Leptospirosis

- Group 3 -
BSN 3Y1-A-4
 Case Scenario
Diego, 54-year-old male came in due to body pains. 2 days PTA, patient had body malaise with associated bilateral lower
extremity pain, abdominal pain, epigastric burning 5/10 radiating to chest, continuous, undocumented fever, LBM of 10 episodes.
No other associated symptoms noted. Patient self- medicated with Ibuprofen, Loperamide, Paracetamol which provided no relief.
No consult done. During interim, progression of symptoms, now with difficulty in ambulation and DOB. this prompt consult and
hence admission.

PMHx:
- No comorbids noted. No COVID vaccine.
FMHx:
- (+) heart failure - maternal
- (+) CVD - paternal
- No other heredofamilial diseases noted
PSHx:
- 15 pack year smoker
- Alcoholic beverage drinker, 10 SD once a week for 30 years
- History of illicit drug use, last intake > 20 years ago
- Currently works as construction worker
- ROS: unremarkable
 Case Scenario
PE:
- Patient is awake, conscious, coherent, ambulatory, in cardiorespiratory distress
- BP: 120/60, 118 bpm. 48 cpm, 38.0, 90% o2 sat at room air.
- (+) conjunctival suffusion, pink palpebral conjunctivae, no nasoaural discharge, no cervicolymphadenopathies, no neck
vein distention
- Symmetric chest expansion, (+) macular rashes at anterior chest, no retractions, no lagging, clear breath sounds.
- Adynamic precordium, normal rate and regular rhythm, no murmurs appreciated
- Flat, normoactive bowel sounds, nontender abdomen
- Grossly normal extremities, no cyanosis, no edema, (+) tenderness on palpation of calf and thigh, (+) purpuric rash at
bilateral leg.

Laboratory:
1. CBC 2. Coagulation Factor 3. Clinical Chemistry 4. ABG
WBC: 11.47 PT: 14.8 BUN: 28.61 TB: 73.42 fully compensated
RBC: 4.44 % Act: 73.03 Crea: 646.37 B1: 76.07 metabolic acidosis
HGB: 121 INR: 1.15 BCR: 10.9 B2: 2.67 with adequate
HCT: 35.8 aPTT: 25.8 eGFR: 8mL/min/1.73m2 oxygenation
PLT: 16 CrCl: 13mL/min LDH: 311.47
CRP: 23.87
Neutrophils: 92.3 AST: 55.94 (1.39 x elev)
lymphocytes: 5.3 ALT: 28.64
Monocytes: 2.2
Eosinophils: 0.2
 Case Scenario
4. CXR: Bilateral mid to lower lung pneumonia: Cardiomegaly, Tortous Aorta

Diagnosis:
- Septic encephalopathy secondary to Leptospirosis, severe
- Acute kidney injury secondary to sepsis
- COVID suspect

Plans:
- Admit to PUI ICU
- IVF: PNSS 1L to run at 100 cc per hour
- Diet: NPO temporarily
- For transfusion of 8 units platelet concentrate
- Diagnostics:
- LeptoMAT
- HBSAg, Anti HCV
- Patient is anuric upon insertion of Foley catheter. Not responsive to hydration
- Plan for emergency IJ catheter insertion and hemodialysis
- Prescription: low flux
- Duration: 2 ½ hrs NSS flushing
- UF: 500 net D5050 1 vial on 2nd hour of hemodialysis
- BFR: 150
- DFR: 500
- HCO3 bath
 Case Scenario
Medication:
1. Penicillin G 1.5 million units TIV q6
2. Methylprednisolone 1gm in 250cc D5W to run for 4 hours OD for 3 days
3. Paracetamol 300mg TIV q4 RTC
4. Ranitidine 50mg TIV OD
Pathophysiology
 Pathophysiology
Modifiable:
Non Modifiable:
• Alcoholic beverage drinker,
10SD once a week for 30 Spiral bacteria that belong to Family History
years the genus Leptospira • (+) heart failure – maternal
• Currently works as
• (+) CVD - paternal
construction worker

Direct invasion of tissue

Signs and Symptoms: Diagnostic and Lab Test:

• Body malaise with associated √ CBC

bilateral lower extremity pain Vasculitis of capillaries
Low High
• Undocumented fever
• HGB: 121 • WBC: 11.47
• (+) conjunctival suffusion, pink
palpebral conjunctivae • HCT: 35.8 • Neutrophils: 92.3
KIDNEY LUNGS
• (+) macular rashes at anterior • PLT: 16
chest
• Lymphocytes: 5.3
• (+) purpuric rash at bilateral leg
• Monocytes: 2.2
 Leptospires Alveolar and
Vital Signs:
migrate to the Interstitial Diagnostic and Lab tests:
interstitium vascular damage
• BP: 120/60, PR: 118 bpm, • CXR: Bilateral mid to lower
RR: 48 cpm, Temp: 38.0, lung pneumonia =
interstitial
90% o2 sat at room air (mild Pulmonary Cardiomegaly Tortuous aorta
hypoxemia) nephritis and
Hemorrhage
tubular necrosis

decreased
Signs and Symptoms Capillary Signs and Symptoms:
glomerular
leakage
• Abdominal pain filtration rate • Cardiorespiratory distress
• Epigastric burning 5/10 radiating
to chest
Leptospirosis
Diagnostic and Lab tests:

Diag and Lab √ Coagulation Factors

LBM of 10 episodes
√ ABG · PT: 14.8

• Fully compensated metabolic · % Act: 73.03

acidosis with adequate oxygenation
· INR: 1.15
 aPTT: 25.8

√ Clinical Chemistry

BUN: 28.61 (high)

Crea: 646.37 (high)

BCR: 10.9

eGFR: 8 mL/min/1.73m2 (low)

CrCl: 13 mL/min (low)

AST: 55.94 (1.39x elev) (high)

TB: 73.42 (high)

B1: 76.07 (high)

B2: 2.67

LDH: 311.47 (high)

CRP: 23.87 (high)

 Diagnostic &
Laboratory Test
 Diagnostic and Laboratory Test
Clinical Chemistry

● Clinical chemistry refers to the biochemical analysis of body fluids. It uses chemical reactions to determine the levels
of various chemical compounds in bodily fluids. Several simple chemical tests are used to detect and quantify different
compounds in blood and urine, the most commonly tested specimens in clinical chemistry. Because the bacteria
targets the liver and kidney, these tests are done to check for the functions of these organs. According to the Center for
Disease Control and Prevention (n.d.) Leptospirosis can lead to kidney damage, meningitis (inflammation of the
membrane around the brain and spinal cord), liver failure, respiratory distress, and even death.

● Since the bacteria targets the liver and kidney, these tests are done to check for the functions of these organs.
According to the Center for Disease Control and Prevention (n.d.) Leptospirosis can lead to kidney damage, meningitis
(inflammation of the membrane around the brain and spinal cord), liver failure, respiratory distress, and even death.

How is it done?

● A member of your health care team takes a sample of blood by inserting a needle into a vein in your arm. The blood
sample is sent to a lab for analysis. You can return to your usual activities immediately. (MayoClinic, n.d.).
 Diagnostic and Laboratory Test
Liver function tests:

● Liver Functions Tests (hepatic panel) are groups of blood tests that provide information about the state of a
patient's liver. It shows an elevation in aminotransferases, bilirubin and alkaline phosphatase, hyperbilirubinemia is
out of proportion to jaundice in cases of icteric leptospirosis.

● Alanine transaminase (ALT) 55.94 (1.39x elev) ELEVATED

is an enzyme found in the liver that helps convert proteins into energy for the liver cells. When the liver is damaged,
ALT is released into the bloodstream and levels increase.

Indication in the case: ALT levels should be monitored in our patient since it is elevated and may lead to liver
damage caused by the bacteria.

● Aspartate transaminase (AST) 28.64 NORMAL

is an enzyme that helps metabolize amino acids. Like ALT, AST is normally present in blood at low levels. An increase
in AST levels may indicate liver damage, disease or muscle damage.

Indication in the case: AST Levels were monitored in the patient to check if there are any underlying condition in the
liver,
 Diagnostic and Laboratory Test
● Bilirubin 73.42 ELEVATED

is a substance produced during the normal breakdown of red blood cells. Bilirubin passes through the
liver and is excreted in stool. Elevated levels of bilirubin (jaundice) might indicate liver damage or
disease or certain types of anemia.

B1 (INDIRECT BILIRUBIN) 78.07 ELEVATED

B2 (DIRECT BILIRUBIN) 2.67 ELEVATED

Indication in the case: Since our patient’s bilirubin is elevated it its ordered to check because
elevated bilirubin indicates liver damage.

● L-lactate dehydrogenase (LD) 311.47 ELEVATED

is an enzyme found in the liver. Elevated levels may indicate liver damage but can be elevated in many
other disorders.

Indication in case: LDH Levels are monitored are monitored in our patient because it is elevated this
may indicate tissue damage that may lead to liver disease
 Diagnostic and Laboratory Test

● C-Reactive Protein 23.87 ELEVATED

is a protein made by your liver. It's sent into your bloodstream in response to inflammation. Inflammation is
your body's way of protecting your tissues if you've been injured or have an infection.

Indication in the case: CRP were ordered to check inflammation caused by bacterial infection such as
infection in our patient.

Normal Values:
AST: 8 to 48 U/L
ALT: 7 to 55 units per liter (U/L)
TB: 0.3 to 1.2 mg/dL or 1.71 to 20.5 µmol/L
B1: about 0.2 to 1.2 mg/dL or 3.4-12.0 μmol/L
B2: >0.3 mg/dL or 1.7-5.1 μmol/L
LDH: 140 units per liter (U/L) to 280 U/L
CPR: Less than 10 mg/L
 Diagnostic and Laboratory Test

Renal function test:

● Renal Functions Tests is a blood test that usually measures the level of urea, creatinine, and certain
dissolved salts (electrolytes) in your blood.

● Blood Urea Nitrogen (BUN). 28.61 ELEVATED

Urea principal nitrogenous waste product of metabolism and is generated from protein breakdown. This
is excreted through urine.

Indication in the case: BUN levels of our patient are elevated indicating that kidney disease is present.

● Creatinine 646.37 ELEVATED

is a chemical waste product in the blood that passes through the kidneys to be filtered and eliminated in
urine. The chemical waste is a by-product of normal muscle function.

Indication in the case: Creatinine levels were monitored in our patient to check if the kidney is working
properly. Elevated creatinine level indicating that the kidney is damaged.
 Diagnostic and Laboratory Test
● Blood urea nitrogen/creatinine ratio. 10.9 NORMAL

The normal range for BUN/Creatinine ratio is anywhere between 5 – 20 mg/dL. BUN/Creatinine ratio
increases with age, and with decreasing muscle mass

Indication in the case: This was ordered to evaluate kidney function of our patient

● Estimated Glomerular Filtration Rate(eGFR). 8 ML/MIN/1.73M2 DECREASED

Your kidneys filter your blood by removing waste and extra water to make urine. The kidney's filtration rate,
called the glomerular filtration rate (GFR), shows how well the kidneys are filtering.

Indication in the case: eGFR is monitored in our patient to measure how well the kidney of our patient can
filter blood. SInce the eGFR is decreased this may indicate that patient chronic kidney disease progresses.

● Creatinine Clearance Test. 13 ML/MIN

This test allows your healthcare provider to look at samples of your urine and blood to see how much
creatinine is filtered out by your kidneys. Abnormal levels of creatinine in your urine and blood could point to
an issue like kidney disease.

Indication in the case: This is ordered to check if there are progression in renal disease.
 Diagnostic and Laboratory Test

Normal Values:

BUN: 6-24 mg/dl

CREA: 61.9 to 114.9 µmol/L or 20 – 320 mg/dL

BCR: between 5 – 20 mg/dl

eGFR: 100 to 130 mL/min/1.73m2

CrCl: 110 to 150 mL/min

 Diagnostic and Laboratory Test
Complete blood count:

● A complete blood count (CBC) is a blood test used to evaluate your overall health and detect a wide
range of disorders, including anemia, infection and leukemia (Mayo Clinic Staff, 2021).

● WBC 11. 47 ELEVATED

Normal values: 5,000-10,000/uL

Indication in the case: Elevated wbc indicating that immune system is working to fight infection

● RBC 4.44 DECREASED

Normal Values: 4.6-6.1 million/uL

Indication in the case: Since the rbc levels of the our patient is decreased this could indicate anemia

● Hemoglobin: 121 DECREASED

Normal values: 132-166 g/L

Indication in the case: Decreased hemoglobin can also indicate anemia

 Diagnostic and Laboratory Test

● Hematocrit: 35.8% DECREASED

Normal values: 42%-52%

Indication in the case: Since decreased hemoglobin was shown in our patient this indicates that there
are too few red blood cells in the body of our patient.

● Platelet 16 DECREASED

Normal Range: 150-400

Indication the case: Result of platelet leves of our patient are decreased indicating that the body is
having trouble forming blood clots.

● Neutrophils: 92.3 ELEVATED

Normal range:55%-77%

Indication in the case: Our patient neutrophils were increased meaning that the infection occurred
 Diagnostic and Laboratory Test

● Lymphocytes: 5.3 Decreased

Normal values: 20%-40%

Indication in the case: This was monitored since it was decreased indicating an infection in our patient
caused by bacteria.

● Monocytes: 2.2 Normal

Normal values: 2%-8%

Indication in the case: Monocytes level of our patent is normal meaning the body of our patient is
fighting infection

● Eosinophils: 0.2 Decreased

Normal range: 1%-4%

Indication in the case: Eosinophils levels were decreased indicating infection and kidney intoxication.
 Diagnostic and Laboratory Test

How is CBC done?

During a CBC, a lab technician will draw blood from a vein, typically from the inside of your elbow or
from the back of your hand. The test will take only a few minutes.

The technician:

1. Cleans your skin with an antiseptic wipe

2. Places an elastic band, or tourniquet, around your upper arm to help the vein swell with blood

3. Inserts a needle in your and collects a blood sample in one or more vials

4. Removes the elastic band

5. Covers the area with a bandage to stop any bleeding

6. Label your sample and send it to a lab for analysis

 Diagnostic and Laboratory Test

Coagulation factors:

● Coagulation tests measure your blood’s ability to clot, and how long it takes to clot. Testing
can help your doctor assess your risk of excessive bleeding or developing clots (thrombosis)
somewhere in your blood vessels (Pietrangelo, 2018).

● Specimen: Plasma

● PT: 14.8 ELEVATED

Normal Values: 11.1-14.3 seconds

Indication in the case: Elevated PT means, it takes longer for the blood to clot This usually
happens because the liver is not making the right amount of blood clotting proteins, so the
clotting process takes longer. A high PT usually means that there is serious liver damage.

● %Act: 73.03 Normal

Normal value: 70-120

Indication in the case: Normal value indicating that the blood tested contains no heparin.
 Diagnostic and Laboratory Test
● INR: 1.15 ELEVATED

Normal range: 0.8-1.1

Indication in the case: Elevated inr meaning that forming blood clots are slow

● aPPT: 25.8 sec DECREASED

Normal Range: 30-40 secs

Indication in the case: our patient aPPT were decreased meaning that there may be a coagulation
factor deficiency or a specific or nonspecific inhibitor affecting the body's clotting ability.

The higher the PT or INR, the longer the blood takes to clot. An elevated PT or INR means the blood is
taking longer to clot.. When PT or INR is too high, there is an increased risk of bleeding.
 Diagnostic and Laboratory Test

Chest X-ray

Chest x-ray uses a very small dose of ionizing radiation to produce pictures
of the inside of the chest. It is used to evaluate the lungs, heart and chest
wall and may be used to help diagnose shortness of breath, persistent
cough, fever, chest pain or injury.

Result: Bilateral mid to lower lung pneumonia: Cardiomegaly;

Tortuous Aorta

Indication: To check for pulmonary and cardiac abnormalities

 Diagnostic and Laboratory Test

Arterial Blood Gas:

● An arterial blood gasses (ABG) test measures the acidity (pH) and the levels of
oxygen and carbon dioxide in the blood from an artery. This test is used to find out
how well your lungs are able to move oxygen into the blood and remove carbon
dioxide from the blood (Healthwise, 2020).
● Indication in the case: ABG is done to determine how the patient’s condition
(bacterial infection) affects him, specifically this determines how well the lungs and
kidneys are working.
● Patient’s ABG Result: Fully compensated metabolic acidosis with adequate
oxygenation due to accumulation of acid in the body as the patient’s condition has
led to acute kidney injury.
Priority Nursing
Care Plan
 Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective data: Impaired gas SHORT TERM GOAL: INDEPENDENT INDEPENDENT SHORT TERM GOAL:
-None exchange related to Within 30 mins to 1 Within 30 mins to 1
Objective data: alveolar-capillary hour of nursing Note respiratory Promotes optimal hour of nursing
-Difficulty in membrane changes intervention the rate, depth, use of chest expansion intervention the
ambulation as evidenced by client will be able accessory muscles, and client was able to
-Difficulty of difficulty of to demonstrate pursed lip drainage of demonstrate
breathing breathing, O2 improved breathing; areas of secretions improved
-RR: 46 cpm saturation of 90%, ventilation and pallor/cyanosis. ventilation and
-90% o2 and respiratory rate adequate adequate
saturation at of 46 cpm. oxygenation of Elevate head of To maintain proper oxygenation of
room air tissues within bed and position airway tissues within
-CXR: Bilateral mid client’s usual client appropriate usual parameters
to lower lung parameters and and absence of
pneumonia: absence of Monitor vital signs To have baseline symptoms of
symptoms of and for detection respiratory distress
respiratory distress on the progress of as evidenced by
as evidenced by the client's
condition
absence of Auscultate breath to distinguish absence of
difficulty of sounds, note areas normal respiratory difficulty of
breathing, O2 of decreased/ sounds from breathing, O2
saturation of 95%, adventitious abnormal saturation of 95%,
and respiratory breath sounds as . and respiratory
rate of 20 cpm. well as fremitus. rate of 20 cpm.
Goal was met.
LONG TERM GOAL: Instruct in the use To promote
relaxation and wellness LONG TERM GOAL:
Within the hospital stress- reduction Within the hospital
stay, the patient techniques, as stay, the patient
will be able to: appropriate was able to show
-Show no signs of no signs of
impaired gas Encourage This promotes impaired gas
exchange. deep-breathing optimal chest exchange and
-Verbalize and coughing expansion, verbalize
understanding of exercises. mobilization of understanding of
causative factors secretions, and causative factors
and appropriate oxygen diffusion. and appropriate
interventions. interventions.
DEPENDENT DEPENDENT

Encourage or assist Ambulation

with ambulation as facilitates lung
per the physician’s expansion, secretion
order. clearance and
stimulates deep
breathing.

Provide supplemental To improve existing

oxygen at lowest deficiencies
concentration
indicated by
laboratory results
and client symptoms
or situation
Administer Pharmacological
medication as agents are varied,
prescribed by the specific to the client,
physician but generally used to
prevent and control
symptoms, reduce
frequency and
severity of
exacerbations, and
improve exercise
tolerance.

COLLABORATIVE COLLABORATIVE

Report the case to For the community to

the community where be aware and make
the patient acquired ways to prevent
the disease. acquiring the
disease.

Refer to respiratory To assist respiratory

therapist problem
Potential Nursing
Care Plan
 Assessment Diagnosis Planning Intervention Rationale Evaluation

OBJECTIVE; Risk for shock Short Term: Independent: Short Term:

related to infection
-the patient After 1 hr. of nursing Assess vital signs, To look for changes After 1 hr. of nursing
diagnosis is severe intervention, the tissue and organ in associated with intervention, the
septic patient will be able perfusion. shock states. patient was able to:
encephalopathy to:
-reduce body
secondary to
-reduce body temperature (from
leptospirosis Provide client care To reduce incidence
temperature (from 38 to 37.3°C)
with infection or progression of
-Patient is anuric 38 to 37.3°C)
prevention infection. -participate in
upon insertion of
-participate in interventions, such interventions to
Foley Catheter and
interventions to as diligent attention reduce risk for
not responsive to
reduce risk for to hand hygiene, shock.
hydration.
shock aseptic wound care
or dressing
Long Term:
changes, isolation GOAL MET
Within the hospital
stay, the patient.
 Assessment Diagnosis Planning Intervention Rationale Evaluation

-Upon physical will be able to: precautions, early Long Term:

examination the intervention in
-free from risk of Within the hospital
patient have; potential
shock as evidenced stay, the patient
infectious
-BP: 120/60 by adequate was able to:
condition
perfusion, stable
-HR: 118 bpm. -free from risk of
vital signs and
To allow shock as evidenced
-RR: 48 cpm. appropriate
Provide a tepid evaporative by adequate
urinary output.
-Temp: 38.0°C bath or sponge cooling because perfusion, stable
bath. increase body vital signs and
temperature is a appropriate
sign of infection urinary output.
that may cause
GOAL MET
shock.
Assessment Diagnosis Planning Intervention Rationale Evaluation

Elevate the head of Head elevation

the bed helps improve the
expansion of the
lungs, enabling the
patient to breath
more effectively

Overexertion
Maintain bed rest reduces myocardial
and assist with workload and
care activities. oxygen usage,
maximizing tissue
perfusion efficacy.
Assessment Diagnosis Planning Intervention Rationale Evaluation

Dependent:

Administer fluids To rapidly restore

and blood or sustain
products as circulating volume
prescribed. and prevent shock
state.
- PNSS 1l to run at
100 cc per hour

- 8 units platelet
concentrate

Administer:
To treat underlying
-Penicillin G 1.5
bacterial infection.
million units TIV q6
To reduce body
-Paracetamol
temperature
300mg TIV q4 RTC
Assessment Diagnosis Planning Intervention Rationale Evaluation

Collaborative:

Collaborate in To maximize
prompt treatment systemic
of underlying circulation and
conditions such as tissue and organ
heart disease, perfusion.
infections, and
prepare for/assist
with medical and
surgical
interventions.
Drug Study
 Mechanism of Nursing
Drug Indication Contraindication Side Effect
Action Consideration

Generic name; Penicillin G exerts Penicillin G are There are no There are no side - Obtain history
Penicillin G a bactericidal considered as first contraindications effects given in the taking about
action against line therapy for given in the scenario. allergies in
Brand name; Not penicillin- treatment of scenario antibiotics and
given in the susceptible leptospirosis. skin test
scenario microorganisms Intravenous
during the stage of antibiotics may be - Monitor signs of
Classification of active required for allergic reactions
drugs; beta-lactam multiplication. It persons with more and anaphylaxis,
antibiotic acts through the severe symptoms. including
inhibition of pulmonary
Dosage; 1.5 million biosynthesis of symptoms or skin
units cell-wall reactions.Notify
peptidoglycan, physician or
frequency; q6 rendering the cell nursing staff
(every 6 hrs) wall osmotically immediately if
unstable. these reactions
Route; TIV occur.
 Mechanism of Nursing
Drug Indication Contraindication Side Effect
Action Consideration

- Monitor injection site

for pain, swelling, and
irritation. Report
prolonged or excessive
injection site reactions
to the physician.

- If an allergic reaction
occurs, penicillin should
be discontinued and
appropriate therapy
instituted. Serious
anaphylactic reactions
require emergency
treatment with
epinephrine and airway
management
 Mechanism of Nursing
Drug Indication Contraindication Side Effect
Action Consideration

Generic name; It acts in various It is beneficial in There are no There are no side - Avoid exposure to
Methylprednisolone ways to decrease severe disease contraindications effects given in the infections. Report
the inflammatory and/or cases with given in the scenario. unusual weight gain,
Brand name; Not cycle including: pulmonary scenario swelling of the
given in the scenario dampening the involvement in extremities, muscle
inflammatory leptospirosis and is weakness, black or
Classification of cytokine cascade, given within the tarry stools, fever,
drugs; inhibiting the first 12 hours of prolonged sore throat,
glucocorticoids activation of T onset of respiratory colds or other
cells, decreasing involvement. infections, worsening
Dosage; 1gm the extravasation primarily of disorder.
of immune cells prescribed for its
frequency; run for 4 into the central anti-inflammatory - WARNING: Taper
hours OD for 3 days nervous system, doses when
facilitating the discontinuing
Route; Not given in apoptosis of high-dose or
the scenario activated immune long-term therapy o
cells, and allow adrenal
recovery
 Mechanism of Nursing
Drug Indication Contraindication Side Effect
Action Consideration

indirectly - WARNING: Do not

decreasing the give live virus
cytotoxic effects of vaccines with
nitric oxide and immunosuppressive
tumor necrosis doses of
factor alpha. corticosteroids

- Do NOT use
methylprednisolone
acetate for IV

- Monitor for
potassium depletion
(fatigue, nausea,
vomiting,
depression,
polyuria,
dysrhythmia and
weakness).
 Mechanism of Nursing
Drug Indication Contraindication Side Effect
Action Consideration

Generic name; Analgesics: Temporary relief of There are no There are no side -Assess onset, type
Paracetamol activates mild to moderate contraindications effects given in ,location,duration of
descending pain,headache, given in the the scenario. pain
Brand name; Not serotonergic fever IV: scenario
given in the inhibitory pathways management of -monitor for clinical
scenario in CNS moderate to severe improvement and
pain when relief of pain
Classification of Antipyretic: combined with
drugs: Central Inhibits opioid analgesics -do not exceed
analgesics hypothalamic heat maximum daily
regulating center Rationale: the recommended dose
Dosage; 300mg patient experience
bilateral lower Monitor IV injection
frequency; Q4 RTC extremity site for pain , swelling
pain,abdominal and irritation if there
Route; TIV pain, and 38.0 is. Report prolonged or
degree celsius . excessive injections
Therefore this site reactions to the
medication is used physician
 Mechanism of Nursing
Drug Indication Contraindication Side Effect
Action Consideration

to address or -Advise patient,

lessen mild to parents, or other
moderate pain as caregivers to
well as decrease contact prescriber
the fever of the if fever or other
patient symptoms persist
despite taking
recommended
amount of drug.

-advise patient to
avoid alcohol
consumption
 Mechanism of Nursing
Drug Indication Contraindication Side Effect
Action Consideration

Generic name; Inhibits histamin Indication of There are no There are no side Do history taking
Ranitidine action at histamine ranitidine include contraindications effects given in prior to medication
H@-receptors of the use in the short given in the the scenario. tp avoid
Brand name; Not gastric parietal term treatment of scenario hypersensitivity to
given in the cells active duodenal drug interaction
scenario ulcer/ prevention
Reduces gastric of duodenal ulcer
Classification of acid secretion and recurrence -Assess mental
drugs; Histamine-2 increases gastric status of patient
Antagonist mucus and Rationale: The
bicarbonate patient experiences Monitor IV injection
Dosage; 50mg abdominal pain site for pain ,
and epigastric swelling and
frequency; OD burning 5/10 irritation if there is.
(once a day) radiating to chest Report prolonged or
.therefore , this excessive injections
Route; TIV medication will site reactions to the
physician
 Mechanism of Nursing
Drug Indication Contraindication Side Effect
Action Consideration

help to inhibits the -Question

gastric acid presence of
secretion and will abdominal or GI
lessen or address distress For
the epigastric patient/family
burning and
abdominal pain of
the patient -Report if there's
presence of
headache

--Advice that
smoking and taking
alcohol decreases
effectiveness of
medication
 Thank You
Lorenzo, Ma. Cheryll
Macarubbo, Princess Alliah
Maribojoc, Loinel John aaron
Masim, John Bryan
Mirabel, Angelica
Miranda, Angel Kate
Moreno, Gertrude
Oliveros, John Dexter
Pante, Ma. Carmella