Docs Orders-Nsg - Theories Final

XI.
DOCTOR’S ORDERS
DATE ORDER RATIONAL REMARKS

July • Pls admit under my >for management of patient’s DONE
05, 2010 service (Dr. Nalupa) illness and for proper
assessment
> To avoid misinterpretation

• Dat, avoid dark of dark-colored stool as occult
colored foods blood in the stool
>to monitor the baseline data
• Monitor vs q4; and health status
>Intake and output

• I&O q shift monitoring is necessary in the
determination of significant
balance in fluid loss and
consumption.
> CBC: Diagnose diseases or

evaluate the stages of a
• Labs particular disease.
Plt Ct: To identify or monitor
1. CBC, Plt Ct, Serum
creatinine the severity or degree of
bleeding to know if platelet
transfusion will be needed.
HCT: High hematocrit is a
danger sign of an increased
risk of dengue shock
syndrome.
Serum Creatinine: an
indication of renal disease
40
to find out if there are any
blockages in the urinary tract
• Ultrasound of
kidneys, uretersand
bladder
>It is active against some

gram positive and many gram
negative organisms like
• Meds: E.Coli, Enterobacter,
Klebsiella, Proteus,
1. Gentamycin 240mg Pseudomonas, Citrobacter,
OD, IVTT ANST Staph. Epidermidis, and
Listeria Monocytogenes and
Campylobacter.
>Relieves fever by acting in

hypothalamic heat regulating
2. Paracetamol 500 center.
mg/ tab itab q 4 prn
for ≥38C >relief of spasm of the genito-
urinary tract or gastro-
intestinal tract and for the
symptomatic relief of Irritable
3. Buscopan Bowel Syndrome
Amn IVTT (slow) now

7-5-10 • Pls give paracetamol >Relieves fever by acting in
41
8 pm 250mg/ SUPP hypothalamic heat regulating
2SUPP per rectum center.
now
The client has some
• ↑OFI
dehydration so he needs to
increase fluid intake to
replace the fluid loss.
> indicated for the relief of

May give HNBB( Hyoscine spasm of the genito-urinary
N-Butyl Bromide) tract or gastro- intestinal tract
and for the symptomatic relief
• amp I amp q 6 prn of Irritable Bowel Syndrome
for most severe pain
• Refer all labs once >for further management and

on evaluation
• IVF TF D5LR I L >D5LR is a hypertonic IV

@40gtts/min
solution which loosely
11 pm
(+) flank resembles the electrolyte
pain
composition of the normal
(-) vomiting
Afebrile blood serum and it supplies
(+) cpr
potassium and calcium to the
body.
• Rounds with Dr >For management and

nalupa
continued care
• ↑OFI >The client has some

dehydration so he needs to
increase fluid intake to
42
replace the fluid loss.
> Strict intake and output

• I&O of 4 H in monitoring is necessary for
absolute figure accurate determination of
fluid loss and consumption
• Continue meds
5:45am
(+) flank • HNBB to PRN q8H
>indicated for the relief of
pain amp
spasm of the genito-urinary
(+) febrile
tract or gastro- intestinal tract
and for the symptomatic relief
of Irritable Bowel Syndrome
• Please relay
ultrasound result of >to find out if there are any
KUB once available blockages in the urinary tract
AP
• IVTF w/ D5LR IL
> To maintain fluid and
@40 gtts/min
electrolytes balance

7-7-10 • IVTF w/ D5LR iL at > To maintain fluid and
6:41 am 40 gtts/min electrolytes balance
• IVF at SR
43
still with
fever
USD=(-)
• Repeat CBC, Hct, > CBC: Diagnose diseases or

BSMP now, then evaluate the stages of a
take BSMP now, particular disease.
then take BSMP q 4 HCT: High hematocrit is a
x 5 takes danger sign of an increased
risk of dengue shock
syndrome.
• D/C Gentamycin Patient does not have malarial

parasite
• Start Cefuroxime
750 mg q8 IVTT For the treatment of many
ANST different types of bacterial
2:30 pm infections such as bronchitis,
sinusitis, tonsillitis, ear
infections, skin infections,
gonorrhea, and urinary tract
infections.
• Dolcet itab now, Given for Moderate to severe

then qhourly for pain.
back pains
• D/C HNBB
>Patient does not experience
any spasm of the urinary tract
or the gastro intestinal tract
Plt 94
1:00pm
Hct 40
• Please monitor plt & >To determine significant
44
changes in the total platelet
hct q6 (next at 6 pm)
volume. Also to know if
• Include blood typing
in the next blood transfusion is needed.
extraction
> to correct dehydration

• IVTT c D5LR iL
5:30 @160cc/hr
• For APTT on the >A blood test that looks at

6:45pm next blood how long it takes for blood to
extraction decrease
BSMP monitoring to clot. Activated partial
every 6 hours to start thromboplastin time is the
at 12 midnight
period required for clot
formation in recalcified blood
plasma after contact
activation and the addition of
platelet substitutes; used to
address the intrinsic and
common pathways of
coagulation.
normal= 25.4 to 38.4 secon

7-8-10 • IVF of D5LR iL > To maintain fluid and
12mn @165cc/hr electrolytes balance
Still with >for further management and
febrile • Please refer to labs evaluation
episodes, once on
low grade
↓ in back
pain
L
hypogastric
pain
45
7-8-10 • Rounds c Dr Nalupa >for further management and
evaluation
• IVTF at same rate > To maintain fluid and

11:45 electrolytes balance
Febrile
• Continue monitoring Serial platelet and hematocrit
CBC, plt, include monitoring are important for
BSMP x 2 takes
determining if it is below
normal and needs transfusion.
>This is done as a general

• Report urinalysis
screening to check for early
signs of disease. It may also
be used to monitor kidney
disease. It may be used to
check for a urinary tract
infection or blood in the
urine.
• IVFTF D5LR iL > D5LR is a hypertonic

7:30 pm @165 cc/hr x 2 solution that could help
cycles rehydrate the patient’s body,
• IVTF D5LR iL
12 mn @165 cc/o

• ↑ IVF to 220 cc/hr electrolytes balance
12:15
Dx Illness
-still febrile >A blood test that looks at
(5th day of • Include APPT repeat
this 6 pm how long it takes for blood to
fever)
clot. Activated partial
thromboplastin time is the
period required for clot
46
formation in recalcified blood
plasma after contact
activation and the addition of
platelet substitutes; used to
address the intrinsic and
common pathways of
coagulation.
normal= 25.4 to 38.4 seconds
>to monitor closely the CBC

result of the patient since the
patient is suffering from
bleeding
• CBC monitoring
>Patient is negatiuve for

cough and raches
(-) rashes • D/C IV cefuroxime >To secure if platelet

(-) cough concentrate is available if
transfusion is to be done.
• To secure 6 units
platelet concentrate
1:45 pm
• IVFTF D5LR iL
@220 cc/hr x 2
cycles

7-9-10 • Pls secure FFP 3-4 >The fluid portion of one unit
10pm units ASAP of of human blood that has been
centrifuged, separated, and
47
Wt=55 kg patient’s blood to frozen solid at -18° C (or
run at fast drip after colder) within 6 hours of
proper retyping collection. It is given to the
patient since FFP contains the
labile as well as the stable
components of the
coagulation, fibrinolytic, and
• Keep mainline on
APTT complement systems; the
control 29.6 KVO rate while on proteins that maintain oncotic
Patient’s BT pressure and modulate
value 60.9 immunity and other proteins
that have diverse activities. In
addition, fats, carbohydrates,
and minerals are present in
concentrations similar to
those in circulation.
>For impaired renal functions

and for nephrotic syndrome,
• Give Furosemide 40 loop diuretics are often the
6pm mg IVTT after BT only drugs that can flush out
plt ct 29 massive edema.
with BP precaution
hct 0.45

7-9-10 • .IVF TF with D5LR > D5LR is a hypertonic
10:30 pm iL @ 220 cc/o solution that could help
rehydrate the patient’s body

7-10-10 • IVFTF c D5LR @ >to maintain fluid balance
12 pm 220 cc/hr
• Pls ff up TFP ASAP >to maintain fluid balance
8:10 pm
Day 6 • Pls refer 12 noon
PC=19 Hct &Plt ASAP >for immediate management
Hct=45 • ↑V/S monitoring to >for close monitoring of
Stable VS q2h unusualities for immediate
BP=100/80
CRT= management
<2secs
48
c dyspnea
> bleeding occurs more often

• Refer for any signs in patients with severe
of active bleeding thrombocytopenia.
>for further management and

• AP aware evaluation
• IVF TF c D5LR iL
@220 cc/hr
Plasma transfusion is
• May proceed c FFP indicated in patients with
1:30 am transfusion documented coagulation
factor deficiencies and active
• Mainline at KVO
bleeding, or who are about to
rate while on undergo an invasive
transfusion procedure.
>Furosemide helps the body

• Give Furosemide 40 to remove this excess fluid.
mg post BT if BP Removing fluid from the
>90/60 blood vessels also decreases
the pressure within the blood
vessels. This makes it easier
for a weak heart to pump
blood around the body.
Furosemide is therefore used
to relieve the symptoms of
heart failure.

7-10-10 • ↑present IVF to > to correct dehydration
PC=40 220cc/hour
Hct=0.47 > to correct dehydration
• IVFTF c D5LR I L
49
to run at 220cc/hr
• Maintain IVF to
6:45 am 220cc/hr > to correct dehydration
11:20 pm • IVFTF c D5LR iL to

run at 220cc/hr > to correct dehydration

7-11-10 • Pls secure 6 units -preparation for transfunsion
2:50 platelet of patients in order to increase the plt
blood type p
count of pt.
retyping & transfer
available in fast drip
ASAP
• ↓IVF to KVO while
in transfusion
• Monitor for >for immediate management
transfusion reaction
like dyspnea and
pruritus
• For assessment c/o >to provide for emergency
NOD every 3 bags patient care
of platelet
transfused
• Thank you!!!
11:15am
4:00 pm
• TF:D5LR
@220cc/hr > to correct dehydration
• IVF TF D5LR @ SR > to correct dehydration

07-11-10 • For chest x-ray view >to demonstrate pleural
(+) • IVF rate at 165cc/hr effusion
occasional > To maintain fluid and
cough • IVF to ff:D5LR iL at electrolytes balance
(-)dyspnea 165cc/hr > To maintain fluid and
(+) rales at • Iterax 25 mg I tab at electrolytes balance
lung field
50
bedtime >Symptomatic treatment of
anxiety, pruritus of allergic
origin
• IVF TF: D5LR iL at

165cc/hr > To maintain fluid and
7:30 electrolytes balance
• Pls transfuse 5 units > to increase platelet count

9pm of plt conc once
available
>in case platelet count is still
• Standby 1 unit plt low
conc
• IVF TF: D5LR iL at electrolytes balance
165 cc/hr

7-12-10 • TF: D5LR iL at > To maintain fluid and
165cc/hr electrolytes balance
7-12-10
Pt 23
Hct 41
• Rounds with Dr
7/12-10 Nalupa >For management and
10:45 AM
continued care
HR-60
• ff-up CX, Plt, CBC

q 8H >the patient has increase
• No need for levels of platetet and other
blood components.
additional unit of plt
>Platelet level stabilisong
conc
7/13/10 • IVFTF w/ D5LR iL
51
12:10 > To maintain fluid and
Ht= 64 at 165 cc/H electrolytes balance
Cct pt= • Report plt conct, Hct
66/4am this 4 hour after 12 >for immediate management
hours
>used to treat several types of
• Start Arythromycin infections caused by bacteria.
50 mg/tab I tab OD Arythromycin, like all
po macrolide antibiotics,
prevents bacterial cells from
growing and multiplying.
>Patient’s body is stabilizing

• ↓IVF rate to
120cc/hr
XII.DIAGNOSTIC EXAMS
07/05/2010
Test Resul Normal Clinical Rationale Interpretation
t Values Significance
52
Hemoglobin 136 135-180 No The actual The patient
significance substance in the hemoglobin is
red blood cells between normal
that carries range.
oxygen from the
lungs to your
Tissues. When
this number is
low, you will feel
more tired. If this
number falls too
low, your doctor
will start
you on a
medicine to
stimulate your
body to make
more red cells, or
send you to the
hospital for a
blood
Transfusion.
Hematocrit .40 .40-.54 No significance This is the The patient

percentage of the hematocrit is
blood made up of between normal
the red blood range
cells. If this is too
low, you are
considered to be
anemic and will
need to be started
on a medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
Erythrocytes 5.05 5.5-6.5 Patient has low RBCs are Erythrocyte of
erythrocytes produced in the patient is below
which mean a bone marrow. A normal range
decrease in the decreased number
number of red represents
53
blood cells Anemia and an
(erythrocytes) increased number
found in the may indicate
blood which dehydration.
indicates less
transport of
oxygen bound to
haemoglobin
molecules
Leukocytes 5.49 5-10 No significance White Blood Leukocytes level
Cells are the of the patient is
body’s defense between normal
mechanism range
against bacteria,
Viruses and
fungus. Your
doctor will watch
this level closely
after a
chemotherapy
treatment.
Neutrophil .85 .55-.65 The patient has a The first line of The patient
high neutrophil defense against neutrophil count
count this means bacterial is above normal
that patient has infections.
short term or
acute infection
Lymphocyte .07 .25-.35 Patient has Low B & T cells that The patient
s numbers of attack foreign neutrophil count
lymphocytes invaders, is above normal
means that it especially viruses.
increase your
risk for
infection.
Monocyte .06 .03-0.06 No significance Ingest foreign The monocyte
material, such as level of the
bacteria and patient is
fungus. between normal
range
Eosinophil .02 .02-0.04 No signifance Destroy parasites The eosinophil
and help with count of the
allergic reactions. client is within
normal range
Basophil 0.00 0-.01 No significane Play a major role The client
in inflammation. basophil level is
within normal
54
range
Platelet 149 150-350 The patient is This is a number The patient has a
experiencing that measures the low platelet
low platelet cell fragments count since the
count which that help stop patient s
represents an bleeding. A experiencing
increased risk decreased dengue fever
for bleeding Number
represents an
increased risk of
bleeding.
55
07/07/2010 @12:00
red blood cells abetween normal
that carries range.
oxygen from the
lungs to your
Tissues. When
this number is
low, you will feel
more tired. If this
number falls too
low, your doctor
will start
you on a
medicine to
stimulate your
body to make
more red cells, or
send you to the
hospital for a
blood
Transfusion.

the red blood range
low, you are
considered to be
anemic and will
need to be started
on a medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
56
blood dehydration.
Leukocytes 1.55 5-10 Patient has low White Blood Leukocytes level
leukocytes Cells are the of the patient is
which mean a body’s defense below normal
decrease in the mechanism range
number of white against bacteria,
blood cells Viruses and
(leukocytes) fungus. Your
found in the doctor will watch
blood, which this level closely
places after a
individuals at chemotherapy
increased risk of treatment.
infection.
Neutrophil .65 .55-.65 No signifance The first line of The patient
defense against experiencing
bacterial neutrophil count
infections. in between
normal range
s numbers of attack foreign lymphocytes
lymphocytes invaders, level is below
means that it especially viruses. normal range.
increase your
risk for
infection.
Monocyte .12 .03-0.06 Patient has high Ingest foreign The monocyte
monocyte it may material, such as level of the
be indicative of bacteria and patient is above
various disease fungus. normal range
states such as
Viral Fever
Eosinophil .00 .02-0.04 Patient has low Destroy parasites The eosinophil
eosinophil count and help with count of the
which increases allergic reactions. client is below
susceptibility to normal range
parasitic worms
and
inflammation
57
within normal
range
for bleeding Number
represents an
increased risk of
bleeding.
58
07/07/2010@ 6pm
Test Result Normal Clinical Rationale Interpretation

Values Significance
percentage of haemoglobin
the blood made count is above
up of the red normal range
blood cells. If
this is too low,
you are
considered to be
anemic and will
need to be
started on a
medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
Platelet 62 150-350 The patient is This is a
Count experiencing number that The patient
low platelet measures the platelet count is
count which cell fragments below normal
represents an that help stop range
increased risk bleeding. A
for bleeding decreased
Number
represents an
increased risk of
bleeding.
Blood O Universal individuals do
Group donor not have either
A or B antigens
on the surface
of their RBCs,
but their blood
serum contains
IgM anti-A
antibodies and
anti-B
antibodies
59
against the A
and B blood
group antigens.
Rh Positiv
e
60
07/09/2010 @ 12:00 am

Hematocrit .39 .40-.54 Patient has low This is the The patient
hematocrit percentage of the haemoglobin
which mean a blood made up of count is below
decrease in the the red blood normal range
number of red cells. If this is too
blood cells low, you are
(erythrocytes) considered to be
found in the anemic and will
blood need to be started
on a medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
Platelet 78 150-350 The patient is This is a number
experiencing that measures the The patient
low platelet cell fragments that platelet count is
count which help stop below normal
represents an bleeding. A range
increased risk decreased
for bleeding Number
represents an
increased risk of
bleeding.
Malarial None The patient is This involves
smear found negative for identification of
malaria malaria parasite or
its
antigens/products
in the blood of the
patient.
61
07/08/2010@ 6:00 am
Hematocrit .40 .40-.54 No This is the The patient
significance percentage of the haemoglobin
blood made up of count is above
the red blood normal range
low, you are
considered to be
anemic and will
need to be started
on a medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
for bleeding Number
represents an
increased risk of
bleeding.
Malarial None The patient is This involves
smear found negative for identification of
its
antigens/products
in the blood of the
patient.
62
07/08/2010 @ 12 pm

Values Significance
Hematocrit .42 .40-.54 No This is the The patient
significance percentage of the haemoglobin
blood made up of count is above
the red blood normal range
low, you are
considered to be
anemic and will
need to be started
on a medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
for bleeding Number
represents an
increased risk of
bleeding.
Malarial NMPS The patient is This involves
smear (No negative for identification of
malarial malaria malaria parasite or
Parasite its
seen) antigens/products
in the blood of the
patient.
63
07/08/2010@6am
red blood cells between normal
that carries range.
oxygen from the
lungs to your
Tissues. When
this number is
low, you will feel
more tired. If this
number falls too
low, your doctor
will start
you on a
medicine to
stimulate your
body to make
more red cells, or
send you to the
hospital for a
blood
Transfusion.
Hematocrit 0.42 .40-.54 No significance This is the The patient
the red blood range
low, you are
considered to be
anemic and will
need to be started
on a medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
Erythrocytes 5.50 5.5-6.5 No significance RBCs are Erythrocyte of
produced in the patient is
bone marrow. A between normal
64
decreased number range
represents
Anemia and an
increased number
may indicate
dehydration.
places after a
infection.
Neutrophil .67 .55-.65 The patient has a The first line of The patient has a
high neutrophil defense against high value of
which is the bacterial neutrophil
primary white infections.
blood cells that
responds to
bacterial
infection
Lymphocyte .25 .25-.35 No signifance B & T cells that The patient
s attack foreign lymphocytes
invaders, level is within
especially viruses. normal range.
range
normal range
Basophil .01 0-.01 No significane Play a major role The client
within normal
range
65
for bleeding Number
represents an
increased risk of
bleeding.
66
07/08/2010 12am

that carries range.
oxygen from the
lungs to your
Tissues. When
this number is
low, you will feel
more tired. If this
number falls too
low, your doctor
will start
you on a
medicine to
stimulate your
body to make
more red cells, or
send you to the
hospital for a
blood
Transfusion.

the red blood range
low, you are
considered to be
anemic and will
need to be started
on a medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
67
blood dehydration.
places after a
infection.
blood cells that
responds to
bacterial
infection
Lymphocyte .23 .25-.35 Patient has Low B & T cells that The lymphocytes
s numbers of attack foreign is below the
lymphocytes invaders, normal range
increase your
risk for
infection.
range
Eosinophil .01 .02-0.04 Patient has low Destroy parasites The patient has
eosinophil count and help with low eosinophil
which increases allergic reactions. count
susceptibility to
68
parasitic worms
and
inflammation
within normal
range
for bleeding Number
represents an
increased risk of
bleeding.
07/09/2010@ 12 am
that carries range.
oxygen from the
lungs to your
Tissues. When
this number is
low, you will feel
more tired. If this
number falls too
low, your doctor
will start
you on a medicine
to stimulate your
body to make
more red cells, or
send you to the
hospital for a
blood
Transfusion.
69
the red blood range
low, you are
considered to be
anemic and will
need to be started
on a medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
blood dehydration.
Leukocytes 1.21 5-10 Patient has low White Blood Cells Leukocytes level
leukocytes are the body’s of the patient is
which mean a defense below normal
places after a
infection.
blood cells that
responds to
bacterial
infection
Lymphocyte .23 .25-.35 Patient has Low B & T cells that The lymphocytes
70
s numbers of attack foreign is below the
lymphocytes invaders, normal range
increase your
risk for
infection.
range
parasitic worms
and
inflammation
within normal
range
low platelet cell fragments that count since the
count which help stop patient s
for bleeding Number
represents an
increased risk of
bleeding.
Malarial NMP The patient is This involves
smear S negative for identification of
its
antigens/products
in the blood of the
patient.
71
07/09/2010
that carries range.
oxygen from the
lungs to your
Tissues. When
this number is
low, you will feel
more tired. If this
number falls too
low, your doctor
will start
you on a
medicine to
stimulate your
body to make
more red cells, or
send you to the
hospital for a
blood
Transfusion.

the red blood range
low, you are
considered to be
anemic and will
need to be started
on a medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
72
produced in the patient is
bone marrow. A between normal
decreased number range
represents
Anemia and an
increased number
may indicate
dehydration.
places after a
infection.
Neutrophil .63 .55-.65 No significance The first line of The patient
defense against neutrophil count
bacterial is netween
infections. normal range
Lymphocyte .71 .25-.35 The patient has a B & T cells that The patient
s high lymphocyte attack foreign lymphocytes
count this means invaders, level is above
that patient especially viruses. normal range.
immune system
is active to fight
viruses and other
foreign invaders
fungus. beltween normal
range
parasitic worms
and
inflammation
73
within normal
range
for bleeding Number
represents an
increased risk of
bleeding.
74
07/09/2010 @6am

that carries range.
oxygen from the
lungs to your
Tissues. When
this number is
low, you will feel
more tired. If this
number falls too
low, your doctor
will start
you on a
medicine to
stimulate your
body to make
more red cells, or
send you to the
hospital for a
blood
Transfusion.

the red blood range
low, you are
considered to be
anemic and will
need to be started
on a medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
75
produced in the patient is within
bone marrow. A normal range
decreased number
represents
Anemia and an
increased number
may indicate
dehydration.
places after a
infection.
Neutrophil .61 .55-.65 No significance The first line of The patient
defense against neutrophil count
bacterial is within normal
infections. range
Lymphocyte .31 .25-.35 No signifance B & T cells that The patient
s attack foreign lymphocytes
invaders, level is within
especially viruses. normal range.
bacteria and patient is within
fungus. normal range
parasitic worms
and
inflammation
within normal
range
76
for bleeding Number
represents an
increased risk of
bleeding.
77
07/09/2010 @ 12pm

that carries range.
oxygen from the
lungs to your
Tissues. When
this number is
low, you will feel
more tired. If this
number falls too
low, your doctor
will start
you on a
medicine to
stimulate your
body to make
more red cells, or
send you to the
hospital for a
blood
Transfusion.

the red blood range
low, you are
considered to be
anemic and will
need to be started
on a medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
78
decreased number
represents
Anemia and an
increased number
may indicate
dehydration.
places after a
infection.
low neutrophil defense against experiencing low
count this means bacterial neutrophil count
more susceptible
to bacterial
infections
immune system
is active to fight
viruses and other
foreign invaders
monocyte it may material, such as level of the
be indicative of bacteria and patient is above
various disease fungus. normal range
states such as
Viral
Feverimmune
system
79
normal range
within normal
range
for bleeding Number
represents an
increased risk of
bleeding.
80
07/09/2010 @6pm

that carries range.
oxygen from the
lungs to your
Tissues. When
this number is
low, you will feel
more tired. If this
number falls too
low, your doctor
will start
you on a
medicine to
stimulate your
body to make
more red cells, or
send you to the
hospital for a
blood
Transfusion.

the red blood range
low, you are
considered to be
anemic and will
need to be started
on a medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
81
transfusion.
blood dehydration.
places after a
infection.
high neutrophil defense against high neutrophils
which is the bacterial level
blood cells that
responds to
bacterial
infection
s numbers of attack foreign lymphocytes
lymphocytes invaders, level is below
means that it especially viruses. normal range.
increase your
risk for
infection.
Monocyte .06 .03-0.06 Patient has low Ingest foreign The monocyte
monocyte count material, such as level of the
which indicate a bacteria and patient is below
deficient fungus. normal range
immune system
82
normal range
within normal
range
for bleeding Number
represents an
increased risk of
bleeding.
83
07/10/10 @12am

that carries range.
oxygen from the
lungs to your
Tissues. When
this number is
low, you will feel
more tired. If this
number falls too
low, your doctor
will start
you on a
medicine to
stimulate your
body to make
more red cells, or
send you to the
hospital for a
blood
Transfusion.

the red blood range
low, you are
considered to be
anemic and will
need to be started
on a medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
84
blood dehydration.
places after a
infection.
more susceptible
to bacterial
infections
immune system
is active to fight
viruses and other
foreign invaders
which indicate bacteria and patient is above
an infection fungus. normal range
Eosinophil .06 .02-0.04 The patient has Destroy parasites The eosinophil
high eosinophil and help with count of the
level which allergic reactions. client is above
could indicate an normal range
allergy attack
85
within normal
range
for bleeding Number
represents an
increased risk of
bleeding.
86
07/10/2010 @6am

that carries range.
oxygen from the
lungs to your
Tissues. When
this number is
low, you will feel
more tired. If this
number falls too
low, your doctor
will start
you on a
medicine to
stimulate your
body to make
more red cells, or
send you to the
hospital for a
blood
Transfusion.

the red blood range
low, you are
considered to be
anemic and will
need to be started
on a medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
87
decreased number
represents
Anemia and an
increased number
may indicate
dehydration.
places after a
infection.
more susceptible
to bacterial
infections
immune system
is active to fight
viruses and other
foreign invaders
which indicate bacteria and patient is above
an infection fungus. normal range
Eosinophil .08 .02-0.04 The patient has Destroy parasites The eosinophil
high eosinophil and help with count of the
level which allergic reactions. client is above
could indicate an normal range
allergy attack
88
within normal
range
for bleeding Number
represents an
increased risk of
bleeding.
89
07/10/10@12pm
Values Significance
blood cells. If
this is too low,
you are
considered to be
anemic and will
need to be
started on a
medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
Number
represents an
increased risk of
bleeding.
90
07/10/10@6pm
Values Significance
blood cells. If
this is too low,
you are
considered to be
anemic and will
need to be
started on a
medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
Number
represents an
increased risk of
bleeding.
91
07/11/2010 @12am
Values Significance
blood cells. If
this is too low,
you are
considered to be
anemic and will
need to be
started on a
medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
Number
represents an
increased risk of
bleeding.
92
07/11/10 @6am
Values Significance
blood cells. If
this is too low,
you are
considered to be
anemic and will
need to be
started on a
medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
Number
represents an
increased risk of
bleeding.
93
07/11/2010 @12pm
Values Significance
blood cells. If
this is too low,
you are
considered to be
anemic and will
need to be
started on a
medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
Number
represents an
increased risk of
bleeding.
94
07/11/10@6pm

Values Significance
blood cells. If
this is too low,
you are
considered to be
anemic and will
need to be
started on a
medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
Number
represents an
increased risk of
bleeding.
95
07/11/10 @6pm
Values Significance
blood cells. If
this is too low,
you are
considered to be
anemic and will
need to be
started on a
medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
Number
represents an
increased risk of
bleeding.
96
07/12/10@ 12am
Values Significance
blood cells. If
this is too low,
you are
considered to be
anemic and will
need to be
started on a
medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
Number
represents an
increased risk of
bleeding.
97
07/12/10@6am
Values Significance
blood cells. If
this is too low,
you are
considered to be
anemic and will
need to be
started on a
medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
Number
represents an
increased risk of
bleeding.
98
07/12/10@12pm
Values Significance
blood cells. If
this is too low,
you are
considered to be
anemic and will
need to be
started on a
medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
Number
represents an
increased risk of
bleeding.
99
07/12/10@12
Values Significance
blood cells. If
this is too low,
you are
considered to be
anemic and will
need to be
started on a
medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
Number
represents an
increased risk of
bleeding.
100
07/13/10@4am
Values Significance
blood cells. If
this is too low,
you are
considered to be
anemic and will
need to be
started on a
medicine to
stimulate your
bone marrow to
produce
More red blood
cells. Some
patients may
require a blood
transfusion.
Number
represents an
increased risk of
bleeding.
101
Urinalysis
Urine Test Result Interpretation
Color Light Yellow Normal
Turbidity Clear Normal
Sugar Negative Normal
Albumin Negative Normal
Reaction Neutral Normal
Sp. Gravity 1.005 Normal (1.005-1.015)
RBC 1-3 Normal (0-3)
Pus cells 0-1 Normal (0-3)
102
Activated Partial Prothrombin Time
Normal Clinical Nursing responsibilities
Date Test Result
Value significance
July Protime - - - 1. If the client is receiving
06,2010 -Control - - - intermittent heparin doses,
Prolonged schedule the APTT to be drawn
APTT 25.4- 45.9 seconds 30-60 minutes before the next
38.4 Clotting heparin dose.
-Control - 25.5seconds - 2. If heparin is given
PTRA - - - countinuously, the blood
specimen can be drawn at any
time.
3. If APTT is greater than 100
seconds, the client is at risk for
bleeding and the physician is
notified.
4. The antidote for heparin is
protamine sulfate.
5. Note whether the client is
taking antihistamines, vitamin
C, or salicylates, as these
INR - - - prolong the PTT time.
Activated Partial Prothrombin Time

Normal Clinical Nursing responsibilities
Date Test Result
Value significance
July 06, Protime - - - 1. If the client is receiving
2010 -Control - - - intermittent heparin doses,
@1:05am Prolonged schedule the APTT to be drawn
APTT 25.4- 43.9 seconds 30-60 minutes before the next
38.4 Clotting heparin dose.
-Control - 79.6 seconds - 2. If heparin is given
PTRA - - - countinuously, the blood
specimen can be drawn at any
time.
3. If APTT is greater than 100
seconds, the client is at risk for
bleeding and the physician is
notified.
4. The antidote for heparin is
protamine sulfate.
5. Note whether the client is
taking antihistamines, vitamin
C, or salicylates, as these
INR - - - prolong the PTT time.
103
07/05/2010@11:14pm
Result Reference Range Significance Interpretation
Creatinine 80.78 M: <50yrs old: less No significance Paitent has normal
than 115 mol/L creatinine
>50 yrs old: Less
than 124 mmol/L
Chest X-Ray
07/12/10 @11:20am
Haziness is seen in both lung fields, more in the right. The rest of the lung fields are clear and
well expanded. The heart is not enlarged. Hemidiaphragms and endophrenic vules are intact. No
other significant findings.
Impression: Bronchial pneumonia is considered.
XIII.DRUG STUDY
104
GENERIC NAME Cefuroxime sodium
BRAND NAME Aeruginox, Zinacef
CLASSIFICATION Cephalosporins
SUGGESTED 750 mg IVTT q8h
DOSE
MODE OF Second-generation cephalosporin that inhibits cell wall synthesis, promoting
ACTION osmotic instability, usually bactericidal
Susceptible mild to moderate infections including pharyngitis/tonsillitis,
INDICATION acute maxillary sinusitis, bronchitis, acute otitis media; uncomplicated skin
and skin structure, UTIs, gonorrhea; early Lyme disease.
Contraindicated in patients hypersensitive to drug or cephalosporins, use
CONRAINDICATI
cautiously in patients with hepatic and renal problem and breast-feeding
ONS
women
Drug-drug.
Aminoglycosides – may cause synergistic activity, may increase
DRUG
nephrotoxicity
INTERACTIONS
Loop diuretics – may increase risk of renal reactions
Probenecid – may inhibit excretion and increase cefuroxime level
CV: thrombophlebitis
Dermatologic: rash, urticaria, erythematous rashes, pain in injection site
SIDE EFFECTS GI: nausea, GI distress, vomiting, diarrhea, anorexia
Hematologic: neutropenia, haemolytic anemia, thrombocytopenia
Other: anaphylaxis, serum sickness
NURSING • Assess the patient’s hepatic function, renal function
RESPONSIBILITIE • Check whether the patient is hypersensitive to drug; perform skin
S testing
105
• Obtain specimen culture and sensitivity before giving the first dose.
• Tell the patient to take drug as prescribed, even after he feels well
• Watch out for any allergic and adverse reactions
GENERIC NAME Furosemide

BRAND NAME Lasix
CLASSIFICATION Loop diuretics, electrolytes and water agent
SUGGESTED 40 mg IVTT post BT
DOSE
MODE OF A potent loop diuretic that inhibits sodium and chloride reabsorption at the
ACTION proximal and distal tubules and ascending loop of Henle.
INDICATION Acute pulmonary edema, edema, hypertension
Contraindicated in patients hypersensitive to drug and those with anuria, use
CONRAINDICATI cautouslty in patient with hepatic cirrhosis and in those allegic to
ONS sulphonamides. Use furosemide during pregnancy only if potential to
mother clearly outweigh risks to fetus
Drug-drug.
Aminoglycosides: may increase ototoxicity
Corticosteroids: may increase risk of hypokalemia
Antidiabetics: may decrease hypoglycaemic effects
Antihypertensives: may increase hypotension
DRUG
Chlorothiazide, metolazone: may cause excessive diuretic response
INTERACTIONS
Lithium: may decrease lithium excretion
NSAIDs: may inhibit diuretic response
Salicylates: may cause salicylate toxicity
Drug-lifestyle.
Sun exposure: may increase risk of photosensitivity
106
CV: thrombophlebitis, orthostatic hypotension
CNS: headache, vertigo, paresthesia, weakness, fever
Dermatologic: dermatitis, purpura, photosensitivity
GI: nausea, GI distress, vomiting, diarrhea, anorexia
SIDE EFFECTS GU: nocturia, polyuria, frequent urination, oliguria
Hepatic: hepatic dysfunction
Metabolic: dehydration, impaired glucose tolerance, hypokalemia,
hyperglycemia, dilutional hyponatremia, hypocalcemia, hypomagnesemia
Other: gout
• Assess the patient’s hepatic function, renal function
• Administer first dose in the morning and second dose early
afternoon to prevent nocturia
• Monitor vital signs and weight regularly
• Stop administration if azotemia and oliguria occur
NURSING
• Monitor for input and output, BUN, electrolyte levels frequently
RESPONSIBILITIE
• Monitor uric acid level and glucose level regularly
S
• Give drug with meals
• Provide potassium and magnesium supplements as ordered by
physician
• Provide safety and comfort measures
• Provide protective clothing and sun block
107
GENERIC NAME Hydroxyzine hydrochloride
BRAND NAME Iterax
CLASSIFICATION Anxiolytics
SUGGESTED 25mg i tab @ bedtime
DOSE
Unknown. A piperazine antihistamine whose action may result from
MODE OF
suppression of activity in certain essential regions of the subcorticol area of
ACTION
the CNS.
INDICATION Anxiety, adjunctive therapy for sedation, pruritus for allergies
CONRAINDICATI Contraindicated in patients hypersensitive to drug, pregnant and breast-
ONS feeding women
Drug-drug.
Anticholinergic: may cause additive cholinergic effects
DRUG CNS depressants: May increase CNS depression
INTERACTIONS Epinephrine: may inhibit and reverse vasopressor effect of epinephrine
Drug-lifestyle.
Alcohol use: may increase CNS depression
CNS: drowsiness, involuntary motor activity
SIDE EFFECTS
GI: dry mouth, constipation
• Provide safety and comfort measures such as raising the bed rails
• If patient is taking CNS drugs, observe for oversedation
NURSING
• Tell patient to avoid alcohol use while taking the drug
RESPONSIBILITIE
• Give sugarless gum or candy for dry mouth
S
• Warn the woman of childbearing age to avoid pregnancy and
breastfeeding
108
GENERIC NAME Tramadol HCl 37.5 mg, paracetamol 325 mg
BRAND NAME Dolcet
CLASSIFICATION NSAIDs- analgesic opiod
SUGGESTED 1 tab q8
DOSE
MODE OF Unknown. A centrally acting synthetic analgesic compound that thought to
ACTION bind to opiod receptors and inhibit reuptake of norepinephrine and serotonin
INDICATION Moderate to severe pain
Contraindicated in patients hypersensitive to drug, patients with epilepsy,
CONRAINDICATI
seizures, with increased ICP or head trauma, respiratory depression, hepatic
ONS
impairment, pregnant and breastfeeding woman
Drug-drug.
CNS depressants: May increase CNS depression
Carbamazepine, quinidine: may increase the drug level
DRUG
MAO inhibitors, neuroleptics, opiods, tricyclic antidepressant: may increase
INTERACTIONS
risk of seizures
Drug-lifestyle.
CNS: drowsiness, dizziness, somnolence, CNS stimulation, asthenia,
anxiety, euphoria, seizures
CV: vasodilation
EENT: visual disturbances
SIDE EFFECTS
GI: dry mouth, constipation, GI distress
GU: urine retention, urinary frequency, menopausal symptoms, proteinuria
Respiratory: Respiratory depression
Skin: Rash, pruritus, diaphoresis
NURSING • Monitor vital signs regularly especially the respiratory rate
109
• Assess for hepatic and renal functioning of the patient
RESPONSIBILITIE • Administer drug with food or milk
S • Provide seizure precautions
• Anticipate need for laxative
• Reduce drug gradually due to withdrawal symptoms
GENERIC NAME Gentamicin

BRAND NAME Cidomycin
CLASSIFICATION Aminoglycosides
SUGGESTED 240 mg IVTT OD
DOSE
MODE OF Inhibits protein synthesis by binding directly to the 30S ribosomal unit
ACTION
Serious infections caused by Pseudomonas aeruginosa, E. Coli, Proteus,
INDICATION
Staphylococcus
Contraindicated in patients hypersensitive to drug and other
CONRAINDICATI
aminoglycosides, patients with renal or neuromuscular disorders, use
ONS
cautiously in neonates, infants and elderly
Drug-drug.
Acyclovir, amphotericin B, cephalosporins, loop diuretics: may increase
DRUG
ototoxicity and nephrotoxicity
INTERACTIONS
Atracurium, doxacurium: may cause respiratory depression
General anesthetics: may increase neuromuscular blockade
SIDE EFFECTS CNS: fever, headache, lethargy, encephalopathy, seizures, vertigo
CV: hypotension
EENT: visual disturbances, ototoxicity, tinnitus
GI: nausea and vomiting
110
GU: nephrotoxic
Respiratory: apnea
Skin: Rash, pruritus, urticaria
Musculoskeletal: muscle twitching, myasthenia gravis-like syndrome
• Monitor vital signs regularly especially the respiratory rate
• Assess for hypersensitivity of the patient to drug, perform skin
testing
• Obtain specimen for culture and sensitivity
NURSING
• Assess for hepatic and renal functioning of the client
RESPONSIBILITIE
S
• Assess for hepatic and renal functioning of the patient
• Administer drug with food or milk
• Watch out for signs and symptoms of superinfection such as
continued chills, fever, increased pulse rate
GENERIC NAME Paracetamol

BRAND NAME Biogesic
CLASSIFICATION NSAIDs
SUGGESTED 500mg 1 tab q6h
DOSE
Paracetamol exhibits analgesic action by peripheral blockage of pain
MODE OF impulse generation. It produces antipyresis by inhibiting the hypothalamic
ACTION heat-regulating centre. Its weak anti-inflammatory activity is related to
inhibition of prostaglandin synthesis in the CNS.
INDICATION
Mild to moderate pain and fever
CONRAINDICATI Contraindicated in patients hypersensitive to drug and other NSAIDs, with
ONS renal and hepatic impairment, use cautiously in elderly patients
111
DRUG Drug-drug.
INTERACTIONS
CNS: headache, dizziness, verti
GI: nausea and vomiting, GI distress
GU: nephrotoxic
SIDE EFFECTS Hepatic: Jaundice
Hematologic: haemolytic anemia, neutropenia, leukopenia
Skin: Rash, pruritus, urticaria
Metabolic: hypoglycemia
• Assess for hepatic and renal functioning of the client
NURSING
RESPONSIBILITIE
• Administer drug with food or milk
S
• Tell client to avoid using alcohol while taking the drug
GENERIC NAME Hyoscine butylbromide

BRAND NAME Buscopan
CLASSIFICATION Anticholinergics
SUGGESTED 10 mg 1 tab supp
DOSE
Inhibits muscarinic action of acetylcholine on autonomic effectors
MODE OF
innervated by postganglionic cholinergic neurons. May affect neural
ACTION
pathways originating from inner ear to inhibit nausea and vomiting.
INDICATION
Spastic states, delirium, preanesthetic sedation, nausea and vomiting
CONRAINDICATI Contraindicated in patients hypersensitive to drug, in patients with angle-
ONS closure glaucoma, obstructive uropathy, obstructive disease on GI tract,
asthma, chronic pulmonary disease, myasthenia gravis, paralytic ileus,
unstable CV status, hyperthyroidism, hiatal hernia, ulcerative colitis, and
112
children younger than 6 years old.
Drug-drug.
Amantadine, antihistamine, antiparkinson, meperidine, CNS depressants:
May increase risk of CNS reactions
DRUG Antacids: may decrease oral absorption
INTERACTIONS Digoxin: may increase digoxin level
Ketoconazole: may interfere ketoconazole absorption
Drug-lifestyle.
CNS: headache, dizziness, restlessness, confusion, impaired memory,
disorientation
GI: nausea and vomiting, GI distress, constipation, dry mouth
SIDE EFFECTS GU: urinary hesistancy, urinary retention
CV: palpitations, tachycardia, paradoxical bradycardia, flushing
Respiratory: bronchial plugging, respiratory depression
Skin: Rash, dryness, dermatitis
• Monitor vital signs especially respiratory rate
• Assess input and output regularly
NURSING • Provide safety and comfort measures such as raising the bed rails
RESPONSIBILITIE and reorient client as needed
S • Advise client that eyes are more sensitive to light while wearing the
patch
• Tell client to avoid using alcohol while taking the drug
113
XIV.NURSING THEORIES
114
THEORIES EXPECTED OUTCOMES TASK PERFORMED
Faye Glenn This theory was created to assist In this theory nurses are intended to
Abdellah’s Human with nursing education of nurses. provide care to those patients in the
needs theory The nurse demonstrates as the hospital.
problem solver who provides care What we did as student nurses was
for the whole individual. to establish rapport with our patient
so that we can understand each
other, find out suitable and
significant data, identify therapeutic
interventions, observe and assess
the patient to identify any attitudes
that affect his actions.
Dorothea Orem’s Self care theory: self care, self We identified self-care theory for
General theory of care agency, self care requisites Hector so that he can still perform
Nursing and thisapeutic self care demand. his independent functions to
• Self care refers to those promote sense of well-being. As
activities an individual student nurses, health teachings
performs independently were rendered for him. We
throughout life to promote encouraged him to comply with the
and maintain personal doctor’s orders, medications and
well-being. health teachings. Such health
• Self care agency is the teaching were eating fruits and
individual’s ability to green leafy vegetables to promote
perform self care wellness, increasing oral fluid
activities. intake and promoting bed rest.
Consists of 2 agents. One Hector understood and showed
who can perform self- care willingness to comply with the
independently and a therapeutic management. Thus, he
person that cannot exhibits participation and
perform independently. exercising positive attitude and
• Self care requisites or self promoting independence for his
care needs are measures or recovery.

actions taken to provide
self care. 115
• Thisapeutic self care
demands refers to all self
care activities required to

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XI.

DATE ORDER RATIONAL REMARKS

> To avoid misinterpretation

>to monitor the baseline data

• Monitor vs q4; and health status

>Intake and output

> CBC: Diagnose diseases or

>It is active against some

>Relieves fever by acting in

Amn IVTT (slow) now

DATE ORDER RATIONAL REMARKS

> indicated for the relief of

• Refer all labs once >for further management and

• IVF TF D5LR I L >D5LR is a hypertonic IV

• Rounds with Dr >For management and

• ↑OFI >The client has some

> Strict intake and output

DATE ORDER RATIONAL REMARKS

• Repeat CBC, Hct, > CBC: Diagnose diseases or

• D/C Gentamycin Patient does not have malarial

• Dolcet itab now, Given for Moderate to severe

• Please monitor plt & >To determine significant

> to correct dehydration

• For APTT on the >A blood test that looks at

DATE ORDER RATIONAL REMARKS

• IVTF at same rate > To maintain fluid and

>This is done as a general

• IVFTF D5LR iL > D5LR is a hypertonic

> To maintain fluid and

>to monitor closely the CBC

>Patient is negatiuve for

(-) rashes • D/C IV cefuroxime >To secure if platelet

DATE ORDER RATIONAL REMARKS

>For impaired renal functions

DATE ORDER RATIONAL REMARKS

DATE ORDER RATIONAL REMARKS

> bleeding occurs more often

>for further management and

> to correct dehydration

>Furosemide helps the body

DATE ORDER RATIONAL REMARKS

11:20 pm • IVFTF c D5LR iL to

DATE ORDER RATIONAL REMARKS

• IVF TF D5LR @ SR > to correct dehydration

DATE ORDER RATIONAL REMARKS

• IVF TF: D5LR iL at

• Pls transfuse 5 units > to increase platelet count

DATE ORDER RATIONAL REMARKS

• ff-up CX, Plt, CBC

7/13/10 • IVFTF w/ D5LR iL

>Patient’s body is stabilizing

Hematocrit .40 .40-.54 No significance This is the The patient

Hematocrit .40 .40-.54 No significance This is the The patient

Test Result Normal Clinical Rationale Interpretation

Test Resul Normal Clinical Rationale Interpretation

Test Result Normal Clinical Rationale Interpretation

Test Resul Normal Clinical Rationale Interpretation

Hematocrit .41 .40-.54 No significance This is the The patient

Hematocrit .44 .40-.54 No significance This is the The patient

Test Resul Normal Clinical Rationale Interpretation

Hematocrit .44 .40-.54 No significance This is the The patient

Test Resul Normal Clinical Rationale Interpretation