Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
In Partial Fulfillment
Of the Requirements for the Degree
Bachelor of Science in Nursing
Submitted By:
Aguarin, Donne Corneille M.
Bognot, FKG L.
Novemver 2019
2
A. Table of Contents
B. GLOSSARY
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I. INTRODUCTION
Ovarian Cancer is a type of cancer that begins in the ovaries. It often goes undetected until it
has spread within the pelvis and abdomen. At this late stage, ovarian cancer is more difficult to treat.
Early stage of ovarian cancer in which the disease is confined to the ovary is more likely to be treated
successfully. Surgery and chemotherapy are generally used to treat ovarian cancer. Malignant ovarian
lesions include primary lesions arising from normal structures within the ovary and secondary lesions
from cancers arising elsewhere in the body. Primary lesions include epithelial ovarian carcinoma (70%
of all ovarian malignancies). Metastases to the ovaries are relatively frequent; common sources are
tumors in the endometrium, breast, colon, stomach, and cervix.
It’s not clear what causes ovarian cancer but in general cancer begins when a cell develops
errors in mutations of DNA. The mutations tell the cell to grow and multiply quickly, creating a mass
or tumor of abnormal cells. The abnormal cells continue living when healthy cells would die. They can
invade nearby tissues and break off from an initial tumor to spread elsewhere in the body. Factors
that can increase the risk of ovarian cancer include older age, inherited gene mutations, family history
of ovarian cancer, estrogen hormone replacement therapy and when menstruation ceased.
Types of ovarian cancer:
Epithelial Tumors
- begin in the thin layers of the tissues that covers the outside of the ovaries
Stromal Tumors
- Begin in the ovarian tissues that contains hormone producing cells
Epithelial ovarian cancer presents with a wide variety of vague and nonspecific symptoms, including
the following:
• Bloating; abdominal distention or discomfort
• Pressure effects on the bladder and rectum
• Constipation
• Vaginal bleeding
• Indigestion and acid reflux
• Shortness of breath
• Tiredness
• Weight loss
• Early satiety
Symptoms independently associated with the presence of ovarian cancer include pelvic and
abdominal pain, increased abdominal size and bloating, and difficulty eating or feeling full.
Symptoms associated with later-stage disease include gastrointestinal symptoms such as nausea and
vomiting, constipation, and diarrhea. [2] Presentation with swelling of a leg due to venous thrombosis
is not uncommon. Paraneoplastic syndromes due to tumor-mediated factors lead to various
presentations.
Diagnosis
Physical findings are uncommon in patients with early disease. Patients with more advanced
disease may present with ovarian or pelvic mass, ascites, pleural effusion, or abdominal mass or
bowel obstruction.
The presence of advanced ovarian cancer is often suspected on clinical grounds, but it can be
confirmed only pathologically by removal of the ovaries or, when the disease is advanced, by
sampling tissue or ascitic fluid.
Screening
Laboratory testing
No tumor marker (eg, CA-125, beta-human chorionic gonadotropin, alpha-fetoprotein, lactate
dehydrogenase) is completely specific; therefore, use diagnostic immunohistochemistry testing in
6
conjunction with morphologic and clinical findings. Also, obtain a urinalysis to exclude other possible
causes of abdominal/pelvic pain, such as urinary tract infections or kidney stones.
Imaging studies
Routine imaging is not required in all patients in whom ovarian cancer is highly suggested. In cases in
which the diagnosis is uncertain, consider the following imaging studies:
• Pelvic ultrasonography [6, 7] : Warranted
• Pelvic and abdominal computed tomography (CT) scanning [6, 7] : Warranted
• Pelvic and abdominal magnetic resonance imaging: Increases specificity of imaging when
sonography findings are indeterminate.
• Chest radiography: Routine imaging to exclude lung metastases
• Mammography: Part of preoperative workup for women older than 40 years who have not had
one in the preceding 6-12 months; estrogen-producing tumors may increase the risk of breast
malignancies, and breast cancers can metastasize to the ovaries and are often bilateral
In patients with diffuse carcinomatosis and GI symptoms, a GI tract workup may be indicated,
including one of the following imaging studies:
• Upper and/or lower endoscopy
• Barium enema
• Upper GI series
Procedures
Fine-needle aspiration (FNA) or percutaneous biopsy of an adnexal mass is not routinely
recommended, as it may delay diagnosis and treatment of ovarian cancer. Instead, if a clinical
suggestion of ovarian cancer is present, the patient should undergo laparoscopic evaluation or
laparotomy, based on the presentation, for diagnosis and staging. An FNA or diagnostic paracentesis
should be performed in patients with diffuse carcinomatosis or ascites without an obvious ovarian
mass.
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Chronic kidney disease (CKD) means the kidneys are damaged and can’t filter blood the way it
should. The main risk factors for developing kidney disease are diabetes, high blood pressure, heart
disease, and a family history of kidney failure. CKD or chronic renal failure (CRF), as it was historically
termed as a term that encompasses all degrees of decreased renal function, from damaged at risk
through mild, moderate, and severe chronic kidney failure.
CKD as either kidney damage or a decreased glomerular filtration rate (GFR) of less than 60
mL/min/1.73 m2 for at least 3 months. Whatever the underlying etiology, once the loss of nephrons
and reduction of functional renal mass reaches a certain point, the remaining nephrons begin a
process of irreversible sclerosis that leads to a progressive decline in the GFR. Hyperparathyroidism is
one of the pathologic manifestations of CKD.
Staging
The different stages of CKD form a continuum. The stages of CKD are classified as follows
Stage 1: Kidney damage with normal or increased GFR (>90 mL/min/1.73 m 2)
Stage 2: Mild reduction in GFR (60-89 mL/min/1.73 m 2)
Stage 3a: Moderate reduction in GFR (45-59 mL/min/1.73 m 2)
Stage 3b: Moderate reduction in GFR (30-44 mL/min/1.73 m 2)
Stage 4: Severe reduction in GFR (15-29 mL/min/1.73 m 2)
Stage 5: Kidney failure (GFR < 15 mL/min/1.73 m 2 or dialysis)
By itself, measurement of GFR may not be sufficient for identifying stage 1 and stage 2 CKD, because
in those patients the GFR may in fact be normal or borderline normal. In such cases, the presence of
one or more of the following markers of kidney damage can establish the diagnosis
Albuminuria (albumin excretion > 30 mg/24 hr or albumin:creatinine ratio > 30 mg/g [> 3
mg/mmol])
Urine sediment abnormalities
Electrolyte and other abnormalities due to tubular disorders
Histologic abnormalities
Structural abnormalities detected by imaging
8
Hypertension is a frequent sign of CKD but should not by itself be considered a marker of it, because
elevated blood pressure is also common among people without CKD. In an update of its CKD
classification system, GFR and albuminuria levels be used together, rather than separately, to improve
prognostic accuracy in the assessment of CKD. More specifically, the guidelines recommended the
inclusion of estimated GFR and albuminuria levels when evaluating risks for overall mortality,
cardiovascular disease, end-stage kidney failure, acute kidney injury, and the progression of CKD.
Referral to a kidney specialist was recommended for patients with a very low GFR (< 15 mL/min/1.73
m²) or very high albuminuria (> 300 mg/24 h). Patients with stages 1-3 CKD are frequently
asymptomatic. Clinical manifestations resulting from low kidney function typically appear in stages 4-
5
Patients with CKD stages 1-3 are generally asymptomatic. Typically, it is not until stages 4-5 (GFR
< 30 mL/min/1.73 m²) that endocrine/metabolic derangements or disturbances in water or electrolyte
balance become clinically manifest.
Signs of metabolic acidosis in stage 5 CKD include the following:
Protein-energy malnutrition
Loss of lean body mass
Muscle weakness
Signs of alterations in the way the kidneys are handling salt and water in stage 5 include the
following:
Peripheral edema
Pulmonary edema
Hypertension
Anemia in CKD is associated with the following:
Fatigue
Reduced exercise capacity
Impaired cognitive and immune function
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Diagnosis
Screening
American College of Physicians guidelines on screening for CKD include the following
recommendations:
Do not screen for CKD in asymptomatic adults without risk factors for CKD (grade: weak
recommendation, low-quality evidence).
Do not test for proteinuria in adults with or without diabetes who are currently taking an
angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin II-receptor blocker (ARB)
(grade: weak recommendation, low-quality evidence).
Laboratory studies
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Laboratory studies used in the diagnosis of CKD can include the following:
Complete blood count (CBC)
Basic metabolic panel
Urinalysis
Serum albumin levels: Patients may have hypoalbuminemia due to malnutrition, urinary
protein loss, or chronic inflammation
Lipid profile: Patients with CKD have an increased risk of cardiovascular disease
Evidence of renal bone disease can be derived from the following tests:
Serum calcium and phosphate
25-hydroxyvitamin D
Alkaline phosphatase
Intact parathyroid hormone (PTH) levels
In certain cases, the following tests may also be ordered as part of the evaluation of patients with
CKD:
Serum and urine protein electrophoresis and free light chains: Screen for a monoclonal
protein possibly representing multiple myeloma
Antinuclear antibodies (ANA), double-stranded DNA antibody levels: Screen for systemic lupus
erythematosus
Serum complement levels: Results may be depressed with some glomerulonephritides
Cytoplasmic and perinuclear pattern antineutrophil cytoplasmic antibody (C-ANCA and P-
ANCA) levels: Positive findings are helpful in the diagnosis of granulomatosis with polyangiitis
(Wegener granulomatosis); P-ANCA is also helpful in the diagnosis of microscopic polyangiitis
Anti–glomerular basement membrane (anti-GBM) antibodies: Presence is highly suggestive of
underlying Goodpasture syndrome
Hepatitis B and C, human immunodeficiency virus (HIV), Venereal Disease Research
Laboratory (VDRL) serology: Conditions associated with some glomerulonephritides
Imaging studies
Imaging studies that can be used in the diagnosis of CKD include the following:
Renal ultrasonography: Useful to screen for hydronephrosis, which may not be observed in
early obstruction or dehydrated patients; or for involvement of the retroperitoneum with
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fibrosis, tumor, or diffuse adenopathy; small, echogenic kidneys are observed in advanced
renal failure
Retrograde pyelography: Useful in cases with high suspicion for obstruction despite negative
renal ultrasonograms, as well as for diagnosing renal stones
Computed tomography (CT) scanning: Useful to better define renal masses and cysts usually
noted on ultrasonograms; also the most sensitive test for identifying renal stones
Magnetic resonance imaging (MRI): Useful in patients who require a CT scan but who cannot
receive intravenous contrast; reliable in the diagnosis of renal vein thrombosis
Renal radionuclide scanning: Useful to screen for renal artery stenosis when performed with
captopril administration; also quantitates the renal contribution to the GFR
Biopsy
Percutaneous renal biopsy is generally indicated when renal impairment and/or proteinuria
approaching the nephrotic range are present and the diagnosis is unclear after appropriate workup.
Type 1 Diabetes
Is also called insulin-dependent diabetes. It used to be called juvenile-onset diabetes, because it
often begins in childhood. It is an autoimmune condition. It’s caused by the body attacking its own
pancreas with antibodies. In people with type 1 diabetes the damaged pancreas doesn’t make insulin.
This type of diabetes maybe cause by a genetic predisposition. It could also be the result of faulty beta
cells in the pancreas that normally produce insulin.
Type 2 Diabetes
Used to be called adult – onset diabetes but with the epidemic of obese and overweight kids,
more teenagers are now developing type 2 diabetes. It was also called non – inulin independent
diabetes and it is often a milder form of diabetes than type 1. Nevertheless, type 2 diabetes can still
cause major health complication particularly in the smallest blood vessels in the body that nourish the
kidneys, nerves, and eyes. It also increases the risk of heart disease and stroke. With type 2 diabetes
the pancreas usually produces some insulin but either the amount produce is not enough for the
body’s needs, or the body’s cells are resistant to it. Insulin resistance or lack of sensitivity to insulin
happens primarily in fat, liver, and muscle cells.
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STATISTICS
CKD is more common in people aged 65 years or older (38%) than in people aged 45-64 years
(13%) or 18-44 years (7%). CKD is more common in women (15%) than men (12%). CKD is more
common in non-Hispanic blacks (16%) than in non-Hispanic whites (13%) or non-Hispanic Asians
(12%). About 14% of Hispanics have CKD
WORLD
CKD is a worldwide public health problem. In the United States, there is a rising incidence and
prevalence of kidney failure, with poor outcomes and high cost. CKD is more prevalent in the elderly
population. However, while younger patients with CKD typically experience progressive loss of kidney
function, 30% of patients over 65 years of age with CKD have stable disease. CKD is associated with an
increased risk of cardiovascular disease and end-stage renal disease (ESRD). Kidney disease is the
ninth leading cause of death in the United States.
PHILIPPINES
One Filipino develops chronic renal failure every hour or about 120 Filipinos per million
population per year. More than 5,000 Filipino patients are presently undergoing dialysis.
CURRENT TRENDS
Early diagnosis and treatment of the underlying cause and/or institution of secondary preventive
measures is imperative in patients with CKD. These may slow, or possibly halt, progression of the
disease. The medical care of patients with CKD should focus on the following:
Delaying or halting the progression of CKD: Treatment of the underlying condition, if possible,
is indicated
Diagnosing and treating the pathologic manifestations of CKD
Timely planning for long-term renal replacement therapy
The pathologic manifestations of CKD should be treated as follows:
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Anemia: When the hemoglobin level is below 10 g/dL, treat with erythropoiesis-stimulating
agents (ESAs), which include epoetin alfa and darbepoetin alfa after iron saturation and
ferritin levels are at acceptable levels
Hyperphosphatemia: Treat with dietary phosphate binders and dietary phosphate restriction
Hypocalcemia: Treat with calcium supplements with or without calcitriol
Hyperparathyroidism: Treat with calcitriol or vitamin D analogues or calcimimetics
Volume overload: Treat with loop diuretics or ultrafiltration
Metabolic acidosis: Treat with oral alkali supplementation
Uremic manifestations: Treat with long-term renal replacement therapy (hemodialysis,
peritoneal dialysis, or renal transplantation)
Indications for renal replacement therapy include the following:
Severe metabolic acidosis
Hyperkalemia
Pericarditis
Encephalopathy
Intractable volume overload
Failure to thrive and malnutrition
Peripheral neuropathy
Intractable gastrointestinal symptoms
In asymptomatic patients, a GFR of 5-9 mL/min/1.73 m², irrespective of the cause of the CKD
or the presence or absence of other comorbidities
.
PURPOSE OF THE STUDY
The purpose of this study is to be able to give information regarding the patient’s condition and
to deliver logical presentation about Chronic Kidney Disease Stage 5 Secondary to Diabetes Mellitus.
And to be able to gain knowledge, skills and attitude on how to handle patient and to develop an
awareness of the potential, physical, behavioral and psychosocial effects of Chronic Kidney Disease
Stage 5 Secondary to Diabetes Mellitus
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PATHOPHYSIOLOGY
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A normal kidney contains approximately 1 million nephrons, each of which contributes to the total
glomerular filtration rate (GFR). In the face of renal injury (regardless of the etiology), the kidney has
an innate ability to maintain GFR, despite progressive destruction of nephrons, as the remaining
healthy nephrons manifest hyper filtration and compensatory hypertrophy. This nephron adaptability
allows for continued normal clearance of plasma solutes. Plasma levels of substances such as urea
and creatinine start to show measurable increases only after total GFR has decreased 50%.
The plasma creatinine value will approximately double with a 50% reduction in GFR. For example, a
rise in plasma creatinine from a baseline value of 0.6 mg/dL to 1.2 mg/dL in a patient, although still
within the adult reference range, actually represents a loss of 50% of functioning nephron mass.
The hyperfiltration and hypertrophy of residual nephrons, although beneficial for the reasons noted,
has been hypothesized to represent a major cause of progressive renal dysfunction. The increased
glomerular capillary pressure may damage the capillaries, leading initially to secondary focal and
segmental glomerulosclerosis (FSGS) and eventually to global glomerulosclerosis. Factors other than
the underlying disease process and glomerular hypertension that may cause progressive renal injury
include the following:
Systemic hypertension
Nephrotoxins (eg, nonsteroidal anti-inflammatory drugs [NSAIDs], intravenous contrast media)
Decreased perfusion (eg, from severe dehydration or episodes of shock)
Proteinuria (in addition to being a marker of CKD)
Hyperlipidemia
Hyperphosphatemia with calcium phosphate deposition
Smoking
Uncontrolled diabetes
A strong association between episodes of acute kidney injury (AKI) and cumulative risk for the
development of advanced CKD in patients with diabetes mellitus who experienced AKI in multiple
hospitalizations. Any AKI versus no AKI was a risk factor for stage 4 CKD, and each additional AKI
episode doubled that risk
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I. NURSING ASSESSMENT
Mr. Polycythemia a 31 year old male stands as father of 2 children the eldest is 8 years
old while the youngest is 2 years old. He is married to Mrs. Polycythemia for 10 years. He lives
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in Sta. Cruz Poblacion San Luis city of San Fernando Pampanga. His nationality is Filipino and
was born in San Luis Pampanga on the 11th of December 1987.
Mr. Polycythemia graduated of Secondary Education in San Luis High School. He was
raised as a Catholic, where he learned about religious values. He believes in super natural
forces and superstitious belief. The client seeks medical help from a physician for a serious
health condition although Mrs. Polycythemia admits to seek help from the “Hoax doctor “or
the local “albularyo “who would prescribed alternative medicine to relieve mild signs and
symptoms and other bodily discomfort.
B. Socio economic
C. Environment
Mr. Polycythemia resides at Sta. Cruz Poblacion San Luis and occupies the ancestry
house of his wife’s family and still living with parents of her wife. The location of their house
is accessible to hospitals, health centers and other government institutions. The client’s wife
did not report problems regarding his environment that could interfere with the client
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condition but instead states that sometimes he cannot control his emotions like getting mad
at her family and getting tired all the time because of his work as stated by Mrs. Polycythemia
D. Activities of Daily living (diet and nutrition, habits/vices,etc )
Mrs. Polycythemia said that Mr. Polycythemia’s diet is by consuming 3 cups of coffee
a day. He also includes soft drinks in his meal. He eats a lot of fatty and salty foods. She said
also that Mr. Polycythemia doesn’t exercise. The client would usually wake up at 5:00 in the
morning and then he would drink coffee while his wife is the one preparing for their breakfast.
His wife cooks fried rice and meat process food like hot dogs and ham in the morning as their
breakfast but sometimes he will just buy” pandesal” and put spread on it. At 6:00 am he
and his eldest child will prepare for school and at exact 6:30 am they will leave the house and
he will drive his son to school since his child is also studying near where he works. In between
9 am to 10 am he will take his snack and usually eat food on the street. He takes his lunch at
12:00 pm and preferred to eat ready to eat food all the time in Cafeteria. The client will stay
until 5:00 pm in terminal then go back home at 5:30 pm. He will pick up his son with his motor
cycle. When he is at home already he will watch TV while at 6:00 pm his wife will prepare their
dinner at exact 7:00 pm he will take his dinner and his favorite food is vegetable and fish when
it comes to dinner, and at 8:00 pm he will watch television until he fall asleep. The client has
bad habits or vices like smoking 1 pack a day and drinking liquor like 1 bottle of brandy once
a week that can interfered his present condition.
Hereditary disease in the family is hypertension which his mother currently has and the
reason of death of his father, his father sibling had a heart attack due to hypertensive. This shows
that hypertension is evident in their family and is hereditary. On maternal side his grandmother
died with arthritis while his grandfather died of natural death. The client’s mother has currently
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hypertension while his father died of hypertension. Mr. Polycythemia uncle died at the age of 60
and he cannot recall anymore the cause of death while his auntie, his mother’s siblings was died
of heart attack at the age of 58. On paternal side, his grandmother and grandfather died in
natural death and all of his uncle and auntie, siblings of his father were all alive and healthy.
Auntie
age:58 Father
died:Hyperten Age: 67
sive died: Hypertensive Uncle age:
unknown alive
and well
Mr.polycythemia
LEGEND
The patient was first met lying in bed with ongoing intravenous fluid of PNSS to be
run at 160 cc per hour, wearing a hospital gown and was unconscious. He has an indwelling
catheter. Mechanical ventilation was hooked. With GCS of 7, Vital signs were taken and
recorded as follows:
Vital signs
T- 37.2 celcius degree
RR- 18 cycle per minute
PR- 100 beat per minute
BP-120/80 mmhg
O2SAT- 96
Skin, Hair, and Nails Inspection
Skin
Skin is pale
Skin is diaphoresis
Hair and Scalp
Hair is black, fine, and even in distribution
Scalp is clean and dry
Hair is thick and fine; Black in color
Nails
Nails are smooth, firm and clean.
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Abdominal Inspection
Color is consistent with the color of the rest of the body
No visible veins of the abdomen are present upon infection
No presence of ulcerations
No presence of rashes
Skin tone of umbilicus is similar with that of abdominal skin tone
Umbilicus is located on midline of the abdomen
No signs of swelling of the umbilicus, no bulges or masses
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Besides being hospitalized for his present condition, Mr. Polycythemia did not have
any previous hospital stays. He had only consulted a doctor when he was 14 years old when
he had an ear infection and took anti biotic to manage which he cannot recall the name of
the drug. He has also episodes of fever, cough and colds and this was managed by taking over
the counter drug like Paracetamol for fever, Solmux for cough and Neozep for colds. He has
also episodes of diarrhea and this was managed by taking over the counter drug like Diatabs.
He was admitted in a private hospital of Mt. Carmel Hospital at 1:00 am on January
26, 2019 with the initial diagnosis of Severe Dehydration to be considered Polycythemia.
Assessment done by the resident duty .Prior to admission after discharged to other institution
patient was then drinking less than 2 glass of water a day in one week. Patient was lethargic
and unresponsive. Vital signs are T- 37.2 Celsius degree RR- 10 cycle per minute PR- 120
beat per minuteBP-120/90 mmhgO2SAT- 86asleep, arousable weak body, dry lips, sunken
eyeball.
In regards to his present illness, Mr. Polycythemia did not notice any sign or symptoms
of his present condition as stated by Mrs. Polycythemia aside of noticing his husband for being
quiet all the time and whenever he sees something on the floor he picked it up and eat it and
then spit it out. She noticed many unusual behaviors like talking to his self which she perceives
not normal for a person to do. She called her relatives to report her husband condition and she
was advised by her relatives to send him in GuaGua Institution. Mr. Polycythemia was admitted
in that institution to treat him in his condition. Until one morning the nurse whose attending him
notice that Mr. Polycythemia was not moving and unconscious, after taking the vital signs and
getting a result which is high than normal range such as Blood Pressure of 160/120 RR of 30 PR
of 120, The institution decided to refer Mr. polycythemia in JBL hospital but unfortunately he
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was not accepted in that Hospital because of no available space or room for him to accommodate
him and that is the time Mr. polycythemia brought to Mt. Carmel Hospital at 1:00 am on January
26, 2019 with the initial diagnosis of Severe Dehydration to be considered Polycythemia.
is one of the
substances that the
kidneys normally
eliminate from
the body.
BUN January They measure 28.0 mg/dL 7.0-18.0 This test showed
Blood urea 28,2019 the level of mg/dL that the result
nitrogen (BUN) is a urea nitrogen was in above
medical test that of the patient normal range. It
measures the in the blood shows that the
amount of urea and it is used kidney of the
nitrogen found to diagnose patient might not
in blood. The liver impaired functioning well
produces urea in kidney and it may
the urea cycle as a function and already damage
waste product of assess liver brought about
the digestion of function the disease or
protein. the medications.
Ionized calcium February They measure 1.35mmol/l 1.10-1.30 This test showed
Ionized 2,2019 the level of mmol/l that the result
calcium is calcium in calcium of the was in above
your blood that is patient in the normal range. It
29
SGPT Serum February They measure 97.0 iu/L 9.0-50.0 iu/L This test
glutamic pyruvic 1,2019 the level of showed that the
transaminase, serum glutamic- result was in
SGPT is released pyruvic above normal
into blood when transaminaseof range. It shows
the liver or heart the patient in that the liver of
is damaged. The the blood and it the patient
blood SGPT levels is used to might not
30
HEMATOCRIT January This test was 0.60 g/L 0.40-0.54 The result showed an
A hematocrit 26,2019 indicated for slight elevated
test, which the patient to number of
maybe perform check if there hematocrit due to
separately or as is still a hemo concentration
part of complete normal ratio of blood
blood count, between the
measures bloods total
percentage by volume which
volume packed is mainly
red blood cells in compose of
a whole blood plasma and
sample. the amount of
Hematocrit is the red blood
proportion or cells.
ration of the
total blood
volume (Plasma)
and the amount
of red blood
cells.
34
Red Blood Cell January This test was 7.0 iu/L 5.5-6.5 iu/L The result showed an
Count 26,2019 indicated for slight elevated
RBC count also the patient to number of
called an check if there hematocrit due to
erythrocyte is still a hemoconcentration
count, is part of a normal ratio of blood
complete blood between the
count. It’s used bloods total
to detect the volume which
number or red is mainly
blood cells in compose of
microliter, or plasma and
cubic millimeter the amount of
of whole blood. red blood
The RBC blood cells.
itself provides no
qualitative
information
regarding the
size, shape or
concentration of
HGB within the
corpuscles, but it
may be used to
calculate two
erythrocyte
indices; MHC,
MCV.
35
WHOLE ABDOMEN January This procedure Mild hydro The result showed
ULTRASOUND 28,2019 was indicated nephrosis ,right that the patient has
Abdominal for the patient Mild hydro
ultrasound is a to evaluate nephrosis ,right
type of imaging organs in the because of swelling
test. It is used to abdomen, of a kidney due to a
look at organs in including the build-up of urine
the abdomen, liver,
including the liver, gallbladder,
gallbladder, spleen,
spleen, pancreas, pancreas, and
and kidneys. kidneys.
38
V. MEDICAL MANAGEMENT
INTRAVENOUS THERAPY
effect on the
tissues and
make the
person feel
hydrated.
MECHANICAL VENTILATION
NEBULIZER
NASOGASTRIC TUBE
to drain urine. Because if you have: the patient output was the order for
it can Urinary incontinence because he monitor accuracy.
be left in place in the (leaking urine or has urinary
bladder for a period of being unable retention Wash hands for
time, to control and to Measure urine
it is also called when you urinate) monitor output as indicated
an indwelling Urinary retention (being output 1 – 4 hourly and
catheter. unable to empty your assess the color
bladder and concentration
when you need to) of urine output.
Surgery on the prostate
or genitals. The IDC insertion
site and
securement should
be assessed at
least once a shift,
to ensure the IDC
is not pulling on
the genitals and
not twisted.
Position drainage
bag to prevent
backflow of urine
or contact with the
floor.
44
INTUBATION
patient every 2
hours.
Provide oral
care at least
every 4 hours
using
antibacterial or
antiseptic
solution.
Assess both
proximal (head)
and distal
(abdominal)
shunt catheter
site incisions
for bleeding,
drainage, and
50
signs of wound
infection.
CHEST TUBE
51
MEDICATIONS
Generic Name: Reduces The purpose of February 3, Patient did Check doctor’s order for
esomeprazole gastric acid esomeprazole 2019 not manifest the medication, route,
sodium secretion sodium is to any signs or dosage and frequency
Brand Name: and treat the symptoms of of administration
Nexium I.V. decreases condition of allergic -To prevent errors.
gastric the patient reaction to Administer the drug
Dosage: acidity. caused by too the drug. Also exactly as prescribed.
40 mg much acid relieve the -To prevent
OD (6AM) production in acid complication for the
Route: I.V. his stomach. production in patient.
his stomach. Administer the drug at
least 1 hour before a
meal.
-For proper absorption
of the drug.
Advise the SO that
antacids can be used
while taking drug unless
otherwise directed by
prescriber.
-For SO knowledge
about the medication.
Monitor GI symptoms
for improvement or
worsening.
-To know the
effectiveness of the
drug. Because this
medication is to reduce
gastric acid and
54
secretion.
Monitor magnesium
level before treatment
and periodically during
treatment.
-because this
medication it can affect
the magnesium level of
the patient and it may
decrease.
Monitor patient for
signs and symptoms of
low magnesium level,
such as abnormal heart
rate or rhythm,
palpitations, muscle
spasms, tremor,
seizures.
-For patient’s safety and
to prevent any other
complication for the
patient.
Tell the SO to inform
prescriber of worsening
signs and symptoms,
pain, or diarrhea that
doesn’t improve.
-Because it may part of
an allergic reaction. So
that the doctor will have
the patient to stop
taking this drug.
55
Instruct SO to alert
prescriber if rashes or
other signs and
symptoms of allergy
occur.
-To prevent other
complication for the
patient.
Warn SO to
immediately report
symptoms of low
magnesium level.
-Because this drug can
decrease the
magnesium level of the
patient.
Generic Name: Not clearly Hydrocortison February 3, Patient did Determine whether
hydrocortisone defined. e is an anti- 2019 not manifest patient is sensitive to
56
Unless contraindicated,
give a low- sodium diet
that’s high in potassium
and protein.
57
Generic Name: Inhibits Digoxin its February The response Check doctor’s order for
digoxin sodium- purpose to the 3,2019 of the patient the medication, route,
Brand Name: potassium- patient is to the dosage and frequency
Lanoxin activated to help make medication is of administration
adenosine the heart beat slows down -To prevent any errors.
Dosage: triphosphata stronger and the rate of his Monitor potassium
0.25 mg se, with a more heart beats, level carefully. Take
59
Instruct SO to report
adverse reactions
promptly. Nausea,
vomiting, diarrhea,
appetite loss
-It may indicators of
toxicity.
feels shortness of
breath.
-withhold the drug if
there is a sign of
shortness of breath.
Because one of the
adverse effect is the
shortness of breath.
Generic Name: Increases The purpose February The response Check patency at
mannitol osmotic of mannitol is 3,2019 of the patient infusion site before and
Brand Name: pressure of to promote to the during administration
Osmitrol glomerular diuresis for medication it -To prevent any
filtrate, thus acute renal forces his problem especially an
Dosage: inhibiting failure to urine infiltration.
100 cc tubular prevent or production in .
62
Generic Name: Inhibits Losartan is February Patient Check doctor’s order for
losartan vasoconstric used with or 3,2019 polycythemia’ the medication, route,
Brand Name: tive and without other s blood dosage and frequency
Cozaar aldosterone medications to pressure was of administration.
secreting treat high maintained to -To prevent any errors.
Dosage: action of blood pressure 120/80 Check the medication
50 mg angiotensin (hypertension) mmHg. It also properly and read labels
65
immediately, because
one of the adverse of
the drug is shortness of
breath.
Chart the medication
after administering.
-For documentation of
all the procedure that
being administer to the
patient and also for
legality purposes.
Generic Name: Actively To function February It helps the Check doctor’s order for
vitamin B participate and 3,2019 patient’s the medication, route,
complex in the development nutrient need dosage and frequency
Brand Name: metabolism of the brain, for his health of administration.
Nascobal of nerve cells, the and gives him -To prevent any errors.
carbohydrat myelin sheaths an energy to Check the medication
Dosage: es, proteins that protect fight in his properly and read labels
68
drug.
-Because faster
systemic elimination
will reduce
effectiveness of
vitamin.
Don’t give large doses
routinely
- Because drug is lost
through excretion.
Protect Vit.B 12 from
light. Don’t refrigerate
or freeze.
-To prevent the
effectiveness of the
drug.
Generic Name: Unknown. It used this January 27 Patient If there is fever, assess
paracetamol Thought medicine to and February polycythemia’ patient’s fever,
to produce help treat pain 3,2019 s fever was intensity, duration,
Brand Name: analgesia and reduce a relief. temperature, and
Biogesic by blocking high diaphoresis.
71
Generic Name: Inhibits The purpose February 3, It treat the Check doctor’s order for
furosemide sodium and of Lasix for the 2019 fluid the medication, route,
Brand Name: chloride patient is to retention dosage and frequency
Lasix reabsorption allow the salt (edema) of of administration.
at the to instead be the patient -To prevent any errors.
Dosage: proximal and passed in his with his liver Check the medication
20 mg distal urine. disease, or a properly and read labels
q12 (2AM- 2PM) tubules and kidney properly.
Route: I.V. the disorder. -To prevent errors and
ascending complication for the
74
loop of patient.
Henle. Know the reason for
which patient is
receiving the
medication.
-To know the purpose
why the patient needs
the medication.
Administer the drug in
morning.
-To prevent need to
urinate at night. If
patient needs second
dose, tell to the SO to
take it in early
afternoon, 6 to 8 hours
after morning dose.
Inform SO to possible
need for potassium or
magnesium
supplements.
-For better absorption
of the drug and to
prevent any other
complication.
Advice the patient’s SO
to immediately report
presence of sore throat
or fever of the patient.
-Because these
symptoms may indicate
toxicity.
75
Tell SO to consult
prescriber or
pharmacist before
taking OTC drugs.
-To prevent any
problem or
complication for the
patient.
Teach SO to avoid the
patient in direct sunlight
and use protective
clothing.
-Because of risk of
photo sensitively
reactions.
Monitor fluid intake and
output and electrolyte,
BUN, and carbon
dioxide levels
frequently.
-Because the use of
these drug is to allow
the salt to instead be
passed in his urine. So
that will able to know
the effectiveness of the
drug.
Watch for signs of
hypokalemia, such as
muscle weakness and
cramps.
-Because it may
76
indicative of adverse
effect to the patient.
Generic Name: A The purpose of February 3, The response Check doctor’s order for
diazepam benzodiazep diazepam to 2019 of the patient the medication, route,
Brand Name: ine that the patient is in diazepam dosage and frequency
Valium probably to relieve medication is of administration.
potentiates muscle treated his -To prevent any errors.
Dosage: the effects of spasms. seizures Check the medication
OD GABA, Because this episode. properly and read labels
Route: depresses medication properly.
the CNS, and works by -To prevent errors and
suppresses calming the complication for the
the spread brain and patient.
of seizure nerves. Know the reason for
77
hematopoietic function
of the patient especially
for prolonged uses.
Generic Name: Replaces This February It prevent the Explain use and
magnesium magnesium medication is 3,2019 seizures administration of drug
sulfate Drip and used to treat episode of the to patient and family.
Brand Name: maintains and prevent patient. -For SO knowledge
magnesium low about the drug being
and blood magnesi administer to the
maintains um and patient.
magnesium seizures of the Tell SO to report
level; as an patient. adverse effects.
anticonvulsa -To prevent other
nt, reduces serious complication for
muscle the patient.
80
in giving the
medication.
Chart the medication
after administering.
-For documentation of
all the procedure that
being administer to the
patient and also for
legality purposes.
82
Generic Name: Not clearly Verapamil me February 3, It treats the Check doctor’s order for
verapamil defined. A dication is used 2019 patient’s the medication, route,
hydrochloride calcium for the patient, hypertension dosage and frequency
Brand Name: channel in order to (high blood of administration.
Verelan blocker that relax the pressure), -To prevent any errors.
inhibits muscles of his and certain Check the medication
Dosage: calcium ion heart and heart rhythm properly and read labels
5 mg influx across blood vessels. disorders. properly.
OD (11AM) cardiac and -To prevent errors and
Route: I.V. smooth- complication for the
muscle cells, patient.
thus Know the reason for
decreasing which patient is
myocardial receiving the
contractility medication.
and oxygen -To know the purpose
demand; it why the patient needs
also dilates the medication.
83
Frequently monitor PR
interval.
-To prevent other
problem for patient.
Monitor BP at the start
of therapy and during
dosage adjustments.
-Because the action of
these drug is to relax the
muscles of patient’s
heart and blood vessels.
It may affect the
patient’s blood
84
pressure.
If signs and symptoms
of heart failure occur,
such as swelling of
hands and feet and
shortness of breath,
notify prescriber.
-To prevent any other
serious complication for
the patient.
Monitor renal function
test and LFT result
during prolonged
treatment.
-Because these drug can
affect the renal function
of the patient especially
for long term use.
Don’t confuse Verelan
with Vivarin or Voltaren.
-To prevent errors in
giving the medication.
Chart the medication
after administering.
-For documentation of
all the procedure that
being administer to the
patient and also for
legality purposes.
85
Generic Name: Inhibits Ciprofloxacin is February Patient did Check doctor’s order for
ciprofloxacin bacterial used to treat or 3,2019 not manifest the medication, route,
Brand Name: DNA prevent certain any signs or dosage and frequency
Cipro synthesis, infections symptoms of of administration.
mainly by caused by allergic -To prevent any errors.
Dosage: blocking bacteria, reaction to Check the medication
400 mg DNA gyrase; because of the the drug. properly and read labels
OD (6AM) bactericidal. patient’s properly.
Route: I.V. pneumonia. -To prevent errors and
complication for the
patient.
Know the reason for
which patient is
receiving the
medication.
-To know the purpose
why the patient needs
the medication.
Check the label three
times before
administering.
-To prevent errors and
complication for the
patient.
Assess patient’s history
86
of allergic reaction to
the drug.
-To prevent any kind of
adverse reaction.
Inform SO about the
side effects and adverse
effects of the
medication.
-For SO knowledge
about the mediation
being administering for
the patient.
Observe the patient for
any reaction to the
drug.
-To prevent any kind of
adverse reaction for the
patient.
Tell SO that it must take
the drug as prescribed,
even after feeling
better.
-To prevent drug
resistance.
If a rash or other
reaction occurs, tell
patient’s SO to stop
drug immediately and
notify prescriber.
-For patient’s SO
Knowledge.
Tell SO that tendon
87
Medication Centered)
(Generic and
Brand Name)
Generic Name: Inhibits cell- The purpose of January 26, tazobactam i Take note that the drug
piperacillin wall the 2019 njection may cause CDAD
sodium/ synthesis piperacillin/taz treats the ranging in severity from
tazobactam during obactam for pneumonia of mild diarrhea to fatal
sodium bacterial the patient is the patient colitis.
Brand Name: multiplicatio to treat a wide with no signs -To monitor patient for
Zosyn n. variety of and diarrhea and initiate
bacterial symptoms of therapeutic measures
Dosage: infections. adverse as needed. Drug may
100 mg Because it is a effect. need to be stopped.
q8 (8AM- 4PM- penicillin Watch out for bacterial
12MN) antibiotic. It or fungal
Route: I.V. works by superinfection.
stopping the -Because if large doses
growth of are given or therapy is
bacteria. prolonged, the patient
can manifest
superinfection.
Monitor patient sodium
intake and electrolyte
levels.
-Because these
medication work as a
bactericidal.
Monitor hematologic
and coagulation
parameters.
-For patient’s safety.
Patient with cystic
89
Treatment or
Medication General Purpose Date Ordered Response of Nursing Responsibilities
(Generic and Action (Patient- the patient
Brand Name) Centered)
Brand Name: bacterial cell infections respiratory -To prevent any serious
Rocephin wall causing tract complication for the
cell death. infections patient.
Dosage: Check regularly the I.V.
1 gm site if there is a
TID discomfort the patient.
Route: I.V. -Because it can lead to
infiltration and can also
cause an edema on the
part of the I.V site of the
patient.
Teach family how to
prepare and give drug
for the patient.
-For SO knowledge.
Tell SO to notify
immediately the
prescriber about the
loose stools or diarrhea.
-Because it may
indicative of the
adverse effect of the
medication.
Monitor patient for
signs and symptoms of
superinfection.
-Because if large doses
are given, therapy is
prolonged, the patient
is at high risk of
superinfection.
92
Generic Name: Act The purpose of February 1, The patient Check doctor’s order for
midazolam selectively this 2019 was get the medication, route,
hydrochloride on medication for drowsy dosage and frequency
polysynaptic the patient is before his of administration.
Brand Name: neuronal as part of the medical -To prevent any errors.
Benzodiazepam pathways anesthesia procedures Check the medication
throughout during surgery and surgery. properly and read labels
Dosage: the CNS. to produce a properly.
1 gm Precise sites loss of -To prevent errors and
Route: I.V. and consciousness. complication for the
mechanism patient.
of action are Know the reason for
not fully which patient is
known. receiving the
However, medication.
benzodiazep -To know the purpose
ines enhance why the patient needs
or facilitate the medication.
the action of Check the label three
GABA, an times before
inhibitory administering.
neurotrans -To prevent errors and
93
TRACHEOSTOMY
This procedure was indicated to the patient because he has difficulty of breathing.
A tracheostomy is an opening created at the front of the neck so a tube can be inserted into the
windpipe (trachea) to help you breathe. If necessary, the tube can be connected to an oxygen supply
and a breathing machine called a ventilator.
A tracheostomy is usually done for one of three reasons: to bypass an obstructed upper
airway; to clean and remove secretions from the airway; to more easily and usually more safely,
deliver oxygen to the lungs.
All tracheostomies are performed due to a lack of air getting to the lungs. There are many
reasons why sufficient air cannot get to the lungs.
Nursing Responsibilities
Before
During
After
>Chest
>Coordinate physiotherapy
with a includes the
respiratory techniques of
therapist for postural
chest drainage and
physiotherapy chest
and nebulizer percussion to
management as mobilize
indicated. secretions
from smaller
airways that
cannot be
eliminated by
means of
coughing or
suctioning.
101
>Intubation
>If secretions may be
cannot be needed to
cleared, consider facilitate
the need for an removal of
intubation tenacious and
copious
amounts of
secretions and
provide
source for
augmenting
oxygenation.
>Position the
patient
upright if
> Position the tolerated.
patient upright if Regularly
tolerated. check the
Regularly check patient’s
the patient’s position to
position to prevent sliding
prevent sliding down in bed.
down in bed.
> Increasing
LONG humidity of
TERM: inspired air
will reduce
103
> Blood
> Administer transfusions
blood products may be
as prescribed. required to
correct fluid
loss
> Provide
measures to
prevent >Antipyretics
excessive can decrease
electrolyte fever and
107
>Urge the
LONG patient to drink >Oral fluid
TERM: prescribed replacement
amount of fluid. is indicated
After 1 to 2 for mild fluid
weeks of deficit and is patient
interventio a cost- shall be
n the effective able to
patient will method for drink
be able to replacement prescribed
drink treatment. amount of
prescribed fluid
amount of
fluid.
> Aid the >Dehydrated
patient if he is patients may
unable to eat be weak and
without unable to
assistance, and meet
encourage the prescribed
family or SO to intake
assist with independentl
feedings, as y.
necessary.
108
>Drop situati
ons where
>Provide patient can
comfortable experience
environment by overheating
covering patient to prevent
with light further fluid
sheets. loss
> Patient
needs to
>Enumerate understand
interventions to the value of
prevent or drinking extra
minimize future fluid during
episodes of bouts of
dehydration. diarrhea,
109
fever, and
other
conditions
causing fluid
deficits.
such as
bacterium, > Antibiotics
virus, work best
fungus, and >administered when a
other antibiotics as constant blood
parasites prescribed level is
invade maintained
susceptible which is done
hosts when
through medications
inevitable are taken as
injuries and prescribed.
exposures.
People >Aseptic
have technique
dedicated > Maintain or decreases the
cells or teach asepsis for changes of
tissues that dressing transmitting or
deal with changes and spreading
the threat wound care, pathogens to
of infection. peripheral IV the patient.
These are and central Interrupting
known as venous the
the management, transmission of
immune and catheter infection along
system. care and the chain of
handling. infection is an
effective way
to prevent
infection.
>Restricting
visitation
> Limit visitors. reduces the
transmission of
pathogens.
> Provide
surgical mask to
visitors who are > Educating
coughing and visitors on the
provide importance of
an explanation preventing
why. Instruct: droplet
Cover mouth an transmission
d nose during from
coughing or themselves to
sneezing. others can
Use tissues to help reduce
contain the infection.
respiratory
secretions with
an immediate
disposal to a no-
112
touch receptacle
; wash hands
with soap and
water afterward.
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