RAD RLE Guide

ANATOMY AND PHYSIOLOGY

FUNCTION:
As a central part of the circulatory system, the heart is primarily responsible for pumping blood and distributing oxygen
and nutrients throughout the body. The heart’s blood-pumping cycle, called the cardiac cycle, ensures that blood is
distributed throughout the body. The oxygen distribution process begins when oxygen-free blood enters into the heart
through the right atrium, goes into the right ventricle, enters the lungs for oxygen refill and release of carbon dioxide, and
transfers into the left chambers, ready for redistribution.

PATHOPHYSIOLOGY

Etiology/Causative agent: obesity, insulin resistance, high alcohol intake, high salt intake and sedentary lifestyle.
Risk factors:Unhealthy diets (excessive salt consumption, a diet high in saturated fat and trans fats, low intake of fruits
and vegetables), physical inactivity, consumption of tobacco and alcohol, and being overweight or obese.
Modifiable: Obesity, Salt Intake, Potassium Intake, Alcohol, Dietary Fibre, Smoking ,Stress Physical Activity and Socio-
economic status. s Non-modifiable: Age, Gender, Genetic Factors and
Ethnicity.
 LABORATORY:

Significance / Interpretation:
 Normal chest X-ray shows normal size and shape of the chest wall and the main structures in the chest.
Significance / Interpretation:
Higher than normal LDH levels usually means you have some type of tissue damage or disease. Disorders
that cause high LDH levels include: Anemia. Kidney disease.
Significance / Interpretation:
 High creatinine levels can mean kidney damage or dehydration.
 A high BUN level means your kidneys aren't working well. But elevated BUN can also be due to: Dehydration, resulting from not drinking
enough fluids or for other reasons. Urinary tract obstruction.
 Too much uric acid stays in the body, a condition called hyperuricemia will occur. Hyperuricemia can cause crystals of uric acid (or urate)
to form.
Significance / Interpretation:
 Ranges between laboratories will vary with the upper limit generally being between 4 to 5. If your level
is higher than this, chances are you have an underactive thyroid.
 Individuals taking medications that modify thyroid hormone metabolism and those with a history of
thyroid cancer or pituitary disease may be optimally managed with a different normal FT4 range.

Significance / Interpretation:
 Activated Partial Thromboplastin Time
Drug Study
 Drug name Classification Mechanism of action Indication Contraindication Adverse reaction Nursing
responsibilities
Generic Name cephalosporin Cephalosporins exert Susceptible mild to patients with CNS: Headache. Before:
Ceferoxime antibiotics bactericidal activity by moderate infections cephalosporin CV:Shortness of breath. - taken on an empty
Brand Name interfering with bacterial including hypersensitivity or Gastrointestinal: stomach 1 hour before
Ceftin cell wall synthesis and pharyngitis/tonsillitis, cephamycin Abdominal pain, or 2 hours after meals,
Actual dosage, inhibiting cross-linking of acute maxillary sinusitis, hypersensitivity. abdominal cramps, but may be taken with
route, frequency the peptidoglycan. The chronic bronchitis, acute Cefuroxime should be flatulence, indigestion, food to reduce
1.5 gm IV drip q 8H cephalosporins are also otitis media, used cautiously in mouth ulcers. stomach upset.
ANST thought to play a role uncomplicated skin and patients with Skin and Subcutaneous During:
Tissue Disorders: Rash, -if your symptoms do
skin structure, UTIs, hypersensitivity to
itch. not improve or if they
gonorrhea, early Lyme penicillin.
Renal and Urinary get worse call your
disease
Disorders: Dysuria. doctor.
Reproductive System and After:
Breast Disorders: -Follow the directions
Vaginitis, vulvar itch. on your prescription
OTHERS: Chills, sleepiness, label carefully, and ask
thirst your doctor or
pharmacist to explain
any part you do not
understand.
-monitor patients
atleast 30minutes.
 Drug name Mechanism of action Indication Adverse reaction / Side Effects Nursing responsibilities

Generic name: The mechanism of action of Upper respiratory tract (CNS):dizziness,seizures,drowsiness, Before:
Azithromycin azithromycin monohydrate is infections, including fatigue, headache. -Assess pt.’s and family’s
Brand name: based upon the suppression streptococcal pharyngitis, knowledge of drug therapy
Zenith of bacterial protein synthesis, acute bacterial exacerbations CV: chest pain, hypotension,
Classification: that is it binds to the of chronic bronchitis, and palpitations, QT prolongation (rare). During:
macrolides ribosomal 50S sub-unit and tonsillitis; Lower respiratory -Give drug with meals to minimize
Actual dosage, inhibits the translocation of tract infections, including (GI): PSEUDOMEMBRANOUS GI distress.
route, frequency,Timing: peptides bronchitis and pneumonia; COLITIS, abdominal pain, diarrhea, -Tablets may be crushed for pt’s.
500 mg/tab, 1 tab OD PO x Acute otitis media; Skin and nausea, cholestatic jaundice, with difficult swallowing.
6 days skin structure infections; elevated liver enzymes, dyspepsia,
Nongonococcal urethritis, flatulence, melena, oral candidiasis. After:
cervicitis, gonorrhea, and -Monitor signs of
chancroid. pseudomembranous colitis,
including diarrhea, abdominal
Contraindication: pain, fever, pus or mucus in stool,
contraindicated in patients and other severe or prolonged GI
with known hypersensitivity to problems (nausea, vomiting,
azithromycin, erythromycin, heartburn).
any macrolide or ketolide -Notify physician or nursing staff
drugs. immediately of these signs.
 Drug name Mechanism of action Indication Adverse reaction / Side Effects Nursing responsibilities

Generic name: Pantoprazole is to inhibit Pantoprazole is used to (CNS): Headache, Fatigue, Before:
Pantoprazole the final step in gastric acid treat certain stomach and Hallucinations, Confusion, -tell your doctor or pharmacist
Brand name: production. In the gastric esophagus problems (such Insomnia and Drowsiness. of all the products you use.
Protonix parietal cell of the as acid reflux). It works by Keep a list of all your
Classification: stomach, pantoprazole decreasing the amount of CV: Chest pain medications with you, and
Proton-Pump Inhibitors covalently binds to the acid your stomach makes. share this information with
Dosage, Frequency, H+/K+ ATP pump to inhibit Contraindication: (GI): Diarrhea,Constipation, your doctor and pharmacist.
Route and Timing: gastric acid and basal acid Hypersensitivity to abdominal pain, diarrhea, During:
40 mg IVTT now then secretion. The covalent pantoprazole or other eructation,and flatulence. -Monitor improvements in GI
40 mg/cap 1 cap OD PO binding prevents acid proton pump inhibitors symptoms (gastritis, heartburn,
ac breakfast secretion for up to 24 (PPIs). and so forth) to help determine
hours and longer. if drug therapy is successful.
-Monitor signs of
hyperglycemia (drowsiness,
fruity breath, increased
urination, unusual thirst).
Patients with diabetes mellitus
should check blood glucose
levels frequently.
After:
-Follow the prescription of your
doctor carefully.
-Instruct the client to take drug
exactly as prescribed.
-monitor the patient atleast
30minutes.
 Drug name Mechanism of action Indication Adverse reaction / Side Effects Nursing responsibilities

Generic name: Citicoline consumption Oral Cerebrovascular (CNS): Dizziness, headache. Before:
Citicholine promotes brain disorders, Cognitive -Teach the patient that
Brand name: metabolism by restoring disorder, Head injury, CV: Bradycardia, tachycardia. citicoline may be taken with or
Cholinerv (UNILAB, Inc.) phospholipid content in the Parkinson's disease. without food.
Classification: brain and regulation of (GI): Diarrhoea, epigastric During:
Psychostimulants and neuronal membrane Contraindication: discomfort, stomach pain. -Monitor for adverse effects;
Nootropics excitability. It also Hypertonia of the instruct patient to report
Dosage, Frequency, influences the parasympathetic nervous immediately if he/she develops
Route and Timing: mitochondria or energy system. chest tightness, tingling in
1 gm IVTT q 6H factories of the brain cells mouth and throat, headache,
and found to improve diarrhea and blurring of vision.
memory function. After After:
several clinical trials, -Follow the prescription of your
Citicoline has been shown doctor carefully.
to raise the amount of -Instruct the client to take drug
acetylcholine in the brain. exactly as prescribed.
- Wear a medical bracelet in
giving medications.
-monitor the patient atleast
30minutes.
 Drug name Mechanism of action Indication Adverse reaction / Side Effects Nursing responsibilities

Generic name: Atorvastatin competitively Atorvastatin is used to treat (CNS): nightmare, dizziness, Before:
Atorvastatin inhibits 3-hydroxy-3- high cholesterol, and to fatigue -Instruct patient to take
Brand name: methylglutaryl-coenzyme A lower the risk of stroke, medication as directed. If a
Lipitor (HMG-CoA) reductase. By heart attack, or other heart CV: epistaxis. dose is missed, omit and
Classification: preventing the conversion complications in people resume usual schedule with
HMG-CoA Reductase of HMG-CoA to with type 2 diabetes, (GI): abdominal discomfort, next dose.
Inhibitors,Lipid- mevalonate, statin coronary heart disease, or eructation, flatulence, hepatitis, -Advise patient to avoid
Lowering Agents, medications decrease other risk factors. cholestasis. drinking more than one quart
Statins cholesterol production in Contraindication: of grapefruit juice or 2 glasses
Dosage, Frequency, the liver. Patients with active hepatic of alcohol per day during
Route and Timing: disease (including therapy.
40 mg/tab, I tab OD PO cholestasis, hepatic During:
encephalopathy, hepatitis, -Instruct patient to notify
and jaundice) or health care professional
unexplained persistent promptly if unexplained muscle
elevations in serum amino pain, tenderness, or weakness
transferase concentrations. occurs, especially if
Atorvastatin is accompanied by fever or
contraindicated in patients malaise.
with atorvastatin After:
hypersensitivity or -Follow the prescription of your
hypersensitive to any doctor carefully.
components of the product -Instruct the client to take drug
selected. exactly as prescribed.
-monitor the patient atleast
30minutes.
 Drug name Mechanism of action
Generic name: Losartan and its principal
losartan potassium active metabolite block the
Brand name: vasoconstrictor and
Cozaar aldosterone-secreting
Classification: effects of angiotensin II by
ARBs selectively blocking the
Dosage, Frequency, binding of angiotensin II to
Route and Timing: the AT1 receptor found in
50 mg/tab, 1 tab OD many tissues, (e.g.,
PO vascular smooth muscle,
adrenal gland).
Indication
Losartan is indicated to treat
hypertension in patients
older than 6 years, reduce
the risk of stroke in patients
with hypertension and left CV:
ventricular hypertrophy hypotension.
(though this benefit may not (GI): diarrhea, abdominal pain, -Monitor signs of angioedema,
extend to patients with
African heritage), and to
treat diabetic nephropathy
with elevated serum
creatinine and proteinuria in
patients with type 2
diabetes and hypertension.
Contraindication:
High levels of potassium in
the blood. renal artery
stenosis. low blood
pressure. liver problems.
Adverse reaction / Side Effects Nursing responsibilities
(CNS): dizziness ,Headache,
Before:
sleep problems (insomnia) -Assess pt.’s and family’s
Tiredness. knowledge of drug therapy.
-Before taking this medication,
chest pain, edema, tell your doctor or pharmacist.
During:
dyspepsia, nausea. including rashes, raised patches
of red or white skin (welts),
burning/itching skin, swelling in
the face, and difficulty
breathing.
-Assess blood pressure
periodically and compare to
normal values.
After:
-Follow the prescription of your
doctor carefully.
-Instruct the client to take drug
exactly as prescribed.
- Wear a medical bracelet in
giving medications.
-monitor the patient atleast
30minutes.
 Drug name Mechanism of action
Generic name: Memantine is a clinically
Memantine useful drug in many
Brand name: neurological disorders,
Namenda XR, Namenda including Alzheimer's
Classification: disease. The principal
NMDA Antagonists mechanism of action of
Dosage, Frequency, memantine is believed to
Route and Timing: be the blockade of current
10 mg/tab ½ tab OD flow through channels of
PO N-methyl-d-aspartate
(NMDA) receptors--a
glutamate receptor
subfamily broadly involved
in brain function.
Indication
Memantine is used to treat
moderate to severe
confusion (dementia)
related to Alzheimer's
disease. It does not cure
Alzheimer's disease, but it
may improve memory,
awareness, and the ability
to perform daily functions.
Contraindication:
No dosage adjustments are
required for patients with
mild to moderate hepatic
impairment. Memantine
should be administered with
caution to patients with
severe hepatic impairment.
Adverse reaction / Side Effects Nursing responsibilities
(CNS): dizziness ,Headache, Before:
confusion, Aggression, -Assess pt.’s and family’s
depression and sleepiness. knowledge of drug therapy.
-Before taking this medication,
CV: cough, shortness of breath tell your doctor or pharmacist.
During:
(GI): diarrhea, Constipation, -Assess dizziness and
Nausea, Vomiting,weight gain drowsiness that might affect
gait, balance, and other
functional activities (See
Appendix C).
-Report balance problems and
functional limitations to the
physician and nursing staff, and
caution the patient and
family/caregivers to guard
against falls and trauma.
After:
-Follow the prescription of your
doctor carefully.
-Instruct the client to take drug
exactly as prescribed.
- Wear a medical bracelet in
giving medications.
-monitor the patient atleast
30minutes.
 Drug name Mechanism of action Indication Adverse reaction / Side Effects Nursing responsibilities

Generic name: Clopidogrel is used to Clopidogrel is FDA approved (CNS): dizziness ,Headache,
Before:
Clopidogrel prevent heart attacks and for the medical depression and Increased
-Assess pt.’s and family’s
Brand name: strokes in persons with management of unstable bleeding, Nosebleeds. knowledge of drug therapy.
Plavix heart disease (recent heart angina (UA)/non-ST- -Before taking this medication,
Classification: attack), recent stroke, or segment elevation CV: Upper respiratory tract tell your doctor or pharmacist.
Antiplatelet Agents, blood circulation disease myocardial infarction infection, Chest pain During:
Cardiovascular; (peripheral vascular (NSTEMI), ST-segment -Assess dizziness and
Antiplatelet Agents, disease). elevation myocardial (GI): diarrhea, Constipation, drowsiness that might affect
Hematologic infarction (STEMI) in Nausea, Vomiting,weight gain gait, balance, and other
Dosage, Frequency, patients receiving functional activities (See
Route and Timing: fibrinolytic therapy, and for Appendix C).
75 mg/tab, 1 tab OD secondary prevention in -Monitor patient for signs of
PO recent myocardial infarction thrombotic thrombocytopenic
(MI), recent stroke, and purpura (low platelet count,
peripheral arterial disease neuro symptoms, renal
Contraindication: dysfunction, fever).
Hypersensitivity Active After:
pathologic bleeding (e.g., -Follow the prescription of your
peptic ulcer, intracranial doctor carefully.
hemorrhage) -Instruct the client to take drug
exactly as prescribed.
- Wear a medical bracelet in
giving medications.
-monitor the patient atleast
30minutes.
NURSING CARE PLAN
Assessment Nursing Diagnosis Scientific Analysis Goal of Care Intervention Rationale
SUBJECTIVE CUES: Decreased Cardiac Your blood pressure is After 6 hrs of 1. monitor BP every1-2 hours, or every5 1. changes in BP may indicates changes in
“madalas ako Output r/t malignant considered high when nursinginterventions, minutes during active titration of patient status requiring prompt attention.
mahilo”, as hypertension as you have consistent theclient will have vasoactive drugs. 2. decrease in cardiac output may result in
verbalized by the manifested by systolic readings of noelevation in blood 2. monitor ECG for dysrrhythmias, changes in cardiac perfusion causing
patient decreased stroke 130 mm Hg or higher pressure conduction defects and for heart rate. dysrhythmias
OBJECTIVE CUES: volume. or diastolic readings abovenormal limits 3. suggest frequent position changes. 3. it may decreases peripheral venous
-lethargic of 80 mm Hg or andwill maintain 4. encourage patient to decrease intake pooling that may be potentiated by vaso
-decreased higher. blood pressure of caffeine, cola and chocolates. dilators and prolonged sitting or standing.
-cardiacoutput withinacceptable 5. observe skin color, 4. caffeine is a cardiac stimulant and may
-decreased limits temperature,capillary refill time and adversely affect cardiac function.
-strokevolume diaphoresis. 5. peripheral vaso constriction may result in
increased pale,cool, clammy skin,with prolonged
peripheral capillary refill time.
vascular
resistance
Vital signs:
T:36.3
RR:24
HR: 64
O2 Sat: 95%
BP: 150/100
 Defining Nursing Diagnosis Scientific Analysis Goal of Care Intervention Rationale
Characteristics
SUBJECTIVE CUES: Actvity intolerance Coughing is the body's After 4 hours of Independent: -after 4hours of nursing interventions, the
“Hindi ako related to exhaustion way of removing nursing -Evaluates patient’s response to activity. patient was be able to demonstrate
makatulog associated with foreign material or Interventions, the - provide quite environment and limit measurable increase in tolerance in activity
dahil sa ubo interruption in usual mucous from the patient visitors during acute phase. with absence of dyspnea and excessive
ko” as sleep pattern lungs and throat. Will demonstrate fatigue.
verbalized by because of A Measurable Dependent:
the patient. discomfort, excessive increase in tolerance - encourage adequate rest balanced with
coughing and in activity with moderate activity.Promote adequate
OBJECTIVE CUES: dyspnea. absence of dyspnea nutritional intake.
Cough and and Excessive
Dyspnea fatigue. Collaborative:
Vital signs: -adminiter medications as prescribe:
T:36.3 mucolytics or expectorants.
RR:24
HR: 64
O2 Sat: 95%
BP: 150/100
 Defining Nursing Diagnosis Scientific Analysis Goal of Care Intervention Rationale
Characteristics
SUBJECTIVE CUES: Imbalanced nutrition: Patient was At the end of 2 hours Independent: - Suggest severity of effect in fluid and
“Wala akong less than experiencing episodes of nursing -Use Flavoring Agents R – To determine electrolyt e balance and nutritional status.
ganang kumain bodyre5uirements of vomiting and loss a intervention the enhance food satisfaction and stimulate -To promote comfort and enhance intake
tapos kapag related to frequent weight over a week patient will be able appetite. -To reduce gastric acidity and improve
kumain naman vomiting and poor to: -Encourage client to choose foods. Have nutrient intake.
ako ay nagsusuka appetite. a) Verbalize family members bring foods that seen -Refer to dietician from modification of diet (
ako” as verbalized Food preference appealing (which are not contraindicated General Liquids) R- to gradually stimulate
by the patient. which is not R – To stimulate appetite. appetite for fast recovery.
Objective: Contraindicated to hr Dependent:
-Vomiting Underlying disease to -Administer medication (metoclopra mide
-Weakness Promote Good 1 ampule IVTT), as ordered R- To decrease
Vital signs: appetite. the occurrence of vomiting
T:36.3 b) Improve Appetite
RR:24 from poor to fair
HR: 64 c) Reduces t.he
O2 Sat: 95% occurrence of
BP: 150/100 vomiting.