Acute myocardial infarction (MI) remains a leading cause of morbidity and mortality worldwide.

Myocardial infarction occurs when myocardial ischemia, a diminished blood supply to the heart, exceeds a critical threshold and overwhelms myocardial cellular repair mechanisms designed to maintain normal operating function and homeostasis. Ischemia at this critical threshold level for an extended period results in irreversible myocardial cell damage or death.

Male

South Asian
HIGHEST RATE is 30-69 years old

Pain in the Left arm

Chest Pain

Shortness of breath

Healthy Lifestyle

electrocardiogram

Angiography

Chest Radiograph

Physical Examination

Cardiac Biomarkers

Demographic Data

41 years old

October 14, 1973

S/P AMI unstable angina Jan. 08, 2014

Muntinlupa city

Filipino

Lingga Calamba city Patient S

laboratory results

medical findings

Patient S
Experiencing pain in the left arm difficulty of breathing and chest heaviness

One day prior to admission

Patient S

On January 08, 2014, the patient was admitted at Dr. Jose Rizal Memorial Hospital at Surgical Ward, bed 3 in Male room, with admitting diagnosis of S/P AMI unstable angina.

Patient S

Not sure if he completed all immunizations

Chicken pox measles

Father, 72y/o

Mother, 69y/o

Father, 74y/o

Mother, 71y/o

Sister, 39y/o

Wife 40y/o

Patient S 41y/o

Sister, 39y/o

Brother, 37y/o

LEGEND: 21y/o 18y/o 15y/o

FEMALE MALE ALIVE AND WELL

Prior to confinement

Patient S

But if the symptoms persist for a week and he cannot go to work because of it

Prior to confinement, the client describes himself as hardworking father to his 3 kids. The client also mentioned that as much as possible, he does not want to get sick

Patient S

During confinement, the client thinks that he needs to change his eating habits

Prior to confinement

During Confinement

Plays basketball and sometimes drink alcohol at night

He is encouraged to complete bed rest without bathroom privileged and limit daily activity as ordered by his attending physician. His activity consists of eating, talking with his wife and sleeping.

Prior to confinement, the client has no difficulty of going to sleep. He also take an afternoon naps. He also said that he does not have snoring problems. During confinement, the client said that he is slightly disturbed with nurses monitoring her every hour.

Prior to confinement

Eats three times a day

Urinates 6 times a day

The client said that he and his wife are both sexually active. He also mentioned that they use family planning method. According to Freud's Psychosexual Development Theory during the final stage of psychosexual development, the individual develops a strong sexual interest in the opposite sex. This stage begins during puberty but last throughout the rest of a person's life.

The client has a nuclear type of family which is composed of his wife and daughters and son. His wife is a house maid, and as the breadwinner of the family, he provides everything especially the financial aspect. He said that his wifes salary together with his salary is sometimes enough to provide for them. The client mentioned that he and his wife always talk especially when it comes to major decisions in life

Prior to hospitalization, the client said that there is no crisis going on within his family. Whenever they have problems concerning with their children they fix it right away. Wala kaming away napinatatagal pa nagkakabati din kami pagkatapos ngmaayos na usapan. He also believes that his wife is the most helpful person in talking things over. Sometimes he feels stressed from work but when he gets home he sleeps.

My patient is an electrician and sideline for driver, according to him since he an electrician he meets many people but before, and also he is a driver. Hes not a shy type person, he loves to go out playing basketball. pala kaibigan naman ako, hilig ko kasi mag laro ng basketball at mag inom dati nung wala pa akong sariling pamilya. Pero ngayon minsan na lang bz na kasi ako sa trabaho, kaya hindi nako maysado nkaka laro ng basketball, medyo hirap na din ako dahil sa edad ko.

ROS
General

1st day
-no chills -afebrile Temp: 8am- 36.0 degree Celsius 12am- 37.1 degree Celcius Head: -facial expressions show grimace Eyes: -pinkish conjunctiva -no itch -PERRLA Ears: -no discharges -no pain -no tenderness Nose: -no discharges Throat: -no bleeding gums -no mouth ulcers

2nd day
-no chills -afebrile Temp: 8am- 36.7degree Celsius 12am- 36.2 degree Celcius Head: -no facial grimace Eyes: -pinkish conjunctiva -no itch -PERRLA Ears: -no discharges -no pain -no tenderness Nose: -no discharges Throat: -no bleeding gums -no mouth ulcers

HEENT

Skin

-no rashes -skin is not warm to touch

-no rashes -skin is not warm to touch

Respiratory

Respiratory rate: 8am - 23cpm 12am- 21 cpm Cardiovascular Cardiac rate: 8am - 67bpm 12am- 70bpm Gastrointestinal - nausea and vomiting

Genitourinary

Urine: -4-6 times this day

Respiratory rate: 8am- 20 cpm 12am- 22 cpm Cardiac rate: 8am - 63 bpm 12am- 62bpm - no signs of nausea and vomiting Urine: -3-6 times this day

The heart itself is made up of 4 chambers, 2 atria and 2 ventricles. De-oxygenated blood returns to the right side of the heart via the venous circulation. It is pumped into the right ventricle and then to the lungs where carbon dioxide is released and oxygen is absorbed. The oxygenated blood then travels back to the left side of the heart into the left atria, then into the left ventricle from where it is pumped into the aorta and arterial circulation.

The pressure created in the arteries by the contraction of the left ventricle is the systolic blood pressure. Once the left ventricle has fully contracted it begins to relax and refill with blood from the left atria. The pressure in the arteries falls while the ventricle refills. This is the diastolic blood pressure.

The atrio-ventricular septum completely separates the 2 sides of the heart. Unless there is a septal defect, the 2 sides of the heart never directly communicate. Blood travels from right side to left side via the lungs only. However the chambers themselves work together. The 2 atria contract simultaneously, and the 2 ventricles contract simultaneously.

Systemic and Coronary Circulation

Pulmonary circulation begins with the right heart. It is here that the oxygenated blood from the venous system enters the right atrium through two large veins, the superior and inferior vena cava. Blood is transported to the lungs via the pulmonary artery and its branches. Oxygen rich blood returns to the left atrium through cerebral pulmonary veins.

EXAM WBC

RESULT
7.6

NORMALVALUE
4.1-10.9x103/QL

0.73

54-62%

Neutrophills
0.22 25-33%

Lymphocytes
0.05 2-8%

Monocytes
4.66 4.2-5.4x 1012/L

RBC
138 120-150gm/L

Hemoglobin
192 150-400x10/L

Platelets
0.41 0.42-0.52

Hematocrit

Generic Name (Brand name)

Drug Classification

Dosage/ Route/ Frequency

Indication/ Contraindication

Side effects

Mechanism of Action

Nursing Responsibilities

Generic Antianginal Name: ISDN isosorbide dinitrate Brand name: isordil

50mg/tab OD

Indication. Acute anginal attacks (S.L. isosorbide dinitrate only); to prevent situations that may cause anginal attacks. Contraindicated: Contraindicated in patients with hypersensitivity or idiosyncrasy to nitrates and in those with severe hypotension, angle-closure glaucoma, increased intracranial pressure, shock, or acute MI with low left ventricular filling pressure. Use cautiously in patients with blood volume depletion (such as from diuretic therapy) or mild hypotension. Overdose S&S: Venous pooling decreased cardiac output, hypotension, and methemoglobinemia.

Side effects CNS: headache, dizziness, weakness. CV: orthostatic hypotension, tachycardia, palpitations, ankle edema, flushing, fainting. EENT: sublingual burning. GI: nausea, vomiting. Skin: cutaneous vasodilation, rash.

Isordil relaxes vascular smooth muscle with a resultant decrease in venous return and decrease in arterial BP, which reduces left ventricular workload and decreases myocardial oxygen consumption.

To prevent tolerance, a nitrate-free interval of 10 to 14 hours per day is recommended. The regimen for isosorbide mononitrate (1 tablet on awakening with the second dose in 7 hours, or 1 extended-release tablet daily) is intended to minimize nitrate tolerance by providing a substantial nitrate-free interval. Monitor blood pressure and heart rate and intensity and duration of drug response. Drug may cause headaches, especially at beginning of therapy. Dosage may be reduced temporarily, but tolerance usually develops. Treat headache with aspirin or acetaminophen. Methemoglobinemia has been seen with nitrates. Symptoms are those of impaired oxygen delivery despite adequate cardiac output and adequate arterial partial pressure of oxygen. Look alikesound alike: Don't confuse Isordil with Plendil, Isuprel, or Inderal.

Generic Name (Brand name) Generic Name: Captopril Brand name: capoten

Drug Classification

Dosage /Route/ Frequency

Indication/ Contraindication

Side effects

Mechanism of Action

Nursing Responsibilities

Antihypertensive 25mg/tab tab BID >Treatment of hypertension alone or in combination with thiazide-type diuretics >Treatment of CHF in patients unresponsive to conventional therapy; used with diuretics and digitalis

Indication:

>Treatment of diabetic
nephropathy >Treatment of left ventricular dysfunction after MI Contraindication: >Known hypersensitivity to the drug. >Bilateral renal artery stenosis, >hereditary angioedema;

Adverse Reactions CNS: dizziness, fainting, headache, malaise, fatigue, fever. CV: tachycardia, hypotension, angina pectoris. GI: abdominal pain, anorexia, constipation, diarrhea, dry mouth, dysgeusia, nausea, vomiting. Hematologic: leukopenia, agranulocytosis, thrombocytopenia, pancytopenia, anemia. Metabolic: hyperkalemia. Respiratory: dry, persistent, nonproductive cough, dyspnea. Skin: urticarial rash, maculopapular rash, pruritus, alopecia. Other: angioedema.

>Captopril competitively inhibits the conversion of angiotensin I (ATI) to angiotensin II (ATII), thus resulting in reduced ATII levels and aldosterone secretion. It also increases plasma renin

Assessment History: Allergy to captopril, history of angioedema, impaired renal function, CHF, salt or volume depletion,

pregnancy, lactation
Physical: Skin color, lesions, turgor; T; P, BP, peripheral perfusion; mucous membranes, bowel sounds, liver evaluation; urinalysis, LFTs, renal function tests, CBC and differential >Monitor patient closely for fall in BP secondary to reduction in fluid volume (due to excessive perspiration, and dehydration, vomiting, or diarrhea); excessive hypotension may occur. >Reduce dosage in patients

activity and
bradykinin levels. Reduction of ATII leads to decreased sodium and water retention. By these mechanisms, captopril produces a hypotensive effect and a beneficial effect in congestive heart

>renal impairment;

failure.

with impaired renal function.

Generic Name (Brand name)

Drug Classification

Dosage/Ro ute/ Frequency

Indication/ Contraindication

Side effects

Mechanism of Action

Nursing Responsibilities

Generic Antihypertensive 50mg/ tab Name: tab BID metoprolol Brand name: lopressor

Indications >Hypertension, alone or with other drugs, especially diuretics >Prevention of reinfarction in MI patients who are hemodynamically stable or within 310 days of the acute MI (immediaterelease tablets and injection) >Treatment of angina pectoris >Treatment of stable, symptomatic CHF of ischemic, hypertensive, or cardiomyopathic origin (Toprol-XL only)

Adverse Reactions CNS: fatigue, dizziness, depression. CV: hypotension, bradycardia, heart failure, AV block, edema. GI: nausea, diarrhea, constipation, heartburn. Respiratory: dyspnea, wheezing. Skin: rash.

Competitively blocks beta-adrenergic receptors in the heart and juxtaglomerular apparatus, decreasing the influence of the sympathetic nervous system on these tissues and the excitability of the heart, decreasing cardiac output and the release of renin, and lowering BP; acts in the CNS to reduce sympathetic outflow and vasoconstrictor tone.

Do not discontinue drug abruptly after long-term therapy (hypersensitivity to catecholamines may have developed, causing exacerbation of angina, MI, and ventricular arrhythmias). Taper drug gradually over 2 wk with monitoring. Ensure that patient swallows the ER tablets whole; do not cut, crush, or chew. Consult physician about withdrawing drug if patient is to undergo surgery (controversial). Give oral drug with food to facilitate absorption.

Contraindications
>Contraindicated with sinus bradycardia (HR < 45 beats/min), second- or third-degree heart block (PR interval > 0.24 sec), cardiogenic shock, CHF, systolic BP < 100 mm Hg; lactation.

Provide continual cardiac monitoring for patients receiving IV metoprolol.

Generic Name (Brand name) Generic Name: Enoxaparin sodium Brand name: Clexane

Drug Classification

Dosage/ Route/ Frequency

Indication/ Contraindication

Side effects

Mechanism of Action

Nursing Responsibilities

Anticoagulants

4,000 units SQ q12

Indication : Prevent pulmonary embolism and deep vein thrombosis after hip or knee replacement surgery, abdominal surgery, patients with acute illness who are at increased risk because of decreased mobility. To prevent ischemic complications of unstable angina and non-Q-wave MI with oral aspirin therapy. Contraindications: Conditions with high risk of uncontrolled hemorrhage including major bleeding disorders. Form: Ampules 30mg/0.3 ml, Syringes (prefilled) 30mg/0.3 ml, 40mg/0.4 ml, Vial300mg/3ml

Hemorrhage. Thrombocytopenia. Local reactions (Small local hematoma). Exceptional cases of skin necrosis. Rarely cutaneous or systemic allergic reaction. Increase liver enzymes.

A low molecular weight heparin derivative that accelerates formation of anti-thrombin IIIthrombin complex and deactivates thrombin, preventing conversion of fibrinogen to fibrin. Has higher antifactor Xa toantifactor IIa activity ratio.

Monitor pregnant women using the drug Instruct patient and family to watch for signs of bleeding or abnormal bruising and to notify prescriber immediately if any occur. Tell patient to avoid OTC drugs containing aspirin or other salicylates unless ordered by physician.

Generic Name (Brand name)

Drug Classification

Dosage/Route / Frequency

Indication/ Contraindication

Side effects

Mechanism of Action

Nursing Responsibilities

Generic Name: Aspirin Brand name: zorprin

NSAID Antipyretic Analgesic (nonopioid) Anti-inflammatory Antirheumatic Antiplatelet Salicylate

80mg/tab OD

>Mild to moderate pain >Fever >Inflammatory conditions rheumatic fever, rheumatoid arthritis, osteoarthritis >Reduction of risk of recurrent TIAs or stroke in males with history of TIA due to fibrin platelet emboli >Reduction of risk of death or nonfatal MI in patients with history of infarction or unstable angina pectoris. Contraindicated with allergy to salicylates or NSAIDs (more common with nasal polyps, asthma, chronic urticaria); allergy to tartrazine (cross-sensitivity to aspirin is common); hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation defects, hypoprothrombinemia, vitamin K deficiency.

Adverse Reactions EENT: tinnitus, hearing loss. GI: nausea, GI bleeding, dyspepsia, GI distress, occult bleeding. GU: renal insufficiency. Hematologic: prolonged bleeding time, leukopenia, thrombocytopenia. Hepatic: hepatitis. Skin: rash, bruising, urticaria. Other: angioedema, Reye syndrome, hypersensitivity reactions.

Analgesic and antirheumatic effects are attributable to aspirins ability to inhibit the synthesis of prostaglandins, important mediators of inflammation. Antipyretic effects are not fully understood, but aspirin probably acts in the thermoregulatory center of the hypothalamus to block effects of endogenous pyrogen by inhibiting synthesis of the prostaglandin intermediary. Inhibition of platelet aggregation is attributable to the inhibition of platelet synthesis of thromboxane A2, a potent vasoconstrictor and inducer of platelet aggregation.

History: Allergy to salicylates or NSAIDs; allergy to tartrazine; hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation defects, hypoprothrombinemia, vitamin K deficiency; impaired hepatic function; impaired renal function; chickenpox, influenza; children with fever accompanied by dehydration; surgery scheduled within 1 wk; pregnancy; lactation

Physical: Skin color, lesions; T; eighth cranial nerve function, orientation, reflexes, affect; P, BP, perfusion; R, adventitious sounds; liver evaluation,

Generic Name

Drug Classification

Dosage/ Route/ Frequency 75mg/tab OD

Indication/ Contraindication

Side effects

Mechanism of Action

Nursing Responsibilities

Generic Antiplatelet Name: Clopidogrel Brand name: Plavix

Indication reduction of atherosclerotic events (eg, MI, stroke, vascular death) in patients with atherosclerosis documented by recent stroke, recent MI, or established peripheral arterial disease; treatment of acute coronary syndrome (ACS) (unstable angina/nonSTsegment elevation MI), including patients managed with coronary revascularization; treatment of ACS in patients with STsegment elevation acute MI. Contraindication: Hypersensitivity to any component of the product; active pathological bleeding, such as peptic ulcer or intracranial hemorrhage.

Adverse Reactions CNS: confusion, fatal intracranial bleeding, hallucinations. CV: hypotension. EENT: epistaxis, rhinitis, taste disorder. GI: hemorrhage, abdominal pain, constipation, diarrhea, dyspepsia, gastritis, ulcers. GU: UTI, hematuria. Hematologic: purpura. Musculoskeletal: arthralgia, myalgia, arthritis. Respiratory: bronchospasm, interstitial pneumonitis, respiratory tract bleeding. Skin: rash, pruritus, bruising, eczema, erythema multiforme, urticaria, Stevens-Johnson syndrome, toxic epidermal necrolysis. Other: flulike syndrome, angioedema, anaphylaxis, serum sickness. Interactions

Clopidogrel is a thienopyridine derivative, chemically related to ticlopidine, which inhibits platelet aggregation. It acts by irreversibly modifying the platelet adenosine diphosphate (ADP) receptor. Therefore, platelet aggregation is inhibited for both ADP- mediated and ADPamplified (by other agonists) platelet activation. Consequently, platelets exposed to clopidogrel are affected for the remainder of their lifespan.

Advise patient that each dose may be taken without regard to meals, but to take with food if stomach upset occurs. Advise patient that if a dose is missed, to skip that dose and take the next dose at the regularly scheduled time. Instruct patient not to change the dose or stop taking unless advised by health care provider. Inform patient that it may take longer than usual to stop bleeding while taking clopidogrel and to report bleeding or unusual bruising to health care provider immediately. Advise patient to inform health care providers about use of this drug before undergoing surgical or dental procedures, and before any new drug is taken.

Generic Drug Dosage/Route/ Name Classification Frequency (Brand name) Generic Name: Simvastatin Brand name: Zocor Antilipemic 40mg/tab OD

Indication/ Contraindication >Adjunct to diet in the

Side effects

Mechanism of Action

Nursing Responsibilities

Adverse Reactions cholesterol and LDL CNS: asthenia, headache. cholesterol with primary GI: abdominal hypercholesterolemia (types pain, IIa and IIb) in those constipation, unresponsive to dietary diarrhea, restriction of saturated fat and dyspepsia, flatulence, cholesterol and other no nausea, pharmacologic measures vomiting. Respiratory: >To reduce the risk of upper coronary disease, mortality, respiratory and CV events, including tract infection.
treatment of elevated total CVA, TIA, MI and reduction in need for bypass surgery and angioplasty in patients with coronary heart disease and hypercholesterolemia Contraindications: >Acute liver disease or unexplained persistent elevations of serum transaminases.

Simvastatin is a prodrug metabolized in the liver to form the active -hydroxyl acid derivative. This inhibits the conversion of HMG-CoA to mevalonic acid by blocking HMG-CoA reductase, an early and rate-limiting step in cholesterol biosynthesis. It reduces total cholesterol, LDLcholesterol and triglycerides and increases HDLcholesterol levels.

Ensure that patient has tried a

cholesterol-lowering diet regimen for 36 mo before beginning therapy. Give in the evening; highest rates of cholesterol synthesis are between midnight and 5 AM. Advise patient that this drug cannot be taken during pregnancy; advise patient to use barrier contraceptives.

Arrange for regular follow-up during long-term therapy. Consider reducing dose if cholesterol falls below target.

ACTUAL PROBLEM
PROBLEM NO. NURSING PROBLEM DATE IDENTIFIED DATE RESOLVED

1 2 3

Acute chest pain Activity intolerance Deficient Knowledge

01-09-14 01-09-14 01-09-14

01-09-14

01-09-14

POTENTIAL PROBLEM
PROBLEM NO. NURSING PROBLEM Sedentary lifestyle DATE IDENTIFIED DATE RESOLVED

01-09-14

01-09-14

ASSESSMENT Subjective: Sumasakit ang dibdib ko (Ive been experiencing chest pains) as verbalized by the patient Objective: Restlessness Facial grimacing Fatigue Peripheral cyanosis Weak pulse Cold and clammy skin Palpitations Shortness of breath Elevated temperature Pain scale of 8/10

DIAGNOSIS Acute (Chest)Pain r/t myocardial ischemia resulting from coronary artery occlusion with loss/restriction of blood flow to an area of the myocardium and necrosis of the myocardium

PLANNING STG: Within 1 hour of nursing interventions, the client will have improved comfort in chest, as evidenced by: States a decrease in the rating of the chest pain. Is able to rest, displays reduced tension, and sleeps comfortably. Requires decrease analgesia or nitroglycerin. LTG:: The client will have an improved feeling of control as evidenced by verbalizing a sense of control over present situation and future outcomes within 2 days of nursing interventions.

INTERVENTION INDEPENDENT: 1. assess characteristics of chest pain, including location, duration, quality, intensity, presence of radiation, precipitating and alleviating factors, and as associated symptoms, have client rate pain on a scale of 1-10 and document findings in nurses notes. 2. Obtain history of previous cardiac pain and familial history of cardiac problems. 3. Assess respirations, BP and heart rate with each episodes of chest pain. 4. Maintain bed rest during pain, with position of comfort, maintain relaxing environment to promote calmness. 5. Prepare for the administration of medications, and monitor response to drug therapy. Notify physician if pain does not abate.

RATIONALE 1. Pain is indication of MI. assisting the client in quantifying pain may differentiate pre-existing and current pain patterns as well as identify complications. 2. This provides information that may help to differentiate current pain from previous problems and complications. 3. Respirations may be increased as a result of pain and associate anxiety. 4. To reduce oxygen consumption and demand, to reduce competing stimuli and reduces anxiety. 5.pain control is apriority, as it indicates ischemia.

EVALUATION STG: Within 1 hour of nursing intervention, the client had improved comfort in chest, as evidenced by: States a decrease in the rating of the chest pain. Is able to rest, displays reduced tension, and sleeps comfortably. Requires decrease analgesia or nitroglycerin. Goal was met. LTG:The client had an improved feeling of control as evidenced by verbalizing a sense of control over present situation and future outcomes within 2 days of nursing intervention. Goal was met.

ASSESSMENT Subjective: The client verbalizes questions regarding problems and misconceptions about his condition. Objective: Lack of improvement of previous regimen Inadequate follow-up on instructions given. Anxiety Lack of understandding.

DIAGNOSIS Deficient Knowledge r/t new diagnosis and lack of understan ding of medical condition.

PLANNING STG: The client will be able to verbalize and demonstrate understanding of information given regarding condition, medications, and treatment regimen within3 days of nursing interventions. L TG:The client willable to correctly perform all tasks prior to discharge.

INTERVENTION INDEPENDENT: 1. Monitor patients readiness to learn and determine best methods to use for teaching. 2. Provide time for individual interaction with patient. 3. Instruct patient on procedures that may be performed. Instruct patient on medications, dose, effects, side effects, contraindications, and signs/symptoms to report to physician. 4. Instruct in dietary needs and restrictions, such as limiting sodium or increasing potassium. 5. Provide printed materials when possible for patient/family to reviews. 6. Have patient demonstrate all skills that will be necessary for post discharge. 7. Instruct exercises to be performed, and to avoid overtaxing activities. DEPENDENT: 1. refer patient to cardiac rehabilitation as ordered

RATIONALE 1. To promote optimal learning environment when patient show willingness to learn. 2. To establish trust. 3. To provide information to manage medication regimen and to ensure compliance. 4. Client may need to increase dietary potassium if placed on diuretics; sodium should be limited because of the potential for fluid retention. 5. To provide reference for the patient and family to refer. 6. To provide information that patient has gained full understanding of instruction. 7. These are helpful in improving cardiacfunction.1. to provide further improvement and rehabilitation post discharge

EVALUATION STG: The client verbalized and demonstrated understanding of info rmation given regarding condition, medications, and treatment regimen within 3 days of nursing interventions. Goal was met. L TG:The client had been able to correctly perform all tasks prior to discharge. Goal was met.

1. Take medications as ordered. 2. Inform the patient to take medications on time or as directed for the full course of therapy even if feeling better. 3. Inform the client about the adverse effects and possible side effects of the medications. 4. Inform the client about the importance of taking prescribed medications and the consequences of not following the treatment regimen. 5. Encourage the patient to report or inform the health team if any of these side effects occur. Inform and explain to the client that other drugs that he is taking will probably have effects with the medication given. Moreover, emphasize the right time interval of these drugs to maximize its effects and avoid further complications. 6. Provide information for better understanding regarding therapeutic regimen.

1. Promote regular light exercise and exercise as tolerated. 2. Encourage exercise in lower and upper extremities to promote good circulation. 3. Inform patient about proper exercise regimen to avoid injury. 4. Alternate rest periods with activity. 5. Encourage walking exercise.

1. Instruct the patient to continue drug therapy as ordered. 2. Inform the patient as well as family the dangers of non compliance to treatment regimen. 3. Discuss to the patient the complications and other problems that might arise from the condition. 4. Inform the patient to exercise and do breathing exercises. 5. Instruct the patient to report to the health team promptly about any changes on health condition. 6. Encourage patient to strictly comply with the doctors orders, especially in taking prescribed medications. 7. Encourage the patient to have followed up visitations to the physician after discharge.

1. Encourage patient to avoid strenuous activities. 2. Improving nutritional intake; meal planning is implemented with High fiber moderate calorie, low fat and low salt as the primary goal. 3. Encourage to balance diet and intake of nutritious food such as vegetables and lean meat, avoiding high fat foods. 4. Check with healthcare provider to evaluate progress of the condition. 5. Encourage to have adequate hydration. Water is the best source of fluid that is needed by the body to maintain its function. 6. Instruct to avoid alcoholic beverages due to a compromised hepatic system. 7. Encourage to have a restful and quiet atmosphere at home. 8. Encourage patient to use relaxation skills when in pain. 9. Encourage patient to seek emotional and social support especially to family and friends to promote strength and comfort. 10. Check the condition with a healthcare provider to evaluate progress of the condition.

1.Remind patient on the arrangements to be made with the physician for follow-up checkups. 2.Follow-up checkup regularly in order to monitor and properly manage patients illness. 3.Inform to continue medication as ordered. 4.Instruct to have a follow-up checkup or refer to the physician if the patient is uncomfortable. 5.Instruct the patient and significant others to report for any irregularities.

1. The diet recommended for the client is High fiber moderate calorie, low fat and low salt 2. Encourage patient to increase nutritious foods intake by eating fresh fruits and vegetables, whole grain products, and lean meat. 3. Recommend eating 5 or more servings of vegetables and fruits each day. 4. Encourage to choose whole grain foods instead of white flour and sugars. 5. Advise to try to limit meats that are high in fat and cut back on processed meats like hot dogs and bacon. 6. Inform patient to avoid food such as salted, cured, smoked, or canned meat. 7. Increase oral fluid intake. Hydration is needed by the body to transport nutrients needed by the body. 8. Instruct to avoid drinking of alcoholic beverages as much as possible. 9. Encourage not to forget to get some type of light exercise because the combination of good diet and regular exercise will help in the maintenance of healthy weight and the feeling of more energetic.

Presented by:
Christine Grace Vanguardia BSN-3a1