PATIENT’S PROFILE

Patient x is a 38 years old male and was born on September 30,

1967 in Las Nieves Agusan del Norte and is currently residing their. He
stands about 5 foot 6 inches tall and weighing 80 kg. He is married. He
is a Roman Catholic. He was able to study on high school but was not
able to finish and proceed to college. Presently he is working in the
Municipality of Las Nieves as a Collector in the Treasurer Department.

He had an elder sister, who were the only one able to finished
college and is currently working as a Teacher. He is currently living with
his wife and five children’s, three of which are females and were
currently studying, the eldest was 14 years old and the youngest was 1
year old.

After the incident, he has never been admitted to a Hospital

before and with no records of any major Medical and Surgical
operations. He has not suffered from any other disorders. He eats his
meals regularly (three times a day), he is a non-smoker and drinks only
occasionally. He sleeps about 6 hours and retires to sleep usually at 10
or 11 pm. in the evening and wakes at 4 or 5am for an early jogging.
Elimination is regular usually in the morning daily. Sexual life is still
active.

He has a brownish skin complexion with long curly hairs and

brown eyes. Skin shows observable signs of trauma likely bruises to his
lower left arm at dorsum metacarpal, bruises on his left-upper eyelids,
lesions on his left lower extremities on the knee and on his back at the
right scapular region then to his head at the back portion, occipitalis
region.

He has a limited range of motion particular to his left leg of were

the major injuries can be observed. He was lying on bed at supine
position. Skin bruises were covered and draped.

He is cooperative and responded well during the interview. He is

calm and coherent upon answering the questions although a little bit
depressed.

Prior to admission, he had been into a road motorcycle accident,

he was still conscious after that but was unable to help himself and
were then immediately admitted to Butuan Doctors’ Hospital that was
on May 29, 2006, Saturday at 4:30 pm. but before that, he was first
carried to Las Nieves Municipal Hospital for the first aid treatments and
at the same hour transferred to Butuan Doctors’.

The patient had been experiencing a burning sensations of pain

at the scale of about 6:10 particular at the lower extremities on the left
leg on his knees as well as back pains as evidenced by skin bruises
related to the accident, muscle pains related to the impact, a little
dizziness prior to head contusions and some joint pains of which are
probably referred pains.

Upon admission he was c/o by Dr. Dacudao as his admitting

physician, were he was given a medication for pain and infection
control. On that day he was also ordered to be X-rayed peculiar to the
affected body part from were it reveals that the bones of his left knee
(patellar bone) were crack or that it shows a slight fracture which
needs to be supported “I pa semento” and lesions to be sutured.
NURSING CARE PLAN: Impaired Walking

Nursing Diagnosis: controlled knee flexion at the left leg due to a crack patellar bone and intense pain upon movement
within a scale of 6:10 as evidenced by an open wound.
Goals Outcomes Nursing Interventions

After a month of 1. Within an hour or less
continued therapy after admission the patient
the patient will be can express a feeling of
able to walk normal relief and satisfaction with
and regain his no alterations in comfort.
optimum level of
functioning. 2. The patient will be
knowledgeable on his
Be able to coop actual and potential health
with his condition problems prior to his
physically and condition.
psychologically as
well. 3. Will be confined for bed
rest with continued
Within 2 months medications at about a
the patient will fully week or more with
recover. controlled body movement
particular on the affected
part from which will be
braced or supported until
observable signs of wound
healing and no pain upon
movement are noted.
1. The patient will be provided with different methods of pain
control measures. Necessary to provide comfort.
2. He will be instructed to lie on bed at supine position with limited
ROM on the affected body part until necessary. Intended to avoid
further complications and provide bed rest.
3. Will be assessed for wound care and change of bondages once a
day and will be medicated according to physicians order. To avoid
infections and hasten the would healing.
4. Vital signs will be monitored every Nursing shifts. To have a data
update for possible complications or signs of infections.
5. He will be demonstrated on the proper body mechanics
regarding on his ROM and will be teached on how to walk with or
without support/scratches or assistance. To promote self-esteem
and maintain self-reliance.
6. Discuss the importance of adequate food and fluid intake (eating
foods that are rich in proteins, carbohydrates, calories). Necessary
towards faster wound healing and recovery.

4. Will be provided
different teachings and
methods of cooping with
his impaired functioning
and within 2 months the
patient will be fully
recovered and function
normally.
ARCOXIA®
etoricoxib
60 mg, 90 mg & 120 mg tablet

Medicine Classification

• Prescription Medicine

Package Qualities

• ARCOXIA 60mg and 90 mg tablets are available in packs of 30 tablets.

ARCOXIA 120mg tablets are available in packs of 10 tablets.

Therapeutic Class

ARCOXIA (etoricoxib) is a member of a class of arthritis/analgesia medications called Coxibs.

ARCOXIA is a highly selective inhibitor of cyclooxygenase-2 (COX-2). Arcoxia (Etoricoxib) is the
newset of the COX-II inhibitors released onto the market by Merck Frosst. Arcoxia (Etoricoxib) can be
used to treat acute gouty arthritis, osteoarthirtis and other conditions as determined by your doctor.

Indications

ARCOXIA is indicated for:

• Acute and chronic treatment of the signs and symptoms of osteoarthritis (OA) and rheumatoid
arthritis (RA)
• The management of ankylosing spondylitis (AS)
• Treatment of acute gouty arthritis
• Relief of acute pain
• Relief of chronic musculoskeletal pain

The decision to prescribe a selective COX-2 inhibitor should only be made:

• if non-pharmacological interventions and simple analgesic therapy have been tried and found
to lack analgesic efficacy or to have unacceptable adverse effects in the individual patient; and
• after assessment of the individual patient's overall risk factors for developing severe adverse
events e.g. history of cardiovascular, renal, or gastrointestinal disease. (See Contraindications
and Warnings and Precautions).

As the cardiovascular risks of the selective COX-2 inhibitors may increase with dose and duration of
exposure, the shortest duration possible and the lowest effective daily dose should be used. Patients
on long-term treatment should be reviewed regularly, such as every three months, with regards to
efficacy, risk factors and ongoing need for treatment.
Dosage and Administration

ARCOXIA is administered orally. ARCOXIA may be taken with or without food.

Analgesia
Acute Pain : The recommended dose is 120 mg once daily. ARCOXIA 120 mg should be used
only for the acute symptomatic period, limited to a maximum of 8 days treatment.
Chronic Musculoskeletal Pain: The recommended dose is 60 mg once daily.

Doses greater than those recommended for each indication have either not demonstrated
additional efficacy or have not been studied. Therefore the dose for each indication is the
maximum recommended dose.

Elderly, Gender, Race

No dosage adjustment in ARCOXIA is necessary for the elderly or based on gender or race.

Hepatic Insufficiency
In patients with mild hepatic insufficiency (Child-Pugh score 5-6), a dose of 60 mg once daily
should not be exceeded. In patients with moderate hepatic insufficiency (Child-Pugh score 7-
9), the dose should be reduced; a dose of 60 mg every other day should not be exceeded.

Renal Insufficiency
In patients with advanced renal disease (creatinine clearance <30 mL/min), treatment with
ARCOXIA is not recommended.

How does it work?

Arcoxia tablets contain the active ingredient etoricoxib, which is a type of medicine known as a non-
steroidal anti-inflammatory drug (NSAID).

NSAIDs work by blocking the action of a substance in the body called cyclo-oxygenase. Cyclo-
oxygenase is involved in producing prostaglandins, in response to injury or certain diseases. These
prostaglandins cause pain, swelling and inflammation. Because NSAIDs block the production of these
prostaglandins, they are effective at relieving pain and inflammation.

Cyclo-oxygenase does not only produce prostaglandins that cause inflammation. It also produces
prostaglandins that have useful roles in the body. There are two different forms of cyclo-oxygenase,
COX-1 and COX-2. COX-2 is the form that (among other things) produces prostaglandins that cause
inflammation. COX-1 does not produce inflammatory prostaglandins, but does produce others that
have useful effects, including some that are involved in maintaining a healthy stomach and intestinal
lining.

Traditional NSAIDs, such as ibuprofen or diclofenac, block the action of both COX-1 and COX-2, and
this is why they can sometimes cause side effects such as stomach irritation and peptic ulcers.
Etoricoxib belongs to a new generation of NSAIDs that selectively block the action of COX-2. This
means that it stops the production of inflammatory prostaglandins, without stopping the production of
prostaglandins that protect the stomach and intestines. It therefore reduces pain and inflammation,
but is less likely than traditional NSAIDs to cause side effects on the stomach and intestines
(although such side effects are still possible).

This medicine can be taken with or without food, but may start to work quicker if taken without food.
Warning!

• This medicine may cause fatigue and dizziness. You should take care when performing
potentially hazardous activites, such as driving or operating machinery, until you know how
this medicine affects you and are sure you can perform such activities safely.

• NSAIDs can occasionally cause serious side effects on the gut, such as ulceration, bleeding
or perforation of the stomach or intestinal lining. This type of side effect is more likely to occur
in elderly people and in people taking high doses of the medicine. The risk can also be
increased by taking certain other medicines (see below). It is important that these people, as
well as people with a history of disorders affecting the stomach or intestines, are closely
monitored by a doctor while taking this medicine. All people taking this medicine should stop
treatment and consult their doctor immediately if they experience any sign of bleeding from
the stomach or intestine during treatment, for example vomiting blood and/or passing
black/tarry/bloodstained stools.

• COX-2 inhibitors may carry an increased risk of heart attacks and stroke when compared to
placebo (no treatment). If you have risk factors for heart disease or stroke, such as diabetes,
high cholesterol or smoking, your doctor will need to assess the overall benefits and risks
before deciding if this medicine is suitable for you. In general, if this medicine is suitable, your
doctor will prescribe the lowest effective dose for as short a time as possible to control your
symptoms, because the risks may increase with higher doses and the longer the medicine is
taken. Do not exceed the prescribed dose. Tell your doctor if you experience shortness of
breath, chest pains or ankle swelling while taking the medicine. Ask your doctor or pharmacist
for further information.

• Your blood pressure should be regularly monitored while you are taking this medicine.

• People with impaired kidney, liver or heart function should have their kidney function
monitored while taking this medicine.

• During long-term treatment your doctor may want to take regular blood tests to monitor your
liver function. Consult your doctor promptly if you develop unexplained itching, yellowing of the
skin or eyes, unusually dark urine, nausea and vomiting, abdominal pains, loss of appetite or
flu-like symptoms while taking this medicine, as they may be signs of a liver problem.

• This medicine may hide fever, which is a sign of infection. This may make you think
mistakenly that an infection is getting better when it isn't, or that an infection is less serious
than it is. For this reason you should tell your doctor if you get an infection while you are
taking this medicine.

• Very rarely, NSAIDS may cause serious blistering or peeling skin reactions (eg Stevens-
Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis). For this reason, you
should stop taking this medicine and consult your doctor if you get a skin rash or sores inside
your mouth while taking this medicine. This side effect is very rare, but if it occurs, is most
likely to happen in the first month of treatment.
Use with caution in

• Elderly people • Liver cirrhosis • High blood pressure

(hypertension)
• History of disorders • Dehydration
affecting the stomach • Raised levels of fats
or intestines, such as • History of heart such as cholesterol
ulceration or failure in the blood
bleeding (hyperlipidaemia)
• Swelling due to
• Decreased kidney excess fluid retention • Diabetes
function (oedema)
• Smokers
• Decreased liver
function

Not to be used in

• Children and adolescents under 16 • Heart failure

years of age
• People in whom aspirin or other
NSAIDs, eg ibuprofen, cause allergic
reactions such as asthma attacks, itchy
rash (urticaria), nasal polyps, nasal
inflammation (rhinitis) or swelling of the
lips, tongue and throat (angioedema)
• Severely decreased liver function
• Moderate to severely decreased kidney
function
• Active peptic ulcer or bleeding from the
gut
• Heart disease caused by inadequate
blood flow to the heart (ischaemic heart
disease), eg angina or history of heart
attack
• Disease of the blood vessels in and
around the brain (cerebrovascular
disease), eg history of stroke
• Poor circulation in the arteries of the
legs or feet (peripheral arterial disease)
• Pregnancy
• Breastfeeding.

• Inflammatory bowel disease such as • Rare hereditary problems of galactose

Crohn's disease or ulcerative colitis intolerance, the Lapp lactase deficiency
or glucose-galactose malsorption
• Uncontrolled high blood pressure (Arcoxia tablets contain lactose).
(hypertension)

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform
your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor
or pharmacist immediately.

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines
may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the
risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy,
before using any medicine.

• This medicine should not be used in pregnancy, particularly the third trimester, as it may delay
labour, increase the length of labour and cause complications in the newborn baby. Some
evidence suggests that NSAIDs should also be avoided by women attempting to conceive, as
they may temporarily reduce female fertility during treatment and may also increase the risk of
miscarriage or malformations. Seek medical advice from your doctor.

• It is not known whether this medicine passes into breast milk. Mothers who need to take this
medicine should not breastfeed. Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following
are some of the side effects that are known to be associated with this medicine. Because a side effect
is stated here, it does not mean that all people using this medicine will experience that or any side
effect.

• Headache • • Depression

• Dizziness • Fatigue • Nosebleeds (epistaxis)

• Disturbances of the gut • Cold or flu-like • Shortness of breath

such as diarrhoea, symptoms (dyspnoea)
constipation, nausea,
vomiting, indigestion, • Skin reactions such as • Chest pain
flatulence or abdominal rash and itch
pain • Heart attack or stroke
• Blurred vision
• Excessive fluid • Ulceration or bleeding
retention in the body • Difficulty in sleeping of the stomach or
tissues, resulting in (insomnia) intestine
swelling (oedema)
• Muscle cramps • Liver or kidney
• High blood pressure disorders
(hypertension)
• Weight gain
• Weakness or loss of
• Anxiety
strength (asthenia)

The side effects listed above may not include all of the side effects reported by the drug's manufacturer.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those
bought without a prescription and herbal medicines, before you start treatment with this medicine.
Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one,
to ensure that the combination is safe.

This medicine may be taken with low-dose (75mg daily) aspirin. However, the combination may carry
an increased risk of ulceration or bleeding in the stomach or intestines compared to taking etoricoxib
on its own. Etoricoxib should not be taken with higher daily doses of aspirin. For more information and
advice ask your doctor or pharmacist.

This medicine should not be taken with other non-steroidal anti-inflammatory drugs (NSAIDs), eg
ibuprofen, diclofenac, as using more than one NSAID together may also increase the risk of side
effects on the gut.

This medicine may increase the anti-blood-clotting effect of warfarin. People taking warfarin or other
anticoagulant medicines at the same time as this medicine should therefore have their blood-clotting
time (INR) regularly monitored, particularly in the first few days of treatment with etoricoxib and
following any dose changes.

This medicine may oppose the effect of diuretics and other medicines for high blood pressure
(antihypertensives).

There may be an increased risk of side effects on the kidneys if this medicine is taken with any of the
following medicines. People taking any of these medicines in combination with etoricoxib should have
their kidney function monitored, particularly if elderly:

• ACE inhibitors, eg enalapril, captopril • diuretics

• angiotensin II antagonists, eg losartan • tacrolimus.

• ciclosporin

This medicine may increase the blood levels of the following medicines:

• lithium (your lithium blood level should be monitored if you are starting, changing dose, or
stopping etoricoxib while taking lithium).

• methotrexate (people taking methotrexate should be well monitored for any side effects of
methotrexate while taking etoricoxib.

• oestrogens in oral contraceptives or HRT (this may increase the risk of side effects from these
medicines. Discuss this with your doctor.)

• digoxin.

Rifampicin may decrease the blood level of this medicine and therefore make it less effective at
treating pain.

Patient Teachings

1. Teach patient to take medicine or medications as physicians ordered.

2. Tell the patient for the possible effects of drug prior to its adverse reactions and consider such
reactions mentioned as normal.

3. Provide the patient with the proper management upon taking medications.

4. Tell the patient to seek for help if no such effects of drug are noted or that if symptoms prior to
his conditions are still noted.
5. Tell patient to maintain his normal diet and the possible consequences of the drugs effect
concerning on his appetite.