Table of Contents

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

A. Background of the Study

This is a case of a 30 y/o, G1P0 who came in due to left back pain. Present
complaint started 1 day PTA when Px experienced left back pain radiating to the
lumbosacral area and difficulty of breathing usually after coughing. Persistent coughing
and back pain, Px was advised and was admitted in our institution.

B. Rationale for Choosing the Case

The case was studied for the following reasons:
1. to know the anatomy and physiology of the lungs
2. to know the pathophysiology of pulmonary edema
3. to know the appropriate nursing intervention in handling Px with pulmonary
edema
4. to know the appropriate medical management in caring for patient with
pulmonary edema

C. Significance of the Study

This study will be able to help students, specially nursing students to know
everything about pulmonary edema, thus being able to render proper nursing care and
intervention to patients with pulmonary edema. This, if implemented, will make it easier
for patients to restore their health. This study may also help student nurses to be more
effective nurses.

D. Scope and Limitation

This study only engage in the following topics:
1. anatomy and physiology of the lungs
2. pulmonary edema
CLINICAL SUMMARY

A. General Data
Name: Rosario S. Banaag
Address: B11 116 PH2 Kawal, Dagat-dagatan, Caloocan City
Date of Birth: 12/18/1976
Age: 29 y/o
Sex: Female
Civil Status: Single
Nationality: Filipino

B. Chief Complaint
Difficulty of breathing

C. Nursing History
a. History of Present Illness
Admitting a case of a 30 y/o, G1P0 who came in due to left back pain.
Present complaint started 1 day PTA when Px experienced left back pain radiating to the
lumbosacral area and difficulty of breathing usually after coughing. Nebulization with
Salbutamol was done affording temporary relief. Persistence prompted consult at
Puericulture where she was advised to consult at a tertiary hospital. 16 hours PTA,
persistence of left back pain associated with DOB prompted consult at Jose Reyes
Memorial Medical Foundation where CBC, UA, UTS and x-ray was requested. She was
advised admission however went on HAMA. Persistence forced consult at our institution
and was subsequently admitted.
b. Past Medical History
(+) suicide attempt – 1990, drug intoxication with anti-TB, confined at
JRMMC
(+) allergy to food – chicken
(-) allergies to drugs
(+) HPN, Dx: Oct. 2006, on Aldomet 250 mg TID, HBP: 160/100
 HBP: 160/100 UBP: 120/90
(+) asthma, Dx 1 week ago at Puericulture, on Ventolin 2 mg tablet q 60
no DM, no PTB
c. Familial History
(+) HPN, both parents (+) asthma - father
(+) DM – mother (+) heart problem – mother
(-) cancer
d. Social History
♣ HS graduate
♣ presently unemployed
♣ living – in for 1 year to 30 y/o computer engineer, Palestinian, whom
she met 2 years ago at Dubai
♣ non-smoker, non-alcoholic beverage drinker
♣ menarche – 14 y/o with regular monthly interval lasting 3-4 days
consuming 2-3 pads/day

D. Physical Assessment
Date of Assessment: 11-22-06
Vital Signs: Temp.: 36.60C RR: 28 bpm
PR: 120 beats/min BP: 150/100
General Survey: Px is conscious, coherent, tachycardia, tachypnea
Parts to be Assessed Technique Used Deviation from Normal
skin palpation, inspection None
head inspection, palpation None
eyes inspection None
ears/nose inspection None
mouth/throat inspection None
neck inspection None
chest/lungs auscultation (+) crackles, R midlung
field
heart auscultation tachycardia
abdomen inspection None
extremities inspection (+) edema on both LE
E. Patterns of Functioning
♣ Activity/Rest
Ability to engage to necessary activities of life, but is having difficulty
having adequate sleep.
♣ Circulation
Inability to transport oxygen necessary to meet cellular needs.
♣ Elimination
Ability to excrete waste products.
♣ Food / Fluid
Ability to maintain intake and utilize nutrients and liquids to meet
physiologic needs.
♣ Hygiene
Ability to perform daily hygienic activities.
♣ Neurosensory
Impaired perception, integration, and respond to internal and external
cues.
♣ Pain / Discomfort
Inability to control internal / external environment to maintain comfort.
♣ Respiration
Inability to provide and use oxygen to meet physiologic needs.
♣ Safety
Ability to provide a safe growth-promoting environment.
♣ Sexuality
Ability to meet requirements and characteristics of female role.
♣ Social Interaction
Ability to establish and maintain relationship among others.

F. Laboratory and Diagnostic Examination

Date: 11-21-06
Components Results Normal Values Interpretation
Neutrophils 69.0% 55%
Lypnhocytes 24.7% 34%
Monocytes 4.8% 1.0%
Eosinophils 1.5% 3.0%
Platelet 522 x 109 L 150-450 x 109 L

Components Results Normal Values

pO2 85 mmHg 80-100 mmHg mild hypoxemia
pCO2 21.00 mmHg 35-45 mmHg respiratory alkalosis
HCO3 12.70 mmol/L 22-26 mmol/L metabolic acidosis
results: mild hypoxemia with respiratory alkalosis and metabolic acidosis

Date: 11-22-06
Components Results Normal Values Interpretation
total protein 58.0 g/L 60-70 g/L
globumin 22.5 g/L 23-35 g/L
PTT 35.0 secs 60-70 secs
PT 81.4% 100%

Date: 11-24-06
Components Results Normal Values Interpretation
hemoglobin 1.519 mmol/L 1.86-2.58 mmol/L
erythrocytes 0.33 mmol/L 0.38-0.47 mmol/L

Date: 11-23-06
Radiological Report
There is a prominence of the pulmonary vascularity.
Heart appear markedly enlarged.
There is haziness in both mod & lower lungfields.
Interstitial infiltrates are likewise noted bilaterally.
Both hemidiaphragms & sulci are obscured.
G. Impression
Cardiomegaly with pulmonary edema
 CLINICAL DISCUSSION OF DISEASE

A. Anatomy and Physiology

The lungs are paired cone-shaped organs in the thoracic cavity. They are
separated from each other by the heart and other structures in the mediastinum which
separates the thoracic cavity into two anatomically distinct chambers. As a result, should
trauma cause one lung to collapse, the other may remain expanded. Our lungs are located
within our chest cavity inside the rib cage. They are made of spongy, elastic tissue that
stretches and constricts as you breathe. The airways that bring air into the lungs (the
trachea and bronchi) are made of smooth muscle and cartilage, allowing the airways to
constrict and expand. The lungs and airways bring in fresh, oxygen-enriched air and get
rid of waste carbon dioxide made by your cells. They also help in regulating the
concentration of hydrogen ion (pH) in our blood.
Two layers of serous membrane, collectively called the pleural
membrane, enclose and protect each lung. The superficial layer lines the wall of the
thoracic cavity and is called the parietal pleura; the deep layer, the visceral pleura,
covers the lungs themselves. Between the visceral and parietal pleurae is a small space,
the pleural cavity, which contains a small amount of lubricating fluid secreted by the
membranes. This fluid reduces friction between the membranes, allowing them to slide
easily over one another during breathing. Pleural fluid also causes the two membranes to
adhere to one another, a phenomenon called surface tension. Separate pleural cavities
surround the left and right lungs. Inflammation of the pleural membrane, called pleurisy
or pleuritis, may in its early stages cause pain due to friction between the parietal and
visceral layers of the pleura. If the inflammation persists, excess fluid accumulates in the
pleural space known as pleural effusion.
The lungs extend from the diaphragm to just slightly superior to the
clavicles and lie against the ribs anteriorly and posteriorly. The broad inferior portion of
the lung, the base, is concave and fits over the convex area of the diaphragm. The narrow
superior portion of the lung is the apex. The surface of the lung lying against the ribs, the
costal surface, matches the rounded curvature of the ribs. The mediastinal (medial)
surface of each lung contains a region, the hilus, through which bronchi, pulmonary
blood vessels, lymphatic vessels, nerves enter and exit. These structures are held together
by the pleura and connective tissue and constitute the root of the lung. Medially, the left
lung also contains a concavity, the cardiac notch, in which the heart lies. Due to the
space occupied by the heart, the left lung is about 10% smaller than the right lung.
Although the right lung is thicker and broader, it is also somewhat shorter than the left
lung because the diaphragm is higher on the right side, accommodating the liver that lies
inferior to it.
The lungs almost fill the thorax. The apex of the lungs lies superior to the
medial third of the clavicle and is the only area that can be palpated. The anterior, lateral,
and posterior surfaces of the lungs lie against the ribs. The base of the lungs extends from
the sixth costal cartilage arteriorly to the spinous process of the tenth thoracic vertebra
posteriorly. The pleura extends about 5 cm below the base from the sixth costal cartilage
anteriorly to the twelfth rib posteriorly. Thus, the lungs do not completely fill the pleural
cavity in this area. Removal of excessive fluid in the pleural cavity can be accomplished
without injuring lung tissue by inserting the needle posteriorly through the seventh
intercostal space, a procedure termed thoracentesis.

Lobes, Fissures, and Lobules

One or two fissure divide each lung into lobes. Both lungs have an
oblique fissure, which extends inferiorly or anteriorly; the right lung also has a
horizontal fissure. The oblique fissure in the left lung separates the superior lobe from
the inferior lobe. In the right lung, the superior part of the oblique fissure separates the
superior lobe from the inferior lobe, whereas the inferior part of the oblique fissure
separates the inferior lobe from the middle lobe. The horizontal fissure of the right lung
subdivides the superior lobe, thus forming a middle lobe.
Each lobe receives its own secondary bronchus. Thus, the right primary
bronchus gives rise to three secondary bronchi called the superior, middle, and inferior
(lobar) secondary bronchi, whereas the left primary bronchus gives rise to superior and
inferior (lobar) secondary bronchi. Within the substance of the lung, the secondary
bronchi give rise to the tertiary (segmental) bronchi, which are constant in both origin
and distribution – there are ten tertiary bronchi in each lung. The segment of the lung
tissue that each tertiary that each tertiary bronchus supplies is called a
bronchopulmonary segment. Bronchial and pulmonary disorders that are localized in a
bronchopulmonary segment may be surgically removed without seriously disrupting the
surrounding lung tissue.
Each bronchopulmonary segment of the lungs has many small
compartments called lobules, each of which is wrapped in elastic connective tissue and
contains a lymphatic vessel, an arteriole, a venule, and a branch froma terminal
bronchiole. Terminal bronchioles subdivide into microscopic branches called respiratory
broncdhioles. As the respiratory bronchioles penetrate more deeply into lungs, the
epithelial lining changes from simple cuboidal to simple squamous. Respiratory
bronchioles, in turn, subdivide into several alveolar ducts. The respiratory passages from
the trachea to the alveolar ducts contain about 25 orders of branching; that is, branching –
from the trachea into primary bronchi (first order braching) into secondary bronchi
(second order branching) and so on down to the alveolar ducts – occurs about 25 times.

Alveoli
Around the circumference of the alveolar ducts are numerous alveoli and
alveolar sacs. An alveolus is a cup-shaped outpouching lined by simple squamous
epithelium and supported by a thin elastic basement membrane; an alveolar sac consists
of two or more alveoli that share a common opening. The walls of the alveoli consist of
two types of alveolar epithelial cells. Type I alveolar cells, the predominant cells, are
simple squamous epithelial cells that form a nearly continuous lining of the alveolar wall.
Type II alveolar cells, also called septal cells, are fewer in number and are found
between type I alveolar cells. The thin type I alveolar cells are the main sites of gas
exchange. Type II alveolar cells, which are rounded or cuboidal epithelial cells whose
free surface between the cells and the air moist. Included in the alveolar fluid is
surfactant, a complex mixture of phospholipids and lipoproteins. Surfactant lowers the
surface tension of alveolar fluid, which reduces the tendency of alveoli to collapse.
Associated with the alveolar walls are alveolar macrophages (dust cells), wandering
phagocytes that remove fine dust particles and other debris in the alveolar spaces. Also
present are fibroblasts that produce reticular and elastic fibers. Underlying the type I
alveolar cells is an elastic basement membrane. On the outer surface of the alveoli, the
lobule’s arteriole and venule disperse into a network of blood capillaries that consist of a
single layer of endothelial cells and basement membrane.
The exchange of O2 and CO2 between the air spaces in the lungs and the
blood takes place by diffusion across the alveolar and capillary walls, which together
form the respiratory membrane. Extending from the alveolar air space to blood plasma,
the respiratory membrane consists of four layers:
1. a layer of type I and type II alveolar cells and associated alveolar macrophages
that constitutes the alveolar wall
2. an epithelial basement membrane underlying the alveolar wall
 3. a capillary basement membrane that is often fused to the epithelial basement
membrane
4. the endothelial cells of the capillary
Despite having several layers, the respiratory membrane is very thin –
only 0.5 µm thick, about one-sixteenth the diameter of a red blood cell. This thinnes
allows rapid diffusion of gases. Moreover, it has been estimated that the lungs contain
300 million alveoli, providing an immense surface area of 70 m2 – about the size of a
handball court – for the exchange of gases.

Blood Supply to the Lungs

The lungs receive blood via sets of arteries; pulmonary arteries and
bronchial arteries. Deoxygenated blood passes through the pulmonary trunk, which
divides into a left pulmonary artery that enters the left lung and a right pulmonary arter
that enters the right lung. Return of the oxygenated blood to the heart occurs by way of
the four pulmonary veins, which drain into the left atrium. A unique feature of pulmonary
blood vessels is their constriction in response to localized hypoxia (low O2 level). In all
other body tissues, hypoxia causes dilation of blood vessels, which serves to increase
blood flow to a tissue that is not receiving adequate O2. In the lungs, however,
vasoconstriction in response to hypoxia diverts pulmonary blood from poorly ventilated
areas to well-ventilated regions of the lungs. This phenomenon is known as ventilation-
perfusion coupling because the perfusion (blood flow) to each area of the lungs matches
the extent of ventilation (airflow) to alveoli in that area.
Bronchial arteries, which branch from the aorta, deliver oxygenated blood
to the lungs. This blood mainly perfuses the walls of the bronchi and bronchioles.
Connection exist between branches of the bronchial arteries and branches of the
pulmonary arteries, however, and most blood returns to the heart via pulmonary veins.
Some blood, however, drains into bronchial veins, branches of the azygos system, and
returns to the heart via the superior vena cava.

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

B. Pathophysiology of Pulmonary Edema

Pulmonary edema is excess water in the lung. The normal lung contains
very little water. It is kept dry by lymphatic drainage & a balance among capillary
hydrostatic pressure, capillary oncotic pressure, & capillary permeability. In addition,
surfactant lining the alveoli repels water, helping fluid from entering the alveoli.
 Modifiable Non-modifiable
lifestyle – crowded environment genetics – (+) HPN
- overdoing of activities - (+) asthma
history – intoxication of anti-TB - (+) heart problem

respiratory and cardiac distress

disrupted lung architecture

 increased permeability

increased force of LV contraction

increased LV O2 demand

LV hypoxia

decreased forc of LV contraction

increased LV preload

pulmonary edema

flooded alveoli increased pulmonary vascular

resistance
compliance (stiff lungs)
RV failure
hypoxemia
increased RV preload

if treated if not treated

oxygenation, suctioning, fibrosis

medical treatment
development of complications
healing
 involvement of all system
recovery
compromiseimmune system

shock

death
 C. Drug Study

Classification Action Available Indication Contraindication Adverse Nursing

Form Effects Consideration
drugs for fluid potassium- tablets – 25 mg > edema >hypersensitivity > give drug with
and electrolyte sparing diuretic; - 50 mg > hypertension to the drug meal to enhance
balance antagonizes - 100 mg > diuretic-induced > Px with anuria, absorption
aldosterone in hyperaldosteronism acute or > protect drug
the distal >heart failure as progressive renal from light
tubules, adjunt to ACE insufficiency, > monitor
increasing Na inhibitors or loop hyperkalemia electrolyte level,
and H2O diuretics I & O, & BP
excretion > inform the
laboratory that
the Px is taking
the drug because
it may interfere
with tests that
measure digoxin
level
> maximum
antihypertensive
respone may be
delayed for up to
2 weeks
> watch for
hyperchloremic
metabolic
acidosis
> instruct Px to
take drug in
morning to
prevent need to
urinate at night
> warn Px to
avoid excessive
ingestion of
potassium-rich
foods to avoid
hyperkalemia
> caution Px to
avoid
 performing
hazardous
activities if
adverse CNS
rxns occur

DIAZEPAM
Antenex, Apo-Diazepam, Diastat, Diazemuls, Diazepam Intensol, Ducene, Novo-Dipam, DMS-Diazepam, Valium, Vinol
 Classification Action Available Form Indication Contraindication Adverse Effects Nursing
Considerations
anxiolytics unknown capsule – 15 mg > anxiety > Px > CNS – > use diastat
CNS drugs injection – 5 > pre-op hypersensitive to drowsiness, rectal gel to treat
mg/ml ssedation drug or soy dysarthria, no more than 5
oral sol. – > cardioversion protein slurred speech, episodes per
5mg/5ml > Px experiencing tremor, transient month & no
- 5mg/ml shock, coma, or amnesia, fatigue, more than one
rectal gel – acute alcohol ataxia, headache, episode every 5
2.5 mg intoxication insomnia, days
- 5 mg > in pregnant paradoxical > dilute oral
- 10 mg women, specially anxiety, concentrate sol.
- 15 mg first trimester hallucinations, just before
- 20 mg > children minor changes in giving
tablets – 2 mg younger than age EEG patterns > monitor
- 5 mg 6 mos. > CV – periodic hepatic,
- 10 mg hypotension, CV renal, &
collapse, hematopoeitic
bradycardia fxn studies in Px
EENT – diplopia, receiving
blurred vision, repeated or
nystagmus prolonged
GI – nausea, therapy
constipation, > warn Px to
diarrhea with avoid activities
rectal form that require
GU – alertness & good
incontinence, coordination
urine retention > tell Px to avoid
HEPATIC – alcohol while
jaundice taking drug
RESP. – > notify Px that
respiratory smoking may
depression, apnea decrease drug’s
SKIN – rash effectiveness
OTHER – altered > warn Px not to
llibido, physical abruptly stop
or psychological drug because
dependence, pain, withdrawal
phlebitis at symptoms may
injection site occur
> warn woman
 to avoid use
during
pregnancy

AMIKACIN SULFATE
Amikin
Classification Action Available Form Indication Contraindication Adverse Effect Nursing
Considerations
aminoglycoside inhibits protein injection – > serious > Px > CNS – > obtain
synthesis by 50 mg/ml infections caused hypersensitive to neuromuscular specimen for
binding directly - 250 mg/ml by sensitive drug blockade C&S before
to the 30S - 5 mg/ml in strains of > EENT – giving first dose
ribosomal NSS Pseudomonas ototoxicity > evaluate Px’s
subunit; aeuroginosa, E. > GU – hearing before &
bactericidal coli, Proteus, azotemia, during therapy if
Klebsiella, or nephrotoxicity, he will be
Staphylococcus possible increase receiving drug
> uncomplicated in urinary longer than 2
UTI caused by excretion of weeks
organism not casts > weight Px &
susceptible to >MUSCULO review renal fxn
less toxic drugs - SKELETAL studies before
>mycobacterium - arthralgia first dose
avium complex > RESP. – apnea > correct
dehydration
before therapy
> monitor renal
fxn
> watch for s/s
 of superinfection
> if no response
occurs after 3-5
days, stop
therapy & obtain
new specimens
for C&S
> instruct Px to
promptly report
adverse rxn
> encourage Px
to maintain
adequate fluid
intake

CAPTOPRIL
Acenorm, Capoten, Enzace, Novo-Captopril
Classification Action Available Indication Contraindication Adverse Effects Nursing
Form Considerations
antihypertensive inhibits ACE, tablets – > hypertension > Px > CNS – dizziness, > monitor Px’s
cardiovascular preventing 12.5mg > left hypersensitive to fainting, headache, BP & PR
system drug conversion of - 25 mg ventricular the drug malaise, fatigue, frequently
angiotensin I to - 50 mg dysfunction fever > assess Px for
angiotensin II, a - 100 mg > CV – signs of
potent tachycardia, angioedema
vasoconstrictor; hypotension, > monitor WBC
less angiotensin angina pectoris & differential
II decrease > GI – abdominal counts in Px with
peripheral pain, anorexia, impaired renal
arterial constipation, fxn or collagen
resistance, diarrhea, dry vascular dse
decrease mouth, dysgeusia, before starting
aldosterone nausea, vomiting Tx, q 2 weeks for
secretion, which >HEMATOLOGIC the first 3 mos of
reduces Na & – leucopenia, therapy, &
H2O agranulocytosis, periodically
pancytopenia, thereafter
anemia, > instruct Px to
thrombocytopenia take drug 1 hour
>METABOLIC – ac taking
hyperkalemia > inform Px that
> RESP. – light-headedness
dyspnea; dry, is possible
persistent, > tell Px to use
nonreproductive caution in hot
cough H2O & during
> SKIN – rash, exercise
maculopapular > advise Px to
rash, pruritus, notify prescriber
alopecia if pregnancy
> OTHER – occurs
angioedema > urge Px to
promptly report
swelling of the
face, lips, or
mouth, or
difficulty
breathing
CEPHALEXIN
(hydrochloride) Keftab
(monohydrate) Apu-Cephalex, Biocef, Keflex, Novo-Lexin, Nu-Cephalex
Classification Action Available Form Indication Contraindication Adverse Effects Nursing
Considerations
cephalosporins first generation (hydrochloride) > respiratory > in Px > CNS – dizziness, > ask Px about
anti-infective cephalosporin tablets – 500mg tract, GIT, skin, hypersensitive to headache, fatigue, post rxns to
that inhibits (monohydrate) soft tissue, the drug agitation, cephalosporins
cell-wall capsules-250mg bone, & joint confusion, or penicillin
synthesis, - 500 mg infections & hallucinations therapy before
promoting oral susp. – otitis media > GI – giving first dose
osmotic 125mg/5ml caused by E. pseudomembrane- > ontain
instability; - 250 mg/5ml coli ous colitis, nausea, specimen for
usually tablets – 250mg anorexia, vomiting, C&S before
bactericidal - 500mg diarrhea, gastritis, giving first dose
-1g glossitis, > monitor Px for
dyspepsia, superinfection if
abdominal pain, therapy is
anal pruritus, prolonged
tenesmus, oral > treat group A
candidiasis beta-hemolytic
> GU – genital streptococcus
pruritus, infections for a
candidiasis, minimum of 10
vaginitis, days
interstitial nephritis > tell Px to take
>HEMATOLOGIC drug exactly as
- netropenia, prescribed even
eosinophilia, after feeling
anemia, better
thrombocytopenia > instruct Px to
>MUSCULO – take drug with
SKELETAL – foodor milk
arthritis, asthralgia, > tell Px to notify
joint pain prescriber if rash
> SKIN – or s/s of
maculopapular & superinfection
erythematus rashes, develop
irticaria
> OTHER –
hypersensitivity
rxns, serum
sickness,
anaphylaxis
FERROUS FUMARATE
Femiron, feostat, hemocyte, ircon, nephrofer, novofumas, palafer, palafer pediatric drops, vitron – C
Classification Action Available Form Indication Contraindication Adverse Effects Nursing
Considerations
hematinics provides drops – 45mg / > iron deficiency > Px with primary > GI – nausea, > between meal
elemental iron, 0.6 ml > as a hemochromatosis epigastric pains doses are
an essential oral susp. – supplement or hemosiderus, vomiting, preferable
component in 100 mg/5 ml during hemolytic constipation, > check for
the formation of tablets – 63mg pregnancy anemia, peptic diarrhea, black constipation
hemoglobin - 200 mg ulcer dse, stools, anorexia, > tell Px to take
- 324 mg regional enteritis, > OTHER – tablets with juice
- 325 mg or ulcerative temporarily or water but not
- 350 mg colitis stained teeth with milk or
tablets – 100mg > Px receiving from suspension antacids
repeated blood & drops > tell Px to take
transfusion suspension with
straw & place
drops at back of
throat
> caution Px not
to crush talets
> advice Px not
to substitute 1
iron salt for
another
MEFENAMIC ACID
Ponstan, Ponstel
Classification Action Available Indication Contraindication Adverse Effects Nursing
Form Considerations
Nonsteroidal inhibits capsule -250mg > short term > ulceration > CNS – > tell Px to take
anti- prostaglandin’s - 500 mg relief of mild to > chronic headache, drug with milk
inflammatory synthesis; moderate pain inflammation of dizziness, or food to
analgesic possesses anti- the GIT somnolence, decrease Gi
inflammatory, > pregnancy insomnia, fatigue, upset
antipyretic, & > children under tinnitus, > arrange for
analgesic effects 14 y/o ophthalmologic periodic
> hypersensitivity effects opthalmogic
to the drug > GI – nausea, examination for
dyspepsia, GI long term
pain, diarrhea, therapy
vomiting, > tell Px to take
constipation, only the
flatulence prescribed
> RESP. – dosage
dyspnea, > inform Px that
hemoptysis, drowsiness or
pharyngitis, dizziness can
brocnhospasm, occur
rhinitis > instruct Px to
> d/c drug &
HEMATOLOGIC consult
- bleeding, prescriber if
platelet inhibition adverse rxn
with higher doses, occur
neutropenia,
eosinophilia,
leukopenia,
pancytopenia,
thrombocytopenia,
agranulocytis,
granulocytopenia,
aplastic anemia,
decreased Hcb or
Hct, bone marrow
depression,
menorrhagia
> GU – dysuria,
renal impairment
> SKIN –rash,
pruritus, sweating,
dry mucous
membrane,
stomatitis
> OTHER –
peripheral edema,
enaphylactoid
rxns to fatal
 anaphylactic
shock

DIGOXIN
Digitex, Digoxin, Lanoxicaps, Lanoxin
Classification Action Available Form Indication Contraindication Adverse Effects Nursing
Considerations
Inotropics Inhibits sodium capsule – > heart failure > Px with > CNS – fatigue, > before giving
Cardiovascular – potassium – 0.05 mg > tachycardia hypersensitivity generalized loading dose,
system drugs activated - 0.1 mg to the drug muscle obtain baseline
adenosine - 0.2 mg > Px with digitalis weakness, data and ask Px
triphosphate, elixir – induced toxicity, agitation, about use of
promoting 0.05 mg/ml ventricular hallucinations, cardiac
movement of injection – fibrillation, or headache, glycosides
calcium from 0.05mg/ml ventricular malaise, within the
extracellular to - 0.1 mg/ml tachycardia dizziness, previous 2-3
intracellular - 0.25 mg/ml unless caused by vertigo, stupor, weeks
cytoplasm and tablets – heart failure paresthesia > loading dose is
strengthening 0.125 mg > CV – usually divided
myocardial - 0.25mg arrythmias over the first 24
contraction > EENT – hours with
yellow-green approximately
halos around half the loading
visual images, dose given in the
bulrred vision, first dose
light flashes, > before giving
photophobia, drug, take
diplopia apical-radial
> GI – anorexia, pulse for a
nausea, minute
vomiting, > monitor
diarrhea potassium level
carefully
METOPROLOL TARTRATE
Apo-Metoprolol, Apo-Metoprolol Type L, Betaloc, Betaloc Durules, Lopresor SR, Lopresor, Minax, Novo-Metoprolol, Nu-Metop
Classification Action Available Form Indication Contraindication Adverse Effects Nursing
Considerations
antihypertensive decreases injection – > hypertension > Px > CNS – fatigue, > always check
cardiovascular cardiac output, 1 mg/ml in 5- hypersensitive to dizziness, Px’s apical pulse
system drug peripheral ml ampules the drug depression > monitor
resistance, and tablets – 50mg > Px with sinus > CV – glucose level
cardiac oxygen - 100 mg bradycardia, bradycardia, closely
consumption - 200 mg greater than 1st hypotension, > Monitor BP
degree heart heart failure, AV frequently
block, block > store drug at
cardiogenic > GI – nausea, room
shock, or overt vomiting temperature
cardiac failure > RESP. – > tell Px to take it
dyspnea with meals
> SKIN – rash > caution Px to
avoid driving if
taking the drug
> tell Px to alert
prescriber if
shortness of
breatn occurs
NALBUPHINE HYDROCHLORIDE
Nubain
Classification Action Available Form Indication Contraindication Adverse Effects Nursing
Considerations
opiod analgesics binds with injection- > moderate to > Px > CNS – > reassess Px
central nervous opiate receptors 10 mg/ml severe pain hypersensitive to headache, level of pain at
system drug in the CNS, - 20 mg/ml the drug sedation, least 15 & 30
altering dizziness, mins. after
perception of vertigo, parenteral
and emotional nervousness, administration
response to pain depression, > monitor
restlessness, circulatory &
crying,l respiratory status
euphoria, > caution Px
hostility, about getting out
confusion, of bed or
unusual dreams, walking
hallucinations,
speech
disturbance,
delusions
> CV –
hypertension,
hypotension,
tachycardia,
bradycardia
> EENT –
blurred vision,
dry mouth
> GI – cramps,
dyspepsia, bitter
taste, nausea,
vomiting,
constipation
> GU – urinary
urgency
> RESP. –
respiratory
depression,
dyspnea, asthma,
pulmonary
edema
> SKIN –
pruritus,
burning,
urticaria,
clamminess,
diaphoresis
 Problem Nursing Scientific Objective Nursing Rationale Evaluation
Diagnosis Rationale Intervention
difficulty of Ineffective disrupted lung At the end of the INDEPENDENT At the end of the
breathing breathing pattern architecture nursing shift, the > place Px in a > this position nursing shift, the
Subjective Cues: r/t lung Px will be able to semi to high allow increased Px was able to
“medyo compliance as a compliance experience fowler position if diaphragmatic experience
nahihirapan nga result of adequate not excursion & adequate
akong huminga, accumulation of hypoxemia respiratory fxn. contraindicated maximum lung respiratory fxn.
lalo na pag fluid in the expansion, as evidencedof
nauubo ako”, as pulmonary difficulty which promotes the ff.:
verbalized by the interstitium breathing optimal alveolar > normal rate,
client ventilation rhythm & depth
> instruct & > frequent of respiration
Objective Cues: assist Px to repositioning > improved
> (+) crackles change position, helps loosen breath sounds
>rapid, shallow, deep breathe, & secretions & > (-) crackles
irregular cough or “huff” promotes a more > blood gases
respiration every 1-2 hours effective cough. within normal
> use of It also promotes ranges
accessory maximum lung > Px verbalizes
muscles when expansion & relief from
coughing stimulates difficulty of
> abnormal surfactant breathing
blood gases production.
> abnormal chest Coughing or
x-ray result huffing
mobilizes
secretions &
facilitates
removal of these
secretions from
the respiratory
tract
> implement > a Px with pain
measures to often guards
reduce pain – respiratory
splint incision efforts – pain
with pillow reduction
during coughing enables the client
& deep breathing to breathe more
deeply which
enhances
alveolar
veltilation &
O2/CO2
DEPENDENT exchange
> implement > excessive
measures to secretions and
facilitate inability to clear
removal of secretions from
pulmonary the respiratory
secretions – tract lead to
suction – as stasis of
orderes secretions
> maintain O2 > supplemental
therapy as O2 increases the
ordered concentration of
 oxygen in the
alveoli, which
increases the
diffusion of O2
across the
alveolar –
capillary
membrane
> administer > medication
meds that may therapy is an
be ordered to integral part of
improve Px’s treating many
respiratory status respiratory
condition
 Problem Nursing Scientific Objective Nursing Rationale Evaluation
Diagnosis Rationale Interventions
fear Fear r/t pre-eclampsia At the end of the INDEPENDENT At the end of the
Subjective Cues: persistent nursing shift, the > encourage > verbalization nursing shift, the
“natatakot nga headache altered BP Px will be able to verbalization of of feelings & Px will be able to
ako eh. kasi sabi experience a feelings & concerns helps experience a
ng doctor may dizziness reduction of fear concerns client identify reduction of fear
high blood daw factors that are as evidenced by
ako. eh lagi pa disturbed sleep causing anxiety the ff:
kong nahihilo. pattern > assure Px that > close contact > verbalization
kaya staff members & a prompt of decreased fear
pakiramdam ko feeling of are nearby; response to & understanding
tuloy parang ang anxiety respond to call requests provide of the medical
sama-sma ng signal as soon as a sense of procedures
pakiramdam ko. fear possible security &
Hindi pa ko facilitates the
makatulog ng development of
maayos trust, thus
kakaisip”, as reducing the
verbalized by the client’s anxiety
client > reinforce > factual
Objective Cues: physician’s information & an
> disturbed sleep explanations & awareness of
pattern clarify what to expect
> weak misconceptions help decrease the
appearance the Px has about anxiety that
the diagnostic arises from
tests, disease uncertainty
condition,
treatment plan &
prognosis
> implement > improvement
measures to of respiratory
reduce distress status helps
relieve anxiety
 associated with
the feeling of not
being able to
breathe
DEPENDENT
> administer > helps reduce
prescribed the Px”s anxiety
antianxiety
agents if
indicated
 Problem Nursing Scientific Objective Nursing Rationale Evaluation
Diagnosis Rationale Interventions
potential potential Hx of At the end of the INDEPENDENT At the end of the
complications of complications of hypertension, whole nursing > implement > in order to whole nursing
heart failure heart failure r/t heart dse. shift, the Px will measures to reduce shift, the Px was
Subjective Cues: acute pulmonary be able to have improve cardiac pulmonary able to have mild
“Hindi kaya edema d/t pulmonary mild to moderate output vascular to moderate
matuloy to sa accumulation of edema prognosis from congetion prognosis from
puso, kasi meron fluid in the lungs pulmonary > place Px in a > to improve pulmonary
kaming sakit sa further lung & edema to prevent high fowler lung expansion edema as
puso”, as heart distress complications position evidenced by the
verbalized by the DEPENDENT ff.”
Px complications of > maintain O2 > to improve O2 >(-) crackles
Objective Cues: heart failure therapy intake > normal result
> Hx of heart dse > administer > to reduce fluid of x-ray
> hypertension’ meds - diuretics accumulation in - blood gas result
> development the lungs within normal
of crackles range
> chest x-ray
showing
pulmonary
edema
> worsening
blood gases