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Case Presentationof
Bronchial sthmaIn cute Exacerbation
Mapili, Anjelika Eurelle C.Sadol, Bryan C.Zamora, Miguel Rodolfo G.
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General Objectives:To fully learn and understand theunderlying processes involved in BronchialAsthma in Acute Exacerbation, itsetiological process, complications andtreatments for its prevention andtermination.
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Specific Objectives:To identify the process of BronchialAsthma in Acute Exacerbation.To enumerate the signs and symptomsof the disease.To trace the Anatomy and Physiologyof the systems involved.To trace the Pathophysiology of thedisease.To identify the different ways intreating the disease.
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Bronchial asthma is a chronic inflammatorydisease of the airways, associated withrecurrent, reversible airway obstruction withintermittent episodes of wheezing anddyspnea. Bronchial hypersensitivity is causedby various stimuli, which innervate the vagusnerve and beta adrenergic receptor cells ofthe airways, leading to bronchial smoothmuscle constriction, hyper secretion ofmucus, and mucosal edema.
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An acute asthma exacerbation occurs whenthe symptoms of asthma worsen suddenly orover a few days.An acute exacerbation indicates that yourasthma is not well controlled. Controllermedications include inhaled steroids, whichwork by decreasing the inflammatoryresponse.
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The symptoms of bronchial asthma includes:* a feeling of tightness in the chest* difficulty in breathing or shortness ofbreath* wheezing* coughingAsthma triggers may include:* Tobacco smoke* Infections such as colds, flu, or pneumonia* Allergens such as food, pollen, mold, dustmites, and pet dander* Exercise
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PatientsName: AA REYAddress: Balagtas, BulacanAge: 78 Years OldSex: FemaleCivil Status: WidowReligion: Roman CatholicBirthday: December 12,1933Room#: 802Attending Physician: Dr Joselito AtabugMedical Diagnosis: CAP-MNBAIAE
HASCVD-NIFChief complaint: Fever
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History of present illness:3 days PTA, patient complained offever maximum of 38C withproductive cough, yellowishsputum. Persistence of symptomsprompted consult hence admission.
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Past Medical History:The patient said that in her childhood she neverexperienced any major illness and was neverhospitalized before. She has a Type 2 Diabetes andHypertension, she said that sometimes she takessome medicine but she cant recall the name of thedrug because she seldom takes it because of financialproblem. She has a Asthma ever since, her daughterusually buy salbutamol ventolin for her nebulization.She also said that whenever she experienced thosecommon illnesses like fever, cough and colds, flu shejust takes Paracetamol and Neozep. The patient hascomplete vaccines. The patient has no allergies bothon food and medicines.
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Family History:Patients parents both died fromunknown cause Both parents hadHypertension and in her mother sidemost of them had history of Bronchialasthma The patients 2 sons are bothHypertensive. Some of her grandchildrenhave asthma.
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Social History:The patient is non-alcoholic beverage drinker.The patient never tried cigarettes or anytobacco products but the people around herenvironment are smokers like her 2 sons. Thepatient lives with her family and relatives in1 compound. She loves to go outside and talkto her neighbors it is a part of her dailyroutine. Their house is near from thehighway. She is exposed to the air pollutioncoming from the vehicles
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LYDIA HALL AND HER THEORYLydia Hall was born in New York City onSeptember 21, 1906.She promoted involvement of the community inhealth-care issues.She derived from her knowledge of psychiatry andnursing experiences in the Loeb Center theframework she used in formulating her theory ofnursing.The theory contains of three independent butinterconnected circles:
the core,the care andthe cure
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The core is the person or patient to whom nursingcare is directed and needed. The core has goals set byhimself and not by any other person. The corebehaved according to his feelings, and value system.The cure is the attention given to patients by themedical professionalsThe theory contains of three independent butinterconnected circlesthe core, the care and thecure.According to the theory, the core is the person orpatient to whom nursing care is directed andneeded. The core has goals set by himself and notby any other person, and that these goals need tobe achieved.The core, in addition, behaved according to hisfeelings, and value system.
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The cure, on the other hand is the attention givento patients by the medical professionals. The modelexplains that the cure circle is shared by the nursewith other health professionals. These are theinterventions or actions geared on treating or curingthe patient from whatever illness or disease he may besuffering from.It is easy to understand from the model that in allof the circles of the model, the nurse is alwayspresents the bigger role she takes belongs to the carecircle where she acts a professional in helping thepatient meet his needs and attain a sense of balance.
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Pattern ofFunctioning BeforeHospitalization DuringHospitalization Analysis/InterpretationHealth
Perception andManagement
Before hospitalization,the patient tends towalk around the houseas her exercise. Shethinks of health as animportant issue thatshould not beneglected.
During herhospitalization,patient does what sheis told to do. Shefollows what she istold in order to getbetter quicker.
Due to her old agepatient prioritized herhealth very seriously,but could not avoidhaving problems withher body.
Nutritional andmetabolicpattern
Before hospitalization,the patient eats alot of vegetables inher meals. Does notdrink or smoke. Sheavoids oily foods.
During herhospitalization,patient eats what isgiven to her. Thepatients diet is LowSalt- Low Fat diet.
The patient is carefulwith what she eatsand drinks and stayshealthy.
Eliminationpattern
Before hospitalization,the patient urinates3-4 times a day. Anddefecates twice a day.One in the morningand another beforeshe goes to sleep.
During herhospitalization,patients eliminationpattern did notchange.
Patient eliminationpattern is normal.There is no difficultyin both urinating anddefecating.
Activity and
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Activity andExercise pattern
Beforehospitalization, thepatient normallyjust walks aroundthe house, talkingto her neighboursabout the latesthappening in theirlives.
Due to beinghospitalized patientjust stays on herbed, watch tv andtalks to herrelatives.
Due to Patientsold age she doesnot do too muchexercise and usuallyjust sits around.
Sleep and Restpattern
According to thepatient she usuallysleeps around 8 or 9pm then wakes uparound 2 am.
Patient gets moresleep. According toher daughter thepatient gets moresleep because herroom is air-conditioned and it hasmore quiteenvironment.
Patient gets a lot ofsleep during her stayin the hospital.
Role andRelationshipPattern
According to herdaughter, patient isloved by everyonein the family. Sheis very close to herfamily.
Patient was beingtaken care by herfamily. Theycooperate with eachother well andenjoy each others.
Patient has a goodrelationship withher family. Theylove to laugh andjoke around andthey became closer.
Coping stress
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Coping stresspattern
According to herdaughter, whenpatient feels stressshe just talks tothe members ofthe family andthen just forgetsabout what she isstressing about.
During herhospitalization,patient seemedrelaxed. And justuses the televisionto divert herattention to thingsthat stresses her.
Patient greatlyrelies to her familyin coping stress.Usually she justtalks to them andthings get better.There is no changewhen it comes tocoping to herstressors.Cognitive and
Perceptualpattern
According to thepatients daughtershe is not hard totalk to. Sheanswers directlyand with focus.
During ourinterview thepatient was verycooperative andanswers ourquestions clearly.
Patient has a goodsense of perception.She understandsher situation andcooperates wellwith others.
Self perceptionand SelfConcept
Due to patientsold age, she feelsthat she cannot dothe things she usedto do. Such ascleaning the houseand doing chores.
Due to beinghospitalized,patient feels moreof a burden becauseshe cannot help attheir house andnow she has to betaken care of.
Patient does notfeel good aboutbeing hospitalizedbecause she feelsshe is giving herfamily moreproblems.
Sexuality and
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Sexuality andReproductivepattern
Patients menarche was at the age of 14 and was menopauseat the age of 45.
Values andBeliefs pattern
Beforehospitalization, thepatient attendsmass on Wednesdayand Sunday. Goesto church onMonday andSaturday and pray.
During herhospitalization, dueto beinghospitalized shecannot go tochurch or attendmass. But shenever fails to pray.All the time.
Patient is veryreligious andattends massregularly. There willbe no change in herstrong faith nomatter whathappens.
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Area Assessed Technique Normal Findings Findings Analysis
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Area Assessed Technique Normal Findings Findings Analysis
A. SkinColor Inspection Light brown,
tanned skin
(may vary
according to race)
Light brown skin Normal
Moisture Inspection/Palpation
Skin normally dry Skin normally dry Normal
Temperature Palpation Normally warm Normally warm Normal
Texture Palpation Smooth and soft Smooth and softslightly saggy.
Presence of
winkles.
Due to her old age.
Turgor Palpation Skin snaps back Skin snaps back Normal
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Turgor Palpation Skin snaps backimmediately
Skin snaps back
immediatelyNormal
B. SkinAppendages
Nails Inspection Transparent,smooth and convex
Transparent,
smooth and convexNormal
Nail beds Inspection Pinkish Pinkish Normal
Nail base Inspection Firm Firm Normal
Hair distribution Inspection Evenly distributed Evenly distributed Normal
Color Inspection Black to light Black with White hair due
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Color Inspection Black to light
brown
Black with
partly white.
White hair due
to her old age.
C. Upper
Extremities
Arms Palpation Warm to touch
and tenderness
Warm to touch,
no lesionsNormal
Palms and
dorsal surface
Inspection /
Palpation
Pinkish and
slightly rough
Pinkish, slightly
roughNormal
Shoulders Inspection Perform w/o anydifficulty
Can movewithout difficulty.
Normal
Elbows Inspection Perform without
any difficulty
Can bend
without difficultyNormal
Inspection
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skullInspection
Generally round Round Normal
D. Eyes
EyesInspection
Non protruding Visual acuity :20/20
Normal
Eyebrows Inspection Symmetrical insize, extension,
hair texture and
movement
Symmetrical in
size, extension,
hair texture and
movement
Normal
Eyelashes Inspection Evenly distributed Evenly distributed Normal
EyelidsInspection
Same colour as
skinSame colour as
skinNormal
Inspection
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Conjunctiva
Inspection
Transparent with
light pink color
Transparent with
light pink color
Normal
Sclera Inspection Color white Color white Normal
Ears Inspection Free of Lesions,
discharge of
inflammation
Free of Lesions,
discharge of
inflammation
Normal
Hearing acuity Inspection Client normally
hears words when
whispered.
Client normally
hears words when
whispered.
Normal
E. Nose Inspection Nose in the
midline; no
discharges; no
bone or cartilage
deviation noted.
No tenderness
noted; no signs of
any discharges
Normal
F. Neck Inspection No mass or
lumps;
symmetrical; no
No mass or
lumps;
Normal
`Inspection non-tender IF Firm; non-tender
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lymph nodes
p
PALPABLE; less
than 1cm in size.
;
and less than 1cm
in size
Normal
thyroid
Inspection
Normally non-palpable; no nodules
palpable
No nodules present Normal
G. Thorax
Lungs
Auscultation Normal lung tissue
produces resonant
sound, diaphragm
has dull sound.
Wheezing is present
when the patient is
inhaling and
exhaling.
Abnormal breath
sounds due to
bronchial asthma in
acute exacerbation.
H. Cardiovascular
Pulsation
Pulse visible; no lift
or heaves.
apical pulsations is
present
Normal
I. Abdomen Inspection
Skin colour is
uniform, no lesions;
some may havepresence of striae or
No venous
engorgement; no
tenderness noted; nomuscles guarding
Normal
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J. Lower extremities
Inspection
Equal in size; no
edema; no
crepitus
Equal in size; no
edema
Normal
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The upper respiratory tract consists of the nose,sinuses, pharynx, larynx, trachea, and epiglottis. Thelower respiratory tract consists of the bronchi,bronchioles and the lungs.The major function of the respiratory system is todeliver oxygen to arterial blood andremovecarbon dioxide from venous blood, a processknown as gas exchange.The normal gas exchange depends on three process:Ventilation-is movement of gases from theatmosphere into and out of the lungs. This isaccomplished through the mechanical acts of inspirationand expirationDiffusion-is a movement of inhaled gases in the alveoliand across the alveolar capillary membranePerfusion-is movement of oxygenated blood from thelungs to the tissues.
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Control of gas exchange - involves neural and chemicalprocessThe neural system, composed of three parts locatedin the Pons, medulla and spinalcord,coordinates respiratory rhythm and regulates thedepth of respirationsThe chemical processes perform several vital functionssuch as:regulating alveolar ventilation by maintaining normalblood gastensionguarding against hypercapnia (excessiveCO2 inthe blood) as well as hypoxia(reduced tissueoxygenation caused by decreased arterial oxygen [PaO2].An increase in arterial CO2 (PaCO2) stimulatesventilation; conversely, a decrease in PaCO2inhibitsventilation.helping to maintain respirations (throughperipheral chemoreceptor) when hypoxia occurs.
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Name: AA REY Sex: Female
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Date: 8-14-2012 Age: 78 years oldBirthday: 12-12-1933 Room : 802Requesting Doctor: Dr. Joselito AtabugLab. ID: 56096Biochem Result Normal Value Interpretation
Glucose Fasting 8.4mmol/L 3.6-6.1 It is high becausethe patient has
diabetes.
Cholesterol 4.2mmol/L Desirable -- 0-5.2Borderline -- 5.2-
6.2High -- > 6.2
Cholesterol level is
Desirable therefore it
is within the normal
range.Triglycerides 1.72mmol/L Borderline -- 1.7-
2.25High -- 5.64Very High -->5.65
Triglyceride is in the
borderline level. It is
within the normal
range.AHDL Cholesterol 1.53mmol/L 0.901.55 NormalLDL Cholesterol
2.10mmol/L
2.60-4.10
Normal
Test Result Normal Value Interpretation
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Sodium 137mmoL 136-145 Normal
Potassium 3.7mmoL 3.5-3.1 NormalChloride 99mmoL 98-107 Normal
II-Non-FastingBlood Urea
Nitrogen2.6mmol/L 2.5-6.4 Normal
Creatinine 75mol/L 53-115 NormalUric Acid 276mol/L 155-428 Normal
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R l f diff t i fl t h i l di t
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Release of different inflammatory chemical mediators.
Leukotrienes and other
inflammatory mediators.Prostaglandins Histamine, Bradykinin and
other infalammatorymediators
Release of Eosinophils
(To combat allergen)
Opening of the mucosal
intrcellular junction.
Inflammatory process
Mucus production Increase vascular
permeability
Direct stimulation of the
vagal efferent.
Mucus edema Bronchoconstriction Further Edema
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More release of other
inflammatory mediators.
Decrease of ciliary function.
Epithelial damage
Increased airway
responsiveness.
Mucus hypersecretion
Dyspnea, tachypnea and
anxiety.
Wheezing, Continuous
coughing, Feeling of
chest tightness
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Drug Dosag Mechanism of Indicatio Contraindicat Adverse Nursing
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e Action ns ions Reaction Responsibilitie
s
Generic
Name:
Hydrocortisone
Sodium
Succinate
Brand
Name:Solu-
Cortef
Generic
Name:
Cefuroxime Axetil
Brand
Name:
Zegen
100
mg
IVEvery
8
hours
1gram
IVEvery
12
hours
Hydrocortison
e Sodium
Succinate isan
adrenocortical
Steroid with
salt-retaining
properties. Itssynthetic
analog form is
mainly used
for anti-
inflammatoryeffects in
different
disorders in
many organ
systems.
-Allergic
disorder
-Collagendisease
-Disorder
of
endocrine
system-Disorder
of eye
-disorder
of
Gastrointestinal
tract
-Fungal
infections,
systemic; usenot
recommended
Unless
controlling a
drug reaction.-
Hypersensitivit
y to
Hydrocortison
e or any othercomponent of
the product.
Dermatologi
c:
Atrophiccondition of
skin,
impaired
wound
healing, sinulcer.
Endocrine
Metabolic:
Disorder of
ProteinMetabolism
-Advise patient
to avoid
vaccines duringtherapy unless
approved by a
Physician.
-This drug may
causehyperglycemia. -
-Advise patients
to report
difficulties in
glycemic control.-Instruct patients
on prolonged
therapy to report
blurred.
Drug Dosag
e
Mechanism of
Action
Indications Contraindicati
ons
Adverse
Reaction
Nursing
Responsibili
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e Action ons Reaction Responsibili
ties
Cefuroxime
Axetil is a
bactericidalsemisynthetic
cephalospori
n that binds
to essential
target
proteins,thereby,
preventing
the synthesis
of bacterial
cell walls.
-Disorder
of
Respiratory
System
-Disorder
of skin
-Bells
palsy
-Breast
Cancer
-Burn
-Cystic
Fibrosis
-Intrathecal
Administrati
on;
Serious
medical
events have
been
reported
.
Hypersensiti
vity to the
cephalospori
n group of
antibiotics.
Musculosk
eletal:
Fracture of
bone,
muscle
weakness,
Osteoporo
sis
Neurologic
:
Headache,
raised
intracranial
pressure
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Drug Dosag
e
Mechanism of
Action
Indications Contraindica
tions
Adverse
Reaction
Nursing
Responsibilities
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e Action tions Reaction Responsibilities
Generic
Name:
CefuroximeAxetil
Brand
Name:
Zegen
1
gram
IV
Every12
hours
Cefuroxime
Axetil is a
bactericidal
semisyntheticcephalospori
n that binds
to essential
target
proteins,
thereby,
preventing
the synthesis
of bacterial
cell walls.
-Acute
bacterial
exacerbat
ion of
chronic
bronchitis
-Acute
otitis
media
-
Bronchitis
, acute
Secondary
bacterial
infection
Hypersens
itivity to
the
cephalosp
orin group
of
antibiotics.
Gastrointe
stinal:
Diarrhea,
Nausea
and
Vomiting
Reproducti
ve:
Vaginitis
Dermatolo
gic:
Erythema
multiforme
Immunolo
gic:Anaphylax
is,
Hypersens
itivity
reaction
-Obtain a
careful history
before
giving/initiatin
g therapy to
determine
previous use
and reactions
to penicillin or
cephalosporin.
-This drug
may cause
diarrhea,
nausea andvomiting. The
patient should
be monitored
by his/her
watcher.
Drug Dosage Mechanism of
Indications Contraindications
AdverseReaction
NursingResponsibili
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ism of
Action
ns Reaction Responsibili
ties
-Gonorrhea,Uncomplica
ted
-Impetigo
-Tonsillitis
-Pharyngitis
-Assesspatient for
renaldysfunction andadjustaccordingly.
-Observepatient forsigns andsymptomsof
anaphylaxis (rash,pruritus,laryngealedema andwheezing)
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Drug Dosage Mechanism of
Action
Indications Contraindica
tions
Adverse
Reaction
Nursing
Responsibili
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Action tions Reaction Responsibili
ties
Generic
Name:
Salmeterol
Xinafoate
Brand
Name:
Seritide
1 Oral
Inhalatio
n
(50mcg)
BID
12 hours
Apart
Salmeterol
Xinafoate is
a long-
acting beta
(2)-
adrenergic
agonist. It
stimulates
adenylcyclase
resulting in
increased
intracellular
cyclic AMP
level whichin turns
triggers
smooth
muscles
relaxation.
-Asthma
-Chronic
Obstructiv
e
Pulmonary
Disease
-Nocturnal
Asthma
-Allergicasthma
-Cystic
fibrosis
-Use for
asthma
symptoms
without a
long-term
asthma
control
medication
.
-
Hypersens
itivity to
salmeterol
or anycomponen
t of the
product.
Musculos
keletal:
Musculosk
eletal pain
Respirato
ry:
Death
Asthma
Exacerbation of
Asthma
-This drug
may cause
dizziness,
headache,
tremors
and throat
irritation.
-Advise
patient onproper
inhalation
technique,
depending
on the
deliverydevice
used.
attack.
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Drug Dosage Mechanism ofAction
Indications Contraindications
AdverseReaction
NursingResponsibili
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Action tions Reaction Responsibili
ties
Generic
Name:
Ipatropium
Br,
Salbutamo
l /
Albuterol
Sulfate
Brand
Name:
Combivent
, Ventolin
Neb
every 6
hours
-Blocks the
action of
acetylcholineat
parasympath
etic sites in
bronchial
smooth
musclecausing
bronchodilati
on
-Relief and
prevention
ofbronchosp
asm.
-Ihalation:
Treatment
of acute
attacks ofbronchopa
sm.
-
Prevention
of exercise
induced
bronchosp
asm.
-Patients
who is
allergic tothe drugs.
-Patients
with
Hypertropi
cobstructive
cardiomyo
pathy.
- Patients
having
tachyarrhy
thmia.
Musculos
keletal:
Finetremor of
skeletal
muscle.
Nervous
system:
Dizziness,Tremor,
Nervousne
ss and
insomnia.
Cardiovas
cular:
Hypertensi
on,
edema,
palpitation
s and
arrhythmia
- Advise
the patient
to rinsemouth with
water after
using the
nebulizer
to
minimizeDry mouth.
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Drug Dosage Mechanismof Action
Indications Contraindications
AdverseReaction
NursingResponsibili
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of Action tions Reaction Responsibili
ties
Generic
Name:
Metformin
Hydrochlor
ide
Brand
Name:
Glumet-XR
1 tablet
500 mg
OD
Metformin
hydrochlori
de is an
oral
antihypergl
ycemic
agent. It
lowers
both basaland
postprandi
al glucose
levels in
type 2
Diabetespatients
through
several
mechanis
ms:
-Diabetes
mellitus
type 2
-diabetes
mellitus:
Prophylaxi
s
-
Gestational Diabetes
mellitus
-Polycystic
ovary
syndrome
-Weightgain,
Antipsycho
tic
therapy-
induced
-
Hypersens
itiity to
metformin.
-Metabolic
acidosis,
acute or
chronic,
includingdiabetic
ketoacidos
is
Gastroint
estinal:
Diarrhea,
flatulence,
indigestion
and
nausea
and
vomiting.Endocrine
Metabolic
:
Lactic
acidosis
Cobalamindeficiency
-Instruct
patient to
report
signs/sym
ptoms of
lactic
acidosis.
-Patientsshould
take
tablets
with meals
and
extended-release
tablets
with the
evening
meal.
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Assessment
Diagnosis Planning Intervention Rationale Evaluation
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t
Subjective:
ok naman
ako kasoinuuubo pa
rin ako at
minsan
nahihirapan
ako
huminga asverbalized
by the
patient.
Objective:
-Presence of
wheezing
sound at
auscultation
-RR of
25bpm
Ineffective
airway
clearance as
evidenced by
wheezing
breath
sounds.
After 8 hours
of effective
nursing
interventionthe patient will
maintain
patent airway
with clear
breath sound
and the patient
will
demonstrate
behaviors to
improve airway
clearance like
coughing
effectively and
expectorate
her
secretions.
Independent:
-Monitor
Vital signs.
-Auscultatebreathsounds, noteareas with
presence ofadventitiousbreathsounds.
-Adequatelyhydrate thepatient.
-For baseline
data.
-CracklesindicateAccumulation of
secretionsand inabilityto clearairways.
-Systemichydrationkeeps thesecretionmoist andeasier toexpectorate.
After 8 hoursof effectivenursing
interventionthe patienthadmaintainedpatent airwaywith clear
breath soundand thepatient haddemonstrated behaviorsthatimproved herairway. Goalwas met.
Assessment
Diagnosis Planning Intervention
Rationale Evaluation Assessment
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-Teach
and
encourage
the use ofdiaphragm
atic
breathing
and
coughing
exercises.
-If there is
no fluid
restriction,Increase
fluid intake
up to
3000ml/da
y.
-These
techniques
help to
improveventilation
and
mobilize
secretions
without
causing
breathless
ness and
fatigue.
-Hydrationhelps
viscosity of
secretions,
facilitating
expectorati
on
Assessment
Diagnosis Planning Intervention
Rationale Evaluation Assessment
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Collaborati
ve:
-Assist in
administeri
ng
nebulizer
as
indicated.
-
Administer
antibiotics
as
prescribed
.
-These
ensure
adequate
delivery of
medication
to theairway.
-Antibiotic
may be
prescribed
to treat the
infection.
Assessment
Diagnosis Planning Intervention Rationale Evaluation
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t
Subjective:
None
Objective:
-Weakness
-Immobility
Activity
Intolerance
related to
decreaseoxygenation.
After 8
hours of
effective
nursingintervention
the patient
will
participate
willingly in
necessary /
desired
activity such
as deep
breathing
exercises.
-Monitor
Vital Signs
-Note
contributingfactors for
fatigue.
-Assess
emotional or
psychologica
l factors.
-Plan care
with rest
periods.
-Assist
patient to
assume
comfortable
position.
-Providequiet
-For
Baseline
data.
-To identifyprecipitating
factor.
-Stress
depression
may
increase
effect of
illness.
-To reduce
fatigue.
-To maintain
functional
position.
-To reducestress.
After 8 hours
of effective
nursing
interventionthe patient
had
participated
willingly in
the activity
such as
deep
breathing
exercises.
Goal was
met.
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Medication Exercise Treatment Healthteaching
OPD Diet Spiritual
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g
Metformin
Hydrochlori
de 1tablet
500mg ODSeritide
1puff BID
Encoura
ge to do
exercises
dailysuch as
brisk
walking
for
30min.
Instructto do
deep
breathing
exercises
and do
chest uptapping
Combiven
t every
6hours(Ne
b)
Encourag
e oral fluid
atleast 8 to
10 glassesa day
Encourag
e pt to sit
up straight
when there
is a DOBEncourag
e to avoid
persons
with
respiratory
infectionssuch as
cold,cough
,pneumoni
a and
many
others.
Instruct
the patient
to visit the
physicianon the
scheduled
date of
visit
Provide
photocopyof all
laboratory
test taken
during
hospitaliza
tion
Low salt
Low fat
Eat high
fiber foodssuch as
fruits and
vegetables
Avoid
salty foods
such asdried fish,
canned
goods and
bagoong.
Eat fruits
with Vit Csuch as
oranges,
guava and
apple.
Encourag
e not to
lose hope
and pray toGod o a
regular
basis
asking Him
for his
constantguidance
and
blessing
continue to
have
strongfaith.
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