Case Ib Study in Ectopic Pregnancy

Introduction
A heart beat signifies life, from the day it starts to beat in the womb, till it stops,
and where death conquers us. The heart beats not only to one tune but it also responds
to the tune of emotions and physical stress. As some of us may have also experience
moments of joy or sorrow and the heart may feel pain or pleasure.
In medicine, an acute disease is a disease with a rapid onset or a short course.
The term Acute may often be confused by the general public to mean severe,
however, this has a different meaning. !oronary, may refer to as the heart or relating
to the heart. "hile syndrome is defined as a set of signs and symptoms that tend to
occur together and which reflect the presence of a particular disease or an increased
chance of developing a particular disease.
Acute !oronary #yndrome is defined as a spectrum of conditions involving chest
discomfort or other symptoms caused by lac$ of oxygen to the heart muscle %the
myocardium&. The unification of these manifestations of coronary artery disease under a
single term reflects the understanding that these are caused by a similar
pathophysiology %sequence of pathologic events& characteri'ed by erosion, fissuring, or
rupture of a pre(existing plaque, leading to thrombosis %clotting& within the coronary
arteries and impaired blood supply to the heart muscle.
According to the morbidity rate, ta$en from the records of the )epartment of
*ealth for region +, the occurrence of cardiovascular diseases per ,--,--- populations
is .,./0. This data is ta$en from the 1--,(1--/, a / years average record. "hile the
occurrence rate for cardiovascular disease for region + by 1--0 is recorded to be 2,.3.
per ,--,--- populations.
,
OBJECTIVES OF THE STUDY
The study aims to explore the concepts about the condition and the quality of
nursing care being rendered to our client 4rs. 5 that was diagnosed with Acute
!oronary #yndrome.
In order to learn more about the health condition of the patient, the study wants
to fathom about the predisposing and precipitating factors, anatomy and physiology and
the pathophysiology of the condition experienced by the client. 6asically the main goal
of this study in relation to $nowledge is to identify the nursing interventions after the
condition of patient 4rs. 5.
The study aims to critically analy'e the qualitative and quantitative data gathered
in order to establish connection between the different manifestations experienced by the
patient with that of the disease process. To be able to improve s$ills, the students also
endeavors to come up with nursing care plans that will alleviate 4rs. 5.7s condition. The
presentors also intend to compare and contrast the ideal management for Acute
!oronary #yndrome with that of the actual management. In addition, the study see$s to
disseminate essential information to everybody for awareness.
5urthermore, by this study, the provider will be able to exercise that attitude of
determination and in order to come up with a successful study.
1
SCOPE AND LIMITATIONS OF THE STUDY
This case study tac$les about Acute !oronary #ydrome specifically on the case
of patient 4rs. 5. It includes essential concepts in relation to the said condition such as
the patient7s profile and health history, nursing assessment and clinical manifestations,
drug study and diagnostic exams done. The anatomy and physiology is also included as
well as the pathophysiology of Acute !oronary #yndrome with its associated factors.
The 4edical and 8ursing 4anagement along with the discharge plans with its referrals
are also being covered. The prognosis is also given.
The scope of the plan encompasses during the 9ecovery :hase which was on
5ebruary ,1, ,., ,2, ,/, ,0, ,; and ,< of year 1--; wherein the assigned students who
have assessed the client with cumulative interaction and good rapport to the patient and
significant others. 8ursing 4anagement covers the above mentioned dates which
encompasses the client7s 9ecovery :hase. )ata gathering about the =aboratory results
covers from 5ebruary -/ to 5ebruary ,0, 1--;.
The areas of concerns are limited to the discussions of Acute !oronary
#yndrome and the quality of 8ursing !are to the patient. The quantity and quality of the
information are limited to the data gathered from the client, significant others and his
medical records.
Immediate family bac$ground is limited because the patient has difficulty in
recalling necessary information that would aid in the data gathering. )ata gathering was
limited in the confines of 4aria 9eyna *ospital, !agayan de >ro !ity and Aluba,
!agayan de >ro. ?enerally, the content of the report is limited to the elaboration of the
diagnosis given to the patient and the corresponding 8ursing 4anagement.
.
PATIENTS PROFILE
Na!" Mr#$ F Mr#$ F
A%!" &' (!ar# o)d &' (!ar# o)d
S!*" F!a)!
Birt+da(" Jun! ,- './0 Jun! ,- './0
Birt+ ran1" /
nd
to t+! !)d!#t
Nu2!r o3 #i2)in%#" 4
R!)i%ion" Roan Cat+o)ic
Ci5i) Statu#" Marri!d
Nu2!r o3 c+i)dr!n" ',- 6it+ '7 )i5in% and , d!c!a#!d
Nationa)it(" Fi)i8ino
H!i%+t" 9 Ft$
:!i%+t" 4, 1%
Addr!##" Baun%on- Bu1idnon
Occu8ation" Hou#! 6i3!
Inco!" P+8$ '9-777; o$
Educationa) Attain!nt" '#t (!ar H$S$
Dat! Aditt!d" F!2ruar( 79- /77&
Ti! Aditt!d" '/" 79 PM
C+i!3 Co8)iant" S+ortn!## o3 2r!at+ and c+!#t 8ain
Dat! Di#c+ar%!d" F!2ruar( '0- /77&
Ti! Di#c+ar%!d" <"'9 PM
Fina) Dia%no#i#" Acut! Coronar( S(ndro!- +(8!rt!n#ion- M(ocardia)
In3arction
2
Si%ni3icanc! o3 t+! #tud(
The study is significant to the following people, the client, the client7s family, the
researchers, nursing student, and future researchers.
The study is significant to the client, because it enlightens the client7s queries and
doubts regarding her condition. Allowing her to understand the situation of her present
state, this would allow her to be more aware of the importance of following the
treatment regimen.
!lient7s family must also be aware of the condition of the client. "ith the study,
the client7s family will be able to participate in the client7s treatment, and they will be
able reali'e the importance of the support system in participating in the client7s care.
The study is also important to the researchers, since it allows them to explore the
client7s condition, giving them first hand experience in observing the manifestations of
the disease condition and allowing them to apply theoretical $nowledge regarding
nursing managements for the manifested signs and symptoms.
8ursing students and future researchers may use the study for reference or basis
purposes in planning an intervention or understanding a condition which could be
similar or related to the study presented.
/

H!a)t+ Hi#tor(
Fai)( Hi#tor(
*istory of hypertension was present to both paternal and maternal side, in
addition to the given data7s from the informant@ there7s no history of !A on the clients
lineages. *owever, on her maternal side a history of diabetes mellitus and heart
problems was present.
4rs. 5.7s grandfather %father side& died due to liver abscess. It was $nown that
her grandfather was a chain tobacco smo$er consuming 12 stic$s or approximately
,pac$ of cigarette per day and drin$s alcoholic beverages such as tuba. Additionally,
patient7s grandmother %father side& died due to normal aging with high blood pressure.
:atient7s maternal side history revealed that grandparents died due to aging.
5urthermore, patient7s father died due to normal aging with hypertension. It was
mentioned that her father was also a smo$er, consuming ,/(1- estimated stic$s of
cigarette per day. *e also drin$s alcoholic beverages li$e tuba. *er mother died at her
;; years of age due to normal aging process.
>n the siblings of the client7s father side, all had hypertension. #ome of her
mother7s siblings had hypertension and one had !AA.
P!r#ona) Socia) +i#tor(
4rs. 5. had her menarche at the age of ,. years old. At the age of 1- years old,
4rs. 5. met 4r. #. at 6aungon, 6u$idnon and got married. 4rs. 5.7s reproductive profile
was ?,., :,., T,., :-, A-, and =,-. #he has ,. children. *er first pregnancy was on
5ebruary ., ,<23 with their first child named #ohrab through 8ormal #pontaneous
Aaginal *ospital delivery. #orab died on Banuary 1<, ,<;< due to an accident. #econd
delivery was a pregnancy uterine full term, normal #pontaneous delivery with a baby
0
boy named after his father, #antiago Br. *istory divulges that the patient7s second child
died after birth. Third pregnancy was still a normal spontaneous vaginal delivery. The
baby was named =eopoldo, =eopoldo died due to measles at the age of .months. *er
fourth pregnancy was still normal named her third child Clleonor with an educational
attainment of *igh #chool level who was born 5ebruary 11, ,<2<. 4rs. 5.7s ,-
remaining pregnancies were all full term and were all delivered through normal
spontaneous vaginal delivery. The remaining ,- children were the followingD ?emma
who was born on )ecember ,; ,</-, married and with an educational attainment of
*igh #chool ?rad, 9osalina born aug. ,;, ,</, with an educational attainment of *igh
#chool graduate ,married %female&, Cfren born #ept. ,; ,</1 with an educational
attainment of *igh #chool level and is married %male&, #alvacion born on 5eb. ,/, ,</.
a *igh #chool level and is married %female&, 4arjorie born on >ct. ,0, ,<01 a *igh
#chool graduate and is married %female&, Bose born on -ct. ,;, ,<0. a *igh #chool
level and is single %male&, 4arites born on )ec. ,-, ,<02 a *igh #chool level and is
married %female&, 8ancy born on Aug. 11, ,<00 a college graduate and is married
%female&,Cdgardo born on 8ov. 1 ,<03 a *igh #chool ?rad and is single%male&.
:atient7s husband, 4r. #. was the 5ormer vice 4ayor of 6aungon, 6u$idnon. >n
the year ,<0.( ,<0/.6eing a wife of the vice mayor, she participated well in politics and
has a lot of programs and campaigns for her husband. #he was also a member of the
!atholic "omen7s =eague and has done a lot of outreach programs for the church.
Their family social status was at pea$ that time, but then a great downfall happened in
their lives. At the age of .< years old, 4r. #antiago was stabbed due to political conflicts
which caused his death. #he hardly accepted it because of the traumatic experience
they had.
After two years, 4rs. 5. got married to 4r. A. *e is a !ebuano who came to
6aungon, 6u$idnon in search for wor$ and found more than what he had expected. 4r.
A was afraid in marrying her because he has to face all of her children to as$ for the
hands of their mother. =uc$ily, all of her children understood and accepted him and they
got married. 4r. A. and 4rs. 5. were not blessed with children somehow blessed with
their adopted children who were 4argie and Eristine.
3
They have their own house in 6aungon, 6u$idnon and too$ cared by her adopted
daughter 4argie. "hen visiting in !agayan de >ro wherein her sons and daughters are
residing in the same area, they stay in her daughter7s house 4arites in Aluba, !oca(
cola compound where they are warmly welcomed. >ur client7s source of income is only
:,/,--- pesos a month from her pension pay.
Pa#t !dica) Hi#tor(
>n ,<0/, the year of 4r. #.7s death, 4rs. 5. had traumatic experience that
caused her psychological and physical stress. It was claimed by the informant that at
the year ,<;2, patient was admitted to !ity *ospital due to her first stro$e attac$. That
admission lasts for a wee$ and she was diagnosed to have !erebro Aascular Accident
or !AA. *er, second attac$ was on year ,<<, at 4adonna *ospital Intensive !are Fnit
%I!F&. After a couple of years from her 1nd admission, patient suffered from persistent
chest pain thus gave way to her third admission at 4aria 9eyna *ospital the year 1--0.
After that admission, patient was given home medications to be maintained which areD
Telmisartan %pritor& 2-mg , tabGday, !lopidogrel %:lavix& 3/mg , tab >), 4etroprolol
/-mg H tab 6I), Amniodarone %!ordarone& 1--mg , tab TI), A#A ;-mg , tab >),
Atorvastatin %=ipitor& ;-mg , TA6 >) I hs, #48 %imdur& 0-mg , TA6 6I).
>ne year after her third admission patient underwent surgery on her left eye. An
Cxtra !apsular !ataract =ens Cxtraction %C!!=C& was done on the year 1--3.
Hi#tor( o3 Pr!#!nt I))n!##
>ne wee$ prior to admission patient experienced blurring of vision and headache
which continue until the day of admission. #he didn7t do anything because she thought
that it7s just a symptom of her cataract. .days prior to adm. !lient too$ Isodril for her
moderate chest pains radiating from the left shoulder to her bac$ but wasn7t relieved.
Informant stated that, , day prior to admission, patient had shortness of breath with
;
inability to lie flat on bed and the night of the same date %5ebruary 2, 1--;&, patient
noted and complained for moderate chest pain radiating to her left shoulder and bac$.
>n the /
th
day of 5ebruary 1--;, #evere !hest pain suffered by the patient persisted
with difficulty in breathing and shortness of breath which prompt her admission at 4aria
9eyna *ospital and was initially diagnosed with *ypertensive !ardiovascular disease.
The client was ruled with the final diagnosis of Acute !oronary #yndrome and was
under the observation and medical treatment of )r. Alenton.
C+i!3 Co8)aint
#hortness of breath
<
D!5!)o8!nta) Data
=RO:TH AND DEVELOPMENT
Pati!nt" Mr#$ F
=!nd!r" F!a)!
A%!" &' (!ar# o)d
P#(c+o#ocia) T+!or( > Eri1 Eri1#on
Cri$ Cri$son7s theory of psychosocial development is one of the best($nown
theories of personality in psychology. *is theory describes the impact of social
experience across the whole lifespan. In each stage, Cri$son believed people
experience a conflict that serves as a turning point in development. In Cri$son7s view,
these conflicts are centered on either developing a psychological quality or failing to
develop that quality. )uring these times, the potential for personal growth is high, but so
is the potential for failure.
In this theory, the patient has the tas$ of Integrity vs. )espair which is the final
tas$ of psychosocial theory which ranges at 0/ years old until death. This phase occurs
during old age and is focused on reflecting bac$ on life. Those who are unsuccessful
during this phase will feel that their life has been wasted and will experience many
regrets. The individual will be left with feelings of bitterness and despair. Those who feel
proud of their accomplishments will feel a sense of integrity. #uccessfully completing
this phase means loo$ing bac$ with few regrets and a general feeling of satisfaction.
These individuals will attain wisdom, even when confronting death.
The patient has developed a feeling of despair. #he7s destructed by her worries
for things that might worsen her condition and for things that might happen to her
offspring. :atient was even afraid of facing death because she felt that she hasn7t done
,-
her best yet for the future of her grown children for the reason that some of her children
didn7t have a stable job and others were unemployed. Another reason of despair was
that the client wasn7t able to prepare for the current health condition she is experiencing
brought by aging. 5or instance, the client wasn7t able to prepare by saving or by ma$ing
investments that could have had supported her health needs and maintenance.
8ormally, it is usually anticipated by any person during younger years when sheGhe is
still able and strong. #he verbali'ed that these emotions triggered her to have the
disease condition.
D!5!)o8!nta) Ta#1 t+!or( > Ro2!rt Ha5i%+ur#t
*avighurst %,<31& defines a developmental tas$ as one that arises at a certain
period in our lives. The successful achievement of which leads to happiness and
success with later tasks while, failure leads to unhappiness, social disapproval, and
difficulty with later tasks. These tas$s provide a framewor$ that a nurse can use to
evaluate a person7s general accomplishments. 9obert *avighurst believed that learning
is basic to life and that people continue to learn throughout life. *e believed that in each
stage in a person7s life, a person has different tas$s to be learned.
In later maturity %0,J& where the patient belongs, there are six %0& tas$s to be learned,
as follows@
,. Adjusting to decreasing physical strength and health.
1. Adjusting to retirement and reduced income.
.. Adjusting to death of a spouse.
2. Adopting and adapting social roles in a flexible way.
/. Cstablishing satisfactory physical living arrangements.
0. Cstablishing an explicit affiliation with one7s age group.
These tas$s are arranged in chronological order@
,,
%,& Adjusting to death of a spouse. At an early age of .<, she became a widow and
left with ,, children. This was not an easy situation after the tragic death of her husband
especially raising the $ids. :resently, patient is happily married with her second
husband 4r. A.
%1& Adopting and adapting social roles in a flexible way. #he used to be the wife of a
vice mayor in their place. #he attended most of the social functions her husband was
connected and interact very well to the constituents in the community. #he remarried at
age 2, and she didn7t have a child with her present spouse. #he was able to adopt her
second marriage for her husband loves her children as his and was also very
supportive.
%.& Adjusted to reduced income. :atient had stopped wor$ing at the age of /;. That
was the time when she was admitted in the hospital due to !A). #he used to wor$ in an
eatery but due to her age and physical condition, her children advised her to stay at
home as they were grown up and would support her.
%2& Cstablishing physical living arrangements with her family. At present, the couple
is no longer wor$ing and is supported by the children. They are happily living together in
their house at 6aungon, 6u$idnon.
%/& Adjusting to decreasing physical strength and health due to her present health
condition and her old age.
%0& Cstablishing an explicit affiliation with one7s age group. Fntil now the patient has
casual communication with her age level. #he still could recogni'e some of her friends
during her younger years and at present. 4uch as she wanted to be with them always
but her health and age condition would not allow anymore.
Int!r8!r#ona) T+!or( > Harr( Stac1 Su))i5an
*arry #tac$ #ullivan was an American psychiatrist who extended theory of
personality development to include the significance of interpersonal relationships. *e
,1
thought that inadequate or nonsatisfying relationships produced anxiety, which he saw
as the basis for all emotional problems.
#ullivan saw interpersonal development as ta$ing place over seven stages, from
infancy to mature adulthood. :ersonality changes can ta$e place at any time but are
more li$ely to occur during transitions between stages.
In this theory, the patient falls under the final stage which is the adulthood stage
which starts from 1. years of age. This is the time when a person establishes a stable
relationship with a significant other person and develops a consistent pattern of viewing
the world. The struggles of adulthood include financial security, career, and family. "ith
success during previous stages, adult relationships and much needed sociali'ation
become easier to attain. "ithout a solid bac$ground, interpersonal conflicts that result
in anxiety become more commonplace.
The patient has developed well according to this theory. In fact, two years after
the death of her first husband, she was able to find herself again, started a new life and
got married with her second husband. #he was able to get over her first husbands
death in just 1 years.
The patient can also be considered as having a good coping mechanism
because she was able to adjust to possible crises in life. 5or instance, though they were
not living a lavish life, but they were able to adopt well a life that suits their resources.
As a couple, they were able to meet their basic needs in life.
,.
M!dica) Mana%!!nt
)octors >rders
)ATC >9)C9# 9ATI>8A=C
F!2ruar(
79- /77&
1D.- pm
:ls. admit under the service of )r.
Alenton.
To render proper
medical management
#ecure consent to care. 5or legal purposes which
pertains to medical
treatment and
procedures.
Temperature :ulse 9espirations q 2
hrs.
To obtain baseline data.
8othing :er >rem temporary To prevent the ris$ for
aspiration.
#tart venoclysis with )/" /--cc at
,-ccGhr.
5or saline loc$@
emergency IATT drugs
used.
=abs.
!omplete 6lood !ount To chec$ for any
hematologic
unusualities.
#odium To chec$ for serum
sodium content in the
body.
:otassium To chec$ for potassium
content in the body.
,2
!reatinine To chec$ for any tissue
damage.
#erum ?lutamic :yrovic
Transimenase
To chec$ for liver
functioning.
Trop T %quantitative& To detect and diagnose
4yocardial infarction.
!reatinine Einase(46(statK To immediately chec$ for
the degree of infarction
Clectrocardiogram ,1 =eads To monitor cardiac
functioning.
!hest +(ray LAntero
posterior %portable&
To detect mediastinal
abnormalities
5asting 6lood #ugar
M=ipid :rofile
To chec$ for blood sugar
level.
4ed7s.
8itroglycerin %Transderm&
patches /mg now x ,1 >).
Treatment of Angina
Aspirin ;-mg 2 tabs now then
, tab >) after%pc& lunch
Treatment and
prophylaxis of
4yocardial infarction
,/
!lopidrogrel %:lavix&
3/g 2 tabs now then
once a day%>)&
Treatment of patients with acute
coronary syndrome and
myocardial infarction
!aptopril 1/g H tab
now then three times
a day %6I)&
Treatment for *ypertension
5ondaparinux
%Arixtra& 1./mg
#ubcutaneous %#N&
now then >)
:revents the formation of
thrombus
Tramadol %)olcet& ,
cap now then three
times a day %TI)&
:rophylaxis for pain
Tramadol %)olcet& ,
cap now then three
times a day %TI)&
:rophylaxis for pain
4etoprolol %8eobloc&
;-mg , tab now then
twice a day %6I)&
:revention of reinfarction in
>xygen inhalation at 1
litersG minute via nasal
cannula.
To provide supplemental
oxygen.
4oderate high bac$ rest To promote lung expansion
!omplete 6ed 9est without
toilet privilege
To prevent increase wor$load of
the heart.
Inta$e and >utput every
shift.
To determine fluid retention and
dehydration.
,0
4onitor vital signs every
hour and record
To chec$ for any unusualities
"ill inform Attending
:hysician
5or proper management and
care.
9efer accordingly To aid for further medical
intervention
/D,.pm
Add7s meds.
Atorvastatin %lipitor&
;-mg , tab now then
>) at
Treatment of elevated =ow
density lipoprotein
=actulose 1-cc >)
at hs.
:revent !onstipation
)ecrease !aptopril to
1/g O tab now then every
;hour.
9educe the ris$ of hypotension
)ecrease 4etoprolol to
/-g H tab then 6I)
9educe the ris$ of hypotension
#tart Iso$et dripD )/"
<-cc J, amp Iso$et at
,-ccGhr.
Treatment for left ventricular
failure secondary to acute
9epeat C!? ,1 =eads
in morning
5or comparison purposes and to
chec$ for the effectivity of drugs
Increase Aspirin to
;-mg 1 tabs >) :! lunch
To attain drug efficacy level.
9emove transderm
patch.
!hest pain subsides@ not
needed for treatment.
,3
Attached to cardiac
monitor.
To monitor cardiac functioning
3D-.pm
9anitidine%Flcin& ,/-g 1
tab 6I) :>
Treatment for sour stomach in
adults
4ay have soft, low salt.
=ow fat diet.
To meet nutritional needs
intended for 4I patient
#hift ranitidine :> to
/-mg IATT q ;hrs.
5or fast drug absorption.
;D-3pm
#oft diet To meet nutritional needs
intended for 4I patient.
,1 lead C!? with long
lead 1
To assess cardiac status
56# lipid profile, uric
acid, #?:T in am
Aid to diagnosed for
hyperglycemia, hyperuricemia
and 4.I
Ealium durule , tab
TI)x0 doses.
Treatment for hypo$alemia
,-D2/pm
Increased Iso$et to,/ccGhr To attain drug efficacy level
?ive Tramadol /-mg
IATT now
Treatment for moderate to
severe pain
,-D/-pm
Increased Iso$et
to1-ccGhr
,;
Increased Iso$et
to1/ccGhr
,,D--pm
Increased Iso$et
to.-ccGhr
?ive morphine 2mg IATT
now.
9elief of moderate to severe
acute pain
,,D.-pm
#hift ranitidine :> to
/-mg IATT q ;hrs.
5or fast drug absorption
F!2ruar( 70-
/77&
0D-/ am
:ls. 5ollow(up repeat
C!? with long lead .
care of heart station.
5or continuous monitoring.
To follow Iso$et dripD )/
water <-cc. plus , amp.
Iso$it at .-cc. G min.
=eft ventricular failure
secondary to acute 4yocardial
infarction
4etformin %Imax&
/--mg. , tab 6I)
>ral treatment for type 1
diabetes
Iso$et drip to consume To obtain effectivity of
medication
Imdur 0-mg. , Tab 6I) :rophylaxis and treatment
for angina pectoris.
2D.- pm
IA follow(up with )/
"ater /--cc.,-ccGhour
5or saline loc$@ emergency
IATT drugs used.
Add , banana per meal. Aid to increase serum
potassium level.
,<
F!2ruar(
74-/77&
0D-/pm
=imit visitors To promote rest and
decrease fatigue.
5acilitate C!? with
long lead 1 in a.m
5or continuous monitoring.
F!2ruar(
7&-/77&
3D,/ am
#ummary of medsD
Isosorbide
4ononitrate
%Imdur& 0-mg ,
tab >)
=eft ventricular failure
secondary to acute 4yocardial
infarction
Isosorbide
)initrate %Isordil&
/mg , tab /=
:98 for chest
pain
Treatment and prophylaxis of
Aspirin ;-mg 1
tabs >) :!
lunch
Treatment of patients with
acute coronary syndrome and
!lopidrogrel
%:lavix& 3/-mg ,
tab >)
!aptopril 1/mg
O tab q ;hrs
Treatment for hypertension
5ondaparinux
%Arixtra& 1./mg
>) #N
:rophylaxis of )eep Aein
thrombosis
1-
4etoprolol /-mg
H tab 6I) :>
:revention of reinfarction in
Atorvastatin
%lipitor& ;-mg ,
tab >) at *#.
Treatment of elevated =ow
density lipoprotein
=actulose 1-cc
at *# hold for
64 PGM 1xGday
:revent constipation
4etformin
/--mg %Imax& ,
tab 6I) :>
>ral treatment for Type II
diabetes mellitus
9anitidine
*ydrochloride
%Qantac& ,/-mg
, tab 6I) :>
:rophylaxis for ?I irritation
Increase
Imdur to 0-mg ,tab
6I)
To attain drug efficacy level
Aastaril
49 , tab 6I)
:rophylaxis and treatment
for Angina pectoris.
8ow give
Isordil q / mins for .
doses of chest pain if
not relieved by first
dose.
Treatment and prevention of
angina pectoris
1D--pm
IA5 to
follow with :8## /--c
at ,-ccGhr.
5or saline loc$@ emergency
IATT drugs used.
1,
F!2ruar( .-
/77&
,D-;am
4etoclopramide %pla'il&
,-mg IATT now
:revention of nausea and
vomiting
Aluminum 4agnesium
*ydroxide %maalox&
,-ml now then TI)
Treatment for hyperacidity
/D2-am
IA5 to ffD :8## /--cc
I ,-ccGhr
#aline loc$@ for emergency
IATT drugs used
;D2-am
9epeat C!? today 5or comparison purposes
and to chec$ for the
effectiveness of the drug
Increase 4aalox ,-ml
to NI) before meals
and *#
Inform I49>) for any
recurrence of chest pain
and #>6
5or further medical
management
2D--pm
>ff >1 L may have -1
:98 for dyspnea
To aid patient during #>6
1--mg !ordarone , tab
TI)
Treatment of ventricular
arrhythmias
F!2ruar(
''-/77&
4ay sit on bed with
dangle legs.
To determine pt. ability to sit
upright in her own
11
F!2ruar(
'/-/77&
#ummary of meds
Aspirin ;-mg 1 tabs >)
:! lunch :>
Treatment and prophylaxis of
!lopidogrel %:lavix&
3/mg , tab >) :>
!aptopril 1/mg O tab q
;h
:rophylaxis and treatment for
hypertension
5ondaparinux %Arixtra&
1./mg >) #=L )ay 3
last dose at 0pm
:rophylaxis of )eep Aein
thrombosis
Tramadol%dolcet& , tab
TI) prn for pain
4oderate to severe pain
4etoprolol /-mg H tab
6I)
*ypertension , Angina
:ectoris, :revention of
reinfarction in 4yocardial
Infarction
Atorvastatin %=ipitor&
;-mg ,tab >) I *#
Treatment of =ow density
=ipoproteins
=actulose 1-cc >), hold
for 64 P 1xGday
:revent constipation
4etformin %I(max&
/--mg ,tab 6I)
>ral treatment for Type II
diabetes
9anitidine %Qantac&
,/-mg ,tab 6I)
:rophylaxis for ?I irritation
1.
Isosorbide 4ononitrite
%Imdur& 0-mg ,tab 6I)
9elieve and prevent angina
Aluminum 4agnesium
*ydroxide %4aalox&
,-ml NI)
8eutrali'es gastric acidity
Amniodarone
%cordarone& 1--mg ,tab
tid
arrhythmias
,-D1-am
9epeat C!? ,1 leads
now
5or comparison purposes
)ICTD decreased fat,
decreased 8a,
hypertensive diet
To prevent hypertension% a
precipitating factor&
4ay sit on bedside chair 9eady for ambulation and
slow assumption of activity daily
living.
4ay wal$ I bedside
with assistance.
To promote exercise and
prevent sudden orthostatic
hypotension.
3D//pm
C!? ,1 lead now To assess cardiac status
?ive
metoclopramide%:la'il&
,-mg IATT now
vomiting
9efer for recurrent of
vomiting and save
vomitus care of I49>)
5or ocular inspection.
4ay decrease Aspirin
;-mg , tab >) pc lunch
To prevent the ris$ of
bleeding.
12
*old 9anitidine #hift to new drug ordered
:antopra'ole
1/
F!2$ ',- /77&
#tart :antopra'ole
%:antoloc& 1-mg , tab
now then >.) :.>
:rophylaxis for epigastric
hyperacidity
,1D//p.m
4ay wal$ inside the
ward.
To promote exercise, and
improved blood circulation
6G: and !ardiac rate
after wal$ing.
To monitor cardiac changes
when doing certain activities.
F!2$ '<- /77&
;D,-p.m
)iscontinue 4aalox Cpigastric hyperacidity
subsides.
4ay wal$ to the
bathroom with
assistance
Cnhances self care and
prevent from sudden orthostatic
hypotension
?ive )omperidone
%4otilium& , tab am then
6I).
Treatment for flatulence
F!2$'9- /77&
;D--am
I.A.5 to consume then
discontinue
:atient7s fluid status is stable,
and in preparation for patients
may go home.
4ay wal$ inside the
ward
To promote exercise and
blood circulation.
6G: and !ardiac rate
after wal$ing and record
To monitor cardiac changes
when doing certain activities.
10
,1D.-pm
4etoclopramide %pla'il&
,-mg. IATT every ;
hours prn
vomiting
F!2$ '0-/77&
,,D-1 am
4?* :atient may continue
treatment at home
*ome medications 5or treatment compliance
regimen.
Telmisartan
%:riton&2-mg ,
tab >.)
Treatment of essential
*ypertension
!lopidogrel
%:lavix& 3/mg ,
tab >.)
Treatment of patients
with acute coronary syndrome
and 4yocardial infarction
4etoprolol /-mg
H tab 6I)
o Treatment for
hypertension
Atorvastatin
%=ipitor& ;-mg ,
tab >) I *.#
for hyperlipidemia
I#48 %Imdur&
0-mg , tab 6I)
for Angina pectoris
Amniodarone
%!ordarone&
1--mg , tab TI)
arrhythmias
Aspirin ;-mg ,
tab >) pc lunch
:rophylaxis for 4I
4etformin %Imax& Treatment for Type II
13
/--mg , tab 6I) diabetes mellitus
)ay 5eb.1-, 1--; at
49* clinic follow(up
chec$(up.
To evaluate for the
effectiveness of medical and
nursing care.
:hotocopy all labs.
9esults %1copies&
5or legal and
documentation purposes.
B)ood C+!i#tr(
7/?79?7&
Test 8ormal 9ange 9esults Implications
!reatinine .3 ( ,.1 ,.. mgGdl 4yocardial Infarction
8a ,.3 L ,2/ ,.1 mmolG= *yponatremia
E ../ L /., ..2 mmolG= *ypo$alemia
A=T < L /1 ..- uG= liver functioning
decrease rGt drugs
adverse effect and
gerontologic
consideration
!E(46 - L ,; 3 uG=
1;
Di33!r!ntia) Count
7/?79?7&
#egmenters // L 0/ R 20 #uggest anemia
=ymphocytes 1/ L ./ R /. Anemia
Cosinophils , L . R -, 9educed in #tress

H!ato)o%(
7/?79?7&
*!T ./ L /- R 1<.2 Iron )eficiency
Anemia
*?6 ,, L ,0./ gGdl <.; Iron )eficiency
Anemia
96! ..; L /.;- ,-Gmm
"6! / L ,- ,-Gmm <,,--
:latelet !ount ,2-,--- L 22-,--- ...,---
1<
C+!#t *?ra( R!8ort
7/?79?7&
E*aination D!#ir!d" CC@R Port
*a'iness seen in the left base
*eart I magnified
Aorta is calcified
#purs seen at the margins of the thoracic spine.

I8r!##ion"
:robable left basal :neumonia
Atherosclerotic Aorta
Thoracic #pondylosis
.-
Fa#tin% B)ood Su%ar Li8id Pro3i)!
-1(-0(-;
?lucose 32 L ,-0 ,.1 mgGd= *yperglycemia
Fric Acid 1./ L 0.1 ;.2 mgGd= *yperuricemia,
!holesterol - L 1-- ,;3 mgGd= *ypercholesterolemia
Triglycerides - L ,/- 0- mgGd= Atherosclerosis
)irect *?= 2- L 0- .; mgGd=
=)= 0- L ,;- ,.3 mgGd=
A)9= 1/ L /- ,1 mgGd=
A=T ; ( /1 13 FG=

Tro8onin T ABuantitati5!C
/$7 n%;)
7/?70?7&
Interpretation of 9esults 9ationale
,. S -.-. ngGml =ow !ardiac 9is$
1. 6etween -.-. ngGml T-., ngGml 4edium !ardiac 9is$ %:ossible
4yocardial damage&
.. 6etween -., ngGml T ..- ngGml *igh 9is$ %4yocardial damage
detected&
2. P 1.- ngGml 4assive 4yocardial damage has
been detected

.,
H=T AH!o%)ucot!#tC
7/?7&?7&
<2 mgGd= %8&

IVF S+!!t
7/?79?7&
6ottle U Types of #olution 9unning hours
gttsGmin
Time #tarted 9ationale
, )/" /--cc ,- ccGhr 1D2/ :4 Isotonic solution
1 )/" <-cc J , amp
Iso$et
,- ccGhr J , amp .D1/ :4 Isotonic solution
. :8## /--cc ,- ccGhr Isotonic solution
2 :8## /--cc ,- ccGhr 1D2/ :4 Isotonic solution
/ :8## /--cc ,- ccGhr Isotonic solution

.1
E)!ctrocardio%ra8+ tracin%
EC= 3indin%#
9hythm #inus Axis J.<
9ateD Atrial <.bpm Aentricular <.bpm :osition
:.9. -.1-sec N.9.# -.,-sec N.T. -.22sec N.T. 9atio
EC= Dia%no#i#
( sinus rhythm
( inferolateral and anterior wall ischemia
..
EC= 3indin%#
9hythm sinus Axis J,-
9ateD Atrial <.bpm Aentricular <.bpm :osition
:.9. -.1- sec N.9.#. -.-; sec N.T. -.22 sec
EC= Dia%no#i#
( sinus rhythm
( anterolateral wall ischemia
( left ventricular hypertrophy by voltage criteria
.2
Pat+o8+(#io)o%( 6it+ Anato( and P+(#io)o%(
A$ R!5i!6 o3 Anato( and P+(#io)o%( o3 t+! Or%an# In5o)5!d
Cardio5a#cu)ar S(#t!
H!art
5or all its might, the cone(shaped heart is a relatively small, roughly the same
si'e as a closed fistVabout ,1 cm %/ in& long, < cm %../ in& wide at its broadest point,
and 0 cm %1./ in& thic$. Its mass averages 1/- g %; o'& in adult females and .-- g %,-
o'& in adult males. The heart rests on the diaphragm, near the midline of the thoracic
cavity. It lies in the mediastinum, a mass of tissue that extends from the sternum to the
vertebral column between the lungs. About two(thirds of the mass of the heart lies to the
left of the body7s midline. Aisuali'e the heart as a cone lying on its side. The pointed
end of the heart is the apex, which is directed anteriorly, inferiorly, and to the left. The
broad portion of the heart opposite the apex is the base, which is directed posteriorly,
superiorly, and to the right.
In addition to the apex and the base, the heart has several surfaces and borders
<margins&. The anterior surface is deep to the sternum and ribs. The inferior surface is
the part of the heart between the apex and the right border and rests mostly on the
diaphragm. The right border faces the right lung and extends from the inferior surface to
the base. The left border, also called the pulmonary border, faces the left lung and
extends from the base to the apex.
./
La(!r# and Co5!rin%# o3 t+! H!art
The heart is located between the lungs in the thoracic cavity and is surrounded
and protected by the pericardium %peri( W around&. The pericardium consists of an outer,
tough fibrous pericardium and an inner, delicate serous pericardium. The fibrous
pericardium attaches to the diaphragm and also to the great vessels of the heart. =i$e
all serous membranes, the serous pericardium is a double membrane composed of an
outer parietal layer and an inner visceral layer. 6etween these two layers is the
pericardial cavity filled with serous fluid. The wall of the heart has three layersD the outer
epicardium %epi( W on, upon@ cardia W heart&, the middle myocardium %myo muscle&, and
the inner endocardium %endo( W within, inward&. The epicardium is the visceral layer of
the pericardium. The majority of the heart is myocardium or cardiac muscle tissue. The
endocardium is a thin layer of endothelium deep to the myocardium that lines the
chambers of the heart and the valves.
Sur3ac! Structur!# o3 t+! H!art
The human heart has four chambers and is divided into right and left sides. Cach
side has an upper chamber called an atrium and a lower chamber called a ventricle.
The two atria form the base of the heart and the tip of the left ventricle forms the apex.
Auricles %auricle W little ear& are pouch(li$e extensions of the atria with wrin$led edges.
#hallow grooves called sulci %sulcus, singular& externally mar$ the boundaries between
.0
the four heart chambers. Although a considerable amount of external adipose tissue is
present on the heart surface for cushioning, most heart models do not show this.
!ardiac muscle tissue that composes the heart walls has its own blood supply and
circulation, the coronary %coronaW crown& circulation. !oronary blood vessels
encompass the heart similar to a crown and are found in sulci. >n the anterior surface
of the heart, the right and left coronary arteries branch off the base of the ascending
aorta just superior to the aortic semilunar valve, and travel in the sulcus separating the
atria and ventricles. These small arteries are supplied with blood when the ventricles
are resting. "hen the ventricles contract, the cusps of the aortic valve open to cover the
openings to the coronary arteries.
A clinically important branch of the left coronary artery is the anterior interventricular
branch, also $nown as the left anterior descending %=A)& branch that lies between the
right and left ventricles and supplies both ventricles with oxygen(rich blood. This
coronary artery is commonly occluded which can result in a myocardial infarct and, at
times, death.
=r!at V!##!)# o3 t+! H!art
The great veins of the heart return blood to the atria and the great arteries carry
blood away from the ventricles. The superior vena cava, inferior vena cava, and
coronary sinus return oxygen(poor blood to the right atrium. The superior vena cava
returns blood from the head, nec$, and arms@ the inferior vena cava returns blood from
the body inferior to the heart. The coronary sinus is a smaller vein that returns blood
from the coronary circulation. 6lood leaves the right atrium to enter the right ventricle.
5rom here, oxygen(poor blood passes out the pulmonary trun$, the only vessel that
removes blood from the right ventricle. This large artery divides into the right and left
pulmonary arteries that carry blood to the lungs where it is oxygenated. >xygen(rich
blood returns to the left atrium through two right and two left pulmonary veins. The blood
then passes into the left ventricle that pumps blood into the large aorta. The aorta
distributes blood to the systemic circulation. The aorta begins as a short ascending
aorta, curves to the left to form the aortic arch, descends posteriorly and continues as
the descending aorta.
.3
Int!rna) Structur!# o3 t+! H!art
The heart has four valves that control the one(way flow of bloodD two
atrioventricular %AA& valves and two semilunar valves %semi- W half@ lunar W moon&.
6lood passing between the right atrium and the right ventricle goes through the right AA
valve, the tricuspid valve %tri W three@ cusp W flap&. The left AA valve, the bicuspid valve,
is between the left atrium and the left ventricle. This valve clinically is called the mitral
valve %miter W tall, liturgical headdress& because the open valve resembles a bishop7s
headdress. #tring(li$e cords called chordae tendineae %tendinous strands& attach and
secure the cusps of the AA valves to enlarged papillary muscles that project from the
ventricular walls. !hordae tendinae allow the AA valves to close during ventricular
contraction, but prevent their cusps from getting pushed up into the atria. The two
semilunar valves allow blood to flow from the ventricles to great arteries and exit the
heart. 6lood in the right ventricle goes through the pulmonary %semilunar& valve to enter
the pulmonary trun$, a large artery. The aortic %semilunar& valve is located between the
left ventricle and the aorta. These two semilunar valves are identical, with each having
three poc$ets that fill with blood, preventing blood from flowing bac$ into the ventricles.
The two ventricles have a thic$ wall between them called the interventricular septum.
6etween the two atria is a thinner interatrial septum.
Coronar( Circu)ation
There are two major coronary arteriesD the right and the left. These two arteries
branch out of the aorta immediately after the aortic valve. The right coronary artery
splits into the marginal branch, which feeds blood into the right ventricle, and the
posterior interventricular branch, which supplies the left ventricle. The left coronary
artery is notably larger than the right coronary artery because it feeds the left heart,
which, as a result of itXs more powerful contractions, requires a more vigorous blood
flow. The left coronary artery splits into the anterior interventricular branch and a
circumflex branch. The anterior interventricular branch runs towards the apex of the
.;
heart, providing blood for both of the ventricles and the ventricular septum. The
circumflex branch, on the other hand, follows the groove between the left atrium and the
left ventricle, providing blood supply to both of these chambers until it reaches and joins
with the right coronary artery in the posterior of the heart.
The coronary arteries are especially subject to bloc$age and narrowing which
can cause a depletion of blood to certain parts of the heart, possibly causing a heart
attac$.
B)ood F)o6 t+rou%+ t+! H!art
The function of the right side of the heart is to collect de(oxygenated blood, in the
right atrium, from the body and pump it, via the right ventricle, into the lungs %pulmonary
circulation& so that carbon dioxide can be dropped off and oxygen pic$ed up %gas
exchange&. This happens through the passive process of diffusion. The left side %see left
heart& collects oxygenated blood from the lungs into the left atrium. 5rom the left atrium
the blood moves to the left ventricle which pumps it out to the body. >n both sides, the
lower ventricles are thic$er and stronger than the upper atria. The muscle wall
surrounding the left ventricle is thic$er than the wall surrounding the right ventricle due
to the higher force needed to pump the blood through the systemic circulation.
#tarting in the right atrium, the blood flows through the tricuspid valve to the right
ventricle. *ere it is pumped out the pulmonary semilunar valve and travels through the
pulmonary artery to the lungs. 5rom there, blood flows bac$ through the pulmonary vein
to the left atrium. It then travels through the mitral valve to the left ventricle, from where
it is pumped through the aortic semilunar valve to the aorta. The aorta for$s, and the
blood is divided between major arteries which supply the upper and lower body. The
blood travels in the arteries to the smaller arterioles, then finally to the tiny capillaries
which feed each cell. The %relatively& deoxygenated blood then travels to the venules,
which coalesce into veins, then to the inferior and superior venae cavae and finally bac$
to the right atrium where the process began.
.<
B)ood V!##!)#
6lood circulates inside the blood vessels, which form a closed transport system,
the so(called vascular system. =i$e a system of roads, the vascular system has its
freeways, secondary roads, and alleys. As the heart beats, blood is propelled into the
large arteries leaving the heart. It then moves successively smaller and smaller arteries
and then into the arterioles, which feed the capillary beds in the tissues. !apillary beds
are drained by venules, which in turn empty into the great veins %venae cavae& entering
the heart. Thus arteries, which carry blood away from the heart, and veins, which drain
the tissues and return the blood to the heart, are simply conducting vessels. >nly the
tiny hair(li$e capillaries, which extend and branch through the tissue and connect the
smallest arteries %arterioles& to the smallest veins %venules&, directly serve the needs of
the body cells. The capillaries are the side streets or alleys that intimately intertwine
among the body cells. It is only through their walls that exchanges between the tissue
cells and the blood can occur. %4arieb, 1--0&
2-
La(!r# o3 B)ood V!##!) :a))#
The walls of blood vessels have three coats, or tunics. The tunica intima which
lines the lumen or interior of the blood vessels, is a thin layer of endothelium %squamous
epithelial cells& resting on a basement membrane. Its cells fit closely together and form
a slic$ surface that decreases friction as blood flows through the vessel lumen. %4arieb,
1--0&
The tunica media is the bul$y middle coat. It is mostly smooth muscle and elastic
tissue. The smooth muscle, which is controlled by the sympathetic nervous system, is
active in changing the diameter of the vessels. As the vessel constrict or dilate, blood
pressure increases or decreases, respectively. 4arieb, 1--0&
The tunica externa is the outermost tunic@ it is composed largely of fibrous
connective tissue. Its function is basically to support and protect the vessels. %4arieb,
1--0&
2,
T+! Microcircu)ation
The microcirculation is that portion of the circulatory system for exchange of
water, gases, nutrients, and waste material. As such, it is the most important part of the
cardiovascular system because it is where the exchange with tissues ta$es place.
Although the microcirculation is considered as a closed system, its walls are much more
permeable than any other part of the circulation.
Factor# A33!ctin% F)o6 o3 B)ood
The flow of a fluid through a vessel is determined by the pressure difference
between the two ends of the vessel and also the resistance to flow.
Pr!##ur! Di33!r!nc!. 5or any fluid to flow along a vessel there must be a
pressure difference otherwise the fluid will not move. In the cardiovascular
system, the pressure head or force is generated by the pumping of the heart
and there is a continuous drop in pressure from the left ventricle to the tissue and
also from the tissue bac$ to the right atrium. %*inchliff, 1---&
R!#i#tanc! to F)o6. 9esistance is a measure of the ease with which a fluid
flows through a tubeD the easier it is the less resistance to flow, and vice versa. In
the circulatory system, the resistance is usually described as vascular resistance,
21
or also $nown as peripheral resistance. 9esistance is essentially a measure of
the friction between the molecules of the fluid, and between the tube wall and the
fluid. The resistance depends on the viscosity of the fluid and the radius and
length of the tube. %*inchliff, 1---&
Radiu# o3 t+! Tu2!. The smaller the radius of a vessel, the greater is the
resistance to the movement of particles. #mall alterations in the si'e of the radius
of the blood vessels, particularly of the more peripheral vessels, can greatly
influence the flow of blood. Atheromatous changes in the walls of large and
medium(si'ed arteries cause narrowing of the lumen of the vessels and result in
an increased vascular resistance. %*inchliff, 1---&
L!n%t+ o3 t+! Tu2!. The longer the tube, the greater the resistance to the flow
of liquid through it. A longer vessel will require a greater pressure to force a given
volume of liquid through it than will a shorter vessel. %*inchliff, 1---&
Vi#co#it( o3 t+! F)uid. Aiscosity is a measure of the intermolecular or internal
friction within a fluid or in other words, of the tendency of the fluid to resist flows.
The greater the viscosity of the fluid, the greater is the force required to move
that liquid. %*inchliff, 1---&
B)ood
B)ood is a speciali'ed bodily fluid %technically a tissue& that is composed of a
liquid called blood plasma and blood cells suspended within the plasma. The blood cells
present in blood are red blood cells %also called 96!s or erythrocytes&, white blood cells
%including both leu$ocytes and lymphocytes& and platelets %also called thrombocytes&.
:lasma is predominantly water containing dissolved proteins, salts and many other
substances@ and ma$es up about //R of blood by volume. 4ammals have red blood,
which is bright red when oxygenated, due to hemoglobin. #ome animals, such as the
horseshoe crab use hemocyanin to carry oxygen, instead of hemoglobin.
2.
6y far the most abundant cells in blood are red blood cells. These contain hemoglobin,
an iron(containing protein, which facilitates transportation of oxygen by reversibly
binding to this respiratory gas and greatly increasing its solubility in blood. In contrast,
carbon dioxide is almost entirely transported extracellularly dissolved in plasma as
bicarbonate ion. "hite blood cells help to resist infections and parasites, and platelets
are important in the clotting of blood.
6lood is circulated around the body through blood vessels by the pumping action of the
heart. Arterial blood carries oxygen from inhaled air to the tissues of the body, and
venous blood carries carbon dioxide, a waste product of metabolism produced by cells,
from the tissues to the lungs to be exhaled.
4edical terms related to blood often begin with hemo( or hemato( %6CD haemo( and
haemato(& from the ?ree$ word YZ [Z Y for Yblood.Y Anatomically and histologically,
blood is considered a speciali'ed form of connective tissue, given its origin in the bones
and the presence of potential molecular fibers in the form of fibrinogen.
Con#titu!nt# o3 +uan 2)ood
6lood accounts for 3R of the human body weight, with an average density of
approximately ,-0- $gGm\, very close to pure waterXs density of ,--- $gGm
.
. The
average adult has a blood volume of roughly / litres, composed of plasma and several
$inds of cells %occasionally called corpuscles&@ these formed elements of the blood are
erythrocytes %red blood cells&, leu$ocytes %white blood cells& and thrombocytes
%platelets&. 6y volume the red blood cells constitute about 2/R of whole blood, the
plasma constitutes about //R, and white cells constitute a minute volume.
"hole blood %plasma and cells& exhibits non(8ewtonian fluid dynamics@ its flow
properties are adapted to flow effectively through tiny capillary blood vessels with less
resistance than plasma by itself. In addition, if all human haemoglobin was free in the
plasma rather than being contained in 96!s, the circulatory fluid would be too viscous
for the cardiovascular system to function effectvely.
22
C!))#
<$4 to 0$' i))ion Aa)!C- <$/ to 9$< i))ion A3!a)!C !r(t+roc(t!#" In
mammals, mature red blood cells lac$ a nucleus and organelles. They contain the
bloodXs hemoglobin and distribute oxygen. The red blood cells %together with endothelial
vessel cells and other cells& are also mar$ed by glycoproteins that define the different
blood types. The proportion of blood occupied by red blood cells is referred to as the
hematocrit, and is normally about 2/R. The combined surface area of all the red cells in
the human body would be roughly 1,--- times as great as the bodyXs exterior surface.
<-777?''-777 )!u1oc(t!#" "hite blood cells are part of the immune system@
they destroy and remove old or aberrant cells and cellular debris, as well as attac$
infectious agents %pathogens& and foreign substances. The cancer of leu$ocytes is
called leu$emia.
/77-777?977-777 t+ro2oc(t!#" :latelets are responsible for blood clotting
%coagulation&. They change fibrinogen into fibrin. This fibrin creates a mesh onto which
red blood cells collect and clot, which then stops more blood from leaving the body and
also helps to prevent bacteria from entering the body.
P)a#a
About //R of whole blood is blood plasma, a fluid that is the bloodXs liquid
medium, which by itself is straw(yellow in color. The blood plasma volume totals of 1.3(
..- litres in an average human. It is essentially an aqueous solution containing <1R
water, ;R blood plasma proteins, and trace amounts of other materials. :lasma
circulates dissolved nutrients, such as, glucose, amino acids and fatty acids %dissolved
in the blood or bound to plasma proteins&, and removes waste products, such as,
carbon dioxide, urea and lactirc acid.
>ther important components includeD
2/
#erum albumin
6lood clotting factors %to facilitate coagulation&
Immunoglobulins %antibodies&
Aarious other proteins
Aarious electrolytes %mainly sodium and chloride&
The term serum refers to plasma from which the clotting proteins have been removed.
4ost of the proteins remaining are albumin and immunoglobulins.
The normal p* of human arterial blood is approximately 3.2- %normal range is 3../(
3.2/&, a wea$ al$aline solution. 6lood that has a p* below 3../ is too acidic, while blood
p* above 3.2/ is too al$aline. 6lood p*, arterial oxygen tension %:a>1&, arterial carbon
dioxide tension %:a!>1& and *!>. are carefully regulated by complex systems of
homeostasis, which influence the respiratory system and the urinary system in the
control the acid(base balance and respiration. :lasma also circulates hormones
transmitting their messages to various tissues.
Co)or
H!o%)o2in
*emoglobin is the principal determinant of the color of blood in vertebrates. Cach
molecule has four heme groups, and their interaction with various molecules alters the
exact color. In vertebrates and other hemoglobin(using creatures, arterial blood and
capillary blood are bright red as oxygen impacts a strong red color to the heme group.
)eoxygenated blood is a dar$er shade of red with a bluish hue@ this is present in veins,
and can be seen during blood donation and when venous blood samples are ta$en.
6lood in carbon monoxide poisoning is bright red, because carbon monoxide causes
the formation of carboxyhemoglobin. In cyanide poisoning, the body cannot utili'e
oxygen, so the venous blood remains oxygenated, increasing the redness. "hile
hemoglobin containing blood is never blue, there are several conditions and diseases
where the color of the heme groups ma$e the s$in appear blue. If the heme is oxidi'ed,
20
methemoglobin, which is more brownish and cannot transport oxygen, is formed. In the
rare condition sulfhemoglobinemia, arterial hemoglobin is partially oxygenated, and
appears dar$(red with a bluish hue %cyanosis&, but not quite as blueish as venous blood.
Aeins in the s$in appear blue for a variety of reasons only wea$ly dependent on the
color of the blood. =ight scattering in the s$in, and the visual processing of color play
roles as well.
#$in$s in the genus Prasinohaema have green blood due to a buildup of the waste
product biliverdin.
H!oc(anin
The blood of most molluscs, including cephalopods and gastropods, as well as
some arthropods such as horseshoe crabs contains the copper(containing protein
hemocyanin at concentrations of about /- grams per litre. *emocyanin is colourless
when deoxygenated and dar$ blue when oxygenated. The blood in the circulation of
these creatures, which generally live in cold environments with low oxygen tensions, is
grey(white to pale yellow, and it turns dar$ blue when exposed to the oxygen in the air,
as seen when they bleed. This is due to change in color of hemocyanin when is it
oxidi'ed. *emocyanin carries oxygen in extracellular fluid, which is in contrast to the
intracellular oxygen transport in mammals by hemoglobin in 96!s.
Pancr!atic I#)!t#
The pancreas, located close to the stomach in the abdominal cavity is a mixed
gland. :robably the best(hidden endocrine glands in the body are the pancreatic islets,
formerly called the islets of Langerhans. These little masses of hormone(producing
tissue are scattered among the en'yme(producing acinar tissue of the pancreas. Two
important hormones produced by the islet cells are insulin and glucagons. %4arieb,
1--0&
23
*igh levels of glucose in the blood stimulate the release of insulin from the beta
cells of the islets. Insulin acts on just about all body cells and increases their ability to
transport glucose across their plasma membranes. >nce inside the cells, glucose is
oxidi'ed for energy or converted to glycogen or fat for storage. These activities are also
speeded up by insulin. #ince insulin sweeps the glucose out of the blood, its effect is
said to be hypoglycemic. As blood glucose levels fall, the stimulus for insulin release
ends %negative feedbac$ control&. Insulin is the only hormone that decreases blood
glucose levels. Insulin is absolutely necessary for the use of glucose by the body cells.
"ithout it, essentially no glucose can get into the cells to be used. %4arieb, 1--0&
?lucagons act as an antagonist of insulin@ that is, it helps to regulate blood
glucose levels but is a way opposite to that of insulin. Its release by the alpha cells of
the islets is stimulated by low blood levels of glucose. Its action is basically
hyperglycemic. Its primary target organ is the liver, which stimulates to brea$ down
stored glycogen to glucose and to release glucose into the blood. %4arieb, 1--0&
In#u)in
The main function of the insulin is to participate in maintaining homeostasis of
blood glucose level and to promote other metabolic activities that are anabolic. "hen
absorbed nutrients, especially glucose, are in excess of immediate needs insulin
promotes storage. It reduces high blood nutrients byD
2;
Acting on cell membranes and stimulating upta$e and utili'ation of glucose by muscles
and connective tissue cells@
Increasing conversion of glucose to glycogen, especially in the liver and s$eletal
muscles@
Accelerating upta$e of amino acids by cells, and the synthesis of proteins@
:romoting synthesis of fatty acids and storage of fat in adipose tissue, and@ :reventing
the brea$down of protein and fat and gluconeogenesis.
=)uca%on
The effect of glucagon is increasing blood glucose levels by stimulatingD
!onversion of glycogen to glucose %in the liver and s$eletal muscle&@
?luconeogenesis, the manufacture of glucose by the body from noncarbohydrate
materials. %6ur$e, ,<</&
Soato#tatin
The effect of somatostatin %also produced by hypothalamus& is to inhibit the
secretion of both insulin and glucagons. It delays intestinal absorption of glucose.
%#melt'er, 1--3&
M!ta2o)i#
4etabolism is a broad term referring to all chemical reactions that are necessary
to maintain life. In involves catabolism, in which substances are bro$en down to simpler
substances, and anabolism, in which larger molecules or structures are built from
smaller ones. )uring catabolism, energy is released and captured to ma$e AT:, the
energy(rich molecule used to energi'e all cellular activities, including catabolic
reactions. %4arieb, 1--0&
2<
Bust as an oil furnace uses oil %its fuel& to produce heat, the cells of the body use
carbohydrates as their preferred fuel to produce cellular energy %AT:&. ?lucose, also
$nown as blood sugar, is the major brea$down product of carbohydrate digestion.
?lucose is also the major fuel used for ma$ing AT: in most body cells. 6asically, the
carbon atoms released leave the cells as carbon dioxide, and the hydrogen atoms
removed %which contain energy(rich electrons& are eventually combined with oxygen to
form water. These oxygen(using events are referred to collectively as cellular
respiration. %4arieb, 1--0& The overall reaction is summed up simply asD
!0*,1>0 J 0 >1 MP 0 !>1 J 0 *1- J AT: %energy&.
/-
Pat+o8+(#io)o%(
/,
/1
/.
/2
//
Nur#in% A##!##!nt AS(#t! R!5i!6 and Nur#in%
A##!##!nt IIC
/0
Nur#in% Mana%!!nt
Id!a) Nur#in% Mana%!!nt
8ursing )iagnosisD 9is$ for decreased cardiac output related to increased vascular
resistance, vasoconstriction
ActionsGInterventions 9ationale
Independent
:rovide calm, restful surroundings,
minimi'e environmental activityGnoise.
=imit the number of visitors and length
of stay.
*elp reduce sympathetic stimulation@
promotes relaxation.
4aintain activity restrictions, e.g.
bedrestGchair rest@ schedule periods of
uninterrupted rest@ assist client with
self(care activities as needed.
9educes physical stress and tension
that affect blood pressure and the
course of hypertension.
:rovide comfort measures, e.g. bac$
and nec$ massage, elevation of head.
)ecreases discomfort and may reduce
sympathetic stimulation.
Instruct in relaxation techniques,
guided imagery, distractions.
!an reduce stressful stimuli, promotes
relaxation.
4aintain activity restrictions, e.g.
bedrestGchair rest@ schedule periods of
uninterrupted rest@ assist client with
self(care activities as needed.
9educes physical stress and tension
that affect blood pressure and the
course of hypertension
:rovide comfort measures, e.g. bac$
and nec$ massage, elevation of head.
)ecreases discomfort and may reduce
sympathetic stimulation.
Instruct in relaxation techniques,
guided imagery, distractions
!an reduce stressful stimuli, produce
calming effect, thereby reducing 6:
)ependent
/3
Administer medications as indicated@
Thia'ide diuretics, e.g. chlorothia'ide
%)iuril&@ hydrochlorothia'ide
%CsidrixG*ydro)IF9I=&@
bendroflumethia'ide %naturetin&@
indapamide %=o'ol&@ metola'one
%)iulol&@ quenthina'one %*ydromox&
)iuretics are considered first(line
medications for uncomplicated stage I
or II hypertension and may be used
alone or in association with other drugs
%such as ](bloc$ers& to reduce 6: in
clients with relatively normal renal
function. These diuretics potentiate the
effects of other antihypertensive agents
as well, by limiting fluid retention, and
may reduce the incidence of stro$es
and heart failure
8ursing )iagnosisD Activity intolerance related to generali'ed wea$ness
Independent
Instruct client in energy( conserving
techniques e.g., suing chair when
showering, sitting to brush teethe or
comb hair, carrying out activates at a
slower pace
Cnergy(saving techniques reduce the
energy expenditure thereby assisting in
equali'ation of oxygen supply and
demand
Cncourage progressive activityGself(
-care when tolerated. :rovide
assistance as needed.
?radual activity progression prevents a
sudden increase in cardiac wor$load.
:roviding assistance only as needed
encourages independence in
performing activities
8ursing )iagnosesD 9is$ for impaired ?as Cxchange related to alveolar(capillary
membrane changes, e.g. fluid collectionGshifts into interstitial spaceGalveoli
Independent
Cncourage frequent position changes *elps prevent atelectasis and
pneumonia
4aintain chairGbed rest, with head of
bed elevated 1-(.- degrees, semi(
9educe oxygen consumptionGdemands
/;
fowler7s position. #upport arms with
pillows
and promotes maximal lung inflation.
)ependent
Administer supplemental oxygen as
indicated
I8cre2ases alveolar oxygen
concentration, which may
correctGreduce tissue hypoxemia.
8ursing )iagnosisD Enowledge deficit related to =ac$ of informationGmisunderstanding of
medical conditionGtherapy needs.
Independent
be alert to signs of avoidance, e.g.,
changing subject away from
information being presented or
extremes of behavior
8atural defenses mechanisms, such as
anger or denial of significance of
situation, can bloc$ learning, affecting
patient7s responses and ability to
assimilate information.
Cncourage identificationGreduction of
individual ris$ factors, e.g.,
smo$ingGalcohol consumption, obesity.
these behaviorsGchemicals have direct
adverse effect on cardiovascular
function and may impede recovery,
increase ris$ for complications
Cducate client regarding gradual
resumption of activities %wal$ing, wor$,
recreational activity.
?radual increase in activity increases
strength and prevents overexertion,
may enhance, collateral circulation, and
allows return to normal lifestyle.
Cmphasi'es importance of contacting
physician if chest pain, change in
anginal pattern or other symptoms
recur.
Timely evaluationGintervention may
prevent complications.
#tress importance of reporting
development of fever in association
w.ith diffuseGatypical chest pain and
joint pain
post 4I(complication of pericardial
inflammation requires further medical
evaluationGintervention.
/<
8ursing diagnosisD Ineffective coping related to situational crisis
ActionsGIntervention 9ationale
Independent
Cncourage patient to tal$ about what is
happening at this time and what has
occurred to precipitate feelings of
helplessness and anxiety.
:rovides clues to assist patient to
develop coping and regain equilibrium.
Allow patient to be dependent in the
beginning, with gradual resumption of
independence in A)=s. #elf(care and
other activities. 4a$e opportunities for
patient to ma$e simple decisions about
careGother activities when possible,
accepting choice not to do so.
:romotes feelings of security %patient
will $now nurse will provide safety&. As
control is regained, patient has the
opportunity to develop adaptive
copingGproblem(solving s$ills.
Accept verbal expressions or anger,
setting limits on maladaptive behavior
Aerbali'ing angry feelings in important
process for resolution of grief and loss.
*owever, preventing destructive
actions %such as stri$ing out at others&
preserves patient7s self(esteem.
)iscuss feelings of inability to find
meaning in lifeGreason for living,
feelings of futility or alienation from
?od.
!risis situation may evo$e, questioning
of spiritual beliefs, affecting ability to
cope with current situation and plan for
the future.
:romote safe and hopeful environment,
as needed. Identify positive aspects of
this experience and assist patient to
view it as a learning opportunity.
4ay be helpful while patient regains
inner control. The ability to learn from
the current situation can provide s$ills
for moving forward
:rovide support for patient to problem(
solve solutions for current situation.
:rovide information and reinforce
reality as patient begins to as$
questions@ loo$ at what is happening.
*elpingG#> to brainstorm possible
solutions %giving consideration to the
pros and cons of each& promotes
feelings of self(controlGesteem.
0-
:rovide for gradual implementation and
continuation of necessary behavior and
lifestly changes. 9einforce positive
adaptationG new coping behaviors
9educes anxiety of sudden change and
allows for developing new and creative
solutions
)ependent
9efer to other resources as necessary
%eg. !lergy, psychiatric clinical nurse
specialistGpsychiatrist, familyG marital
therapist, addiction support groups&.
Additional assistance may be needed
to help patient resolve problems or
ma$e decisions.
8ursing )iagnosisD 5amily !oping, ineffectiveD ris$ for compromised related to
prolonged diseaseGdisability progression that exhausts the supportive capacity of family
members.
Independent
Cvaluate pre(illnessGcurrent behaviors
that may be interfering with the
careGrecovery of client
Information about family problems
%e.g., divorceG separation, financial
limitations, substance use& will be
helpful in determining options and
developing an appropriate plan of care.
)iscuss underlying reasons for patient
behaviors with family.
"hen family members $now why
patient is behaving in different ways, it
helps them understand and acceptGdeal
with situation
Assist familyGpatient to understand
who owns the problem and who is
responsible for resolution. Avoid
balance blame or guilt.
"hen these boundaries are defined,
each individual can begin to ta$e care
of own self and stop ta$ing care of
others in inappropriate ways.
Involve family in information giving,
problem solving and care of patient as
feasible. Identify other ways of
demonstrating support while
maintaining patient7s independence
Information can reduce feelings of
helplessness. Involvement in care
enhances feelings of control and self
worth
)ependent
0,
9efer to appropriate resources for
assistance as indicated %e.g.
counseling, psychotherapy, financial,
spiritual&.
4ay need additional assistance in
resolving family issues.
8ursing )iagnosisD Therapeutic 9egimenD ris$ for ineffective management related to
perceived barriers@ economic difficulties, side effects of therapy, mistrust of regimen
andGor healthcare personnel@ complexity of healthcare system.
ActionGIntervention 9ationale
Independent
9eview patientsG#>7s $nowledge and
understanding of the need for
treatmentGmedication, as well as
consequences of the need for
treatmentGmedication, as well as
consequences of actions and choices.
8ot ability to comprehend information,
including literacy, level of education,
primary language.
:rovides opportunities to clarify
viewpointsGmisconceptions. Aerifies
that patientG#> has accurateG factual
information with which to ma$e
informed choices.
6e aware of developmental and
chronological age.
Impacts ability to understand own
needsGincorporate into treatment
regimen.
)etermine cultural, spiritual, and health
beliefs and ethical concerns
.
:rovide insight into thoughtsGfactors
related to individual situation. 6eliefs
will affect patient7s perception of
situation and participation in treatment
regimen. Treatment may be
incongruent with patient7s
socialGcultural lifestyle and perceived
roleGresponsibilities
01
8ursing )iagnosisD :ain related to an imbalance in oxygen supply and demand
ActionGInterventions 9ationale
:osition patient in bed in semi(
fowler7s position
Pthis allows for rest and adequate
chest excursion, to increase available
oxygen and to decrease cardiac wor$.
Administer oxygen by way of
nasal cannula at 2=Gmin.
maintain oxygen saturation at
<1R or above.
Pto increase oxygen supply. 4ay
decrease pain and :A!s
Administer nitroglycerin and
morphine based on vital signs
and pain relief.
P both medications will help alleviate
pain by decreasing venous return to the
heart, thereby decreasing cardiac wor$.
4orphine will also help to decrease the
patients sensation of pain.
4onitor 6: closely by way of
non(invasive 6: monitor.

Pboth medications may decrease 6:
because both will decrease venous
return. Intra(arterial blood pressure
monitoring may be used if condition
warrants.
Attach electrodes for continuous
bedside cardiac monitor. 4onitor
heart rate and rhythm frequently.
Pincreased rate may indicate heart
bloc$@ dysrhythmias are common
initially, increased frequency suggests
ischemia.
Administer and monitor
thrombolytic therapy
Pmay help to relieve the coronary
occlusion.
4onitor signs of bleeding@ avoid
unnecessary venous or arterial
punctures.
Pthrombolytics cause clot lysis may
cause bleeding.
0.
8ursing )iagnosisD decreased cardiac output related to decreased cardiac contractility
and dysrrhythmias.
ActionsG Interventions
9ationales
Administer I.A fluids as ordered
PI.A fluid may be necessary to
compensate for the decreased venous
return caused by nitrates and
morphine.
4onitor closely for signs of
developing left ventricular failure
%e.g auscultate lung sounds for
crac$les and heart sounds for
s.&.
Pleft ventricular failure may develop as
a result of the decreased myocardial
contractility andG or the administration
of excess fluids.
4onitor urine output hourly
P4onitor urine output hourly
4onitor mental status
Pa change in mental status may
indicate a decrease in cardiac output.
Interpret rhythm strip at least
every 2 hours, more frequently
as condition warrants.
Administer antiarrythmics, if
indicated.
Pdysrythmias such as :A!s result in a
decreased stro$e volume and less
coronary artery filling time. 5requent
monitoring, especially during the first
few hours of an acute 4I and during
thrombolytic therapy administration, is
necessary to prevent and treat lethal
dysrhythmias
Administer vasopressors@ titrate
to 6: response.
Padministration of vasopressors with
aqcute 4I is controversial in that they
may cause an increase in systemic
vascular resistance, which increases
cardiac wor$.
Cmploy hemodynamic
monitoringD central venous
pressure !A: and pulmonary
artery catheter and pulmonary
artery pressure.
Pthese parameters will help to guide
fluid volume administration, vasoactive
drug administration and assess cardiac
performance.
02
8ursing )iagnosisD Anxiety related to fear of death
InterventionsG Actions 9ationales
Cxplain equipment,
procedures, and need for
frequent assessment to the
patient and family. )iscuss
visiting hours and the need to
allow for rest
Phelps conserve energy.
>bserve for autonomic signs
and symptoms for anxiety %eg
increase heart rate, 6: and
respiratory rate&
Panxiety is associated with an increase
in sympathetic activity, which increases
cardiac wor$.
Administer dia'epam
%valium& or morphine
Pmay aid in limiting patient7s anxiety
>ffer bac$ massage
Ptouch and massage may promote
relaxation.
4aintain continuity of care
Pconsistency of routine and staff
promotes trust and confidence.
0/
8ursing )iagnosisD activity intolerance related to imbalance between myocardial oxygen
supply and demand.
)ocument heart rate and
rhythm and 6: changes
before, during, and after
activity as indicated.
!orrelate with reports of
chest painGshortness of
breath.
Ptrends determine patients response to
activity and may indicate myocardial
oxygen deprivation that may require
decrease in activity levelG return to
bedrest, changes in medication
regimen or use of supplemental
oxygen.
Cncourage rest %bedGchair&
initially. Thereafter, limit
activity on basis of painG
adverse cardiac response.
:rovide nonstress
diversional activities
Preduces myocardial wor$loadG oxygen
consumption, reducing ris$ of
complications %e.g extension of 4I&.
Instruct patient to avoid
increasing abdominal
pressure . e.g straining
during defecation
Pactivities that require holding of breath
and bearing down can result in
bradycardia %temporarily reduced
cardiac output& and rebound
tachycardia with elevated 6:.
Cxplain pattern of graded
increase increases of activity
level e.g, getting up to
commode or sitting in a chair
Pprogressive activity provides
controlled demand on the heart,
increasing strength and preventing over
exertion.
9eview signs and symptoms
reflecting intolerance of
present activity level.
Ppalpitations, pulse irregularities,
development of chest pain, or dyspnea
may indicate changes in exercise
regimen or medication.
00
8ursing )iagnosisD Ineffective tissue perfusion related to interruption of blood flow.
A!TI>8#GI8TC9AC8TI>8# 9ATI>8A=C
Investigate sudden changes
or continued alterations in
mentation e.g, anxiety,
confusion, lethargy, stupor.
Pcerebral perfusion is directly related to
cardiac output and is also influenced by
electrolyteG acid(base variations,
hypoxia, and systemic emboli.
Inspect pallor, cyanosis,
mottling, coolGclammy s$in.
8ote strength of peripheral
pulse.
Psystemic vasoconstriction resulting
from diminished cardiac output may be
evidenced by decreased s$in perfusion
and diminished pulses.
4onitor respirations, note
wor$ of breathing
Pcardiac pump failure andG or ischemic
pain may precipitate respiratory
distress@ however, suddenG continued
dyspnea may indicate thromboembolic
pulmonary complications.
4onitor inta$e. 8ote
changes in urine output.
9ecord urine specific gravity
as indicated.
Pdecreased inta$eG persistent nausea
may relut in reduced circulating
volume, which negatively affects
perfusion and organ function. #pecific
gravity measurements reflect hydration
status and renal function.
Administer medications as
indicated auch as clopidogrel
%plavix&
Preduces mortality in 4I patients, and
is ta$en daily.
Assessing ?I function, noting
anorexia, decreasedGabsent
bowel sounds,
nauseaGvomiting, abdominal,
distention, constipation
Preduced blood flow to mesentery can
produce ?I dysfunction. C.g, loss of
peristalsis. :roblems may be
potentiateG aggravated by use by use of
analgesics, decreased activity and
dietary changes.
03
SOAPIE
S )ali ra $o $apuyon $ung ipaba$od ug ipala$aw(la$aw as verbali'ed by the client.
O
*eart rate of /1 beats per minute
?enerali'ed wea$ness
!old, clammy s$in %Temp(.0.;!&
A )ecreased cardiac output related to underlying physiological condition
P
#*>9T TC94D at the end of , hour, the client will be able to verbali'e feelings to cooperate
=>8? TC94@ at the end of 1 days, the client will be able to participate in daily activities
I
a. monitored pulse rate
every four hours
To better detect arrhythmias which indicate cardiac arrest or
other complications.
b. monitored s$in
temperature every four
hours
!old, clammy s$in may indicate decreased cardiac output
c. instructed patient to
report chest pain
immediately
This may be a signal of myocardial hypoxia or injury
d. instructed patient to
avoid overexertion
% e.g., straining during
bowel movements
>verexertion increases myocardial oxygen demand which may
cause bradycardia and decreased cardiac output
e. administered
antiarrythmic drugs,
such as cordarone, as
prescribed by the
doctor
Antiarryythmic drugs acts on peripheral smooth muscle to
decrease peripheral resistancce
E At the end of , hour, the client verbali'ed cooperation
0;
S 8o verbal cues
O
4oist, cool clammy s$in %T(.0.;!&
8on palpable dorsalis pedis both left and right
:oor capillary refill( / seconds
:ale extremities
)iaphoresis
:ulse rate of /1 beats per minute
A Ineffective peripheral tissue perfusion related to decreased cardiac output
P
#*>9T TC94D at the end of , hour, the client will be able to have an improvement on
peripheral tissue perfusion
=>8? TC94@ at the end of , wee$, the patient will maintain improved peripheral tissue
perfusion
I
A. Assisted the client to
ambulate but within her
tolerance
To prevent thrombus formation, thus, improving blood circulation
6. 4onitored and
recorded inta$e and
output
4ay be a sign of decreased renal perfusion
!. :rovided a diet is low
in fat and sodium
5oods high in fat and sodium contributes to the plaque formation
that leads to decreased blood flow.
). Instructed the
significant others not to
let the client wear tight
clothing
To prevent impairment of blood flow.
C. Administered
anticoagulants such as
clopidogrel as
prescribed by the doctor
To dilute and enhance further blood flow to periphery
E At the end of , hour, the client was able to have an improvement on peripheral tissue perfusion
0<
S $inahanglan pa $o aga$on para ma$aba$od as verbali'ed by the client
O
*eart rate of /1beats per minute
?enerali'ed wea$ness
Fnable to prompt up by herself
A Activity intolerance related to generali'ed body wea$ness.
P
#*>9T TC94D at the end of , hour, the client will be able to participate in carrying out
activities while on bed with assistance
=>8? TC94D at the end of 1 days, the client will be able to continue in performing activities of
daily living.
I
A. Ta$en and recorded vital signs before
and after the activities
This is to provide baseline data
6. :erformed passive range of motion
To asses the degree of motion
!. Cncouraged client to have frequent
rests during activities To prevent the patient from fatigue
). :rovided relief through comfort
measures To enhance ability to participate in activities
C. 9eminded the significant others in
assisting the patient
To improve the mobility of the patient
E
At the end of , hour, the client was able to participate in carrying out activities while on bed
with assistance.
)ili man $ayo $o ga$aon as verbali'ed by the client
3-
O
)ecreased consumption of her daily meal( ate . tbsp. of her share
)ecreased weight %:resent weight of 3, $ilograms from her :ast weight( 3. $ilograms&
A Imbalanced nutritionD less than body requirements related to loss of appetite
P
#*>9T TC94D at the end of .- minutes, the patient will increase consumption of daily meal.
=>8? TC94D at the end of , day, the client will be able to demonstrate behaviors and lifestyle
changes to maintain appropriate weight.
I
A. :resented meal in an attractive
manner
To entice the client7s appetite
6. :rovided small frequent feeding
To encourage the client to eat
!. :rovided a well(ventilated area,
conducive for eating
To improve the client7s appetite
). reminded the client the importance of
eating
To determine weight loss and weight gain
C. regulated and monitored IA fluids as
ordered by the doctor
To provide nutritional supplements
E
At the end of .- minutes, the patient was able to increase consumption of daily meal %; tbsp
per meal&.
3,
S
^dili $o $a$laro as verbali'ed by the client
O
!loudiness of the right eye
:resence of senile ring around the patient7s left eye
*istory of cataract surgery
A 9is$ for injury related to cloudiness of the eye secondary to aging
P
#*>9T TC94D at the end of , hour, the client will be able to reduce ris$ factors and protect
self from injury.
=>8? TC94D at the end of . days, the client will be able to verbali'ed feeling of safety,
comfort and security.
I
A. Instructed the significant others to
never to leave the client
To prevent any accidents that may happen to
the client
6. :laced pillow at the sides of the client
This is to promote safety
!. 9aised side rails.
To prevent patient from falling off the bed
). Anticipated with the patient7s needs. To avoid accidents that may cause injury to
the client
C. :rovided information regarding
condition that may result increased
ris$ of injury
To reduce the ris$ of possible occurrence of
injuries
E At the end of , hour, the client was able to reduce ris$ factors and protect self from injury.
31
S da$u man $ayo mi ug bayrunon diri, $anusa man $o ma$auli_ as verbali'ed by the client
O
#tares blan$ly for about a minute
9estlessness %consistent in changing side lying position from one side to the other&
5inancial resources with a 5amily income of ( ,/,--- pesosG month
5acial ?rimace
A Anxiety related to present status secondary to hospital confinement
P
#*>9T TC94D at the end of 2/ minutes, the client will be able to adapt to the situational crisis
and have a positive outloo$ with her condition.
=>8? TC94D at the end of 1 days, the patient will be able to cope with the present situation
I
A. Cncouraged client
to express feelings
>ne way of releasing tension and assessing the level of anxiety.
B. =istened attentively
concerning client7s
feelings
To identify client7s problem regarding the situation
C. )iverted client7s
attention through
listening to a
soothing music
This will help client divert her attention for the time being
D. :rovided a less
stressful
environment
To prevent client from an environment that could trigger stress.
E. Instructed
significant others to
schedule visiting
others
To promote restful environment.
E At the end of 2/ minutes, the client was able to have a sense of control over the current crisis
3.
S
di na$o ganahan mubali$ sa doctor, pareha raman gihapon, nana man a$ong $araan na
record sa C!?, pwede nato as verbali'ed by the client
O
9estlessness
Information misinterpretation
Inadequate follow through of instructions
A Enowledge deficit related to disease condition
P
#*>9T TC94D at the end of , hour, the client will participate in learning process regarding her
current condition
=>8? TC94D at the end of 1 days, the client will understand the importance of her treatment.
I
A. Cncouraged client to verbali'e
feelings
To $now client7s current problem
6. )iscussed possible options to the
family regarding her present
treatment
?iving information to the family members and
client7s $nowledge regarding disease
condition helps client cope with present
condition
!. :rovided information for client to refer
to.
To facilitate learning regarding her treatment
). :rovided information about additional
learning resources
To promote wellness
C. Cmphasi'ed the importance of follow
up chec$(up
To have a better understanding of her
condition.
E At the end of , hour, the client was able participate in the learning process.
S di $o ganahan muinom sa a$ong mga tambal $ay daghan $aayo. As verbali'ed by the client
32
O 8on compliance with medication
A 9is$ for ineffective therapeutic regimen
P
#*>9T TC94D at the end of 2/ minutes, the client will be able to comply with the medications.
=>8? TC94D at the end 1 days, the client will be able to properly comply with the medications
I
A. Cncouraged client to verbali'e
feelings
To express client7s concerns
6. =istened attentively to client
6y actively listening, this helps in determining
client7s problems and feel comfortable
!. )iscussed to verbali'e options
regarding treatment of condition
To provide alternatives and choices regarding
the course of treatment
). 9efrained family members from
verbali'ing negative expectations with
the presence of the client
To not show inacceptance of the situation
C. 9eferred patient7s concern to the
attending physician
To help patient understand the importance of
proper compliance
E At the end of , hour, the family was able to verbali'ed feelings of control over their plight.
3/
Pro%r!## Not!#
Dat!" 5ebruary ,1, 1--;
Da( '
S8!ci3ic O2D!cti5!#"
At the end of 1 hours clinical visit at 4aria 9eyna *ospital, the group will be able
toD
,. 6e acquainted with the management and staff of #aint Boseph7s "ard /.
1. As$ permission from the family and from 4rs. 5. to be the subject of the case
study.
.. *ave the formalG written consent signed, and receive the management7s
approval.
2. Inform the family and 4rs. 5 about the purposes and objectives of the visit.
/. Cstablish a contract that notes the 8urse L !lient 9esponsibilities.
0. !onduct an interview about 4rs. 57s family history.
3. !onduct an assessment about 4rs. 57s past and present health conditions.
;. Identify problems related to 4rs. 57s present health condition.
<. #et goals for care.
,-. Inform 4rs. 5 about follow L up visits of the group.
30
Pro2)!# id!nti3i!d"
6lurred vision at the right eye
Cpigastric pain
8ausea and vomiting
:allor
)iaphoresis
"ea$ pulses %radial, femoral, popliteal, posterior tibial&
Absence of pulse beats at the )orsalis :edis site
"ea$ness of lower extremities
9estless
E5a)uation"
After 1 hours, the group was able to meet the objectives for the day. The group
was able to meet 4rs. 5 and the family@ explained the purpose of the meeting,
established individual roles, identified problems, and set L up parameters of succeeding
meetings.
33
Dat!" 5ebruary ,., 1--;
Da( /
At the end of ; hours clinical duty at 4aria 9eyna *ospital, the group will be able
toD
,. As$ consent from the family and 4rs. 5 for further interview and assessment.
1. !onduct further interview about 4rs. 57s family history.
.. !onduct an assessment about 4rs. 57s past and present health condition.
2. Identify problems related to 4rs. 57s health condition.
/. Apply nursing interventions for the problems identified.
0. :rovide health teachings for the improvement of 4rs. 57s health condition.
3. Cvaluate progress after providing nursing care.
;. 9emind 4rs. 5about follow L up visits of the group.
Pro2)!# id!nti3i!d"
6lurred vision at the right eye
:allor
)iaphoresis
"ea$ pulses %radial, femoral, popliteal, posterior tibial&
Absence of pulse beats at the )orsalis :edis site
3;
9estless
E5a)uation"
After ; hours, the day7s objectives were met. The group was able to conduct
further assessment@ applied nursing interventions for the problems identified, noted new
problems and complaints, and reminded 4rs. 5 about the next visits.
3<
Dat!" 5ebruary ,2, 1--;
Da( ,
At the end of ; hours clinical duty at 4aria 9eyna *ospital, the group will be able
toD
.. !onduct further assessment about 4rs. 57s past and present health condition
2. Identify problems regarding 4rs. 57s health condition.
/. 9ender nursing interventions for the problems identified.
;. !opy data from 4rs. 57s chart.
<. 9emind 4rs. 5 about follow L up visits of the group.
Pro2)!# id!nti3i!d"
6lurred vision
Abdominal fullness
)iaphoresis
:allor
"ea$ :ulse %femoral, popliteal, posterior tibial&
Absence of pulse beats at the dorsalis pedis site
;-
E5a)uation"
After 1 hours, the objectives of the group were met. "ith the family and 4rs. 57s
consent, the group was able to conduct further assessment about 4rs. 57s past and
present health conditions and was able to apply nursing interventions in relation to the
problems identified by the group and copied data from 4rs. 57s chart and reminded 4rs.
5 about succeeding visits of the group.
;,
Dat!" 5ebruary ,/, 1--;
Da( <
At the end of 1 hours clinical visit at 4aria 9eyna *ospital, the group will be able
toD
.. !onduct further assessment about 4rs. 57s past and present health condition.
2. Identify problems regarding 4rs. 57s health condition.
/. 9ender nursing interventions for the problems identified.
;. !opy data from 4rs. 57s chart.
<. 9emind 4rs. 5 about follow L up visits of the group.
Pro2)!# id!nti3i!d"
6lurred vision
)iaphoresis
"ea$ pulse %popliteal, posterior tibial&
Absence of pulse beats at the dorsalis pedis site
"ea$ness of the lower extremities
E5a)uation"
After 1 hours, the group was able to meet the day7s objectives. The group was
able to assess 4rs. 5 and identified new problems, gave health teachings and reminded
4rs. 5 about the group7s following visits.
;1
Dat!" 5ebruary ,;, 1--;
Da( 9
At the end of 1 hours home visit at Aluba, !agayan de >ro !ity, the group will be
able toD
,. Aisit 4rs. 5 at !oca L !ola !ompound, Aluba, !agayan de >ro !ity.
1. As$ consent from the family and 4rs. 5 for further interview and assessment.
.. !onduct further interview about 4rs. 57s family history.
2. !onduct further assessment about 4rs. 57s condition after discharge.
/. :rovide health teachings for the improvement of 4rs. 57s health condition.
0. 9emind 4rs. 5 about the ending of the group7s correlation.
E5a)uation"
After 1 hours, the group was able to meet the objectives. The group was able to visit
and examine 4rs. 5 after being discharged from the hospital. The group was able to
impart health teachings such as to return to 4aria 9eyna *ospital for follow L up chec$
L up, to maintain prescribed home medications until advised by physician to discontinue
and to do exercise regularly. The group also reminded 4rs. 5 that 5ebruary ,<, 1--;
will be the group7s last visit.
;.
Dat!" 5ebruary ,<, 1--;
Da( 0
At the end of 1 hours home visit at Aluba, !agayan de >ro !ity, the group will be
able toD
,. Aisit 4rs. 5 at !oca L !ola !ompound, Aluba, !agayan de >ro !ity.
1. As$ consent from the family and 4rs. 5 for the completion of the interview and
assessment.
.. :rovide additional health teachings for the improvement of 4rs. 57s health
condition.
2. Than$ the family and 4rs. 5 for the approval and cooperation with the group.
/. Cnd the group7s correlation with the family and 4rs. 5.
E5a)uation"
After 1 hours, the group was able to meet the objectives for the day. The group
was able to complete the interview and assessment of the needed data for the case
study and gave a to$en as a sign of appreciation for the family and for 4rs. 57s approval
and cooperation.
;2
Di#c+ar%! P)an and R!3!rra)#
M!dication#
=ast 5ebruary ,0, 1--; 4rs. 5 was discharged and advised to have her follow(up
chec$(up on 5ebruary 1-, 1--; with the following home medication by instructionsD
Telmi'artan %:riton& 2- mg ,tab. >.) %Angiotensin II
receptor bloc$er&.
!lopidogrel %:lavix& 3/ mg , tab >.) %Anti(coagulant&.
4etoproplol%8eobloc& /-mg H tab >.) %6eta 6loc$erGAnti(*ypertensive&.
Atorvastatin %=ipitor& ;- mg , tab >.) q hs. %Anti(*yperlipidemic&.
I#48 %Imdur& 0- mg , tab >.) %Anti(anginalG8itrateGAasodilator&.
Trimeta'idine %Aastarel& , tab 6I) %Anti(anginal drugs&.
Amiodarone %!ordarone& 1-- mg , tab 6I) %!lass IIIGAnti(arrythmic&.
Aspirin %Acet& ;- mg , tab >.) p.c lunch %Anti(coagulant&.
4etformin *!= %I(max& /-- mg , tab 6I) %Anti(diabetic&.
Cncouraged the patient and instructed the significant others to follow
prescribed home medications and give drugs on time.
Instructed the significant others to give drugs with food when indicated.
Acti5it(
Cncouraged the patient and instructed the significant others to control
activities of daily living.
Cncouraged the patient and instructed the significant others to
participate in passive active range of motion as tolerated.
Instructed the significant others to provide safety precautions to the
patient, especially when ambulating or using the bathroom.
Instructed the client7s significant others to minimi'e prolonged
exposure to sunlight.
Di!t
Cncouraged the patient and instructed the significant others to prepare
foods that areD
;/
Lo6 ca)ori! ( !alorie restriction in individuals with
hypertension is recommended. >therwise normal individuals need the daily(
recommended calorie according to the age, sex and physical activity.
Lo6 3at ( It is advisable to reduce the fat consumption since
hypertension has greater ris$ of arteriosclerosis. It is better to avoid high
inta$e of animal fat or hydrogenated oils, which contain saturated fatty
acids. The cholesterol rich foods such as liver, meat, organ meat, egg yol$,
lobster, crab and prawns should be minimi'ed in the diet. The dietary fats
should consist of vegetable oil li$e corn oil, olive oil and sunflower oil.
Hi%+ 3i2!r? 8ot only does a high fiber diet aid in healthy
bowel movements but also research has shown that it also lowers
cholesterol. There are even types of fiber that will help reduce the ris$ of
colon cancer.
Hi%+ 8rot!in L 4ost high protein foods are extremely low in
carbohydrates and extremely low in saturated fat. Therefore, by eating a
high protein diet loaded with high protein foods, at the same time youXd end
up eating low carbohydrates foods and low saturated fat foods. And, if you
didnXt already $now, in order to lose weight and lose fat, eating low
carbohydrates and eating little or no saturated fat is a must. !hic$en, lean
meats, beef and fish and egg whites.
Lo6 #odiu and +i%+ 8ota##iu di!t( *elp to lower high
blood pressure. 4oderate sodium restriction 1( . gm per day decreases
diastolic blood pressure 0( ,- mm*g and enhances the blood pressure
lowering effect of diuretic therapy. :otassium inta$e should be increased.
5ood sources of potassium should be increased to patients who are on
diuretics. 5or example apricots, tomato, watermelon, banana, leafy
vegetables, and potato should be included in the daily diet since they
contain low sodium and high potassium. *ypertensive patients with $idney
disease should avoid a high inta$e of potassium as it puts an excessive load
on the $idney.
;0
Oat!a) Banana
Ra6
Carrot#
A88)!
Brocco)i Ra6
Toato!#
C!r!a)#

Instructed the significant others to avoid gastric irritant foods, such as
spicy products this is to minimi'e gastrointestinal disorder, such as
nausea and vomiting, abdominal pain, !8# disorder li$e di''iness,
headache.
;3
Tr!at!nt
Cncouraged patient to verbali'e feelings and needs when presence of
chest pain, wea$ness, and prolonged headache, this is to lessen the
burden of the patient and for immediate action as well as to minimi'e
entertaining negative thoughts.
Cncouraged patient and instruct the significant others to monitor weight
and blood pressure daily.
;;
Pro%no#i#
H(8!rt!n#ion"
There is no cure for hypertension, but it can be controlled by changes in one7s
lifestyle and the use of prescribed medications. The major goal of nursing care for
hypertensive patients focuses on lowering and controlling the blood pressure without
adverse effects and value cost. The patient needs to understand the disease process
and how life7s changes and medications can control hypertension@ the nurse needs to
emphasi'e the concept of controlling *:8 rather than curing it.
` *ypertension is more common in men than women and in people over the age of
0/ than in younger persons. *ypertension is serious because people with the condition
have a higher ris$ for heart disease and other medical problems than people with
normal blood pressure. ?etting regular blood pressure chec$s and treating hypertension
as soon as it is diagnosed can avoid serious complications.
If left untreated, hypertension can lead to the following medical conditionsD
Arteriosclerosis, also called atherosclerosis
*eart attac$
#tro$e
Cnlarged heart
Eidney damage
9is$ factors for hypertension includeD
Age over 0-
4ale sex
"eight
1/*eredity
Dia2!t!# M!))itu#"
In most patients diabetes can be controlled by diet, exercise and insulin
injections. If the condition is not treated, however, some serious complications may
result.
5or example, uncontrolled diabetes is the leading cause of blindness, $idney
disease and amputations of arms and legs. It also doubles a person7s ris$ for heart
;<
disease and increases the ris$ of stro$e. Cye problems also occur more commonly
among diabetes than in general population.
)iabetes 4ellitus %)4& is a common metabolic disorder in aging populations with
increased morbidity, disability and premature death. The prevalence of diabetes is
about 1-R in persons over 0/ years of age and about 2-R in persons over ;/ years. A
recent communication from Eol$ata %8#9 4edical college& as per patients attending
>:) service, the prevalence was ,,R in persons aged between 0/(0< years. In
another study at 6hubaneshwar %>rissa&, prevalence of diabetes was found as high as
1-R in the age group of 0/ and above. The vast majority of patients with )4 in the
elderly are type 1 %8I))4& diabetics. Aery rarely autoimmune destruction of 6eta cells
leading to Type , %I))4& )4 can occur in the elderly. #ome cases could be secondary
to associated diseases or drugs.
M(ocardia) In3arction
The incidence and prevalence of acute myocardial infarction %4I&, increases
progressively with age. 6ased on the official survey of the )epartment of *ealth %)>*&
9egion ,-, the rate of 4yocardial Infarction morbidity cases was .,./0. The rate was
<3..R. In addition, mortality rates following Acute 4yocardial Infarction %A!#& increases
exponentially with age. In particular, elderly patients are less li$ely to report chest pain
than younger patients. !onfusion or altered mental status may be the presenting
manifestation of Acute 4yocardial Infarction in up to 1-R of patients over ;/ years of
age. >lder patients are more li$ely to have #I=C8T or unrecogni'ed 4I7s as well as
4Is without #T(segment elevation.
As compared with younger patients who experience heart failure, atrial fibrillation,
and cardiac rupture and shoc$. All of which are associated with increase mortality.
>ther factors contributing to the poor prognosis following Acute 4yocardial Infarction in
elderly individuals includeD
4ar$ed decline in cardiovascular reserve in elderly
Increase prevalence of morbid conditions
Fnderutili'ation of evidence L based theories
"omen have high mortality rate after Acute 4yocardial Infarction
compared with men. The extent to which their increased ris$ varies in
treatment is not well understood.
5rom the information stated above, therefore the patient has poor prognosis
attributed to age, sex, presence of other diseases as well as financial constraint may a
<-
hindrance of her treatment. According to )r. !ristina !abral(:auig, cardiologist from the
Fniversity of the :hilippines(:hilippine ?eneral *ospital said that both hypertension and
diabetes are Yrobust independent ris$ factors to the development and progression of
cardiovascular disease and nephropathy.Y In addition, hypertension and diabetes
together raise !A) ris$, even worsen prognosis.
<,
E5a)uation
The mainstay of nursing and medical treatment with the patient having with these
conditions is to help the patient to cope, alleviate distress, prevent further complications
and help the patient to recover as well as to encourage the patient and the significant
others to participate in the therapy. 5rom the initiation of nursing and medical
interventions the client showed some signs of recuperation and gradually showed signs
of progress. This was evidence form the complete bed rest up to the condition she was
given the chance to ambulate gradually as tolerated.
>n the last day of visitation the patient has returned to her normal daily activity
but with controlled environment and efforts in carrying tas$s. Fpon interview the client
showed orientation in time, place and person and was aware of her condition and
$nows the prohibition in order to prevent complications and aggravations of her
condition. *er significant other, were also supportive and showed concern for the
patient.
5rom this, our goal was achieved as evidenced by the desire of the patient to go
bac$ to her normal daily routine and from the progress of the patient.
<1

Case Ib Study in Ectopic Pregnancy

Caricato da

Informazioni sul documento

Titolo originale

Copyright

Formati disponibili

Condividi questo documento

Condividi o incorpora il documento

Opzioni di condivisione

Hai trovato utile questo documento?

Questo contenuto è inappropriato?

Copyright:

Formati disponibili

Case Ib Study in Ectopic Pregnancy

Caricato da

Copyright:

Formati disponibili

Introduction

Potrebbero piacerti anche