Nephrotic Syndrome

Group 57
 Introduction
 Nephrotic syndrome is a nonspecific disorder in which the
kidneys are damaged, causing them to leak large amounts of
protein (proteinuria at least 3.5 grams per day per 1.73
m2body surface area) from the blood into the urine. Other
symptoms include hypoalbuminemia (decrease in albumin in
the blood), edema, hypercholesterolemia (high serum
cholesterol), and normal renal function.


 * The most common sign is excess fluid in the body. This may
take several forms:
 o Puffiness around the eyes, characteristically in
the morning.
 o Edema over the legs which is pitting (i.e., leaves a
little pit when the fluid is pressed out, which resolves
over a few seconds).
 o Fluid in the pleural cavity causing pleural
effusion. More commonly associated with excess fluid is
pulmonary edema.
 o Fluid in the peritoneal cavity causing ascites.
 
 The following are baseline, essential
investigations


 * Urine sample shows proteinuria

(>3.5g per 1.73 m2 per 24 hour).
 * Comprehensive metabolic panel (CMP)
shows Hypoalbuminemia: albumin level
≤2.5g/dL (normal=3.5-5g/dL).
 * High levels of cholesterol
(hypercholesterolemia), specifically
elevated LDL, usually with
concomitantly elevated VLDL
 * Electrolytes, urea and creatinine
(EUCs): to evaluate renal function.
•
 Causes:
Nephrotic syndrome has many causes and may either
be the result of a disease limited to the kidney,
called primary nephrotic syndrome, or a condition
that affects the kidney and other parts of the
body, called secondary nephrotic syndrome.
Primary causes of nephrotic syndrome are usually

described by the histology, i.e., minimal change

disease (MCD), focal segmental glomerulosclerosis
(FSGS) and membranous nephropathy (MN), sickle
cell disease, diabetes mellitus and malignancy
such as leukemia.
Secondary causes of nephrotic syndrome occurs

after an infectious disease, such as infection

with group A beta-hemolytic streptococci,
syphilis, malaria, tuberculosis, or viral
infections, including varicella, hepatitis B, HIV,
and infectious mononucleosis.
 Epidemiology:
 Nephrotic syndrome is often
described as a disease of
children and is relatively rare.
It is 15 times more common in
children than in adults. The
reported annual incidence rate is
2 to 5 per 100,000 children
younger than 16 years. The
cumulative prevalence rate is
approximately 15.5 per 100,000
individuals. Nephrotic syndrome
prevalence is difficult to
establish in adults, because the
 Case Study Format

I. PATIENT DEMOGRAPHIC DATA

Name: Rose Nina Francisco Age/Sex: 14/Female Status: Single Religion: Roman Catholic
Home Address: Cogon, Pardo Nationality: Filipino Occupation: N/A

II. HEALTH HISTORY PROFILE

A. Past Medical History
1. Pediatric and Adult Illness

Date Illness Medication Remarks

NONE NONE NONE NONE

2. Immunization
Immunization Doses Dates Remarks

BCG 1 Can’t Recall Complete

DPT 3 Can’t Recall Complete
OPV 3 Can’t Recall Complete
 3. Hospitalization
Date/Year Hospital Diagnosis Duration

2007 Cebu City Medical Center Nephrotic Syndrome 1 week

2008 Cebu City Medical Center Nephrotic Syndrome 1 week

4. Injuries and Accidents- The patient did not experience any injuries and
accidents.
5. Transfusions- The patient did not undergo any transfusions such as blood
transfusion.
6. Allergies(specify)- The patient has no any allergies .

B. Family History

Rodrigo Francisco
Nelia Francisco

Legend:

Father
Mother
Patient
Rose Nina Francisco
 C. Social and Personal History
•
1.Occupation-N/A
2.Number of Children-N/A
3.Military experiences, foreign travel-N/A
4.Habits (tobacco, alcohol, non-prescription drugs, others)-N/A
5.Diet-fruits, vegetables, pork chop, dried fish
6.Type of Family-Extended Family
7.Cultural and Religious Beliefs-N/A
8.Brief description of average day:

5:30 am-wake up
6:00 am-breakfast
7:00-9:00 am-class hours
9:15-9:30 am-recess
9:30-12:00 am-class hours
12:00-1:00 pm-lunch
1:00-5:00 pm-class hours
5:30 pm-do homework
6:00 pm-dinner
7:00-8:00 pm-watch T.V
8:00 pm-sleeping time
 D. Review System (for the past 6 months). Physical Assessment
General Weight loss Fatigue Anorexia Night sweats
Chills Fever Weakness
The patient experienced fever due to cough and colds.
The patient experienced fatigue due to illness and lack of sleep.
The patient experienced weakness due to fatigue.
Skin Itch Rash Lesions Bruising
Bleeding Color change
NONE

Eyes Pain Discharge Itch Vision loss Diplopia

Excessive tearing Glasses/Contact lens Date of last exam
NONE

Ears Earaches Discharges Tinnitus Hearing loss

NONE

Nose Obstruction Discharges Epistaxis

NONE

Throat and Mouth Sore throats Bleeding gums Toothache Dentures

NONE

Neck and Head Swelling Dysphagia Hoarseness

NONE

Chest Cough Sputum: Amount and Character Hemoptysis

Wheeze Pain on respiration Dyspnea
The patient experienced dyspnea due to obstruction of the airway.
Cardiovascular Precordialpain Palpitation Dyspneaon exertion Orthopnea
Dyspnea Paroxysmal nocturnal Edema Heart murmur
Claudication Thrombophlebitis
NONE

Gastrointestinal Heartburn Nausea Vomiting Diarrhea Food intolerance

Excessive gas or indication Constipation Jaundice Bloating
Change in Bowel movement Melena Hemorrhoids Hernia
NONE

Genitourinary Heartburn Nausea Vomiting Diarrhea Food intolerance

Excessive gas or indication Constipation Jaundice Bloating
Change in Bowel movement Melena Hemorrhoids Hernia
NONE

Extremities Joint pains Varicose veins Claudication Back pain

Edema Stiffness Deformities

The patient experienced edema due to illness which is nephrotic syndrome.

Endocrine Hot flashes Hair loss Temperature intolerance

Polydipsia Goiter

NONE

Neurology Numbness Tingling Tremor Fainting

Headaches Muscle weakness Ataxia Seizure Unconsciousness Paralysis/Paresis
Memory loss Dizziness
The patient experienced headaches due to fever.
 Psych Anxiety Depression Sexual problems Insomnia
Nightmares
NONE

Others NONE

III. CURRENT HEALTH PROFILE

A.Presenting complaints and medical diagnosis to include intervention done prior to
hospitalization.
Rosa Nina Francisco was diagnosed for Nephrotic Syndrome. She Complain of
difficulty in breathing.
B. Application of the Nursing Process
1. Assessment Finding (Head –to-Toe)
Skin Uniform skin color, no jaundice, cyanosis
Hair Skin intact
Hair is evenly distributed over scalp
Skin
Hair warm and dry
Nails Color pink, well and
color black thin ad convex, smooth and firm
groomed
Head No lesions or pediculosis
Normocephallic, erect and midline
Head symmetrical, no masses, nontender
Face Facial expression appropriate, no abnormal movements or lesions
Facial bones smooth, intact,symmetrical,nontender
Ears Ears aligned with eyes, symmetrical, no redness, lesions or drainage
Eyes Eyes clear and bright, equal parallel alignment
Eyelids color consistent with clients complexion
Eyelashes evenly distributed, no excessive tearing or dryness

Nose Nose midline, symmetrical, no deviation, no flaring

No deformities or nasal tenderness
Sinuses Sinuses clear, nontender
Mouth Lips pink, moist, no lesions
Oral mucosa pink, moist, no lesions, intact
Teeth complete
Tongue pink, moist,midline

Neck Neck symmetrical, skin intact, no masses

Upper Extremities Skin color uniform; no erythema, edema
Abdomen Skin color consistent, no lesions, rashes, scars or discoloration.
Hair distribution appropriate for client’s age and gender.
Abdomen flat and symmetrical, no bulges or hernias
Umbilicus midline
Abdomen soft, nontender, no masses

Lower Extremities Leg hair evenly distributed; color uniform; no edema or lesions
Laboratory/Diagnostic Results

Date Lab Exam Patient Results Normal Findings Interpretation/Significant

09-01-09 Protein to 1.55 0.5-0.9 Suggests the presence of

Creatinine ratio nephrotic range proteinuria.

Serum albumin 0.9g/dl 3.4-5.4g/dl Hypoalbuminemia can be caused

by Excess excretion by the
kidneys.
Human anatomy

KIDNEY
Parts of the


human kidney
• NORMAL KIDNEY SIZE
- The normal kidney size of an adult human is about 10 to
13 cm (4 to 5 inches) long and about 5 to 7.5 cm (2 to 3
inches) wide. It is approximately the size of
a conventional computer mouse.
• NORMAL KIDNEY COLOR
- The kidneys are dark-red, bean-shaped organs. One side
of the kidney bulges outward (convex) and the other
side is indented (concave)
• NORMAL KIDNEY LOCATION

- towards the back of the abdominal cavity, just
above the waist. One kidney is normally located just
below the liver, on the right side of the abdomen and
the other is just below the spleen on the left side.
-
•
 Kidney anatomy and
excretion
• The most basic structures of the kidneys, are
nephrons. They are responsible for filtering the
blood.
• The renal artery delivers blood to the kidneys each
day. Over 180 liters (50 gallons) of blood pass
through the kidneys every day. When this blood
enters the kidneys it is filtered and returned to the
heart via the renal vein.
• The process of separating wastes from the body
fluids and eliminating them, is known as excretion
. The urinary system is one of the organ systems
responsible for excretion. The kidneys are the
main organs of the urinary system.
•
 Kidney anatomy and blood
vessels
• The kidney is full of blood vessels. Every
function of the kidney involves blood,
therefore, it requires a lot of blood
vessels to facilitate these functions.
• Together, the two kidneys contain about
160 km of blood vessels.
•
 Renal capsule
• is a tough fibrous layer surrounding
the kidney and covered in a thick
layer of adipose tissue. It provides
some protection from trauma and
damage
 Renal cortex

• is the outer portion of the kidney between

the renal capsule and the renal medulla.
In the adult, it forms a continuous
smooth outer zone with a number of
projections (cortical columns) that
extend down between the pyramids.
• ultrafiltration occurs.
 Renal medulla

• is the innermost part of the kidney

• split up into a number of sections, known
as the renal pyramids
• contains the structures of the nephrons
responsible for maintaining the salt and
water balance of the blood
• is hypertonic to the filtrate in the nephron
and aids in the reabsorption of water.
•
 Renal pyramids

 are cone-shaped tissues of the kidney

 made up of 8 to 18 of these conical
subdivisions
 The broad base of each pyramid faces
the renal cortex, and its apex, or papilla,
points internally
 The base of each pyramid originates at the
corticomedullary border and the apex
terminates in a papilla, which lies within a
minor calyx, made of parallel bundles of
urine collecting tubules
 Minor calyx

• surrounds the apex of the malpighian

pyramids. Urine formed in
the kidney passes through a papilla at
the apex into the minor calyx then into
the major calyx.
• Peristalsis of the smooth muscle
originating in pace-maker cells
originating in the walls of the calyces
propels urine through the pelvis and
ureters to the bladder.
•
 Major calyx

• surrounds the apex of the malpighian

pyramids. Urine formed in
the kidney passes through a papilla at
the apex into a minor calyx then into
major calyx before passing through
the renal pelvis into the ureter.
• Peristalsis of the smooth muscle
originating in pace-maker cells
originating in the walls of the calyces
propels urine through the pelvis and
ureters to the bladder.
•
 Renal papilla
• is the location where the
Medullary pyramids
empty urine into the
renal pelvis
 Renal column
• is a medullary extension of the
renal cortex in between the renal
pyramids. It allows the cortex to
be better anchored.
• Each column consists of lines of
blood vessels and urinary tubes
and a fibrous material.

 Renal pelvis
• is the funnel-like dilated proximal part
of the ureter in the kidney.
• It is the point of convergence of two or
three major calyces. Each renal
papilla is surrounded by a branch of
the renal pelvis called a calyx.
• The major function of the renal pelvis is
to act as a funnel for urine flowing to
the ureter.
•
 Ureter
• are muscular ducts that
propel urine from
the kidneys to urinary
bladder. In the adult, the
ureters are usually 25–
30 cm (10–12 in) long.
 Pathophysiology:
• Nephrotic syndrome results from damage to the kidney’s glomeruli,
the tiny blood vessels that filter waste and excess water from the
blood and send them to the bladder as urine. They consist of
capillaries that are fenestrated, that is, have small openings,
which allow fluid, salts, and other small solutes to flow through
but normally not proteins. Damage to the glomeruli from
diabetes, glomerulonephritis, or even prolonged hypertension,
causes the membrane to become more porous, so that small
proteins, such as albumin, pass through the kidneys into urine.
As protein continues to be excreted, serum albumin is
decreased, which in turn decreases the serum osmotic pressure.
Capillary hydrostatic fluid pressure becomes greater than
capillary osmotic pressure, which results in generalized edema.
As fluid is lost into the tissues, the plasma volume decreases,
stimulating secretion of aldosterone to retain sodium and water,
which decreases the glomerular filtration rate to retain water. This
additional water also passes out of the capillaries into the tissue,
leading to even greater edema.

•
 NURSING CARE PLAN
Name of Patient: Rose Nina Francisco Patient’s Health Profile: Received the patient lying in bed with Dopamine 67ml at
Age: 14 yrs. old Sex: Female 31 gtts/min, unconscious, uncoherent and afebrile.
Occupation: N/A
Date of Admission: September 1, 2009 Initial Complaint: dyspnea
Status: Single Religion: Roman Catholic Diagnosis/Impression: Nephrotic Syndrome

Needs/Nsg. Scientific Analysis Objective Nursing Problem/ Rationale Evaluation

Diagnosis/Cues Interventions
Physiologic Nephrotic syndrome is a After 8 hours of nurse- Assess and monitor Identifies nutritional Goals met. After 8 hours
Imbalanced Nutrition, nonspecific disorder in patient interaction, the food/fluid ingested. deficits/ therapy needs. of nurse-patient
less than body which the kidneys are patient will be able to: Monitor weight daily at To assess the health interaction, the patient
requirements related to damaged, causing them to Identify the appropriate same time, same clothing status of patient. Same was able to:
poor appetite, restricted leak large amounts of diet for her condition. and same scale. clothing, same time and a.Identify the appropriate
diet, and protein loss protein from the blood (Low-sodium diet)  same scale makes the diet for her condition.
Cues: into the urine. Damage to b.Follow the diet  weight equal/fair than (Low-sodium diet)

the glomeruli causes the prescribed.  yesterday. b.Follow the diet
S: “Wala koy gana membrane to become c.Verbalize realization of Smaller portions may prescribed.
mukaon.”, as verbalized more porous, so that the importance of proper Recommend small,
enhance intake. c.Verbalize realization of
by the patient. small proteins, such as diet. frequent meals. This electrolyte can the importance of proper
O: protein-creatinine ratio albumin, pass through the Restrict sodium as
quickaccumulate, causing diet.
of 1.55 kidneys into urine. indicated, and limit fluid fluid retention, and
Serum albumin of 0.9g/dl intake to 100ml. weakness.
(Rick Daniels,  Replaces vitamin/mineral

Contemporary Medical- deficits resulting from

Administer
Surgical Nursing, malnutrition.
Thomson Learning Asia, multivitamins, as
volume 2, 2007, page indicated.
1784)
Needs/Nsg. Scientific Analysis Objective Nursing Problem/ Rationale Evaluation
Diagnosis/Cues Interventions
Because of the Administer Reduces
leaking proteins medications as stimulation of the
from the blood to appropriate. vomiting center.
the urine, the Monitor laboratory To assess

nutrients needed in studies development and

her body are being status.
excreted. This
causes her to lose
the nutrients in the
body, making her
nutrition less than
body requirements.
NURSING DIAGNOSIS SCIENTIFIC OBJECTIVES NURSING RATIONALE EVALUATION
ANALYSIS INTERVENTIONS

Excess fluid volume Nephrotic syndrome is a After 8 hrs of Record accurate intake and
  Accurate intake and output is After 8 hrs of
related to compromised clinical disorder of nursing output of the patient necessary for determining the renal nursing
regulatory mechanism unknown cause interventions, the  function and fluid replacement needs interventions, the
with changes in characterized by patient will display and reducing risk of fluid overload patient was able to
Monitor urine specific gravity 
hydrostatic or oncotic proteinuria, stable weight, vital Measures the kidneys ability to display stable
Weight daily at same time of
vascular pressure and hypoalbuminemia, edemasigns within concentrate urine. weight, vital signs
increased in activation of and hyperlipidemia. This patient’s normal the day, on same scale, with Daily body weight is the best within patient’s
rennin angiotensin conditions result from range, and nearly same equipment and clothing monitor of fluid status. A weight gain normal range, and
Assess skin, face, dependent
aldosterone system excessive leakage of absence of edema. of more than 0.5 kg/day suggest fluid nearly absence of
S: “murag nanghupong plasma proteins into the areas of edema retention. edema.
aq anak sa iya bitiis” as urine because of the  Edema occurs primarily in

verbalized by the mother impairment of the dependent tissues of the body. It will
Monitor heart rate and blood
O: edema, glomerular capillary serve as a parameter the severity of
weight gain, membrane. pressure. fluid excess
changes in vital signs 


Tachycardia and hypertension can


occur because of failure of the

kidneys to excrete urine
NEEDS/NSG SCIENTIFIC OBJECTIVE NURSING PROBLEM/ RATIONALE EVALUATION
DIAGNOSIS/CU ANALYSIS INTERVENTIONS
ES
Assess level of May reflect
consciousness: fluid shifts and
investigate electrolyte
changes in imbalances
mentation,
presence of
restlessness.
 NURSING CARE PLAN
Name: Rose Nina Francisco Patient’s Health Profile: Received the patient lying in bed with
Age: 14 Sex: Female Dopamine 67ml @ 31 gtts/min, unconscious, uncoherent, and
Date of Admission: September 1, 2009 a febrile.
Occupation: N/A Initial complaint: Dyspnea
Status: Single Religion: Roman Catholic Diagnosis: Nephrotic Syndrome

Needs/Nursing Scientific Analysis Objectives Nursing Rationale Evaluation

Diagnosis Interventions
Self- Actualization Nephrotic Syndrome After 4 hours of Assess readiness to To facilitate Goal was met. The
Cues 

Knowledge deficit is a set of symptoms nurse-patient and learn. successful learning, patient and the
related to chronic that are caused by significant others it is important to significant others
illness many different interaction, the assess readiness to were able to
problems, most patient and the learn. identified the
commonly significant others interferences to
glomerulonephritis or will be able to: Physical limitations learning and made

some systemic Assess ability to or cognitive specific actions to

disorder such as Identify perform desired limitations must be deal with it. And
diabetes or lupus interferences to health-related care. identified and they were to
erythematosus. The learning and specific considered when performed necessary
symptoms are heavy actions to deal with establishing procedures correctly
loss of protein in the it. treatment plan. and they explained
urine, resulting in the
hypoalbuminemia Perform necessary Provide an Environment should reasons for the

and massive edema. procedures correctly environment that is be free of actions they made.
There may also be a and explain reasons conducive to distractions and And they were able
high blood for the actions. learning. noise. to initiated necessary
cholesterol level. lifestyle changes and
Medical-Surgical  Provide written  Reinforces learning participated in
Nursing Initiate necessary information/guidelin process, allows treatment regimen
Philadelphia/London lifestyle changes and es and self-learning client to proceed at by allowing them to
/Toronto participate in modules for client to own pace. practice and
W.B Saunders treatment regimen. refer to as necessary. demonstrate the
Company treatment regimen.
Vol.1, 1974 Allow practice and

Page 728 demonstrations. To ensure accurate

learning and
Knowledge deficit accurate evaluation
result when an of ability to perform
individual desired skills, repeat
experiences an demonstrations need
inability to state or to be observed.
explain information
or demonstrate a
required skill
related to health care
measures necessary
to maintain or
improve wellness.
Nursing Diagnosis
in Critical Practice
United States of
America
Delmar Publishers /,
Inc
1992
Pages 339-342
 DRUG STUDY
Name of patient : Rose Nina Francisco Patient’s health profile: Received patient lying in bed with dopamine 67 ml at
Age: 14 years old Sex: Female 31 gtts/min unconscious, uncoherent and afebrile.
Occupation: none
Date of admission: September 1 ,2009 Initial Complaint : dyspnea
Status: single Religion: Catholic Diagnosis: Nephrotic Syndrome
Name of drug: Classification Mechanism Contraindication Route Side Nursing
generic name of and effects responsibilities
brand name action dosage

Captopril Antihypertensive, Competitive Hypersensitivity to 50 mg Dermatologic: >Do not discontinue

(NuCapto) inhibitor of inhibitor of captopril or any rash with pruritus without the
angiotensin angiotensin- component of the and occasionally providers consent.
synthesis converting enzyme formulation; fever, Stevens- >obtain baseline
(ACE); prevents angioedema related Johnson Syndrome hematologic and
conversion of to previous CV: MI, CVA, CHF, renal finction test.
angiotensin I to treatment with an cardiac arrest, >observe for
angiotensin II, a ACE inhibitor; bronchospams, precipitous drop in
potent idiopathic or pulmonary BP within 3 hr after
vasoconstrictor; hereditary embolism, initial dose if client
results in lower angioedema; pulmonary has been on diuretic
levels of bilateral renal artery infarction. therapy and a low-
angiotensin II stenosis; pregnancy Hematologic: salt diet.
which causes an (2nd or 3rd aplastic or >take 1 hr before
increase in plasma trimester) hemolytic anemia meals, on an empty
renin activity and a stomach; food
reduction in interferes with drug
aldosterone absorption.
secretion >report any fever,
skin rash, sore
throat, mouth sores.
Name of drug: Classification Mechanism Contraindication Route Side Nursing
generic name of and effects responsibilities
brand name action dosage

Ranitidine GASTROINTESTI Competitive >Hypersensitivity to 50 g IVTT q 8 allergic reaction: >Potential toxicity

Zantac, Zantac NAL AGENT; inhibition of ranitidine or any hives; difficulty results from
EFFERdose, Zantac ANTISECRETORY histamine at H2- component of the breathing; swelling decreased clearance
GELdose, Zantac- (H2-RECEPTOR receptors of the formulation of your face, lips, (elimination) and
75 ANTAGONIST) gastric parietal cells, tongue, or throat. therefore prolonged
which inhibits >chest pain, fever, action; greatest in
gastric acid feeling short of the older adult
secretion, gastric breath, coughing up patients or those
volume, and green or yellow with hepatic or renal
hydrogen ion mucus; dysfunction.
concentration are >easy bruising or >Lab tests: Periodic
reduced. Does not bleeding, unusual liver functions.
affect pepsin weakness; fast or Monitor creatinine
secretion, slow heart rate; clearance if renal
pentagastrin- problems with your dysfunction is
stimulated intrinsic vision; present or
factor secretion, or >fever, sore throat, suspected. When
serum gastrin. and headache with a clearance is <50
severe blistering, mL/min,
peeling, and red manufacturer
skin rash; or n recommends
>nausea, stomach reduction of the
pain, low fever, loss dose to 150 mg
of appetite, dark once q24h with
urine, clay-colored cautious and gradual
stools, jaundice reduction of the
(yellowing of the interval to q12h or
skin or eyes). less, if necessary.
NAME OF CLASSIFICATION & INDICATION AND CONTRAINDICATIO SIDE-EFFECTS/ NURSING
DRUG MECHANISM OF DOSAGE N ADVERSE RESPONSIBILITIES
ACTION REACTIONS
>Be alert for early
signs of
hepatotoxicity
(though low and
thought to be a
hypersensitivity
reaction): jaundice
(dark urine, pruritus,
yellow sclera and
skin), elevated
transaminases
(especially ALT) and
LDH.
>Long-term therapy
may lead to vitamin
B12 deficiency.
Name of drug: Classification Machanism Contraindication Route Side Nursing
generic name of and effects responsibilities
brand name action dosage

Furosemide ELECTROLYTIC Inhibits >Hypersensitivity 30 g IVTT q 12 allergic reaction: >Take this

Fumide , AND WATER reabsorption of to furosemide, any hives; difficulty medication exactly
Furomide , Lasix, BALANCE sodium and component, or breathing; swelling as it was prescribed
Luramide AGENT; LOOP chloride in the sulfonylureas; of your face, lips, for you. Do not take
DIURETIC ascending loop of anuria; patients tongue, or throat. the medication in
Henle and distal with hepatic coma dry mouth, thirst, larger amounts, or
renal tubule, or in states of nausea, vomiting; take it for longer
interfering with the severe electrolyte feeling weak, than recommended
chloride-binding depletion until the drowsy, restless, or by your doctor.
cotransport system, condition improves light-headed; fast or Follow the
thus causing or is corrected uneven heartbeat; directions on your
increased excretion muscle pain or prescription label.
of water, sodium, weakness; urinating >Avoid becoming
chloride, less than usual or dehydrated. Follow
magnesium, and not at all; easy your doctor's
calcium bruising or instructions about
bleeding, unusual the type and
weakness; a red, amount of liquids
blistering, peeling you should drink
skin rash; hearing while you are
loss; or nausea, taking furosemide.
stomach pain, low
fever, loss of
appetite, dark urine,
clay-colored stools,
jaundice (yellowing
of the skin or eyes).
NAME OF CLASSIFICATION & INDICATION AND CONTRAINDICATIO SIDE-EFFECTS/ NURSING
DRUG MECHANISM OF DOSAGE N ADVERSE RESPONSIBILITIES
ACTION REACTIONS
>It is important that
patients be closely
followed for
hypokalemia,
hypomagnesemia, and
volume depletion because
of significant diuresis. If
given the morning of
surgery, it may render the
patient volume depleted
and blood pressure may
be labile during general
anesthesia.
Name of drug: Classification Mechanism Contraindication Route Side Nursing
generic name of and effects responsibilities
brand name action dosage

Prednisone hormones and >Decreases >Hypersensitivity to 10 mg 6 OD allergic reaction: >Establish baseline

Apo-Prednisone , synthetic substitutes; inflammation by prednisone or any hives; difficulty and continuing data
Deltasone, adrenal suppression of component of the breathing; swelling regarding BP, I&O
Meticorten, Orasone, corticosteroid; migration of formulation; serious of your face, lips, ratio and pattern,
Panasol, Prednicen- glucocorticoid polymorphonuclear infections, except tongue, or throat. weight, and sleep
M, Sterapred, leukocytes and tuberculous problems with your pattern. Start flow
Winpred reversal of increased meningitis; systemic vision; swelling, chart as reference for
capillary fungal infections; rapid weight gain, planning
permeability; varicella feeling short of individualized
suppresses the breath; severe pharmacotherapeutic
immune system by depression, unusual patient care.
reducing activity and thoughts or behavior,
volume of the seizure >Check and record
lymphatic system; (convulsions); BP during dose
suppresses adrenal bloody or tarry stabilization period
function at high stools, coughing up at least 2 times daily.
doses. Antitumor blood; pancreatitis Report an ascending
effects may be (severe pain in your pattern.
related to inhibition upper stomach >Report symptoms
of glucose transport, spreading to your of GI distress to
phosphorylation, or back, nausea and physician and do not
induction of cell vomiting, fast heart self-medicate to find
death in immature rate); low potassium relief.
lymphocytes. (confusion, uneven
Antiemetic effects heart rate, extreme
are thought to occur thirst, increased
due to blockade of urination,
cerebral innervation
of the emetic center
via inhibition of
NAME OF CLASSIFICATION & INDICATION AND CONTRAINDICATIO SIDE-EFFECTS/ NURSING
DRUG MECHANISM OF DOSAGE N ADVERSE RESPONSIBILITIES
ACTION REACTIONS

prostaglandin synthesis. leg discomfort, muscle >Take drug as prescribed and

weakness or limp do not alter dosing regimen or
feeling); or dangerously stop medication without
high blood pressure consulting physician.
(severe headache, >Be aware that a slight weight
blurred vision, buzzing gain with improved appetite is
in your ears, anxiety, expected, but after dosage is
confusion, chest pain, stabilized, a sudden slow but
shortness of breath, steady weight increase [2 kg (5
uneven heartbeats, lb) per wk] should be reported
seizure). to physician.
Name of drug: Classification Machanism Contraindication Route Side Nursing
generic name of and effects responsibilities
brand name action dosage

Ampicillin antiinfective; >Inhibits bacterial >Hypersensitivity to 1500 g q 6 ANST allergic reaction: >Determine
Unasyn antibiotic; cell wall synthesis ampicillin, any hives; difficulty previous
aminopenicillin by binding to one or component of the breathing; swelling hypersensitivity
more of the formulation, or other of your face, lips, reactions to
penicillin binding penicillins tongue, or throat. penicillins,
proteins (PBPs); fever, sore throat, cephalosporins, and
which in turn and headache with a other allergens prior
inhibits the final severe blistering, to therapy.
transpeptidation step peeling, and red skin >Lab tests: Baseline
of peptidoglycan rash; diarrhea that is C&S tests prior to
synthesis in bacterial watery or bloody; initiation of therapy;
cell walls, thus fever, chills, body start drug pending
inhibiting cell wall aches, flu results.
biosynthesis. symptoms; easy >Report promptly
Bacteria eventually bruising or bleeding, unexplained
lyse due to ongoing unusual weakness; bleeding (e.g.,
activity of cell wall urinating less than epistaxis, purpura,
autolytic enzymes usual or not at all; ecchymoses).
(autolysins and agitation, confusion, >Monitor patient
murein hydrolases) unusual thoughts or carefully during the
while cell wall behavior; or seizure first 30 min after
assembly is arrested. (black-out or initiation of IV
convulsions). therapy for signs of
hypersensitivity and
anaphylactoid
reaction (see
Appendix F).
NAME OF CLASSIFICATION & INDICATION AND CONTRAINDICATIO SIDE-EFFECTS/ NURSING
DRUG MECHANISM OF DOSAGE N ADVERSE RESPONSIBILITIES
ACTION REACTIONS
Serious anaphylactoid reactions
require immediate use of
emergency drugs and airway
management. >Observe for and
report symptoms of
superinfections (see Appendix
F). Withhold drug and notify
physician.
>Monitor I&O ratio and
pattern. Report dysuria, urine
retention, and hematuria.
Name of drug: Classification Machanism Contraindication Route Side Nursing
generic name of and effects responsibilities
brand name action dosage
]
Nifedipine cardiovascular >Inhibits calcium >Hypersensitivity to 10mg tab TID >an allergic reaction >Keep a record of
Adalat, Adalat CC, agent; calcium ion from entering nifedipine or any (difficulty nitroglycerin use
Procardia, Procardia channel blocker; the "slow channels" component of the breathing; closing and promptly report
XL antiarrhythmic or select voltage- formulation; of the throat; any changes in
(class iv); nonnitrate sensitive areas of immediate release swelling of the lips, previous pattern.
vasodilator. vascular smooth preparation for tongue, or face; or Occasionally,
muscle and treatment of urgent hives); unusually people develop
myocardium during or emergent fast or slow increased frequency,
depolarization, hypertension; acute heartbeats; severe duration, and
producing a MI dizziness or severity of angina
relaxation of fainting; psychosis; when they start
coronary vascular yellowing of the treatment with this
smooth muscle and skin or eyes drug or when
coronary (jaundice); or dosage is increased.
vasodilation; swelling of the legs >Monitor BP
increases or ankles. carefully during
myocardial oxygen titration period.
delivery in patients Patient may become
with vasospastic severely
angina hypotensive,
especially if also
taking other drugs
known to lower BP.
Withhold drug and
notify physician if
systolic BP <90.
NAME OF CLASSIFICATION & INDICATION AND CONTRAINDICATIO SIDE-EFFECTS/ NURSING
DRUG MECHANISM OF DOSAGE N ADVERSE RESPONSIBILITIES
ACTION REACTIONS
>Monitor blood sugar in
diabetic patients. Nifedipine
has diabetogenic properties.
>Monitor for gingival
hyperplasia and report
promptly. This is a rare but
serious adverse effect (similar
to phenytoin-induced
hyperplasia).
Name of drug: Classification Machanism Contraindication Route Side Nursing
generic name of and effects responsibilities
brand name action dosage

Cephalexin antiinfective; >Inhibits bacterial >Hypersensitivity 75 g q 8 ANST allergic reaction: >Determine history
Cefanex, antibiotic; first- cell wall synthesis to cephalexin, any hives; difficulty of hypersensitivity
Ceporex_A, Keflet, generation by binding to one or component of the breathing; swelling reactions to
Keflex, Keftab, cephalosporin more of the formulation, or of your face, lips, cephalosporins and
Novolexin_A penicillin-binding other tongue, or throat. penicillin and
proteins (PBPs) cephalosporins diarrhea that is history of other
which in turn watery or bloody; drug allergies
inhibits the final seizure before therapy is
transpeptidation (convulsions) initiated.
step of fever, sore throat, >Lab tests:
peptidoglycan and headache with aEvaluate renal and
synthesis in severe blistering, hepatic function
bacterial cell walls, peeling, and red periodically in
thus inhibiting cell skin rash; patients receiving
wall biosynthesis. pale or yellowed prolonged therapy.
Bacteria eventually skin, dark colored >Monitor for
lyse due to ongoing urine, fever, manifestations of
activity of cell wall confusion or hypersensitivity
autolytic enzymes weakness; (see Signs &
(autolysins and easy bruising or Symptoms,
murein hydrolases) bleeding, unusual Appendix F).
while cell wall weakness; Discontinue drug
assembly is and report their
arrested. appearance
promptly.
NAME OF CLASSIFICATION & INDICATION AND CONTRAINDICATIO SIDE-EFFECTS/ NURSING
DRUG MECHANISM OF DOSAGE N ADVERSE RESPONSIBILITIES
ACTION REACTIONS
confusion, >Take medication for the
agitation, full course of therapy as
hallucinations directed by physician.
(seeing things that >Keep physician
are not there); or informed if adverse
urinating less than reactions appear.
usual or not at all.
S:
SOAPIE
O:
A: Knowledge deficit related to chronic illness
P: After 4 hours of nurse-patient and significant others interaction,
the patient and the significant others will be able to:
Identify interferences to learning and specific actions
to deal with it.
Perform necessary procedures correctly and explain reasons
for the actions.
Initiate necessary lifestyle changes and participate in treatment
regimen.
I:Assessed readiness to learn.
Provided an environment that is conducive to learning.
Provided written information/guidelines and self-learning modules
for client to refer to as necessary.
Allowed practice and demonstrations.
E: Goal was met. After 4 hours of nurse-patient and significant others
interaction, the patient and the significant others will be able to
identified the interferences to learning and made specific actions to
deal with it. And they were to performed necessary procedures
correctly and they explained the reasons for the actions they made.
And they were able to initiated necessary lifestyle changes and
participated in treatment regimen by allowing them to practice and
demonstrate the treatment regimen.
 SOAPIE
S- “Wala koy gana mukaon.”, as verbalized by the patient.
O- : protein-creatinine ratio of 1.55
Serum albumin of 0.9g/dl
A- Imbalanced Nutrition, less than body requirements
related to poor appetite, restricted diet, and protein loss.
P- After 8 hours of nurse-patient interaction, the patient
will be able to:
a.Identify the appropriate diet for her condition. (Low-
sodium diet)
b.Follow the diet prescribed.
c.Verbalize realization of the importance of proper diet.
I- Assessed and monitored food/fluid ingested and
calculate caloric intake.
•Monitored weight daily at same time, same clothing and
same scale.
•Recommended small, frequent meals.
•Restricted sodium as indicated, and limited fluid intake
to 100ml
•Administered multivitamins, as indicated.
•Administered medications as appropriate.
•Monitored laboratory studies.
E- Goals met. After 8 hours of nurse-patient interaction,
the patient was able to identify the appropriate diet for her
condition. (Low-sodium diet). Follow the diet prescribed.
Verbalize realization of the importance of proper diet.
 SOAPIE
S- “Murag nanghupong akong anak sa iya bitiis.”, as
verbalized by the mother.
O- Edema, weight gain, changes in vital signs
A- Excess fluid volume related to compromised
regulatory mechanism with changes in hydrostatic
vascular pressure and increased activation of rennin
angiotensin aldosterone system.
P-After 5 hrs of nursing interventions, the patient will
be able to:
display stable weight
vital signs within patient’s normal range
nearly absence of edema.
I-Record accurate intake and output of the patient
Monitor urine specific gravity
Weight daily at same time of the day, on same scale, with
same equipment and clothing
Assess skin, face, dependent areas of edema
Monitor heart rate and blood pressure
Assess level of consciousness: investigate changes in
mentation, presence of restlessness.
E-Goals were fully met. After 5 hrs of nursing
interventions, the patient was able to display stable weight,
vital signs within patient’s normal range, and nearly
absence of edema.