3h C Case Presentation 2022 Final

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UNIVERSITY OF THE CORDILLERAS

College of Nursing
Governor Pack Road, Baguio City, Philippines 2600
(+6374) 442-3316, 442-2564, 442-8219, 442-8256
E-mail: webmaster@bcf.edu.ph
Website: www.bcf.edu.ph
ACUTE MYOCARDIAL INFARCTION; HYPERTENSIVE URGENCY
A Case Presented to the

College of Nursing
In Partial Fulfillment of the requirements in the Course

NCM 112 Care of The Clients With Problems In Oxygenation, F&E, Infectious, I&I Response, Cellular
Abberation, Acute & Chronic
Submitted By:
Benito, Danny
Gesmundo, Lorraine
Limmang, Clarissa Marie
Maigi, Nicalin
Pagadian, Ia Rylyn
Paguirigan, Kryzza Leizel
Pangda, Jaceziel Kaye
Saavedra, Joy
Tucyapao, Irish P.
Villanueva, Jayson
(Date: 25-11-2022 )
Noted and Approved for Presentation:

Name of Case Presentation Adviser or Panel/s
Ma’am Hannah Lee Antonio Sir Laudemar Luis

Signature of Adviser / Date Signature of Adviser / Date
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ABSTRACT
TITLE: A Comprehensive Case Study on Acute Myocardial Infarction: Hypertensive Urgency
AUTHOR INFORMATION: Danny C. Benito, Lorraine P. Gesmundo, Clarissa Marie P. Limmang, Nicalin
G. Maigi, Ia Rylyn C. Pagadian, Kyrzza Leizel G. Paguirigan, Jaceziel Kaye D. Pangda, Joy Anne V.
Saavedra, Irish P. Tucyapao, Jayson L. Villanueva
BACKGROUND: WHY DID YOU CHOOSE? BASIS? SPECIFIC ASSESSMENT
Acute Myocardial Infarction, also known as “heart attack” is the irreversible necrosis of the heart muscle
secondary to prolonged ischemia. This is usually the result from an imbalance of oxygen supply and demand
which is most often caused by the rupturing of a plaque with thrombus formation in a coronary vessel which
leads to an acute reduction of blood supply going to a portion of the myocardium. The damage in the
myocardium is essentially the result of tissue response of inflammatory changes.
The patient has a history of hypertension and a family history of stroke. He is a smoker and an alcohol
beverage drinker and loves to eat salty, fatty and sweet foods. Before admission, the patient was on his daily
routine as a laborer when he felt tightening of his chest, shortness of breath and fatigue. With this kind of
situation, a strict diet is very important. However, according to the wife, he seems to be ignoring all the advice
of the doctor for the past medical checkups which contributed to the progression of his disease such as
hypertension. This causes the heart to pump or work harder to supply the rest of the body which induces
structural and functional changes in the myocardium. These changes include the left ventricular hypertrophy
which is the admitting diagnosis of the patient.
SMOKING WHEN DID IT START? HOW? HOW MANY PACKS ? WHY SMOKING?
ATTRIBUTES? LIFESTYLE? NON=COMPLIANCE TO MEDS
Thus, this case is significant to study to further understand and learn more about the progression of this
Acute Myocardial Infarction and the impending complications including the nursing and medical intervention
specifically eliminating complications..
CASE DESCRIPTION:
Patient X, a 46 years old male residing at Suyo Poblacion Itogon, Benguet and was admitted at Benguet
General Hospital, medical ward. The patient had a history of hypertension. 1 week prior to admission he
experienced sudden onset of chest pain, SOB, cough and fever. The patient stated that he enjoys eating high-
salt foods like "watwat." In addition, he smokes and drinks alcohol. His father was diagnosed with
hypertension and died from a stroke seven years ago. 1 day prior to admission, the patient had a chief
complaint of chest pain and was diagnosed with Acute Myocardial; Hypertension. His previous hospitalization
was due to hypertension. Right after admission, the doctor ordered laboratory tests to make sure what is the
condition of the patient and some medications were given to avoid progression of the disease.
HOW MANY CIGARRETES? PACKS? HOW MANY BOTTLE OF ALCOHOL?
HOW MANY YEARS? WHEN DID IT START? WHEN IT ENDS
The unhealthy diet of the patient which includes salty and fatty foods are rich in cholesterol which can
lead to the thickening of the walls of the arteries or atherosclerosis. Eating a diet high in saturated fats, trans
fat, and cholesterol has been linked to heart disease and related conditions, such as atherosclerosis. Also, too
much salt (sodium) in the diet can raise blood pressure. Cigarette smoking can damage the heart and blood
vessels, which increases your risk for heart conditions such as atherosclerosis and heart attack. Drinking too
much alcohol can also raise blood pressure levels and the risk for heart disease. It also increases levels of
triglycerides, a fatty substance in the blood which can increase the risk for heart disease according to (2019).
Centers for Disease Control and Prevention.
CONCLUSION:
We considered the case care delivered to our patient diagnosed with Acute Myocardial Infarction;
Hypertensive Urgency. Since the heart is one of the most vital organs and is essential to our survival, it is
necessary to undergo proper detection and understanding of these ailments. With proper understanding, we
will be able to render a holistic nursing approach. When the patient receives a better planned nursing care as
well as on nursing classifications, the evaluation of the improvement in the obtained results shows the
efficiency of the proposed interventions and to turn care systemization into a feasible and effective tool in
patient care.
BASE ON BACKGROUND
TABLE OF CONTENTS
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I. Introduction......................................................................................................................................................3
II. Statement of Objectives...................................................................................................................................3
A. General Objectives...........................................................................................................................................3
B. Specific Objectives...........................................................................................................................................3
III. Patient’s Profile................................................................................................................................................4
IV. Chief Complaint...............................................................................................................................................4
V. Present History of Illness.................................................................................................................................4
VI. Past History of Illness......................................................................................................................................4
VII. Family Health History.....................................................................................................................................4
VIII. Developmental History....................................................................................................................................4
IX. Social and Environmental History.................................................................................................................5
X. Lifestyle and Health Practices........................................................................................................................5
XI. Health Assessment...........................................................................................................................................5
A. General Survey.................................................................................................................................................5
B. Head to Toe Assessment..................................................................................................................................5
C. 13 Areas of Assessment...................................................................................................................................6
XII. Diagnostics........................................................................................................................................................9
XIII. Comprehensive Pathophysiology.................................................................................................................11
XIV. Treatment/Management................................................................................................................................12
A. Drugs..........................................................................................................................................................12
B. IV Fluids.....................................................................................................................................................33
XV. Nursing Care Plans........................................................................................................................................35
A. Prioritization of Problems............................................................................................................................35
a.1. List of Problems....................................................................................................................................35
a.2. Basis for Prioritization............................................................................................................................35
B. Nursing Care Plans......................................................................................................................................36
NCP 1..................................................................................................................................................................36
NCP 2..................................................................................................................................................................37
NCP 3..................................................................................................................................................................39
NCP 4..................................................................................................................................................................40
NCP 5..................................................................................................................................................................41
C. Discharged Plan.............................................................................................................................................43
XVI. Learning Insights...........................................................................................................................................44
XVII. List of References...........................................................................................................................................47
XVIII. Appendices.....................................................................................................................................................48
I. Introduction
A complete obstruction to blood flow in a coronary artery may result in a Myocardial Infarction (MI),
commonly called a heart attack. Infarction means the death of an area of tissue because of interrupted blood
supply. Because the heart tissue distal to the obstruction dies and is replaced by noncontractile scar tissue, the
heart muscle loses of its strength location of the infracted (dead) area, an infraction may disrupt the conduction
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system of the heart and cause sudden death by triggering ventricular fibrillation. Treatment for myocardial
infarction may involve injection of thrombolytic (clot-dissolving) agent such as streptokinase or t-PA, plus
heparin (an anticoagulant), or performing coronary angioplasty or coronary artery bypass grafting. Fortunately,
heart muscle can remain alive in a resting person if it receives as little as 10-15% of its normal blood supply.
(Tortora, G., Derrikson, B., 2011).
Myocardial infarction (MI) is one of the leading causes of mortality and morbidity worldwide. It is
responsible for over 15% of deaths each year, and its prevalence is generally higher among men in all specific
age groups than in women. In the Philippines alone, Ischemic Heart Disease remains as the leading cause of
mortality, accounting for 84,120 (14.5%) of all deaths in 2017. (Khan MA, et.al 2022). According to the 2017
WHO Non-Communicable Disease Report, about 3,000 Filipinos suffer from premature mortality due to high
consumption of TFAs. Studies have shown that high intake or consumption of TFA increases bad cholesterol,
decreases good cholesterol and increases blood sugar, therefore contributing to the risk of developing
cardiovascular and other non-communicable diseases. STATISTICS MAIN OBJECTIVE/ GOAL?
Internist-endocrinologist Dr. Mary Ann Roa claims that there are two types of risk factors for
hypertension “Hypertension has two risk factors: modifiable and non-modifiable. Non-modifiable risk factors
include age, gender, race, and family history or genetics. Modifiable risk factors include smoking, alcoholic
drinking, obesity, diabetes, stress, lack of exercise, and unhealthy diet”. Genetic factors likely play some role
in high blood pressure, heart disease, and other related conditions. However, it is also likely that people with a
family history of heart disease share common environments and other factors that may increase their risk. The
risk for heart disease can increase even more when heredity combines with unhealthy lifestyle choices, such as
smoking cigarettes and eating an unhealthy diet.
PARAPHASE KUNO
II. Statement of Objectives
A. General Objectives
This case analysis aims to increase the understanding and knowledge of student
nurses on how to care for patients with Acute Myocardial Infarction; Hypertensive Urgency
effectively and efficiently.
B. Specific Objectives
Specifically, this case analysis aims to:

1. Define Acute Myocardial Infarction; Hypertensive Urgency and its
effects to the body as a whole;
2. Illustrate the pathophysiology of Acute Myocardial Infarction; Hypertensive Urgency
and in relation to the signs and symptoms specifically observed in the patient;
3. Describe and identify the common signs and symptoms of Acute Myocardial
Infarction; Hypertensive Urgency
4. Discuss the medical and surgical interventions for the management of Acute
Myocardial Infarction; Hypertensive Urgency
5. Formulate appropriate nursing care plans suited for the patient based on the
assessment findings;
6. Identify care measures to be given to the patient and family to promote continuity of
care and independence after discharge.
III. Patient’s Profile
Name : Patient X
Age : 46 years old
Sex : Male
Nationality : Filipino
Ethnic Background : Ibaloi
Civil Status : Married
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Religion : Roman Catholic

Occupation : laborer
Admitting Diagnosis : Myocardial Infraction: Hypertensive Urgency
Final/Principal Diagnosis : Myocardial Infraction: Hypertensive Urgency
Date and Time Admitted : November 11, 2022, 4:05 pm
IV. Chief Complaint
Patient X complains of chest pain. DURING THE SHIFT
V. Present History of Illness
Patient X is a 46-year-old, male and a resident of Suyo, Poblacion (Central), Itogon Benguet. He was
admitted for the first time at Benguet General Hospital with a chief complaint of chest pain. The present
condition began 1 week before complaints of chest pain. ECG shows that there is a possible left atrial
abnormality and left ventricular hypertrophy and his Troponin I (Quantitative) results is 0.29.
VI. Past History of Illness
The patient had a previous hospitalization due to hypertension and taking medication of amlodipine
and losartan. He also had minor illnesses, such as cough, colds and fever and was remedied with over the
counter medications such as Bio flu with water therapy and bed rest.
VII. Family Health History
The patient claims that his father’s side of the family has a history of hypertension. Seven years ago,
his father suffered a stroke and passed away.
VIII. Developmental History BEHAVIORAL THEORY OR OTHER THEORIES
HOW THEY CAN AFFECT?
According to Erik Erikson’s theory of psychosocial development, the patient is in the stage
of Generativity versus stagnation. This stage takes place during middle adulthood (ages 40 to 65 years). During
this stage, middle age individuals experience a need to create or nurture things that will outlast them, often
having mentees or creating positive changes that will benefit other people. He displayed behavior of
generativity as he stated that he is happy with his family and knows his responsibility as a father, therefore he
is working to provide for their everyday expenses.
IX. Social and Environmental History
ONLY FOCUS ON THE CASE DESCRIPTION
The patient states that he likes to be involved in local and provincial social gatherings like weddings,
birthday parties, and funerals. The patient currently resides in Suyo, Poblacion (Central), Itogon Benguet with
his wife, son, and two daughters. He commutes to and from work every day in public utility jeepneys.
Due to health issues that have not been remedied by rest and at-home remedies, the patient and his
family attended district hospital. After experiencing sudden onset chest pain, the patient rushed to Itogon
District Hospital immediately. He was then referred to Benguet General Hospital for a diagnosis confirmation
and management. Access to medical facilities and treatments is not a major issue for a family from an average
socioeconomic background.
X. Lifestyle and Health Practices
The patient smokes and drinks alcohol especially when he is at work. The patient eats three complete
meals a day which mostly consists of rice, eggs, pork and vegetables. Patient stated that he drinks 1-2 glasses
of water every day. He does not exercise but does physical activities such as walking, he is able to perform his
ADL’s at home. He is aware of the possible health concerns associated with vices related to lifestyle, such as
smoking, drinking, and eating salty foods. He is also taking medication such as amlodipine and losartan to
maintain his blood pressure under control.
XI. Health Assessment

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A. General Survey SIGNS AND SYMPTOMS
The patient was received awake, lying on bed with an ongoing IVF of PNSS 1L x KVO @400 cc level
and with a side drip of Nicardipine 10 mg infusing well on the left arm and with oxygen inhalation at 1-2
LPM/ via the nasal cannula, connected to cardiac monitor.
SUBJECTIVE DATA
Patient appears weak, and needs assistance when going to the bathroom and in changing positions. He
wears a neat gown, hygiene is fair. Patient is cooperative and conversant; speech is well formulated; oriented
to date, time, place and people around him.
B. Head to Toe Assessment

C. RELATE TO 13 AREAS AND CASE DESCRIPTION
1. Head No abnormal findings AFEBRILE

2. Eyes No abnormal findings
3. Ears No abnormal findings
4. Nose and sinuses No abnormal findings
5. Mouth Lips are dry and a presence of dry oral mucosa noted.
6. Neck ROM intact, able to change direction of head slowly but with
complaints of pain.
7. Chest Respiratory rate ranges from 19-30 cpm. Use of accessory muscle
when breathing. NAHIRAPAN DAW HUMINGA?
8. Cardiac Cardiac rate ranges from 88-125 bpm, with sinus rhythm.
A dull, low-pitched sound (S4) noted upon auscultation. Increased
blood pressure as evidenced by 171/80; palpitations noted. CHEST
PAIN RATE KANO
9. Breast/Chest No abnormal findings
10. Abdomen Abdomen is distended, abdominal pain noted on the 4 quadrants.
11. Genitals No abnormal findings

12. Musculoskeletal Patient is able to move with ease but needs minimal
assistance from his watcher. There was use of accessory muscles
noted during respiration. Muscle strength at the right side is 3/5 while
the rest of extremities are 4/5.
13. Integumentary Nails are intact but not well trimmed. Pitting edema noted on both
feet graded as +2. FEVER DATA LIKE WARM TO TOUCH
KANO NU MA DEFEND MO
C. 13 Areas of Assessment
1. Psychosocial and Psychological Status
The patient is a 46-year-old male, married residing at Suyo Poblacion, Itogon, Benguet. He worked as a
laborer; his income together with his wife's income is enough to sustain their family’s basic needs. He is a
Roman catholic with no tradition, culture or beliefs practices which might affect in providing health care.
According to Erick Erikson Psychosocial theory, the patient falls under Generativity vs. Stagnation.
Wherein the patient is establishing his mark in the society through raising his children well, being a loving
husband and becoming involved in community/social activities.
2. Mental and Emotional Status
The patient is conscious, alert, and well oriented to time, date and place. He responds in every verbal,
touch and pain stimuli. He acts and talks according to his age. He responds appropriately to questions being
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asked with minimal eye contact. He displays facial grimace and guarding behavior due to chest pain, back pain
and when positioning.
3. Environmental Status
The patient lives with his wife and children. The family resides not too far from the city making it
easy for them to go to hospitals when they need medical assistance. The patient is admitted at Benguet General
Hospital. During admission, the patient’s bed is located near the window providing him proper ventilation and
adequate lighting during the day. Bed rails also were raised to ensure safety. Drinks, foods and other
necessities are easily accessible on the patient's bedside table.
4. Sensory Status
a. Visual Status
No abnormal findings were observed.
b. Auditory Status
c. Olfactory Status
d. Gustatory Status
e. Tactile Status
5. Motor Status
Due to pain, the patient has limited movement and needs assistance and support when positioning and
using the restroom.
6. Thermoregulatory Status
Normal body temperature is within 36.5 C to 37.5 C. However, during the 2nd day of shift the patient
was febrile with a temperature of 38.8 C.
Date Time Temperature
November 14, 2022 2am 36.5 °C
6 am 36.7 °C
November 15, 2022 2am 38.28 °C
6 am 36.9 °C
November 16, 2022 2am 36.7 °C
6 am 36.5 °C
7. Respiratory Status
Normal respiratory rate is 12 - 20 cpm for adults. However, irregular breathing pattern and use of
accessory muscle are noted. Normal SpO2 ranges from 95-100%. Patient is in O2 therapy via nasal cannula at
1-2 lpm with an SpO2 ranging from 92-96%.
Date Time RR SPO2
November 14, 2022 2am 19 cpm 94 %
6 am 18 cpm 92 %
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November 15, 2022 2am 25 cpm 95 %
6 am 24 cpm 96 %
November 16, 2022 2am 25 cpm 97 %
6 am 22 cpm 96 %
8. Circulatory Status
Normal cardiac rate for an adult is 60-100 beats per minute. Patient’s cardiac rate is within normal with
a capillary refill of 1-2 seconds.
Date Time CR Capillary BP
November 14, 2022 2am 68 bpm 1-2 seconds
6 am 64 bpm
6 am 85 bpm
6 am 85 bpm
9. Nutritional Status
Prior to hospitalization, the patient verbalized that he likes eating salty-fatty foods such as pork. He is
not a picky eater and eats three times a day. During hospitalization, he strictly follows a low-fat-low-sodium
diet as per order. The patient is able to swallow his food and medications as well. The patient denied any
indigestion or vomiting. There is no culture or religious dietary restriction reported by the patient and watcher.
10. Elimination Status
The patient is in I&O monitoring, he urinated 5-6 times a day during the shift with yellowish colored
urine. Patient verbalized that he did not defecate at least once during the shift.
11. Sleep, Rest and Comfort Status
During the shift, the patient verbalized having minimal sleep. He was unable to sleep comfortably due
to the routine of checking vital signs and is disturbed by the noises of his surroundings. The patient reports
back pain due to complete bed rest however, he was assisted in turning on his sideway every two hours to
promote comfort and prevent bed sores. WITH BATHROOM PRIVILEGES
12. Fluids and Electrolytes Status
Prior to admission, the patient's fluid consumption ranges between 500 to 1000 mL. During
hospitalization, the patient is in I&O monitoring and strictly follows fluid intake as per order. The patient has
ongoing IV fluid of PNSS 1L x KVO and with an ongoing side drip of Nicardipine 10 mg was infused.
13. Integumentary Status
Skin is pale and nails are intact but not well trimmed. EDEMA +2 ON BOTH FEETH
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XII. Diagnostics YOU CAN INCLUDE IN THE NCP ; CHOLESTEROL LEVEL

RELATIONSHIP ONLY TO THE PATIENT
Diagnostic procedure Description of procedure Significance/ Purpose of the Significant findings Nursing Implications
and date done procedure
A Serum Electrolyte test is a blood test that measures the Serum sodium and potassium Blood Urea Nitrogen: A high BUN level means your kidneys aren't
Serum Electrolytes levels of the body's main electrolytes which are; sodium, levels are prognostic Normal range: 2.80- 7;30 working well. A high BUN also indicates
potassium, chloride, and ionized calcium. indicators, rise in sodium Result: 14.64 – high dehydration, high protein diet and
November 11,2022 levels after initial fall was medications.
indicative of clinical
improvement. Therefore, Creatinine: Poor kidney function and Reduced
estimation of sodium and Normal range: myocardial blood flow
potassium level in acute MI 70.0-115.0
patients can help assess their Result: 355.1 – high
prognosis.
Potassium Low potassium indicates heart problems such
Normal range: as irregular heartbeat or irregular activity of
3.50-5.30 heart.
Result: 2.86 – low
Ionized Calcium Low levels of free calcium can cause your

Normal Range: heart rate to slow down or speed up, cause
1.13-1.32 muscle spasms, and even result in a coma.
Result: 0.97 – low
Complete Blood A Complete Blood Count (CBC) may be ordered when a Obtain a complete blood cell White blood cells A high white blood cell count usually
Count person has any number of signs and symptoms that may (CBC) count if myocardial Normal Range: indicates that more white blood cells are
be related to disorders that affect blood cells. infarction is suspected in 4.50-11.0 being created to fight an illness or as a result
order to rule out anemia as a Result: 16.2 – High of a drug that increases white blood cell
cause of decreased oxygen production.
supply and prior to giving
thrombolytic agents.
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Creatinine test Measures creatinine levels in blood and/or urine. Increased creatinine levels Normal Range: High creatinine is an indication of poor
Creatinine is a waste product made by your muscles as during hospitalization are a 70.0-115.0 kidney function, which can be problem in a
November 11, 2022 part of regular, everyday activity. Normally, your marker of poor cardiac treatment of patient with heart failure.
kidneys filter creatinine from your blood and send it out output, leading to diminished Result: 422.3 mmol/l
of the body in your urine. If there is a problem with your renal blood flow and reduced
kidneys, creatinine can build up in the blood and less ability to tolerate inpatient
will be released in urine. heart failure treatment.
Troponin I A troponin test measures the level of troponin in your This test is most often used Reference Range: If your troponin levels are low or normal
blood. Troponin is a type of protein found in the muscles to diagnose a heart attack. It <0.30 after experiencing chest pain, you probably
November 11, 2022 of your heart. Troponin isn't normally found in the is sometimes used to monitor have not experienced a heart attack.
blood. When heart muscles become damaged, troponin angina, a condition that Result 0.29- Low
is sent into the bloodstream. As heart damage increases, limits blood flow to the heart
greater amounts of troponin are released in the blood. and causes chest pain.
Angina sometimes leads to a
heart attack.
Prothrombin Test The prothrombin time is monitored if you are taking the A PTT was done to make Reference Ranges: 10-17 A number lower than that range means blood
blood-thinning medication warfarin. This method also is sure that there is no problem second clots more quickly than normal.
used to determine how quick your blood to form a clot in doing medication and Result: 9.2
and investigate potential blood disorders. treatment with the patient.
INR: INR levels that are too low may mean you are
Reference Range: 1-2 Result: at risk for dangerous blood clots.
0.79
Diagnostic Procedure Description of the Procedure Significance/ Purpose of the Date Findings and Implications
Procedure
Electrocardiogram An electrocardiogram records First test done to diagnose a heart November 11, 2022 • Left Ventricular Hypertrophy indicates thickened heart wall can be
the electrical signals in the attack records electrical signals as stiff. Blood pressure in the heart increases. The changes make it harder
heart. It's a common and they travel through the heart. An heart to effectively pump blood. Uncontrolled high blood pressure is th
painless test used to quickly ECG can show if you are having common cause of left ventricular hypertrophy
detect heart problems and or have had a heart attack.
monitor the heart's health. • Possible Left atrial Abnormality
• Unconfirmed Diagnosis
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XIII. Comprehensive Pathophysiology

REVISE HUHUHU
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XIV. Treatment/Management
A. Drugs
DRUG STUDY 1: AMLODIPINE ORDER TO PATIENT HOW MANY TIMES
DRUG NAME MECHANISM OF ACTION CONTRAINDICATIONS & ADVERSE NURSING RESPONSIBILITIES

WHAT DOES IT DO TO THE INDICATIONS EFFECTS R/T TO PATIENT ONLY
PATIENT RELATIONSHIP ONLY TO RELATIONSHIP
MECHANISM OF ACTION TO THE PATIENT ONLY TO THE
THE PATIENT ONLY PATIENT
Generic Name: Binds to dihydropyridine and non- Contraindications: CNS: Anxiety, BEFORE:
AMLODIPINE dihydropyridine cell membrane Hypersensitivity to amlodipine dizziness, fatigue, Dx:
BESYLATE receptor sites on myocardial and or its components headache, lethargy, a. Verify doctor’s order.
vascular smooth muscle cells and light-headedness, b. Assess allergy to amlodipine or its components.
Brand Name: inhibits influx of extracellular Indications: paresthesia, tremor Tx:
Norvasc calcium ions across slow calcium Indicated for the treatment of CV: Arrhythmias, c. Prepare the medication at the right time and right dosage.
channels. This decreases hypertension chest pain, EDx:
Chemical Class: intracellular calcium level, hypotension, d. Educate the patient and SO about the purpose and importance of the
Dihydropyridine inhibiting smooth-muscle cell Drug to drug Interaction: palpitations drug.
contractions and relaxing coronary beta blockers: Possibly EENT: Dry mouth e. Educate patient on drug therapy to promote compliance.
Therapeutic Class: and vascular smooth muscles, excessive hypotension GI: Abdominal
Antianginal, decreasing peripheral vascular cyclosporine: Possibly cramps, abdominal DURING:
Antihypertensive resistance, and reducing systolic pain, anorexia, Dx:
increased blood cyclosporine
and diastolic blood pressure. constipation, f. Verify client’s identity.
Dosage: 5 mg Decreased peripheral vascular levelsCYP3A4 inhibitors such diarrhea, dysphagia, g. Assess patient frequently for chest pain when starting or increasing the
resistance also decreases as diltiazem, ketoconazole, flatulence, dose of amlodipine, because worsening of angina or an acute MI can
Route: Oral myocardial workload, oxygen itraconazole, and ritonavir: indigestion, occur.
demand, and possibly angina. Possible increased blood jaundice, nausea, Tx:
INCLUDE HOW Also, by inhibiting coronary artery amlodipine level vomiting h. Administer medication following the 10 rights of medication.
MANY TIMES/ muscle cell contractions and MS: Myalgia i. Suggest taking amlodipine with food to reduce GI upset.
HOW OFTEN restoring blood flow, drug may fentanyl: Increased risk of RESP: Dyspnea j. Assist patient when taking the medication.
WHAT TIME relieve Prinz metal’s angina. severe hypotension and SKIN: Dermatitis, EDx:
flushing, rash k. Instruct SO to report persistent adverse effects such as dizziness,
increased fluid volume
SOURCE: Other: Weight loss difficulty breathing, arm or leg swelling, and rash.
Jones & Bartlett Learning
requirements during surgery
(2015). Nurse’s Drug Handbook. AFTER:
Fourteenth Edition. Dx:
simvastatin: Increased exposure
l. Monitor patient’s BP for postural changes.
to simvastatin m. Monitor drug effectiveness.
Tx:
n. Promote safety and comfort.
EDx:
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o. Encourage the patient to verbalize feelings and concerns.
DRUG STUDY 2: ASPIRIN
MECHANISM OF ACTION CONTRAINDICATIONS & ADVERSE EFFECTS NURSING RESPONSIBILITIES

INDICATIONS
Generic Name: Blocks the activity of Contraindications: CNS: Confusion BEFORE:
ASPIRIN cyclooxygenase, the enzyme Allergy to tartrazine dye, asthma, EENT: Hearing loss, Dx:
needed for prostaglandin bleeding problems (such as tinnitus a. Verify doctor’s order.
Brand Name: synthesis. Prostaglandins, hemophilia), hypersensitivity to GI: Diarrhea, GI b. Assess allergy to aspirin or its components.
Aspergum important mediators in the aspirin or its components, peptic bleeding, heartburn, Tx:
inflammatory response, cause ulcer disease hepatotoxicity, nausea, c. Prepare the medication at the right time and right dosage.
Chemical Class: local vasodilation with swelling vomiting EDx:
Salicylate and pain. With blocking of Indications: HEME: Decreased d. Educate the patient and SO about the purpose and
cyclooxygenase and inhibition of Mild to moderate pain or fever blood iron level importance of the drug.
Therapeutic Class: prostaglandins, inflammatory including rheumatoid arthritis, Other: salicylism e. Educate patient on drug therapy to promote compliance
Anti-inflammatory, symptoms subside. Pain is also osteoarthritis, thromboembolic (dizziness, tinnitus,
Antiplatelet, relieved because prostaglandins disorders; transient ischemic attacks, difficulty hearing, DURING:
Antipyretic, play a role in pain transmission rheumatic fever, postmyocardial vomiting, diarrhea, Dx:
Nonopioid analgesic from the periphery to the spinal infarction, prophylaxis of MI, confusion, CNS f. Verify patient’s identity.
cord. Aspirin inhibits platelet ischemic stroke, angina depression, diaphoresis, g. Assess patient’s condition.
Dosage: 80 mg aggregation by interfering with headache, Tx:
production of thromboxane A2, a hyperventilation, and h. Administer medication following the rights of giving
Route: Oral substance that stimulates platelet Drug to drug Interaction: lassitude) with regular medication.
aggregation. Aspirin acts on the ACE inhibitors: Decreased use of large doses i. Suggest taking aspirin with food or after meals because it
heat-regulating center in the antihypertensive effect may cause GI upset.
hypothalamus and causes activated charcoal: Decreased j. Assist patient when taking the medication.
peripheral vasodilation, EDx:
aspirin absorption
diaphoresis, and heat loss. k. Instruct patient not to cut, crush or chew the medication.
carbonic anhydrase inhibitors:
Salicylism corticosteroids: Increased AFTER:
SOURCE: excretion and decreased blood level Dx:
Jones & Bartlett Learning of aspirin heparin: Increased risk of l. Monitor patient for signs and symptoms.
(2015). Nurse’s Drug Handbook. bleeding m. Monitor drug effectiveness.
Fourteenth Edition. ibuprofen: Possibly reduced Tx:
n. Promote safety and comfort.
cardioprotective and stroke
EDx:
preventive effects of aspirin o. Instruct patient and SO to notify the nurse if any symptoms
NSAIDs: Possibly decreased blood of stomach or intestinal bleeding occur such as black, tarry
NSAID level and increased risk of or bloody stools.
14
adverse GI effects sulfonylureas:

Possibly enhanced effect of
sulfonylureas with large doses of
aspirin
DRUG STUDY 3: ATORVASTATIN

INDICATIONS
Generic Name: Reduces plasma cholesterol and Contraindications: CNS: dizziness, emotional BEFORE:
ATORVASTATIN lipoprotein levels by inhibiting Active hepatic disease, breastfeeding, lability, fatigue, fever, Dx:
CALCIUM HMG-CoA reductase and hypersensitivity to atorvastatin or its headache, malaise, a. Verify doctor’s order.
cholesterol synthesis in the liver components, pregnancy, unexplained paresthesia, weakness b. Assess allergy to atorvastatin or its components.
Brand Name: Lipitor and by increasing the number of persistent rise in serum transaminase CV: Arrhythmias, Tx:
LDL receptors on liver cells to level orthostatic hypotension, c. Prepare the medication at the right time and right
Chemical Class: enhance LDL uptake and palpitations, phlebitis dosage.
Synthetically derived breakdown. Indications: EENT: dry mouth, EDx:
fermentation product As adjunct for primary epistaxis, d. Educate the patient and SO about the purpose and
hypercholesterolemia (types Ia, Ib), ENDO: Hyperglycemia or importance of the drug.
Therapeutic Class: SOURCE: hypoglycemia e. Educate patient on drug therapy to promote compliance
dysbetalipo proteinemia, elevated
Antihyperlipidemic Jones & Bartlett Learning GI: Abdominal or biliary
(2015). Nurse’s Drug triglyceride levels, prevention of pain, constipation, diarrhea, DURING:
Dosage: 40 mg Handbook. Fourteenth Edition. CV disease by reduction of heart vomiting Dx:
risk in those with mildly elevated MS: back or muscle pain, f. Verify patient’s identity.
Route: Oral cholesterol. gout, leg cramps, myalgia, g. Assess patient’s condition.
neck rigidity Tx:
RESP: Dyspnea h. Provide comfort measures and arrange for analgesics if
headache occurs.
i. Assist patient when taking the medication.
Drug to drug Interaction: EDx:
Azole Antifungals, Colchicine, j. Instruct the patient to report unexplained muscle pain,
Erythromycin, Gemfibrozil, tenderness or weakness, especially with fever or
LipidModifying Doses of Niacin, malaise.
Other Fibrates: Increased risk of k. Encourage patient to take medication to the prescribed
myopathy and rhabdomyolysis frequency.
cyclosporine
AFTER:
Digoxin: Increased digoxin level and Dx:
increased risk of toxicity efavirenz, l. Monitor for therapeutic effectiveness which is indicated
rifampin, other by reduction in the level of LDL-C.
Tx:
15
m. Promote safety and comfort measures.

EDx:
n. Encourage patient to report any side and adverse effect.
DRUG STUDY 4: LACTULOSE EXERTION

INDICATIONS
Generic Name: Arrives unchanged in the colon, Contraindications: GI: Abdominal cramps and BEFORE:
LACTULOSE where it breaks down into lactic Hypersensitivity to lactulose or its distention, diarrhea, Dx:
acid and small amounts of formic components, low-galactose diet flatulence a. Verify doctor’s order.
Brand Name: Duphalac and acetic acids, acidifying fecal ENDO: Hyperglycemia b. Assess allergy to lactulose or its components.
contents. Acidification leads to Indications: Other: Hypernatremia, Tx:
Chemical Class: increased osmotic pressure in the Indicated for the treatment of hypokalemia, hypovolemia c. Prepare the medication at the right time and right
Synthetic disaccharide colon, which, in turn, increases constipation dosage.
sugar stool water content and softens d. Don’t give concurrently with other laxatives.
stool. Also, lactulose makes EDx:
Therapeutic Class: intestinal contents more acidic Drug to drug Interaction: e. Educate the patient and SO about the purpose and
Ammonia reducer, than blood. This prevents Anti-infectives: decreased lactulose importance of the drug.
Laxative ammonia diffusion from intestine efficacy f. Educate patient on drug therapy to promote
into blood, as occurs in hepatic compliance.
Dosage: 30 cc encephalopathy. The trapped Other laxatives: interference with
ammonia is converted into response to lactulose (in patients DURING:
Route: Oral ammonia ions and, by lactulose’s Dx:
with hepatic encephalopathy
cathartic effect, is expelled in g. Verify patient’s identity.
feces with other nitrogenous h. Assess patient’s condition.
wastes. Tx:
i. Check the solution appears pale yellow to yellow,
viscous liquid. Cloudiness, darkened solution does not
SOURCE: indicate potency loss.
Jones & Bartlett Learning
(2015). Nurse’s Drug EDx:
Handbook. Fourteenth Edition. j. Emphasize the importance of drinking adequate fluids
and to report signs and symptoms of dehydration.
AFTER:
Dx:
k. Monitor the patient's activity and vital signs.
l. Monitor for possible adverse effects of medication.
Tx:
m. Assess the patient and determine unusual changes.
16
n. Evaluate therapeutic response: decreased constipation,

decreased blood ammonia level, clearing of mental
status.
EDx:
o. Instructed to immediately report to the prescriber, if
unusual changes are noticed.
p. Instructed not to use as a laxative long term; to use as
prescribed.
DRUG STUDY 5: CLOPIDOGREL

INDICATIONS
Generic Name: Binds to adenosine diphosphate Contraindications: CNS: Confusion, dizziness, BEFORE:
CLOPIDOGREL (ADP) receptors on the surface of Active pathological bleeding, bleeding, fatigue, fever, Dx:
BISULFATE activated platelets. This action including peptic ulcer and headache a. Verify doctor’s order.
blocks ADP, which deactivates intracranial hemorrhage; CV: Chest pain, b. Assess allergy to clopidogrel or its components.
Brand Name: Plavix nearby glycoprotein IIb/IIIa hypersensitivity to clopidogrel or its hypertension, hypotension Tx:
receptors and prevents fibrinogen components EENT: Altered taste; c. Prepare the medication at the right time and right
Chemical Class: from attaching to receptors. conjunctival, ocular, or dosage.
Thienopyridine Without fibrinogen, platelets Indications: retinal bleeding; epistaxis EDx:
derivative can’t aggregate and form Treatment of patients at risk for GI: Abdominal pain; d. Educate the patient and SO about the purpose and
thrombi. ischemic events— diarrhea; nausea importance of the drug.
Therapeutic Class: history of MI, ischemic stroke, GU: Elevated serum e. Educate patient on drug therapy to promote
Platelet aggregation peripheral artery creatinine level compliance.
inhibitor SOURCE: disease; Treatment of HEME: unusual bleeding
Jones & Bartlett Learning patients with acute coronary or bruising DURING:
Dosage: 75 mg (2015). Nurse’s Drug syndrome MS: back pain, myalgia Dx:
Handbook. Fourteenth Edition. Other: Anaphylaxis, f. Verify patient’s identity.
Route: Oral angioedema, flulike g. Assess patient’s condition.
Drug to drug Interaction: symptoms, serum sickness Tx:
aspirin: Increased risk of bleeding h. Administer medication as prescribed.
i. Assist when taking the medication.
CYP2C19 inhibitors, such as
EDx:
cimetidine, esomeprazole, etravirine,
j. Instruct patient to notify prescriber promptly if she
felbamate, fluconazole, fluoxetine, experiences side effects such as fever, weakness,
fluvoxamine, extreme skin paleness, purple skin patches,
ketoconazole, omeprazole, yellowing of the skin or eyes, or neurologic changes.
ticlopidine,
voriconazole: Decreased plasma AFTER:
clopidogrel level, decreased platelet Dx:
17
inhibition k. Be alert for signs of GI bleeding signs (abdominal pain,

fluvastatin, phenytoin, torsemide: vomiting blood, blood in stools, black/tarry stools) or
Interference with metabolism of other signs of bleeds (bleeding gums, nosebleeds,
these drugs unusual bruising, hematuria; fall in hematocrit or blood
NSAIDs: Increased risk of GI pressure). Notify physician or nursing staff
immediately if these signs occur.
bleeding, interference with NSAID
l. Monitor the effectiveness of the drug.
metabolism Tx:
warfarin: Prolonged bleeding time, m. Promote safety and comfort measures.
interference with warfarin EDx:
metabolism n. Caution patient that bleeding may continue longer than
usual. Instruct him to report unusual bleeding or
bruising.
o. Instruct patient not to discontinue clopidogrel abruptly

or without first consulting prescriber.
DRUG STUDY 6: ISMN

INDICATIONS
Generic Name: Isosorbide may interact with Contraindications: CNS: Agitation, confusion, BEFORE:
ISOSORBIDE nitrate receptors in vascular Angle-closure glaucoma; cerebral dizziness, headache, Dx:
MONONITRATE smooth-muscle cell membranes. hemorrhage; concurrent use of restlessness, vertigo, a. Verify doctor’s order.
By interacting with receptors’ sildenafil; head trauma; weakness b. Assess allergy to its components.
Brand Name: Monoket sulfhydryl groups, drug is hypersensitivity to isosorbide, other CV: Arrhythmias, Tx:
reduced to nitric oxide. Nitric nitrates, or their components; orthostatic hypotension, c. Prepare the medication at the right time and right
Chemical Class: oxide activates the enzyme orthostatic hypotension; severe palpitations, tachycardia dosage.
Organic Nitrate guanylate cyclase, increasing anemia EENT: Blurred vision d. Keep isosorbide protected from heat and light.
intracellular formation of cyclic GI: Abdominal pain, EDx:
18
Therapeutic Class: guanosine monophosphate Indications: diarrhea, indigestion, e. Educate the patient and SO about the purpose and
Antianginal, (cGMP). An increased cGMP Indicated for the treatment or nausea, vomiting importance of the drug.
Vasodilator level may relax vascular smooth prevention of angina pectoris HEME: Hemolytic anemia f. Educate patient on drug therapy to promote compliance
muscle by forcing calcium out of MS: Arthralgia, muscle
Dosage: 30 mg muscle cells, causing twitching DURING:
vasodilation. This improves Drug to drug Interaction: Dx:
Route: Oral cardiac output by reducing acetylcholine, norepinephrine: g. Verify patient’s identity.
mainly preload but also afterload. Possibly decreased effectiveness of h. Assess patient’s condition.
these drugs Tx:
i. Give drug 1 hour before or 2 hours after meals. Give
antihypertensives, calcium channel
SOURCE: with meals if patient experiences severe headaches or
Jones & Bartlett Learning blockers, opioid analgesics, other
adverse GI reactions.
(2015). Nurse’s Drug vasodilators: Increased risk of
j. Administer medication as ordered.
Handbook. Fourteenth Edition. orthostatic hypotension
k. Assist patient when taking the medication.
aspirin: Increased blood level and EDx:
pharmacologic action of isosorbide l. Caution patient not to crush or chew isosorbide E.R.
sildenafil, tadalafil, vardenafil: capsules or tablets or S.L. tablets unless specifically
Increased risk of hypotension and ordered to do so by prescriber.
death m. Instruct patient to take drug before any situation or
sympathomimetics: Increased risk of activity that might precipitate angina.
hypotension, possibly decreased
therapeutic effects of isosorbide AFTER:
Dx:
n. Monitor blood pressure often during isosorbide therapy,
especially in elderly patients; drug may cause severe
hypotension.
Tx:
o. Know that patient may experience daily headaches from
isosorbide’s vasodilating effects. Give acetaminophen,
as prescribed, to relieve pain.
p. Promote safety and comfort measures.
EDx:
q. Encouraged patient to verbalize feelings and concerns.
r. Instruct patient to notify prescriber about blurred vision,
fainting, increased angina attacks, rash, and severe.
19
DRUG STUDY 7: FUROSEMIDE
DRUG NAME MECHANISM OF ACTION CONTRAINDICATIONS & ADVERSE EFFECTS NURSING RESPONSIBILITIES
INDICATIONS
Generic Name: Inhibits sodium and water Contraindications: CNS: Dizziness, BEFORE:
FUROSEMIDE reabsorption in the loop of Henle Anuria unresponsive to furosemide; drowsiness, fever, headache, Dx:
and increases urine formation. As hypersensitivity to furosemide, lethargy, restlessness, a. Verify doctor’s order.
Brand Name: Lasix sulfonamides, or their components b. Assess allergy to sulfonamide or its components.
the body’s plasma volume vertigo, weakness
Tx:
Chemical Class: decreases, aldosterone production c. Prepare the medication at the right time.
increases, which promotes Indications: CV: Arrhythmias, elevated
Sulfonamide Pulmonary edema; edema with HF, EDx:
sodium reabsorption and the loss cholesterol and triglyceride d. Educate the patient and SO about the purpose and
hepatic disease, nephrotic levels, orthostatic
Therapeutic Class: Anti- of potassium and hydrogen ions. importance of the drug.
hypertensive, Diuretic syndrome, ascites, hypertension hypotension, tachycardia e. Educate patient on drug therapy to promote compliance
Furosemide also increases the
excretion of calcium, magnesium,
Dosage: 100 mg ENDO: Hyperglycemia DURING:
bicarbonate, ammonium, and
Dx:
Route: IV phosphate. By reducing Drug to drug Interaction: GI: Abdominal cramps, f. Verify patient’s identity.
intracellular and extracellular ACE inhibitors, angiotensin II g. Obtain patient’s weight before and periodically during
anorexia, constipation,
fluid volume, the drug reduces receptor blockers: Possibly first-
diarrhea, vomiting furosemide therapy to monitor fluid loss.
dose hypotension, severe
blood pressure and decreases
hypotension, deterioration in renal
cardiac output. Over time, cardiac MS: Muscle pain or spasms Tx:
function
output returns to normal. h. Administer medication as ordered.
aminoglycosides, cisplatin,
Other: Allergic reaction i. Assist patient when taking the medication.
ethacrynic acid: Increased risk of
(interstitial nephritis, EDx:
ototoxicity
cephalosporins: Increased risk of necrotizing vasculitis, j. Advise patient to change position slowly to minimize
SOURCE: cephalosporin-induced systemic vasculitis) effects of orthostatic hypotension and to take
Jones & Bartlett Learning nephrotoxicity furosemide with food or milk to reduce GI distress.
(2015). Nurse’s Drug Handbook. agents: Increased furosemide k. Instruct to report palpitations, signs of electrolyte
Fourteenth Edition. effects imbalances (noted previously), hearing abnormalities
insulin, oral antidiabetic drugs:
Increased blood glucose level (sense of fullness in ears, tinnitus).
norepinephrine: Possibly decreased
arterial response to norepinephrine AFTER:
NSAIDs: Possibly decreased Dx:
diuresis l. Monitor vital signs especially blood pressure.
propranolol: Possibly increased m. Monitor for possible adverse effects of medication.
blood propranolol level Tx:
20
thiazide diuretics: Possibly n. Promote safety and comfort measures.

profound diuresis and electrolyte o. Assess the patient and determine unusual signs.
imbalances EDx:
p. Encourage patient to verbalize feelings and concerns.
q. Emphasize the importance of weight and diet control,
especially limiting sodium intake.
DRUG STUDY 8: TRAMADOL HYDROCHLORIDE
INDICATIONS
21
Generic Name: Binds with mu receptors and Contraindications: CNS: Agitation, anxiety, BEFORE:
TRAMADOL inhibits the re-uptake of Alcohol intoxication; excessive use depression, dizziness, Dx:
HYDROCHLORIDE norepinephrine and serotonin, of central-acting analgesics, emotional lability, fatigue, a. Verify doctor’s order.
hypnotics, opioids, or other b. Assess allergy to tramadol or its components.
which may account for fever, hallucinations,
Brand Name: Ultram Tx:
tramadol’s analgesic effect. psychotropic drugs; hypersensitivity headache, restlessness, c. Prepare the medication at the right time and right
Chemical Class: to tramadol or its components; use tremor, vertigo, weakness dosage.
Cyclohexanol within 14 days of MAO inhibitor EDx:
therapy CV: Chest pain, orthostatic d. Educate the patient and SO about the purpose and
SOURCE:
Jones & Bartlett Learning (2015).
hypotension importance of the drug.
Therapeutic Class: Nurse’s Drug Handbook. Indications: e. Educate patient on drug therapy to promote
Analgesic Fourteenth Edition. To relieve pain severe enough to EENT: Blurred vision compliance.
require opioid-like treatment and for
Dosage: 50 mg which alternative treatment options GI: Abdominal pain, DURING:
such as nonopioid analgesics or constipation, diarrhea, Dx:
Route: IV indigestion, nausea, f. Verify patient’s identity.
opioid combination products are
vomiting g. Assess patient’s condition.
inadequate or not tolerated. Tx:
Management of moderate to severe h. Administer medication as prescribed.
GU: Urinary frequency,
pain, chronic pain EDx:
urine retention
i. Instruct patient to notify prescriber promptly if she
Drug to drug Interaction: experiences side effects such as fever, dizziness, chest
alpha blockers, CYP2D6 and CYP3A4 MS: Arthralgia; back, limb,
pain, vomiting, nausea, and weakness.
inhibitors (amitriptyline, erythromycin, or neck pain
fluoxetine, paroxetine, quinidine), AFTER:
RESP: Cough, dyspnea Dx:
MAO inhibitors, and norepinephrine
reuptake inhibitors, tricyclic j. Monitor patient for side effects.
SKIN: rash k. Monitor the effectiveness of the drug.
antidepressants, triptans: Increased
risk of serotonin syndrome; CNS
Tx:
l. Promote safety and comfort measures.
depressants such as barbiturates,
EDx:
phenothiazines, sedative-hypnotics, m. Instruct patient to inform all prescribers of tramadol
tranquilizers: Additive CNS
therapy because of potential drug interactions.
depression
warfarin: Possibly increased INR
22
DRUG STUDY 9: OMEPRAZOLE

INDICATIONS
Generic Name: Contraindications: GI: acid regurgitation BEFORE
Omeprazole Interferes with gastric acid Hypersensitivity to drug, Hepatic Dx:
secretion by inhibiting the disease, pregnancy CNS: dizziness, a. Assess for allergy to omeprazole.
Brand Name: hydrogen potassium drowsiness, fatigue, b. Assess for other contraindications in drug
Prilosec adenosine triphosphatase Indications: headache, weakness administration.
enzyme system or proton pump, Gastric ulcer, short term treatment Tx:
Chemical Class: in gastric parietal cells if duodenal ulcer, pathologic CV: Chest pain
Substituted hypersecretory conditions, Gastro 0. Had phentolamine readily available in case of
benzimidazoles esophageal reflux disease DERM: itching, rash hypertensive crisis.
(GERD) a. Prepare medication observing proper technique
Therapeutic Source: Jones and Bartlett MS: back pain and the R’s of drug administration.
Class: Proton Pump Learning (2021) Nurse’s Drug b. Keep diphenhydramine injection readily available
inhibitor; Antiulcer Handbook Drug to drug Interaction: in case extrapyramidal reactions occur (50 mg
Anticholinergics, opioids: IM).
Dosage: 40mg antagonism of metoclopramide’s
GI motility effect Edx:
Route: IV Antidepressants, antihistamines,
other CNS depressants (such as 0. As appropriate, review all other significant and
opioids, sedative-hypnotics): life-threatening adverse reactions and interactions,
additive CNS depression especially those related to the drugs, tests, and
Cimetidine, digoxin: decreased behaviors mentioned above.
blood levels of these drugs a. Urge the patient to report persistent or serious
General anesthestics: exaggerated adverse reactions promptly.
hypotension Haloperidol, b. Educate the patient about the drug and the purpose
phenothiazines: increased risk of of the drug.
extrapyramidal reactions
Levodopa: decreased DURING
metoclopramide efficacy MAO Dx:
inhibitors: increased 0. Monitor BP carefully during IV administration.
catecholamine release a. Monitor diabetic patients.
Tx:
0. Give direct IV doses slowly over 1-2 minutes.
a. For IV infusion, give over at least 15 minutes.
b. Perform 15 rights of medication
Edx:
0. Take this drug exactly as prescribed.
a. Ensure to the patient the possible side and
adverse effects of the drug.
23
b. Tell the patient to notify the prescriber if he

developed a rash, fever, chills. A rash is the most
common allergic reaction, especially if
allopurinol is also being taken.
AFTER
Dx:
0. Assess for current medications.
a. Assess the patient for any presence of adverse
reaction or side effects.
Tx:
0. Provide comfort and safety to the patient.
a. Note anything abnormal that happens with the
patient.
b. Do proper documentation.
Edx:
0. Instruct to report involuntary movement of the
face, eyes, or limbs, severe depression, severe
diarrhea.
a. Instruct not to use alcohol, sleep remedies or
sedatives; serious sedation could occur.
DRUG STUDY 10: LOSARTAN
INDICATIONS
Generic Name: Blocks vasoconstricting and Indication: CNS: dizziness, BEFORE
Losartan aldosterone- secreting effects of insomnia, headache, Dx:
Treatment of hypertension, alone or fatigue, weakness, 0. Assess the patient's health history.
angiotensin II at various receptor
Brand Name: in combination with other anti- restlessness a. Assess the patient's blood pressure.
sites, including vascular smooth
Cozaar hypertensive agents. b. Assess the patient's renal function.
muscle and adrenal glands. Also Tx:
CV: edema
Chemical Class: increases urinary flow and 0. Introduce name and build rapport.
Angiotensin II enhances excretion of chloride, Contraindication: GI: diarrhea, dyspepsia a. Verify doctor’s order.
Receptor Antagonist magnesium, calcium, and
(ARBs). Contraindicated with patient Edx:
phosphate Musculoskeletal: muscle
hypertensive to drugs. cramps, myalgia, back or
Therapeutic Class: leg pain 0. Educate in the purpose of the drug.
Respiratory: nasal a. Explain the possible side and adverse effects of the
Antihypertensive; Source: Drug-drug Interactions: congestion, cough upper drug.
Angiotensin II respiratory infection, b. Tell patient to avoid salt substitutes; these products
Decreased serum levels and
24
McGraw-Hill Nurse’s Drug effectiveness if taken concurrently sinusitis. may contain potassium, which can cause
receptor antagonist Handbook Seventh Edition with phenobarbital Losartan is hyperkalemia in patients taking losartan.
converted to an active metabolite by
Dosage: 100 mg DURING
cytochrome P450-3A4. Drugs that
Dx:
inhibit 3A4 (ketoconazole, 0. Monitor patient’s intake and output.
Route: PO
fluconazole, diltiazem) may a. Monitor blood pressure closely to evaluate
decrease the antihypertensive effectiveness of therapy.
effects of losartan b. Monitor patients who are taking diuretics for
symptomatic hypotension.
Drug-Food Interactions: Tx:
Salt substitutes containing 0. Administer drug on empty stomach one hour
potassium: hyperkalemia before or two hours after meal.
a. Ensure to observe the following rights of the
patient (right medication, right route, right patient,
right time and right dosage).
b. Regularly assess the patient’s renal function (via
creatinine and BUN levels).
Edx:
0. Educate patients on the importance of healthy

lifestyle choices which include regular exercise,
weight loss, smoking cessation, and low-sodium
diet.
a. Emphasize to the client the importance of strict
adherence to drug therapy.
AFTER
Dx:
0. Assess patient response to the drug.

a. Monitor for adverse effects.
b. Monitor patient’s sleeping pattern
Tx:
0. Be alert for adverse reactions.

a. Promote comfort measures to help the patient
tolerate drug effects.
b. May cause hypotension, tachycardia, angioedema,
hyperkalemia.
Edx:
25
0. Educate patients and family members about the

drug's effect on the body and manifestations that
would need reporting.
a. Tell the patient to inform Physician or nurse once
she experiences the following: a light- headed
feeling like he might pass out; pain or burning
when he urinates; nausea, weakness, tingly
feeling, chest pain.
DRUG STUDY 11: CARVEDILOL WHEN BINIBIGAY?
INDICATIONS
Generic Name: Decreased heart rate and BP. INDICATION: CNS: dizziness, fatigue, BEFORE
Carvedilol Improved cardiac output, slowing weakness, anxiety, Dx:
Hypertension depression, drowsiness, 0. Assess for contraindications and cautions such as
of the progression of HF and
Brand Name: Coreg insomnia, memory loss, any known allergies to the drug.
decreased risk of death.
mental status changes, a. Obtain vital signs.
Chemical Class: CONTRAINDICATIONS: nervousness Tx:
Adrenergic 0. Verify doctor’s order.
antagonist Source: History of serious hypersensitivity EENT: blurred vision, a. Introduce name and build rapport.
reactions; Pulmonary edema; dry eyes, intraoperative b. Reposition the client in semi-fowler's position as
Therapeutic Class: Davis’s Drug Guide for Nurses floppy iris syndrome, tolerated.
Cardiogenic shock; Bradycardia,
Antihypertensive hearblock or sick sinus syndrome; nasal stuffiness. Edx:
Uncompensated HF requiring IV 0. Educate in the purpose of the drug.
Dosage: 6.25 mg Resp: bronchospasm, a. Explain the possible side and adverse effects of
inotropic agents; Severe hepatic
wheezing. the drug.
Route: Per Orem impairment. b. Encourage to verbalize any queries or concerns
CV: bradycardia, HF, about the medication
pulmonary edema. DURING
Dx:
GI: diarrhea, constipation,
nausea. 0. Ensure to observe the following rights of the
patient (right medication, right route, right patient,
GU: erectile right time and right dosage).
dysfunction,plibido. a. Take an apical pulse before administering.
Derm: stevens-johnson Tx:

syndrome, toxic
epidermal 0. Positioned patient in proper position.
a. Administer with food to minimize orthostatic
26
NECROLYSIS, itching, hypotension.

rashes, urticaria. b. Assisted patient in taking medication.
Endo: hyperglycemia, Edx:

hypoglycemia.
0. Advise patient and SO to change positions slowly
MS: arthralgia, back pain, to minimize orthostatic hypotension.
muscle cramps. Neuro: a. Advise patient and SO to notify health care
paresthesia. professionals if slow pulse, difficulty breathing,
wheezing, cold hands and feet, dizziness,
confusion, depression, rash, fever, sore throat,
unusual bleeding, or bruising occurs.
AFTER
Dx:
0. Assess patient response to the drug.

a. Monitor for adverse effects.
b. Monitor intake and output ratios and daily weight.
c. Assess patient routinely for evidence of fluid
overload.
Tx:
0. Promote comfort measures to help the patient

tolerate drug effects.
a. Provide safety measures (e.g. adequate lighting,
raised side rails, etc.) to prevent injuries.
Edx:
0. Advise patient to make sure enough medication is

available for weekends, holidays, and vacations.
Teach patient and family how to check pulse and BP and
check it biweekly.
DRUG STUDY 12: METOPROLOL
INDICATIONS
Generic Name: Competitively blocks beta- Contraindications: CNS: dizziness, vertigo, BEFORE
27
Metoprolol adrenergic receptors in the Drug hypersensitivity, sinus tinnitus, fatigue, Dx:
heart and juxtaglomerular bradycardia, greater than first- emotional depression a. Check doctor’s order.
Brand Name: apparatus, decreasing the degree heart block, cardiogenix b. Review medication record.
Troprol XL influence of the sympathetic shock, or overt cardiac failure Respiratory: c. Assess allergy to metoprolol and its components.
nervous system on these tissues when used to treat hypertensionor bronchospasm, dyspnea, Tx:
Chemical Class: and the excitability of the heart, angina. When used to treat MI, pharyngitis
Beta¹-selective decreasing cardiac output and contraindicated in patients with 0. Prepare the medication at the right time.
adrenergic blocker the release of renin, and heart rate of less than 45 bpm, CV: heart failure, cardiac EDx:
lowering BP; acts in the CNS to greater than firdt-dgree heart block, arrythmias
Therapeutic Class: reduce sympathetic outflow and systolic blood pressure less than 0.
Educated the patient and SO about the purpose
Antihypersentive vasoconstrictor tone 100 mmHg, or moderate to severe Dermatologic: rash, and importance of the drug.
caridac failure. pruritus, sweating, dry a. Educated SO on drug therapy to promote
Dosage:50 mg Source: 2022 Lippincott’s skin compliance
Nursing Diagnosis Guide Indications: DURING
Route: PO Hypertension, along with other EENT: eye irritation, dry Dx:
drugs, especially diuretics; eyes, conjunctivitis 0. Introduce self to the patient.
prevention of reinfarction of MI a. Verify patient’s identity.
patients who are hemodynamically GI: gastric pain, b. Assess patient’s condition.
stable or within 3-10days of acute flatulence, constipation, Tx:
MI; long term management of diarrhe, nausea, vomitting 0. Administer medication as ordered.
angina pectoris; treatment of stable a. Assist patient when taking the medication.
symptomatic heart failure of GU: impotence, decreased EDx:
ischemic, hypertensive or libido 0. Inform drug’s therapeutic effect.
cardiomyopathic origin a. Inform side effects.
MUSCULOSKELETAL
: joint pain, muscle cramp AFTER:
Drug to drug Interaction: Dx:
Metoprolol should not be used Other: decreased exercise 0. Evaluate therapeutic response.
concomitantly with paroxetine, tolerance
fluoxetine or bupropion due to Tx:
extensive interactions and the risk of 0. Watch for adverse effects.
a. Promote safety and comfort measures.
serious adverse effects.
EDx:
0. Encouraged patient to verbalize feelings and

concerns.
a. Instruct patient to notify prescriber if shortness of
breath occurs.
28
DRUG STUDY 13: ENOXAPARIN
INDICATIONS
Generic Name: Contraindications: CNS: dizziness, BEFORE:
Enoxaparin Accelerates formation of anti- Known hypersensitivity to headache, insomnia Dx:
thrombin III-thrombin complex enoxaparin (urticaria, a. Check doctor’s order.
Brand Name: and deactivates thrombin, anaphylactoid reactions, CV: edema b. Assess allergy to its components.
Levenox preventing conversion pf anaphylaxis) or any heparin c. Asess for heparin or pork product hypersensitivity.
fibrinogen to fibrin. Drug has a products; active major bleeding GI: constipation, nausea, Tx:
Chemical Class: higher antifactor-Xa-to- such as gastrointestinal bleed; reversible increase in liver a. Prepare the medication at the right time.
low molecular weight antifactor-IIa activity ratio than history of heparin-induced enzymes, vomiting b. Keep protected from heat and light.
heparins heparin. thrombocytopenia within the past EDx:
100 days or presence of circulating GU: urinary retention a. Educated the patient and SO about the purpose and
Therapeutic Class: antibodies; history of importance of the drug.
Anticoagulant Source: hypersensitivity to benzyl alcohol F&E: hyperkalemia
Inhibition of Thrombin - an in neonates (benzyl alcohol is DURING:
Dosage: 0.6 mg overview | ScienceDirect present in the multiple-dose Hemat: bleeding, anemia, Dx:
Topics. (n.d.). Retrieved from formulation of enoxaparin). thrombocytopenia a. Verify patient’s identity.
Route: SQ https://www.science b. Assess patient’s condition.
direct.com/topics/ Local: erythema at c. Assess for signs of bleeding
chemistry/inhibition-of-thrombin Indications: injection site, hematoma, Tx:
Prevention of deep vein thrombosis irritation, pain a. Administer medication as ordered.
(DVT) and pulmonary embolism b. Assist patient when taking the medication.
(PE) in surgical and medical Misc: fever
patients. Treatment of DVT (with AFTER:
warfarin). Prevention of ischemic Dx:
complications (with aspirin) from a. Monitor vital signs.
unstable angina, non–Q-wave MI.
Unlabeled Use: Systemic Tx:
anticoagulation for other
diagnoses. a. Promote safety and comfort measures.
EDx:
a. Encouraged patient to verbalize feelings and concerns.

b. Advised not to rub injection site
c. Instruct patient to notify prescriber or report any unusual
bleeding or weakness.
29
DRUG STUDY 14: ISDN
INDICATIONS
Generic Name: Relaxation of vascular smooth Contraindications: CNS: headache, BEFORE:
Isosorbide Dinitrate muscle and consequent Isordil Titradose is dizziness, syncope, Dx:
dilatation of peripheral arteries contraindicated in patients who lightheadedness a. Check doctor’s order.
Brand Name: and veins, especially the latter. are allergic to isosorbide dinitrate b. Assess allergy to its components.
Isordil Dilatation of the veins or any of its ingredients. Do not CV: orthostatic Tx:
promotes peripheral pooling of use Isordil Titradose in patients hypotension, tachycardia, a. Prepare the medication at the right time.
Chemical Class: blood and decreases venous who are taking certain drugs for angina pectoris, b. Keep isosorbide protected from heat and light.
Nitrates return to the heart, thereby erectile dysfunction bradycardia EDx:
reducing left ventricular end- (phosphodiesterase inhibitors), a. Educated the patient and SO about the purpose and
Therapeutic Class: diastolic pressure and such as sildenafil, tadalafil, or EENT: glaucoma importance of the drug.
Antianginal, pulmonary capillary wedge vardenafil. Concomitant use can b. Educated SO on drug therapy to promote compliance
pressure. cause severe hypotension, GI: nausea and vomiting DURING:
Dosage: 5 mg syncope,or myocardial ischemia. Dx:
Source: DERM: allergic skin a. Verify patient’s identity.
Route: Isordil TitradoseTM reactions, exfoliative b. Assess patient’s condition.
Sublingual (isosorbide dinitrate) Tablets. dermatitis/Stevens-
(n.d.). https://www. Indications: Johnson Syndrome or Tx:
accessdata.fda. Isordil (isosorbide dinitrate) angioedema a. Give tablets slowly, only 5 mg initially, because severe
gov/drugsatfda_ Titradose tablets are indicated for hypotension can occur; ensure that patient does not chew
docs/label/2015/ the prevention of angina pectoris HEME: or crush sustained-release preparations.
012093s052lbl.pdf due to coronary artery disease. methemoglobinemia,
The onset of action of hemolytic anemia b. Give oral preparations on an empty stomach, 1 hr before
immediate-release oral isosorbide or 2 hrs. after meals; take with meals if severe,
dinitrate is not sufficiently rapid RESP: alveolar uncontrolled headache occurs.
for this product to be useful in hypoventilation with
aborting an acute anginal consequent hypoxemia c. Administer medication as ordered.
episode.
Other: peripheral d. Assist patient when taking the medication.
edema, cutaneous
vasodilation with EDx:
flushing, excessive
perspiration, rash a. Caution patient not to crush or chew isosorbide E.R.
capsules or tablets or S.L. tablets unless specifically
ordered to do so by prescriber.
AFTER:
Dx:
a. Monitor vital signs.
30
Tx:
a. Know that patient may experience dizziness,
lightheadedness, headache, flushing of the neck or face.
b. Promote safety and comfort measures.
EDx:
a. Encouraged patient to verbalize feelings and concerns.
b. Instruct patient to report blurred vision, persistent or
severe headache, rash, more frequent or more severe
angina attacks, fainting.
B. IV Fluids
Name Classification Component/s Use & Effects Nursing Responsibilities
1. Nicardipine Chemical Class: The active substance is INDICATION: BEFORE:
Hydrochloride Dihydropyridine Nicardipine. Dx:
To manage angina pectoris and Prinzmetal’s
MEDICATION derivative Each Nicardipine a. Check doctor’s order.
DAW ILAGAY solution for angina, to manage hypertension
b. Check blood pressure and pulse rate before nicardipine
Therapeutic class: injection ampoule therapy begins, during dosage changes, and periodically
Brand Name: Cardene Antianginal, anti- contains Nicardipine Adverse Reactions
throughout therapy.
hypertensive hydrochloride CNS: confusion, dizziness, drowsiness,
Dosage/ Frequency/ Route: 10mg/10ml. Tx:
headache, nervousness, paresthesia, tremor, c. Prepare the medication at the right time and right dosage.
The other ingredients are weakness EDx:
10 mg + 90 cc PNSS sorbitol, citric acid CV: Arrhythmias (bradycardia, tachycardia), d. Educated SO on drug therapy to promote compliance.
monohydrate, sodium chest pain, exacerbation of angina (chronic
citrate, hydrochloric therapy), heart failure, orthostatic DURING:
acid, sodium hydroxide Dx:
hypotension, palpitations, peripheral edema
and water for injections. e. Monitor blood pressure and heart rate continually during
EENT: Altered taste, blurred vision, dry
infusion and avoid too rapid or excessive blood pressure drop
mouth, epistaxis during treatment. If there is concern of impending
ENDO: hyperglycemia hypotension or tachycardia, the infusion should be
GI: Anorexia, constipation, diarrhea, discontinued.
indigestion, nausea, thirst, vomiting Tx:
GU: Dysuria, nocturia, polyuria, urinary f. Administer nicardipine as ordered.
frequency g. Check and regulate the drop rate.
EDx:
HEME: Anemia, leukopenia,
h. Encourage to verbalize feelings and concerns.
thrombocytopenia
31
MS: Joint stiffness, muscle spasms AFTER:

SKIN: diaphoresis, flushing, pruritus, rash Dx:
Other: Hypokalemia, injection-site i. Monitor fluid intake and output and daily weight for signs of
irritation, weight gain fluid retention, which may precipitate heart failure.
j. Assess for signs of heart failure, such as crackles, dyspnea,
jugular vein distention, peripheral edema.
Tx:
k. Be alert of fluid overload.
l. Promote safety and comfort measures.
EDx:
m. Advise patient to notify prescriber immediately about chest
pain that’s not relieved by rest or nitroglycerin, constipation,
irregular heartbeats, nausea, pronounced dizziness, severe or
persistent headache, and swelling of hands or feet.
Name Classification Component/s Use & Effects Nursing Responsibilities

2. PNSS (Plain Normal Isotonic Intravenous The solution contains 9 grams of INDICATION: BEFORE:
Saline Solution) Solution sodium chloride (NaCI) dissolved in Dx:
Used because it has little to
1 liter of water. At 22 degrees a. Obtain history of the patient’s fluid and electrolyte status before
Form: IV Fluid Celsius, 1 milliliter of normal saline no effect on the tissues and therapy and reassess regularly.
weighs 1.0046 grams. Because makes the person hydrated, b. Identify the patient before administering IVF.
Dosage/Frequency/Route: sodium chloride has a molecular preventing hypovolemic Tx:
1000 ml x 12 hours, IV @ weight of approximately 58 grams shock or hypotension. c. Assess vital signs.
27-28 gtts/min per mole, 58 grams of sodium d. Check and regulate the drop rate.
chloride equals 1 mole. The e. Change the IVF solution if needed.
concentration is 9 grams per liter Adverse Reactions EDx:
divided by 58 grams per mole, or f. Instruct the patient not to move her hands frequently where the
0.154 moles per liter, because  Fast heartbeat IVF was attached.
normal saline contains 9 grams of  Fever g. Educate the patient about the IVF solution.
NaCI. Because NaCI dissociates into  Rash h. Instruct to report if dislodged occurs.
two ions, sodium and chloride, 1
 Joint pain, or
molar NaCI is equivalent to 2 DURING:
osmolar NaCI. As a result, NS  Shortness of breath. Dx:
contains 154 mEq/L of Na+ and CI. i. Do not connect flexible plastic containers of IV solutions in
series connections.
j. Vent IV administration sets with the venting the open position
should not be used with flexible plastic containers.
k. Monitor for signs of infiltration/ sluggish flow.
Tx:
l. Be alert of fluid overload.
32
m. Promote safety and comfort measures.

EDx:
n. Instructed the patient and watcher not to self-regulate the IVF to
avoid over infusion.
AFTER:
Dx:
o. Monitor for side effects.
p. Monitor fluid intake and output per shift.
Tx:
q. Palpate and inspect site for puffiness, redness, blanching, skin
temperature (very warm or very cool), wetness,
EDx:
r. Instruct SO to report untoward signs and symptoms.
33
XV. Nursing Care Plans

TOTAL REVISION!
RELATE TO PATIENTS CASE DESCRIPTION
A. Prioritization of Problems
a.1. List of Problems
1. Elevated Blood Pressure related to Hypertension as evidence by BP: 171/80 mmHg

2. Acute Pain related to Ischemia as evidenced by pain score of 8 out of 10
3. Altered Body Temperature related to infection as evidenced by body temperature of 38.8 C
4. Fluid Volume Excess related to rupture of ventricular septum as manifested by pitting
edema
5. Risk for Deficient Fluid Volume related to excessive sweating and decreased fluid intake
a.2. Basis for Prioritization

START WITH ASSESSMENT
NURSING DIAGNOSIS JUSTIFICATION
1. Elevated BP related to Physiological needs are the highest priority in Maslow's Hierarchy of
Hypertension as Needs. This indicates that in order to reach the four remaining levels,
evidence by BP: 171/80 one must meet his or her physiological needs, which include keeping
mmHg one's body in good condition. Elevated blood pressure is a diagnosis
that affects a person's physical health; thus, it is crucial to take the
NORMAL LNG SKNYA appropriate measures and medications to maintain it at a healthy
level.
The desire for safety is considered a basic human need, which is

2. Acute pain related to provided on the second tier of the pyramid, the safety sector,
Ischemia as evidenced by pain according to Maslow's Hierarchy of Needs. Being in pain can
score of 8 out of 10 impair a patient's well-being, thus we make this our 2nd priority
8/10 WHAT WILL HAPPEN
TO THE PATIENT? HEART BAKIT NAGKAROON NG PAIN
ATTACK 8/10 IS AN
EMERGENCY!
FOR HOW LONG?
This is our third priority because, according to Orlando's Nursing

3. Elevated body temperature Process Theory, "identifying the patient's condition becomes a high
related to infection as concern for the nurse since the condition will likely deteriorate
evidenced by body temp of 38.8 with time and make proper care, or the supply of essential aid,
C? increasingly difficult." Fever must be treated initially to avoid the
return of even serious consequences.
Physiological requirements should be met as the 4th priority,

4. Fluid volume excess r/t according to Maslow's hierarchy of needs.
rupture of ventricular septum As a result, measures to alleviate the condition must be carried out.
as manifested by pitting edema
34
The patient has been experiencing excessive sweating which might

5. Risk for Deficient Fluid be a cause of dehydration. This needs to be prioritized as well, based
Volume related to excessive on the ABCD (Airway, Breathing, Circulation, Dehydration) to
sweating and decreased fluid prevent worst case scenarios such as low blood volume or
intake hypovolemic. Hence, according to Maslow’s Hierarchy of Needs,
fluid intake is a physiological need.
35
B. Nursing Care Plans
NCP 1: Elevated BP related to Hypertension as evidence by BP: 171/80 SMART KANO

SYSTEMATIC, MEASURABLE, ATTAINABLE, RELIABLE, TIME BOUND
Assessment Explanation of the Objective Nursing Intervention Rationale Evaluation

Problem
Subjective: Hypertensive urgency is a STO: Dx: GOAL MET

marked elevation in blood
“Talaga nga nangato pressure without evidence of Within 3 hours of effective ● Monitored blood pressure. ● Severe hypertension is classified in STO:
BPk”as verbalized. target organ damage, such as nursing interventions, the adults as a diastolic pressure elevation
pulmonary edema, cardiac patient will be able: of 110 mmHg; progressive diastolic After 3 hours of effective
Objective: ischemia, neurologic deficits, readings above 120 mmHg are nursing interventions, the
or acute renal failure. a. To experience considered first accelerated, then patient’s BP returned to
 BP: 171/80 lower blood malignant (very severe). normal ranges.
 Headache SOURCE: pressure
Alley, W. D., & Copelin II, E. L. GOAL MET
 Shortness of (2020). Hypertensive Urgency.
breath PubMed; StatPearls
LTO: Tx:
● Decreases discomfort and may reduce LTO:
Within 24 hours of effective ● Provided comfort measures such as sympathetic stimulation.
nursing intervention, patient back and neck massage, and elevation of Within 24 hours of effective
Nursing Diagnosis: will be able: head. ● Diuretics are considered first-line nursing intervention, patient
medications for uncomplicated stage I was able to report an
Elevated BP related to a. To report an ● Administer anti-anginal medication as or II hypertension and may be used improvement in his blood
Hypertensive Urgency as improvement in his indicated. alone or in association with other drugs pressure as evidenced by no
evidence by BP: 171/80 blood pressure as (such as beta-blockers) to reduce BP in shortness of breath with
evidenced by no patients with relatively normal renal minimal exertion and heart
shortness of breath function. rate within safe limits.
with minimal
exertion and heart ● These restrictions can help manage
rate within safe Edx: fluid retention and, with the associated
limits. hypertensive response, decrease
● Instructed to reduce salt (sodium), fat myocardial workload.
● Alcohol increases blood levels of the
36
hormone renin, which causes the blood

and cholesterol intake. vessels to constrict.
● Bulking up on fiber may help people

● Encouraged to avoid alcohol. keep their blood pressure under control.
● Advised to take plenty of fiber in the

form of vegetables and fruits.
NCP 2: Acute pain related to Ischemia as evidenced by pain score of 8 out of 10

Problem
Subjective: Chest pain is the most STO: Dx: GOAL MET

common presenting ● Most patients with an acute MI
“Masaket dito banda sa complaint of acute Within 3 hours of effective ● Assessed characteristics of pain, pain appear ill, distracted, and focused on STO:
dibdib ko”, as verbalized. myocardial infarction. The nursing interventions, the level and area. Noting verbal reports, pain.
classic manifestation of patient will be able: nonverbal cues such as moaning, crying, After 3 hours of effective
Objective: ischemia is usually described grimacing, restlessness. nursing interventions, the
as a heavy chest pressure or a. To display reduced patient displayed reduced
 Facial grimacing squeezing, a “burning” tension, relaxed ● Obtained full description of pain from ● Pain is a subjective experience and tension, relaxed manner, and
 Chest pain feeling, or difficulty in manner, and ease of patient including location, intensity must be described by a patient. Provides ease of movement.
breathing. The discomfort or movement. (using scale of 0–10), duration,
 Restlessness pain often radiates to the left characteristics (dull, crushing, described a baseline for comparison to aid in
 Guarding behavior shoulder, neck, or arm. LTO: as “like an elephant in my chest”), and determining effectiveness of therapy,
 Pain score of 8/10 radiation. resolution and progression of problem. GOAL MET
SOURCE: Within 24 hours of nursing
Malik, M. A., Alam Khan, S., intervention, patient will be
37
Safdar, S., & Taseer, I.-U.-H. ● Nitrates are useful for pain control by
Nursing Diagnosis: (2013). Chest Pain as a able: Tx: LTO:
coronary vasodilating effects, which
presenting complaint in patients
with acute myocardial infarction increase coronary blood flow and
Acute pain related to (AMI). Pakistan Journal of a. To verbalize relief ● Administered anti-hypertensive After 24 hours of effective
myocardial perfusion.
Ischemia as evidenced by Medical Sciences, 29(2), 565– of chest pain. medication as indicated. nursing interventions, the
pain score of 8 out of 10 568. patient verbalizes relief and
https://www.ncbi.nlm.nih.gov/p ● Decreases external stimuli, which control of chest, pain.
mc/articles/PMC3809224/#:~:tex may aggravate anxiety and cardiac
t=Chest%20pain%20is%20the strain, limit coping abilities and
%20most adjustment to current situation.
● Provided a quiet environment, calm
activities, and comfort measures.
● Increases amount of oxygen available
for myocardial uptake and thereby may
relieve discomfort associated with
● Administered supplemental oxygen by tissue ischemia.
means of nasal cannula or face mask, as
indicated. ● Helpful in decreasing perception and
response to pain. Provides a sense of
Edx: having little control over the situation,
and an increase in positive attitude.
● Instructed to do relaxation techniques:
deep breathing exercises and distraction
behaviors.
NCP 3: Elevated body temperature as evidenced by 38.8 C

Problem
Subjective: Fever sometimes STO: Dx: GOAL MET

“Nasakit ulok” as accompanies acute Within 2 hours of effective ● Monitored vital signs and recorded. ● To establish baseline data. STO:
verbalized. myocardial infarction and nursing interventions, the After 2 hours of effective
may be a pointer to the patient will be able: ● Assessed for signs of factors that affect ● It will help guide treatment and nursing interventions, the
Objective: extent of infarction and the a. To reduce body core body temperature. nursing interventions. patient was be able to reduce
 Temperature of prognosis. temperature from body temperature from
38
38.8-degree 38.8 ° C to 37.5° C. Tx: 38.8 to 37.5° C.

Celsius; HR – 88 SOURCE: ● Performed tepid sponge bath. ● A tepid sponge bath is a non-
bpm; RR – 25 cpm Smid, J., Scherner, M., Wolfram, LTO: pharmacological measure to allow GOAL MET
 Flushed face O., Groscheck, T., Wippermann, Within 24-48 hours of evaporative cooling. LTO:
 Warm to touch J., & C. Braun-Dullaeus, R. nursing intervention, patient ● Removed excess clothing and blanket. After 24-48 hours of nursing
(2018). Cardiogenic Causes of
 Weak in will be able: ● Exposing skin to room air decreases intervention, patient was
Fever. Deutsches Ärzteblatt
appearance International, 115(12), 193–199. a. Display a core heat and increases evaporative cooling. able to display a core
https://doi.org/10.3238/arztebl.20 temperature within ● Administered paracetamol as ordered. temperature within normal
Nursing Diagnosis: 18.0193 normal range. ● To help lower the body temperature. range.
Elevated body ● Keep clothing and bed linens dry.
temperature as evidenced ● Promotes comfort and helps prevent
by 38.8 C chilling since diaphoresis occurs during
Edx:
defervescence.
● Instructed to increase oral fluid intake.
● To replace fluid loss due to

perspiration.
NCP 4: Fluid volume excess r/t rupture of ventricular septum as manifested by pitting edema
Assessment Explanation of the Problem Objective Nursing Intervention Rationale Evaluation
Subjective: Fluid Volume Excess (FVE), or STO: Dx: ● Increased heart rate and GOAL MET
“Agmanas toy sakak” as hypervolemia refers to an Within 8 hours of effective ● Monitored vital signs. respiratory rate and bounding STO:
verbalized. isotonic expansion of the ECF nursing interventions: peripheral pulse can indicate an Within 8 hours of effective
due to an increase in total body a. The client will increase in fluid volume. nursing interventions:
Objective: sodium content and an increase display normal a. The client was able
in total body water. This fluid fluid volume and ●Monitoring sources of intake via oral to display normal
 BP: 171/80 mmhg overload usually occurs from electrolytes. ● Monitored Intake and Output. and Intravenous and comparing to the fluid volume and
39
 Excessive sweating compromised regulatory b. The client will be patient’s output will prevent electrolytes.
 Noticeable pitting mechanisms for sodium and able to verbalize fluid overload. b. The client was able
edema on both feet, water as seen commonly in understanding on to verbalize
graded as +2 heart failure (CHF), and fluid restrictions. ● Pitting edema is manifested by a understanding on
myocardial infarction. Tx: depression that remains after one’s fluid restrictions.
LTO: ● Noted for presence of edema by finger is pressed over an edematous
Within 16 hours of palpating over the tibia, ankles, and area and then removed.
SOURCE:
effective nursing feet.
Nursing Diagnosis: Wayne, G. (2022). Nurseslabs. Fluid GOAL MET
Volume Excess Nursing Care Plan. interventions: ● May be necessary to correct fluid LTO:
Fluid volume excess r/t a. The client edema overload. Drug choice is usually
https://nurseslabs.com/excess-fluid- Within 16 hours of
rupture of ventricular volume/ particularly in dependent on the acute or chronic effective nursing
septum as manifested by lower extremities ● Administer diuretics (furosemide) as nature of symptoms. interventions, the client
pitting edema will slowly edema particularly in lower
ordered.
decrease. ● Elevation increases venous return to extremities was slowly
the heart and, in turn, decreases decreasing.
edema.
● Elevated edematous extremities.
● Sodium enhances fluid retention
● Provide a low-sodium diet/beverage. and should therefore be restricted
during active MI phase and/or if heart
failure is present.
● For better adherence. Fluid

Edx: restrictions prevent the
● Enforced fluid restrictions and patient from taking in too
educated on the importance. much extra fluid.
NCP 5: Risk for Deficient Fluid Volume related to excessive sweating and decreased fluid intake
Assessment Explanation of the Objectives Nursing Interventions Rationale Evaluation
Problem
Objective: Dehydration is a common STO: Dx: ● Indirect indicators of fluid volume GOAL MET
 Decreased oral condition that affects Within 1 hour of effective ● Assessed skin turgor and oral mucous STO:
intake patients of all ages. nursing interventions, the membranes for signs of dehydration. After 1 hour of effective
 Excessive sweating Sweating is part of your patient will be able to: nursing interventions, the
body’s natural cooling ● Provides information about the
 Dry mucous a. Demonstrate patient was able to
40
membrane process. When you become awareness of the ● Monitored the intake and output. adequacy of fluid volume and demonstrate and awareness
 Decreased skin hot, your sweat glands significance of replacement needs. of the significance of
turgor activate to release moisture increase fluid intake increase fluid intake in body
from your body in an in body ● Monitored for the existence of factors ● Early detection of risk factors and maintenance
attempt to cool it off. maintenance causing deficient fluid volume. early intervention can decrease the
Nursing Diagnosis: occurrence and severity of
Risk for Fluid Volume GOAL MET
SOURCE: LTO: complications from deficient fluid LTO:
Deficient as evidenced by Taylor, K., & Jones, E. B.
Within 24- 48 hours of volume. After 24- 48 hours of
excessive sweating and (2021, October 10). Adult Tx:
decreased fluid intake Dehydration. PubMed; effective nursing ● Provided frequent oral hygiene. effective nursing
StatPearls Publishing. interventions, the patient interventions, the patient
https://www.ncbi.nlm.nih.gov/ will; ● Oral mucous membranes become was able to exhibit moist
books/NBK555956/ a. Exhibit moist mucous membranes, good
dry and sticky due to loss of fluid in
mucous skin turgor, and stable vital
● Administered parenteral fluids as the interstitial spaces.
membranes, good signs
skin turgor, and prescribed.
stable vital signs. ● Fluids are necessary to maintain
Edx: hydration status
● Instructed patient to increase oral

fluid intake.
● To maintain hydration status, thus
avoiding dehydration.
● Educated the patient about the
benefits and importance of adequate
fluid intake. ● To understand the benefits of
adequate fluid intake
● Educated patient about possible

causes and effects of fluid loss or
decreased fluid intake. ● Enough knowledge aids the patient
in taking part in their plan of care.
41
C. Discharged Plan
LIFESTYLE PLEASE INCLUDE
HEALTH
TEACHING
Diet/ Nutrition  Encouraged to avoid consuming salty foods.

 Advised to stay away from fast food restaurants.
Activity  Avoid heavy lifting. Get some help with household chores if you can.
 Instructed to take 30 to 60 minutes to rest in the afternoon for the first 4 to 6
weeks and to get plenty of sleep.
 Instructed to monitor and record blood pressure daily.
Medication  Instructed to take medicines exactly as directed and not skip doses.
 Instructed to check with healthcare provider in case of missed dose/doses.
 Educated regarding the importance of taking medication at a proper dose
and time.
 MEDICATION COMPLIANCE
 Informed on the side effects of the drugs being taken.
 Instructed to contact physician if there are any adverse effects to the
medication prescribed.
42
XVI. Learning Insights
A. BENITO, Danny C.
It was a very challenging case for me. It is a bit difficult because there were lots of problems and
matters that met us in making this presentation. Moreover, this case study was an eye-opening experience
for me. It serves as an opportunity to develop and enhance my state of thinking critically and
systematically. Case presentation taught me about learning and researching deeper and criticizing
scenarios either actual or potential which we are going to present. And I had also learned that on case
presentation collaboration and appearance in group activities is very important because for me, I can't or
maybe can do case presentation by myself but it will be more possible to do it as a group given the parts of
the case that needs to be done. It will be easier to finish it if we have working group mates.
B. GESMUNDO, Lorraine
Our case is about a 46-year-old male, who had been diagnosed with Acute Myocardial infarction;
Hypertensive urgency. Myocardial Infarction is the condition in which the heart muscles die due to the
inadequate supply of oxygen to those muscles. This is mainly due to the blocks in the coronary artery (the
artery that supplies blood to the heart itself) hence there is a reduction in blood supply and oxygen to the
heart. This condition is commonly referred to as heart attack. Myocardial Infarction is characterized with
shortness of breath, chest pain (angina), nausea, cold sweating and being tired at all times in which we
have observed in the patient. In our case the patient is known for its cigarette and alcohol consumption
wherein the lifestyle of the patient has a high cause of the disease. As I finally read through the case, I
have learned and gained knowledge about how this condition develops and how the system goes. The
quantity of risk factors, signs and symptoms that affected the patient. What are the proper medical
treatments such as medications and nursing interventions that will help the client manage the disease.
C. LIMMANG, Clarissa Marie P.

I may not be part of the directly monitoring the patient but I was able to learn a lot from our case
like I’ve learnt more about the patient’s diagnosis and its management in more detailed manner. But the
most notable thing I’ve learnt from this group is being able to learn from my groupmates’ insights and be
productive as a group member, which has helped me delegate tasks more easily. It has influenced my own
thinking and broadened my knowledge, and from our case presentation, I acquired new ideas that will
benefit me in the future as a nurse.
D. MAIGI, Nicalin
This case helped me understand the value of fairly assessing sets of information. I realized that we
would not have been able to complete the case study through teamwork and cooperation if we had not
carefully examined the case and practiced our critical thinking abilities. In comparison to our first case
study during online distance learning, which required adjustment since we weren't able to gather data in a
clinical setting, this time we had the chance to put what we had learned about conducting head-to-toe
assessments, identifying 13 key areas, and gathering additional relevant data to good use. All things
considered, this study provided me with essential knowledge, such as nursing interventions, that I may use
in the field whenever I come across myocardial infarction patients. Additionally, reading about the various
43
case-related aspects, such as the patient's chart and diagnostic test findings, improved my understanding
and analysis of our situation.
E. PAGADIAN, Ia Rylyn
Handling the patient was quite challenging and interesting. Although during the first day of duty, I
was anxious that I am going to give care to a patient who is suffering like this. However, I still had the
courage to get it and make it my motivation in fulfilling my dreams because the more toxic a patient you
handle, the more knowledge you will gain from the hospital and from our instructors. The challenging part
here in our case presentation was the formation of pathophysiology. At first, I was thinking that I cannot
do it but with the help of my classmates and friends, I was able to create one and I was so amazed that I
was able to finish it despite the fact that I really don't have an idea in creating such because this is my first
time.
F. PAGUIRIGAN, Kryzza Leizel

I wasn't able to handle the patient during the rotation but in the nursing profession, a nursing care
plan is important to our nurses for better client care and documentation. It helps me think critically about
the patient to develop interventions that are tailored to the patient. Studying and doing our case
presentation leads me to analyze and understand further about the complications that were handled by the
patient.
G. PANGDA, Jaceziel
Even though I am not part of the patient's direct monitoring, I was still able to gain a lot of
knowledge from our case study. It showed me that each patient has a unique disease but only one objective
to be disease-free. This case study taught me that each patient requires a lot of attention in order to provide
quality healthcare. As a nursing student, I was able to construct and use some step-by-step techniques
especially in nursing responsibilities in order to get rid of those diseases from the people who had them;
while they may not be totally cured, but they can prolong their lives. Therefore, it's crucial to get checked
out for the early discovery of sickness to avoid problems.
H. SAAVEDRA, Joy Anne

Myocardial Infarction is a case I never got to handle personally. A case I find intriguing for how
delicate these patients can be. I observed that it takes great care and careful observation to handle patients
with said case.
I. TUCYAPAO, Irish P.
As a future nurse, this case adds up on my knowledge, skills and understanding in this specific
condition. During the journey of our completion, unity and cooperation is the best ingredient in successful
completion of this presentation. This case helped me to identify certain nursing responsibilities
and expectations in patients with this kind of disease. Thorough patient assessment is the key in the
success of nursing diagnosis and intervention as well as data gathering as our basis in formulating
effective nursing care.
J. VILLANUEVA, Jayson
44
Because of this case study, I was able to research more about different heart conditions. From there,
I was able to understand how to distinguish between a heart attack and a heart failure. A heart attack
occurs when a blood vessel becomes blocked off, cutting off the blood flow to a portion of the heart
muscles. As a result, some muscle tissue is destroyed. Heart failure is a condition where the heart muscle
no longer functions properly. It struggles to contract, which makes it unable to pump blood efficiently. In
light of this, we must be prepared to deliver healthcare in the future by possessing the necessary
information and awareness of our patients' conditions. This will enable us to offer the patient the correct
interventions, diagnoses, and treatments they require to recover.
45
XVII. List of References

Alley, W. D., & Copelin II, E. L. (2020). Hypertensive Urgency. PubMed; StatPearls.
Centers for Disease Control and Prevention. Know Your Risk for Heart Diseasecdc.gov. (2019, December 9).
Centers for Disease Control and Prevention.
Cleveland Clinic, (2022). Fasting Blood Sugar Test, Retrieved From :
https://my.clevelandclinic.org/health/diagnostics/21952-fasting-blood-sugar
Dr.Mandal, A. (2022) Hematology Test. Retrieved From:

https://www.news-medical.net/health/Hematology-Tests.aspx
Heart Attack: Symptoms, Causes and Recovery. (n.d.). Cleveland Clinic

Heart Attack Symptoms, Risk Factors, and Recovery | cdc.gov (2022, July 12).
Inhibition of Thrombin - an overview | ScienceDirect Topics. (n.d.). Retrieved from

https://www.sciencedirect.com/topics/chemistry/inhibition-of-thrombin
Jones & Bartlett Learning (2015). Nurse’s Drug Handbook. Fourteenth Edition.
Malik, M. A., Alam Khan, S., Safdar, S., & Taseer, I.-U.-H. (2013). Chest Pain as a presenting complaint in
patients with acute myocardial infarction (AMI). Pakistan Journal of Medical Sciences, 29(2), 565–568.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809224/#:~:text=Chest%20pain%20is%20the%20most
Mayo Clinic, (2021). Heart Attack, Retrieved From:

https://www.mayoclinic.org/diseases-conditions/heart-attack/diagnosis-treatment/drc-20373112
MedlinePlus, (2021) Prothrombin Time Test and INR. retrieved From:

https://medlineplus.gov/lab-tests/prothrombin-time-test-and-inr-ptinr/
Registered Deaths in the Philippines, 2017 | Philippine Statistics Authority.” Registered Deaths in the
Philippines, 2017 | Philippine Statistics Authority, 10 June 2019, psa.gov.ph/vital-statistics/registered-deaths-
philippines-2017.
Smid, J., Scherner, M., Wolfram, O., Groscheck, T., Wippermann, J., & C. Braun-Dullaeus, R. (2018).
Cardiogenic Causes of Fever. Deutsches Ärzteblatt International, 115(12), 193–199.
https://doi.org/10.3238/arztebl.2018.0193
Taylor, K., & Jones, E. B. (2021, October 10). Adult Dehydration. PubMed; StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK555956/
Tortora, G., Derrikson, B. (2011) (Principles of Anatomy and Physiology Maintenance and Continuity of the
Human Body (13th ed.). Wiley.
Vera, M. (2022). Nurseslabs. 7 Myocardial Infarction Nursing Care Plans. https://nurseslabs.com/7-

myocardial-infarction-heart-attack-nursing-care-plans/
Wayne, G. (2022). Nurseslabs. Fluid Volume Excess Nursing Care Plan. https://nurseslabs.com/excess-fluid-
volume/
2022 Lippincott’s Nursing Diagnosis Guide

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UNIVERSITY OF THE CORDILLERAS

ACUTE MYOCARDIAL INFARCTION; HYPERTENSIVE URGENCY

A Case Presented to the

In Partial Fulfillment of the requirements in the Course

Noted and Approved for Presentation:

Ma’am Hannah Lee Antonio Sir Laudemar Luis

TITLE: A Comprehensive Case Study on Acute Myocardial Infarction: Hypertensive Urgency

BACKGROUND: WHY DID YOU CHOOSE? BASIS? SPECIFIC ASSESSMENT

Specifically, this case analysis aims to:

III. Patient’s Profile

Religion : Roman Catholic

IV. Chief Complaint

Patient X complains of chest pain. DURING THE SHIFT

V. Present History of Illness

VI. Past History of Illness

VII. Family Health History

VIII. Developmental History BEHAVIORAL THEORY OR OTHER THEORIES

HOW THEY CAN AFFECT?

IX. Social and Environmental History

ONLY FOCUS ON THE CASE DESCRIPTION

X. Lifestyle and Health Practices

XI. Health Assessment

A. General Survey SIGNS AND SYMPTOMS

B. Head to Toe Assessment

1. Head No abnormal findings AFEBRILE

11. Genitals No abnormal findings

1. Psychosocial and Psychological Status

2. Mental and Emotional Status

Date Time Temperature

November 14, 2022 2am 36.5 °C

November 15, 2022 2am 38.28 °C

November 16, 2022 2am 36.7 °C

Date Time RR SPO2

November 14, 2022 2am 19 cpm 94 %

November 15, 2022 2am 25 cpm 95 %

November 16, 2022 2am 25 cpm 97 %

Date Time CR Capillary BP

November 14, 2022 2am 68 bpm 1-2 seconds

November 15, 2022 2am 87 bpm 1-2 seconds

November 16, 2022 2am 88 bpm 1-2 seconds

10. Elimination Status

11. Sleep, Rest and Comfort Status

12. Fluids and Electrolytes Status

13. Integumentary Status

XII. Diagnostics YOU CAN INCLUDE IN THE NCP ; CHOLESTEROL LEVEL

Ionized Calcium Low levels of free calcium can cause your

XIII. Comprehensive Pathophysiology

DRUG NAME MECHANISM OF ACTION CONTRAINDICATIONS & ADVERSE NURSING RESPONSIBILITIES

o. Encourage the patient to verbalize feelings and concerns.

DRUG STUDY 2: ASPIRIN

MECHANISM OF ACTION CONTRAINDICATIONS & ADVERSE EFFECTS NURSING RESPONSIBILITIES

adverse GI effects sulfonylureas:

DRUG STUDY 3: ATORVASTATIN

MECHANISM OF ACTION CONTRAINDICATIONS & ADVERSE EFFECTS NURSING RESPONSIBILITIES

m. Promote safety and comfort measures.

DRUG STUDY 4: LACTULOSE EXERTION