Case Presentation Final

JMJ Marist Brothers
Notre Dame of Marbel University

College of Arts and Sciences – Nursing Department
Koronadal City, South Cotabato
NURSING DEPARTMENT
I. Introduction
ADHF, also known as Acute Decompensated Heart Failure, is one of the leading admissions
diagnoses worldwide, it represents a common and potentially life-threatening cause of immediate
respiratory distress. Its clinical manifestation involves dyspnea, often linked to swift fluid build-up
within the lung's spaces, stemming from heightened cardiac filling pressures (known as cardiogenic
pulmonary edema). In their 2021 study titled "Pathophysiology and Therapeutic Approaches to Acute
Decompensated Heart Failure," Joyce N. Njoroge and John R. Teerlink highlighted an important
observation. They noted that Acute Decompensated Heart Failure (ADHF) can exhibit increased left
ventricular filling pressures and concurrent dyspnea even in the absence of pulmonary edema. ADHF is
most commonly due to LV systolic or diastolic dysfunction, with or without additional cardiac
pathology, such as coronary artery disease or valve abnormalities. However, a variety of conditions or
events can cause cardiogenic pulmonary edema due to an elevated pulmonary capillary wedge pressure
in the absence of heart disease, including primary fluid overload (e.g., due to blood transfusion), severe
hypertension (particularly renovascular hypertension), and severe renal disease.
In the large majority of patients who present with ADHF, acute or subacute decompensation is
in the context of chronic HF with reduced ejection fraction (also known as systolic HF) or HF with
preserved ejection fraction (also known as diastolic HF) and in many cases, there is a prior history of
episodes of decompensation. In such patients, information regarding the precipitating factors, workup
for HF, and the elements of successful therapy for prior episodes (eg, types and doses of diuretics used)
can be of great value in approaching the current episode. The clinical presentation of symptoms and
signs of congestion and poor organ perfusion due to HF requiring urgent, usually intravenous, therapy
has been variously called AHF, ADHF, AHF syndrome, and hospitalized HF, as well as other terms.
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For the purposes of this review, ADHF will be used, recognizing that the patient has a subacute
evolution of symptoms and signs resulting from cardiac and vascular dysfunction due to a variety of
etiologies and triggers resulting in decompensated hemodynamics.
The subacute or acute dysfunction in ADHF overwhelms compensatory mechanisms resulting
in signs and symptoms of left or right (and often both) ventricular increased filling pressures leading to
symptoms including dyspnea, exercise intolerance, palpitations, presyncope, peripheral edema,
abdominal bloating, early satiety, and fatigue. Pulmonary vascular congestion from left ventricular
failure increases right ventricular pressures and results in a cascading effect on multiorgan function.
While the most common cause of right HF is left HF, isolated right HF is becoming increasingly
recognized and can also result in increased peripheral signs of congestion and end-organ dysfunction.
Since many of these patients with right HF have a severe pulmonary disease as the cause of their HF,
they can present with significant dyspnea independent of pulmonary congestion. Physical exam
findings include pulmonary crackles in the presence of pulmonary edema and pleural effusions, and
peripheral edema. Signs of end-organ dysfunction secondary to congestion include aforementioned
pulmonary edema, gastrointestinal edema. Additionally, the onset of an acute ST-elevation myocardial
infarction (STEMI) signifies a critical phase where transmural myocardial ischemia leads to
myocardial injury or necrosis, characterizing the clinical syndrome of myocardial infarction (MI). This
event involves myocardial ischemia, presenting with specific electrocardiogram (EKG) changes and
chest pain. Confirming the presence of myocardial ischemic injury through abnormal cardiac
biomarkers becomes crucial in diagnosing MI accurately.
Increased pulmonary arterial pressures are also frequently observed in ADHF often due to a
combination of elevated left ventricular filling pressures, preexistent pulmonary hypertension, and
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hypoventilation-related pulmonary artery vasoconstriction. Increases in systemic vascular resistance
are predominantly mediated by arteriolar vasoconstriction and result in elevated left ventricular
pressures increasing ventricular wall stress, exacerbating myocardial ischemia, and contributing to
myocardial injury. The marked sympathetic activation associated with ADHF can exacerbate the
arterial vasoconstriction, particularly in the setting of underlying systemic hypertension and endothelial
dysfunction. Importantly, as part of a feedback system, in ADHF with decreased cardiac output,
decreased baroreceptor activation results in signaling to paradoxically increase peripheral arterial
vasoconstriction resulting in detrimental increased afterload. In ADHF, acute and often dramatic
increases in afterload due to sympathetic system activation can result in rapidly developing pulmonary
congestion or flash pulmonary edema, especially in the setting of diastolic dysfunction and HFpEF.
The correlation between Acute Decompensated Heart Failure (ADHF) and concurrent lung
problems such as community-acquired pneumonia and chronic obstructive pulmonary disease (COPD)
exacerbations presents a multifaceted clinical landscape. ADHF, characterized by dyspnea and
cardiogenic pulmonary edema stemming from elevated cardiac filling pressures, often precedes or
coexists with these respiratory complications. ADHF, primarily attributed to left ventricular
dysfunction, is a precursor to the emergence of lung-related issues. The clinical presentation of ADHF,
with its spectrum of symptoms including dyspnea, peripheral edema, and crackles denoting pulmonary
edema, intertwines with the onset of community-acquired pneumonia and COPD exacerbations. This
intricate interplay complicates the diagnostic and therapeutic approaches, amplifying the challenges in
managing the combined cardiac and pulmonary pathologies.
The complex interrelationship between Acute Decompensated Heart Failure (ADHF) and
concurrent lung conditions such as community-acquired pneumonia and exacerbations of chronic
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obstructive pulmonary disease (COPD) creates a challenging clinical scenario. ADHF, characterized by
dyspnea and cardiogenic pulmonary edema resulting from increased cardiac filling pressures, often
precedes or coexists with these respiratory issues. The overlapping symptoms such as dyspnea,
peripheral edema, and pulmonary crackles add complexity to both diagnosis and treatment strategies,
thereby compounding the difficulties in managing combined cardiac and pulmonary disorders.
Addressing this intricate interplay between ADHF and lung-related problems necessitates a
comprehensive, integrated approach to medical care. This case study is highlighted by the case study of
a 64-year-old male diagnosed with acute decompensated congestive heart failure secondary to an acute
ST elevation myocardial infarction attributed hypertensive cardiovascular disease, acute coronary
disease, and atrial fibrillation with a rapid ventricular response. This individual is classified as NYHA
Class IV and presents with concurrent moderate-risk community-acquired pneumonia, chronic
obstructive pulmonary disease in acute exacerbation, and likely nutritional-related hypokalemia.
I. Objectives of the Study
The researchers intend to comprehensively discuss the case of a patient who was diagnosed
with acute decompensated congestive heart failure secondary to ACUTE ST elevation, myocardial
infarction secondary to hypertensive cardiovascular disease, acute coronary disease, atrial fibrillation
with rapid ventricular response, NYHA Class IVE, community acquired pneumonia moderate risk,
chronic obstructive pulmonary disease in acute exacerbation, hyperkalemia probably nutritional.
This research specifically sought to:
A. Discuss its nature by determining and defining its causative factors, signs and symptoms.
B. Introduce the chosen patient by presenting his personal information which serves as a data base
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C. Gather patient’s health history which comprises the patient’s past and present illnesses, previous
hospitalizations, surgery, accidents, immunization status, family history of inheritable health
problems, current medications, allergies, health related practices, social history, and activities of
daily living.
D. Obtain general survey through physical assessment and gather subjective data through a hospital
assessment as well as objective data through a cephalocaudal assessment and diagnosis test.
E. Present the normal anatomy and physiology of the affected organs.
F. Trace the pathophysiology of the final diagnosis
G. Identify the medical management, surgical management, and medications being used by the patient
and explain how these medicines work through a pharmacological analysis.
H. Interpret the diagnostic and laboratory tests results to determine underlying causative factors of the
final diagnosis
I. Formulate a drug study to determine the importance of medication to cure the final diagnosis
J. Analyze the result of prognosis and determine the result by rating: poor, fair, good, and excellent.
K. Produce a nursing Care Plan (NCP) to organize the proper nursing intervention in accordance with
the physician’s order, evaluations, drug studies, diagnostic results, prognosis, and discharge plan.
L. Pinpoint the discharge plan by following the METHODS guide, and as well as the instruction
given by the attending physician.
II. Data Base

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Demographic Data
Name: N. T. L.
Sex: Male
Age: 64
Birthday: June 19, 1959
Address: Tantangan, South Cotabato
Birth Place: New Lambunao, Tantangan, South Cotabato
Religious Affiliation: Roman Catholic
Language Spoken: Filipino, Hiligaynon
Educational Attainment: Elementary Graduate
Occupation: Farmer
Civil Status: Married
Name of Spouse: H. O. L.
Occupation: House Wife
Height: 157cm
Weight: 55kg
BMI: 22.9 Normal Weight
Annual income: 40, 000
Date and time admitted: September 23, 2023, 10:27 am
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Chief complaints: SOB
Initial diagnosis: Bronchial Asthma in Acute Exacerbation Community Acquired
Pneumonia Moderate with Stage ll Uncontrolled Chronic Obstructive
Pulmonary Disease.
Final diagnosis: Acute Decompensated Congestive Heart Failure Secondary to Acute ST
Elevation Myocardial Infarction Secondary to Hypertensive
Cardiovascular Disease, Acute Coronary Disease, Atrial Fibrillation with
Rapid Ventricular Response, NYHA Class IVE, Community Acquired
Pneumonia Moderate Risk, Chronic Obstructive Pulmonary Disease in
Acute Exacerbation, Hypokalemia Probably Nutritional.
Table 1. Demographic Data of the Patient
III. Nursing History Collection
A. Past and Present Illness
Patient, N.T.L, a 64-year-old male, was born in New Lambunao, Tantangan South Cotabato, on
June 19, 1958. He explained that since his childhood, his mother consistently preferred hospitalization
and "hilot" treatments in their community because they were cost-effective and saved them money.
However, the patient currently adheres to a regimen called "baby aspilet," which he uses whenever he
experiences discomfort and fever for relief. Neither the patient nor his significant other can recall the
specific reasons for their frequent hospital visits. Additionally, he mentioned experiencing frequent
physical pain (referred to as "balda") during his childhood.
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The patient underwent multiple hospitalizations in 2022, totaling six visits that year. The initial
hospitalization occurred at Dr. Arturo Pingoy Medical Center, South Cotabato, lasting approximately
two weeks and supervised by Dr. Solit. The primary complaint was discomfort related to lung and liver
problems. However, the patient cannot recall the intervals between hospitalizations, stating, "Ambot ga
abot lang abi siya." Subsequently, the patient was admitted for a second time at the same hospital. The
third hospitalization led to a transfer to Allah Valley, lasting another two weeks. The final
hospitalization occurred at Socomedics Medical Center, referred by Doc. Solit to Doc. Non, lasting the
longest at 17 days. Despite the prolonged hospital stays, no surgical procedures were undertaken,
although Dr. Manzera from Allah Valley suggested heart surgery, which the patient declined due to
financial constraints. Throughout his life, the patient did not encounter any major accidents. However,
he has a medical history of asthma and hypertension.
Immunization Status
Patient N.T.L. provided details indicating that his immunization was fully completed, including
the final dose of Sinovac for the COVID-19 vaccination. This final dose should have been administered
4 to 6 months after completing the primary vaccination series. However, the patient couldn't recall
specific vaccines received before COVID-19 due to difficulties in remembering. Nevertheless, he
mentioned, "Wala man problema sa mga bakuna ko" (I didn't encounter any issues with my vaccines).
The patient believes his immunization status during his younger years was likely complete, but he's
uncertain due to the limited prevalence of immunization during that time. Despite this, he completed
two doses of Sinovac during the COVID-19 pandemic.
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Family History Reveals risk factors for disease
The patient provided insight into the family history, revealing a high risk for asthma,
hypertension, and diabetes mellitus. He expressed, "Sa lahi namon kami tanan may ara gid asthma lalo
na utod ko nga panganay na napatay tungod sa hapo". It was mentioned that the patient has three
siblings, one of whom passed away from asthma, while the other two are alive, with one currently
dealing with diabetes. The patient completed a treatment lasting 6 months for Tuberculosis, during
which he took 8 tablets of 2 classifications, including losartan, a medication taken for blood pressure
spikes. Furthermore, it was discussed that Patient N.T.L.'s late relative had a habit of smoking and
consuming alcohol. It's possible that exposure to these habits from parental figures influenced the
patient, potentially exposing him to risks associated with complications from smoking and alcohol
consumption. However, the patient stated that he presently abstains from using these products.
a. Most recent physical examinations and findings
The recent physical examination recorded the following vital signs: Blood pressure at 130/80,
pulse rate of 64 beats per minute, a normal respiratory rate of 17 cycles per minute, axillary
temperature of 36.4 degrees Celsius, and oxygen saturation levels at 94%. These measurements
indicate a return to normal ranges except for the temperature and oxygen saturation. Contrasting the
hospitalization records where the blood pressure was 180/90, respiratory rate was 35, pulse rate was 83,
oxygen saturation was 76%, and temperature was 36.5 degrees Celsius.
During the hospital assessment, the patient weighed 55 kilograms. However, there seems to be
an omission regarding the patient's weight upon subsequent weighing. Additionally, no anomalies were
noted during a comprehensive head-to-toe physical assessment. The patient's head appeared
symmetrical, but there were signs of edema, specifically in the right leg.
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B. History of the Present Illness
The patient has a medical history that includes diagnoses of Bronchial Asthma in acute
exacerbation, moderate-risk community-acquired pneumonia, uncontrolled stage II hypertension, and
chronic obstructive pulmonary disease, all diagnosed at the age of 64. The patient recalled an instance
at 62 years old when extended hospital stays became frequent, despite never having been hospitalized
before. He admitted to a relatively sickly childhood but clarified that it never escalated to requiring
hospitalization.
The patient highlighted his initial hospitalization, which occurred due to sudden difficulty in
breathing. Notably, over the past 6 months, he underwent tuberculosis treatment due to persistent and
excessive coughing. Despite this, subsequent tests at the health center ruled out tuberculosis.
Additionally, the patient disclosed a pre-existing hypertensive condition. Although it didn't lead
to hospitalizations, the patient and family managed it using herbal medicine and massage ("hilot")
whenever symptoms like headaches arose. This history of high blood pressure might have served as an
early indication for the recently diagnosed acute transmural myocardial infarction."
The patient’s current medication
The patient's current medication regimen is limited due to financial constraints, allowing only
one medication to address symptoms as needed. This singular medication primarily manages his
chronic obstructive pulmonary disorder (COPD). Known as Spiolto Respimat, it's an inhalation
solution prescribed by the physician for daily use in the mornings. This medication, provided in a
single-pack inhaler with a reusable seal, serves as a maintenance treatment for the patient's condition
and is used alongside another mentioned medication.
The patient’s allergies

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The patient mentioned specific food allergies, restricting intake of high-sodium foods and
certain seafood, such as shrimp, milkfish, and tilapia. Additionally, he avoids meat sourced from
animals fed with synthetic feed, although he occasionally indulges in beef.
The patient’s current health-related practices
Since being diagnosed with his condition, the patient has not adhered to any specific health-
related practices. He noted that when experiencing health discomfort, he no longer relies on traditional
remedies like "albularyo" or "hilot" within the community. Instead, he opts to visit the hospital for
medical evaluation.
Social History
Regarding social interactions, the patient enjoys a close relationship with family, children, and
friends. His children extend financial support and occasionally visit on Sunday mornings with their
own children, providing him with joy and motivation. However, he mentioned a lack of close friends,
stating, "Kung amigo ang istoryahan, wala gid may ga lakat di pero kung damo ka sang manok damo
ka man amigo" (When talking about friends, there aren't really many around; if you have many
chickens, you'll have many friends).
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C. Activities of Daily Living
Table 2
Gordon’s 11 Before Hospitalization (6 During Hospitalization Analysis
Functional Pattern Months Prior to
Hospitalization)
1. Health Patient have perceived his The shift in Perception: Pre - hospitalization
Perception health as secondary to Perspective:
family responsibilities, Hospitalization have
potentially overlooking or prompted a re- The patient likely
downplaying early signs evaluation of his health placed a higher
or symptoms due to perception, highlighting emphasis on fulfilling
prioritizing family needs. the importance of family obligations,
prioritizing personal possibly downplaying
Self-Care Prioritization: health and well-being. his own health concerns
in favor of caring for
Might have prioritized his family.
family well-being over
personal health needs, Impact of
possibly delaying seeking Hospitalization:
medical attention or
regular health checkups. The experience of being
hospitalized might have
Physical Demands: prompted a

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Juggling multiple reevaluation of his
responsibilities might health perception,
have led to neglecting his emphasizing the need
own health concerns, for self-care and
attributing any discomfort prioritizing personal
or symptoms to stress or health needs.
fatigue.
Recommendations:
Health Awareness:
Encourage the patient
and involve significant
others to maintain
awareness of the
patient’s health needs
while fulfilling their
own familial
responsibilities, and
promoting regular
health checkups and
self-care practices.
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Balanced Approach:
Emphasize to the
family the importance
of balancing family
care with personal
health needs,
recognizing that
maintaining personal
health is crucial for
effective caregiving
within the family.
2. Nutritional Diet: Dietary Changes: Impact of Diet The pre-
Metabolic hospitalization diet, rich
Pattern The patient's diet Due to the hospital's in processed foods and
primarily consisted of dietary regulations, the poor in essential
processed foods high in patient received nutrients, likely
sodium, and saturated controlled sodium, exacerbated the
fats, and low in fruits and balanced meals, with patient's respiratory
vegetables. emphasis on fruits, conditions (asthma,
vegetables, and whole COPD) and
Caloric Intake: grains. - Caloric intake uncontrolled
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was adjusted to hypertension.
Irregular meals, often accommodate the
skipping breakfast and patient's medical needs Metabolic Imbalances
eating larger portions and oxygen Irregular eating patterns
during dinner, leading to requirements. and nutrient-poor meals
an inconsistent calorie may have contributed to
intake. Nutritional Support: unstable blood pressure,
affecting overall
Fluids: The patient received metabolic health.
nutritional supplements
Most likely less than to support respiratory Hospitalization Effects
3liters a day. function and immune The hospital's
health, ensuring controlled, balanced
Nutrient Intake adequate intake of diet improved the
Low intake of essential vitamins and minerals. patient's nutritional
nutrients like vitamin C, - Close monitoring of intake, supporting
which could impact fluid intake to maintain respiratory function and
immune function, and hydration levels. possibly aiding in
inadequate hydration stabilizing blood
levels. pressure and glucose
levels.
3. Elimination Bowel Movements: Elimination Changes: Effect of Diet:

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Pattern
Improved bowel
Patient experiences movements due to a The lack of fiber and
Irregular bowel hospital diet rich in hydration in the pre-
movements due to a diet fiber from fruits, hospitalization diet
low in fiber and vegetables, and whole likely contributed to
inadequate hydration. grains. irregular bowel
Medications adjusted to movements and
Urination: Normal ensure minimal impact occasional constipation.
frequency, but potential on urination frequency
fluctuations due to and volume. Medication Impact:
uncontrolled
hypertension. Fluid Management: Certain medications for
hypertension might
Hydration Status: Close monitoring of have influenced urinary
Inadequate fluid intake fluid intake and output frequency and output,
contributed to occasional to maintain hydration potentially exacerbated
constipation and might balance, especially by inadequate
have affected urinary considering the hydration.
output. patient's respiratory
issues. Hospitalization
Benefits:
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The hospital's dietary
modifications,
particularly increased
fiber intake, likely
improved bowel
regularity, aiding in
better elimination
processes.
Hydration Monitoring:
Close monitoring of
fluid intake during
hospitalization could
have positively
impacted both bowel
movements and urinary
output.
Recommendations:
Emphasize a diet high
in fiber-rich foods and
increased fluid intake
post-hospitalization to
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maintain regular bowel
movements and support
proper hydration.
Adjust medications if
necessary to minimize
potential impacts on
urinary patterns while
ensuring adequate
hydration levels.
4. Activity/ Occupational Activity: Activity Limitations: Occupational Demands:
Exercise
Pattern Engaged in farming Hospitalization limited The patient's
activities involving physical exertion occupation in fisheries
fisheries and crop significantly, reducing and crop production
production, which the usual workload likely involved regular
required physical associated with farming moderate physical
exertion. activities. activity, but it also
Restricted movement exposed them to
Exercise Routine: due to respiratory potential asthma
distress and medical triggers.
Limited structured interventions might
exercise due to have impacted daily Asthma Challenges:
occupational demands but physical activity levels.
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involved moderate
physical activity through Asthma episodes during
work. intense physical
exertion might have
Asthma and Physical hindered consistent
Exertion: exercise routines or
preventive measures
Experiences of asthma due to work priorities.
during intense physical
activities due to potential Hospitalization Impact:
triggers like dust, pollen,
or strenuous work Restricted activity
conditions. during hospitalization
Irregular use of might have temporarily
preventive inhalers or alleviated the potential
medications due to work triggers for asthma but
demands, potentially also led to decreased
exacerbating asthma physical exertion.
symptoms during peak
workload periods. Recommendations:
Balanced Activity:
Post-hospitalization,
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gradually reintroduce
moderate physical
activities, ensuring
adequate asthma
management with
regular preventive
inhalers or medications.
Occupational Health
Measures:
Implement strategies to
minimize asthma
triggers in the
workplace, such as
wearing masks or
adjusting work
schedules during peak
trigger seasons.
Consultation:
Encourage regular
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consultations with a
healthcare provider to
manage asthma
symptoms and ensure
safe engagement in
physical activities
related to farming
duties.
5. Sleep Pattern Late Nights: Sleep during Pre-Hospitalization
Hospitalization: Sleep:
The patient typically
stayed up late at night, The hospital Irregular sleep patterns
possibly due to work environment and and late nights could
demands or irregular structured routines was have affected the
sleep habits. unlikely promoted a patient's overall rest
better sleep but a good quality, potentially
Sleep Duration: hygiene compared at impacting their immune
home wherein patient system and
Irregular sleep duration stated that he often exacerbating asthma
with shorter nights due to appeared disheveled. symptoms.
late bedtime and early And in a way that Work Impact:
morning work Occupational demands

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commitments. somehow it might have contributed
reduced the stress and to irregular sleep
Rest Quality: physical demands that schedules, causing
might have contributed disruptions in the
Potential interruptions in to more regular sleep patient's rest and sleep
rest due to asthma patterns. routine.
symptoms or discomfort
during sleep. Hospitalization Effect:
Work-related Factors: A structured hospital
environment might
Occupational demands have provided a
might have led to conducive setting for
irregular sleep schedules, better rest due to
impacting the patient's reduced stress and
ability to maintain a physical demands.
consistent bedtime
routine. Recommendations:
Establish Routine:
to maintain a consistent
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sleep schedule post-
hospitalization,
ensuring adequate rest
with a regular bedtime
routine.
Stress Management:
Implement stress
reduction techniques
related to work
demands, promoting a
healthier work-life
balance to support
better sleep habits.
Asthma Management:
Manage asthma
symptoms effectively to
prevent sleep
disruptions and ensure
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uninterrupted rest.
6. Cognitive/ Work-related Mental Cognitive Changes Work-Related Stress:
Perceptual Stress: during Hospitalization:
Pattern Demanding agricultural
Engaging in demanding Reduced mental work might have led to
agricultural activities such stressors from work mental fatigue,
as the pesticide and a controlled potentially impacting
application might have environment might the patient's cognitive
contributed to mental have temporarily abilities.
fatigue and stress. alleviated cognitive
strain. Asthma's Influence:
Attention and Focus: Potential improvement
in cognitive function Asthma episodes or
Possible challenges in due to better respiratory distress
maintaining focus and oxygenation and could have affected
attention due to work reduced asthma triggers cognitive function
pressures and the in the hospital setting. temporarily due to
presence of respiratory reduced oxygen levels
symptoms. during these episodes.
Memory and Decision- Hospitalization Impact:
making:
Reduced stressors and a
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controlled environment
Asthma episodes might might have positively
have occasionally influenced cognitive
impacted memory or function by providing
decision-making abilities relief from work-related
making patient more strain and improved
likely to be irritated. oxygenation.
Impact of Respiratory Recommendations:
Conditions:
Work-life Balance:
Respiratory distress or
asthma exacerbations Post-hospitalization,
might have temporarily emphasizes strategies to
affected cognitive manage work-related
function due to reduced stressors and promotes
oxygen supply during a healthier work-life
episodes. balance to support
cognitive health.
Asthma Management:
Effective asthma
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management can help
prevent cognitive strain
during respiratory
distress episodes.
Cognitive Exercises:
Encourage activities or
exercises that promote
cognitive health, such
as puzzles, memory
games, or relaxation
techniques, to support
mental well-being.
7. Self- The patient’s self- Shift in Self- Pre-Hospitalization
Perception/ perception might have Perception: Perspective:
Self Pattern been centered around
being a dedicated Hospitalization might The patient’s self-
provider and caregiver, have prompted a shift perception likely
placing a high value on in patients self- revolved around
fulfilling family needs perception, highlighting fulfilling familial roles,
over personal aspirations the need for self-care possibly prioritizing

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or self-care. and acknowledging family needs over
personal health needs personal well-being.
Self-Concept: alongside familial
responsibilities. Impact of
Identified himself Hospitalization:
primarily as a nurturing Reevaluation of Self-
and supportive figure Concept: The experience might
within the family, valuing have triggered a
his role as a provider and The experience might reevaluation, prompting
emotional support system have prompted a a more balanced view
for his children. reassessment of his role that recognizes the
within the family, importance of personal
Role Prioritization: recognizing the health alongside family
importance of personal care.
Likely placed a strong well-being in fulfilling
emphasis on fulfilling familial duties Recommendations:
familial roles, potentially effectively.
overlooking personal Balanced Self-
needs or aspirations for Perception:
the sake of family well-
being. Encourage the patient
to adopt a more
balanced view that

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integrates personal
well-being into his self-
perception alongside
fulfilling family roles.
Self-Care Emphasis:
Highlight the
significance of self-care
and personal
aspirations,
emphasizing that
maintaining personal
health enhances his
ability to care for the
family effectively.
8. Sexual/ Parental Guidance: Shift in Focus: Pre-Hospitalization
Reproductive Dynamics:
Pattern The patient states that he Hospitalization might
is unlikely sexually have temporarily The patient likely
active, therefore provided shifted the focus away played a role in creating
guidance on sexual and from discussions or an environment
reproductive health topics interactions related to conducive to open and
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in a supportive and age- sexual and reproductive respectful discussions
appropriate manner, health due to health about sexual health
fostering understanding concerns. within the family.
and respect within the
family. Impact of
Hospitalization:
Respect for Privacy:
The temporary shift in
Respected individual focus toward health
privacy and boundaries concerns might have
regarding discussions momentarily disrupted
about intimate matters, discussions or
ensuring sensitivity and interactions related to
openness in addressing sexual and reproductive
sexual health topics. health within the
family.
Health Education:
Recommendations:
Encouraged open
communication about Continued Support:
sexual and reproductive
health, potentially Encourage ongoing
emphasizing the communication about

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importance of responsible sexual and reproductive
behaviors and respect. health within the
family, even during
challenging times like
hospitalization.
Utilize Resources:
Suggest utilizing
trusted family members
or professionals for
guidance or support on
sexual health topics
during this period.
9. Role/ Parental Relationship: Impact on Pre-Hospitalization
Relationship Relationships: Dynamics:
Pattern The patient as a father
likely exemplified a During the patient’s The father likely played
loving and supportive hospitalization, family a role in fostering a
relationship with his members play an supportive and
partner, providing a important role in giving communicative
positive model for healthy emotional support, environment for
adult relationships within assisting with care discussing relationships
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the family. decisions, and and values within the
partnering with family.
Parental Guidance: healthcare experts to
ensure complete and Impact of
Offered guidance and compassionate care. Hospitalization:
support in cultivating Patient also shows
healthy relationships, and resiliency during this The temporary shift in
demonstrating mutual period of time by focus toward health
respect and understanding means of the societal concerns might have
within the family unit. standards of what a momentarily disrupted
father should be. discussions or
Communication: interactions related to
relationships and
Encouraged open intimacy within the
communication within the family.
family, providing a safe Recommendations:
environment for Continued
discussions about Communication:
relationships and values. Encourage ongoing
communication about
relationships within the
family, even during
challenging times like

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hospitalization.
Utilize Resources:
Suggest utilizing
trusted family members
or professionals as a
resource for guidance
or support during this
period.
10. Coping/ Coping Mechanisms: Shift in Coping Pre-Hospitalization
Stress Strategies: Coping:
Tolerance The patient likely copes
with stress through Hospitalization might The patient displays
effective time have challenged the effective coping
management, seeking patients usual coping mechanisms through
support from family strategies, leading to his family, managing
members, and increased stress due to multiple responsibilities
maintaining a positive health concerns and a while maintaining
outlook despite temporary shift in focus composure and support
challenges. to personal health. for the family.
Stress Tolerance: Impact of
Hospitalization:
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Manages stress by The shift in focus
balancing family towards personal health
responsibilities, work might have temporarily
demands, and emotional disrupted the patients
support for a child usual coping
working abroad, mechanisms,
displaying a resilient and potentially increasing
composed demeanor. stress levels due to
health concerns.
Recommendations:
Adaptation and
Support:
to adapt coping
strategies to manage
stress related to health
concerns during
recovery.
Family Support:
Emphasize the
importance of family
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support during this
period, encouraging
open communication
and assistance in
managing
responsibilities.
11. Value/ Belief Values and Beliefs: Faith and Coping: Influence of Faith:
Pattern
The patient likely upholds His Roman Catholic The patient’s Roman
Roman Catholic values of faith might serve as a Catholic beliefs likely
compassion, love, and source of comfort and shape his values,
family unity, guiding his strength during guiding principles, and
interactions and decision- hospitalization, interactions within the
making within the family. providing solace and family, fostering a
hope amid health sense of unity,
Faith Integration: concerns. compassion, and
support.
Integrates his Roman
Catholic beliefs into daily Role of Faith in
life, through prayer, Coping:
attending religious
services, and instilling During hospitalization,
these values in his his faith plays a
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interactions with his significant role in
children and providing emotional
grandchildren. support and resilience
amid health-related
Support System: challenges.
Relies on faith and Recommendations:
community support in
times of challenges, finds Faith Support:
strength and guidance Encourage continued
through his religious engagement with the
beliefs. patient’s spiritual
practices to find solace
and strength during the
recovery period.
Family Integration:
Emphasize the
importance of
incorporating Roman
Catholic values of love,
compassion, and unity

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within the family,
fostering a supportive
environment during the
patient’s recovery.
D. Physical Assessment
General Survey
Patient N.T.L., a 64-year-old male, appeared to match his stated age. Throughout the interview, he
presented as conscious, coherent, and responsive; however, the patient appears a little sad and anxious
of what is happening to him as of the moment. He followed simple commands during various
assessments and provided coherent, precise responses to all interview questions. Notably, his overall
appearance, including clothing, was tidy, and devoid of any body odor during observation. Physically,
he seemed well-developed, however slightly-nourished, maintaining a BMI of 22.3 kg/m2 indicative of
a normal weight.
Throughout the conversation, signs of fatigue and evidence of shortness of breath were apparent. He
was positioned in a semi-fowler's posture, where the head of the bed was raised to aid in easier
breathing. Moreover, the patient's physique appeared slender, although a slightly bloated stomach was
noticeable. He appeared pale and had a slight sheen of sweat. There were frequent instances of
grimacing and holding his chest observed consistently during the interview.
Despite these concerning symptoms, Patient N.T.L. remained mentally alert and appropriately oriented
to person, place, and time. Continuous monitoring of vital signs during the assessment displayed
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varying levels in his blood pressure (180/90mmHg), respiratory rate (35 cpm), cardiac rate (146 bpm),
pulse rate (141 bpm), and peripheral oxygen saturation (96%). Yet, there were observable variations in
the vital signs, transitioning from abnormal to normal and vice versa during the continuous monitoring
throughout the assessment. These fluctuations indicated changes in cardiovascular and respiratory
function, potentially requiring further assessment and intervention from healthcare professionals.
A. Integumentary System
Inspection:
Hair
The individual had predominantly gray hair with occasional patches of black due to aging, evenly
distributed across the head and cut short. No signs of lesions or infestations were observed.
Skin and Nails
The patient's skin exhibited a consistent brown tone, with lighter areas, particularly on covered regions.
Wrinkles around the forehead and near the corner of the eyes, attributed to aging, were observed,
alongside a few black moles on the forehead. Edema was evident in the right lower extremity. Pallor
and slight sweating of the skin was also observed. Fingernails were long, not properly trimmed, and
slightly pale, without any signs of clubbing. There were no masses or tenderness detected on the scalp
upon inspection.
Eyes
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The patient exhibited redness or irritation on the sclera of his left eye. There were no signs of crusting
or infestation on the eyelashes, and no edema or lesions were observed on the eyelids. However, the
patient reported experiencing blurry vision, particularly at 14 inches away when asked to read the
newspaper. Additionally, the patient’s pupils were equally round and reactive to light and
accommodation (PERRLA). The patient also mentioned experiencing a few black spots or floaters in
his field of vision.
Ears
The ears are symmetrical in shape. The auricle, tragus, and lobule were all present. Both ears had the
same color as the facial skin. Auricles recoiled after being folded. They were firm, mobile, and non-
tender. Though, difficulty in hearing was noted during the interview.
Nose
Nose is midline and symmetrical, skin is intact without lesion, no signs of sinus infections noted such
as redness and swelling. Nasal flaring was evident and absence of drainage was also noted.
Mouth
The patient displayed darker-toned lips and vertical creases encircling the mouth, attributed to an
extensive history of smoking. Paleness of lips was also observed. Stained, brownish teeth with signs of
decay and a loss of five teeth were evident. The oral mucosa appeared slightly pale, while the tongue
showed a symmetrical slightly pale hue without any sores or lesions.
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Neck
The patient’s neck was straight and centrally aligned. Small brown pigmentation or pinpoint marks
were also noticed on the patient’s neck. The skin appeared intact without any discoloration, rashes, or
swelling. Furthermore, there were no visible signs of an enlarged thyroid gland.
Palpation:
Hair
The patient's hair displayed a smooth texture, and there were no detected masses or tenderness on the
scalp. No lesions or infestations noted upon palpation.
Skin and Nails
The skin showed good turgor, swiftly returning to its normal state when grasped. While the skin
temperature felt slightly cool on the hands and feet, a capillary refill, taking more than 2 seconds, was
observed.
Nose
No tenderness or pain was felt when pressing on the frontal and maxillary sinuses. Additionally, there
were no observed masses in these areas.
Neck
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No lumps or abnormalities were felt on the neck upon examination. There was no tenderness when
touching the area, and there were no signs of enlarged lymph nodes.
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B. Neuro-Sensory System
Table 3
Cranial Nerve Patient’s Response Significance
(Intact/Not
Intact)
CN 1: Olfactory The patient accurately identified scents, distinguishing Intact
between pleasant and unpleasant smells.
CN 2: Optic The patient experienced difficulty reading and seeing clearly Not Intact
without issues. When one eye was covered, he couldn't read at
a distance of 14 inches away when asked to read the
newspaper, and his vision was blurry.
CN 3: Oculomotor Patient’s pupils were equally round and reactive to light and Intact
accommodation (PERRLA).
CN 4: Trochlear The patient demonstrated coordinated and unrestricted Intact
movement of the eyes. Both eyelids blinked bilaterally.
CN 5: Trigeminal Patient’s jaw has a Full range of motion (ROM) and Temporal Intact
and masseter muscles contract bilaterally.
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CN 6: Abducens Patient has good bilateral eye movement. Intact
CN 7: Facial The patient adeptly followed all instructions regarding facial Intact
expressions. They effectively executed tasks such as smiling,
frowning, showing upper and lower teeth, raising eyebrows,
puffing cheeks, pursing lips, and tightly closing their eyes,
even when there was an attempt to open them by the student
nurse. The patient also demonstrated the ability to close their
eyes against resistance.
CN 8: The patient couldn't hear and repeat whispered words Not Intact
Vestibulocochlear properly. During the Watch-tick and Whisper Test, the
patient's right ear failed to detect the watch's tick and couldn't
repeat the whispered words.
CN 9: Patient’s uvula was midline and it rises bilaterally along with Intact
Glossopharyngeal the soft palate.
CN 10: Vagus Patient’s gag reflex was intact and he was able to swallow Intact
without difficulty or pain felt.
CN 11: Spinal The patient's movement while shrugging their shoulders Intact
Accessory (trapezius) appeared even on both sides, and they could only
lightly resist force without experiencing pain. Similar
resistance levels were observed when the patient turned their
head to the side, testing the sternocleidomastoid muscle. Both

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muscles were graded at 4 on the scale.
CN 12: Patient was able to protrude tongue medially and as well as Intact
Hypoglossal move it side to side.
C. Respiratory System
Inspection:
Posterior Thorax
The spinous process was straight and aligned properly, while the posterior thorax showed symmetrical
proportions. The shape of the scapula was even and not protruding. The spine appeared straight without
any signs of Scoliosis or Kyphosis. No deformities or masses were noticed in the thorax, and there
were no irregular skin colorations. The ratio of the front-to-back diameter compared to side-to-side
diameter was 1:2.
Anterior Thorax
The anterior part of the chest was balanced, displaying downward-sloping ribs and a centered
alignment of the trachea and sternum. No chest deformities, masses, or swellings were observed, and
the angle between the ribs (costal angle) measured at 90 degrees. There were no signs of skin
discoloration. The sternum was positioned centrally, and the usage of accessory muscles like the
scalene to aid in breathing was noticed. The respiratory rate was at 35 cycles per minute which was
higher than the normal. He also appeared to be doing rapid (or fast) deep breathing which indicates
dyspnea.
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Palpation:
Posterior Thorax
While examining the back of the chest, the patient reports no pain, and there's no noticeable crepitus
upon palpation. The skin feels slightly cool to the touch on both sides. There are no indications of
moisture, masses, swelling, or deformities. Furthermore, the tactile fremitus is uniform on both sides.
Anterior Thorax
When examining the front of the chest through palpation, the patient reports no pain, and the skin feels
slightly cool to the touch. There's uniform warmth on both sides without any indications of moisture,
swelling, masses, or deformities. The tactile fremitus is also consistent on both sides.
Percussion:
Posterior and Anterior Thorax
The presence of dull sounds during percussion in the lungs indicates the possibility of fluid residing
either within the lungs or in the area surrounding them, potentially caused by community-acquired
pneumonia.
Auscultation:
Posterior and Anterior Thorax
Presence of crackles was heard on both lungs.
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D. Cardiovascular System/Circulatory System
Inspection
The patient's blood pressure measured 180/90 mmHg, highly elevated and suggesting a hypertension.
Upon admission, the oxygen saturation levels were recorded at 76%, but it increased to 96% after the
administration of oxygen during the assessment and intervention, signaling a return to normal levels of
oxygen in the blood. Edema was noticeable in the patient's right lower extremity. The upper extremities
displayed symmetrical features without signs of swelling or prominent veins. The skin color of both
upper and lower extremities was even. No nail clubbing was observed, as indicated by a negative
Schamroth Test result. The patient displayed signs of chest pain, grasping the chest and expressing a
grimace that suggested pain, rated at 8 out of 10 on the pain scale according to the patient's
verbalization
Palpation:
Capillary refill takes more than two seconds in all extremities, signifying poor peripheral circulation.
The skin slightly cool to the touch but without any indications of cyanosis, indicating sufficient blood
flow. The peripheral pulses were rapid, measuring 141 beats per minute, and within the abnormal
range. However, they were graded as +1 on the scale, signifying a weak or diminished pulse strength.
Apical pulse was located at the fifth intercostal space at the left midclavicular line. The patient was
able to perceive sharp objects upon palpation but did not sense dull ones.
Auscultation:
The heart exhibited irregular rhythms and abnormal sounds. Both S3 and S4 heart sounds were
detectable. Upon auscultation the cardiac rate of a patient was 146 beats per minute indicating a high
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cardiac rate. This might be linked to the patient's apprehension and worry about the potential
occurrence of something unfavorable, like the fear of death, compounded by their current medical
state.
E. Gastrointestinal System
Inspection:
The patient exhibited a symmetrical, large, and slightly bloated abdomen without any observed scars or
stretch marks. The skin tone was lighter in comparison to other exposed body areas and appeared
devoid of lesions or rashes. Notably, the umbilicus was round and inwardly protruding upon
inspection. The patient expressed feeling a touch of nausea and slight stomach ache caused by the fear
and anxiety about something negative happening to him such as dying.
Auscultation:
Auscultation revealed gurgling sounds in the lower two quadrants of the abdomen.
Palpation
Upon palpation, the abdomen felt soft, and non-tender, and exhibited no presence of masses.
Percussion:
Percussion elicited low, flat, and dull sounds across all four abdominal quadrants.
F. Genitourinary System
Inspection:
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The patient's urine appeared a pale yellow upon inspection. The patient reported no pain or burning
sensation while urinating. There were no signs of urinary incontinence as the patient retained control
over urination, and there were no observed abnormal discharges. The total amount of fluid consumed
by the patient from 3 PM to 11 PM had been 320cc, while the amount of urine passed was 400cc.
G. Breast and Lymphatic
Inspection:
The patient's nipple had a light brown hue with no irregularities in its shape. Both breasts appeared
symmetrical in shape and size, without any signs of edema, hyperpigmentation, or discoloration. The
areola was small, evenly shaped, and slightly darker than the surrounding skin. There were no masses
or lesions observed. Both nipples were inverted, and there were no discharges or lesions present.
Palpation:
No tenderness was reported. Additionally, there were no detected masses upon palpation, and no
discharges were observed.
H. Musculoskeletal System
Inspection:
The patient exhibited a slightly slouched posture, but his head remained centered. The natural curves of
the spine appeared normal. Both knees were symmetrical without any deviations. While walking, the
patient's gait displayed a slight sway, yet weight distribution was even between both legs, and there
were no inward or outward turning of the toes. Movements were coordinated, and the client's stride
length was appropriate. The strength of the muscles seemed balanced in both upper extremities, though
there was a slight weakness likely attributed to fatigue. However, there was noticeable swelling in the
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right extremity compared to the left due to the presence of edema. In addition, the patient easily gets
tired when doing simple activities which indicates that the patient has fatigue. The patient also reported
feeling weak and slightly unsteady after doing some activities which indicates dizziness that is related
to symptoms of having fatigue.
Palpation:
The patient demonstrated full range of motion in all major joints with no limitation or pain reported
during flexion, extension, abduction, adduction, and rotation movements. The patient displays
moderate muscle strength, graded as 4, in all significant muscle groups. This is observed through the
ability to move against gravity with slight resistance, albeit experiencing fatigue after engaging in basic
tasks. He required small assistance with moving, like adjusting his position while lying in bed.
However, no areas of tenderness, swelling, crepitus, or abnormal masses were noted upon palpation of
the muscles and joints. Additionally, the patient reported no sensations of numbness, tingling, or
altered feelings, indicating intact nerve function.
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IV. Anatomy and Physiology
THE CARDIOVASCULAR SYSTEM
The heart, a vital organ sustaining life,
orchestrates the symphony of our circulatory
system, pumping blood to every corner of our
body. Every day, the heart pumps over eight pints
of blood—more than 100,000 times—throughout
the body. In addition to supplying blood that is
rich in nutrients and oxygen, this clears waste
from tissues and organs (Kohli, 2020). The heart
is a hollow structure that is approximately the

Figure 1 The heart and its placement
size of an adult fist and has a weight of around 10
ounces, or 300 grams (g).
It is connected to the large vessels by a broad, superior base, and the superior diaphragm is
immediately followed by a pointed apex or termination. The heart is situated deep in the sternum in the
mediastinum, in between the pleural cavities of the chest. About two-thirds of the heart rest on the left
side of the midsagittal plane when it is normally inclined (Roiger, D., Bullock, N., 2019).
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CARDIOVASCULAR SYSTEM: Cardiac Muscle Tissue
The myocardium, or cardiac muscle
tissue, is a particular kind of muscular
tissue that makes up the heart. Only the
heart has cardiac muscle, which is
responsible for the heart's involuntary
contractions and releases that keep the
blood flowing throughout the body. It is
made up of cardiac muscle cells, which
work in unison to maintain blood flow
throughout the body and the heart

Figure 2 Heart’s Engine: Unveiling Cardiac Muscle
working (Eske, 2019)
Your heart pumps through involuntary
motions that are caused by your cardiac muscle. It is distinct from skeletal muscle tissue in that it has
this property, which is within your control. The specialized cells known as pacemaker cells enable it to
accomplish this. They regulate how your heart contracts. Your heart rate might increase or decrease
depending on the messages your nervous system delivers to the pacemaker cells. The cardiac muscle
cells that make up your pacemaker cells are linked to each other so that signals may be sent. Your
heartbeat is produced as a result of a wave of contractions in your cardiac muscle (Schulman, 2018).
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CARDIOVASCULAR SYSTEM: Chambers and Valves
The heart's four chambers are
arranged into the left and right
pumps, which provide blood to the
pulmonary and systemic
circulations. Through the superior
and inferior vena cavae, the right
atrium gets deoxygenated blood
from the systemic circulation, which
includes the whole body except for
the lungs. Additionally, the coronary

Figure 3 Chambers & Valves at work
sinus allows deoxygenated blood from
the heart muscle itself to empty into the right atrium. As a result, the right atrium serves as a storage
space for blood that has lost oxygen. From this point on, blood enters the right ventricle—the right
heart's primary pumping chamber—through the tricuspid valve.
To supply blood flow to the pulmonary and systemic circulations, the heart's four chambers are
arranged into the left and right pumps. Through the superior and inferior vena cavae, the body's
circulation—which includes the lungs—supplies the right atrium with deoxygenated blood.
Additionally, the coronary sinus allows the right atrium to receive deoxygenated blood from the heart
muscle itself. Deoxygenated blood is thus gathered in the right atrium, which serves as a reservoir. The
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tricuspid valve then allows blood to pass through, filling the right ventricle, the heart's primary
pumping chamber.
The pulmonary artery receives blood from the right ventricle and delivers it to the lungs for
oxygenation. The blood travels through the right ventricular outflow tract, the pulmonic valve, and the
pulmonary artery. Blood oxygenates in the lungs during its passage through the capillaries, when it is
sufficiently near to the oxygen found in the lung's alveoli. The four pulmonary veins—two in each lung
—collect this oxygenated blood.
Each of these four veins empties into the left atrium, which serves as a holding area for blood
enriched with oxygen. Similar to the right atrium, the left atrium uses both passive flow and active
pumping to transfer blood to its ventricle. Hence, blood that has been oxygenated passes through the
mitral valve and fills the left ventricle. The primary pumping chamber of the left heart, the left
ventricle, pumps out newly oxygenated blood through the aortic valve to the systemic circulation. The
following heartbeat then repeats the entire cycle once more (Rehman, I., Rehman, A., 2023).
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Figure 4 Paradigm of how blood flows in the heart
CARDIOVASCULAR
SYSTEM: Cardiac Conduction System
The network of specialized cardiac
muscle cells known as the cardiac
conduction system generates and
transmits the electrical impulses that
cause the synchronized contractions of
every cardiac cycle. These unique cells
have the capacity to spontaneously
produce an action potential (self-
excitation) and transfer it to neighboring
Figure 5 Inside the Heart’s Conduction Network cells (conduction), including
cardiomyocytes (Crumbie, 2023).
A heartbeat (heart contraction) is started by the sinoatrial (SA) node, patch of specialized
cardiac muscle cells located in the wall of the right atrium near the opening for the superior vena cava.
The SA node is the heart’s pacemaker.
The SA node is vulnerable to damage and disease, particularly pericardial inflammation,
because it is located just 1 mm below the visceral pericardium. The sinus node artery, which goes
through the middle of the node, supplies the SA node with blood. The sympathetic and
parasympathetic nervous systems innervate the SA node. Depending on age and physical state, the SA
node in resting adults produces between 60 and 100 action potentials every minute. Every action
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potential swiftly travels between cells, across the atria's myocardium, and onto the atrioventricular
node (AV node), where it triggers the contraction of both atria and the start of systole (Hidayat, 2023)
The atrioventricular (AV) bundle (bundle of His) divides intro branches that continue to carry
the electrical impulse form the AV node down to the interventricular septum toward the heart’s apex.
Purkinje fibers, fan out from the ends of the AV bundle to the walls of the ventricles, stimulating the
cardiac muscle cells of the ventricular myocardium to depolarize and contract (Bullock, 2019)
Figure 6 Paradigm Navigating the Heart’s Conduction
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THE RESPIRATORY SYSTEM
In the grand theater of our bodies, the respiratory system takes the stage, playing the lead role in
a ceaseless performance called life. As we step into the wings of this vital production, let's unravel the
significance of the respiratory system—a choreographer of breath, a guardian of vitality, and the
unseen maestro behind the curtain of our very being.
RESPIRATORY SYSTEM: THE LUNGS
Figure 7 Lungs in a closer look
Every lung has an apex that extends superiorly to a point about 2.5 cm above the collarbone,
and a base that rests on the diaphragm. In addition, it features three borders: anterior, posterior, and
inferior, as well as a medial surface. The smaller mediastinal surface of the lungs faces medially,
whereas the larger coastal surface presses on the rib cage. The lungs receive the bronchus, blood
vessels, lymphatic vessels and nerves through a slit in the mediastinal surface called the hilum, and the
structures entering the hilum constitutes the lungs root. The right lung is larger and weighs more than
the left lung. Since the heart tilts to the left, the left lung is smaller than the right and has an indentation
called the cardiac impression to accommodate the heart. This indentation shapes the inferior and
anterior parts of the superior lobe into a thin tongue-like process called the lingual (Physiopedia, 2023).
RESPIRATORY SYSTEM: The lungs and the Bronchial Tree
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The right and the main bronchi each enters its respective lung at an area on the medial surface
of the lung called hilum. This is the same location used by pulmonary arteries and veins to enter and
leave the lung. The left bronchus is slightly more horizontal than the right bronchus due to the location
of the heart. The main bronchi and all of their further branches make up the bronchial tree. Upon
entering the lung, each main bronchus branches to become the lobar bronchi, each going to a separate
lobe of the lung. The left lung has fewer lobes (two) than the right, again because of the position of the
heart. The right lung has three lobes, and therefore three lobar bronchi.
Figure 8 The bronchial tree
RESPIRATORY SYSTEM: Alveoli
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At the end of the bronchioles, the lungs'
branch-like tubes, are tiny air sacs called alveoli.
Your circulation is exchanged with molecules of
carbon dioxide (CO2) and oxygen through the
alveoli. The respiratory system's tiniest structures
are called alveoli. They are grouped together at
the termini of the airways that enter the lungs
(respiratory tree) throughout the lungs. O2 and

Figure 9 Alveoli Anatomy oxygen can move more easily between the alveoli
and tiny blood arteries (capillaries) due to the alveoli's extremely thin walls. Because the capillaries
have a lower concentration of oxygen than the alveoli, oxygen can move from the alveoli to them.
Likewise, CO2 travels in the opposite direction since it is less concentrated in the alveoli than it is in
the capillaries (Eldridge, 2023).
ALVEOLI: Cell types
Type I pneumocytes
Each alveolus has 70% of its internal surface covered by type I pneumocytes. These squamous,
thin cells are perfect for exchanging gases. They constitute the air-blood barrier, which is where gas
exchange takes place, along with pulmonary capillary endothelium via sharing a basement membrane
(Mandiga, 2023)
Type II pneumocytes
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The two roles of type II alveolar cells, often referred to as type II pneumocytes, are to (1)
secrete pulmonary surfactant and (2) restore the alveolar epithelium in cases where squamous cells are
injured. Phospholipids and protein make up surfactant, which covers the tiniest bronchioles and alveoli
to stop alveoli from collapsing due to pressure buildup during expiration. In the absence of surfactant,
the walls of a deflated alveolus would have a tendency to stick together like damp sheets of paper,
making it extremely difficult to inflate them again during the subsequent breath (Ferng, 2023)
Alveolar Macrophages
Alveolar macrophages play an important role in scavenging microbes such as viruses, bacteria,
fungi, inhaled environmental particles like coal, silica, asbestos, tissue debris, and cancer cells. It is the
most numerous of all cells in the lung, which drift through the alveolar lumens and the connective
tissue between them clearing up debris through phagocytosis. These macrophages “eat” the dust
particles that escape from mucus in the higher parts of the respiratory tract, as well as other debris that
is not trapped and cleared out by your mucus. If your lungs are infected or bleeding, the macrophages
also function to phagocytize bacteria and loose blood cells
RESPIRATORY SYSTEM: Gas Exchange
The respiratory system's main job is to expel carbon
dioxide and absorb oxygen, a process known as gas exchange.
The oxygen that is inhaled travels via the lungs to the alveoli.
Each layer of cells lining the alveoli and the capillaries around
them is only one cell thick, and they are in close proximity to
one another. This air-blood barrier allows oxygen to enter the
Figure 10 The Alveolus

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blood in the capillaries fast. In a similar manner, carbon dioxide enters the alveoli from the blood and is
subsequently expelled (Dezube, 2023).
Figure 11. Gas Exchange Paradigm
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Figure 12. Pathophysiology of the Disease
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The clinical pathogenesis presentation of a patient experiencing acute decompensated
congestive heart failure (ADHF) secondary to acute ST-elevation myocardial infarction (STEMI) in the
context of hypertensive cardiovascular disease, acute coronary disease, and atrial fibrillation with rapid
ventricular response presents a multifaceted challenge. This intricate scenario, compounded by the
patient's classification as New York Heart Association (NYHA) Class IV heart failure, is further
complicated by the coexistence of community-acquired pneumonia with a moderate risk profile and
chronic obstructive pulmonary disease in an acute exacerbation. Additionally, the presence of
hypokalemia, likely of nutritional origin, adds another layer of intricacy to the clinical picture.
Understanding the interplay of these conditions is crucial for unraveling the pathophysiological
mechanisms at play and developing an effective and comprehensive management approach tailored to
the patient's intricate health profile.
The disease process also includes various diagnostic tests and lab tests that further justify the
current diagnosis of the patient. The following diagnostic tests have deviations and interpretations that
are highly supportive of the case. The patient underwent two sets of chest X-rays, one is the PA and the
other is PAL, the first test, which is the Posterior-Anterior Lateral came out with an impression of
Progressive PTB. Superimposed pneumonia is not ruled out. Pleural fluid/reaction, left, whereas the X-
ray for the Posterior Anterior came out with an impression of, Fibroid PTB (Scar), left with possible
bronchiectasis. Regressing interstitial pneumonia is also considered. For the hematology results, only
the white blood cells, neutrophils, and platelets had constant high deviations from the normal range
while the lymphocytes remained low. The urinalysis test also shows that the hyaline cast is
exceptionally high and deviates from the normal. The clinical chemistry test results also showed that
the Glucose fasting, triglycerides, and HbA1c is higher than normal. The patient’s electrolyte results
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also posed different deviated results such as instances of high sodium and constant low potassium
results which explains how the patient has hypokalemia. For the ABG test results, in the first set of
ABG results, the patient exhibited a normal pH and PCO2, with elevated bicarbonate (HCO3) and base
excess (BE), indicating metabolic alkalosis. The second set of results showed a high pH, elevated
PCO2, and low PO2, suggesting a combination of respiratory alkalosis, respiratory acidosis, and
hypoxemia, alongside elevated bicarbonate and base excess, pointing to ongoing metabolic alkalosis.
The third set of results revealed a high pH, high PCO2, normal PO2, elevated bicarbonate, and high
base excess, indicating a mix of respiratory acidosis, respiratory alkalosis, and metabolic alkalosis,
emphasizing a complex acid-base imbalance. The Gram stain shows the presence of Gram-positive
cocci in pairs (1+) with an abundance of polymorphonuclears and a few epithelial cells observed per
low-power field (LPF). Lastly, the Troponin I level of 142.4 ng/L exceeds the normal range (less than
19 ng/L) and falls within the range indicative of suspected myocardial infarction (19 ng/L-100 ng/L),
suggesting a potential cardiac injury. With a value beyond 100 ng/L, the result is classified as
POSITIVE for myocardial infarction, indicating a higher likelihood of significant cardiac damage.
The factors influencing susceptibility to the disease encompass both predisposing and
precipitating elements. Predisposing factors comprise significant contributors such as age, with a
noteworthy emphasis on individuals over 60 years old, males, those with a family history of
hypertension and asthma, and those exposed to chemicals and pesticides. Conversely, precipitating
factors involve unhealthy lifestyle choices, including smoking, excessive alcohol consumption, poor
dietary habits, inadequate sleep, and heightened stress levels.
Tracing the root of the disease proper, considering the longevity of the disease as per history
assessment, the pathogenesis begins with asthma. Asthma initiates airway hyper-responsiveness,
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leading to variable and reversible airflow obstruction influenced by genetic and environmental factors.
Genetic predisposition, evident in family history, combines with exposure to environmental allergens,
including indoor and outdoor triggers. This sets the stage for allergic hypersensitivity in the airways,
where subsequent exposure to various triggers such as infections, allergens, pollution, smoke, and
certain drugs can induce asthma in susceptible individuals.
When exposed, triggers sensitize helper T cells, prompting IgE antibody production by B cells.
Upon re-exposure, these antibodies bind to mast cells, initiating the release of inflammatory mediators
like histamines. This cascade causes vasodilation, edema, goblet cell hyperplasia, and bronchial smooth
muscle contraction, collectively resulting in early-phase airway obstruction. A delayed response
involves cytokine release inducing eosinophil maturation, contributing to bronchial constriction.
Manifestations include bronchospasm, where the bronchial tree undergoes further narrowing, mucoid
gland enlargement, and airway obstruction. This persistent constriction, potentially leading to fibrosis,
compromises bronchial structural integrity. Impaired ventilation, compromised respiratory defenses,
and increased susceptibility to infections follow. Pathogenic microorganisms may infiltrate, facilitated
by factors like aspiration and their migration to the pulmonary bed. This inflammatory response leads
to swelling, fever, pain, redness, and loss of function. White blood cells infiltrate alveolar air spaces,
forming exudates and occluding airways. This cascade decreases alveolar oxygen tension, contributing
to a ventilation/perfusion (V/Q) mismatch, and exacerbating arterial hypoxemia. Clinical symptoms
include wheezing, shortness of breath, coughing, chest tightness, increased respiratory rate, fatigue,
difficulty sleeping, and decreased peak expiratory flow (PEF). Additionally, a high neutrophil count of
0.79 may indicate ongoing inflammation. These signs and symptoms collectively underscore the
complex interplay of asthma's pathophysiological processes and their impact on respiratory function.
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Triggers of asthma, including active cigarette smoking, are linked to pneumonia, a condition
where exposure to pathogens occurs through inhalation, aspiration, tissue spread, or blood
transmission. Susceptibility is heightened by factors such as smoking, which impairs neutrophil
function and damages lung epithelium, and chronic lung conditions like COPD, asthma, and lung
cancer, which compromise lung tissue integrity.
In a susceptible host, virulent pathogens proliferate in lower airways and alveoli, initiating a
systemic and local inflammatory response. Systemically, cytokine release disrupts thermal regulation,
leading to symptoms like fever. Locally, alveolar epithelial cells release chemokines, recruiting
neutrophils to the inflammation site. The inflammatory response varies based on the invading
pathogen, with different patterns seen in infections caused by Streptococcus pneumoniae (lobar) and
Haemophilus influenza (interstitial). Clinical signs and symptoms of pneumonia include cough,
shortness of breath, rapid and shallow breathing, sharp or stabbing chest pain, loss of appetite, low
energy, and fatigue. These manifestations underscore the impact of pneumonia on respiratory function
and the systemic response to the infection.
Pneumonia affects both ventilation and diffusion, with inflammatory reactions in the alveoli
producing an exudate that hinders oxygen and carbon dioxide diffusion. Neutrophils migrate into the
alveoli, filling the air-filled spaces and causing areas of the lung to be inadequately ventilated. This
leads to a ventilation-perfusion (V/Q) mismatch, resulting in poorly oxygenated venous blood entering
the pulmonary circulation, contributing to arterial hypoxemia and hypoxia.
Genetic predisposition or familial history implicates defects in sodium excretion, functional
regulation of vascular tone, and structural modulation of vascular caliber. Poor diet, particularly
elevated sodium intake, have the potential to magnify the impact of genetic factors. The ensuing
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elevation in both cardiac output and peripheral resistance plays a pivotal role in the development of
hypertension. However, due to the long-term blood pressure of ≥ 135/85, it progresses to chronic
hypertension wherein the patient showed signs and symptoms such as severe headaches, chest pain,
dizziness, difficulty breathing, and abnormal heart rhythm.
Chronic hypertension leads to elevated afterload which is indicative of increased resistance to
left ventricle ejection wherein it triggers a series of adaptations within the myocardium to surmount
this hindrance and safeguard cardiac output. This response encompasses structural and functional
modifications, giving rise to left ventricular hypertrophy and fibrosis, resulting in a stiffened ventricle.
Subsequently, the contractility of the left ventricle diminishes, impeding the efficient flow of blood
from the heart. This impairment in blood flow culminates in the backing up of blood into the lungs and
a reduction in perfusion throughout the body. The progressive inability of the heart to meet metabolic
demands ultimately leads to Acute Decompensated Congestive Heart Failure (ADCHF), marked by a
sudden exacerbation of symptoms and a rapid decline in cardiac function. Furthermore, hypertension
contributes significantly to prolonged stress on the endothelium of systemic blood vessels initiates a
sequence of events culminating in cardiovascular complications. Chronic hypertension eventually leads
to persistent stress on the endothelium of systemic blood vessels sets off a chain of events with
profound implications for cardiovascular health. Chronic exposure leads to endothelial dysfunction and
a compromise of the endothelial barrier, rendering the vessel wall susceptible to infiltration by
lipoproteins (LBL) and immune system cells. This predisposes the development of atherosclerosis,
where, in stable conditions, atheromatous plaques serve as fixed luminal obstructions to blood flow. If
vessel stenosis becomes significant (≥70%), the myocardial oxygen demand can exceed its supply,
particularly during exertion, resulting in predictable, transient myocardial ischemia and stable angina.
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However, the scenario shifts if the atheromatous plaque becomes unstable. Thrombogenic plaque
contents, especially tissue factors, are exposed to coagulation factors in the vessel lumen, leading to
platelet activation and the clotting cascade at the rupture site. This culminates in thrombus formation
over the already partially occluded plaque, resulting in decreased perfusion of the myocardium. This
critical condition, known as Myocardial Ischemia and eventually Acute Coronary Syndrome which are
unstable angina and myocardial infarction primarily ST Elevation Myocardial Infarction (STEMI)
wherein signs and symptoms manifested by the patient consist of chest pain (angina), shortness of
breath or trouble breathing, nausea, stomach pain or discomfort, heart palpitations, anxiety or a feeling
of impending doom, diaphoresis, dizziness, and fatigue. The consequences of myocardial infarction
involve the formation of necrotic, non-functional myocytes, leading to a decrease in left ventricular
(LV) contractility and systolic dysfunction. This, in turn, manifests as a reduced ejection fraction and
can progress to Acute Decompensated Congested Heart Failure, highlighting the intricate interplay
between endothelial dysfunction, atherosclerosis, and their downstream effects on cardiac function and
health. In addition, due to hypertension, the elevation of left ventricular (LV) end-diastolic pressure
triggers a chain of events in the cardiovascular system. The increase in LV end-diastolic pressure is
accompanied by a rise in left atrial (LA) pressure, contributing to heightened LA wall stress and atrial
dilatation. This persistent stress and dilatation induce structural remodeling characterized by fibrosis,
which, in turn, causes conduction slowing. This slowed conduction promotes the conditions conducive
to reentry and/or ectopic beats. Concurrently, electrical remodeling takes place, marked by changes in
ion channel function, fostering the initiation and perpetuation of atrial fibrillation (AF). The
combination of structural and electrical remodeling synergistically leads to the development and
persistence of atrial fibrillation, underscoring the intricate interplay between hemodynamic changes,
structural alterations, and electrophysiological remodeling in the progression of cardiac pathology.

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Atrial fibrillation, characterized by irregular and rapid ventricular response rates, sets off a series of
physiological consequences. The irregular rhythm leads to a decrease in diastolic filling time,
subsequently reducing preload and left ventricular end-diastolic volume (LVEDV). This altered
hemodynamic state triggers a decompensated Frank-Starling response, diminishing stroke volume (SV)
and, consequently, cardiac output (CO). The compromised blood flow resulting from these changes can
contribute to myocardial ischemia, potentially escalating to myocardial infarction. Furthermore, Atrial
fibrillation is driven by multiple mechanisms and initiates a cascade of physiological effects on the
heart. Prolonged episodes of atrial fibrillation contribute to tachycardia-induced cardiac remodeling
and dilatation, altering the structural integrity of the heart. This remodeling process can lead to the
development of tachycardia-induced cardiomyopathy, where the heart's pumping ability is
compromised due to sustained rapid heart rates. This then progresses to Acute Decompensated
Congestive Heart Failure (ADCHF), representing a critical state of heart failure marked by a sudden
exacerbation of symptoms and a rapid decline in cardiac function. Signs and symptoms portrayed by
the patient comprise fatigue, cough dyspnea, orthopnea, Paroxysmal Nocturnal Dyspnea, increased
abdominal girth, peripheral edema, nausea/vomiting, and weight loss. The same sign and symptoms
was manifested by the patient as he was diagnosed with hypokalemia most likely nutritional which
occurs when there is a decrease in dietary potassium (K+) intake which can lead to reduced potassium
availability for gastrointestinal absorption.
If the condition is treated, non-pharmacologic management strategies play a crucial role in
addressing heart failure, emphasizing lifestyle modifications and diagnostic tests to inform a
comprehensive approach. Dietary sodium and fluid restriction, along with attention to weight gain, are
fundamental components. Physical activity, tailored to individual needs, is encouraged. Lifestyle
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changes, such as smoking cessation and alcohol avoidance, contribute to overall well-being. Oxygen
therapy is implemented when needed. Diagnostic tests, including chest x-ray, echocardiography,
cardiac radionuclide scan, MRI, electrocardiogram, and BNP or NT-pro-BNP levels, provide valuable
insights. Laboratory tests encompass B-type Natriuretic Peptide (BNP) or N-terminal pro-BNP,
complete blood count (CBC), basic metabolic panel (BMP) or comprehensive metabolic panel (CMP),
liver function tests (LFTs), thyroid function tests, urinalysis, and arterial blood gas (ABG).
Pharmacologic management involves a range of medications, such as diuretics, vasodilators, inotropic
agents, anticoagulants, beta-blockers, ACE inhibitors, ARBs, calcium channel blockers, digoxin,
nitrates, BNPs, I(f) inhibitors, ARNIs, soluble guanylate cyclase stimulators, SGLT2Is, and
mineralocorticoid receptor antagonists. Surgical interventions, including catheter ablation, implanted
devices, coronary artery bypass graft (CABG), valve repair or replacement, ventricular assist devices
(VAD), and heart transplant, may be considered based on the severity and specific characteristics of the
heart failure. This multifaceted approach aims to optimize patient outcomes and improve the overall
management of heart failure which will lead to a fair prognosis.
However, in the absence of timely intervention, the progression of untreated heart failure
follows a perilous course. The initial decline in cardiac output sets off a chain of events, initiating the
activation of the Sympathetic Nervous System. This response, intended to compensate for decreased
cardiac output, paradoxically leads to fluid retention. The ensuing systemic vasoconstriction, driven by
the activation of the renin-angiotensin-aldosterone system, exacerbates the strain on the heart. Organ
dysfunction becomes evident as vital organs experience compromised perfusion. Electrolyte
imbalances disrupt the body's delicate equilibrium, while the stressed heart becomes susceptible to
arrhythmias, further diminishing cardiac function. This downward spiral may culminate in multi-organ
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failure, reaching a critical point where cardiogenic shock ensues. The failure of the heart to meet the
metabolic demands of the body ultimately leads to a life-threatening outcome – death. This underscores
the urgency of prompt and comprehensive intervention to mitigate the devastating consequences of
untreated heart failure.
I. Management
A. Medical Management
1. Physician’s Order
Table 4
Copy the Physician’s order from admission to discharge.
Date and Time Doctor’s Order
September 23, 2023  IVF: PNSS 1L x KVO rate
10:27 AM
 Hook to non rebreather mask @ 10L -
12L/min - not available face mask at
10L/min.
Laboratory Test:
 Complete Blood Count
 Urinalysis
 Sodium, Potassium, Urea, Calcium
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 SGPT
 Lipid profile
 Fasting blood sugar
 Arterial blood gas
 Troponin - I
 ECG
 Activated Partial Thromboplastin Time
 Prothrombin Time
 Rapid antigen test
 Chest X-ray PAL
Medication:
 Furosemide 40mg IVTT NOW
 Hydrocortisone 250 mg IVTT NOW
 Nebulize salbutamol + Ipratropium 1 neb
3 doses every 15 minutes
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 Budesonide 1 neb BID
 Isodril 5 mg 1 tab SL NOW
Other Order:
 Maintain complete bed rest with no
bathroom privileges.
 NPO temporarily
 Maintain VS q15 for 1 hour then VS q1hr
and refer for saturation <94%.
 I and O q shift if urine output is <70 cc.
September 23, 2023  Advised for ICU admission: INFUSED
11:00 AM ADMISSION
 For 2D Echo
September 23, 2023  Start isoket drip: PNSS 40 cc + 10 mg
12:31 PM isoket amp in a soluset with 3 cc/hr
 May start on streptokinase treatment,
report for any absolute VS, check
contraindications before starting the
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medication.
September 23, 2023  AP informed of the relatives of absolute
12:50 PM contraindications of streptokinase
 Hold streptokinase
 Dr. Mancera informed them the test.
September 23, 2023  May decrease O2 @ 4L/min.
12:33 PM
 Manage patient conservatively, may give
morphine 2 mg IVTT now.
September 23, 2023  Monitor vital signs q hourly, check and
1:10 PM refer for abnormalities.
 Reiterate the importance of ICU to the
patient
 Elevated VS, monitor to q hourly
 Refer if persistently tachycardic
 Relatives appraised of the very high risk
status of the patient, more than 70% risk
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of adverse cardiovascular events.
 CLOSE WATCH
 Continue present management.
September 23, 2023  Admit to ICU
3:09 PM
 How to BIPAP: PAP 10 cm H2O, PAP 5
cm H2O, O2 60%.
 Start Hydrocortisone 100 mg IV @6AM
Q8
 Decrease O2 to 2L/min. Nasal cannula
 NPO
 Nebulize Salbutamol + Ipratropium 1 neb
q8
 Start Ceftriaxone 2g (Forgram) in 50 cc
PNSS soluset to consume for 1 hour OD,
ANST
 Complete bed rest
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 Monitor VS q hourly.
September 24, 2023  Follow up sputum CS
12:50 PM
 Facilitate sputum TB genexpert
 Repeat ABG tomorrow AM
 O2 with 2L/min NC
 Continue Ceftriaxone 2g OD, use
Fogram.
 Start Budesonide Nebulization
 IVF: PNSS 1L to run at KVO
 May start low salt, low fat diet
September 24, 2023  Start Losartan (Kenzar) 50mg 1 tab
4:00 PM
 D/c Captropil
 Carvedilol 6.25mg 1/2 tab BID
 Continue present management
September 25, 2023  Starting tomorrow, decrease Amiodarone
10:30 PM to 200 mg 1 tab BID

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 Increase Carvedilol to 6.25 mg 1 tab BID
 Add Ramipril (Amivan) 5mg 1 tab 1/2
tab at lunch OD
September 26, 2023  Continue present medication
8:30 PM
 Follow up TB genexpert
 Facilitate repeat laboratory tomorrow AM
 D/c O2, may look back if with
desaturation or respiratory distress
 Follow up sputum GS/CS + Blood CS
and relay result.
September 27, 2023  Plan to complete 5 days of Enoxaparin
11:00 AM
 Approved for PCI by subsequent
revascularization , however patient and
family opted to maximize medical
therapy.
 Decrease Amiodarone to 200mg 1 tab
OD
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 Increase Carvedilol to 12.5mg 1 tab
 D/c Ramipril
 In AM start Spironolactone (Spinofar)
25mg 1tab OD with BP precaution
September 28, 2023  Shift ceftriaxone (Program) to cefixime
7:10 AM 200mg/cap 1 cap BID
September 28, 2023  D/c O2
8:15 AM
 Encourage deep breathing exercise
 Please look back to O2 at 1 LPM NC if
with oxygen saturation <88% + persistent
low or with respiratory distress
 Decrease salbutamol + Ipratropium neb
@12 hours in between budesonide neb.
 Repeat potassium and sodium today.
September 29, 2023  Add another Potassium chloride 20 mEq
12:56 AM + nss 100 cc to run for 4 hrs. x 3 cycles,
repeat potassium post potassium chloride
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drip.
September 29, 2023  Continue potassium correction
9:30 PM
 Start KCL 1 tab TID
 For possible d/c tomorrow
 T/c IVF then shift to heplock
 Increase KCL IV infuse to 5 hours
 Salbutamol + Ipratropium 1 neb to Q8
 Relay S.K result
 Give MgSO4 2g slow IV push now
September 29, 2023  Start another 2 cycles of Potassium
9:50 PM chloride drip.
2. Medical Impression and Diagnosis
Upon admission, it was noted that the patient was experiencing body weakness, chest pain/discomfort,
dyspnea, and shortness of breath with an oxygen saturation of 76%. Upon further assessment and
diagnostic tests performed, medical diagnosis of Acute Decompensated Congestive Heart Failure
Secondary to Acute ST Elevation Myocardial Infarction Secondary to Hypertensive Cardiovascular
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Disease, Acute Coronary Disease, Atrial Fibrillation with Rapid Ventricular Response, New York
Heart Association Class IV, Community Acquired Pneumonia Moderate Risk, Chronic Obstructive
Pulmonary Disease in Acute Exacerbation, Hypokalemia Probably Nutritional was made.
3. Medical Physical Findings
General Survey: Awake, coherent, in respiratory distress spo2 76%
Skin: (-) Edema
HEENT: (+) Diaphoresis
Chest/lungs: use of accessory muscles, (+) Bilateral wheezing, chest retraction, (+) Irregular rhythm.
Abdomen: Dull
GU (IE;Rectal): Renal urinary output
4. Diagnostic Test and Laboratory Result
Table 5
Diagnostic Test Results
Diagnostic Test Result Significance
X-ray Chest PAL Progressive PTB. The patient's tests revealed
Superimposed pneumonia is progressive PTB and pleural
not ruled out. Please correlate fluid/reaction, left. A chest X-
with other laboratory ray can assist in detecting if
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examinations. Pleural you have any pneumonia
fluid/reaction, left. complications, such as
abscesses or pleural effusions
(fluid around the lungs). It
can also determine how well
your lungs and heart are
functioning.
X-ray Chest PA Fibroid PTB (Scar?), left with A chest X-ray is necessary in
possible bronchiectasis. patients with respiratory
Regressing interstitial disease because it can show
pneumonia is also considered. lung scarring, which is an
indication of bronchiectasis,
and it can help rule out other
pulmonary disorders.
Table 6
Diagnostic Test Results
Electrocardiogram Artrial fibrillation with ST Atrial fibrillation (AF) is
Elevation Myocardial one of the most common
Infarction. arrhythmias in patients
with ST-segment elevation
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myocardial infarction
(STEMI). The presence of
AF is well known to have
major adverse
consequences for patients
with STEMI. The patient's
ECG result indicates an
abnormal rhythm which is
common for patients
having heart problems.
The patient's ECG result
indicates a possible heart
attack and a need for
monitoring.
Table 7
Hematology Test Results
Hematology
Date of test: September 23, 2023
84
Laboratory Result Normal Value
JMJ Marist Interpretation
Brothers Significance
Test College of Arts and Sciences – Nursing Department
NURSING DEPARTMENT
Hemoglobin 145g/L M: 140- 170 Within normal range The patient has
g/L cardiovascular and
lung disease but the
F: 120-140 g/L hemoglobin is within
the normal range.
Hemoglobin test is
involved with the
diagnosis of health
problems like kidney
disease, blood
disorders,
malnutrition, some
kinds of cancer, and
heart and lung
conditions.
Hematocrit 0.44g/L M: 0.40-0.50 g/L Within normal range Hematocrit test is a
major determinant of
F: 0.37-0.43 g/L blood viscosity, blood
pressure, venous
return, cardiac output,
and platelet
adhesiveness. The
patient’s hematocrit
85
level is within a
normal range which
ensures an adequate
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Red Blood 4.6 / L 4.5-5.6 x Within normal range The patient’s RBC is
12
Cells Count 10 / L within normal range.
Measuring RBCs
helps in diagnosing
anemia, and other
blood related disease,
a condition in which
the body doesn’t have
enough healthy red
blood cells.
White Blood 16.1/L 4-11 x 109 / L High WBC test indicates
Cells Count elevated level of
white blood cells,
which is associated
with infections. This
is relevant to the
patient’s condition
since the patient has
pneumonia and
cardiovascular
diseases.
Platelet Count 354/L 150-350 x 109 / L High Platelets are small
cells that circulate in

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the blood and form
blood clots that allow
wounds to heal and
prevent excessive
bleeding. The
patient’s platelet
count is high
indicating the ability
for faster wound
healing.
Mean 94 fL 80-100 fL Within normal range An MCV blood
Corpuscular test measures the
Volume average size of red
blood cells. The
patient’s MCV is
within the normal
range but a high
MCV can be
associated with a
group of cancers
called
myelodysplastic
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syndromes, vitamin
deficiency, and or
liver disease.
Mean 31 pg 26-34 pg Within normal An MCH test is one
Corpuscular range part of a panel of tests
Hemoglobin called the red blood
cell (RBC) indices, it
evaluates different
characteristics and
functions of red blood
cells. MCH is a
useful measurement
for understanding
how effectively
oxygen is being
distributed
throughout the body.
Changes in MCH or
other RBC indices
may be a sign of
a blood
disorder called
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anemia.
Mean 33 g/L 31-35 g/dL Within normal MCHC test is a
Corpuscular grams per liter range measurement of the
Hemoglobin (g/L) amount of
Concentration hemoglobin a red
blood cell has relative
to the cell's volume.
Measuring
hemoglobin through
an MCHC blood test
can help determine
whether someone
have a medical
condition.
Red Cell 12.4 10-20% Within normal range An RDW blood test
Distribution measures the red
Width blood cells’ variation
in size and volume.
An RDW blood test
can help healthcare
provider diagnose
anemia and other

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related conditions,
along with other tests
that provide
information about the
red blood cells.
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Table 8
Differential Count Result
Differential Count
Date of Test: September 23, 2023
Laboratory Result Normal Interpretation Significance
Test Value
Neutrophils 0.79 0.50 – 0.65 High Neutrophils are
the most common
type of white
blood cell in the
body. It helps the
immune system
fight infections
and heal injuries.
An absolute
neutrophil count
identifies whether
the body has
enough
neutrophils to
fight infection or
if the count is
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above or below a
healthy range
Lymphocytes 0. 08 0.26 - 0.35 Low The patient has
low levels of
lymphocytes.
Lymphocytes
help the body’s
immune system
fight cancer and
foreign viruses
and bacteria
(antigens). Low
levels of
lymphocytes in
the blood are
called
lymphocytopenia
Monocytes 0.10 0.02 - 0.12 Within normal Monocytes play

range a role in both
the
inflammatory
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and anti-
inflammatory
processes that
take place
during an
immune
response.
It provides
significant
identifying
clues for the
diagnosis of
several
hematologic
disorders and
inflammatory
and immune
disorders.
Eosinophils 0.03 0.01 - 0.04 Within normal Eosinophils do
range two important
things in
the immune
system: curb
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infections and
boost
inflammation,
which can help the
body fight off a
disease.
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Table 9
Hematology Test Results
Hematology
95
Laboratory Result Normal Value Significance
JMJ Marist Interpretation
Brothers
Test College of Arts and Sciences – Nursing Department
NURSING DEPARTMENT
Hemoglobin 143g/L M: 140- 170 Within normal range The patient has
g/L cardiovascular and
lung disease but the
F: 120-140 g/L hemoglobin is within
the normal range.
Hemoglobin test is
involved with the
diagnosis of health
problems like kidney
disease, blood
disorders,
malnutrition, some
kinds of cancer, and
heart and lung
conditions.
Hematocrit 0.44g/L M: 0.40-0.50 g/L Within normal range Hematocrit test is a
major determinant
F: 0.37-0.43 g/L of blood viscosity,
blood pressure,
venous return,
cardiac output, and
platelet
adhesiveness. The
96
patient’s hematocrit
level is within a
normal range which

JMJ Marist Brothers
NURSING DEPARTMENT
Red Blood Cell 4.6 / L 4.5-5.6 x Within normal range The patient’s
12
Count 10 / L RBC is within
normal range.
Measuring RBCs
helps in
diagnosing
anemia, and
other blood
related disease, a
condition in
which the body
doesn’t have
enough healthy
red blood cells.
White Blood 9.0/L 4-11 x 109/ L Within normal range WBC test
Cell Count indicates
elevated level of
white blood
cells, which is
associated with
infections. This
is relevant to the
patient’s
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condition since
the patient has
pneumonia and
cardiovascular
diseases.
Platelet Count 392/L 150-350 x 109/ L High Platelets are
small cells that
circulate in the
blood and form
blood clots that
allow wounds to
heal and prevent
excessive
bleeding. The
patient’s platelet
count is high
indicating the
ability for faster
wound healing.
Mean 95 fL 80-100 fL Within normal range An MCV blood
Corpuscular test measures the
Volume average size of red

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blood cells. The
patient’s MCV is
within the normal
range but a high
MCV can be
associated with a
group of cancers
called
myelodysplastic
syndromes, vitamin
deficiency, and or
liver disease.
Mean 31 pg 26-34 pg Within normal An MCH test is
Corpuscular range one part of a
Hemoglobin panel of tests
called the red
blood cell
(RBC) indices,
it evaluates
different
characteristics
and functions of
red blood cells.

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MCH is a useful
measurement for
understanding
how effectively
oxygen is being
distributed
throughout the
body. Changes
in MCH or other
RBC indices
may be a sign of
a blood
disorder called
anemia.
Mean 33 g/L 31-35 g/dL Within normal MCHC test is a
Corpuscular grams per liter range measurement of the
Hemoglobin (g/L) amount of
Concentration hemoglobin a red
blood cell has
relative to the cell's
volume. Measuring
hemoglobin through
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an MCHC blood test
can help determine
whether someone
have a medical
condition.
Red Cell 12.5 10-20% Within normal range An RDW blood test
Distribution measures the red
Width blood cells’ variation
in size and volume.
An RDW blood test
can help healthcare
provider diagnose
anemia and other
related conditions,
along with other
tests that provide
information about
the red blood cells.
Table 10
Differential Count Result
Differential Count
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Date of Test: September 27, 2023
102
Laboratory Result NormalJMJ Marist Brothers
Interpretation Significance
Test Value
NURSING DEPARTMENT Neutrophils are the
Neutrophils 0.81 0.50 – 0.65 High
most common type
of white blood cell in

Table
the body. It helps the
11
immune system fight
infections and heal
injuries. An absolute
neutrophil count
identifies whether
the body has enough
neutrophils to fight
infection or if the
count is above or
below a healthy
range
Lymphocytes 0.11 0.26 - 0.35 Low The patient has low
levels of
lymphocytes.
Lymphocytes help
the body’s immune
system fight cancer
and foreign viruses
and bacteria
(antigens). Low
103
levels of
lymphocytes in the
blood are called

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Urinalysis Test Results
Urinalysis
Laboratory Result Normal Interpretation Significance
Test Value
Color Light yellow Normal The color of urine
can indicate a
number of things,
including hydration
state, the presence
of blood, and
infection.
Transparency Clear Normal Clear urine
transparency is
considered normal
and healthy,
however cloudy
urine can indicate
an underlying
health issue.
Reaction (pH) 6.0 4.5 – 8.0 pH Within normal The pH level of the
range patient is within the
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normal range. Urine
pH monitoring may
aid in the
prevention of
kidney stone
development since
patient with ADHF
is prone to having
kidney disease.
Specific 1.010 1.005 – Within normal The patient's
Gravity 1.030 range urine specific
gravity is within the
normal range. The
specific gravity of
urine can be used to
determine kidney
function and ability
of the kidneys
to concentrate
urine.
Sugar Negative Normal, no There was no sugar
sugar found in found in the urine.
urine Sugar testing in
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ADHF patients can
help in the
identification of
underlying
conditions such as
diabetes, kidney
disease, and
hereditary
abnormalities.
Albumin Trace Normal Protein in the urine
is an important
indicator of kidney
damage and can be
used to track
disease progression
and guide
treatment. Elevated
albumin seems
especially
predictive of heart
failure.
Pus cells 3-5 /HPF 0-5 /HPF Within normal The patient's pus
range cells are within the
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normal range. It is
important to check
the pus cells
because high level
of pus cells in the
urine may indicate
a urinary tract
infection or other
underlying
inflammatory
conditions.
Red Blood 2-3 /HPF 2-5 /HPF Within normal There are no red
Cells range blood cells in the
patient's urine. Red
blood cells in the
urine may indicate
that you have a
medical issue that
requires treatment,
such as an infection
or kidney disease.
This test is essential
since heart failure is
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a significant risk
factor for renal
disease.
Epithelial cells Few Normal A few numbers of
epithelial cells in
the urine are
normal. However, a
higher quantity of
epithelial cells in
urine might indicate
urinary tract
inflammation or
infection.
Hyaline Cast 5-7/LPF 0-2/LPF High Large volumes of
hyaline cast in urine
may suggest renal
disease owing to
reduced blood
supply to the
kidneys. Pathogenic
causes of hyaline
casts also
include congestive
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heart failure and
dehydration.
Table 12
Chemical Test Results
Clinical Chemistry
Laboratory Results Normal Interpretation Significance
Test Value
Creatinine 114.92 53-133 Within the normal The patient’s
umol/L umol/L range creatine level is
within the
normal range. It
is critical to
evaluate the
creatinine level
since a sudden
increased of
creatinine in the
body may be a
sign of poor
kidney
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function.
Uric Acid 392.70 210 – 420 Within the normal The patient’s
umol/L umol/L range uric acid level
is within the
normal range. It
is critical to
evaluate the
uric acid level
since high
levels of uric
acid can be a
sign of gout
problem or
kidney stones.
SGPT 0.65 ukat/L <0.68 ukat/L Within the normal The patients
range SPGT level is
within the
normal range.
Keeping track
of these levels
is essential to
evaluate liver
health, assess
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liver disease or
damage and
ensure early
intervention to
prevent further
damage.
Table 13
Clinical Chemistry
Test Value
Glucose 7.92 mm3.9-5.5 High Fasting blood sugar
fasting mmol/L mmol/L is a simple, common,
safe blood test that
can
diagnose prediabetes,
diabetes and
gestational diabetes.
Based on patient
LNT glucose fasting
result, it shows that
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he is a candidate for
diabetes mellitus
condition.
Cholesterol 4.29 <5.2 mmol/L Within the The patient’s
mmol/L normal range Cholesterol level
shows that it is
within the normal
range. Maintaining
one’s cholesterol
levels is essential for
overall health,
particularly
cardiovascular
health. Cholesterol is
a fatty substance
found in our blood
and plays a crucial
role in various bodily
functions, including
building cell
membranes,
producing hormones,
and supporting
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digestion.
Triglycerides 1.84 <1.7 mmol/L High Based on patient
mmol/L LNT triglyceride
results, it shows that
his triglycerides are
within borderline
high. Borderline high
triglycerides are not
usually a cause for
concern, but they can
increase the patient’s
risk of developing
certain health
problems, such as
heart disease and
pancreatitis
HDL 0.90 >1.56 Low The patient’s HDL
mmol/L mmol/L level shows low
result from the
normal range. A low
HDL count is a
concern because it is
linked to
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an increased risk of
heart disease. The
same is true if the
patient’s "bad" low-
density lipoprotein
(LDL) cholesterol is
high. Together, a low
HDL and high LDL
place a person at
increased risk of
having a heart attack
or stroke
LDL 2.53 <3.9 mmol/L Within the Unlike with the
mmol/L normal range result of patient
HDL, his LDL
cholesterol result is
within the normal
range. LDL
cholesterol, also
known as "bad"
cholesterol, is a type
of fat that carries
cholesterol through
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the bloodstream.
Maintaining it is
crucial for overall
cardiovascular health
and reducing the risk
of heart disease.
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Table 14
Clinical Chemistry
Test Value
HbA1C 6.3% 4.0-6.0% High The patient’s
HbA1C level
shows high
result from the
normal range
A high level of
HbA1c
indicates that
the patient is a
candidate for
diabetes or
prediabetes
complication.
HbA1c is a
blood test that
measures a
person’s
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average blood
sugar level over
the past two to
three months.
Table 15
Electrolytes Results
Electrolytes
Test Value
Sodium 155.8 135 – 146 High The results show
mmol/L mmol/L that patient’s
sodium levels are
high. Usually, A
sodium level that
is high within the
normal range
means that a
person’s sodium
level is higher
than it typically
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is, this condition
is what we call
as
hypernatremia.
Potassium 3.36 mmol/L 3.5 – 5.3 Low The results show
mmol/L that patient’s
potassium levels
are low. Which
means, patient
LNT is a
candidate for
Hypokalemia (a
condition that
characterized
with low serum
potassium
concentrations in
the blood).
Calcium 1.14 mmol/L 1.13 – 1. 32 Within the The calcium
mmol/L normal range level of patient
LNT is within
the normal
range. Having
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the right amount
of calcium in our
blood
is necessary for
our nerves,
muscles, and
heart to work
properly. Hence,
if there is too
much or too little
calcium in the
blood, it may be
a sign of a wide
range of medical
conditions, such
as bone disease,
thyroid disease,
parathyroid
disorders, kidney
disease, and
other conditions.
Magnesium 1.95 mg/dL 0.70 – 2.40 Within the Patient LNT
mg/dL normal range magnesium level
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is within the
normal range.
Magnesium is
essential for
maintaining
normal cellular
and organ
function.
In-adequate
magnesium
balance can be
associated with
various
disorders, such
as skeletal
deformities,
cardiovascular
diseases, and
metabolic
syndrome.
Table 16
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Electrolytes
Test Value
Sodium 138.5 mmol/L 135-146 Within the The results
mmol/L normal range show that
patient’s
sodium levels
decrease from
high percentage
to within the
normal range.
A sodium level
within the
normal range
indicates that
patient HDL
sodium levels
are balanced
and within the
healthy range.
This is a good
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sign as sodium
plays an
important role
in maintaining
your body's
fluid balance,
nerve function,
and muscle
function.
Potassium 2.03 mmol/L 3.5-5.3 Low The results
mmol/L show that
patient’s
potassium
levels are low;
patient LNT is a
candidate for
Hypokalemia.
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Table
Electrolytes
Test Value
mmol/L show that
patient’s
potassium levels
are still low. A
low potassium
level can lead to
various health
complications,
making it
essential to
address and
manage it
promptly.
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Table 17
Electrolytes
Test Value
mmol/L show that
patient’s
potassium
levels still
remain low. A
persistently low
potassium level,
also known as
hypokalemia,
can be a
concerning
issue as it
indicates an
ongoing
imbalance of
this essential
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electrolyte in a
person’s body.
Table 18
Electrolytes
Laboratory Results Normal Value Interpretation Significance
Test
Creatinine 115.80 53.00 – 133.00 Within the The patient’s
umol/L umol/L normal range creatine level is
still within the
normal range. It
is critical to
evaluate the
creatinine level
since a sudden
increased of
creatinine in the
body may be a
sign of poor
kidney function.
Sodium 141.50 135.00 – Within the The results of
mmol/L 145.00 normal range patient’s
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mmol/L sodium levels
still remain
within the
normal range.
A sodium level
within the
normal range
usually
indicates that
patient HDL
sodium levels
are balanced
and within the
healthy range.
This is a good
sign as sodium
plays an
important role
in maintaining
your body's
fluid balance,
nerve function,
and muscle
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function.
mmol/L show that
patient’s
potassium
levels still
remain low.
This can be a
cause for
concern, as
potassium is an
important
electrolyte that
helps a person’s
muscles,
nerves, and
heart function
properly.
Table 19
ABG Result Form
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Arterial Blood Gas
Time: 10:06 AM
Laboratory Result Normal Value Interpretation Significance
Test
pH 7.380 7.35-7.45 Within normal The patient pH level
range in arterial blood gas
(ABG) test is within
normal range. The
lungs and kidneys do
much work to keep
the acid-base
balance normal. So,
the acid-base
measurement from
an ABG test can
help diagnose and
monitor conditions
that affect
the lungs and kidney
s as well as many
other conditions that
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may upset our acid-
base balance.
Partial Pressure of 52.7 34-45 mmHg High Based on patient
Carbon Dioxide arterial blood gas
(PCO2) (ABG) result. It
shows that his
PCO2 is
significantly
elevated and
indicates
respiratory acidosis,
a condition
characterized by an
abnormally high
level of carbon
dioxide (CO2) in
the blood.
Partial Pressure of 32 80-100 mmol/L Low Based on the
Oxygen (PO2) laboratory result, the
patient PO2 value
falls below the normal
range, indicating that
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the oxygen level in
his arterial blood has
mismatch of
ventilation and
perfusion and there’s
a possibility of
hypoxemia.
Bicarbonate 30.5 22-26 mmol/L High Based on the
(HCO3) laboratory result,
the patient's
bicarbonate
(HCO3) level is
considered to be
elevated and
indicates metabolic
alkalosis. Metabolic
alkalosis is a
condition
characterized by an
abnormally high
level of bicarbonate
(HCO3-) in the
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blood.
Base Excess (BE) 5.4 (-2) – (+2) High Based on the
mmol/L laboratory result,
the patient's BE
falls into a higher-
than-normal excess
of base. BE is a
measure of the
body's acid-base
balance,
specifically the
excess or deficit of
bases relative to the
normal range. A
high BE indicates
an excess of bases,
which is a hallmark
of metabolic
alkalosis occurs
when the body's
bicarbonate
(HCO3-) level is
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abnormally high or
when the body
loses too much acid
Total Carbon - 23-30 mmol/L
Dioxide (tCO2)
Hematoctrit Test 45 38-51% Within normal Based on the
range patient HCT level,
it shows that it is
within normal
range. A normal
Hct level ensures
that there are
enough red blood
cells (RBCs) to
adequately
transport oxygen
and meet the body's
needs.
Oxygen Saturation 60 95-100% Low Based on the
(SO2) patient's SO2 level,
it shows that it is
below the normal
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range. A low SO2
level signifies that
there is insufficient
oxygen available in
the blood to be
delivered to tissues
throughout the
body.
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Table 20
Arterial Blood Gas
Time: 12:39 PM
Test
pH 7.414 7.35-7.45 Within normal The patient pH level
range in arterial blood gas
(ABG) test is within
normal range. The
lungs and kidneys
do much work to
keep the acid-base
balance normal. So,
the acid-base
measurement from
an ABG test can
help diagnose and
monitor conditions
that affect
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the lungs and kidney
s as well as many
other conditions that
may upset our acid-
base balance.
Partial Pressure of 45.1 35-45 mmHg Within normal Based on patient
Carbon Dioxide range arterial blood gas
(PCO2) (ABG) result, it
shows that his
PCO2 is within the
normal range
which means that
there is sufficient
alveolar ventilation
within the lungs
Partial Pressure of 82 80-100 mmol/L Within normal Based on the
Oxygen (PO2) range laboratory result, the
patient PO2 value
falls within the
normal range,
indicating that the
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oxygen level in his
arterial blood is
within the expected
and healthy range.
This finding usually
signifies that the
lungs are effectively
transferring oxygen
from the inhaled air
into the blood.
the patient's
bicarbonate
(HCO3) level is
considered to be
elevated and
indicates metabolic
alkalosis. An
HCO3- level of
36.4 falls into the
moderate range of
metabolic
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alkalosis.
Metabolic alkalosis
is a condition
characterized by an
abnormally high
level of
bicarbonate
(HCO3-) in the
blood.
mmol/L laboratory result, the
patient's BE falls into
a higher-than-normal
excess of base. BE is
a measure of the
body's acid-base
balance, specifically
the excess or deficit
of bases relative to
the normal range. A
high BE indicates an
excess of bases,
which is a hallmark
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of metabolic
alkalosis occurs when
the body's
bicarbonate (HCO3-)
level is abnormally
high or when the
body loses too much
acid
Dioxide (tCO2)
Hematocrit Test 43 38-51% Within normal Based on the
range patient HCT level,
it shows that it is
within normal
range. A normal
Hct level ensures
that there are
enough red blood
cells (RBCs) to
adequately
transport oxygen
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and meet the
body's needs.
Oxygen Saturation 96 95-100% Within normal Based on the
(SO2) range patient's SO2 level,
it shows that it is
within normal
range. A normal
SO2 level signifies
that there is
sufficient oxygen
available in the
blood to be
throughout the
body.
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Table 21
Arterial Blood Gas
Time: 6:25 AM
Test
pH 7.505 7.35-7.45 High The patient pH level
in arterial blood gas
(ABG) test is high.
A high range pH in
arterial blood gas
(ABG) test usually
indicates a
condition known as
alkalosis. Alkalosis
is characterized by
an elevated pH
level, meaning the
blood has more
alkaline than the
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normal range of
7.35 to 7.45.A pH
above 7.45 is
considered
alkalosis, and a pH
of 7.5 falls into the
mild range of
respiratory alkalosis
Partial Pressure of 47.2 35-45 mmHg High Based on patient
Carbon Dioxide arterial blood gas
(PCO2) (ABG) result. It
shows that his
PCO2 is
significantly
elevated and
indicates
respiratory
acidosis, a
condition
characterized by an
abnormally high
level of carbon
dioxide (CO2) in
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the blood.
Partial Pressure of 92 80-100 mmol/L Within normal Based on the
Oxygen (PO2) range laboratory result, the
patient PO2 value
falls within the
normal range,
indicating that the
oxygen level in his
arterial blood is
within the expected
and healthy range.
This finding usually
signifies that the
lungs are effectively
transferring oxygen
from the inhaled air
into the blood.
the patient's
bicarbonate
(HCO3) level is
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considered to be
elevated and
indicates metabolic
alkalosis. An
HCO3- level of
36.4 falls into the
moderate range of
metabolic
alkalosis.
Metabolic alkalosis
is a condition
characterized by an
abnormally high
level of
bicarbonate
(HCO3-) in the
blood.
mmol/L laboratory result, the
patient's BE falls into
a higher-than-normal
excess of base. BE is
a measure of the
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body's acid-base
balance, specifically
the excess or deficit
of bases relative to
the normal range. A
high BE indicates an
excess of bases,
which is a hallmark
of metabolic
alkalosis occurs
when the body's
bicarbonate (HCO3-)
level is abnormally
high or when the
body loses too much
acid.
Dioxide (tCO2)
Hematocrit Test 40 38-51% Within the Based on the
normal range patient HCT level,
it shows that it is
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within normal
range. A normal
Hct level ensures
that there are
enough red blood
cells (RBCs) to
adequately
transport oxygen
and meet the
body's needs.
Oxygen Saturation 98 95-100% Within the Based on the
(SO2) normal range patient's SO2
level, it shows that
it is within normal
range. A normal
SO2 level signifies
that there is
sufficient oxygen
available in the
blood to be
throughout the
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body.
Table 22
Microbiology Section
Microbiology
Date received:
September 23, 2023
Date of test:
September 24, 2023
Laboratory test Result Significance
Gram Stain Gram Positive Cocci in Based on patient sputum
pairs (1+) gram staining result.
Remarks There’s a presence of
● Polymorphonucle Gram-positive cocci in pairs
ars/LPF- Many (1+)t along with many
● Epithelial Polymorphonuclears
Cells/LPF- Few (PMNs)/LPF and few
Epithelial Cells/LPF. This
finding usually suggests a
mild to moderate bacterial
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infection of the lower
respiratory tract. Gram-
positive cocci are a type of
bacteria that appear blue or
purple under a Gram stain
microscope. They are
typically round or oval in
shape and can be arranged
in pairs, chains, or clusters.
The "1+" indicates a mild to
moderate growth of these
bacteria in the sputum
sample. PMNs on the other
hand, also known as
neutrophils, are the most
abundant type of white
blood cell. They are part of
the body's immune system
and are attracted to sites of
infection to fight off
invading bacteria. The
presence of many PMNs in
the sputum sample suggests
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that the body is actively
trying to fight off an
infection. On the contrary,
Epithelial cells are the cells
that line the surfaces of the
respiratory tract, including
the lungs, airways, and
alveoli. They are
responsible for producing
mucus and protecting the
lungs from harmful
substances. The presence of
few epithelial cells in the
sputum sample suggests
that the infection is not
severe and has not caused
significant damage to the
respiratory epithelium.
Table 23
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Microbiology
Date received:
September 29, 2023
Date of test:
September 29, 2023
Gram Stain No Organism Found Based on the patient’s blood,
Remarks no organisms were found.
● Polymorphonucle Samples such as blood and
ars/LPF- None cerebrospinal fluid are
● Epithelial generally sterile. Bacteria are
Cells/LPF- None not usually present in these
samples when there is no
bacterial infection. Bacteria
may initially be present in
low numbers with an
infection, and this type of
sample may require extra
processing in order to
concentrate the bacteria so
that they can be detected by a
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Gram stain. Other body fluids
and sites, such as sputum or
skin, typically have cells and
normal flora present in
addition to any bacteria that
are causing an infection.
Table 24
Microbiology
Date received:
September 24, 2023
Date of test:
September 27, 2023
Laboratory test Result Significance
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Culture and Sensitivity Test Light growth of candida The patient culture and
albicans sensitivity test show light
Remarks: Resistant growth of candida albicans.
While light growth of
Candida albicans may not
cause immediate symptoms,
it indicates an overgrowth
of the fungus. Monitoring
this level is crucial to
prevent progression to a
more severe infection.
Table 25
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Microbiology
Date received:
September 23, 2023
Date of test:
September 29, 2023
Culture and Sensitivity Test No growth after 5 days of Based on the patient’s
incubation blood, no organisms
Remarks: Resistant were found upon a 5-day
incubation. The finding
suggests that a mild to
moderate bacterial
infection is only found at
lower respiratory tract.
There is no bacterial
infection present in the
blood or there were not
enough bacteria present
in the sample to be seen
with the stain under a
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microscope.
Table 26
Troponin I (Quantitative)
Troponin I
Test
Troponin I 142.4 ng/L Less than 19 Patient is Troponin I tests
ng/L positive for look for
myocardial troponin T or
Suspected infarction. troponin I
Myocardial proteins in the
Infarction: blood. When
19ng/L-100 the heart muscle
ng/L is damaged,
such as during a
POSITIVE heart attack,
Myocardial these proteins
Infarction: are released.
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Greater than The more
100 ng/L damage done to
the heart, the
more troponin T
and I there will
be in the blood.
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Table 27
Activated Partial Thromboplastin Result
Activated Partial Thromboplastin Time
Examination Patient Control Reference ValueSignificance
Time 27.0 26.1 23.5-36.4 secs. Activated Partial

Thromboplastin
Time is a screening
test that helps
evaluate a person’s
ability to
appropriately form
blood clots. It
measures the
number of seconds
it takes for a clot to
form in a sample of
blood after
substances
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(reagents) are
added. Compared to
the reference value
of interval for
clotting time, the
patient is within the
range of having
appropriate clotting
ability.
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Table 28
Prothrombin Time Result
Prothrombin Time
Examination Patient Control Reference Significance
Value
TIME 11.8 10.7 9.9-12.9 secs The average time
range for blood to
clot is about 10 to
13 seconds, and the
result shows that the
patient is within the
normal clotting
range. A number
higher than that
range means it takes
blood longer than
usual to clot. A
number lower than
that range means
blood clots more
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quickly than normal.
% ACTIVITY 128.7 % 70-100 % Based on the result,
the patient’s
percentage activity
is high. When the
PT is high, it takes
longer for the blood
to clot. This usually
happens because the
liver is not making
the right amount of
blood clotting
proteins, so the
clotting process
takes longer.
International 0.91 0.8-1.29 Helps diagnose the
Normalized Ratio cause of bleeding or
(INR) clotting disorders. It
also checks to see if
a medicine that
prevents blood clots
is working the way
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it should.
Table 29
Serology
Laboratory Test Result
COVID-Ag RAPID TEST Negative
5. Drug Studies
Table 30
Drug Study of N-Acetylcysteine
Date ordered September 23, 2023
Doctor’s order 600mg 1 sachet (Flemisten) 1 sachet on ½ glass of water
Generic name N-Acetylcysteine
Brand Name Exflem
Functional Classification Expectorant/Mucokinetics
Pharmacologi Mucolytic
Classification
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Route Oral
Frequency OD
Timing 7 AM
Mechanism of Acetylcysteine may protect against acetaminophen
overdose-induced hepatotoxicity by maintaining or

Action
restoring hepatic concentrations of glutathione. It does this
by producing the glutathione precursor cysteine.
Glutathione is required to inactivate an intermediate
metabolite (N-acetyl-p- benzoquinoneimine) of
acetaminophen that is thought to be hepatotoxic.
Indication Acetylcysteine is used mainly as a mucolytic and in the
management of paracetamol (acetaminophen) overdose
Contraindicatio Hypersensitivity to acetylcysteine; patients at risk of
n gastric hemorrhage;
Use cautiously in elderly or debilitated patients with severe
respiratory insufficiency;
Adverse Reaction ● CNS: fever, drowsiness.
● CV: chest tightness, flushing, tachycardia, edema.
● EENT: rhinorrhea, pharyngitis, throat tightness.
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● GI: nausea, stomatitis, vomiting.
● Respiratory: bronchospasm, cough, dyspnea, rhonchi.
● Skin: clamminess, diaphoresis, pruritus, rash, urticaria.
● Other: anaphylactoid reaction, chills.
Rationale for giving the NAC can help prevent side effects from drug reactions
drug to the patient and toxic chemicals, as well as aid in the breakdown of
mucus in the body. It appears to be beneficial in the
treatment of some respiratory conditions, such as
bronchitis and COPD.
Nursing Responsibility 1.Monitor patient for rashes with peeling of the skin or
blistering of the lips, mouth, or eyes accompanied by
fever
2. Monitor cough type and frequency.
3. Donot mix the drugs with the acetylcysteine solution.
4. Warn patient that drug may have a foul taste or smell
that can be distressing
Table 31
Drug Study of Levodropropizine
Date ordered September 25 & 26, 2023
Doctor’s order levodropropizine 10ml
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Generic name Levodropropizine
Brand Name Tissiler
Functional Classification Cough Supressants
Pharmacologi Antitussive agent
Classification
Route PO
Frequency OD
Timing 8 AM – 1 PM – 6 PM
Mechanism of inhibiting the afferent pathways that mediate the generation
of the cough reflex.

Action
Indication This medicine is used to treat, control, improve and prevent
cough in children and adults. It is also used to treat acute
and chronic bronchitis. The drug can be made in the form
of tablets or syrup with similar effects.
Contraindicatio its is contraindicated to patients with liver disease and
n kidney disease
Adverse Reaction CNS: Dizziness
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CV: Heartburn
GI: Diarrhea
Rationale for giving the This medication is used in adults to treat, control,
drug to the patient improve, and prevent cough. It is also used to treat
bronchitis, both acute and chronic.
Nursing Responsibility 1. Monitor signs of bronchospasm and respiratory
irritation, including wheezing, cough, dyspnea,
increased secretions, and tightness in the chest and
throat. Report excessive or prolonged respiratory
problems to the physician.
2. When used as a mucolytic, assess the quantity and
consistency of sputum to help document whether this
drug is successful in reducing the viscosity of
respiratory secretions.
3. Monitor signs of angioedema, including rashes, raised
patches of red or white skin (welts), burning/itching
skin, swelling in the face, and difficulty breathing.
Notify physician of these signs immediately.
Table 32
Drug Study: ISMNC
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Doctor’s order ISMNC (ISMODIN) 30MG 1TAB/OD HS 9PM
Generic name Isosorbide Mononitrate
Brand Name Ismodin
Functional Classification Vasolidator
Pharmacologic Organ nitrates
Classification
Frequency OD
Timing 9 PM
Mechanism of Nitric oxide acts as a potent vasodilator, relaxing the smooth
action muscle cells in blood vessel walls. This vasodilation leads to an
increased diameter of blood vessels, enhancing blood flow,
particularly in the coronary arteries supplying the heart. By
improving coronary blood flow, isosorbide mononitrate helps
alleviate angina pectoris symptoms, providing relief from chest
pain or discomfort associated with reduced blood supply to the
heart muscle. The overall effect of isosorbide mononitrate's
vasodilatory action contributes to a reduction in cardiac
workload, making it a valuable medication in the management of
angina and certain cardiovascular conditions.
Route PO
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Indication Isosorbide mononitrate is indicated for the prevention and
treatment of angina pectoris, a condition characterized by chest
pain or discomfort resulting from reduced blood flow to the heart
muscle.
Contraindicati  Hypersensitivity to nitrates or nitrites.
on  Severe anemia.
 Closed-angle glaucoma.
 Increased intracranial pressure.
 Use with caution in patients with hypothyroidism.
Adverse  Headache
Effect  Dizziness
 Hypotension
 Flushing
 Nausea
 Vomiting
 Weakness
 Palpitations
 Tachycardia
 Syncope
 Reflex tachycardia
 Methemoglobinemia (rare)
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 Allergic reactions (rare)
Rationale for
isosorbide mononitrate helps alleviate angina pectoris symptoms,
giving the drug
which the patient experiences.
to the patient
Nursing Responsibilities 1. Perform a thorough assessment of the patient's medical
history, including any history of hypersensitivity to
nitrates, presence of closed-angle glaucoma, anemia, or
other conditions that may contraindicate the use of
isosorbide mononitrate.
2. Assess vital signs, especially blood pressure and heart
rate, before and after administering the medication.
3. Provide detailed education to the patient regarding the
purpose of isosorbide mononitrate, the expected
therapeutic effects, and potential side effects.
4. Emphasize the importance of adherence to the prescribed
dosage and schedule.
5. Monitor the patient for adverse effects such as headache,
dizziness, hypotension, and other cardiovascular effects.
6. Keep track of the patient's response to therapy, including
the frequency and severity of angina episodes.
Table 33
Drug Study: AMIODARONE
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Doctor’s order Amiodarone 200mg 1TAB
Generic name Amiodarone
Brand Name Nexterone
Functional Classification Anti-arrhythmics
Pharmacologic Benzofuran derivative
Classification
Frequency BID
Timing 8 AM
Mechanism of Amiodarone is classified as a class III anti-arrhythmic medication.
action It inhibits potassium currents that cause heart muscle
repolarization during the third phase of the cardiac action
potential. As a result, amiodarone prolongs the action potential and
increases the effective refractory period of cardiac cells
(myocytes). As a result, cardiac muscle cell excitability is reduced,
which helps to prevent and treat abnormal heart rhythms.
Route PO
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Indication Amiodarone are recurrent ventricular fibrillation (VF) and
recurrent hemodynamically unstable ventricular tachycardia (VT).
The FDA emphasizes that this drug should only be used in these
conditions when they are clinically documented and have not
responded to normal therapeutic doses of other antiarrhythmic
agents, or when other drugs are not tolerated by the patient.
Contraindicati Cardiogenic shock; severe sinus-node dysfunction, causing
on marked sinus bradycardia; Second- or third-degree atrioventricular
block; bradycardia, that has caused syncope.
Hypersensitivity to the drug or to any of its components, including
iodine.
Adverse Resp: Adult respiratory distress syndrome (ARDS), Pulmonary
Effect Fibrosis, Pulmonary Toxicity.
CV: Congestive Heart Failure, Worsening of Arrhythmias
Derm: Toxic Epidermal Necrolysis
Rationale for It is used to restore normal heart rhythm and keep the heartbeat
giving the drug regular and steady. It works by preventing certain electrical signals
to the patient in the heart from causing irregular heartbeats.
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Nursing Responsibilities 1. Instruct patient to take amiodarone precisely as prescribed
and to not take larger doses or longer duration than
prescribed.
2. Instruct patient that amiodarone may cause dizziness,
lightheadedness, or fainting and be cautious when rising
from a sitting or lying position.
3. Advise patient to notify the healthcare team if they
experience any unusual signs or symptoms, such as chest
pain, shortness of breath, arrhythmias, joint pain, or
swelling.
4. Instruct patient to promptly report any vision or hearing
changes.
5. Advise patient that amiodarone may cause photosensitivity,
so they should limit their sun exposure and wear protective
clothing and sunscreen when outdoors.
6. Instruct patient to report any new or worsening symptoms
of lung or breathing problems, such as coughing,
wheezing, or shortness of breath, to their healthcare team.
Table 34
Drug Study: Ramipril
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Doctor’s order Ramipril Amivan 5mg 1 tab, ½ tab at lunch
Generic name Ramipril
Brand Name Amivan
Functional Classification Ace inhibitor
Pharmacologic Angiotensin-converting enzyme
Classification
Frequency OD
Timing 8 AM
Mechanism of action Ramipril inhibits the RAAS system by binding to and inhibiting
ACE thereby preventing the conversion of angiotensin I to
angiotensin II.
Route PO
Indication For the management of mild to severe hypertension. May be used
to reduce cardiovascular mortality following myocardial infarction
in hemodynamically stable individuals who develop clinical signs
of congestive heart failure within a few days following myocardial
infarction.
Contraindication contraindicated in patients who are hypersensitive to this product
or any other ACE inhibitor (e.g., a patient who has experienced
angioedema during therapy with any other ACE inhibitor).
Ramipril capsules are contraindicated in combination with a
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neprilysin inhibitor.
Adverse Effect CV: hypotension
GI: GI upset
Rationale for giving Ramipril helps prevent future strokes, heart attacks and kidney
the drug to the patient problems. It also improves your survival if you're taking it for
heart failure or after a heart attack. It works by widening your
blood vessels and making it easier for your heart to pump blood
around your body.
Nursing Responsibilities 1. Advice that it may cause chronic dry cough.
2. Instruct patient to notify healthcare provider before taking
any OTC medications prior to using salt substitutes
containing potassium & if you suffer from; persistent rash,
angioedema, abdominal pain, jaundice, excessive fatigue,
irregular heart rate, or chest pain.
3. Encourage the patient to avoid sudden position changes to
avoid orthostatic hypotension
4. Encourage the patient to maintain adequate status
Table 35
Drug Study: Hydrocortisone
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Date ordered September 27, 28, 29, 30 2023
Doctor’s order HYDROCORTISONE 100mg IV Q12h x 2 doses
Generic name Hydrocortisone
Brand Name Solu-CORTEF
Functional Classification Anti-inflammatory adrenocortical steroid
Pharmacologic Corticosteroids
Classification
Frequency Q12
Timing 6 AM & 6 PM
Mechanism of action A glucocorticoid that reduces inflammation by suppressing the
migration of polymorphonuclear leukocytes and reversing the
increased capillary permeability.
Route IV
Indication Treat certain medical conditions, such as inflammation (swelling),
severe allergic reactions, kidney diseases, adrenal problems,
arthritis, asthma
Contraindication Systemic infections (unless treated with specific anti-infective),
cerebral malaria; untreated oral infection (buccal tab). Spinal or
other non-diarthrodial joints (intra-articular/local inj). Herpes
simplex or other viral diseases of conjunctiva and cornea; ocular
tuberculosis, purulent infections and fungal diseases of the eye,
untreated fungal, bacterial, or viral infections; tubercular or
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syphilitic lesions, acne vulgaris, peri-oral dermatitis, rosacea; use
in widespread plaque psoriasis (as hydrocortisone butyrate).
Concomitant use with live or live-attenuated vaccines
(immunosuppressive doses).
Adverse Effect CNS: depression, euphoria, headache, increased intracranial
pressure (children only), personality changes, psychoses,
restlessness.
EENT: cataracts, increased intraocular pressure.
CV: hypertension.
GI: PEPTI CULCERATION, anorexia, nausea, vomiting.
Derm: acne, decreased wound
healing, ecchymoses, fragility, hirsutism, petechiae. Endo: adrenal
suppression, hyperglycemia. F and E: fluid retention (long-term
high doses), hypokalemia, hypokalemic alkalosis.
Hemat: THROMBOEMBOLISM, thrombophlebitis.
Metab: weight gain, weight loss. MS: muscle
wasting, osteoporosis, aseptic necrosis of joints, muscle pain.
Misc: hypersensitivity reactions, INCLUDING
ANAPHYLAXIS, cushingoid appearance (moon face, buffalo
hump), increased susceptibility to infection.
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Rationale for giving Treat patients with low levels of corticosteroids by replacing
the drug to the patient steroids that are normally produced naturally by the body. It works
to treat other conditions by reducing swelling and redness and by
changing the way the immune system works.
Nursing Responsibilities 1. Monitor signs of thrombophlebitis (lower extremity
swelling, warmth, erythema, tenderness) and
thromboembolism (shortness of breath, chest pain, cough,
bloody sputum). Notify physician or nursing staff
immediately, and request objective tests (Doppler
ultrasound, lung scan, others) if thrombosis is suspected.
2. Monitor and report signs of peptic ulcer, including
heartburn, nausea, vomiting blood, tarry stools, and loss of
appetite.
3. Monitor signs of hypersensitivity reactions or anaphylaxis,
including pulmonary symptoms (tightness in the throat and
chest, wheezing, cough, dyspnea) or skin reactions (rash,
pruritus, urticaria). Notify physician or nursing staff
immediately if these reactions occur.
4. Assess any muscle or joint pain. Assess if patient reports
persistent or increased musculoskeletal pain to determine
presence of bone or joint pathology (aseptic necrosis,
fracture).
5. Assess muscle strength periodically to determine degree of
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muscle wasting during long- term use.
6. Measure blood pressure periodically and compare to
normal values. Report a sustained increase in blood
pressure (hypertension) to the physician.
7. Assess peripheral edema using girth measurements,
volume displacement, and measurement of pitting edema.
Report increased swelling in feet and ankles or a sudden
increase in body weight due to fluid retention.
8. Monitor personality changes, including depression,
euphoria, restlessness, hallucinations
Table 36
Drug Study: Isordil
Doctor’s order Isordil 5 mg 1 tab 25l, PRN for chest pain
Generic name Isordil
Brand Name Isosorbide dinitrate
Functional Classification Nitrates
Pharmacologic Anti-Anginal Drugs
Classification
Frequency PRN
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Timing As needed
Mechanism of Isosorbide dinitrate is converted to the active nitric oxide to
action activate guanylate cyclase. This activation increases levels of
cyclic guanosine 3',5'-monophosphate (cGMP). cGMP activates
protein kinases and causes a series of phosphorylation reactions
which leads to dephosphorylation of myosin light chains of
smooth muscle fibres. Finally there is a release of calcium ions
which causes smooth muscle relaxation and vasodilation.
Route PO
Indication Acute & chronic CHF (including that associated w/ MI). Patients
w/ increased left ventricular end diastolic pressure, & normal or
approx normal cardiac output in whom pulmonary congestion or
edema is the primary problem. Tab: Prophylaxis of ischemic heart
pain associated w/ coronary insuffiency. SL tab: Treatment of
angina pectoris & for prophylaxis in situations likely to provoke
an angina attack ie, physical or emotional stress.
Contraindicati Hypersensitivity or idiosyncrasy to isosorbide dinitrate or related
on compd. Concomitant use w/ soluble guanylate cyclase (GC)
stimulator eg, riocigulant.
Adverse Vascular headache. Cutaneous vasodilation w/ flushin; transient
episodes of dizziness & weakness, other signs of cerebral ischemia
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Effect associated w/ postural hypotension; marked sensitivity to the
hypotensive effects; drug rash or exfoliative dermatitis.
Rationale for Isordil works by widening blood vessels, allowing more blood and
giving the drug oxygen into the heart. Isordil may also help with the treatment of
to the patient certain types of heart failure.
Nursing Responsibilities 1. Monitor vital signs and serum electrolytes.
2. Advise the patient to take it on an empty stomach,
30 minutes before meals or 1 hour after meal.
3. Inform the patient that headache, dizziness,
lightheadedness, or faintness may occur, especially
when you get up quickly from a lying or sitting
position.
4. Instruct patient to rest after taking the medicine to
get up slowly.
5. Raise bedside rails to patient safety.
Table 37
Drug Study: Morphine
Doctor’s order Morphine 2mg IV, PRN for severe chest pain
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Generic name Morphine
Brand Name
Functional Classification Opioid receptors blocks transmission of nociceptive signals
Pharmacologic Analgesics (Opioid)
Classification
Frequency PRN
Timing
Mechanism of Roughly 85% of the reaction to morphine administration is caused
action by morphine-6-glucuronide. The mu and kappa opioid receptors
are agonistically activated by morphine and its metabolites. The
effects of morphine on the brain's ventral tegmental region depend
critically on the mu-opioid receptor. Agonism of the delta-opioid
receptor in the nucleus accumbens mediates the activation of the
reward pathway by morphine, whereas antagonism of the mu-
opioid receptor mediates the alteration of the respiratory system
and addiction disorder.
Route IV
Indication Relief of moderate to severe pain
Contraindicati Hypersensitivity. Paralytic ileus.
on
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Adverse Hyponatremia; thirst, dry mouth, asthenia, constipation,
Effect pollakiuria or polyuria, hyperglycemia.
Rationale for Confusion, insomnia; dizziness, headache, involuntary muscle
giving the drug contractions, somnolence; nausea, constipation, abdominal pain,
to the patient anorexia, dry mouth, vomiting, hyperhidrosis, rash; asthenia,
fatigue, malaise, pruritus.
Nursing Responsibilities 1. Monitor blood pressure prior administration; hold if
systolic BP <100 mmHg or 30 mmHG below
baseline.
2. Reasses pain after administration of morphine
3. Monitor for respiratory depression and hypotension
frequently up to 24 hours after administration of
morphine.
4. Asses for clinical improvement; record onset of
pain relief.
5. Encourage the patient to report ineffective pain
control, constipation, and urinary retention.
Table 38
Drug Study: Furosemide
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Date ordered September 24-29, 2023
Doctor’s order FUROSEMIDE LASIX 40 MG VERY SLOW IV PUSH WITH
BP PREC.
Generic name Furosemide
Brand Name Lasix
Functional Classification Antihypertensive, Diuretic
Pharmacologic Diuretics
Classification
Frequency q12, OD
Timing 6am, 6pm
Mechanism of Inhibits sodium and chloride reabsorption at the proximal and
action distal tubules and the ascending loop of Henle.
Route PO
Indication For the treatment of edema associated with heart failure, including
pulmonary edema, and with renal and hepatic disorders and maybe
effective in patients unresponsive to thiazide diuretics. Allergy to
thiazides and sulfonamides. Prevent severe Hypersensitivity
reactions
Contraindicato Electrolyte depletion. Can be potentiated by the changes in fluid
n and electrolyte levels caused by diuretics.
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Severe renal failure, anuria, exacerbated by the effects of the drug.
A renal failure with anuria not responding to furosemide; renal
failure due to poisoning by nephrotoxic or hepatoxic agents; renal
failure associated with hepatic coma, electrolyte disturbances (e.g.
severe hyponatremia, severe hypokalemia)
CNS: Dizziness CV: hypotension
GI: GI upset GU: Hypokalemia
Adverse CNS: Dizziness
Effect CV: hypotension
GI: GI upset
Rationale for Furosemide is given to the patient after the blood transfusion.
giving the drug The rationale behind this common practice is to reduce the
to the patient vascular overload that may be imposed by the additional blood
volume delivered during transfusion.
Nursing Responsibilities 1. Monitor weight, BP, and pulse rate routinely with long-
term use.
2. Drug is potent diuretic and can cause severe diuresis
with water and electrolyte depletion. Monitor patient
closely and adjust dose carefully.
3. If oliguria develops or increases, drug may need to be
stopped.
4. Monitor fluid intake and output and electrolyte, BUN,
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and carbon dioxide levels frequently.
5. Watch for signs of hypokalemia, such as muscle
weakness and cramps.
Table 39
Drug Study: Tolvaptan
Doctor’s order Tolvaptan 15 mg ½ tab OD
Generic name Tolvaptan
Brand Name Samsca
Functional Classification Selective vasopressin V2-receptor antagonist
Pharmacologic Diuretics
Classification
Frequency OD
Timing 8 PM
Mechanism of A competitive antagonist of vasopressin V2 receptors is tolvaptan.
action It primarily acts on the renal collecting ducts, where it decreases
the absorption of water and causes aquaresis without losing
sodium. This increases the clearance of free water and rectifies
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dilutional hyponatraemia.
Route PO
Indication Adjunct treatment of vol overload in heart failure when adequate
response is not obtained w/ other diuretics (loop diuretics).
Treatment of clinically significant hypervolemic and euvolemic
hyponatremia (serum Na <125 mEq/L or less marked
hyponatremia that is symptomatic and has resisted correction w/
fluid restriction) including patients w/ syndrome of inappropriate
antidiuretic hormone secretion and heart failure.
Contraindicati Hypersensitivity to tolvaptan or benzazepine derivatives. Urgent
on need to raise serum Na acutely; inability to autoregulate fluid
balance, hypernatremia; risks associated w/ worsening
hypovolemia including complications eg, hypotension and renal
failure concomitant use of strong CYP3A inhibitors (eg,
clarithromycin, ketoconazole, itraconazole, ritonavir, indinavir,
nelfinavir, saquinavir, nefazodone and telithromycin); anuric
patients.
Adverse Hyponatremia; thirst, dry mouth, asthenia, constipation,
Effect pollakiuria or polyuria, hyperglycemia.
Rationale for A selective vasopressin V2-receptor antagonist called tolvaptan is
giving the drug used to slow the deterioration of kidney function in people who are
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to the patient at risk of developing autosomal dominant polycystic kidney
disease (ADPKD) rapidly. used to treat hyponatremia that is both
hypervolemic and euvolemic.
Nursing Responsibilities 1. Avoid fluid restriction during the first 24 hours of
therapy.
2. Inform patients that grapefruit juice may increase
the concentration of the drug.
3. When the tolvaptan treatment is stopped, instruct
patients to resume fluid restriction as directed by
their healthcare provider.
Table 40
Drug Study: Losartan
Doctor’s order Losartan 50mg 1Tab
Generic name Losartan
Brand Name Kenzar
Functional Classification Antihypertensives
Pharmacologic ARBS (Angiotensin receptor blockers)
Classification
Frequency BID
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Timing 6am, 6pm
Mechanism of It inhibits vasoconstrictive and aldosterone secreting action of
action angiotensin II by blocking angiotensin II receptor on the surface of
vascular smoot muscle and other tissue cells.
Route PO
Indication For the treatment of edema associated with heart failure, including
pulmonary edema, and with renal and hepatic disorders and
maybe effective in patients unresponsive to thiazide diuretics.
Allergy to thiazides and sulfonamides. Prevent severe
Hypersensitivity reactions
Contraindicati Contraindicated in patient’s hypertensive to drug.
on Use cautiously in patients with impaired renal or hepatic function.
Adverse Patient with HTN or left ventricular hypertrophy.
Effect CNS: dizziness, asthenia, fatigue, headache, insomnia.
CV: edema, chest pain.
EENT: nasal congestion, sinusitis, pharyngitis
GI: abdominal pain, nausea, diarrhea, dyspepsia
Other: angioedema patients with nephropathy
Rationale for Losartan is a medication that is used to treat high blood pressure
giving the drug (hypertension) and to protect the kidneys from damage caused
to the patient by diabetes. It is also used to reduce the risk of stroke in people
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who have high blood pressure and an enlarged heart. Lowering
blood pressure aids in the prevention of strokes, heart attacks,
and kidney problems.
Nursing Responsibilities 1. Tell the patient to avoid salt substitutes these products may
contain potassium, which can cause high potassium level in
patients taking losartan.
2. Advise the patient to report all adverse reactions and to
immediately report swelling of face, eyes, lips or tongue or
breathing, difficulty.
Table 41
Drug Study: Ceftriaxone
Doctor’s order CEFTRIAXONE 2g IVTT (-) ANST IN SOLUSET PLUS 50
CC PNSS TO CONSUME X 1HR (if ok with AP)
Generic name Ceftriaxone
Brand Name Rocephin
Functional Classification Third-generation cephalosporin
Pharmacologic Cephalosporin Antibiotics
Classification
Frequency OD
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Timing 1 PM
Mechanism of It binds to 1 or more penicillin-binding proteins (PBPs) inhibiting
action the final transpeptidation step of peptidoglycan synthesis in the
bacterial cell walls, leading to bacterial cell lysis and death.
Route IVTT
Indication To treat infections such as, Community-acquired pneumonia and
Lower respiratory tract infections
Contraindicati Hypersensitivity to ceftriaxone, other cephalosporins, or history of
on severe hypersensitivity reaction to any other type of β-lactam
antibiotic (e.g. penicillins, monobactams, carbapenems).
Adverse Blood and Lymphatic System Disorders: Eosinophilia,
Effect leucopenia, thrombocytopenia, granulocytopenia, neutropenia,
anemia, coagulopathy.
GI: Nausea, vomiting, diarrhea, loose stools, dysgeusia
Nervous System Disorders: Dizziness, headache.
Skin and subcutaneous tissue disorders: Rash, pruritus,
diaphoresis.
Vascular disorders: Flushing; phlebitis (IV).
Potentially Fatal: Hypersensitivity reactions, including
anaphylaxis and anaphylactic shock; severe cutaneous adverse
reactions (e.g. Stevens-Johnson syndrome, toxic epidermal
necrolysis, drug reaction with eosinophilia and systemic
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symptoms).
Rationale for To treat bacterial infections in different parts of the body and
giving the drug reduce the inflammatory response to pneumonia
to the patient
Nursing Responsibilities 1. Determine the history of hypersensitivity reactions to
cephalosporins and penicillin and history of other allergies,
particularly to drugs, before therapy is initiated.
2. Perform culture and sensitivity tests before initiation of
therapy and periodically during therapy. Dosage may be
started pending test results. Periodic coagulation studies
(PT and INR) should be done.
3. Inspect injection sites for induration and inflammation.
Rotate sites. Note IV injection sites for signs of
phlebitis (redness, swelling, pain).
4. Monitor for manifestations of hypersensitivity. Report
their appearance promptly and discontinue drug.
5. Watch for and report signs: petechiae, ecchymosis
areas, epistaxis, or any unexplained bleeding.
6. Check for fever if diarrhea occurs: Report both
promptly. The incidence of antibiotic-produced
pseudomembranous colitis is higher than with most
cephalosporins.
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Table 42
Drug Study: Azithromycin
Doctor’s order AZITHROMYCIN 500mg/Tab/OD (x5 days then d/c)
Generic name Azithromycin
Brand Name Zithromax
Functional Classification Anti-inflammaatory and Antibacterial
Pharmacologic Macrolide Antibiotics
Classification
Frequency OD
Timing 8 PM
Mechanism of It inhibits RNA-dependent protein synthesis by binding to the 50s
action ribosomal subunit, preventing the translocation of peptide chains.
Route PO
Indication Treatment of mild to moderate bacterial infections caused by
susceptible strains of the microorganisms such as respiratory tract
infections, skin infections, ear infections, throat infections,
sexually transmitted diseases, lung infections, pneumonia, sinuses
and bronchitis.
Contraindicati Hypersensitivity to macrolide antibiotics. History of hepatic
on dysfunction/cholestatic jaundice following previous antibiotic use.
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Adverse Significant: Myasthenia gravis.
Effect Ear and labyrinth disorders: Deafness.
Eye disorders: Pruritus, burning, stinging of the eye or ocular
discomfort, sticky eye sensation, foreign body sensation
(ophthalmic).
GI: Diarrhea, vomiting, abdominal pain, nausea, flatulence,
dyspepsia, dysgeusia.
Metabolism and nutrition disorders: Anorexia.
Musculoskeletal and connective tissue disorders: Arthralgia.
Nervous system disorders: Headache, dizziness, paresthesia.
Skin and subcutaneous tissue disorders: Pruritus, rash.
Potentially Fatal: Rarely, serious hypersensitivity reactions (e.g.
anaphylaxis, angioedema, Stevens-Johnson syndrome, toxic
epidermal necrolysis, acute generalized exanthematous pustulosis
drug reaction with eosinophilia and systemic symptoms),
fulminant hepatitis leading to liver failure, prolonged cardiac
repolarisation and QT interval, cardiac arrhythmia.
Rationale for Treat and manage wide variety of bacterial infections, including
giving the drug community-acquired pneumonia. It works by stopping the
to the patient growth of bacteria.
Nursing Responsibilities 1 Assess patient for infection (appearance of wound, sputum,
urine, and stool; WBC) at beginning of and throughout
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therapy.
2 Obtain specimens for culture and sensitivity before
initiating therapy. First dose may be given before receiving
results.
3 Observe for signs and symptoms of anaphylaxis (rash,
pruritus, laryngeal edema, wheezing). Notify health care
professional immediately if these occur.
4 Inform patient that the medication may cause drowsiness
and dizziness.
5 Advise patient to use sunscreen and protective clothing to
prevent photosensitivity reactions.
6 Advise patient to report symptoms of chest pain,
palpitations, yellowing of skin or eyes, or signs of
superinfection (black, furry overgrowth on the tongue;
vaginal itching or discharge; loose or foul-smelling stools)
or rash.
7 Instruct patient to notify health care professional if fever
and diarrhea develop, especially if stool contains blood,
pus, or mucus. Advise patient not to treat diarrhea without
advice of health care professional.
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Table 43
Drug Study: NAC
Doctor’s order NAC 600mg 1 tab dilute in ¼ glass of water, BID
Generic name Acetylcysteine
Brand Name NAC
Functional Classification Mucolytics
Pharmacologic Mucolytic agents
Classification
Frequency OD
Timing 8 PM
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Mechanism of An N-acetyl derivative of the amino acid L-cysteine. It exhibits its
action mucolytic action through its free sulfhydryl group that breaks up
the disulfide linkages of mucoproteins, thus reducing mucous
viscosity; this action may also benefit patients with ocular mucus
abnormality.
Route PO
Indication As adjunctive mucolytic therapy for respiratory tract disorders
associated with excessive, viscous mucus:
Contraindicati For mucolytic use (oral): Children <2 years.
on
Adverse Significant: Increased risk of upper gastrointestinal hemorrhage,
Effect rarely, bronchospasm; serious skin reactions (e.g. Stevens-Johnson
syndrome, Lyell's syndrome), generalized urticaria
Cardiac disorders: Tachycardia; cardiac arrest
Eye disorders: Eye irritation, pain or swelling, blurred vision.
Gastrointestinal disorders: Nausea, vomiting, stomatitis;
diarrhea, abdominal pain
Nervous system disorders: Headache
Respiratory, thoracic and mediastinal disorders: Rhinorrhea;
throat tightness, pharyngitis, rhonchi, cough
Skin and subcutaneous tissue disorders: Pruritus, rash,
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angioedema; exanthema
Rationale for Helps break down mucus in the body and treat some respiratory
giving the drug conditions, such as bronchitis and COPD
to the patient
Nursing Responsibilities 1. Monitor signs of angioedema, including rashes, raised
patches of red or white skin (welts), burning/itching skin,
swelling in the face, and difficulty breathing. Notify
physician of these signs immediately.
2. Monitor signs of bronchospasm and respiratory irritation,
including wheezing, cough, dyspnea, increased secretions,
and tightness in the chest and throat. Report excessive or
prolonged respiratory problems to the physician.
3. Assess the quantity and consistency of sputum to help
document whether this drug is successful in reducing the
viscosity of respiratory secretions.
4. Counsel patient on proper inhalation techniques, and
advise patient not to exceed the recommended dose or
frequency of inhalations. Contact physician immediately if
bronchospasm or other respiratory symptoms are increased
by drug inhalation.
5. Instruct patient and family/caregivers to report other
troublesome side effects such as severe or prolonged
drowsiness, chills, fever, nasal inflammation, or GI
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problems (nausea, vomiting, irritation in/around the
mouth).
Table 44
Drug Study: Enoxaparin
Doctor’s order Continue Enoxaparin 0.6 ml
Generic name Lovenox
Brand Name Enoxaparin
Functional Classification Anticoagulants
Pharmacologic Low- molecular weight heparins
Classification
Frequency QID
Timing 7AM- 7PM
12AM-12NN
Mechanism of Accelerates formation of antithrombin III-thrombin complex and
action deactivates thrombin, preventing conversion of fibrinogen to
fibrin. Drug has a higher antifactory- Xa- to antifactory-IIa activity
ratio than heparin.
Route IVTT
Indication Enoxaparin is used to prevent ischemic complications in unstable
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angina and non-Q-wave myocardial infarction; it is also used to
treat acute ST elevation myocardial infarction in conjunction with
percutaneous intervention and/or other treatments.
Contraindicati Contraindicated in patient hypersensitive to drug, heparin, pork
on products or benzyl alcohol; in those with active major bleeding
and in those with history of immune mediated heparin- induced
thrombocytopenia (HIT) within the past 100 days or in the
presence of circulating antibodies.
Adverse CNS: confusion, fever, pain
Effect CV: edema, peripheral edema
GI: nausea, diarrhea
Hematologic: Thrombocytopenia, hemorrhage, ecchymoses,
bleeding complications.
Respiratory: dyspnea
Other: angioedema, anaphylaxis
Rationale for Enoxaparin injection is used to prevent deep venous thrombosis, a
giving the drug condition in which dangerous blood clots form in the legs' blood
to the patient arteries. These blood clots can move to the lungs and become
buried in the lungs' blood veins, resulting in pulmonary embolism.
It stops platelets (a kind of blood cell) from adhering together and
producing a deadly blood clot. If you have an elevated risk of
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blood clots, using clopidogrel can help avoid them.
Nursing Responsibilities 1. Instruct patient and family to watch for signs of bleeding or
abnormal bruising and to notify prescriber immediately.
2. Tell the patient to immediately report signs and symptoms
of spinal or epidural hematoma, such as numbness
(especially of the lower limbs) and muscle weakness.
Table 45
Drug Study: Carvedilol
Doctor’s order Carvedilol Dilabloc 6.25 mg ½ tab BID
Generic name Carvedilol
Brand Name Kaufmann
Functional Classification Antihypertensive
Pharmacologic Beta-Blockers
Classification
Frequency BID
Timing 8AM- 8PM
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Mechanism of Treatment for hypertension, left ventricular dysfunction following
action myocardial infarction with ventricular ejection fraction ≤40%, and
mild to severe heart failure with carvedilol is indicated.
Route PO
Indication Management of Hypertension and angina pectoris, and as adjunct
therapy in symptomatic heart failure
Contraindicati Hypersensitivity; bronchospasm or asthma, history of obstructive
on airways disease, hepatic impairment.
Adverse CNS: anxiety, depression, insomnia, memory loss,
Effect mental status changes, nervousness, nightmares.
EENT: blurred vision, intraoperative floppy iris
syndrome, nasal stuffiness.
RESP: bronchospasm, wheezing.
GU: erectile dysfunction
DERM: steven-johnson syndrome, urticaria.
ENDO: hyperglycemia, hypoglycemia.
MISC: anaphylaxis, drug-induced lupus syndrome.
Rationale for Heart failure and elevated blood pressure are treated with
giving the drug carvedilol. Additionally, if your heart is not pumping efficiently
to the patient after a heart attack, it can increase your chances of surviving.
Reduced hypertension aids in the avoidance of heart attacks,
strokes, and kidney issues. This medication functions by
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obstructing the effects of certain endogenous substances, like
adrenaline, on the heart and blood vessels.
Nursing Responsibilities 1. Monitor blood pressure and pulse rate frequently
during the dose adjustment period and on a regular
basis throughout therapy.
2. Check the patient on a regular basis for signs of
fluid overload, such as jugular venous distention,
fatigue, rales or crackles, peripheral edema, and
dyspnea. When HF therapy is started, patients may
notice a worsening of their symptoms.
3. Keep an eye out for overdose symptoms in patients
taking beta blockers, such as bradycardia, extreme
dizziness or fainting, extreme sleepiness, dyspnea,
bluish fingertips or palms, and seizures. Inform a
healthcare provider right away if any of these
symptoms appear.
4. Encourage the patient to reach out to a healthcare
provider if they experience any of the following
symptoms: depression, dizziness, confusion, fever,
sore throat, unusual bleeding, bruising, cold hands
and feet, wheezing, slow heartbeat, or cold sore
throat.
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5. Encourage the patient to slowly change positions in
order to reduce orthostatic hypotension, particularly
when starting a new treatment plan or increasing
the dosage.
Table 46
Drug Study: Cefixime
Doctor’s order Cefixime 200mg/1cap
Generic name Cefixime
Brand Name Suprax
Functional Classification Anti-infective
Pharmacologic Cephalosporin antibiotics
Classification
Frequency BID
Timing 8 AM – 8 PM
Mechanism of Cefixime binds to specific penicillin-binding proteins (PBPs)
action found within the bacterial cell wall, inhibiting the third and final
stage of cell wall synthesis. Cell lysis is then mediated by autolytic
enzymes of the bacterial cell wall, such as autolysins; cefixime
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may interfere with an autolysin inhibitor.
Route PO
Indication  Gram negative infections
 Urinary tract infections
 Diarrhea
 Enteric fever
Contraindicati Patients with known allergy to the cephalosporin group of
on antibiotics
Adverse Pseudomembranous colitis, nausea and vomiting, diarrhea,
Effect hypersensitivity, hepatic dysfunction including cholestasis and
elevation in serum transaminase, moderate transient neutropenia,
and fever.
Rationale for It is used to treat a wide range of bacterial infections. It works by
giving the drug inhibiting bacterial growth. This antibiotic only treats bacterial
to the patient infections.
Nursing Responsibilities 1. Educate the patient on the purpose of cefixime, the
importance of finishing the entire course of
antibiotics, and any potential side effects.
2. Watch for seizures; notify physician immediately if
patient develops or increases seizure activity.
3. Instruct the patient and family to report any other
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bothersome side effects, such as severe or
prolonged skin problems (rash, hives) or
gastrointestinal problems (nausea, vomiting,
diarrhea, cramps).
Table 47
Drug Study: Atorvastatin
Doctor’s order Atorvastatin 50mg / tab 1 tab OD HS 9PM
Generic name Atorvastatin
Brand Name N/A
Functional Classification Antilipemic
Pharmacologic HMG-CoA reductase inhibitors
Classification
Frequency OD
Timing 9 PM
Mechanism of Atorvastatin competitively inhibits the enzyme 3-hydroxy-3-
action methylglutaryl-coenzyme A (HMG-CoA) reductase. This
inhibition disrupts the conversion of HMG-CoA to mevalonate,
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resulting in a reduction in cholesterol synthesis within the liver.
Additionally, atorvastatin promotes an increase in the quantity of
low-density lipoprotein (LDL) receptors on the surface of liver
cells.
Route PO
Indication Atorvastatin is a medication primarily prescribed to lower levels of
low-density lipoprotein and triglycerides in the blood while
increasing levels of high-density lipoprotein or HDL.
Contraindicati  Allergy to atorvastatin or its components.
on  Active liver disease or unexplained persistent elevations in
liver function tests.
 Pregnancy.
 Breastfeeding.
Adverse  Liver problems (unexplained fatigue, yellowing of the skin
Effect or eyes, dark urine)
 Muscle problems (persistent muscle pain, tenderness, or
weakness)
 Allergic reactions (rash, itching, swelling, severe dizziness,
difficulty breathing)
Rationale for Atorvastatin is a statin medication that is known for its
giving the drug cholesterol-lowering effects. Elevated levels of cholesterol,
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to the patient particularly low-density lipoprotein (LDL) cholesterol, are
associated with an increased risk of cardiovascular events,
including acute transmural myocardial infarction which the patient
was diagnosed with.
Nursing Responsibilities
1. Thoroughly assess the patient's medical history, including
allergies, liver function, and past reactions to statins.
2. Monitor lipid levels and check for any signs of
cardiovascular disease.
3. Provide the patient with detailed information about
Atorvastatin, including its purpose, how it works, and
stress the importance of sticking to the prescribed dosage.
4. Make sure the patient understands potential side effects
and emphasize the need to report any unusual symptoms
promptly.
Table 48
Drug Study: Salbutamol
Doctor’s order NEBULIZE SALBUTAMOL + IPRATROPIUM 1
NEB/Q8/6am-2pm-10pm
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Generic name Salbutamol
Brand Name N/A
Functional Classification Bronchodilator
Pharmacologic Beta-2 adregergic agonist
Classification
Frequency Q8
Timing 6 AM – 2 PM – 10 PM
Mechanism of
action Salbutamol, also known as albuterol, exerts its therapeutic effects
through its selective activation of beta-2 adrenergic receptors in
the airway smooth muscle cells. As a short-acting beta-2
adrenergic agonist, salbutamol promotes bronchodilation by
relaxing the smooth muscles surrounding the bronchi and
bronchioles.
Route Nebulization
Indication Salbutamol is indicated for the relief of bronchoconstriction in
conditions such as asthma, chronic obstructive pulmonary disease
(COPD), and other reversible obstructive airway diseases.
Contraindicati Salbutamol is contraindicated in individuals with a known
on hypersensitivity to albuterol or any of its components.
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Adverse  Allergic reactions (rash, itching, swelling, severe dizziness,
Effect difficulty breathing)
 Paradoxical bronchospasm (worsening of breathing
difficulties)
 Cardiovascular effects (chest pain, irregular heartbeats)
Rationale for Salbutamol facilitates bronchodilation, which is useful for the
giving the drug patient, as he was diagnosed with bronchial asthma, therefore
to the patient needing a way to alleviate bronchoconstriction. Ssalbutamol may
help prevent or minimize exacerbations that could lead to
respiratory infections such as pneumonia, which the patient was at
risk for.
Nursing Responsibilities 1. Conduct a thorough assessment of the patient's
respiratory status, including the presence of
wheezing, shortness of breath, and overall
respiratory distress.
2. Educate the patient on the proper use of the inhaler
or nebulizer, emphasizing the importance of
following the prescribed dosage and inhalation
technique.
3. Provide information on the expected onset of action
and duration of relief.
4. Monitor for potential side effects such as tremors,
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palpitations, and increased heart rate.
5. Observe for signs of paradoxical bronchospasm
(worsening of breathing difficulties) and allergic
reactions.
Table 49
Drug Study: Budesonide
Doctor’s order BUDESONIDE 1NEB/BID/10AM-10PM
Generic name Budenoside
Brand Name N/A
Functional Classification Corticosteroid
Pharmacologic Inhaled corticosteroids
Classification
Frequency BID
Mechanism of As an inhaled corticosteroid, budesonide operates by entering
action airway cells and attaching to intracellular glucocorticoid receptors.
This connection results in the suppression of inflammatory
reactions, including the restraint of cytokine release, ultimately
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diminishing airway inflammation and offering relief from
symptoms in conditions like asthma and chronic obstructive
pulmonary disease (COPD).
Route Nebulization
Indication Budesonide is indicated for the management of inflammatory
respiratory conditions, such as asthma and chronic obstructive
pulmonary disease (COPD)
Contraindicati  Hypersensitivity to budesonide or its components.
on  Acute bronchospasm or status asthmaticus.
 Active or quiescent respiratory infections (tuberculosis,
fungal, bacterial, viral).
 Systemic corticosteroid dependency.
 Budesonide is not the primary treatment for status
asthmaticus.
 Age restriction for certain formulations (e.g., not
recommended for children under 6 years of age).
Effect  Throat irritation
 Hoarseness
 Dry mouth
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 Cough
 Oral candidiasis (thrush)
 Increased risk of respiratory infections
 Adrenal suppression
 Growth suppression in children
 Osteoporosis with long-term use (systemic effects)
Rationale for Budesonide is a corticosteroid that acts locally in the airways to
giving the drug reduce inflammation. This makes it particularly effective in
to the patient treating conditions where inflammation plays a central role, such
as asthma and chronic obstructive pulmonary disease (COPD),
both of which the patient had.
1. Conduct a thorough respiratory assessment, including lung
sounds, respiratory rate, and overall respiratory status.
2. Assess the patient's medical history, allergies, and any
contraindications to budesonide.
3. Provide comprehensive education to the patient on the
purpose of budesonide, proper inhaler technique, and
adherence to the prescribed dosage.
4. Explain potential side effects and the importance of
reporting any adverse reactions.
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5. Monitor the patient for therapeutic effectiveness, observing
improvements in respiratory symptoms and lung function.
6. Regularly assess for potential adverse effects, such as oral
candidiasis (thrush), and educate the patient on preventive
measures.
Table 50
Drug Study: Trimetazidine
Doctor’s order TRIMETAZIDINE 35g 1tab
Generic name Trimetazidine
Brand Name N/A
Functional Classification Anti-ischemic
Pharmacologic Partial fatty acid oxidation inhibitors
Classification
Frequency BID
Mechanism of Trimetazidine operates by inhibiting the enzyme 3-ketoacyl
action coenzyme A thiolase, a key component of mitochondrial fatty acid
oxidation. This inhibition leads to a shift in cellular energy
production from fatty acid metabolism to glucose oxidation,
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enhancing energy efficiency. This metabolic adjustment is
particularly advantageous during ischemic conditions when the
heart faces oxygen deprivation. By promoting glucose utilization,
trimetazidine aids the heart in producing energy more efficiently,
reducing the risk of cellular damage. Furthermore, the medication
has been linked to anti-oxidative and anti-inflammatory effects,
contributing to its overall cardioprotective properties.
Route PO
Indication trimetazidine is primarily indicated for the treatment of angina
pectoris. Angina is a condition characterized by chest pain or
discomfort that occurs when the heart muscle doesn't receive
enough oxygen-rich blood. Trimetazidine is often prescribed in the
following situations related to angina.
Contraindicati  Hypersensitivity to trimetazidine or its components.
on  Parkinson's disease or other extrapyramidal disorders.
 Severe renal impairment (creatinine clearance less than 30
ml/min).
 Severe hepatic impairment.
 Co-administration with cytochrome P450 2D6 inhibitors.
 Co-administration with strong CYP1A2 inhibitors.
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Effect  Throat irritation
 Hoarseness
 Dry mouth
 Cough
 Oral candidiasis (thrush)
 Increased risk of respiratory infections
 Adrenal suppression
 Growth suppression in children
 Osteoporosis with long-term use (systemic effects)
Rationale for
Trimetazidine helps ease the chest pain of the patient, caused by
giving the drug
angina pectoris.
to the patient
Nursing Responsibilities 1. Perform a thorough assessment of the patient's medical
history, including any allergies or contraindications to
trimetazidine.
2. Assess baseline vital signs, cardiac status, renal function,
and hepatic function.
3. Provide patient education regarding the purpose of
trimetazidine, the importance of adherence to the
prescribed regimen, and potential side effects.
4. Instruct patients on the proper administration of the
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medication, including dosage and timing.
5. Monitor the patient for any signs of adverse reactions or
side effects, such as dizziness, nausea, or palpitations.
6. Regularly assess the patient's cardiac status and response to
trimetazidine.
Table 51
Drug Study: Acetylsalicylic acid
Doctor’s order ASA 100mmg 1tab
Generic name Aspirin
Brand Name N/A
Functional Classification Anti-inflammatory drug
Pharmacologic Non-steroidal anti-inflammatory drugs
Classification
Frequency OD
Timing 8 AM
Mechanism of Aspirin inhibits the activity of cyclooxygenase enzymes,
action specifically COX-1 and COX-2, which are crucial in the synthesis
of prostaglandins. Prostaglandins play a key role in mediating
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inflammation, pain, and fever.
Route PO
Indication Primarily recognized for its analgesic, anti-inflammatory, and
antipyretic properties, aspirin is widely used to alleviate pain,
reduce inflammation, and lower fever. Additionally, its unique
antiplatelet effects make it a crucial agent in preventing
cardiovascular events, such as heart attacks and strokes. Aspirin's
ability to irreversibly inhibit cyclooxygenase enzymes contributes
to its anti-inflammatory actions, while its impact on platelet
function helps mitigate blood clot formation. Beyond its
cardiovascular applications, aspirin finds utility in managing
various inflammatory conditions, such as rheumatoid arthritis,
osteoarthritis, and certain infections. Its multifaceted
pharmacological profile positions aspirin as a versatile medication
with a significant impact on both pain management and
cardiovascular health.
Contraindicati  Hypersensitivity or allergy to aspirin or other NSAIDs
on  Active peptic ulcer disease
 History of gastrointestinal bleeding
 Severe liver or kidney dysfunction
 Bleeding disorders or tendencies
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 Asthma induced by aspirin or other NSAIDs
 Third-trimester pregnancy
 Children or teenagers recovering from viral infections,
particularly flu or chickenpox (due to the risk of Reye's
syndrome
 Concurrent use with certain medications, such as
anticoagulants like warfarin or other NSAIDs
 Before surgery, including dental procedures, where there is
an increased risk of bleeding
Adverse  Gastrointestinal irritation and ulcers
Effect  Increased risk of bleeding
 Allergic reactions
 Reye's syndrome in children and teenagers with viral
infections
 Tinnitus (ringing in the ears)
 Gastrointestinal bleeding
 Renal impairment
 Hepatic impairment
 Bronchospasm in individuals with asthma
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 Prolonged bleeding time
Rationale for The rationale for administering aspirin to a patient with acute
giving the drug transmural myocardial infarction (MI) is grounded in its
to the patient antiplatelet properties and its ability to mitigate the progression of
thrombus formation within the coronary arteries.
1. Conduct a thorough assessment of the patient's medical
history, allergies, and current medications to identify
any contraindications or potential interactions with
aspirin.
2. Provide comprehensive education to the patient about
the purpose of aspirin therapy, potential side effects,
and the importance of adherence to the prescribed
regimen.
3. Monitor the patient for signs of adverse effects, such as
gastrointestinal bleeding, tinnitus, or allergic reactions.
4. Assess vital signs regularly, especially blood pressure,
as aspirin can impact cardiovascular parameters.
5. Prognosis
Given the intricate combination of conditions in this case—acute decompensated
congestive heart failure following an acute ST-elevation myocardial infarction, coupled
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with atrial fibrillation, community-acquired pneumonia of moderate risk, acute
exacerbation of chronic obstructive pulmonary disease, and likely nutritional
hypokalemia—the prognosis calls for careful consideration. The complexity of these
overlapping health concerns presents significant challenges to the patient's recovery.
Immediate, comprehensive medical interventions tailored to address each condition will
be crucial in managing potential complications. However, due to the complexity
involved, a cautious approach is warranted. The patient's response to treatment,
adherence to prescribed therapies, including smoking cessation and supplementary
oxygen therapy, and commitment to necessary lifestyle changes will profoundly impact
their overall prognosis. Adhering meticulously to prescribed medications, particularly in
quitting smoking, along with the incorporation of supplementary oxygen therapy, will
play crucial roles in enhancing treatment effectiveness and improving respiratory
function. Collaborative efforts among specialists and diligent monitoring are essential to
navigate these uncertainties and maximize the patient's long-term well-being.
B. Surgical Management
Considering initial surgical considerations, the patient eventually chose a non-surgical
method based on a thorough examination of their medical condition and preferences.
Conservative approaches were favored, with an emphasis on personalized care and a
reduction in the need for intrusive procedures. This patient-centered approach emphasizes
the value of collaborative decision-making in healthcare, allowing for customized
treatment programs that correspond with individual beliefs and aspirations.
II. Nursing Care Plan
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A. Nursing Problem List
Table 52
Problem list Ranking Date Identified Date Resolved
Impaired Gas 1 September 25, 2023 September 25, 2023
Exchange related
to altered oxygen
supply
Acute Pain related 2 September 25, 2023 September 25, 2023
to inflammation,
coughing, and
increased
respiratory effort
Ineffective tissue 3 September 25, 2023 September 25, 2023
perfusion related
to compromised
circulation as
evidenced by
diminished
peripheral pulses
and skin pallor
Activity 4 September 25, 2023 September 25, 2023
intolerance related
to dyspnea,
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decreased
oxygenation, and
generalized
weakness.
Anxiety related to 5 September 26, 2023 September 26, 2023
diffuclty breathing
fear of
exacerbation, and
the chronic nature
of respiratory
conditions.
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Table 53: Nursing care plan on Impaired gas exchange related to altered oxygen supply
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Table 54 Nursing care plan on Acute pain related to inflammation, coughing, and increased respiratory effort
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Table 55: Nursing care plan on Ineffective Tissue Perfusion
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Table 56: Nursing care plan on Activity Intolerance related to dyspnea, decreased oxygenation, and generalized weakness.
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Table 57. Nursing care plan on Anxiety related to difficulty breathing, fear of exacerbation, and the chronic nature of respiratory
conditions.
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B. Discharge Plan
Table 58
Discharge Plan and Health Teaching on Medication
Medication
Ensure the patient understands the prescribed When patients comprehend the purpose,
medications, including their names, dosages, dosage, and potential side effects of their
frequencies, and potential side effects. medications, they are more likely to take
them as instructed, leading to better
disease management and improved health
outcomes.
Emphasize the importance of taking medications Taking medications consistently, even
as prescribed, even if the patient feels better. when feeling better, is crucial for
preventing recurrent cardiac events.
Explain the purpose of each medication and how Understanding the purpose of each
it helps manage the patient’s condition. medication enhances patient compliance
and adherence to the prescribed regimen.
Encourage open communication with the Open communication with the healthcare
healthcare provider regarding any concerns or provider fosters trust and ensures that any
questions about medications. concerns or questions are promptly
addressed.
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Table 59
Discharge Plan and Health Teaching on Excercise
Exercise
Develop a personalized exercise plan that is A personalized exercise plan tailored to
appropriate for the patient's current fitness level the patient's individual needs and abilities
and limitations. ensures safety and prevents overexertion.
Provide clear instructions on how to perform each Clear instructions on exercise techniques
exercise safely and effectively. promote proper form and reduce the risk
of injury.
Table 60
Discharge Plan and Health Teaching on Treatment
Treatment
Educate the patient and their caregiver about MI, Educating the patient and caregiver
its risk factors, and lifestyle modifications to empowers them to make informed
prevent future cardiac events. decisions about their health and promotes
self-management.
Encourage and teach caregiver of patient regular Monitoring of vital signs allows for early
monitoring of vital signs at home, such as blood detection of potential complications and
pressure and heart rate and respiratory rate. timely intervention.
Encourage open communication with the Open communication with the healthcare
healthcare provider regarding any concerns or provider fosters trust and ensures that any
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questions about medications or overall health. concerns or questions are promptly
addressed.
Arrange for home health services if necessary, Home health services can help ensure that
such as assistance with medication the patient is taking their medications
administration, monitoring vital signs, and correctly, managing their conditions
management techniques. effectively, and adhering to treatment
plans.
Table 61
Discharge Plan and Health Education
Health Education
Provide clear instructions on medication Clear medication instructions ensure
administration, including dosage, frequency, and adherence to the prescribed regimen,
potential side effects. which is crucial for preventing recurrent
cardiac events.
Educate the patient and their caregiver about his Educating the patient and caregiver
condition, its risk factors, and lifestyle empowers them to make informed
modifications to prevent further complications. decisions about their health and promotes
self-management.
Discuss strategies for managing stress and Chronic health conditions can contribute
anxiety, such as relaxation techniques, to stress and anxiety, which can negatively
mindfulness exercises. impact overall health.
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Table 62
Discharge Plan and Health Teaching on Out Patient Follow-up Care
Out patient Follow-up care
Schedule follow-up appointments with the Regular follow-up appointments allow for
cardiologist and primary care physician. monitoring of the patient's condition and
timely adjustments to their medication
regimen or lifestyle recommendations.
Provide contact information for emergency Emergency contact information ensures
services and the healthcare provider in case of timely access to medical care in case of
any concerns or complications. complications.
Arrange for home health services if necessary, Home health services provide additional
such as assistance with medication support for patients who may require
administration, monitoring vital signs, and assistance with daily activities, medication
providing respiratory therapy. administration, and respiratory therapy,
especially during the initial recovery
period.
Table 63
Discharge Plan and Health Teaching on Diet
Diet
Provide clear guidelines on a heart-healthy and Provide clear guidelines on a heart-
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lung-friendly diet tailored to the patient's healthy and lung-friendly diet tailored to
individual needs and preferences. the patient's individual needs and
preferences.
Emphasize the importance of regular meal Maintaining a healthy weight is crucial for
planning and portion control to maintain a reducing the strain on the heart and lungs.
healthy weight and manage calorie intake. Regular meal planning and portion control
can help achieve and maintain a healthy
weight.
Encourage a low-sodium diet to control blood Reducing sodium intake helps manage
pressure and reduce fluid retention, which can blood pressure, a significant risk factor for
exacerbate COPD symptoms. MI and can alleviate fluid retention, which
can worsen COPD symptoms such as
shortness of breath.
Emphasize the importance of hydration by Adequate hydration is essential for
drinking plenty of water throughout the day. maintaining overall health and can help
loosen secretions in the lungs, making it
easier to cough and clear mucus.
Table 64
Discharge Plan and Health Teaching on Social, spiritual, Sexual
Social, spiritual, Sexual
Provide resources for support groups or Emotional and psychological support can
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community resources that can help the patient be beneficial for recovering patients and
cope with the emotional and psychological their caregivers.
impact of MI.
Encourage involvement in social activities and Social engagement can help combat
community groups, as tolerated. feelings of isolation, loneliness, and
depression, which may be exacerbated by
chronic health conditions. Participation in
social activities can promote overall well-
being and quality of life.
Encourage participation in religious or spiritual Religious or spiritual activities can
activities, as desired. provide a sense of purpose, meaning, and
connection, which can be particularly
important for patients facing chronic
health conditions.
Emphasize the importance of maintaining strong A strong social support system can
social connections and seeking support when provide emotional support, practical
needed. assistance, and a sense of belonging,
contributing to overall well-being and
resilience. Encourage the patient to
connect with family, friends, community
groups, or support organizations.
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III. References
Shoar, S., & Musher, D. M. (2020). Etiology of community-acquired pneumonia in adults: a
systematic review. Pneumonia, 12(1). https://doi.org/10.1186/s41479-020-00074-3
Nazir, A. (2023). Exercise intolerance in COPD: A review of the pathophysiology and Clinical
Assessment. Indonesian Journal of Physical Medicine and Rehabilitation, 12(01), 1–12.
https://doi.org/10.36803/indojpmr.v12i01.382
Christiansen, C. F., Løkke, A., Bregnballe, V., Prior, T. S., & Farver-Vestergaard, I. (2023).
COPD-Related Anxiety: A Systematic Review of Patient Perspectives. International
Journal of Chronic Obstructive Pulmonary Disease, Volume 18, 1031–1046.
https://doi.org/10.2147/copd.s404701
Alice Ferng B.S., M. (2023, October 30). Alveoli. Kenhub.
https://www.kenhub.com/en/library/anatomy/alveoli
Dezube, R. (2023, November 12). Exchanging oxygen and carbon dioxide - lung and airway
disorders. MSD Manual Consumer Version. https://www.msdmanuals.com/home/lung-
and-airway-disorders/biology-of-the-lungs-and-airways/exchanging-oxygen-and-carbon-
dioxide
236
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Histology, alveolar cells - statpearls - NCBI bookshelf. (n.d.).
https://www.ncbi.nlm.nih.gov/books/NBK557542/
Lorenzo Crumbie MBBS, Bs. (2023, August 17). Conduction system of the heart. Kenhub.
https://www.kenhub.com/en/library/anatomy/conducting-system-of-the-heart
Lynne Eldridge, M. (2023, June 18). What are alveoli and how do they work?. Verywell Health.
https://www.verywellhealth.com/what-are-alveoli-2249043
MediLexicon International. (n.d.-a). Cardiac muscle tissue: Definition, function, and structure.
Medical News Today. https://www.medicalnewstoday.com/articles/325530
MediLexicon International. (n.d.-b). The heart: Anatomy, how it works, and more. Medical News
Today. https://www.medicalnewstoday.com/articles/320565
Roiger, D., & Bullock, N. (2019). ANATOMY, PHYSIOLOGY, & DISEASE: Foundation for the
health professions. McGraw-Hill.
Seladi-Schulman, J. (2018, April 5). Cardiac muscle tissue: Function, structure, conditions, and
pictures. Healthline. https://www.healthline.com/health/cardiac-muscle-tissue
TE;, W. H. (n.d.). Alveolar type I and type II cells. Australian and New Zealand journal of
medicine. https://pubmed.ncbi.nlm.nih.gov/6598039/
View of overview of the cardiac conduction system: A narrative literature review. (n.d.).
https://phlox.or.id/index.php/sjim/article/view/18/18
237
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MIMS (n.d.). Atorvastatin: Indication, dosage, side effect, precaution | MIMS Philippines.
Retrieved from: https://www.mims.com/philippines/drug/info/atorvastatin?mtype=generic
MIMS (n.d.). Aspirin: Indication, dosage, side effect, precaution | MIMS Philippines.
Retrieved from: https://www.mims.com/philippines/drug/info/aspirin?mtype=generic
MIMS (n.d.). Budesonide: Indication, dosage, side effect, precaution | MIMS Philippines.
Retrieved from: https://www.mims.com/philippines/drug/info
MIMS. (n.d.). Isosorbide mononitrate: Indication, Dosage, Side Effect, Precaution | MIMS
Philippines. Retrieved from:
https://www.mims.com/philippines/drug/info/isosorbide
MIMS. (n.d.). Salbutamol: Indication, dosage, side effect, precaution | MIMS Philippines.
Retrieved from: https://www.mims.com/philippines/drug/info/salbutamol?mtype=generic
MIMS. (n.d.). Trimetazidine: Indication, dosage, side effect, precaution | MIMS Philippines.
Retrieved from: https://www.mims.com/philippines/drug/info/trimetazidine
World Health Organization: WHO. (2022, June 10). The Sinovac-CoronaVac COVID-19 vaccine: What
you need to know. https://www.who.int/news-room/feature-stories/detail/the-sinovac-covid-19-
vaccine-what-you-need-to-know?
fbclid=IwAR2UaZsGDhI4gdREuuFohPUSDnRjAGlpCW__OFfOnACkk9s1yKgIqprYGOU#:~:
text=A%20booster%20dose%20may%20be,with%20the%20WHO%20Prioritization
%20Roadmap
Lippincott home. (n.d.-b). https://lww.com/pages/default.aspx?fbclid=IwAR0cQ50vgWEHpaluDIQlA-
ZUqjAo7_P7BH6YOv-KzLC-VwgY_bg1C_w_UZY
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Calgary Guide. (2020, August 17). Calgary Guide. The Calgary Guide to Understanding Disease.
https://calgaryguide.ucalgary.ca/?
fbclid=IwAR3lFy4mSPSQa_dpOsO0AA3ED9xrSRNFPuU4UN8khFSVqip4MXamf1dQJ4g
IV. Appendices
APPENDIX A
PHYSICIAN’S CONSENT
September 25, 2023
Dr.
South Cotabato Provincial Hospital
Dear Doctor:
Greetings!
We, the Level III of Bachelor of Science in Nursing students of Notre Dame of
Marbel University are having our clinical exposure at South Cotabato Provincial Hospital. To
enrich our knowledge in special areas, we are required to conduct a case study about a particular
patient who we had assisted during exposure in the Male Surgery Ward of Socomedics Medical
Center.
In line with this, we would like to request your permission to allow us to copy pertinent
data in the patient’s chart and to conduct interview with the patient named
_______________________________,______,_______,admitted
in________________________________________ with an admitting diagnosis of
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___________________________________, We assure the patient’s data will be treated with
utmost privacy and confidentiality. We are hoping for a favorable response regarding this matter.
Respectfully yours,
Group Representative
Mobile no.
Noted by: Approved by:
Lennie Anne S. Flores, RN, MN Dr.
Clinical Coordinator Attending Physician
Annaleah M. Caberoy, RN, MAN
Nursing Program Coordinator
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APPENDIX B
PATIENT’S CONSENT
I ______________________________________, _____ years old, resident of
______________________________________________ with the diagnosis of
_________________________________________________ under the care of
____________________________________, do hereby authorize the level __ students of Notre
Dame of Marbel University to conduct a case study with me as their respondent. I allow them to
gather data which will facilitate the conduct of the study with full knowledge and consent.
____________________________________ __________________
Signature over Printed Name Date signed
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APPENDIX C
MEDICAL RECORDS CONSENT
Medical Director
Thru:
Medical Records Section Head
Dear Doctor
Greetings!
We, the Level III Bachelor of Science in Nursing students of Notre Dame of Marbel
University are having our clinical exposure at the Male Surgical ward. To enrich our knowledge
in special areas, we are required to conduct a case study about a particular patient who we had
assisted during exposure in the delivery room of your institution.
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In line with this, we would like to request your permission to allow us to copy pertinent
data in the patient’s chart and to conduct interview with the patient named
_________________________, _____, _____, admitted in _______________________ with an
admitting diagnosis of ______________________________________________. We assure the
patient’s data will be treated with utmost privacy and confidentiality. We are hoping for a
favorable response regarding this matter.
Respectfully yours,
Group Representative
Mobile no.
Noted by:
Lennie Anne S. Flores, RN, MN
Clinical Coordinator
Annaleah M. Caberoy, RN, MAN
Nursing Program Coordinator
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Approved by:
Medical Director
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Appendix D – Activities of Daily Living
Activities on Daily Living
Before
Gordon’s 11 Hospitalization
During Analysis
Functional (6 months
Hospitalization
Pattern prior to
hospitalization)
1. Health
Perception
2. Nutritional
Metabolic
Pattern
3. Elimination
Pattern
4. Activity/
Exercise
Pattern
5. Sleep Pattern
6. Cognitive/
Perceptual
Pattern
7. Self-
perception /
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Self pattern
Concept
8. Role /
Relationship
Pattern
9. Sexual /
Reproductive
Pattern
10. Coping /
Stress
Tolerance
11. Value/Belief
Pattern
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APPENDIX E
Significance
Cranial Nerve Patient’s Response
(Intact/Not Intact)
CN 1: Olfactory
CN 2: Optic
CN 3: Oculomotor
CN 4: Trochlear
CN 5: Trigeminal
CN 6: Abducens
CN 7: Facial
CN 8:
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Vestibulocochlear
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CN 9:
Glossopharyngeal
CN 10: Vagus
CN 11: Spinal
Accessory
CN 12:
Hypoglossal
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Appendix F – Diagnostic Tests and Laboratory Results
Medical Physical Findings (PA)
Skin
HEENT
Chest / Lungs
CVS
Abdomen
GU (IE; Rectal)
Extremities
Neuro Examination
Diagnostic Tests:
Blood Compatibility Test
Blood Compatibility Test
Type Results Remarks Significance
O+
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Laboratory Tests:
1. Urinalysis
Urinalysis Result
Urinalysis
Laboratory
Test ResultNormal ValueInterpretationSignificance
Urine color
Transparency
Reaction (pH)
Specific Gravity
Sugar
Albumin
White Blood Cells
Erythrocytes
Amorphous Urate
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2. Complete Blood Count
Complete Blood Count Result
Complete Blood Count
Laboratory
Result Normal value Interpretation Significance
Test
Hemoglobin
Hematocrit
WBC count
Segmenters
Lymphocytes
Eosinophils
Monocytes
Basophils
Platelet Count
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APPENDIX G
List of Ordered Drugs of Patient X
Date Doctor's order
Drug Study of
Date Ordered
Doctor’s Order
Generic Name
Brand Name
Functional Classification
Pharmacologic Classification
Mode of Action
Indication
Contraindication
Adverse Effects
Rationale for giving the drug to the patient
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APPENDIX H
Date Date
Problem Lists Ranking
Identified Resolved
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APPENDIX I
Patient’sName: Age: Sex:

Chief Complaints: Diagnosis: Date Admitted:
ASSESSMENT NEEDS NURSING BACKGROUND NURSING INTERVENTIONS RATIONALE EVALUATION

CUES DIAGNOSIS INFORMATION OBJECTIVES
Subjective:
Objective:
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256

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JMJ Marist Brothers

Notre Dame of Marbel University

diagnoses worldwide, it represents a common and potentially life-threatening cause of immediate

hypertension (particularly renovascular hypertension), and severe renal disease.

etiologies and triggers resulting in decompensated hemodynamics.

The subacute or acute dysfunction in ADHF overwhelms compensatory mechanisms resulting

symptoms including dyspnea, exercise intolerance, palpitations, presyncope, peripheral edema,

peripheral edema. Signs of end-organ dysfunction secondary to congestion include aforementioned

biomarkers becomes crucial in diagnosing MI accurately.

hypoventilation-related pulmonary artery vasoconstriction. Increases in systemic vascular resistance

decreased baroreceptor activation results in signaling to paradoxically increase peripheral arterial

exacerbations presents a multifaceted clinical landscape. ADHF, characterized by dyspnea and

managing the combined cardiac and pulmonary pathologies.

concurrent lung conditions such as community-acquired pneumonia and exacerbations of chronic

ST elevation myocardial infarction attributed hypertensive cardiovascular disease, acute coronary

Class IV and presents with concurrent moderate-risk community-acquired pneumonia, chronic

obstructive pulmonary disease in acute exacerbation, and likely nutritional-related hypokalemia.

I. Objectives of the Study

chronic obstructive pulmonary disease in acute exacerbation, hyperkalemia probably nutritional.

This research specifically sought to:

hospitalizations, surgery, accidents, immunization status, family history of inheritable health

E. Present the normal anatomy and physiology of the affected organs.

F. Trace the pathophysiology of the final diagnosis

and explain how these medicines work through a pharmacological analysis.

given by the attending physician.

II. Data Base

Birthday: June 19, 1959

Address: Tantangan, South Cotabato

Birth Place: New Lambunao, Tantangan, South Cotabato

Religious Affiliation: Roman Catholic

Language Spoken: Filipino, Hiligaynon

Educational Attainment: Elementary Graduate

Civil Status: Married

Occupation: House Wife

BMI: 22.9 Normal Weight

Annual income: 40, 000

Date and time admitted: September 23, 2023, 10:27 am

Chief complaints: SOB

Initial diagnosis: Bronchial Asthma in Acute Exacerbation Community Acquired

Pneumonia Moderate with Stage ll Uncontrolled Chronic Obstructive

Final diagnosis: Acute Decompensated Congestive Heart Failure Secondary to Acute ST

Elevation Myocardial Infarction Secondary to Hypertensive

Cardiovascular Disease, Acute Coronary Disease, Atrial Fibrillation with

Rapid Ventricular Response, NYHA Class IVE, Community Acquired

Pneumonia Moderate Risk, Chronic Obstructive Pulmonary Disease in

Acute Exacerbation, Hypokalemia Probably Nutritional.

Table 1. Demographic Data of the Patient

III. Nursing History Collection

A. Past and Present Illness

physical pain (referred to as "balda") during his childhood.

he has a medical history of asthma and hypertension.

specific vaccines received before COVID-19 due to difficulties in remembering. Nevertheless, he

two doses of Sinovac during the COVID-19 pandemic.

Family History Reveals risk factors for disease

a. Most recent physical examinations and findings

B. History of the Present Illness

exacerbation, moderate-risk community-acquired pneumonia, uncontrolled stage II hypertension, and

The patient’s current medication

and is used alongside another mentioned medication.

The patient’s allergies

animals fed with synthetic feed, although he occasionally indulges in beef.

The patient’s current health-related practices

chickens, you'll have many friends).