CaseStudy ICU Lim Romias Sison

University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES
BACHELOR OF SCIENCE IN NURSING – LEVEL IV
CASE STUDY ON
CEREBROVASCULAR
ACCIDENT INFARCT
Presented by:
RLE Group A – BSN IV
Ayuyang, Aldwin
Betana, Kristel Diane
Castillo, Rhea Juren
Lim, Cielo Rose
Romias, Jhoanna Mae
Sison, Melanie
Soliven, I-den Noriel
INTRODUCTION
Cerebrovascular Disease Infarct
Definition
The word cerebrovascular is made up of two parts – "cerebro" which refers to the large
part of the brain, and "vascular" which means arteries and veins. Together, the word
cerebrovascular refers to blood flow in the brain. The term cerebrovascular disease includes all
disorders in which an area of the brain is temporarily or permanently affected by ischemia or
bleeding and one or more of the cerebral blood vessels are involved in the pathological process.
Cerebrovascular disease includes stroke, carotid stenosis, vertebral stenosis and intracranial
stenosis, aneurysms, and vascular malformations.
Cerebrovascular accident (CVA) is the medical term for a stroke. A stroke is when blood
flow to a part of the brain is stopped either by a blockage or the rupture of a blood vessel. When
that happens, part of the brain cannot get the blood and oxygen it needs, so the brain cells die.
The brain is an extremely complex organ that controls various body functions. If a stroke
occurs and blood flow can't reach the region that controls a particular body function, that part of
the body won't work as it should.
NOTE: Underlined statements were present to the patient.

Risk Factors
 High blood pressure. Blood pressure of 140/90 or higher can damage blood vessels
(arteries) that supply blood to the brain.
 Heart disease. Heart disease is the second most important risk factor for stroke, and the
major cause of death among survivors of stroke. Heart disease and stroke have many of
the same risk factors.
 High blood cholesterol and lipids. High cholesterol levels can contribute to thickening
or hardening of the arteries (atherosclerosis) caused by a buildup of plaque. Plaque is
deposits of fatty substances, cholesterol, and calcium. Plaque buildup on the inside of the
artery walls can decrease the amount of blood flow to the brain. A stroke occurs if the
blood supply is cut off to the brain.
 Physical Inactivity
 Being overweight or obese
 Abnormal heart rhythm. Some types of heart disease can raise your risk for stroke.
Having an irregular heartbeat (atrial fibrillation) is the most powerful and treatable heart
risk factor of stroke.
Risk factors for stroke that can’t be changed:
 Older age. For each decade of life after age 55, the chance of having a stroke more than
doubles.
 Gender. Stroke occurs more often in men, but more women than men die from stroke.
 Heredity or genetics. The chance of stroke is greater in people with a family history of
stroke.
Statistics
From 2009 to 2019, stroke remains the second leading cause of death and one of the top
five leading causes of disability in the Philippines (Philippine Statistics Authority). The true stroke
prevalence is uncertain, but reported estimates vary between 0.9% (2005) to 2.6% (2017) of the
population. Based on types of stroke, seven out of 10 cases are diagnosed as ischaemic while the
other three are considered hemorrhagic
The incidence of stroke in Filipinos was higher compared to European studies.
Hypertension is the most common risk factor in the world followed by diabetes mellitus and
dyslipidemia. In Filipinos however, cultural vices such as smoking and alcoholism were the second
and third leading risk factors..
Types of Stroke
There are two main types of cerebrovascular accident, or stroke: an ischemic stroke is caused by a
blockage; a hemorrhagic stroke is caused by the rupture of a blood vessel. Both types of stroke
deprive part of the brain of blood and oxygen, causing brain cells to die.
Ischemic Stroke
Infarction or Ischaemic stroke are both names for a stroke caused by a blockage in a blood
vessel in the brain and prevents blood and oxygen from getting to a part of the brain. This is the
most common type of stroke.
There are two ways that this can happen. One way is an embolic stroke, which occurs when
a clot forms somewhere else in the body and gets lodged in a blood vessel in the brain. The other
way is a thrombotic stroke, which occurs when the clot forms in a blood vessel within the brain.
Hemorrhagic Stroke
A hemorrhagic stroke occurs when a blood vessel ruptures, or hemorrhages, and then
prevents blood from getting to part of the brain. The hemorrhage may occur in any blood vessel in
the brain, or it may occur in the membrane surrounding the brain.
Signs and Symptoms

Warning signs of stroke may include a combination of the following symptoms:
 Sudden numbness or weakness of the face, arm or leg, particularly when it
happens on one side of the body
 Confusion, trouble speaking or understanding others
 Vision problems in one or both eyes, such as dimness, blurring, double vision, or loss of
vision
 Loss of balance or coordination, dizziness, and trouble walking
 Severe headache with no known cause
Recognize these signs of stroke and act FAST!
 FACE: Ask the person to smile. Does one side of the face droop?
 ARMS: Ask the person to raise both arms. Does one arm drift downward?
 SPEECH: Ask the person to repeat a simple phrase. Is it slurred or strange?
 TIME: is critical! If you see any of these signs, call 9-1-1 immediately.
Diagnosis
● Doppler sonography (carotid ultrasound). A test that uses sound waves to create
pictures of the inside of the carotid arteries. This test can show if plaque has narrowed or
blocked the carotid arteries.
● Cerebral Computed Tomography (CT) Scan. The first and most important test after a
stroke is a CT scan, which is a series of X-rays of the brain that can help identify whether
there is bleeding or blockage. This test will help determine whether the stroke is ischemic
or hemorrhagic.
● Electrocardiogram (ECG). This test records the heart’s electrical activity. It shows any
irregular heart rhythms that may have caused a stroke.
Treatment
Treatment is most effective when started right away. Emergency treatment after a stroke may
include:
 Clot-busting medicines (thrombolytics or fibrinolytics). These medicines dissolve the

blood clots that cause an ischemic stroke. They can help reduce the damage to brain cells
caused by the stroke. To be most effective, they must be given within 3 hours of a stroke
occurring.
 Tissue plasminogen activator (tPA), also called alteplase, is a medication made
of a protein that can dissolve blood clots. This so-called “clot-buster” is a life-
saving treatment for stroke and heart attack.
 Antiplatelets, such as Aspirin and Clopidogrel, are prescribed for many stroke patients.
They make blood clots less likely to form.
 Blood-pressure medicines such as Furosemide, Nicardipine, and Clonidine help lower
high blood pressure. High blood pressure damages arteries throughout the body, creating
conditions in which they can burst or clog more easily.
 Cholesterol-lowering drugs such as Atorvastatin make plaque less likely to build up in
the artery walls, which can reduce the risk for stroke.
 Heart medicines such as Isosorbide Dinitrate can treat certain heart problems that
increase the risk of stroke.
PATIENT’S PROFILE
Name: Patient J.D

Age: 55
Gender: M
Birth Date: January 19, 1967
Place of Birth: Tabuk, Kalinga
Address: Tabuk, Kalinga
Occupation: Government Employee
Marital Status: Married
Weight: 69 kg
Height: 168 cm
BMI: 25.3 (Overweight)
Nationality: Filipino
Language/s Used: Ilocano, Tagalog
Religion: Roman Catholic
Admission Date: July 7, 2022, 3:37 PM
Trans-in Date: July 10, 2022, 11:30 AM
Chief Complaint: Slurred speech, Body weakness
Admitting Diagnosis: CVD Infarct
Final Diagnosis: Hypothyroidism secondary to Radioactive Iodine (RAI), CKD secondary to
Hypertensive Nephrosclerosis, Acute Myocardial Infarction, Coronary Artery Disease
Attending Physician: Dr. M. Sibbaluca
Referrals: Dr. R. Gonzales, Dr. W. Manuela, Dr. Cureg
Date Handled: July 11 - 13, 2022
Admitting Vital Signs (July 7, 2022):
BP: 210/110 mmHg
PR: 78 bpm
RR: 22 bpm
Temp: 36.9 C
O2 Sat: 98%
Final Vital Signs (July 13, 2022):
BP: 120/80 mmHg
PR: 71 bpm
RR: 19 bpm
Temp: 37.4 C
O2 Sat: 97%
HISTORY OF PAST ILLNESS

Childhood Illness
Patient J.D has not experienced any childhood illness according to his wife.
Immunization
According to his wife and son, they were unsure whether Patient J.D has received complete
immunization as a child. But he has received his 1st and 2nd dose of COVID-19 vaccine.
Accidents and Operations
Patient J.D was never involved in any accidents and has never undergone any operation.
Hospitalizations
Patient J.D was hospitalized 5 years ago due to suspected hyperthyroidism and was
admitted for 5 days at Southern Isabela Medical Center, Santiago City. He experienced symptoms
such as fatigue and body weakness He then underwent thyroid scan at University of Santo Tomas
Hospital, where it was confirmed that he had hyperthyroidism. He was treated with radioactive
iodine (RAI) therapy at Veterans Memorial Medical Center, Quezon City. He was also diagnosed
with hypertension alongside his hyperthyroidism.
After the treatment he received at VMMC, he had his regular check-up at Divine Mercy
Wellness Center where he was prescribed Atenolol 50 mg OD for his hypertension and
Levothyroxine 50 mg OD by Dr. Cureg. He continued to receive his regular check-up until all his
blood tests became normal, then he stopped going for regular check-ups at DMWC according to
his son and wife.
Allergy
He does not have any food or medication allergies according to his wife and son.
Medications
Patient J.D takes Atenolol 50 mg OD and Levothyroxine 50 mg OD as a maintenance drug
prescribed by Dr. Cureg, and takes Vitamin B-Complex. Whenever he experiences common
illnesses such as fever, cough and colds, he would take OTC drugs for children such as Tempra
and Ascof Lagundi Leaf, because according to his son, his father told him that adult OTC drugs
are not effective for him. He also takes the herbal medicine Sante Barley, which is recommended
by some of their relatives.
Illnesses
Patient J.D was complaining of abdominal pain at the epigastric area and joint pains which
has occurred regularly for the past two months. According to his son, the patient has consulted a
doctor friend who told him that it might be gout.
HISTORY OF PRESENT ILLNESS
Few hours prior to his admission on July 4, 2022 at San Juan General Hospital, Kalinga he
experienced a sudden onset of slurring of speech, dizziness, and body weakness while at work at
around 8:00 AM, which prompted him to go to the hospital. Upon admission at the said hospital,
his blood pressure was 200/110 mmHg. Antihypertensive medications and stroke management
was immediately done. The medications given during his entire hospital stay at San Juan General
Hospital was Mannitol 100cc IV every 4 hours, Nicardipine drip at 15 ugtts/min, Citicholine 1g
IV every 8 hours, Furosemide 20mg IV every 8 hours, Rosuvastatin 10 mg OD, Irbesartan 150mg
BID, Amlodipine 10mg OD, Aspirin 80 mg OD and Ranitidine 50 mg IV every 8 hours.
He was diagnosed with Cerebrovascular Accident, Infarct; Hypertensive Cardiovascular
Disease. During the patient’s hospital stay, his slurring of speech and body weakness progressed.
He was then referred to DMWC on July 7, 2022 due to lack of neurologist as stated by the patient’s
son.
FAMILY HISTORY
GORDON’S FUNCTIONAL HEALTH PATTERN
Health Pattern Before Hospitalization During Hospitalization
Health Perception/ Patient J.D’s wife described him as According to Patient J.D’s wife
Health Management a health conscious person. “Naging and son, he is currently unable to
Pattern maingat na yan simula nung manage himself therefore they
nagkasakit siya noon. Di na yan rely on the doctors and nurses to
masyado sa matataba pati maalat help him recover from his
na pagkain'' as verbalized by his current condition.
wife. The most important thing that
he does to be healthy is avoiding
fatty and salty foods. He also takes
Sante Barley, a herbal medicine.
“Nirecommend yan ng mga
kamag-anak namin kasi
antioxidant daw.” as verbalized by
his son. Whenever he experiences
common illnesses such as fever,
cough and colds, he would take
OTC drugs for children such as
Tempra an Ascof Lagundi Leaf,
because according to his son, his
father told him that adult OTC
drugs are not effective for him. He
is taking maintenance medications
which are Atenolol 50 mg OD for
his hypertension and
Levothyroxine 50 mg OD.
However when the patient’s SO
are asked whether he takes his
maintenance drugs regularly, they
verbalized “Ay di namin sure, kasi
di naman namin siya
nababantayan.” Patient J.D does
not smoke or drink alcohol. He
used to have regular check-ups at
Divine Mercy Wellness Center but
stopped when all his blood
laboratories and blood pressure are
within normal range.
“Nagpapacheck-up yan noon dito
sa Divine, kay Dr. Cureg, pero
nung naging normal na kasi yung

blood works niya pati na rin BP
tumigil na siya sa pagpunta.”
Nutritional - The patient has no allergies to Upon admission on July 7, 2022,

Metabolic Pattern foods and eats 3 times a day, with Patient J.D was placed on a low
snacks in between. His usual diet salt, low fat, soft diet with strict
consists of fish and vegetables with aspiration precaution (SAP).
1 - 2 cups of rice. He avoids fatty However on July 11, 2022, his
and salty foods. He has a good family noticed that he was
appetite and does not have any having difficulty swallowing
difficulty in chewing or and it was confirmed by the
swallowing. He consumes nurses which they referred to his
approximately 3 - 4 liters of water attending physician. Hence an
every day and does not drink NGT was ordered and inserted.
coffee. “Pati kape iniiwasan na He is on osterized feeding of
niyan simula nung nagkasakit siya 1800 kcal/day in 6 equal
noon.” He takes Vitamin-B feedings.
Complex and Sante Barley, a
herbal medicine.
July 7, 2022
Weight: 69 kg
Height: 168 cm
BMI: 25.3 (Overweight)
Elimination Pattern When asked about Patient J.D’s Patient J.D usually uses about 5
voiding pattern, his wife stated diapers a day. He defecated only
that, “Di lang namin alam kung once from July 11 - 13, 2022
ilang beses kasi di naman naming with a soft yellowish stool
nakikita”. He defecates 1 - 2 times possibly due to the lactulose that
a day. He does not have any was administered. His urine
difficulty or discomfort in voiding output on July 11 was 2,950,
or defecating/ 2200 mL on July 12, 2022, and
4000 mL on July 13, 2022.
Activity - Exercise Patient J.D’s work routine during Patient J.D is confined to his bed
Pattern weekdays usually consists of paper as he is experiencing weakness
work so he is mainly confined to on the right side of his body. He
his desk during his entire work needs the assistance of his
hours. On weekends he cleans family and nurses in performing
around the house, takes care of his his ADLs such as eating,
poultry every morning and sweeps voiding, eliminating, and

the dried leaves in their backyard. bathing. His limbs movement
He considers this as his form of grade as of July 13, 2022 is as
exercise. “Mahilig maglinis si follows:
papa, tsaka yung mga alaga niya
talaga sa likod yung laging RU - 1 LU - 5
pinagkaka-abalahan niya.” as RL - 1 LL - 5
verbalized by his son. The patient
does not take any energy vitamins.
He does not perform vigorous
exercises as he easily tires out.
“Madali na mapagod si papa lately,
yan yung napansin namin after
niya magkasakit.” as verbalized
the patient’s son. Patient J.D does
not seek assistance in performing
ADLs.
Sleep - Rest Pattern According to his wife, Patient J.D Patient J.D is asleep most of the
usually sleeps at around 10:00 PM time but wakes up when
and wakes up at around 5:00 AM. stimulated.
He feels rested upon waking up.
He takes an afternoon nap at
around 1:00 PM which usually
lasts for about 1 - 2 hours on
weekends. He does not have any
difficulty in sleeping and does not
take sleep-inducing medications.
Cognitive Perceptual According to his wife, Patient J.D On July 11 - 12, 2022, patient
Pattern is fluent in Ilocano and Tagalog. J.D had a GCS of 11 (E4 V1
He does not have any difficulty M6). On July 13, 2022, he had a
with his senses prior to GCS score of 15 (E4 V5 M6). He
hospitalization. He recalls events is alert and conscious and able to
from the past easily and can learn follow commands appropriately
new things with ease too. “Hindi but has a slurred speech. He is
naman makakalimutin si papa.” as oriented to time, place, and
verbalized by his son. person. His wife and son
answered the questions during
the interview due to his current
condition.
Role - Relationship Patient J.D is married for 26 years. His relationship with his family
Pattern He lives with his wife and two is fine and stable. When asked
children. He is a loving husband how his family feel about his
and a good father according to his hospitalization, his son
wife. When asked about his verbalized “Nabigla kami nung
relationship with his siblings, his nalaman namin na na-stroke
wife stated that they get along siya, akala namin di magiging
really well. “Close naman silang ganito kalala yung kalagayan
magkakapatid.” as verbalized by niya kasi nga parang health
the patient’s wife. According to conscious na siya after ng sakit
his wife, whenever they have niya noon.” His wife and his
misunderstandings as a family, eldest son are the one who stayed
they resolve it immediately by at the hospital to check up on
talking. Patient J.D is the one who him regularly while his youngest
decides for the family. His wife son and siblings call every now
also stated that he handles his and then to check on his
responsibilities as the head of the condition.
family really well.
Self - Perception/Self - Patient J.D is a cheerful person Due to his current condition,
Concept Pattern with a good sense of humor which Patient J.D is unable to verbalize
is why when he is sick or in pain, his perception about himself
they would not know it during his hospitalization.
immediately according to his son
and wife. “Palabiro yang si papa
kaya pag may masakit sakanya
hindi namin nalalaman agad.” as
verbalized by his son. He is also
not the type of person who tells
what he feels to others. He is a
hardworking person who ensures
that his family is always in a good
condition. His wife stated that the
thing that makes Patient J.D
irritable is an unkempt
environment. “Pag makalat yung
bahay nagagalit na yan agad, ayaw
niya kasi na madaming makalat.”
as verbalized by his wife.
Sexuality - Patient J.D was circumcised at the Patient J.D is not sexually active.
Reproductive Pattern age of 11. He had his coitarche at
the age of 25. He is not sexually
active with this wife anymore.
According to his wife, they did not

use any type of contraception.
Patient J.D does not have any
history of sexually transmitted
disease.
Coping - Stress According to Patient J.D’s wife, he Patient J.D seems to be irritated
Tolerance Pattern considers the illness he had 5 years with his NGT and he has
ago to be the biggest change in his managed to pull it out once. He
life. It made him become more is reluctant to have it re-inserted
conscious of his health and well- again and has firmly rejected it
being. His family helped him the until his son has persuaded him
most in coping with that change. for his own benefit. His family is
His wife stated that prior to his always there to comfort him
hospitalization, Patient J.D rarely whenever he is stressed.
experiences problems in life,
especially in financial, because his
two children are now employed.
The only thing that irritates him is
an unkempt home environment,
which is why his family always try
to keep the house clean. “Lagi
nalang kami naglilinis at iniiwasan
namin na magkalat kasi ayaw niya
ng makalat yan.” as verbalized by
the patient’s wife. But when
misunderstandings occur within
their family, they talk things over
to resolve it. He does not drink or
smoke whenever he is stressed.
Value - Belief Pattern Patient J.D is a Roman Catholic Because he is currently

and prays every Sunday of the hospitalized, Patient J.D is
week. He is an active member of unable to attend Sunday masses.
the Lectors Ministry and Knights
of Columbus. His wife stated that
he does not believe in any
superstitious beliefs. “Hindi yan
mahilig sa pamahiin, hindi naman
daw totoo.” as verbalized by his
wife. Patient J.D’s major priority
in life is the well-being of his
family. His wife also stated that he
is content with his

accomplishments in life because
his two children both graduated
and are now employed.
COURSE IN THE WARD
DATE AND TIME DOCTOR’S ORDER RATIONALE NURSING

INTERVENTION
07-07-2022  Please admit to  To implement  Patient was
ROC under the plan of care and admitted for
service of Dr. M. appropriate resumption of care
Sibbaluca. management. under the service
of Dr. Sibbaluca.
 Inform Dr. M.
Sibbaluca about
the admission.
 Secure consent for  To ensure that  Secure consent

admission understanding is form for
made and there is admission.
an agreement or
permission of
care, treatment
and services.
 Low salt, low fat To prevent and control  Inform dietary

high blood pressure department about
and protect against the dietary
heart disease. modification of the
patient.
 Incorporate low
salt and fat diet.
 Endorse to next
shift NOD.
 Diagnostics:  To detect diseases  Inform the patient

 CBC, RBS and help rule out and SO of the
 Na, K, Crea particular purpose of the said
 FBS, Lipid condition. diagnostic tests.
Profile, BUA -  Request CBC,
done from RBS, Na, K,
referring Creatinine, CXR
hospital AP, 12 Lead ECG,
 CXR AP RAT, and Cranial
 12 Lead ECG CT-Scan Plain
 RAT accordingly.
 Cranial CT-
Scan Plain
 Tx:
IVF: PNSS 1L x KVO  For fluid and  Hook IVF 1Lx
electrolyte KVO
replenishment.  Regulate to 10
gtts/min
 Ensure tubing’s
patency.
 Monitor for signs
and symptoms of
fluid overload.
Furosemide 40 mg/IV  To help treat fluid  Observe rights of

now retention and drug
swelling. administration.
 Administer
Furosemide 40
mg/IV as ordered
 Monitor blood
pressure and fluid
levels.
Nicardipine drip 1 amp  To treat high  Observe rights of

+ 90cc D5W x 25 blood pressure. drug
ugtts/min administration.
 Administer
Nicardipine drip 1
amp + 90cc D5W
via soluset and

regulated to 25
ugtts/min.
 Monitor blood
pressure and fluid
levels.
Zynapse 1g/IV q8  To treat stroke.  Adminster

Zynapse 1g IV as
ordered.
 Cont:  To continue  Observe rights of

 Rosuvastatin medication drug
10mg tab OD treatment. administration.
 Irbesartan 150  Continue
mg tab BID administration of
 Amlodipine medications as
10 mg tab OD ordered.
 Aspirin 80 mg
tab OD
 Omeprazole
40 mg/IV OD
 VS q 2  For baseline data  Monitor vital signs

every hour and
documented on
patient’s chart.
 I&O q shift  To determine  Monitor intake and

fluid balance of output every shift
the patient. and documented it
on patient’s chart.
 Endorse to next
shift NOD
 Refer  To inform the  Refer any

attending untoward signs
Dr. Arcardama/Dr. M. physician of any and symptoms to

Sibbaluca untoward signs Dr. Sibbaluca.
and symptoms.
07-11-2022 (1:17  Decrease  To achieve the  Regulated

am) Nicardipine desired blood Nicardipine Drip
Drip by 10 pressure at 30 ugtts/min and
BP - 130/80 mmHg ugtts/min and reduction and to Isoket Drip at 30
Isoket Drip by 5 prevent ugtts/min.
ugtts/min hypotension.
For Nicardipine Drip:
 Closely
monitored
blood pressure
during and after
completion of
infusion.
For Isoket Drip:
 Monitored
effectiveness of
drug in
relieving
angina.
 Monitored
adverse
reactions.
 Recheck after  To determine  Assessed vital

20 minutes whether vital signs and recorded
signs, especially on patient’s chart.
blood pressure, is
within normal
range.
Dr. Gonzales
7:00 AM  Movelax 60 ml  To treat  Observed rights of

OD constipation. drug
administration.
 Administered
Movelax 60 ml as
ordered.
 Monitored for
bowel movement.
07-11-2022 (8:43  Refer to Dr. A.  For collaborative  Referred to Dr.
am) Cureg management. Cureg
accordingly.
 Dr. Cureg agreed
for co-
management.
EMO: DR. M.  Informed Dr.
Sibbaluca Sibbaluca
accordingly.
07-11-2022 (12:30  Dear DR.  Medical history  Referred Dr.
pm) Sibbaluca, and data are Cureg’s notes to
Thank you. presented to help Dr. Sibbaluca.
 S/P RAI deliver the
therapy 5 years appropriate and
ago effective
treatment which
is also helpful to
diagnose possible
illness.
 A:
Hypothyroidis
m secondary to
RAI
 D: For TSH and  To determine  Informed patient

Hba1c on 5 am thyroid function and family about
tom and measure the test ahead of
For FT4 tom at average blood time.
5 am sugar over the  Requested TSH,
past 2 - 3 months. Hba1c and FT4
accordingly.
 Endorsed to next
shift NOD
 Do not give  Blood samples  Endorsed to next

Euthyrox tom must be taken shift NOD.
before
administering the
drug.
 Start Euthyrox  To treat thyroid  Observed rights of

50 mg/tab 1 tab hormone drug
30 mins before deficiency administration.
breakfast after  Administered
extract of TSH Euthyrox
FT4 HbA1C. 50mg/tab 1 tab 30
minutes before
breakfast as
ordered.
Dr. Cureg
12:35 PM  Insert NGT  To prevent  Informed patient’s
Pain + Difficulty aspiration when SO of the
Swallowing consuming food procedure and its
and water. purpose.
 Secured consent
form for NGT
insertion.
 Informed ROD of
the said procedure
via telephone call.
 Assisted ROD on
inserting NGT.
 Documented
procedure on
Dr. Cureg patient’s chart.
07-11-2022 (1:30  Start NGT  To prevent  Informed the

pm) Osterized aspiration when patient and
Feeding at 1800 consuming food significant other
kcal in 6 equal and water. about the purpose
feedings and method of the
feeding regimen.
 Elevated the head
of the bed at least
30 to 35 degrees
prior to feeding to
prevent aspiration.
 Checked the tube
placement through
auscultation.
 Maintained the
patient into a semi-
upright position
for 30 minutes
after feeding.
 Documented
feeding on
patient’s chart.
 ASA 2 tab now  Indicated for the  Observed rights of

then 1 tab OD treatment of mild drug
pain. Also used to administration.
prevent heart  Adminsitered
attacks and ASA 2 tabs as
strokes. ordered.
 Crushed the 2
tablets and
dissolved in a
warm water to be
administered
Dr. Sibbaluca through NGT.
07-11-2022 (11:00  Increase  To lower blood  Updated
pm) Amlodipine to pressure and is medication card to
1 tab 2x a day used to help blood Amlodipine
flow more easily 10mg/tab 1 tab
to the heart when BID as ordered.
arteries in the  Monitored blood

heart are blocked. pressure.
 Klyte 1 tab 2x a  Used to prevent  Observed rights of

day x 4 doses low amounts of drug
potassium in the administration.
blood.  Dissolved in warm
water to be
administered
through NGT.
 Administered K-
lyte 1 tab 2x/day x
4 doses as ordered.
 Monitored intake
and output ratio
every shift and
observed for signs
of dehydration.
 Checked vital
Dr. Gonzales signs hourly.
07-12-2022 (7:25  Decrease  To decrease the  Updated
am) Omeprazole 40 amount of acid in medication card to
No abdominal mg IV OD the stomach Omeprazole 40 mg
tenderness, no pain IV OD.
Dr. Manuela
07-12-2022 ( 12:30  Euthyrox 50 +  To provide more  Observed rights of
pm) 25 mg 1 tab thyroid hormone, drug
each this is normally administration.
HbA1C: 6% produced by the  Administered the
thyroid gland, for drug as ordered.
the treatment of  Crushed one and a
hypothyroidism. half tablet of
Euthyrox and
dissolved in warm
water to be
administered
through NGT.
07-12-2022 (5:02  Decrease  To achieve the  Regulated
pm) Nicardipine to desired blood Nicardipine drip to
25 ugtts/min pressure 25 ugtts/min and
Awake and Isoket to 25 reduction and to Isoket Drip to 25
No verbal output ugtts/min prevent ugtts/min as
hypotension. ordered.
For Nicardipine Drip:
 Closely
monitored
blood pressure
during and after
completion of
infusion.
For Isoket Drip:
 Monitored
effectiveness of
drug in
relieving
angina.
 Monitored
adverse
reactions.
 Hold Irbesartan  To prevent further  Withhold

tab reduction of Irbesartan as
blood pressure. ordered.
shift NOD
 Na, K,  To monitor  Informed the

creatinine sodium, patient and SO of
CKMB in AM potassium, the purpose and
creatinin, and the need to test
CKMB levels of sodium,
the patient. potassium,
creatinine, and
CKMB.
 Requested Na, K,
creatinine CKMB.
shift NOD
 Discontinue To prevent  Discontinued

Arixtra after 3 complications that Arixtra after 3
doses may arise with doses.
prolonged use of  Removed Arixtra
anticoagulants. from medication
sheet.
Dr. Gonzales shift NOD
07-12-2022 ( 5:22  Suggest  For collaborative  Informed the
pm) nephrology co- management patient and family
management focusing on CKD about the
treatment. suggestion of
nephrology co-
Dr. Gonzales management.
07-12-2022 ( 5:57  Refer to DR. E.  For collaborative  Referred to Dr.
pm) Bautista management. Bautista
accordingly.
 Dr. Bautista
agreed for co-
management.
 Informed Dr.
Dr. Sibbaluca Sibbaluca
accordingly.
7-13-2022 (6:10am)
 Thank you for the
NCl: 127.2 referral
K: 3.58  IMP: CKD
Crea: 478 (536) secondary to
Hgb: 119 Hypertensive
Nephrosclerosis
 Treatment:
• ABG –  To inform the  Relayed ABG
relay doctor about the result accordingly.
ABG of the
patient once the pH - 7.32
results are PaO2 - 106
available and to mmHg
determine what PaCO2 - 27.6
kind of mmHg
intervention the HCO3 - 13.9
patient needs mEq/L
based on the data. BE - -12.1
mEq/L
SaO2 - 98%
• Ketoanalo  To detour protein  Observed rights of

gues + deficiency that drug
Amino may result from a administration.
Acid 650 very low protein  Administered
mg/tab diet. Ketoanalogues +
Amino Acid 650
mg/tab 1 tab TID
as ordered.
 Crushed 1 tab and
dissolved in warm
water to be
administered
through NGT.
 Monitored vital
signs every hour
especially cardiac
changes.
• NaHCO3  To treat metabolic  Observed rights of

650 mg/tab acidosis drug
OD administration.
 Administered
NaHCO3 650
m/tab BID as
ordered.
 Crushed 1 tab and
dissolved in warm
water to be
administered
through NGT.
 Monitored
laboratory results
as it may increase
sodium and lactase
levels and may
decrease
potassium level.
• Repeat  To monitor  Informed patient

Creatinine creatine level and and family about
July 15 evaluate kidney the test ahead of
function. time.
 Secured
laboratory request
Dr. E. Bautista form for
creatinine.
7-13-2022 (6:40  Shift IV  Oral is more  Shifted drug as
am) Omepron to painless and ordered by Dr.
oral Omepron inexpensive Sibbaluca.
40mg/cap 1 cap  Updated
OD medication card to
Omperazole
40mg/cap 1 cap
OD.
shift NOD.
Dr. M. Sibbaluca
7-13-2022 (8:00  Increase  To achieve  Administered the
am) NaHCO3 tab to desired drug as ordered.
BID therapeutic  Updated
efficacy of medication card to
NaHCO3 NaHCO3 650
mg/tab 1 tab BID.
 Monitored
laboratory results
as it may increase
sodium and lactase
levels and may
decrease
potassium level.
shift NOD.
EMO: Dr. E. Bautista
7-13-2022 (10:55  Repeat FT4  To determine the  Informed the
am) TSH after one thyroid function patient and the
month of the patient. family ahead of
time.
Dr. A. Cureg
7-13-2022 (1:00  NaCl 1g/tab  To prevent  Administered

pm) BID sodium loss and NaCl 1g as
help prevent ordered.
(+) patient from  Crushed 1 tab
incomprehensible becoming NaCl and
verbal output dehydrated. dissolved in warm
water to be
administered
through NGT.
 Assessed patient’s
Dr. M. Sibbaluca fluid status.
PHYSICAL ASSESSMENT
Date of Assessment: July 13, 2022

AREA ASSESSED TECHNIQUE NORMAL ACTUAL ANALYSIS
USED FINDINGS FINDINGS
SKIN
- Color Inspection Varies with race Light Brown Normal
- Temperature Palpation Warm to touch Warm to touch Normal
- Turgor Palpation Springs back to Springs back Normal
previous state to previous
(1-2 seconds) state
(1 second)
- Moisture Palpation Moist Moist Normal

- Texture Palpation Smooth Smooth Normal
- Lesion Inspection Smooth, without Smooth, Normal
lesion without lesion
HAIR
- Color Inspection Varies with race Light Black Normal
- Distribution Inspection Evenly Evenly Normal
distributed distributed
- Texture Palpation Smooth and Smooth and Normal
Silky Silky
NAILS
- Color of Nail Inspection Pinkish in color Pinkish Normal
Bed
- Texture Palpation Smooth Smooth Normal
- Capillary Palpation Pink tone returns Pink tone Normal
Refill Time immediately returns in 1
when pressure is second
released (<2
seconds)
HEAD
- Shape and Inspection Normocephalic Normocephalic Normal
Symmetry and Symmetric and Symmetric
- Consistency Palpation Hard and Hard and Normal
Smooth; without Smooth;
lesions and without lesions
masses and masses
FACE
- Symmetry Inspection Proportionate Proportionate Normal
and Symmetric and Symmetric
- Facial Inspection Movements are Movements are Normal
Movement equal equal bilaterally
bilaterally
- Color Inspection Same as body Same as body Normal
color color
- Lesion Inspection Smooth Abrasion at both Possibly due to
without Lesion side of cheeks oxygen tubing
rubbing against
the skin of the
cheeks.
EYES
- Position Inspection Symmetric Symmetric Normal
- Eyelids Inspection Without Without Normal
swelling, swelling,
discharge and discharge and
lesions lesions
- Conjunctiva Inspection Pinkish; free of Pinkish; free of Normal
discharge, discharge,
lesions, redness lesions, redness
and lacerations and lacerations
- Sclera Inspection White; free of White; free of Normal
discharge, discharge,
lesions, redness lesions, redness
and lacerations and lacerations
- Pupils Inspection Color varies Black in color; Normal
with race; PERRLA; 2 mm
PERRLA; 2 - 4 in diameter
mm in diamete
- Eyebrows Inspection Symmetric in Symmetric in Normal
and shape and shape and
eyelashes movement; hair movement; hair
evenly evenly
distributed distributed
EARS
- Position Inspection Symmetric Symmetric Normal
- Size Inspection Symmetric on Symmetric on Normal
both sides both sides
- Texture Palpation Smooth Smooth without Normal

without lesions, lumps or
lesions, lumps nodules
or nodules
MOUTH
- Lip Inspection Smooth and Dry Possibly due
Consistency moist lack of fluid
intake by
mouth. Patient
on NGT
feeding.
- Lip Color Inspection Varies with Light Brown Normal
race
NOSE
- Position Inspection Midline in Midline in face; Normal
and Size face; Symmetric and
Symmetric straight
- Color Inspection Same as the Light brown Normal
rest of the body
-Discharges Inspection No discharges no discharges Normal
-Nasal Inspection No nasal No nasal flaring Normal
Flaring flaring
THORAX
- Shape Inspection Smooth, Rounded and Normal
Rounded and Symmetric
Symmetric
- Respiratory Inspection Respirations Unlabored and Normal
Effort should be regular
unlabored and respiration; RR:
regular; RR = 18 cpm
12 - 20 cpm
- Tenderness Palpation No tenderness No tenderness Normal
and Masses and masses and masses noted
noted
- Breath Auscultation Clear breath Clear breath Normal
Sounds sounds can be sounds
heard; no
adventitious
sounds
HEART
- Apical Auscultation Regular and HR = 69 bpm; Normal
Pulse rapid; 60 - 100 regular and rapid
bpm
- Heart Auscultation Louder, higher Louder and Normal
pitched, and of higher pitched;
shorter no murmurs
duration; noted
innocent
murmurs are
normal
ABDOMEN
- Shape Inspection Rounded and Rounded; Normal
prominent in prominent in
supine position supine position
- Color Inspection Same color as Light brown Normal

the rest of the
body
- Masses and Palpation Soft to Soft; without Normal
Tenderness palpation; masses and
without masses tenderness
and tenderness
MUSCULOSKELETAL
- Upper and Inspection Warm and Warm Due to
lower mobile extremities infarction at the
Extremities extremities; RU - 1 LU - 5 left frontal lobe
symmetric in RL - 1 LL - 5 of brain.
size;
- Joints Inspection No swelling No swelling and Normal
and redness redness noted
- Lesion Inspection Smooth w/o Smooth without Normal
lesions lesions
- Edema Palpation No edema 1 + non-pitting Due to IV
edema on right catheter
hand infiltration
LABORATORY/DIAGNOSTIC RESULTS
July 8,2022
CLINICAL CHEMISTRY (CK-MB, TROP I)
TEST REFERENCE UNIT RESULT REMARKS
RANGE
CK-MB 0 - 7.0 ng/mL 36.34 Elevated possibly
due to the recent
heart attack that
caused myocardial
injury, releasing CK-
MB from damaged
heart muscle into the
circulation.

RANGE
Troponin I, 0 - 0.03 ng/mL Greater Elevated [possibly
Quantitative than 15.0 due to the damage to
the patient’s heart
muscle. Troponin I is
a cardiac biomarker
substance that is
released into the
blood when the heart
is damaged or
stressed.
July 9,2022
RANGE
CK-MB 0-7.0 ng/mL ng/mL 6.04 NORMAL
HEMATOLOGY (CBC PC)

RANGE
White Blood 4.50-11.00 x10^9/L 11.9 Elevated.
Cell
Possibly due to
recent heart attack
causing the nervous
system to signal
production of white
blood cells, which
travels to the heart
and remove the dead
tissue.
Possibly due to
atherosclerosis
which caused
inflammation to the
arterial wall, thereby
increasing white
blood cell
production.
Neutrophils 36-65 % 73 Elevated possibly

due to recent
myocardial
infarction which
caused neutrophils to
be produced and
recruited to the
ischemic region,
where they initiate
Lymphocytes 20-40 % 12 inflammatory
response aiming at
cleaning up dead cell
debris.
Inflammation
possibly due to
atherosclerotic blood
vessels triggers
production of
neutrophils and
lowers the
lymphocytes.
Monocytes 2-6 % 12 Elevated possibly
due to the
recruitment of
monocyte to the
infarcted
myocardium to
remove debris and
facilitate the repair
process and to the
inflamed arterial
wall to engulf the
LDLs invading the
arteries.
Eosinophils 0-5 % 3 NORMAL
Basophils 0-1 % 0 NORMAL
Bands 0-5 % 0 NORMAL

RBC Count 4.50-6.00 x10^9/L 3.92 Decreased possibly
due to decreased
erythropoietin
production caused by
hypertensive
nephrosclerosis.
Hemoglobin 140-180 g/L 119 Decreased RBC also
causes decreased
Hemoglobin.
Hematocrit 0.40-0.54 % 0.359 Decreased RBC also
decreases
Hematocrit.
MCV 80-94 fL 92 NORMAL
MCH 27-31 pg 30.4 NORMAL
MCHC 310-360 g/L 332 NORMAL
RDW 11.50-14.50 % 13.0 NORMAL
Platelet Count 150-450 x10^9/L 182 NORMAL
MPV 7.80-11.00 % 7.8 NORMAL
July 10,2022

RANGE
Serum 136 - 145 (ISE) mmol/L 127.6 Possibly due to
Sodium (Na+) Furosemide which
stimulates the
kidneys to produce
Serum 3.5 - 5.1 (ISE) mmol/L 3.44
more urine. Along
Potassium
with an increased
(K) urine production,
Furosemide causes
loss of sodium and

potassium.
Creatinine M: 80 - 115 µmol/L 536 Elevated possibly
due to damage to the
F: 53 - 97
kidneys causing
decreased GFR
which resulted in
waste products, such
as creatinine, to
accumulate in the
blood.

RANGE
CK-MB 0-7.0 ng/mL ng/mL 16.36 Elevated possibly
due to the recent
heart attack that
caused myocardial
injury, releasing CK-
MB from damaged
heart muscle into the
circulation.
July 11,2022
IMMUNOSEROLOGY (FT4, TSH)
RANGE
fT4 12.0 - 22.0 pmol/L 6.56 Indicates underactive
thyroid gland.
TSH 0.270 - 4.20 µIU/L 100
July 12,2022
CLINICAL CHEMISTRY
RANGE
HbA1c 4.0-6.0 % 6.0 NORMAL
CLINICAL CHEMISTRY (Blood Gas Analysis)

RANGE
pH 7.35 - 7.45 mmHg 7.32 Metabolic acidosis
possibly due to
PaO2 80 - 100 mmHg 106
damage to the
PaCO2 35 - 45 mmHg 27.6 kidneys, making it
unable to excrete
HCO3 22-26 mEq/L 13.9 hydrogen ions and
BE -2+2 mEq/L -12.1 reabsorb bicarbonate
ions.
SaO2 95 - 100 % 98 NORMAL
July 7, 2022
PLAIN CT SCAN OF THE HEAD
Multiple contiguous axial images of the head were obtained without intravenous contrast.
 There are two ill-defined hypodense areas in the right centrum semiovale and in the
parasagittal regions of the left frontal lobe (including the body, genu, and rostrum of the
corpus callosum).
 There are patches of low attenuation in both periventricular and deep white matter
regions.
 There are cacific densities in both basal ganglia.
 The ventricles, cisterns, and sulci are normal in size and shape.
 There is no midline shift, mass, or mass effect.
 There are calcific densities along the walls of both internal carotid and vertebrobasilar
arteries.
 The mastoid air cells and the visualized paranasal sinuses are well aerated.
 The visualized osseous structures are unremarkable.
IMPRESSION:
Consider acute Ischemic Infarcts, left frontal lobe (including the corpus callosum) and
right centrum semiovale. Close follow up is suggested.
Small vessel Ischemic changes, both periventricular and deep white matter regions.
Non-specific bilateral basal ganglia calcifications.
Atherosclerotic bilateral Internal carotid and vertebrobasilar arteries.
CHEST X-RAY (AP SITTING VIEW)

 There are hazy densities in the left lower lung.
 The heart is enlarged.
 The aorta is tortuous and calcified.
 Both hemidiaphragm, costophrenic sulci, and visualized bones are intact.
IMPRESSION:
Pneumonia versus parenchymal crowding, left lower lung.
Cardiomegaly.
Atheromatous aorta.
July 8, 2022
ELECTROCARDIOGRAM
EKG Interpretation:
Sinus Rhythm
Left Ventricular Hypertrophy
ST/T change secondary to strain/ischemia
ANATOMY AND PHYSIOLOGY
NERVOUS SYSTEM
The brain is an amazing three-pound organ that controls all functions of the body, interprets
information from the outside world, and embodies the essence of the mind and soul. Intelligence,
creativity, emotion, and memory are a few of the many things governed by the brain. Protected
within the skull, the brain is composed of the cerebrum, cerebellum, and brainstem.
Brain
The brain is composed of the cerebrum, cerebellum, and brainstem
Cerebrum: is the largest part of the brain and is composed of right and left hemispheres. It
performs higher functions like interpreting touch, vision, and hearing, as well as speech, reasoning,
emotions, learning, and fine control of movement.
Cerebellum: is located under the cerebrum. Its function is to coordinate muscle movements,
maintain posture, and balance.
Brainstem: acts as a relay center connecting the cerebrum and cerebellum to the spinal cord. It
performs many automatic functions such as breathing, heart rate, body temperature, wake and
sleep cycles, digestion, sneezing, coughing, vomiting, and swallowing.
Right brain – left brain
The cerebrum is divided into two halves: the right and left hemispheres. They are joined by a
bundle of fibers called the corpus callosum that transmits messages from one side to the other.
Each hemisphere controls the opposite side of the body. If a stroke occurs on the right side of the
brain, your left arm or leg may be weak or paralyzed.
Not all functions of the hemispheres are shared. In general, the left hemisphere controls speech,
comprehension, arithmetic, and writing. The right hemisphere controls creativity, spatial ability,
artistic, and musical skills. The left hemisphere is dominant in hand use and language in about
92% of people.
Axons from each side of the brain travel to the medulla oblongata, and then into the spinal cord
and beyond. Within the medulla, they cross over to the contralateral side of the body, rather than
turn back to the ipsilateral side - a technical term known as ‘decussation’. It’s the difference
between writing an X and an L - the X is (two) smooth strokes, an L requires transitioning from
writing in one direction to a different direction.
Lobes of the brain
The cerebral hemispheres have distinct fissures, which divide the brain into lobes. Each
hemisphere has 4 lobes: frontal, temporal, parietal, and occipital. Each lobe may be divided, once
again, into areas that serve very specific functions. It’s important to understand that each lobe of
the brain does not function alone. There are very complex relationships between the lobes of the
brain and between the right and left hemispheres.
Frontal lobe
 Personality, behavior, emotions

 Judgment, planning, problem solving
 Speech: speaking and writing (Broca’s area)
 Body movement (motor strip)
 Intelligence, concentration, self-awareness
Parietal lobe
 Interprets language, words

 Sense of touch, pain, temperature (sensory strip)
 Interprets signals from vision, hearing, motor, sensory and memory
 Spatial and visual perception
Occipital lobe
 Interprets vision (color, light, movement)
Temporal lobe
 Understanding language (Wernicke’s area)

 Memory
 Hearing
 Sequencing and organization
Language
In general, the left hemisphere of the brain is responsible for language and speech and is called the
"dominant" hemisphere. The right hemisphere plays a large part in interpreting visual information
and spatial processing. In about one third of people who are left-handed, speech function may be
located on the right side of the brain. Left-handed people may need special testing to determine if
their speech center is on the left or right side prior to any surgery in that area.
Aphasia is a disturbance of language affecting speech production, comprehension, reading or
writing, due to brain injury – most commonly from stroke or trauma. The type of aphasia depends
on the brain area damaged.
Broca’s area: lies in the left frontal lobe. If this area is damaged, one may have difficulty moving
the tongue or facial muscles to produce the sounds of speech. The person can still read and
understand spoken language but has difficulty in speaking and writing (i.e., forming letters and
words, doesn't write within lines) – called Broca's aphasia.
Wernicke's area: lies in the left temporal lobe. Damage to this area causes Wernicke's aphasia.
The individual may speak in long sentences that have no meaning, add unnecessary words, and
even create new words. They can make speech sounds; however, they have difficulty
understanding speech and are therefore unaware of their mistakes.
CIRCULATORY SYSTEM
Blood Vessels
Blood vessels circulate blood throughout the body. They help deliver oxygen to vital
organs and tissues, and also remove waste products. Blood vessels include veins, arteries and
capillaries.
Blood vessels form a closed loop, like a circuit, that begins and ends at the heart. Together,
the heart vessels and blood vessels form the circulatory system. The body contains about 60,000
miles of blood vessels.
There are blood vessels throughout the body.
The aorta is the main artery that carries blood away from your heart to the rest of your
body. The blood leaves the heart through the aortic valve. Then it travels through the aorta, making
a cane-shaped curve that allows other major arteries to deliver oxygen-rich blood to the brain,
muscles and other cells.
The main vein in the body is the vena cava. The vena cava has two parts: the superior vena
cava and the inferior vena cava. The superior vena cava carries blood from the head, neck, arms,
and chest. The inferior vena cava carries blood from the legs, feet, and organs in the abdomen and
pelvis. The vena cava is the largest vein in the body.
Blood vessels have three layers of tissue:
Tunica intima: The inner layer surrounds the blood as it flows through the body. It regulates blood
pressure, prevents blood clots and keeps toxins out of the blood. It keeps the blood flowing
smoothly.
Tunica Media: The middle layer contains elastic fibers that keep the blood flowing in one
direction. The media also helps vessels expand and contract.
Tunica Adventitia: The outer layer contains nerves and tiny vessels. It delivers oxygen and
nutrients from the blood to the cells and helps remove waste. It also gives blood vessels their
structure and support.
There are three types of blood vessels:
 Arteries carry blood away from the heart.

 Veins carry blood back toward the heart.
 Capillaries, the smallest blood vessels, connect arteries and veins.
Function
The function of blood vessels is to deliver blood to the organs and tissues in the body. The
blood supplies them with the oxygen and nutrients they need to function. Blood vessels also carry
waste products and carbon dioxide away from the organs and tissues.
Each type of blood vessel serves a different function:
 Arteries: These strong, muscular blood vessels carry oxygen-rich blood from the heart to
the body. They handle a large amount of force and pressure from the blood flow but don’t
carry a large volume of blood. At any given time, only about 10% to 15% of the body’s
blood is in your arteries.
 Arterioles: Arteries branch into smaller vessels called arterioles. Both arteries and
arterioles are very flexible. They get bigger or smaller to help maintain the body’s blood
pressure.
 Capillaries: These tiny blood vessels have thin walls. Oxygen and nutrients from the
blood can move through the walls and get into organs and tissues. The capillaries also
take waste products away from your tissues. Capillaries are where oxygen and nutrients
are exchanged for carbon dioxide and waste.
 Venules: Veins begin as tiny vessels called venules and get gradually larger as they near
the heart. Venules receive blood from capillaries.
 Veins: Unlike arteries, veins don’t have to carry highly pressurized blood, but they do
have to carry large volumes of deoxygenated blood back to the heart. Thin, less elastic
walls help them handle high volumes and low pressure. Most veins have valves that open
and close. The valves control blood flow and keep your blood flowing in one direction.
About 75% of your blood is in your veins.
PATHOPHYSIOLOGY
DRUG STUDY
LEVOTHYROXINE
Classification Action Indication Contraindication Adverse effects Nursing responsibilities
Clinical: Thyroid Synthetic form of Used for Hypersensitivity to CNS: Irritability,  Monitor pulse before
Hormone thyroxine that diminished levothyroxine, nervousness, insomnia, each dose during dose
affects the growth thyroid function. severe headache adjustment. If rate is
Pharmacotherapeutic: of tissues, energy cardiovascular >100, consult
Synthetic isomer of expenditure, and condition, and CV: Palpitations, physician.
thyroxine the turn over of all adrenal tachycardia,
substrates. insufficiency. arrhythmias, angina  Monitor for adverse
pectoris, hypertension. effects during early
Generic Name:
Levothyroxine adjustment. If
GI: Nausea, diarrhea, metabolism increases
Brand Name: Euthyrox change in appetite. too rapidly, especially
SYSTEMIC: Weight in older adults and heart
Dosage/Route/ disease patients,
loss, heat intolerance,
Frequency: symptoms of angina or
50+25 mg/tab OD sweating, fever, leg
cramps. cardiac failure may
appear.
 Thyroid replacement
therapy is usually
lifelong.
 Notify physician if rate
begins to increase above
100 or if rhythm
changes are noted.
 Notify physician
immediately of signs of
toxicity such as chest

pain, palpitations, and
nervousness.
OMEPRAZOLE
Classification Action Indication Contraindication Adverse Effects Nursing Responsibilities
Clinical: Proton Pump Inhibits proton To suppress gastric Hypersensitivity to CNS: Headache,  Evaluate for therapeutic
Inhibitor pumps activity by acid secretion omeprazole. Dizziness, Fatigue response, such as relief
binding to relieving gastro- from GI symptoms.
hydrogen intestinal distress. GI: Diarrhea, abdominal
Pharmacotherapeutic:
Benzimidazole potassium pain, nausea. Mild  Lab tests: Monitor
adenosine transient increases in urinalysis for hematuria
liver function test.
Generic Name: triphosphatase, and proteinuria.
Omeprazole located at secretory UROGENITAL: Periodic liver function
surface of gastric Hematuria, Proteinuria tests with prolonged
Brand Name: Omepron parietal cells to use.
Dosage/Route/ suppress gastric SKIN: Rash
Frequency: acid secretion.  Report any changes in
40mg/cap 1 cap OD urinary elimination
such as pain or
discomfort associated
with urination, or blood
in urine.
 Report severe diarrhea;
drug may need to be
discontinued.
NEUROAID
Class: Food SupplementNeuroAiD is a To promote Hypersensitivity to  Dry Mouth/Throat  Crush tablets and
recovery neurorestoration drug  Nausea dissolve in warm water
Generic Name: Vitamin stimulator and is usually  Vomiting to be administered
B1, B6 + B12 dedicated to repair recommended to  Diarrhea through NGT.
neurological stroke patients to  Feeling Hot
Brand Name: NeuroAid functions. optimize the  Record patient’s
recovery and to dietary history
support regaining carefully as an
Dosage/Route/Frequency:
3 tabs/q6 independence. essential part of
vitamin replacement
therapy.
 Learn about each
dietary sources of
Vitamin B1, B6 + B12.
FUROSEMIDE
Clinical: Diuretic, Inhibits Antihypertensive History of CV: Postural  Observe patients

Antihypertensive reabsorption of agent that hypersensitivity to hypotension, dizziness receiving parenteral
sodium and decreases edema furosemide or with excessive diuresis, drug carefully; closely
Pharmacotherapeutic: chloride primarily and intravascular sulfonamides which acute hypotensive monitor BP and vital
Loop diuretic in loop of Henle volume. increases oliguria, episodes, circulatory signs.
and also in anuria, fluid and collapse.
Generic Name: proximal and distal electrolyte depletion Metabolic:  Monitor for signs and
Furosemide renal tubules. states. Hypovolemia, symptoms of
dehydration, hypokalemia
Brand Name: Diuspec
hyponatremia  Monitor blood pressure
Dosage/Route/ hypokalemia, during periods of
Frequency: hypochloremia metabolic diuresis and through
40mg/IV/q12 alkalosis, period of dosage
hypomagnesemia, adjustment.
hypocalcaemia,
 Observe older adults
hyperglycemia, closely during period of
glycosuria, elevated brisk diuresis. Sudden
BUN, hyperuricemia. alteration in fluid and
GI: Nausea, vomiting, electrolyte balance may
precipitate significant
oral and gastric burning,
adverse reactions.
anorexia, diarrhea,
Report symptoms to
constipation, abdominal physician.
cramping, acute
pancreatitis, jaundice.  Monitor I&O ratio and
pattern. Report decrease
Urogenital: Allergic or unusual increase in
interstitial nephritis, output.
irreversible renal failure,
 Note: Excessive
urinary frequency.
dehydration is most
Hematologic: Anemia, likely to occur in older
leukopenia, adults.
thrombocytopenic
purpura; aplastic anemia,  Consult physician

agranulocytosis. regarding allowable salt
and fluid intake.
Special Senses:
Tinnitus, vertigo, feeling  Make position changes
of fullness in ears, slowly because high
hearing loss, blurred doses of
antihypertensive drugs
vision.
taken concurrently may
Skin: Pruritus, urticaria, produce episodes of
exfoliative dermatitis, dizziness or imbalance.
purpura,  Avoid replacing fluid
photosensitivity, losses with large
porphyria cutanea tarde, amounts of water.
necrotizing angiitis.
Systemic: Increased
perspiration;
paresthesias; activation
of SLE, muscle spasms,
weakness;
thrombophlebitis, pain at
IM injection site.
NICARDIPINE
Clinical: Anti-anginal, It inhibits calcium For hypertension Hypersensitivity to CNS: dizziness, light  Dilute with PNSS
Antihypertensive ion influx across nicardipine; headedness, asthenia before administration.
cardiac and advanced aortic  Administer via soluset
Pharmacotherapeutic: smooth muscle stenosis CV: peripheral edema, with 90 cc PNSS + 1
Calcium Channel Blocker cells, decreasing palpitations, angina, ampule and regulate at
myocardial tachycardia, flushing. 30 ugtts/min.
Generic Name:  Closely monitor blood
Nicardipine pressure during and
Hydrochloride after completion of
infusion.
Brand Name: Nicardin  Titrate infusion rate if
hypotension or
Dosage/Route: tachycardia occurs.
90cc PNSS + 1 ampule  Establish baseline data
30 ugtts/min before treatment is
started including vital
signs, especially blood
pressure.
 Monitor blood pressure
during initiation and
titration of dosage
carefully.
 Discontinue IV
infusion if hypotension
or tachycardia develop
 Notify physician if any
of the following occur:
 Irregular heart beat,
 Shortness of breath,
 Swelling of the feet,
 Pronounced
dizziness,
 Nausea, or drop in
blood pressure.
GANATON
Clinical: Gastroprokinetic Activates Treatment of Hypersensitivity to  Diarrhea  Taken with empty
Agent gastrointestinal chronic gastritis or itopride stomach.
 Headache
propulsive motility non-ulcer hydrochloride or  Inform the physician if
Pharmacotherapeutic: due to its dopamine dyspepsia. any of the  Decrease in white patient gets watery
Acetylcholine esterase D2 antagonizing excipients of blood cells and diarrhea, fever, or
inhibitor and dopamine D2 activity and Ganaton. platelets stomach pain that does
receptor antagonist acetylcholinesteras  Constipation not go away.
e inhibitory  Increased salivation  It may cause dizziness
Generic Name: activity. and sleepiness.
Itopride Hydrochloride  Dizziness  Report any instance
 Increased liver indicating bleeding of
Brand Name: enzyme levels in the the stomach like the
Ganaton blood presence of blood in
stools, black or coffee-
Dosage/Route/ colored stools to the
Frequency: doctor immediately.
50 mg/tab TID AC
ISOKET
Clinical: Antianginals Relaxes vascular To prevent angina Hypersensitivity to SYSTEMIC:  Wrap the IV tubings
smooth muscle or chest pain nitrates or nitrites; Hypersensitivity reaction, and the soluset with foil
Pharmacolotherapeutic with resulting caused by coronary severe anemia; paradoxical increase in because the drug is
Class: Nitrates vasodilation. artery disease. head trauma; anginal pain, known to be light
increased methemoglobinemia sensitive.
Generic Name: intracranial (overdose).  Store drug in a cool, dry
Isosorbide Dinitrate pressure. place, in a tightly
CNS: Headache, closed container.
Brand Name: dizziness, weakness,  Monitor effectiveness
Isoket IV lightheadedness, of drug in relieving
restlessness. angina.
Dosage/Route/  Note: Headaches tend
Frequency: CV: Palpitation, postural to decrease in intensity
1 amp + 90 cc PNSS hypotension, tachycardia. and frequency with
30 ugtts/min continued therapy but
GI: Nausea, vomiting. may require
Skin: Flushing, pallor, administration of
perspiration, rash, analgesic and reduction
exfoliative dermatitis. in dosage.
 Note: Chronic
administration of large
doses may produce
tolerance and thus
decrease effectiveness
of nitrate preparations.
AMLODIPINE
Clinical: Antihypertensive Inhibits calcium Management of Contraindicated for Overdose may produce  Assess blood pressure,
ion influx across hypertension patients with sick excessive peripheral if systolic BP is less
Pharmacotherapeutic: cell membrane sinus syndrome, vasodilation, marked than 90 mmHg,
Calcium Channel Blocker during cardiac 2nd or 3rd degree hypotension with reflex withhold medication
depolarization; heart block, tachycardia, peripheral and consult physician.
Generic Name: produces relaxation hypersensitivity, edema, syncope
of coronary smooth  Change patient
Amlodipine severe aortic
muscle. position slowly in bed
stenosis.
to prevent orthostatic
Brand Name: Provasc
hypotension.
Dosage/Route/  Notify physician of
Frequency: irregular heartbeat,
10mg/tab 1 tab BID shortness of breath,
swelling of feet and
hands, severe
dizziness, constipation,
nausea, and
hypotension.
 Assess peripheral
edema using girth
measurements and
measurement of pitting
edema. Report
increased swelling in
feet and ankles due to
peripheral
vasodilation.
NEUROTAIN PLUS
Drug Class: Food Acts as a food Indicated to post- Contraindicated for GI discomfort such as  Store at room temperature
Supplement supplement for stroke patients for patients with diarrhea, stomach not exceeding to 30
neuroprotections faster recovery history of upset/fullness, nausea, degrees Celsius.
Generic Name: Gotu Kola and memory which also helps in squamous cell dizziness and
 Notify physician if
+ Phosphatidylcholine + problems. improving carcinoma, basal drowsiness
diarrhea and steatorrhea
Taurine cognitive function cell skin cancer or
develops in the patient.
and memory. melanoma.
Brand Name: Neurotain
Plus
Dosage: 1 cap BID

ATORVASTATIN
Clinical: Inhibits HMG- Dyslipidemias: Hypersensitivity to CNS: Headache,  Obtain baseline
Antihyperlipidemic CoA reductase Reduces risk of Atorvastatin, insomnia cholesterol and
enzyme which stroke and heart Contraindicated to triglycerides.
CV: Peripheral edema
Pharmacotherapeutic: reduces cholesterol attack patients with active
 Store drug in cool
Hydroxymethyl glutaryl synthesis. hepatic disease EENT: Rhinitis,
environment in tight
CoA (HMG-CoA) sinusitis, and
container protected from
reductase inhibitor pharyngitis
light.
Generic Name:
GI: Abdominal pain,
Atorvastatin  Assess for rash, pruritus,
constipation, and
and malaise.
diarrhea.
Brand Name: Itorvaz
 Monitor cholesterol and
GU: Urinary tract
triglyceride laboratory
Dosage/Route/ infection
values for therapeutic
Frequency:
MUSCULOSKELET response.
80mg/tab 1 tab OD
AL: Arthritis,
 Watch for signs of
arthralgia, and myalgia
myositis.
RESPIRATORY:
 Notify physician of
Bronchitis
adverse reactions such as
SKIN: Rash muscle pain, and fever.
OTHER: Allergic
reactions and infection
KETOANALOGUE
Class: Normalizes It is used for Hypercalcemia, Hypercalcemia may  Assess electrolyte levels
Nutrition and Dietary metabolic process, nutritional support disturbed amino develop  Assess allergy to the
supplement promotes recycling in chronic kidney acid metabolism, drug
product exchange disease and to slow allergy and  Administer drug at right
Generic Name: and reduces ion down the sensitivity to the time, route and dosage
Ketoanalogue concentration of progression of drug  Monitor vital signs
potassium, renal failure. especially cardiac
Brand Name: Aminolog magnesium and changes.
phosphate.  Document
Dosage/Route/ administration of drug
Frequency:  Report immediately if
650 mg/tab TID symptoms of
hypercalcemia occurs
like muscle weakness,
constipation
 Monitor signs of
hypercalcemia and
electrolyte levels.
SODIUM BICARBONATE
Clinical: Antacid Restores buffering Indicated in the Hypersensitivity to CNS: Tetany  Monitor blood pH, partial
capacity of the treatment of sodium bicarbonate, pressure of arterial
CV: Edema
Pharmacotherapeutic: body and metabolic acidosis Hypernatremia, oxygen, partial pressure
Alkalinizer neutralizes excess Alkalosis, GI: Gastric distention, of arterial carbon
acid. Hypocalcemia, belching, flatulence dioxide, and electrolyte
Generic Name: Sodium Severe Pulmonary levels to avoid the risk of
Bicarbonate Edema METABOLIC: alkalosis. Notify
Hypokalemia, physician about the
metabolic alkalosis, laboratory results.
Brand name: Supracid
hypernatremia,
hyperosmolarity with  Monitor laboratory
Dosage/Route/
overdose results as it may increase
Frequency:
sodium levels and may
650 mg/tab BID
decrease potassium and
calcium levels.
 Watch for signs of
metabolic alkalosis and
fluid overload.
 Assess for clinical
improvement of
metabolic acidosis such
as relief from
hyperventilation,
weakness, and
disorientation.
 Monitor daily pattern of
bowel activity and stool
consistency.
POTASSIUM CHLORIDE
Clinical: Potassium The potassium ion To prevent and Severe renal CNS: Paresthesia of  If GI disturbance is
replenisher is in the principle treat potassium impairment; severe limbs, listless ness, noted, dilute preparation
intracellular cation deficit secondary to hemolytic mental confusion, further.
Pharmacotherapeutic: of most body diuretic or reactions; untreated weakness, heaviness of  Be alert to decreased
Electrolyte tissues. It corticosteroid Addison's disease; legs, flaccid paralysis, urinary output which
participates in a therapy. crush syndrome; pain, and fever. may be an indication of
Generic Name: renal insufficiency.
number of early postoperative
Potassium Chloride GI: Nausea, vomiting,  Be alert to evidence of
physiological oliguria (except hyperkalemia such as
diarrhea, abdominal
Brand Name: processes including during GI skin pallor/coldness and
K-lyte distension.
the maintenance of drainage); paresthesia.
intracellular adynamic ileus; Urogenital: Oliguria,  Be alert for potassium
Dosage/Route/ tonicity, the acute dehydration; anuria. intoxication; may result
Frequency: transmission of heat cramps, from any therapeutic
8 meq/tab 1 tab x 4 doses Hematologic: dosage, and the patient
nerve impulses, the hyperkalemia,
BID Hyperkalemia. may be asymptomatic.
contraction of patients receiving
cardiac, skeletal and potassium-sparing Respiratory:  Monitor continuous

smooth muscle and diuretics, digitalis Respiratory distress. ECG and electrolyte
the maintenance of intoxication with levels during therapy.
CV: Arrhythmias,  Report continuing signs
normal renal AV conduction
cardiac arrest, heart of potassium deficit to
function. disturbance.
block, ECG changes, physician: weakness,
and hypotension. fatigue, polyuria, and
polydipsia.
SODIUM CHLORIDE
Clinical: Electrolyte Controls water Treat or prevent Hypersensitivity to Hematologic: (Within  Obtain baseline sodium
distribution, fluid sodium loss any of its 12–24 h of instillation) and chloride levels
Pharmacotherapeutic: and electrolyte components, fluid Coagulation changes; before starting therapy
Electrolyte Supplement balance, and retetention, increased plasma and reassess regularly
maintains acid-base hypernatremia, volume, fibrin levels, thereafter to monitor
Generic Name: Sodium balance hypokalemia thrombin, prothrombin, drug effectiveness.
Chloride and partial
 Monitor VS, especially
thromboplastin times;
BP every hour.
Brand Name: Euromed
Metabolic: Ascites,
 Assess and monitor fluid
hypervolemia,
Dosage/Route/ balance (I&O).
circulation failure,
Frequency:
severe electrolyte  Monitor serum
1g/tab 1 tab BID
disturbances. electrolytes and acid-
base balance.
Urogenital:
hemorrhagic fever,
infection, sepsis.
Respiratory:
Pulmonary embolism.
Systemic: Fever,
flushing, cortical
necrosis of kidneys.
CLONIDINE
Clinical: Stimulates alpha-2- Treatment of Hypersensitivity Overdose produces  Obtain BP immediately

Antihypertensive adrenergic receptors hypertension to Clonidine profound hypotension, before each dose is
in the brainstem, irritability, bradycardia, administered. Be alert
Pharmacotherapeutic: reducing sympathetic respiratory depression, of BP fluctuations.
Alpha 2 adrenergic outflow from the CNS arryythmias, and apnea.
 Notify physician of low
agonist
Abrupt withdrawal may blood pressure,
result in rebound especially if patient
Generic Name:
hypertension associated experiences dizziness or
Clonidine
with nervousness, syncope.
agitation, anxiety,
Brand Name: Clonipress  Report an unusually low
insomnia, paresthesia,
heart rate or signs of
tremor, flushing, and
Dosage/Route/ other arrythmias
diaphoresis
Frequency: including palpitations,
150mg/tab 1 tab TID chest discomfort,
shortness of breath,
fainting, and fatigue.
 Give last dose
immediately before
bedtime to ensure
overnight BP control
and to minimize
daytime drowsiness.
ASPIRIN
Clinical: Anti-platelet Irreversibly inhibits Used as platelet History of CNS: Dizziness,  Monitor patient for
formation of aggregation hypersensitivity to confusion, drowsiness. hypersensitivty
Pharmacotherapeutic: thromboxane, inhibitor in the salicylates reactions such as
Non-steroidal anti- resulting in prevention of stroke including methyl anaphylaxis and asthma.
inflammatory drug inhibiting platelet and MI. salicylate (oil of Special Senses:
 Lab tests: frequent
aggregation. wintergreen); Tinnitus, hearing loss.
Prothrombin Time with
Generic Name: sensitivity to other
GI: Nausea, vomiting, concurrent
Aspirin (acetylsalicylic NSAIDs; patients
diarrhea, anorexia, anticoagulant therapy;
acid) with "aspirin
heartburn, stomach more frequent fasting
triad" (aspirin
pains, ulceration, occult blood glucose levels
Brand Name: Aspilets sensitivity, nasal
bleeding, GI bleeding. with diabetes.
polyps, asthma);
Dosage/Route/ chronic rhinitis; Hematologic:  Assess history of GI
Frequency: chronic urticaria; Thrombocytopenia, bleed and PUD.
80 mg/tab 1 tab OD history of GI hemolytic anemia,
ulceration,  Monitor for salicylate
prolonged bleeding
bleeding, or other toxicity. In adults, a
time.
problems; sensation of fullness in
hypoprothrombine the ears, tinnitus, and
mia, vitamin K Skin: Petechiae, easy decreased or muffled

deficiency, bruising, rash. hearing are the most
hemophilia, or frequent symptoms
Urogenital: Impaired
other bleeding associated with chronic
renal function.
disorders; CHF. salicylate overdosage.
Other: Prolonged
 Do not give if vinegar-
pregnancy and labor
like odor s noted,
with increased
indicates chemical
bleeding.
brekdown.
 Observe and report
signs of bleeding such
as petechiae,
ecchymoses, bleeding
gums, bloody or black
stools, cloudy or bloody
urine.
CITICOLINE
CLASSIFICATION ACTION INDICATION CONTRAINDIC ADVERSE NURSING
ATION EFFECTS RESPONSIBILITIES
Clinical: Increases blood flow Treat stroke Hypertonia of the CV: Bradycardia,  Monitor blood
Psychostimulants and oxygen parasympathetic tachycardia. pressure, pulse and
consumption in the nervous system heart rate.
Pharmacotherapeutic: brain.  Watch out for
Pyrimidine GI: Diarrhoea, hypotensive effect.
ribonucleoside epigastric discomfort,  Assess allergic

diphosphates stomach pain. reaction like GI
disturbances.
Generic Name:  Contact the
Citicoline General disorders physician
and admin site immediately if
Brand Name: Zynapse conditions: Fatigue. allergic reaction
such as hives, rash,
Dosage/Route/Frequen CNS: Dizziness, or itching, swelling
cy: headache. in your face or
1g / IV / q8 hands, mouth or
throat, chest
INTEG: Rashes. tightness or trouble
breathing are
Vascular experienced.
disorders: Hypotensio
n.
CLOPIDOGREL
CLASSIFICATION ACTION INDICATION CONTRAINDI ADVERSE NURSING
CATION EFFECTS RESPONSIBILITIES
Clinical: Antiplatelet Inhibits the binding of To reduce rate of Contraindicated HEMATOLOGIC:  Assess allergy to
Drugs the P2Y12 MI and stroke. to patients Thrombocytopenia, clopidogrel,
component of ADP to hypersensitive to leucopenia, bleeding disorders,
Pharmacotherapeutics: its platelet receptor, drug or its eosinophilia, recent surgery,
Thienopyridine impeding ADP- components, in neutropenia. hepatic impairment,
derivative mediated activation those with a peptic ulcer.
and subsequent history of  Obtain baseline

Generic Name: platelet aggregation, hypersensitivity GI: Diarrhea, chemistry such as
Clopridogel and irreversibly or hematologic abdominal pain, platelet count
modifies the platelet reaction to other dyspepsia, gastric before drug
Brand Name: Clovix ADP receptor. thienopyridines, ulcer, duodenal ulcer, therapy.
and in those with gastritis, vomiting,  Abrupt
Dosage/Route/ pathologic nausea, constipation,
discontinuation of
Frequency: bleeding. flatulence.
drug therapy
75mg/oral/TID
CNS: Headache, produces elevated
paraesthesia, dizziness. platelet count
within 5 days.
Renal and urinary  Monitor platelet
disorders: Haematuria count for signs of
. thrombocytopenia.
 Report any usual
Respiratory, thoracic bleeding.
and mediastinal  Report skin rash,
disorders: Epistaxis. chest pain, fainting,
severe headache,
Skin and
abnormal bleeding.
subcutaneous tissue
disorders: Bruising,
pruritis.
Vascular
disorders: Hematoma.
MOVELAX
CLASSIFICATION ACTION INDICATION CONTRAINDIC ADVERSE NURSING
ATION EFFECTS RESPONSIBILITIES
Clinical: Hyperosmotic Increases fecal bulk, Treatment of Allergy to GI: Transient  Assess for allergy to
laxative softened stools and constipation. lactulose, low- flatulence, distension, lactulose, low-
shortened transit galactose diet, Use intestinal cramps, galactose diet,
Pharmacotherapeutic: time. . cautiously with belching, diarrhea, diabetes.
Lactose derivative diabetes. nausea.  Do not freeze
laxative form.
Generic Name: Hematologic: Acid-  Extremely dark or
Lactulose base imbalances cloudy syrup may
be unsafe; do not
Brand Name: use.
Movelax  Monitor daily
pattern of bowel
Dosage/Route/ activity and stool
Frequency: consistency.
60ml OD  Assess for
abdominal
disturbances.
 Monitor for adverse
drug effects. Report
diarrhea, severe
belching,
abdominal fullness.
 The following side
effects may occur:
abdominal fullness,
flatulence,
belching.
NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION
Subjective Ineffective After 8 hours of Independent After 8 hours of nursing

cerebral tissue nursing interventions,
“Di siya perfusion related interventions, Assessed and monitored To readily detect
nakakapagsalita to clot emboli in the patient’s neurological neurological  Still with no verbal
ngayon sabi ni doc the left frontal lobe ● The patient status every hour. deterioration and output
kasi daw yung of the brain will display provide interventions  GCS 11 (E4 V1 M6)
natamaan yung signs of immediately.  Weak right extremities
speech part sa brain decreased RU: 1
niya. Tapos di niya ineffective RL: 1
maigalaw yung cerebral Monitored vital signs Blood pressure within LU: 4
right side ng tissue every hour, especially the the normal range LL: 4
katawan niya.” as perfusion as blood pressure. promotes adequate  Vital Signs
verbalized by the evidenced cerebral perfusion. BP: 130/90 mmHg
patient’s son. by improved HR: 78 bpm
level of RR: 19 bpm
Objective consciousnes Placed the patient in a Lowers arterial pressure Temp: 37.1 C
s, cognition, neutral position with the by encouraging venous O2Sat: 98%
 With oxygen at and motor head slightly elevated at drainage and may  The patient did not
4 lpm function. least 30 degrees. enhance cerebral demonstrate any
 No verbal perfusion. degradation or relapse
output ● The patient of deficits.
will
 GCS 11 (E4 V1 demonstrate

M6) no further Maintained bed rest, Adequate sleep Goal partially met.
 Weakness of degradation provide a peaceful and supports
right or relapse of soothing environment, neuroplasticity, the
extremities deficits. and limit visits and brain's ability to
RU: 1 activities. restructure and create
RL: 1 new neural connections
LU: 4 in healthy parts of the
LL: 4 brain, allowing stroke
 Vital Signs survivors to re-learn
BP: 140/90 movements and
mmHg functions.
HR: 71 bpm
RR: 16 bpm
Temp: 36. 4 Dependent
C
O2Sat: 99% Administered Aspirin 80
 CT Scan mg tab OD as prescribed. Reduces the tendency
Result: Acute of the platelets in the
ischemic blood to clump together
infarct, left and form clots, and so it
frontal lobe. reduces the patient's
risk of another stroke.
Administered Neurotain For faster recovery of

Plus BID as ordered. post-stroke patients and
improves cognitive
function and memory.
Administered NeuroAid Neuroaid may improve

3 tabs every 6 hours as blood flow in the brain
ordered. and functional recovery
after stroke in patients.
It prevents platelets (a
Administered type of blood cell) from
Clopidogrel 75 mg OD. sticking together and
forming a dangerous
blood clot.
Administered Citicholine
For immediate
1g IV every 8 hours.
treatment of stroke due
to a clot.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective Ineffective After 8 hours of Independent After 8 hours of nursing

peripheral and nursing interventions, the patient
“Nung na-admit siya renal tissue interventions, Monitored vital signs, Vital signs, especially manifested the following:
sa Kalinga, mataas na perfusion related especially blood pressure blood pressure, within
daw yung BP niya to increased  The patient will every hour. the normal range may  Warm to touch
kaya hanggang vascular maintain vital indicate adequate extremities
ngayon minomonitor resistance signs, peripheral tissue  Capillary refill time - 1
pa rin yung BP niya.” especially perfusion. second
as verbalized by the blood pressure  1+ radial and posterior
patient’s son within the tibial pulse
normal range. Monitored intake and A decrease in urine  Intake and Output
output. output could indicate a Day shift (7/12/2022)
Objective  The patient will deterioration in renal Intake - 1240
maintain function due to Output - 300
 With oxygen at 4 maximum decreased renal tissue Net Balance - + 940
lpm. tissue perfusion perfusion.  Vital Signs
 Warm to touch to vital organs, BP: 130/90 mmHg
extremities as evidenced by HR: 67 bpm
 Capillary Refill warm and dry Maintained bed rest and Lessens physical stress RR: 18 bpm
Time - 1 second skin, present schedule uninterrupted and tension that affect Temp: 37.2 C
 1+ radial and and strong rest periods. blood pressure and the O2Sat: 98%
posterior tibial peripheral course of hypertension.
pulse pulses, Goal partially met
 Intake and balanced I&O,
Output (7/11/22) and normal
Night shift
Intake - 995 ABGs and Ensured a low fat, low To help manage fluid
Output - 400 creatinine level. salt diet. retention associated
+ 595 with hypertensive
 Creatinine - 536 response.
umol/L
 Vital Signs
BP: 150/90 Kept the patient warm by Keep the patient warm
mmHg having the patient wear to maintain vasodilation
HR: 74 bpm socks and putting a and blood supply to
RR: 21 bpm blanket over the patient. vital organs.
Temp: 36.9 C
O2Sat: 99%
 ABG Result Dependent
(Metabolic
Acidosis): Maintained oxygen To enhance tissue
pH - 7.32 therapy at 4 lpm as perfusion and increase
PaO2 - 106 ordered. oxygenation to vital
PaCO2 - 27.6 organs.
HCO3 - 13.9
BE - -12.1
SaO2 - 98%
 Hematology Administered Clonidine To lower high blood
Results: 150 mcg/tab TID A.C as pressure.
Decreased ordered.
RBC -
3.92x10^12/L
Decreased Administered To lower high blood
hemoglobin Amlodipine 10 mg/tab pressure.
levels - 119 BID as ordered.
g/L
Decreased
hematocrit Administered Sodium To treat metabolic
levels - Bicarbonate 650 mg/tab acidosis.
0.359% BID as ordered.
Administered Potassium To treat low potassium

Chloride 1 tab x 4 doses levels of the patient.
BID.
Administered Sodium To treat low sodium

Chloride 1g/tab 1 tab levels of the patient.
BID.
Administered To reduce nitrogen

Ketoanalogue 650 intake while preventing
mg/tab TID. the deleterious
consequences of
inadequate dietary
protein intake and
malnutrition.
Administered To increase the flow of

Furosemide 40 mg/IV urine and treat high
every 12 hours as blood pressure.
ordered.
Administer Nicardipine To treat high blood

1 amp + PNSS 90 cc x pressure and to control
30 ugtss/min. angina.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION
Subjective Decreased cardiac After 8 hours of Independent After 8 hours of nursing

output related to nursing interventions,
“Minsan decreased interventions,
nagrereklamo siya na ventricular filling Assessed vital signs Vital signs, especially  The patient’s vital signs
masakit yung dibdib secondary to left  The patient will every hour. blood pressure, is an were within normal
niya, tapos nung last ventricular demonstrate important indicator of range.
friday (July 8, 2022) hypertrophy adequate adequate cardiac BP: 120/80 mmHg
bago siya ma heart cardiac output output. HR: 69 bpm
attack, bigla siyang as evidenced by RR: 18 bpm
nahihirapan huminga vital signs Temp: 37.4 OC
tapos sumasakit daw within normal Reduced cardiac output O2Sat: 99%
Monitored intake and
yung dibdib niya.” as range and results in reduced
verbalized by the adequate
output every shift.  Intake and Output
perfusion of the Day Shift (07/13/22)
patient’s son urinary output kidneys, with a
 The patient will Intake - 1190
resulting decrease in Output - 1100
not manifest urine output.
signs and Net Balance - +90
Objective symptoms of
dyspnea and Assessed and monitored

 Capillary refill chest pain the patient for chest
time - 1 second pain. May indicate an
 Vital Signs evolving heart attack.
BP: 130/90
mmHg Kept patient in a semi-
HR: 78 bpm fowlers position. To decrease oxygen
RR: 18 bpm consumption.
Temp: 37.1
O
C Provided a restful
O2Sat: 98% environment and Minimizing
 I&O encourage periods of controllable stressors
Night Shift rest and sleep. and unnecessary
(7/12/2022) disturbances reduces
Intake - 1030 cardiac workload and
Output - 700 oxygen demand.
Dependent
+330
 1+ radial and
posterior tibial
pulse Administered oxygen
therapy at 4 lpm as To increase oxygen
 ECG Result:: ordered. available for cardiac
Left function.
Ventricular
Hypertophy Administered
ST/T change Furosemide 40 mg/IV To promote urine
secondary to every 12 hours as excretion and control
strain/ ordered. blood pressure.
ischemia
 Chest X-Ray:
Cardiomegaly
Administered Isoket 1 Treatment of

amp in 90 cc PNSS x unresponsive left
30ugtts/min. ventricular failure.
Administered To control the patient's

Nicardipine 1 amp + chest pain and high
PNSS 90 cc x 30 blood pressure.
ugtss/min.
REFERENCES
Ineffective tissue perfusion nursing diagnosis & care plan. RNlessons. (n.d.). Retrieved July 28,
2022, from https://rnlessons.com/ineffective-tissue-perfusion/
Gil Wayne, B. S. N. (2022, May 9). Decreased cardiac output nursing care plan. Nurseslabs.
Retrieved July 28, 2022, from https://nurseslabs.com/decreased-cardiac-output/
Mayfield Brain & Spine. Brain anatomy, Anatomy of the human brain | Mayfield Brain & Spine
Cincinnati, Ohio. (n.d.). Retrieved July 28, 2022, from https://mayfieldclinic.com/pe-
anatbrain.
Blood vessels: Types, anatomy, Function & Conditions. Cleveland Clinic. (n.d.). Retrieved July
28, 2022, from https://my.clevelandclinic.org/health/body/21640-blood-vessel
Cerebrovascular disease. AANS. (n.d.). Retrieved July 28, 2022, from

https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-
Treatments/Cerebrovascular-Disease
U.S. National Library of Medicine. (n.d.). Stroke | CVA | cerebrovascular accident. MedlinePlus.
Retrieved July 28, 2022, from https://medlineplus.gov/stroke.html
Mayo Foundation for Medical Education and Research. (2022, January 20). Stroke. Mayo Clinic.
Retrieved July 28, 2022, from https://www.mayoclinic.org/diseases-
conditions/stroke/symptoms-causes/syc-20350113
Risk factors for stroke. Johns Hopkins Medicine. (2021, November 15). Retrieved July 28, 2022,
from https://www.hopkinsmedicine.org/health/conditions-and-diseases/stroke/risk-factors-
for-stroke

CaseStudy ICU Lim Romias Sison

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University of Saint Louis

Tuguegarao City, Cagayan 3500

NOTE: Underlined statements were present to the patient.

Signs and Symptoms

 Clot-busting medicines (thrombolytics or fibrinolytics). These medicines dissolve the

Name: Patient J.D

HISTORY OF PAST ILLNESS

GORDON’S FUNCTIONAL HEALTH PATTERN

Health Pattern Before Hospitalization During Hospitalization

nung naging normal na kasi yung

Nutritional - The patient has no allergies to Upon admission on July 7, 2022,

poultry every morning and sweeps voiding, eliminating, and

According to his wife, they did not

Value - Belief Pattern Patient J.D is a Roman Catholic Because he is currently

is content with his

COURSE IN THE WARD

DATE AND TIME DOCTOR’S ORDER RATIONALE NURSING

 Secure consent for  To ensure that  Secure consent

 Low salt, low fat To prevent and control  Inform dietary

 Diagnostics:  To detect diseases  Inform the patient

Furosemide 40 mg/IV  To help treat fluid  Observe rights of

Nicardipine drip 1 amp  To treat high  Observe rights of

via soluset and

Zynapse 1g/IV q8  To treat stroke.  Adminster

 Cont:  To continue  Observe rights of

 VS q 2  For baseline data  Monitor vital signs

 I&O q shift  To determine  Monitor intake and

 Refer  To inform the  Refer any

Dr. Arcardama/Dr. M. physician of any and symptoms to

07-11-2022 (1:17  Decrease  To achieve the  Regulated

For Isoket Drip:

 Recheck after  To determine  Assessed vital

7:00 AM  Movelax 60 ml  To treat  Observed rights of

 D: For TSH and  To determine  Informed patient

 Do not give  Blood samples  Endorsed to next

 Start Euthyrox  To treat thyroid  Observed rights of

07-11-2022 (1:30  Start NGT  To prevent  Informed the

 ASA 2 tab now  Indicated for the  Observed rights of

arteries in the  Monitored blood

 Klyte 1 tab 2x a  Used to prevent  Observed rights of

For Nicardipine Drip:

For Isoket Drip:

 Hold Irbesartan  To prevent further  Withhold

 Na, K,  To monitor  Informed the

 Discontinue To prevent  Discontinued

• Ketoanalo  To detour protein  Observed rights of

• NaHCO3  To treat metabolic  Observed rights of

• Repeat  To monitor  Informed patient

7-13-2022 (1:00  NaCl 1g/tab  To prevent  Administered

Date of Assessment: July 13, 2022

- Moisture Palpation Moist Moist Normal

- Texture Palpation Smooth Smooth without Normal

- Color Inspection Same color as Light brown Normal

CLINICAL CHEMISTRY (CK-MB, TROP I)

HEMATOLOGY (CBC PC)

Neutrophils 36-65 % 73 Elevated possibly

Bands 0-5 % 0 NORMAL

TEST REFERENCE UNIT RESULT REMARKS

loss of sodium and