Case Pre.docx.

8/12/2019 Case Pre.docx.

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CENTRAL LUZONS DOCTORS HOSPITAL E-I

SAN PABLO, TARLAC CITY

IN PARTIAL FULFILLMENT IN NCM 102

CASE STUDY IN SURGICAL WARD

PRESENTED BY:

Cherry Tabucol

Nova Ibarra

Tina Caryl Corpuz

Everlasting Silverio

Jerami Carreon

Mark Chris Garbin

Irish Antonio

PRESENTED TO:

Angelina Sibug RN, MSN


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TABLE OF CONTENTS

I. INTRODUCTION Significance/ relevance to the concept

II. OBJECTIVEIII. NURSING HEALTH HISTORY

Biographical Information Reasons for Seeking Health Care Clients Expectations Present Illness Past Health History Spiritual Health

IV. ASSESSMENT Cephalocaudal


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V. ANATOMY AND PHYSIOLOGY Pathopysiology Labaratory Findings Doctors Orders

VI. MEDICAL MANAGEMENT Drug Study

VII. NURSING MANAGEMENT Nursing Care Plan

VIII. DISCHARGE SUMMARY Methods Approach


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I. Introduction

After three weeks of exposure at CLDH hospital, we came up to study the case congestive heart failure.

To be more specific, what are those illnesses?

Congestive Heart Failure - often called congestive heart failure (CHF) or congestive cardiac failure (CCF), occurs when the heart is unable to provide sufficient

pump action to maintain blood flow to meet the needs of the body.

For the confidentiality and privacy of the patient, we named her as Patient A. Patient A is 51 years old, married, with 4 kids (2 girls and 2 boys), and from

Tarlac City.

Significance/Relevance to the Concept

This case shows us student what we have read from books. It proves that complications or abnormalities can occur at any moment. This also taught us to

deal with patient with problems competitively and the proper way of treating them.


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II. Objectives

To establish rapport between nurse and the patient To be able to know the proper care for patient with Congestive Heart Failure To be able to provide information and health teaching to the patient To be able to describe the development, pathophysiology and nursing care of a client who have undergone To be able to carry out hospital routines and the treatment prescribed to the patient To be able to perform nursing procedures and nursing considerations for a client in the preoperative and postoperative stages


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III. Nursing Health History

For the confidentiality and privacy of the patient, we named her:

a. Biographical Information

Surname: B

First Name: AMiddle Name: C

Age: 51Weight: 55.2 kg

Birthdate: Dec. 15, 1961Birth Place: Balungao, Pangasinan

Nationality: FilipinoAddress: Landig, Cuyapo, Nueva Ecija

b. Reasons for seeking Health Care

Mrs. A seeks for health care because of the chief complaint is difficulty of breathing.

c. Client Expectations

Mrs. A expectations in the following areas:>Information needed about her disease process and involvement in decision making.

>Caring and compassion expressed by care providers>Timeliness of caregivers response to client requests

>Relief of pain and symptoms

d. Present Illness

Mrs. A admitted to the Intensive Care Unit, last July 29, 2013(Monday) subsequently complaining of difficulty of breathing t. With an admitting impressionin Congestive Heart Failure class IV-E with RVR.

e. Past Health HistoryThere is no past confinement of the client.


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f. Spiritual Health

Mrs. A is a Roman Catholic and makes it a point to visit and attend a mass every Sunday with her husband and children. Their beliefs about life, their

source for guidance in acting their beliefs, and the relationship they have in exercising their faith is truly on a God-centered manner.

IV. Assessment bbn

Area/region Findings Normal

Findings

Abnormal

findings

Interpretation/analysis

Skin in general

Temperature

Patients skin

color is dark

brown

Skin feels is

warm to touch

Light tones in

lightskinned

persons

Normal

Abnormal

Abnormal

Due to deficient supply

of blood to the system

Due to heat intolerance

Areas to assess Findings Normal/abnormal Interpretation

SKIN

Hair: characteristics Resilient, silky

hair

Normal Normal

Scalp: Characteristics

Deformities

Shiny and

smooth w/o

lesions, masses

or mumps

No trauma

Normal

Normal

Normal

Normal


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Redness orscaliness

findings

No redness or

scaliness

Normal Normal

Skull Characteristics

Symmetry offacial features and

movement

Rounded andsmooth skull

contour w/o any

signs of

enlargement

Symmetrical in

facial features

and movement

Normal

Normal

Normal

Normal

Eyes Characteristics

Symmetry of eyefeatures and

movement

Pink

conjunctiva,

anicteric sclera

Bilateral

exopthalmus

Abnormal The sclera

should be

white

Presence of

edema

Neck Symmetry

Thyroid gland

Enlarged and

palpable mass

on anterior

portion of the

neck

Presence of mass

during

palpitation

Abnormal Due to lack of

iodine

Nails Capillary refill (-)slow capillary

refill, (-)

Normal Normal


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crushing pain

Lungs Characteristics rales, (+), cough

(+)

Abnormal Excessive

accumulation

of mucous

membrane

Musculoskeletal Characteristics Fine tremors Abnormal Due to bodyweakness

Neurologic Characteristics Irritable and

restless

Abnormal Due to body

weakness

Abdomen Characteristics (+) symmetrical

(-) bruit sound (-

) pain

Normal Paracentesis

done

After Physical assessment there was no abnormalities expect for resilient and silky hair, bilateral exopthalmus of her eyes, excessive sweating of his skin

enlarged and palpable mass on the anterior portion of the neck, fine tremors, irritable and restless.

ASSESSMENTName: MilwidaDela CruzAge: 46

Temperature: 36Blood Pressure: 110/80

Respiratory rate: 20Pulse rate: 75

Date Performed: July 16, 2013

AREA TECHNIQUE NORMALFINDINGS

ACTUALFINDINGS

INTERPRETATIONANALYSIS

GENERAL

APPEARANCE

INSPECTION Relaxed,erect

posture;

Irritable Posture is erect

and properly

Abnormal dueto illness


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coordinated

movement

Clean, neat;no bodyodor

aligned

Clean,Neat, nobody odor Normal

SKIN INSPECTIONPALPATION

Skin texturemust besoft. Hair is

evenlydistributed

and variesthe color

from therace.

Free fromany lesion,

wounds,

scars andscabies.

Skin has darkcomplexion ,the hair is

evenlydistributed

Skin is dry Pale, Grayish

color .

No signs oflesion,wounds, scars,

and scabies.

Normal Abnormal due

to illness

Normal

HAIR INSPECTION

PALPATION

Evenlydistributedhair and

uniform incolor.

Thick, silkyand resilient

hair. Black shiny

The hair isblack shinny,well

distributedand it is thin

and coarse.

Normal

Normal


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hair, it may

be thicksmooth.

Neitherbrittle nor

dry.

Normal

HEAD INSPECTIONPALPATION

The skull isrounded and

smooth

Absence ofnodules andmasses.

Head isrounded and

smooth.

Absence ofnodules andmasses.

Normal Normal

EYES INSPECTION

PALPATION

PERRLA

Eyebrows areevenlydistributed

and skin isintact.

Eyelashes areequally

distributed. Pupil

constrictwhen expose

to sunlight. Cornea is

cleartransparent.

The color ofthe iris

depends onthe persons

Eyebrows areevenlydistributed.

Eyelashesturn outward.

Pupilsconstrict

when exposeto sunlight

Cornea istransparent.

The sclera iswhite in

color.

Pupils areequal andreactive to

light

Normal

Normal Normal

Normal Normal

Normal


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NAILS INSPECTIONPALPATION

Convexcurvature,

angle ofnail plate is

160 Smooth

texture,highly

vascular,clean and

pink incolor.

Prompt toreturn of

pink orusual color

in capillaryrefill(1-2

sec) incolor

No clubbingand spoon

nail

Nails areshort andclean

Capillaryrefill is

about 2 sec.in color

Normal

Normal

Normal

EAR INSPECTIONPALPATION

Ear lobesare bean

Ears areparallel and

Normal

race.

The sclerashould be

white incolor.


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no lesion and

air moves freelyas client breathe

through thenares.

Patient is withO2 inhalationand on and off

difficulty ofbreathing

obstruction.

Normal Normal

MOUTH INSPECTION

PALPATION

Normal lipscolor variesfrom the race.

Teeth arewhitish in color.

Tongue is incentral position,

pink in color,moist and

moves freely.

The lips arepinkish in color.

Teeth arewhitish in color.

Tongue is incentral position,

pink in colorand movesfreely.

Normal

Normal

Normal

NECK INSPECTIONPALPATION

Muscle equal insize; head

centered, goodrange of

motion,(hyperextension

, flexion androtation),

necked color isproportion to

Muscles equalin size; head

centered, goodrange of motion

is present andneck color is

proportioned toskin color.

Normal


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the skin.

Jugular neckvein is not

visible Lymph nodes

are notpalpable.

Trachea is incentral

placement in the

neck. Thyroid gland is

not visible in

inspection,

moves up whenswallowing.

Distendedjugular neck

veins No palpable

lymph nodes. Trachea is in

central

placement in theneck.

Thyroid gland isnot visible.

Abnormal

Abnormal

Normal

normal

CHEST andTHORAX

INSPECTIONPALAPATION

AUSCULTAION

Chest issymmetrical

, spine isvertically

aligned andspinal

column isstraight.

Quit,rhythmic

andeffortless

Chest issymmetrical,

spine isvertically

aligned andspinal column

is straight.

Rapid chestmovement

Normal

Due todyspnea

.


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respiration.

Nopresence of

lumps andtenderness

No presenceof lumps and

tendernessduring

palpation.

Normal

HEART INSPECTIONPALPATION

AUSCULTAION

Nomurmurs

must beheard.

Notenderness,

masses andlumps in

palpation.

Rales soundsis heard upon

ascultation

No tenderness,masses and

lumps inpalpation.

Due toventricular

obstruction

Normal

ABDOMEN INSPECTIONAUSCULTATION

PERCUSSIONPALPATION

Uniform incolor, flat

rounded noevidence of

enlargementof liver and

spleen. No

abdominaldistention

Audiblebowelsounds

No

NoOrganomegaly

Presence ofabdominal

distention

Audible bowelsounds

Abdominal

Normal

Due toaccumulation of fluid

in theabdomen

Due to


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tenderness;

relaxedabdomen

withsmooth,

consistenttension. It must be

regularpattern not

deep.

tenderness fluid

accumulation

EXTREMITIES INSPECTIONPALPATION

AUSCULTAIONPERCUSSION

Muscles areequal size

on bothsides of the

body.

Bones andjoints, no

deformities,tenderness

andswelling,

joints movesmoothly.

Presence ofedema in

bothextremities

( + 1)

AbnormalInadequate

blood supply

\


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Coronary Arteries

The coronary arteries supply oxygen to the heart muscle.

The heart has three main coronary arteries:

Right coronary artery: supplies the right ventricle Left coronary artery: supplies the left ventricle Posterior circumflex artery: supplies the posterior aspect of both ventricles

Anatomy examples:

Coronary angiogram Front view of the heart and coronary arteries Back view of the heart and coronary arteries
http://www.freemd.com/congestive-heart-failure/anatomy.htm#/et/coronary-angiogram.htmhttp://www.freemd.com/congestive-heart-failure/anatomy.htm#/et/coronary-angiogram.htm


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Cardiac Conduction System

An electrical impulse stimulates the muscle fibers in the heart to contract. The impulse spreads through the heart in a very organized manner, so that the atria

contract first, followed by the ventricles.

The electrical impulse proceeds in the following manner:

The electrical impulse originates at the sinoatrial (SA) node, which is located in the wall of the right atrium. The SA node is the heart's naturalpacemaker:it regulates the heart rate.

The impulse proceeds through the atria, stimulating them to contract. After the atria are stimulated to contract, the atrioventricular (AV) node slows the electrical impulse before it proceeds to the ventricles. This pause allows

the ventricles to fill with blood before they contract.

The AV node is located between the atria and the ventricles.

After the pause, the impulse then proceeds through the ventricles, stimulating them to contract.Anatomy examples:

The cardiac conduction system ECG showing electrical activity of heart
http://www.freemd.com/arrhythmia/treatment-pacemaker.htmhttp://www.freemd.com/congestive-heart-failure/anatomy.htm#/et/ekg.htmhttp://www.freemd.com/congestive-heart-failure/anatomy.htm#/et/ekg.htmhttp://www.freemd.com/arrhythmia/treatment-pacemaker.htm


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VI. Pathophysiology

CONGESTIVE HEART FAILURE

NON MODIFIABLE RISK MODIFIABLE RISK

Age StressGender Diet

Heredity Lifestyle

|_________________________________________________________|

Clogging of the coronary blood vessels

(coronary athesclerosis)

Persistent increase of BP

Increase myocardial demand

Heart compensate to double pump___________________________________

Blood backs up in the left side is unable to eject blood to systemic circulation

Systemic circulation

lungs swollen with blood

Peripheral congestion,

Distended neck vein, fluid leaks

Edema (feet, ankles and finger ),

Hepatomegaly

Cortal hypertension Pulmonary edema/ congestionDyspnea


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PATHOPHYSIOLOGY

Congestive Heart Failure

The pumping action of the healthy heart maintains a balance between cardiac output and venous return. But when the pumping efficiency of the

heart is depressed so that circulation is in adequate to meet tissue needs, congestive heart failure occurs.

Congestive Heart Failure is usually a progressive condition that reflects weakening of the heart by coronary atherosclerosis (clogging of the

coronary vessels with fatty build up ), persistent high blood pressure, or multiple myocardial infarctions ( leading to repair with non-contracting scar

tissue ).

Because the heart is a double pump, each side can fail independently of the other. If the left heart fails, pulmonary congestion occurs. The right side

of the heart continues to propel blood to the lungs, but the left is unable to eject the returning blood into the systemic circulation. As blood vessels swollen

with blood, the pressure within them increases, and fluid leaks from the circulation into the lung tissue, causing pulmonary edema. If untreated the person

suffocates.

If the right side of the heart fails, peripheral congestion occurs as bloods back up in the systemic systemic circulation. Edema is the most noticeable in the

distal parts of the body. The feet the ankles,and fingers become swollen and puffy. Failure of one side of the heart puts a greater strain on the opposite side,

and eventually the whole heart fails.


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VII. Medical Management

a. Drug Studyb. Laboratory Findings and Interpretationc. Doctors order

Drugs name Action Route

and

dosage

Classification Indication Contraindication Adverse effect Nursing responsibilities

Aldactone

(spironolactone)

Cause loss of

sodium

bicarboante

and calcium

while saving

potassium

and hydrogen

ions

25mg

tab

(BID)

Diuretics

*potassium

sparing

diuretics

Counteract

potassium loss

caused by other

diuretics.

Hypersensitivity,

hyperkalemia

*use cautiously in:

hepatic

dysfunction,

geriatric or

debilitated patients

or patients with

D.M

CNS:

dizziness,

clumsiness,

headache

CV:

arrhythmias

GI:

constipation

Monitor I and o ratiosand daily weight during

therapy

Monitor Blood Pressure Monitor BUN, serumcreatinine and electrolytes

before and periodically during

therapy

Metoprolol Blocks

stimulation

of

beta1(myoca

rdial)

adrenergicreceptors

50mg

Tab

(BID)

Anti angina

Antihyperten

sives

Hypertension

Angina pectoris

Prevention of M.I

Management of

stable,

symptomaticheartfailure due to

Uncompensated

CHF, pulmonary

edema,

cardiogenic shock

bradycardia or

heartblock

Cns: Fatigue,

weakness,

anxiety,

depression

dizziness,

drowsiness,insomnia

-Monitor bp and pulse

frequency during dose

adjustments and periodically

during therapy

-Monitor vital signs every 5-15

min during and for several hrsafter parenteral administration


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Lasix (furosemide)

does not

usually affect

beta2

adrenergic

receptor sites

Inhibits the

re absorption

of sodium

and chloride

from the loop

of henle and

distal renal

tubule

Increasesrenal

excretion of

water,

sodium,

chloride,

magnesium,

hydrogen,

and calcium.

May have

renal and

peripheral

vasodilatoryeffect

20g

IV

Every 8

hours

Diuretics

Loop

diuretics

ischemic

hypertensive

origin

Edema due to

CHF, hepatic or

renal disease,

hypertension

Hypersensitivity

cross sensitivity

with thiazides and

sulfonamides may

occur.

Pre- existing

electrolyte

imbalance hepatic

coma or anuria.Some liquid

products may

contain alcohol,

avoid patients

with alcohol

intolerance

EENT:

Blurred

vision

Stuffy nose

CV:

bradycardia

Hypotension

CNS:

dizziness

Encepalopath

y

Headache

Insomnia

Nervousness

EENT:

hearing lossTinnitus

CV:

hypotension

GI:

constipation

Diarrhea

Dry mouth

Dyspepsia

Nausea and

vomiting

CNS: fatigue,

headache,weakness

- asses fluid status during

therapy

Monitor daily weight, I and o

ratios

-Amount and location of

edema, lung sounds, skin

turgor, and mucous

membranes

- monitor BP, and pulse beforeand during administration

- monitor apical pulse for 1 full

min before administering.

With hold dose and notify

physician if pulse rate is less

than 60beats per minute


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Lanoxin Increases the

force of

myocardial

contraction.

Prolongs

refractory

period of the

AV node.

Decreases

conduction

through the

SA and AV

nodes

0.25

mg

TAB

once a

day

anti

arrythmics,

inotropics

Treatment of

CHF.

Tachyarrythmias:

atrial fibrillation

and atrial flutter

(slows ventricular

rate), paroxysmal

atrial tachycardia

Hypersensitivity.

Uncontrolled

ventricular

arrhythmias. AV

block, idiopathic

hypertropic

subaortic stenosis.

Constrictive

pericarditis.

Known alcohol

intolerance

EENT:

blurred

vision, yellow

or green

vision

CV:

arryhtmias

Bradycardia

Ecg changes

AV- block

SA-block

GI: anorexia

Nausea

Vomiting

DiarrheaENDO:

gynecomasta

HEMAT:

thrombocytop

enia

METAB:

Hyperkalemia

with acute

toxicity

EENT:

hearing loss

Tinnitus

-monitor apical pulse for 1 full

minute before administering.

With hold dose and notify

physician if pulse rate is


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Clinical

laboratory

Result Reference Method Interpretation

Creatinine Increase108umol/L 62-106umol/L Vitros 350

Blood urea

nitrogen

Increase

6.3mmol/L

2.5-6.1mmol/L Vitros 350

Albumin 30g/L 35-50g/L Vitros 350

Interpretations:

1. Creatinine-Raised creatinine levels will be developing when the filtration mechanism becomes gradually damaged by long-term raised blood pressure or diabetes.

As the kidneys become increasingly unable to cope, so the creatinine level rises

2. BUN

-A disease condition is often present. One of the most common causes of RBC's in the urine, is infection or inflammation of the urinary tract itself

3. Albumin-Decreased blood albumin levels may occur when your body does not get or absorb enough nutrients and may be a sign of kidney diseases and liver

diseases.

RADIOLOGIC FINDINGS

Chest x-ray (CXR)

There is a hazed capacity in the right lower lung field Heart is enlarge Diaphragm is intact. Costophrenic sulci are intact The rest is visualized chest structure are unremarkable


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IMPRESSION

Consider pneumonia, right lower lobe Cardiomegaly

Clinical correlation is recommended

DIAGNOSIS

Community Acquired Pneumonia High risk (with hypoxemia) Rheumatic Heart Disease

PROCEDURES: S/P Paracentesis

1st- july 29 (First Session)

2nd- july 30 ( Second Session)

3rd

- july 31, 2013 ( Third Session)


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VIII. Nursing Management

a. NCP

Assessment Diagnosis Analysis Planning NursingInterventions Rationale Evaluation

Subjective:

Objectives

>with productive

cough yellowish

in color

>(+) Difficulty of

Breathing

>with pale

conjunctiva, nail

beds and buccal

mucosa

>30

Ineffective

airway clearance

related to

retained

secretions as

evidence by

presence of rales

on both lung

feilds

Inability to clear

secretions or

obstructions

from the

respiratory tract

to maintain a

clean airway

Short Term:

> After 3-4 hours

of nursing

interventions,

the patient will

be able to

establish and

maintain airway

AEB absence of

signs of

respiratory

distress.

Long Term:

>After 2-3 days

of nursing

interventions,

the patient will

be able to

demonstrate

>Monitor and

record vital

signs.

>Monitor

respirations and

breath sounds,

noting rate and

sounds.

>Position

appropriately

and discourage

use of oil-based

products around

nose.

>Auscultate

breath sounds

and assess air

>To obtain

baseline data

>To determine

respiratory

distress and

accumulation of

secretions.

>To prevent

vomiting with

aspiration into

lungs

>To ascertain

status and note

progress

Short Term:

>The patient

shall have been

able to and

maintain airway

patency AEB

absence of

respiratory

distress.

Long Term:

>The patient

shall have been

able to

demonstrate

improve airway

clearance AEB

reduction of

congestion with

breath sounds


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improve airway

clearance AEB

reduction of

congestion with

breath sounds

clear andimprove RR.

movement.

>Encourage

deep breathing

and coughing

exercises.

>Keep back dry

and loosen

clothing.

>Instruct patient

have adequaterest periods and

limit activities to

level of activity

intolerance.

>Give

expectorants and

bronchodilators

as ordered.

>To maximize

effort

>To promote

comfort and

adequate

ventilation

>Rest will

prevent fatigue

and decrease

oxygen demands

for metabolic

demands

>To further

mobilizesecretions

>To clear airway

when secretions

are blocking the

airway

clear and

improved RR.


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>Suction

secretions PRN.

>Administer

oxygen therapyand other

medications as

ordered.

>Indicated to

increase oxygen

saturation


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and use of

accessory

muscles

>Measure tidal

volume and vitalcapacity

>Assess

emotional

response

>Position patientin optimal body

alignment in

semi-fowlers

for breathing

>indicates

volume of airmoving in and

out of lungs

>detects use of

hyperventilation

as a causative

factor

>optimizesdiaphragmatic

contraction


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Assessment Diagnosis Analysis Planning NursingInterventions

Rationale Evaluation

Subjective:

None

Objective:

>generalized

weakness

>limited range of

motion as

observed

Activity

intolerance

related to

imbalance

oxygen supply

and demand as

evidence by

ROM,

generalizedweakness and

DOB

Insufficient

physiological or

psychological

energy to endure

or complete

required or

desired daily

activities

Short Term:

>After 3-4 hours

of nursing

interventions,

the patient will

use identified

techniques to

improve activity

intolerance.

Long Term:

>After 2-3 days

of nursing

interventions,

the patient will

report

measurable

increase in

activity

>Establish

rapport

>Monitor and

record V/S

>Assess patients

general condition

>Adjust clients

daily activities

and reduce

intensity of level.

>to gain clients

participation and

cooperation in

the nurse patient

interaction

>to obtain

baseline data

>to note for any

abnormalities

and deformities

present within

the body

>to prevent

strain and

overexertion

Short Term:

> The patient

shall have used

identified

techniques to

improve activity

intolerance.

Long Term:> The patient

shall have

reported

measurable

increase in

activity

intolerance.


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intolerance. Discontinue

activities that

cause undesired

psychological

changes.

>Instruct client

in unfamiliar

activities and in

alternate ways of

conserve energy.

>Encourage

patient to have

adequate bed

rest and sleep.

>Provide the

patient with a

calm and quiet

environment.

>Assist client in

ambulation

>to conserve

energy and

promote safety

>to relax the

body

>to provide

relaxation

>to prevent risk

for falls that

could lead to

injury


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>Assist the client

in a semi-

fowlers position

>Elevate the

head of the bed

>Instruct the SO

not to leave the

client unattended

>Encourage the

client to

maintain a

positive attitude.

>Give client

information that

provides

evidence of daily

or weekly

progress

>Provide client

with a positive

atmosphere.

>to promote easy

breathing

>to maintain an

open airway

>to avoid risk

for falls

>to enhance

sense of well

being

>to sustain

motivation of

client

>to help

minimize

frustration and


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rechannel energy

Assessment Diagnosis Analysis Planning Interventions Rationale Evaluation

S=O=

>bulging of eyes

>irritable

>decrease

appetite

>weight loss

>poor muscle

tone

>lack of

available food

Nutritionalimbalance, risk

for less than

body

requirements

Intake ofnutrients

insufficient to

meet metabolic

needs

After nursingintervention the

patient

demonstrate

stable weight

with normal

laboratory

values and be

free of signs and

malnutrition

Monitordaily food intake.

Weight daily and

report losses.

Encourage

patient to eat

and increase andsnacks using

high calorie

foods that are

easily digested

Consult

with dietitian to

provide diet high

Continuedweight loss of

adequate caloric

intake may

indicate failure

of anti-thyroid

therapy

Aids in

keeping caloric

intake highenough to keep

up with rapid

expenditure of

calories caused

by hyper

metabolic state

May need

assistance to

ensure adequate

After nursingintervention the

patient

demonstrate

stable weight

with normal

laboratory

values and be

free of signs and

malnutrition


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in calories,

protein,

carbohydrate

and vitamins

intake of

nutrients identify

appropriate

supplements

IX. METHODS

M- Lasix- 40mg 1 tab ODAldactone- 25mg ODLanoxin- 0.25mg tab OD

Metropolol- 50mg 1 tab BIDSafdicure- 300mg 1 cap for 5 days

E- Bed rest, restrain from any strenuous activities.

T- oral care, Proper personal hygiene

H- Advice pt. to consume and take meds as prescribed.- Advice pt. to avoid strenuous activity to conserve energy.- Advice pt. to remain at rest to prevent fatigue

O- OPD- follow up check up on august 12, 2013 at 12 nn

D- low salt include tomato soup, salted crackers, bakon, canned meats, and fish. low fat, try lemon and herbs as a subtition. Provide potassium supplements,dercrease fluid intake.

S-Not applicable


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