Kidney Injury On Top of CKD Group 06

BATAAN PENINSULA STATE UNIVERSITY
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College of Nursing and Midwifery www.bpsu.edu.ph
City of Balanga, 2100 Bataan cnm_mc@bpsu.edu.ph
ACUTE KIDNEY INJURY ON TOP OF

CHRONIC KIDNEY DISEASE
In Partial Fulfillment of the Course Requirements in

NRCM 0116
Care of Clients with Problems in Nutrition and Gastro-intestinal, Metabolism and Endocrine,
Perception and Coordination, Acute and Chronic
Prepared by:
Group 06
Gonzales, Miguel Victor G.

Griarte, James Ernest L.
Guiao, Mhaecy B.
Guila, Aira Gracelle B.
Iguico, Harrah Mae G.
Infante, Meryll Joyce L.
Inieto, Karl Louie I.
Javier, Nikki B.
Kimpo, Nicole Joy M.
Laborcero, Dayanara Jean D.
Larman, Keiza Gale
Prepared for:
Ronnell Dela Rosa, PhD, DNM, RN, RM, LPT
Sr. Noravien Veldepinas, RN, MAN
Jullie Ann Esconde, RN,MAN
Ruby V. David, RN, MAN
Date Submitted:
June 24, 2023
Our Vision Our Mission

A leading university in the Philippines To develop competitive graduates and empowered community members by
recognized for its proactive contribution to providing relevant, innovative and transformative knowledge, research,
Sustainable Development through equitable and extension and production programs and services through progressive
inclusive programs and services by 2030. enhancement of its human resources capabilities and institutional
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General Objective:
The student nurses will be able to gain a thorough understanding about Acute Kidney
Injury on top of Chronic Kidney Disease throughout the presentation. The goal of this study, which
provides a comprehensive assessment of the disease indicated above, is to:
Specific Objective:
● Gain further understanding and extensive knowledge through collaborating with each
other.
● Understand and practice the proper way to handle a patient with Acute Kidney Injury on
top of Chronic Kidney Disease.
● Acquire comprehensive knowledge regarding the diagnostic procedures to be done and
the medication to be administered to the patient.
● Establish dependent, independent, and collaborative nursing interventions.

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I. INTRODUCTION
Acute kidney injury (AKI), also known as acute renal failure (ARF), is a sudden episode
of kidney failure or kidney damage that happens within a few hours or a few days. AKI causes a
build-up of waste products in your blood and makes it hard for your kidneys to keep the right
balance of fluid in your body. Most cases of AKI are caused by reduced blood flow to the kidneys,
usually in someone who's already unwell with another health condition. This reduced blood flow
could be caused by: low blood volume after bleeding, excessive vomiting or diarrhea, or severe
dehydration. Moreover, Acute Kidney Injury is a rapid decrease in renal function over days to
weeks, causing an accumulation of nitrogenous products in the blood (azotemia) with or without
reduction in the amount of urine output. It often results from inadequate renal perfusion due to
severe trauma, illness, or surgery but is sometimes caused by a rapidly progressive, intrinsic renal
disease. Symptoms may include anorexia, nausea, and vomiting. Seizures and coma may occur if
the condition is untreated. Fluid, electrolyte, and acid-base disorders develop quickly.
Diagnosis is based on laboratory tests of renal function, including serum creatinine.

Urinary indices, urinary sediment examination, and often imaging and other tests (including
sometimes a kidney biopsy) are needed to determine the cause. Treatment is directed at the cause
but also includes fluid and electrolyte management and sometimes dialysis. Dialysis is usually
required to manage the complications of AKI, such as severe and nonresponsive hyperkalemia,
uremic pericarditis, and pulmonary edema. In some cases, AKI may resolve in a couple of days
with fluid and antibiotics. People with kidney disease need to take a smaller amount of antibiotics
than people with healthy kidneys. In other cases, the illness affecting the kidneys and the rest of
the body may be so severe that recovery takes two or three weeks or even longer. Acute kidney
failure can be fatal and requires intensive treatment. However, acute kidney failure may be
reversible. If you're otherwise in good health, you may recover normal or nearly normal kidney
function.
In summary, Acute Kidney Injury (AKI) and chronic kidney disease (CKD) are two distinct
conditions that affect the kidneys, but they differ in terms of their causes, duration, and
progression. Acute kidney injury is a sudden and often reversible loss of kidney function that
occurs over a short period, while chronic kidney disease is a progressive and irreversible decline
in kidney function that develops over months or years. Prompt identification and management of
AKI are crucial to prevent its progression to CKD.
Chronic kidney disease (CKD) refers to a progressive, long-term condition in which the
kidneys gradually lose their function over time. This impairment can lead to a variety of
complications and health problems. CKD is typically characterized by the presence of kidney
damage or a decreased level of kidney function for a period of three months or longer. The five
stages of CKD refer to how well the kidneys are working. Kidney disease can get worse in time.

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In the early stages (Stages 1–3), kidneys are still able to filter waste out of blood. In the later stages
(Stages 4–5), kidneys must work harder to filter your blood and may stop working altogether.
Stage 1 CKD means normal eGFR of 90 or greater and mild damage to kidneys. Stage 2
CKD means eGFR has gone down to between 60 and 89, and has mild damage to kidneys. Stage
3 CKD means having an eGFR between 30 and 59 and mild to moderate damage to the kidneys.
Stage 3 CKD is split into two substages based on your eGFR: Stage 3a means eFGR between 45
and 59 Stage 3b means eGFR between 30 and 44. Stage 4 CKD means you have an eGFR between
15 and 29 and moderate to severe damage to your kidneys. Stage 5 CKD means you have an eGFR
of less than 15 and severe damage to your kidneys.
The causes of CKD can vary, including conditions like diabetes, high blood pressure,
glomerulonephritis, polycystic kidney disease, and other kidney-related disorders. The
management of CKD involves addressing the underlying cause, controlling blood pressure and
blood sugar levels, making dietary modifications, and potentially undergoing dialysis or kidney
transplantation in advanced stages.
CKD often progresses slowly, and in its early stages, it may not exhibit noticeable
symptoms. However, as the condition worsens, various signs and symptoms may manifest.
Common symptoms associated with CKD include constant fatigue, frequent shortness of breath,
unable to focus and often forget things, trouble falling asleep, frequent urination, or experiencing
unusual pressure when passing urine
The early stages of CKD rarely have any symptoms. Therefore, diagnosis is usually made
through health screenings: a urine test to measure the albumin-to-creatinine ratio (ACR) or protein-
creatinine ratio (PCR) and a blood test to determine the estimated glomerular filtration rate
(eGFR). Treatment usually consists of measures to help control signs and symptoms, reduce
complications, and slow the progression of the disease. If kidneys become severely damaged, it
might need treatment for end-stage kidney disease. Kidney disease complications can be
controlled. Medications to high blood pressure, anemia, lower cholesterol levels, and lower protein
diet to minimize waste products in blood. If kidneys can't keep up with waste and fluid clearance
on their own, individuals may develop complete or near-complete kidney failure and have end-
stage kidney disease. At that point, dialysis and kidney transplant may be needed.
STATISTICS
The study conducted by Manuel Gorostidi et al. (2018), found prevalence of CKD was
15.1% (95% CI: 14.3–16.0%). CKD was more common in men (23.1% vs. 7.3% in women),
increased with age (4.8% in 18–44 age group, 17.4% in 45–64 age group.

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A study conducted by William Herrington et al. (2017), 1,405,016 adults aged 20–79 with
mean BMI 27.4kg/m2 (SD 5.6) were followed for 7.5 years. Compared to a BMI of 20 to
<25kg/m2, higher BMI was associated with a progressively increased risk of CKD stages 4–5
(hazard ratio 1.34, 95% CI 1.30–1.38 for BMI 25 to <30kg/m2; 1.94, 1.87–2.01 for BMI 30 to
<35kg/m2; and 3.10, 2.95–3.25 for BMI ≥35kg/m2). This study provides direct evidence that being
overweight increases risk of advanced CKD, that being obese substantially increases such risk.
Strategies to reduce weight among those who are overweight, as well as those who are obese may
reduce CKD risk, with each unit reduction in BMI yielding similar relative reductions in risk.
In 2021, a global report showed that hypertension increases the risk for chronic kidney
disease by 125.2 %, according to Chen et al. While approximately 6% of patients with hypertension
have CKD and are at risk for end stage renal disease, according to Bahrey et al. (2019). While
based on a national survey of Tedla et al. (2011), hypertension occurs for about 35.8% for patients
with CKD stage 1, 48.1% of stage 2, 59.9% of stage 3, and 84.1% of stage 4-5 CKD patients.
Furthermore, in the Philippines, Ona et al. (2021) found out that prevalence of hypertension
increased for about 36% in stage 1 and 84% for chronic kidney disease stage 4 and 5.
Based on the extrapolation report of the National Kidney Institute from data collected since
2016, at least 7 million Filipinos are suffering from chronic kidney disease (CKD) as of 2021, with
one Filipino every hour getting the disease. Data from the Institute for Health Metrics and
Evaluation showed that CKD became the fourth most common cause of death in the Philippines
in 2019 after ischemic heart disease, stroke, and lower respiratory infection. Tuberculosis was
fifth.
Significance of the Study:

Nursing students: As nursing students, it is one of our responsibilities to focus and
develop our learning capability in studying and acquiring knowledge about the illness. Broadening
of our knowledge will enable us to provide better patient care as well as giving the client the health
education they need to know about the significant details of the illness. As future nurses, we always
bear in mind how to provide the best and quality care to them as well as treating them equally and
justifiably. As this will also serve as an opportunity for us to enhance our learnings. Furthermore,
it is our mission to protect our patients by providing them the essential knowledge they have to
obtain as well as the accurate health information and education that will help them avoid the
possible acquisition of any kind of disease.
Community: This study will help the community especially the community’s Rural Health
Unit (RHU) allowing them to provide health information and health education to their people. And
to encourage them to take care of their health by avoiding the risk factors that could trigger the
disease as well as guiding them the proper steps towards the maintenance of their normal health
condition.
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II. Patient's Profile
Name: JR
Age: 54
Sex: Male
Birthday : February 14, 1969
Address: Gabon Abucay, Bataan
Birth Place: Bataan
Race/ Nationality/ Ethnicity: : Filipino
Religion: Catholic
Marital Status: Married
Height: 175 cm
Weight: 85 kgs
BMI: 27.8 (Overweight)
Source of History/ Reliability: Patient and Daughter
Chief Complaint: Epigastric pain x2 days
Date and Time Admitted: May 30, 2023 / 02:19 PM
Final Diagnosis: Acute Kidney Injury on top of Chronic

Kidney Disease
Ward: Medical Ward
Attending Physician: Dr. Danny Joseph Tuazon and Dr. Bryan

Ilagan

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III. PERSONAL SOCIAL HISTORY
A. Nutritional Status
Before Hospitalization During Hospitalization
There are no restrictions on the patient’s When the patient is admitted, there are still
diet. Prior to admission, the patient ate four no dietary restrictions in place, but his
times a day. His typical breakfast consists of eating habits are disturbed because of his
eggs, ham, fish, and rice. He eats a variety hospitalization. He claims that he is unable
of dishes for lunch, but the most common is to eat properly while in the hospital and
meat with rice, occasionally with fish, currently only eats two to three times a day,
vegetables, and fruits. He also eats snacks in with porridge and an egg sandwich as his
between meals. Furthermore, the patient main meals. The patient drinks 6000 ml of
said he does not eat at night and drinks 6000 water per day.
ml of water per day.
The patient weighs around 85 kilograms, while his height is 175 centimeters; this
corresponds to a score of 27.8 in the body mass index, indicating that the patient is
overweight. His height is therefore not proportionate to his weight.
B. Sleeping Pattern (before and after hospitalization)
The patient gets approximately six to eight The patient’s sleeping pattern is disturbed
hours of sleep. Typically goes to bed around due to his environment in the hospital. His
2:00 a.m. due to his binge watching and admission to the hospital bothers him, and
wakes up to void his urine and move his most of the time the patient is restless
bowel but cannot remember the time of because he can only afford to sleep lightly.
occurrence. The patient usually wakes up The duration of sleeping hours only lasts
around between 8:00 and 10:00 in the for two to three hours.
morning.
C. Urine Elimination (before and after hospitalization)
The patient typically voids his urine six to The patient voids his urine seven to ten
eight times per day, and it is transparent in times per day, which is light yellowish in
color. color.

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D. Bowel Elimination (before and after hospitalization)
The patient is able to move his stool three to The patient moves his stool once a day, but
four times a day, with a watery and soft with a lumpy and soft consistency and
consistency and brown in color. brown in color.
E. Social and Economic Status
The patient said he is currently unemployed and lives with his wife and children, a
girl and a boy. He was also the former governor's driver and bodyguard, passed the teacher
licensure exam. His interests include riding motocross bikes since the sixth grade and
visiting the shooting range in Mount Samat. He claimed that his wife supports their
household through her employment at the Land Transportation Office with a salary of
30,000 pesos per month.

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IV. FAMILY HISTORY

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V. PAST MEDICAL HISTORY
a. Previous Health/Medical Disease
● The patient states he does not have any medical condition. In addition, the patient
did not take any medication as maintenance.
b. Previous Hospitalization
● The patient refused to disclose the information regarding his previous

hospitalization due to inability to recall a specific period of time
c. Previous Operation/ Surgery
● The patient underwent circumcision surgery at the age of 11.

● The patient underwent reconstructive surgery such as a Titanium Placement in the
left leg due to a motorcycle accident. The date and location of the said surgery
was not noted.
d. Screening Test
● The patient refused to disclose the information regarding his screening test due to
inability to recall a specific period of time.
e. Previous History of Allergy
● The patient has no previous history of allergy.
f. Immunization Status
● According to the patient he had Immunization such as Influenza (flu) Vaccine,

Pneumonia Vaccine, the exact date cannot be remembered by the patient and
family
● According to the patient he had Covid- 19 Vaccine last 2021, the exact date
cannot be remembered by the patient and family.

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VI. History of Present Illness

Mr. JR, a 54-year-old patient, was brought to Balanga Medical Center Corporation due to
epigastric pain, hyperacidity, and gradual body weakness. According to the patient, he does not
have any medical conditions and medications as maintenance.
The patient reported occasional coughing one week before admission. Additionally, two
days prior to admission, he experienced frequent bowel movements (three to four times), the
characteristic of stool is watery and soft consistency with brown color. The patient mentioned
eating four times a day but skipped dinner, opting only for water. The reason behind this choice
was not further disclosed. One hour before the consultation, he began experiencing gradual body
weakness. Upon admission, he reported non-radiating epigastric pain with a pain scale of 5 out of
10 on which the pain was not associated with nausea or vomiting. The vital signs are also taken
with the temperature of 38.8°C, blood pressure of 130/90 mmHg, pulse rate of 118 bpm, and
respiratory rate of 23 breaths per minute. Furthermore, the patient described his body weakness as,
“Mahina ang katawan bagsak talaga… papatayin ka na lang, ganon pakiramdam ng bumaba ang
potassium”. During his hospitalization, he also reported pain in the upper abdomen and tremors
in his upper extremities. Upon evaluation, Mr. JR exhibited poor skin turgor, clear nasal discharge,
dry lips, and pale gums.
Dr. Danny Joseph Tuazon and Dr. Bryan Ilagan, the attending physicians, ordered several
laboratory tests including Hematology, Urinalysis, Blood chemistry, Radiology, and Ultrasound.
Based on the results of these tests, Dr. Tuazon and Dr. Ilagan diagnosed the patient with acute
kidney injury on top of Chronic Kidney Disease. In addition, the patient also underwent blood
transfusion. Afterwards, a treatment plan was initiated, and the patient was prescribed various
medications including Omeprazole, Rebamipide Mucosta, Kalium durule, Epoetin alfa,
Paracetamol, Cetirizine, Ceftriaxone, Nasaflo, Azitromycin, Folic acid, NAHCO3, Renalog,
Febuxostat, Sevelamer, KCL, Hidrasec, Tolvaptan, Calciumade, Loperamide, Twynsta,
Colchicine.

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VII. PHYSICAL ASSESSMENT
A. General Assessment
Height: 175 cm Weight: 85 kg BMI: 27.8 (overweight)
Vital Signs taken as follows:
12:00 PM Monitoring
· Temperature: 36.2°C
· Blood Pressure: 100/70
· Pulse: 84 bpm
· Respiration: 20 bpm
· O2 Saturation: 98%
Body Part Technique Assessment Interpretation
Skin Inspection Skin color: absence of abnormal NORMAL

discoloration such as
hyperpigmentation and
hypopigmentation;
No skin lesion
Palpation Poor skin turgor, non-edematous Poor skin turgor is common in older
people as the skin gradually loses its
elasticity that results from aging.
Head and Scalp Head is normocephalic, evenly

distributed and lesion, No signs of
Inspection lice or other parasites.
NORMAL

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No tenderness
Palpation
Nails Inspection Smooth, without pits or grooves,

uniform in color and consistency
and free of spots or discoloration.
NORMAL
Palpation Capillary refill is normal ( < 2

seconds)
Eye Inspection Eyes noted with the absence of

discoloration, pupils are round,
(PERRLA) reactive to light and NORMAL
accommodation. There was no
presence of discharges, no swelling
or redness, black and equal in size
Ears are symmetrical, aligned with

eyes’ outer canthus, no discharges
Ears Inspection NORMAL
Nose
External nares Inspection Symmetric and straight, no flaring, NORMAL

uniform in color.
Mucosa Inspection Moist NORMAL
Discharges Inspection Clear discharge was noted. Presence of clear discharge can
indicate allergies or some kind of
environmental factors such as
smoke

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Mouth
Lips Inspection Dry lips A compensatory mechanism: the

body rehydrates the cells by pulling
fluids retained in parts of the body
such as lips, causing it to dry up
Gums Inspection Pale, moist, firm, no retraction Pale gums are related when the body
and bleeding is not getting sufficient oxygen-rich
blood
Tongue Inspection Pink in color, no lesions noted, NORMAL

able to move the tongue freely
and with strength.
Neck
Neck muscles Inspection The client showed coordinated, NORMAL

smooth head movement with no
discomfort.
Lymph nodes Palpation No presence of submandibular NORMAL

lymph nodes is noted
Thyroid glands Palpation Non palpable NORMAL
Thorax and Lungs
Posterior thorax
Contour Inspection Chest symmetrical NORMAL
Thoracic muscles Palpation Patient refused to be examined.

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Auscultation Vesicular breath sounds are NORMAL

noted as low-pitched, soft, and
rustling sounds
Fremitus Palpation Patient refused to be examined.
Anterior Thorax
Thoracic muscles Palpation Patient refused to be examined.
Lateral Thorax Percussion Patient refused to be examined.
Heart Auscultation Regular rate and rhythm, normal NORMAL

S1 and S2 sounds, no murmurs
Abdomen Inspection Patient refused to be examined. The patient refused to be

examined as he reported pain in
the upper abdomen as it
Auscultation Patient refused to be examined. indicates inflammation or
irritation.
Percussion Patient refused to be examined.
Palpation Patient refused to be examined.
Upper Extremities Inspection Upper extremities are atraumatic in Muscle wasting and a slow-to-
appearance without tenderness or fast shift in fiber type
deformity. Extremities are without composition resulting in
swelling or erythema. Full range of weakness and an earlier onset
motion is noted to all joints of the of muscle fatigue. Tremor is
right upper extremity. Presence of common in older adults as a
tremors on left upper extremity. result of aging and
There was no swelling of the degeneration of nerves.
joints.

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Palpation bilaterally equal radial pulses NORMAL
Lower Extremities Inspection The extremities are symmetrical in NORMAL

size and length.
Muscles: The muscles are not

palpable with the absence of
tremors. They are normally firm
and show smooth, coordinated
movements.
Bones: There was no presence of

bone deformities, tenderness and
swelling.
Joints: There was no swelling,
tenderness and joints moved

smoothly.
Palpation Patient refused to be examined.

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VIII. Theoretical Framework
THEORY OF HUMAN CARING
Between 1975 and 1979, Jean Watson worked on the theory of human caring which states
that nursing is concerned with health promotion, disease prevention, caring for the sick, and health
restoration. Caring is an essential part of nursing and promotes health better than simple medical
interventions. She believes that a holistic approach to health care is central to the practice of caring
in nursing.
Additionally, Watson believed that caring in the practice of nursing empowers the patient
in order to attain the highest possible level of health. And that a patient should be viewed as they
are and believe with their potential. Furthermore, Watson also defined three of the four
metaparadigm concepts in nursing, including the person or human being, health, and nursing. She
referred to the human beings as a valued person in and of themselves to be cared for, respected,
nurtured, understood, and assisted; in general, a person’s philosophical view as a fully functional
integrated self. A human is viewed as greater than and different from the sum of his or her parts.
Meanwhile, health is defined as a high level of overall physical, mental, and social functioning, a
general adaptive-maintenance level of daily functioning, the absence of illness, or the presence of
efforts leading to the absence of illness. And nursing is a science of persons and health-illness
experience mediated by professional, personal, scientific, and ethical care interactions. However,
she does not define the fourth metaparadigm concept of the environment but instead devised 10
caring needs specific carative factors critical to the caring human experience that need to be
addressed by nurses with their patients when in a caring role.

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In relation to the patient’s case, encouraging the patient to maintain a well-discipline in

order to prevent occurrence of complications would be the role of the nurse. Nurses are known to
be the patient advocate in terms of health statuses. Thus, acknowleding that he is already 54 years
old, body functions are diminished, with that, health should be taken care of. The patient is viewed
as greater than the sum of its parts and in order to achieve a holistic health, the nurse should assist
the patient with the help of nursing, promotion of health, and aid of carative factors. To sum up,
this theory aids in viewing the patient as a holistic human being greater than the sum of its parts,
nursing with care, promoting health, and using the 10 carative factors.
IX. LABORATORY FINDINGS
Blood Chemistry
DATE COMPONENTS NORMAL RESULT INTERPRETATION

VALUE
May 30, 2023 Uric Acid 4.0 – 7.0 13.1 Elevated uric acid
mg/dL levels indicating an
overproduction or
decreased excretion of
uric acid. It can lead to
the formation of urate
crystals, which can
deposit in joints and
tissues, causing
inflammation and pain.
Low ionized calcium

levels can be
Ionized Calcium 1.05 – 1.30 0.81 accompanied by high
mmol/L phosphorus levels,
which can contribute to
further complications
like vascular
calcification, soft tissue
calcification, and
disturbances in vitamin
D metabolism.

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High Phosphorus
indicating impaired
Phosphorus 2.6 – 4.4 4.7 kidney function as its
(Inorganic) mg/dL ability to excrete excess
phosphorus is
compromised
REMARKS: TESTS DONE TWICE
Blood Chemistry

VALUE
Elevated urea levels

(known as BUN, blood
May 30, 2023 Urea 8 – 23 mg/dL 194.95 urea nitrogen) can also
indicate kidney
dysfunction.
Increased creatinine
levels often indicate
Creatinine 0.8 – 1.4 6.89 impaired kidney
mg/dL function.
SGPT (ALT) 4 – 44 units 34.2 Normal
Elevated SGOT levels

suggest possible
SGOT (AST) 8 – 38 units 54.2 damage or stress to
organs rich in SGOT,
such as the liver, heart,
skeletal muscles, and
kidneys.

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Low sodium levels can

disrupt the balance
Sodium 135 – 145 124.5 between fluids inside
meq/L and outside of cells,
leading to an excess of
water in the cells
(cellular swelling).
This can result in
cellular dysfunction
and affect the overall
fluid balance
throughout the body.
Low potassium level

indicates a slower rate
Potassium (K+) 3.5 – 5.5 3.20 of potassium exchange
meq/L and increase in
residual sodium
composed of
intracellular sodium
and exchangeable
bone sodium.
Urinalysis
DATE COMPONENTS NORMAL RESULT INTERPRETATI

VALUES ON
May 30, Color Variable, Light Normal

2023 pale-yellow yellow
to dark amber
Transparency Clear Slightly This may be related

hazy to presence of
bacteria and
inflammation that
form a suspension in
the urine,
contributing to its
appearance.

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Glucose Negative Negative Normal
Blood Negative Trace Presence of blood in

the urine can occur
due to irritation in
the urinary tract
Bilirubin Negative Negative Normal
Urobilinogen Normal Normal Normal
Ketone Negative Negative Normal
Protein Negative Trace Presence of the

protein in the urine
indicates a leakage of
protein through
kidney's filters and
into urine. It can be a
sign that the kidneys
are damaged.
Nitrate Negative Negative Normal
Leukocytes Negative Negative Negative
pH 4.5 – 8 5.5 Normal
Specific Gravity 1.003 – 1.030 1.025 Normal
RBC 0 – 1 / hpf 2 – 4 / hpf Presence of RBC

indicates damage to
the urinary tract.
WBC 5 - 10 / hpf 5 – 10 /hpf Normal

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Epithelial Cells RARE Normal
Bacteria Few Presence of bacteria

in the urine is an
indication of
infection as the
bacteria is present in
the urinary tract
through urethra and
multiply
REMARKS: Hyaline cast: 0 -1 /hpf
Arterial Blood Gas

VALUE
Normal
May 30, pH 7.35 – 7.45 7.422

2023
Low pCO2 causes a
decrease in carbon
pCO2 35 – 45 18.6 dioxide levels in the
mmHg blood, leading to a
decrease in carbonic
acid formation. This
shift disrupts the
balance of acids and
bases in the body,
resulting in an increase
in blood pH, known as
alkalosis.

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High pO2 levels in the

blood result in
pO2 80 – 100 190.4 increased oxygen
mmHg saturation, which
means a higher amount
of oxygen is bound to
hemoglobin molecules.
High pO2 levels can
promote the
elimination of carbon
dioxide from the body
through increased
ventilation.
Bicarbonate plays a
crucial role in
HCO3 22 – 26 m 11.8 maintaining the acid-
Eq/L base balance in the
body. When HCO3
levels are low, it leads
to an accumulation of
acids in the blood,
causing a decrease in
blood pH.
It indicates a negative
base excess, which
B.E. +/- 2 m Eq/ L -12.6 suggests a deficit of
base (bicarbonate) in
the blood. And a state
of metabolic acidosis
or compensation for
respiratory alkalosis.
O2 STAT 97% 99.40 Normal

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When the body detects

an imbalance in its
CtCo2 12.4 acid-base status, the
respiratory system can
compensate by
increasing ventilation
to eliminate excess
CO2. This
compensatory response
can lead to a low
CtCO2 level.
Radiographic Report
DATE RESULT INTERPRETATION/IMPRESSION
May 30, No active parenchymal infiltrates Atheromatous Aorta

2023 are noted
Heart is not enlarged
Aorta is tortuous and
The hemidiaphragms, sinuses, and

soft tissues are intact
Note of mild rightward curvature of

the thoracic spine

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Ultrasound
DATE INTERPRETATION/IMPRESSION
May 30, 2023 Gallbladder calculi chronic bilateral renal parenchymal disease with a
cyst on the left
Normal sonogram of the liver, pancreas, spleen, urinary bladder and

prostate non dilated biliary tree
Clinical Laboratory

VALUE
May 31, Procalcitonin 0 – 0.5 ng/mL 15.63 ng/mL Elevated procalcitonin

2023 levels are most
associated with
bacterial infections.
When the body detects
the presence of
bacteria, it releases
procalcitonin as part of
the immune response.

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Blood Chemistry

VALUES
Increased creatinine
levels often indicate
May 31, Creatinine 0.8 – 1.4 6.90 impaired kidney
2023 mg/dL function.
Alkaline 104 – 338 265.0 Normal

Phosphatase meq/L
Low sodium levels can

disrupt the balance
Sodium 135 – 145 122.9 between fluids inside
mmol/L and outside of cells,
water in the cells
(cellular swelling).
This can result in
cellular dysfunction
and affect the overall
fluid balance
Low potassium level

indicates a slower rate
Potassium 3.5 – 5.5 meq/L 3.10 of potassium exchange
and increase in
residual sodium
composed of
intracellular sodium
and exchangeable
bone sodium.

mechanism.
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B1B2
Total Bilirubin 0.1 – 1.2 1.4 High total bilirubin

mg/dL levels indicate an
increased production
of bilirubin, impaired
liver function, or an
obstruction in the bile
ducts.
High levels of direct

bilirubin suggest a
Direct Bilirubin 0.1 – 0.4 0.6 problem with the
mg/dL liver's ability to
process and excrete
bilirubin.
Indirect Bilirubin up to 0.8 0.8 Normal

mg/dL
Urinalysis
DATE COMPONENTS NORMAL RESUL INTERPRETATION

VALUES T
June Color Variable, Light Normal

01, pale-yellow yellow
2023 to dark
amber
Transparency Clear Clear Normal

mechanism.
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Blood Negative Trace Presence of blood in the

urine can occur due to
irritation in the urinary
tract
Bilirubin Negative Negative Normal
Urobilinogen Normal Normal Normal
Ketone Negative Negative Normal
Protein Negative Trace Presence of the protein

in the urine indicates a
leakage of protein
through kidney's filters
and into urine. It can be
a sign that the kidneys
are damaged.
Nitrate Negative Negative Normal
Leukocytes Negative Negative Negative
pH 4.5 – 8 7.0 Normal
Specific Gravity 1.003 – 1.015 Normal

1.030

mechanism.
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PUS 4 – 6 /hpf The presence of pus in

the urinalysis indicates
the presence of white
blood cells (WBCs) in
the urine, which is often
a sign of inflammation
or infection in the
urinary tract.
RBC 0 – 1 / hpf 8 – 12 /hpf Presence of RBC

indicates damage to the
urinary tract.
WBC 5 - 10 / hpf 5 – 10 /hpf Normal
Epithelial Cells RARE Normal
Bacteria RARE Normal
Blood Chemistry

VALUE T
June 2. Uric Acid 4.0 – 7.0 5.71 Normal

2023 mg/dL

mechanism.
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Sodium 135 -– 145 131.9 Low sodium levels can

meq/L disrupt the balance
between fluids inside
and outside of cells,
water in the cells
(cellular swelling). This
can result in cellular
dysfunction and affect
the overall fluid balance
Potassium 3.5 – 5.5 3.28 Low potassium level

meq/L indicates a slower rate
of potassium exchange
and increase in residual
sodium composed of
intracellular sodium and
exchangeable bone
sodium.
Hematology

VALUES T
June 02, HGB 14-16 g% 9.6 Low hemoglobin levels

2023 mean there is less
oxygen available for
delivery, resulting in
reduced oxygen
transport to various
parts of the body.

mechanism.
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HCT 42-52 vol % 27 Low hematocrit, there

are fewer red blood
cells available to carry
oxygen throughout the
body. This results in
reduced oxygen-
carrying capacity,
leading to inadequate
oxygen delivery to
tissues and organs.
RBC 5.5 3.23 Low RBC count, blood

becomes less viscous,
which can affect blood
flow. Reduced viscosity
can lead to decreased
resistance to blood
flow, potentially
causing issues such as
low blood pressure and
impaired circulation.
WBC 5000- 6,600 Increased production of

10000/mm3 white blood cells to
fight an infection
DIFFERENTIAL COUNT
Neutrophils 55 - 65 % 75 Elevated neutrophils

result from a bacterial
infection. To combat
the infection, immature
neutrophils leave the
bone marrow too soon
and enter into the
bloodstream.

mechanism.
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Lymphocytes 25-35% 25 Normal
Platelet Count 150000 – 117000 Normal

350000/mm3

mechanism.
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X. ANATOMY AND PHYSIOLOGY
THE URINARY SYSTEM
The urinary system consists of two kidneys, two ureters, a urinary bladder, and a urethra.
This system removes waste products from the blood, maintains the body’s level of water and
electrolytes, and plays critical roles in the body’s homeostatic balance. The kidneys alone perform
the functions just described and manufacture urine in the process, while the other organs of the
urinary system provide temporary storage reservoirs for urine or serve as transportation channels
to carry it from one body region to another. Each individual has two kidneys which is described
as bean-shaped, dark red organ located against the dorsal body wall in a retroperitoneal position
(beneath the parietal peritoneum) in the superior lumbar region; they extend from the T12 to the
L3 vertebra; thus, they receive protection from the lower part of the rib cage. The right kidney is
positioned slightly lower than the left because of the presence of the liver. An adult kidney is about
12 cm (5 inches) long, 6 cm (2.5 inches) wide, and 3 cm (1 inch) thick, about the size of a large
bar of soap. A transparent fibrous capsule encloses each kidney and gives a fresh kidney a
glistening appearance called the fibrous capsule. A fatty mass, the perirenal fat capsule, surrounds
each kidney and acts to cushion it against blows. The renal fascia, the outermost capsule, anchors
the kidney and helps hold it in place against the muscles of the trunk wall. The kidneys are divided
into three regions: the cortex, or outer portion which is light in color; the medulla, or inner portion
mechanism.
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is a darker, reddish-brown area; and the renal pelvis. The medulla has many basically triangular
regions with a striped appearance, the renal, or medullary pyramids; the broader base of each
pyramid faces toward the cortex while its tip, the apex, points toward the inner region of the kidney.
The pyramids are separated by extensions of cortex-like tissue, the renal columns. Medial to the
hilum is a flat, basin like cavity, the renal pelvis, which is continuous with the ureter leaving the
hilum. Extensions of the pelvis, calyces, form cup-shaped areas that enclose the tips of the pyramid
and collect urine, which continuously drains from the tips of the pyramids into the renal pelvis.
The arterial supply of each kidney is the renal artery, which divides into segmental arteries as it
approaches the hilum, and each segmental artery gives off several branches called interlobar
arteries. At the cortex-medulla junction, interlobar arteries give off arcuate arteries, which curve
over the medullary pyramids. Small cortical radiate arteries then branch off the arcuate arteries
and run outward to supply the cortical tissue. Furthermore, each kidney contains over a million
tiny structures called nephrons, which are the functional part of the kidneys that filters the blood
(renal corpuscle), reabsorbs minerals/water and secretes waste (renal tubule), and produces the
substance called urine which will drain down into the ureters, be stored in the bladder, and voided
out via the urethra. Each kidney contains millions of nephrons which are found in the renal cortex
and renal medulla of the kidney. Nephrons consist of the following parts: the renal corpuscle is
responsible for filtration where glomerulus and Bowman’s capsule are located. While the renal
tubule is responsible for reabsorption and secretion where the proximal Convoluted Tubule, Loop
of Henle, Distal Convoluted Tubule are located. The afferent arteriole sends blood to the first part
of the nephron called the Glomerulus. It is a collection of circular capillaries that have extremely
high pressure which help perform ultrafiltration. During this process the blood will be filtered and
filtrate will be created (which is a liquid consisting of the collection of fluid and particles that came
from the blood). These substances will “drip” down into a capsule that surrounds the glomerulus
and Bowman’s capsule (collects the filtrate). Then the newly filtered blood exits via the efferent
arterioles which will go on and form the peritubular capillaries that will surround the nephrons.
The peritubular capillaries on the loop of Henle are known as the vasa recta. The peritubular
capillaries will play a role in carrying the reabsorbed nutrients from the filtrate back into the body’s
system to the renal vein and secreting substances (urea, ions) and drugs found in the blood into the
tubules at certain points. The created filtrate then flows through the proximal convoluted tubule
(PCT) and this tubule reabsorbs most of the parts of the filtrate that we need to survive which just
came from the Bowman’s capsule. Then the filtrate enters into the Loop of Henle (remember it is
found down in the renal medulla). The loop of Henle has a descending limb and ascending limb.
Its goal is to concentrate the urine and it will accomplish this with the renal medulla. The renal
medulla’s interstitial fluid is very hypertonic. This helps reabsorb water from the filtrate to
maintain the body’s water and salt balance. The descending limb is only permeable to water, while
the ascending limb is only permeable to ions. The filtrate then enters in the distal convoluted tubule
where more substances are reabsorbed and secreted. Then it travels to the collecting tubule where
the filtrate is brushed up with the final touches of reabsorption. Then the filtrate leaves the
collecting tubule as urine which again flows through the renal papilla, minor/major calyx, renal
mechanism.
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pelvis, ureters which are two slender tubes each 25 to 30 cm (10 to 12 inches) long and 6 mm (1/4
inch) in diameter, down to the bladder which is a smooth, collapsible, muscular sac that stores
urine temporarily, and urethra which is a thin-walled tube that carries urine by peristalsis from the
bladder to the outside of the body. The female urethra is about 3 to 4 cm (1 1/2 inches) long, and
its external orifice, or opening, lies anteriorly to the vaginal opening. In males, the urethra is
approximately 20 cm (8 inches) long and has three named regions: the prostatic, membranous, and
spongy (penile) urethra; it opens at the tip of the penis after traveling down its length.
Furthermore, the kidneys have hormonal function in regulation of blood pressure, erythropoiesis,
and Vitamin D activation. Red blood cell (RBC) production (erythropoiesis) takes place in the
bone marrow under the control of the hormone erythropoietin (EPO). In addition, it is produced
predominantly by specialized cells called interstitial cells in the kidney. Once it is made, it acts on
red blood cells to protect them against destruction. At the same time, it stimulates stem cells of the
bone marrow to increase the production of red blood cells. Juxtaglomerular cells in the kidney
produce erythropoietin in response to decreased oxygen delivery (as in anemia or hypoxia) or
increased levels of androgens. In addition to erythropoietin, red blood cell production requires
adequate supplies of substrates, mainly iron, vitamin B12, folate, and heme.

mechanism.
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XII. DRUG STUDY
NAME OF MECHANISM DOSAGE INDICATION CONTRA- ADVERSE NURSING

DRUG OF ACTION INDICATION REACTION ALERT
Generic An antisecretory Adult: Omeprazole is

Long-term use CNS: Assessment &
name: compound that 40mg(IV OD) indicated to:
for Headache, Drug Effects
is a gastric acid • Treatment of
gastroesophage dizziness,
Omeprazol pump inhibitor. active al reflux fatigue. Lab tests: - - -
e Suppress gastric duodenal ulcer
disease GI Monitor urinalysis
acid secretion by in adults (GERD), : Diarrhea, for hematuria and
inhibiting the duodenal abdominal proteinuria.
H+, K+-ATPase Classification • Eradication ulcers; proton pain, nausea, Periodic liver
Brand enzyme system of Helicobacter pump mild transient function tests with
Gastrointestin
names: and the acid pylori to inhibitors increases in prolonged use.
al agent,
proton H+ pump reduce the risk (PPIs) liver function
Proton pump
Prilosec in the parietal of duodenal tests. Patient & Family
inhibitor
cells. ulcer Urogenital: Education
recurrence in Hematuria,
adults proteinuria. - Report any
Skin: Rash. changes in urinary
• Maintenance elimination such
of healing of as pain or
EE due to acid- discomfort
mediated associated with
GERD in urination, or
patients 1 year blood in urine.
of age and
older - Report severe
diarrhea; drugs
• Pathologic may need to be
hypersecretory discontinued.
conditions in
adults
Gastro-
esophageal
reflux

mechanism.
MAIN CAMPUS

Generic Indicated for Itching and

name: It suppresses 100g TID gastric ulcer Elderly and skin rash -Monitor for any
gastric mucosal and used as children adverse reaction
Rebamipide injuries by treatment of patients with Nausea and -It should
increasing chronic illness vomiting administer the
gastric mucosal
Brand effects of gastric lesions including drug before
Dizziness meals.
names: mucosal (erosion, cancer.
prostaglandin bleeding, Loss of
Mucosta and protective redness, and Patients with a appetite -Regularly check
effect of gastric edema) in history of the BP
mucosa. It acute gastritis hypersensitivit Bitter or after giving the
increases gastric and acute y to any unusual taste medication
mucosa and Drug exacerbation of ingredient of
blood flow to chronic this drug. Dry mouth -Let the patient
Classificatio
improve n: Anti-ulcer gastritis. verbalize
hemodynamic Blurry vision discomfort after
disorder. It administration
Eye irritation
consequently
suppresses Eye discharge -If transaminase
inflammation levels are marked
and repairs Constipation increased or even
gastric mucosa. rash develop,
Bloating discontinue the
drug.
Diarrhea
Epigastric
pain Heat,
belching
Cold sweat
Feeling short
of breath

mechanism.
MAIN CAMPUS

Generic Principal It is indicated

intracellular 700mg, OD Contraindicate -Stomach -Monitor I&O
name: for the ratio and pattern in
cation; treatment and d with allergy patients
essential for upset receiving the
Kalium prophylaxis of tartrazine,
maintenance of aspirin therapy - Nausea parenteral drug. If
Durule hypokalemia in
intracellular with oliguria occurs,
isotonicity, patients for -Diarrhea
potassium- stop infusion
Brand transmission of whom dietary
sparing promptly
names: nerve management -Vomiting and notify the
impulses, with potassium- diuretics or physician.
-Intestinal
Potassium contraction of rich foods or aldosterone-
Chloride cardiac, diuretic dose inhibiting gas -Lab test: Frequent
Classificatio serum electrolytes
skeletal, and n: reduction are agents, severe
smooth renal are warranted.
Electrolytic insufficient Monitor for and
muscles, and impairment
maintenance of report signs of GI
Water with oliguria, ulceration
normal kidney Balance anuria,
function, and (esophageal or
agent; azotemia, epigastric pain or
for enzyme Replacement
activity. Plays hyperkalemia, hematemesis).
solution acute
a prominent -Monitor patients
role in both dehydration
receiving
formation and heat cramps. parenteral
correction of potassium closely
imbalances in with a cardiac
acid–base monitor.
metabolism. Irregular heartbeat
is usually the
earliest clinical
indication of
hyperkalemia.
-Be alert for
potassium
intoxication

mechanism.
MAIN CAMPUS
NAME MECHANISM DOSAGE INDICATION CONTRA- ADVERSE NURSING

OF OF ACTION INDICATION REACTIO ALERT
DRUG N
Generic Don’t shake the

name: Stimulates the Dosage: To treat anemia Hypersensitivit CNS: vial while
release of 4000 units due to chronic y to epoetin Anxiety, preparing to
Epoetin reticulocytes kidney disease alfa, epoetin asthenia, avoid denaturing
Alfa from the bone Frequency: alfa-epbx, or its CVA, glycoprotein, an
marrow into the 2 times a components; dizziness, inactivating drug.
Brand bloodstream, week pure red cell fatigue,
names: where they aplasia that fever, Know that
develop into Route: began after headache, hemoglobin
Epogen, mature RBCs. Subcutaneou treatment with insomnia, shouldn’t exceed
Eprex s epoetin alfa, paresthesia, 11 g/dl when
(CAN), epoetin alfa- seizures treating anemia
Procrit epbx, or other in patients with
erythropoietin CV: Chest chronic renal
Classificatio pain,
n: protein drugs; failure on
uncontrolled congestive dialysis and 10
Erythropoieti heart failure,
n hypertension; g/dl for patients
use of deep vein not on dialysis.
multidose vials. thrombosis, Exceeding these
edema, parameters
hypertension increases risk of
, MI, life-threatening
tachycardia, adverse
thromboemb cardiovascular
olic events effects.
GI: Monitor patients
Constipation for hypertensive
, diarrhea, or thrombotic
indigestion, complications,
nausea, especially if
vomiting hemoglobin is
approaching the
target goal.
Be aware that
epoetin alfa
shouldn’t be
given to cancer
patients when a
cure is
anticipated
because the drug
may decrease
survival rate and
increase tumor
progression.
Evaluate the
patient’s serum
iron level before
and during
treatment, as
ordered. Expect
to give an iron

mechanism.
MAIN CAMPUS
supplement (I.V.
iron dextran, if
needed) because
iron requirements
rise when
erythropoiesis
consumes
existing iron
stores
Use epoetin alfa

cautiously in
patients who
have conditions
that could
decrease or delay
response to drug,
such as
aluminum
intoxication,
folic acid
deficiency,
hemolysis,
infection,
inflammation,
iron deficiency,
malignant
neoplasm,
osteitis (fibrosa
cystica), or
vitamin B12
deficiency.
Be aware that the

multidose vial of
epoetin contains
benzyl alcohol,
which can cause
a fatal toxic
syndrome in
neonates and
premature infants
characterized by
circulatory, CNS,
renal, and
respiratory
impairment and
metabolic
acidosis.

mechanism.
MAIN CAMPUS

OF OF ACTION INDICATION REACTIO ALERT
DRUG N
Generic Take with food

name: The central Dosage: 300 This drug is Paracetamol is CNS: or milk to
analgesic effect mg/500g/1tb used to treat contraindicated headache minimize GI
Paracetam of paracetamol mild to to patients with: upset.
ol is due to the moderate pain caloric under CV: chest
activation of (from nutrition. Acute pain, This drug is not
Brand descending Frequency: headaches, liver failure. dyspnea for regular use
names: serotonergic PRN (as menstrual Liver problems. with any form of
pathways, it needed) periods, severe renal Skin rashes, liver disease.
Acetamin inhibits toothaches, impairment. a itching or
ophen, prostaglandin backaches, condition where hives Avoid alcohol.
Ifimol synthesis. Fever osteoarthritis, the body is
Route: IV, Swelling of
is reduced by or cold/flu unable to Do not exceed
PO the throat,
paracetamol, aches and maintain the recommended
which affects a tongue or
pains) and to adequate blood dosage.
part of the brain face
reduce fever. flow called
that controls our Classificatio shock. Reduce dosage
Shortness of
body n: Analgesics acetaminophen with hepatic
breath or
temperature (the and overdose. acute impairment.
wheezing
hypothalamic antipyretics inflammation of
heat-regulating the liver due to Skin rash or Avoid using
center). hepatitis C peeling, or multiple
Paracetamol virus. mouth ulcers preparations
relieves mild to containing
moderate pain acetaminophen.
and reduces Carefully check
fever about as all OTC
well as aspirin products.
and ibuprofen,
but it does not Discontinue
reduce drugs if
inflammation. hypersensitivity
reactions occur.

mechanism.
MAIN CAMPUS
NAME MECHANIS DOSAGE INDICATION CONTRA- ADVERSE NURSING

OF M OF INDICATION REACTION ALERT
DRUG ACTION
Generic Cetirizine is a 10mg tab Antihistamines Contraindicated -drowsiness - Closely monitor

Name: second- are designed to with allergy to patients who
generation reduce or block any - dry mouth receive cetirizine
Cetirizine as a
antihistamine histamine, a antihistamines,
- headache premedication for
that works by chemical in hydroxyzine. blood
Brand
selectively Classification your body - fatigue transfusions for
Name:
blocking the s: that’s any signs of an
Aller-tec, action of Antihistamine responsible for - nausea allergic reaction,
such as hives,
Zyrtec, histamine at the ; H1-Receptor hives’ welts-
H1 receptors in like bumps and - dizziness itching, swelling,
Zyrtec-D Antagonist; or difficulty
the body. Non-Sedating itching. - abdominal breathing.
Histamine is a
pain
chemical that is - Do not use in
released by the - diarrhea combination with
body in OTC
response to an antihistamines.
- sore throat
allergic - Avoid alcohol
reaction. When - cough and other
histamine binds sedatives while
-nosebleeds taking cetirizine,
to the H1
receptors, it as these
triggers a substances can
increase the
cascade of drowsiness
events that caused by the
result in the medication.
symptoms of
an allergic - Do not engage
in driving or
reaction, such
other hazardous
as itching, activities, before
swelling, and experiencing
inflammation. your responses to
the drug.
- In rare cases,
cetirizine can
cause an allergic
reaction. If a
patient
experiences
symptoms such
as difficulty
breathing, hives,
or swelling of the
face, lips, tongue,
or throat, they
should seek
medical attention
immediately.

mechanism.
MAIN CAMPUS
NAME MECHANIS DOSAGE INDICATION CONTRA ADVERSE NURSING

DRUG ACTION
Generic Ceftriaxone is 2mg via IV Treatment of Hypersensitivit Body as a - Administer

Name: a 3rd infection of the y to ceftriaxone, Whole: ceftriaxone as
generation q 24 hrs lower other Pruritus, ordered,
Ceftriaxon broad-spectrum respiratory cephalosporins, fever, chills, ensuring proper
e cephalosporin tract, acute or history of pain, dosage, route,
antibiotic. It bacterial otitis severe induration at and frequency.
binds to 1 or media, skin hypersensitivity IM injection
more Classification and skin reaction to any site; phlebitis - Monitor the
Brand
penicillin- s: structure other type of β- (IV site). patient for
Name:
binding infection, UTI, lactam adverse
Rocephin proteins Anti- uncomplicated antibiotic (e.g. GI: Diarrhea, reactions, such
(PBPs) Infective; gonorrhea, penicillins, abdominal as allergic
inhibiting the Antibiotic; pelvic monobactams, cramps, reactions, rash,
final Third- inflammatory carbapenems). pseudomembr fever, or
transpeptidatio Generation disease, anous colitis, diarrhea.
n step of Cephalosporin bacterial biliary sludge.
- Inspect
peptidoglycan septicemia,
Urogenital: injection sites
synthesis in the bone and joint
Genital for induration
bacterial cell infections,
pruritus; and
walls, leading intra-
moniliasis. inflammation.
to bacterial cell abdominal
Rotate sites.
lysis and death. infections,
Note IV
meningitis.
injection sites
for signs of
phlebitis
(redness,
swelling, pain).
- Monitor for
manifestations of
hypersensitivity.
Report their
appearance
promptly and
discontinue the
drug.

mechanism.
MAIN CAMPUS
NAME MECHANIS DOSAGE, INDICATION CONTRA- ADVERSE NURSING

OF M OF ROUTE, INDICATION REACTION ALERT
DRUG ACTION FREQUENC
Y
Generic
name: Decrease in 1 spray per Prevention & Hypersensitivity - Headache - Check the
symptoms of nostril 2x a day treatment of to fluticasone order of the
Nasoflo allergic and allergic - Dryness, physician.
nonallergic rhinitis. stinging,
Brand rhinitis. burning or - Observe the 12
name: irritation in rights.
the nose
Fluticason - Instruct the
e patient to shake
Propionate the bottle gently
Classification: before each use.
Corticosteroids - Instruct the

patient to clear
nostrils before
administering
the medication.
- Educate the
patient if it is
their first time
using it.
- Instruct the
patient to report
adverse reactions
to the
medication.

mechanism.
MAIN CAMPUS
NAME MECHANIS DOSAGE, INDICATION CONTRA- ADVERSE NURSING

OF M OF ROUTE, INDICATION REACTION ALERT
DRUG ACTION FREQUENCY
Generic
name: It prevents Dosage: 500 mg Azithromycin - CNS: - Check the
bacteria from should be used Hypersensitivit fatigue, order of the
Azithromy growing by Route: PO only to treat or y to headache, physician.
cin interfering with prevent azithromycin, dizziness
their protein Frequency: infections that erythromycin, - Observe the 12
Brand synthesis. Once daily are proven or any macrolide CV: chest rights.
name: strongly or ketolide pain,
Classification: palpitations
suspected to be drug. - Assess for
Zithromax Macrolides caused by hypersensitivity
susceptible GI: to azithromycin.
bacteria in abdominal
order to pain, - Administer
prevent the anorexia, after meals.
development of diarrhea,
antimicrobial nausea, - Educate the
resistance and vomiting. patient on the
maintain the side effects of
efficacy of the medication
azithromycin. and what to
expect.
- Instruct the
patient to report
adverse reactions
to the
medication
promptly.

mechanism.
MAIN CAMPUS
NAME OF MECHANIS DOSAGE INDICATION CONTRA- ADVERSE NURSING

DRUG M OF INDICATION REACTION ALERT
ACTION
Generic -Assess for

name: Increase Red Dosage: Folic acid is -Folic acid - fatigue,
Blood Cells, 400mcg indicated for the sensitivity Bronchospas dyspnea,
Folic Acid and platelets treatment of m weakness,
(vitamin B formation in folic acid -Pernicious dyspnea that are
9) megaloblastic deficiency, Anemia -Erythema signs of
anemias. megaloblastic megaloblastic
Brand Elevates the anemia, and in -Renal disease, -Malaise anemia
names: serum iron anemias of renal failure,
concentration nutritional renal -Pruritus
-Assess for
Apo-folic, which then origins, impairment HGB, HCT, and
-Rash
Folate, helps to form pregnancy, reticulocyte
Folvite, high or infancy, or -Slight count.
Novo trapped in the Classificatio childhood. flushing
Folacid, reticuloendoth n: -Assess client
Vitamin B9 elial cells for Vitamin B history for any
storage and complex contraindication
eventual group s.
conversion to
a usable form Water -Assess for
of iron. soluble allergies to folic
Vitamin acid or any
component
Chemical: found in the
N- acyl supplement
amino acid being taken.
-Assess drugs
already being
taken for any
adverse drug
interactions.
- Instruct clients
not to drink
alcohol during
the duration of
folic acid
supplementation
.

mechanism.
MAIN CAMPUS

DRUG M OF INDICATION REACTION ALERT
ACTION
Generic Increase 17 meq Treatment of Hypoventilation - -Monitor vital

Name: plasma NaCHO3 + metabolic , hypocalcemia, Hypernatremi signs and notify
bicarbonate, 17ml SW acidosis; increased serum a the physician of
Sodium which excess promotion of osmolarity, abnormalities.
bicarbonate buffer H ion gastric, further in all -Serum
concentrations: systemic and situations where -Obtain patient
reverse Route: urine sodium intake - history (drug
metabolic IV Drip alkalinization must be Hyperosmolar history and any
acidosis in the case of restricted. ity hypersensitivity)
neutralize intoxication
-Paravenous -Monitor fluid
gastric acids, Classification with weak
organic acids administration balance (input-
which forms :
in order to may lead to output ratio,
water, NaCI, fluids and
improve the tissue weight, edema).
CO2, raises electrolytes
solubility of necrosis.
blood pH
drug -Monitor
substances that manifestations
are poorly of hypokalemia
soluble in and
neutral acid hyponatremia
medium and in
-Report any
the case of
symptoms such
hemolysis
as nausea,
vomiting and
anorexia.

mechanism.
MAIN CAMPUS

Generic Allows the 600mg 2 tab For prevention Hypersensitivity Metabolism - Monitor
name: intake of BID and therapy of to the active and nutrition calcium levels.
essential amino damages due to substances or to disorders:
Alpha acids while faulty or any of the Very rare: - Instruct the
ketoanalog minimizing the deficient excipients. hypercalcaem patient to limit
ue amino-nitrogen protein ia. intake of protein.
intake. metabolism in Hypercalcemia.
- Instruct the
Following chronic renal
Disturbed patient to take
Brand ingestion, the insufficiency.
amino acid Nausea, medication
names: ketoanalogues
metabolism. vomiting, during melas to
are
diarrhea, and allow proper
Renolog transaminated
Classificatio Diabetic abdominal absorption and
by taking
n: nutritional Nephropathy. pain. metabolism into
nitrogen from
or dietary the
non-essential
supplements. corresponding
amino acids,
amino acids.
thereby
decreasing the
formation of
urea by re-using
the amino
group.

mechanism.
MAIN CAMPUS

OF DRUG OF ACTION INDICATION REACTION ALERT
Generic Inhibits 80mg Chronic High uric acid Nausea, - Monitor

name: conversion of management of level in the abdominal laboratory tests
hypoxanthine to hyperuricemia blood. pain, dark such as uric acid
Febuxostat xanthine to uric in adult urine, yellow blood level and
acid; at patients with skin/eyes. liver function
therapeutic gout. tests.
Brand dosages,
decreases - Instruct the
names: Pink/bloody
production of patient not to
urine, painful take azathioprine
Adenuric uric acid
urination. and
without
Classificatio mercaptopurine.
disrupting
n: xanthine
synthesis of
oxidase - Watch out for
vital purines and Increase liver
inhibitors, pink or bloody
pyrimidines enzymes
antigout urine/ or painful
Classification: agentsD urination.
xanthine oxidase
inhibitors,
antigout
agentsD

mechanism.
MAIN CAMPUS

Generic Control of - Assess patient's

name: By binding 800mg OD serum - Vomiting medical history,
phosphate in phosphorus in Hypersensitivity including any
Sevelamer the adults. to sevelamer. Nausea allergies or
gastrointestinal contraindications
Brand tract and - Diarrhea to sevelamer.
names: decreasing Hypophosphate
absorption, Abdominal
mia - Assess the
sevelamer pain
Renagel patient's renal
carbonate function and
Constipation
lowers the Classificatio serum phosphate
phosphate n: levels to
concentration in Phosphate determine the
the serum. Binders appropriate
dosage and
monitoring
requirements.
- Monitor the
patient for any
signs of
gastrointestinal
side effects, such
as nausea,
vomiting, or
constipation.
- Evaluate the
patient's response
to sevelamer,
including any
improvements in
phosphate control

mechanism.
MAIN CAMPUS

DRUG M OF INDICATION REACTIO ALERT
ACTION N
Generic
name: Potassium 600 mg Potassium Potassium Hyperkalemi - Monitor I&O
chloride tablets chloride tablets Chloride is a ratio and pattern
KCL work by TID are widely used contraindicated in patients
delivering a to treat or in hyperkalemic Bradycardia receiving the drug.
Brand source of prevent patients because If oliguria occurs,
names: potassium, a hypokalemia, an increase in Ventricular notify the
vital electrolyte or low serum potassium Fibrillation physician.
K-Tab that aids in the potassium content can
healthy Asystole
levels in the cause cardiac - Monitor patients
functioning of Classificatio body. arrest. receiving
Fatigue
the body's n: potassium closely
cells, neurons, Nausea with cardiac
and muscles. Electrolyte Muscle monitors.
The pills supplement weakness or Vomiting Irregular heartbeat
dissolve in the cramps: is usually the
stomach, Potassium Diarrhea earliest clinical
allowing chloride pills indication of
potassium ions may be advised Flatulence hyperkalemia.
to be absorbed to restore
and used by the potassium - The risk of
body to balance in cases hyperkalemia with
maintain fluid of muscle potassium
balance, weakness or supplement
promote heart cramps caused increases (1) in
function, and by low older adults
facilitate nerve potassium because of
impulses. levels. decremental
changes in kidney
Potassium function
chloride pills associated with
can be used to aging, (2) when
supplement a dietary intake of
diet deficient in potassium
potassium-rich suddenly
foods, increases, and (3)
guaranteeing an when kidney
adequate intake function is
of this significantly
electrolyte. compromised.

mechanism.
MAIN CAMPUS

DRUG ACTION
Generic General - Store at room

name: Racecadotril is 100 mg/cap Indication: Hypersensitivity Nervous temperature away
an Treatment of to the active system from moisture and
Racecadot antisecretory Route: PO acute diarrhea substance or to disorders: heat. Do not allow
ril agent with a in adults. any of the the liquid
different Frequency: excipients. Common: medicine to
Brand mechanism of TID PC Patient’s Patients who headache. freeze.
names: action from meals Indication: have reported
existing Treatment for angioedema Skin and - Instruct the
antidiarrheal Availability/ subcutaneou
Hidrasec acute diarrhea with angiotensin patient to increase
agents. It Form: s tissue
converting intake of food
functions by Capsule disorders:
enzyme with fiber
selective inhibitors (such Uncommon:
inhibition of as captopril, rash, - Advise patient to
the enzyme enalapril, erythema. eat mild foods,
Classificatio
neutral n: lisinopril, such as rice, dry
endopeptidase Infections
Antidiarrheal perindopril, toast or crackers
(also known as and
agent ramipril) should and bananas and
enkephalinase), infestations:
not take to eat several
a cell Uncommon:
racecadotril. small meals
membrane tonsillitis.
instead of two or
peptidase three large ones.
Skin and
enzyme found
subcutaneou
most - Advise patient to
s tissue
commonly on keep drinking the
disorders:
the epithelium prescribed water
Uncommon:
of the small intake
rash,
intestine.
erythema.
- Keep rooms
well-ventilated. If
possible, to
promotes easier
breathing

mechanism.
MAIN CAMPUS

DRUG ACTION
Generic Treatment of Assess

name: Tolvaptan is a ½ tablet after symptomatic Patients with Nausea,
Tolvaptan competitive meals and resistant to autosomal vomiting, - Vital signs
antagonist at fluid restriction dominant constipation
Brand vasopressin V2 euvolemic or polycystic - Weight
headache,
names: receptors. Its hypervolemic kidney disease
confusion, - Hydration status
Samsca major action is hyponatremia
in the renal Unable to sense insomnia,
- Dehydration
Classifica collecting ducts or respond to increased
tion: to reduce water thirst thirst, - Enema, fluid
vasopressi reabsorption Hypovolemic injection site overload
n V2 and produce hyponatremia reactions,
receptor aquaresis Taking strong - Signs of hypo-
hypokalemia, or hypernatremia
antagonist without sodium CYP3A
loss, thus hypomagnese
s inhibitors
increasing free mia, Monitor
water clearance hyponatremia
and correcting - Intake, output,
dilutional weight, vital signs
hyponatremia. hydration status,
serum osmolality,
sodium, BUN,
and creatinine
Side effects
- Therapeutic
response: fluid
and electrolyte
balance
- Monitor for
weight loss,
tachycardia, and
hypotension. If
clinically
significant
dehydration or
hypovolemia
occurs,
discontinue or
interrupt tolvaptan
therapy and
provide
supportive care
with careful
management of
vital signs and
fluid and

mechanism.
MAIN CAMPUS
electrolyte
balance
- Avoid fluid
restriction during
the first 24 hours
of tolvaptan
therapy as this
may increase the
possibility of
rapid correction
of serum sodium.

mechanism.
MAIN CAMPUS

OF OF ACTION INDICATION REACTION ALERT
DRUG
Generic -known
name: Calciumade 1 tablet This medicine hypersensitivity Hives, - Monitor
Calciuma provides bone contains a or allergy to any hemodynamics
de and joint care combination of of its Difficulty
because it has Calcium, components; Breathing, - May causes
Brand high levels of Frequency: Vitamin D, -hypercalcemia hypotension,
names: elemental Magnesium, and Swelling Of bradycardia, and
calcium 2x a day The Face,
Bayer Zinc, and hypercalciuria; arrhythmias
Womens, carbonate that Manganese -kidney failure Lips,
Cal Gest, helps strengthen which are or severe renal Tongue, Or - Hypercalcemia
Chooz, bones, Vitamin nutrients known disease. Throat, can increase risk
Diphen, D3 for better to help protect for digoxin
calcium Nausea,
Duo against toxicity
Fusion, absorption, and osteoporosis Vomiting, • Instruct pt on
Healthy minerals Classificatio and promote foods that contain
Mama (magnesium, n: optimum bone Loss Of Vitamin D and
zinc, and Vitamins & health. A Appetite, encourage
manganese) that Minerals medicine to adequate intake
help in making help maintain Unusual
joints flexible. optimum bone Weight Loss, - Monitor
function and parathyroid
reduce the risk Mental Or hormone
of osteoporosis Mood
later in life. Changes,
Bone Or
Muscle Pain

mechanism.
MAIN CAMPUS

DRUG
Generic is indicated for The Patient - Instruct patients

name: Loperamide Dosage: the control and who should Diarrhea to report to the
Loperami acts by slowing symptomatic not take That Is physician or
de intestinal 4 mg relief of Loperamide is Watery Or nurses if
motility and by acute the one with Bloody, experiencing side
Brand affecting water nonspecific bloody diarrhea effects
names: and electrolyte diarrhea in and diarrhea Stomach Pain
Diamode, movement patients 2 years with a high fever Or Bloating, - Store at room
Imodium, through the of age and older temperature away
Imodium bowel. and of chronic Ongoing Or from moisture
Multi- Loperamide Worsening
Classificatio diarrhea in Diarrhea,
and heat. Do not
symptom binds to the n: adults allow the liquid
Relief opiate receptor Antidiarrheal associated with medicine to
in the gut wall. Fast Or
s inflammatory freeze.
Pounding
Classifica Consequently, bowel disease.
it inhibits the Heartbeats,
tion: it is also - Instruct the
Antidiarrh release of indicated for Fluttering In patient to
eals acetylcholine reducing the increase intake of
Your Chest,
and volume of food with fiber
prostaglandins, discharge from Shortness Of
thereby ileostomies. Breath, And - Advise patient
reducing to eat mild foods,
propulsive Lightheadedn such as rice, dry
peristalsis, and ess toast or crackers
increasing and bananas and
intestinal transit to eat several
time. small meals
Loperamide instead of two or
increases the three large ones.
tone of the anal
sphincter, - Advise patient
thereby to keep drinking
reducing the prescribed
incontinence water intake
and urgency.
- Keep rooms
well-ventilated. If
possible, to
promotes easier
breathing

mechanism.
MAIN CAMPUS

DRUG
Generic Indicated for Contraindicated - Administer oral

name: Colchicine 0.6 mg PO prophylaxis of to patients with Diarrhea drugs with milk
binds to gout flares in renal or food to reduce
Colchicin tubulin, a once a day adults. impairment nausea possibility of GI
e protein upset.
involved in cramping
Brand microtubule - Assess if the
assembly. By abdominal
names: patient has an
binding to pain
allergy before
Mitigare tubulin, administering
vomiting
colchicine Classificatio medication
disrupts the n: rash
polymerization Antigout - Monitor for
of microtubules agents itching/swelli adverse effects.
and destabilizes ng (especially
existing of the - Monitor for
microtubule face/tongue/t early signs of
structures. This hroat) colchicine
impairs various toxicity.
cellular severe
processes, dizziness - Monitor I&O
including the ratio and pattern
migration of (during acute
neutrophils to gout attack):
the site of
inflammation.

mechanism.
MAIN CAMPUS

Generic Twynsta is a Hypertensio Treatment of Hypersensitivity CV: Assessment &

name: calcium n mild to to amlodipine Palpitations, Drug Effects
channel moderate flushing
Adult:
Telmisarta blocking agent hypertension - Monitor BP for
PO 5–10 mg tachycardia,
n- that selectively therapeutic
Amlodipin blocks calcium once daily peripheral or effectiveness. BP
e ion reflux facial edema, reduction is
across cell bradycardia, greatest after peak
membranes of chest pain levels of
cardiac and Classificatio amlodipine are
Brand vascular n: CNS: Light- achieved 6–9 h
names: smooth muscle Angiotensin following oral
headedness,
without II receptor doses.
Twynsta changing serum fatigue,
blockers.
calcium headache. - Monitor BP with
concentrations. postural changes.
It GI: Report postural
predominantly Abdominal hypotension.
acts on the pain, nausea, Monitor more
peripheral frequently when
anorexia,
circulation, additional
decreasing constipation, antihypertensives
peripheral dyspepsia, or diuretics are
vascular diarrhea, added.
resistance, and flatulence,
increases vomiting. - Monitor heart
cardiac output. rate; dose-related
palpitations
Respiratory:
Dyspnea. Patient & Family
Skin: Education
Flushing,
rash. - Report
Other: significant
swelling of face or
cramps,
extremities.
- Take care to
have support
when standing &
walking due to
possible dose-
related light-
headedness/dizzin
ess.
- Report shortness
of breath,
palpitations,
irregular
heartbeat, nausea,
or constipation to
physician.

mechanism.
MAIN CAMPUS
XIII. NURSING CARE PLANS
ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION

DIAGNOSIS
Altered tissue Independent: Goal Met.

Objective Data: perfusion related Short Term:
to insufficient - Monitor blood -Vital sign
Decreased level of hemoglobin and After 2 days of pressure, heart rate, monitoring
the ff: hematocrit as nursing respiratory rate, and helps assess
evidence by intervention, oxygen saturation. the patient's
- Hgb: 9.2 (14- body weakness, the patient will Continuously hemodynamic
16g%) fatigue and pale demonstrate monitor status and
-Hct: 26 (42- gums the absence of hemoglobin and response to
52vol%) body hematocrit levels. interventions.
- RBC: 3.14 (5.5) weakness, Regularly
fatigue and monitoring
- Body weakness pale gums, and laboratory
patient's rbc, values
- Fatigue hemoglobin provides
and hematocrit objective data
- Pale gums
levels will be on the patient's
within the blood
range as per composition,
lab values. allowing for
timely
adjustments to
the care plan.
-Administer -Supplemental
supplemental oxygen can
oxygen as help increase
prescribed to the amount of
optimize tissue oxygen
oxygenation. available to
tissues,
enhancing
tissue
perfusion and
alleviating
symptoms of
tissue hypoxia.
-Encourage the -Resting and

patient to rest and conserving
limit physical energy reduce
exertion. Provide metabolic
opportunities for demands,
adequate sleep and allowing the
rest periods. body to
prioritize
oxygen
delivery to
vital organs
and tissues,
thus improving

mechanism.
MAIN CAMPUS
tissue
perfusion.
-Encourage the -Physical

patient to engage in activity and
appropriate mobility
physical activity exercises
and mobility promote blood
exercises within circulation,
their capabilities. increase
oxygen
delivery to
tissues, and
enhance
overall tissue
perfusion.
Dependent
- Administer blood -Blood

transfusions or transfusions
medications such as can help
iron supplements or increase the
erythropoietin as oxygen-
doctors ordered. carrying
capacity of the
blood,
improving
tissue
perfusion.
Medications
like iron
supplements or
erythropoietin
can stimulate
red blood cell
production,
addressing the
underlying
cause of tissue
perfusion
alteration.
Health Teachings:
-Provide education -Patient and

on the importance family
of adherence to education
prescribed improves
medications, understanding,
maintaining a compliance
healthy lifestyle, with the care
and recognizing plan, and early
signs of worsening recognition of
tissue perfusion. symptoms
requiring
prompt
medical
attention.
mechanism.
MAIN CAMPUS
Assessment Nursing Planning Nursing Rationale Evaluation

Diagnosis Intervention
Subjective Fluid and Short Term: Independent: - Symptoms such Goal met if after
Data: Electrolyte as weakness or 3 hours of
Imbalance After 3 hours of - Identify headache may nursing
“Mahina ang related to Nursing causes that associate intervention, the
katawan basak decreased levels intervention the associates with electrolyte patient is able to
talaga… of potassium and patient will be able electrolyte imbalance. Early identify the risks
papatayin ka na sodium as to: imbalance intervention may and engage in
lang, ganon evidenced by reduce risk of appropriate
pakiramdam ng - Identify
body weakness electrolyte behaviors or
bumaba ang individual risks
and fatigue imbalances. lifestyle changes
potassium” as and engage in
to prevent or
verbalized. appropriate -Regular
- Weigh patient reduce the
behaviors or monitoring of
daily frequency of
lifestyle changes to patient’s weight electrolyte
prevent or reduce will indicate if
Objective Data: imbalances.
the frequency of there is fluid
electrolyte volume excess
Decreased level
imbalances which could
of the ff:
- Na: 122.9 cause changes in
mmol/L (135- electrolyte levels
- Assess the Goal partially
145 mmol/L)
level of met
- The client is
- K: 3.10 consciousness
After 3 day of usually
mmol/L (3.5 – and After 3 days of
5.5 mmol/L) nursing conscious and
neuromuscular nursing
intervention the alert; however,
function, intervention, the
- Body weakness patient will be able including muscular
patient did not
to: paresthesia,
- Tremors sensation, fully maintain
weakness, and
strength, and changes in
- Fatigue -Patient will flaccid paralysis
movement potassium and
maintain normal may occur.
sodium levels
potassium and -Assess color
- Monitoring
sodium levels. and amount of
urine output
urine; report
helps assess
urine output
renal function
less than 30
and adequacy of
ml/hr for two
fluid
consecutive
replacement.
hours.
Urine output
below 30 ml/hr
may indicate
inadequate fluid
volume.
Dependent:
- Used to replace
- Administer deficits in the
medications, as presence of

mechanism.
MAIN CAMPUS
indicated by the chronic or

doctor ( sodium ongoing losses
chloride, and Used to
potassium correct
chloride) potassium
deficit,
especially during
diuretic therapy.
-If patients’
-Supplement
electrolyte levels
electrolyte
are low
levels as
additional
appropriate and
supplements may
as ordered by
be needed orally
the healthcare
or intravenously
provider.
to maintain
appropriate
levels,
administer these
as ordered by the
Health healthcare
Education: provider.
- Educate the - Electrolytes are

patient about salts and
dietary sources minerals, like
of electrolytes. sodium,
potassium,
calcium,
magnesium, and
chloride, in the
body that
maintain fluid
balance and
blood pressure.
A balanced diet
provides the
patient with
sources of
electrolytes to
prevent
imbalances.
- Educate
patient about -Enough
possible causes knowledge aids
and effects of the patient in
fluid loss or taking part in
decreased fluid their plan of
intake. care.

mechanism.
MAIN CAMPUS
ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATIO

DIAGNOSIS N
Subjective Data: Short Term Independent: Short Term

“Wala nga akong gana Imbalanced Goal: Goal:
kumain kapag andito nutrition: less Encourage the A soft food diet
ko sa hospital” as than body After 3 hours patient to eat at refers to food Goal met if
verbalized. requirements of nursing least a soft meal that is soft in After 3 hours of
related to interventions, diet for nutrition texture, low in nursing
insufficient the patient intake. fiber and easy intervention, the
Objective Data: dietary intake will make to digest. patient regained
as evidenced appropriate his usual
by poor food Seasoning may appetite and was
● Decreased appetite and selections to Consider at least improve the able to eat
food intake decreased maintain mild seasoning for flavor of the independently.
food intake nutrition and patients with foods and
● Weak in to regain changes in their enhance
appearance appetite. sense of taste, if not appetite and Goal partially
contraindicated. attract eating. met
● Fatigue
Patients who After 3 hours of
Modify the diet by consider a good intervention the
suggesting to diet lessen the patient is still
consider fish, complications trying to regain
chicken breast, and of any diseases. his appetite into
low-fat soy its normal state.
products as well as
low-fat dairy
products. Maintaining a
healthy level of
Offer a moderate nutrition and
fluid intake as hydration can
limited to the help to prevent
prescribed amount or treat illness
to boost up the and symptoms
body regularites. and improve
treatment
outcomes for
patients.
Education will
Health Education: help the patient
to become more
Educate the patient independent
on the importance upon discharge
of maintaining a and will help
proper nutrition them to
status regularly. understand
what they can
do to prevent
further episodes
of dehydration.

mechanism.
MAIN CAMPUS
Inadequate
Dependent: nutrition
patients may
Administer require IV
intravenous hydration,
hydration, enteral enteral and
and parenteral parenteral
nutrition and feeding to
electrolyte sustain
replacement/s as adequate
ordered by the nutrition.
physician.
Various
Complete a medications can
medication affect appetite
reconciliation. or alter
Include over-the- absorption and
counter metabolism.
medications, herbal Some
supplements, and medications’
vitamins. side effects
may act as
appetite
stimulants, and
others might
cause a
decrease in
appetite.
Interdependent:
Collaborate with
the dietitian to
develop a balanced The dietitian
diet plan that meets can determine
the patient’s the patient’s
nutritional needs daily caloric
while considering and nutritional
fluid restrictions, if requirements to
applicable. maintain weight
and maintain an
ideal nutrition.

mechanism.
MAIN CAMPUS
Assessment Nursing Planning Nursing Rationale Evaluation

Diagnosis Intervention
Subjective Data: Acute pain Short Term Independent: Short Term

related to
“Sumasakit excess After 3 hours of Assess the Pain being Goal met.
talaga ang tiyan cholesterol in nursing whole perceived may
ko” as verbalized the bile. As intervention, abdomen: not only be
evidenced by perceived pain document the manifested in
Pain Scale: scaled at 5/10 will quality, gastritis and may
presence of
gallbladder be reduced to 3/10 duration, and or may not
5 /10
calculi, (minimal) location of coincide with
Objective Data: guarding pain. another health
behavior and condition.
● Guarding Long Term
weak in Long Term
behavior Asking about
appearance Goal met.
● Weak in the aggravating
After 3 days of
Appearanc factors can
nursing Ask the patient
e provide
intervention, the about the
● Presence information on
patient will aggravating and
Gallbladde possible triggers
experience relief alleviating
r calculi that can worsen
from pain. factors.
abdominal pain.
Abdominal pain
may be relieved
with a specific
Assist to a position that
position of promotes
comfort. comfort. A knee-
to-chest or side-
lying position
tends to decrease
the intensity of
abdominal pain.
Hot compress
allows dilation
Apply hot of blood vessels
compress on and relaxation of
the area of contracted
abdomen where muscles,
pain is being reducing pain
felt, as desired
These methods
are used to
provide comfort
Provide by altering
nonpharmacolo psychological
gic pain

mechanism.
MAIN CAMPUS
management. responses to
Such as guided pain.
imagery,distract
ion, and
eliciting the
relaxation
response.
Dependent: Ensuring
appropriate
Administer
dosage and
prescribed pain
monitoring for
medication as
any side effects.
ordered
Health
Education: Educating
patients about
Educate the
medication usage
patient about
promotes safe
the importance
and appropriate
of following the
pain
prescribed
management.
instructions of
the medication.

mechanism.
MAIN CAMPUS
Assessment Nursing Planning Implementatio Rationale Evaluation

Diagnosis n
Subjective data: Disturbed sleep Short-term goal: Independent Goal unmet if after
“Hindi ako pattern related After 2 days of nursing 2 days of nursing
makatulog kapag to hospital nursing function: intervention, the
nasa ospital ako, confinement as intervention, the patient is not able
pumipikit lang ako evidenced by patient will be able Determine the To provide a to have an
pero hindi ako irritability, to have an patient’s baseline on how improved sleep
makatulog” as fatigability, and improved sleep sleeping pattern to improve the experience as
verbalized body weakness. experience as before patient’s sleep. evidenced by
evidenced by hospitalization. rested appearance,
Objective data: rested appearance, verbalization of
verbalization of Sleeping in feeling rested, and
- Irritable feeling rested, and Instruct the daytime improvement in
- fatigability improvement in patient to increases the sleep pattern.
- Body weakness sleep pattern. expend more likelihood of
energy during having
the day. difficulty
sleeping at night
time.
Help the patient

understand the Misconceptions
main cause of and myths about
sleeping sleep exist.
difficulties. Wrong notions
about sleep
disturbances
may cause fear
and anxiety.
Discourage
intake of Caffeine blocks
caffeine 2 hours sleep-promoting
before bedtime. receptors in the
brain called
adenosine
receptors.
Minimize
environmental Dim light,
distractions taking warm
and/or baths, and
introduce listening to slow
relaxing music can help
activities such in aiding sleep.
as listening to
music and
taking warm
baths.
Offer tea to This can help

help induce the body to feel
sleep. calm and
relaxed.
Instruct the Excessive

patient to weight may
maintain a result in daytime
reasonable fatigue and sleep

mechanism.
MAIN CAMPUS
weight. apnea.
Instruct the
patient to Frequent
minimize fluid voiding can
intake before disrupt the
bedtime. timing of sleep.
Render bedtime
nursing care
such as back These kinds of
rub and other activities
relaxation facilitate
techniques. relaxation and
promote the
Place the onset of sleep.
patient in a
room away The nursing
from any station is often
distraction or the center of
noise such as noise and
the nursing activity.
station.
Dependent
nursing
function:
Administer Melatonin,
medications antihistamines,
that can induce sedative-
sleep as antihypnotics,
prescribed by anti-anxiety
the physician. drugs, induce
sleep.

mechanism.
MAIN CAMPUS
ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION

DIAGNOSIS
Deficient Short-term Independent: Short-term

Subjective data: knowledge goal: The patient goal:
related to lack of After 2 hours Consider the patient brings to the
“Marami ako information of nursing learning style to learning Goal met.
kumain parang about his intervention, determine situation a
piyesta kasi samin, medical the patient will appropriate nursing unique After 1 hour of
madalas naman ako condition as be able to approach personality, nursing
evidenced by verbalize food established intervention, the
uminom ng tubig
careless eating and water social patient will be
isang gallon.” as habits and BMI intake interaction able to verbalize
verbalized. of 27.8 restrictions patterns, cultural food and water
regarding his norms and intake
Objective data: medical values. restrictions
condition. regarding his
BMI: 27.8 - Provide thorough Patients are medical
overweight and understandable better able to ask condition.
explanations and questions when
demonstrations. they have basic
information
about what to
expect.
Teaching portion It also allows for

control helps better control of
individuals caloric intake
understand and helps
appropriate serving individuals
sizes. develop a
healthier
relationship with
food.
Encourage To determine if
questions and the patient was
evaluation of able to
understanding understand the
required dietary
and fluid intake
regarding his
condition.
Encourage patient Eating low-

to make healthy sodium,
food and fluid phosphorous,
selection based on and protein
their food foods helps
preferences. manage kidney
disease and slow
kidney damage
by preventing
mineral buildup.

mechanism.
MAIN CAMPUS
ASSESSMENT NURSING PLANNING INTERVENTIO RATIONALE EVALUATIO

DIAGNOSIS N N
Subjective Data: Short Term Independent: Short Term

“Nagpapaalalay lang Risk for fall Goal: Goal:
ako papunta sa cr” as related to -Assess and -Regular
verbalized. electrolytes After 2 hours monitor the assessment of Goal met if
imbalance as of nursing patient's gait and gait and balance After 3 hours of
evidence by intervention, balance regularly helps detect any nursing
Objective Data: unsteady gait the client will to identify any changes or intervention, the
verbalize changes or deterioration patient regained
understanding detorioration. that may his usual
Decrease level of the of fall increase fall appetite and
following: prevention risk. Early was able to eat
strategies and identification independently.
Potassium chloride: activity allows for
3.10 mmol /L engaged in prompt
(Normal value:3.5 - their intervention and Goal partially
5.5 ) implimentatio reduces the met
n. chances of falls.
Sodium chloride: After 3 hours of
124.5mmol/L Long Term -Conduct a -Identifying and intervention the
(normal value: 135- Goal: thorough addressing patient is still
145) assessment of the environmental trying to regain
After 3 days patient's hazards reduces his appetite into
of nursing environment to the risk of falls. its normal state.
intervention, identify and A thorough
the client will address any assessment
demonstrate potential fall allows for the
improved hazards, such as implementation
balance and poor lighting. of appropriate
stability while interventions to
walking and create a safe
the clients environment for
potassium the patient.
level will be
within the
range (as per -Encourage -Patients at risk
lab values) patients to call for for falls should
assistance when be encouraged
needing to get out to seek
of bed or move assistance to
around, rather minimize the
than attempting to risk of injury.
do so Encouraging
independently. them to call for
assistance
promotes a
safety-
conscious
mindset and
reduces the
likelihood of
falls due to
attempts at
independent
movement.
-Teach the -Teaching

mechanism.
MAIN CAMPUS
patients proper proper body

body mechanics mechanics and
and safe safe techniques
techniques for for transferring
transferring or or moving helps
moving one the patient
position to maintain
another. stability and
minimize the
risk of falls.
This knowledge
empowers the
patient to
perform
movements
safely and
reduces the
strain on
muscles and
joints.
-Engage the -Regular

patient in regular mobility
mobility exercise exercises and
and encourage physical activity
them to engage in help improve
physical activity muscle strength,
within the balance, and
capabilities. coordination.
Engaging in
appropriate
physical activity
within the
patient's
capabilities
promotes
overall physical
well-being and
Dependent reduces the risk
Nursing of falls.
Function:
-Administer -Helps restore

potassium and maintain
chloride and the normal
sodium chloride range of
as per doctor’s potassium and
order. sodium in the
body
Interdependent
Nursing
Function:
-Collaborate with -Collaborating

the healthcare with the
mechanism.
MAIN CAMPUS
team to monitor healthcare team

and manage the ensures a
patient's comprehensive
potassium levels approach to
through dietary managing
modifications or potassium
medication levels. Regular
adjustments. monitoring
helps maintain
potassium
within the
appropriate
range, which in
turn supports
optimal muscle
function and
reduces fall
Health risk.
Education:
-Educate the -Educating the

patient and their patient and their
family members family members
about the about the
importance of relationship
maintaining between
adequate potassium
potassium levels levels, balance,
and potential and muscle
impact on balance function helps
and muscle promote
function. understanding
and motivation
to maintain
optimal
potassium
levels. This
knowledge can
encourage
adherence to
dietary
modifications or
medications
aimed at
managing
potassium
levels.

mechanism.
MAIN CAMPUS
REFERENCES:
7M Filipinos have chronic kidney disease as of 2021. (2023, June 2). Republic of the Philippines,
Philippines News Agency. https://www.pna.gov.ph/articles/1202791
American Kidney Fund. (2023). Stages of kidney disease. American Kidney Fund.
https://www.kidneyfund.org/all-about-kidneys/stages-kidney-disease
Bsn, G. W., RN. (2023). Knowledge Deficit & Patient Education Nursing Care Plan and
Management. Nurseslabs. https://nurseslabs.com/deficient-knowledge/
Chen, A., Zou, M., Young, C. M., Zhu, W., Chiu, H., Jin, G., & Tian, L. (2021). Disease Burden
of Chronic Kidney Disease Due to Hypertension From 1990 to 2019: A Global Analysis.
Frontiers in Medicine, 8. https://doi.org/10.3389/fmed.2021.690487
Chronic kidney disease - Diagnosis and treatment - Mayo Clinic. (2021, September 3).
https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/diagnosis-
treatment/drc-20354527
Gorostidi, M., Sánchez-Martínez, M., Ruilope, L. M., Graciani, A., De La Cruz, J. J., Santamaria,
R., Del Pino, M. D. S., Guallar-Castillón, P., De Álvaro, F., Rodríguez-Artalejo, F., &
Banegas, J. R. (2018). Chronic kidney disease in Spain: Prevalence and impact of
accumulation of cardiovascular risk factors. Nefrología, 38(6), 606–615.
https://doi.org/10.1016/j.nefroe.2018.04.010
Kidney Disease Symptoms. (n.d.). My Kidney Journey. https://apac.mykidneyjourney.com/en-
PH/chronic-kidney-
disease/symptoms?utm_source=SEM&utm_medium=CPC&utm_campaign=PH_SEM_2
023&utm_content=Signs-Symptoms_RSA&gclid=Cj0KCQjw4s-kBhDqARIsAN-
ipH0WoUH3DKabMaXbLZSIkI2tWtd016P2SZM5E-
sawqDyNYWDysXej0oaAgtBEALw_wcB
Malkina, A. (2023, June 21). Acute Kidney Injury (AKI). MSD Manual Professional Edition.
https://www.msdmanuals.com/professional/genitourinary-disorders/acute-kidney-
injury/acute-kidney-injury-aki
Nursing, O. R. F. (n.d.). 14.3 Applying the Nursing Process. Pressbooks.
https://wtcs.pressbooks.pub/nursingfundamentals/chapter/14-3-applying-the-nursing-
process/

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Ona, D. I. D., Jimeno, C., Jasul, G. V., Bunyi, M. L. E., Oliva, R. V., Gonzalez-Santos, L. E.,
Mercado-Asis, L. B., Luz, V. A., Leus, A. G., Diaz, A. A., Santos, M., Belen, A., Bonzon,
D. D., Bote-Nunez, J., Cawed-Mende, R. M. N., Chua, A. S., Javier, A. M. J. T., Juangco,
D. N. A., Madrigal-Dy, C., . . . Villanueva, N. J. (2021). Executive summary of the 2020
clinical practice guidelines for the management of hypertension in the Philippines. Journal
of Clinical Hypertension, 23(9), 1637–1650. https://doi.org/10.1111/jch.14335
Tadesse, D. B., Gebremedhn, G., Mariye, T., Girmay, A., Aberhe, W., Hika, A., Teklay, G., Tasew,
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chronic kidney disease among adult hypertensive patients in Tigray teaching hospitals: a
cross-sectional study. BMC Research Notes, 12(1). https://doi.org/10.1186/s13104-019-
4610-8
Tedla, F., Brar, A., Browne, R. F. J., & Brown, C. M. (2011). Hypertension in Chronic Kidney
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https://www.nhs.uk/conditions/acute-kidney-injury/

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Kidney Injury On Top of CKD Group 06

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BATAAN PENINSULA STATE UNIVERSITY

ACUTE KIDNEY INJURY ON TOP OF

In Partial Fulfillment of the Course Requirements in

Gonzales, Miguel Victor G.

Our Vision Our Mission

Our Vision Our Mission

Diagnosis is based on laboratory tests of renal function, including serum creatinine.

Our Vision Our Mission

Our Vision Our Mission

Significance of the Study:

II. Patient's Profile

Birthday : February 14, 1969

Address: Gabon Abucay, Bataan

Birth Place: Bataan

Race/ Nationality/ Ethnicity: : Filipino

Marital Status: Married

BMI: 27.8 (Overweight)

Source of History/ Reliability: Patient and Daughter

Chief Complaint: Epigastric pain x2 days

Date and Time Admitted: May 30, 2023 / 02:19 PM

Final Diagnosis: Acute Kidney Injury on top of Chronic

Ward: Medical Ward

Attending Physician: Dr. Danny Joseph Tuazon and Dr. Bryan

Our Vision Our Mission

III. PERSONAL SOCIAL HISTORY

Before Hospitalization During Hospitalization

B. Sleeping Pattern (before and after hospitalization)

Before Hospitalization During Hospitalization

C. Urine Elimination (before and after hospitalization)

Before Hospitalization During Hospitalization

Our Vision Our Mission

D. Bowel Elimination (before and after hospitalization)

Before Hospitalization During Hospitalization

E. Social and Economic Status

Our Vision Our Mission

IV. FAMILY HISTORY

Our Vision Our Mission

V. PAST MEDICAL HISTORY

a. Previous Health/Medical Disease

● The patient refused to disclose the information regarding his previous

c. Previous Operation/ Surgery

● The patient underwent circumcision surgery at the age of 11.

e. Previous History of Allergy

● The patient has no previous history of allergy.

● According to the patient he had Immunization such as Influenza (flu) Vaccine,

Our Vision Our Mission

VI. History of Present Illness

Our Vision Our Mission

VII. PHYSICAL ASSESSMENT

Height: 175 cm Weight: 85 kg BMI: 27.8 (overweight)

Vital Signs taken as follows:

· Blood Pressure: 100/70

Body Part Technique Assessment Interpretation

Skin Inspection Skin color: absence of abnormal NORMAL

Head and Scalp Head is normocephalic, evenly

Our Vision Our Mission

Nails Inspection Smooth, without pits or grooves,

Palpation Capillary refill is normal ( < 2

Eye Inspection Eyes noted with the absence of

Ears are symmetrical, aligned with

External nares Inspection Symmetric and straight, no flaring, NORMAL

Mucosa Inspection Moist NORMAL

Our Vision Our Mission