need for laxative.

42

C H E C K

Generic name:levofloxacin

Brand name:Levaquin

Classification:Antibiotic, florquinolone

Bactericidal: interferes with DNA by inhibiting DNA gyrase replication in susceptible gram-negative and gram-positive bacteria, preventing cell reproduction

treats bacterial infection Administer without regards to meals with a glass of water; given twice a day per Orem

Instruct patient to drink plenty of fluids while taking this drug

Instruct to report rash, visual changes, severe GI problems, weakness, tremors

Arrange for culture and sensitivity tests before beginning therapy

Ensure patient is well hydrated

Administer oral drug without regard to meals with a glass of water; separate oral drug from other cation administration, including antacids by at least 2 hours

Discontinue at any sign of hypersensitivity (rash, photophobia) or at complaint of tendon pain, inflammation or rupture

43

C H EC

K

Generic name:Potassium Chloride

Brand name:Potassium Chloride

Classification:Electrolyte

Principal intracellular cation of most body tissues, participates in a number of physiologic processes—maintaining intracellular tonicity, transmission of nerve impulses, contraction of cardiac, skeletal and smooth muscle, maintenance of normal renal function; also plays a role in carbohydrate metabolism and various enzyme reaction

prevent and correct potassium deficiency

Not affected by meals Caution patient not to use salt substitutes

Report toughing of the hands or feet unusual tiredness or weakness, feeling of heaviness in legs, severe nausea, vomiting, abdominal pain,black or tarry stools, pain at IV injection site

Agitate prepare IV solution to prevent “” of potassium, do not add potassium to an IV bottle

in the hanging position

Monitor IV injection sites regularly for necrosis, tissue sloughing and phlebitis

Monitor cardiac rhythm carefully during IV administration

44

C H E C K

Generic name:Eperisone

Brand name:EperisoneClassification:Antispasmodic

Eperisone acts by relaxing both skeletal muscles and vascular smoothmuscles, and demonstrates a variety of effects such as reduction of myotonia, improvement of circulation, and suppression of the pain reflex.The drug inhibits the vicious cycle of myotonia by decreasing pain,ischaemia, and hypertonia in skeletal muscles, thus alleviating stiffnessand spasticity, and facilitating muscle movement.

Treats muscle spasm Should be taken with food; given three times a day per Orem

Report fever, erythema, blistering, itching, ocular congestion or stomatitis

In the event of symptoms such as redness, itching, urticaria, or edema of the face and other parts of the body,dyspnoea etc, treatment should be discontinued and appropriate measures taken

Patients should be carefully observed, treatmentDiscontinued and approriate measures taken, in the event of symptomssuch as fever, erythema, blistering, itching, ocular congestion or stomatitis, etc

45

C H E C K

Generic name:Multivitamins with Buclizine

Brand name:Multivitamins with Buclizine

Classification:Multivitamins supplement

Buclizine is a piperazine antihistamine with antimuscarinic and moderate sedative properties. It is used mainly for its antiemetic action and in the treatment of migraine in combination with analgesics.

Treats nausea, vomiting and dizziness

Should be taken with food. (Take within ½ hr before meals.) Given once a day

Avoid over the counter drugs; may contain ingredients that cause serious reactions with drug

Avoid alcohol; serious sedation could occur

Report difficulty breathing; hallucinations, remors, loss of coordination; visual disturbances, irregular heart beat

Assess orientation, reflexes, affects; visual examinations; P, BP;RR, adventitious sounds; bowel sounds, normal GI output, normal urinary output

46

C H E C K

Generic name:Potassium Chloride

Brand name:Potassium Chloride

Classification:Electrolyte

Principal intracellular cation of most body tissues, participates in a number of physiologic processes—maintaining intracellular tonicity, transmission of nerve impulses, contraction of cardiac, skeletal and smooth muscle, maintenance of normal renal function; also plays a role in carbohydrate metabolism and various enzyme reaction

prevent and correct potassium deficiency

Not affected by meals Caution patient not to use salt substitutes

Report toughing of the hands or feet unusual tiredness or weakness, feeling of heaviness in legs, severe nausea, vomiting, abdominal pain,black or tarry stools, pain at IV injection site

Agitate prepare IV solution to prevent “” of potassium, do not add potassium to an IV bottle

in the hanging position

Monitor IV injection sites regularly for necrosis, tissue sloughing and phlebitis

Monitor cardiac rhythm carefully during IV administration

47

X.V HEALTH TEACHING PLAN

Medication Exercise Treatment Hygiene Outpatient Diet1. Generic name: FurosemideBrand name: Lasix

C: Loop Diuretic

H: Treat hypertension

E: Not affected by meals. It is given every twelve hours (q12h) IVTT.

C: Advise patient to stand slowly to prevent dizziness, not to drink alcohol and to minimize strenuous exercise in hot weather

K: Monitor weight, peripheral edema, breath sounds, blood pressure, fluid intake and output, and electrolyte, glucose, BUN, and carbon dioxide levels.

2. Generic name:

Exercise plays its part in the treatment of lupus. It is very important to keep muscles & joints active for a variety of reasons. Muscles need to be toned in order to function adequately. The size of the muscle & its blood circulation depend on its function (where the muscle is & what it does). Physical therapy is very beneficial to the patient who is trying to maintain muscle integrity & tone. Joints depend on tendons & the calcification of bones. These in turn depend on continued movement. Significant bone loss through osteoporosis occurs when bones are not used regularly. Encourage significant other to do passive ROM (Range of motion) exercises for the client.

1. Musculoskeletal

The goal for the treatment of systemic lupus erythematosus

1.Dietary regulation-alcohol restriction.

2. Treatment of associated condition. Monitor intake and

output to identify the output and fluid replacement needs.

Vital signs taking every hour to assess any changes on health status

Encourage fluid intake to replace fluid and blood loss and to maintain blood pressure and renal function

Administer medications as ordered to prevent infections

Encourage and assist significant other to turn

For maintaining skin integrity:

1. Keep skin clean while relieving itching and dryness.

Sponge bath

Mild soap added to water to moisturize the skin.

2. Keep nails short and trimmed to prevent excoriation.

3. Keep hair clean and moisturized.

4. Provide or encourage oral hygiene to minimize dryness of oral mucous membranes. Preventive dental

hygiene care in Lupus patients is very important. Chlorhexidine mouthwashes could help contain

Adherence to pharmacological and non-pharmacological interventions.

Stress to patient and family the importance of follow-up examinations and treatment because of changing physical status. Allowing monitoring of symptoms, disease activities, and treatment of side effects.

Refer patient for continuous physical therapy for the improvement of the condition..

Refer patient to a nutritionist because of the dietary changes required.

Get enough sleep and rest.

Suggested diet is DASH diet (high in fruits and vegetables, moderate in low-fat dairy products, and low in mimimal protein, has a substantial amount of plant protein from legumes and nuts

Promote intake of vegetable-value protein foods: soy protein, broccoli

The client must have a high fiber vegetable diet, such as a medium-size piece of fruit (an orange, small banana, medium-size apple).

Advice client to avoid foods or drinks that contain

48

Prednisone Brand name: Prelone

C: Corticosteroids

H: Suppresses immune response; stimulates bone marrow

E: Given orally with food if possible to reduce GI irritation. It is given once a day every am and once every pm.

C: Teach patient signs and symptoms of adrenal insufficiency: fatigue, muscle weakness, joint pain, fever, anorexia, nausea, shortness of breath, dizziness, fainting.

K: Monitor for Cushingoid effects: moon face, buffalo hump, central obesity, thinning hair, hypertension and increased susceptibility to infection.

3. Generic name: losartanBrandname: Cozaar

activity (designed to enhance flexibility & mobility)

Types of Activities:Passive ROM Exercises

Duration: 10-15 minutes

Frequency: Everyday, 2-4 hours

2. Stretching Exercises (to specifically target joint weakness)

Types of Activities:Chin-to-chest. Raise the back of the person's head up from the bed. Gently tip his chin toward his chest. Try to rest the person's chin on his chest if possible.

Head turns. Put one hand on each side of the person's face. Turn the person's head toward the right as if he were looking over his right shoulder. Then slowly turn the person's head so he is looking over his left shoulder. Turn the head only far enough so

and move the patient to prevent bed sores and immobility

Avoid sun exposure. Sunscreens and clothing covering the extremities can be helpful to prevent flares.

Prescribed medications: NSAIDs: For people

with joint or chest pain or fever, drugs that decrease inflammation, called nonsteroidal anti-inflammatory drugs (NSAIDs), are often used. Although some NSAIDs, such as ibuprofen and naproxen, are available over the counter, a doctor’s prescription is necessary for others. NSAIDs may be used alone or in combination with other types of drugs to control pain, swelling, and fever. Even though some NSAIDs may be

periodontal disease. Mucous membrane ulcers can be treated with hydrogen peroxide gargle, buttermilk gargle, or steroid impregnated gel.

5. Proper food preparation

Avoid too much sun exposure and wear protective clothing to prevent direct sunlight.

Use sunsceen and suunblocks to protect the skin.

Use sunglasses for cases of photosensitivity.

alcohol, alcohol restriction is a must because of clients’ condition.

The client should consume amounts of necessary calories to maintain moderate body weight. Fat intake should be limited to 30% of the total calories

Instruct patient to limit fluid intake to 500-600 ml/day.

Include foods rich in zinc. These foods include oysters, meats, seafood, poultry and eggs.

Include rich sources of iron in your diet. To increase absorption, consume with an acid-containing food or one with vitamin C. Sources of iron

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C: antihypertensives, angiotensin II receptor antagonists, Management of hypertension

H: the blood pressure of the patient will be lowered.

E: Medication usually given once a day, the same time per day.

C: Tell patient to avoid salt substitutes; these products may contain potassium, which can cause high potassium level.

K: Monitor patient’s blood pressure to evaluate effectives of drug therapy. When used alone, drug has less of an effect on blood pressure.

4. Generic name: Amlodipine besylateBrandname: Norvasc

that the person's nose is lined up above their shoulder.

Head tilts. Put one of your hands on each side of the person's face. Tilt the head to the side, bringing the right ear toward the right shoulder. Then slowly tilt the person's head to bring the left ear toward the left shoulder.

Intensity:Start with minimal stretching, gradually increasing

Duration: 15-20 minutes

Frequency: 2-4 times a week

3.Ankle & Foot ExercisesTypes of Activities:How to start: Hold the right ankle with one hand. Put your other hand on the bottom of the foot.

purchased without a prescription, it is important that they be taken under a doctor’s direction.

Antimalarials: Antimalarials are another type of drug commonly used to treat lupus. These drugs were originally used to treat malaria, but doctors have found that they also are useful for lupus. A common antimalarial used to treat lupus is hydroxychloroquine (Plaquenil1). It may be used alone or in combination with other drugs and generally is used to treat fatigue, joint pain, skin rashes, and inflammation of the lungs.

Corticosteroids: The mainstay of lupus treatment involves the use of corticosteroid hormones, such as

include cream of wheat, liver, beef, lamb, pork, chicken, turkey, eggs, fish, beans baked with molasses, prunes, prune juice, apricots, green peas, enriched breads, and cereals

Take medications with food to decrease the irritating effect on the stomach and small intestine. Foods and drugs taken together also increase the time available for the absorption of the drug.

Include foods rich in Vitamin D. These include foods primarily of animal origin: eggs, butter, milk, fish oils, cereals, margarines and breads. This

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C: Cardiovascular agent; calcium channel blocker; antihypertensive agent

H: Treat hypertension

E: Not affected by meals. It is given once a day.

C: Report shortness of breath, palpitations, irregular heartbeat, nausea, or constipation to physician

K: Special Precautions for patients w/ impaired hepatic & renal function, CHF. Elderly. Pregnancy & lactation.

5. Generic name: MeropenemBrand name: Merrem IV

C: Miscellaneous anti-infectives

H: Prevent complicated skin and skin structure infections

E: Not affected by meals. It is given every eight hours (Q8h).

Ankle bends. Push the person's foot so his toes point up toward the ceiling. Then put your hand on top of the foot and push the foot down again.

Ankle rotation. Hold the ankle with one hand. Hold the person's upper foot with your other hand. Gently turn the foot and ankle in circles.

Toe bends. With your palm on top of the person's foot, curl the toes down toward the sole (bottom) of the foot. Then straighten and stretch the toes.

Toe spreads. Use your fingers to spread the toes apart one at a time. Then bring them together again. Intensity:Gradually increasing from soft to moderate pressure.Duration:2-3 Sessions, 15-20 minutes a dayFrequency:

prednisone (Deltasone), hydrocortisone, methylprednisolone (Medrol), and dexamethasone (Decadron, Hexadrol). Corticosteroids are related to cortisol, which is a natural anti-inflammatory hormone. They work by rapidly suppressing inflammation.

Immunosuppressives: For some patients whose kidneys or central nervous systems are affected by lupus, a type of drug called an immunosuppressive may be used. Immunosuppressives, such as cyclophosphamide (Cytoxan) and mycophenolate mofetil (CellCept), restrain the overactive immune system by blocking the

along with calcium decreases the risk of osteoporosis.

Include foods rich in Vitamin B6 (Pyridoxine). These foods include whole grain cereals, breads, liver, avocados, spinach, green beans, bananas, fish, poultry, meats, nuts, potatoes, green leafy vegetables.

Increase your intake of foods high in Vitamin C. These foods include broccoli, oranges, strawberries, cauliflower, cantaloupe, cabbage and green peppers.

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C: Tell patient to report adverse effects if drug or signs and symptoms of superinfection.

K: Obtain specimen for culture and sensitivity before giving first dose.

6. Generic name: Tramadol + ParacetamolBrand name: Ultram

C: Analgesic

H: Relieve moderate to moderately severe pain

E: Not affected by meals. It is given thrice a day (TID).

C: ell patient to avoid driving or other hazardous activities that require mental alertness until drugs CNS effects are

K: Reassess patient’s level of pain at least 30 minutes after administration.

7. Generic name: Calcium

2-4 times a week. Consultation must be done first before engaging to any exercise programs. This is to ensure the safety and limitations of exercises intended for end stage renal disease patients.

Encourage significant other (wife) to do ROM (range of motion) exercises on the time required to prevent immobility of the patient.

Instruct significant other to perform proper stretching and warm up activities before engaging patient to a higher intensity ROM exercises. Aerobic conditioning

exercise is the best exercise for lupus patients.

production of immune cells. These drugs may be given by mouth or by IV infusion.

BLyS-specific inhibitors: Belimumab (Benlysta®), a B-lymphocyte stimulator (BLyS) protein inhibitor, was approved by the U.S. Food and Drug Administration (FDA) in March 2011 for patients with lupus who are receiving other standard therapies, including those listed above. Given by IV infusion, it may reduce the number of abnormal B cells thought to be a problem in lupus.

Alternative and complementary therapies: Because of the nature and cost of the medications used to treat lupus and the potential for serious side effects, many patients seek other ways of treating the

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+Vit DBrandname: Calvit

C: Dietary supplements

H: improve and strengthen bones and joints

E: Should be taken with food, swallow whole and do not chew.

C: Monitor blood pressure, ECG, renal function, magnesium, phosphate, potassium, serum, and urine calcium concentrations.

K: Avoid using two (2) hours prior to or until four (4) hours after taking other medications

8. Generic name: LevofloxacinBrand name:

C: Antibiotic, florquinolone

H: treat fatigue, joint pain, skin rashes, and inflammation of the lungs.

E: With or without meals

disease. Some alternative approaches people have tried including special diets, nutritional supplements, fish oils, ointments and creams, chiropractic treatment, and homeopathy.

Diagnostic tools for lupus: Medical history

Complete physical examination

Laboratory tests:

Complete blood count (CBC) Erythrocyte sedimentation rate (ESR) Urinalysis Blood Chemistries Complement levels Antinuclear antibody tests (ANA) Other autoantibody tests (anti-DNA, anti-Sm, anti-RNP, anti-Ro [SSA], anti-La [SSB]) Anticardiolipin antibody test

Skin Biopsy

Kidney Biopsy

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with a glass of water

C: Report rash, visual changes, severe GI problems, weakness, tremors

K: Discontinue at any sign of hypersensitivity (rash, photophobia) or at complaint of tendon pain, inflammation or rupture

9. Generic name: KCLBrand name:

C: Electrolyte

H: Replaces potassium and maintains potassium level

E: Taken with or after meals with full glass of water or fruit juice

C: Report toughing of the hands or feet unusual tiredness or weakness, feeling of heaviness in legs, severe nausea, vomiting, abdominal pain,black or tarry stools, pain at IV injection site

K: Monitor IV injection sites regularly for

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necrosis, tissue sloughing and phlebitis

10. Generic name: EperisoneBrand name:

C: antispasmodic

H: Relaxation of hypertonic skeletal muscles, Improves intramuscular blood flow, Reduction of muscle spindle sensitivity via motor neurons, Vasodilatation and augmentation of blood flow.

E: After meals

C: Report symptoms such as fever, erythema, blistering, itching, ocular congestion or stomatitis, etc

K: Monitor symptoms such as redness, itching, urticaria, or edema of the face and other parts of the body,dyspnoea etc, treatment should be discontinued and appropriate measures

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taken

11. Generic name:Multivitamins with BuclizineBrand name: Multivitamins with Buclizine

C: Antihistamines & Antiallergics

H: Relieved Motion sickness, migraine, nausea, pruritic skin disorders

E: Should be taken with food. (Take within ½ hr before meals.)

C: Report signs of hypersensitivity.

K: Make sure it is taken after meals to prevent GI disturbances.

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