SYSTEMS PLUS COLLEGE FOUNDATION

Angeles City

COLLEGE OF NURSING
First Semester Academic Year 2021-2022
Problem Based Learning
2nd Rotation

NCM 112 – Medical Surgical Nursing (ICU)

PROBLEM BASED LEARNING

Objectives:

1. The main objective of the PBL, as of any methodology, is improving the

learning of our students.
2. Integrate knowledge and skills from various areas through more complex
and multidisciplinary projects
3. Autonomous learning and work: unstructured problems that need research.
Autonomy will lead to research and the search for information, and in that
context is essential to develop their ability to discern which information is
reliable and which is not.
4. Teamwork: preparing students for a social environment
5. Self-evaluation and self-criticism, against self-complacency, trying to see
beyond their own ideas and knowledge

CASE 1

Mang Johnny a 56 year old male, a diabetic client with a blood glucose ranging 180-
300mg/dl on his RBS results upon checking regularly every morning and evening. He
was diagnosed with diabetes 2 years ago. He is known also to be a hypertensive
taking Atenolol 10mg taking 1 tablet 2 times a day. Presently he was confined in the
ICU with a complaint of chest pain. Prior to admission to the emergency department
he complained of chest tightness with a difficulty of breathing and easy fatigability
when moving. In the emergency department he was given nitroglycerin tablet
sublingually for 3 doses but no relief and having a blood pressure of 130/70mm/hg.
Morphine sulfate 0.5cc was administered instead. He was relieved from his chest
pain. ECG result indicates premature ventricular contractions (PVCs). Oxygen was
ordered 2Lpm per nasal canula.

Questions:
1. What is the most likely diagnosis?

2. What are the diagnostics steps?

3. What therapies should be instituted immediately?

4. What some diagnostics procedures for Acute MI.

5. What recommended health teachings will you give to mang Johnny?

6. What medication can be possibly given to Mang Johnny?

Case 2

A 65 yearl old man was admitted to the Medicine ward with and altered level of
consciousness. The patient symptoms began approximately 48 hours previously,
when he complained of body weakness and a 2 month old non-healing wound. His
RBS result is 300mg/dl. He complained of frequent urination, excessive thirsts every
now and then, and increased frequency in eating due to body weakness.. a 12 lead
ECG shows sinus tachycardia.

Questions:

1. What is most likely the diagnosis?

2. What are your emergency interventions and therapies be instituted immediately?

3. What is the possible diagnostic procedures?

A 34 year old Type 1 diabetic male is brought into the emergency department for the
suspected diagnosis of Diabetic Mellitus. Which of the following would ,provide the
strongest evidence of the diagnosis?

The patient’s glucose level elevated at 6am at 250mg/dl, Nurse Andrea checked the
sliding scale before giving insulin SQ.

What is a sliding scale?

Case 3

A 68 year old woman in the medicine department complained of respiratory distress

with a respiratory rate of 40breaths per minute. Nurse Vincent made a referral at 9am
to Dr. Divina for an intervention. Dr. Divina ordered Lasix 40mg to be given
intravenously as a STAT order. Her blood pressure raise to 180/100 mmHg. Edema
on his ankles were noted. The patient has the history of DM type I.

Questions:

A. What mostly is the diagnosis?

B. What would be the appropriate independent and dependent nursing interventions?

C. Why Lasix is given intravenously?

Evaluated by: _______________________ Student Signature: ____________

Signature of the Clinical Instructor