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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.
Diagnostic/laboratory
Date Result Normal values Interpretation
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
Date Result Normal values Interpretation
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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.
CLINICAL CHEMISTRY SECTION
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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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.
Diagnostic/laboratory
Date Result Normal values Interpretation
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.
CLINICAL CHEMISTRY SECTION
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.
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.
Diagnostic/laboratory
Date Result Normal values Interpretation
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.
Tell him that the test requires a blood sample. Explain who will perform the
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.
Procedure and posttest care
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.
Diagnostic/laboratory
Date Result Normal values Interpretation
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.
CLINICAL CHEMISTRY SECTION
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.
Procedure and posttest care
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.
Diagnostic/laboratory
Date Result Normal values Interpretation
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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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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.
Helps to expandintravascularvolume; corrects
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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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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
must be properlyregulated asordered by thedoctor.
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.
Helps to expandintravascularvolume; correctsan underlyingimbalance in fluids
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.
Helps to expandintravascularvolume; correctsan underlyingimbalance in fluids
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.
and electrolytes,and compensatesthe loss in thebody.
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
and electrolytes,and compensatesthe loss in thebody.
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
must be properlyregulated asordered by thedoctor.
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.
Patient wasdiagnosed to havemetabolic acidosisthat is why thedrug was given to
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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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.
Helps to expandintravascularvolume; corrects
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.
Patient wasdiagnosed to havemetabolic acidosisthat is why thedrug was given to
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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.
Observe for signs of hypersensitivity.
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.
Nursing Considerations:
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
Nursing responsibilities:
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
Nursing responsibilities:
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:
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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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.
Nursing Considerations:
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.
Nursing responsibilities:
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:
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:
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.
Monitor pain, including its frequency, duration, interval, characteristics and
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.
Nursing Considerations:
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
effects. The client should be free of pain.
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.
Nursing responsibilities:
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:
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:
Patient will be free of abdominal pain after the drug management.
IMPLEMENTATION:
Check and verify Doctors order.
Observe the12 rights of drug administration.
Observe for signs of hypersensitivity.
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Inform prescriber about the laboratory results.
Monitor pain, including its frequency, duration, interval, characteristics and
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.
Nursing Considerations:
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
effects. The client should be free of pain.
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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