COLLEGE OF ALLIED HEALTH SCIENCES

S.Y. 2021 - 2022

CASE STUDY: SYPHILIS

A partial fulfillment for the requirements in Bachelor of Science in Nursing

3rd year 1st semester

ABSTRACT

The bacteria Treponema pallidum is caused by syphilis. You get it by

contacting someone else directly through a syphilis sore. This usually
happens during sex, but the bacteria can also enter your body by having cuts
on your skin or mucous membranes. Syphilis is an infection with sexual
transmission (STI). Syphilis is a highly contagious disease that spreads
mostly through sex, including oral and anal sex. The person infected is often
not aware of the disease and passes it on to his or her sexual partner. Even if
they have no symptoms, a person can transmit syphilis.
Syphilis is divided up into stages, with different signs and symptoms
associated with each stage (primary, secondary, latent, and tertiary). In most
cases, a person with primary syphilis has a sore or sores at the original
infection site. These sores typically occur in or around the genitals, the anus,
the rectum, or the mouth. Usually, but not always, these sores are firm, round,
and unpainful. Skin rash, swollen lymph glands, and fever are symptoms of
secondary syphilis. Principal and secondary syphilis signs and symptoms can
be mild and unnoticed. No signs or symptoms occur during the latent stage.
Severe medical problems are linked to tertiary syphilis. Tertiary syphilis can
usually be diagnosed by a doctor through several tests. The heart, brain, and
other organs of the body can be affected.
Early penicillin treatment is important because the disease can lead in the
long run resulting in life-threatening consequences. However, treatment may

1
not rectify any damage already done by the infection. People with syphilis
must avoid sexual contact until all treatment has been completed and blood
test results are received to confirm that the condition has been rectified. For
blood tests, syphilis may take several months to determine the appropriate
level of syphilis. Adequate treatment is confirmed by low enough levels.

CASE SCENARIO

Chief Complaint
“I think I am allergic to something.”

History of Present Illness

JS is a 27-year-old man who presents to a free health clinic at the county
hospital. He states he was in his usual state of health until about 3 days ago
when he began developing a rash on his stomach that is now on the palms of
his hands and soles of his feet. The rash is not painful or itchy. He states that
he had this strange little “ulcer-like” thing on his penis a couple weeks ago but
it went away and never really hurt. He is single and sexually active with two to
three concurrent male partners. He has had unprotected sex with “at least one
of his partners” in the past couple of weeks. He doesn’t know the sexual
histories of his current or past sexual partners, and admits to over 15 lifetime
partners. He endorses rectal and oral sex. He doesn’t ever recall being tested
for HIV, and knows he received all his childhood vaccines, “cause my mom
told me.” He has never been vaccinated against HPV stating, “that’s a
woman’s disease,” and is unsure if he ever has received a hepatitis A
vaccine.

Past Medical History

None

Surgical History
None

Family History
Father had HTN and passed away from a stroke 4 years ago; mother is still
living and has type 2 DM

Social History
MSM with multiple sexual partners; (+) EtOH, (–) Tobacco, (+) Marijuana, (–)
Illicit drugs

Allergies
NKDA

Home Medications
Ibuprofen 200 mg PO PRN pain (has taken 4 doses in the last day)

Physical Examination

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Vital Signs
Temp 101°F, P 72, RR 16 breaths per minute, BP 141/85 mm Hg, pO 2  94%,
Ht 5′7″, Wt 60 kg

General
NAD, awake, alert, slightly underweight man

Skin
Diffuse mucocutaneous rash noted on abdomen, back, upper extremities
(including palms of hands) and soles of feet; macules are easy to blanch and
are not associated with any area of fluctuance

HEENT
PERRLA; EOMI; mucous membranes are moist and neck is supple without
any evidence of lymphadenopathy

Pulmonary
Clear auscultation with no wheezing or rhonci

Cardiovascular
NSR; no m/r/g

Abdomen
NTND with no rebounding or guarding; (+) BS; noted rash

TABLE OF CONTENTS

Abstract ……………………………………………………………………….……..2

Case Scenario ………………………………………………………………….…...2

Table of Contents ………………………………………………………………,…..4

Significance of the Case Study ……………………………………………………5

Patient Profile ……………………………………………………………………….5

Laboratory/Diagnostic Examination ………………………………………………9

Chain of Infection ………………………………………………………………….10

Pathophysiology …………………………………………………………….……..11

Medical Management ……………………………………………………………..13

List of Nursing Diagnoses ………………………………………………………..14

Nursing Care Plans ……………………………………………………………….18

3
Drug Study ….…………………………………………….……………………..…29

References …………………………………………………………………………33

SIGNIFICANCE OF THE CASE STUDY

In Nursing Education
There is a major advantage of learning with case studies is that the students/
nurses are actively engaged in figuring out the principles by abstracting from
the case studies. It develops our skills in Problem solving, using analytical
tools, quantitative and/or qualitative depending on the case, and making
critical decisions.

In Nursing Practice

Theoretical learning, conclusion, and recommendation from the case study

can help nursing practice. It will help in investigating and understanding the
underlying conditions in a future experience within a real-life situation. The
result of the case study can make an improvement in patient care. 

In Nursing Research

Nursing research and case studies have the same goal and that is to discover
and learn more knowledge. They both have their purpose to gain more

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 information. The research aims to have reliable and meaningful information
about a problem. A case study is about explaining and exploring a case the is
used for record-keeping. 

PATIENT PROFILE

I. BIOGRAPHIC DATA

a. Patient’s Name: JS
b. Age: 27 years old
c. Sex: Male
d. Civil Status: Single

II. CHIEF COMPLAINTS

“I think I am allergic to something.”

III. PREVIOUS ILLNESS/HOSPITALIZATION/SURGERIES

None

IV. PAST MEDICAL HISTORY

None

V. HISTORY OF THE PRESENT ILLNESS

JS is a 27-year-old man who presents to a free health clinic at the county

hospital. He states he was in his usual state of health until about 3 days ago
when he began developing a rash on his stomach that is now on the palms of
his hands and soles of his feet. The rash is not painful or itchy. He states that
he had this strange little “ulcer-like” thing on his penis a couple weeks ago but
it went away and never really hurt. He is single and sexually active with two to
three concurrent male partners. He has had unprotected sex with “at least one
of his partners” in the past couple of weeks. He doesn’t know the sexual
histories of his current or past sexual partners, and admits to over 15 lifetime
partners. He endorses rectal and oral sex. He doesn’t ever recall being tested
for HIV, and knows he received all his childhood vaccines, “cause my mom
told me.” He has never been vaccinated against HPV stating, “that’s a
woman’s disease,” and is unsure if he ever has received a hepatitis A
vaccine.

5
 VI. FAMILY MEDICAL HISTORY

Diseases Mother Father

Hypertension - +
Type 2 Diabetes Milletus + -
Stroke - +

VII. IMMUNIZATION

Patient mentioned that he received all his childhood vaccines.

VIII. ALLERGIES

No Known Drug Allergies

IX. PSYCHOSOCIAL HISTORY

MSM with multiple sexual partners;

Alcohol Use (+)

Tobacco Use (-)

Drug Use (+) - Marijuana

X. VITAL SIGNS

a.Temperature:  101°F

b.Pulse Rate: 72 bpm

c.Respiratory Rate: 16 bpm

d.Blood Pressure: 141/85 mm Hg

e.Oxygen saturation: 94%

f. Weight: 60 kg

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 g. Height: 5’7

XI. REVIEW OF ANATOMY & PHYSIOLOGY OF SYPHILIS

Mucocutaneous rash noted on abdomen, back, upper extremities (including

palms of hands), and soles of feet.
One or more painless, firm, and round syphilitic sores or chancres are
symptoms of primary syphilis. It appears ten days to three months after the
bacteria enter the body. In 2-6 weeks, chances will be resolved. The disease
may however remain in the body without treatment and may advance to the
next stage. The rush may be confined or spread over several parts of your
body. The appearance of the rash is distinct from one another. One common
feature is rough brown, reddish spots on your feet's base and on your palm's
hands. The rash normally feels scaly, but can be smooth as well. Sometimes
the rash appears to be caused by a different disease, which makes diagnosis
more difficult. It may last several years in a latent phase. The body will bear
no symptoms during that time. T. pallidum bacteria remain in the body,
however, and recurrence is always likely. At this stage, even though
symptoms don't happen, the doctors still recommend treating syphilis. Tertiary
syphilis may occur ten to thirty years after an infection begins, typically after a
latency period during which symptoms are not present.

XII. MEDICAL DIAGNOSIS

Syphilis is a sexually transmitted infection (STI) caused by Treponema

pallidum type of bacteria. A small painless sore is the first sign of syphilis. It
may appear in or within the mouth, rectum, or sexual organs. This wrath is
known as a chancre. It is often not immediately seen by people. The four
stages of syphilis are primary, secondary, latent, and tertiary. The first two
phases of syphilis are most infectious. In the hidden or latent stage of syphilis,

7
the disease remains active, but often without symptoms. The most damaging
to health is tertiary syphilis.

ETIOLOGIC FACTORS

Predisposing Factors Precipitating Factors

Modifiable Non-Modifiable Modifiable Non-Modifiable
 Sexually active  Age: 27  MSM with  Signs and
years old multiple sexual symptoms of
 Unprotected sex
partners syphilis
 Sex: Male
 Alcohol intake
 Tobacco and Drug
Use (Marijuana)

CLINICAL MANIFESTATIONS

Subjective Data Objective Data

“I was in my usual state of health Vital Signs
until about 3 days ago when I began Temperature:  101°F
developing a rash on my stomach Pulse Rate: 72 bpm
that is now on the palms of my hands Respiratory Rate: 16 bpm
and soles of my feet” as verbalized Blood Pressure: 141/85 mm Hg
by the patient. Oxygen saturation: 94%
Weight: 60 kg
“My rash is not painful or itchy, I had Height: 5’7
this strange little”ulcer-like” thing on
my penis a couple weeks ago and it General
went away and never really hurt” as NAD, awake, alert, slightly
verbalized by the patient. underweight man

Sexually active: MSM with multiple

Skin
sexual partners, has had unprotected
Diffuse mucocutaneous rash noted
sex with “at least one of his on abdomen, back, upper
partners”. extremities (including palms of
hands) and soles of feet; macules
Endorses rectal and oral sex. are easy to blanch and are not
associated with any area of
“I never been vaccinated against fluctuance
HPV because that’s a woman’s

8
 disease and I am not sure if I ever HEENT
received a hepatitis A vaccine” as PERRLA; EOMI; mucous
verbalized by the patient. membranes are moist and neck is
supple without any evidence of
“My mother told me that I received all lymphadenopathy
my childhood vaccine” as verbalized
by the patient. Pulmonary
Clear auscultation with no wheezing
Drinking alcohol and smoking or rhonci
marijuana.
Cardiovascular
Taken 4 doses of Ibuprofen 200mg NSR; no m/r/g
PO PRN for pain in the last days.
Abdomen
NTND with no rebounding or
guarding; (+) BS; noted rash

LABORATORY/DIAGNOSTIC EXAMINATIONS

N/A

CHAIN OF INFECTION

Infectious
agent:
Treponema
pallidum
Susceptible
Host:
Universal, sexually
Reservoir:
active people who Humans
have unprotected
sex. Mostly, men who
have sex with men.

Chain of
Infection:
Syphilis 9

Portal of Entry: Portal of Exit:

 genitalia, cervix, sore on external
mouth, perianal genitals, vagina,
area, or anal Mode of anus, rectum,
canal Transmission: lips or mouth
Transmission of the
organism occurs
PATHOPHYSIOLOGY during vaginal, anal,
or oral sex. Pregnant
women with the
Etiology
disease can pass it to
It is the branch of medicine the
thatbabies
merelythey are on the causes or origins of a
focuses
carrying.
mental or physical disease. In medicine, the etiology of an illness or condition
refers to the frequent studies to determine one or more factors that come
together to cause the illness.

Syphilis

Precipitating Factors Predisposing Factors

- MSM with multiple sexual - Sexually active - 27 years old
partners - Unprotected sex - Male

- Signs and symptoms of syphilis - Alcohol intake

- Tobacco and Drug Use
(Marijuana)

Etiologic Agent Mode of Transmission

Treponema pallidum Person to person by direct
contact with a syphilitic sore.

This bacterium is thought to enter the body through very small breaks
in the skin or mucous membranes. Its entry is facilitated by the minor
abrasions that often occur during sexual intercourse.

Syphilis is a complex disease in which many organs and tissues of

the body can become infected by T. pallidum. The infection causes
the production of antibodies that also react with normal tissues.

It has a variety of signs and symptoms that can mimic a number of

other diseases. Consequently, compared with other STIs, it is more
difficult to recognize syphilis. If it is not treated,10specific clinical stages
are characteristic of the progression of the disease.
 Stages of Syphilis

Primary Secondary Latent Tertiary

The primary stage Skin rash and Absence of signs or Tertiary syphilis
of syphilis is usually mucous membrane symptoms. Can be may occur
marked by the lesions characterize diagnose based on approximately three
appearance of a the secondary positive specific to 15 years after the
single sore (called a stage. This stage treponemal initial infection, and
chancre), but there typically starts with antibody test may be divided into
may be multiple the development of together with three different
sores. The time a rash on one or normal CSF and forms: gummatous
between infection more areas of the absence of clinical syphilis (15%), late
with syphilis and the body. The rash manifestations. neurosyphilis
start of the first usually does not (6.5%), and
Duration of stage:
symptom can range cause itching. cardiovascular
Throughout life or
from 10 to 90 days Occurs a few weeks syphilis (10%).
progression to late
(average 21 days). after chancre
stage Duration of stage:
appears. Symmetric
Duration of stage: Chronic (without
rash that begins on
3-8 weeks treatment), possibly
the trunk and
fatal
involves the palms
and soles. Mucous
patches in the
mouth, tongue, or
cervix.
Duration of stage:
1-2 yrs

Management Diagnostic
Studies/Tests
Penicillin G benzathine
(Bicillin) or aqueous procaine N/A
penicillin G is the treatment of
choice for all stages of syphilis.

11
MEDICAL MANAGEMENT

When diagnosed and treated in its early stages, syphilis is easy to cure. The
preferred treatment at all stages is penicillin, an antibiotic medication that can
kill the organism that causes syphilis. If you're allergic to penicillin, your doctor
may suggest another antibiotic or recommend penicillin desensitization. If you
are diagnosed with primary, secondary or early-stage latent syphilis, the
recommended treatment is a single injection of penicillin. If you've had syphilis
for longer than a year, you may need additional doses.

12
LIST OF NURSING DIAGNOSIS

Assessment Findings Priority

Nursing Diagnosis Number Reason for Prioritization

Subjective Objective

Vital Signs

 Taken 4 doses  Temperature:

of Ibuprofen 101°F Homeostasis is a
200mg PO PRN  Pulse Rate: 72 bpm Physiological needs in
for pain in the  Respiratory Rate: 16 order to live comfortably.
Hyperthermia related to the infectious
last days. bpm
process as evidenced by temperature 1
 Blood Pressure:
of 101°F
141/85 mm Hg
 Oxygen saturation:
94%
 Weight: 60 kg
 Height: 5’7

 2

 “I am single and Infection transmission related to If not being monitored or

sexually active multiple male sexual partners and prevented, it might worsen
with two to unprotected sexual intercourse
three
 concurrent male
partners. I had
unprotected sex
with at least one
of my partners
in the past
couple of
weeks.” As
verbalized by
the patient.

 “I think I am  Diffuse Deficient knowledge related to 3

allergic to mucocutaneous unfamiliarity with disease
something” as rash noted on transmission information. Not everyone is
verbalized by abdomen, back, knowledgeable regarding
the patient. upper extremities sexual transmitted disease.
(including palms of This will provide preventive
 “I was in my measures.
hands) and soles of
usual state of
feet; macules are
health until
about 3 days easy to blanch and
ago when I are not associated
began with any area of
developing a fluctuance.
rash on my
stomach that is
now on the  Slightly underweight
palms of my man
hands and
 soles of my
feet” as
verbalized by
the patient.

 “My rash is not

painful or itchy,
I had this
strange
little”ulcer-
like”thing on my
penis a couple
weeks ago and
it went away
and never really
hurt” as
verbalized by
the patient.

 “My mother told

me that I
received all my
childhood
vaccine ” as
verbalized by
the patient.

 “I never been
vaccinated
against HPV
 because that’s
a woman’s
disease and I
am not sure if I
ever received a
hepatitis A
vaccine” as
verbalized by
the patient.

 MSM with
multiple sexual
partners.

NURSING CARE PLAN

Nursing Desired
Analysis Intervention Rationale Resources Evaluation Plan
Diagnosis Outcomes
Hyperthermia Pyrogens cause After the nursing  Assess and  Temperature  Vital sign  Stable body
related to the a rise in body interventions, monitor 38°C (101°F) equipmen temperature,
infectious process temperature, it the patient will client’s and above t within normal
as evidenced by also acts as an be able to: temperature may suggest specificall limits 97°F
temperature of antigen and note for infectious y (36.1°C) to 99°F
38°C (101°F) triggering presence of disease thermom (37.2°C).
 immune system chills/ process. eter
Objective: responses. The  Resume profuse
hypothalamus and diaphoresis;  Healthcar
Vital Signs reacts a raise maintain also note for  Room e
the set point and normal body degree and temperature providers
 Temperature: the body temperature pattern of may be guide and
101°F (38°C) respond by . occurrence. accustomed help in
producing heat. to near monitorin
(Fundamentals  Adjust and normal body g patients
of Nursing, monitor temperature condition.
Harry & Perry) environment and blankets
al factors like and linens  Conduciv
room may be e
temperature adjusted as environm
and bed indicated to ent.
linens as regulate
indicated. temperature
of the
patient.

 Administer  Antipyretic
antipyretics medications
as prescribed lower body
by the temperature
physician, by blocking
utilizing the the synthesis
10Rs in of
giving prostaglandi
medication. ns that act in
the
 hypothalamu
 Encourage s.
the client to
increase fluid  Water
intake. regulates
body
 Educate temperature.
client of
signs and  Providing
symptoms of health
hyperthermia teachings to
and help him client could
identify help client
factors cope with
related to the disease
occurrence condition
of fever; and could
discuss the help prevent
importance further
of increased complication
fluid intake to s of
avoid hyperthermia
dehydration.

Nursing Desired
Analysis Intervention Rationale Resources Evaluation Plan
Diagnosis Outcomes
Infection Men who have After the nursing  Identify  Timely interv  Hands Verbalize he will
transmission sex with men interventions, signs/sympto ention may out and abstain from sexual
related to multiple have increased the patient will ms of prevent visual contact with his
male sexual rates of human be able to: infection. complication aids. multiple partners
partners and immunodeficien Discuss impo s and until his infection is
unprotected sexual cy virus infection  Verbalize he rtance of enhance  Time and healed to prevent
intercourse and sexually will abstain prompt likelihood of effort. disease
transmitted from sexual reporting a positive transmission.
Subjective: diseases, contact with to healthcare outcome.
unprotected his multiple provider. ( Martin,2019 ( )YES ( )NO
 “I am single sexual activity partners ) Why:
and sexually plays a role in until his  Obtain
active with two spreading many infection is information  Multiple Verbalize
to three other kinds of healed to regarding sexual understanding of
concurrent infections. prevent client’s past partners or causative factors and
male partners. Anyone who is disease and intercourse appropriate
I had sexually active transmission present sexu with bisexual intervention.
unprotected risks some . al partners men
sex with at degree of and increases ( )YES ( )NO
least one of my exposure to a  Verbalize exposure to risk of Why:
partners in the sexually understandi any STDs. exposure to
past couple of transmitted ng of STDs Verbalize ways on
weeks.” As disease or a causative  Discuss and HIV/AID how to prevent
verbalized by sexually factors and mode of S. acquiring sexually
the patient. transmitted appropriate transmission ( Martin,2019 transmitted diseases.
infection. intervention. of )
( Mayer,2019 ) specific infect ( )YES ( )NO
 Verbalize ions, as  Provides Why:
ways on appropriate. information
how to to assist the Patient will review
prevent  Administer client in techniques and
acquiring medication making decis lifestyle changes to
 sexually as prescribed ions relative reduce risk of
transmitted by the to infection and will
diseases. doctor’s lifestyle/beha achieve timely
order. vioral healing, free form
 Patient will changes; complications and
review  Assess reinforces infections
techniques rashes on need for ( )YES ( )NO
and lifestyle stomach, partner to be Why:
changes to palm and treated.
reduce risk feet. ( Martin,2019
of infection )
and will  Educate
achieve patient on  It helps the
timely safe sex patient to
healing, free practice. treat or
form reduce his
complication risk for
s and infection and
infections. complication
s. ( Tudor,
2017 )

 To ensure
healing has
occurred
( Tudor,
2017 )

 Increasing
patient’s
 knowledge
and
improving
their
attitudes
related to
sexual and
reproductive
health and
behaviors.
( Unisco,201
8)

Nursing Desired
Analysis Intervention Rationale Resources Evaluation Plan
Diagnosis Outcomes
Deficient Syphilis is a After the nursing Involve patient Patient Healthcare  Ask patient to
knowledge relatedbacterial interventions, in writing specific involvement providers. describe
to unfamiliarity with
infection usually the patient will outcomes for the improves methods for
disease spread by be able to: teaching session, compliance with preventing and
transmission sexual contact. such as health regimen A booklet for tteating STIs.
information The disease  Patient will identifying what and makes patient
starts as a use is most important teaching and containing
Subjective:
painless sore — measures to to learn from learning a need-to-know  During follow-up
 “I think I am typically on your maintain their viewpoint partnership. details on the visit, determine
allergic to genitals, rectum sexual and lifestyle. diagnosis, whether patient
something” as or mouth health and treatment, with an STI has
 verbalized by Syphilis spreads prevent Different people and used safe sex
the patient. from person to acquisition take in prevention of practices.
person via skin and Give syphilis
information in
 “I was in my or mucous transmission information with
usual state of membrane different ways..
of sexually the use of  Ask parents or
health until contact with transmitted media. Use Clean and patient if HPV
about 3 days visual aids like
these sores. infections Healthy vaccination was
ago when I
began
The (STIs) diagrams, environment. achieved.
developing a bacterium Trepo pictures,
rash on my nema pallidum videotapes,
stomach that is (T. audiotapes, and
now on the pallidum) cause interactive
palms of my s syphilis.
Internet
hands and
soles of my websites, such
feet” as as Nurseslabs.
verbalized by All sexual
the patient. contact needs to
Provide clear, be notified and
 “My rash is not thorough, and receive
painful or itchy, treatment for
I had this understandable
STI.
strange explanations
little”ulcer- and
like”thing on demonstrations.
my penis a
couple weeks Patients are
ago and it went
The nurse will better able to
away and
 never really encourage the ask questions
hurt” as client to name when they have
verbalized by any additional basic
the patient. sexual partners information
 “My mother told about what to
me that I expect.
received all my
childhood
vaccine ” as
verbalized by
the patient.

 “I never been
vaccinated
against HPV
because that’s
a woman’s
disease and I
am not sure if I
ever received
a hepatitis A
vaccine” as
verbalized by
the patient.

 MSM with
multiple sexual
partners.
Objective:

 Diffuse
mucocutaneou
s rash noted
on abdomen,
back, upper
extremities
(including
palms of
hands) and
soles of feet;
macules are
easy to blanch
and are not
associated
with any area
of fluctuance.

 Slightly
underweight
man
DRUG STUDY

Classification/
Adverse
Drug Name Mechanism of Indications Contraindications Nursing Responsibilities
Reactions
Action
Generic Classification: Indicates to relieve mild  Patients with  Upset Assessment
Name: NSAID to moderate pain known stomach  History: Allergy to
Ibuprofen related to hypersensitivity ibuprofen,
Mechanism of dysmenorrhea, to Ibuprofen.  Nausea salicylates or other
Brand Name: Action: The exact headache, migraine, NSAIDs; CV
Advil mechanism of postoperative dental  Patients who  Vomiting dysfunction,
action of ibuprofen pain, spondylitis, have hypertension; peptic
Dosage: is unknown. osteoarthritis, experienced  Headache ulceration, GI
200 mg However, ibuprofen rheumatoid arthritis, asthma, bleeding; impaired
is considered an and soft tissue urticaria, or  Diarrhea hepatic or renal
 NSAID and thus it is disorder. allergic-type function.
Route: a non-selective reactions after  Constipation
Oral inhibitor of As ibuprofen is a widely taking aspirin or  Physical: Skin color,
cyclooxygenase, used medication, the other NSAIDs.  Dizziness or lesions; T;
which is an enzyme main therapeutic Drowsiness  orientation, reflexes,
involved in indications are:  Treatment of ophthalmologic
prostaglandin peri-operative evaluation,
(mediators of pain  Patent Ductus pain in the audiometric
and fever) and Arteriosus - it is a setting of evaluation,
thromboxane neonatal condition coronary artery peripheral
(stimulators of blood wherein the ductus bypass graft sensation; P, BP,
clotting) synthesis arteriosus (blood (CABG) edema; R,
via the arachidonic vessel that surgery. adventitious sounds;
acid pathway. connects the main liver evaluation,
Ibuprofen is a non- pulmonary artery to bowel sounds; CBC,
selective COX the proximal clotting times,
inhibitor and hence, descending aorta) urinalysis, LFTs,
it inhibits the activity fails to close after renal function tests,
of both COX-1 and birth causing serum electrolytes,
COX-2. The severe risk of heart stool guaiac
inhibition of COX-2 failure. The
activity decreases prostaglandin Interventions
the synthesis of inhibition of
prostaglandins ibuprofen has been  BLACK BOX
involved in studied for the WARNING: Be
mediating treatment of this aware that patient
inflammation, pain, condition as it is may be at increased
fever, and swelling known that risk of CV event, GI
while the inhibition prostaglandin E2 is bleeding, monitor
of COX-1 is thought responsible for accordingly.
to cause some of keeping the ductus
the side effects of arteriosus open.  Administer drug with
ibuprofen including food or after meals if
GI ulceration.  Rheumatoid- and GI upset occurs.
osteo-arthritis -
ibuprofen is very  Arrange for periodic
commonly used in ophthalmologic
the symptomatic examination during
treatment of long-term therapy.
inflammatory,
musculoskeletal  Discontinue drug if
and rheumatic eye changes,
disorders. symptoms of
hepatic impairment,
 Cystic fibrosis - the or renal impairment
use of high occur.
dosages of  WARNING: Institute
ibuprofen has been emergency
proven to decrease procedures if
inflammation and overdose occurs:
decreasing Gastric lavage,
polymorphonuclear induction of emesis,
cell influx in the and supportive
lungs. therapy.

 Orthostatic Teaching points

hypotension -
ibuprofen can  Use drug only as
induce sodium suggested; avoid
retention and overdose. Take the
 antagonize the drug with food or
effect of diuretics after meals if GI
which has been upset occurs. Do
reported to be not exceed the
beneficial for prescribed dosage.
patients with severe
orthostatic  Avoid over-the-
hypotension. counter drugs. Many
of these drugs
 Dental pain - contain similar
ibuprofen is used to medications, and
manage acute and serious overdosage
chronic orofacial can occur.
pain.
 You may experience
 Minor pain - these side effects:
ibuprofen is widely Nausea, GI upset,
used to reduce dyspepsia (take
minor aches and drug with food);
pains as well as to diarrhea or
reduce fever and constipation;
manage drowsiness,
dysmenorrhea. It is dizziness, vertigo,
very commonly insomnia (use
used for the relief of caution when driving
acute indications or operating
such as fever and dangerous
tension headaches. machinery).

 Report sore throat,

 Investigational uses fever, rash, itching,
- efforts have been weight gain,
put into developing swelling in ankles or
ibuprofen for the fingers, changes in
prophylaxis of vision, black or tarry
Alzheimer's stools.
disease, Parkinson
disease, and breast
cancer.
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