Drug Study And Ncp

Date

Lab Test

Normal Value

Patients Values

Significance

October 01, 2009

Hemoglobin

11 - 16 g/dL

15.5 (Normal)

Hematocrit

37 - 47 %

47.3 (H)

WBC

4.5 - 11 10g/L

6.39 (Normal)

The increase number of hematocrit is due to low oxygen level in the blood No alteration to the normal value of the results

Platelet

150-450 10g/L

176 (Normal)

No alteration to the normal value of the results

No alteration to the normal value of the results

Nursing Care Informed patient’s watcher to provide the patient with nutritious foods. Advice patient to increase food intake rich in vitamin B12 Informed patient’s watcher to provide the patient with nutritious foods. Informed patient’s watcher to provide the patient with nutritious foods.

Generic Name/ Trade Name/ Form of Medication

Lanoxin (Digoxin) Tablet

Date Ordered

October 01, 2009

Classific a-tion

Cardiac Drug Antiarryth -mic Inotropic

Dosage And Frequen cy

0.25mg 1 Tab OD 6AM

Mechanism Of Action

Indication

Digoxin increases Cardiac Failure the strength and accompanied by vigor of heart atrial contraction and is fibrillation; useful in the management of treatment of heart chronic cardiac failure. It inhibits failure where the activity of an systolic ezyme that dysfunction or controls ventricular movement of dilatation is calcium, sodium dominant; and potassium management of into heart certain muscles. Calcium supraventricucontrols the force Lar arrythmias, of contraction, particularly inhibiting ATPase chronic atrial increases calcium flatter and in heart muscle fibrillation. and therefore increases the force of heart

Contraindication

Adverse Reaction

Nursing Responsiblity

In patients with hypersensitivi ty to the drug or any of its components and in those with Digoxin induced toxicities, ventricular fibrillation or ventricular tachycardia unless by heart failure. Used to patient with MI.

CNS: Agitation, Dizziness, Fatigue, Generalized muscle weakness, hallucinations, headache, malaise, paresthesia, vertigo CV: Arrythmias, heart failure, EENT: Blurred vision, myopia, light flashes, photophobia, GI: Anorexia, diarrhea, nausea and vomiting

>Before loading dose, obtain baseline heart rate and rhythm, blood pressure and electrolyte levels. >Instruct patient and care giver about drug action, dosage regimen, pulse taking, reportable signs and follow-up plans. > Instruct patient not to substitute 1 brand of digoxin for another. > Intruct patient to eat K reach food.

contractions. Spironolactone (Aldactone) Tablet

Octiober 01, 2009

Diuretic

25 mg ½ Tab OD 6 AM

Specific pharmacologic antagonist of aldosterone, acting primarily through competitive binding of receptors at the aldosteronedependent Na-K exchange site in the distal convoluted renal tubule. It causes increased amounts of Na and water to be excreted, while K is retained. It acts both as a diuretic and as an antihypertensiv e drug by this mechanism.

Aldactone is indicated to patients having hyperaldosteron ism, edema, congestive heart failure, cirrhosis of the liver, nephritic syndrome, hypertension, hypokalemia

Aldactone is contraindicate d for patients with anuria, acute renal insufficiency, significant impairment of renal excretory function, or hyperkalemia.

GI: Gastric bleeding, ulceration, gastritis, diarrhea, cramping, nausea & vomiting GU: impotence CNS: Confusion, ataxia, headache, drowsiness, lethargy Metabolic: dehydration,hyp erkalemia, hyponatremia, mild acidosis

> Monitor vital signs as well as intake and output > to prevent serious hyperkalemia, warn patient not to eat large amounts of potassium – containign salt substitutes > Tell patient to take drug with meals

Cefuroxime (Zegen) Capsule

Octiober 01, 2009

Cephalosporin

500 mg 1 Tab BID 8-8

Inhibits cellwall synthesis, promoting osmotic instability; usually bactericidal. Hinders or kills susceptible bacteria, including many gram-positive organisms and enteric gramnegative bacilli.

Treatment of bone & joint infections, bronchitis (& other lower resp tract infections), gonorrhea, meningitis, otitis media, peritonitis, pharyngitis, sinusitis, skin infections, surgical infections & UTI.

Known allergy to cephalosporin s.

Thrombophlebit is. Pruritus, urticaria, diarrhea, nausea, pseudomembra nous colitis. Decrease in Hb & hematocrit, transient increase in liver enzymes, elevation in serum creatinine & BUN. Possibly seizure & angioedema.

>Advice the patient to take meals before taking the medication >Tell the patient to report adverse reaction >Advice the patient to increase fluid intake

Nursing Problem: Shortness of Breath

Date Identified: October 2, 2009

Assessmen Diagnosi t s

Inferenc e

Planning

Interventi on

SUBJECTIVE “Naglisud ko ug ginhawa,murag mawad-an gyud ko ug hangin” as verbalized by the patient.

Heart failure refers to the inability of the heart to maintain cardiac output sufficient to meet the body’s metabolic needs or if adequate cardiac output can only be achieved with elevated filling pressures. This definition also includes the inability of the heart

After 8 hours of duty patient will be able to demonstrate adequate ventilation and be free of symptoms of respiratory distress.

Independent Instruct patient ineffective coughing, deep breathing.

Objective: -Restlessness -Chest pain Shallow,labored breathing -Orthopnea -Vital Signs taken as follows: T: 37°C PR: 84bpm

Impaired Gas Exchange related to decreased tissue perfusion

Encourage frequent position changes. Maintain chair/bedrest, with head of bed elevated 20–30 degrees, semiFowler’s position. Support arms with pillows. Collaborative

Date Evaluated: October 2, 2009

Rationale Clears airways and facilitates oxygen delivery.

Helps prevent atelectasis and pneumonia.

Reduces oxygen consumption/demand s and promotes Maximal lung inflation.

Evaluatio n Goal Unmet Patient was not able to demonstrate adequate ventilation and symptoms of respiratory distress are still present.

R: 26cpm BP: 130/90 mmHg

to clear venous return, resulting in vascular congestion and a secondary drop in cardiac output. Heart failure commonly leads to pulmonary congestion and or peripheral edema, at which point it can be called a Congestive Heart Failure.

Administer supplemental oxygen as indicated.

Increases alveolar oxygen concentration, which may Correct/reduce tissue hypoxemia.

Administer medications as indicated: Aldactone

Reduces alveolar congestion, enhancing gas exchange.

Nursing Problem: Chest Pain

Date Identified: October 2, 2009

Assessmen t

Diagnos is

Inferenc e

Plannin g

SUBJECTIVE DATA: “Sakit akong dughan if muginhawa ko ug kana pod kong naa ko buhaton nga manginahanglan ug kusog” as verbalized by the patient.

Decreased Cardiac Output related to altered myocardial contractility and/or structural changes

Heart failure refers to the inability of the heart to maintain cardiac output sufficient to meet the body’s metabolic needs or if adequate cardiac output can only be achieved with elevated filling pressures. This definition also includes the inability of

After 8 hours of duty patient will be able to display vital signs within acceptable limits, report decreased episodes of dyspnea, angina. Participate in activities that reduce cardiac workload.

OBJECTIVE DATA: -Chest Pain -Orthopnea -Tachycardia -Restlessness -Vital signs taken as follows T: 37°C PR: 84bpm R: 26cpm BP: 130/90

Interventi on Independent Auscultate apical pulse; assess heart rate, rhythm (document dysrhythmia if telemetry available).

Date Evaluated: October 2, 2009

Rationale

Evaluation

Monitor BP.

Goal Partially Met Patient was able to participate in activities that reduce cardiac workload but was not able to display vital In early, moderate, or signs within chronic HF, BP may acceptable be elevated limits and report because of increased decreased SVR. In advanced HF, episodes of the body may dyspnea,angina no longer be able to . compensate, and profound/irreversible hypotension may occur.

Encourage rest, semirecumbent in bed or chair. Assist

Physical rest should be maintained during acute or refractory HF to

Tachycardia is usually present (even at rest) to compensate for decreased ventricular contractility.

mmHg

the heart to clear venous return, resulting in vascular congestion and a secondary drop in cardiac output. Heart failure commonly leads to pulmonary congestion and or peripheral edema, at which point it can be called a Congestive Heart Failure.

with physical care as indicated.

improve efficiency of cardiac contraction and to decrease myocardial oxygen demand/consumption and workload.

Provide quiet environment; explain medical/nursing management; help patient avoid stressful situations; listen/respond to expressions of feelings/fears.

Psychological rest helps reduce emotional stress, which can produce vasoconstriction, elevating BP and increasing heart rate/work.

Collaborative Administer supplemental oxygen as indicated.

Increases available oxygen for myocardial uptake to combat effects of hypoxia/ischemia.

Nursing Problem: Unable to tolerate physical activities

Date Identified: October 2, 2009

Assessmen Diagnosis Inference t

Planning

Intervention

SUBJECTIVE “Kapoyan ko magtindog or bisan maglakaw lang sa palibot,luya lang gyud kayo ko kadto kausa nakuyapan gyud ko” as verbalized by the patient.

After 8 hours of duty patient will be able to participate in desired activities; meet own self-care needs and achieve measurable increase in activity tolerance, evidenced by reduced fatigue and weakness

Independent Check vital signs before and immediately after activity, especially if patient is receiving vasodilators, diuretics, or beta-blockers.

OBJECTIVE -Fatigue -Weakness -Restlessness -Fainting episodes -Vital signs taken as

Activity Intolerance related to imbalance between oxygen supply and demand

Heart failure refers to the inability of the heart to maintain cardiac output sufficient to meet the body’s metabolic needs or if adequate cardiac output can only be achieved with elevated filling pressures. This definition also includes

Document cardiopulmonary response to activity. Note tachycardia, dysrhythmias, dyspnea, diaphoresis, pallor.

Date Evaluated: October 2, 2009

Rationale

Evaluation

Orthostatic hypotension can occur with activity because of medication effect (vasodilation), fluid shifts (diuresis), or compromised cardiac pumping function.

Goal Partially Met Patient was able to participate in desired activities but didn’t achieve an increase in activity tolerance.

Compromised myocardium/inability to increase stroke volume during activity may cause an immediate increase in heart rate and oxygen demands, thereby aggravating weakness and fatigue.

follows T: 37°C PR: 84bpm R: 26cpm BP: 130/90 mmHg

the inability of the heart to clear venous return, resulting in vascular congestion and a secondary drop in cardiac output. Heart failure commonly leads to pulmonary congestion and or peripheral edema, at which point it can be called a Congestive Heart Failure.

Assess for other precipitators/causes of fatigue, e.g., treatments, pain, medications.

Fatigue is a side effect of some medications (e.g., betablockers, tranquilizers, and sedatives). Pain and stressful regimens also extract energy and produce fatigue.

Evaluate accelerating activity intolerance.

May denote increasing cardiac decompensation rather than overactivity.

Provide assistance with self-care activities as indicated. Intersperse activity periods with rest periods.

Meets patient’s personal care needs without undue myocardial stress/excessive oxygen demand. Strengthens and improves cardiac function under stress, if cardiac dysfunction is not irreversible.

Collaborative

Implement graded cardiac Gradual increase rehabilitation/activity in activity avoids program. excessive myocardial workload and oxygen consumption.