C.

Interpretation of Client’s Laboratory/ Diagnostic Results

Laborator Date Normal Significance of the

y/ Perform Value Result

Actual Result
Diagnostic ed (Referenc

Test e)

Complete Novembe WBC 15.82 10^9L 4.5-11.5  Increase in the

Blood r 30, number of

Count 2017 RBC 2 .43 10^12/L 4.6-6.0 WBC count

indicates two

Hemoglobin 75 g/L 140-180 reasons:

chronic fibrotic

conditions and

Hematocrit 0.20 0.40-0.54 infection.

Decrease in

RBC count

Platelet count 261 150-450 indicates an

10^9/L impairment in

the RBC

Differential count: 50-70 production in

Neutrophil: 83.5% 18-42 the body.

Lymphocyte: 8.3% 2-11 Decreases in

Monocyte: 7.11% hemoglobin in

pancreas
 indicates

inadequate

production of

coagulating

factors which

causes increase

in bleeding

tendencies

causing

anemia.

 Abnormally

high levels of

neutrophils

indicate an

infection has

occurred in the

body. Decrease

levels of

lymphocytes in

pancreatitis

indicatespleeno

megaly due to

portal

hypertension.
Blood Novembe SGPT: 137 mg/dL 0-42  Increasing

Chemistry r 23, SGOT:183.34 mg/dL levels of SGPT

2016 mg/dL 0-32 and SGOT

Bilirubin: 182 mg/dL highly suggest

mg/dL 0.3-1.0 pancreatic

Albumin: 1.33 g/dL mg/dL damage.

Urea: 34.56 mg/dL 3.5-5.5 Increase

Creatinine: 4.34 g/dL bilirubin levels

mg/dL 10-20 is due to

mg/dL impaired

pancreatiticfun

ction and

hemolytic

disorders.

Increase levels

of creatinine

and urea

indicates

pancreaslimpai

rment.

Serum Novembe Sodium: 126.2 135-148  Decrease levels

Electrolyte r 30, mmol/L mmol/L of sodium and

s 2017 Potassium:3.59mmo 3.5-5.0 chloride

l/L mmol/L indicates

Chloride: 90.3 98-115 problems in

 mmol/L mmol/L glomerular

Ionized Calcium: 1.13-1.32 function as

1.01 mmol/L mmol/L seen in

hepatorenal

syndrome. Low

levels of

ionized calcium

highly suggest

an increasing

levels of

metabolic

waste is

accumulated in

the blood

stream.

Urinalysis Novembe Color: yellow- Yellow to  Yellow orange

r 30, orange with blood amber urine occurs

2017 Clear during

Transparency: 5.0-8.0 hyperbilibirubi

cloudy 1.010- nemia which is

pH: 7.2 1.025 seen during

Specific gravity: Negative pancreatitis.Clo

1.025 Negative udy urine is

Glucose: negative 0-5/hpf caused by

Protein: ++++ 0-5/hpf several factors

 WBC: 0-1/hpf and commonly

RBC: 2-3/hpf None caused by

Cast: renaland

 Hyaline cast: None pancreas

3-5/hpf defects.

 Bilirubin None Presence of

cast: 3-5/hpf protein in high

 Waxy cast: Rare to levels in the

3-5/hpf few urine indicates

Bacteria: plenty filtration

dysfunction.

Presene of

hyaline and

waxy cast is

seen in pt. with

severe

glomerular

damage.

Culture Novembe Specimen: Peritoneal ---  Common

and r fluid microorganism

Senstivity 30, 2017 Organism: E. coli s in

Susceptibility: spontaneous

Cefoxitin, bacterial

Ceftaroline, peritonitis in

Vancomycin, pancreatitis are

 Ceftriaxone E. coli and K.

pneumonia.

Most common

is E. coli due to

their presence

in the GI tract.

--- 

CT-scan Unrecalle  CT SCAN --- 

(Chest and d date WAS DONE

Abdomen) AT

ZAMBOAN

GA

Biopsy is ordered but no exact date yet.

 Pathophysiology

Obstructive pancreatitis is a progressive inflammatory disease of the pancreas,

loss of exocrine and endocrine function results from parenchymal fibrosis. Abdominal

pain and maldigestion.

Predisposing Factors Precipitating Factors

-Pt. is alcoholic and
Modifiable Non-Modifiable Etiology: smoker
-history of intestinal
-Alcoholism -age OBSTRUCTIVE obstruction and operation
PANCREATITIS -Pt. is Hep. B reactive
-Lifestyle
-Environment
-Diet, Pt. loves eating to
carenderia and barbeque

Cystic Fibrosis

Signs and symptoms

Disrupts ion
-abdominal pain in RUQ Uncontrolled
transportinfla
-pain in urination and defecation

-stool and urine with blood Pancreatic

secretion become
sticky and thick

ductal dilatation

Acinar atrophyfrom
hemorrhage (destruction
damagedof
pancreatic tissue)
blood vessels

Inflammation of the pancreas

( head part)
Stool with blood

(melena ) and urine with blood

(hematuria)

JAUNDICE
Medical-Surgical Management

IDEAL MANAGEMENT ACTUAL MANAGEMENT

1. Laboratory Doctor’s Order:

A. Complete Blood Count- a very

important routine examination that

determines the different blood

components of the body in which it will Complete Blood Count @ November

reflect the effects of the disease condition 30, 2017

as reflected by the result it will incur.

Nursing responsibilities:

1. Explain test procedure. Explain that

slight discomfort may be felt when
the skin is punctured.
2. Encourage to avoid stress if possible
because altered physiologic status
influences and changes normal
hematologic values. Blood Chemistry @ November 30,
3. Explain that fasting is not necessary.
However, fatty meals may alter some 2017
test results as a result of lipidemia.
4. Apply manual pressure and dressings Serum Electrolytes @ November 30,
over puncture site on removal of
dinner. 2017
5. Monitor the puncture site for oozing
or hematoma formation.
6. Instruct to resume normal activities
and diet.

b. Blood Chemistry- an important

examination that will help to determine

the extent of the effects of the disease. It

will show how to disease interacts with

the different chemical components of the

body including electrolytes, enzymes and Urinalysis @ November 30, 2017

important compounds in the body.

c. Fibro Test- a partially definitive test

for cirrhosis that will determine the 6

biomarkers present in the disease

condition.

d. Urinalysis- a test that is very

significant in determining renal

complications regarding the condition.

This test helps to determine the

functionality of the kidneys with regards

to the underlying condition.

Nursing responsibilities:

1. Instruct the patient to void directly

into a clean, dry container. Sterile,
disposable containers are
recommended. Women should
always have a clean-catch specimen
if a microscopic examination is
ordered. Feces, discharges, vaginal
secretions and menstrual blood will
contaminate the urine specimen.
2. Collect specimens form infants and
young children into a disposable
collection apparatus consisting of a
plastic bag with an adhesive backing
around the opening that can be
fastened to the perineal area or
around the penis to permit voiding
directly to the bag. Depending on
hospital policy, the collected urine
can be transferred to an appropriate
specimen container.
3. Cover all specimens tightly, label
properly and send immediately to the
laboratory.
4. If a urine sample is obtained from an
indwelling catheter, it may be
necessary to clamp the catheter for
about 15-30 minutes before
obtaining the sample. Clean the
specimen port with antiseptic before
aspirating the urine sample with a
needle and a syringe.
5. Observe standard precautions when
handling urine specimens.
6. If the specimen cannot be delivered
to the laboratory or tested within an
hour, it should be refrigerated or
have an appropriate preservative
added.

2. Diagnostic Test Doctor’s Order:

a. Abdominal ultrasound-an imaging Ordered, not yet done to the institution

test that uses ultrasound. It is one of the of VSMMC

most common test to check the abdominal

structures but it will only show the

outline of the involved organs for any

enlargement.

b. Computed tomography Scan- an

imaging test that uses dye as a medium CT-scan @ Zamboanga Del Norte

for the visualization of the affected site. Medical Center

This test is important in the diagnosing of

the disorder as this provides a clear image

of the structure involved.

 c. Magnetic Resonance Imaging- an

imaging test that uses magnetic waves to Not ordered

get an image of the structure involved. It

provides a much detailed image of the

structure being analyzed and is one that

determines the establishment of diagnosis

of the condition.

d. Biopsy- a surgical diagnostic test that

will check the histological status of the Liver Core Needle Biopsy @

liver. It is used to check the tissue November 30, 2016

integrity of the liver and to check

presence of necrosis, fibrosis and on-

going inflammation.

e. Fine Needle Aspiration biopsy- it will

analyze the cellular component of the Needle Aspiration Biopsy not done

affected partto check for malignancy.

f. Electrocardiography- a test that will

check the conduction system of the heart.

Nursing Responsibilities:

BEFORE Procedure:
· Before an ultrasound, the woman needs
a good explanation of what will happen.
Also tell her that it is safe for the father of
the baby to remain in the room during the
test. Other Test Done:
· To ensure that the mother has a full
bladder at the time of the procedure, she Abdominal X-ray @ Zamboanga del
should drink a full glass of water every 15
minutes beginning an hour and a half Norte Medical Center
before the procedure.
· Instruct the mother not to void before
the procedure.

DURING Procedure:
· Explain to patient the procedure and its
purpose.
· The ultrasound technician may apply a
clear gel to the skin in order to help the
transducer more freely over the body.
· Ask the patient to relax while the
procedure is going on.

AFTER Procedure:
· Allow mother to void.
· Allow the mother to take home a
photograph of the sonogram image which
can enhance bonding because it is a proof
that the pregnancy exists and that the
fetus appears well.

3. Medications Doctor’s order:

a. CIPROFLOXACIN - this medication Ordered , administered 400mg

is anti-infectives and given to treat IVTT q 12 hours

infections.

b. METRONIDAZOLE-this drug is Ordered, administered 500mg

antibiotic, anti-bacterial, anti-protozoal IVTT q 8 hours

and given to treat infection.

c. VIT. K-this drug is given to manage Ordered, administered 1amp q8

and prevent bleeding. hours

d. TRANXENEMIC ACID- this drug is Ordere, administered 500mg

Anti fibrinolytic and anti hemorrhagic, q 8hours

anti hemophilic.

Nursing responsibilities:

-assess that the medication ordered is the

correct medication.

-Assess the patient's ability to self-

administer medications

-Determine whether a patient should

receive a medication at a given time

-Administer medications correctly, and

closely monitor their effects.

-Educate Patient and family about proper

medication administration and

monitoring.

- Do not delegate any part of the

medication administration process to

nursing assistive personnel

-Apply the nursing process to medication

administration.

-practice the 10 rights

4. Surgery Doctor’s Order:

STILL FOR OR SCHEDULING

a. PEUSTON PROCEDURE- Pt, with Not yet ordered

chronic pancreatitis have multiple areas

of their pancreatic duct, obstruction cause

back up of the pancreatic juices that gives

rise to the severe pain. Opening the

pancreatic duct through a large opening

and directing the flow of pancreatic juice

into intestine relieve obstruction and pain.

b. WHIPPLE OPERATION AND

PANCREATIC HEAD RESECTION- Not yet ordered

Inflammation in the head part of the

pancreas, removal of this portion of the

pancreas involved in the inflammatory

process leading to pain.

Nursing responsibilities:

 Assessing and correcting

physiological and psychological
problems that may increase
surgical risk.
 Giving the patient and significant
others complete learning and
teaching guidelines regarding
the surgery.
 Instructing and demonstrating
exercises that will benefit the
patient postoperatively.
 Planning for discharge and any
projected changes in lifestyle due
to the surgery.
 Explore the client’s fears, worries
and concerns.
 Encourage patient verbalization of
feelings.
 Provide information that helps to
allay fears and concerns of the
 patient.
 Give empathetic support.

5. Diet Doctor’s order:

a. Low fat, high residue diet- this form a. Low fat diet

of dietary instruction is very essential for

patients having pancreatitis. This diet

helps to reduce hepatic damage from fat

accumulation and relieves constipation.

6. Referral Doctor’s order:

a.Gastroenterologist- for co- Not yet ordered

management with the disease condition. Refer to Urologist for co-

management
Outline of Nursing Management

1. TO RELIEVE PAIN

 Assess reports of pain, noting specifics, location and intensity

( 0-10 )scale

 Note factors that aggravate and relieve pain

 Maintain bedrest during acute phase

 Provide quiet, restful environment and provide alternative comfort

measures or diversional activities

 Administer analgesics if/ as ordered.

2. TO PROMOTE GOOD BOWEL ELIMINATION

 Assess and identify factors( medications, bed rest, diet) that may

include/ cause contribute to constipation

 Encourage increased fluid intake, unless contraindicated

 Auscultate abdomen, palpate and percuss

 Advise / instruct patient on high fiber diet as appropriate

 Evaluate medication profile for gastro intestinal side effects

3. TO AVOID AND PREVENT BLEEDING

  Monitor patient’s vital signs especially BP and HR. look for signs of

orthostatic hypotension

 Review laboratory results for coagulation status

 Check stool and urine. Occult blood

 Assess skin and mucous membranes

 Monitor hematocrit and hemoglobin lab results.

4. TO IMPROVE TISSUE PERFUSION

 Assess pt. heart rate, blood pressure and capillary refill time. Note for

unusual heart sounds during auscultation.

 Monitor pt. for bleeding gums, presence of purpura, melena, reddish-

colored urine and hematemesis.

 Protect pt. from physical injury such as falls and abrasions. Monitor

the IV site for inflammation.

 Monitor urine output every hour. Note for sudden changes in the

volume.

 Check the pt. laboratory values such as platelet count, hemoglobin

levels, hematocrit and RBC count.

 Instruct the pt. to avoid straining during defecation.

 Provide enough rest periods for the patient.

 Administer oxygen as prescribed by the doctor.

 Anticipate for blood transfusion procedure to replenish lost blood

components.
5. TO MAINTAIN ADEQUATE HYDRATION

 Monitor BP and other vital signs

 Monitor and measure I&O including vomiting, gastric aspirate, diarrhea.

Calculate 24 hour fluid balance.

 Note decrease in urine output (less than 400mlm per 24hr)

 Record color and character of gastric drainage

 Note poor skin turgor, dry skin and mucous membranes.

 Weigh as indicated correlate with calculated fluid balance

ANATOMY AND PHYSIOLOGY

The pancreas is a glandular organ in the upper abdomen, but really it serves as two
glands in one: a digestive exocrine gland and a hormone-producing endocrine gland.
Functioning as an exocrine gland, the pancreas excretes enzymes to break down the
proteins, lipids, carbohydrates, and nucleic acids in food. Functioning as an endocrine
gland, the pancreas secretes the hormones insulin and glucagon to control blood sugar
levels throughout the day. Both of these diverse functions are vital to the body’s
survival
Anatomy of the pancreas:
The pancreas is an elongated, tapered organ located across the back of the abdomen,
behind the stomach. The right side of the organ (called the head) is the widest part of
the organ and lies in the curve of the duodenum (the first section of the small
intestine). The tapered left side extends slightly upward (called the body of the
pancreas) and ends near the spleen (called the tail).
The pancreas is made up of two types of glands:

 exocrine
The exocrine gland secretes digestive enzymes. These enzymes are secreted
into a network of ducts that join the main pancreatic duct, which runs the
length of the pancreas.
 endocrine
The endocrine gland, which consists of the islets of Langerhans, secretes
hormones into the bloodstream.

Gross Anatomy
The pancreas is a narrow, 6-inch long gland that lies posterior and inferior to the
stomach on the left side of the abdominal cavity. The pancreas extends laterally and
superiorly across the abdomen from the curve of the duodenum to the spleen. The
head of the pancreas, which connects to the duodenum, is the widest and most medial
region of the organ. Extending laterally toward the left, the pancreas narrows slightly
to form the body of the pancreas. The tail of the pancreas extends from the body as a
narrow, tapered region on the left side of the abdominal cavity near the spleen.
Glandular tissue that makes up the pancreas gives it a loose, lumpy structure. The
glandular tissue surrounds many small ducts that drain into the central pancreatic
duct. The pancreatic duct carries the digestive enzymes produced by endocrine cells
to the duodenum.
Microscopic Anatomy
The pancreas is classified as a heterocrine gland because it contains both endocrine
and exocrine glandular tissue. The exocrine tissue makes up about 99% of the
pancreas by weight while endocrine tissue makes up the other 1%. The endocrine
tissue is arranged into many small masses known as acini. Acini are small raspberry-
like clusters of exocrine cells that surround tiny ducts. The exocrine cells in the acini
produce digestive enzymes that are secreted from the cells and enter the ducts. The
ducts of many acini connect to form larger and larger ducts until the products of many
acini run into the large pancreatic duct.
The endocrine portion of the pancreas is made of small bundles of cells called islets of
Langerhans. Many capillaries run through each islet to carry hormones to the rest of
the body. There are 2 main types of endocrine cells that make up the islets: alpha cells
and beta cells. Alpha cells produce the hormone glucagon, which raises blood glucose
levels. Beta cells produce the hormone insulin, which lowers blood glucose levels.
Physiology of the Pancreas

Digestion
The exocrine portion of the pancreas plays a major role in the digestion of food. The
stomach slowly releases partially digested food into the duodenum as a thick, acidic
liquid called chyme. The acini of the pancreas secrete pancreatic juice to complete the
digestion of chyme in the duodenum. Pancreatic juice is a mixture of water, salts,
bicarbonate, and many different digestive enzymes. The bicarbonate ions present in
pancreatic juice neutralize the acid in chyme to protect the intestinal wall and to create
the proper environment for the functioning of pancreatic enzymes. The pancreatic
enzymes each specialize in digesting specific compounds found in chyme.

 Pancreatic amylase breaks large polysaccharides like starches and glycogen

into smaller sugars such as maltose, maltotriose, and glucose. Maltase secreted
by the small intestine then breaks maltose into the monosaccharide glucose,
which the intestines can directly absorb.
 Trypsin, chymotrypsin, and carboxypeptidase are protein-digesting enzymes
that break proteins down into their amino acid subunits. These amino acids
can then be absorbed by the intestines.
 Pancreatic lipase is a lipid-digesting enzyme that breaks large triglyceride
molecules into fatty acids and monoglycerides. Bile released by the
gallbladder emulsifies fats to increase the surface area of triglycerides that
pancreatic lipase can react with. The fatty acids and monoglycerides produced
by pancreatic lipase can be absorbed by the intestines.
 Ribonuclease and deoxyribonuclease are nucleases, or enzymes that digest
nucleic acids. Ribonuclease breaks down molecules of RNA into the sugar
ribose and the nitrogenous bases adenine, cytosine, guanine and uracil.
Deoxyribonuclease digests DNA molecules into the sugar deoxyribose and the
nitrogenous bases adenine, cytosine, guanine, and thymine.
Blood Glucose Homeostasis
The endocrine portion of the pancreas controls the homeostasis of glucose in the
bloodstream. Blood glucose levels must be maintained within certain limits so that
there is a constant supply of glucose to feed the cells of the body but not so much that
glucose can damage the kidneys and other organs. The pancreas produces 2
antagonistic hormones to control blood sugar: glucagon and insulin.

 The alpha cells of the pancreas produce glucagon. Glucagon raises blood
glucose levels by stimulating the liver to metabolize glycogen into glucose
molecules and to release glucose into the blood. Glucagon also stimulates
adipose tissue to metabolize triglycerides into glucose and to release glucose
into the blood.
 Insulin is produced by the beta cells of the pancreas. This hormone lowers
blood glucose levels after a meal by stimulating the absorption of glucose by
liver, muscle, and adipose tissues. Insulin triggers the formation of glycogen
in the muscles and liver and triglycerides in adipose to store the absorbed
glucose.

Regulation of Pancreatic Function

The pancreas is controlled by both the autonomic nervous system (ANS) and the
endocrine system. The ANS has 2 divisions: the sympathetic and the
parasympathetic.

 Nerves of the sympathetic division become active during stressful situations,

emergencies, and exercise. Sympathetic neurons stimulate the alpha cells of
the pancreas to release the hormone glucagon into the bloodstream. Glucagon
stimulates the liver to begin the breakdown of the energy storage molecule
glycogen into smaller glucose molecules. Glucose is then released into the
bloodstream for the organs, especially the heart and skeletal muscles, to use
as energy. The sympathetic nerves also inhibit the function of beta cells and
acini to reduce or prevent the secretion of insulin and pancreatic juice. The
inhibition of these functions provides more energy for other parts of the body
that are active in dealing with the stressful situation.
 Nerves of the parasympathetic division of the ANS become active during
restful times and during the digestion of a meal. Parasympathetic nerves
stimulate the release of insulin and pancreatic juice by the pancreas. Pancreatic
juice helps with the digestion of food while insulin stores the glucose released
from the digested food in the body’s cells.

The endocrine system uses 2 hormones to regulate the digestive function of the
pancreas: secretin and cholecystokinin (CCK).

 Cells in the lining of the duodenum produce secretin in response to acidic

chyme emerging from the stomach. Secretin stimulates the pancreas to
produce and secrete pancreatic juice containing a high concentration of
bicarbonate ions. Bicarbonate reacts with and neutralizes hydrochloric acid
present in chyme to return the chyme to a neutral pH of around 7.
 CCK is a hormone produced by cells in the lining of the duodenum in
response to the presence of proteins and fats in chyme. CCK travels through
 the bloodstream and binds to receptor cells in the acini of the pancreas. CCK
stimulates these cells to produce and secrete pancreatic juice that has a high
concentration of digestive enzymes. The high levels of enzymes in pancreatic
juice help to digest large protein and lipid molecules that are more difficult to
break down.

Pancreatic health problems

If the ducts leading from the pancreas are blocked in some way – such as when a
gallstone blocks the ampulla of Vater - pancreatic fluids can build up in the pancreas
and may then become activated so that they digest the pancreas itself. This condition
is known as acute pancreatitis. If the onset is gradual and longer-term, we call it
chronic pancreatitis.
Pancreatic cancer has one of the direst prognoses of any of the types of cancer, in part
because it tends to be very metastatic (it spreads rapidly) and because it is often
undiagnosed at an early stage.
Pancreatic surgery can be quite problematic for several reasons:

 The pancreas’ soft, spongy, tissue is very blood-rich, but its texture makes it
extremely difficult to suture.
 Tumors are often advanced by the time they are detected.

Due to the complexities, candidates for surgery are often strongly advised to seek
their treatment in a facility that conducts a higher volume of such procedures.
Functions of the pancreas:
The pancreas has digestive and hormonal functions:

 The enzymes secreted by the exocrine gland in the pancreas help break down
carbohydrates, fats, proteins, and acids in the duodenum. These enzymes
travel down the pancreatic duct into the bile duct in an inactive form. When
they enter the duodenum, they are activated. The exocrine tissue also secretes
a bicarbonate to neutralize stomach acid in the duodenum.
 The hormones secreted by the endocrine gland in the pancreas are insulin and
glucagon (which regulate the level of glucose in the blood), and somatostatin
(which prevents the release of the other two hormones).
PT. RT HEIGHT: 5’6 WT: 55KLS.

VITALSIGNS: T- 36.8 PR- 81BPM RR-21CPM BP-110/70

Pt. Has yellow sclera

Conjunctiva is pale

Has edema on left hand

Nail color is pale

Abdominal pain @RUQ PS

10/10

Constipated for 2 days

already

Urine and stool with blood

Jaundice /yellowish skin

color

ACUTE PAIN R/T

OBSTRUCTION OF
PANCREATIC BILIARY
DUCTS

ALTERED BOWEL
ELIMINATION R/T
CONSTIPATION

RISK FOR BLEEDING R/T

DECREASED HEMATOLOGIC
RESULTS; MELENA AND
HEMATURIA
 DRUGSTUDY

Name of DoseFrequen
Date Mechanismof Specifi
Drug Classification cyRoute&Ti SideEffects Nursing
Ordere Action cIndicati
Generic and me Responsibilities
d on
Brand Name
Metronidazole November Antibiotic Dose:500mg Inhibits growth of - To treat CNS: headache, Before:
30, 2017 amoebae by infectio dizziness, lethargy,
(flagyl) Antibacterial 1. Assess pt.
Frequency: q 8 bindng to DNA, n with paresthesias
infection.
Amebecide resulting in loss of suscepti 2. Observe the 10
helical structure, GI: nausea,
hours be R’s befor giving
antiprotozoal stand breakage, vomiting, diarrhea,
anaerob the drug.
inhibition of anorexia, 3. Instruct to take
ic
Route: IVTT abdominal pain, the drug with
nucleic acid bacteria
flatulence, food or milk to
(ANST (-) ) synthesis and cell - -to treat
pseudomembranou decrease GI
death. intestina
s colitis, diarrhea upset
l During:
Time: 8am-4pm-
- amoebia
sis 1. Monitor pt. for
12mn
unusualities.
2. Inform that drug
may turn urine
brown
3. Watch carefully
for edema
because it may
cause sodium
retention
After:

1. Report
immediately to
doctor if any
unusualities
occur.

Reference: NURSE’S DRUG HANDBOOK McGraw-Hill

 DRUGSTUDY

Name of DoseFreque
Date Mechanismo Specific
Drug Classification ncyRoute& SideEffects Nursing
Ordere fAction Indicatio
Generic and Time Responsibilities
d n
Brand Name
CIPROFLOXACIN November Anti-infectives Dose:400mg Inhibits bacterial -to treat CNS: dizziness, Before:
30 2017 DNA synthesis by infections of the headache,
1. Assess pt. BP
Frequency: q 12 inhibiting DNA. skin, lungs, insomnia
prior to drug
airways, nones administration
Death of and joints GI:abdominal
hours 2. Assess for
susceptible caused ny pain, nausea
infection prior
bacteria, spectrum susceptible to and during
Route: IVTT broad activity GU:intestinal
bacteria. therapy
includes many cystitis
During:
gram positive -to treat urinary
pathogens. infections  Obtain
Endo: specimens for
culture and
hyperglycemia,
sensitivity
hypoglycemia before initiating
therapy
 Observe any
unusualities
After:

1. Report to doctor
for any signs
and symptoms
of anaphylaxis(
rash, pruritus,
laryngeal
edema,
wheezing)
2. Discontinue
drug and notify
physician
immediately if
these problems
occur.
 DRUGSTUDY

Name of DoseFreque
Date Mechanismo Specific
Drug Classification ncyRoute&T SideEffects Nursing
Ordere fAction Indicatio
Generic and ime Responsibilities
d n
Brand
VIT.Name
K November Blood Dose:1 amp Promotes hepaic To treat and Dizziness, Before:
30, 2017 coagulation formation of prevent diaphoresis,
1. Assess skin
modifier Frequency: q 8 coagulation factor hemorrhage rapid/weak pulse,
hypotension, chest 2. Assess urine for
Essential for pain and dyspnea hematuria
hours 3. Assess HCT,
ormal clotting of
platelet counts,
blood. urine and stool
Route: IVTT culture.
Readily absorbed
4. Assess vital
from GI tract( signs
duodenum) after
IM, subcutaneous
administration During:
metabolized in
 Obtain R’s
liver. Excreted in
 Advise pt. to
urine, eliminated
report
by biliary system immediately
onset of action( any
increase unusualities.
coagulation After:
factors)
1. Report
immediately to
doctor.

Reference: NURSE’S DRUG HANDBOOK McGraw-Hill

 Name of DoseFreque
Date Mechanismo Specific
Drug Classification ncyRoute&T SideEffects Nursing
Ordere fAction Indicatio
Generic and ime Responsibilities
d n
TRANEXAMIC
Brand Name November Anti- Dose:500mg Forms areversible To control and Chest pain, Before:
ACID 30, 2017 fibrinolytic complex that prevent confusion,
1. Assess vital
Frequency: q 8 displaces hemorrhage headache, body
(HEMOSTAN) Anti malaise,shortness signs
plasminogen from
hemorrhagic of breath During:
hours fibrin resulting in
Anti hemophilic inhibition of  Obtain R’s
agent fibrinolysis. It  Advise pt. to
Route: IVTT report
also inhibits the
proteolytic immediately
any
activity of
unusualities.
plasmin And change in
bleeding pattern
After:

1. Severe allergic
reactions such as
rash, hives,itching,
dyspnea,tightness in
the chest should be
reorted
immediately.
 Nursing Care Plan

Assessment Nursing Client Goal Outcome Nursing Rationale Actual

Diagnosis Criteria Intervention Evaluation
Subjective: ACUTE After all the After all of Investigate Pain is often diffuse, severe, After 6 hours of
PAIN RELATED interventions, nursing verbal and unrelenting in acute or nursing
‘’sakit kayo TO patients pain will interventions, pt. reports hemorrhagic pancreatitis. interventions, pt
akoangtiyan” as OBSTRUCTION be will be able to of pain, Severe pain is often the had partially met
verbalized by the OF relieved/reduced. verbalize noting major symptom in patients the goal as
patient PANCREATIC reduced of pain. specific with chronic pancreatitis. evidenced by:
BILIARY location and Isolated pain in the RUQ -reduced of pain
DUCTS intensity reflects involvement of the from 10/10 to
(0–10 head of the pancreas. Pain 6/10
scale). Note in the left upper quadrant
factors that (LUQ) suggests
aggravate involvement of the
Objective: SCIENTIFIC and relieve pancreatic tail. Localized
BASIS: pain. pain may indicate
-abdominal pain Acute pancreatitis development of pseudocysts
Ps of 10/10 is a serious and at or abscesses.
-abdominal times life-
guarding threatening Decreases metabolic rate
behavior inflammatory and GI stimulation and
process of the secretions, thereby reducing
pancreas pancreatic activity.
This process is Maintain bedrest
caused by a during acute attack.
premature Provide quiet,
activation of restful
pancreatic environment.
enzymes that
destroy ductal Reduces abdominal
tissue and pressure and tension,
pancreatic cells. providing some measure of
Resulting in Promote position of comfort and pain
autodigestion and comfort on one relief. Note: Supine position
fibrosis of the side with knees often increases pain.
pancreas. The flexed, sitting up
pathologic and leaning
changes occur in forward.
variable degrees.
The severity of
pancreatitis Promotes relaxation and
depends on the enables patient to refocus
extent of attention; may enhance
inflammation and Provide alternative coping.
tissue destruction. comfort measures
(back rub),
encourage
relaxation
techniques (guided
imagery, Sensory stimulation can
visualization), quiet activate pancreatic
diversional enzymes, increasing pain.
activities (TV,
radio).

Keep environment Severe and prolonged pain

free of food odors. can aggravate shock and is
more difficult to relieve,
requiring larger doses of
medication, which can
mask underlying problems
and complications and may
Administer contribute to respiratory
analgesics in timely depression.
manner (smaller,
more frequent
doses).
 Nursing Care Plan

Assessment Nursing Client Goal Outcome Nursing Rationale Actual

Diagnosis Criteria Intervention Evaluation
Subjective:  After 5 After 5 hours of identify factors Assessing After 5 hours of
”Maglisodjudkogkalibang, ALTERED hours, pt nursing medications, bed causative nursing
ginagmaylangpdniyanaapajuddugo” BOWEL will intervention, pt. rest, diet) that factors is an intervention,
as verbalized by the patient ELIMINATION verbalize will be able to may cause essential first goal was unmet
RELATED TO reduced of show signs of or contribute to step in teaching As evidenced
CONSTIPATION pain, reduced of pain, constipation. and planning for by, ptient still
comfort of comfort of stool improved bowel defecates small
stool passage, stool elimination. amount of stool
passage, soft, formed and with blood.
stool soft, absence of Encourage
Objective: formed and blood. increased fluid Sufficient fluid
-2 days constipated absence of intake, unless intake is
-pain during defecation blood. contraindicated. necessary for
Stool with blood (melena) the bowel to
absorb
sufficient
amounts of
liquid to
Evaluate promote proper
medication stool
profile for consistency
gastrointestinal
side effects.
Constipation is
a common side
effect of many
drugs including
narcotics and
Instruct client on antacids.
a high-fiber diet,
as appropriate. Fiber absorbs
water, which
adds bulk and
softness to the
 stool
and speeds up
Inform client passage through
about the health the intestines.
benefits and
physiologic
effects Activity
of exercise. influences
bowel
elimination by
improving
muscle tone and
stimulating
peristalsis.
 Nursing Care Plan

Assessment Nursing Client Goal Outcome Nursing Intervention Rationale Actual

Diagnosis Criteria Evaluation
Subjective: RISK FOR After all the After all Goal
“Luspad man kayo kougnag yellow akongpanit. BLEEDING nursing nursing 1. Established To obtain pt. partially met
Muragsige pa r/t interventions, interventions, rapport to the trust and as evidenced
judkougkaliponglabinamobarogkogikansakatre” decreased the pt. will pt will be pt. cooperation by patient
as verbalized by the patient. hematologic be showing able to 2. Assess the pt. still to repeat
results; improvement manifest heart rate, Heart rate CBC and
melena and in the tissue signs of blood pressure and blood othe
hematuria. perfusion improvement and capillary pressure laboratory
Objective: status. in tissue refill time. reflects the examinations
-heart rate of 81bpm perfusion as Note for perfusion and ordered
-BP of 110/70 mm Hg evidenced unusual heart status of the to have
by: sounds during body. blood
-reduction of auscultation. Increasing transfusion.
blood 3. Monitor pt. for capillary
pressure bleeding gums, refill time
-increasing presence of indicates
hemoglobin purpura, decrease
and melena, tissue
hematocrit reddish- perfusion.
levels colored urine
-increasing and
RBC levels hematemesis. Bleeding
-reduction in 4. Protect pt. tendencies
pallor from physical decreases the
-diminishing injury such as amount of
dyspnea falls and circulating
-increasing abrasions. blood in the
levels of Monitor the IV system
energy. site for causing
inflammation. reduction of
tissue
perfusion.

Physical
injuries
 causes skin
5. Monitor the pt. breakdown.
urine output Due to
every hour. altered
Note for production of
sudden clotting
changes of factors, the
urine output pt. could face
and color. increase risk
6. Check pt. of bleeding.
laboratory Bleeding can
values such as decreases the
hemoglobin circulating
levels, blood
hematocrit, volume by
and RBC shunting it to
count. the vital
7. Instruct pt. to organs
avoid straining causing
during alteration of
defecation. perfusion to
8. Encourage pt. the other
to use soft- tissues as
bristled well.
tootbrush Urine output
when brushing reflects the
one’s teeth. perfusion
9. Provide status of the
adequate rest body.
periods for the Decrease
patient. urine output
indicated
alteration in
Dependent: tissue
1. Administer perfusion.
oxygen as
prescribed by
the doctor. Reduction of
2. Administer hemoglobin
clotting factors and RBC
 as prescribed. levels causes
Collaborative: reduction of
1. Anticipate for oxygen
blood perfusion on
transfusion the tissues.
procedure to
replenish and
supply Straining
adequate blood causes blood
components. vessels in the
anal area to
erupt causing
bleeding.
Vigorous
brushing of
teeth causes
bleeding
gums to pt.
with
impaired
clotting
production.

Increase rest
periods
decreases
oxygen
consumption
and demand
of the heart,
making the
heart to
pump
effectively.

Supplemental
oxygen
increases the
oxygen
content of the
blood needed
for the
tissues.
Clotting
factors are
needed to
prevent
episodes of
bleeding.

Blood
transfusion is
need when
there is
decreases
blood
volume in the
circulation to
improve
tissue
perfusion.
Conclusion:

Pancreatitis, which is the inflammation of the pancreas, can be acute or chronic in nature.
It may be caused by edema, necrosis or hemorrhage. In men, this disease is commonly
associated to alcoholism, peptic ulcer or trauma; in women, it’s associated to biliary tract
disease. Prognosis is usually good when pancreatitis follows biliary tract disease, but
poor when the factor is alcoholism. Mortality rate may go as high as 60% when the
disease is associated from necrosis and hemorrhage. (Schilling McCann, 2009)

Pancreatitis ranges from a mild, self-limited disorder to a severe, rapidly fatal disease that
does not respond to any treatment.

Discharge and Home Care Guidelines

A prolonged period is needed to regain the strength of a patient who has experienced
pancreatitis and to return to the previous level of activity.

 Teaching. Teaching needs to be repeated and reinforced because the patient

may have difficulty in recalling many of the explanations and instructions
given.
 Prevention. The nurse instructs the patient about the factors implicated in the
onset of pancreatitis and about the need to avoid high-fat foods, heavy meals,
and alcohol.
 Identification of complications. The nurse should give verbal and written
instructions about the signs and symptoms of pancreatitis and possible
complications that should be reported promptly to the physician.
 Home care. The nurse would be able to assess the patient’s physical and
psychological status and adherence to the therapeutic regimen.
References:
a. Book-based References:

 Saunders-Black Medical Surgical Nursing 6th Edition Volume 2

 Brunner and Suddarth’s Textbook of Medical-Surgical Nursing
 Nurse’s dug handbook mcgraw-hill
 NANDA Handbook

b. Websites

 www.emedicine.medscape.com
 www.mayoclinic.org
 www.rnspeak.com
 www.ncbi.org