Table of Contents

I. Introduction
A. Background of the study
B. Rationale for Choosing the Case
C. Significance of the Study
D. Scope and Limitation
II. Clinical Summary
A. General Data
B. Chief Complaint
C. Nursing History
a. History of Present Illness
b. Past Medical History
c. Familial History
d. Social History
D. Physical Assessment
F. Laboratory and Diagnostic Exams
G. Impression/Diagnosis
III. Clinical Discussion of Disease
A. Anatomy and Physiology
B. Pathophysiology
C. Drug Studies
IV. Nursing Process
A. Problem List
B. Nursing Care Plan
C. Long Term Objective
D. Discharge Planning

INTRODUCTION
A. Background of the Study
This is a case of a 30 y/o, G1P0 who came in due to left back pain. Present
complaint started 1 day PTA when Px experienced left back pain radiating to the
lumbosacral area and difficulty of breathing usually after coughing. Persistent coughing
and back pain, Px was advised and was admitted in our institution.
B. Rationale for Choosing the Case
The case was studied for the following reasons:
1. to know the anatomy and physiology of the lungs
2. to know the pathophysiology of pulmonary edema
3. to know the appropriate nursing intervention in handling Px with pulmonary
edema
4. to know the appropriate medical management in caring for patient with
pulmonary edema
C. Significance of the Study
This study will be able to help students, specially nursing students to know
everything about pulmonary edema, thus being able to render proper nursing care and
intervention to patients with pulmonary edema. This, if implemented, will make it easier
for patients to restore their health. This study may also help student nurses to be more
effective nurses.
D. Scope and Limitation
This study only engage in the following topics:
1. anatomy and physiology of the lungs
2. pulmonary edema

CLINICAL SUMMARY
A. General Data
Name: Rosario S. Banaag
Address: B11 116 PH2 Kawal, Dagat-dagatan, Caloocan City
Date of Birth: 12/18/1976
Age: 29 y/o
Sex: Female
Civil Status: Single
Nationality: Filipino
B. Chief Complaint
Difficulty of breathing
C. Nursing History
a. History of Present Illness
Admitting a case of a 30 y/o, G1P0 who came in due to left back pain.
Present complaint started 1 day PTA when Px experienced left back pain radiating to the
lumbosacral area and difficulty of breathing usually after coughing. Nebulization with
Salbutamol was done affording temporary relief. Persistence prompted consult at
Puericulture where she was advised to consult at a tertiary hospital. 16 hours PTA,
persistence of left back pain associated with DOB prompted consult at Jose Reyes
Memorial Medical Foundation where CBC, UA, UTS and x-ray was requested. She was
advised admission however went on HAMA. Persistence forced consult at our institution
and was subsequently admitted.
b. Past Medical History
(+) suicide attempt 1990, drug intoxication with anti-TB, confined at
JRMMC
(+) allergy to food chicken
(-) allergies to drugs
(+) HPN, Dx: Oct. 2006, on Aldomet 250 mg TID, HBP: 160/100

HBP: 160/100

UBP: 120/90

(+) asthma, Dx 1 week ago at Puericulture, on Ventolin 2 mg tablet q 60

no DM, no PTB
c. Familial History
(+) HPN, both parents

(+) asthma - father

(+) DM mother

(+) heart problem mother

(-) cancer
d. Social History
HS graduate
presently unemployed
living in for 1 year to 30 y/o computer engineer, Palestinian, whom
she met 2 years ago at Dubai
non-smoker, non-alcoholic beverage drinker
menarche 14 y/o with regular monthly interval lasting 3-4 days
consuming 2-3 pads/day

D. Physical Assessment
Date of Assessment: 11-22-06
Vital Signs:

Temp.: 36.60C

RR: 28 bpm

PR: 120 beats/min

BP: 150/100

General Survey: Px is conscious, coherent, tachycardia, tachypnea

Parts to be Assessed
skin
head
eyes
ears/nose
mouth/throat
neck
chest/lungs
heart
abdomen
extremities

Technique Used
palpation, inspection
inspection, palpation
inspection
inspection
inspection
inspection
auscultation

Deviation from Normal

None
None
None
None
None
None
(+) crackles, R midlung

auscultation
inspection
inspection

field
tachycardia
None
(+) edema on both LE

E. Patterns of Functioning
Activity/Rest
Ability to engage to necessary activities of life, but is having difficulty
having adequate sleep.
Circulation
Inability to transport oxygen necessary to meet cellular needs.
Elimination
Ability to excrete waste products.
Food / Fluid
Ability to maintain intake and utilize nutrients and liquids to meet
physiologic needs.
Hygiene
Ability to perform daily hygienic activities.
Neurosensory
Impaired perception, integration, and respond to internal and external
cues.
Pain / Discomfort
Inability to control internal / external environment to maintain comfort.
Respiration
Inability to provide and use oxygen to meet physiologic needs.
Safety
Ability to provide a safe growth-promoting environment.
Sexuality
Ability to meet requirements and characteristics of female role.
Social Interaction
Ability to establish and maintain relationship among others.
F. Laboratory and Diagnostic Examination
Date: 11-21-06
Components
Neutrophils
Lypnhocytes

Results
69.0%
24.7%

Normal Values
55%
34%

Interpretation

Monocytes
Eosinophils
Platelet

4.8%
1.5%
522 x 109 L

1.0%
3.0%
150-450 x 109 L

Components

Results
Normal Values
pO2
85 mmHg
80-100 mmHg
mild hypoxemia
pCO2
21.00 mmHg
35-45 mmHg
respiratory alkalosis
HCO3
12.70 mmol/L
22-26 mmol/L
metabolic acidosis
results: mild hypoxemia with respiratory alkalosis and metabolic acidosis
Date: 11-22-06
Components
total protein
globumin
PTT
PT

Results
58.0 g/L
22.5 g/L
35.0 secs
81.4%

Normal Values
60-70 g/L
23-35 g/L
60-70 secs
100%

Interpretation

Date: 11-24-06
Components
hemoglobin
erythrocytes

Results
1.519 mmol/L
0.33 mmol/L

Normal Values
1.86-2.58 mmol/L
0.38-0.47 mmol/L

Interpretation

Date: 11-23-06
Radiological Report
There is a prominence of the pulmonary vascularity.
Heart appear markedly enlarged.
There is haziness in both mod & lower lungfields.
Interstitial

infiltrates

are

likewise

Both hemidiaphragms & sulci are obscured.

G. Impression
Cardiomegaly with pulmonary edema

noted

bilaterally.

CLINICAL DISCUSSION OF DISEASE

A. Anatomy and Physiology
The lungs are paired cone-shaped organs in the thoracic cavity. They are
separated from each other by the heart and other structures in the mediastinum which
separates the thoracic cavity into two anatomically distinct chambers. As a result, should
trauma cause one lung to collapse, the other may remain expanded. Our lungs are located
within our chest cavity inside the rib cage. They are made of spongy, elastic tissue that
stretches and constricts as you breathe. The airways that bring air into the lungs (the
trachea and bronchi) are made of smooth muscle and cartilage, allowing the airways to

constrict and expand. The lungs and airways bring in fresh, oxygen-enriched air and get
rid of waste carbon dioxide made by your cells. They also help in regulating the
concentration of hydrogen ion (pH) in our blood.
Two layers of serous membrane, collectively called the pleural
membrane, enclose and protect each lung. The superficial layer lines the wall of the
thoracic cavity and is called the parietal pleura; the deep layer, the visceral pleura,
covers the lungs themselves. Between the visceral and parietal pleurae is a small space,
the pleural cavity, which contains a small amount of lubricating fluid secreted by the
membranes. This fluid reduces friction between the membranes, allowing them to slide
easily over one another during breathing. Pleural fluid also causes the two membranes to
adhere to one another, a phenomenon called surface tension. Separate pleural cavities
surround the left and right lungs. Inflammation of the pleural membrane, called pleurisy
or pleuritis, may in its early stages cause pain due to friction between the parietal and
visceral layers of the pleura. If the inflammation persists, excess fluid accumulates in the
pleural space known as pleural effusion.
The lungs extend from the diaphragm to just slightly superior to the
clavicles and lie against the ribs anteriorly and posteriorly. The broad inferior portion of
the lung, the base, is concave and fits over the convex area of the diaphragm. The narrow
superior portion of the lung is the apex. The surface of the lung lying against the ribs, the
costal surface, matches the rounded curvature of the ribs. The mediastinal (medial)
surface of each lung contains a region, the hilus, through which bronchi, pulmonary
blood vessels, lymphatic vessels, nerves enter and exit. These structures are held together
by the pleura and connective tissue and constitute the root of the lung. Medially, the left
lung also contains a concavity, the cardiac notch, in which the heart lies. Due to the
space occupied by the heart, the left lung is about 10% smaller than the right lung.
Although the right lung is thicker and broader, it is also somewhat shorter than the left
lung because the diaphragm is higher on the right side, accommodating the liver that lies
inferior to it.
The lungs almost fill the thorax. The apex of the lungs lies superior to the
medial third of the clavicle and is the only area that can be palpated. The anterior, lateral,
and posterior surfaces of the lungs lie against the ribs. The base of the lungs extends from

the sixth costal cartilage arteriorly to the spinous process of the tenth thoracic vertebra
posteriorly. The pleura extends about 5 cm below the base from the sixth costal cartilage
anteriorly to the twelfth rib posteriorly. Thus, the lungs do not completely fill the pleural
cavity in this area. Removal of excessive fluid in the pleural cavity can be accomplished
without injuring lung tissue by inserting the needle posteriorly through the seventh
intercostal space, a procedure termed thoracentesis.
Lobes, Fissures, and Lobules
One or two fissure divide each lung into lobes. Both lungs have an
oblique fissure, which extends inferiorly or anteriorly; the right lung also has a
horizontal fissure. The oblique fissure in the left lung separates the superior lobe from
the inferior lobe. In the right lung, the superior part of the oblique fissure separates the
superior lobe from the inferior lobe, whereas the inferior part of the oblique fissure
separates the inferior lobe from the middle lobe. The horizontal fissure of the right lung
subdivides the superior lobe, thus forming a middle lobe.
Each lobe receives its own secondary bronchus. Thus, the right primary
bronchus gives rise to three secondary bronchi called the superior, middle, and inferior
(lobar) secondary bronchi, whereas the left primary bronchus gives rise to superior and
inferior (lobar) secondary bronchi. Within the substance of the lung, the secondary
bronchi give rise to the tertiary (segmental) bronchi, which are constant in both origin
and distribution there are ten tertiary bronchi in each lung. The segment of the lung
tissue that each tertiary

that each tertiary

bronchus supplies is called a

bronchopulmonary segment. Bronchial and pulmonary disorders that are localized in a

bronchopulmonary segment may be surgically removed without seriously disrupting the
surrounding lung tissue.
Each bronchopulmonary segment of the lungs has many small
compartments called lobules, each of which is wrapped in elastic connective tissue and
contains a lymphatic vessel, an arteriole, a venule, and a branch froma terminal
bronchiole. Terminal bronchioles subdivide into microscopic branches called respiratory
broncdhioles. As the respiratory bronchioles penetrate more deeply into lungs, the
epithelial lining changes from simple cuboidal to simple squamous. Respiratory

bronchioles, in turn, subdivide into several alveolar ducts. The respiratory passages from
the trachea to the alveolar ducts contain about 25 orders of branching; that is, branching
from the trachea into primary bronchi (first order braching) into secondary bronchi
(second order branching) and so on down to the alveolar ducts occurs about 25 times.
Alveoli
Around the circumference of the alveolar ducts are numerous alveoli and
alveolar sacs. An alveolus is a cup-shaped outpouching lined by simple squamous
epithelium and supported by a thin elastic basement membrane; an alveolar sac consists
of two or more alveoli that share a common opening. The walls of the alveoli consist of
two types of alveolar epithelial cells. Type I alveolar cells, the predominant cells, are
simple squamous epithelial cells that form a nearly continuous lining of the alveolar wall.
Type II alveolar cells, also called septal cells, are fewer in number and are found
between type I alveolar cells. The thin type I alveolar cells are the main sites of gas
exchange. Type II alveolar cells, which are rounded or cuboidal epithelial cells whose
free surface between the cells and the air moist. Included in the alveolar fluid is
surfactant, a complex mixture of phospholipids and lipoproteins. Surfactant lowers the
surface tension of alveolar fluid, which reduces the tendency of alveoli to collapse.
Associated with the alveolar walls are alveolar macrophages (dust cells), wandering
phagocytes that remove fine dust particles and other debris in the alveolar spaces. Also
present are fibroblasts that produce reticular and elastic fibers. Underlying the type I
alveolar cells is an elastic basement membrane. On the outer surface of the alveoli, the
lobules arteriole and venule disperse into a network of blood capillaries that consist of a
single layer of endothelial cells and basement membrane.
The exchange of O2 and CO2 between the air spaces in the lungs and the
blood takes place by diffusion across the alveolar and capillary walls, which together
form the respiratory membrane. Extending from the alveolar air space to blood plasma,
the respiratory membrane consists of four layers:
1. a layer of type I and type II alveolar cells and associated alveolar macrophages
that constitutes the alveolar wall
2. an epithelial basement membrane underlying the alveolar wall

3. a capillary basement membrane that is often fused to the epithelial basement

membrane
4. the endothelial cells of the capillary
Despite having several layers, the respiratory membrane is very thin
only 0.5 m thick, about one-sixteenth the diameter of a red blood cell. This thinnes
allows rapid diffusion of gases. Moreover, it has been estimated that the lungs contain
300 million alveoli, providing an immense surface area of 70 m2 about the size of a
handball court for the exchange of gases.
Blood Supply to the Lungs
The lungs receive blood via sets of arteries; pulmonary arteries and
bronchial arteries. Deoxygenated blood passes through the pulmonary trunk, which
divides into a left pulmonary artery that enters the left lung and a right pulmonary arter
that enters the right lung. Return of the oxygenated blood to the heart occurs by way of
the four pulmonary veins, which drain into the left atrium. A unique feature of pulmonary
blood vessels is their constriction in response to localized hypoxia (low O2 level). In all
other body tissues, hypoxia causes dilation of blood vessels, which serves to increase
blood flow to a tissue that is not receiving adequate O2. In the lungs, however,
vasoconstriction in response to hypoxia diverts pulmonary blood from poorly ventilated
areas to well-ventilated regions of the lungs. This phenomenon is known as ventilationperfusion coupling because the perfusion (blood flow) to each area of the lungs matches
the extent of ventilation (airflow) to alveoli in that area.
Bronchial arteries, which branch from the aorta, deliver oxygenated blood
to the lungs. This blood mainly perfuses the walls of the bronchi and bronchioles.
Connection exist between branches of the bronchial arteries and branches of the
pulmonary arteries, however, and most blood returns to the heart via pulmonary veins.
Some blood, however, drains into bronchial veins, branches of the azygos system, and
returns to the heart via the superior vena cava.
Breathing Pattern

When we inhale, the diaphragm and intercostal muscles (those are the
muscles between your ribs) contract and expand the chest cavity. This expansion lowers
the pressure in the chest cavity below the outside air pressure. Air then flows in through
the airways (from high pressure to low pressure) and inflates the lungs. When you exhale,
the diaphragm and intercostal muscles relax and the chest cavity gets smaller. The
decrease in volume of the cavity increases the pressure in the chest cavity above the
outside air pressure. Air from the lungs (high pressure) then flows out of the airways to
the outside air (low pressure). The cycle then repeats with each breath.
As we breathe air in through our nose or mouth, it goes past the epiglottis
and into the trachea. It continues down the trachea through your vocal cords in the
larynx until it reaches the bronchi. From the bronchi, air passes into each lung. The air
then follows narrower and narrower bronchioles until it reaches the alveoli.
Within each air sac, the oxygen concentration is high, so oxygen passes or
diffuses across the alveolar membrane into the pulmonary capillary. At the beginning
of the pulmonary capillary, the hemoglobin in the red blood cells has carbon dioxide
bound to it and very little oxygen. The oxygen binds to hemoglobin and the carbon
dioxide is released. Carbon dioxide is also released from sodium bicarbonate dissolved in
the blood of the pulmonary capillary. The concentration of carbon dioxide is high in the
pulmonary capillary, so carbon dioxide leaves the blood and passes across the alveolar
membrane into the air sac. This exchange of gases occurs rapidly (fractions of a second).
The carbon dioxide then leaves the alveolus when you exhale and the oxygen-enriched
blood returns to the heart. Thus, the purpose of breathing is to keep the oxygen
concentration high and the carbon dioxide concentration low in the alveoli so this gas
exchange can occur!
B. Pathophysiology of Pulmonary Edema
Pulmonary edema is excess water in the lung. The normal lung contains
very little water. It is kept dry by lymphatic drainage & a balance among capillary
hydrostatic pressure, capillary oncotic pressure, & capillary permeability. In addition,
surfactant lining the alveoli repels water, helping fluid from entering the alveoli.

Modifiable

Non-modifiable

lifestyle crowded environment

genetics (+) HPN

- overdoing of activities

- (+) asthma

history intoxication of anti-TB

- (+) heart problem

respiratory and cardiac distress

disrupted lung architecture

increased permeability
increased force of LV contraction
increased LV O2 demand
LV hypoxia
decreased forc of LV contraction
increased LV preload
pulmonary edema
flooded alveoli

increased pulmonary vascular

resistance

compliance (stiff lungs)

RV failure
hypoxemia
increased RV preload

if treated
oxygenation, suctioning,

if not treated
fibrosis

medical treatment
development of complications
healing

involvement of all system

recovery
compromiseimmune system
shock
death

C. Drug Study
Classification

Action

drugs for fluid

potassium-

and electrolyte

sparing diuretic;

balance

antagonizes

Available
Form
tablets 25 mg

Indication

Contraindication

Adverse
Effects

Nursing

> edema

>hypersensitivity

Consideration
> give drug with

- 50 mg

> hypertension

to the drug

meal to enhance

- 100 mg

> diuretic-induced

> Px with anuria,

absorption

aldosterone in

hyperaldosteronism acute or

> protect drug

the distal

>heart failure as

progressive renal

from light

tubules,

adjunt to ACE

insufficiency,

> monitor

increasing Na

inhibitors or loop

hyperkalemia

electrolyte level,

and H2O

diuretics

excretion

I & O, & BP
> inform the
laboratory that
the Px is taking
the drug because
it may interfere
with tests that
measure digoxin
level
> maximum

antihypertensive
respone may be
delayed for up to
2 weeks
> watch for
hyperchloremic
metabolic
acidosis
> instruct Px to
take drug in
morning to
prevent need to
urinate at night
> warn Px to
avoid excessive
ingestion of
potassium-rich
foods to avoid
hyperkalemia
> caution Px to
avoid

performing
hazardous
activities if
adverse CNS
rxns occur

DIAZEPAM
Antenex, Apo-Diazepam, Diastat, Diazemuls, Diazepam Intensol, Ducene, Novo-Dipam, DMS-Diazepam, Valium, Vinol

Classification
anxiolytics
CNS drugs

Action
unknown

Available Form

Indication

Contraindication Adverse Effects

Nursing

capsule 15 mg

> anxiety

> Px

> CNS

Considerations
> use diastat

injection 5

> pre-op

hypersensitive to

drowsiness,

rectal gel to treat

mg/ml

ssedation

drug or soy

dysarthria,

no more than 5

> cardioversion

protein

slurred speech,

episodes per

> Px experiencing

tremor, transient

month & no

shock, coma, or

amnesia, fatigue,

more than one

rectal gel

acute alcohol

ataxia, headache,

episode every 5

2.5 mg

intoxication

insomnia,

days

- 5 mg

> in pregnant

paradoxical

> dilute oral

- 10 mg

women, specially

anxiety,

concentrate sol.

- 15 mg

first trimester

hallucinations,

just before

- 20 mg

> children

minor changes in

giving

younger than age

EEG patterns

> monitor

6 mos.

> CV

periodic hepatic,

hypotension, CV

renal, &

collapse,

hematopoeitic

bradycardia

fxn studies in Px

EENT diplopia,

receiving

blurred vision,

repeated or

oral sol.
5mg/5ml
- 5mg/ml

tablets 2 mg
- 5 mg
- 10 mg

nystagmus

prolonged

GI nausea,

therapy

constipation,

> warn Px to

diarrhea with

avoid activities

rectal form

that require

GU

alertness & good

incontinence,

coordination

urine retention

> tell Px to avoid

HEPATIC

alcohol while

jaundice

taking drug

RESP.

> notify Px that

respiratory

smoking may

depression, apnea

decrease drugs

SKIN rash

effectiveness

OTHER altered

> warn Px not to

llibido, physical

abruptly stop

or psychological

drug because

dependence, pain, withdrawal

phlebitis at

symptoms may

injection site

occur
> warn woman

to avoid use
during
pregnancy

AMIKACIN SULFATE
Amikin
Classification

Action

Available Form

Indication

Contraindication Adverse Effect

Nursing
Considerations

aminoglycoside

inhibits protein
synthesis by

injection
50 mg/ml

> serious

> Px

> CNS

> obtain

infections caused hypersensitive to

neuromuscular

specimen for

blockade

C&S before

binding directly

- 250 mg/ml

by sensitive

to the 30S

- 5 mg/ml in

strains of

> EENT

giving first dose

Pseudomonas

ototoxicity

> evaluate Pxs

subunit;

aeuroginosa, E.

> GU

hearing before &

bactericidal

coli, Proteus,

azotemia,

during therapy if

Klebsiella, or

nephrotoxicity,

he will be

Staphylococcus

possible increase

receiving drug

> uncomplicated

in urinary

longer than 2

UTI caused by

excretion of

weeks

organism not

casts

> weight Px &

susceptible to

>MUSCULO

review renal fxn

less toxic drugs

- SKELETAL

studies before

>mycobacterium

- arthralgia

first dose

avium complex

> RESP. apnea

> correct

ribosomal

NSS

drug

dehydration
before therapy
> monitor renal
fxn
> watch for s/s

of superinfection
> if no response
occurs after 3-5
days, stop
therapy & obtain
new specimens
for C&S
> instruct Px to
promptly report
adverse rxn
> encourage Px
to maintain
adequate fluid
intake

CAPTOPRIL
Acenorm, Capoten, Enzace, Novo-Captopril
Classification
antihypertensive

Action
inhibits ACE,

Available
Form
tablets

Indication
> hypertension

Contraindication Adverse Effects

> Px

> CNS dizziness,

Nursing
Considerations
> monitor Pxs

cardiovascular
system drug

preventing

12.5mg

> left

hypersensitive to

fainting, headache,

BP & PR

the drug

malaise, fatigue,

frequently

fever

> assess Px for

> CV

signs of

potent

tachycardia,

angioedema

vasoconstrictor;

hypotension,

> monitor WBC

less angiotensin

angina pectoris

& differential

II decrease

> GI abdominal

counts in Px with

peripheral

pain, anorexia,

impaired renal

arterial

constipation,

fxn or collagen

resistance,

diarrhea, dry

vascular dse

decrease

mouth, dysgeusia,

before starting

aldosterone

nausea, vomiting

Tx, q 2 weeks for

secretion, which

>HEMATOLOGIC the first 3 mos of

reduces Na &

leucopenia,

therapy, &

H2O

agranulocytosis,

periodically

pancytopenia,

thereafter

anemia,

> instruct Px to

thrombocytopenia

take drug 1 hour

>METABOLIC

ac taking

hyperkalemia

> inform Px that

conversion of

- 25 mg

ventricular

angiotensin I to

- 50 mg

dysfunction

angiotensin II, a

- 100 mg

> RESP.

light-headedness

dyspnea; dry,

is possible

persistent,

> tell Px to use

nonreproductive

caution in hot

cough

H2O & during

> SKIN rash,

exercise

maculopapular

> advise Px to

rash, pruritus,

notify prescriber

alopecia

if pregnancy

> OTHER

occurs

angioedema

> urge Px to
promptly report
swelling of the
face, lips, or
mouth, or
difficulty
breathing

CEPHALEXIN
(hydrochloride) Keftab
(monohydrate) Apu-Cephalex, Biocef, Keflex, Novo-Lexin, Nu-Cephalex
Classification

Action

Available Form

Indication

Contraindication Adverse Effects

cephalosporins

first generation

(hydrochloride)

> respiratory

> in Px

anti-infective

cephalosporin

tablets 500mg

tract, GIT, skin, hypersensitive to

Nursing

> CNS dizziness,

Considerations
> ask Px about

headache, fatigue,

post rxns to

that inhibits

(monohydrate)

soft tissue,

cell-wall

capsules-250mg

the drug

agitation,

cephalosporins

bone, & joint

confusion,

or penicillin

synthesis,

- 500 mg

infections &

hallucinations

therapy before

promoting

oral susp.

otitis media

> GI

giving first dose

osmotic

125mg/5ml

caused by E.

pseudomembrane-

> ontain

instability;

- 250 mg/5ml

coli

ous colitis, nausea,

specimen for

anorexia, vomiting,

C&S before

- 500mg

diarrhea, gastritis,

giving first dose

-1g

glossitis,

> monitor Px for

dyspepsia,

superinfection if

abdominal pain,

therapy is

anal pruritus,

prolonged

tenesmus, oral

> treat group A

candidiasis

beta-hemolytic

> GU genital

streptococcus

pruritus,

infections for a

candidiasis,

minimum of 10

vaginitis,

days

interstitial nephritis

> tell Px to take

usually
bactericidal

tablets 250mg

>HEMATOLOGIC drug exactly as

- netropenia,

prescribed even

eosinophilia,

after feeling

anemia,

better

thrombocytopenia

> instruct Px to

>MUSCULO

take drug with

SKELETAL

foodor milk

arthritis, asthralgia,

> tell Px to notify

joint pain

prescriber if rash

> SKIN

or s/s of

maculopapular &

superinfection

erythematus rashes, develop

irticaria
> OTHER
hypersensitivity
rxns, serum
sickness,
anaphylaxis

FERROUS FUMARATE
Femiron, feostat, hemocyte, ircon, nephrofer, novofumas, palafer, palafer pediatric drops, vitron C
Classification
hematinics

Action

Available Form

Indication

Contraindication Adverse Effects

Nursing

provides

drops 45mg /

> iron deficiency > Px with primary

> GI nausea,

Considerations
> between meal

elemental iron,

0.6 ml

> as a

hemochromatosis

epigastric pains

doses are

an essential

oral susp.

supplement

or hemosiderus,

vomiting,

preferable

during

hemolytic

constipation,

> check for

pregnancy

anemia, peptic

diarrhea, black

constipation

component in
the formation of

100 mg/5 ml
tablets 63mg

hemoglobin

- 200 mg

ulcer dse,

stools, anorexia,

> tell Px to take

- 324 mg

regional enteritis,

> OTHER

tablets with juice

- 325 mg

or ulcerative

temporarily

or water but not

- 350 mg

colitis

stained teeth

with milk or

> Px receiving

from suspension

antacids

repeated blood

& drops

> tell Px to take

tablets 100mg

transfusion

suspension with
straw & place
drops at back of
throat
> caution Px not
to crush talets
> advice Px not
to substitute 1
iron salt for
another

MEFENAMIC ACID
Ponstan, Ponstel
Classification

Action

Available

Contraindication Adverse Effects

Nursing

> short term

> ulceration

> CNS

Considerations
> tell Px to take

relief of mild to

> chronic

headache,

drug with milk

moderate pain

inflammation of

dizziness,

or food to

possesses anti-

the GIT

somnolence,

decrease Gi

inflammatory,

> pregnancy

insomnia, fatigue,

upset

antipyretic, &

> children under

tinnitus,

> arrange for

Nonsteroidal

inhibits

anti-

prostaglandins

inflammatory

synthesis;

analgesic

Form
capsule -250mg

Indication

- 500 mg

analgesic effects

14 y/o

ophthalmologic

periodic

> hypersensitivity

effects

opthalmogic

to the drug

> GI nausea,

examination for

dyspepsia, GI

long term

pain, diarrhea,

therapy

vomiting,

> tell Px to take

constipation,

only the

flatulence

prescribed

> RESP.

dosage

dyspnea,

> inform Px that

hemoptysis,

drowsiness or

pharyngitis,

dizziness can

brocnhospasm,

occur

rhinitis

> instruct Px to

>

d/c drug &

HEMATOLOGIC

consult

- bleeding,

prescriber if

platelet inhibition

adverse rxn

with higher doses,

occur

neutropenia,
eosinophilia,

leukopenia,
pancytopenia,
thrombocytopenia,
agranulocytis,
granulocytopenia,
aplastic anemia,
decreased Hcb or
Hct, bone marrow
depression,
menorrhagia
> GU dysuria,
renal impairment
> SKIN rash,
pruritus, sweating,
dry mucous
membrane,
stomatitis
> OTHER
peripheral edema,
enaphylactoid
rxns to fatal

anaphylactic
shock

DIGOXIN
Digitex, Digoxin, Lanoxicaps, Lanoxin
Classification

Action

Available Form

Indication

Contraindication

Adverse Effects

Nursing

capsule

> heart failure

> Px with

> CNS fatigue,

Considerations
> before giving

potassium

0.05 mg

> tachycardia

hypersensitivity

generalized

loading dose,

activated

- 0.1 mg

to the drug

muscle

obtain baseline

adenosine

- 0.2 mg

> Px with digitalis

weakness,

data and ask Px

induced toxicity,

agitation,

about use of

ventricular

hallucinations,

cardiac

fibrillation, or

headache,

glycosides

Inotropics

Inhibits sodium

Cardiovascular
system drugs

triphosphate,
promoting
movement of

elixir
0.05 mg/ml
injection

calcium from

0.05mg/ml

ventricular

malaise,

within the

extracellular to

- 0.1 mg/ml

tachycardia

dizziness,

previous 2-3

intracellular

- 0.25 mg/ml

unless caused by

vertigo, stupor,

weeks

heart failure

paresthesia

> loading dose is

cytoplasm and

tablets

strengthening

0.125 mg

> CV

usually divided

myocardial

- 0.25mg

arrythmias

over the first 24

> EENT

hours with

yellow-green

approximately

halos around

half the loading

visual images,

dose given in the

bulrred vision,

first dose

light flashes,

> before giving

photophobia,

drug, take

diplopia

apical-radial

> GI anorexia,

pulse for a

nausea,

minute

vomiting,

> monitor

diarrhea

potassium level

contraction

carefully

METOPROLOL TARTRATE
Apo-Metoprolol, Apo-Metoprolol Type L, Betaloc, Betaloc Durules, Lopresor SR, Lopresor, Minax, Novo-Metoprolol, Nu-Metop
Classification

Action

antihypertensive

decreases

cardiovascular

cardiac output,

system drug

peripheral
resistance, and

Available Form

Indication

Contraindication Adverse Effects

Nursing

> Px

Considerations
> CNS fatigue, > always check

1 mg/ml in 5-

hypersensitive to

dizziness,

Pxs apical pulse

ml ampules

the drug

depression

> monitor

> Px with sinus

> CV

glucose level

injection

tablets 50mg

> hypertension

cardiac oxygen

- 100 mg

bradycardia,

bradycardia,

closely

consumption

- 200 mg

greater than 1st

hypotension,

> Monitor BP

degree heart

heart failure, AV frequently

block,

block

> store drug at

cardiogenic

> GI nausea,

room

shock, or overt

vomiting

temperature

cardiac failure

> RESP.

> tell Px to take it

dyspnea

with meals

> SKIN rash

> caution Px to
avoid driving if
taking the drug
> tell Px to alert
prescriber if
shortness of
breatn occurs

NALBUPHINE HYDROCHLORIDE
Nubain
Classification

Action

Available Form

Contraindication

Adverse Effects

> moderate to

> Px

> CNS

Considerations
> reassess Px

severe pain

hypersensitive to

headache,

level of pain at

the drug

sedation,

least 15 & 30

altering

dizziness,

mins. after

perception of

vertigo,

parenteral

and emotional

nervousness,

administration

response to pain

depression,

> monitor

restlessness,

circulatory &

crying,l

respiratory status

opiod analgesics

binds with

injection-

central nervous

opiate receptors

10 mg/ml

system drug

in the CNS,

- 20 mg/ml

Indication

Nursing

euphoria,

> caution Px

hostility,

about getting out

confusion,

of bed or

unusual dreams,

walking

hallucinations,
speech
disturbance,
delusions
> CV
hypertension,
hypotension,
tachycardia,
bradycardia
> EENT
blurred vision,
dry mouth
> GI cramps,
dyspepsia, bitter
taste, nausea,
vomiting,
constipation

> GU urinary
urgency
> RESP.
respiratory
depression,
dyspnea, asthma,
pulmonary
edema
> SKIN
pruritus,
burning,
urticaria,
clamminess,
diaphoresis

Problem

Nursing

Scientific

Objective

Nursing

Rationale

Evaluation

Rationale
disrupted lung

At the end of the

Intervention
INDEPENDENT

architecture

nursing shift, the

> place Px in a

> this position

nursing shift, the

Px will be able to

semi to high

allow increased

Px was able to

experience

fowler position if diaphragmatic

experience

adequate

not

excursion &

adequate

respiratory fxn.

contraindicated

maximum lung

respiratory fxn.

expansion,

as evidencedof

difficulty of

Diagnosis
Ineffective

breathing

breathing pattern

Subjective Cues:

r/t lung

medyo

compliance as a

nahihirapan nga

result of

akong huminga,

accumulation of

lalo na pag

fluid in the

nauubo ako, as

pulmonary

difficulty

which promotes

the ff.:

verbalized by the interstitium

breathing

optimal alveolar

> normal rate,

ventilation

rhythm & depth

> instruct &

> frequent

of respiration

Objective Cues:

assist Px to

repositioning

> improved

> (+) crackles

change position,

helps loosen

breath sounds

compliance
hypoxemia

client

At the end of the

>rapid, shallow,

deep breathe, &

secretions &

> (-) crackles

irregular

cough or huff

promotes a more

> blood gases

respiration

every 1-2 hours

effective cough.

within normal

> use of

It also promotes

ranges

accessory

maximum lung

> Px verbalizes

muscles when

expansion &

relief from

coughing

stimulates

difficulty of

> abnormal

surfactant

breathing

blood gases

production.

> abnormal chest

Coughing or

x-ray result

huffing
mobilizes
secretions &
facilitates
removal of these
secretions from
the respiratory
tract
> implement

> a Px with pain

measures to

often guards

reduce pain

respiratory

splint incision

efforts pain

with pillow

reduction

during coughing

enables the client

& deep breathing to breathe more

deeply which
enhances
alveolar
veltilation &
O2/CO2
DEPENDENT

exchange

> implement

> excessive

measures to

secretions and

facilitate

inability to clear

removal of

secretions from

pulmonary

the respiratory

secretions

tract lead to

suction as

stasis of

orderes

secretions

> maintain O2

> supplemental

therapy as

O2 increases the

ordered

concentration of

oxygen in the
alveoli, which
increases the
diffusion of O2
across the
alveolar
capillary
membrane
> administer

> medication

meds that may

therapy is an

be ordered to

integral part of

improve Pxs

treating many

respiratory status respiratory

condition

Problem

Nursing

fear

Diagnosis
Fear r/t

Subjective Cues:

persistent

natatakot nga

headache

Scientific
Rationale
pre-eclampsia
altered BP

ako eh. kasi sabi

ng doctor may

dizziness

Objective

Nursing

At the end of the

Interventions
INDEPENDENT

nursing shift, the

> encourage

> verbalization

nursing shift, the

Px will be able to

verbalization of

of feelings &

Px will be able to

experience a

feelings &

concerns helps

experience a

reduction of fear

concerns

client identify

reduction of fear

factors that are

as evidenced by

causing anxiety

the ff:

> assure Px that

> close contact

> verbalization

staff members

& a prompt

of decreased fear

are nearby;

response to

& understanding

respond to call

requests provide

of the medical

signal as soon as

a sense of

procedures

high blood daw

ako. eh lagi pa

disturbed sleep

kong nahihilo.

pattern

kaya
pakiramdam ko

feeling of

tuloy parang ang

anxiety

sama-sma ng

Rationale

Evaluation
At the end of the

pakiramdam ko.

fear

possible

security &

Hindi pa ko

facilitates the

makatulog ng

development of

maayos

trust, thus

kakaisip, as

reducing the

verbalized by the

clients anxiety

client

> reinforce

> factual

Objective Cues:

physicians

information & an

> disturbed sleep

explanations &

awareness of

pattern

clarify

what to expect

> weak

misconceptions

help decrease the

appearance

the Px has about

anxiety that

the diagnostic

arises from

tests, disease

uncertainty

condition,
treatment plan &
prognosis
> implement

> improvement

measures to

of respiratory

reduce distress

status helps
relieve anxiety

associated with
the feeling of not
being able to
breathe
DEPENDENT
> administer

> helps reduce

prescribed

the Pxs anxiety

antianxiety
agents if
indicated

Problem

Nursing

potential

Diagnosis
potential

complications of

complications of

heart failure

heart failure r/t

Subjective Cues:

acute pulmonary

Hindi kaya

edema d/t

matuloy to sa

accumulation of

puso, kasi meron

fluid in the lungs

Scientific
Rationale
Hx of
hypertension,
heart dse.
pulmonary
edema

Objective

Nursing

At the end of the

whole nursing

> implement

> in order to

whole nursing

shift, the Px will

measures to

reduce

shift, the Px was

be able to have

improve cardiac

pulmonary

able to have mild

mild to moderate

output

vascular

to moderate

congetion

prognosis from

> to improve

pulmonary

lung expansion

edema as

prognosis from
> place Px in a

kaming sakit sa

further lung &

edema to prevent high fowler

puso, as

heart distress

complications

Px
Objective Cues:

complications of
heart failure

Evaluation

Interventions
INDEPENDENT

pulmonary

verbalized by the

Rationale

At the end of the

position

evidenced by the

DEPENDENT

ff.

> maintain O2

> to improve O2

>(-) crackles

therapy

intake

> normal result

> Hx of heart dse

> administer

> to reduce fluid

of x-ray

> hypertension

meds - diuretics

accumulation in

- blood gas result

the lungs

within normal

> development
of crackles
> chest x-ray
showing
pulmonary
edema
> worsening
blood gases

range