CHN

Republic of the Philippines
Central Mindanao University

College of Nursing
University town, Musuan,
Maramag, Bukidnon
College of Nursing
A FAMILY CASE STUDY
In partial fulfilment of the subject
CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND
ELECTROLYTE IMBALANCE, NUTRITION AND METABOLISM AND

ENDOCRINE
(NCM 63.1)
Submitted to:
Theresa Linda C. Narreto, RN, MSN
Submitted by:
Baya, Aika C.
Borres, Mary Joy C.
Escobia, Blessie P.
Felimon, Mary Freyah
Laride, Kyle Lorenz B.
Luza, Nicole Hope L.
Mangubat, Yzrah Duffnee Dezz P.
Olano, Jomar Ray B.
Palma, Dechy Lyn B.
Taguiam, Jessa D.
December 2017
ACKNOWLEDGEMENT
The completion of this undertaking could not have been possible
without the participation and assistance of so many people whose
names may not be all enumerated. Their contributions are sincerely
appreciated and gratefully acknowledged. However, the group would
like to express their deep appreciation and indebtedness particularly to
the following:
Ms. Theresa Linda C. Narreto for her endless support, kindness,
understanding, guidance and patience during the conduct of the study.
To all family, friends and others who in one way or another shared
their support, either morally, financially and physically thank you so
much.
Above all to the Great Almighty, the author of knowledge and
wisdom for his countless love.
BACKGROUND OF THE STUDY

Ureterolithiasis is the formation of urinary stones, also known as
renal calculi, in the ureters, which are muscular tubes that move urine
to the bladder from the kidneys. When ureterolithiasis develops, the
stones can block one or both of the ureters, causing a painful condition
known as a renal colic attack. The pain from such an attack usually
starts in the loin and travels through the urinary tract to the genitals
as the stones are passed from the body.
There are several possible reasons for the formation of the urinary
stones that cause ureterolithiasis, though it is not always possible for
a doctor to find a cause. Diet can play a role in the growth of stones,
though it is not commonly believed to cause their formation.
A family or personal history with kidney stones, metabolic
disorders and cystic kidney disease are all believed to play a role in the
development of urinary stones. A high percentage of patients who have
the rare disease renal tubular acidosis also tend to grow kidney stones.
Calcium-based antacids and some kinds of diuretics can also increase
the chances of getting kidney stones.
The symptoms of ureterolithiasis tend to appear after the early
stages of kidney stone development. If symptoms of kidney stones
present themselves, they will usually appear when the stones move into
the urinary tract. This condition happens later during the progression
of the stones through the body, when they move into one or both of the
ureters.
Stones in the ureter can cause extreme pain as the body attempts
to push them through the tubes and into the bladder. A patient may
experience pain in the groin, nausea, and vomiting. Urine can appear
pink, due to the presence of blood. Patients may also experience
burning during urination and the urge to urinate more frequently. In
some cases, an infection may develop, causing chills and fever in
addition to these other symptoms.
Ureterolithiasis is usually treated by simply making the patient
more comfortable while the kidney stones finish their journey to the
bladder. Heavy consumption of water can help the kidney stones to
move through the system. A doctor may also prescribe medication for
the management of pain. Often a doctor will request that a patient catch
and keep the kidney stones when they have passed. This is so the
stones can be analyzed in the hopes that the reason for their formation
can be determined and measures can be taken to prevent future kidney
stone growth.
Introduction
The family is a basic unit of study in many medical and social

science disciplines. Definitions of family have varied from country to
country, and also within country. The family is a basic unit of study in
many social science disciplines, such as sociology, psychology,
economics, anthropology, social psychiatry, and social work. It is also
a unit of study in the medical sciences especially in understanding the
epidemiology and the natural history of diseases (Sharma, 2013). The
family unit principally a man and a woman living together in harmony
and peace is and always will be the basic social organization or unit
of any society. This relationship alone provides stability in a sexual,
emotional, intellectual and social way as no other can.
The family is the most important social unit of society. This is a

fact that everyone must learn. The family is not only the basic societal
unit. It is also the basic sexual unit, the basic child-raising unit, the
basic communication unit, and the basic all-around fun and friendship
unit (Wilson, 2013). It also forms the basic unit for family medicine.
Census definitions of family have varied from country to country and
also from census to census within country. The word household has
often been used as a replacement for family. The UNESCO report stated
that a family is a kinship unit and that even when its members do not
share a common household, the unit may exist as a social reality. This
definition may be too broad to serve the purpose of identification of a
family unit for the purpose of assessment as a factor in variables such
as health.
Family nursing is a part of the primary care provided to patients

of all ages, ranging from infant to geriatric health. Nurses assess the
health of the entire family to identify health problems and risk factors,
help develop interventions to address health concerns, and implement
the interventions to improve the health of the individual and family.
Family nurses often work with patients through their whole life cycle.
This helps foster a strong relationship between health care provider and
patient (Peteprin, 2016). Family nursing is not as much patient-
centered care as it is centered on the care of the family unit. It also
takes a team approach to health care.
In the course of the family care assessment, it has been found
that Marcos family incurred problems regarding environmental
sanitation. Environmental Health is concerned with preventing illness
through managing the environment and by changing people's behavior
to reduce exposure to biological and non-biological agents of disease
and injury. It is concerned primarily with effects of the environment to
the health of the people. Per assessment it was found that the Marcos
family gives low attention to environmental sanitation. According to the
WHO Director-General Dr Margaret Chan "Sanitation is a cornerstone
of public health". "Improved sanitation contributes enormously to
human health and well-being, especially for girls and women. We know
that simple, achievable interventions can reduce the risk of contracting
diarrhoeal disease by a third". Ann M. Veneman, UNICEF Executive
Director said that Nearly 40% of the worlds population lacks access to
toilets, and the dignity and safety that they provide". The absence of
adequate sanitation has a serious impact on health and social
development, especially for children. Investments in improving
sanitation will accelerate progress towards the Millennium
Development Goals and save lives (WHO & UNICEF, 2008).
Health problems result from the lack of sanitation facilitates,

especially among the urban poor living in overcrowded informal
settlements which is greatly affects to their health. Environmental poor
sanitation, globally an estimated 2000 under the age of five die every
day from diseases and these some 1800 deaths are linked to water,
sanitation and hygiene (United Nations International Children
Emergency Fund). In the Philippines, an estimated 25% of Filipinos do
not have improved sanitation, translating to more than 24 million
people. (UNICEF WHO Progress on Drinking Water and Sanitation
2012).
For the clinical case, Mister M of the Marcos family was found to
be suffering from Nephrolithiasis. It is a process of forming a kidney
stone, a stone in the kidney (or lower down in the urinary tract). Kidney
stones are a common cause of blood in the urine and pain in the
abdomen, flank, or groin. Kidney stones occur in 1 in 10 people at some
time in their life. The development of the stones is typically related to
increased excretion of stone-forming components such as calcium,
oxalate, urate or cystine. The pain with kidney stones is usually of
sudden onset, very severe and colicky (intermittent), not improved by
changes in position, radiating from the back, down the flank, and into
the groin. Nausea and vomiting are common.
The incidence and prevalence of kidney stones is increasing

globally and is seen across sex, race, and age. Changes in dietary
practices may be a key driving force influencing these trends as well as
the effects of global warming.
THEORETICAL FRAMEWORK
Florence Nightingales Theory (Environmental Theory)

The environmental theory by Florence Nightingale defined
Nursing as the act of utilizing the environment of the patient to assist
him in his recovery. It involves the nurses initiative to configure
environmental settings appropriate for the gradual restoration of the
patients health, and that external factors associated with patients
surroundings affect life or biologic and physiologic processes, and his
development.
Nightingale stated that nursing ought to signify the proper use
of fresh air, light, warmth, cleanliness, quiet and the proper selection
and administration of diet-all at the least expense of vital power to the
patient. She reflected the art of nursing in her statement that, the art
of nursing, as now practiced, seems to be expressly constituted to
unmake what God had made disease to be,.., a reparative process.
The physical environment is stressed by Florence Nightingale in
her theory. Nightingales theory reflects a community health model in
which all that surrounds human beings is considered in relation to their
state of health.
Florence Nightingales theory focused on the environment and
she gave a detailed description of each aspect of environment in her
theory. Nightingale did not specifically define the four major concepts
of nursing theory; however, each component was evolved from her
various documents.
Seven assumptions of Nightingales theory were identified, several
of them are3 discussed. Natural laws: Nightingale defined a law as the
thought of God. Mankind can achieve perfection; Nightingale viewed the
role of the nurse was to provide environment in which perfection might
be achieved. Nursing is an art and science; nightingale indicated that
nursing will be practiced by educated individuals using current
research and common logic. Further assumptions include; Nursing is
distinct and separate from medicine, Nursing is achieved through
environmental alteration and requires a specific educational base.
Family Nursing Assessment
A. Family Structure Characteristics and Dynamics

The Marcos family is headed by the 50 years Mr. M and he is
living with his wife named Mrs. T who is 40 yrs. Old at Purok-B
Barangay Panadtalan , Maramag Bukidnon. They have 5 children and
all of them got married and have individual families, Their children
visits them together with their kids weekly or monthly. The eldest is
Mr. N 42 yrs old, who was married to Mrs. P and 3 kids. Second is Mr.
Y 38 yrs old, who was married to Mr. Z and had 3 kids. Third was Mrs.
J, who was married to Mr. K and had 2 kids. Fourth was Mrs. A who
was married to Mr. B and had 2 kids. Last is Mr. O and married to Mrs.
L who had 2 kids who was currently separated with their kids.
They are a nuclear family, they live together in one house. They
have a good family relationship, they do help each other in many
matters like in promoting a healthy lifestyle but sometimes they have
conflicts which cant be avoided but they make sure that they fix their
conflicts as soon as they can.
Mrs. T, the wife of Mr. M, is the one who decides for matters like
healthcare and all other decision making.
B. Socio-economic and Cultural Characteristics

The head of the family, Mr. M was born on __________; He is
married with Mrs. T and have 5 children. Mr. M achieved a college
level of education ,he was a laborer before he got sick and has a
weekly income of Php1500.00.
Mrs. T is the wife of Mr. M she was born on ______________.

Achieved an elementary level of education and she was a housekeeper.
In terms of family matters Mrs. T and Mr. M usually argues in the
things like sustaining their daily viands be the wife wants healthy
foods but the husband insists on eating salty foods.
The family participates in any programs of their purok because

Mr. M is the current Purok leader. They are affiliated into any other
groups, they are Cebuano.
Both of them often go to church for a mass and any special

ocasion like birthdays, Christening, Christmass and New Year. Mr. M
was also a Lay Minister of their Catholic church.
C. Home and Environment
The family lives in a house made up of a light materials like

woods, hallowblocks and cemented flooring. Kitchen area is not
cemented. They have two bedrooms and three beds. Mr. M and Mrs. T
occupies the first bedroom. The second bedroom is reserved for their
children when they visit them. They have a small living room and they
also use it as their dining area and sleeping place for Mr. M. There
was breeding sites and resting sites of mosquitoes and flies around
teir house. There are also accident hazards present in their backyard
as evidenced by a loose stair case. They usually store their foods in a
covered plate placed on top of the table. They use kettle and casserole
in cooking their food. They also use woods and coal in cooking. They
hang their clothes inside their house. They get their water supply in
NAWASA. they used karamba waterjug and bottled container in
storing their water. They drink water directly without boiling. They
have a water sealed toilet. They usually pack their garbage in an open
receptacle and dispose it in the garbage dump in their block. Some
times they burn their garbage infront of their house or even at the side
of their house. They have a blind drainage system with an unsanitary
condition because of the presence of molds and worms.
The family lives in a congested neighborhood as evidenced by

the number of the houses around them. They lack knowledge about
social and health facilities. They dont use cellphone as a mean of
communication but they listen to radio for other news and
informations . They also watch television with the speaker connected
to the radio. They dont own any transport vehicle instead they use
tricycle for transportation. They dont have any health equipments like
first aid kit inside their house.
D. Health Status Of Each Family Member
Mr. M had a maintenance for hypertension and currrently
suffering with chronic kidney disease. He was confined last_________at
Polymedic General Hospital for____ days and undergone dialysis. Now
he was at home with maintenance and was advised to heve a follow up
check up. Mrs. T also taking hypertensive medications. He taking
herbal medicines like garlic for hypertension. They visit regularly health
center for follow up check up and maintenance for hypetension. They
only seek medical doctor if they cannot tolerate what they feel anymore.
Blood Pressures were taken during home visits and recorded as follows
130/80mmHg for Mr. M and 130/70mmHg for Mrs. T.

The family has inadequate knowledge regarding their healthy
lifestyle as evidenced by the manner of eating habits. They eat
whatevers there even if its meat or canned goods. During night time,
they use mosquito net as a protective measure from mosquitoes. They
have good sleeping pattern. They usually treat common illnes such as
cold, cough and fever with over the counter drugs like paracetamol and
pain relievers. They appear tidy and clean.

NUTRITIONAL ASSESSMENT
Name of Height Weight Chest Abdomen Lower Higher Quantity and Eating/feeding BMI
the (cm) (kg) (cm) (cm) extremities extremities quality of food practices
family (cm) (cm) (cm) (cm)
member
Theresita 158 64 37 33 21 13 Meat, rice, Thrice a day 25.64
cm fruits, Overweight
vegetables,
water
Moises 160 60 34 36 20 11 6 glasses of Thrice a day 23.44
cm water/day, Normal
low salt
intake
approximately
1 pinch of
salt,
vegetables,
fish
specifically
fresh water
fish
NAME IMMUNIZATION HEALTHY REST EXERCISE USE OF STRESS USE OF
OF FAMILY LIFESTYLE AND ACTIVITIES PROTECTIVE MANAGEMENT PROMOTIVE-
MEMBER PRACTICES SLEEP MEASURE ACTIVITIES PREVENTIVE
HELATH
SERVICES
Theresita COMPLETE Usually Sleeps at House Uses Talks to her Use of herbal
eats fruits, 9pm and chores mosquito net husband, medicines
vegetables wakes up and uses children and and over the
and meat at 5am slippers neighbours counter
drugs
Moses COMPLETE Usually Sleeps at Walking Uses Talks to his Use of herbal
eats fruits, 9pm and every mosquito net wife and medicines
vegetables wakes up morning for and uses children and
and fish at 5 am 30 minutes slippers prescribed
specifically and drugs
fresh water sometimes
fish, 1 he would
pinch of wake up
salt in at 3 am
every meal, with
and 8 unknown
reason.
glasses of
water a day
Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention

Patients Profile
Name: Cardo
Age: 64 years old
Sex: Male
Birthdate: February 16, 1953
Birthplace: Tupsan, Mambajao, Camiguin, Province
Religion: Roman Catholic
Civil Status: Single
Address: Purok 2B, Panadtalan, Maramag,
Bukidnon
Race: Asian
Nationality: Filipino
Ethnic Group: Cebuano
Educational
Attainment: College Level
Occupation: Purok Leader
Height: 161 cm
Weight: 56 kg
Usual source of
Medical care: Doctor/ Physician Hospital and
Quack Doctor
Source of
information: Primary Source Client
Admission date: August 02, 2017
Admission time: 10:30 AM
Hospital: Valencia Polymedic General Hospital
Area: Surgical Ward
Admitting Physician: Dr. Adonis Latayan
GENOGRAM
Figure 1
(Undetermined) (Undetermined) (Undetermined) (Undetermined)
(Undetermined) (Undetermined)
76 (Undetermined)
(Undetermined) 71 (Undetermined)
(Kidney Problem) (Hypertension)
60 68 64 62
59
(Vehicular Accident) AW Client AW
(Hypertension)
Stage Freud Erikson Kohlberg Havighurst
Stage Description Genital Stage. Generativity vs. Post-conversional-universal The period of Middle Age. This is
Pleasure is Stagnation This is focus. An individual follows what the person thought of:
Middle Adulthood- 64 directed in the when the concern for is right in accordance with 1. Achieving adult civic and
years old. development of about establishing ethical principles.
social responsibilities.
sexual relations. and guiding next
generation. People in 2. Establish economic and
this stage are on
standard living.
their middle-life
crisis. And unable 3. Assisting teenage children
to accomplish this is
become responsible and
stagnated.
happy adults.
4. Developing adult leisure-
time activities
5. Relating oneself to ones
spouse as a person
6. Accepting and adjusting to
the physiological changes of
middle age.
Client Observations The patient has It was perceived that The patient upholds the basic The patient has already changed
already achieved the patient teaches rights, values, and legal his lifestyle by changing his eating
his sexual his children and has contracts of the society. habits little by little.
satisfaction. surpassed midlife
crisis.
Physical Assessment
Table 3
General Survey
Well-groomed
conscious and responsive
Animated affect
able to talk properly
no slurring of speech noted
able to walk properly without difficulty
able to move with coordination
no gross deformities noted
appears stated age
face and body symmetrical
Hair evenly distributed.
Physical development inconsistent with the age.
The client is lean.
Body parts symmetrical.
Area/ System Description SUBJECTI INSPECTION PALPATION PERCUSSI AUSCULTATI NURSING

VE ON ON DIAGNOS
IS
INTEGUMENTARY The Diri ko gi Skin- Skin- N/A N/A Impaired
SYSTEM integument operahan scar due to Evenly warm skin
[SKIN, HAIR, includes the sa akong surgical in cision skin integrity.
NAILS, skin, hair, tuo nga noted on the right good skin
APPENDAGES] and nails. kilid ky tuo side of the turgor
The man nako abdomen 6-8 smooth hair
examination nga kidney inches in length and capillary
begins with ang Nails- refill of less
generalized apektado than 2 second
inspection. sakit sad Nails are No tenderness.
Assessment labi nag smooth, Nails-
of the skin bugnaw translucent, Nails are smooth, Self care
involves ang and consistent nontender, and deficit
inspection panahon in thickness. firmly adherent
and palpation mga 5/10 Untrimmed to the nail bed.
ang sakit and untidy Lateral and
ani ug ga nails proximal folds
hupong ni are nontender
akong mga Hair- and nonswollen.
tiil as Hair is equally
verbalized and
by the symmetrically
patie distributed
across the
scalp.
Hair shafts are
smooth, shiny,
of even
consistency,
and without
evidence of
breakage.
Scalp skin is
of color
consistent
with the rest
of the body.
HEEN During the Head- Head- N/A No bruit or
[HEAD, EYES, assessment of The head is Scalp is vascular
EARS, NOSE] the head, the centered, symmetric sounds are
nurse proportional to without audible at the
examines the the body, tenderness, temporal
skull, face, erect, and masses, lesions, arteries.
eyes, ears, without or differences in
nose, tremors, tics firmness.
sinuses, or unusual Lymph nodes not
mouth and movement. swollen.
pharynx. The skull is No periorbital
round without edema.
obvious Eyes-
deformities Lacrimal
Nasolabial apparatus is not
folds are tender.
symmetric. Ears-
Hair is evenly Ears are firm
distributed without lumps,
across the lymph tissue is
scalp, not palpable, and
extending from ears are
the superior nontender.
aspect of the The canal has
forehead to fine hairs; some
the base of the cerumen lining
cranium and the wall skin is
to the top of intact, with no
the ears discharge.
bilaterally. Nose-
Eyes- No tenderness,
Eyebrows are or break in
evenly contour.
distributed. Sinuses-
Eyebrows No tenderness or
show no fullness is
unexplained present at the
hair loss. maxillary,
Lashes are ethmoid, and
evenly frontal sinus
distributed area.
along the lid Mouth-
margins. No swelling or
Eyelids open tenderness at the
and close parotid,
completely, submandibular,
with and sublingual
spontaneous glands.
blinking every
few seconds.
Eye shape
round and
symmetrical.
Lacrimal
apparatus is
not enlarged.
Bulbar
conjunctiva is
transparent
with small
blood vessels
visible.
Sclera is clear,
smooth, and
white.
Iris color is
even, smooth
and without
apparent
vascularity.
Pupil is black.
PERRLA:
Pupils Equal,
Round,
Reactive to
light, and
Accommodatio
n.
Ears-
Ears are
symmetrical,
equal size, and
fully formed.
Nose-
Symmetrical,
midline, and
proportional to
face.
Skin surface is
smooth
without
lesions; color
is consistent
with facial
expression.
Septum is
midline and
no prominent
blood vessels
or crusts.
Drainage is
clear.
Airflow is
adequate.
Sinuses-
Symmetrical
with no
redness or
swelling.
Mouth-
Lips no
lesions.

RESPIRATORY Includes Posture is Nontender resonan All .
assessing the Upright. thorax, no ce heard anterior
thorax and Retractions lesions, lumps, upon and
lungs. absent. masses or percussi posterior
No clubbing is crepitus. on lung fields
present. are clear
Spinous without
processes of adventitio
vertebrae are us sound.
midline;
scapulae are
symmetric,
Chest wall is
cone-shaped,
symmetrical
and oval.
NECK Examination The neck Thyroid is N/A No bruit or
of the neck muscles are smooth, rubbery, vascular
includes the symmetric. nontender, sounds are
muscles, Trachea is symmetrical, and audible at
lymph nodes, midline. barely palpable the carotid
trachea, No beneath the arteries.
thyroid gland, enlargement sternocleidomast
carotid or lesions are oid.
arteries and noted. Nodes are
jugular veins. Jugular veins symmetrical,
not distended. soft, and
nontender.
CARDIOVASCULA Includes Carotid Carotid arteries N/A Carotid
R [CENTRAL] assessing the arteries strength is arteries
normal contour is moderate, pulses has no
function of smooth with are equal sounds or
the heart. rapid upstroke bilaterally. bruits are
and slower heard.
downstroke.
CARDIOVASCULA Includes ga hupong Arms and Arms and hands N/A 120/80 Excess
R [PERIPHERAL] assessing the ni akong hands are are warm and mmHg fluid
peripheral mga tiil symmetrical equal in volume
blood flow. as with full joint temperature.
verbalized movement. with pitting
by the Bipedal edema bipedal edema +2
patient Arms and Color returns
hand are within 2 seconds
consistent during capillary
without refill.
prominent
venous
pattern.
No edema.
BREAST AND Breast Breasts skin Nontender N/A N/A
AXILLAE needed to be is pinkish. nodes.
inspected and No discharges Breast
palpated. No lesions. nontender.
Breast are flat No masses.
in shaped.
Areolas are
round, averted
and equal in
size,
Skin is
uniform in
color.
Both nipples
point to the
same
direction.
GASTROINTESTIN The nurse Diri ko gi Umbilicus no masses Dullness 20 clicks Impaired
AL locates and operahan inverted palpated over the per minute skin
divides the sa akong Yellowish Incision site is a liver in in each integhrity
abdominal tuo nga stool. little painful the quadrant
findings kilid ky tuo No ascites. when touched RUQ. heard
using two man nako scar due to Spleen not upon
common nga kidney surgical palpable. auscultati
methods of ang incision noted on.
subdividing apektado on the right
the abdomen: sakit sad side of the
quadrants labi nag abdomen 6-8
and regions; bugnaw inches in
Inspection, ang length
auscultation, panahon
percussion, mga 5/10 no hernia
palpation to ang sakit noted
avoid bowel ani as abdomen not
stimulation. verbalized distended
by the
patient
MUSCULOSKELE The ga hupong Length of long No tenderness. N/A N/A Excess

TAL musculoskele ni akong bones, size of No bumps, fluid
tal system mga tiil muscles are nodules or volume
encompasses as symmetrical. deformity.
the muscles, verbalized Head midline TMJ Muscles are
bones and by the above the symmetrical,
the joints. patient spine. smooth, and
Shoulders are nontender.
equal in Bipedal pitting
height. edema grade +2
Jaw is
symmetrical
bilaterally.
Shoulders no
redness,
swelling,
deformity or
atrophy is
present.
NEUROLOGIC Examination Awake, Able to sense +3 N/A
of the conscious and sensations. activity
neurologic passive. reflex.
system Olfactory
includes nerve no
assessment of deviation.
the mental Optic nerve,
status and oculomotor
LOC, cranial and trochlear
nerves, reflex, nerves
motor symmetrical,
function and with ocular
sensory movements,
function. moves eyeball
downward and
laterally.
Trigeminal
nerve blink
reflex present,
light sensation
present.
Abducens
moves eyeball
laterally.
Facial nerve
flat affect.
Acoustic nerve
not
assessed.
Glossopharyng
eal ease in
swallowing,
can move
tongue.
Accessory
nerve can
moves head.
Hypoglossal
nerve moves
tongue.
GENITOURINARY Includes the Genitals No tenderness. N/A N/A
genital and without
the urinary lesions
system. Genitals no
breakdown,
papules or
vesicles.
No protrusion
seen.

GORDONS Functional Assessment
Initial Appraisal Ongoing Appraisal

(September 22, 2017) (November 19, 2017)
Health Perception - Health Management Pattern
Perceived level of health and well-being, and practices for maintaining health.
Habits that may be detrimental to health are also evaluated, including
smoking and use of alcohol or other drugs.
When asked about alcohol The patient described his health
consumption, patient stated that before as fair and strong but now, he
probably he drinks alcoholic considered it as deteriorating and
beverages before, twice in a week. He weak due to the medical condition
also used cigarettes before and can that he has, manifested by non-pitting
consumed 1 pack of Fortune every edema, pain and easy fatigability. This
day, but when he knew his medical is also because of limitations imposed
condition his doctor advised him to to him like he cant eat the food that
stop this habits and so he did. he likes and doing activities with his
Furthermore, patient no longer close neighbours. He is aware that his
remember his childhood present condition is something that is
immunizations. He only visits to a really serious and needs maintenance
hospital or seek a medical doctor medications. Also, he is aware that the
when he and his family experience an symptoms he is experiencing is not
illness that cant be treated with over- normal and presents a chronic
the-counter drugs. Based on his disease. Before, the patient eats more
statements, he perceives his illness as salty foods and drinks only small
a serious and a life-threatening amount of water. But now, he
condition that needs an immediate understands the importance of
medical intervention. He started sodium intake restriction. The patient
taking pharmacologic treatments adheres to his medication therapy
such as ketoanalogue, metolazone, because he believes that taking those
folic acid, sodium bicarbonate and drugs will help him to cure his illness
terraferrol to treat his illness. and alleviate his pain.
Nutrition and metabolism
Pattern of food and fluid intake relative to metabolic needs. The adequacy of
local nutrients supplies is evaluated.
Prior to his illness, he was 60 After patients admission, his
kilograms with a height of 161 physician prescribed him
centimeters. Currently he weighs 56 maintenance medicines, these are
kilograms. Patient eats a meal thrice ketoanalogue (Ketobest), Sodium
in a day with no difficulty in Bicarbonate, Ferrous Sulfate + Folic
swallowing and chewing food. He has Acid + Multivitamins, Folic Acid,
good appetite and is able to eat whole Metolazone and Eposino. The patient
share of meal with 2 cups of rice and was also encourage to take more of
a viand. He eats vegetables every day calcium and vitamin D to make him
and eats fruits regularly. He likes to stronger and because his calcium
eat humba, pinakbet and fried levels is low. Also, the patient doesnt
chicken and doesnt have any food drink any alcoholic beverages and
dislikes. He drinks 3-4 glasses of follows physicians advises. In
water in day usually after every meal addition, there is a recent change in
with no difficulties in drinking. When his appetite and often eats a little on
he found out his illness, he was each meal.
prohibited to eat meats and salty
foods. Also, his water intake is strictly
monitored. The doctor advised him to
consume only 3-5 glasses of water in
day because he has excess fluid in his
body and this caused him to lose 4
kilograms in just 3 months. In
addition, he only eats fresh-water fish
and select foods carefully. Sometimes
he cheats in his dietary restrictions by
eating dried fish. Patient stated that
he has no known food allergies and
takes Terraferrol, a multivitamins with
iron for his daily supplement.
Elimination Pattern
Excretory pattern (GI,GU and Skin). Incontinence, constipation, diarrhea and

urinary retention may be identified.
When asked about urine and bowel The patient can freely go to the
elimination, patient stated that he comfort room to void or defecate. He
urinates 3-4 times in a day with a has no musculoskeletal deficits that
yellowish urine in minimal amount limits his movements. There is no
with no pain and presence of blood. burning sensation during urination
Until time came that he had difficulty unlike before that each time he
in urinating and pain had felt in his urinates he experiences severe pain
right ileac crest. Also, there was and notes presence of blood. In
presence of blood in his urine which addition, he experiences nocturia. His
made him concern and seek stool is brownish and formed. Also, he
healthcare approach. He defecates verbalized that he constantly suffers
once in day usually at morning with a constipation. Furthermore, edema is
brown, firmed and smooth stool with still present and evident on both legs
no pain and presence of blood. and feet but is already non-pitting.
Sometimes, he experience
constipation and intervene it by eating
high fiber food such as papaya.
Activity-Exercise Pattern
Activities of Daily Living(ADLs) requiring energy expenditure including self-

care activities. Assess major body system involved with the activity and
exercise including respiratory,cardiovascular, and musculoskeletal syatems.
During assessment, patient verbalized The patient is still restricted to do
that his activities of daily living had strenuous activities. Every day, he
change when he had his illness. He still does his walking exercise. He
was just staying at home for whole day doesnt feel any pain in any area of his
to rest and sleep. He was advised by bones and muscles. He has full range
his children to stop working due to his of motion and able to move freely with
present illness. Also, he was no assistance.
prohibited to go anywhere unless for
spiritual purposes like attending a
mass. Patient has no musculoskeletal
deficits, he can sit, walk and stand
without intolerance and assistance
from his significant others. He also
began exercising by walking everyday
early in the morning for 30 minutes.
Sleep-Rest Pattern Sleep
Rest and relaxation practices. Dysfunctional sleep patterns and fatigue may
be identified
Patient verbalized that nothing had The patient is able to sleep well with
change in his sleep and rest pattern 6-8 hours every night. He doesnt have
when he have his condition. He is able any complaints regarding his rest and
to sleep well and position himself sleep. No complaints of chest pain and
comfortably in a continuous manner. laboured breathing. He can change
He is able to sleep for 6-8 hours with positions comfortably. The client
no difficulty in going to sleep. His usually stays in bed and reads
earliest time in going to bed is 9 newspapers sometimes. This is also
oclock in the evening and his latest his way to promote sleep. Also he
time in waking up is at 5 oclock in the takes a 2-3 hours nap in the
morning. Sometimes he awakes at 3 afternoon.
oclock with no known reason and he
cant go back to sleep anymore. Also,
He didnt experience having an
insomnia or any problems concerning
with his sleep. His method to promote
sleep is through watching a TV. HE
doesnt take any medications to
induce sleep. During his
hospitalizations, he saw white light
and perceives it as a sign from heaven,
and this made him cry and lose hope
to overcome his medical condition.
Cognitive-Perceptual Pattern
Ability to comprehend ad use information. Assess sensory functions. Sensory

experience such as pain and altered sensory input may be identified and
evaluated.
During assessment, patient is At present the patient can correctly
conscious and coherent. He is hear, smell, taste and feel well. But
oriented to people, time and place. now, he cannot read newspapers
Also, He is able to answer our without his reading eyeglasses. He
questions appropriately. Patient is a speaks slowly when answering our
50 year old male. He can recall past questions and sometimes asks us to
events such as when he had his repeat it. He can communicate well,
elementary graduation. Also he is able and has no speech problems. He is
to recall what happened to him during able to understand questions and
his illness in a clear statements. instructions. Also, the patient still
Patient stated that he had only finish experiences slight pain in his incision
his secondary level which is high site but not as painful like before. This
school. Patient is able to read and precipitates when he eats salty food.
write simple and complex sentences.
He has no sensory deficits. During his
illness, he experienced severe pain
with pain scale of 10 over 10 but after
some surgical and pharmacological
interventions, this was relieve. At the
present, whenever the weather is cold,
he experience pain in his surgical site
with pain scale of 5 over 10, and he
manage this by wearing jacket and
thick blankets to cover his body.
Role-Relationship Pattern
Roles in the world and other relationships. Satisfaction with roles, role strain,
or dysfunctional relationship may be further evaluated.
During assessment he appeared calm The patient still lives with his wife. He
and relax. He perceives himself as old is very thankful with his children
and ill. His major concern is his because they support him in coping
medical condition and dietary his current condition. His family
restrictions. Also he desires to recover especially his grandchildren gives
soon and regain his fully functioning happiness in his life. They serve as his
health. inspiration. He is also glad that his
Patient is married to Mrs. T who grandchildren visits him frequently.
assisted him during his He considers his place as not-so safe
hospitalizations and takes care of him home environment for they are prone
at the present. They are still living to vehicular accidents because they
together in their own house with a live near the highway. Also patient is
good husband and wife relationship. still the Purok leader of their place and
They are blessed with five children somehow, this is one of the reasons
and all of them are married and stable that boosts his self-esteem and
in life. enables him to do his tasks in their
place and that his illness wont be a
hindrance.
Sexuality-Reproductive Pattern
Satisfaction/dissatisfaction with sexual patterns and reproductive functions.

Concerns with sexuality may be identified.
Patient is married and he doesnt have Patient have no concerns about his
any problems regarding with his sexuality and believes that it doesnt
sexuality. He didnt experience any interfere with his illness. He also
identity crisis in his teenage years. He
also stated that he was satisfied with believes that they are already too old
his sexual relationship. Before, they to have sexual activity.
use family planning method such as
pills and condom to control and for
proper spacing of years of their
children.
Coping-Stress Tolerance Pattern
When asked about coping mechanism The patient believes that the support
and how he manage the stress in his and love of his family is the main
life, he stated that he talks with his reason why he is coping with his
wife and verbalized his feelings. He illness. He feels that he is well loved by
prays to God more often when he had his family. The patient also admitted
his illness. Also, by taking enough rest that having an illness is considered to
and sleep to reduce the pain. be his main stressor now. It gives him
and his family financial distress due to
the maintenance of his medicines.
Value-Belief Pattern
Patient is a Roman Catholic. He The patient still have a big faith and
believes in God and have a strong faith hope in God. He believes that God has
in him. He stated that he serve in a purpose behind everything and he is
church by being a member of Alagad willing to accept Gods will. Also he
sa Dios for 10 years. His medical believes that God will not give you
condition made him to draw more problems that you cannot solve.
close to God. He often pray and goes
church to ask help from God and to
give him hope and cure his illness. He
doesnt have any problems regarding
his values and beliefs in life.
Laboratory and Diagnostics
HEMATOLOGY (09-19-17)
LABORATO CLIENT NORMAL INTERPRETAT NURSING

RY RESUL VALUES ION RESPONSIBILI
TS TIES
Hematocrit 31.9% 42-50% Indicates Encouraged

nutritional patient to
deficiencies, increase oral
blood loss, fluid intake, eat
anemia and nutritious foods
bone marrow especially foods
suppression. that are rich in
iron and
vitamin C such
as green leafy
vegetables,
liver, eggs and
meat product.
Hemoglobi 10.5g/ 14- Indicates Instructed
n dL 18g/dL nutritional patient to
deficiencies, comply with
blood loss, medication
anemia, renal regimen and
problems and take iron and
bone marrow multivitamin
suppression. supplements as
prescribed by
the doctor
Red blood 3.72 4.5- Indicates Encouraged
cells 5.9x10^12 anemia, blood patient to
/L loss and increase oral
nutritional fluid intake, eat
deficiencies nutritious foods
especially foods
that are rich in
iron and
vitamin C such
as green leafy
vegetables,
liver, eggs and
meat product.
White 15.3 5.0- Indicates Emphasized the
blood cells 10.0x10^9 bacterial importance of
/L infection or proper hand
inflammatory washing,
disease proper hygiene,
proper
nutrition and
increase in oral
fluid intake.
Instructed not
to share
personal care
items such as
toothbrushes,
washcloths,
and towels.
Described the
rationale of how
infections can
be transmitted
from shared
personal items.
Neutrophils 78 55-65% Indicates Instructed to
neutrophilia concentrate on
that can be a good nutrition
sign for and fluid
infection. intake.
Balanced diet
that includes
grains, fruits,
vegetables, and
controlled
quantities of fat
and protein
promote good
health and help
resist infection.
Fluid intake
should also
include 6 to 8
glasses of water
daily.
Lymphocyt 16 25-35% Within normal Encouraged
es range patient to
perform at least
15 minutes
exercise every
day. This can
include activity
as simple as
range-of-
motion.
Monocytes 05 2-10% Within normal Emphasized the
range importance of
keeping the
home sanitary,
including daily
trash removal,
disinfection of
kitchen and
bathroom
surfaces, and
regular
laundering of
clothes,
household and
bed linens.
Eosinophils 01 0-5% Within normal Instructed
range patient to avoid
raw or
unpasteurized
dairy products,
and raw or
uncooked meat.
Basophils 0 0-1% Within normal Emphasized the
range importance to
avoid crowds,
visitors, or
family members
that have a
contagious or
potentially
contagious
conditions.
Platelet 416 150- Within normal Instructed
counts 450x10^9 range patient on the
/L most effective
way of
preventing
infections
which is
frequent hand
washing, this is
the first line of
defence. Hands
may spread
hundreds of
microorganisms
to our clothes,
meals,
environment
and skin.
CLINICAL CHEMISTRY (09-19-17)

LABORATORY CLIENT NORMAL INTERPRETATION NURSING
RESULTS VALUES RESPONSIBILITIES
Creatinine 4.10 0.9- Indicates renal Instructed to limit
1.5mg/dL dysfunction/problems intake of processed
foods such as:
frozen dinners and
packaged meals,
canned fish and
meats, pickled
foods, salted
snacks, lunch
meats, sauces,
most cheeses and
fast foods.
Blood uric 5.58 3.4- Within normal range Encouraged patien
acid 7.0mg/dL to eat unprocessed
foods to lower
sodium, such as:
fresh turkey and
chicken, lean beef,
unsalted tuna,
fresh fish, fresh
vegetables and
fruits.
SGPT 62.23 3-35U/L Indicates liver Emphasized the
problems importance of not
using salt
substitutes that
are high in
potassium,
avoidance of
drinking softened
water because of
the sodium
content.
URINALYSIS (09-19-17)

Color yellow Light- Within normal Discussed the
dark range importance of
yellow increasing oral
fluid intake to
promote urine
production and
output.
Transparency hazy Clear May indicate Instructed patient
infection. on the most
effective way of
preventing
infections which is
frequent hand
washing, this is the
first line of defence.
Hands may spread
hundreds of
microorganisms to
our clothes, meals,
environment and
skin.
Glucose 1+ (-) Indicates that the Discussed to the
blood glucose patient the
level are too high importance in
minimizing sugar
intake as well as
sodium intake.
Protein 3+ (-) Indicate urinary Informed the
tract infection, importance of
inflammation, maintaining
malignancies and sufficient fluid
any other intake to promote
disorders that urine production
destroy red blood and output. This
cells helps flush the
microorganisms
present in the
bladder and
urethra.
Specific 1.015 1.010- Within normal Encouraged to take
Gravity 1.130 range medicines exactly
as directed and get
plenty of rest and
get more sleep at
night.
pH 6.5 4.5-8.0 Within normal Informed patient
range about the
importance in
limiting sodium
intake and
increasing oral
fluid intake to
maintain the pH
level of urine.
Pus cells 15-17 0-4/hpf Indicates urinary Discussed to the
tract infection patient the
relationship
between hygiene,
rest, activity, and
nutrition in the
chain of infection.
Red Blood 4-5 0-4/hpf Indicates Informed the
cells presence of importance of
hematuria that maintaining
usually happens sufficient fluid
when there is an intake to promote
injury in the urine production
urinary tract, and output. This
kidney problems helps flush the
and trauma microorganisms
present in the
bladder and
urethra.
Epithelial Moderate few Indicates Instructed to do
cells presence of proper hand
infections, hygiene (before
inflammations, handling foods,
and malignancies. before eating, after
toileting, before
and after any
required home care
treatment, and
after touching body
substances such
as wound drainage)
and related
hygienic measures
to all family
members.
Bacteria Moderate none Indicates infection Suggested
techniques for safe
food preservation
and preparation
(wash raw fruits
and vegetables
before eating them,
refrigerate all
opened and
unpackaged foods)
HEMATOLOGY (10-24-17)
LABORAT CLIENT NORMAL INTERPRETATION NURSING

ORY RESULTS VALUES RESPONSIBILITIES
Hematocr 33.5% 42-50% Indicates Encouraged patient

it nutritional to increase oral
deficiencies, blood fluid intake, eat
loss, anemia and nutritious foods
bone marrow especially foods
suppression. that are rich in iron
and vitamin C such
as green leafy
vegetables, liver,
eggs and meat
product.
Hemoglob 10.7g/dL 14-18g/dL Indicates Instructed patient
in nutritional to comply with
deficiencies, blood medication regimen
loss, anemia, and take iron and
renal problems multivitamin
and bone marrow supplements as
suppression. prescribed by the
doctor
Red blood 3.75 4.5- Indicates anemia, Encouraged patient
cells 5.9x10^12 blood loss and to increase oral
/L nutritional fluid intake, eat
deficiencies nutritious foods
especially foods
that are rich in iron
and vitamin C such
as green leafy
vegetables, liver,
eggs and meat
product.
White 8.3 5.0- Within normal Emphasized the
blood 10.0x10^9 range importance of hand
cells /L washing, proper
hygiene, proper
nutrition and
increase in oral
fluid intake.
Instructed not to
share personal care
items such as
toothbrushes,
washcloths, and
towels. Described
the rationale of how
infections can be
transmitted from
shared personal
items.
Neutrophi 69 55-65% Indicates Instructed to
ls neutrophilia that concentrate on
good nutrition and
can be a sign for fluid intake.
infection. Balanced diet that
includes grains,
fruits, vegetables,
and controlled
quantities of fat
and protein
promote good
health and help
resist infection.
Your fluid intake
should also include
6 to 8 glasses of
water daily.
Lymphocy 22 25-35% Within normal Encouraged patient
tes range to perform at least
15 minutes
exercise every day.
This can include
activity as simple
as range-of-motion.
Monocyte 08 2-10% Within normal Emphasized the
s range importance of
keeping the home
sanitary, including
daily trash
removal,
disinfection of
kitchen and
bathroom surfaces,
and regular
laundering of
clothes, household
and bed linens.
Eosinophi 01 0-5% Within normal Instructed patient
ls range to avoid raw or
unpasteurized
dairy products, and
raw or uncooked
meat.
Basophils 0 0-1% Within normal Emphasized the
range importance to avoid
crowds, visitors, or
family members
that have a
contagious or
potentially
contagious
conditions.
Platelet 278 150- Within normal Instructed patient
counts 450x10^9/ range on the most
L effective way of
preventing
infections which is
frequent hand
Hands may spread
hundreds of
microorganisms to
our clothes, meals,
environment and
skin.
CLINICAL CHEMISTRY (10-24-17)

Creatinine 3.16 0.9- Indicates renal Instructed to limit
1.5mg/dL dysfunction/problems intake of processed
foods such as:
frozen dinners and
packaged meals,
canned fish and
meats, pickled
foods, salted
snacks, lunch
meats, sauces,
most cheeses and
fast foods.
Electrolytes 133.6 135-145 Hyponatremia Instructed patient
Sodium mmol/L to limit fluid
intake. Drink only
the amounts
directed by the
physician.
Encouraged to take
all the medicines
exactly as directed.
Certain medicines
can lower blood
sodium levels.
Potassium 4.20 3.5-5.5 Within normal range Instructed to limit
mmol/L processed foods
such as: frozen
dinners and
packaged meals,
canned fish and
meats, pickled
foods, salted
snacks, lunch
meats, sauces,
most cheeses and
fast foods including
Balanced diet that
includes grains,
fruits, vegetables,
and controlled
quantities of fat
and protein
promote good
health and help
resist infection.
Your fluid intake
should also include
6 to 8 glasses of
water daily.
Ionized 1.1-1.4 Indicates Instructed patient
Calcium mmol/L hypocalcemia to take calcium,
vitamin D, or
magnesium
supplements as
prescribed.
Encouraged to eat
foods rich in
calcium and spend
time in the sun to
help increase
vitamin D level.
Total Calcium 2.2-2.9 Indicates Instructed patient
mmol/L hypocalcemia to take calcium,
vitamin D, or
magnesium
supplements as
prescribed.
Encouraged to eat
foods rich in
calcium and spend
time in the sun to
help increase
vitamin D level.
URINALYSIS (10-24-17)

Color Light Light- Within normal Discussed the
yellow dark range importance of
yellow increasing oral
fluid intake to
promote urine
production and
output.
Transparency Hazy Clear Indicates Instructed patient
infection. on the most
effective way of
preventing
infections which is
frequent hand
Hands may spread
hundreds of
microorganisms to
our clothes, meals,
environment and
skin.
Glucose (-) (-) Within normal Discussed to the
range patient the
importance to
minimize sugar
intake as well as
sodium intake.
Protein 3+ (-) Indicates urinary Informed the
tract infection, importance of
inflammation, maintain sufficient
malignancies and fluid intake to
any other promote urine
disorders that production and
destroy red blood output. This helps
cells flush the
microorganisms
present in bladder
and urethra.
Specific 1.015 1.010- Within normal Encouraged to take
Gravity 1.130 range medicines exactly
as directed and get
plenty of rest and
get more sleep at
night.
pH 6.0 4.5-8.0 Within normal Informed patient
range about the
importance in
limiting sodium
intake and
increasing oral
fluid intake to
maintain the pH
level of urine
Pus cells 10-12 0-4/hpf Indicates urinary Discussed to the
tract infection patient the
relationship
between hygiene,
rest, activity, and
nutrition in the
chain of infection.
Red Blood 1-3 0-4/hpf Within normal Informed the
cells range importance of
maintaining
sufficient fluid
intake to promote
urine production
and output. This
helps flush the
microorganisms
present in bladder
and urethra.
Epithelial Rare few Indicates Instructed proper
cells presence of hand hygiene
infections, (before handling
inflammations, foods, before
and malignancies. eating, after
toileting, before
and after any
required home care
treatment, and
after touching body
substances such
as wound drainage)
and related
hygienic measures
to all family
members
Bacteria Few none Indicates infection Suggested
techniques for safe
food preservation
and preparation
(wash raw fruits
and vegetables
before eating them,
refrigerate all
opened and
unpackaged foods)
RESULTS OF DIAGNOSTIC PROCEDURE
Diagnostic Clients result Nursing Responsibilities

Procedures (Impression)
Chronic Renal Instructed patient to practice
UTRASOUND Parenchymal healthy diet and proper exercise
Disease, to improve blood circulation to
Bilateral prevent infection and
cardiovascular diseases.
Encouraged patient to eat
unprocessed foods to lower
sodium, such as: fresh turkey
and chicken, lean beef, unsalted
tuna, fresh fish, fresh vegetables
and fruits.
Paracalyceal Instructed to limit processed
Cyst, Right foods such as: frozen dinners
and packaged meals, canned
fish and meats, pickled foods,
salted snacks, lunch meats,
sauces, most cheeses and fast
foods. Emphasized the
importance of not using salt
substitutes that are high in
potassium, avoidance of
drinking softened water,
because of the sodium content.
Partially Filled Informed the importance of
Urinary Bladder maintaining sufficient fluid
intake to promote urine
production and output. This
helps flush the microorganisms
in the bladder and urethra.
Drug Study
DRUG CLASSIFICATION MECHANISM OF SIDE ADVERSE NURSING

ACTION EFFECTS EFFECTS RESPONSIBILITY
GENERIC THERAPEUTIC Short acting, Frequent GI: Belching, 1. Be aware that long term
NAME: CLASSIFICATION: potent systemic urge to gastric use of oral preparation
Sodium Antacid antacid. Rapidly urinate, distention, with milk or calcium can
Bicarbonate neutralizes gastric headache, flatulence cause milk-alkali
BRAND acid to form loss of Metabolic: syndrome: anorexia, renal
NAME: PHARMACOLOGIC sodium chloride, appetite, metabolic insufficiency, nausea,
CLASSIFICATION: carbon dioxide mood and alkalosis, vomiting, headache,
Alkalinizers and water. This mental electrolyte mental confusion,
DOSE, buffers excess changes, imbalance, hypercalcemia, soft tissue
TIMING, hydrogen ion unpleasant sodium calcification,renal and
ROUTE: concentration and taste, overload ureteral calculi, metabolic
650 mg 1 raises blood pH, increased (pulmonary alkalosis.
tablet BID thereby reversing thirst and edema), 2. Symptoms of fluid
the clinical stomach hypocalcemia overload should be
manifestation of cramps (tetany), reported such as
acidosis. It is also hypokalemia, hypertension, edema,
a urinary milk-alkali difficulty f breathing or
alkalizer, syndrome, dyspnea, rales or crackles
increasing the dehydration and frothy sputum
excretion of free GU: renal 3. Signs of acidosis
bicarbonate ions calculi or should be assessed such
in the urine, thus crystals, as disorientation,
effectively raising impaired headache, weakness,
the urinary pH.
By maintaining kidney dyspnea and
the alkaline urine, function hyperventilation
the actual CNS: tetany 4. Assess for alkalosis by
dissolution of uric CV: edema monitoring the client for
acid stones may SKIN: pain confusion, irritability,
be accomplish. and irritation paresthesia, tetany, and
at injection altered breathing pattern
site 5. Tablets must be taken
with a full glass of water
6. Hypernatremia clinical
manifestations should be
assessed and monitored
which includes: edema,
weight gain, hypertension,
tachycardia, fever, flushed
skin and mental
irritability.
7. Hypokalemia should
also be assessed by
monitoring signs and
symptoms such as:
weakness, fatigue, U wave
on ECG, arrhythmias,
polyuria and polydipsia
GENERIC THERAPEUTIC Ketobest allows the No known Hematologic: 1. Ketobest should be
NAME: CLASSIFICATION: intake of essential side Hypercalcemia taken during meals to
Ketoanalogue Nutritional amino acids while effects and allow proper absorption
Supplements minimizing the abnormalityin and metabolism into
amino-nitrogen serum the corresponding
BRAND intake. Following albumin level amino acids.
NAME: ingestion, the 2. Serum calcium level
Ketobest ketoanalogues are should be monitored
transaminated by regularly.
taking nitrogen from 3. Ensure that the
DOSE, non-essential amino patient has a proper
TIMING, acids, thereby supply of calories.
ROUTE decreasing the 4. Assess allergy to the
600 mg 1 formation of urea by drugs
tablet TID reusing the amino 5. Caution patient to
group. The levels of different side effects
accumulating 6. Instruct patient to
uremic toxins are report immediately if
decreased. Ketoacid- symptoms of
containing hypercalcemia occurs
supplements have a like muscle weakness
positive influence in and constipation.
the renal
hyperphosphatemia
and secondary
hyperparathyroidism
and can improve
renal
osteodystrophy. The
use of ketobest in
association with a
very low protein diet
allows reduced
intake of nitrogen
while avoiding the
deleterious
consequences of
inadequate dietary
protein intake and
malnourishment.
GENERIC THERAPEUTIC Vitamin B complex Abdominal Skin: Rash 1. May be taken with or
NAME: CLASSIFICATION: essential for cramps, CNS: sleep without food
Folic Acid Vitamin B9 nucleoprotein diarrhea, disorders, 2. Monitor patient for
synthesis and stomach irritability, hypersensitivity
maintenance of upset confusion, 3. Caution should be
BRAND normal seizures, exercised in patients with
NAME: erythropoiesis. excitability. history of long-term
Foliage Acts against folic infection, seizure disorder,
acid deficiency liver problems and kidney
that impairs dialysis.
DOSE, thymidylate
TIMING, synthesis and
ROUTE production of
1 capsule defective DNA that
OD leads to
megaloblast
formation and
arrest of bone
marrow
maturation.
GENERIC THERAPEUTIC Metoz is a Abdominal Allergy 1. Observe patient for
NAME: CLASSIFICATION: quinazoline pain, reactions: severe allergic reaction:
Metolazone Diuretics diuretic, with blurred Rash, hives, trouble breathing,
properties vision, itching, swelling on throat and
generally similar constipation, raised welts, tongue and hives
BRAND to the thiazide diarrhea, facial 2. Instruct patient not to
NAME: diuretics. Its dry mouth, swelling, drink alcoholic beverages
Metoz PHARMACOLOGIC action results headache fever, while taking metolazone,
CLASSIFICATION: from interference difficulty this can increase risk of
Thiazide-like with the renal breathing, orthostatic hypotension
DOSE, diuretics tubular peeling or 3. Close monitoring of
TIMING, mechanism of blistering kidney function is
ROUTE: electrolyte skin. necessary while taking
5 mg 1 reabsorption. It Heart this medication.
tablet OD acts primarily to problems: Appropriate dose
every inhibit sodium Irregular adjustments should be
morning reabsorption at heartbeat, done based on the renal
PRN for the cortical chest pain. function of the patient.
edema diluting site and Liver
to a lesser extent problems:
in the proximal Yellowing or
convoluted whites of
tubule. The eyes or skin,
increased delivery weakness or
of sodium to the tiredness,
distal tubular nausea,
exchanged site vomiting
results in Nerve
increased problems:
potassium Muscle pain
excretion. or cramps,
numbness
on hands
and feet
GENERIC THERAPEUTIC Terraferron refers orthostatic Allergic 1. Monitor blood
NAME: CLASSIFICATION: to a group of hypotension sensitization, studies of patient
FeSO4+FA+MV Nutritional water-soluble and angina 30 CNS: 2. Caution patient
supplements vitamins. It has minutes after paresthesia, to make position
high biological administration somnolence, changes slowly to
BRAND NAME: activity. due to reflex nausea, minimize
Terraferron Terraferron is tachycardia headaches orthostatic
necessary for Respiratory: hypotension
normal nasal 3. Instruct patient
DOSE, hematopoiesis congestion, to avoid
TIMING, (promotes dyspnea concurrent use of
ROUTE: maturation of Cardiovascular: alcohol or OTC
200/400 1 erythrocytes). CHF medicine without
capsule BID 2 Involved in the Musculoskeletal: consulting the
hours after processes of muscle cramps, physician
meals transmethylation, flushing 4. Advise patient
hydrogen to consult
transport, physician if
synthesis of irregular
methionine, heartbeat,
nucleic acids, dyspnea, swelling
choline, cteatine. on hands and feet
Contributes to and hypotension
the ccumulation occurs
in erythrocytes of
compounds 5. Inform patient
containing that angina
sulfhydryl attacks may occur
groups. Has a 30 min. after
beneficial effect administration
on liver function due to reflex
and the nervous tachycardia
system. Activates 6. Instruct patient
the coagulation of to take with a full
blood in high glass of water
doses causes an 7. Encourage
increase in the patient to avoid
activity of using antacids,
thromboplastin coffee, tea, dairy
and prothrombin. products within 1
hour after
8. Inform patient
about dark, green,
or black stools to
avoid panick
DRUG CLASSIFICATION MECHANISM SIDE ADVERSE NURSING
OF ACTION EFFECTS EFFECTS RESPONSIBILITY
GENERIC THERAPEUTIC For the Headache, Allergic reactions 1. During the
NAME: CLASSIFICATION: treatment of low fever such as: skin treatment with
Epoetin Alfa Colony stimulating anemia, and rashes or Epoetin Alfa, the
factors especially in fatigue, urticarial, allergic haematocrit should
renal anemia muscle shock. be checked regularly
BRAND NAME: resulting from pain, CV:Hypertension, (once a week at the
Eposino renal function arthralgia, CNS: disturbance early stage and once
PHARMACOLOGIC insufficiency, nausea, of consciousness, every two weeks in
CLASSIFICATION: including vomiting, convulsion, maintenance period).
DOSE, TIMING, Recombinant hemodialysis anorexia, encephalorrhagia, The haematocrit
ROUTE: human and non- diarrhea GI: hepatic should be
2,000 units erythropoetins hemodialysis of function maintained under
injection once a chronic renal impairment. GOP 30vol% to avoid the
week failure. and GPT may formation of
subcutaneously rise. extraordinary
Mimics effects erythropoiesis.
of Should
erythropoietin. erythropoiesis
Functions as happen, suitable
growth factor treatment shall be
and as a taken such as
differentiating temporary stopping
factor, use of Epoetin Alfa.
enhancing RBC 2. Hyperkalemia may
production. appear during the
course of treatment,
diet should be
adjusted or the drug
should be stopped for
use when
hyperkalemia occurs
until the normal level
is recovered.
3. For aged patients
with complications of
hypertension or
circulation system
disease because of
hypo-function, when
Epoetin Alfa is used,
the blood pressure
and haematocrit
should be monitored
frequently, and the
dosage and times of
administration
should be adjusted
accordingly.
4. During the
treatment with
Recombinant Human
Erythropoietin Alfa,
iron concentration in
serum usually
decreases. Therefore
it is necessary to
provide iron to meet
the body needs. If
serum ferric
concentration is less
than 100mg/mL or
the transfer in
saturation falls below
20% daily
ferrotherapy should
be adopted
5. Folic and Vitamin
B12 insufficiency and
ultra-high aluminium
may reduce efficacy
of EPOSINO
6. The drug should
be used carefully for
the patients with
myocardial infarction
or to pulmonary
infarction or those
with allergic history
and tendency.

GENERIC THERAPEUTIC Angiotensin II Oliguria, CNS: 1. Avoid give first dose at
NAME: CLASSIFICATION: receptor blocker. It Nausea, asthenia, night due to increase
Losartan Antihypertensive competitively Vomiting, fatigue, hypotensive risk
blocks the AT1 Headache, insomnia, 2. Monitor blood pressure
BRAND PHARMACOLOGIC receptor where Dizziness, neutropenia and pulse frequently
NAME: CLASSIFICATION: angiotensin II is Diarrhea CV: 3. Enquire the complete
Cozaar Angiotensin II attached and Hypotension, health history of the
receptor initiates its edema, chest patient especially any renal
DOSE, antagonist biological actions. pain disease
TIMING, This blockage EENT: nasal 4. Check patient for
ROUTE directly causes congestion, angioedema
1 capsule vasodilation and sinusitis, 5. Monitor electrolytes
OD aldosterone. This pharyngitis, especially sodium and
actions reduces sinus disorder potassium levels, uric acid
Blood Pressure. GI: abdominal levels and CBC
pain, 6. Instruct patient to avoid
dyspepsia potassium rich diet and
Respiratory: supplements when taking
cough, upper losartan
respiratory 7. Inform patient the signs
infection and symptoms of
Hematology: hypotension
Hyperkalemia, 8. Instruct patient to
Leukopenia increase oral fluid intake.
GU: abnormal
hepatic
function,
acute renal
function
Urinary System Anatomy and Physiology
Figure 2
The urinary system, also known as the renal system, consists of
the kidneys, ureters, bladder, and the urethra. Each kidney consists of
millions of functional units called nephrons. The purpose of the renal
system is to eliminate wastes from the body, regulate blood volume and
blood pressure, control levels of electrolytes and metabolites, and
regulate blood pH. The kidneys have an extensive blood supply via the
renal arteries which leave the kidneys via the renal vein. Following
filtration of blood and further processing, wastes (in the form of urine)
exit the kidney via the ureters, tubes made of smooth muscle fibers that
propel urine towards the urinary bladder, where it is stored and
subsequently expelled from the body by urination (voiding). The female

and male urinary system is very similar, differing only in the length of
the urethra.
Urine is formed in the kidneys through a filtration of blood. The
urine is then passed through the ureters to the bladder, where it is
stored. During urination, the urine is passed from the bladder through
the urethra to the outside of the body.
Kidneys
Figure 3
The kidneys are a pair of bean-shaped organs found along the
posterior wall of the abdominal cavity. The left kidney is located slightly
higher than the right kidney because the right side of the liver is much
larger than the left side. The kidneys, unlike the other organs of the
abdominal cavity, are located posterior to the peritoneum and touch the
muscles of the back. The kidneys are surrounded by a layer of adipose
that holds them in place and protects them from physical damage. The
kidneys filter metabolic wastes, excess ions, and chemicals from the
blood to form urine.
Ureters
The ureters are a pair of tubes that carry urine from the kidneys to
the urinary bladder. The ureters are about 10 to 12 inches long and run
on the left and right sides of the body parallel to the vertebral column.
Gravity and peristalsis of smooth muscle tissue in the walls of the
ureters move urine toward the urinary bladder. The ends of the ureters
extend slightly into the urinary bladder and are sealed at the point of
entry to the bladder by the ureterovesical valves. These valves prevent
urine from flowing back towards the kidneys.
Urinary Bladder
The urinary bladder is a sac-like hollow organ used for the storage
of urine. The urinary bladder is located along the bodys midline at the
inferior end of the pelvis. Urine entering the urinary bladder from the
ureters slowly fills the hollow space of the bladder and stretches its
elastic walls. The walls of the bladder allow it to stretch to hold anywhere
from 600 to 800 milliliters of urine.
Urethra
The urethra is the tube through which urine passes from the
bladder to the exterior of the body. The female urethra is around 2
inches long and ends inferior to the clitoris and superior to the vaginal
opening. In males, the urethra is around 8 to 10 inches long and ends at
the tip of the penis. The urethra is also an organ of the male reproductive
system as it carries sperm out of the body through the penis.
The flow of urine through the urethra is controlled by the internal and
external urethral sphincter muscles. The internal urethral sphincter is
made of smooth muscle and opens involuntarily when the bladder
reaches a certain set level of distention. The opening of the internal
sphincter results in the sensation of needing to urinate. The external
urethral sphincter is made of skeletal muscle and may be opened to
allow urine to pass through the urethra or may be held closed to delay
urination.
Urinary System Physiology
Maintenance of Homeostasis
The kidneys maintain the homeostasis of several important internal
conditions by controlling the excretion of substances out of the body.
Ions. The kidney can control the excretion of potassium, sodium,
calcium, magnesium, phosphate, and chloride ions into urine. In
cases where these ions reach a higher than normal concentration,

the kidneys can increase their excretion out of the body to return
them to a normal level. Conversely, the kidneys can conserve these
ions when they are present in lower than normal levels by allowing
the ions to be reabsorbed into the blood during filtration. (See more
about ions.)
pH. The kidneys monitor and regulate the levels of hydrogen ions
(H+) and bicarbonate ions in the blood to control blood pH. H+ ions
are produced as a natural byproduct of the metabolism of dietary
proteins and accumulate in the blood over time. The kidneys
excrete excess H+ ions into urine for elimination from the body.
The kidneys also conserve bicarbonate ions, which act as
important pH buffers in the blood.
Osmolarity. The cells of the body need to grow in an isotonic
environment in order to maintain their fluid and electrolyte
balance. The kidneys maintain the bodys osmotic balance by
controlling the amount of water that is filtered out of the blood and
excreted into urine. When a person consumes a large amount of
water, the kidneys reduce their reabsorption of water to allow the
excess water to be excreted in urine. This results in the production
of dilute, watery urine. In the case of the body being dehydrated,
the kidneys reabsorb as much water as possible back into the

blood to produce highly concentrated urine full of excreted ions
and wastes. The changes in excretion of water are controlled by
antidiuretic hormone (ADH). ADH is produced in the hypothalamus
and released by the posterior pituitary gland to help the body
retain water.
Blood Pressure. The kidneys monitor the bodys blood pressure to
help maintain homeostasis. When blood pressure is elevated, the
kidneys can help to reduce blood pressure by reducing the volume
of blood in the body. The kidneys are able to reduce blood volume
by reducing the reabsorption of water into the blood and producing
watery, dilute urine. When blood pressure becomes too low, the
kidneys can produce the enzyme renin to constrict blood vessels
and produce concentrated urine, which allows more water to
remain in the blood.
Filtration
Inside each kidney are around a million tiny structures called nephrons.
The nephron is the functional unit of the kidney that filters blood to
produce urine. Arterioles in the kidneys deliver blood to a bundle of
capillaries surrounded by a capsule called a glomerulus. As blood flows
through the glomerulus, much of the bloods plasma is pushed out of the
capillaries and into the capsule, leaving the blood cells and a small
amount of plasma to continue flowing through the capillaries. The liquid
filtrate in the capsule flows through a series of tubules lined with filtering
cells and surrounded by capillaries. The cells surrounding the tubules
selectively absorb water and substances from the filtrate in the tubule
and return it to the blood in the capillaries. At the same time, waste
products present in the blood are secreted into the filtrate. By the end of
this process, the filtrate in the tubule has become urine containing only
water, waste products, and excess ions. The blood exiting the capillaries
has reabsorbed all of the nutrients along with most of the water and ions
that the body needs to function.
Storage and Excretion of Wastes
After urine has been produced by the kidneys, it is transported through
the ureters to the urinary bladder. The urinary bladder fills with urine
and stores it until the body is ready for its excretion. When the volume of
the urinary bladder reaches anywhere from 150 to 400 milliliters, its
walls begin to stretch and stretch receptors in its walls send signals to
the brain and spinal cord. These signals result in the relaxation of the
involuntary internal urethral sphincter and the sensation of needing to
urinate. Urination may be delayed as long as the bladder does not exceed
its maximum volume, but increasing nerve signals lead to greater
discomfort and desire to urinate.

Urination is the process of releasing urine from the urinary bladder
through the urethra and out of the body. The process of urination begins
when the muscles of the urethral sphincters relax, allowing urine to pass
through the urethra. At the same time that the sphincters relax, the
smooth muscle in the walls of the urinary bladder contract to expel urine
from the bladder.
Production of Hormones
The kidneys produce and interact with several hormones that are
involved in the control of systems outside of the urinary system.
Calcitriol. Calcitriol is the active form of vitamin D in the human
body. It is produced by the kidneys from precursor molecules
produced by UV radiation striking the skin. Calcitriol works
together with parathyroid hormone (PTH) to raise the level of
calcium ions in the bloodstream. When the level of calcium ions in
the blood drops below a threshold level, the parathyroid glands
release PTH, which in turn stimulates the kidneys to release
calcitriol. Calcitriol promotes the small intestine to absorb calcium
from food and deposit it into the bloodstream. It also stimulates
the osteoclasts of the skeletal system to break down bone matrix to
release calcium ions into the blood.

Erythropoietin. Erythropoietin, also known as EPO, is a hormone
that is produced by the kidneys to stimulate the production of red
blood cells. The kidneys monitor the condition of the blood that
passes through their capillaries, including the oxygen-carrying
capacity of the blood. When the blood becomes hypoxic, meaning
that it is carrying deficient levels of oxygen, cells lining the
capillaries begin producing EPO and release it into the
bloodstream. EPO travels through the blood to the red bone
marrow, where it stimulates hematopoietic cells to increase their
rate of red blood cell production. Red blood cells contain
hemoglobin, which greatly increases the bloods oxygen-carrying
capacity and effectively ends the hypoxic conditions.
Renin. Renin is not a hormone itself, but an enzyme that the
kidneys produce to start the renin-angiotensin system (RAS). The
RAS increases blood volume and blood pressure in response to low
blood pressure, blood loss, or dehydration. Renin is released into
the blood where it catalyzes angiotensinogen from the liver into
angiotensin I. Angiotensin I is further catalyzed by another enzyme
into Angiotensin II.
Angiotensin II stimulates several processes, including stimulating
the adrenal cortex to produce the hormone aldosterone.

Aldosterone then changes the function of the kidneys to increase
the reabsorption of water and sodium ions into the blood,
increasing blood volume and raising blood pressure. Negative
feedback from increased blood pressure finally turns off the RAS to
maintain healthy blood pressure levels.

PATHOPHYSIOLOGY OF CHRONIC KIDNEY DISEASE
- is a condition characterized by a gradual loss of kidney function over time.
Predisposing Factors
Precipitating Factors
Modifiable Non - Modifiable
- High-protein Diet - 60 years old
- High- salt Diet - Male
- Obstructive nephropathy - Family History of stones
- Low water intake
- Alcoholism
Uric acid, ammonia phosphate

Supersaturation of urine by stone
and calcium oxalate stone
forming constituents
material deposition on proximal
renal tubule
Formation of microscopic
crystalline structure Nephron calcinosis on proximal
tubule
Nidation of crystals or foreign

bodies from the supersaturated Randalls Plaque Low back
urine
pain
UTI caused by urea splitting

microorganism
Increased production of
WBC
Dysur
ia Accumulation of Progression of stone to Pyuric
stones loop of henle
Blood vessel wall surface Hematur

attraction ia
Protenur
Stone formation in kidney Decrease reabsorption of ia
protein
Increase size of stones in

kidney
Stone matric progression
Urinary calculus
Progression of calculus to
ureter
Increase size of stones in

the water
A
Obstruction in the ureter

Ureteral exploration,
Ureterolithiasis ureterolotothomy right
P/3rd
Obstructive neprhropathy
Activation of intrinsic
ureteral pacemakers A
Glomelular injury
Clinical chemistry
Increase proximal
Decreased glomelular - increase serum creatinine
peristalsis 4.10 (9/19/17)
filtration
- increase serum creatinine
3.16 (10/24/17)
Hypertrophy of remaining
Muscle spasm, local nephrons Loss of Na in the Hyponatremia
inflammation and urine
irritation and edema
Inability to concentrate Nocturia
at the site of Clinical chemistry
obstruction urine
- decrease Na 133.6
(10/26/17)
Further loss of nephron
Chemoreceptor activation
function
and stretching of
submucosal free nerve
endings Chronic Kidney Disease Loss of non- Failure to convert
excretory renal inactive form of
function calcium
B C D E F
Failure to produce
Anemia Decrease calcium
Abrupt severe erythropoietin absorption
Hypocalcemia Osteodystrophy
colicky pain in the
flank area
ipsilateral, lower D
B C E F
abdomen radiation
UTZ
to testicles
- chronic renal Ketoanalo
parenchymal disease, gue
bilateral 600mg 1
- partially filled urinary
tab TID
bladder
- para calyceal cyst
Hematology
Loss of excretory Decrease HCT 31.9% (9/19/17)
renal function Decrease HCT 33.5%
(10/24/17) -Epoietin Alfa 2,000
Decreased Hgb 10.5 g/dl units injection once
(9/19/17) a week
Decreased Hgb 10.7 f/dl subcutaneously
(10/24/17) - FeSo4+FA+MV
200/40g 1 cap BID 2
hours after meal
Decrease excretion Decreased sodium - Folic acid 1 cap OD
of nitrogenous malabsorption in
waste tubules
Clinical chemistry
G - increased H
Proteinuria
creatinine 4.10
(9/19/17
Water retention
Urinalysis - increased
- increased protein creatinineEdema
3.16
3+ (9/19/17) (10/24/17)
- increased protein
3+ G(10/24/17) H
HTN
Metolazone
5mg 1 tab
OD every
morning PRN
for edema
BP:
180/100
mmHg Losartan
OD
HEALTH CONDITIONS PROBLEMS
The result of the student nurses in-depth second-level
assessment on the identified health condition and/or health problems
and threats are presented in the following tables. Note that the problem
statements have been defined in specific terms so as to reflect the
families inability to perform certain aspects of the health task. Thus
the problems are stated as family nursing problems.
CUES/DATA FAMILY NURSING PROBLEM
A. Poor environmental
sanitation
Presence of breeding sites 1. Inability to provide a
Improper drainage home environment which
Usahay nalang mi makalimpyo is conducive to health
kay kapoy og tigulang name dali maintenance and to
ra mi kapoyon development due to
presence of breeding sites
of insects or other vector;
improper drainage
system related to lack of
knowledge of importance
of sanitation and
preventive measures
2. Inability to recognize
possible complication of
having a poor
environmental sanitation
B. Faulty Eating Habits
1. Inability to recognize the
presence of the condition
High Protein Diet or problem due to attitude
High Sodium Diet in life which hinders
Lami man gud ang parat-parat recognition of the
nap ag kaon oy tas sigi pud mi problems.
og kaon og karni 2. Inability to recognized
possible complication for
having a faulty eating
habit
C. Presence of Health threats
House is near the road due to accident hazard
Hadlok man mo gawas usahay house is situated near the
oy kay daghan sakyanan ga agi, road
dagko pa jud 1. Inability to provide a
home environment which
is conducive to health
maintenance due to lack
of family resources.
SCALE FOR RANKING HEALTH CONDITIONS AND PROBLEMS
ACCORDING TO PRIORITIES
A. Poor Environmental Sanitation
CRIETERIA COMPUTATION ACTUAL JUSTIFICATION
SCORE
1. Nature of the 2/3 = 0.6 x 1 0. 6 This is perceived
problem as health threat
because
In poor
environmental
sanitation there
is a gap between
actual and
achievable
health status.
2. Modifiability 2/2 = 1 x 2 2 This is easily
of the modifiable
problem because the
probability of
success of the
intervention is
high.
3. Preventive 3/3 = 1 x 1 1 It can be highly
potential minimized or
prevented if
intervention is
done on this
condition.
4. Salience of 2/2 = 1 x 1 1 It is a condition
the problem needing an
immediate
attention since it
causes
complications
and diseases.
Total Score 4.6
B. Presence of Health Threats Due to Accident Hazard House is
situated near the Road
SCORE
1. Nature of the 2/3 = 0.6 x 1 0.6 This is perceived
because
In unsanitary
toilet there is a
gap between
actual and
achievable
health status.
2. Modifiability 2/2 = 1 x 2 2 This is easily
of the modifiable
problem because the
probability of
success of the
intervention is
high
3. Preventive 3/3 = 1 x 1 1 It can be highly
potential minimized or
prevented if
intervention is
done on this
condition
4. Salience of 0/2 = 0 x 1 0 it is not
the problem recognized as a
problem because
it could not
cause any
complications.
Total Score 3.6
C. Faulty Eating Habits
SCORE
1. Nature of the 2/3 = 0.6 x 1 0.6 This is perceived
because
In faulty eating
habits there is
an actual and
achievable there
is a gap between
actual and
achievable
health status
2. Modifiability 2/2 = 1 x 2 2 Faulty eating
of the habits it can be
problem easily modified
by changing
usual food
intake to healthy
balanced diet
3. Preventive 3/3 = 1x 1 1 Preventive
potential potential is high
since food intake
can be easily
changed.
4. Salience of 2/2 = 1 x 1 1 It is perceived
the problem problem or
condition
needing changes
since faulty
eating habits
can cause
complications.
Total Score 4.6

Family Nursing Care Plan
Health Family Goal of Care Objectives of Intervention Plan

Problem Nursing Care
Problems Nursing Method of Resources
Interventions Nursing Required
Family
Contact
Poor Inability to After four weeks Short term: 1. Establish Home Family
environ provide a of home visits, the After two rapport visits resources:
mental home family will be able weeks of Interview >initiative,
sanitatio environment to know how to home visits, 2. Discuss Health time and full
n which is prevent diseases the family importance of teachings participatio
conducive to due to unclean will be able to waste segregation n of family
health environment and verbalize members in
maintenance know the understandi 3. Explain the applying the
and to health importance of ng of the effects of untidy segregation
development proper waste actual system
environment to a
due to the disposal. condition >garbage
presence of that exists healthy living cans and
breeding within the sacks
4. Encourage the
sites of family and
insects or the proper family to utilize
other vectors; disposal resources like
improper techniques empty rice sacks
drainage with the or cans as Human
system consequence garbage resources:
related to of containers, -knowledge ,
lack of skills, and
knowledge of disregarding making sure they attitude in
importance it. are left covered. discussing
of sanitation Long term: the nature of
and After four 5. Point out the the problem
preventive weeks of result of piles of - time and
measures. home visits, garbage settled effort of the
the family nursing
along the
will students
demonstrate drainage canal to
the use and the health of the Financial
maintenance people living in resources:
of a clean the house. -money for
environment the fare of
and proper 6. Teach and student
garbage encourage the use nurses for
disposal of a compost pit transportati
system in on
compliance
with the
health
teachings
imparted

Problems
Nursing Method of Resources
Family
Contact
Faulty In ability to After four weeks Short term: >explain to the Home Family
eating recognize the of home visits the After two family the effects visits resources:
habits presence of family will be able weeks of of this problem to Interview >initiative,
the condition to acquire the home visits Health time and full
their health
or problem knowledge the family teachings participatio
due to regarding high will be able >discuss to family n of family
attitude in protein diet and to. members in
the importance of
life which alcoholism. 1.Understan applying the
hinders d that faulty having a healthy segregation
recognition of eating habits and balanced diet system
the and
problems. alcoholism >discuss to the Human
does not family the resources:
contribute to possible disease -knowledge ,
better health. they can acquire skills, and
2.realize that due to faulty attitude in
faulty eating eating habit discussing
habits and the nature of
alcoholism is >encourage them the problem
a serious to have a food - time and
problem and effort of the
diary
that it can nursing
lead to students
complication.
Long term: Financial
After four resources:
weeks of
home visits -money for
the family the fare of
will be able to student
demonstrate nurses for
life style transportati
changes on
regarding
health
teaching s
imparted.

Problems Nursing Method of Resources
Family
Contact
Presence Inability to After _________ of Short term: >discuss with the Home Family
of health provide home nursing After ________ family why the visits resources:
threats environment intervention, the of home visits presence of Interview >initiative,
due to conducive for family b able to the family Health time and full
accident hazard
accident health perform some will be able to teachings participatio
hazard: maintenance interventions to verbalize which could be n of family
house is due to lack of reduce or understandi harmful to the members
situated family minimize the ng of the health family
near the resources health problem health Human
road teachings >demonstrate the resources:
imparted ways on how to -knowledge ,
Long term: prevent accident skills, and
After ________ hazards within attitude in
of nursing discussing
familys available
interventions the nature of
the family resources the problem
will be able to - time and
maintain an effort of the
environmnen nursing
t which is students
free from
injury and Financial
accidents resources:
-money for
the fare of
student
nurses for
transportati
on
NURSING CARE PLAN (ACTUAL)
Nursing Diagnosis: fluid volume excess r/t excessive sodium intake
ASSESSMENT DIAGNOSIS OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

Subjective: Fluid volume Short term: Independent: Short term:
lami man gud excess r/t After two home review Such
ang bulad excessive visits, the client patients information Goal partially met,
mam as sodium intake will be able to: history to can assist to patient was able
verbalized by secondary to >have a determine direct to:
the patient chronic balanced the management. Verbalized
parenchymal intake and probable awareness
usahay disease output as cause of of causative
maam, gamay evidence by fluid Sudden factors and
ra akong ihi diminished imbalance weight gain behaviors
as verbalized pitting edema. monitor may mean essential to
Objective: weight fluid correct fluid
>bipedal >Verbalize regularly retention excess such
pitting edema awareness of using the as
+2 causative same scale adherence
>altered factors and and at the to
electrolytes behaviors same time medication
(Na=133.6) essential to of the day regimen and
>decreased correct fluid monitor Dehydration diet therapy
Hgb (10.7) and excess by input and may be the Verbalized
Hct (33.5%) enumerating at output result of fluid importance
least 3 factors. closely shifting even of sodium
if fluid intake restriction
is adequate
>explains monitor Sinus
measures that and not tachycardia
can be taken to blood and
treat or prevent pressure increased
fluid volume and heart blood Long term: Goal
excess such as rate pressure are met. The patient
balanced was able to:
intake and evident in
output, early stages symptoms
balanced diet that
and restriction assess indicates
of sodium urine Recording urgent
intake. output in two voids consultation
response versus six to health
to diuretic voids after a care
Long term: therapy diuretic provider like
medication pitting
After four may provide edema,
weeks of home more useful restless and
visits, the client note information tachycardia
will be able to: presence Edema Manifests
>normovolemic of edema occurs when non-pitting
as evidenced by fluid edema
urine output accumulates Verbalized
greater than or in the an
equal to extravascular estimation
30ml/hr review spaces of urine
>describes serum output of
symptoms that elctrolytes, All are 600cc a day
indicate the urine indicators of
need to consult osmolality, fluid status
with health and urine and guide
care provider specific therapy
such as pitting gravity
edema,
restlessness, check for Significantly
tachycardia, excessive increased
response response to
and abnormal to diuretics
breath sounds diuretics may lead to
the fluid
deficit
limit
sodium Restriction of
intake as sodium aids
prescribed in decreasing
fluid
retention
elevate
edematous Elevation
extremities increases
and venous
handle return to the
with care heart and in
turn
decreases
edema
educate
patient Information
and family is key to
members managing
regarding problems
fluid
volume
excess and
its causes
Dependent: Inhibits
reabsorption
administer of sodium
diuretics and chloride
as ions
indicated
Reference: Doenges, M.E., Moorhouse, M. F. and Murr, A. C. (2012). Nursing Care Plans, Guidelines for
Individualizing Client Care Across the Life Span. 14th ed. P. 328. F. A. Davis Company; Pennsylvania.
Nursing Diagnosis: Acute pain related to post-surgical incision secondary to ureteral exploration
ureterolithotomy
ASSESSMEN NURSING OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

T DIAGNOSIS
Subjective: Acute pain Short term: Independent: Short term:
sakit akong related to post- After four Regularly Pain is Goal met,
kilid nga surgical hours of assess pain subjective and patient was
gioperahan incision nursing (quality, may change able to:
labi na og secondary to interventions severity, from time to >verbalize
ting tugnaw ureteral the client will location, time. reports of pain
nga exploration be able to: onset, with pain scale
panahon as ureterolithoto >verbalize duration and of 4/10
verbalized by my relief of pain as precipitating >verbalized
the patient evidenced by factors) understanding
Objective: pain scale of of non-
-pain scale of less than or pharmacologic
5/10 equal to 4/10 Observe non- Observations al methods
-facial >verbalize verbal may not be such as guided
grimace understanding cues/pain congruent imagery and
-guarding of non- behaviors and with verbal use of
behaviour pharmacologic other reports. diversional
-general body al methods to objectives activities
malaise provide pain defining
relief such as characteristics Long term:
guided as noted Goal met. the
imagery, patient was
therapeutic able to:
touch and
diversional Provide Moral support >adhere to
activities. comfort boosts medication
Long term: measures: patients regimen.
After two home touch, condition and Verbalize
visits, the repositioning, may help in d relief of
client will be and presence faster recovery pain as
able to: of family evidence
> verbalize members d by pain
relief of pain as scale of
evidenced by Encourage use To promote 2/10
pain scale of of non- use of non- and able
less than or pharmacologic pharmacologic to
equal to 2/10 al methods al methods performs
>adhere to such as guided and not to rely activities
medication imagery and directly with of daily
regimen diversional medications living
activites
Encourage use To reduce
of relaxation anxiety and
techniques discomfort
such as deep
breathing
exercises
Assess the
patients Some patients
anticipation may be
for pain relief. satisfied when
pain is no
longer
massive;
others will
demand
complete
elimination of
Acknowledge pain.
reports of pain Pain can be
immediately aggravated
with anxiety
and fear
especially
when pain is
Dependent: delayed.
Administer
medications as
indicated Reduces pain
by directly
targeting
affected area
by disrupting
prostaglandin
synthesis
Nursing Diagnosis: Activity intolerance related to generalized body malaise
ASSESSMENT DIAGNOSIS OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

Subjective: Activity Short term: Independent: Short term: Goal
dili na ko intolerance After two Assess the Provides partially met,
kabuhat sa akong related to home visits, physical baseline patient was able
ginabuhat sauna generalized the client will activity information to:
kay ingon sa body be able to: level and for Reports
doctor di na kayo malaise >identify mobility of formulating ability to
mag sge og lihok factors that the patient nursing perform
as verbalized by aggravate goals during daily
the patient activity goal setting activities
intolerance Assess the Adequate such as
Objective: >report the patients energy taking a
Sedentary ability to nutritional reserves are bath and
lifestyle perform status needed going to the
Imposed required during bathroom
activity activities of activity Verbalized
restriction daily living use of
Pain scale >verbalize Observe Sleep conservation
of 5/10 at use of energy- and deprivation techniques
incision site conservation monitor and such as
techniques the difficulties frequent
such as patients during sleep position
prioritizing sleep can affect the changes
activities, pattern activity level Long term: goal
sitting to do and of the patient partially met. The
tasks and amount of patient was able
frequent sleep to:
position achieved Identified
changes over the methods to
reduce
Long term: past few activity
After four days intolerance
weeks of Close such as
home visits, monitoring getting
the client will Observe will serve as enough rest
be able to: and a guide for and having
>exhibit document optimal enough
tolerance response progression sleep
during to activity of activity Normal
physical blood
activities as Depression pressure
evidence by over the (120/80
normal Assess inability to mmHg)
fluctuation of emotional perform
vital signs response activities can
during to be a source
physical limitations of stress and
activity in physical frustration
>identify activity
methods to Assistive
reduce devices
activity Dependent: enhance the
intolerance Asses the mobility of
such as need for the patient
getting ambulation by helping
enough rest aids him
and having overcome
enough sleep limitations
>maintain
blood
pressure
within normal
limits three
minutes after
activity
Health Teaching
AREAS HEALTH TEACHINGS

Diet Encouraged to eat decrease sodium
consumption
Encouraged to eat green leafy vegetables
such as kangkong, talbos ng kamote and
petchay
Encoraged to adhere prescribed fluid
intake
Instructed to have a complete and balance
diet
Restrict calcium intake that causes kidney
stones
Low purine diet
Limited food high in oxalate
Medications Instructed to comply prescribed
medications
Instructed to adhere to round the clock
antibiotics
Encouraged to take medications on right
time and dose
Instructed to report any adverse effects of
medications
Encourage to stop taking OTC drugs
Instructed to adhere to specific drug
prescribed to him
Treatment/ Encourage to elevate foot with pillows to
Procedure increase venous return
Encouraged to have proper environmental
sanitation
Encouraged to verbalized feeling and
support group
Discharge Instructed to comply to follow up checkup.
Instruction Instructed to oblige to doctors order
Oblige diet restrictions
Instructed to have urine culture every two
months
Instructed patient about signs and
complication of stone removal and
recurrence of stone formation
Exercise/ Encourage to have a daily exercise for at
Mobility least 10-30 minutes
Encourage to limit strenuous activities
Instructed to have a diversional activity
such as gardening
References
Sharma, R. (2013). The Family and Family Structure

Classification Redefined for the Current Times. Retrieved November 12,
2017, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4649868/
Wilson, L. (2013). The Family Unit and Its Importance. Retrieved

November 12, 2017, from http://drlwilson.com/articles/families.htm
Petiprin, A. (2016). Family Nursing. Retrieved November 12,

2017, from http://www.nursing-theory.org/theories-and-
models/family-nursing.php
Geneva. (2008, March). Poor sanitation threatens public health.

Retrieved November 12, 2017, from
http://www.who.int/mediacentre/news/releases/2008/pr08/en/

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Republic of the Philippines

Central Mindanao University

A FAMILY CASE STUDY

In partial fulfilment of the subject

CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND

ELECTROLYTE IMBALANCE, NUTRITION AND METABOLISM AND

Theresa Linda C. Narreto, RN, MSN

Borres, Mary Joy C.

Felimon, Mary Freyah

Laride, Kyle Lorenz B.

Luza, Nicole Hope L.

Mangubat, Yzrah Duffnee Dezz P.

Olano, Jomar Ray B.

Palma, Dechy Lyn B.

The completion of this undertaking could not have been possible

without the participation and assistance of so many people whose

names may not be all enumerated. Their contributions are sincerely

appreciated and gratefully acknowledged. However, the group would

like to express their deep appreciation and indebtedness particularly to

Ms. Theresa Linda C. Narreto for her endless support, kindness,

understanding, guidance and patience during the conduct of the study.

their support, either morally, financially and physically thank you so

Above all to the Great Almighty, the author of knowledge and

wisdom for his countless love.

BACKGROUND OF THE STUDY

to the bladder from the kidneys. When ureterolithiasis develops, the

as the stones are passed from the body.

stones that cause ureterolithiasis, though it is not always possible for

though it is not commonly believed to cause their formation.

A family or personal history with kidney stones, metabolic

development of urinary stones. A high percentage of patients who have

Calcium-based antacids and some kinds of diuretics can also increase

the chances of getting kidney stones.

The symptoms of ureterolithiasis tend to appear after the early

stages of kidney stone development. If symptoms of kidney stones

pink, due to the presence of blood. Patients may also experience

burning during urination and the urge to urinate more frequently. In

some cases, an infection may develop, causing chills and fever in

addition to these other symptoms.

Ureterolithiasis is usually treated by simply making the patient

bladder. Heavy consumption of water can help the kidney stones to

can be determined and measures can be taken to prevent future kidney

The family is a basic unit of study in many medical and social

The family is the most important social unit of society. This is a

Family nursing is a part of the primary care provided to patients

Health problems result from the lack of sanitation facilitates,

The incidence and prevalence of kidney stones is increasing

Florence Nightingales Theory (Environmental Theory)

Nursing as the act of utilizing the environment of the patient to assist

him in his recovery. It involves the nurses initiative to configure

environmental settings appropriate for the gradual restoration of the

patients health, and that external factors associated with patients

surroundings affect life or biologic and physiologic processes, and his

Nightingale stated that nursing ought to signify the proper use

and administration of diet-all at the least expense of vital power to the

of nursing, as now practiced, seems to be expressly constituted to

unmake what God had made disease to be,.., a reparative process.

The physical environment is stressed by Florence Nightingale in

her theory. Nightingales theory reflects a community health model in

which all that surrounds human beings is considered in relation to their

Florence Nightingales theory focused on the environment and

she gave a detailed description of each aspect of environment in her

of nursing theory; however, each component was evolved from her