GROUP - 2 CASE SCENARIO

Date prepared: August 22, 2021

Presentation will commence after my lecture
on either august 26 or 27. Please be ready

TASK: Present the case scenario assigned per group with pathophysiology,
make NCP and Drug study following the format below

1. NCP

CUES NURSING GOALS AND NURSING IMPLEMENTATION EVALUATION

DIAGNOSIS DESIRED INTERVENTION
OUTCOME

(INCLUDE RATIONALE AFTER EVERY NSG INTERVENTION)

2. DRUG STUDY

DRUG MECHANISM OF ACTION/ INDICATION/CONTRAINDICATION NURSING

SIDE EFFECT RESPONSIBILITIES

Brand name:
Generic name:
Classification:
Route:
Dosage:
Frequency:
GROUP- 1: COPD
1. Ismael, Fathyma
2. Kikkawa, Reiji
3. Tatel, Mikole Anne

CASE SCENARIO:
On august 22, 2021, Mrs. Adelaida Antonio, 62 years old, married, from Tetuan, was
rushed to the hospital by her son due to difficulty of breathing. She was apparently
well few days ago, but had shortness of breath and wheezing on exertion associated
with chronic cough with greenish sputum. Her vital signs were: BP-180/120, HR-
104, RR- 34, T-38.7, 02 SAT- 90% at room air. Oxygen was administered via nasal
cannula at 1-2 lits./min. and was put on high back rest.

MEDICAL HISTORY
She was admitted for the third time this year with an acute exacerbation of her
severe COPD. Her FEV1 was 35% predicted at the recent outpatient visit. She retired
from her job as a shop assistant 5 years ago because of her breathlessness and now
devotes her time to her grandchildren who ‘exhaust her’ but give her a lot of
pleasure.

PAST HISTORY
She quit smoking 5 years ago. Over the years, her medication has increased, as
nothing seemed to relieve her uncomfortable breathlessness.

DIAGNOSTICS:
Chest X- ray Pa view was ordered by the Dr. Garcia and ECG

THERAPEUTICS:
She was given
1. Inhalation with salbutamol I nebule now then every 15 minutes x 3 doses
2. Tiotropium inhalation powder (Spiriva) 18 mcgs(2 inhalations) P.O. OD using a
handihaler
3. Clarithromycin 500 mg. BID for 7 days.
4. Paracetamol 500 mg PO every 4 hours as needed for fever
5. Crabocisteine 375 mg. 1 cap TID PO
6. Captopril 25 mg. Sublingual now
GROUP -2: PULMONARY EMBOLISM
1. Quimson, Ezekiel Kim
2. Renolla, Clouise Junice
3. Sanaani, Nur-Hathi

CASE CENARIO:
Gloria Tan, 79 year old, married from San Jose, was brought to the emergency room
of Zamboanga Doctors’ Hospital with chief complaints of two episodes of vomiting,
body weakness and loss of consciousness 2 hours PTA. She was triaged as having a
life – threatening condition thus, she was placed on a stretcher on semi recumbent
position, oxygen inhalation was administered at 2-3 lits/min. Patient was alert on
arrival.

Vital signs were checked:

Pulse rate: 105 bpm, Pulse rhythm: Regular, BP 110/80, RR-20 per minute, regular,
shallow, Resp quality : Normal, equal bilateral air entry, T- 37.1 ℃, O2 Sat: 85% @
room air, GCS : 15/15
THERAPEUTICS
1. Aspirin 300mg PO administered.
2. GTN 800mcg administered sublingually. Pain/”lump feeling” resolved after
second dose of GTN.
3. Thrombolysis using streptokinase
4. Furosemide 20 mg. PO OD
DIAGNOSTICS done:
1. 12 leads ECG
2. Chest X- ray PA View
3. Cardiac Enzyme- Troponin I
GROUP- 3: DILATED CARDIOMYOPATHY
1. Pastor, Charisma
2. Reyes, Richelle Mae
3. Sahali, Jorgee
CASE SCENARIO:
On January 23, 2021, at around 7:00 am, Mr. Edwin Jose, 54 years old, married from Sta.
Maria, was brought to Zamboanga Doctors’ Hospital due to worsening of shortness of
breath. Two weeks PTA, he complained to his wife that he was experiencing shortness of
breath and unable to walk a distance of 100 meters nor take a bath on his own. He was
diagnosed to have dilated cardiomyopathy at the age of 50 . On evaluation, he was found
to have severe left ventricular (LV) dysfunction. Vital signs taken : Pulse rate – 100/min,
BP – 110/80 mmHg, Respiratory rate-30 b/min., Oxygen saturation- 91%, Temperature-
36.8 ℃. Oxygen inhalation was administered at 3 lits/min.

On general physical examination, the following were found:

Pedal edema +
Pallor/icterus/cyanosis/clubbing: Absent
Jugular venous pressure raised
Electrocardiography – Sinus tachycardia
Two-dimensional echo – Global hypokinesia
Severe LV dysfunction (LV ejection fraction [LVEF]) – 20%.

DIAGNOSTICS ordered:
Biomarkers- Brain natriuretic peptide (BNP) – 1000 pg/ml (<100 pg/ml)
Serum ST-2 60 ng/ml (<35 ng/ml).
Renal functions and liver function tests were within normal limit.
12 LEADS ECG
CHEST X-RAY PA
TREATMENT GIVEN
The patient visited a cardiologist and he was started on the following medications at the
first visit:
Digoxin
Angiotensin receptor-neprilysin inhibitor (ARNI)
Ivabradine
Spironolactone.

GROUP – 4: ACUTE ISCHEMIC HEART DISEASE

1. Patiño,Paolo
2. Salih, Indira
3. Usman, James

CASE SCENARIO:
At 11 am last April, 10, 2020, Mrs. Rico, 35, married , from Tugbungan, was brought to the
Emergency room of ZDH by the ambulance with a complaint of chest pain. The records
show EMS arriving at her house and finding the patient on the couch.
EMT Notes. Patient appears to be anxious and hyperventilating. Encouraged patient to slow
breathing down. VS obtained: Pulse 120; BP 152/112; Resp. 22and was shallow , O2 Sat at
room air- 92 %, Temp-37.7 ℃. Patient complains of: intermittent sharp chest pain located
in sternum area non-radiating; started at 8:30 am. Pain is 8 on a scale of 1-10. Patient also
complains of an increase in pain upon palpation to the sternum and with coughing. Patient
has a productive cough of a clear, thick substance. Denies fever or recent trauma. Patient
states she has had the chills for the past week. Lung sounds are clear and present in all
lobes excluding the left lower lobe, which is diminished. Abdomen soft non-tender. Further
exam unremarkable.

PAST MEDICAL HISTORY (PMH)

With a family history of HTN and CVA.
Upon arrival at the ER, The Resident doctor ordered acute chest pain protocol, which
included:
1. Oxygen 2L/min by nasal cannula
2. IV 0.9 normal saline at 125 ml/hr
3. Aspirin 325 mg PO
4. Morphine Sulfate 2mg IV PRN titrate to pain
5. Metoprolol 5 mg IV slow q 5 minutes x3, or until HR 50-60 and SBP> 90

Basic Metabolic Profile was also ordered:

BMP, troponin, CBC pulse-ox, ECG on arrival and at 1 hour, Chest X-ray. The initial chest X-
ray was interpreted as normal by the emergency physician, who noted, "no infiltrates,
normal heart size." Her Pulse Ox was 98%-99% on room air. Her electrolytes, CBC, and BMP
were all within normal limits; troponin was 0.05 (reported as normal for this hospital)

GROUP -5: ARRHYTHMIAS

1. Agustin, Aizel
2. Usman, Yusrhina
3. Kahal, Merhoneza

CASE SCENARIO

A case of Ruben Alonzo, 72 year-old, married from Putik. He was apparently well for the
past few days. Five (5) PTA, he suddenly experienced acute onset of palpitations and mild
shortness of breath, low grade fever and body weakness which prompted his admission for
further work up. He has a history of leukemia and active chemotherapy treatment. His
respiratory rate is 24 per minute, BP is 100/60 mm Hg, Heart rate is 145 bpm, Temp-37.7℃
and oxygen saturation is 90% on room air. Oxygen inhalation was administered at 2-3 lits/
min via nasal cannula.

DIAGNOSTICS
CBC
12 LEADS ECG - reveals atrial fibrillation with an uncontrolled ventricular response.
CHEST X-RAY PA VIEW
CARDIAC ENZYME- TROPONIN-I

THERAPEUTICS
Carvedilol 6.25 mg. PO, OD, hold for HR <60 and BP< 90/70
Clopidogrel 75 mg PO, OD post lunch
Amniodarone 300 mg IV bolus Stat