DALLALhead Nurse Autosaved

EMILIO AGUINALDO COLLEGE
School of Nursing
In Partial Fulfillments of the Requirements in N107
NURSING MANAGEMENT
(Intensive Practicum)
DOCUMENTATION IN HEADNURSING
Submitted by:
Delal Ali Abdo
Submitted to:
Ms. Cherylline Mendoza, RN, MAN
Clinical Instructor
(8:00am – 5:00pm)
BSNURSING 4TH Year

TABLE OF CONTENTS
Cover page…………………….……1 Ghant’s Chart…………….…………9
Table of Contents…………………..2 8 hours Nursing Sheet +Patient Requirements of BERNA GOROSPE

Classification Sheet……………...…10
Final Grading …………………………………..17
System+Grades………………..……3 Patient Assignment………..…..……11
Requirements of YUSRA ABDULLAH
Grading of TPR Sheet………..……………...….12 ……………………… ……….…19
Requirements………………………..4 Input/OutputSheet………………..…13 Requirements of RIANE QUIACHON
Daily Requirements Checklist………,, IV Fluids Monitoring Sheet……...,,..14 ………………………….. ………20
…………………..5
Contents of HN (Students) Requirements of ELDON ISIDRO
Attendance Sheet….………………..6 Requirements……………….………15
…………………… ………..……21
Organizational Chart ……….……...7 Requirements of DELIYA ABDU
Schedule of Activities………….…...8 …………………….…..16
School of Nursing
JUNE 23, 2020 (8:00am – 5:00pm)
FINAL GRADE SYSTEM + GRADE
NAME PERFORMANCE REQUIREMENTS QUIZ ATTENDANCE FINAL GRADE
X.10
X.40 X.40 X.10
Abdu deliya 34.8 34.4 8 10 87.2
Berna gorospe 35.2 33.4 8 10 86.6
Yusra Jamal Abdullah 34.4 35.4 9 10 88.8
Riane Quiachon 34.4 29.2 10 10 83.6
Eldon Isidro 34 28.6 8 10 80.6
PERFOMANCE EVALUATION 40%

REQUIREMENTS 40%
QUIZ 10%
ATTENDANCE, GROOMING, 10%
PARAPHERNALIA
TOTAL 100%
Prepared by: Noted by:
Delal Ali Abdo. Cherylline Mendonza, RN, MAN

Student Head Nurse Clinical Instructor
School of Nursing
MARCH 7, 2020 (6:00am – 2:00pm)
REQUIREMENTS QUIZ ATTENDANCE
NAME ATTENDANCE
ENDORSEMENT
SCHEDULE OF
DRUG STUDY
NARRATIVE
ACTIVITES
JOURNAL
REPORT
SHEET
TOTAL
NCP
Abdu deliya 95 89 90 88 77 79 86 8 95
Berna gorospe 96 89 0 89 78 79 83.6 8 95
Yusra Jamal Abdullah 96 90 90 97 78 80 88.5 9 95
Riane Quiachon 95 90 0 96 77 80 73 8 95
Eldon Isidro 95 89 0 89 77 79 71.5 10 95

School of Nursing
JUNE 23, 2020 (8:00am – 5:00pm)
REQUIREMENTS CHECKLIST
NAME JOURNAL SCHEDULE OF NARRATIVE DRUG STUDY NAME JOURNAL

ACTIVITIES REPORT
Abdu, Deliya ali Done Done Done Done Abdu, Deliya ali Done
Berna gorospe Done Done Done Done Berna gorospe Done
Yusra Jamal Done Done Done Done Yusra Jamal Done

Abdullah Abdullah
Riane Quiachon Done Done Done Done Riane Quiachon Done
Eldon Isidro Done Done Done Done Eldon Isidro Done
Prepared by: Noted by

ATTENDANCE SHEET
JUNE 23, 2020 (8:00am – 5:00pm)
ATTENDANCE SHEET
Student Name Time - In Signature Time Out Signature
HEAD NURSE
Abdo, Delal Ali 8:00am 5:00pm
STAFF NURSES
Abdu,deliya ali 8:00am 5:00pm
Berna gorospe 8:00am 5:00pm
Yusra jamal Abdullah 8:00am 5::00pm
Riane Quiachon 8:00am 5:00pm
Eldon Isidro 8:00am 5:00pm
Delal ali abdo Cherylline Mendonza, RN, MAN

JUNE 23, 20 (8:00am –5:00pm)
ORGANIZATIONAL CHART
Head Nurse
ABDO, DELAL ALI
Staff Nurse Staff Nurse Staff Nurse
Staff Nurse
MEDICATION
NURSE
DELIYA BERNA ELDON

YUSRA GOROSPE ISIDRO
ALI ABDU
JAMAL
RIANE
QUIACHON
SCHEDULE OF ACTIVITIES
JUNE 23, 2020 (8:00am – 5:00pm)
TIME ACTIVITIES
8:00am – 9:30am  Sub-group the members and delegation of areas of responsibilities

 Check attendance, gromming
9:30am – 10:30am  Endorsement
10:30am – 11:00am  Pre-conference

 Scan Cases of designated patients
11:00am – 12:30am  Video call with the Headnurse for documention
12:30 am- 1:00 am  Assess patient’s condition

 Check Vital Signs
 Contraption And Record Taking
1:00am – 1:30am  Observe For Drug Reaction
1:30am – 2:30am  Quiz taking
2:30am – 3:00am  Break Time
3:00am –3:30am  Video call for any clarification
3:30am – 4:00am  Assessment of patient’s condition, rendering specific care to designated patients
(ex. CBG)
4:00am – 4:30pm
 Writing Proper Vital Signs based on the paients condition
 Check IVF Level
 Record V/S, IVF rate and I/O
4:30pm- 5:00pm  Evaluate head nurse by the staff
 Post- Conference
Delal ali abdo. Cherylline Mendonza, RN, MAN

5:3 6:0 6:3 7:0 7:3 8:0 8:3 9:0 9:3 10:0 10:3 11:0 11:3 12:0 12:3 1:0 1:3
2:00
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 Sub-group the members and
delegation of areas of responsibilities
 Check attendance, grooming and
paraphernalia
 Endorsement
 Pre-conference
 Scan the chart of the designated
patients
 Medicine preparation for 8 am
 Drug study for the said medication
 Assess patient’s condition
 Check IVF; regulate if necessary
 Take Vital signs
 Record V/S
 Record IVF rate
 Administration of medicine (8:00)
 Perform morning care to patients

 Rendering specific care to designated
patients
 Interview a patient for case study
 Physical assessment, copy patient’s
chart
 Medicine preparation for 12 pm
 Drug study for the said medication
 Break Time
 Assessment of patient’s condition,

rendering specific care to designated
patients (ex. CBG)
 Taking Vital signs
 Check IVF level
 Check I/O results for the entire shift
 Administration of medicine (12:00pm)
 Counter check all the chart and

handled patients
 Evaluate staff nurses’ performance
 Post-Test, Evaluate head nurse by the
staff
 Post-conference
School of Nursing
JUNE 23, 2020 (8:00am – 5:00pm)
8 HOUR NURSING SHEET
CENSUS 5 POST-OP 0
ADMISSION 0 PRE – OP 0
DISCHARG 0
E
TRANSFER 0
TOTAL 5 TOTAL 0
School of Nursing
JUNE 23, 2020 (8:00am – 5:00pm)
PATIENT CLASSIFICATION SHEET
Room No. Patients Name Age Diagnosis Category of Care
110 Mj 53 Spinal cord compression lll
103 Cj 75 T/c urosepsis ll
116 Da 82 Protine energy ll

malnutrition colorectal
mass
120 Jm 27 Acute non complicated ll
cystits
111 Md 34 Cellulitis tattoo. Infection ll
left thigh
CATEGORY I – Self Care or Minimal Care

CATEGORY II – Moderate Care or Intermediate Care
CATEGORY III – Total Complete of Intensive Care
CATEGORY IV – Highly Specialized Critical Care

School of Nursing
JUNE 23, 2020 (8:00am – 5:00pm)
PATIENT’S ASSIGNMENT
Student’s Name Patient’s Name Room Number Diagnosis

Abdu,deliya ali Mj 110 Spinal cord compression
Berna gorospe Cj 103 T/c urosepsis
Yusra jamal Abdullah Da 116 Protine energy malnutrition colorectal

mass
Riane Quiachon Jm 120 Acute non complicated cystits
Eldon Isidro Md 111 Cellulitis tattoo. Infection left thigh

Student Head Nurse Clinical Instructo

School of Nursing
JUNE 23, 2020 (8:00am – 5:00pm)
VITAL SIGNS MONITORING SHEET
Room & Patient’s Name 8am 12pm

Bed No.
BP Temp PR RR BP Temp PR RR
111 MD 120/80 37.5 76 18 130/90 36.9 69 19
116 DA 200/90 36.2 90 18 170/80 36.5 93 15
120 JM 120\80 37.3 87 19 120\80 36.8 85 17
103 CJ 120\80 36.7 85 20 120\80 36.3 80 20
110 MJ 110/60 37.7 82 21 120/70 36.8 78 16


School of Nursing
JUNE 23, 2020 (8:00am – 5:00pm)
INPUT and OUTPUT LOG SHEET
INPUT OUTPUT
Room – Patient’s Name ORAL PARENTERAL TOTAL URINE STOOL OTHERS TOTAL
Bed
Number
111 MD 750 580 1330 500 0 0 500
116 DA 500 168 668 50 0 0 50
120 JM 250 450 700 100 0 0 100
103 CJ 1000 0 1000 200 1x 0 200+1
110 MJ 500 500 1000 800 ML 0 0 800ML

School of Nursing
JUNE 23, 2020 (8:00am – 5:00pm)
IV FLUIDS MONITORING SHEET
ROOM NO. PATIENT’S NAME BOTTLE NO. IVF HOURS TO RUN RATE TIME DATE/TIME AMOUNT RECEIVED LEVEL
STARTED FROM ENDORSED TO
(GTTS/MIN) NEXT SHIFT
LAST SHIFT
111 MD 1 D5NR 12 HR 13gtts/min 8AM 23\06\20 585cc 253cc
116 DA 1 PNSS KVO 42gtts/min 8am 23\06\20 KVO KVO
120 JM 15 PNSS 40CC\HR 28gtts\min 10 am 23\06\20 640 419
103 CJ HL HL HL HL HL 23\06\20 ----- ------
110 MJ 7 D5LR 8 HR 31gtts\min 8AM 23\06\20 375cc 875cc

Requirements of head nurse (students)
1) Attendance
2) NCP
3) Quizz
4) Drug Study
5) Journal with reflection
6) Narrative report
7) Endorsement sheet
8) Schedule of activity
Requirements of YOUSRA ABDALLA 16-1-21380
TIME ACTIVITIES



3:30am – 4:00am  Assessment of patient’s condition, rendering specific care to designated patients
(ex. CBG)
4:00am – 4:30pm

 Check IVF Level
DRUG STUDY
NAME:_Abdalla yousra _ DATE: _23/06/2020________
STUDENT #:_16-1-21380________ Pt name: D. A Age:82 Gender: Female Dx: Protein Energy malnuturtion
Generic Name: Classification and Indication: Mechanism of Action: Contraindications: Side Effects: Nursing Considerations
Category:
chlorthalidone Management of mild Increases excretion of Hypersensitivity (cross- dizziness, - Monitor BP, intake, output,
to moderate sodium and water by sensitivity with other drowsiness, and daily weight and assess
Brand Name: hypertension. inhibiting sodium thiazides or sulfonamides lethargy, feet, legs, and sacral area for
Thalitone Treatment of edema reabsorption in the distal may exist); Some hypotension, edema daily.
A. Chemical: associated with: HF, tubule. Promotes excretion products contain muscle cramps,
Dosage: 100mg - Assess patient, especially if
Renal dysfunction, of chloride, potassium, tartrazine and should be nausea, vomiting.
thiazide diuretics Cirrhosis, magnesium, and avoided in patients with taking digitalis glycosides, for
anorexia, nausea, vomiting,
Glucocorticoid bicarbonate. May produce known intolerance;
therapy, Estrogen arteriolar dilation Anuria; muscle cramps, paresthesia,
Route: PO
and confusion. Notify
B. Therapeutic: therapy. Lactation:Lactation.
physician or other health
antihypertensives, care professional if these
Frequency: OD diuretics Adverse Reactions: signs of electrolyte
imbalance occur. Patients
hypokalemia,
taking digitalis glycosides are
dehydration,
Pharmacokinetics: C. Pregnancy at risk of digitalis toxicity as a
pancreatitis,
Category: B result of the potassium-
Onset: 2 hr hypercholesterole
depleting effect of the
mia.
diuretic.
Duration: 48–72 hr
- Assess patient for allergy to
Half-life: 35– 50 hr
sulfonamides
Peak: 2 hr
- Monitor BP before and
periodically throughout
therapy.
Source DRUG HANDBOOK
DRUG STUDY
NAME:_Abdalla yousra _ DATE: _23/06/2020________
Category:
Monitan CNS: fatigue, headache, Give medication as
dizziness, insomnia, ordered monitor the BP
Brand Name: - Hypertension Contraindicated in depression Q1 watch out for
- Ventricular patients with persistent
Acebutolol HCL Unknown. Possible hypersensitivity
arrhythmias severe bradycardia, CV: chest pain, edema,
A. Chemical: mechanism include
Dosage: second and third degree bradycardia, heart
reduced. Cardiac heart blockz overt failure, hypotension
Antiarrhythmic/
400mg output, decreased
antidysrhthmic cardiac failure, and
sympathetic outflow to cardiogenic shock. GI: nausea,
Route: po peripheral vasculature, constipation, diarrhea,
ans inhibition or renin dyspepsia, flatul6,
B. Therapeutic: release. Drugs decrease vomiting
myocardial contractility
Frequency: TID Antihypertensive and heart rate has mild GU: dysuria, impotence,
intrinsic no turia, urinary
sympathomimetic frequency
C. Pregnancy Category: D activity
Musculoskeletal:
arthralgia, myalgia
Respiratory: dyspnea,
bronchospasm, cough
Skin: rash
Adverse Reactions:
Source DRUG HANDBOOK

NURSING CARE PLAN
NAME:_Abdalla Yousra__ PATIENT NAME: _D.A____________________ AGE: 49__ DATE: 06/23/2020____
ASSESSMENT NURSING DIAGNOSIS PLANNING NURSING INTERVENTION RATIONALE EVALUATION

Subjective: Nutrition imbalanced less After 3 hours. of nursing Independent: Identify 3 hours. of nursing
than body requirements interventions, the client interventions, the client
none • 
related to loss of appetites will be able to maintain will be able to maintain
usual weight. After 3 hours. Of nursing  Little food can reduce usual weight.
intervention s, the client will be able
Objective: to maintain usual weight. 
“Nagsusuka ako” as verbalized by input.

patient.
V/S: deficiencies,
Objective:
T- 36.5 suspect the
PR- 80 • Hyperactive bowel possibility of
RR- 15 sounds. intervention.
BP- 170/80 • Pale conjunctiva Observing caloric
SPO2- 95% and mucus membrane. intake / lack of
• quality food
Avoid foods that might cause or consumption.
exacerbate abdominal cramping like
caffeinated beverages, chocolate, vulnerabilities
orange juice.
and increase
•
input also
7Might increase abdominal
cramping. prevents gastric
Independent: distention.
Increased
appetite and oral
 Eliminate smells from the

environment.
 Measure abdominal girth.
 Provides quantitative
evidence of changes in
gastric or intestinal
distention. Hypovolemia,
fluid shifts and nutritional
deficits contribute to poor
skin
 Observe skin or mucous

membrane dryness, and
turgor. Note peripheral
edema
 Nutrition imbalanced less
than body requirements
related to nausea and
vomiting.
SOURCE : NANDA BOOK

23-6-2020
JOURNAL
16-1-21380
Protein energy malnutrition, nutritional intervention and personalized cancer care

Abstract
Cancer patients often experience weight loss caused by protein calorie malnutrition (PCM) during the course of the disease or treatment. PCM is expressed as severe if the
patient has two or more of the following characteristics: obvious significant muscle wasting, loss of subcutaneous fat; nutritional intake of <50% of recommended intake
for 2 weeks or more; bedridden or otherwise significantly reduced functional capacity; weight loss of >2% in 1 week, 5% in 1 month, or 7.5% in 3 months. Cancer
anorexia-cachexia syndrome (CACS) is a multifactorial condition of advanced PCM associated with underlying illness (in this case cancer) and is characterized by loss of
muscle with or without loss of fat mass. Cachexia is defined as weight loss of more than 5% of body weight in 12 months or less in the presence of chronic disease. Hence
with a chronic illness on board even a small amount of weight loss can open the door to cachexia. These nutritional challenges can lead to severe morbidity and mortality in
cancer patients. In the clinic, the application of personalized medicine and the ability to withstand the toxic effects of anti-cancer therapies can be optimized when the
patient is in nutritional homeostasis and is free of anorexia and cachexia. Routine assessment of nutritional status and appropriate intervention are essential components of
the effort to alleviate effects of malnutrition on quality of life and survival of patients.
Keywords: malnutrition, cancer therapy, chemo treatment, biomarkers, nutritional intervention
Go to:
INTRODUCTION
Protein-Calorie Malnutrition (PCM) refers to a nutritional status in which reduced availability of nutrients leads to changes in body composition and function [ 1]. Disease-
associated malnutrition is a common problem among patients with cancer, affecting more than 50% of patients with certain cancers (e.g., pancreas, esophageal,
gastrointestinal, and head and neck cancers). Acute and chronic inflammation play a major role in the pathogenesis of cancer-related malnutrition [ 2]. Altered nutritional
status may be due to increased nutrient requirements of the tumor, changes in host metabolism induced by tumor or due to side effects of aggressive anti-cancer therapies
[3]. PCM in cancer patients is caused by several factors including loss of appetite, altered taste, and smell, physical inability to ingest food and metabolic alterations
including insulin resistance, glucose intolerance, energy imbalance and increased lipolysis and proteolysis. These factors are influenced by the type of cancer, local tumor
effects, the anticancer therapy being employed, and psychosocial response to therapy [4, 5].
Weight loss in cancer patients is often characterized by loss of muscle mass and adipose tissue which is different from starvation induced weight loss [ 6]. If left untreated,
it often progresses to severe wasting associated with cancer anorexia-cachexia syndrome (CACS). CACS, a condition of advanced PCM, is a major paraneoplastic
syndrome characterized by metabolic abnormalities and loss of skeletal muscle with or without loss of adipose tissues. Anorexia, clinically defined as a loss of appetite or
desire to eat is present in 15-20% of cancer patients at diagnosis, and is a common side effect in individuals with metastatic disease [ 7]. Anorexia is a major component of
cachexia.
Cancer cachexia is clinically categorized by severe loss of skeletal muscle and overall - body mass due to metabolic alterations and advanced malnutrition. Cachexia is
defined as weight loss of more than 5% of body weight in 12 months or less in the presence of chronic illness; cachexia is also defined as a body mass index (BMI) less
than 20 kg/m2 accompanied by three of following criteria: decreased muscle strength, fatigue, anorexia, low fat-free mass index, increased levels of C-reactive protein or
IL-6 and low serum albumin [8]. The European Society for Clinical Nutrition and Metabolism (ESPEN) identifies pre-cachexia in cancer patients as unintentional weight
loss of 5% within six months [7]. The underlying mechanisms of CACS are currently under extensive investigations and there are no clinically available biomarkers that
would identify patients who are at a high risk of developing CACS.
Nutrient intake in cancer patients is also affected by abnormalities in gastrointestinal (GI) tract functions due to anticancer therapies. Commonly found symptoms involved
in GI tract problems include nausea, vomiting, constipation and diarrhea. Tumor-associated and therapy-associated pain and fatigue also adversely affect nutrient intake
[9]. The extent and range of symptoms varies among patients, and there are no readily available clinical methods to identify patients who are more likely to develop serious
complications. The American Society for Parenteral and Enteral Nutrition (ASPEN), the American Dietetic Association, and ESPEN suggest that physicians begin
nutritional support in malnourished patients and in patients who may have difficulty eating [10–12]. The National Comprehensive Cancer Network (NCCN) suggests
treating malnutrition in patients with life expectancies measured in months to years but not in patients with shorter life expectancies [ 12]. Here, we provide a
comprehensive overview of factors affecting nutrient intake in cancer patients with a focus on nutritional support available for undernourished patients; we discuss
promising biomarkers under investigation that may be used to identify patients who are likely to develop severe nutritional complications.
Go to:
TUMOR-INDUCED MOLECULAR CHANGES ASSOCIATED WITH CACS

The beginnings of malnutrition in cancer patients can be traced to molecular changes induced by tumor-host interactions (Figure (Figure1).1). Tumor cells have an
elevated requirement for nutrients compared to normal tissues. Mobilization of metabolites by tumor, aimed at supporting its growth has a systemic effect on metabolism at
the whole organism level which leads to the onset of CACS [13]. CACS occurs as a result of a number of factors including mechanical changes due to the tumor location,
systemic inflammation resulting in altered catabolism, and anorexia and neuroendocrine changes occurring due to tumor presence. Skeletal muscle and fat loss in cancer
patients caused by decreased protein synthesis, increased protein degradation, and increased lipolysis are not readily reversed through conventional nutritional support [ 14,
15]. Increase in circulating inflammatory cytokines is implicated in regulating metabolic responses leading to both cachexia and associated anorexia [ 16].
Figure 1
Tumor induced changes in different organs leading to the development of CACS
CACS is a multi-organ syndrome promoted by different factors secreted by tumor like cytokines and Lipid Mobilizing Factor (LMF). These factors induce changes in
metabolic pathways and variations in appetite ultimately leading to loss of skeletal muscle mass.
Anorexia
Cancer anorexia involves alterations in signaling pathways modulating energy intake mediated by hormones (e.g., leptin), neuropeptides (e.g., Neuropeptide Y [NPY]),
inflammatory cytokines (e.g., interleukin-1 [IL-1], interleukin-6 [IL-6], tumor necrosis factor-alpha [TNF- α], and neurotransmitters (e.g., serotonin and dopamine) [ 17].
Peripheral signals including hormones and inflammatory cytokines being sent to the arcuate nucleus of hypothalamus cause variations in the balance of appetite stimulating
neurotransmitters (e.g., NPY and Agouti Related Peptide [AGRP]) or appetite inhibiting neurotransmitters (Opiomelanocortin and Cocaine Amphetamine Related Factor
[18]), which alter food intake [19, 20]. It has been reported that in patients with CACS, the melanocortin system is persistently activated [9]. Frequently used tools to
diagnose anorexia in cancer patients such as the Functional Assessment of Anorexia/Cachexia Therapy (FAACT) and the North Center Cancer Treatment Group (NCCTG)
questionnaire are based on assessments of appetite and appetite related symptoms. However, anorexia is often under diagnosed, and the associated advancement of
malnutrition effects become distinguishing features of cachexia [7].
Inflammatory responses
Pro-inflammatory cytokine activity increases during cancer progression, and systemic inflammation is the hallmark of cancer cachexia indicated by production of acute-
phase response (APR) proteins such as C-reactive protein and fibrinogen. Increased production of APRs could result in a higher requirement for amino acids compensated
by increase in muscle catabolism [21]. Cachexia often appears with anorexia as a result of imbalances between pro-inflammatory (e.g., TNF-α, IL-1, IL-6, interferon-
gamma [IFN-γ]) and anti-inflammatory cytokines (e.g., interleukin-4 [IL-4], interleukin-12 [IL-12], interleukin-15 [IL-15]) [7]. Pro-inflammatory cytokines such as TNF-
α, IL-1, IL-6, and IFN-γ are transported across the blood-brain barrier, and they interact with brain endothelial cells causing release of substances that affect appetite
(Figure (Figure1).1). These cytokines alter metabolic pathways in muscle, liver, and adipose tissue, which collectively contribute to cancer cachexia [ 22]. TNF-α has been
implicated in wide range of cachexia- associated mechanisms including protein and lipid synthesis and degradation, gluconeogenesis and expression of Uncoupling
proteins. It promotes skeletal muscle wasting by activating the NF-κB pathway [23]. Circulating levels of IL-6 has been shown to be elevated in cachectic cancer patients
and it can activate signal transducer and activator of transcription3 (STAT3) which is known to be involved in muscle wasting [24]. Leukemia inhibitory factor, a member
of IL-6 family, has also been implicated in pathogenesis of cachexia [25]. However, unlike anorexic patients, cachectic patients have both low leptin (inhibits appetite)
levels and high ghrelin (stimulates appetite) levels [26, 27].
Metabolic alterations
Increased resting energy expenditure and a wide range of metabolic activity from hypo- to hypermetabolism have been reported in cancer patients [ 28]. Hypermetabolism
in malnourished patients contributes to a negative energy balance, which manifests in weight loss. Resting energy expenditure has been shown to vary by tumor type.
Gastric and colorectal cancer patients tend to have normal resting energy expenditure, while pancreatic and lung cancer patients have higher resting energy expenditure
[29]. The increase in resting energy expenditure experienced by lung cancer patients is generally the result of a systemic inflammatory response
MANAGEMENT FOR NUTRITION-RELATED COMPLICATIONS

Adequate calorie and nutrient intake is imperative for the management of cancer-related symptoms and adverse effects of treatment. In general, the most highly
recommended diet for cancer patients is a high calorie, high protein diet that includes a wide variety of fruits, vegetables, and proteins, and is low in saturated fats, but high
in monounsaturated fats. Aggressive efforts should be made to ensure that patients continue to consume foods that are high in calories and protein to meet their nutritional
needs throughout the course of their treatmen
REFERENCES
1. Marshall S. Protein-energy malnutrition in the rehabilitation setting: Evidence to improve identification. Maturitas. 2016;86:77–85. [ PubMed] [Google Scholar]
2. Jensen GL, Compher C, Sullivan DH, Mullin GE. Recognizing malnutrition in adults: definitions and characteristics, screening, assessment, and team approach. JPEN J
Parenter Enteral Nutr. 2013;37:802–7. [PubMed] [Google Scholar]
3. Nitenberg G, Raynard B. Nutritional support of the cancer patient: issues and dilemmas. Crit Rev Oncol Hematol. 2000;34:137–68. [PubMed] [Google Scholar]
REFLECTION PAPER :
. Protein–energy malnutrition (PEM), sometimes called protein-energy undernutrition (PEU), is a form of malnutrition that is defined as a range
of pathological conditions arising from coincident lack of dietary protein and/or energy (calories) in varying proportions. The condition has mild,
moderate, and severe degrees. lthough protein energy malnutrition is more common in low-income countries, children from higher-income countries are also affected,
including children from large urban areas in low socioeconomic neighborhoods. This may also occur in children with chronic diseases, and children who are
institutionalized or hospitalized for a different diagnosis. Risk factors include a primary diagnosis of intellectual disability, cystic fibrosis, malignancy, cardiovascular
disease, end stage renal disease, oncologic disease, genetic disease, neurological disease, multiple diagnoses, or prolonged hospitalization. In these conditions, the
challenging nutritional management may get overlooked and underestimated, resulting in an impairment of the chances for recovery and the worsening of the situation. [15]
PEM is fairly common worldwide in both children and adults and accounts for 6 million deaths annually. [2] In the industrialized world, PEM is predominantly seen in
hospitals, is associated with disease, or is often found in the elderly. [2]
The general explanation of increased infectious comorbidity in malnourished people is that (1) the immune system is what prevents such diseases from being more
widespread in healthy, well-nourished people and (2) malnutrition stresses and diminishes immune function. In other words, malnutrition tends to cause (mild or moderate)
immunodeficiency, eroding the barriers that normally keep infectious diseases at bay. For example, this reversal is well established regarding the variable natural history
of tuberculosis in the pre–TB drug era. Epidemiologically, there are also associations between malnutrition and other health risks via the common underlying factor of
poverty. For example, condoms can reduce spread of HIV, but impoverished people often may not have money to buy condoms or a nearby place to buy them. Also, once
a poor person has any particular infection, they may not have access to optimal treatment of it, which allows it to get worse, present more chances of transmission, and so
on. Even when a developing country nominally/officially has national health insurance with universal health care, the poorest quarter of its population may face a de facto
reality of poor health care access.
Abdalla Yousra jamal
16-1-21380
06/23/2020
Narrative Report
Today is my first day in utilizing the online RLE in head nursing. The head nurse for today was dalal and cyrl. I got assigned to dalal to be one of her
functional staffs. At exactly 8 in the morning we began our video conference. Ma’am Mendoza, our clinical instructor in head nursing, gave us a brief orientation
on what should be the expected outcome of our online RLE. She wants us to see as if we’re at the actual hospital having our duty. Dalal , organized a plan of
activities and assigned us to our patients. Our head nurse instructed us to do the requirements until 5 pm. My paient was brought to hospital to the hosptail
before yestday 21/6/2020 morning due to weekness and pain at the rectum but he was not complaining of pain during my shift, My patient was 82 with protein
energy malnutrition Colorectal mass/ hypertention as well morning his bp was high then the doctor imdiatly precriped Acebutolol 400 po tid in the afternon my
patient’s bp was 170/80 RR-15 t-36.5c 02 95% so my nursing probem was to fcous on his loss of appetites his weight 1 month before was 90kg since he loss of
apptities he lost intreset eating and was 60kg, at 8am my goal was to make my client to consume atleast 50% of breakfast lunch and dinner but she only ate half
amount (Rise and ½ of the banana) at 1:30 we had our quiz given by HN dalal at At 3 pm we resumed our video conference to present our gathered data and we
ended at 5 pm.
Endorsement Sheet
R Vital Sign Intake and Output

O Diagnosis Diet Medications 8am 12NN Intake Output
O
M
1 Name of Patient: Protein Energy Soft diet Chlorthalidone BP T PR RR BP T PR RR O P TOTAL U S V D O TOTAL
1 D.A malnuturtion 50mg PO OD 200/9 36.2 90 18 170/ 36.5 93 15 500C 168C 668cc 50C 0 0 0 0 50
6 0 80 C C C
Age: 82 Food Allergies : cheese Acutolol 400mg PO
TID 02=9 02=
Gender: f 5% 95%
IVF SPECIAL ENDORSEMENT NURSING PROBLEMS
PNSS 1L x KVO Nutrition imbalanced less than body requirements
CREDIT = 876 related to loss of appetites
DUE:3 PM
Attending Physician:
42 GTTS/MIN
Quiz
1. Air way breathing cirulation solution 1 200ml / 120min x 20 gtt/ml = 33gtts/min

2. Assess
3. Treatment
4. Abdomen
5. Activity daily living
6. Complain of
7. --
8. -
Requirements of ELDON VINCE Endorsement Sheet
Vital Sign Intake and Output

Room# Diagnosis Diet Medications 8am 12NN Intake Output
Name of Patient: DX: BP T PR RR BP T PR RR O P TOTAL U S V D O TOTAL
120 Fosfomycin 1 120/8 37.3 87 19 120/8 36.8 85 17 400c 400 800cc 600cc 1 0 0 0 600cc
JM NKA
Acute non packet 3g PO 0 0 c cc 1
stool
complicated OD
cystitis
Age: hyperkalemia
27 secondary to
DAT
GI losses IVF SPECIAL ENDORSEMENT NURSING PROBLEMS
Trimethoprim Urinalysis Pain Relief
100 mg PO Q12 1L PNSSx12 hours
DUE 10pm Cystoscopy
Gender:
M CC: fever
BP T PR RR BP T PR RR O P TOTAL U S V D O TOTAL

QUIZ:
1. Airway breathing circulation

2. Assessment
3. Treatment
4. Abdomen
5. Activities of daily living
6. Care of
7. .
8. .
9. 33gtts/min
10. 50gtts/min
Narrative Report
Today is our second day in online head nursing, I almost got late today, because I had a hard time sleeping last night. For this second day of head nursing our Clinical
Instructor to have 2 meetings which means one head nursing group for the morning and a different head nursing group in the afternoon. After learning that I learned
that there is gonna be a time pressure for us in which we need to move faster and complete the requirement faster. So far everything went well and everyone was
handling it well. After the 2 post conferences, our Clinical said that tomorrow is gonna be our rest day and a day to complete our requirements.
Prevention of Cystitis: Travelling between the Imaginary and
Reality
Vecchio M. · Iroz A. · Seksek I.
Cystitis is the most common lower urinary tract infection (UTI). It is a bacterial contamination of the bladder representing one of the most common
infectious diseases in women, and the second most common cause of antimicrobial medicine prescriptions in primary and secondary care [1, 2].
The lifetime risk of developing cystitis has been estimated to be over 50% in women [3], with at least one third of the episodes diagnosed before the age of
24 [4]. Approximately 5% of women with initial cystitis have multiple episodes within a year; a high recurrence rate, ranging between 25 and 30%, has
been shown to affect the entire female population [5, 6]. As cystitis is not a reportable disease, doctors do not necessarily report cases to local health
officials, and this makes cystitis frequency in many countries difficult to measure.
Cystitis is a source of significant cost and morbidity. Most episodes are self-limiting but occasionally can be associated with significant complications such as
pyelonephritis and sepsis. Composite data revealed that overall expenditures for the treatment of UTIs in women in the United States, excluding spending
on outpatient prescriptions, were approximately 2.47 billion U.S. dollars in 2000 [7]. Moreover, UTI accounts for approximately 15% of all antibiotic
prescriptions written [8], and concerns are rising due to its direct correlation with the development of antimicrobial resistance.
There are multiple reasons to prevent cystitis in women. The foremost is to reduce morbidity associated with the infections, which are often related to pain
and general discomfort. Besides, the prevention of cystitis can potentially reduce the use of antibiotics in these subjects [9]. This reduction is particularly
relevant in 3 ways. First, Escherichia coli, the primary causative agent of uncomplicated cystitis, gains increased resistance to a variety of antibiotics, including
fluoroquinolones and β-lactams. This resistance is increasingly observed among community-acquired UTI cases [10]. Second, there can be a significant
impact of short courses of antibiotics on the gut and vaginal microbiota, which can contribute to recurrence and antibiotic resistance [11]. Third, there are
risks associated with antibiotic use, including allergic reactions, side effects, and vaginal candida infections, which occur in up to 22% of women treated for
uncomplicated cystitis [12].
Non-pharmacologic antimicrobial-sparing strategies that prevent recurrent cystitis in premenopausal women generally include education about risk factors
such as sexual intercourse and usage of spermicidal products. Lifestyle changes, including urination as often as needed (especially after intercourse),
properly washing the vulvovaginal area, and drinking plenty of water are often suggested [13-16]. However, none of these recommendations has been
scientifically validated. While the use of daily antibiotics or post-coital antibiotics is effective, the rise of bacterial resistance has made these strategies less
attractive. Different approaches have been proposed, including the use of probiotic lactobacillus, functional foods, and vaccines [9]. Although promising,
existing data for prevention of UTI using lactobacillus are to date insufficient and await further validation [17, 18].
The most studied functional foods thus far have been cranberries and their extracts. Some years ago, a Cochrane review of cranberry research evaluated 24
studies with a total number of 4,473 participants [19]. Meta-analyses found that (compared to placebo, water, or no treatment) cranberry products did not
significantly reduce the occurrence of symptomatic UTI in the entire sample (relative risk [RR] 0.86, 95% CI 0.71–1.04) or for any of these subgroups:
women with recurrent UTI (RR 0.74, 95% CI 0.42–1.31); older women (RR 0.75, 95% CI 0.39–1.44); pregnant women (RR 1.04, 95% CI 0.97–1.17);
children with recurrent UTI (RR 0.48, 95% CI 0.19–1.22); cancer patients (RR 1.15 95% CI 0.75–1.77); or people with neuropathic bladder or spinal injury
(RR 0.95, 95% CI 0.75–1.20). Due to these results, no recommendation can be made regarding the consumption of any cranberry-based product [20].
Abundant fluid intake may prevent recurrent episodes of infection by promoting the passage of urine and flushing of the urethra. Health care providers often
recommend that women affected by recurrent cystitis drink more water. The rationale for this approach is that drinking more fluid increases voiding
frequency, resulting in the dilution and flushing of bacteria from the urothelium. As such, increasing fluid intake increases the frequency and volume of
voiding, and potentially reduces the risk of recurrent cystitis. Support for this hypothesis exists in a multivariate analysis that compared 791 female
teachers, who deliberately restricted their fluid intake, to women drinking without restrictions. This study found that women in the fluid restricted group
were at a significantly higher risk of UTI (p = 0.0002) than women in the latter group [21]. A separate study of 1,613 women evaluated the frequency of
voiding as a factor in the development of UTI [22]. Results of this study demonstrated that women aged 20–25 had a higher rate of low voiding frequency,
compared to women aged 30–35 or 40–45. In all 3 groups, women who voided 3 times or less per day had significantly more urinary infections than those
with 4 or more voids per day. Several other nonrandomized studies have reported that low fluid intake or reduced number of daily voids were associated
with an increased risk of recurrent infections in women having a history of UTI [23-27]. Conversely, 3 studies found no difference in fluid intake between
women with recurrent infections and controls; also, no association was observed between fluid intake and UTI [28-30]. Thus, the interpretation of the
results is inconclusive due to the lack of randomization, small sample sizes, and the fact that none of these studies were designed as interventions to assess
the effect of increased water intake on UTIs.
To this date, the only published interventional study showed that optimal hydration assessed by self-measurement of urine specific gravity resulted in a
reduced frequency of cystitis [31]. However, because fluid intake was not assessed in this study, these results are not definitive.
Women who consume a low volume of total fluid each day are usually reluctant to increase their water intake due to the consequent increase in the number
of voids. In the sample of teachers observed in 1997 (see above), Nygaard and Linder [21] showed that 25% of women voluntarily self-imposed fluid
restriction to decrease their voiding frequency. Similarly, Su et al. [26] showed that cleanroom workers limited their water intake and avoided the bathroom
because of a short break-time, and the special toilet procedures required to maintain a clean workplace environment. Increased fluid intake seems to be
perceived as a burden for women even in an unrestricted work environment. An increased number of voids and nocturia is perceived as a barrier to normal
daily activities and as impediments to developing healthy lifestyle habits. However, the quality of life of women with a high fluid intake has never been
assessed systematically and should be further evaluated.
REFLECTION:
In my own opinion, relevant and accurate information about the prevention of cystitis is lacking in the scientific literature and well-designed intervention studies are needed.
Given this unmet need, we stress the necessity of a well-designed randomized controlled trial, powered to assess the effects of increased water intake on cystitis. Water,
which is widely available and unassociated with adverse effects, may someday provide doctors with further motivation to strongly encourage increased water intake for the
prevention of recurrent cystitis in women.
DRUG STUDY
NAME:_______ISIDRO, ELDON VINCE________________________________ DATE: _____6-23-20_________
STUDENT #:____16-1-41178______________
Category:
Fosfomycin For infection in the It inhibits the 1st stage of Hx of hypersensitivity to Nausea Administer fosfomycin 1 hour
thrometamine urinary tract intracellular bacterial cell the drug. or 2 hours before meals.
wall synthesis by Fatigue
Brand Name: peptidoglycan synthesis. WOF signs of allergic reaction
Headache or hypersensitivity to the
Monurol D. Chemical: drug.
Constipation
Dosage: Phosphonic acid
3g/packet
Route: E. Therapeutic:
Adverse Reactions:
PO Urinary antiseptics
Vestibular loss
Frequency:
Impaired hearing
OD F. Pregnancy
Category: Metallic taste
Pharmacokinetics:
B
Peak: 4hrs
Duration: 10-14hrss
MIMS PHILIPPINES 2019
DRUG STUDY
NAME:___Eldon Vince Isidro____________________________________ DATE: ___6-23-20___________
STUDENT #:_______16-1-41178___________
Category:
Trimethoprim For treatment of Is a reversible inhibitor of Hx of hypersensitivity to Vomiting WOF signs of any allergic
infection dihydrofolate reductase, it the drug and drug reaction of the patient to
Brand Name: inhibits the conversion of allergic reaction. Nausea the drug.
Zithromax bacterial dihydrofolic acid Headache
to tetrahydrofolic acid. Always administer the
G. Chemical: correct dosage of the drug
Dosage: Confusion
Trimethoprim and to the patient.
100mg derivatives
If allergic reaction occur
Route: discontinue.
PO H. Therapeutic: Adverse Reactions:
Frequency: Antibiotics Thrombocytopenia
Q12 Megaloblastic
anemia
Pharmacokinetics: I. Pregnancy
Category: Leucopenia
Onset: unknown
C
Peak: 1-4hrs
Duration: 24hrs
MIMS PHILIPPINES 2019
NURSING CARE PLAN
NAME:___ISIDRO, ELDON VINCE_____________________ PATIENT NAME: ____JM_______________________ AGE: __27____ DATE: __6-23-20____
STUDENT #:____16-1-41178______________ DIAGNOSIS: ________Uncomplicated Cystitis Hyperkalemia secondary to GI Losses__________________ GENDER:____M_________
Subjective: After 8 hours of nursing  Advice the relative to note the  This is for the nurse After 8 hours of nursing intervention the
to determine which
“Kokonti lang iniihi ko” as intervention the patient will be color, odor, consistency and patient was not able to show signs of
verbalized by the patient. Impaired Urinary elimination appropriate action to
able to show signs of frequency of urine. improve in volume of urine.
perform.
r/t decreased urine output as
improvement in volume of urine  Instruct the patient to lessen  To avoid kinking of
The goal was not met.
evidenced by dysuria the foley catheter
from 600ml-1L moving frequently.
 To prevent
Objective:
 Instruct patient to try to
accumulation of
-restlessness
urinate every 1-2 hours. urine thus limiting
-dysuria the number of
 Administer medications as
-irritability bacteria.
prescribed by the doctor.
 To prevent infection
-bipedal edema
 Refer to medical technologist.  For urinalysis
NANDA
Requirements of RIANE QUIACHON

DRUG STUDY
NAME:_Riane Marie S. Quiachon_____ PATIENT DIAGNOSIS: Cellulitis, Tattoo Infection DATE: _June 23, 2020__
Category:
Ceftriaxone =Treatment of skin and =Bind to the bacterial cell wall =Hypersensitivity =Headache =before administration, check
skin structure infections that causes cell death. records if there are any
Brand Name: caused by susceptible Bactericidal action against =Renal impairment =diarrhea allergies to cephalosporins.
organisms. susceptible organism.
Rocephin =patients with poor =nausea =Obtain specimens for culture
J. Chemical: nutritional status and sensitivity before initiating
Dosage: =vomiting
therapy. First dose may be
Third generation
1g/50ml given before receiving results.
cephalosporins
Route: =Assess the Infection. Noting
the appearance, color,skin and
IV size)
K. Therapeutic:
Frequency: Anti-infectives Adverse Reactions:
Q12 =seizures
L. Pregnancy Category: =rashes

B
=thrombocytopenia
=vaginal monilliasis
=hemolytic anemia
STUDENT #:_16-1-11093____
DRUG STUDY
NAME:_Riane Marie S. Quiachon_____ PATIENT DIAGNOSIS: Cellulitis, Infected Wound DATE: _June 23, 2020__
STUDENT #:_16-1-11093____
Category:
Acetaminophen =for fever and for mild = inhibits the synthesis of =hypersensitivity =nausea and =Assess overall health status
pain prostaglandins that may vomiting and alcohol usage before
Brand Name: =products with alcohols,
serve as mediators of pain administering
and fever, primarily in the saccharine or tartrazine. acetaminophen.
Acephen
M. Chemical: CNS. =hepatic/renal disease
Dosage: =asses fever;note the
Adverse Reactions: presence of associated signs
500mg (diaphoresis,tachycardia and
=urticaria malaise)
Route:
N. Therapeutic: =rashes =instruct the patient to avoid
PO
Antipyretics,nonopio alcohol use when taking the
=neutropenia
Frequency: d analgesics medication because it may
=leukopenia increase the possibility of
Q6 liver damage.
O. Pregnancy
Category: B
NURSING CARE PLAN
NAME:_____Riane Marie S. Quiachon ___ PATIENT NAME: _____X_________ AGE: __34____ DATE: _June 23,2020_________
STUDENT #:___16-1-11093_____ DIAGNOSIS: __Cellulitis, Tattoo Infection_ GENDER:__F ______

Subjective: =keep the area clean and dry. =To assist body’s natural
=Impaired Skin Carefully dress wounds. process of repair and to
“Ang pangit na ng balat ko, Integrity due to Tattoo =After an 8-hr of Nursing prevent more =After an 8-hr shift,
nasira ng infection” as Infection as evidenced Intervention, the nurse complication. maintained timely
verbalized by the patient. by disruption of skin should maintain timely healing of wound by
surface and skin healing of the wound = Use appropriate barrier =to protect the wound and providing nursing
layers. without complications. dressings and coverings it’s surrounding tissues. intervention without
complications.
=emphasize importance of =in presence of reduced

Objective: proper fit of clothing. sensation/circulation
= disruption of skin surface

and skin layers =after debridement
=Maintain appropriate moisture
=inflammation of the infected environment.
area.
Vital Signs:
BP:120/80,T:37.5,PR:76,RR: =Instruct client to increase fluid =Good hydration helps
18, SaO2:99% intake. faster healing of wounds.
Name: Riane Marie S. Quiachon Patient Diagnosis: Cellulitis, Tattoo Infection Date: June 22,2020
Student#: 16-1-11093 Age: 34 Gender: Female
FOCUS DATA ACTION RESPONSE

= Acute pain due to inflammation and =seen awake, lying flat in bed with legs = Kept the area clean and dry =The client demonstrates relief from pain
burning sensation of the skin in the Left elevated. Alert and responsive. as evidenced by a decreased in pain scale
=Instructed the client to keep hydrated.
Thigh related to tattoo infection as from 8/10 to 4/10
=Facial Grimace during assessment of Increase fluid intake.
evidenced by Pain of 8/10.
wound.
=Maintained a warm and moisture
=Restlessness environment
Vital signs: BP=120/80, T=37.5, PR=76, = covered wound with appropriate

RR=18, SaO2=99%, PAIN SCALE= 8/10 dressings.
=Ceftriaxone 1g/50ml IV given at 8am
Endorsement Sheet
Diagnosis Diet Medications 8am 12NN Intake Output
Name of Patient: Cellulitis, Tattoo DAT Ceftriaxone 1g/50ml BP T PR RR BP T PR RR O P TOTAL U S V D O TOTAL
M.D Infection q12 IV 120/80 37.5 76 18 130/90 36.9 69 19 750 580 1330 500 0 0 0 0 500
(Left Thigh) 8am,8pm SaO2: 99% SAo2: 99%
Age:34 13gtts/min
Gender: Female
Acetaminophen #1 PNSS 1Lx12hrs CBC W/ ACUTE PAIN
Allergies:
500mg q6 PO Start:5am DIFFERENTIAL(CREA,BICARBON
Seafood
8am,2pm,8pm Due:5pm ATE,C-REACTIVE PROTEIN)
Attending Physician: Credit:750
Dr. JA, Dr. OG 83cc/hr, 28gtts/min
NARRATIVE REPORT
Riane Marie S. Quiachon June 24, 2020

Today is Tuesday. I received my patient at 7:30am then began with my rounds at 8am.My patient is a 34 years old female
diagnosed with Cellulitis because of Tattoo Infection in the Left Thigh 3 days prior to confinement. At 8am, I gave her medications. the Acetaminophen and
Ceftriaxone for fever, pain and antibiotics. During my shift, she kept on complaining about the pain she was experiencing. I assessed her pain by Pain scale and
asked her to describe the pain. She stated that it is a burning sensation around the affected area and the Pain was 8/10. As a nurse on duty, I cleaned her wound using
a right aseptic technique. Provided her with a warm and moisture environment and instructed her to increase her fluid intake. My patient is in her #1 bottle of PNSS
which is due at 5pm. It is for 12hrs so it started at 5am and to be regulated at 28gtts/min. I made sure that for my whole shift, I provided the right and appropriate
nursing care for my patient. Before my shift ends, I assessed her again especially the pain and I am glad to know that it decreases from 8 to 4. This is the end of my
shift for 8 hours.
RIANE MARIE S. QUIACHON
POST-TEST 06/23/2020
1. AIRWAY,BREATHING,CIRCULATION
2. ASSESSMENT
3. TREATMENT
4. ABDOMEN
5. ACTIVITY OF DAILY LIVING
6. COMPLAINS OF
7. INFLAMMATORY BOWEL DISEASE
8. IRRITABLE BOWEL SYNDROME
9.) 200ml/120min x 20gtts/ml / 60min = 33gtts/min
10.) 1200ml/ 6hrs = 200cc/hr
1200ml/6hrs x 15gtts/ml / 60mins = 50gtts/min
Riane Marie S. Quiachon BSN 4YS1
Cellulitis in adult patients: A large, multicenter, observational, prospective study of 606 episodes and analysis of the factors related to the response to treatment
Background
Cellulitis is a frequent cause of hospital admission of adult patients. Increasing prevalence of multiresistant microorganisms, comorbidities, predisposing factors and medical and
surgical therapies might affect cellulitis response and recurrence rate.
Methods
Prospective and observational study of 606 adult patients with cellulitis admitted to several Spanish hospitals. Comorbidities, microbiological, clinical, diagnostic, treatment
(surgical and antibiotic) data were analyzed according to the cellulitis response. Good response implied cure. Poor response implied failure to cure or initial cure but relapse
within 30 days of hospital discharge.
Results
Mean age was 63.3 years and 51.8% were men. Poor responses were significantly associated with age, previous episodes of cellulitis, prior wounds and skin lesions, venous
insufficiency, lymphedema, immunosuppression and lower limbs involvement. No differences in ESR or CRP blood levels, leukocyte counts, pus or blood cultures positivity or
microbiological or imaging aspects were observed in those with good or poor responses. Regarding antimicrobials, no differences in previous exposition before hospital
admission, treatment with single or more than one antibiotic, antibiotic switch, days on antimicrobials or surgical treatment were observed regarding good or poor cellulitis
response. Prior episodes of cellulitis (P = 0.0001), venous insufficiency (P = 0.004), immunosuppression (P = 0.03), and development of sepsis (P = 0.05) were associated with
poor treatment responses, and non-surgical trauma (P = 0.015) with good responses, in the multivariate analysis.
Conclusions
Prior episodes of cellulitis, non-surgical trauma, venous insufficiency, sepsis and immunosuppression were independently associated with treatment response to cellulitis, but
not the causative microorganism, the number of antimicrobials administered or its duration.
Cellulitis [a common type of skin and soft tissue infection] is a frequent bacterial infection of the skin and subcutaneous tissues, whose incidence is rising, and that results in
substantial economic and healthcare burdens [1–7]. In fact, although mild cellulitis can be managed in the ambulatory setting by family doctors, more serious cases represent a
common and progressively increasing cause of hospital admissions in developed countries, particularly among the elderly and individuals with predisposing factors or
comorbidities [1–4].
In the hospital setting, patients are usually treated with intravenous (IV) antibiotics for 5–7 days, although IV or oral therapy may be prolonged up to 14 days or longer in
immunosuppressed or in complex cases, depending on the response [4–6, 8]. The causative microorganism is not identified in most cases of cellulitis, but Streptococcus
pyogenes, other streptococci and Staphylococcus aureus account for about three-fourths of those cases in which an agent is recovered, although the relative proportion may
differ depending on the type cellulitis and the individual characteristics of the patients [3–7, 9, 10]. However, cellulitis management may be complicated if it is caused by certain
agents, such as methicillin-resistant S. aureus (MRSA), a difficult-to-treat and potentially deadly microorganism requiring specific antimicrobials for its cure [6, 7, 9, 11].
Furthermore, healthcare costs are increased because of frequent hospital readmissions due to the high recurrence rate of cellulitis, which is favored by diverse local and
systemic factors [3–5].
All these clinical and healthcare circumstances emphasize the value of identifying the factors leading to cellulitis for prevention purposes. In this regard, a number of
predisposing factors have been described, involving mainly skin integrity, immunity or vasculature [3–5, 12–16]. Likewise, the identification of the factors related to the response
to therapy would be highly desirable, in order to improve the management and outcome of these infections.
Despite its frequency, few large series of cellulitis have been published and few studies, mostly with relatively reduced sample sizes, have analyzed the interactions of the
multiple potential causes leading to cellulitis, the clinical, microbiological and therapeutic aspects and the outcome. In addition, the published studies may be difficult to
compare because of the variety in designs, objectives, settings, criteria, endpoints, nature and management of the infection, and type of data recorded. Finally, the vast majority
of the studies are retrospective, with information obtained from medical charts or computerized databases, and their analyses have been restricted to the relatively few data
gathered, obviating the confounding effect of other covariates not recorded.
Reflection:
As i learned in this journal. there are going cases of cellulitis among people especially in men. There's an increasing cases of infection
that is caused by a multi resistant microorganisms. It is seen that most of the people who are affected are those who has poor economic
status because they are the ones who don't have the capacity to seek medical treatment and then the cellulitis progresses over time. For
patients with cellulitis, we should provide a warm and moist environment, increase fluid intake, give antibiotics and clean wounds with
proper and appropriate dressing. Trauma, immunocomprised and poor hygiene contributes to a possibility of having a cellulitis. Cellulitis is
a deep infection of the skin caused by bacteria. It usually affects the arms and legs. It can also develop around the eyes, mouth, and anus,
or on the belly. Normal skin can be affected by cellulitis. But it usually happens after some type of injury causes a skin break, including
trauma or surgery. Once the skin breaks, bacteria can enter and cause infection. Staph and strep bacteria are commonly found on the skin
and mucous membranes of the mouth and nose in healthy people. The infection happens when there is a break in the skin that lets the
bacteria enter. Other causes may include human or animal bites, or injuries that happen in water. Each person may experience symptoms
differently.
Requirements of DELIYA ABDU
SCHEDULE OF ACTIVITIES
TIME ACTIVITIES



3:30am – 4:00am  Assessment of patient’s condition, rendering specific care to designated

patients (ex. CBG)
4:00am – 4:30pm
 Check IVF Level
Endorsement Sheet

Room# Diagnosis Diet Medications 8am 12NN Intake Output
Name of BP T PR RR BP T PR RR O P TOTA U S V D O TO
110 Patient: L A
DX : SPINAL Tramadol 50 110/6 37.7 82 21 120/ 37 78 16 500 500 1000 80 0 0 0 0 80
M.J CORD DAT W\SAP mg IV q8 0 70 0m m
Start
COMPRESSIO l
venolysis
N SEC. TO LS with D5LR @
Age:
COMPRESSIO 20 gtts/ min
53 N DEFORMITY
Food allergy: IVF SPECIAL ENDORSEMENT NURSING PROBLEMS
SEAFOOD
Gender: #7 D5LR 1Lx8HRS Acute pain
CC: NAPE
-
M PAIN
BP T PR RR BP T PR RR O P TOTA U S V D O TO
L A
NURSING CARE PLAN
NAME:__ABDU, DELIYA ALI___ PATIENT NAME: ___M.J________ AGE: _53_____ DATE: _23-6-2020_________
STUDENT #:__15-2-21367________________ DIAGNOSIS: ____ SPINAL CORD COMPRESSION ___ GENDER:___M__________

ASSESSMENT NURSING DIAGNOSIS PLANNING NURSING INTERVENTION RATIONALE
EVALUATION
SUBJECTIVE: Within the duration of duty, the patient will maintain
position of function and skin integrity as evidenced by
 Continually asses motor function by requesting
patient to perform certain actions.
 . Evaluates status of individual
situation (motor-sensory Goal not met the pt. was
Impaired physical mobility related to
absence of foot drops, contractures and decubitus
ulcer
impairment may be mixed and/ or
not clear) for a specific level of
not cooperative.
neuromascular impairment. injury, affecting type and choice of
intervention.
“dili kaayo ko ka lihok lihok” as verbalized by the
patient.
 Enables patient to have sense of

control, and reduces fear of being
OBJECTIVE: left alone.
 Enhances circulation, restores or

 Decreased muscle control/strength
maintains muscle tone and joint
mobility, and prevent disuse
 Limited ROM
contractures and muscle atrophy.
 Inability to purposefully more
within the physical environment.
 Provide means to summon help.  Prevents fatigue, allowing

opportunity for maximal efforts or
participations by patient.
 Reduces pressure areas, promotes

peripheral circulation.
 Assist in range of motion exercises on all

extremities and joints, using slow, smooth
movements.  Open expression allows client to
deal with feelings and begin
problem solving.
 Plan activities to provide uninterrupted rest periods.

Encourage involvement within individual tolerance
or ability.  Altered circulation, loss of
sensation, and paralysis potentiate
 Reposition periodically even when sitting in chair. pressure sore formation.
Teach patient how to use weight-shifting
techniques.
 Encourage verbalization of feelings.

 Helpful in planning and
implementing individualized
exercise program and identifying
or developing assistive devices to
 Inspect the skin daily. Observe for pressure areas, maintain function enhance mobility
and provide meticulous skin care. and independence.
NURSING CARE PLAN
NAME:__ABDU, DELIYA ALI___ PATIENT NAME: ___M.J________ AGE: _53_____ DATE: _23-6-2020_________
STUDENT #:__15-2-21367________________ DIAGNOSIS: ____ SPINAL CORD COMPRESSION ___ GENDER:___M__________
Subjective: Activity intolerance r/t neuromuscular impairment Within the duration of duty, the patient will  Evaluated clients actual and perceive limitations/ degree of  To provide comparative baseline and
demonstrate a decrease in physiologic sign of deficit in light of usual status provide information about needed
intolerance education/ intervention regarding quality
“Dali rako kapoyon maong matulog nlang ko”
of life Goal not met. The patient didn’t cooperate.
Objective:  Symptoms may results of/or contribute to

intolerance of activity
 Needs assistance in repositioning
Inability to do his ADL’s
 To determined current status and needs

associated with participation in needed
 Noted client’s report of weakness, fatigue, pain and
desired activities.
difficulty accomplishing his task.
 To assist the client to deal with
 Ascertained ability to move about and degree of assistance
contributing factors and manage activities
necessary use of equipment
within individual limits
 Encouraged expression of feelings contributing to his

 To protect from injury
condition
 To enhanced the ability to

 Assist with activities and provide/ monitor clients use of
participate in activities
assistive devices
 Promote comfort measures and provide relief of pain
 To prevent bedsore and to maintain body

alignment all the time.
 Repositioning every 2 hours To prevent bedsore and to promote circulation.
Made repositioning schedule and post at bedside and educated the

patient’s S.O in proper turning the patient
DRUG STUDY
NAME:__ABDU, DELIYA ALI_____________ DATE: ___23-6-2020___________
STUDENT #:_15-2-21367_________________
DRUG/MEDICATION CLASSICATION ACTION INDICATION SIDE EFFECTS NSG.IMPLICATION

Tramal Dose:30 mg Non-steroidal anti- Unknwon. Though Short-term CNS: drowsiness, >use cautiously in
Route: IVTT inflammatory drugs to inhibit management o sedation, patients with
Frequency: q 8 =prevent prostaglandin moderately dizziness, hepatic or renal
inflammation, pain synthesis severe, acute pain headache. impairment
and fever support Route: IV single-dose CV: edema, >carefUlly
the blood clotting Onset: immediate treatment. hypertension, observed patients
function of Peak: 1 to 3min. palpitations. with coagulopathies
platelets, and Duration: 6 to 8 GI: nausea, and those taking
protect the lining of hrs. dyspepsia, GI coagulant.
the stomach from pain, diarrhea, >don’t give drug
the damaging peptic ulceration, epidurally or
effects of acid vomiting, intrathecally
constipation, because of alcohol
flatulence, content.
stomatitis. >correct
HEMATOLOGIC: hypovolemia before
prolonged bleeding giving.
time
SKIN: rash,
diaphoresis.
JOURNAL WITH REFLECTION: How not to miss metastatic spinal cord
compression
INTRODUCTION
The National Institute for Health and Care Excellence (NICE) estimates that each year in the UK around 2.5 million people will
approach their GP with back pain. Fortunately most cases are due to non-specific causes and are often self-limiting.
Metastatic spinal cord compression (MSCC) is one of the ominous causes of back pain where there is a compression of the thecal
sac and its components by tumour mass. This is a true spinal emergency, and if the pressure on the spinal cord is not relieved
quickly, it may result in irreversible loss of neurologic function. The most important prognostic factor for functional outcome is
neurologic function before treatment.1 Hence, any delay could result in poorer functional outcome and decreased quality of life, with
increased dependence on healthcare resources. There is a need for improving awareness among all clinicians so as to make prompt
diagnosis and referral of MSCC a reality.2
EPIDEMIOLOGY AND AETIOLOGY

Bone is the third most common site of metastases after the liver and the lung. MSCC is seen in up to 5% of cancer patients;
however, in up to 20% of MSCC cases, cord compression may be the first sign of malignancy.3 Although the exact incidence of
MSCC is not known, intelligent estimates put the number at about approximately 4000 cases in England and Wales.4
The most common primary tumours that metastasize to the spine are breast, lung, prostate, and kidney tumours. Tumours may
spread to the spine via the arterial route, vertebro-venous plexus, or by direct invasion. Once the tumour mass begins to grow it can
cause spinal cord damage secondary to direct pressure, vascular compromise, and demyelination. Spinal cord compression could
also occur due to the spinal instability caused by the collapse of vertebrae affected by the tumour.
PRESENTATION
The most common presenting feature for spinal metastases is increasing back pain. The pain may be localised or generalised and is
due to compression, pathological fractures, or axial pain from mechanical instability. It often increases in recumbent position or with
activities such as sneezing or coughing secondary to distension of the epidural venous plexus. Radicular pain may develop due to
nerve root compression by the tumour or secondary to vertebral collapse. It is important however to bear in mind that patients might
present with backache totally unrelated to MSCC and some patients with MSCC experience no backache.
Box 1.
When to think of metastatic spinal cord compression

Low index of suspicion High index of suspicion
Known cancer diagnosis with bone

metastases
Night-time pain during movements
Persistent back pain localised to Band-like bilateral nerve root

an area pain/radiculopathy
No neurological signs Unsteadiness of gait
No cancer diagnosis Progressive weakness of limbs
No bowel or bladder symptoms
Usually the progression to sensori-motor deficits and bladder and bowel dysfunction occurs slowly. Heaviness or clumsiness of limbs
may be an early sign of motor deficits. Sensory deficits include anaesthesia, hyperaesthesia, or paraesthesia in the involved
dermatomes. Autonomic dysfunction with bowel and bladder problems is associated with a poorer prognosis and irreversibility of
functional recovery.
In patients with undiagnosed cancers, using detailed history taking and physical examination coupled with awareness of red flags
would increase chances of detection of suspected cases of MSCC. One needs to explore other cancer symptoms such as anorexia,
weight loss, lymphadenopathy, cough, and bowel and bladder symptoms.
Physical examination findings may vary from isolated spinal tenderness with no definite neurology to hard neurological signs with
deficits.
PATIENT EDUCATION
Significant efforts are needed to educate patients and carers about MSCC. This can be achieved effectively by an MSCC card which
can be given to patients with diagnosed cancers to highlight the key symptoms and local contacts available (Box 2).
Box 2.
Stop Cancer Disability — Think Spine (front and back of specimen MSCC card)
Cancer may rarely spread to the spine and compress the spinal cord and nerves. It is important to be aware of this condition as the
earlier it is treated the better will be the final outcome.
Symptoms to look out for:
 Back pain which is new, in a specific area, severe or different from your usual pain.
 Back pain spreading to the front of the chest like a band.
 Difficulty in walking.
 Pins and needles or numbness in upper or lower limbs.

If any of the symptoms mentioned on the front of the card are present contact:
 Hospital team, GP or Nurse within 24 hours.
 If unable to contact anyone go to nearest A&E.
 Tell the health professional that you have cancer and are worried about your spine.
urgently
 Problems controlling bowels or bladder
 Progressive weakness of legs
 Increasing numbness and heaviness of arms or legs.
MANAGEMENT
Referral
As per the NICE guidelines, every cancer network should be setting up an MSCC coordinator (Figure 1). They would be the point of
contact for every suspected MSCC and through whom the referrals would be routed.4
 Download figure
 Open in new tab
 Download powerpoint
Figure 1.
Referral.
Investigation
Plain radiographs are often used in general practice to evaluate new-onset backache. However, it is a poor screening test and
identifies only advanced cases with vertebral collapse and pathological fractures.
Magnetic resonance imaging (MRI) is the gold-standard investigation in MSCC. NICE guidelines state that MRI should be done early
(within 24 hours if a high index of suspicion) so that definite treatment can be planned within a week. Computed tomography (CT)
scans with or without three-dimensional reconstruction complement MRI and help operative planning. Bone scans can screen the
entire skeleton and give an overall picture of bone involvement. However, they may miss para-spinal tumours with epidural
extensions.
TREATMENT
A multidisciplinary team approach is followed with involvement of the spinal surgical team, oncologist, and radiologist. There is also
an important role for the palliative care and allied healthcare professionals, with paramount emphasis on patient preference. The aim
of the treatment is not curative. The major goals are pain control and preservation of function with a better quality of life for the
patient.
Treatment options are broadly surgery and radiotherapy. There is a definite role for commencing steroids in the patients with
suspected MSCC to reduce oedema and prevent further injury to the cord.
Surgery
Surgery is preferred in the presence of spinal instability and neurological signs in patients who have a moderate to good prognosis.
Surgical treatments could involve simple spinal decompression, spinal stabilisation procedures, or both. Vertebroplasty or
kyphoplasty could also be considered in a specific subset of patients for pain relief and to prevent further collapse of the vertebrae.
Radiotherapy
Radiotherapy could be initiated in isolation for poor surgical candidates or non-surgical candidates. It is also used as an adjunctive
therapy in patients who undergo surgery as treatment of the spinal metastases. NICE recommends palliative single-fraction
radiotherapy even to patients who have a poor prognosis of possible pain relief.
Research evidence suggests that early detection and surgical treatment could be more effective than radiotherapy alone in
maintaining mobility in a select subset of patients affected by MSCC.
Provenance
Freely submitted; not externally peer reviewed.
Competing interests
The authors have declared no competing interests.
REFLICTION PAPER:
With the continued growth of the older population and improvements in cancer therapies, the number of patients with symptomatic
spinal metastases is likely to increase. As most of these patients will be managed in the community they are more likely to present
first to their GPs. It is said that ‘the eyes cannot see what the mind doesn’t know’. Knowledge of the presentation, suspicion of the
condition, and awareness of referral pathways are essential for better and prompt management of this condition and to prevent
disability.
Abdu, Deliya ali
15-2-21367
JUNE, 23, 2020
Narrative report:
Today was the second day in head nursing via online, so at 8am in the morning we checked our attendance and after
that we had our endorsement through our head nurse, so she assigned the patient for us after that the endorsement,
and my patient’s diagnosed was SPINAL CORD COMPRESSION SEC. TO LS COMPRESSION DEFORMITY. And the V/S was:
Blood Pressure: 110/60 mmHg
Temperature: 37.7O C
Pulse Rate: 82 bpm
Respiration: 21 cpm
So I started to read the chart and complete our endorsement sheet and did our requirements, at 11 until 12;30 am we
had a video call with our head nurse for documentation, and we took our quiz after that and After that we went for a
break 45 minutes, we went back to complete the rest requirement because we need to submit it to the head nurse
after that at 3pm we met with Ma’am to explain everything until 5pm.
At the end of our duty we evaluated our head nurse and submitted our requirements.
QUIZ 4) abd.: abdomen
5) ADL: avtivity of daily living
NAME : ABDU, DELIYA ALI 6) c\o:
DATE: 06/23/20 7) IBD: inflammatory bowel disease
8) IBS:
Q1: Nursing abbreviations:
1) ABC: airway, breathing, circulation
2) Ax: assessment
3) Tx: treatment
Q2:
9) Calculate the IV flow rate for 200 mL of 0.9% NaCl IV over 120 10) Calculate the IV flow rate for 1200 mL of NS to be infused in 6
minutes. Infusion set has drop factor of 20 gtts/mL. hours. The infusion set is calibrated for a drop factor of 15 gtts/mL.
Volume /hour x drops factor/60 mins Volume /hour x drops factor/60 mins
200 / 2 hours x 20 / 60mins = 33 gtts/min 1200ml/6 hours x 15 gtts/mL /60 mins = 50 gtss/mins
Requirements of BERNA GOROSPE

DRUG STUDY
NAME:_Bernadette B. Gorospe__ DATE: _06/23/2020________
STUDENT #:_15-1-79654__________ Pt name: C.J Age: 75 Gender: male Dx: T/C Urosepsis
Category:
trimethoprim/ Urinary tract infections Combination inhibits the Hypersensitivity to nausea, vomiting, - Assess for infection (vital signs;
sulfamethoxazole metabolism of folic acid in sulfonamides or diarrhea, hypotension appearance of wound, sputum,
bacteria at two different points. trimethoprim; History of urine, and stool; WBC) at
Brand Name: drug-induced immune beginning of and during therapy.
thrombocytopenia due to
Bactrim - Obtain specimens for culture
P. Chemical: sulfonamides or
trimethoprim; Megaloblastic and sensitivity before initiating
Dosage: 960mg folate antagonists,
anemia secondary to folate Adverse Reactions: therapy. First dose may be given
sulfonamides before receiving results.
deficiency; Severe hepatic or
ERYTHEMA
renal impairment
MULTIFORME, - Inspect IV site frequently.
Route: PO
STEVENS-JOHNSON Phlebitis is common.
Q. Therapeutic: SYNDROME, TOXIC
EPIDERMAL - Assess patient for allergy to
anti-infectives,
Frequency: BID antiprotozoals NECROLYSIS, mental sulfonamides.
depression,
AGRANULOCYTOSIS, - Monitor intake and output
APLASTIC ANEMIA, ratios. Fluid intake should be
Pharmacokinetics: R. Pregnancy Category: hemolytic anemia, sufficient to maintain a urine
C leukopenia, output of at least 1200– 1500 mL
Onset: rapid daily to prevent crystalluria and
megaloblastic anemia,
thrombocytopenia. L stone formation.
Duration: 6–12 hr
Half-life: 6– 11 hr; 9-12hr
Peak: 2–4 hr
DRUG STUDY
NAME:_Bernadette B. Gorospe__ DATE: _23/06/2020________
STUDENT #:_15-1-79654__________ Pt name: C.JAge: 75 Gender: male Dx: T/C Urosepsis

Category:
levofloxacin Treatment of the Inhibits bacterial DNA synthesis Hypersensitivity (cross- nausea, dizziness, - Assess for infection (vital
following bacterial by inhibiting DNA gyrase sensitivity within class may drowsiness, signs; appearance of wound,
Brand Name: infections: Urinary tract enzyme. exist); QTc interval abdominal pain, sputum, urine, and stool; WBC;
infections, including prolongation; Uncorrected diarrhea urinalysis; frequency and
Levaquin
cystitis, pyelonephritis, hypokalemia or urgency of urination; cloudy or
S. Chemical:
Dosage: 500mg and prostatitis, hypomagnesemia; foul-smelling urine) at
thiazide diuretics Respiratory tract Concurrent use of Class IA beginning of and during
infections, including antiarrhythmics therapy.
acute sinusitis, acute (disopyramide, quinidine, Adverse Reactions:
Route: PO exacerbations of chronic procainamide) or Class III - Obtain specimens for culture
T. Therapeutic: bronchitis, community- antiarrhythmics and sensitivity before initiating
ELEVATED
acquired pneumonia, (amiodarone, sotalol) (qrisk INTRACRANIAL therapy. First dose may be
antihypertensives,
and nosocomial of QTc interval prolongation PRESSURE (including given before receiving results.
Frequency: OD diuretics
pneumonia, and torsade de pointes); pseudotumor
- Assess for signs and symptoms
U. Pregnancy Uncomplicated and History of myasthenia gravis cerebri), SEIZURES, :
of peripheral neuropathy (pain,
Category: B complicated skin and (may worsen symptoms TORSADE DE
Pharmacokinetics: burning, tingling, numbness,
skin structure infections. including muscle weakness POINTES,
and/or weakness or other
Post-exposure treatment and breathing problems) HEPATOTOXICITY,
Onset: 2 hr alterations of sensation
of inhalational anthrax. PSEUDOMEMBRANO
including light touch, pain,
Duration: 24 hr US COLITIS, STEVENS-
temperature, position sense,
JOHNSON
and vibratory sensation)
Half-life: 8 hr SYNDROME.
periodically during therapy.
Peak: 1–2 hr Symptoms may be irreversible;
discontinue levofloxacin if
symptoms occur.
NURSING CARE PLAN
NAME:_Bernadette Gorospe__________ PATIENT NAME: _C.J____________________ AGE: 75__ DATE: 06/23/2020____

STUDENT #:_15-1-79654_________________ DIAGNOSIS: _T/C Urosepsis GENDER:_Male____________
Subjective: Impaired urinary elimination related After 4 hours of nursing intervention, Independent: 1. Serve as a basis for determining After 4 hours of nursing
to frequent urination, urgency, and the patient will achieve normal urinary appropriate interventions. intervention, the patient has
none hesitancy. elimination pattern, as evidenced by 1. Assess the patient’s pattern of elimination. achieved normal urinary
absence sign of urinary disorders 2. To help improve renal blood flow. elimination pattern, as evidenced
(urgency, oliguria, dysuria). 2. Encourage increased fluid intake (3-4 liters a by absence sign of urinary
day if tolerated). 3. To prevent the accumulation of disorders (urgency, oliguria,
urine thus limiting the number of dysuria).
3. Encourage the client to void every 2-3 hours. bacteria.
Objective: 4. Maintain an acidic environment of the bladder 4. To prevent the occurrence of

by the use of agents such as Vit.C, Mandelamine bacterial growth.
(a urinary antiseptic) when appropriate.
5. To help aid in eliminating
V/S: Dependent: infection
T- 36.7 5. Administer prescribed antibiotics such as

Bactrim and levofloxacin
PR- 85
RR- 20
BP- 120/80
SPO2- 96%
- Dysuria.
- Urinary frequency; urge.
- Urinary hesitancy.
Approach to a Patient with Urosepsis

Urosepsis implies clinically evident severe infection of the urinary tract and/or the male genital tract (e.g. prostate) with features consistent with systemic
inflammatory response syndrome.[1] It may be associated with multi-organ dysfunction, hypo-perfusion or hypo-tension. Severe sepsis is usually associated with
pulmonary and abdominal infections with urinary tract infections (UTIs) accounting for about five per cent cases.[2] However, among the nosocomial infections,
UTIs account for approximately 40% of the cases.[3,4] Though sepsis is commoner in men than in women, it has been found that urosepsis is commoner in women
than in men. While severe sepsis has a reported mortality rate of 20 to 42%, urosepsis may be associated with high mortality rates in special patient groups.[5]
Therefore, patients with urosepsis should be identified at an early stage and promptly treated to prevent development of organ failure and other complications.
Complicated UTI is the commonest precursor of urosepsis. Complicated UTI usually refers to an infection that occurs in a patient with a structural or functional
abnormality, impeding urine flow, or in a host with altered defences or in patients with metabolic disorders like diabetes or azotemia. When complicating factors are
present, antimicrobial resistance is more common and the response to therapy is often disappointing, even with agents active against the causative microbial
pathogens. In addition, severe complications frequently occur which may lead to urosepsis, renal scarring or even end-stage renal disease. Drug treatment of
urosepsis often has to be complemented with endoscopic and/or surgical intervention.
Go to:
RISK FACTORS
Several genito-urinary abnormalities may be associated with urosepsis. The most common determinant of urosepsis is obstruction to free flow of urine which may
quickly lead to severe sepsis. Various structural and functional abnormalities of the genito-urinary tract associated with urosepsis have been mentioned in Table 1.
Patients at higher risk for developing urosepsis include elderly patients, diabetics and immuno-suppressed patients such as transplant recipients, patients with AIDS,
patients receiving anticancer drugs and immunosuppressive agents. Any male urinary infection is usually considered complicated as uncomplicated urinary infection
is rare in men.[6] Bacteriuria is more prevalent among the elderly, with 50% of geriatric women having bacteriuria. The risk of infection varies with different
abnormalities.
The risks are multiplied in cases of hospitalization or long- term care due to indwelling long-term catheters and the transfer of resistant bacterial strains. In a study
conducted during 1990s, Richards et al., noted that 23% of all cases of hospital-acquired sepsis were due to UTI and mostly seen in catheterized patients.[7]
ESGNI-004, a pan-European study, reported an incidence of hospital-acquired UTIs of 3.55/1,000 patient days and 51.5% of all patients were febrile, 31.9% went
on to develop plain sepsis, 2% severe sepsis, 0.3% septic shock and 1.7% multi-organ failure.[8] Two point-prevalence studies about hospital-acquired UTIs, the
Pan European Prevalence (PEP) study and the Pan EuroAsian Prevalence (PEAP) study were carried out during the year 2003–2004. The prevalence of hospital-
acquired UTIs in the PEP study was 10% and 14% in the PEAP and urosepsis accounted for 12% of all episodes.[4]
Go to:
MICROBIOLOGICAL DATA
Gram-negative bacilli account for majority of the cases of urosepsis. These include Escherichia coli (50%), Proteus spp. (15%), Enterobacter and Klebsiella spp.
(15%), and Pseudomonas aeruginosa (5%) which dominate the bacterial spectrum in urosepsis, while Gram-positive organisms are involved less frequently (15%).
[9] The ESGNI-004 reported that Gram-positive organisms represented 21.2% of all hospital-acquired UTI isolates, whereas Gram-negative organisms accounted
for 65.9% and yeasts 12.9%. The ESGNI-004 found that in the catheterized patients Candida spp. and P. aeruginosa were more common, with E. coli being the
commonest bacterium isolated in both catheterized and non-catheterized patients. Data from the PEP and PEAP studies reported a microbiologically proven
infection in 74% of patients (urine culture 91%, blood culture 7%, other source 2%). In another multi-centre, prospective study from Portugal, 7% patients admitted
to Portuguese ICUs had urosepsis with isolation rate of 68% and blood culture positivity of 41%.[10] All isolates except one were Gram-negative rods with E.
coli dominating the microbiological profile.
E. coli strains isolated from symptomatic patients with complicated urinary infection have a lower prevalence of genetic or phenotypic virulence characteristics and
are less likely to originate from a uropathogenic clone than strains isolated from patients with acute uncomplicated infection. Polymicrobial bacteriuria is seen in
elderly patients and patients with chronic urological devices. The micro-organisms commonly responsible for post-transplant urosepsis are the enteric Gram-
negative bacilli and enterococci. Organisms isolated from patients with complicated urinary infection and urosepsis tend to be more resistant to antimicrobials than
strains isolated from uncomplicated urinary infection.
CLINICAL PRESENTATION
The clinical presentation may be varied. Urosepsis represents the most severe clinical manifestation of UTI. Signs and symptoms of systemic inflammatory response
syndrome such as fever, tachycardia, tachypnea, respiratory alkalosis which were earlier considered mandatory for the diagnosis of sepsis, are now considered to be
the alerting symptoms. These have been mentioned in Table 2.
Only one-third patients classically present with fever and chills along with hypotension. The patient may present with tachypnea, tachycardia, and can have a febrile
flushed appearance with alteration of mental status. Initially, because of increased cardiac output and decreased systemic vascular resistance, the clinical appearance
is that of ‘warm shock’ with hypotension but with further loss of intravascular volume and decreased vascular tone the manifestation is that of ‘cold shock’ with
hypotension and cold extremities. This is an ominous development signifying need for prompt intervention. Additional symptoms like flank pain, renal angle
tenderness, ureteric or renal colic, dysuria may be present.
With further progression there may be appearance of pulmonary edema with ARDS. Multi-organ failure may follow with renal and/or hepatic dysfunction and
disseminated intravascular coagulation.
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2840933/
Reflection:
Urosepsis is a dreaded complication of UTI with mortality rates as high as 40%. Early recognition of symptoms followed by appropriate investigations, accurate
diagnosis and early goal directed therapy is essential to improve outcomes. Comprehensive management requires team approach with timely inputs from
microbiologists, radiologists, surgeons and intensive care physicians.
Urinary tract infections can occur in all age groups and produce an exceptionally broad range of clinical syndromes ranging from asymptomatic bacteriuria to acute
pyelonephritis with Gram negative sepsis to septic shock. In approximately one-quarter of all patients with sepsis, the focus of infection is localized to the urogenital
tract. This may lead to substantial morbidity and significant economic implications. We present a review of the current approaches to managing urospesis.
Bernadette Gorospe
15-1-79654
Narrative Report
Today is our second day of online activities. Our head nurses for today is Delal and Ciryl. I am under with Delal. At 8 am, we meet at google meet
for video conference to check the attendance and she endorsed to us our respective patients. Then, I assessed my assigned patient, he is 75 years old, diagnosed with
t/c Urosepsis. My initial vital signs for my patient was BP-120/80, T- 36.7, PR- 85, RR- 20. He has no IV fluids with him and is currently heplock. He is on diet as
tolerated and no known allergies. His medications are Bactrim 960mg PO twice a day and Levofloxacin 500mg OD PO. There was an order for may go home
tomorrow and repeat CBC at 1pm and urinalysis at 9am. The results of his urinalysis show that there is still urinary tract infection. And the doctor ordered for a
blood culture at 6pm to determine if he is negative for bacteria in the bloodstream. He was undergone CTScan yesterday and reveals no damage in kidneys. At
12pm, we did a video conference again with our clinical instructor for the documentation of our patients. After that, I did my requirements so I can pass it to my
head nurse this day.
Endorsement Sheet

Diagnosis Diet Medications 8am 12NN Intake Output
1 Name of Patient: T/C Urosepsis DAT Bactrim 960mg bid BP T PR RR BP T PR RR O P TOTA U S V D O TOTA
0 CJ PO L L
3 120/ 36.7 85 20 120/ 36.3 80 20 1000 0 1000 200 1x 0 0 0 200 +
Age:75 Levofloxacin 500mg 80 80 1
OD
Gender: M
- Repeat CBC @1pm Impaired urinary elimination
HL - repeat UA @9am
-blood culture @6pm
Attending
-CT Scan (6/22)
Physician:
-MGH TMW
QUIZ
NAME Bernadette Gorospe
DATE: 06/23/20
Q1: Nursing abbreviations:
1) ABC: airway breathing circulation
2) Ax: assessment
3) Tx: treatment
4) abd.: abdomen
5) ADL: activities of daily living
6) c\o: care of
7) IBD: inflammatory bowel disorder
8) IBS: irritable bowel syndrome
Q2:
9) Calculate the IV flow rate for 200 mL of 0.9% NaCl IV over 120 minutes. Infusion set has drop factor of 20 gtts/mL
33 gtts/min
10) Calculate the IV flow rate for 1200 mL of NS to be infused in 6 hours. The infusion set is calibrated for a drop factor of 15 gtts/mL.
51 gtts/min

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EMILIO AGUINALDO COLLEGE

In Partial Fulfillments of the Requirements in N107

Delal Ali Abdo

Ms. Cherylline Mendoza, RN, MAN

BSNURSING 4TH Year

Cover page…………………….……1 Ghant’s Chart…………….…………9

Table of Contents…………………..2 8 hours Nursing Sheet +Patient Requirements of BERNA GOROSPE

JUNE 23, 2020 (8:00am – 5:00pm)

FINAL GRADE SYSTEM + GRADE

NAME PERFORMANCE REQUIREMENTS QUIZ ATTENDANCE FINAL GRADE

PERFOMANCE EVALUATION 40%

Prepared by: Noted by:

Delal Ali Abdo. Cherylline Mendonza, RN, MAN

MARCH 7, 2020 (6:00am – 2:00pm)

REQUIREMENTS QUIZ ATTENDANCE

Berna gorospe 96 89 0 89 78 79 83.6 8 95

Yusra Jamal Abdullah 96 90 90 97 78 80 88.5 9 95

Eldon Isidro 95 89 0 89 77 79 71.5 10 95

Prepared by: Noted by:

Delal Ali Abdo. Cherylline Mendonza, RN, MAN

JUNE 23, 2020 (8:00am – 5:00pm)

NAME JOURNAL SCHEDULE OF NARRATIVE DRUG STUDY NAME JOURNAL

Berna gorospe Done Done Done Done Berna gorospe Done

Yusra Jamal Done Done Done Done Yusra Jamal Done

Riane Quiachon Done Done Done Done Riane Quiachon Done

Eldon Isidro Done Done Done Done Eldon Isidro Done

Prepared by: Noted by

Delal Ali Abdo. Cherylline Mendonza, RN, MAN

JUNE 23, 2020 (8:00am – 5:00pm)

Student Name Time - In Signature Time Out Signature

Abdo, Delal Ali 8:00am 5:00pm

Abdu,deliya ali 8:00am 5:00pm

Berna gorospe 8:00am 5:00pm

Yusra jamal Abdullah 8:00am 5::00pm

Riane Quiachon 8:00am 5:00pm

Eldon Isidro 8:00am 5:00pm

Prepared by: Noted by

Delal ali abdo Cherylline Mendonza, RN, MAN

Staff Nurse Staff Nurse Staff Nurse

DELIYA BERNA ELDON

8:00am – 9:30am  Sub-group the members and delegation of areas of responsibilities

10:30am – 11:00am  Pre-conference

12:30 am- 1:00 am  Assess patient’s condition

1:30am – 2:30am  Quiz taking

2:30am – 3:00am  Break Time

3:00am –3:30am  Video call for any clarification

Prepared by: Noted by

Delal ali abdo. Cherylline Mendonza, RN, MAN

 Administration of medicine (8:00)

 Perform morning care to patients

 Assessment of patient’s condition,

 Administration of medicine (12:00pm)

 Counter check all the chart and

JUNE 23, 2020 (8:00am – 5:00pm)

8 HOUR NURSING SHEET

JUNE 23, 2020 (8:00am – 5:00pm)

PATIENT CLASSIFICATION SHEET

Room No. Patients Name Age Diagnosis Category of Care

110 Mj 53 Spinal cord compression lll

103 Cj 75 T/c urosepsis ll

116 Da 82 Protine energy ll

CATEGORY I – Self Care or Minimal Care

NAME:_Abdalla Yousra__ PATIENT NAME: _D.A______________ AGE: 49 DATE: 06/23/2020