1

High Sweet Heart

NSTEMI secondary to Hypertension, DM

1
 2

Case Presentation

I. Introduction
II. Nursing Theories
III. Patient's Data
IV. History of Present Illness
V. Review of System
VI. Physical Assessment
VII. Course in the ward
VIII. Review of Related Literature
IX. Anatomy and Physiology
X. Pathophysiology
XI. Laboratory and Diagnostic test
XII. Drug study
XIII. NCP
XIV. Discharge Plan

2
 3

I. INTRODUCTION

The patient is a 73 years old female, admitted at 10:00 pm of June 21, 2019 at Quirino
Memorial Medical Center (QMMC) Female Philhealth Ward. The patient’s complain is difficulty of
breathing. After series of assessment and procedures, the patient admitting diagnosed NSTEMI
Hypertension: Diabetes Mellitus type 2

Hypertension is another name for high blood pressure. It can lead to severe
complications and increases the risk of heart disease, stroke, and death.

Diabetes Mellitus type 2 most prevalent form of diabetes is characterized by a

combination of insulin resistance and insulin deficiency.

Myocardial Infarction also known as a heart attack occurs when blood flow
decreases or stops to a part of the heart, causing damage to the heart muscle. The most
common symptom is chest pain or discomfort which may travel into the shoulder, arm, back,
neck, or jaw.

NSTEMI is a type of heart attack. NSTEMI stands for Non-Segment elevation of

myocardial infarction. Sometimes an NSTEMI is known as a non-STEMI. A myocardial infarction is
the medical term for a heart attack. ST refers to the ST segment, which is part of the EKG heart
tracing used to diagnose a heart attack.

On june 27, 2019, I was care and handled the patient for 2 days.

3
 4

NURSING THEORIES

Dorothea Orem Self Care Deficit

In the Dorothea Orem Self Care Deficit Nursing Theory, the role of a nurse is to fill-in the gaps of care
that an individual cannot provide for themselves. Orem theorizes that individuals will initiate and perform
their own self-care activities on a regular basis so that their overall health and well-being can be
maximized.

It is only when an individual can no longer care for themselves that they will seek out professional care
from a provider, such as a nurse. This means nursing is more of a reactive than proactive action in the
eyes of Orem. Only when a person cannot care continuously for themselves is it appropriate for a nurse to
provide assistance.

According to Orem, nurses have the ability to provide five different methods of help in order to restore an
individual’s ability to care for themselves.

 By acting on a health issue immediately while providing services for others.

 Guiding others in the actions necessary to provide care.
 Supporting other nurses and supporting patients in providing and maintain care needs.
 Continuously providing an environment which promotes personal development instead of nursing
reliance.
 Teaching one another to enhance skill-building at all levels of the nursing spectrum.

4
 5

There are 6 primary assumptions that Orem makes within the Self Care Deficit Nursing Theory.

1. People are supposed to be self-reliant, responsible for their personal care and anyone else in their
family who may be in need of care.
2. Each person is a distinct individual.
3. Nursing should be considered a form of action because it is an interaction which occurs between
2+ people.
4. One of the most important components of prevention and the removal of ill health at the primary
care level is to successfully meet developmental and universal self-care requisites.
5. The knowledge an individual has about their potential health issues is a necessary component of
any self-care behaviors they may be able to implement.
6. Self-care and dependent care are both learned behaviors within the context of a socio-cultural
element.
These assumptions are based on the idea that everyone at their core level has a desire to perform the
basics of universal self-care. Sometimes referred to as the activities of daily living, or ADLs, these are the
life processes of self-care that everyone can perform at some level.
This includes being able to access air, food, and water resources when necessary. It also includes a
provision of care when elimination processes need to be implemented.
The 3 Steps of Orem’s Nursing Process
Based on the need to help others and the assumptions about nursing, Orem developed a 3-step process
that helps to determine when there is a self-care deficit that would need to be addressed. These steps are
similar to the standard nursing processes of assessment, diagnosis, and implementation/evaluation, but
with greater detail.
Step #1: Data Collection. The first step in the Self Care Deficit Nursing Theory is to determine why
nursing is required. By evaluating the health status of an individual, what the doctor’s perspective of that
health status happens to be, and then the individual’s perception, it becomes possible to analyze and
interpret the data collected to make a judgment regarding care.
Additional data to be collected includes the health goals of the individual, how those goals are reflected
within the context of that person’s life, and what their requirements for future self-care happen to be.
Step #2: Organization. The second step in this theory has the nurse designing a system that will be at
least partially compensatory or supportive in the education of the patient. This is done through an
organization of the components an individual would need to perform effective future self-care and then
selecting the correct combination of methods to create a treatment plan. The overall goal is for an
individual to overcome any current self-care deficits.
Step #3: Assistance. Once the methods for overcoming a self-care deficit are identified, the nurse will
then assist the individual or the family/caregivers of the individual in self-care matters. A plan will be
implemented so that all goals can be achieved so that the desired health results can happen. Assistance is
provided in evaluating results so that actions can be directed or modified based on the events which occur.
Each step is then implemented with current technologies, polices, and skills that are available to the nurse.
The goal is always the same: to promote human growth and development within a healthcare perspective.
The Strengths and Weaknesses of the Self Care Deficit Nursing Theory
As with any theory, there are strengths and weaknesses which should be examined when looking at this
idea. Orem’s Self Care Deficit Nursing Theory does provide a number of unique strengths to the health
care industry. This theory does have some limitations which must be considered as well.
It provides nurses with a comprehensive basis for their practice. It also provides a foundation for research,
education, and administration within the nursing industry so that skill-building can occur. It species when
nursing is required and promotes ongoing health maintenance through the concept of promoting ongoing
good health.
On the other hand, this idea is a general system theory which does not take into account individualized
variables. Orem treats the nursing system as a single entity instead. This causes some individuals who

5
 6

may have physical, mental, or emotional deficits that prevent effective self-care from possibly receiving
the primary care they need.
Health is also a dynamic entity, always changing under the guise of this theory. This is not always the
case. The theory is also orientated to illnesses, so trauma and other health concerns are not addressed
whatsoever. If someone is consistently in good health, the assumption is that they are maintaining their
own self-care appropriately.
The goal of Dorothea Orem’s Self Care Deficit Nursing Theory is to help nurses understand their patients
on a better level. By teaching people and other nurses how self-care can be implemented, it becomes
possible to treat illness or disease more effectively. In return, better overall health can be achieved.
It refers to my patient will seek out a balance between rest, activity and social interaction, or work. They
will avoid any hazards that may put their life at risk while promoting the mechanisms of human
functioning. That able to fill-in the deficit that has occurred so an individual can restore their own self-
care. This may mean must provide the ADLs an individual requires until they are able to restore their
own self-care. It also means that for some individuals, long-term total care may also be required
because there is a chronic deficit that has been identified.

6
 7

Patient’s Data

Name: Biaco, Erlinda Zamora

Address: 80 Kalayaan Diliman Central, Quezon City
Age: 73 y/o
Gender: Female WEIGHT: 48 kg
Birthdate: 5/17/1946
Birthplace:, Pangasinan
WARD: Female Philhealth Ward 5
OCCUPATION: Housewife
Marital status: Married
Religion: Catholic
Health Insurance: Philhealth and Senor Citizen
Date of Admission: June 21, 2019
Admission Diagnosis: NSTEMI secondary Hypertension, Diabetes mellitus type 2

CHIEF COMPLAINT:
DOB upon admission
Weakness
Shortness of breath
Dizziness

HISTORY OF PRESENT ILLNESS:

6 months prior to admission patient stated that she always shortness of breath every when she
walk, washes clothes and do household chores. Every time she experience she rest and no
medication to be taken.
5 months prior to admission patient stated while she get washes their clothes she can feel
chest pain and it runs fron the left arm and shortness of breath and suddenly when she get rest
while she walk to the sofa she make unconscious. Then her husband goes with him in QMMC
then arrived with unconscious and need to intubate due to lack of oxygen and refer to laboratory.
To the Echo result dilated left ventricular dimension with concentric left ventricular hypertrophy
with normal contractility and systolic function with dropler evidence of Grade I diastolic
dysfunction (impaired relaxation). Mitral Valve sclerosis with mild regurgitation.Mitral annular
calcifications. Mild Tricuspid regurgitation.Normal Pulmonary artery pressure. ECG result Sinus
rhythm. Left Ventricular hypertrophy by voltage criteria with strain and/or ischemia pattern.
Blood Test: Red blood cells low range 2.99, Hemoglobin low 94.00, Hematocrit low 0.28, MCH
high 31.60.LDL low 2.00.Potassium high 5.42. Then after 6 days may go home and give
medication to be taken ff.: Clopidogrel, Omeprazole, ketoanalogue, atorvastatin.
4 months prior to admission patient stated no signs and symptoms and anything experience.
3 months prior to admission patient don’t have anything experience of sickness.
2 months prior to admission patient stated that sometimes she feels of shortness of breath.
When she walk and doing household chores.

7
 8

11:00 am prior to admission patient preparing their food then feels shortness of breath so she
go to sofa and rest.
4:00 pm prior to admission patient feels a pain in chest and shortness of breath.
5:00 pm prior to admission patient arrived in QMMC with difficulty of breathing and sudden
onset of chest pain with heaviness. Without fever and cough and colds.
6 days handling my patient does physical assessment patient that she can feel shortness of
breath when she walks and dizziness with a body of weakness.

PAST MEDICAL HISTORY:

Hypertension 2016 taking medication Losartan and Amlodipine

Diabetes mellitus 2007 Metformin
Jan.26, 2019 diagnosed Myocardial Infarction secondary to Hypertension; diabetes mellitus type
2

FAMILY HISTORY:

Father Mother

Diabetes Mellitus type2 Heart attack

Sister Brother

Heart attack Hypertension

PSYCHOSOCIAL HISTORY:

The patient stated that she does household chores: cooking, laundry washes and washing dishes
and after she watch t.v or sometimes she can nap. She stated that has an average of 8 hours sleep
per day, usually from 9:00 pm to 5:00 Am.
She lives in a small house with her daughter and husband.

8
 9

REVIEW OF SYSTEM

GENERAL DATA:
(+) weight loss (+) weakness
(+) conscious

INTEGUMENTARY SYSTEM:
(-) scars (-) change in color
(-) skin rashes

HEAD, EARS, NOSE, THROAT:

(-) hair loss (-) dandruff
(+) dizziness (-) hearing loss
(+) dental problems (-) tenderness
(+) change in vision (-) eye color change
(+) pale conjunctiva (-) difficulty swallowing

MOUTH:
(-) dry lips (-) mouth sores

NECK:
(-) Lumps\swelling (-) Enlarged or tender nodes
(-) goiter

BREAST:
(-) Nipple discharge (-) Lump/tenrderness/swelling

RESPIRATORY:
(-) chest pain (-) cough and colds

NEURO:
(+) blurring of vision
(+) dizziness

CHEST AND LUNGS:

(+) symmetrical (+) clear sounds (+) resonance

HEART:
Precordium Heart rate rhythm
(+) dynamic (+) fast beat (+) regular

9
 10

ABDOMEN:
(+) soft to touch (+) normoactive
(-) abdominal pain (+) vascular bruit (+) resonance

EXTREMITIES:
Capillary refill: (+) <3 secs (-) no edema

GENITOURINARY:
(-) dysuria

FEMALE GENITAL:
(+) Menopause

MUSCULOSKELETAL:
(-) muscle pain (-) joint pain
(-) back pain (+) muscle weakness

10
 11

PHYSICAL ASSESSMENT

General Physical Survey

Patient was received conscious, coherent and cooperative. The patient wearing t-shirt and black shorts
lying on bed.

The patient’s Vital sign are as follows:

Temp. 36.7
RR: 25cpm
PR: 110bpm
BP: 180/70
O2: 97

Head: generally round normo-cephalic and symmetrical,with frontal, parietal, and occipital prominences.
Has a smooth skull contour. No tenderness about palpitation.The facial features are symmetric and no
nodules and masses. Has symmetric facial movement. Black hair and short hair cut. No infections noted.
Skin: smooth skin and warm to touch. Skin color is fair, no pallor and jaundice.
Nails: have an intact epidermis and a capillary refill of less than 3 seconds
Eyes: symmetrically aligned with equal movement. Eyelashes equal distributed. An eyelid closed
symmetrically has complete closure of the eyes. Both eyes are coordinated, with parallel alignment,
pupils equally reactive to light and accommodation. The patient have pale in conjunctiva. Sclera is white
Ears: Ear color is same as facial skin, they are symmetrical and normal aligned, not painful to touch, firm
and not tender. No visible discharge.
Mouth: lips are not dry. Teeth are complete missing. No signs of tenderness. The lips color is black.
Patient can purse his lips and puff out her cheek. Patient can easily open and close her mouth. The tongue
moves easily and without tremor. Tonsils are lesion free and right in size for the patient’s age. Voice is
clear yet minimal.
Nose: nose is symmetric. No discharge, no tenderness, no lesions noted. Nasal airway is patent.
Neck: symmetrical with intact skin and no masses, swelling and no lymph node enlargement.
Breast: Skin is smooth. Nipples are round and inverted. No signs mass and tenderness
Lungs and Thoracic: Symmetric chest expansion, resonance upon percussion. No masses or nodules
were inflamed during palpitation. Breath sounds are normal upon auscultation.
Abdomen: Have a flabby round abdomen with vascular bruits sounds upon auscultation. Resonance
sounds upon percussion. During palpitation no tenderness and pain .
Urinary: The patient not experiencing dysuria.
Musculoskeletal: All muscle of upper and lower extremities have a weakness with a grade of 3. They
have no pain. Body parts are symmetrical. Body is in alignment.

11
 12

COURSE IN THE WARD

DOCOTORS ORDER

6/21/2019

10:10 pm

 Please admit patient under the service of Dr.Lobator to MICU

 Secure patient for admission and management
 IVF:ISDN drip: 10mg = 90cc PNSSx 15 ggts/min
 2-3ggts/min until chest pain free
 NGT feeding : 1200 kcal divided into 6 feedings

 Laboratory test: CBC ,Na,K,U, BUN,Crea, SGPT,SGOT,PT,PTT,Chest X-ray, ABG

Meds: Aspirin 80mg/tab OD, clopidogrel 75mg/tab OD, Lactulose 70cc OD,Enoxaparin 0.4 c SQ
OD,captopril 25g/tab BID,furosemide 40mg TIV evry12 hrs.,Ampicillin,omeprazole 40mg TIV OD,

 insulin sliding scale:

180-200 -2 units
201-250 -4 units
251-300 – 6 units
301-300 – 8 units
350-400 – 10 units
>400 refer to mrod
> menoclopromide 10mg TIV every 8 hrs, as necessary, atorvastatin 40 mg/tab OD.
Give clonidine 75mcg

Nurse,s notes

6/21/2019
11:37 pm

FOCUS: Ineffective Airway

DATA: > Admitted for inhalation occupied by due to dyspnea asses with cough and cold.
 Seen and examine of DOB with advice made and carried into
 Conscious and coherent
ACTION: > Consent for advice and management done and signed.
 ISDM drop @ 15mgtts/min.
 PNSS 90 cc
 v/s BP 160/80
 PR 110 RR 3298% o2 sat
 Temp. 36.7C CBG 306 then refered with sliding order
 Close watcher and monitoring.
RESPONSE: >

12
 13

6/22/2019

6am FOCUS: Health Instructiolns

DATA: Awake and coherent. Companion on bedside

ACTION: provided health instructions on treatment required.

Instructed client mofifications: low salt low fat and exercises, limit activities.

RESPONSE: knowledge of condition.

6/22/2019

2pm FOCUS: risk for chest pain

DATA: with ongoing ISDN drip as order

ACTION: Maintained on high

RESPONSE: no chest

6/22/2019

10 pm FOCUS: elevate bed.

DATA: bp 170/80 mmhg

ACTION: safety precaution

Clonidine 75mcg

Refer to Dr.

RESPONSE:

6/23/2019
2:00 pm

 Remove IFC,NGT
 Start LSLF diet with SAP
 CBC monitoring to TID premeals
 Start amlodipine, clonidine, PRN
 Mgt. sit on bed . sign and symptom of headache
 Vs evry 2

6/23/2019

6am FOCUS: Risk for aspiration

DATA: on bed, awake with NGT intact

13
 14

ACTION: Monitored for intoward signs and symptoms

provided adequate rest and comfort. Encourage do deep breathing exercises.

With strict aspiration precaution via NGT

IFC and NGT removal aseptically. Istructed to eat per orem but with aspirate precaution.

RESPONSE: safe, feedy and tablets tolerated.

6/23/2019

2pm FOCUS: Health instructions

DATA: awake

ACTION:side rails up

inform medication

RESPONSE: safe

6/24/2019
2:00pm

 To consume ISDN shift to heplock

 Hold Amlodipine
 Stop captopril
 Start metropolol
 Repeat CBC Na K Cl BUN Crea tom AM

4:05 pm

 Maintain full bladder and/or clamp IFC 4hrs prior procedure

 Transport patient to DRS 15 min prior Dr. Regullano

6/24/2019

6 am FOCUS: Risk for Aspiration

DATA: on bed, awake, with NGT removal

With ISDN drip @ 15ugtts/min

ACTION: encourage to deep breathing

Monitored for aspiration. Provide adequate rest and comfort.

14
 15

RESPONSE: feedy per orem tolerated, safe

6/24/2019

2pm FOCUS: risk for chest pain

DATA: ISDN drip

ACTION: kept safe, side rails up. Monitoring

RESPONSE: no chest pain

6/24/2019

10 pm FOCUS: provision of care

DATA: awake, conscious. Maintain side rails up. Encourage verbalize feeling.

Monitored and referred for any signs and symptoms

Clonidine75 mcg BP 160/80

Kept safe

6/25/2019
5 pm
 Mgt transfer .patient to female ward
 Secure transfer lu ppmc divided into 2 aliqouts
 IVF to 40 cc/hr day transfusion
 WOF : congestion

6/25/2019

6am FOCUS: health teaching

DATA: on bed,awake. With heplockintact

ACTION: deep breathing exercise. P;rovide adequate rest and comfort.

2pm FOCUS: provision of care

DATA: on bed

ACTION: safety measure on bed

RESPONSE:

10 pm FOCUS: provision of care

ACTION: maintained side rails up

15
 16

Encourage to verbalize feelings. Monitored and refered for any signs and symptoms

Verified doctors order for blood teransfusion. Baseline vital signs taken prior to BT. BP 140/80, t: 36.6

PR 82 RR 20 o2 Sat 92 %

4 pm FOCUS: risk for blood transfusion reaction

BT of 1st drip PRBC at with NUBSP 20190374655, properly typed and crossmatched

Obstruct per any BT reactions. Kept safe. Endorsed with ongoing BT.

6/26/2019

6am FOCUS: Risk for BT reaction

DATA: received with B T of PRCB Type A t approximately 50cc NVBSP 20190379655

ACTION: observed for any signs and symptoms of BT reaction

BT consumed @ am. Transfused and align @ 1pm. NVBSP 20190379655. Blood extracted on 5/28/19.

Expiration 7/9/19.

RESPONSE: Endorsed with ongoing BT.

6/26/2017
7:45pm

 Remove and replace present IV site (r-hand) (phlebitis)

 Maintain heplock
 Hold captopirl
 Complete 5 days enoxaparin and discontinue
 Atorvastatin to 40mg 1tab OD
 Omeprazolen IV to Omeprazole 40mg 1cup po OD
 Secure 1 units PRBC and crossmatched in 2 aliqouts
 May walk around
 Hold Lantus for now
 Continue CBG monitoring

6:00 pm

 Repeat CBCPC + BUN Crea 6hrs BT

 Still for FOMT bottle at bedside

6/26/2019

6am FOCUS: Risk for BT reaction

DATA: received with B T of PRCB Type A t approximately 50cc NVBSP 20190379655

16
 17

ACTION: observed for any signs and symptoms of BT reaction

BT consumed @ am. Transfused and align @ 1pm. NVBSP 20190379655. Blood extracted on 5/28/19.

Expiration 7/9/19.

RESPONSE: Endorsed with ongoing BT.

6/26.2019

2pm FOCUS: risk for BT reaction

DATA: Advised with ongoing BT of alignments infusinf well

ACTION: observed for any BT reaction. Kept siderails up. BT ended

Observe for any past BT reaction

RESPONSE: no noted BT reaction

10 pm FOCUS: provision of care

DATA: awake and conscious

ACTION: maintained siderails up. Encourage to verbalize feeling. Monitored and refered signs ans

symptoms. Kept safe

6/27/2019
2:00 pm

 NonST
 For repeat HBGs today

 Repeat to SVC consultant

4:00 pm

 Follow up repeat ABG

 For partial MGH once ok

 Refer

 Start linagliptin 5mg tab po OD

 To discharge once okay

17
 18

6/27.2019

 6am FOCUS: Health promotion

 DATA: awake, conscious

 ACTION: safety measured provided, monitored for recurrence of chest pain.

Advised to avoid stream activities.

 RESPONSE: not in distress

6/27.2019

 2pm FOCUS: fall precaution

DATA: awake, conscious

ACTION: kept siderails up. Observed for any outward signs and symptoms

RESPONSE: safe and stable.

 10pm FOCUS: provision care

DATA: awake, conscious and coherent

ACTION: kept siderails up for safety. Encouraged adequate rest and sleep. Position

comfort

RESPONSE: keptsafe and rested.

6/28/2019

6 am FOCUS: provision of care

DATA: on bed, conscious and coherent

ACTION: safety measures provided. Provided adequate rest and sleep.Monitored for any signs and

symptoms.

Keep monitored.

18
 19

REVIEW OF RELATED LITERATURE

Hypertension- Sytolic when the ventricle of the heart is contract.

Diastolic when the ventricle is relax.

Is the force that a person's blood exerts against the walls of their blood vessels. This pressure depends on
the resistance of the blood vessels and how hard the heart has to work.

Etiology: the measure of the force of blood pushing against blood vessel walls. The heartpumps
blood into blood vessels, which carry the blood throughout the body. High blood pressure, also
called hypertension, is dangerous because it makes the heart work harder to pump blood out to the
body and contributes to hardening of the arteries, or atherosclerosis, to stroke, kidney disease, and
to heart failure.

The effects of hypertension may take years develop, but ultimately. If untreated—high
blood pressure overworks the heart, because the left ventricle works harder to pump blood,it is
the area most often affected, leading to left ventricle hypertrophy or muscle enlargement. As a
result, this extra tissue does not have adequate blood supply,often leading to chestpain due to
ischemia or myocardial infarction. Over a period of years the vessel will become hardened and
lose elasticity.

 Stage 1 high blood pressure: 130-139/80-89

 Stage 2 high blood pressure: 140 and above/90 and above

Treatment:

Diet Low salt Low fat, Exercise

Medication: Anti-Hypertensive: Ace inhibitors, Calcium channel blockers, Thiazide diuretics,
Beta blocker, Angiotensin.

Diabetes Mellitus type 2

Etiology: Insulin resistance with relative of insulin deficiency. Most of these clients is obese,
when weight is lose the insulin resistance will diminishes but reappears if the clients regain
weight. Age, lack of exercise, hypertension amd dyslipidemia are all risk factors.

Hyperglycemia results when the pancreas cannot match the body’s need for insulin and/or when
the number of insulin receptor sites are decreased or altered.

Treatment: There is no cure for diabetes but we aim is to control the blood sugar and prevention
of early detection of complication.

19
 20

Exercises, diet
Medication: metformin tablet and Insulin injection.

Myocardial Infarction NSTEMI

Etiology: When the heart muscle does not get adequate oxygen due to decrease in blood supply,
an increase oxygen need or a combination of both. The decrease in blood supply in most
commonly caused by atherosclerotic plaque of coronary artery disease. Any that increase oxygen
need of the heart beyond the supply level may lead to myocardial infarct. Activities may include
shock, hemorrhage, stress or excessive physical exertion.

Symptoms: svere chest pain, diaphoresis(sweating), nausea, is not obvious pain left arm,shoulder
and jaw pain.

Treatment: Involves immediate attention to prevent shock, relieve respiratory distress and
decrease workload on the heart.

In individual lying in position and tight or restrictive clothing to improve respiratory function.

If cardiac arrest occur CPR can do that. Administer oxygen and pain medication. Medication to
treat arrhythmias.

IV thrombolytic or clot busting therapy using tissue plasminogen activator or streptokinase to

utilize open occlusion and restore blood flow.

Prognosis: Improves if vigorous treatment begins immediately.

Blood Test: Troponin I levels: point of care testing

CK-MB or creatinine kinase and myoglobin.

ECG, to the ECHO.

20
 21

Anatomy and Physiology

Cardiovascular system
Anatomy of the Heart

The heart, arteries, and veins, along with the blodd., make up the cardiovascular system. The
heart is a four chambered muscular structure. It is about the size of a man’s fist and weighta about 300
grams. The heart is situated approximately in the middle of the chest, slightly to the left behind the
sternum (breastbone).
The heart is composed of the pericardium, the chambers, and the valves. The pericardium is a
two-layer sac with fluid between the layers. The wall of the heart is divided into three layers.
Epicardium is the outermost layer , the myocardium is the middle layer, and the endocardium is the
innermost layer.
There are fourchambers in the heart, the right atrium, right ventricle,left atrium, and the left
ventricle. The tricuspid valve is between the right atrium and ventricle, the pulmonary valve is between
the right ventricles and pulmonary artery, and the aortic valve is between the left ventricle and the aorta.
Blood enters the heart from the superior vena cava, then passes through the right atrium and the
tricuspid valve into the right ventricle. It then passes through the pulmonary valve into the pulmonary
artery, and travels to the lungs where carbon dioxide is exchange for oxygen. The oxygenated blood
returns to the heart through the pulmonary vein, and is pumped into the left atrium through the mitral
valve and into the left ventricle. It passes through the aortic valve into the aorta and to the body. The
heart itself is supplied with blood by the coronary arteries.

Cardiac muscle normally contracts continually throughout one’s lifetime. Designated areas of the heart
produce electrical stimulation, causing the heart muscle to contract and pump the blood into the body.
This sequence of events is termed the cardiac cycle. It begins in th sinoatrial (SA) node, then passes to
the atrioventricular (AV) node to the bundle og HIS and the Purkinje fibers.

21
 22

One sequence of the conduction pathway is one cardiac cycle. This is represented on the
electrocardiogram as the PQRST segment. The P wave represents the electrical stimulation beginning
and passing over the atria (depolarization). The QRS wave is caused be stimulation passing over the
ventricles. The T wave represents the recovery of the ventricles (repolarization). The cardiac cycle
repeats itself approximately 60-100 times per min. in the average adult. One cycle is one heart beat. The
pulsation (heart beat) felt with hand over the chest or the finger tips placed over an artery (such as at
the wrist and neck) is called the pulse. The pulse rate is the number of pulsation felt in a minute. The
closing of the heart valves produces the sounds heard when listeniong with a stethoscope over the
heart.
The circulatory component of the cardiovascular systems includes the arteries and veins. The three
major subsystems include the portal unit, pulmonary unit, and the systemic unit. Each of these
circulatory subsystems have special functions in addition to delivering blood to the body. The portal unit
or subsystem includes the circulation to the stomach, spleen, intestine and pancreas. Blood from these
organs goes through the liver before returning to the heart. The pulmonary susbsystem includes the
pulmonary artery and its divisions. Leading from the heart to lungs, the circulation through the lungs,
the pulmonary vein leading from the lungs back to the heart. In this suvbsystem, nonoxygenated blood
from the systemic circulation passes through the lungs where an exchange of carbon dioxide for oxygen
occurs. The oxygenated blood returns to the heart to the pumped through the body. The systemic
subsystem includes all the arteries and veins, and their capillaries not already included in the previous
subsystem. This subsysrtem carries the oxygenand nutrients to the body cells and removes waste
products.
The level of pressure of the blood pushing against the walls of the vessels as it is delivered
throughout the body referred to as blood pressure. Most individuals are familiar with the arterial blood
pressure taken by the arm over the brachial artery. The pressure measured with sphygmomanometer is
divided into two parts. The systolic pressuire, caused by contraction of the ventricles, is the first number
to record. The second number is diastolic pressure, reflectiong the relaxation of the ventricles. The
average adult pressure is 120/80 mm Hg (millimeters of mercury).

ENDOCRINE SYSTEM

The liver, the largest gland of the body, can be considered a chemical factory that manufactures, stores,
alters, and excretes a large number of substances involved in metabolism. The location of the liver is
essential in this function because it receives nutrient-rich blood directly from the gastrointestinal (GI)
tract and then either stores or transforms these nutrients into chemicals that are used elsewhere in the
body for metabolic needs. The liver is especially important in the regulation of glucose and protein
metabolism. The liver manufactures and secretes bile, which has a major role in the digestion and
absorption of fats in the GI tract. The liver removes waste products from the bloodstream and secretes
them into the bile. The bile produced by the liver is stored temporarily in the gallbladder until it is
needed for digestion, at which time the gallbladder empties and bile enters the intestine (Fig. 39-1).

Anatomy of the Liver

The liver is a large, highly vascular organ located behind the ribs in the upper right portion of the
abdominal cavity. It weighs between 1200 and 1500 g and is divided into four lobes. A thin layer of

22
 23

connective tissue surrounds each lobe, extending into the lobe itself and dividing the liver mass into
small, functional units called lobules (Rodes, Benhamou, Blei, et al., 2007).

The circulation of the blood into and out of the liver is of major importance to liver function. The blood
that perfuses the liver comes from two sources. Approximately 80% of the blood supply comes from the
portal vein, which drains the GI tract and is rich in nutrients but lacks oxygen. The remainder of the
blood supply enters by way of the hepatic artery and is rich in oxygen. Terminal branches of these two
blood vessels join to form common capillary beds, which constitute the sinusoids of the liver (Fig. 39-2).
Thus, a mixture of venous and arterial blood bathes the liver cells (hepatocytes). The sinusoids empty
into venules that occupy the center of each liver lobule and are called the central veins. The central
veins join to form the hepatic vein, which constitutes the venous drainage from the liver and empties
into the inferior vena cava, close to the diaphragm (Rodes, et al., 2007). In addition to hepatocytes,
phagocytic cells belonging to the reticuloendothelial system are present in the liver. Other organs that
contain reticuloendothelial cells are the spleen, bone marrow, lymph nodes, and lungs. In the liver,
these cells are called Kupffer cells. As the most common phagocyte in the human body, their main
function is to engulf particulate matter (eg, bacteria) that enters the liver through the portal blood. The
smallest bile ducts, called canaliculi, are located between the lobules of the liver. The canaliculi receive
secretions from the hepatocytes and carry them to larger bile ducts, which eventually form the hepatic
duct. The hepatic duct from the liver and the cystic duct from the gallbladder join to form the common
bile duct, which empties into the small intestine. The sphincter of Oddi, located at thejunction where
the common bile duct enters the duodenum, controls the flow of bile into the intestine.

Functions of the Liver

Glucose Metabolism

23
 24

The liver plays a major role in the metabolism of glucose and the regulation of blood glucose
concentration. After a meal, glucose is taken up from the portal venous blood by the liver and converted
into glycogen, which is stored in the hepatocytes. Subsequently, the glycogen is converted back to
glucose (glycogenolysis) and released as needed into the bloodstream to maintain normal levels of
blood glucose. However, this process provides a limited amount of glucose. Additional glucose can be
synthesized by the liver through a process called gluconeogenesis. For this process, the liver uses amino
acids from protein breakdown or lactate produced by exercising muscles. This process occurs in
response to hypoglycemia (Shils, Shike, Ross, et al., 2006).

Ammonia
Conversion Use of amino acids from protein for gluconeogenesis results in the formation of ammonia as
a byproduct. The liver converts this metabolically generated ammonia into urea. Ammonia produced by
bacteria in the intestines is also removed from portal blood for urea synthesis. In this way, the liver
converts ammonia, a potential toxin, into urea, a compound that is excreted in the urine (Porth &
Matfin, 2009).

Protein Metabolism

The liver also plays an important role in protein metabolism. It synthesizes almost all of the plasma
proteins (except gamma-globulin), including albumin, alpha-globulins and beta-globulins, blood clotting
factors, specific transport proteins, and most of the plasma lipoproteins. Vitamin K is required by the
liver for synthesis of prothrombin and some of the other clotting factors. Amino acids are used by the
liver for protein synthesis (Porth & Matfin, 2009).

Fat Metabolism

The liver is also active in fat metabolism. Fatty acids can be broken down for the production of energy
and ketone bodies (acetoacetic acid, beta-hydroxybutyric acid, and acetone). Ketone bodies are small
compounds that can enter the bloodstream and provide a source of energy for muscles and other
tissues. Breakdown of fatty acids into ketone bodies occurs primarily when the availability of glucose for
metabolism is limited, as in starvation or in uncontrolled diabetes. Fatty acids and their metabolic
products are also used for the synthesis of cholesterol, lecithin, lipoproteins, and other complex lipids
(Porth & Matfin, 2009). In some conditions, lipids may accumulate in the hepatocytes, resulting in the
abnormal condition called fatty liver.

Vitamin and Iron Storage

Vitamins A, B, and D and several of the B-complex vitamins are stored in large amounts in the liver.
Certain substances, such as iron and copper, are also stored in the liver. Because the liver is rich in these
substances, liver extracts have been used for therapy for more than a century for a wide range of
nutritional disorders; however, the U.S. Food and Drug Administration (FDA) has urged caution
regarding the use of any animal organ extract because of possible risk of exposure to pathogenic
organisms.

Bile Formation

Bile is continuously formed by the hepatocytes and collected in the canaliculi and bile ducts. It is
composed mainly of water and electrolytes such as sodium, potassium, calcium, chloride, and

24
 25

bicarbonate, and it also contains significant amounts of lecithin, fatty acids, cholesterol, bilirubin, and
bile salts. Bile is collected and stored in the gallbladder and is emptied into the intestine when needed
for digestion. The functions of bile are excretory, as in the excretion of bilirubin; bile also serves as an
aid to digestion through the emulsification of fats by bile salts. Bile salts are synthesized by the
hepatocytes from cholesterol. After conjugation or binding with amino acids (taurine and glycine), bile
salts are excreted into the bile. The bile salts, together with cholesterol and lecithin, are required for
emulsification of fats in the intestine, which is necessary for efficient digestion and absorption. Bile salts
are then reabsorbed, primarily in the distal ileum, into portal blood for return to the liver and are again
excreted into the bile. This pathway from hepatocytes to bile to intestine and back to the hepatocytes is
called the enterohepatic circulation. Because of the enterohepatic circulation, only a small fraction of
the bile salts that enter the intestine are excreted in the feces. This decreases the need for active
synthesis of bile salts by the liver cells (Porth & Matfin, 2009).

Bilirubin Excretion

Bilirubin is a pigment derived from the breakdown of hemoglobin by cells of the reticuloendothelial
system, including the Kupffer cells of the liver. Hepatocytes remove bilirubin from the blood and
chemically modify it through conjugation to glucuronic acid, which makes the bilirubin more soluble in
aqueous solutions. The conjugated bilirubin is secreted by the hepatocytes into the adjacent bile
canaliculi and is eventually carried in the bile into the duodenum. In the small intestine, bilirubin is
converted into urobilinogen, which is partially excreted in the feces and partially absorbed through the
intestinal mucosa into the portal blood. Much of this reabsorbed urobilinogen is removed by the
hepatocytes and secreted into the bile once again (enterohepatic circulation). Some of the urobilinogen
enters the systemic circulation and is excreted by the kidneys in the urine. Elimination of bilirubin in the
bile represents the major route of its excretion. The bilirubin concentration in the blood may be
increased in the presence of liver disease, if the flow of bile is impeded (eg, by gallstones in the bile
ducts), or if there is excessive destruction of red blood cells. With bile duct obstruction, bilirubin does
not enter the intestine; as a consequence, urobilinogen is absent from the urine and decreased in the
stool (Porth & Matfin, 2009).

Drug Metabolism

The liver metabolizes many medications, such as barbiturates, opioids, sedatives, anesthetics, and
amphetamines. Metabolism generally results in drug inactivation, although activation may also occur.
One of the important pathways for medication metabolism involves conjugation (binding) of the
medication with a variety of compounds, such as glucuronic acid or acetic acid, to form more soluble
substances. These substances may be excreted in the feces or urine, similar to bilirubin excretion.
Bioavailability is the fraction of the administered medication that actually reaches the systemic
circulation. The bioavailability of an oral medication (absorbed from the GI tract) can be decreased if the
medication is metabolized to a great extent by the liver before it reaches the systemic circulation; this is
known as first-pass effect. Some medications have such a large first-pass effect that their use is
essentially limited to the parenteral route, or oral doses must be substantially larger than parenteral
doses to achieve the same effect.

25
 26

PATHOPHYSIOLOGY

Precipitating Predisposing

Diet: carbohydrates Age: 73 yrs olg

Genetics: family history of
diabetes mellitus type and
heart attack

Beta cell degradation of Insulin resistance

insulin receptor site

Dysfunction of pancreas Glucose cannot enter into

the bloodstream

Impaired insulin secretion Decrease production of ATP

Increase insulin demand Weakness

Compensation of pancreas

Exhaustion of pancreas

Insulin insufficiency

Glucose builds up in the

bloodstream
(hyperglycemia)

Increase blood viscosity Increase blood pressure in

the arterioles

26
 27

Increased Peripheral
resistance Insulin resistance

Vasoconstriction

Arteriolar narrowing

Damage of coronary
arteries

Atherosclerosis

Vascular endothelium
injury

Thrombus formation

Blockage of the heart

muscle

Decreased oxygen rich

Hypoxemia Anemia
supply

Difficulty of breathing Dizziness

27
 28

Interpretation

Beta cells degrataion of insulin receptor site the pancreas will dysfunction and impaired insulin secretion
and insuliun demand in compensation of pancreas.Exhaustion of pancreas insulin insufficiency that
glucose builds up in the blood stream (hyperglycemia) that glucose cannot enter into the bloodstream and
decrease production of ATP and experience of weakness of the body. And it will increase blood viscosity
to increase blood pressure in the arterioles that increased pheripheral resistance that may cause
vasoconstriction and it can narrowing of the arteriolar and the coronary may damage and it can be cause
of atherosclerosis and the vascular endothelium can injured so it can be transform in thrombus
transformation. This can be blockage of the heart muscle. If they have a plaque the oxygen rich supply
you need can be decreases. Due to the flow of the blood carries oxygen into the body can be difficult to
flow. And make you a hypoxemia is the blood can’t carry enough oxygen into the body. And shortness
of breath appears. Due to lack of oxygen they need. Experience anemia is a condition in which
you don't have enough healthy red blood cells to carry adequate oxygen to the body's tissues
and you can sign of dizziness.

28
 29

LABORATORY RESULTS

Name: BiacPatient B Age: 73 Date: 6/21/2019 Time: 9:39pm

Room/Bed: ER FIO2: 21%

ARTERIAL BLOOD GAS

Results:

Ph 7.45 (7.35-7.45) HCO3 14.4 (22-26 mEq/L)

pCO2 23.3 (35-45) B.E -8.8 ( +/-2 mEq/L)

po2 67.8 (80-100) O2 sat 93.5

Interpretation:

Respiratory alkalosis: the ph is normal range and the PCO2 and HCO3 is decreased in normal range.
This is the range of oxygen and carbon dioxide into the body.

Name: Patient B Age: 73 Date: 6/21/2019 Time: 5:15 am

Room/Bed: ER FIO2 : 44%

ARTERIAL BLOOD GAS

Results:

Ph 7.45 (7.35-7.45) HCO3 22.5 (22-26 mEq/L)

pCO2 26.8 (35-45) B.E -3.6 ( +/-2 mEq/L)

po2 70.5 (80-100) O2 sat 97.1%

Interpretation:

Respiratory alkalosis: the ph is normal range and the PCO2 and HCO3 is decreased in normal range.
This is the range of oxygen and carbon dioxide into the body.

29
 30

Name: Patient B
Received Lab Checked-in Released
25-june-2019 5:49 am 29-june-2019 5:55 am 25-june-2019 5:56 am

Test Name Result Unit Reference Range

Hematology
Complete Blood Count
RBC count L 2.93 4.7-6.1
Hemoglobin L 83.0 140-180
Hematocrit L 0.25 0.40-0.54
MCV 86.50 80.0-96.0
MCH 28.40 27.0-31.0
MCHC 32.90 32.0-36.0
RDW 13.0 11.6-14.6
Platelet count 451 150-450
MPV 8.50 6.5-12.0
PDW 15.90 15.0-17.0
WBC 52 5.0-10.0
Different count
Nuetrophil 0.63 0.50-0.70
Lymphocytes 0.24 0.2-0.5
Eosinophil 0.06 0.0-0.06
Monocytes 0.06 0.02-0.09
Basophil 0.01 0.0-0.02

Interpretation:
The second hematology report, which was taken last june 21, 2019, shows normal result aside from the
RBC,Hemoglobin, hemnatocrit, MCH, neutrophil and lymphocytes.
The decreased level of hemoglobin will result to decrease oxygen supply to the body and decreased
hematocrit indicates that the mass of RBC is decreased due to the plaque of the vessels.

Name: Patient B
Received Lab Checked-in Released
25-june-2019 5:49 am 29-june-2019 6:14 am 25-june-2019 6:22 am
Test Name Result Unit
Clinical chemistry
Sodium 143.26 137-145 Mmol/L
Potassium 3.58 3.5-5.1Mmol/L
Chloride 106.00 98-107 Mmol/L
Blood urea nitrogen 5.2 2.5-6.1 Mmol/L
Creatinine 86 46-92 Mmol/L

Interpretation:
The CBC count taken june 29,2019 .The sodium, Potasium,chloride, BUN,CREA is in normal range.

30
 31

Name: Biaco, Erlinda Zamora

Received Lab Checked-in Released
21-june-2019 6:07 pm 21-june-2019 6:32 pm 21-june-2019 6:41 pm

Test Name Result Unit Reference Range

COAGULATION
Prothrombin Time 12.1 secs 11.7-14.8
protime 115
PT Percent Activity 0.91 INR
PT INR 13.2 secs 11.7-14.8
PT Normal control
APTT
APTT L 24.8 secs 27.2-32
APTT Normal Activity 31.1 secs 26.00-34.00

Interpretation:
Decreased APTT the range secs to form a clot.

Name: Patient B
Received Lab Checked-in Released
21-june-2019 6:07 pm 21-june-2019 6:50 pm 21-june-2019 6:59 pm

Test Name Unit Reference Range

Immunology
Troponin 0.968 high ng/mL 0.034

Interpretation:

Elevated Troponin I is the range of damage of the heart muscle.

31
 32

Name: Patient B
Received Lab Checked-in Released
21-june-2019 6:07 pm 21-june-2019 6:19 pm 21-june-2019 6:21 pm

Test Name Result Unit Reference Range

Hematology
Complete Blood Count
RBC count L 2.89 4.7-6.1
Hemoglobin L 92.0 140-180
Hematocrit L 0.27 0.40-0.54
MCV 94.80 80.0-96.0
MCH H 31.70 27.0-31.0
MCHC 33.50 32.0-36.0
RDW 12.4 11.6-14.6
Platelet count 246 150-450
MPV 9.10 6.5-12.0
PDW 15.90 15.0-17.0
WBC 9.7 5.0-10.0
Different count
Nuetrophil H 0.75 0.50-0.70
Lymphocytes L 0.17 0.2-0.5
Eosinophil 0.03 0.0-0.06
Monocytes 0.04 0.02-0.09
Basophil 0.01 0.0-0.02

Interpretation:
The first hematology report, which was taken last june 21, 2019, shows normal result aside from the
RBC,Hemoglobin, hemnatocrit, MCH, neutrophil and lymphocytes.
The decreased level of hemoglobin will result to decrease oxygen supply to the body and decreased
hematocrit indicates that the mass of RBC is decreased due to the plaque of the vessels.
The increased neutrophils and decresed lymphocytes due to infection be blocking the vessel.
The high MCH decreased due to the thickening or large blood cells.

32
 33

NAME: Patient B Date: 6/25/2019

AGE: 73 y/0 Gender: female Lab.no.: 6.24 Hosp.no: 1246980
BLOOD TYPING AND CROSSMATCHING RESULT

Patient’s blood type: A Rh Group: POSITIVE Done by:

Source Serial componen ABO Rh phase Salin Protei Coomb’ interpretatio
of numb t typing typing s e (RT) n 37 C s (AHG) n
blood er C I
Hemolyzed
QMMC NVB PRBC A positive MAJO reg reg reg inpatens
SP R
20190 (PSRD
37965 )
5
AUTO
CONT
ROL
(PSPR)
EXTRACTION: 5/28/2019 EXPIRATION: 7/9/2019

Interpretation:

The type of blood is type A+.

33
 34

DRUG STUDY

Name of Classification Mechanism of Contraindication Indications, Side and Nursing Responsibilities

Drug Action Route and Adverse Effects
Dosage
Metoprolol Antianginal Inhibits Acute heart I: CNS: Anxiety, -Advise patient to notify
Tartate Antihypertens stimulation of failure, Hypertensi Confusion, prescriber if pulse rate falls
(Lopressor ive beta1 – Bradycardia < 45 on Dizziness, below 60 bpm or is significantly
) MI receptor sites bpm, D:50 Drowsiness, lower than usual.
Prophylaxis in decreased Hypersensitivity mg/tab Fatigue, -be aware that patients who take
and treatment cardiac to metoprolol or Headache metoprolol may be at risk for AV
excitability, its components CV: Angina, block.
cardiac output arrhythmias, -If AV block results from
and myocardial Orthostatic depressed AV node conduction,
oxygen hypotension prepare to administer
demand. EENT: Nasal appropriate drug, as prescribed,
These effects congestion, or assist with insertion of
help relieve Taste temporary pacemaker.
angina and disturbance -Be aware that abrupt
reduce blood GI: withdrawal of drug can
pressure. Constipation, precipitate thyroid storm in
Diarrhea, patient with hyperthyroidism or
Nausea, thyrotoxicosis.
Vomiting -Abrupt discontinuation of drug
MS: Backpain, can cause myocardial ischemia,
Myalgia Mi or severe hypertension
RESP: Dyspnea especially in patient with cardiac
SKIN: diseases.
Diaphoresis, -Check blood pressure an hour
Rash, Urticaria or two after administering the
drug.

34
 35

Name of Indications Adverse Effect Nursing Responsibilities

Drug Dosage Contraindications
Brand Name: 40 mg > Contraindicated >Short-term treatment of
Prilosec /cup with active duodenal ulcer;
Generic OD AC hypersensitivity to First-line therapy in
treatment of heartburn
name: omeprazole its
or symptoms of
Omeprazole components;use gastroesophageal reflux
cautiously with disease(GERD); >Short-
pregnancy,lactatio term treatment of active
n. benign gastric ulcer;
GERD,severe erosive
esophagitis,poorly
responsive
symptomaticGERD;
>Long-term
therapy:Treatment of
pathologic hyper secretory
conditions (Zollinger-
Ellisonsyndrome,multiplead
enomas,systemicmastocyt
osis);Eradication of H.
pylori With
amoxicillin or metronidazole.
>diarrhea,nausea,fatigue,c
onstipation,
vomiting,flatulence,acid
regurgitation,taste
prevention.arthralgia,myalg
ia.urticaria,dry mouth,
dizziness,headache,paraes
thesia,abdominal pain,skin
rashes, weakness,back
pain,upper respiratory
infection,cough.
Potentially fatal:
Anaphyolaxis
>caution patient to
swallow capsules whole-
not to open,chew,or
crush them.
>Arrange for further
evaluation of patient
after 8 weeks of
theraphy for gastroreflux
disorders;not intended
for maintenance
theraphy.
>Administer antacids
with omeprazole,it
needed.
Teaching points:
Take the drug before
meds.
Swallow the capsules
whole;do not chew,open,
or crush them.This drug
will need to be taken for
upto 8 week (short-term
therapy)or far a
prolonged period >5yrs
in some classes.have
regular medical follow-
up visits.

35
 36
Name of Contraindications Indications
Drug Dosage
Brand Name: >hypersensitivity,ac >reduction of risk of stroke
Atorvastatin tive liver disease or and heart attack in type @
Generic unexplained diabetes patients without
evidence of heart disease but
name: persistent elevation
with other CV risk factors and
Lipitor of serum revascularization procedures
transaminase,porph in patient without evidence if
yria,pregnancy,lact coronary heart
ation. disease(CHD)but multiple
risk factors other than
diabetes(eg.smoking,HTN,lo
w HDL, family history of
CHD,to reduce risk of
MI,revascularization
procedures,hospitalization for
CHF and angina.
. muscle pain, tenderness, or
36
Adverse Nursing Responsibilities
Effect
>Headache,plat >Stress that atorvastatin
ulence,diarrhea, is anadjunct to not a substitute
vomiting,anorexi for low-cholesterol diet
aangioedema,m >Tell patient to take drug
yalgia,alopecia, at thesame time each day
allergy,infection, tomaintain its effects
chest pain
Potentially fatal: >Instruct patient to take a
Thrombocytope missed dose as soon as
nia,rhabdomyoly possible. If it’s almost time
sis with acute for his next dose, he should
renal failure. skip the missed dose.
>Advise patient to
notify prescriber immediately
if he develops unexplained
weakness,especially if
accompanied by fatigue or
fever
 37

Name of Contraindications Indications Adverse Nursing Responsibilities

Drug Dosage Effect
Brand Name: ORAL > Hypersensitivity.Disorders of > It is indicated >.Side Effects: > Monitor BP carefully when
Catapres 0.1mg cardiac pacemaker is the treatment >Dry mouth discontinuing clonidine;hypertension
Generic 0.2mg activityand conduction.Pregnancy for >Drowsiness usually returns within 48 hr2.
hypertension. >Dizziness
name : o.3mg andlactation.
>Constipation Advise patient to take
Clonidine 75mg / >Sedation drug exactly as prescribed and not to
tablet PRN Adverse stop abruptly because withdrawal
Effects: symptoms andsevere hypertension
>Vomiting may occur..
>Loss of
appetite Instruct patient to
>Malaise (a consult prescriberif dry mouth or
generalill drowsiness becomesa problem.
feeling)
>Elevated During oral clonidine therapy.
liverenzymes Tominimize these effects,
(foundusing a prescriber may suggest taking most of
blood test) dosage at bedtime.5.
>Weight gain
>Rash. Instruct patient to report
chest pain,dizziness with position
changes,excessive drowsiness,
rash, urineretention, and vision
changes. Asneeded, tell patient to
rise slowly toavoid hypotensive
effects..

37
 38

Name of Indications Adverse Effect Nursing Responsibilities

Drug Dosage Contraindications
Brand Name: >Contraindicated i > Reduction > CNS: > Assessment
Clopidogrel 75mg 1 n: of atherosclerotic Depression,Dizziness, Assess patient for symptoms of
Tab PO Hypersensitivity events(MI, Fatigue,HeadacheEENT: stroke,peripheral vascular disease, or
Pathologic stroke, Epistaxis. MI periodically during therapy.Monitor
OD
bleeding(peptic vascular death) in Resp: patient for signs of thrombotic thrombocytic
ulcer, intracranial patients at riskfor Cough, Dyspnea. purpura
hemorrhage)Lactati such events CV: (thrombocytopenia,microangiopathic
on. including recent Chest Pain, hemolytic anemia,neurologic findings, renal
Use Cautiously in: MI,acute Edema,Hypertension. dysfunction, fever).May rarely occur, even
Patients at risk coronary GI: after short exposure(<2 wk). Requires
for bleeding syndrome GI Bleeding, Abdominal prompt treatment.
(trauma,surgery, or (unstable Pain, Diarrhea,Dyspepsia, Implementation
angina/non-Q- Gastritis. Discontinue clopidogrel 5-7 days
other pathologic
waveMI), stroke, Derm: beforeplanned surgical procedures.
conditions)History or peripheral Pruritus, Purpura,Rash. PO:
of GIbleeding/ulcer vascular disease. Hemat: Administer once daily without regardto
disease Severe Bleeding,Neutropenia, food.
hepatic impairment. Thrombotic Patient/Family Teaching
ThrombocytopenicPurpura. Instruct patient to take medication exactly
Metab: as directed. Take missed doses as soon as
Hypercholesterolemia. possible unless almost time for next dose;
MS: do not double doses. Advise patient to
Arthralgia, Back Pain. notify health care professional promptly if
Misc: fever, chills, sore throat, or unusual
Fever,Hypersensitivity bleeding or bruising occurs. Advise
Reactions. patient to notify health care professional of
medication regimen prior to treatment or
surgery.

38
 39

Name of Nursing
Contraindications Indications Adverse Effect
Drug Dosage Responsibilities

> Monitor CBC and

> Patients at risk for
platelet counts.watch
thromboembolic
Brand Name: for signs and
complications due to
Lenovox >CNS: dizziness, symptoms of bleeding
>hypersensitivity to severely restricted
headache,insomnia,conf > Teach patient safety
mobility during acute
drug usion, cerebrovascular measures to avoid
Generic illness.
heparin,sulfites,benzyl >prevention of accident. bruising or bleeding.
name : CV: edema, chest pain, >As appropriate,
alcoholor pork ischemic complications
Enoxaparin 0.4 cc atrial fibrillation, heart review all other
products of unstable angina or
SQ OD failure. significant and life-
>thrombocytopenia non Q wave
GU: Urinary retention threatening adverse
>active major myocardial infarction.
Therapeutic Skin: btuising.pruritis, reactions and
>Hospitalized patients
bleeding. rash. Urticaria. interactions, especially
class: with acute DVT with or
those related to drugs,
anticoagulant without pulmonary
tests.
embolism.(given with
warfarin sodium)

39
 40

Name of Drug Contraindications Indications Adverse Effect Nursing Responsibilities

Dosage
Brand Name: >hypersensitivity to >Mild pain. >EENT: hearing >watch for signs and
Bayer aspirin > 80mg salicylates, other >acute loss, tinnitus symptoms of
1 TAB NSAIDS rheumatic >GI: nausea, hypersensitivity and other
fever vomiting, abdom adverse reactions,
Generic name : OD >renal impairment
>to reduce risk inal pain, heart especially bleeding
Aspirin >blood coagulation of transient burn, anorexia tendency
defects ischemic Respiratory: >stay alert for signs and
Therapeutic class: Concurrent attacks wheezes symptoms of acute toxicity
Anti-piuretic, anticoagulant use >to reduce risk SKIN: >monitor elderly partients
antiplatelet drug >pregnancy of myocardial rash.urticaria, carefully because they’re
Pharmacological: . infarction bruising at greater risk for salicylate
angioedema toxicity.
NSAIDS
> check salicylate blood
Nonsteroidal anti- levels frequently.
inflamatory drug >evaluate patient for signs
and symptoms of hearing
loss tinnitus, vertigo

40
 41

Name of Drug Contraindications Indications Adverse Effect Nursing

Dosage Responsibilities
Brand Name: >hypersensitivity to >Essential >CNS: headachedizziness, > monitor patient
Norvasc 75mg 1 drug hypertension, drowsiness, fatigue,weakness for worsening
Generic name : tab PRN . chronic stable CV: peripheral edema, angina.
angina pectoris and angina,bradycardia,hypotension >monitor heart rate,
Amlodipine
vasospastic angina. GI: nausea, abdominal blood pressure
besylate discomfort >assess for heart
Musculoskeletal:muscle failure,report signs
Therapeutic cramps, muscle pain and symptoms.
class: SKIN: rash,pruritis,
Antihypertensive urticaria,flushing

Name of Drug Contraindications Indications Adverse Effect Nursing

Dosage Responsibilities
Brand Name: >Hypersensitivity >to fascilitate small >CNS:drowsiness,restless > Monitor blood
Metoclopramide 10 mg >pheochromocytoma bowel intubation; ness, anxiety,depression, pressure during iv
hydrochloride IV >parkinson’s radiologic irritability, fatgigue, administration.
examination when insomnia. >stay alert for
Generic name : PRN disease
delayed >CV: hypertension, depression and other
Q8 >suspected GI gastricemptying hypotension edverse effect.
Therapeutic class: obstruction, interferes. >GI: nausea, constipation, Tell patient to take 30
antiemetic , GI stimulant perforation or >gastroesophageal diarrhea, dry mouth minutes before meals.
hemorrhage reflux >instruct patient to
>history of seizure >prevention of report involuntary
disorder. postoperative movements of face and
nausea and altered consciousness or
vomiting blood pressure

41
 42

Name of Nursing
Contraindications Indications Adverse Effect
Drug Dosage Responsibilities

>Monitor for
sudden blood
pressure drop
Brand within 3 hours of
Name: initial dose if
Capoten >CNS:
patient is receiving
>hypersensitivity to dizziness,headache,drowsin
>hypertension concurrentdiuretics
drug or other ACE ess,fatigue, weakness
Generic >heart failure .
inhibitors CV: angina: pectoris,
name : 25 mg >left ventricular >tell patient to take
tachycardia
> Angioedema dysfunction after drug 1 hour before
Captopril 1TAB BID EENT:sinusitis
> pregnancy myocardial meals on empty
GI:nausea,
infarction stomach.
Therapeutic diarrhea,anorexia
. >advice patient to
SKIN: angioedema
class: report fever, rash,
Anti- aore throat, mouth
hypertensive sores, irregular
heart beat, chest
pain.

42
 43

Nursing Care Plan

Assessment Planning Interventions Rationale Evaluation

Diagnosis

Subjective:

“nanghihina Activity Short-term goal: 1. Establish rapport. 1. To gain trust. Short-term goal:
ako.” intolerance 2. Monitored and 2. To obtain baseline
related to assessed vital sign. data.
As verbalized by 3. Assessed patient’s 3. To note for any
plaque After 2-3 hrs of nursing After 2 hrs of nursing
the patient. general physical abnormality.
manifested intervention the condition. 4. To determine muscle intervention patient
Objective: by weakness. patient will participate 4. Performed muscle functioning on the will participated in
of range motion strength test. extremities. range of motion
PR: 110 exercise on 5. Promoted adequate 5. To boost strength. exercise.
rest. 6. Knowledge promotes
RR:25 extremities.
6. Range of motion by awareness to prevent
closed and open the complication of
BP: 180/70 arms and overexertion. Long-term goal:
Long-Term Goal: stretching.
Muscle strength
test:
After 2 days of nursing
Right arm: 4/5 After 2 days of nursing intervention patient
Left arm: 4/5 Intervention patient can walk and do
will do daily activity activities with assist of
Right Leg: 4/5 with assist of family family members.
members.
Left leg: 4/5

43
 44

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective:

“hinihingal ako “ as Ineffective airway Short-term goal: 1. Monitor vital 1. Provides baseline Short-term goal:
verbalized by the patient clearance related to signs PR,RR and data information
plaque as manifested blood pressure. for formulating
2. Observe and goals.
by shortness of After 3-5 hrs of After 5 hrs of nursing
monitor the 2. Sleep deprivation
Objective: breath. nursing patients sleep and difficulties intervention patient can
intervention patient pattern. during sleep can walk slowly to comfort
PR: 110 will do daily living 3. Observe and affect the activity room with support.
activities. document level of patient.
RR: 25 response to 3. Close monitoring
activity. will serve as a
BP: 160/80 4. Teaching patient cause for optimal Long-term goal:
Long-term goal: activity of deep progression of
breathing activity.
exercises 3x a 4. Knowledge
day or more promotes After 2 days of nursing
After 2 days of daily. awareness to intervention patient can
nursing 5. Sitting up in 30 prevent the go to toilet room slowly
intervention patient mins. 3x daily. complication of without any signs of
overexertion.
can do daily difficulty breathing.
activities with
support without
any signs of
difficulty breathing.

44
 45

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective:

“Nahihilo ako kapag Risk for injury related Short-term goal:  Monitor vital  For provides data Short-term goal:
tumatayo” as to high pressure as signs information.
verbalized by the manifested by After 5 hrs of nursing PR,RR,BP,and  For the safety of
intervention patient TEMP, the patient.
patient. dizziness. After 5hrs. of nursing
can cooperate.  Keep the side  For the
Objective: rails up. knowledge intervention patient can
 Teach the awareness and to cooperate of my nursing
PR: 110 patient to sitting circulate the care to her.
Long-term goal: 30 mins. blood flow.
RR: 25  Keep the linen  For the physical
stretch. mobility.
BP: 160/80  Instruct the  For the safety of Long-term goal:
After 2 days of patient for the patient.
nursing intervention assistance if
patient can be safety when she’s
and free from injury. doing. After 2 days of nursing
intervention patient is are
free from injury and goal
has been met.

45
46

46