CENTRAL LUZON DOCTORS’ HOSPITAL EDUCATIONAL INSTITUTION

ROMULO HIGH WAY, SAN PABLO, TARLAC CITY

ANEMIA
PROBABLY SECONDARY
TO UPPER
GASTROINTESTNAL
BLEEDING

Submitted to:

Mr. Arnel A. Gervacio, RN,MSN

Submitted by:

Solksjaer Jeanne D. Repollo

 CENTRAL LUZON DOCTORS’ HOSPITAL EDUCATIOAL INSTITUTION

ROMULO HIGH WAY, SAN PABLO, TARLAC CITY

I. Introduction

II. Objectives

III. Nursing Progress

A. Bata Base
a. Nursing Health History A
1. Demographic data
2. Chief complaint
3. History of present illness
4. Past medical history
5. Family history
6. Socio-economic background
7. Review of systems
b. Nursing Health History B
1. General Description Pattern
2. Health Perception-Health Management Pattern
3. Nutritional-Metabolic Pattern
4. Elimination Pattern
5. Activity-Exercise Pattern
6. Sleep Rest Pattern
7. Cognitive-Perceptual Pattern
8. Self-Perception Pattern
9. Role-Relationship Pattern
10. Sexual-Reproductive Pattern
11. Coping-Stress Tolerance Pattern
c. Genogram
d. Physical Examination
e. Laboratory
f. Anatomy and Physiology
g. Pathophysiology
B. Nursing Care Plan
C. Drug Study

IV. Evaluation

V. Recommendation
I. Introduction

Patient is a 69 year old male who was admitted to Tarlac Provincial Hospital with
a chief complaint of general body weakness and was admitted last September 14,2017. He was
diagnosed of Anemia probably secondary to Upper Gastrointestinal Bleeding.

Anemia is a decrease in the total amount of red blood cells (rbcs) or hemoglobin in

the blood, or a lowered ability of the blood to carry oxygen. When anemia comes on slowly, the
symptoms are often vague and may include feeling tired, weakness, shortness of breath or a poor
ability to exercise.  Anemia that comes on quickly often has greater symptoms, which may
include confusion, feeling like one is going to pass out, loss of consciousness, or increased
thirst. Anemia must be significant before a person becomes noticeably pale. Additional
symptoms may occur depending on the underlying cause.

The most important element of red blood cells is called hemoglobin. Hemoglobin is a protein
that carries vital oxygen from the lungs through the bloodstream to the cells, tissues and organs
of the body. Many symptoms of anemia are due to a decreased amount of hemoglobin in the
blood. These symptoms can include dizziness, shortness of breath, weakness, palpitation, fatigue
and fainting. Hypotension and pallor or pale skin are also common symptoms.

The three main types of anemia are due to blood loss, decreased red blood cell production, and
increased red blood cell breakdown. Causes of blood loss include trauma and gastrointestinal
bleeding, among others. Causes of decreased production include iron deficiency, a lack of
vitamin B12, thalassemia, and a number of neoplasms of the bone marrow. Causes of increased
breakdown include a number of genetic conditions such as sickle cell anemia, infections
like malaria, and certain autoimmune diseases. It can also be classified based on the size of red
blood cells and amount of hemoglobin in each cell. If the cells are small, it is microcytic
anemia. If they are large, it is macrocytic anemia while if they are normal sized, it is normocytic
anemia. Diagnosis in men is based on a hemoglobin of less than 130 to 140 g/L (13 to 14 g/dl),
while in women, it must be less than 120 to 130 g/L (12 to 13 g/dl). Further testing is then
required to determine the cause.

Diagnosing anemia and its underlying cause begins with taking a thorough personal and family
medical history, including symptoms, and completing a physical examination.

Anemia can be generally diagnosed with a blood test called a complete blood count (CBC). A
complete blood count can determine the number, size, and color of the red blood cells and the
amount of hemoglobin they hold.

Making a diagnosis also includes performing a variety of other tests to help to diagnose the
underlying disease, condition or disorder causing anemia. This may include a blood test that
measures ferritin, a test for vitamin B12 deficiency and tests to determine if a person has sickle
cell trait or thalassemia trait.
A digital rectal examination and testing for fecal occult blood are also generally performed. A
digital rectal examination involves inserting a finger into the rectum to feel for any abnormalities
and obtain a sample of stool to test for the presence of blood, which may not be visible to the
naked eye. If blood is present in stool, the cause of anemia may be a disease or condition that
causes bleeding in the gastrointestinal tract, a common cause of anemia.

In this case, making a diagnosis of the underlying cause of anemia includes performing special
imaging tests to see a picture of the inside of the gastrointestinal tract. These may consist of
some combination of tests, such as a barium X-ray, CT scan, MRI, and a variety of tests using
video imaging technology, such as sigmoidoscopy or colonoscopy.

Sigmoidoscopy or colonoscopy involves passing a small flexible tube fitted with a camera
through the anus into the colon to look for abnormal areas and sites of bleeding. The upper areas
of the gastrointestinal tract, such as the esophagus and stomach, can be examined in a similar
way through the mouth and esophagus in an endoscopy procedure.

II. Objectives

After nursing interventions, the student nurses will be able to:

1. Assess the patient’s condition and health care needs.

2. Identify possible complications and risks of the patient’s health condition.
3. Plan for proper nursing interventions to meet the client’s needs.
4. Render proper nursing interventions for the patient.
5. Evaluate the patient’s condition after rendering proper nursing interventions.
III. Nursing Process:

A. Data Base
a. Nursing Health History

Demographic Data

Name: Patient A

Age: 69 year old

Gender: Male

Address: Gerona Tarlac

Civil Status: Married

Nationality: Filipino

Religion: Catholic

Chief Complaint: General Body Weakness

Examiner: Solksjaer Jeanne Repollo

History of Present Illness

. The patient condition started 3 days prior to admission when he experienced body
weakness due to financial problem he did not seek for consultation. He only took rest for his own
seeking that he might feel good.

2 days prior to admission the patient experienced body weakness and difficulty of
breathing when he gets out of his bed and tries to go to their kitchen.

Few hours prior to admission the patient experience generalize body weakness reason for
him to sought consultation, hence this admission.

Past Medical History

 Patient was diagnosed with Pulmonary Tuberculosis 6 years ago and was treated for 6
months.

Family History

Patient has no known history of cancer, hypertension, endocrine, gastrointestinal or

respiratory diseases

Socio-Economic Background

He worked as a farmer. He doesn’t smoke but drinks alcohol beverages occasionally

Review of System

Cardiovascular

He had difficulty of breathing and feels dizziness

Genitourinary

He seldom experienced dysuria

Musculoskeletal

He experienced body weakness and fatigue

Respiratory

He experienced difficulty of breathing

Gastrointestinal

He experienced abdominal pain

Integumentary

No itchiness of skin, (-) skin disease

Endocrine

He experienced weight loss and easy fatigability

Extremities

Scars are present on the both lower extremities

Nursing History B

General description of the client

The client was a 69 year old male with an endomorph body type. His skin was light
brown, his hair turned gray, and his eyes were protruded. During the interview, the patient was
conscious, coherent and cooperative.

Health Perception Pattern- Health Management Pattern

The patient believed in natural healing and also taking medications as prescribed by his
doctor whenever he gets ill.

Nutritional-Metabolic Pattern

The patient’s typical three times a day consists of rice, meat and more on vegetables and
he is fund of drinking coffee every meal. He also drinks 1-1.5 litre of water per day.

Elimination Pattern

He urinates 5 to 6 times a day with light yellow urine color and defecates 1 to 2 times a
day with black tarry stool

Activity-Rest Pattern

The patient considers farming as his mode of exercise.

Sleep-Rest Pattern

He usually sleeps 10 o’clock in the evening and wakes up at 4am in the morning.

Cognitive-Perceptual Pattern

He participates and answers questions in complete details. There were no speech

difficulties and was oriented to time, date, place and person.

Self-Perception Pattern

He perceives himself as a simple person and contented with his life.

Role Relationship Pattern

He does have a good relationship with his family and states that he’s doing his duties and
responsibilities as a father and husband to his wife

Sexual-Reproductive Pattern
 According to the patient he don’t do sex intercourse anymore due to his age.

Coping-Stress tolerance Pattern

The patient states that whenever he feels stress he distracts himself with activities such
as watching tv, listening to radio and playing with his grandchildrens

Values-Belief Pattern

Patient was a catholic and seldom goes to church every Sunday.

GENOGRAM

FATHER
MOTHER

BROTHER
SISTER PATIENT
SISTER

SON SON

DAUGHTER DAUGHTER
 - Hypertension
- Anemia

PHYSICAL ASSESSMENT

During Admission:

Vital Signs: Blood Pressure: 90/60mmHg Pulse: 80 bpm

Respiratory rate: 18 cpm Temperature: 37.1 ‘C

During Assessment:

Vital Signs: Blood Pressure: 90/60mmHg Pulse: 88 bpm

Respiratory rate: 20 cpm Temperature: 36 ‘C

Body parts Technique Under Parts Actual Findings

examined
Skin Inspection Surface of the Pale skin, moist to touch
Palpation skin Presence of few scars on the lower
extremities
Head Inspection Head Hair is thin, dry and grey in color
Palpation Hair No lesions on scalp
Scalp No palpated tenderness and mass
Face
Nails Inspection Nails Finger nails are trimmed and brittle
Palpation capillary refill of 2 seconds
Toe nails appears dry

Eyes Inspection External eye Sclera is white

Eyelids Conjunctivas are pale
Sclera and The iris are black and symmetrical
conjunctiva Pupils are equal, round and reactive to
Cornea light.
Iris Eyes are protruded
Pupils
Nose Inspection External nose No lesions and no discharges present
Palpation Sinuses
Nares
Ears Inspection External and Ears are symmetrical and without
internal ears deformity.
Mouth and Inspection Lips and gums Lips are dry.
throat Palpation Tongue No lesions on buccal mucosa
Tongue is midline
Neck Inspection Thyroid gland Symmetrical
Palpation Trachea No jugular venous distension
Auscultation Cervical lymph No visible mass or lumps
nodes

Thorax and Inspection Thorax Chest expansion is symmetrical

lungs Palpation Scapula Moves symmetrically on breathing
Percussion Lungs with no obvious masses
Auscultation Presence of crackles on the lower part
of the lungs.
Heart auscultation Heart Heart beat is regular rhythm and rate
of 88 bpm.
Apical impulse is at the 5th ICS MCL.
Abdomen Inspection Umbilicus No lesions, tenderness or masses
Auscultation Liver Low pitched gurgling sounds heard
Percussion Spleen upon auscultation
Palpation Kidney
Bladder
Upper Inspection Arms No edema, bruising or lesions.
extremities Palpation Hands Presence of IV line on hand
Fingers Capillary refill of 2 seconds
Lower Inspection Legs No presence of edema, bruising or
extremities Palpation Feet lesions.
Toes Presence of few scars
LABORATORY RESULT

FECALYSIS September 15, 2017

PHYSICAL CHARACTERISTICS CHEMICAL TESTS
Color: BROWN Occult Blood: NEGATIVE
Consistency: FORMED
MICROSCOPIC FINDINGS RBC /HPF
Pus Cells /HPF
Ova or Parasites Fat Globules
Bacteria

Others: Start Granules

COMPLETE BLOOD COUNT September 15, 2017

Result Normal Value Result Normal Value

Hemoglobin 6.2g/dl Male (14-18g/dl) Segmenters 73% (40-70%)
Female: (12-16g/dl)
Hematocrit 18 Male: (40-50) Lymphocytes 20% (20-50%)
Female: (35-45)
RBC Count Monocytes 2% (2-6%)
WBC Count 10.75 x10/L (4.8-10.8 x10/L) Eosinophils 5% (0-5%)
Platelet Count 387 (150-450 x10?mm3)
BLOOD CHEMISTRY
RBS/HGT

Hematology Result September 16, 2017

Test Result
Hemoglobin (135-170g/dl) 54
Hematocrit (0.390-0.500) 0.171
RBC (3.9-5.7 x 10 /L) 2.46
MCV (80-96/L) 69.5
MCHC (334-355g/L) 316
MCH (27.5-32.2 pg) 22.0
WBC (4.5-10.5 x 10 9/L) 7.6
Polys (0.55-0.63) 0.629
Lympho (0.23-0.35) 0.234
Platelet (150,000-450,000) 398,000
Blood Type B
BLOOD CHEMISTRY September 16, 2017

NORMAL RANGE RESULT

RBS/HGT (2.5 – 7.2 mmol/L ) 7.23
BUN ( 2.9 – 8.2 mmol/L ) 6.76
CREATININE ( 53.0 – 106.0 umol/L ) 135.25

ELECTROLYTES September 16, 2017

NORMAL RANGE RESULT

SODIUM ( 135 – 148.0 mmol/L ) 137.0
POTASSIUM ( 3.50 – 5.30 mmol/L ) 354
CHLORIDE ( 98.0 – 107.0 meq/L ) 105.0

URINALYSIS September 17,2017

CHEMICAL PHYSICAL MICROSCOPIC

Leukocytes: NEGATIVE Color: LIGHT Pus cells: 0-3 /HPF
Nitrite: NEGATIVE YELLOW Red cells: 0-2 /HPF
Urobilinogen: NORMAL Transparency: CLEAR Epithelial cells: RARE
Protein: NEGATIVE Mucus Threads:FEW
pH: 6.0 Bacteria: RARE
Blood: NEGATIVE
Specific Gravity: 1.010
Ketone: NEGATIVE
Bilirubin: NEGATIVE
Glucose: NEGATIVE

ABDOMINO PELVIC ULTRASOUND

Result
Liver is normal in size with a homogenous parenchyma no mass lesion. Intrahepatic ducts and
common bile duct are dilated. Gall bladder is normal in size with an echo-free lumen. Gall bladder wall is
normal in thickness. Pancreas and spleen are normal in size and echopattern. Abdominal aorta is not
dilated. Both kidneys are within normal size, isoechoic echogenicity with multiple cyst one in the right
measures 2.5 x 1.9 cm, one in the left measures 3.0 – 3.2 cm. No calculus or hydronephrosis seen. The
right kidney measures 8.9 x 3.6 cm. The left kidney measures 8.5 x 4.3cm. There is no ascites. Urinary
bladder is distended showing smooth mucosa no mass lesion or calculi. Prostate gland measures 4.1 x 4.2
x 4.2 cm with an estimated weight of 38.5 grams.
Impression:
Bilateral renal parenchymal disease and renal cysts.
Normal scan of the liver, gall bladder, pancreas, spleen, and urinary bladder.
Enlarged prostate gland.

Anatomy and Physiology

PATHO
Day 2 (July 25, 2017)
Patients vital signs including intake and output and O2 saturation is still being monitored.
Physician ordered another 2D Echo, 12 Lead ECG, T3 T4 and TSH. He also requested for the
chest x-ray and other lab exams to be followed up.

Day 3 (July 26, 2017)

Until her 3rd day laboratory results are still being requested for follow up by the physician. Vital
signs, intake and output and O2 saturation still being monitored. Physician also ordered to watch
out for chest pain and dyspnea.

DISCHARGE PLAN
Medications:

 Omeprazole 40mg
 FeSo4 BID

Exercise

 Instructed patient to rest and conserve energy while symptomatic and then slowly
increasing activities.

 Instructed patient to do deep breathing exercise when difficulty of breathing occur.

 Instructed client to prevent doing strenous activity.

Treatment

 Encouraged patient to take prescribed medications regularly and explain about its side
effects.

 Instructed patient to have adequate rest and sleep.

Health Teaching

 Instructed the client and her family about the causes, signs and symptoms of severity of
her illness

 Explain to the client the needs of following checked up.

 Instructed patient to avoid smoking and drinking alcohol

 Adviced client to use soft brittle toothbrush

Out Patient Department

 Instructed patient to have follow up checked up after a week.

Diet

 Instructed patient to eat foods that are high in Iron

 Instructed to patient to increase his fluid intake.

 Instructed patient to take Iron supplement and nutritional supplements to boost his
immune system.

Social, Sexual
The patient is not sexually active
ASSESSMENT NURSING SCIENTIFIC PLANNING INTERVENTIONS RATIONALE EVALUATION
DIAGNOSIS EXPLANATION
Subjective: Fatigue related  loss of ability of ti After series -Monitor vital signs, -Pulse is After series of
“Madali akong to increase ssues to respond to  of nursing noting pulse rate at typically nursing
mapagod, hypermetabolic stimuli that normal interventions rest and when active. elevated and, interventions the
pakiramdam ko state with ly evoke muscular  the patient even at rest, patient was able
hinag hina ako” increased contraction or othe will be able tachycardia (up to verbalize
energy r activity. Muscle  to: to 160 increase in level
Objective: requirements cells Verbalize beats/min) may of activities
-lack of energy generally require a  increase in be noted.
-disinterest in refractory or recov level of
surrounding ery period after act energy. -Note development -O2 demand and
-decreased ivity, when cells re Display of tachypnea, consumption are
performance store their energy s improved dyspnea, pallor, and increased in
upplies and excret ability to cyanosis. hypermetabolic
e participate in   state,
metabolic waste pr desired potentiating risk
oducts. activities of hypoxia with
activity
.
-Provide for quiet -Reduces stimuli
environment; cool that may
room, decreased aggravate
sensory stimuli, agitation,
soothing colors, hyperactivity,
quiet music. and insomnia.

-Encourage patient  -Helps

to restrict activity counteract
and rest in bed as effects of
much as possible. increased
 metabolism

-Provide comfort -May decrease

measures: touch nervous energy,
therapy or massage, promoting
cool showers. relaxation.
Patient with dyspnea  
will be most  
comfortable sitting  
in high Fowler’s
position.

-Provide for -Allows for use

diversional activities of nervous
that are calming, energy in a
e.g., reading, radio, constructive
television. manner and may
reduce anxiety.

-Avoid topics that -Increased

irritate or upset irritability of the
patient. Discuss CNS may cause
ways to respond to patient to be
these feelings. easily excited,
  agitated, and
prone to
emotional
outbursts.

-Discuss with SO -Understanding

reasons that the behavior
for fatigue and is physically
emotional lability. based may
enhance coping
with current
situation and
encourage SO to
respond
positively and
provide support
for patient.
.
ASSESSMENT NURSING SCIENTIFIC PLANNING INTERVENTIONS RATIONALE EVALUATION
DIAGNOSIS EXPLANATION

Sujective:”kuma Imbalanced Thyroid disease After series -Monitor daily food -Continued After series of
kain naman ako nutrition less also has a marked of nursing intake. Weigh daily weight loss in nursing
pero pumapayat than body effect on BMR, interventions and report losses. face of interventions the
pa rin ako” requirements since thyroid horm the patient adequate patient was able
related to ones regulate will be able caloric intake to:
increased the rate of to: may indicate Demonstrate
Objective: metabolism cellular metabolis Demonstrate failure of stable weight and
-weight loss (55 m. Hyperthyroidis stable weight antithyroid be free of signs of
kg to 50 kg) m in which there is and be free therapy malnutrition.
-dry lips an increase in the of signs of -Encourage patient
-decreased production malnutrition. to eat and increase -Aids in
subcutaneous of thyroid hormon number of meals and keeping caloric
fats es leads to snacks. Give or intake high
a high BMR suggest high-calorie enough to keep
foods that are easily up with rapid
digested. expenditure of
calories caused
by
hypermetabolic
state.
-Provide a balance  
diet, with six meals -To promote
per day. Avoid foods weight gain.
that increase Note: If patient
peristalsis and fluids has edema,
that cause diarrhea. suggest a low-
sodium diet.
Increased
 motility of GI
tract may result
in diarrhea and
impair
absorption of
needed
-Consult with nutrients
dietitian to provide
diet high in calories, -May need
protein, assistance to
carbohydrates, and ensure
vitamins. adequate
intake of
nutrients,
identify
appropriate
supplements.
Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis

S > Nahihirapan ako Ineffective After series of  Determine  It would cause After series of
minsan huminga breathing pattern nursing presence of factors breathing nursing
related to disease intervention or physical impairments. intervention
client was able
process client will conditions  To evaluate
to establish
O> establish  Auscultate and presence/ normal and
normal and percuss chest characteristic of effective
 Shortness of effective breath sounds respiratory
breath respiratory and secretions. pattern as
pattern as  Anxiety may be evidenced by
 Body  Note emotional
evidenced by causing chronic absence of
weakness responses signs and
absence of hyperventilatio
symptoms of
 Restlessness signs and  Maintain calm n hypoxia
symptoms of attitude while  To limit level
hypoxia dealing with the of anxiety
patient

 Medicate with  To promote

analgesics as deeper
appropriate respiration and
cough
 Emphasize the
importance of good  To maximize
posture and respiratory
effective use of effort
 accessory muscles

 Encourage
adequate rest  To limit
periods between fatigue
activities

 Put the patient on a  To promote

semi fowler’s lung expansion
position
 To give
 Give O2 inhalation oxygen to the
as needed patient.
ASSESSMENT NURSING SCIENTIFIC PLANNING INTERVENTON RATIONALE EVALUATIO
DIAGNOSIS EXPLANATION N
S: “Madali po Activity -easy fatigability After series of -note clients report -symptoms - After series of
akong intolerance is caused by an nursing of weakness, fatigue, may be result nursing
mapagod.” evidenced by increase in intervention, the pain, difficulty of of or contribute intervention,
weakness, metabolic client will be accomplishing tasks to intolerance the client was
O: fatigue, demands due to able to identify and or insomnia. of activity. able to identify
-shallow and dyspnea, increasing the negative the negative
rapid abnormal heart number of thyroid factors affecting -identify activity -to evaluate factors
respirations rate, and blood hormones that intolerance and needs versus desires. appropriatenes affecting
-RR 25 cpm pressure in leads to eliminate or s. intolerance and
-PR 118 bpm response to intolerance of reduce their eliminate or
activity. activity. effects when reduce their
possible. -reduce intensity -to prevent effects when
level or discontinue over exertion. possible.
activities that cause
undesired
physiological
changes.

-plan care carefully -to reduce

balance rest periods fatigue.
with activities.

-assist with activities -to protect

and provide or client from
monitor client’s use injury.
of assistive devices.
Assessment Nursing Planning Interventions Rationale Evaluation
Diagnosis

Subjective: Lagi Decreased Patient’s decreased Monitor BP, pulse Increase TH After series of
akong nahihirapang Cardiac cardiac output will rate and rhythm, increases cardiac nursing intervention,
huminga and madali Output related be lessened. respiratory rate and rate, stroke volume the patients decreased
akong mapagod. As to alteration breath sounds and tissue demand cardiac output is
verbalized by the in heart rate, for oxygen, causing lessen.
patient. rhythm and Patient stress on the heart.
conduction demonstrates Patients demonstrated
 Objective: adequate cardiac Assess for peripheral A physical adequate cardiac
cold clammy output as evidenced edema, jugular vein comfortable and output. Vitals signs
skin by BP and PR and distention and psychologically showed in normal
 Pale skin rhythm within increased activity calm, environment parameters. There
 Decrease normal parameters intolerance. reduce stimuli and was no symptoms of
peripheral for patient, strong stressors. dyspnea, syncope or
pulses peripheral, and an chest pain.
ability to tolerate Suggest keeping the Rest periods
activity without environment as cool decreases energy
symptoms of and free of expenditure and
dyspnea, syncope distraction as tissue requirements
or chest pain. possible. for oxygen,
decreasing demands
Patient remains free on the heart by Patient was remain
of side effects from decreasing cardiac free of side effects
the medications Encourage patient to workload. from the medications
used to achieve balance activity with used for the
adequate cardiac rest periods. treatment.
 output.

Assessment Nursing Planning Interventions Rationale Evaluation

Diagnosis
Subjective: Natatakot Anxiety To be able for the Assess for the The context in which After series of nursing
ako kasi baka mamatay related to lack patient to verbalize, presence of culture anxiety is interventions, the
ako dahil sa sakit ko. of knowledge if asked, what to bound anxiety experienced, its patient was able to
as verbalized by the about the expect. states. meaning, and verbalized that she
patient disease responses to it are understands and can
process Relate less anxiety culturally mediated. described own anxiety
Objective: after teaching. and coping patterns.
 Restlessness Assess the patient’s The patient with
 Facial grimace Assist the patient to level of anxiety. mild anxiety will Patient demonstrated
 Feeling tense gain insight into have minimal or no the ability to reassure
anxiety and reason. physiological self.
symptoms of
Help patient anxiety. Patient identified
reappraise the threat Moderate anxiety strategies to reduced
and learn a new way may appear anxiety.
to deal with it. energized, with more
animated facial
expressions and tone
of voice.
Severe anxiety,
patient will have
symptoms of
increased autonomic
nervous system
activity.
 Panic level of
anxiety, the
autonomic nervous
system increases to
the level of
sympathetic
neurotransmitter
release.

Assess physical Anxiety also plays a

reactions to anxiety. role in somatoform
disorders, which are
characterized by
physical symptoms
such as pain, nausea,
weakness, or
dizziness that have
no apparent physical
cause.

Familiarize patient Awareness of the

with the environment
environment and promotes comfort
new experiences or and may decrease
people as needed. anxiety experienced
by the patient.
Anxiety may
intensify to a panic
level if patient feels
threatened and
unable to control
environmental
stimuli.
Drug Study

DRUG CLASSIFIC DOSAGE/ ACTIONS INDICATIO CONTRAINDI SIDE NURSING

NAME ATION ROUTE NS CATIONS EFFECTS RESPONSIBILIT
FREQUEN IES
CY
Clopidogr Platelet 75 mg tab Binds to To reduce Active CNS: -advise the patient
el aggregation OD after adenosine atheroscleroti pathological confusion, to avoid the
inhibitor lunch diphosphate c events, such bleeding, dizziness, medication in
receptors on as stroke and including peptic headache, patients who have a
the surface of MI, in ulcer and hallucinations, genetic variation in
activated patients with intracranial fatigue CYP2C19 or are
platelets. This atherosclerosi hemorrhage; receiving
action blocks s documented hypersensitivity CV: chest CYP2C19
ADP, which by recent to clopidogrel or pain, edema, inhibitors. Platelet
deactivates stroke, MI, or it’s components . hypercholester inhibition may
nearby peripheral olnemia, decline, increasing
glycoprotein artery disease. hypotension, the risk of adverse
receptors and vasculitis cardiovascular
prevents GI: abdominal effects after MI.
fibrinogen pain, acute -inform the patient
from liver failure, to use clopidogrel
attaching to colitis, cautiously in
receptors. diarrhea, patients with sevee
Without duodenal, hepatic or renal
fibrinogen, gastric or disease, risk of
platelets can’t peptic ulcer, bleeding from
aggregate and elevated liver trauma or surgery,
form thrombi. function test or conditions that
results, predispose to
gastritis, bleeding.
indigestion,
nausea, -inform the patient
noninfectious about the action of
hepatitis,pancr the drugs and its
eatitis. side effects

-instruct the patient

to tell to the
physician or other
health care
providers if he
experience any of
the side effects
-obtain blood cell
count, as ordered,
whenever signs and
symptoms suggests
a hematologic
problem.
 DRUG CLASSIFIC DOSAGE/ ACTIONS INDICATIO CONTRAINDI SIDE NURSING
NAME ATION ROUTE NS CATIONS EFFECTS RESPONSIBILIT
FREQUEN IES
CY
Aspirin Anti- 80 mg tab Aspirin To relieve Allergy to CNS: -inform the patient
inflammatory OD inhibits the mild pain or tartrazine dye, confusion, about tinnitus. This
, anti- platelet fever. asthma, bleeding CNS reaction usually
platelet, anti- aggregation problems, depression occurs when blood
pyretic, no- by interfering hypersensitivity EENT: aspirin level
opioid with to aspirin or it’s hearing loss, reaches or exceeds
analgesic production of components, tinnitus maximum for
thromboxane peptic ulcer GI: diarrhea, therapeutic effect.
A2, a disease . GI bleeding -advise adult
substance that heartburn, patient to taking a
stimulates hepatotoxicity, low-dose of aspirin
platelet nausea, not to also take
aggregation. stomach pain, ibuprofen because
Aspirin acts vomiting. it may reduce the
on the heat- cardioprotective
regulating and stroke
center in the preventive effects
hypothalamus of aspirin.
and causes
peripheral -instruct the patient
vasodilation, to take aspirin with
diaphoresis food or after meals
 and heat loss. because it may
.cause GI upset if
taken on an empty
stomach

DRUG CLASSIFI DOSAGE/ ACTIONS INDICATI CONTRAIND SIDE EFFECTS NURSING

NAME CATION ROUTE ONS ICATIONS RESPONSIBILITIES
FREQUEN
CY
methima Anti- 20 mg tablet  Pallia  Hypers CNS: drowsiness,  Monitor response
zole thyroid bid Inhibits the headache, vertigo
synthesis tive ensitivity; for symptoms of
agents treatment  Lactati GI: diarrhea, hyperthyroidism or
of thyroid hepatotoxicity,
hormones. of on: Lactatio thyrotoxicosis
loss of taste,
Therapeut hyperthyr n nausea, parotitis, (tachycardia,
ic oidism. vomiting palpitations,
Effect(s):  Used Derm: rash, skin nervousness,
Decreased as an discoloration, insomnia, fever,
signs and adjunct to urticaria diaphoresis, heat
symptoms control Hemat: AGRAN intolerance, tremors,
of ULOCYTOSIS,
hyperthyr weight loss, diarrhea).
hyperthyroi anemia,
oidism in  Assess for
dism. leukopenia,
preparatio thrombocytopenia development of
n for MS: arthralgia hypothyroidism
thyroidect Misc: fever, (intolerance to cold,
omy or lymphadenopathy constipation, dry skin,
radioactiv headache, listlessness,
e iodine tiredness, or
therapy. weakness). Dose
adjustment may be
 required.
 Assess for skin
rash or swelling of
cervical lymph nodes.
Treatment may be
discontinued if this
occurs..
 Monitor WBC
and differential counts
periodically during
therapy.
Agranulocytosis may
develop rapidly;
usually occurs during
the first 2 mo and is
more common in
patients over 40 yr and
those receiving >40
mg/day. This
necessitates
discontinuation of
therapy.
 May cause ↑ AST,
ALT, LDH, alkaline
phosphatase, serum
bilirubin, and
prothrombin time.
 DRUG CLASSIFI DOSAGE ACTIONS INDICATIO CONTRAINDICA SIDE NURSING
NAME CATION /ROUTE NS TIONS EFFECTS RESPONSIBILIT
FREQUE IES
NCY
Dexameth Chemical 40mg IV Binds to To treat Administration of Fever -Use drug
asone class: OD intracellular endocrine live-virus vaccine ,malaise, cautiously in
Synthetic glucocorticoid disorders to patient or family headache, patients with
adrenocortic receptors and member, insomnia, light congestive heart
al steroid. suppresses hypersensitivity to headedness failure,
Therapeutic inflammatory dexamethasone or Arrhythmias, hypertension, or
class: Anti- and immune its components bradycardia, renal insufficiency
inflammator responses by: including sulfites, edema, because drug can
y diagnostic -Inhibiting idiopathic tachycardia cause sodium
aid, neutrophil and thrombocytopenic retention, which
immunosup monocyte may lead to edema
pressant accumulation and hypokalemia.
at
inflammation -Give oral drug
site and with food to
suppressing decrease GI
phagocytic distress.
and
bactericidal -Monitor fluid
action. intake and output
-Stabilizing and daily weight,
lysosomal and watch for
membranes. crackles, dyspnea,
-Suppressing peripheral edema,
antigen and steady weight
response of gain.
macrophages
and helper T-
cells.
-Inhibiting
synthesis of
inflammatory
response
mediators
such as
cytokines,
interleukins,
and
prostaglandins
.
DRUG CLASSIFICA DOSAGE ACTION INDICATI CONTRAINDI SIDE NURSING
NAME TION ROUTE and ON CATION EFFECTS RESPONSIBITIY
FREQUENC
Y
Furosemi Loop diuretic, 40 mg IV Inhibits the To reduce Anuria, Dizziness,  Monitored
de antihypertensiv reabsorptio edema unresponsiveness headache, input and
e n of associated to furosemide; restleness, output
sodium and with CHF, hypersensitivity weakness,  Encourage
chloride in nephrotic to furosemide, orthostatic increase fluid
the syndrome, sulfonamide, or hypotension intake.
proximal hepatic their components. .  Monitored BP
and distal cirrhosis, Several renal  Monitored for
tubules as and ascites. disease and serum and
well as the lactation. electrolytes
ascending  Assessed for
loop of edema
Henle; this  Observed for
results in signs and
the symptoms of
excretion hypokalemia.
of sodium,
chloride
and to a
lesser
degree,
potassium
 and
bicarbonate
ions.

DRUG CLASSIFICA DOSAGE ACTION INDICATIO CONTRAINDIC SIDE NURSING

NAME TION ROUTE and N ATION EFFECTS RESPONSIBITI
FREQUEN Y
CY
PTU or Antithyroid 50 mg q6 Propylthiour For treatment Hypersensitivity CNS:headache,  Instruct
propypl agent acil is used of patients to drowsiness,dizi patient to
thiourac to with Graves propylthiouracil ness take resting
il treat overact disease with or any of the pulse daily
ive thyroid hyperthyroidi product's GI:diarrhea, and
(hyperthyroi sm or toxic components nausea, encourage
dism). It multinodular vomiting patient to
works by goiter who are keep
stopping intolerant of Derm:rash,urti recorded
the thyroid methimazole caria chart.
gland from and for whom  Advise
making too surgery or patient to
much thyroi radioactive monitor
d hormone. iodine therapy weight at
is not an least 2 to 3
appropriate times.
treatment  Emphasize
regimen; to importance
ameliorate of
hyperthyroidi following
sm in
 preparation dietary
for subtotal restrictions
thyroidectom regarding
y or shellfish,
radioactive iodized
iodine therapy salt, and
in patients other foods
who are high in
intolerant of iodine.
methimazole.

DRUG CLASSIFICA DOSAGE ACTION INDICATIO CONTRAINDIC SIDE NURSING

NAME TION ROUTE and N ATION EFFECTS RESPONSIBITI
FREQUEN Y
CY
propano Antihypertensiv 10 mg tab Propranolol  Hypertensio Sinus Cold Take this drug with
lol e, antianginal, BID competitivel n alone or bradycardia, extremities, meals. Do not
antiarrhythmics y blocks β1- with other cardiogenic insomnia, discontinue the
and β2- drugs, shock, pulmonary fatigue, medication
receptors especially di oedema, severe dizziness, vivid abruptly; abrupt
resulting to uretics. hyperactive dreams, discontinuation can
decreased Angina airway disease, lassitude, cause a worsening
heart rate pectoris compensated nausea, constip of your disorder.
myocardial caused by cardiac failure, ation or
contractility, coronary Raynaud’s diarrhea, If you
BP and atherosclero disease, vomiting, have diabetes, the
myocardial sis. hypoglycaemia, anorexia, normal signs of
oxygen Prophylaxis severe stomach hypoglycaemia
demand. It for migraine haemorrhage, discomfort, (tachycardia) may
only headache. metabolic impotence. be blocked by this
possesses acidosis, severe Weakness, drug; monitor your
membrane- peripheral arterial paresthesia, blood or urine
stabilising disease, 2nd or wheezing, glucose carefully.
 properties. 3rd degree heart pharyngitis,
block. Pregnancy bronchospasm.
(2nd and 3rd
trimesters).

Drug data Dosage Indication Action Side effect Nursing Responsibilities

Generic 0.25 mg IV OD  Heart Increases the Tachycardia,  Assess cardiac function
Name: Digoxin failure. force of Headache,  Measure liquids precisely
Brand  Atrial myocardial Dizziness  Assess for signs of toxicity,
Name: Lanoxin fibrillation and contraction Mental especially in children and
Classification:  atrial flutter and Prolongs disturbances the elderly
Cardiac (slows refractory N&V, Diarrhea  Give IV slowly over 5
glycoside ventricular period of the Anorexia, minutes
rate). AV node. Blurred vision,  Note possible drug
 Paroxysma Decreases Death from interactions
l atrial conduction ventricular  Assess for hyperthyroidism
tachycardia. through the fibrillation or hypothyroidism
SA and AV Acute
 Obtain ECG
nodes. hemorrhage
 Monitor CBC, serum
Convulsions,
electrolytes, calcium, MG,
Visual
renal and liver function tests
disturbances
Angioneurotic  Obtain written heart rate
edema parameters for drug
administration as drug may
cause extreme bradycardia
 Do not administer if HR is
<50. Hold if HR is 90-110
bpm in children
 Monitor weight and I&O
 Use antacid if gastric
 distress occurs
 Use caution during
withdrawal
 Take after meals to lessen
gastric irritation
 Maintain a sodium-
restricted diet
Drug data Dosage Indication Action Side effect Nursing Responsibilities
Generic Name: 25 mg ½ tab Used alone or in Used to block the hypotension,  Monitor blood pressure and
Captopril BID combination of action of dizziness, dry pulse frequently.
Brand Names: other drugs for the angiotensin mouth, itching, sleep  Monitor weight and assesses
Capoten, management of converting problems, rashes, patient frequently for signs of
Acepril, Ace- hypertension. It is enzyme (ACE) diarrhea, fluid overload if with
Bloc, Bloc-Med, also used in which is naturally constipation, hair concurrent diuretic therapy.
Capomed, combination with produced in the loss, dry irritating  assessments of urine protein
Capotec, other drugs in the body. ACE cough, changes in may be ordered. Proteinuria and
Captogen, treatment of heart produces the way things taste, nephrotic syndrome may occur
Captor, Captril, failure after a heart angiotensin II upset stomach, with therapy.
Cardiovaz attack. Also used which causes abdominal pain,  Monitor BUN, Creatinine
Classification: A to treat kidney constriction and shortness of breath, and electrolyte levels
CE Inhibitor problems caused narrowing of the agranulocytosis, periodically.
by diabetic blood vessels neutropenia  WBC should be monitored
nephropathy. thereby prior to therapy and periodically
increasing blood thereafter.
pressure. By  May cause false positive
blocking ACE, result for urine acetone
production of
angiotensin II
decreases
allowing the
blood vessels to
relax and widen
resulting in
decrease blood
pressure.