Past & Current Medical Diseases
Medical Diagnosis
Alzheimer’s disease unspecified
Hypertensive Chronic kidney
disease (CKD) stage 1-4
Definition Pathophysiology Expected Signs & Symptoms
A form of dementia Abnormal deposits of proteins form o Memory problems and confusion grow worse as the Alzheimer’s
characterized by amyloid plaques and tau tangles disease progress
progressive, throughout the brain, as well as o Difficulty in word-finding, vision/ spatial issues
irreversible changes in brain structure and o Impaired reasoning or judgment
deterioration of function, and once healthy neurons o Mild:
general intellectual stop functioning, lose connections  Wandering and getting lost
functioning. with other neurons, and die.  Trouble handling money and paying bills
 Repeating questions
 Taking longer to complete normal daily tasks
 Personality and behavior changes
o Moderate:
 May have hallucinations, delusions, paranoia
 Impulsive behavior
o Severe:
 Cannot communicate and completely dependent on others
 In bed most or all the times as the body shuts down
Kidney damage with Depending on the underlying Endocrine
resulting dysfunction disease process. If the cause is o Hyperparathyroidism, glucose intolerance
(GFR < 60 mL/min) hypertensive nephrosclerosis, it is a Respiratory
that persists for long-standing hypertension that o Pulmonary edema, respiratory rate and depth increase
three or more leads to sclerosis and narrowing of (Kussmaul’s respirations), pleuritis
months. Eventually, renal arterioles and small arteries Urinary
the kidneys are with subsequent reduction of blood o Proteinuria, hematuria, fixed specific gravity, nocturia, oliguria,
unable to excrete flow leading to ischemia, anuria
metabolic wastes glomerular destruction, and tubular Gastrointestinal
and regulate fluid athrophy. o Anorexia, nausea and vomiting, gastroenteritis, hiccups,
and electrolyte abdominal pain, uremic fetor
balance adequately, o Potential complications: peptic ulcer, GI bleeding
a condition known as Musculoskeletal
kidney failure or end- o Osteodystrophy, bone pain, spontaneous fractures
stage renal disease Neurologic
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(ESRD), the final o Apathy, lethargy, headache, impaired cognition, insomnia,
stage of CKD restless leg syndrome, gait disturbances, paresthesia
o Potential complications: seizures, decreased LOC, coma
Cardiovascular
o Hypertension, edema, coronary heart disease, dysrhythmias
o Potential complications: pericarditis, pericardial effusion,
cerebrovascular disease, heart failure
Hematologic
o Anemias, impaired clotting
Reproductive
o Amenorrhea (female), impotence (male)
o Potential complications: spontaneous abortion
Integumentary
o Pallor, uremic skin color (yellow-green), dry skin, poor turgor,
pruritis, ecchymoses, uremic “frost”
Immune System
o Diminished leukocyte count, increased susceptibility to infection
Metabolic Processes
o Azotemia (increased BUN and serum creatinine), hyperkalemia,
hyperphosphatemia, hypocalcemia, hypermagnesia, acidosis,
hyperlipidemia, hyperuricemia, malnutrition
Stages of CKD 1-5
Stage 1
o GFR > 90 mL/min/1.73 m2
o Kidney damage with normal or increased GFR
o Asymptomatic; normal BUN and creatinine
Stage 2
o GFR 60-89 mL/min/1.73 m2
o Mildly decreased
o Asymptomatic, possible hypertension; blood work generally
within normal limits
Stage 3
o GFR 30-59 mL/min/1.73 m2
o Moderate GFR decreased
o Hypertension; possible anemia and fatigue, anorexia, possible
malnutrition, bone pain; slight elevation of BUN and serum
creatinine
Stage 4

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Type 2 Diabetes Mellitus with
diabetes CKD
Condition of fasting DM is a group of metabolic diseases
hyperglycemia that characterized by hyperglycemia
occurs despite the resulting from defects in the
availability of secretion of insulin, the action of
endogenous insulin. insulin, or both. Carbohydrate, fat,
and protein metabolism are
affected by the imbalance between
insulin availability and insulin need.
Cellular starvation occurs as the
body in unable to move glucose
into fat and muscle cells.
o GFR 15-29 mL/min/1.73 m2
o Severely decreased GFR
o Hypertension, anemia, malnutrition, altered bone metabolism;
edema, metabolic acidosis, hypercalcemia; possible uremia;
azotemia with increasing BUN and serum creatinine levels
Stage 5
o GFR < 15 mL/min/1.73 m2
o End-stage renal disease
o Kidney failure with azotemia and overt uremia
Early Manifestations
o Polyuria, polydipsia, blurred vision
Progressive Complications
o Hyperglycemia
 Diabetic ketoacidosis, hyperosmolar hyperglycemic state
o Hypoglycemia
Late Complications
Neurologic
o Somatic neuropathies
 Paresthesia, pain, loss of cutaneous sensation, loss of fine
motor control
o Visceral neuropathies
 Sweating dysfunction, pupillary constriction, fixed heart rate,
constipation, diarrhea, incomplete bladder emptying, sexual
dysfunction
Sensory
o Diabetic retinopathy, cataracts, glaucoma
Cardiovascular
o Orthostatic hypotension, accelerated atherosclerosis,
cerebrovascular disease (stroke), coronary artery disease (MI),
peripheral artery disease, blood viscosity and platelet disorders
Renal
o Hypertension, albuminuria, edema, chronic kidney disease
Musculoskeletal
o Joint contractures
Integumentary
o Foot ulcers, gangrene of the feet, atrophic changes
Immune System
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 o Impaired healing, chronic skin infections, periodontal disease,
urinary tract infections, lung infections, vaginitis
Osteoporosis Metabolic bone Involve an imbalance of the activity o Loss of height
disorder of osteoblasts that form new bone o Progressive curvature of the spine. Dorsal kyphosis and cervical
characterized by loss and osteoclasts that resorb bone. lordosis develop (“dowager’s hump”)
of bone mass, Until adulthood when peak bone o Low back pain
increased bone mass is reached, bone formation o Fractures of the forearm, spine, or hip
fragility, and an occurs more rapidly than does o Minimal movements such as bending, lifting, or jumping may
increase risk of resorption. After peak bone mass is precipitate pain
fractures. achieved at about age 30, however,
resorption exceeds formation and
slightly more bone is lost than is
gained (about 0.7 %/year). This loss
is accelerated if the diet is deficient
in vitamin D and calcium. In
women, bone loss further increases
after menopause (with loss of
estrogen), then slows but does not
stop at about age 60. While
testosterone levels in men decline
with aging, this is a more gradual
process and associated bone loss
occurs more slowly.
Cortical bone becomes more
porous with increased remodeling
activity. When coupled with
changes to internal bone structure,
this reduces the biomechanical
strength of long bones and
increases the risk for fracture.

History Leading to Admission

Alzheimer’s Disease Unspecified

Significant Past Health History

Fractured Hip

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 Medication List

Drug Name Classification Action Side Effects Nursing Implications Dose Adm. Time
Generic/Brand & Route
Aspirin EC 81 mg Chemical class: Blocks the activity of CNS: Confusion, CNS  Do not crush time-release or controlled- 81 mg, 1 Daily at 0900;
tablet Salicylate; cyclooxygenase, the depression release aspirin tablets unless directed. tablet po
Therapeutic class: enzyme needed for EENT: Hearing loss, tinnitus (Warning Use an immediate-release aspirin
anti-inflammatory, prostaglandin GI: Diarrhea, GI bleeding, in situation where a rapid onset of action is
antiplatelet, synthesis. heartburn, hepatotoxicity, required such as in the acute treatment of
antipyretic, Prostaglandins, nausea, stomach pain, myocardial infarction or before
nonopioid important mediators vomiting percutaneous coronary intervention)
analgesic in the inflammatory HEME: decreased blood  Ask about tinnitus. This reaction usually
Pregnancy response, cause local iron level, leukopenia, occurs when blood aspirin level reaches
category: D vasodilation with prolonged bleeding time, or exceeds maximum dosage for
swelling and pain. shortened life span of RBCs, therapeutic effect.
With blocking of thrombocytopenia Patient teaching
cyclooxygenase and RESP: Bronchospasm  Advise adult patient taking low-dose
inhibition of SKIN: Ecchymosis, rash, aspirin not to also take ibuprofen
prostaglandins, urticaria because it may reduce the
inflammatory Other: Angioedema, Reye’s cardioprotective and stroke preventive
symptoms subside. syndrome, salicylism (CNS effects of aspirin
Pain is also relieved depression, confusion,  Instruct patient to take aspirin with food
because diaphoresis, diarrhea, or after meals because it may cause GI
prostaglandins play a difficulty hearing, dizziness, upset if taken on an empty stomach
role in pain headache, hyperventilation,  Caution patent not to take Durlaza 2
transmission from the lassitude, tinnitus, and hours before or 1 hour after consuming
periphery to the spinal vomiting) with regular use alcohol. Also advise him to take the
cord. Aspirin inhibits of large doses. capsule with a full glass of water at the
platelet aggregation same time everyday and to swallow the
by interfering with capsule whole
production of  Instruct patient to stop taking aspirin and
thromboxane A2, a notify prescriber if any symptoms of
substance that stomach or intestinal bleeding occur such
stimulates platelet as passage of bloody or tarry stools or if
aggregation. Aspirin
acts on the heat-

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 regulating center in patient is coughing up blood or vomit
the hypothalamus and that looks like coffee grounds
causes peripheral  Advise patient with tartrazine allergy not
vasodilation, to take aspirin
diaphoresis, and heat  Tell patient to construct prescriber
loss. before taking aspirin with any
prescription drug for blood disorder,
diabetes, gout, or arthritis
 Tell patient not to use aspirin if it has a
strong vinegar-like odor
DOK 250 mg Chemical class: Act as a surfactant CNS: Dizziness, syncope (Warning Expect long-term or excessive use 250 mg, Twice daily at
softgel Anionic surfactant that softens stool by CV: Palpitations of docusate to cause dependence on 1 softgel 0900 & 1700;
Therapeutic class: decreasing surface GI: Abdominal cramps and laxatives for bowel movements, electrolyte po
Laxative, stool tension between oil distention, diarrhea, imbalances, osteomalacia, steatorrhea, and
softener and water in feces. nausea, perianal irritation, vitamin and mineral deficiencies)
Pregnancy This action lets more vomiting  Assess for laxative abuse syndrome,
category: C fluid penetrate stool, MS: Muscle weakness especially in women with anorexia
forming a softer fecal nervosa, depression, or personality
mass. disorders.
Patient teaching
 Tell the patient not to use docusate when
she has abdominal pain, nausea, or
vomiting
 Advise patient to take docusate with a
full glass of water or milk
 Encourage patient to increase fiber
intake, exercise regularly, and drink 6 to 8
glasses (240 ml/glass) of water daily to
help prevent constipation
 Instruct patient to notify prescriber about
rectal bleeding; symptoms of electrolyte
imbalances, such as dizziness, light-
headedness, muscle cramping, and
weakness; and unrelieved constipation

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Hydralazine 25 Chemical class: May act in a manner CNS: Chills, fever,  Hold for systolic B/P less than 120 25 mg, 1 Three times
mg tablet Phthalazine that resembles headache, peripheral  Monitor ANA titer, CBC, ad lupus tablet daily at 0900,
derivative organic nitrates and neuritis erythematosus cell preparation before 1300, and
Therapeutic class: sodium nitroprusside, CV: Angina, edema, therapy and periodically as ordered 1700; po
Antihypertensive, except that orthostatic hypotension, during long-term treatment
vasodilator hydralazine is palpitations, tachycardia  Anticipate that drug may change color in
Pregnancy selective for arteries. EENT: Lacrimation, nasal solution. Consult pharmacist if color
Category: C It: congestion changes
 Exerts a direct GI: Anorexia, constipation,  Be aware that hydralazine may change
vasodilating effect diarrhea, nausea, vomiting color when exposed to a metal fiber
on vascular smooth RESP: Dyspnea  Give tablets with food to increase
muscle SKIN: Blisters, flushing, bioavailability
 Interferes with pruritus, rash, urticaria  Monitor blood pressure and pulse rate
calcium movement Other: Lupus-like regularly and weigh patient daily during
in vascular smooth symptoms, especially with therapy
muscle by altering high doses;  Check blood pressure with patient in
cellular calcium lymphadenopathy lying, sitting, and standing position, and
metabolism watch for signs of orthostatic
 Dilates arteries, not hypotension. Expect orthostatic to be
veins, which most common in the morning, during hot
minimizes weather, and with exercise
orthostatic (Warning Expect to discontinue drug
hypotension and immediately if patient has lupus-like
increases cardiac symptoms, such as arthralgia, fever,
output and cerebral myalgia, pharyngitis, and splenomegaly)
blood flow  Expect prescriber to withdraw
 Causes reflex hydralazine gradually to avoid a rapid
autonomic response increase in blood pressure
that increases  Expect to treat peripheral neuritis with
cardiac output, pyridoxine
heart rate, and left Patient teaching
ventricular ejection  Instruct patient to take hydralazine
fraction tablets with food
 Has a positive  Advise patient to change position slowly
inotropic effect on especially in the morning. Caution that
the heart hot showers may increase hypotension

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  Instruct patient to immediately notify
prescriber about fever, joint and muscle
aches, and sore throat
 Urge patient to report numbness and
tingling in limbs, which may require
treatment with another drug
 Caution patient against stopping drug
abruptly because doing so may cause
severe hypotension
Lisinopril 20 mg Chemical class: May reduce blood CNS: Ataxia, confusion,  Hold for systolic B/P less than 120 20 mg, 1 Daily at 0900;
tablet Lysine ester of pressure by inhibiting depression, dizziness,  Contraindication tablet po
enalaprilat conversion of fatigue, hallucinations, o patient who is hemodynamically
Therapeutic class: angiotensin I to headache, insomnia, unstable after an acute MI
Antihypertensive, angiotensin II. irritability, memory  Precaution
vasodilator Angiotensin II is a impairment, mood o fluid volume deficit, heart failure,
Pregnancy potent vasoconstrictor alterations, nervousness, impaired renal function, or sodium
Category: D that also stimulates paresthesia, peripheral depletion
adrenal cortex to neuropathy, somnolence, o severe aortic stenosis or hypertrophic
secrete aldosterone. stroke, syncope, transient cardiomyopathy because symptomatic
Lisinopril may also ischemic attack, tremor, hypotension may occur
inhibit renal and vertigo  Monitor
vascular production of CV: Arrhythmias, chest pain, o blood pressure often, especially during
angiotensin II. fluid overload, hypotension, the first 2 weeks of therapy and
Decreased release of MI, orthostatic whenever the dose of lisinopril and /or
aldosterone reduces hypotension, palpitations, prescribed diuretic is increased
sodium and water peripheral edema, vasculitis o anaphylaxis, especially patient being
reabsorption and ENDO: Hyperglycemia, dialyzed with high-flux membranes
increases their hypoglycemia (patients on o dehydration, which can lead to
excretion, thereby insulin or oral antidiabetic hypotension especially if patient
reducing blood agents), syndrome of experiences diarrhea or vomiting
pressure. inappropriate ADH o hepatic dysfunction, may starts with
secretion cholestatic jaundice or hepatitis and
EENT: Blurred vision, progresses to fulminant hepatic
diplopia, dry mouth, necrosis
olfactory or taste o serum creatinine
disturbance, photophobia, o blood glucose level if patient take
tinnitus, visual loss insulin or an oral antidiabetic

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GI: Abdominal pain,
anorexia, cholestatic
jaundice, constipation,
diarrhea, elevated liver
enzymes, flatulence,
fulminant hepatic necrosis,
gastritis, hepatitis,
indigestion, nausea,
pancreatitis, vomiting
GU: Acute renal failure,
decreased libido,
impotence, pyelonephritis
HEME: Agranulocytosis,
anemia, hemolytic anemia,
neutropenia,
thrombocytopenia
MS: Arthralgia, arthritis,
bone or joint pain, muscle
spasms, myalgia
RESP: Bronchospasm,
cough, dyspnea, paroxysmal
nocturnal dyspnea,
pulmonary embolism and
infarction, upper
respiratory tract infection
SKIN: Alopecia, cutaneous
pseudolymphoma,
diaphoresis, erythema,
flushing, herpes zoster,
infections, pemphigus,
photosensitivity, pruritus,
psoriasis, rash, Steven-
Johnson syndrome, toxic
epidermal necrolysis,
urticaria
Other: anaphylaxis,
angioedema, dehydration,
o serum potassium level for
hyperkalemia
 Notify prescriber
o persistent, nonproductive cough
o developed jaundice or a marked
elevation in liver enzymes
o decreased renal function
Patient teaching
 lisinopril helps to control, but doesn’t
cure, hypertension and that patient may
need lifelong therapy
 take lisinopril at the same time every day
 not to stop taking the drug even if patient
feels well
 report dizziness, esp. for the first few
days of therapy
 avoid hazardous activities such as driving
until dizziness or other nervous system
symptoms abates
 persistent, nonproductive cough may
develop. Notify prescriber immediately if
cough becomes difficult to tolerate
 drink adequate fluids and avoid excessive
sweating, which can lead to dehydration
and hypotension
 not to use salt substitutes that contain
potassium
 report signs of infection, which may
indicate neutropenia
 urge to monitor blood glucose level and
watch for symptoms of hypoglycemia if
patient has diabetes and takes insulin or
an oral antidiabetic
 notify prescriber immediately if pregnant.
Breastfeeding is not recommended while
taking lisinopril because adverse
reactions may develop in the infant
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 gout, hyponatremia, weight  inform all prescribers of lisinopril therapy
gain or loss
Tylenol 325 mg Chemical class: Inhibits the enzyme ENDO: Hypoglycemic coma Precaution 325 mg, Every
tablet Nonsalicylate, cyclooxygenase, GI: Abdominal pain,  hepatic impairment or active hepatic 2 tablets morning at
(Acetaminophen) para-aminophenol blocking prostaglandin hepatotoxicity (possibly disease, alcoholism, chronic malnutrition, (650 mg) 0900; po
derivative production and severe), nausea, vomiting severe hypovolemia, or severe renal
Therapeutic class: interfering with pain HEME: Hemolytic anemia impairment
Antipyretic, impulse generation in (with long-term use),  ensure that the daily dose of
nonopioid the peripheral leukopenia, neutropenia, acetaminophen from all sources does not
analgesic nervous system. pancytopenia, exceed maximum daily limits
Pregnancy Acetaminophen also thrombocytopenia Monitor
Category: B acts directly on SKIN: Acute generalized  renal function in patient on long-term
temperature- exanthematosus pustulosis, therapy
regulating center in blisters, jaundice, pruritus,  Before and during long-term therapy
the hypothalamus by rash reddening, Steven- including parenteral therapy, liver
inhibiting synthesis of Johnson syndrome, toxic function test results, including AST, ALT,
prostaglandin E2. epidermal necrolysis, bilirubin, and creatinine levels, as
urticaria ordered
Other: Anaphylaxis, Patient teaching
angioedema,  Tell patient that tablets may be crushed
hypersensitivity reaction or swallowed whole
 Instruct patient to read manufacture’s
label and follow dosage guidelines
precisely
 Caution patient not to exceed
recommended dosage or take other
drugs containing acetaminophen at the
same time because of risk of liver
damage
 Teach patient to recognize signs of
hepatotoxicity, such as bleeding, easy
bruising, and malaise, which commonly
occurs with chronic overdose
(Warning Caution patient that serious skin
reactions, although rare, may occur even
with first-time use and any time
acetaminophen is used, even if no skin

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 reactions occurred with a previous use of
drug)

Laboratory & Diagnostic Tests

Test Results Reference Range Explanation for Abnormal Value

X-ray chest 2 views The lungs are hyperinflated compatible with air-
trapping. No acute consolidations/ pleural
effusions are seen. There are prominent lung
markings. The heart is [default value]. The bones
are not seen well. There is generalized osteopenia.
Degenerative changes and an accentuated thoracic
kyphosis are noted.
Conclusion: exacerbated of COPD.
Urine culture Gram stain:
o few WBC many Gram (+) rods few Gram (-) rods
o Final: > 100,000 cfu/m
o Citrobacter koseri
o Organism: 51 AMP
CBC o Abs Neut Auto H 14.47
o Abs Lymph Auto L 0.38
o Abs Mono Auto H 1.05
o BUN H 24
o RBS H 198
o WBC H 15.9
o RBC L 391
o Hct L 36.5

Prioritized Nursing Interventions based on Patient’s Health Problems and Health Care Needs

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Develop Nursing Care Plans

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