Cardiomyopathy Manu

I.
Introduction
Cardiomyopathy constitutes a group of diseases that directly affect the structural or
functional ability of the myocardium. Dilated cardiomyopathy is the most common type
of cardiomyopathy. Dilated cardiomyopathy is characterized by a diffuse inflammation
and rapid degeneration of myocardial fibers that results in ventricular dilation, impaired
of systolic function, atrial enlargement, and stasis of blood in the left ventricle.
The signs and symptoms of dilated cardiomyopathy may develop acutely after a
systemic infection or slowly over a period of time. Most people eventually develop heart
failure. Symptoms include decreased exercise capacity, fatigue, dyspnea at rest,
paroxysmal nocturnal dyspnea, and orthopnea. As the disease progresses the patient may
experience dry cough, palpitations, abdominal bloating, nausea, vomiting and anorexia.
Signs can include an irregular heart rate with an abnormal S3 and/or S4, tachycardia or
bradycardia, pulmonary crackles, edema, weak peripheral pulses, pallor, hepatomegaly
and jugular vein distention. Heart murmurs and dysrhythmias are common. Decreased
blood flow through an enlarged heart promotes stasis and blood clot formation and may
lead to systemic embolization. (Borromeo, A., 2014)
According to Abadonio and Jorge (2015), as they conducted a prospective cohort
clinical study in Philippine Heart Center and used sixty-one (61) participant with thirty-
five (35) male and twenty-six (26) female, one of the three (3) most common heart disease
that leads to heart failure is Dilated Cardiomyopathy (Rheumatic Heart Disease and
Ischemic Cardiomyopathy are the other two.)
3AN2 (Batch 2021)
Borres; De Leon; Diaz; Galido; Garabiles; Guevarra; Matoza; Mendoza

Dilated cardiomyopathy is the most common form, affects five in 100,000 adults
and 0.57 in 100,000 children. It is the third leading cause of heart failure in the United
States behind coronary artery disease and hypertension. (Wexler, R., et al 2009)
Studying this topic has not only provided the student nurses an advance knowledge
but it inspired the students on learning this disease as part of being cautious on any possible
incidences in near future in case. This study can be served as an eye opener not only to the
student nurses themselves, but also to people around them. All the knowledge they gathered
in this paper may be the key for early prevention and intervention to everyone else.
II. Objectives
a. General Objectives:
This study aims to provide an understanding about a condition called Dilated
Cardiomyopathy. This is to help identify and define the problems experiencing by
the client. Also, to gather appropriate and adequate knowledge about the disease in
order to provide effective nursing interventions and enhanced the skills and attitude
towards the clients.
b. Specific Objectives:
Knowledge
⚫ Define Dilated Cardiomyopathy.
• Identify and describe the signs and symptoms of Dilated Cardiomyopathy.
Discuss its pathophysiology and etiology.
• Deliver proper nursing diagnosis, intervention and outcome for the patient.
3AN2 (Batch 2021)

• Prepare a discharge plan and provide appropriate health teaching for patients
suffering from Dilated Cardiomyopathy.
Skills
• Recognize signs and symptoms of Dilated Cardiomyopathy.
• Identify the steps appropriate in providing effective medical and nursing
management to the patient with Dilated Cardiomyopathy in specific, measurable,
attainable, realistic and time-bound (SMART) manner.
Attitude
⚫ Establish rapport with the patient in professional matter.
⚫ Deliver therapeutic nursing management and provide professional support
towards their condition with consideration of the patient’s own cultures and
beliefs.
III. Nursing History
a. Bibliography
Name: Patient R.A.B.T.
Address: Guadalupe Nuevo, Makati City
Age: 63 years old
Gender: Male
Height: 172.72 cm
Weight: 86 kg
3AN2 (Batch 2021)

Nationality: Filipino
Religion: Catholic
Civil Status: Married
Date of Admission: September 23, 2019
Hospital: Ospital ng Makati
Mode of Admission: Ambulatory
Date of Interview: September 26, 2019
Informant: Patient R.A.B.T., Patient’s significant other and
Patient’s chart
Chief Complaint: Nonhealing wound, right foot
Diagnosis: Dilated Cardiomyopathy
b. History of Present Illness
In 2018, when he was about to have a surgery for his right eye, his physician
requested for immediate stop of the operation to have his blood pressure checked
up on and it was found out that he has a high blood pressure so the surgery was
postponed. It was later confirmed that he is diagnosed with Dilated
Cardiomyopathy.
One week prior to admission, Patient noticed a non-healing wound on the
last digit of his right foot, and he decided to have a check-up at Ospital ng Makati.
Prior to admission, as Patient and his wife visited a near diagnostic clinic for his
laboratory due to unavailability in the hospital, Patient suddenly experience
dizziness and chest pain. His wife rushed him to Ospital ng Makati’s Emergency
3AN2 (Batch 2021)

Room and advised to be confined immediately at Intensive Care Unit but due to
unavailability of bed, the hospital asked for his wife’s consent to have the patient
confine to ward, first.
c. Past Medical History
According to the patient, he loves to drink to soft drinks during his free time
on his work. He can drink up to 3 bottles of soft drink, which leads to his diagnosis
of diabetes mellitus type II and chronic kidney disease stage III in 2014. It was just
an accident with barbeque stick, the wound he got from it did not heal. He had a
checkup about it and there, he was diagnosed with Diabetes Mellitus type II. His
first finger on left toe was amputated. In 2018, glaucoma was seen on his right eye.
He is also diagnosed with hypertensive atherosclerotic cardiovascular disease and
is scheduled to be operated. He also has an asthma.
d. Personal and Social History
Patient is known to be a happy person. He sees himself as a strong person. Patient
was a driver but was advised to stopped in 2017 when his eldest starting working.
During his free time, he often converses with his friends or he invites them to play
billiards on his house together with his family. Sometimes, he likes to walk around
to destress, or he goes to Antipolo to visit his other children with his wife.
Whenever problem arises, Patient prefer to talk it out immediately with his wife.
e. Family History
Patient is a loving father of four children, with one already deceased due to motor
accident, and trustful husband to his wife. He is the second child of the family. One of
3AN2 (Batch 2021)

his siblings died due to having the same case with him. Both of his parents are deceased
as well.
3AN2 (Batch 2021)

f. Genogram
3AN2 (Batch 2021)

3AN2 (Batch 2021)

IV. GORDON’S FUCTIONAL HEALTH PATTERN
Functional Health Prior to During Analysis and

Pattern Hospitalization Hospitalization Interpretation
I. Health Prior to During The patient and
Perception hospitalization, hospitalization, his significant
Health Patient stated that Patient stated that other follow and
Management- “hindi ako madalas he understands the cooperate with the
Pattern nagkakasakit pero pag importance of health care team.
nagsakit ako, lagi being diligent to
akong naoospital.” He receive his Normal
usually observes his physician’s Readiness for
condition first and advises. enhanced
drop by the local clinic therapeutic
to have a check-up and regimen
prescription for his management
condition. He also
verbalizes that, Reference:
“napansin ko na Nurses Pocket
inaatake ako ng Guide 14th
asthma ko kapag yung Edition by
weather nagiiba iba.” Marilyn E.
He does not have any Doenges
vitamin/ supplement. p.691-694
He is known to be
compliant with his
maintenance.
II. Nutritional Before he was During Prior to
and Metabolic diagnosed with hospitalization, hospitalization,
Pattern Diabetes Mellitus, Patient and his Patient was
Patient verbalized, significant other known to have a
“kapag napapagod verbalized the good appetite but
ako, umiinom ako ng changes in his during
soft drinks, yung sarsi, appetite as he hospitalization, he
nakakatatlong bote cannot consume had a change in
ako.” But when he got the full plate of the appetite and was
diagnosed and served meal and able to consume
undergone surgery in only was able to half of the served
2014, he stopped eat half of it due to hospital meal. It
drinking soft drinks loss of appetite. He was also noted
and substituted it with also verbalized that that he has
water. He drinks water he is controlling
3AN2 (Batch 2021)

equivalent to how his water intake, decreased water
much he drinks soft the last record of intake.
drinks. The patient has his intake is
no known allergies 150mL for eight Abnormal
and has a good (8) hours. Imbalanced
appetite, he eats 3-4 nutrition: less
times a day including than body
breakfast, lunch, requirements
afternoon snacks and
dinner. He usually eats Reference:
fried egg, pandesal, Nurses Pocket
and coffee for his Guide 14th
breakfast. As for his Edition by
lunch, as a driver, he Marilyn E.
often eats at random Doenges
karinderyas when he p. 369-374
sees his co-drivers
lining up for that store.
He likes to eat
vegetables but due to
his worsened
condition and
contraindication with
his medication,
Warfarin, he was
advised to stop eating
vegetable.
III. Elimination The patient stated that Patient verbalized, There are no noted
Pattern he voids regularly “di ako makatae changes regarding
with yellowish to clear kasi namamahay the Patient’s
color without any foul ako, ilang araw na urination prior and
odor and not more din simula nung during
than 300-400 mL per naconfine ako.” hospitalization but
urination. He also His significant there is in his
verbalized that He other also stated defecation as he is
defecates 1-2 times that his last having a hard time
daily. The color of his defecation was 4 due to being
stool is brown. The days ago as he is uncomfortable
quality is soft and hard not comfortable with diaper and
sometimes. The with defecating on new environment.
patient does not have the diaper and new
problems in urinating environment. Abnormal
and defecating. The Constipation
patient also stated that
3AN2 (Batch 2021)

he does perspire a lot Reference:
due to his work but has Nurses Pocket
no foul body odor. Guide 14th
Edition by
Marilyn E.
Doenges
p.162-167
IV. Activity and The patient verbalized Due to his present Due to his
Exercise that his work is also condition, his condition, Patient
Pattern his exercise. On his physician advised is still at risk of
rest day, he often him to have experiencing
walks to visit some complete bed rest insufficient
friends or just to without bathroom physiological
unwind. He can walk privilege. Even energy to
from his home up to though, the patient complete an
some known park. wanted to walk for activity which
some stretching, or why a complete
--- go to the bathroom assistance and bed
instead of using a rest is advised.
diaper, his
Different level of daily condition does not Abnormal
activities: permit him to do Activity
so. Intolerance
• Getting up
from bed: -- Reference:
Level 0 Nurses Pocket
• Sitting on Guide 14th
his/her own: Different level of Edition by
Level 0 daily activities: Marilyn E.
• Eating: Level 0 Doenges
• Taking a bath: • Getting up p.65-68
Level 0 from the
• Elimination: bed: Level
Level 0 II
• (Defecation/U • Sitting on
rination): her own:
Level 0 Level II
• Change of • Eating:
Clothes: Level Level I
0 • Taking a
• Hygiene and bath: Level
grooming: II
Level 0 • Eliminatio
3AN2 (Batch 2021)

• Movement: n: Level III
Level 0 • (Defecatio
n/Urination
): Level II
• Level 0 – Full • Change of
self-care clothes:
• Level I – Level II
Requires • Hygiene
assistance of and
equipment or grooming:
device Level II
• Level II – • Movement:
Requires Level II
assistance or
supervision
from another
person
• Level III—
Requires
assistance or
supervision
from another
person or
device
• Level IV – Is
dependent and
does not
participate.
V. Sleep-Rest The patient stated that According to Patient can’t get
Pattern he usually sleeps early Patient, when he enough sleep due
at 8:00 pm and woke got admitted he to environmental
up at 4:00 am to assist usually had a hard stimuli.
his grandchildren to time catching sleep
get ready for school. due to feeling Abnormal
He also does take a uncomfortable Disturbed sleep
nap during his two (2) with the pattern
hours break after environment and
lunch in his work. often visits from Reference:
Patient is not taking his health care Nurses Pocket
any medications or providers. Guide 14th
sleeping pills. His Edition by
significant other also Marilyn E.
mentioned that Patient Doenges
falls asleep easily. p.502-507
3AN2 (Batch 2021)

VI. Cognitive - The patient is oriented During interview, The patient is well
Perceptual to people, time and the patient shows oriented during
Pattern place, responses to no signs of interview and
stimuli verbally and confusion. He is showing interest
physically. He can well-oriented with upon asking
speak and understand the environment questions as well.
Filipino and is able to and can follow
read and write. The commands. His Normal
Patient has problems eyes are also Readiness for
in his vision on his blinking enhanced
right eye due to spontaneously. knowledge
glaucoma that was
caused by his diabetes. Glasgow coma Reference:
He has no hearing scale: Nurses Pocket
problem and does not Eyes – 4 (Open Guide 14th
use any hearing spontaneously) Edition by
assistance device. He Verbal – 5 Marilyn E.
usually learns more (Oriented) Doenges
when it is being demo. Motor – 6 (Obeys p.338-340
command)
Total: 15
VII. Self- The patient visualized Patient is still on The patient can
Perception- himself as a strong and his normal self. adjust and cope up
Self-Concept positive person. He The patient stated in his environment
Pattern usually gets mad at his that he does not knowing his
children when they are feel anything strength and
disobedient but does strange or changes limitations.
not physically hurt about himself. He
them and he knows thinks nothing Normal
how to control his changed on how he Readiness for
temper. “Masayahin sees himself, prior enhanced self-
ako,” as verbalized by and during concept
the Patient. hospitalization.
Reference:
Nurses Pocket
Guide 14th
Edition by
Marilyn E.
Doenges
p.736-740
VIII. Role- The patient plays the Patient stated that The patient did not
Relationship role of a father to his his relationship change of being a
Pattern three (3) children with his family is father to his
(total of four but one still strong and his children, being
3AN2 (Batch 2021)

(1) of them is already family gives their friendly,
deceased), and a full support to approachable to
husband to his wife. boost his others and stays
The patient stated that confidence optimistic despite
he has a good especially during of his condition.
relationship with his his hospitalization.
family. The patient He receives a Abnormal
also has a good and positive Risk for caregiver
strong relationship reinforcement, role strain
with his friends, comfort and
neighbors and co- reassurance. The Reference:
workers; there are no patient also has a Nurses Pocket
conflicts among them, good relationship Guide 14th
and he shares his ideas with the healthcare Edition by
when it comes to team. But, because Marilyn E.
decision-making. of his condition, he Doenges p. 670-
“Kapag may is anxious for his 683
problema, pinag- youngest child, he
uusapan namin ng said, “gusto ko pa
asawa ko saka hindi magtrabaho para
ko pinapatagal,” as sa bunso ko,
verbalized by the mapatapos ko man
patient. lang siya kaso
hindi na pwede
dahil di ko na
kaya.”
IX. Sexuality- According to Patient, The patient stated Due to
Reproductive he and his wife are that he is sexually environmental
both sexually inactive inactive even if his and physiological
as they already getting wife is present to factors, Patient’s
old and knowing that accompany him. sexual inactive is
his condition does not normal.
permits to do so. They
do not have family Normal
planning specifically Ineffective
and only does sexuality pattern
withdrawal as birth
control mechanism.
Reference:
Nurses Pocket
Guide 14th
Edition by
Marilyn E.
Doenges
3AN2 (Batch 2021)

p.484-487
X. Coping-Stress The patient copes up Patient copes to The patient is still
Tolerance with stress by stress by talking to optimistic and
Pattern travelling to Antipolo his companion and copes to stress by
with his wife to visit talking to other
sharing her
their children who are patients.
currently living there. problems and
He also takes care of talking to her
his grandchildren as family and
his leisure time. friends. despite of
his health
condition.
Normal
Readiness for
enhanced coping
Reference:
Nurses Pocket
Guide 14th
Edition by
Marilyn E.
Doenges
p.186-189
XI. Value-Belief The patient religious The patient The patient
Pattern affiliation is Catholic. verbalized that remains faithful to
He never forgets to their faith remains God and did not
pray to thank God for the same as they
blame Him for his
their everyday life, believed that with
even though he does the help of God, condition.
not regularly go to the patient’s health
Readiness for
church, he always condition will soon
watches the Eucharist get better. The enhanced
Mass/ Healing Mass patient never spiritual well-
on TV every Sunday to blames God for his being
listen to God’s words. condition. The
patient also stated Reference:
that there is Nurses Pocket
nothing more Guide 14th
important in the Edition by
physical world Marilyn E.
than the spiritual Doenges
life. The patient p. 821– 824
3AN2 (Batch 2021)

can't go to church,
but he never
forgets to pray.
V. Physical Assessment
a. General Survey
Client is awake, conscious and coherent. Patient’s vital signs were as follows:
Temperature: 36.5 Heart Rate: 83 bpm
Respiratory Rate: 30 bpm Blood Pressure: 130/80 mmHg
Height: 172.72 cm Weight: 86 kg
Diet: DM Diet Contraption: Nasal cannula and
Oxygen Saturation: 91% Heplock (R)
Neuro Vital Signs:

Eye: 4 Verbal: 5 Motor:6
Total: GCS 15/15
b. Table 5.1
September 26, 2019
6:00 PM
Organ/ Technique Actual Findings Analysis and

System Interpretation
Skin Inspection Color: brown complexion- Normal
3AN2 (Batch 2021)

even Normal
Smooth
Palpation Good-skin turgor Normal

Hair Inspection Color: Black and white Normal
Residing hairline Normal
Not evenly distributed Normal
Moist Normal
No infestations Normal
Head Inspection Symmetrical facial features Normal
(-) lesions Normal
(-) deformities Normal
(-) masses Normal
Ears Inspection Symmetry Normal
(-) discharge Normal
(+) earwax Normal
(-) lesions Normal
(-) nodules Normal
(-) redness Normal
Eyes Inspection Pink conjunctivae Normal
Sclera – not totally white Normal
(+) PERRLA- left eye Normal
(+) glaucoma in the right eye Abnormal
Glaucoma is the result of
damage to the optic nerve,
blind spots will develop in
visual field as this nerve
gradually deteriorates. This
nerve damage is usually
related to increased pressure
in the eye.
Reference:
Glaucoma. Retrieved from:
https://www.mayoclinic.org/
diseases-conditions
/glaucoma/symptoms-
causes/sys-20372839
(-) discharges Normal
Palpation Eyelids:
(-) masses Normal
Nose Inspection Symmetrically aligned Normal
3AN2 (Batch 2021)

(-) discharge Normal
(+) flaring of nares Abnormal
Flaring of nose with every
breath is a sign of
respiratory distress.
Reference:
Respiratory distress.
Retrieved from:
www.khanacademy.org/scie
nce/health-and-
medicine/respiratory-
system-diseases
(+) nasal cannula Normal

Mouth Inspection Pale Normal
and Moist Normal
Throat Pink mucosa Normal
(+) dentures in upper portion Normal
(+) lost teeth in lower portion Normal
(-) swelling Normal
(-) bleeding Normal
(-) infection Normal
Gums are pink Normal
Yellowish teeth Normal
(-) lesion Normal
Palpation (-) Lumps Normal

Neck Inspection (-) swelling Normal
(-) lesion Normal
Palpation Palpable carotid pulse Normal

No palpable lymph nodes Normal
Thorax Inspection Symmetrical chest expansion Normal
and with respiration
Lungs (-) Retractions Normal
Smooth Normal
Palpation Warm Normal
Dry Normal
Auscultati Bronchial sound Normal

on (-) wheezing sound Normal
(-) Crackle Sound Normal
3AN2 (Batch 2021)

(-) Rales
Heart Inspection (-) Visible PMI Normal
Normal
Auscultati (+) Regular Rhythm
on (-) Thrills
(-) Murmurs
Upper Inspection (-) Pallor Normal
Extremi- (-) Rashes Normal
ties (-) Bruises Normal
(+) Contraptions Normal
Heplock in Right arm Normal
(-) Swelling Normal
(-) Edema Normal
Abdomen Inspection Symmetrical Normal

(+) Globular shape Normal
(-) Masses Normal
(-) Lesions Normal
Ausculta- (+) Normal bowel sounds Normal

tion
Percussion (+) Dull sounds when organs Normal
are percussed
(-) Masses Normal
(-) Tenderness Normal
(-) Rigidity Normal
(-) Distention Normal
Lower Inspection (-) Pallor Normal

Extremi- (-) Rashes Normal
ties
(+) Gangrenous 5th digit Abnormal
(+) Right foot with Gangrene occurs when body
surrounding erythema tissue dies that caused by a
(+) Swelling loss of blood supply mostly
(+) Left first digit removed occurs in patient with
Diabetes that can lead to
amputation.
Reference:
Gangrene, Retrieved from:
https://www.webmd.com/ski
n -problems-and-
3AN2 (Batch 2021)

treatments/guide/gangrene-
causes-symptoms-
treatments
(-) Edema
Normal
Palpation
(+) Poor peripheral pulses Abnormal
Irregularities in the pulse
suggest the presence of
premature beats, and
completely irregular pulse
implies the presence of
atrial fibrillation.
Reference: Irregular pulse.
Retrieved
from:https:/www.ncbi.nlm.g
ov/books/NBK350/
VI. Review of System

Table 6.1
Subjective Analysis Interpretation
System
cues
Cardio- “Mataas talaga Dilate Cardiomyopathy (DCM) Ineffective Tissue
vascular yung BP ko, can be hard to recognise. The Perfusion
System namana na typical symptoms, such as
breathlessness, can build up
namin yun sa
slowly, and can be caused by
magulang other conditions. For example,
namin,” as asthma also causes
verbalized by breathlessness. This can delay
the patient. diagnosis of the condition,
which means that the heart may
be severely affected by the time
DCM is diagnosed. Some of the
typical symptoms are Fatigue
(tiredness) – as the heart’s
function is reduced, less energy
is delivered to the tissues, causes
excessive tiredness.Hypertension
- decrease in the cardiac output
causes impaired tissue perfusion
3AN2 (Batch 2021)

.
Refernce: Dilated
cardiomyopathy An introduction
to dilated cardiomyopathy or
‘DCM’ (2017) Retrieved from:
https://www.cardiomyopathy.org
/dilated-cardiomyopathy/intro
Respira- “Nahihirapan Dilated cardiomyopathy is Impaired Gas
tory ako huminga, defined as a primary heart Exchange related
System saka pag exhale muscle disorder characterised by to decrease oxygen
ko parang may a dilated, poor functioning left saturation as
sumisipol, kaya ventricle. The main functions of evidence by 02
sabi ni Doc, the heart pumping and relaxing saturation of 91%
lagi kong suotin are impaired. As a result of this,
tong oxygen,” the exercise capacity can be Ineffective
as verbalized diminished causing increased breathing pattern as
by the client. tiredness, fluid retention and evidenced by
shortness of breath. Symptoms difficulty of
at the time of presentation are breathing, and
very variable; the range from nasal flaring
none to severe limitation. The secondary to
symptoms reflect the incapacity dilated
of the heart muscle to cope with cardiomyopathy
the human body's activities; this
is why we call it heart failure. Risk for injury
related to activity
intolerance,
Reference: imbalance between
Tome, M., Exercise in dilated oxygen supply and
cardiomyopathy (DCM) (2017) demand as
Retrieved from evidenced by
https://www.cardiomyopathy.org weakness
/dilated-
cardiomyopathy/exercise-in-
dilated-cardiomyopathy-dcm
VII. Course in the Ward
Date Doctor’s Order Nursing Patient Reaction/

Responsibilities Evaluation
September 30, • DM diet • Explained to • Patient
2019 the client the complied
0600H changes in
3AN2 (Batch 2021)

his diet plan with the diet
and the ordered.
importance of
it in his
present
• Heplock condition.
• Assessed the • No signs of
site for the swelling,
patency: inflammation
redness, on the site.
swelling or
• Provide inflammation
adequate • Observed 14 • The client
analgesia rights of understand
giving the
medication importance
and assess for of taking the
any allergic medication
and adverse and show no
1400H reactions. signs of
• Still for ray allergy and
amputation of • Coordinate to toxicity.
5th digit right the • Patient and
foot once with department S.O
clearance in-charge and understands
explain the the
procedure to importance
be scheduled. of procedure
• To secure 7 • Secured to be
units of FFP proper units scheduled.
for transfusion of FFP
prior to OR
• Adequate • Monitored • Patient is
CBG control CBG updated
properly about the 7
units FFP
• Moderate to • Facilitated • Clients CBG
high back rest high back rest is within
• Refer • Referred normal range
accordingly • Patient felt
1430H comfortable
•
• Maintain on • Maintained
strict DM diet strict DM diet
3AN2 (Batch 2021)

and explained
the
importance of • Patient
changes in complied
• Heplock his diet plan. with the diet
• Assessed the ordered.
site for the
patency:
redness,
swelling or • No signs of
• Continue inflammation. swelling,
current • Observed 14 inflammation
antibiotics rights of on the site.
giving
medication • The client
and assess for understand
any allergic the
and adverse importance
reactions. of taking the
• Plans for ray medication
amputation of • Coordinate to and show no
5th digit Right the
signs of
foot once department
allergy and
Hema and in-charge and
MRA cleared explain the toxicity.
procedure to • Patient and
be scheduled. S.O
• Recheck for understands
• Noted the the
availability of availability of importance
7 units FFP 7 units of of procedure
FFP to be
scheduled.
• Facilitate • Facilitated
reverse typing reverse • Patient
of additional 5 typing of FFP understand
units FFP the
importance
of
• Monitored transfusing
• Ensure CBG FFP
adequate CBG properly • Patient did
control not
3AN2 (Batch 2021)

• Instructed the experience
• Encourage client to any allergic
deep breathing exercise deep reactions
and breathing and during
ambulation importance of transfusion
ambulation. • Patient’s
• Referred CBG is
ccordingly. within
• Refer normal range
• Patient felt
• Explained to comfortable
ENDO NOTES the client the
• Continue DM changes in
diet his diet plan
and the
importance of
it in his
present
condition.
• Increased
units of • Patient
• Increase Insulin as complied
Insulin ordered. with the diet
Glargine to 18 ordered.
units SC once
a day at 9pm
• Monitored
CBG thrice a • Patient
day and complied
• CBG obtained and
monitoring Glucose level understand
TID; refer if at acceptable
the
<80 or >200 range
importance
• Referred
of increasing
accordingly
the insulin
units.
• Refer • Patient’s
CBG is
within
acceptable
range
3AN2 (Batch 2021)

•
October 1, • Maintain NPO • Maintained • Patient

2019 post breakfast NPO diet complied
prior to OR with the diet
and explained ordered.
the
importance of
• IVF: D5LR 1L NPO diet in • No signs of
x 10 hours an operation. swelling,
while on NPO • Assessed the inflammation
site for the on the site.
patency:
redness,
swelling or • The client
• Medications inflammation understand
as ordered • Observed 14 the
rights of importance
giving of taking the
medication medication
and assess for and show no
any allergic signs of
and adverse allergy and
reactions. toxicity.
• Plans: for ray • Patient and
amputation of • Coordinate to S.O
5th digit right the understands
foot once department the
Hema and in-charge and importance
MRA cleared explain the of procedure
procedure to to be
be scheduled. scheduled.
• Secure consent • Secured
for procedure materials • Patient and
and materials needed and S.O
consent for understands
the the
procedure. importance
• Ensure • Monitored of procedure
adequate CBG CBG and to be
control obtained scheduled.
Glucose level • Patient’s
CBG is
3AN2 (Batch 2021)

at acceptable within
• Encourage range acceptable
deep breathing • Instructed the range
and client to
ambulation exercise deep • Patient felt
breathing and comfortable
importance of
ambulation.
Referred accordingly
Refer
October 2, ORTHO NOTES

2019 • For emergency • Explained the • Patient and
1400H ray amputation importance of S.O
for 5th toe the understands
Right foot procedure. the
importance
of procedure
• Secure consent • Secured to be
consent with scheduled.
regards to the • Patient and
procedure to S.O
be performed. understands
• Maintain on • Maintained the
NPO while on NPO diet importance
IV fluids prior to OR of procedure
and explained to be
the scheduled.
importance of • The client
NPO diet in understand
an operation. the
importance
• CBG of taking the
monitoring q2 • Monitored medication
while on NPO CBG and and show no
and record obtained signs of
Glucose level allergy and
at acceptable toxicity.
range
3AN2 (Batch 2021)

• Refer • Referred • Client’s
2200H accordingly CBG is
within
acceptable
• Transfuse 7 • Recheck the range
units FFP 7 units FFP
properly and monitor
reverse typed for any
for 30 minutes allergic
for each unit reactions or
adverse • Patient
effects. understand
the
importance
of
• WOF dyspnea, • Monitor for transfusing
desaturation any allergic FFP and
and etc. reactions or Patient did
adverse not
effects. experience
• Refer • Referred any allergic
accordingly. reactions
• Maintain on • Maintained during
NPO NPO diet transfusion
prior to OR • No allergic
and explained reactions
the noted.
importance of
NPO diet in
• IVF: D5LR 1L an operation.
x 10 hours • Assessed the
site for the • Patient
patency: complied
redness, with the diet
swelling or ordered.
inflammation
• Continue • Observed 14
antibiotics rights of • No signs of
giving swelling,
medication inflammation
and assess for on the site.
any allergic
and adverse
reactions.
3AN2 (Batch 2021)

• The client
• Facilitate BT • Facilitated 7 understand
of 7 units FFP units of FFP the
importance
of taking the
medication
and show no
signs of
allergy and
toxicity.
Refer Referred accordingly • Patient
understand
the
importance
of
transfusing
FFP and
Patient did
not
experience
any allergic
reactions
during
transfusion
•
VIII. Diagnostic/ Laboratory Tests

HEMATOLOGY
September 27, 2019
3AN2 (Batch 2021)

Test Name Observed Normal Interpretation and Analysis
Result Range
Haemoglobin 11.0 L 14.0-18.0 g/dL Patients with Chronic kidney disease are not
making enough of a hormone called
erythropoietin that helps the body make red blood
cells
Reference:
Stivelman (2014), Anemia in CKD. Retrieved
from:
https://www.niddk.nih.gov/health-
information/kidney-disease/anemia
Hematocrit 0.34 L 0.40-0.54 Low hematocrit level may indicate low
production of red blood cell in patient with
chronic kidney disease.
Reference:
Stivelman (2014). Anemia in CKD. Retrieved
from:
White blood 12.7 H 4.0-11.0 array Elevated white blood cell count is a well-known
cell Count predictor of chronic kidney disease progression.
An elevated white blood cell count is a risk factor
for atherosclerotic disease.
Reference:
Meguroku (2017).Elevated white blood cells in
CKD. Retrieved from:
https://www.ncbi.nlm.nih.gov/pubmed/28699033
Red blood 3.9 L 5.0-6.4 array When kidneys are diseased or damaged, they do
cell Count not make enough erythropoietin. As a result, the
bone marrow makes fewer red blood cells,
causing anemia.
Reference:
Stivelman (2014). Anemia in CKD. Retrieved
from:
Platelet count 281 150-450 array NORMAL
3AN2 (Batch 2021)

Mean Cell 86.2 80-96.0 fL NORMAL
Volume
Mean Cell 28.2 27.0-31.0 pg NORMAL
Hemoglobin
Mean Cell 32.7 32.0-36.0 g/L NORMAL
Hemoglobin
Concentration
Mean Cell 8.1 6.5-12.0 fL NORMAL
platelet
volume
Red cell 14.8 H 11.6-14.6 % If Red cell distribution width is too high, it could
distribution be an indication of a nutrient deficiency, such as a
width deficiency of iron, folate, or vitamin B-12. These
results could also indicate macrocytic anemia,
when your body doesn't produce enough
normal red blood cells, and the cells it does
produce are larger than normal.
Retrieved from:
Gonzales (2019). Red cell distribution width
TEST. Retrieved from:
https://www.healthline.com/health/rdw-blood-
test
Neutrophils 84 H 50-70 % Having a high percentage of neutrophils in your
blood is called neutrophilia. This is a sign that
your body has an infection. Neutrophilia can point
to a number of underlying conditions and factors,
including: infection, most likely bacterial.
Reference:
Vercelloti (2012). Neutrophils mediate insulin
resistance. Retrieved from:
https://www.hematology.org/Thehematologist/Di
ffusion/1110.aspx
Lymphocytes 9L 20-40 % The high occurrence of apoptosis
in lymphocytes was accompanied by
a reduced number of blood-
circulating lymphocytes in diabetic patients.
Reference:
Sampson (2017). Understanding Neutrophils.
Retrieved from:
https://www.healthline.com/health/neutrophils
3AN2 (Batch 2021)

Monocytes 6H 2-5 % Monocytes from diabetic patients have a pro-
inflammatory profile. Inflammation and
activation of the innate immune system could be
linked diabetes pathogenesis and also to the
development of common diabetic complications,
mainly atherosclerosis.
Reference:
Ethen (2007). Monocytes. Retrieved from:
https://www.ncbi.nlm.nih.gov/pubmed/17112620
Eosinophils 1L 2-4 % low levels of eosinophils are not usually of
concern unless other white cell counts are also
abnormally low. If all white cells counts are low,
this can signal a problem with the bone marrow.
Reference:
Marcin (2017). Eosinophil count. Retrieved from:
https://www.healthline.com/health/eosinophil-
count-absolute
HEMATOLOGY PTT
October 1, 2019
Test Name Observed Result Normal Values Interpretation and Analysis
Prothrombin time 18.5 H 10.4-14.0 seconds May indicate that blood is taking
longer than normal to clot and may
be a sign of many conditions,
including: Bleeding or clotting
disorder, Lack of vitamin K
Reference:
Webmd (2019). Prothombin Time.
Retrieved from:
https://www.webmd.com/a-to-z-
guides/prothrombin-time-test#1
PT Percent 39.5 L 73-127 % Quick value of only 30%, indicates
Activity that the blood coagulation time is
longer than normal.
Reference:
Webmd (2019). Retrieved from:
3AN2 (Batch 2021)

PT international 1.63 H 0.88-1.21 In healthy people an INR of 1.1 or
normalized ratio below is considered normal.
An INR range of 2.0 to 3.0 is
generally an effective therapeutic
range for people
taking warfarin for disorders such
as atrial fibrillation or a blood clot
in the leg or lung.
Reference:
Mayo clinic staff (2018). Retrieved
from:
https://www.mayoclinic.org/tests-
procedures/prothrombin-
time/about/pac-20384661
Activated PTT 47.1 H 30.4-41.2 seconds A typical aPTT value is 30 to 40
seconds. If patient is taking
heparin PTT results is 120 to 140
seconds, and aPTT to be 60 to 80
seconds. If the number
is higher than normal, it could
mean several things, from a
bleeding disorder to liver disease.
Reference:
Webmd (2019). Retrieved from:
CLINICAL CHEMISTRY
October 1, 2019
3AN2 (Batch 2021)

X-RAY
CHEST
Impressions:
Magnified Heart, Atheromatous aorta, Thoracic spondylosis.
Test Name Observe Normal Interpretation and Analysis

d Result Values
CREATININE 138 H 64 – 100 As the kidneys become impaired, the creatinine level in
umol/L the blood will rise due to poor clearance of creatinine by
the kidneys. Abnormally high levels of creatinine thus
warn of possible malfunction or failure of the kidneys
Reference:
Davis (2017) Creatinine. Retrieved from:
https://www.medicinenet.com/creatinine_blood_test/artic
le.htm
BLOOD 248 208-428 NORMAL
URIC ACID umol/L
SODIUM 135 135.0 – NORMAL

148
mmol/L
POTASSIUM 3.8 3.5 – 5.3 NORMAL
mmol/L
CHLORIDE 102.4 98.0 – NORMAL
107
mmol/L
RIGHT FOOT
Impressions:
No lytic changes, discrete fracture or dislocation in the views provided.
Atherosclerosis.
3AN2 (Batch 2021)

IX. Differential Diagnosis
a. Table 9.1
Signs & Dilated Hypertrophic Restrictive Myocarditis Acute

Symptoms Cardiomyopathy Pericarditis
Cardiomyopathy Cardiomyopathy
Fatigue / / / / /
Dyspnea at / / / / /
rest
Holosystolic / / / X X
Murmur
S4 / / X X X
S3 / / / X X
Weak / X / / /
Peripheral
Pulses
Cardiomegaly / / / / /
Dysrhythmias / X X / /
Hypertrophic cardiomyopathy (HCM) is a genetic cardiovascular disease. It is defined
by an increase in left ventricular wall thickness that is not solely explained by abnormal
loading conditions. This disorder is caused by a mutation in cardiac sarcomere protein
genes and is most frequently transmitted as an autosomal dominant trait. HCM has a
variable presentation. Signs and symptoms of HCM can include the following, sudden
cardiac death (the most devastating presenting manifestation), dyspnea (the most common
presenting symptom),syncope and presyncope, angina, palpitations, orthopnea and
paroxysmal nocturnal dyspnea (early signs of congestive heart failure.

3AN2 (Batch 2021)

Restrictive cardiomyopathy (RCM) is a rare disease of the myocardium and is the least
common of the three clinically recognized and described cardiomyopathies. [1, 2] It is
characterized by diastolic dysfunction with restrictive ventricular physiology, whereas
systolic function often remains normal. Atrial enlargement occurs due to impaired
ventricular filling during diastole, but the volume and wall thickness of the ventricles are
usually normal. RCM accounts for approximately 5% of all cases of diagnosed
cardiomyopathies.
Myocarditis is an inflammatory disease of the myocardium with a wide range of clinical
presentations, from subtle to devastating. Myocarditis usually manifests in an otherwise
healthy person and can result in rapidly progressive (and often fatal) heart failure and
arrhythmia. Patients with myocarditis have a clinical history of acute decompensation of
heart failure, but they have no other underlying cardiac dysfunction or have low cardiac
risk.
Acute pericarditis is an inflammation of the pericardium characterized by pericarditic
chest pain, pericardial friction rub, and serial electrocardiographic (ECG) changes (eg, new
widespread ST-elevation or PR depression; new/worsening pericardial effusion).The first
and last stages of ECG changes are seen in the images below. Chest pain is the cardinal
symptom of pericarditis, usually precordial or retrosternal with referral to the trapezius
ridge, neck, left shoulder, or arm. Common associated signs and symptoms include low-
grade intermittent fever, dyspnea/tachypnea (a frequent complaint and may be severe, with
myocarditis, pericarditis, and cardiac tamponade), cough, and dysphagia. In tuberculous
pericarditis, fever, night sweats, and weight loss are commonly noted (80%).
3AN2 (Batch 2021)

Interpretation:
The table above shows the four differential
diagnosis of Dilated Cardiomyopathy,
Hypertropic Cardiomyopathy does not elicit
dysrhythmia and weak peripeharl pulses, while
Restrictive Cardiomyopathy does not elicit signs
of S4 heart sound and dysrhythmia. Myocarditis and Pericarditis both does not elicit signs
of S3, S4 sound and Holosystolic murmurs because the definitive sign is pericardial friction
rub.
X. Anatomy and Physiology
Cardiovascular System
The Cardiovascular system is the transport
system of the body, through which the
nutrients are conveyed to places where these
are utilized, and the metabolites (waste
products) are conveyed to appropriate places
from where these are expelled. The
3AN2 (Batch 2021)

conveying medium is a liquid tissue, the blood, which flows in tubular channels called
blood vessels. The circulation is maintained by the central pumping organ called the heart.
Anatomy of the Cardiovascular System
Heart
- Approximately the size of a person’s fist, the hollow, cone-shaped heart is a four-
chambered muscular organ which pumps blood to various parts of the body. Each half of
the heart has a receiving chamber called atrium, and a pumping chamber called ventricle.
It is enclosed within the inferior mediastinum. Its more pointed apex is directed toward the
left hip and rests on the diaphragm, approximately at the level of the fifth intercostal space.
Arteries
- Blood vessels that deliver oxygen-rich blood from the heart to the tissues of the body.
Each artery is a muscular tube lined by smooth tissue. The largest artery is the aorta, the
main high-pressure pipeline connected to the heart's left ventricle. The aorta branches into
a network of smaller arteries that extend throughout the body.
Veins
- Blood vessel that return deoxygenated blood from your organs back to your heart.
Deoxygenated. Deoxygenated blood that flows into your veins is collected within tiny
blood vessels called capillaries.
3AN2 (Batch 2021)

Arteries and veins have a similar wall structure. They have an outer layer called the tunica
adventitia or externa, a middle layer called the tunica media and the inner layer called the
tunica intima.
1. Tunica Externa, this is the outer layer of the vein wall, and it’s also the thickest. It’s
mostly made up of connective tissue, these anchor arteries to nearby tissues. The
tunica externa also contains tiny blood vessels called vasa vasorum. The vasa
vasorum are found in large veins and arteries such as the aorta and its branches.
These small vessels serve to provide blood supply and nourishment for tunica
adventitia and outer parts of tunica media of large vessels
2. Tunica Media, the tunica media is the middle layer. It’s thin and contains a large
amount of collagen. Collagen is one of the main components of connective tissue.
3. Tunica Intima, this is the innermost layer. It’s a single layer of endothelium cells
and some connective tissue.
Capillaries
- These are networks of microscopic vessels which connect arterioles with the venules.
These come in intimate contact with the tissues for a free exchange of nutrients and
metabolites across their walls between the blood and the tissue fluid. The metabolites are
partly drained by the capillaries and partly by lymphatics. Capillaries are replaced by
sinusoids in certain organs, like liver and spleen.
Blood
3AN2 (Batch 2021)

- Blood is a special type of tissue of human body. The character which differentiates it from
rest of the tissues of human body is that it is in fluid form. It is composed of Blood Cells
and Plasma. Plasma is the watery portion of blood and makes about 55% of the blood
volume. The blood cells make about 45% of the blood volume and are of three types: Reb
Blood Cells (RBC), White Blood Cells, Platelets.
Physiology of the Cardiovascular System
Oxygen enters the bloodstream through tiny membranes in the lungs that absorb oxygen as
it is inhaled. As the body uses the oxygen and processes nutrients, it creates carbon dioxide,
which your lungs expel as you exhale.
The circulatory system works thanks to constant pressure from the heart and valves
throughout the body. This pressure ensures that veins carry blood to the heart and arteries
transport it away from the heart. (Hint: to remember which one does which, remember that
“artery” and “away” both begin with the letter A.) There are three different types of
circulation that occur regularly in the body: Pulmonary Circulation, Systemic Circulation,
Coronary Circulation.
1. Pulmonary circulation: This part of the cycle carries oxygen-depleted blood away
from the heart, to the lungs, and back to the heart.
2. Systemic circulation: This is the part that carries oxygenated blood away from the
heart and to other parts of the body.
3AN2 (Batch 2021)

3. Coronary circulation: This type of circulation provides the heart with oxygenated
blood so it can function properly.
XI. Pathophysiology
3AN2 (Batch 2021)

3AN2 (Batch 2021)

XII. Medical Management
DRUG NAME MECHANISM INDICATIO SIDE EFFECTS/ CONTRAINDICATION NURSING

OF ACTION N ADVERSE RESPONSIBILITIES
EFFECTS
3AN2 (Batch 2021)

GENERIC NAME Piperacillin • Used to treat CNS: • Contraindicated to BEFORE
pneumonia patients who are
Piperacillin • Headache • Assess the Vital
and skin, hypersensitive to
Tazobactam
Kills the • fever Signs
gynecologic the drug and its
bacteria that al, and components
cause infection • Assess for
BRAND NAME abdominal EENT:
patient for drug
(stomach
Zosyn area) • mouth sores hypersensitivity
infections
Tazobactam caused by
CLASSIFICATION • Observe 14
bacteria. RESPI:
rights of giving
penicillin antibiotics
• difficulty medications
Prevents the
beta-lactamase breathing or
bacteria from
inhibitor swallowing
destroying Piper
DOSAGE acillin • wheezing
GI: DURING
4.5 g/ 100 ml / vial • stomach • Give only the

pain prescribed
through IV every 6
• diarrhea dosage.
hours
Reference: • constipat
ion • Administer
• nausea slowly
• vomiting Intravenously
3AN2 (Batch 2021)

Nursing2005 • heartbur
drug n AFTER
handbook • Advised the
SKIN: patient and his
Lippincott
Significant
Williams rash others to report
&Wilkins any signs of
itching
adverse
hives reactions.
• Monitor Vital
signs
3AN2 (Batch 2021)

EFFECTS
GENERIC NAME Clindamycin • used EENT: • Contraindicated to BEFORE

for the patients who are
Clindamycin • unpleasant • Assess Vital
treatment hypersensitive to
or metallic Signs
of serious the drug and its
taste in • Obtain Culture
BRAND NAME inhibits infections components.
mouth infection before
ribosomal caused by
Cleocin • Yellowing o therapy
translocation susceptibl
f eyes • Infusion must
e
(jaundice). be diluted prior
anaerobic
CLASSIFICATION to I.V. administ
bacteria. GI:
ration
• Antibiotics
bacterial protein • Observe 14
• abdominal
synthesis rights of giving
pain
inhibitor
• pseudo medications
DOSAGE membranou
s colitis
300 mg/ 50 ml /vial • esophagitis DURING
through IV every 6
bacteriostatic • nausea
hours • vomiting • Give only the
effect • Diarrhea prescribed
dosage.
3AN2 (Batch 2021)

SKIN: • should be
infused over at
Reference: • hypersensiti least 10-60
vity reactions
Nursing2005 minutes
(rash and hives)
drug • itching,
handbook AFTER
Lippincott • Monitor LFTs

and renal
Williams
function tests,
&Wilkins and blood
counts with
prolonged
therapy.
• Advised the
patient and his
Significant
others to report
any signs of
adverse
reactions.
• Monitor Vital
signs
3AN2 (Batch 2021)

EFFECTS
GENERIC NAME Pantoprazole

• Gastro
CNS: • Contraindicated to BEFORE
patients who are
Pantoprazole esophageal • Headache • Assess patient
Reflux hypersensitive to
routinely for
Disease the drug and its
epigastric or
Associated components.
BRAND NAME binds to the GI: abdominal pain
With A
(H+, K+)- and for frank or
PROTONIX History Of
ATPase enzyme Erosive • nausea occult blood in
system Esophagitis • diarrhea stool, emesis, or
CLASSIFICATION • abdominal gastric aspirate.
pain
Proton Pump • vomiting • Observe 14
Inhibitor (PPI) • dizziness rights of giving
suppresses the
final step in medications
• SKIN:
gastric acid
DOSAGE •
production • Redness DURING
40 mg/vial 40 mg • Pain
through IV once a • swelling • Give only the
day Reference: • prescribed
• dosage.
3AN2 (Batch 2021)

Nursing2005 • Should
drug be administered
intravenously
handbook
over a period of
approximately
Lippincott
15 minutes at a
Williams rate of
&Wilkins approximately 7
mL/min.
• Reconstitute
each vial with
10 mL of 0.9%
NaCl.
Reconstituted
solution is
stable for 6 hr at
room
temperature.
AFTER
• Monitor bowel
function.
Diarrhea,
abdominal
3AN2 (Batch 2021)

cramping, fever,
and bloody
stools should be
reported to
health care
professional
promptly as a
sign of
pseudomembra
nous colitis.
May begin up to
several weeks
following
cessation of
therapy
• Instruct patient
to take
medication as
directed for the
full course of
therapy, even if
feeling better.
3AN2 (Batch 2021)

• Advise patient
to report onset
of black, tarry
stools; diarrhea;
or abdominal
pain to health
care
professional
promptly.
to notify health
care
professional
immediately if
rash, diarrhea,
abdominal
cramping, fever,
or bloody stools
occur and not to
treat with anti-
diarrheals
without
consulting
3AN2 (Batch 2021)

health care
professional.
3AN2 (Batch 2021)

EFFECTS
GENERIC NAME Atorvastatin • used along CNS: ▪ Contraindicated with BEFORE

with a allergy to
Atorvastatin • Headache Atorvastatin, fungal • Obtain history
proper diet
• Drowsiness byproducts, active for allergies
to help • confusion liver disease or
lower • memory
BRAND NAME Slows the unexplained and • Assess
production of "bad" problems persistent elevations orientation,
Lipitor cholesterol • Fever of transaminase
cholesterol in affect, muscle
the body and fats levels, pregnancy,
GI: strength; liver
(such as lactation.
CLASSIFICATION evaluation,
LDL,
• constipation ▪ Use cautiously with abdominal
Statins triglycerid • diarrhea impaired endocrine examination;
es) and • nausea function.
decrease the lipid studies,
amount of
raise • Heartburn LFTs, renal
DOSAGE "good" • Flatulence
cholesterol in function tests
the arteries cholesterol
40 mg/ tab 1 tab MUSCO:
once a day (HDL) in • Obtain LFTs as
the blood. a baseline and
• Fatigue
Reference: • Mild muscle periodically
pain during therapy;
discontinue
3AN2 (Batch 2021)

Nursing2005 URO: drug if AST or
drug ALT levels
• Dark urine increase to 3
handbook
times normal
level
Lippincott
Williams
&Wilkins • Ensure that
patient has tried
cholesterol-
lowering diet
regimen for 3–6
mos. before
beginning
therapy.
DURING
• Administer drug
without regard
to food, but at
same time each
day.
• Consult
dietitian about
low-cholesterol
diets.
3AN2 (Batch 2021)

AFTER
• Report muscle
pain, weakness,
tenderness;
malaise; fever;
changes in color
of urine or
stool; swelling.
3AN2 (Batch 2021)

EFFECTS
GENERIC NAME Paracetamol • Treatment CNS: • Contraindicated to BEFORE:

of short patients who are
Paracetamol
term, mild hypersensitive to • Asses Vital
• headache
to the drug and its Signs
moderate • dizziness components.
BRAND NAME • Observe 14
peripheral pain • Fever
Perfalgan blockage of and/or rights of giving
pain impulse fever medications
HEMA:
generation when
• Infuse over 15
CLASSIFICATION enteral
• Neutropeni minutes, do not
route not
Analgesic
available a continue
Anti-pyretic Analgesic or • Leukopenia beyond 48
Effect contraindi
cated • Thrombocy hours.
(Anderson topenia
DOSAGE
Paracetamol 2005) DURING:
100 mg TIV every 6 GI:
hours for pain • Give only the
prescribed order.
3AN2 (Batch 2021)

• Vomiting • Do not mix with
inhibits the any other
hypothalamic SKIN:
intravenous fluids
heat-regulating
or medications
centre • Rash
inhibition of AFTER:
prostaglandin
synthesis in the
CNS
• Instruct the
patient and S.O to
report signs of
Anti-pyretic adverse reactions.
Effect
Reference:
Monitor Vital Signs
Nursing2005
drug
handbook
3AN2 (Batch 2021)

Lippincott
Williams
&Wilkins
3AN2 (Batch 2021)

EFFECTS
Carvedilol
GENERIC NAME • used to CNS: • Contraindicated to BEFORE
treat high patients who are
Carvedilol blocks α1 • Assess Vital
blood • dizziness hypersensitive to
receptors signs
pressure the drug and its
BRAND NAME and heart components
• headache • Take carvedilol
causes failure
Coreg
vasodilation of with food.
blood vessels EENT: Taking it with
CLASSIFICATION food reduces
• dry eyes
non-selective beta leads to your risk of side
adrenergic receptor decreased
effects.
blocker (β1, β2) and peripheral
CV:
an alpha adrenergic vascular
receptor blocker (α1) resistance • Don’t store this
• low blood
medication in
pressure
DOSAGE antihypertensiv moist or damp
e effect areas, such as
6.25 mg/ tab 1 tab • slower heart
twice a day bathrooms.
rate
3AN2 (Batch 2021)

Reference:
• Obtain 14 rights
Nursing2005 MUSCO:
of giving
drug medications
• unusual
handbook
tiredness
Lippincott DURING
Williams • lack of
• Give only the
&Wilkins energy or
ordered dosage.
weakness
• You can crush

GI:
carvedilol
tablets.
• diarrhea
• nausea AFTER
SKIN: • Monitor the

following:
• dry, itchy
✓ blood pressure
skin
✓ heart rate
✓ weight
3AN2 (Batch 2021)

✓ blood sugar (if
you have
OTHERS: diabetes)
✓ liver function
• weight gain
✓ potassium
• changes in levels
✓ cholesterol
sex drive or
levels
performance
• high blood
sugar
3AN2 (Batch 2021)

EFFECTS
GENERIC NAME Isosorbide • used to CNS: • Contraindicated BEFORE

mononitrate prevent with allergy to
Isosorbide • headache nitrates, severe • ObtainHistory:
chest pain Allergy to
mononitrate • dizziness anemia, head
(angina) in nitrates, severe
• lightheaded trauma, cerebral
patients anemia, GI
ness hemorrhage,
BRAND NAME relaxes and with a • fainting hypertrophic hypermobility,
widens blood certain cardiomyopathy, head trauma,
Isosorbide nitrates heart narrow-angle cerebral
vessels
glaucoma, hemorrhage,
condition
EENT: postdural hypertrophic
CLASSIFICATION hypotension. cardiomyopathy
• dry mouth
Nitrates
blood can flow • Use cautiously • Assess Skin
more easily to with pregnancy,
color, T,
the heart CV: lactation, acute
DOSAGE MI, CHF. lesions;
orientation,
30mg /tab 1 tab once • irregular reflexes, affect;
a day heart rates
P, BP,
• chest pain
causes a orthostatic BP,
relaxation of baseline ECG,
peripheral
3AN2 (Batch 2021)

vascular smooth RESPI: perfusion; R,
muscle adventitious
• shortness of
sounds; liver
breath
evaluation,
Reference: normal output;
CBC, Hgb
Nursing2005 GI:
drug
• nausea
handbook • vomiting DURING
• Constipatio
• Give sublingual
Lippincott n
• Diarrhea preparations
Williams under the
tongue or in the
&Wilkins
buccal pouch;
discourage the
SKIN:
patient from
swallowing.
• skin warmth
or redness,
• Give oral
preparations on
an empty
stomach, 1 hr
before or 2 hr
after meals;
take with meals
if severe,
3AN2 (Batch 2021)

uncontrolled
headache occurs
• Place sublingual
tablets under
the tongue or in
the cheek; do
not chew or
swallow the
tablet.
AFTER
• Report blurred
vision,
persistent or
severe
headache, and
rash, more
frequent or
more severe
angina attacks,
fainting.
3AN2 (Batch 2021)

EFFECTS
GENERIC NAME Spironolactone • Indicated CNS: • Contraindicated to BEFORE

for the patients who are
Spironolactone • Dizziness • Obtain history
treatment hypersensitive to
of allergy to
Aldosterone of • Headache the drug and its
spironolactone;
BRAND NAME Antagonist hypertensio components
• Drowsiness hyperkalemia;
n, to lower
renal disease
ALDACTONE blood • Tiredness • Contraindicated
pressure. • restlessness for patients with
• Assess skin
anuria, acute renal
CLASSIFICATION causes the color, lesions,
insufficiency,
kidneys to edema;
Potassium-sparing significant
eliminate EENT: orientation,
diuretics impairment of
unneeded water reflexes, muscle
and sodium • Dry mouth renal excretory
strength; P,
and thirst function,
baseline ECG,
DOSAGE hyperkalemia,
BP; R, pattern,
25 mg / tab 1 tab Addison's disease,
adventitious
once a day and with
reduces the loss CV: sounds; liver
concomitant use of
of potassium evaluation,
• Arrhythmia eplerenone.
from the body bowel sounds;
urinary output
3AN2 (Batch 2021)

patterns,
• Unusual
menstrual cycle;
Reference: bleeding or
bruising CBC, serum
Nursing2005 electrolytes,
GI: renal function
drug
tests, urinalysis
handbook • pain in the
upper right
Lippincott abdomen
• loss of DURING
Williams
appetite
• Give daily
&Wilkins • vomiting
doses early so
blood
that increased
• bloody urination does
stools not interfere
with sleep.
OTHERS: AFTER
• Erectile • Avoid giving

dysfunction food rich in
potassium
• Weigh on a
regular basis, at
the same time
and in the same
clothing, and
3AN2 (Batch 2021)

record the
weight on your
calendar.
• Report weight
change of more
than 3 pounds
in 1 day,
swelling in your
ankles or
fingers,
dizziness,
trembling,
numbness,
fatigue,
enlargement of
breasts,
deepening of
voice,
impotence,
muscle
weakness, or
cramps.
3AN2 (Batch 2021)

OF ACTION N ADVERSE RESPONSIBILITIE
EFFECTS S
GENERIC NAME Enalapril • indicated for CNS: • Contraindicated to BEFORE

the patients who are
Enalapril
• dizziness • Obtain history for
treatment of hypersensitive to
• lightheaded allergy to
hypertension the drug and its
ness enalapril,
BRAND NAME inhibits ACE components.
• sleep impaired renal
VASOTEC problems function, salt or
(insomnia) volume depletion
• drowsiness • History of
• headache angioedema due to • Assess skin color,
CLASSIFICATION decreases levels
previous treatment lesions, turgor; T;
of angiotensin GI:
Ace inhibitors with ACE
II orientation,
inhibitors; bilateral reflexes, affect,
• nausea
renal artery
DOSAGE • vomiting peripheral
stenosis.
• diarrhea sensation; P, BP,
10 mg/ tab 1 tab Pregnancy peripheral
less
once a day CV: perfusion;
vasoconstriction
and decreased mucous
• slow/irregul membranes,
blood pressure ar heartbeat
bowel sounds,
• weak pulse
liver evaluation;
3AN2 (Batch 2021)

Reference: urinalysis, LFTs,
renal function
Nursing2005 tests, CBC, and
drug differential
SKIN:
handbook
• skin itching
Lippincott rash DURING
Williams • Give only the
&Wilkins prescribed
dosage.
AFTER
• Monitor patients
on diuretic
therapy for
excessive
hypotension after
the first few doses
of enalapril.
• Monitor patient
closely in any
situation that may
lead to a drop in
BP secondary to
reduced fluid
3AN2 (Batch 2021)

volume
(excessive
perspiration and
dehydration,
vomiting,
diarrhea) because
excessive
hypotension may
occur.
• Report mouth
sores; sore throat,
fever, chills;
swelling of the
hands, feet;
irregular
heartbeat, chest
pains; swelling of
the face, eyes,
lips, tongue,
difficulty
breathing.
3AN2 (Batch 2021)

EFFECTS
GENERIC NAME Insulin glargine • used to CNS: • Contraindicated to BEFORE

improve patients who are
Insulin glargine • Dizziness
blood hypersensitive to
• Drowsiness • Assess for
sugar the drug and its
• Confusion symptoms of
BRAND NAME Lowers the control in components
adults hypoglycemia
levels of
Lantus (anxiety;
glucose (sugar)
EENT: restlessness;
in the blood
• Blurred tingling in
CLASSIFICATION Reference: hands, feet, lips,
vision
Parenteral blood- or tongue;
Nursing2005
glucose-lowering CV: chills; cold
agent drug sweats;
• Tachycardia
handbook confusion; cool,
pale skin;
DOSAGE Lippincott difficulty in
RESPI:
Williams concentration;
12 units
Subcutaneous once a • Rapid drowsiness;
&Wilkins
day breathing nightmares or
trouble
sleeping;
3AN2 (Batch 2021)

• Fruity excessive
breath odor hunger;
headache;
• Difficulty of irritability;
breathing nausea;
nervousness;
tachycardia;
URO: tremor;
weakness)and
• Increased hyperglycemia
urination
(confusion,
drowsiness;
SKIN: flushed, dry
skin; fruit-like
• Itching breath odor;
• Swelling rapid, deep
breathing,
polyuria; loss of
appetite;
unusual thirst)
periodically
during therapy
• Insulin is only
intended for the
subcutaneous
route, which is
3AN2 (Batch 2021)

the layer of skin
below the
dermis &
epidermis.
• Insulin should
not be mixed
with any other
insulin
solutions.
• Unopened
insulin should
be kept in the
refrigerator
DURING
• Alternate
injection sites
as skin can
become
irritated.
• Monitor blood
glucose every 6
3AN2 (Batch 2021)

hr during
therapy
• Use onlyinsulin
syringes to
draw up dose.
Insulin syringe
or SoloStar can
be used for
administration.
Prior to
withdrawing
dose, rotate vial
between palms
to ensure
uniform
solution; do not
shake
• Administer
subcutaneously
once daily at
any time during
the day, but at
the same time
each day
3AN2 (Batch 2021)

AFTER
on proper
technique for
administration.
Include type of
insulin,
equipment
(syringe,
cartridge pens,
alcohol swabs),
storage, and
place to discard
syringes.
Discuss the
importance of
selection and
rotation of
injection sites,
and compliance
with therapeutic
regimen
• Explain to
patient that this
3AN2 (Batch 2021)

medication
controls
hyperglycemia
but does not
cure diabetes
• Emphasize the
importance of
compliance
with nutritional
guidelines and
regular
exercise, as
directed by
health care
professional.
• Advise patient
to notify health
care
professional if
nausea,
vomiting, or
fever develops,
if unable to eat
regular diet, or
if blood sugar
3AN2 (Batch 2021)

levels are not
controlled
on signs and
symptoms of
hypoglycemia
and
hyperglycemia
and what to do
if they occur.
3AN2 (Batch 2021)

XIII. Nursing Care Plan
NURSING CARE PLAN PRIORITIZATION
Impaired Gas Exchange related to decrease oxygen saturation as evidence by 02
saturation of 91%
Ineffective breathing pattern as evidenced by difficulty of breathing, and nasal flaring
secondary to dilated cardiomyopathy
Acute pain related to Diabetes Mellitus in the Right Foot
Risk for injury related to activity intolerance, imbalance between oxygen supply and
demand as evidenced by weakness
Risk for Caregiver Role Strain related to Health Impairment
3AN2 (Batch 2021)

Assessment Nursing Inference Planning Nursing Intervention Rationale Evaluation
Diagnosis
Subjective Cues Impaired Dilated Short term: Independent Independent Short term:
Gas Cardiomyopath • Administer - To initially imrove After 5 minutes
“Nahihirapan Exchange y After 5 minutes of Oxygen via patient's oxygen of nursing
ako huminga, related to nursing intervention, the nasal cannula 2- saturation intervention, the
saka pag exhale decrease patient will be able to 3 Liters per patient were
ko parang may oxygen Weakened initially imrove oxygen minute. able to imroved
sumisipol,” as saturation as pumping saturation by - To educate the oxygen
verbalized by evidence by mechanism of administration of nasal • Explain to the patient and prevent the saturation.
the client. 02 saturation the heart cannula 2-3 Liters per patient the incidence of
of 91% minute. importance of withdrawing the
oxygen oxygen via nasal
Objective Cues Decrease administration. cannula.
cardiac output Long term:
• O2 sat: Long term: After 8 hours of
91% After 8 hours of nursing nursing
- To help with lung
• RR: 33 intervention, the patient • Elevate the intervention, the
expansion.
cpm Decrease will be able to maintain head of the bed patient were
• Weak hemoglobin oxygen saturation within to 45° degree able to maintain
peripher levels normal range of 95- oxygen
al pulse 100%. • Instruct the - To enhance gas saturation within
• Use of patient to do exchange. normal range of
acessory Decrease deep breathing 95-100%.
muscles oxygen levels in exercises. - For baseline data
• Nasal the blood • Monitor the
flaring Vital Signs
• Wheeze regularly
s during
3AN2 (Batch 2021)

expirati Decrease
on oxygen
saturation Dependent:
Dependent::
Impaired Gas • For baseline
Exchange - Monitor Laboratory data
Results ( such as
hemoglobin levels and
Reference: chest x- ray results )
Nursing Collaborative:
Diagnosis
Reference • To
Manual Sixth continuously
Edition by monitor
Sparks and Collaborative: patient’s
Taylor condition
• Refer to
Physician
3AN2 (Batch 2021)

ASSESSMENT DIAGNOSIS INFERENCE PLANNING INTERVENTION RATIONALE EVALUATION
Subjective: Ineffective Weakened left Short Term: Independent: Short Term:

“Nahihirapan breathing ventricle 5 minutes of • Assess vital • To obtain After 5 minutes
ako huminga, pattern as nursing signs baseline of nursing
saka pag exhale evidenced by intervention • Assess ABG data. intervention
ko parang may difficulty of the client levels, • To monitor the client
sumisipol, kaya breathing, Decreased will indicate according to oxygen and verbally said
sabi ni Doc, lagi tachypnea, and pumping of verbally facility policy ventilation he is now
kong suotin tong nasalflaring blood feeling status. comfortable
oxygen,” as secondary to comfortable • Assist the • Permits when breathing
verbalized by the dilated when client in a maximum GOAL MET
client. cardiomyopathy breathing high back rest lung
Hypoperfusion position expansion Long Term:
of tsissue After 30
Long Term: • Encourage • This minutes of
After 30 diaphragmatic method nursing
Objective: minutes of breathing for relaxes intervention
Pulmonary nursing patients with muscles the client’s
• O2 sat: congestion intervention chronic and respiratory rate
91% the client disease increases decreased from
• RR: 33 will patient’s 32 cpm to 25
cpm maintain oxygen cpm and with
• Weak Dyspnea normal level absence of
peripheral respiratory • Instruct about • This nasal flaring
pulse rate, depth pursed-lip measures and dyspnea.
• Use of and absence breathing allow GOAL MET
acessory Increased of dyspnea patient to
muscles respiratory and will participate
rate establish in
3AN2 (Batch 2021)

• Nasal normal maintaining
flaring breathing health
• Wheezes pattern. status
during improve
expiration ventilation.
• Encourage the • To prevent
client to eat infections
nutritious such as
foods such as nosocomial
green leafy infections
vegetables
and lean meat
without
compromising
his DM diet
Dependent:
• Hook patient • Will help
into oxygen the patient
3-4 lpm as alleviate
ordered by the his
doctor difficulty
of
Collaborative: breathing
• Review for
client’s X-ray
• To
determine
severity of
conditions
3AN2 (Batch 2021)

Assessment Nursing Inference Planning Nursing Intervention Rationale Evaluation
Diagnosis
Diabetes mellitus
Subjective Acute pain Short term: Independent: Independent: Short term:
Cues related to After 30 minutes of • Monitor vital • Notes progress After 30
Diabetes Wound in the nursing intervention signs every and changes in minutes of
“Masakit ang Mellitus in right toe after giving analgesic 4hours condition nursing
aking paa, the Right the pain is reduced • These measure intervention
mga 8/10 Foot from a pain scale of • Teach patient reduce muscle after giving
yung sakit” as Delayed wound 8/10 to 6/10 breathing tension or spasm analgesic the
verbalized by healing exercise to pain is reduced
the client reduce pain • To help patient from a pain
focus on non- scale of 8/10 to
• Plan activities pain-related 6/10
Objective Acute Pain with patient to matters Goal met
Cues provide
Facial Long term: distraction such
grimace After 8 hours of as reading,
Weakness nursing intervention television and • To redistribute Long term:
Pain scale of and providing visits. pressure on body After 8 hours of
8/10 activities and nursing
parts
breathing exercise the • Help patient into intervention and
patient is able to a comfortable activities and
tolerate the pain and position breathing
will express feeling of exercise the
Reference: comfort and relief Dependent: patient is able to
Nursing from pain • Reduces pain tolerate the pain
Diagnosis and will express
3AN2 (Batch 2021)

Reference Manual Dependent: feeling of
Sixth Edition by • Administer comfort and
Sparks and Taylor analgesic relief from pain
medication as Goal Met
ordered to
reduce pain
Assessment Nursing Inference Planning Intervention Rationale Evaluation

Diagnosis
3AN2 (Batch 2021)

Subjective Imbalance Long Term Independent Independent Long Term
cues: Risk for between oxygen Objective: • Instruct and help • To reduce the Objective:
“Nahihirapan injury related supply and After 3 days of the patient to body’s oxygen After 3 days of
ako huminga, to activity demand nursing intervention alternate periods demand and nursing
saka pag intolerance, the client will report of rest and prevent fatigue intervention the
exhale ko imbalance measurable increase activity client reported
parang may between Insufficient in activity intolerance measurable
sumisipol, oxygen energy with minimal • Encourage increased in
kaya sabi ni supply and assistance of patient to help • Participation in activity
Doc, lagi demand as significant other plan activity planning helps intolerance with
kong suotin evidenced by Weakness or progression, ensure patient minimal
tong weakness lethargy being sure to compliance. assistance of
oxygen,” as include activities significant other
verbalized by Short Term he considers
the client. Objective: essential GOAL MET
Limited /activity After 5 hours of
intolerance nursing intervention • Monitor
the client will use physiologic Short Term
Objective identified techniques physiologic • To ensure return Objective:
cues: to enhance activity responses to to normal a few After 5 hours of
(+) intolerance with the increased activity minutes nursing
Generalized Reference: assistance of level including intervention the
weakness Sparks and significant other such heart rate, client used
noted Taylor as doing self-care and respirations, and identified
RR: 30bpm Sixth Edition performing range of rhythm, and techniques to
(+)Oxygen Nursing motion blood pressure. enhanced
via nasal Diagnosis activity
cannula Reference • Teach patient intolerance with
Manual how to conserve the assistance of
(pg.26-27) energy while significant other
such as doing
3AN2 (Batch 2021)

performing • These measures self-care and
activities of daily reduce cellular performing
living such as metabolism and range of motion
sitting in a chair oxygen demand
while dressing, GOAL MET
wearing
lightweight
clothing, wearing
slip ons.
• Support and
encourage
activity to
patient’s level of
tolerance
• This help
Dependent develops the
• Administer patient’s
medication as independence.
ordered
Dependent
• To improve
client’s status and
Collaborative reduce factors
that aggravate
3AN2 (Batch 2021)

• Refer to activity
physician intolerance
• Refer to
recreation and
leisure specialist
Collaborative
• For further
assessment
• To develop
individual
appropriate
therapeutic
regimen
ASSESSME DIAGNOSIS INFERENCE PLANNING NURSING RATIONALE EVALUATION

NT INTERVENTIO
N
3AN2 (Batch 2021)

Subjective: Risk for Caregiver Role Health Short Term Independent: Short Term:
Strain related to Health impairment Outcome: Goal Met
- “Hind Impairment - After 30 1. Identify safety 1. Even if fully
i na minutes of issues concerning driven to fulfill After 30 minutes
ako nursing caregiver and the role of of nursing
pinap intervention, the receiver caregiver, the interventions,
ag Caregiver patient will person may the patient
trabah isolation due to verbalize have physical verbalized
ao ng present illness understanding of: impairments or understanding of
asawa Limiting the role cognitive his current
ko.” of caregiver due impairments that condition and
as to his current influence the needed
verbal condition, & quality of the limitations as
ized Vulnerable to Participating in caregiving caregiver of his
by the experiencing support groups, 2. Determine activities. family, and that
patien difficulty in and that the current 2. Noting the patient
t. performing the patient and knowledge of the misconceptions, identified
- Patien family caregiver significant other situation. and lack of significant
t role will identify information may stressors.
stated suitable & interfere with
that comfortable caregiver Long Term:
his stress-relieving response to Goal met
relatio methods to 3. Allow illness.
nship Risk for practice. caregiver to 3. Groups that After one week
with Caregiver Role participate in come together of nursing
his Strain Long Term support group. for mutual interventions the
famil Outcome: support can be patient
y is - After 1 week of advantageous in Identified
still nursing providing appropriate
strong REFERENCE: interventions, the education and relieving
and Nurses Pocket patient will methods with
3AN2 (Batch 2021)

his Guide 10th Edition exhibit the 4. Allow the care anticipatory the use of
famil by Marilyn E. following: recipient to show guidance. available
y Doenges p.210 - Identify risk gratitude for care resources and/or
gives 214 factors and given. 4. Feeling support system
their appropriate stress 5. Introduce appreciated for significant
full relieving factors stress-reducing decreases stressors,
suppo for intervention, methods to the feelings of Demonstrated
rt to Use of available caregiver. strain. change in
boost resources 5. It is important behavior and
his appropriately, that the lifestyle.
confid Demonstrate/initi caregiver has the Reported no
ence ate behaviors or opportunity to dissatisfaction in
especi lifestyle changes relax and current situation.
ally to prevent reenergize
durin development of emotionally
g his impaired Collaborative: throughout the
hospit function, Report day to assume
alizati satisfaction with 1. Determine care
on. current situation use/effectiveness responsibilities.
of resources and
Objective: support systems.
- Awak 1. Resources
e, grant
consci opportunity for
ous multiple
and 2. Provide safe competent
coher and effective providers and
ent alternatives to services on a
medication. temporary basis
3AN2 (Batch 2021)

- Docto or for a more
r’s extended period.
order
of 2. This is
compl necessary when
ete the use of
bed medication is
rest inappropriate
due to side
effects, the risk
Vital Signs
of drug
are as
interactions, or a
follows: lack of evidence
BP: 130/80 of their
Temp: 36.5°c effectiveness in
RR: 16 cpm treating the
PR: 83 bpm problem.
O2 Sat.: 99%
GCS: 15/15
3AN2 (Batch 2021)

XIV. Discharge Plan
MEDICATION ➢ Instruct and explain to the patient and significant other

that the prescribed medications are important to be
sustained until duration of physician’s order for the
client’s optimum recovery.
➢ Orient the client and the significant other about the
drug prescribed, name of drugs, their action, exact
dosage, route of administration, frequency and when
the drugs should be taken.
➢ Atorvastatin (Lipitor) 40 mg/tablet, 1 tablet once a day
used along with a proper diet to help lower "bad"
cholesterol and fats (such as LDL, triglycerides) and
raise "good" cholesterol (HDL) in the blood.
➢ Carvedilol (Coreg) 6.25 mg/tablet, 1 tablet twice a
day, used to treat high blood pressure.
EXERCISE ➢ Educate the patient and significant other about active

and passive range-of-motion exercises and encourage
the significant other to perform appropriate passive
range of motion exercises onto the client.
➢ Advise the client to have complete bed rest as ordered
by his Physician.
➢ Instruct the client to limit activity and that he can
perform active range of motion exercises while in
complete bed rest.
➢ Advise the significant other to assist patient at all
times.
TREATMENT ➢ Instruct the client and the significant other to follow

and comply with the physician’s order for the client’s
optimum recovery.
➢ Instruct the client and the significant other to avoid
OTC (over the counter) and complementary drugs
without consulting their physician first.
HEALTH ➢ Educate the client and significant other to establish a

TEACHING/ Diabetic diet, composed of food that are low in fat and
HYGIENE calories, key elements if a diabetic diet are fruits
3AN2 (Batch 2021)

vegetables and whole grains. The significant other and
relatives should also be encouraged to partake in order
to motivate strengthen the patient’s change in
behavior.
➢ Educate the client and significant other about the
importance of each drug prescribed to the client to
gain patient’s optimum recovery.
➢ Inform the client and the significant other about the
side effects as well as the adverse effects that are
expected with the prescribed drugs.
OUT PATIENT ➢ Any manifestations such as sudden onset of Shortness

of breath, Swelling of the legs, Fatigue, Weight gain
of 2 kilos within 3 days, Fainting, and Chest pain must
be reported to the patient’s physician, and/or must be
taken to the nearest hospital immediately.
DIET ➢ Instruct the client and significant other the importance

of preparing a taking balance diet to aid in the
recovery.
➢ Encourage client and significant other to continue
giving diet according to the Doctor’s order.
➢ Increase nutrient needs related to increased demand as
evidenced by present medical condition.
➢ Meal Plan
Day 1:
Breakfast
-1/2 cup of rice, 1 medium sized egg, 1 glass of
water, and 1 cup of low-fat milk
Morning snack
- 1 pack of Fita with 2 slices of Eden cheese, and 1
½ glass of water
Lunch
- 1 cup of rice, 1 serving of sinigang na manok, 1 ½
glass of water
Afternoon snack
- 1 medium sized orange, and 1 ½ glass of water
Dinner
- 1 cup of rice, 1 serving of steamed chicken breast
with 1 serving of spinach or kangkong, ½ cup of
steamed squash mashed with 2 tsp. of olive oil, 2
glasses of water
Total caloric intake: 1,177 KCAL
3AN2 (Batch 2021)

Day 2:
Breakfast
- 1 cup of coffee, 1 serving of Yogurt with 3 slices
of bread, and 2 glasses of water
Morning snack
- 1 box (50 g) of raisins, and 1 ½ glass of water
Lunch
- 2 ½ cups of Vegetable weight loss soup, 1 ½ glass
of water
Afternoon snack
Dinner
- 1 serving of pancit bihon, 1 medium sized mango,
2 glasses of water
Day 3:
Breakfast
-1/2 cup of rice, 1 medium sized egg, 1 glass of
water, and 1 cup of low-fat milk
Morning snack
- 1 pack of Fita with 2 slices of Eden cheese, and 1
½ glass of water
Lunch
- 1 cup of rice, 1 serving of sinigang na manok, 1 ½
glass of water
Afternoon snack
Dinner
- 1 cup of rice, 1 serving of steamed chicken breast
with 1 serving of spinach or kangkong, ½ cup of
steamed squash mashed with 2 tsp. of olive oil, 2
glasses of water
SPIRITUALITY ➢ Encourage client and significant other to continue to

pray, strengthen faith and always seek God’s guidance
during hard and challenging times.
3AN2 (Batch 2021)

XV. Evaluation
Throughout the process all members exerted effort to achieve the main goal of the
group and individual capabilities and knowledge regarding different cases was enhanced
and individuals’ critical thinking was improved. The group was able to determine the
meaning, etiology, signs and symptoms, pathophysiology, risk factors, and prevention of
Dilated Cardiomyopathy.
As the students work on this case, they encountered difficulties in coming up with
a precise output. But the students were able to work together as a group to gather the needed
data to complete this case study. The purpose of the case study is to educate the students
about Dilated Cardiomyopathy and able to come up with a well-founded care plan for the
patient. The objectives and plan of goal were met and the students gained knowledge and
experience from this case study which also allowed each of the members to understand
whole heartedly the purpose of choosing this case. The case has been defined and explained
in a clear manner and the pathophysiology was also discussed and constructed in a way
that makes the reader understand it easily.
This study is recommended to be a reference for further research and update of the
Dilated Cardiomyopathy including its treatment, diagnostic tests, medications and therapy.
XVI. Bibliography
3AN2 (Batch 2021)

Cardiomyopathy Manu

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Cardiomyopathy Manu

Uploaded by

Copyright:

Available Formats

I.

Cardiomyopathy constitutes a group of diseases that directly affect the structural or

of cardiomyopathy. Dilated cardiomyopathy is characterized by a diffuse inflammation

failure. Symptoms include decreased exercise capacity, fatigue, dyspnea at rest,

bradycardia, pulmonary crackles, edema, weak peripheral pulses, pallor, hepatomegaly

lead to systemic embolization. (Borromeo, A., 2014)

According to Abadonio and Jorge (2015), as they conducted a prospective cohort

Ischemic Cardiomyopathy are the other two.)

3AN2 (Batch 2021)

Borres; De Leon; Diaz; Galido; Garabiles; Guevarra; Matoza; Mendoza

This study aims to provide an understanding about a condition called Dilated

Cardiomyopathy. This is to help identify and define the problems experiencing by

towards the clients.

⚫ Define Dilated Cardiomyopathy.

• Identify and describe the signs and symptoms of Dilated Cardiomyopathy.

Discuss its pathophysiology and etiology.

Borres; De Leon; Diaz; Galido; Garabiles; Guevarra; Matoza; Mendoza

suffering from Dilated Cardiomyopathy.

• Recognize signs and symptoms of Dilated Cardiomyopathy.

• Identify the steps appropriate in providing effective medical and nursing

management to the patient with Dilated Cardiomyopathy in specific, measurable,

attainable, realistic and time-bound (SMART) manner.

⚫ Establish rapport with the patient in professional matter.

⚫ Deliver therapeutic nursing management and provide professional support

III. Nursing History

Name: Patient R.A.B.T.

Address: Guadalupe Nuevo, Makati City

Age: 63 years old

3AN2 (Batch 2021)

Borres; De Leon; Diaz; Galido; Garabiles; Guevarra; Matoza; Mendoza

Civil Status: Married

Date of Admission: September 23, 2019

Hospital: Ospital ng Makati

Mode of Admission: Ambulatory

Date of Interview: September 26, 2019

Informant: Patient R.A.B.T., Patient’s significant other and

Chief Complaint: Nonhealing wound, right foot

Diagnosis: Dilated Cardiomyopathy

b. History of Present Illness

postponed. It was later confirmed that he is diagnosed with Dilated

One week prior to admission, Patient noticed a non-healing wound on the

laboratory due to unavailability in the hospital, Patient suddenly experience

3AN2 (Batch 2021)

Borres; De Leon; Diaz; Galido; Garabiles; Guevarra; Matoza; Mendoza

confine to ward, first.

c. Past Medical History

He is also diagnosed with hypertensive atherosclerotic cardiovascular disease and

is scheduled to be operated. He also has an asthma.

d. Personal and Social History

Patient is known to be a happy person. He sees himself as a strong person. Patient

3AN2 (Batch 2021)

Borres; De Leon; Diaz; Galido; Garabiles; Guevarra; Matoza; Mendoza

3AN2 (Batch 2021)

Borres; De Leon; Diaz; Galido; Garabiles; Guevarra; Matoza; Mendoza

3AN2 (Batch 2021)

Borres; De Leon; Diaz; Galido; Garabiles; Guevarra; Matoza; Mendoza

Borres; De Leon; Diaz; Galido; Garabiles; Guevarra; Matoza; Mendoza

Functional Health Prior to During Analysis and

Borres; De Leon; Diaz; Galido; Garabiles; Guevarra; Matoza; Mendoza

Borres; De Leon; Diaz; Galido; Garabiles; Guevarra; Matoza; Mendoza

Borres; De Leon; Diaz; Galido; Garabiles; Guevarra; Matoza; Mendoza

Borres; De Leon; Diaz; Galido; Garabiles; Guevarra; Matoza; Mendoza