1

INTRODUCTION Myocardial (heart muscle) dysfunction occurs very commonly, usually due to other diseases such as coronary artery disease, high blood pressure, and diseases of the heart valves. Disease originating in the heart muscle itself (cardiomyopathy) is much rarer. Unfortunately, by the time it is diagnosed, the disease often has reached an advanced stage and heart failure has occurred. Consequently, about 50 percent of patients with dilated cardiomyopathy live 5 years once heart failure is diagnosed; about 25 percent live 10 years after such a diagnosis. Typically, patients die from a continued decline in heart muscle strength, but some die suddenly of irregular heartbeats. For patients with advanced disease, heart transplantation greatly improves survival: 75 percent of patients live 5 years after a transplantation. However, the disease also may remain fairly stable for years, especially with treatment and regular evaluation by a physician. Cardiomyopathy is a result of pre-existing medical condition and can lead to a more serious heart disease. There are 79, 320 cases of death cause cardiomyopathy in the whole world. The following Table 1.1 is showing the mortality rate based from (WHO) World Health Organization Statistics Information Systems compiled January, 2004 .

Table 1.1 Mortality Statistics

WORLDWIDE MORBILITY CASES OF DILATED CARDIOMYOPATHY The following Table 1.2 attempts to show morbidity extrapolate prevalence rate for Dilated cardiomyopathy to the populations of various countries and regions. These prevalence extrapolations for Dilated cardiomyopathy are only estimates, based on applying the prevalence rates from the US (or a similar country) to the population of other countries, and therefore may have very limited relevance to the actual prevalence of Dilated cardiomyopathy in any region:
Country/Region USA Canada Mexico Belize Guatemala Nicaragua Puerto Rico Brazil Chile Colombia Paraguay Peru Venezuela Denmark Finland Iceland Sweden Extrapolated Prevalence 587,310 65,015 209,919 545 28,561 10,719 7,795 368,202 31,647 84,621 12,382 55,088 50,034 10,826 10,429 587 17,972 Population Estimated Used 293,655,405 32,507,874
2 2 1

Dilated cardiomyopathy in North America (Extrapolated Statistics)

104,959,594 272,945
2 2

Dilated cardiomyopathy in Central America (Extrapolated Statistics) 14,280,596 5,359,759 3,897,960

2

Dilated cardiomyopathy in Caribbean (Extrapolated Statistics)

2

Dilated cardiomyopathy in South America (Extrapolated Statistics) 184,101,109 15,823,957 42,310,775 6,191,368
2 2 2 2 2 2

27,544,305 25,017,387 5,413,392 5,214,512 293,966

2 2 2 2

Dilated cardiomyopathy in Northern Europe (Extrapolated Statistics)

8,986,400

Dilated cardiomyopathy in Western Europe (Extrapolated Statistics) Britain (United Kingdom) 120,541 Belgium France Ireland Luxembourg Monaco Netherlands (Holland) 20,696 120,848 7,939 925 64 32,636 60,270,708 for UK 10,348,276 60,424,213 3,969,558 462,690 32,270
2 2 2 2 2 2 2

16,318,199

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2

United Kingdom Wales Austria Czech Republic Germany Hungary Liechtenstein Poland Slovakia Slovenia Switzerland Belarus Estonia Latvia Lithuania Russia Ukraine Azerbaijan Georgia Portugal Spain Greece Italy Albania Bulgaria Croatia Macedonia Romania

120,541 5,836 16,349 2,492 164,849 20,064 66 77,252 10,847 4,022 14,901 20,621 2,683 4,612 7,215 287,948 95,464 15,736 9,387 21,048 80,561 21,295 116,114 7,089 15,035 8,993 4,080 44,711

60,270,708 2,918,000 8,174,762

2

Dilated cardiomyopathy in Central Europe (Extrapolated Statistics)

2 2 2 2

1,0246,178 82,424,609 10,032,375 33,436

2

38,626,349 5,423,567 2,011,473 7,450,867

2

Dilated cardiomyopathy in Eastern Europe (Extrapolated Statistics) 10,310,520 1,341,664 2,306,306 3,607,899
2 2 2 2 2

143,974,059 47,732,079 7,868,385 4,693,892

2 2 2 2 2

Dilated cardiomyopathy in the Southwestern Europe (Extrapolated Statistics)

10,524,145 40,280,780 10,647,529 58,057,477 3,544,808 407,608

2 2 2 2 2

Dilated cardiomyopathy in Southern Europe (Extrapolated Statistics)

2 2

Dilated cardiomyopathy in the Southeastern Europe (Extrapolated Statistics) Bosnia and Herzegovina 815

7,517,973 4,496,869 2,040,085

22,355,551 10,825,900 2,751,314

2

2 2

Serbia and Montenegro 21,651 Mongolia Kazakhstan 5,502 30,287

Dilated cardiomyopathy in Northern Asia (Extrapolated Statistics) Dilated cardiomyopathy in Central Asia (Extrapolated Statistics) 15,143,704
2

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2 2

Tajikistan Uzbekistan China Hong Kong s.a.r. Japan Macau s.a.r. North Korea South Korea Taiwan Turkey Afghanistan Bangladesh Bhutan India Pakistan Sri Lanka East Timor Indonesia Laos Malaysia Philippines Singapore Thailand Vietnam Gaza strip Iran Iraq Israel Jordan Kuwait Lebanon Saudi Arabia Syria United Arab Emirates

14,023 52,820 2,597,695 13,710 254,666 890 45,395 96,467 45,499 137,787 57,027 282,680 4,371 2,130,141 318,392 39,810 2,038 476,905 12,136 47,044 172,483 8,707 129,731 165,325 2,649 135,006 50,749 12,398 11,222 4,515 7,554 51,591 36,033 5,047

7,011,556

26,410,416

Dilated cardiomyopathy in Eastern Asia (Extrapolated Statistics) 1,298,847,624 6,855,125 445,286

2 2 2 2 2 2 2

127,333,002 22,697,553 48,233,760 22,749,838 68,893,918 28,513,677 2,185,569

2

Dilated cardiomyopathy in Southwestern Asia (Extrapolated Statistics)

2

Dilated cardiomyopathy in Southern Asia (Extrapolated Statistics)

2 2

141,340,476

1,065,070,607 159,196,336 19,905,165 1,019,252 6,068,117

2 2 2 2

Dilated cardiomyopathy in Southeastern Asia (Extrapolated Statistics) 238,452,952

2 2 2

23,522,482 86,241,697 4,353,893

2

64,865,523 82,662,800 1,324,991

2

2 2

Dilated cardiomyopathy in the Middle East (Extrapolated Statistics) 67,503,205 25,374,691 6,199,008 5,611,202 2,257,549 3,777,218
2 2 2 2 2 2 2 2

25,795,938 18,016,874 2,523,915

2

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2 2

West Bank Yemen Egypt Libya Sudan Congo Brazzaville Ghana Liberia Niger Nigeria Senegal Sierra leone

4,622 40,049 152,234 11,263 78,296 5,996 41,514 6,781 22,721 35,500 21,704 11,767

2,311,204

20,024,867 76,117,421 5,631,585

2

Dilated cardiomyopathy in Northern Africa (Extrapolated Statistics)

2

39,148,162 2,998,040 3,390,635

2

Dilated cardiomyopathy in Western Africa (Extrapolated Statistics) 20,757,032

2 2 2 2

11,360,538 10,852,147 5,883,889 3,742,482 9,538,544 8,238,673

2

12,5750,356
2

Dilated cardiomyopathy in Central Africa (Extrapolated Statistics) Central African Republic 7,484 Chad Congo Kinshasa Rwanda Ethiopia Kenya Somalia Tanzania Uganda Angola Botswana South Africa Swaziland Zambia Zimbabwe Australia New Zealand Papua New Guinea 19,077 116,634 16,477 142,673 65,964 16,609 72,141 52,780 21,957 3,278 88,896 2,338 22,051 7,343 39,826 7,987 10,840
2 2 2

58,317,030
2

Dilated cardiomyopathy in Eastern Africa (Extrapolated Statistics) 71,336,571 32,982,109 8,304,601

2 2 2 2 2

36,070,799 26,390,258 10,978,552 1,639,231 1,169,241

2

Dilated cardiomyopathy in Southern Africa (Extrapolated Statistics)

2

44,448,470
2

11,025,690

2 2

1,2671,860 19,913,144 3,993,817 5,420,280

2 2

Dilated cardiomyopathy in Oceania (Extrapolated Statistics)

2

Table 1.2 Morbidity Extrapolate Prevalence rate for Dilated Cardiomyopathy Source: US Census Bureau, Population Estimates, 2004 US Census Bureau, International Data Base, 2004

LOCAL MORBIDITY STATISTICS In this Table 1.3 shows the morbidity rate in the Philippines on 2000- 2004 & 2005. The disease of the heart was 7th most leading cause of morbidity cases ranges 43, 898. And highest most leading cause is Acute Lower Respiratory Infection ranging 690,566.

Table 1.3 Morbidit:10 Leading Causes, Number and Rate.

OBJECTIVES OF THE STUDY General Objectives Readers will be able to gain more knowledge and information about cardiomyopathy. As third year students, we learned patient based heart complication. In this matter, what we learned inside the room will be able to apply to an actual patient depending on the condition his needs. Patient centered Gather all necessary data of the patient that are related to heart disease that are available as is may be helpful to case study. Present the definition of the complete diagnosis that will explain the illness or complication.

Study the anatomy and physiology of that certain body part that is affected by the complication. Trace the pathophysiology of cardiac disease (cardiomyopathy). Determined the possible diagnostic test needed for the case including implication and nursing responsibility for the needs of the patient. Formulate a nursing care base plan on the possible secondary complication. Evaluate complications to nursing practice, education and research. To render health teachings and guidelines to those patients in the future for them to prevent the risk of heart failure. The student nurse wants to learn actual complication that may occur on the future.

Nurse centered After the completion of the case study the student nurse should be able to: Present comprehensive and detailed report regarding the complication. Have a well-structured nursing diagnosis of the complication based on patient integration data. Understand the factors that might have been contributed to the development of the complication. To provide an organized and structured nursing interventions as a response to the patient anticipated needs. Provide relevant information on available alternative therapies and management.

NURSING ASSESSMENT FAMILY GENOGRAM Mr. Ferding (code name) not his real name is the youngest siblings from Mr. Swirding(father of client, 65, deceased ) and Mrs. Sorayna(mother of client, 72, deceased). Five of the family members are alive and well. Three of his brother and two sisters died with a history of cardiac arrest and 2 died in spontaneous abortion. His grandparents on mother side and father side, most of them died in cardiac arrest as he stated when we did an interview with him. See Figure 1.1 to elaborate more on his family tree.

Figure 1.1FAMILY TREE (FAMILY HEALTH/ ILLNESS HISTORY)

PERSONAL HISTORY Mr. Ferding (code name) not his real name is a 53 yrs. old male born on April 30 1959. His parents are both gone, he has siblings 7 of them are already gone while 6 are still alive. He married his wife (Esme) at the age of 25 yrs. old. Now he is a father of 6 children. Mr. Ferding and his family are protestant. He is a carpenter and is earning enough to support his family including their education.

Lifestyle and Activities of Daily Living

Family Lifestyle Mr. Ferding works 6 days a week fixing and repairing houses while his wife takes care of their children at home. Their children are quite good and they are cooperative when they are told to do so.

Activities of Daily Living Mr. Ferding usually gets up at 5 am to prepare himself to go for work. He will just eat at 6 AM, at 7 AM he will now go to his work. During morning until 12 at noon then have his lunch for 1 hr. After 1 hr. he will now start working again for another 5 hrs. When he comes home at 5 pm he will just take a short break. He will then make sure that all his children is home at 7-8 before they eat their dinner. At 9 pm Mr. Ferding usually on bed ready to sleep and prepare for the next day routine.

Eating Pattern Mr. Ferding stated that he likes to eat heavy meals because of the kind of his work. He eats fried rice in the morning to sustain his activities. He also eats rice and partner usually with meat or fish and vegetables at noon and dinner. His wife is the one who prepares his food for work.

Bowel and Bladder Elimination Mr. Ferding stated that he is usually defecates once a day. Sometimes he exerts effort just to expel it. But when he feels like he is constipated, he drinks warm liquid after a while he will then go to the toilet. He also stated that he have no hard time urinating, there is no pain or any burning sensation. Family Relationship Mr. Ferding stated that he is a family man. He always makes sure that all his children is equally given attention to. He also added that his children are open to share their problems. And as a father he always gives advice with an open minded. Home and Neighborhood Condition Ms. Ferdings house is consisting of 3 bedrooms, 1 for him and his wife, 1 for his girls and the other is for his boys. The bedroom of his children is consisting of bunk beds. They have living room and kitchen. They have friendly neighbors and never had been in the fight before. HISTORY OF PAST AND PRESENT ILLNESS Past Illness According to Mr. Ferding 20 years ago he was a smoker then, and was diagnosed with hypertension. He did not comply with maintenance medication because he cannot afford it

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and he feel like he still have hypertension after a while so he thought he was ok and no need to take it.

Present Illness Mr. Ferding decided to go to the hospital because of excessive coughing and feeling of easy fatigability.

June 22- 2 weeks prior to admission Mr. Ferding experiences slight chills and fever but he still went to work. When he came home he took Biogesic for his fever and since his daughter is a nurse he just ask her to take his vital signs. Everything was normal but a slightly elevated temperature. The next morning he felt ok. Then decided to go back to work

July 6 -1 day prior to admission experienced coughing and feeling of easy fatigability. He did not got to work and he took a rest hoping that it will go away.

July 7 - 1 hour prior to admission Mr. Ferding experiencedexcessive coughing and DOB.

ACTUAL PHYSICAL ASSESSMENT Nutrition assessment The muscle tone of the patient was firm and developed with unequal strength on the upper peripheral extremities. Body fat was equally distributed in the waist thighs and triceps. Posture was erect but difficulty walking. The patient experienced easy fatigability. Skin is rough, dry and decrease skin turgor. Nail was firm and pale nail beds. Hair was brittle and dry. Lips are puffy with visible fissures on the corner of the mouth. Eyes are clear and pale. There was normal reflex. Apical rate of 73 bpm and a blood pressure of 110/70.

Skin and nail assessment Brown color skin, there was a thick but smooth texture with a clammy temperature. Skin turgor of 5 seconds. There was a presence of grade 2 edema in the lower extremities. Patient had a black dry hair. Scalp was symmetrical smooth and there was no presence of lesion and no parasites. There was a round nail with 180 O nail base, thick in texture and immobile.

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Head and Neck Head was symmetrical round hard and smooth. Face was symmetrical centered head position. Neck had a smooth and control movement and ROM of (flexion-45O , extension-55 O , lateral abduction-40 O , and rotation-70 O .) trachea and thyroid are in the midline position and non-tender.

Eyes and Ears Blinking was symmetrical and involuntary. Cornea was transparent, iris and pupils are round and equal. Iris was clear and uniform in color. There was no discharge and tenderness on the lacrimal apparatus upon palpation. Pinna of the ear was aligned with corner of the eye. Skin smooth without nodule and color was the same with the face. Auricle tragus was non-tender upon palpation. Mastoid process was not-tender when palpated, warm in temperature and easily palpated without edema.

Mouth throat and nose Lips and surrounding tissues are relatively symmetrical in position. There was fissure and puffiness on the side of the mouth when smiling. Tongue was fissure and moves smoothly and slightly pale in color. Color of the nose was the same as the face, smooth and symmetrical in appearance. There was visible nasal flaring during inspiration. There are no nodules, masses or pain reported during palpation. Sinuses are non-tender during palpation.

Chest and Lungs Color in the chest was slightly pallor, intercostals space is retracting during with RR of 24 bpm. Chest symmetrical was equal. There was no pain upon palpation but there was a presence of wheezing sound on both lung fields.

Heart Apical pulse was 73 bpm upon auscultation with 53 PR upon palpation.

Peripheral vascular

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Brachial artery blood pressure of 110/70 mmhg, 53 bpm PR. Extremities are slightly pallor. Temperature of 34.2 O can identify pain. Radial pulse was weak and slow. Lower extremities are slightly pallor with grade 2 bipedal edema. Verbalized no calf pain.

ANATOMY AND PHYSIOLOGY

Figure 1.2 Layers of the heart

Pericardial cavitythe space between the layers of the pericardium contains approximately 10 30 ml of fluid. Parietal pericardium-surround almost the entire ascending aorta and main pulmonary artery as well as portion of the inferior and superior vena cava and the pulmonary vein. Fibrous pericardium ( Parietal Layer) surrounds the heart and attaches to the great vessels which are several large blood vessels that return blood to the heart. Coronary blood vessel the blood vessels that supplies oxygen and nutrient to the heart itself. Endocardium is the inner layer of the heart where the blood is filled during cardiac relaxation. Myocardium is responsible for contraction and expelling blood during cardiac contraction. Epicardium( Visceral Pericardium ) contains the epicardial coronary arteries and veins. This is the inner lining of the pericardium; it is delicate inner lining of the parietal pericardium and is the outer lining the great vessel. (See figure 1.2)

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Figure 1.3 Blood flow illustration

Blood Flow First, superior vena cava carries deoxygenated blood from the upper extremities while inferior vena cava carries .deoxygenated blood from lower extremities. From the vena cavas blood will drain in the right atrium. From the right atrium blood will now go to the right ventricle through the tricuspid valve. From right ventricle deoxygenated blood will pass through the pulmonary valve and pulmonary artery going to the pulmonary trunk and lungs for the process of oxygenation. In the lungs blood will release carbon dioxide and will be oxygenized. Blood will pass through the pulmonary vein down to the left atria. From left atria the mitral valve will open and will be drain down to the left ventricle. The left ventricle now will pump the oxygenated blood towards the aortic valve ascending and descending aorta. The oxygenated blood is now going to for the systemic circulation. The movement of the blood through the heart is controlled by the opening and closing of the valves and the contraction and relaxation of the myocardium. Coronary circulation delivers oxygenated blood to myocardium and removes carbon dioxide from it. Deoxygenated blood

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from the heat returns to the atria via coronary sinus. (See Figure 1.3) Malfunction of this system can result to angina pectoris or myocardial infarction.

Figure 1.4 SA node and AV node

Conduction system of the heart The conduction system of the heart consists of specialized cardiac muscle tissue that generates and distributes action potential. Components of this system are the sinoatrial (SA) node this is the peacemaker, and initiate the cardiac contraction by passing electric impulse to atrioventricular (AV) node(See Figure 1.4), in which this node passes the electric impulse going to the bundle of his. From the bundle of His electric impulse will pass through the purkenji fibers. Thus, cardiac contraction happens.

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PATHOPHYSIOLOGY(Patient based)

Figure 1.5 Pathophysiology (Patient-Based)

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Figure 1.6 Pathophysiology(book based)

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DEFINITION OF THE DISEASE Heart muscle disease is called cardiomyopathy and is a problem with the physical shape of the muscle. Often its origin is unknown. Cardiomyopathy is a serious condition that can lead to heart failure, dysrhythmias and death.

SYNTHESIS OF THE DISEASE RISK FACTORS (patient based) Genetic factor-if the person has a family history of heart diseases 20-30% possibility that he/she will acquire that disease from them as it already runs on the genes. (Daniels 2010). From the start a person with family history of cardiomyopathy has already a cardiac abnormalities and its unknown if this will progress to full cardiomyopathy to later life. There is a presence of disease genes (dystrophin, tatazzin, cardiac actin, desmin, Lamin A/C, delta-sarcoglycan, cardiac beta myocin heavy chain, and cardiac troponin T-gene). The mutation in Lamin A/C is the one that causes cardiomyopathy. Other mutations are the cause in addition skeletal muscle myopathy. Dystrophin mutation are the cause of the rare X-linked dilated cardiomyopathy without skeletal muscle involvement and a progressive course in young men. Other mutation in dystrophin gene, mainly deletion , are the cause of muscular dystrophy Becker and Duchenne which are also present in dilated cardiomyopathy. Age-the higher the age of a person the higher the risk for heart diseases because of the degeneration of the tissues. And the presence of atherosclerotic disease that usually occurs in the late stage of life. This atherosclerosis causes a strain in the heart muscle because of compensatory mechanism of the body usually being a tachycardic. Gender- male is more prone to having cardiac related diseases than the female because of the vices (smoking, drinking). This activity causes the destruction and toxicity of cells in the heart. PRECIPITATING FACTOR Smoking- cigarrete contain a chemical nicotine that is responsible in the hardening of the arteries that causes increase workload in the heart that may lead to myocardial disease or heart failure. While the carbon monoxide toxicity causes the heart to weakens.

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Respiratory infection- bacterial infection causes increase in secretion causing coughing and increase in oxygen demand leading to a compensatory mechanism of the body such as increase in heart rate and respiratory rate.

easy fatigability s being experienced because of the increase in oxygen demand cough because of the reaction of bacterial infection in the RR system Pulse deficit most possible is because of the medication specifically the Digoxin.

SIGNS AND SYMPTOMS (patient based) Signs and symptoms Rationale The high temperature of the patient is caused by respiratory infection by the inflammation of the tracheal and bronchial area, due to pathogenic invasion. The inflammation will cause releasing of pyrogens from cells. These endogenous pyrogens will stimulate the release of prostaglandin that will trigger the hypothalamic thermostat to higher temperature. Or high blood pressure. It is because of decrease vascular regulation(atherosclerosis) resulting from malfunction of arterial blood flow due to formation of clots. And then there would be elevated blood pressure that will lead to increased heart rate. Due to continuous exertion of heart and increase in oxygen demand. It will cause an overuse stage and eventually the body will experience of feeling weakness, tiredness and listlessness. Due to myocardial dysfunction secondary to decrease mayocardial contraction there would be an abnormal perfusion. That explains the amount of blood ejected from left ventricle diminished and the heart cannot pump enough blood to meet body needs. It will cause limited airflow which leads to decreased cardiac output. Due to long term HPN and irregular cardiac pattern there is an impaired heart muscle resulting to decrease its capacity to function normally also resulting to decrease blood volume and oxygen in the systemic circulation causing easy fatigability

Fever

Hypertension

Easy fatigability

Impaired gas exchange

Activity intolerance

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Nail and skin color changes

Abnormal urine output

Edema

Decrease cardiac output and decrease arterial perfusion will cause abnormal process of circulation to a capillary bed in blood tissue that affects the skin color changes and the extremities. -Decrease cardiac output and decrease RBC will cause R-A-A stimulation. It means that there is re-absorption of sodium and water in the blood. It will bring about by fluids and electrolytes imbalances. -Due to decrease kidney function there is an improper absorption of water and wastes from the blood stream. Due to decrease kidney function and R-A-A stimulation the retention of too much salt causes the body to retain water. This water then leaks into the interstitial tissue space. This is what we call edema.

TREATMENT DIAGNOSTICS AND LABORATORY PROCEDURES General nursing responsibilities Check doctors order Explain to the client the importance of the test and what it is for

ECG Before Remove all metals attached to the body Make sure your health care provider knows about all the medications you are taking, as some can interfere with test results. Exercising or drinking cold water immediately before an ECG may cause false results. An ECG is painless. No electricity is sent through the body. The electrodes may feel cold when first applied. In rare cases, some people may develop a rash or irritation where the patches were placed.

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During You will be asked to lie down. The health care provider will clean several areas on your arms, legs, and chest, and then attach small patches called electrodes to the areas. It may be necessary to shave or clip some hair so the patches stick to the skin. The number of patches used may vary. The patches are connected by wires to a machine that turns the heart's electrical signals into wavy lines, which are often printed on paper. The test results are reviewed by the doctor. You usually need to remain still during the procedure. The health care provider may also ask you to hold your breath for a few seconds as the test is being done. Any movement, including muscle tremors such as shivering, can alter the results. So it is important to be relaxed and relatively warm during an ECG recording. Sometimes this test is done while you are exercising or under minimal stress to monitor changes in the heart. This type of ECG is often called a stress test. After Remove the patches slowly

Diagnostic/laboratory Date ordered: procedure

July 2012 7,

General description

Indication or purpose

Result

Normal values

Analysis and interpretation

ECG

Date result in: July 7, 2012

Standardized recording of electrical activity of the heart

To detect cardiac ischemia and abnormal rhythms.

PR-0.30 seconds
QRS-0.06 seconds

PR-0.120.20 sec QRS-0.060.12 sec

QT-0.26 seconds

QT-0.320.44 sec

The PR wave was prolong. The QRS is normal. The QT is shorter than normal.

URINE TEST Before Instruct the patient to void directly into a clean, dry container. Sterile, disposable containers are recommended.

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During Cover all specimens tightly, label properly and send immediately to the laboratory. If a urine sample is obtained from an indwelling catheter, it may be necessary to clamp the catheter for about 15-30 minutes before obtaining the sample. Clean the specimen port with antiseptic before aspirating the urine sample with a needle and a syringe. After Observe standard precautions when handling urine specimens. If the specimen cannot be delivered to the laboratory or tested within an hour, it should be refrigerated or have an appropriate preservative added
Diagnostic/labo ratory procedure
Date ordered: July 7 2012 Date in: result

General description
Urine test is a test where in urine is being collected to examine in a microscope

Indicatio n or purpose To determine the proper function of the kidney

Result
Color-yellow Transparencyclear PH-4.0 Specific gravity-1.020 Albumin-trace Sugar-negative Pus cels-HPF2.4 RBC/HPF-2.4 Epithelial cells-few A.urates- few

Normal values Coloryellow

Transparency

Analysis and interpretatio n

Color is normal Transparency normal PH- is in normal range Specific gravity-is in normal range No sugar found indicating its normal RBC is slightly above the normal range And it is normal for the epithelial and A urates to be found in the urine providing in a few number.

URINE TEST

July 7 2012

- clear PH-4.6-8 Specific gravity1.003-1.025

AlbuminSugar-Nil Pus cellsRBC-102/low power field 1/ high power field Epithelial cells, and A urates can be found in the urates in a few number

BLOOD TEST Before Nurses must help position patients properly, like rolling the patient over, in order to
complete the necessary diagnostic testing.

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Check a patient's vital signs (blood pressure, pulse, breathing rate), assess physical
condition and keep an eye on any monitors that the patient needs to remain hooked up to during the tests, such as a heart monitor or ventilator. Nurses may also be required to connect or disconnect any monitors or devices that can interfere with the testing.

During Draw the sample before giving or one hour after giving I.M. injections. I.M. injections will increase the total CK level. Be sure to obtain the blood samples on schedule. Always note on the laboratory slip, the time the sample was drawn and the hours elapsed since onset of chest pain. Be sure to draw blood samples in a 7-ml red top tube. Be sure to handle the sample gently to prevent hemolysis. Always have the sample transported to the lab promptly because CK activity diminishes significantly after 2 hours at room temperature. After the procedure Apply cotton ball with slight pressure to the site to bleeding. Test results are reported to the patient's doctor, specialists and others in need of the information by nurses. Results may be phoned in, faxed or sent electronically via a computer. It may be the nurse's responsibility to check for the results of the tests as well. They may be in charge of entering the results into the patient's medical record. Nurses must also notify the patient's physician when abnormal or critical results that require an immediate response, such as abnormal blood work with critical potassium levels, are found.
Diagnostic/labo ratory procedure
Date ordered: July 7 ,2012 Date result in: July 7, 2012

General descriptio n
Blood chemistry

Indicatio n or purpose Give specific informatio n about the condition of your organs.

Result

Normal values RBS-3.859.0mmol/l BUN-1.78.3mmol/l Createnine60120mmol/l CK-MB-0-

Analysis and interpretatio n RBS is in normal range BUN is in normal range CREATENIN E is in normal range CK-MB is is

Blood test

RBS-6.88 BUN-4.0 Createnine98.3 CK-MB-8.18 Troponin I-Nil

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Sodium-141.9 Potassium3.45 Hemoglobin144 25IV/l TroponinNil Sodium135145mmol/l Potassium3.55.5mmol/l Hemoglobi n-125175mmol/l Hematocrit0.40-0.52 WBC-510x10/l Neutrophils -0.45-0.65 Platelet count-150400x10?l normal range There is no troponin I found SODIUM is in normal range POTASSIU M is slightly low HEMOGLOB IN is in normal range HEMATOCR IT is in normal range WBC is slightly elevated NEUTROPHI LS is in normal range PLATELET COUNT is in normal range

Hematocrit-43 WBC-11.4 Neutrophils-.7 Platelet count248

Diagnostic/labo ratory procedure

Date ordered: July 7, 2012 Date result in:

General descriptio n
HEMATOL OGY

Indicatio n or purpose To determine the total volume of blood

Result

Normal values HGB-140180gm/l WBC-510x10mo/l RBC-4.56.3x10/l HCT-0.400.54L/L

Analysis and interpretatio n HGB is in normal range WBC is in normal range RBC is in nor mal range HCT is in normal range

Blood test

HGB-143 WBC-8.8 RBC-5.0 HCT-0.43

July 7 2012

24 Diagnostic/labo ratory procedure

Date ordered: Date result in:

General descriptio n
Chemical chemistry

Indicatio n or purpose To determine the proper function of the heart

Result

Normal values
BUN-2.17.1mmo1/l CREATENI NE-62106mmol/l SODIUM135148mmol/l POTASSIU M-3.55.3mmol/l

Analysis and interpretatio n BUN, CREATENIN E, SODIUM, POTASSIUM

Blood test

July 7 2012

BUN-2.8 CREATENIN E-70.8 SODIUM143.8 POTASSIUM3.55

are all in normal range

IVF Before Lean the site with cotton balls with alcohol During Make sure to maintain bed rest Continues cardiac monitoring Report any abnormal findings to the physicians Increase the rate of infusion as prescribe, but monitor for fluid overload No evidence of dehydration should be noticed Check the IV site for redness, swelling and infiltration After Apply cotton balls to the site to prevent bleeding
MEDICAL MANAGEMENT 1ST D5LRS 1LxKVO Date ordered: July 7 Date started: July 7 Date Changed: July 8 GENERAL DISCRIPTION D5LRS are fluids which are intended to be administered because hypertonic solution are those that have an effective osmolarity greater than the body fluids. INDICATION PORPOSE This pulls the fluids into the vascular by osmosis resulting in an increase vascular volume .It raises intravascular osmotic pressure and provides fluid, electrolyte and calories for energy. CLIENTS RESPONSE Client maintain fluid balance despite of strict monitoring of I&O

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O2 THERAPHY Before Instruct the client and visitors about the hazard of smoking with oxygen use. Make sure that electric devices (such as razors, hearing aids, radios, televisions, and hearing pads) are in good working order to prevent the occurrence of short-circuit sparks. Ensure proper delivery method (cannula, face mask, face tent) Teach client proper use of oxygen During Avoids materials that generate static electricity, such as woolen blankets and synthetic fabrics. Cotton blankets should be used, and client and caregivers should be advised to wear cotton fabrics. Regulate flow if necessary After Always make sure that the oxygen tank is properly closed

MEDICAL MANAGEMENT OXYGEN 1-2 liter/min

Date ordered July 7, 2012 Date started July 7, 2012

GENERAL DESCRIPTION Oxygen is a colorless gas that exists in the air that all living things needed in order to live.

INDICATION PORPOSE To provide enough oxygen despite of difficulty of breathing

CLIENTS RESPONSE Patient was relieved experiencing DOB

DRUGS General nursing responsibilities Before Check doctors order Explain to the patient what the medication is for. During: During Give the medication on time. After: Document the medication done.

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CEFTRIAXONE Before Read carefully the name cephalosporins have similar sounding and similar spelled names. Reconstitute 1 mL of cephalosporin to 5 mL of sterile water. Determine allergy to the cephalosporin through skin testing. During Do no infuse rapidly, it causes pain and irritation
Name of the drug:
Date ordered: July 7, 2012 Date started: July 7, 2012

Route: IV infusion Dosage and frequency: 1 gm Q12

Generic name:
Ceftriaxone sodium

General action 3rd generation cephalosporin antibiotic

Indication Lower respiratory infection due to pneumonia

Clients response to the actual adverse reaction The client did not manifest any S&S of infection

Brand name:
Rocephin

Date discontinued: July 9, 2012

FUROSEMIDE Before Do not confuse Lasix with Lanoxin (a cardiac glycoside) Asses closely for a sign of vascular thrombosis and embolism. Take Blood Pressure before administering the medication give IV injection slowly, may cause pain and irritation. During Do not infuse rapidly After For rapid diuresis observe for dehydration. Assess for S and Sx for hyperkalemia. Let the client change the position from lying to sitting the stand slowly. Supplement diet with vegetable and fruits that are high in potassium. (ex. Bananas, peaches and oranges.)

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Name of the drug: Date ordered: July 7, 2012 Date started: July 7, 2012 Route: IV bolus Dosage and frequency: 40 mg Date discontinued: July 8 2012 Q 6 (12 , 6) General action Loop Diuretic Indication Edema Clients response to the actual adverse reaction There was in increase in urine output from 45cc in 2 hrs. to 300cc in 5 hrs.

Generic Name: Furosemide Brand Name: Lasix

AMIODARONE HYDROCHLORIDE Before Correct potassium and Magnesium During Follow recommended dietary guidelines. Avoid or limit salt and fluid as directed. Avoid grape fruit. After Record BP and pulse for providers review. Identify specific levels to hold drugs. HR <60, BP <90/60.
Name of the drug: Date ordered: July 7 Date started: July 7 Date discontinued: July 9, 2012 Route: Oral Antiarrhytmic Dosage and frequency: O.D. (8) Brand Name: Cordarone, Pacerone Prolong the duration of the membrane action potential(relative refractory period) without the change the phase of depolarization or the resting action membrane potential. The client maintains a normal heart rate of 73 bpm General action Indication Clients response to the actual adverse reaction

Generic Name: Amiodarone Hydrochloride

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LOSARTAN POTASSIUM Before Do not confuse Lozaar with Zocor (Antihyperlipidimic) . Take pulse rate and BP before administering medication. After Low fat, low sodium diet and avoid grape fruit. Do not change position suddenly.
Name of the drug: Date ordered: July 7, 2012 Date started: Generic Name: Losartan Potassium Brand Name: Lozaar July 7, 2012 Dosage and frequency: 50 mg (8 ) Date discontinued: July 9, 2012 Antihypertensive, Angiotensin II receptor blocker Antihypertensive, alone or with combination with other antihypertensive drugs(including diuretics). Reduces risk of stroke in clients with hypertension and left ventricular hypertrophy. Route: Oral The patient maintains a normal blood pressure of 110/70 mmhg General action Indication Clients response to the actual adverse reaction

LEVOFLOXACIN Before: Check if patient is able to swallow or in need of NGT. Prepare the medication and other materials to be used.
Name of the drug: Date ordered: July 7, 2012 Date started: Generic Name: Levofloxacin Brand Name: Levaguin, Quixin Date discontinued: July 9, 2012 July 7, 2012 Dosage and frequency: Oral (8 ) Flouroquinolone Antibiotic 5 day treatment regimen for community acquired pneumonia due to Streptococcus Pneumoniae. Route: Oral The patient prevent further infection General action Indication Clients response to the actual adverse reaction

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DIGOXIN Before Monitor bradycardia/ arrhythmias, count apical rate for atleast one minute. Before administering. Have digoxin immune FAB available After Monitor for pulse deficit. (It indicates adverse drug reaction.) For severe toxicity. Use caution: Digoxin withdrawal may worsen heart failure. Take at the same time each day. Do not change brands.
Name of the drug: Date ordered: July 7, 2012 Date started: July 7, 2012 Route: Oral Dosage and frequency: 25 mg Digoxin Brand Name: Lanoxin Date discontinued: July 9, 2012 (8) Cardiac Glycoside Propylaxis and treatment of recurrent paroxysmal AV junction rhythm. The patient maintains a normal heart rate of 73 bpm General action Indication Clients response to the actual adverse reaction

Generic Name:

POTASSIUM CHLORIDE Before Obtain renal function test, dysfunction leads to hyperkalemia. Prepare the medication. During Do not draw or dissolve in the mouth. Monitor I/O. After Report any sign of weakness, fatigue or cardiac arrhythmias, it is a sign of hypokalemia. Record the medication done.

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Monitor input/output
Name of the drug: Date ordered: July 7. 2012 Date started: July 7, 2012 Route: Oral Dosage and frequency: O.D. Date discontinued: July 9, 2012 (8 ) Hypokalemia with or without metabolic acidosis following in increase urinary excretion. The client maintains a normal level of K of 3.55 General action Indication Clients response to the actual adverse reaction

Generic Name: Potassium Chloride Brand Name: Kalium Durule

Electrolytes

CALCIUM GLUCONATE Before Do not administer together with other medication Make sure provider is aware of all the medication prescribed.
Name of the drug: Date ordered: July 7,2012 Date started: July7, 2012 Route: IV The client maintains a normal level calcium in the blood General action Indication Clients response to the actual adverse reaction

Generic Name: Ca gluconate Brand Name: Cal-G

Dosage and frequency: 1 ampule STAT

Calcium salt

Date discontinued: July 8, 2012

Prophylaxis of hypocalcemia during exchange transfusion

MAGNESIUM SULFATE Before Asses for absent patellar reflex, <100ml in for hr urine output Asses for Sign and symptoms of hypermagnesemia (flushing, sweating, hypotension or hypothermia)
Name of the drug: Date ordered: July 7,2012 Route: IV General action Indication Clients response to the actual adverse reaction

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Date started: July 7, 2012 The client maintains normal HR

Generic Name: Magnesium sulfate Brand Name: Epsom salt

Dosage and frequency: 2 gram STAT

Date discontinue: July 7, 2012

Miscellaneous, essential element for muscle contraction, certain enzyme, and nerve transmission

Replacement therapy in Mg deficiency especially in acute hypomagnesaemia accompanied by signs of tetany similar to those seen in hypocalcemia

ASPIRIN Before Have epinephrine available to counter act hypersensitivity occurs Note history of peptic ulcer or bleeding tendencies During Take with full glass of water to prevent lodging in esophagus After Inform the patient to report ringing in the ear, difficulty hearing, dizziness or fainting spells, unusual increase in sweating, severe abdominal pain or mental confusion (this is a sign of a toxic effect)
Name of the drug: Date ordered: July 7,2012 Date started: Generic Name: Acetylsalicylic Acid Brand Name: Aspirin July 7, 2012 Date discontinued: July 7, 2012 Dosage and frequency: 80 mg OD Inhibit platelet aggregation Use for cardiovascular disease Patient prevents platelet aggregation Route: Oral General action Indication Clients response to actual adverse reaction the

DIET Before

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Check the doctors order. Question for any inconsistencies regarding patients diet and condition Explain the importance of diet prescribed After Document intake as to amount and provide a separate sheet for fluid and output Take note of patients response to the diet
TYPE OF DIET GENERAL DESCRIPTION Low fat and low sodium diet INDICATION/PURPOSE SPECIFIC FOOD TAKEN pineapple

LFLS

To prevent the further accumulation of atherosclerotic plaque that will contribute to increase workload of the heart. To prevent constipation that may stimulate the vagus nerve and lead to heart failure.

Soft diet

Fluid or soft food

Water, arozcaldo

ACTIVITY BED REST Before Explain to the patient why it is necessary Inform the patient to wear pressure stocking and explain why it is necessary During Always make sure that there is somebody with him to assist his needs Make sure your patient is changing position at least every two hours as permitted by her doctor to avoid bed sores that will put her into risk of impaired skin integrity related to immobility. Always elevate the bedrails After Let the client stand or move in a gradual motion
MEDICAL MANAGEMENT Date ordered: July 7, 2012 GENERAL DISCRIPTION INDICATION PURPOSE CLIENTS RESPONSE

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Bed Rest Date started: STAT A medical treatment involving a period of consistent (day and night) recumbence in bed and Reducing activities. Prevent any restraints that can cause easy fatigability and further problem to the heart The patient was cooperative and reduces the feeling of easy fatigability.

DAILY PATIENTS RECORD/EVALUATION Days Nursing problems Admission-Day 1(July 7, 2012) Cough, easy fatigability Day 2(July 8, 2012) Easy fatigability

Vital signs

BP-110/70, RR-17, PR-78, Temp-36 Hematology, chemical chemistry, urinalysis, blood chemistry, electrolytes D5LRS 10 gtts (KVO) O2-2 LPM Ceftriaxone 1 gm q12, furosemide 40 mg IV q6, MgSO4 2 gm IV STAT, Ca gluconate 1 amp IV STAT, amiodarone 200 mg OD, Losartan 50 mg 1 tab OD, Lanoxin 25 mg 1/2 tab OD, levofloxacin 500 mg 1 tab OD, kalium durule 1 tab BID, aspirin 80 mg 1 tab OD NPO

BP-110/70, RR-24, PR-53, Apical-78, Temp-36.2 None

laboratory

IVF, O2

#2 D5LRS D5LRS 10 gtts (KVO) O2-2 LPM Levofloxacin500 mg 1 tab OD, , lanoxin25 mg 1/2 tab OD, kalium durule, furosemide 40 mg IV q6, ceftriaxone1 gm q12,, losartan50 mg 1 tab OD, Kalium durule1 tab BID , amniodarone 200 mg OD

Drugs

Diet

LFLS

Activity

Bed rest

Bed rest

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DISCHARGE PLANNING Strategy Deep breathing exercises Objective To improve the lung capacity thus decreases the workload of the heart Content Deep Breathing Exercises Deep breathing is a relaxation technique that can be self-taught. Deep breathing releases tension from the body and clear the mind, improving both physical and mental wellness. We tend to breathe shallowly or even hold our hold our breath when we are feeling anxious. Sometimes we are not even aware of it. Shallow breathing limits your oxygen intake and adds further stress to your body, creating a vicious cycle. Breathing exercises can break this cycle How to do Deep Breathing Exercises: 1.Sit up straight. (Do not arch your back) First exhale completely through your mouth. 2.Place your hands on your stomach, just above your waist. 2.Breathe in slowly through your nose, pushing your hands out with your stomach. This ensures that you are breathing deeply. 3.Imagine that you are Time frame Every time necessary Resources Teaching and demonstration

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filling your body with air from the bottom up. 4.Hold your breath to a count of two to five, or whatever you can handle. It is easier to hold your breath if you continue to hold out your stomach. 5.Slowly and steadily breathe out through your mouth, feeling your hands move back in as you slowly contract your stomach, until most of the air is out. Exhalation is a little longer than inhalation. 6.After you get some experience you dont need to use your hands to check your breathing. You can also do the above breathing exercise lying on your back. Deep breathing exercises can help you to relax before you go to sleep for the night, or fall back asleep if you awaken in the middle of the night.

You can also practice deep breathing exercises standing e.g. while sitting in traffic, or standing in a lineup at the grocery store. If you are really tense and feel as if you are holding your breath, simply concentrate on slowly breathing in and out.

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Strategy Early Ambulation

Objective To improve cardiac muscles and improve its function

Content Safety tips for Stair Climbing Safety and effective climbing should be your goal for stair climbing. The following safety tips can help you start an effective stair climbing regime:

Time frame Once a day

Resources Health teaching

Keep people informed about stair climbing whether at office or home. Always carry water or fluids with you. Be aware of your knee alignment as it can cause a knee or ankle sprain. Inspect the stairs before climbing them as an exercise. Watch out for opening doors at the end of the stairway.

What is the Ideal Way to Start Stair Climbing? Any aerobic exercise should be started very slowly and gradually. The ideal form of any exercise or stair climbing should take care of the following:

1. 5-15 minutes of warm up exercises are absolutely

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essential for starting anyworkout session

2. Start climbing with gradual slow steps.

3. You can alternate between quicker and low step routines andslower and deep step routines.

4. Finally, relax and cool yourself down.

Control the intensity of your exercise and do not over-exert yourself in your first and initial attempt. Set a goal for yourself like increasing the pace by one flight of stair per week

Strategy Low fat Low sodium Diet

Objective To avoid the formation of atherosclerotic plaque

Content By following such diet, the risk of heart disease, gallbladder disease, diabetes, and even some forms of cancer is greatly reduced. It is also a great way to lose weight.

Time frame Throughout the day

Resources Health teachings

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Example of a low fat low sodium diet Breakfast-scramble egg, diced mushroom and red and green peppers, oatmeal with a sliced banana Lunch- fresh fruits and vegetables salad with baked fish or chicken on top Dinner- boiled fresh vegetables
All you need is 30 minutes of moderate-level physical activity on most days of the week. Examples of such activities are brisk walking, bicycling, raking leaves, and gardening.

Strategy Moderate active ROM exercise

Objective To prevent sudden onset of rapid heartbeat .Range-ofmotion exercise enhance muscle flexibility.

Content
All you need is 20-30 minutes of moderate-level physical activity on most days of the week. Examples of such activities are 1.Chin to chest 2. Head turns 3. Head tilts 4. Shoulder movement, up and

Time frame 30 minutes everyday

Resources Health teachings

39 down 5. Shoulder rotation 6. Elbow bends up and down 7. Elbow bends side to side 8. Wrist rotation 9. Palm up, palm down 10. Finger bends 11. Finger spread 12. Hip and knee bend 13. Leg movement side to side 14. Leg rotation 15. Knee rotation 16. Ankle and toe bends 17. Ankle and toe rotation

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NURSING CARE PLAN EXCESS FLUID VOLUME

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INEFFECTIVE BREATHING PATTERN

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ACTIVITY INTOLERANCE

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ACTIVITY INTOLERANCE

SUMMARY Some people who have cardiomyopathy have no signs or symptoms and need no treatment. For other people, the disease develops quickly, symptoms are severe, and serious complications occur. Treatments for cardiomyopathy include lifestyle changes, medicines, surgery, implanted devices to correct arrhythmias, and a nonsurgical procedure. These treatments can control symptoms, reduce complications, and stop the disease from getting worse Cardiomyopathy is a common disease affecting more than 1 million people around the world. There are so many contributing factors that trigger the onset of this cardiac disease. Based on our patient some of these factors are (age, family history, gender, and history of smoking). It is hard to predict if the person is when he/she is going to acquire the disease. Easy fatigability

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and cough was the symptom why the patient admits himself in the hospital for he perceives that it was a life threatening situation for her. Diagnostics was required to determine the exact problem and the treatment is consists of combination of medication in order for his heart to function on is normal. But this is not enough there should be a strict and continuous monitoring of the patient status in order for the patient to recover faster. RECOMMENDATION Patient with or without a family history of cardiac disease (cardiomyopathy) should be very cautious in terms of life style and should avoid the triggering factors that will cause this disease to emerge. All people is risk to having different kind of diseases how much more of those who have a history. Therefore we recommend that everyone should be concern and be knowledgeable about things that are needed to do. As a student nurses it is our responsibility to enforce teachings that will maintain or at least prevent the occurrence of problem and thus it will help create a healthy community. LEARNING DERIVED Policarpio, Jeffrey S. ICU is the second rotation I had since starting my clinical duty. Compared to delivery room, ICU is more in depth when it comes to giving patient care. Due to the time spent with patient, I was able to develop other nursing care skills. I was able to practice my skills with compassion due to prolonged time spent with patient. Nursing is not just giving treatment; it is how you give care. As early as now, I am learning to incorporate compassion with my chosen profession. Familiarizing myself with patients chart, drug administration and utilizing different hospital machines such as mechanical ventilator, ECG and atrial defibrillator, provided me with understanding of nursing practice in a whole new level. With this rotation, I had gained more awareness with the practice of infection control not just for me but especially for the patient. Patients in ICU had to deal not just with their major diagnosis but also complications. In line with this, practicing good handwashing, masking and maintaining cleanliness, is my way of showing I care. In my mind, if I dont practice infection control, this will expose my patients to more medical problems mainly that their immune system is already compromised. Delivery room is a fast paced environment. In ICU, it gives me more time to know not just my patients medical problems but my patient as a person as well. My patients need me and depend on me with their needs, thus, I need to show that they can count on me just to relieve them a little bit of what they are going through. Moreover, in ICU, I need to give individualized care which gave me the opportunity to learn more about different nursing interventions. Critical thinking is always a part of nursing practice. My ICU experience gave me the opportunity to practice this skill, taking into consideration the welfare of my patient, thus showing that nurses are not just mechanical workers that move in a routine manner. Nevertheless, nurses move with precise interventions and with compassion.

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It will always be in my mind that in my chosen career, I deal with human beings. These human beings, sometimes needs machines to survive in ICU, but it will make a big difference if a nurse incorporates love when using those machines with them. And for sure, the patient will know the difference of a nurse who provides interventions just for the heck of it and a nurse who moves with passion and care.

ROWENA P. LIGON Being in the ICU is a challenging experience a student nurse will acquire. Having an actual patient is very crucial part in the studies of a student nurse. This is the time of realization that life of a person is at risk if the person that will handle that patient is not equipped with knowledge on how to handle a patient. Knowing the Patient that as a student nurse will provide an assessment in the ICU is a very important step. The student nurse should know to protect the privacy and the integrity of the patient assigned to him/her. The student nurse will not only base his/her analysis from the questions and assessment being conduct to his assigned patient, but rather to gather all the necessary data from other sources like the laboratory results, genogram that will support to have accurate case study. IRISH SANTOS Data collection, assessment taken, is where everything must start, because if a student nurse fail to determine the needs of the patient, there will be a failure to the speedy recovery of his Patient. Communicating skills is also a very crucial stage of assessment for a student nurse to be able to gain their trust you must establish rapport. Health teaching is very necessary due to lack of knowledge to some patient. Teaching them the importance of seeking immediate help when they feel that something is wrong to them, in order to treat the problem immediately. We have to be cautious enough about our health to live longer and be with our love ones. Like the famous saying: Health is wealth. Being free from disease is to live a healthy lifestyle. It is up to the person how they will utilize the resources around them.

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MARY LEZ D. PERRY Though it was my first time to be assign in the ICU I learned so many things that a student nurse should know. Some of it was very unfamiliar to me, like the negatoscope, the solucet, and it was my first time to observed somebody doing a sunctioning. I was able to understand how ECG is being apply to the chest. I was I able to understand what the lines mean in the ECG result. It was my first time to administer lantus to a patient. It was a very nice experience taking care of the patient. I was able to observe what could be a patient would ned in the situation where in nobody want to be.

MARK OLIE B. LAYAG Being in ICU, the first thing that comes in my mind are those patients who are in critical condition. Having an actual patient is very crucial part in the studies of a student nurse. . I felt very nervous because I dont know what I will expect in ICU and what are the things should be done. You are going to analyze an ethical conflict and come up with a course of action that is morally defensible and medically reasonable. And assist patients and their families at time of critical illness with respect, concern for their dignity, and careful attention to pain control and suffering. The most I learned is to how to prioritize the needs of the patients. On how to be attentive on monitoring because we know that these patients need to be closely monitored because of their situation.

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REFERENCES MEDICAL SURGICAL (CONCEPTS AND CLINICAL APPLICATION) 2ND EDITION 2009
JOSIE QUIAMBAO UDAN

NURSES POCKET GUIDE (DIAGNOSES INTERVENTIONS AND RATIONALES

MARILYN E. DOENGES, MARY FRANCES MOORHOUSE, ALICE C. MURR

POCKET NURSES DICTIONARY BY GUPTA CONTEMPORARY MEDICAL-SURGICAL NURSING VOLUME 1

RICK DANIELS, LAURA NOSEK, LESLIE NICOLL

DELMARS NURSES DRUG HANDBOOK 2010 EDITION

GEORGE r. SPRATTO, ADRIANNE l. WOODS

NURSES HANDBOOK OF HEALTH ASSESSMENT SIXTH EDITION

WILLIAM &LIPPINCOT

INTRODUCTION TO THE HUMAN ANATOMY 7TH EDITION

TORTORA & DERRICKSON