dm type 2 case pres
TRANSCRIPT
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Diabetes Mellitus
Type 2
TABLE OF CONTENTS
I. Introduction
II. Patient¶s Profile
III. Past history
IV. Present history
V. Family history
VI. Social history
VII. Theoretical framework
VIII. Activities of daily living
IX. Physical assessment
X. Laboratories
XI.
Anatomy and physiology XII. Pathophysiology
XIII. Nursing care plan
XIV. Drug studies
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I. INTRODUCTION
Description
Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels
that result from defects in insulin secretion, or action, or both. In patients with diabetes, the absence or
insufficient production of insulin causes hyperglycemia. Diabetes is a chronic medical condition, meaning that
although it can be controlled, it lasts a lifetime.
Diabetes mellitus type 2 or type 2 diabetes (formerly called non-insulin-dependent diabetes mellitus
(NIDDM), or adult-onset diabetes) is a disorder that is characterized by high blood glucose in the context of
insulin resistance and relative insulin deficiency.
Over time, diabetes can lead to blindness, kidney failure, and nerve damage. These types of damage
are the result of damage to small vessels, referred to as microvascular disease. Diabetes is also an important
factor in accelerating the hardening and narrowing of the arteries (atherosclerosis), leading to strokes,
coronary heart disease, and other large blood vessel diseases.
There are an estimated 23.6 million people in the U.S. (7.8% of the population) with diabetes with
17.9 million being diagnosed, 90% of whom are type 2. With prevalence rates doubling between 1990 and
2005, CDC has characterized the increase as an epidemic.
Philippines is still low on this score compared with other countries, especially Scandinavian nations
like Finland, Sweden, and Norway, but we are also seeing an increase every year. Moreover, mathematical
modeling on projection yields that 380 million people are expected to develop diabetes by 2025 based on
International Diabetes Federation/World Health Organization data, a good percentage will be coming from
Southeast Asian countries, including the Philippines. This finding is no longer astonishing considering the
latest statistics on Filipinos afflicted with diabetes and hypertension which continues to increase on the scale
of medical records. This goes to show that statistics on Diabetes Mellitus in the Philippines continues to be
unfavorable to the general population because of the continuous rise in the number of Filipinos developing
diabetes every year which adds to the number of people who cannot enjoy life and are becoming less
productive due to this disease.
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By 2025, most people with diabetes will be in aged 65 years or more, while in developing countries
most will be in the aged 45 to 65 years range and it's affected in their most productive years", WHO deplores.
In Southern Asia, diabetes is considered as one of the top 10 causes of death. In the Philippines, diabetes
claims at least 5,000 lives each year. The Department of Health (DOH) reports that diabetes mortality rate in
the total population has increased by 92% over 10-year period.
Unknowingly, many Filipinos who are afflicted with diabetes do not know the early signs of the disease and
even don't know if they have the disease already . "Many of the patients die because it is already too late to
remedy the situations, " many doctor says. "A doctor cannot tell that to complain and usually that is already
late as far as complications are concerned. This disease has no cure. What doctors can do is just onset a little
later because the disease is more manageable among older people.
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II. Patient¶s Profile
Patients name: Mrs. AV
Age: 56 yrs old
Sex: Female
Marital Status: Married
Occupation: Buy and sell of vinegar
Address: Gabon Abucay Bataan
Birthday: June 23, 1955
Birthplace: Paompong, Bulacan
Nationality: Filipino
Religion: Roman Catholic
Name of father: Mr. FV
Name of mother: MrsBV
Admission date: July 18, 2011
Time of admission: 12:20 AM
Attending physician: Dr. Mallari
Chief Complaint: DOB
Admitting diagnosis: Pulmonary Congestion, DM type 2, Nephropathy, HPN
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III. Past History
Mrs. A.V. was born on June 23, 1955 via normal spontaneous home delivery assisted by a ³hilot´. The patient
claimed that she had completed all immunizations in her childhood, those immunization were administered by
their health center personnel. The Health center is their family¶s main health care service when she was
growing up She also stated that she has a history of measles and mumps she also had fever , colds, diarrhea
during childhood. She had taken OTC drug in order to relieve her diseases. Mrs. A.V. is a multipara, having
four children, all born alive and well via normal spontaneous delivery at Bataan Doctors Hospital. The patient
was diagnosed of (Type II) DM last 2001. Before her DM diagnosis, Mrs A.V described her symptoms as
being hungry a lot of times, always thirsty. This made her gain weight. She was also waking up at night to
urinate and this sometimes disrupts her sleep . What she did was she stopped drinking a lot of fluid few hours
before she sleeps so she can avoid waking up. She has been admitted in the hospital several times because of
loss of consciousness. She stated that ever since she was diagnosed of DM she was going back and forth in thehospital. She described it as sometimes weekly at the worst and sometimes once a month. This was from
2001 to 2009. From 2010 and till 2011, this was her 1st
visit to the hospital. The patient underwent an
operation last 2007 due to her ingrown oh her left foot at Bataan Doctors Hospital on with her surgeon, Dr.
Sampang. Besides her ingrown incidence, she didn¶t have anymore operations. She has no known allergies.
Mrs. A.V doesn¶t eat seafood but not because she is allergic but she doesn¶t like the taste of it. She has a
maintenance drug Glibenclamide but she doesn¶t take it because she thinks that if she doesn¶t have the
symptoms she don¶t need the medication. Patient didn¶t have any injuries growing up. Patient used to drink
when she was single but stopped when she got married. The patient used to smoke for ten years after her
youngest was born. She says that it relaxes her. Mrs A.V used to work in the morning as an exercise, she say
that they would go by the seas side and walk as early as in the morning. But this stopped because of her illness. Now she considers cleaning the house as an exercise.
IV. Present History
Three days to admission, the patient experienced difficulty of breathing, hyperventilation, and chest
pain. This prompted her to seek medical assistance. Prior to consultation, she has self-administered
Salbutamol nebulization but then, symptoms persist. Mrs. A.V. was rushed in the emergency room on July 20,
2011 at 12:20 AM. During the initial assessment, her first vital signs were the following: BP190/100mmHg,
T- 34.60C, PR 112-bpm, RR 35-bpm. She has an admitting diagnosis of Pulmonary Congestion, Diabetes
Mellitus, nephropathy and Hypertension and her admitting physician was Dr. Malixi. Upon admission, several
laboratory tests were requested to help diagnose the patient such as BUN, creatinine, cholesterol,
triglycerides, HDL, LDL, and CBC.
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V. Family History
Grandfather
36 y/o,dead
(Diabetes)
Grandfather
Dead,
(CVA)
Father
Dead
HPN
CVA,
dead
A & W A & WA & W
Grandmother
Dead,
Breast
Grandmother
Dead
HPN
Mother
83 y/o
Diabete
s A & W
Diabete
s
Patien
A.VDiabe
tes
Dia
bet
Female
Male
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VI. Personal-Social History
Mrs. A.V. is a 56 years old, working as a businesswoman. She buys and sells vinegar from Bulacan. Prior to
this business, she used to work in Abu Dhabi as a cook from 1992 to 1996. She also used to buy and sell fruits
before working in Abu Dhabi.
In her business, the patient travel back and forth from Bataan to Bulacan. For leisure, the patient plays
bingo with her neighbors.
Mrs. A.V.¶s husband died last July 2, 2011 so she is still depressed about it. Her husband died with
CVA. She talk to her children regarding his feelings, also one of her children is now living with her with the
company of her children¶s family. Patient has 4 grandchildren. The patient has no pet. She used to have 2
dogs but she sold them because of foul smell. Mrs. A.V. finished high school and then started a business.
Currently, the patient is receiving money from her children, one from abroad and one from the Philippines.
She stated that the money that she is receiving is enough for her daily expenses including medication. Mrs
A.V also talks to her brothers and sisters ad they help her do things in the house. She also accompanies her to
wherever she goes. The patient states that her friends are also her neighbors. The patient considers her self as
an average level of economic status. She states that her earning are fairly enough for her.
Mrs. A. V considers herself to be religious but stated that couldn¶t go to church every sunday due to
her business. The patient can do fairly everything for herself. She cooks, cleans and washes her clothes. But
due to her physical condition right now, the patients couldn¶t do all those. Now, her daughter in law helps her
to do the basic chores in the house.
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VII. Theoretical Framework
Self-Care Deficit Theory of Nursing
By: Dorothea Orem
Self-care is an activity that promotes a person¶s well-being. It is performed by persons who are aware
of the time frames on behalf of maintaining life, continuing personal development and a healthy functionalliving.
Self-care requisites are insights of actions or requirements that a person must be able to meet and
perform in order to achieve well-being. These are reasons for any actions of self-care that must be undertaken.The two elements of self-care requisites are: The factor to be controlled or managed to keep as aspect(s) of
human functioning and development within the norms compatible with life, health, and personal well-beingand the nature of the required action.
These are universally set goals that must be undertaken in order for an individual to function. In scopeof a healthy living. The eight self-care requisites common in men, women, and children are as follows:
Maintenance of a sufficient intake of air, maintenance of a sufficient intake of food, maintenance of a
sufficient intake of water, provision of care associated with elimination, maintenance of balance between
activity and rest, maintenance of balance between solitude and social interaction, prevention of hazards to
human life, human functioning and human well-being, and promotion of human functioning and development.
Self care deficit of Orem is specifies when nursing is needed. Nursing is required when an adult (or in the case
of a dependent, the parent) is incapable or limited in the provision of continuous effective self care. Orem
identifies 5 methods of helping: Acting for and doing for others, guiding others, supporting another, providing
an environment promoting personal development in relation to meet future demands, teaching another
In relation to our client¶s case, our client needs a lot of care, since we know that she is suffering in her
problem which is nephropathy secondary to diabetes mellitus. Before hospitalization she was able to carry out
activities of daily living but during hospitalization she became dependent to nurse and to her daughter in law
in able to meet her needs. She doesn¶t take it because she thinks that if she doesn¶t have the symptoms she
doesn¶t need the medication. Being a health care provider to our client we must guide, support, provide and
teach her to achieve well-being. We help our client to establish or identify the ways to perform self-care
activities. She also needs to have good elimination and urination. Maintenance of balance between activities
and rest and avoid hazards to human life, human functioning, and human well-being.
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VIII. Activities of Daily living
Before Hospitalization During Hospitalization (day1)
Nutrition The patient eats 3 times a day. Sheusually eats 1-2 cups of rice and redmeat. She likes soft drinks too. The
patient doesn¶t like eating fish. Sheusually prepares her food by herself.
Don¶t like snacks and vegetables.
The patient doesn¶t eat much. Thismorning she have half cup of riceand some viand. At lunch she had ½
of siopao. She had biscuits for snacks. Her daughter in law assisted
her in preparing her foods.
Elimination The patient has normal bowel
movement without changes inconsistency and shape. She also had
good urine output of 4 to 5 times aday.
The patient has an IFC. The color of
her urine is amber and odor isammonia like.Her output is350cc for
5hours.
Hygiene The patient takes a bath 2 times aday. She takes a bath in the afternoon
after cleaning her house and an hour before sleeping. The patient practices
good hygiene.
The patient hasn¶t take a bath yet.She only washed her face this
morning with the help of her daughter in law.
Rest and sleep
a) Routine
b.)Sleeping
pattern
The patient goes to bed around 9 pm
and wake up around 4 am.Sometimes she wakes in the middle
of the night having DOB. She takessome naps in the afternoon for at
least 2 hours.
The patient has an altered sleep
pattern. She doesnt sleep well due
to the noise inside the hospital. Also
She wakes up in the middle of the
night due to DOB . She takes naps
once in a while during the day.
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IX. Assessment
PHYSICAL ASSESSMENT
Findings Analysis
Initial V/S are as follows :
BP- 190/100
Temp- 34.6
PR- 112
RR- 35
Hypertensive
Afebrile
Tachycardic , full and bounding pulse
Tachypneic
General Status : conscious , coherent
SHEENT : (-) pallor , pale conjunctiva
Chest : (+) retractions
Abdomen : (-) tenderness on all quadrants
Extremities : (-) gross deformities
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July 18, 2011 Monday 5:00 PM
BODY PART EXAMINED TECHNIQUE USED ACTUAL FINDINGS INTERPRETATION
/ANALYSIS
SKIN
Color
Lesions
Moisture
Edema
Skin turgur
HAIR
Quality
Texture and oiliness
Prescense of parasites
SCALP
NAIL
Fingernail and toenail
bed color
Capillary refill
HEAD
Skull and face
Inspection
Inspection
Palpation
Palpation
Inspection
Palpation
Inspection
Palpation
Inspection
Inspection
Palpation
Inspection
Inspection
Palpation
Inspection
Inspection
Palpation
Inspection
Evenly colored skin tones
without unusual or
prominent discolorations
Birth marks are flat and soft
Moisture in skin folds and
axillae
Skin rebounds and does not
remain inderted when
pressure is released
When pinched ,skin springsback to previous state
Thick , evenly distributed
Silky resistant hair
None
Smooth and firm without
lesion and redness
The nail bed is pink in color
and clean
Pink tone returns
immediately to blanched
nailbeds when pressure is
released
Rounded smooth skull
contour with symmetric
facial features and
movement
Bipedal , non-pitting
edema
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EYES
Pupil
Eyelids
EARS
Auricle
NOSE
LIPS
GUMS
TONGUE
NECK
CHEST
ABDOMEN
LUNGS
Inspection
Inspection
Inspection
Palpation
Inspection
Inspection
Inspection
Inspection
Inspection
Palpation
Inspection
Palpation
Inspection
Palpation
Auscultation
PERRLA
Skin intact no discharge and
discoloration
Color same as facial skin ,
symmetrical , firm ,and not
tender
Symmetrical and no lesion
Firm and moist no ulceration
Pink gums , no bleeding
Normally , midline
Symmetrical , lymph nodes
are not palpable
Symmetrical , chest
expansion as observed
No tenderness
Crackles in both lungss
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X. Laboratory
DIAGNOSTIC
PROCEDURE
DATE
ORDERED/DATE
RELEASED
TESTS RESULTS NORMAL
VALUES
ANALYSIS AND
INTERPRETATIONS
Complete
blood count
July 18, 2011 Hemoglobin 99.0 g/l 120-150
g/l
EPO production
decreases because
the kidney is
malfunctioning. As aresult, R BC count
decreases, as does
hemoglobin.Hematocrit 0.30 0.37 - 0.47 Decreased
production of
erythropoeitin or
your bone marrow
does not work
properly
WBC count 8.8 x 10 g/l 5.0 x 10
g/l
This can result from
bacterial infections,
Lymphocytes 0.59 0.25 0.35
It might signify
infection the
patient currently
having
HBA1C JULY 18, 2011 Glucosynate
hemoglobin
8.9% 4.2 6.2% A high HbA1c
represents poor
glucose control.
Blood
chemistry
July 18, 2011 FBS 8.6 mmol/l 4.6 6.1
mmol/l
Positive for increase
glucose in the body
BUN 12.0 mmol/l 2.5 7.6
mmol/l
It is characterized
by decreased
effective circulating
blood volume withdecreased renal
perfusion, in
postrenal
obstruction of urine
flow, and in high
protein intake
states.
Creatinine 472.7 umol/l 62 120
umol/l
Increase in serum
creatinine is seen a
renal functional
impairment.
Because of its
insensitivity indetecting early renal
failure
Cholesterol 7.5 mmol/l < 6.5
mmol/l
When there is too
much cholesterol
(a fat-like
substance) in your
blood, it builds up
in the walls of your
arteries and blood
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flow to the heart is
slowed down or
blocked.
Triglycerides 1.0 mmol/l 0.46 0.90
mmol/l
Risk for developing
heart disease
HDL 0.74 0.9 1.7 It removes the
waste or the
cholesterol build
up in the arteries
LDL 6.5 2.0 4.4 High LDLcholesterol leads to a
cholesterol
Build-up in the
arteries.
x- ray July 18, 2011 Chest PA Cardimegaly with
pulmonary
edema/congestion
R/O pneumonia
negative Patients have a
enlarged
heart,and
accumulation of
fluids in the lungs
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XI. ANATOMY AND PHYSIOLOGY
Every cell in the human body needs energy in order to function. The body¶s primary energy source is
glucose, a simple sugar resulting from the digestion of foods containing carbohydrates (sugars and starches).
Glucose from the digested food circulates in the blood as a ready energy source for any cells that need it.
Insulin is a hormone or chemical produced by cells in the pancreas, an organ located behind the stomach.
Insulin bonds to a receptor site on the outside of cell and acts like a key to open a doorway into the cell
through which glucose can enter. Some of the glucose can be converted to concentrated energy sources like
glycogen or fatty acids and saved for later use. When there is not enough insulin produced or when the
doorway no longer recognizes the insulin key, glucose stays in the blood rather entering the cells.
Anatomy of the pancreas:
The pancreas is an elongated, tapered organ located across the back of the abdomen, behind the stomach. The
right side of the organ (called the head) is the widest part of the organ and lies in the curve of the duodenum
(the first section of the small intestine). The tapered left side extends slightly upward (called the body of the
pancreas) and ends near the spleen (called the tail).
The pancreas is made up of two types of tissue:
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1. Exocrine tissue
The exocrine tissue secretes digestive enzymes. These enzymes are secreted into a network of ducts that join
the main pancreatic duct, which runs the length of the pancreas.
2. Endocrine tissue
The endocrine tissue, which consists of the islets of Langerhans, secretes hormones into the bloodstream.
Functions of the pancreas:
The pancreas has digestive and hormonal functions:
The enzymes secreted by the exocrine tissue in the pancreas help break down carbohydrates, fats, proteins,
and acids in the duodenum. These enzymes travel down the pancreatic duct into the bile duct in an inactive
form. When they enter the duodenum, they are activated. The exocrine tissue also secretes a bicarbonate to
neutralize stomach acid in the duodenum.
The hormones secreted by the endocrine tissue in the pancreas are insulin and glucagon (which regulate the
level of glucose in the blood), and somatostatin (which prevents the release of the other two hormones.
Anatomy of kidney
The kidneys play key roles in body function, not only by filtering the blood and getting rid of waste
products, but also by balancing levels of electrolytes in the body, controlling blood pressure, and stimulating the
production of red blood cells.
The kidneys are located in the abdomen toward the back, normally one of each side of the spine. They get
their blood supply through the renal arteries directly from the aorta and send blood back to the heart via the
renal veins to the vena cava. (The term "renal" is derived from the Latin name for kidney.)
The kidneys have the ability to monitor the amount of body fluid, the concentrations of electrolytes like
sodium and potassium, and the acid-base balance of the body. They filter waste products of body metabolism,
like urea from protein metabolism and uric acid from DNA breakdown. Two waste products in the blood can
be measured: blood urea nitrogen (BUN) and creatinine (Cr).
Kidneys are also the source of erythropoietin in the body, a hormone that stimulates the bone marrow to make
red blood cells. Special cells in the kidney monitor the oxygen concentration in blood. If oxygen levels fall,
erythropoietin levels rise and the body starts to manufacture more red blood cells.
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XII. Pathophysiology
Family Hx Asian Age 56yrs Diet
Chance to have response to carbohydrate intake
Defective pancreas Insulin increases glucose in
the bloodstream
Destruction of B-cells
In pancreas
glucose level in blood
Insulin Production
Insufficient intracellurlar glucose *8.6mm/dl Increased LDL 6.5mm/dl
Polyphagia Hyperglycemia
Glycosuria Chronic increased Ldl
Polyuria Sluggish Circulation Atherosclorosis
Dehydration of cell Insufficient renal tissue perfusion chronic BP increased
Thirst Nephropathy Cardiomegaly
Polydipsia
GFR Hgb HCT
Fluid in ECF BUN Creatinine DOB Pale conjunctiva12.0 mm/dl 472.7 mm/dl
RR CR
Fluid volume excess *35bpm * 112PR
Hydrostatic pressure
Fluid shift to interstitial
Compartment
Periphery Increase BP Lungs
* 190/100 *Xray result with pulmonary/edema congestion
Bipedal Edema Pulmonary congestion
Crackles
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XIII. Nursing care plan
Assessment Diagnosis Planning Intervention Rationale Evaluation
S>"Nahihirapan akohuminga"as claimed
O> RR of 30bpm>C O2 inhalation of
4-5 lpm>C crackles upon
auscultation>C facial
grimace;noted>use of accessory
muscles for respiration>CXR revealed
pulmonary edema
Impaired gasexchange r/taccumulation of
fluid in both lungfields as
evidenced bycrackles upon
auscultation
After 1 day of nursingintervention, the
pt. will have a better gas
exchange asevidenced by
RR of 30 to thenormal range of
12-20bpm,abscense
of pulmonaryedema and
crackles .
INDEPENDENT>Place pt. onhigh fowler's
position>Teach the pt.
appropriate deep breathing
technique
>kept rested
DEPENDENT
>Administer O2inhalation as
ordered
>Furosemide asordered
>To promote proper lungexpansion
>Promoteoptimal
chestexpansion
and tofacilitate
adequate air >To promote
relaxation of the body
thereforedecreases O2
demand>To have an
adequatesupply of O2
in the body>Furosemide
is a Diuretics
w/c makes patienturinate
thereforedecreased
fluid vol.and relieve
pulmonaryedema
Goal partimet
>RR decreased
from 30 to22bpm
>crackleswere just
slightlyheard upo
auscultatio> C mild
pulmonaryedema
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Assessment Diagnosis Planning Intervention Rationale Evaluati
S>" Hirap akomakahinga" as
claimedO>RR of 30bpm
>O2 inhalation of 4-5 lpm
>use of accessorymuscles for
respiration>CXR revealed
pulmonary edema>crackles upon
auscultation
Fluid volumeexcess r/t
accumulation of fluid in the lungs
as evidenced by pulmonary
edema uponCXR
After 1 day of nursing
intervention, the pt.will be able to have
stabilized fluidvolume as
evidenced byabsence of edema
>Place pt. on highfowler's position
>Teach pt.
appropriate deep breathing
technique
>kept rested
DEPENDENT
>Administer O2inhalation as
ordered
>To promote proper lung
expansion>To promote
chestexpansion and
to facilitate air better
>To promoterelaxation of
the bodytherefore
decreases O2demand
>To haveadequate
supply of O2to the body
Goal partially
met>CXR
revealedmild
pulmonaedema
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Assessment Diagnosis Planning Intervention Rationale Evaluatio
S>Hindi akomasyado makatulog
dahil hirap akomakahinga" as
claimedO> RR of 30bpm
>C O2 inhalationof 4-5 lpm
>weak inappearance
>C episodes of yawning
>Irritability>fatigue
Sleep patterndisturbance r/t
DOB secondaryto pulmonary
congestion asevidenced by
episodes of yawning
After 6 hours of nursing
intervention, the pt.can able to increase
the sleeping hoursfrom 4 to 8 hours S
interruption of DOB
INDEPENDENT>Place pt. on high
fowler's position
>Teach clientappropriate deep
breathingtechnique
>Kept rested
>Limit fluidintake before
bedtime
DEPENDENT
>Administer O2inhalation as
ordered
>To promote proper lung
expansion>To promote
chestexpansion and
to facilitateair better
>To promoterelaxation of
the bodytherefore
decreases O2demand
>To preventurinary
bladder retention
causingdribbling of
urine
>To haveadequate
supply of O2to the body
Goal met
>Pt.sleeping
patternincreased
from 4 tohours S
complainof DOB
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Assessment Diagnosis Planning Intervention Rationale Evaluation
S>Hindi ako masyado
makatulog dahil hirapako makahinga" as
claimedO> RR of 30bpm
>C O2 inhalation of 4-5 lpm
>weak in appearance>C episodes of
yawning>Irritability
>fatigue
Sleep pattern
disturbancer/t DOB
secondary to pulmonary
congestion asevidenced by
episodes of yawning
After 6 hours of
nursingintervention, the pt.
can able to increasethe sleeping hours
from 4 to 8 hours Sinterruption of
DOB
INDEPENDENT
>Place pt. on highfowler's position
>Teach client
appropriate deep breathing
technique
>Kept rested
>Limit fluid
intake before bedtime
DEPENDENT>Administer O2
inhalation asordered
>To
promote proper lung
expansion>To
promotechest
expansionand to
facilitate air better
>To promote
relaxation of the body
thereforedecreases
O2 demand>To prevent
urinary bladder
retentioncausing
dribbling of urine
>To have
adequatesupply of
O2 to the body
Goal met
>Pt.
sleeping pattern
increasedfrom 4 to 8
hours Scomplainin
of DOB
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XIV. Drug Study
July 18, 2011
DRUGS ACTION INDICATION CONTRAIN
DICATION
SIDE EFFECT NURSING
CONSIDERATION
CLONIDINE
Brand Name:
DURACLON
CLASSIFICATI
ON:
Antihypertensiv
e
Dosage/Route:15mcg tab OD
Inhibits
sympathetic
vasomotor
center inCNS, which
reduces
impulses in
sympathetic
nervous
system;
blood pressure,
pulse rate,
cardiac
outputdecrease,
prevents
pain signal
transmission
in CNS by
a-adrenergic
receptor
stimulation
of the spinalcord.
Mild to
moderate
hypertension
, used aloneor in
combination
Hypersens
itivity,
bleeding
disorders
CNS: Drowsiness,
Sedation, headache,
fatigue, nightmares,
insomnia, mentalchanges, anxiety,
depression,
hallucinations, delirium
CV:Palpitations, ECG
abnormalities
GI: Nausea, Vomiting,
malaise, constipation,
dry mouth
ASSESS: Blood studies:
neutrophils, decreased
platelets.Renal studies: protein,
BUN, creatinine,
increased levels may
indicate nephritic
syndrome.
BP, pulse if used for
hypertension, reportsignificant changes.
Edema in feet legs
daily; monitor I&O;
check for falling outpu
Teach patient: Not to discontinu
drug abruptly o
withdrawal
symptoms ma
occur; increase
BP, pulse. Not to use OT
(cough, cold oallergy) produc
unless directed b
prescriber.
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DRUGS ATION INDICATION CONTRAINDICATION
SIDE EFFECT NURSINGCONSIDERATION
LOSARTAN
+
HYDROCHL
OROTHIAZI
DE
Brand Name:
COZAAR
UROZIDE
CLASSIFICA
TION:
Antihypertens
ive
Dosage/Route
:50mg/12.5mg
tab OD
PO (1-0-0)
Blocks the
vasoconstrictor
and aldosterone-
secreting effects
of angiotensin II;
selectively blocks
the binding of
angiotensin II tothe AT1 receptor
found in tissues.
Acts on distal
tubule and
ascending limb of
loop of Henle by
increasing
exretions of
water, sodium,chloride,
potassium.
Hypertensio
n, alone or
in
combination
,nephropathy
in type 2
diabetes,hypertension
with left
ventricular
hypertrophy.
Edema,
hypertension
dieresis,
CHF,idiopathic
lower
axtremityedema
therapy.
Pregnancy 2nd
/3rd
trimesters,
hypersensitivity
Hypersensitivity
to thiazide or
sulfonamides,
anuria, renaldecompensatio.
CNS: Dizziness,insomnia, anxiety,
confusion,abnormal dreams,
migraine, tremor,
vertigo, headache.
CV: angina pectoris, 2nd
degree AV block
cerebrovascular
accident,hypotension,myocardial
infarction,dysrhythmias.
GI: Diarrhea,
dyspepsia,
anorexia,
constipation, drymouth, flatulence,
gastritis,
vomiting.
GU: impotence,nocturia, urinary
frequency, UTI,
renal failure.
HEMA: Anemia
ASSESS: BP with positio
changes, pulsenote rate, rhyth
quality
Electrolytes: K
Na,Cl
Skin turgor,dryness of muc
membrane for
hydration statu
Teach patient: To comply wit
dosage schedueven if feeling
better. To notify
prescriber of m
sores fever,
swelling of hanor feet, irregula
heartbeat, ches
pain. The drug may
cause dizzinessfainting; light-
headedness ma
occur.
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Drug studyJuly 18, 2011
DRUGS ACTION INDICATION CONTRA-
INDICATION
ADVERSE
EFFECT
NURSING
CONSIDERATION
Furo-
semide
Brand
name: lasix
Classific
ation:
Loop
Diuretic
Dosage/Route:
40 mg IV
OD
Inhibits
reabsorptionof sodium
and chlorideat proximal
and distaltubule and I
the loop of Henle
Pulmonary
edema; edemain CHF,
hepaticdisease,
nephroticsyndrome,
ascites,hypertension
Hypercalcemi
a in malignancy,hypertensive
emergency/urgency
CNS:
Headache,fatigue, weakness
CV:Orthostatic
hypotension,chest pain,
circulatorycollapse
ENDO:Hyperglycemia
GU:
Renal failure, polyuriaHEMA:
Thrombocyto- penia,
leucopenia,anemia
Monitor blood
pressure lying,standing; postural
hypotension mayoccur
Assess signs of metabolic alkalosis:
drowsiness, restlessnessMonitor weight,
intake and output daily todetermine fluid loss,
Assess rate, depth
rhythm of respiration,effect of exertion, lungsounds
Monitor serumelectrolytes; Ca, Na
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Drug study
July 18, 2011
DRUGS ACTION INDICATION CONTRA-
INDICATION
ADVERSE
EFFECT
NURSING
CONSIDERATION
Amlodipine
Brand name: Norvasc
Classification:
AntianginalAnti
hypertensiveCalcium
channel blocker
Dosage/Route:
10g tab OD
decrease
cardiaccontractility
and the work
load of theheart thusdecreasing
the need for oxygen
Chronic
stable angina pectoris,
hypertension,
variant angina
Hypertension
(pediatric clients)
CNS:
Headache,fatigue,
dizziness,
depressionCV:Dysrythmia,
peripheraledema
GI: Nausea,
vomiting,diarrhea,
gastric upsetGU:
Nocturia, polyuria
Assess cardiac
status; B/P, pulse,respiration
Monitor I & O
and weight dailyAdminister without regard to
mealsAdvice to take
hazardous activitiesuntil stabilize on
product, dizziness isno longer problem
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Drug study
July 18, 2011
DRUGS ACTION INDICATIO
N
CONTRA-
INDICATION
ADVERSE
EFFECT
NURSING
CONSIDERATIO
Simvastatin
Brand name:
Zocor
Classification
:
Antilipedemic
Dosage/Route
:
20g tab OD
Inhibits
HMG-CoAreductace, the
enzyme that
catalyzes thefirst step in thecholesterol
synthesis pathway,
resulting in adecrease serum
cholesterol,serum LDL¶s
and either anincrease in
serum HDL¶s
As an
adjunct in primary hiper
cholesterolem
ia,type IIIhyperlipoproteinemia
Pregnancy
(x),breastfeeding,
hypersensitivit
y, activehepatic disease
CNS:
headacheGI:
nausea,
constipation, liver dysfunction
RESP:upper respiratory
tract infection
INTEG:rash, pruritus,
photosensitivity
Assess 12-hour
fasting lipid profile:LDL, HDL
Advice to eat lo
cholesterol diet andexercise programAssess renal
studies in patients wcompromised renal
system: BUN, I & Oratio, creatinine
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Drug studyJuly 18, 2011
DRUGS ACTION INDICATION CONTRA-
INDICATION
ADVERSE
EFFECT
NURSING
CONSIDERATIO
N
Salbutamol
Classificatio
n:
Anti
asthmaticBeta2
selectiveadrenergic
agonist
Dosage/Rout
e:
Nebule 6o
Longacting agonist
that binds toBeta2 receptors
in the lungscausing
bronchodilation; also inhibits
release of inflammatory
mediators inthe lung,
blockingswelling and
inflammation
Maintenance therapy for
asthma and prevention of
bronchospasmin patients with
reversibleobstructive
airway diseaseincluding
nocturnalasthma. Long
termmaintenance
treatment of bronchospasm
related toCOPD.
Prevention of exercise
induced bronchospasm.
Contraindicated with
hypersensitivity tosalbutamol, acute
asthma attack,worsening or
deterioratingasthma (life
threatening) acuteairway
obstruction.
CNS:headache,
tremor,dizziness
CV:tachycardia,
palpitations,hypertension
Respirator y: worsening
of asthma,difficulty of
breathing, bronchospasm,
asthma relateddeaths( risk
higher in black than white
patients)Other:
pain
Documentindications for
therapy, onset,other agents use
and anticipatedtreatment period.
Should beused with caution
in patient withHPN and narrow ±
angle glaucomaContraindicate
d hyperthyroidismand uncontrolled
seizureMonitor BP
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DRUGS ACTION INDICATION CONTRAINDICATION SIDE EFFECT NURSING
CONSEDIRATION
RAPID ACTING
INSULIN
Dosage/Route:
RAI 8units SC
now
Rapid-acting
insulin begins
working very
quickly inside
the body -
usually within 5
and 10 minutes.This type of
insulin should
be taken just
before or just
after eating. It
operates at
maximum
strength for
one to two
hours and
duration is
typically up to
four hours..Extra fast-
acting insulins
are very
convenient
because they
allow diabetic
patients to
inject
themselves just
when they eat.
Treatment
of Aspart
Insulins
Repaglinide is
contraindicated in
patients with a
known
hypersensitivity to
repaglinide, in
patients with type1 diabetes mellitus
(since repaglinide
is not effective in
the absence of
functioning beta-
cells) and in
diabetic
ketoacidosis as it
requires treatment
with insulin.
Repaglinide should
be used cautiously
in patients withimpaired hepatic
function.
Sinusitis, rhinitis,
bronchitis,
headache,
nausea, diarrhea,
constipation,
vomiting and
dyspepsia.Musculoskeletal
disorder back
pain may occur in
some patient.
Patients on
repaglinide
therapy can mis
or postpone a m
without increas
risk of
hypoglycemia ocompromising
glycogenic cont
Repaglinide whe
combined with
metformin has
shown better
glycogenic cont
in patients with
type 2 diabetes
mellitus.