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Simply Maroon
Objectives
E
N
O
G C.G.
67y.o.
M.G.
57y.o.
R Y.C.
A
35y.o.
Severe
Anemia
C. Family History
Illness
Y.C. is the only child of her parents. And both sides have no
known serious illness. The most common cause of death
among their family is old age.
Patterns of Functioning
Breathing Patterns
Her usual RR ranges from 20 to 24 breaths per minute and
she has a normal and calm manner of breathing.
Circulation Patterns
Her usual BP is equal to 110/80 mm Hg accompanied by her
AR that ranges from 70 to 75 beats per minute and PR of 65- 70
beats per minute.
A CASE PRESENTATION: SEVERE ANEMIA
Patterns At Home At the Hospital
c. Sleeping Patterns She sleeps at around She sleeps for as early
9 oclock in the as 7:30 in the evening
evening and she is and cant be
satisfied with 2 comfortable if she
pillows, one doesnt have three or
supporting her head more pillows
and the other one is in surrounding her. And
between her thighs. always in a high back
And she is usually in a rest or semi- fowlers
side lying position position with head
facing her kids. tilted in left side.
a. Educational Background
She is a high school graduate.
b. Occupation
None, shes a plain housewife and a full time mother.
c. Religious Practices
She is a solid Roman Catholic who hears mass every
Sunday and on special days like fiesta, Christmas and her
birthday. She also prays rosary when she finds time.
d. Economic Status
They are a member of the middle Class.
2. Height: 5 3
Weight: 65 kg (121 pounds)
A. General Appearance
-appears to be pale, weak and restless; in a semi-
fowlers position.
G. Respiratory System
-normal respiratory sound is heard during
auscultation.
H. Cardiovascular System
-normal heart rhythm; no complain of chest pain.
K. Musculoskeletal System
-positive weakness but to prefer to
walk around and sit; has a limited ROM.
b. Language
-can fluently speak Hiligaynon and a little of Tagalog.
c. Hearing
-she can hear clearly and can comprehend well.
d. Mental Status
-conscious and coherent.
e. Emotional Status
-anxious about her condition, how are they going to pay
her hospital bills and stated that she misses her children
so much.
A CASE PRESENTATION: SEVERE ANEMIA
Textbook
discussion
SEVERE ANEMIA
Impression:
Pulmonary Congestion
Right Basal Pneumonia
Cardiomegaly with Multichamber Enlargement
Prominent Pulmonary Arteries
Impression:
Segmental Ileus
Urinary Bladder:
The urinary bladder is partially filled. There is a foley catheter
balloon within the urinary bladder. There is no intraluminal
lithiasis.
Pelvis:
The antevertid uterus measures 132x80.4mm (LxAP)
The borders are defined
Heterogenous structures is noted within the uterine
cavity measuring 78.4x22.2 to 28mm (LxAP)
The cervix measures 29.9mm
There is fluid in the posterior Culde sac approximately
39.6mL
The adrexae are obscuired by the bowel loops
The anterior abdominal wall appears thickened and
edematous
There is no fluid in the Monsons Pouch
Gallbladder:
The Gallbladder is normal in size measuring approximately
61.0x38.3x28.9mm (LWH) with a volume of 35.4mL
It has smooth walls
The Gallbladder walls has a thickness of approximately 3.6 to
5.3mm
No intraluminalAechoes seenSEVERE ANEMIA
CASE PRESENTATION:
Ultrasoun
d
Impression:
Fatty liver with hepatic congestion
Thick gallbladder walls could be
due to:
Cholecystitis
Hypoalbuminemia
Hepatitis
Mechanism of Action
Chemical effect: Causes potent and selective stimulation of
uterine and mammary gland smooth muscle.
Therapeutic effect: Induces labor and milk ejection and r
educes postpartum bleeding.
Indications:
-To induce or stimulate labor.
-To reduce postpartum bleeding after expulsion of
placenta.
-Uterine hemorrhage
-Incomplete or inevitable abortion.
Adverse Recations:
CNS:
Dizziness, headache, seizures, .hallucinations,
CVA with IV use.
CV:
Hypertension, transient chest pain, palpitations,
hypotension, thrombophlebitis.
A CASE PRESENTATION: SEVERE ANEMIA
EENT:
Tinnitus, nasal congestion.
GI: nausea, vomiting, diarrhea, foul taste.
GU:
Hematuria
Musculoskeletal: leg cramps
Resp:
Dyspnea
Skin:
Diaphoresis
Mechanism of Action
Chemical effect: Provides elemental iron, an essential
component in formation of hemoglobin.
Therapeutic effect: Relieves iron deficiency.
Indications:
Treatment and prevention of iron deficiency and
concomitant folic acid deficiency with associated
deficient intake or increase need for vitamin B-
complex.
Adverse effects:
GI:
Anorexia, black stools, constipation, diarrhea,
epigastric pain, nausea, vomiting.
Nursing Responsibilities:
-Obtain baseline assessment of patients iron
deficiency before starting therapy.
-Evaluate hemoglobin level, hematocrit, and
reticulocyte count during therapy.
A CASE PRESENTATION: SEVERE ANEMIA
Drug: Kalium Durule
Dosage: 1 tab tid p.c. (8am-12nn-6pm)
Pharmacologic class: Potassium supplement
Therapeutic class: Minerals, Vitamins
Mechanism of Action
Chemical effect: Aids in transmitting nerve impulses,
contracting cardiac and skeletal muscle, and
maintaining intracellular tonicity, cellular metabolism,
acid-base balance, and normal renal function.
Therapeutic effect: Replaces and maintains potassium
level.
Indications:
-Hypokalemia.
-As prophylaxis during treatment with diuretics.
Adverse effects:
CNS:
Flaccid paralysis, listlessness, mental confusion,
paresthesia of limbs, weakness or heaviness of legs.
CV:
Arrhythmias, cardiac arrest, ECG changes, heart block.
GI:
Abdominal pain, diarrhea, hemorrhage, nausea,
obstruction, perforation, ulcerations, vomiting.
Nursing Responsibilities:
-Monitor ECG, renal function, fluid intake and output,
and potassium, creatinine, and BUN levels.
Mechanism of Action
Chemical effect: Inhibits cell wall synthesis during
microorganism multiplication.
Therapeutic effect: Kills susceptible bacteria.
Indications:
-Moderate to severe systemic infections.
-To prevent post streptococcal rheumatic fever and
glomeruloneprhitis
-Bacterial endocarditis.
-Mild cases of streptococcal pharyngitis and skin
structure infections.
A CASE PRESENTATION: SEVERE ANEMIA
Contraindications:
-Hypersensitivity to penicillins.
Adverse effects:
CNS:
Neuropathy, seizures
CV: Thrombophlebitis
Musculoskeletal: Arthralgia
Mechanism of Action
Chemical effect: Stimulates normal erythropoiesis and
neucloprotein synthesis.
Therapeutic effect: Nutritional supplement.
Indications:
-To maintain health
megaloblastic or macrocytic anemia caused by folic acid or
other nutritional deficiency, hepatic disease, alcoholism,
intestinal obstruction, excessive hemolysis.
-Nutritional supplement
-To test folic acid deficiency in patients with megaloblastic
anemia without masking pernicious anemia.
A CASE PRESENTATION: SEVERE ANEMIA
Contraindications:
Contraindicated in patients with vitamin B12 deficiency
or undiagnosed anemia
Adverse effects:
CNS:
General malaise
GI:
Anorexia, bitter taste, flatulence, nausea.
Respiratory: Bronchospasm,
Other:
Allergic reactions
Mechanism of Action
Chemical effect: Antagonizes aldosterone in distal tubule
Therapeutic effect: Promotes water and sodium excretion and
hinders potassium excretion, lowers blood pressure, and
helps to diagnose primary hyperaldosteronism.
Indications:
-Essential hypertension, edema, CHF, liver cirrhosis,
nephrotic syndrome, idiopathic edema.
-Management of edema, antihypertensive, diagnosis of
primary hyperaldosteronism, treatment of diuretic- induced
hypokalemia
Adverse effects:
CNS:
Headache, drowsiness, lethargy, confusion, ataxia
GI:
Diarrhea, gastric bleeding, ulceration, cramping,
gastritis, vomiting
GU:
Impotence, menstrual disturbances
A CASE PRESENTATION: SEVERE ANEMIA
Hematologic:
Agranulocytosis
Metabolic:
Hyperkalemia, hypernatremia, mild acidosis,
dehydration
Skin:
Urticaria, hirsutism, maculopapular eruptions,
erythematous rash
Other:
Drug fever, gynecomastasia, breast soreness.
Nursing Responsibilities:
Monitor electrolyte levels, fluid intake and output,
weight, and blood pressure.
A CASE PRESENTATION: SEVERE ANEMIA
Drug: Tarka
Dosage: 1 tab OD
Pharmacologic class: Calcium channel blocker
Therapeutic class: Antianginal, antiarrhythmic,
antihypertensive
Mechanism of Action
Chemical effect: Not clearly defined; inhibits calcium ion
influx across cardiac and smooth muscle cells,
thus decreasing myocardial contractility and oxygen
demand. Drug also dilates coronary arteries and
arterioles.
Therapeutic effect: Relieves angina, lowers blood
pressure, and restores normal sinus rhythm.
Indications:
Essential Hypertension
A CASE PRESENTATION: SEVERE ANEMIA
Contraindications:
Cardiogenic shock, 2 nd and 3rd degree AV block and sick
sinus syndrome except in patients with a functioning
artificial pace maker, atrial fibrillation/ flutter.
History of angioedema associated with administration of
an ACE inhibitor, pregnancy, lactation.
Adverse effects:
CNS:
Asthenia, dizziness, headache
CV:
AV block, bradycardia, heart failure, peripheral edema,
transient hypotension, ventricular fibrillation,
ventricular asystole
Resp:
Pulmonary edema
Skin:
Rash
Nursing Responsibilities:
-Monitor blood pressure at start of therapy and during
dosage adjustments
Mechanism of Action
Chemical effect: May produce analgesic effect by
blocking pain impulses by inhibiting prostaglandin
or pain receptor sene-sitizers. May relieve fever by
acting hypothalamic heat- regulating center.
Therapeutic effect: Relives pain or fever
Indications:
- Fever
Adverse effects:
GI:
Hepatic failure, hepatoxicity (overdose)
GU:
Renal failure (high doses/ chronic use)
Skin:
Rash, urticaria
Mechanism of Action
Chemical effect: Bind to bacterial cell wall membrane,
causing cell death
Therapeutic effect: Bactericidal action
Indications:
- Lower & upper resp tract infections, Genito- Urinary
Tract infections, gonorrhea including acute
uncomplicated gonococcal urethritis & cervicitis.
Adverse effects:
CNS:
Seizures (high doses)
GI:
pseudomembranous colitis, nausea, vomiting, cramps
Skin:
Rashes, urticaria
Mechanism of Action
Chemical effect: Inhibits sodium and chloride
reabsorption at proximal and distal tubules and
ascending loop of henle.
Therapeutic effect: Promotes water and sodium
excretion
Indications:
-Acute Pulmonary Edema
-Heart failure and chronic renal impairment
-Hypertension
-Hypercalcemia
A CASE PRESENTATION: SEVERE ANEMIA
Contraindications:
-Contraindicated in patients hypersensitive to drug or
any of its components and in dose with anuria
-Use cautiously in patients with hepatic cirrhosis
-Patients with allergy to sulfonamide may also be
allergic to furosemide
Adverse effects:
CNS:
Dizziness, fever, headache, paresthesia, restlessness,
vertigo and weakness
CV:
Orthostatic hypotension, thrombophlebitis (with IV use),
volume deplesion, dehydration
GI
Abdominal discomfort, anorexia, constipation, diarrhea,
pancreatitis, vomiting
GU
Azothemia, frequent urination, nocturia, olyguria,
polyuria
Hematologic
Agranulocytosis, anemia, aplastic anemia, leucopenia,
thrombocytopenia
Hepatic
hepatic dysfunction
A CASE PRESENTATION: SEVERE ANEMIA
Metabolic
Asymptomatic hyperurecemia: fluid and electrolyte
imbalances, including dilutional hyponatremia,
hypocalcemia, hypomagnecemia
Nursing Responsibilities:
-Monitor weight, peripheral edema, breath sounds,
blood pressure, fluid intake and output, and
electrolyte, glucose, BUN, and Carbon dioxide level
-Monitor uric acid level, especially if patient has history
of gout
-Be alert for adverse reactions and drug interactions
Mechanism of Action
Chemical effect: Direct acting trichomonacide and
amebicide that works at both intestinal and
extraintestinal sites
Therapeutic effect: Hinders growth of selected
organisms, including most anaerobic bacteria and
protozoa
Indications:
-Amebic hepatic abscess
-Intestinal amebiasis
A CASE PRESENTATION: SEVERE ANEMIA
-Trichomoniasis
-Refractory trichomoniasis
-Bacterial infections caused by anaerobic microoragnisms
-To prevent postoperative infections in contaminated or
potentially contaminated colorectal surgery
-Inflammatory papules and pustules of acne rosacea
-Pelvic inflammatory disease
-Bacterial vaginosis
-Active crohns disease
-Helicobacter pylori with peptic ulcer disease
Contraindications:
-Contraindicated in patients hypersensitive to drug and
other nitroimidazole derivatives
-Use cautiously in patients receiving hepatotoxic drugs
and in patients with history of blood discrasia or CNS
disorder, retinal or visual field changes, hepatic disease,
or alcoholism
A CASE PRESENTATION: SEVERE ANEMIA
Adverse Effects:
CNS
Ataxia, confusion, depression, drowsiness, fatigue,
fever, headache, incoordination, insomnia, irritability,
neuropathy, paresthesia of limbs, psychic stimulation,
restlessness, seizures, sensory neuropathy, vertigo
and weakness
CV
Edema, flattened T-wave, flushing, thrombophlebitis
EENT
Eye tearing
GU
Cystitis, darkened urine, dry vagina and vulva,
dyspareunia, dysuria, incontinence, polyuria, pyuria,
sense of pelvic pressure
Hematologic
-neutropenia, thrombocytopenia, transient
leukopenia
Mechanism of Action
Chemical effect: Increases peristalsis, probably by
acting directly on smooth muscle of intestine. May
irritate musculature, stimulate colonic intramural
plexus, and promote fluid accumulation in colon and
small intestine.
Therapeutic effect: Relieves constipation .
Indications:
-Chronic constipation; preparation for childbirth,
surgery, or rectal or bowel examination
A CASE PRESENTATION: SEVERE ANEMIA
Contraindications:
-Contraindicated in patients hypersensitive to drug or
other penicillins and in dose with a history of amoxicillin-
related cholestatic jaundice or hepatic dysfunction.
-Use cautiously in patients with other drug allergies,
especially to cephalosporin, and those with
mononucleusis or hepatic impairment
Adverse effects:
CNS
Agitation, anxiety, behavioral changes, confusion,
dizziness, insomnia
GI
Abdominal pain, black hairy tongue, diarrhea,
enterocolitis, gastritis, glossitis, indigestion, nausea,
stomatitis and vomiting
A CASE PRESENTATION: SEVERE ANEMIA
GU
Vaginal candidiasis, vaginitis
Hematologic
Agranulocytosis, anemia, eosinphilia, leucopenia,
thrombocytopenia, thrombocytopenic purpura
Nursing Responsibilities:
-Before therapy begins, assess patients infection, ask
about past allergic reactions to penicillins, and
obtain specimen for culture and sensitivity test.
-Be alert for adverse reactions and drug interactions.
-Monitor hydration status if adverse GI reactions
occur.
Adverse effects:
GI
Abdominal cramps, burning sensation in rectum (with
suppositories), diarrhea (with high doses), laxative dependents
(with long-term or excessive use), nausea, protein-losing
enteropathy (with excessive use), vomiting
Metabolic
Alkalosis, fluid and electrolyte imbalance, hypokalemia
Musculoskeletal
Muscle weakness ( with excessive use), tetany
A CASE PRESENTATION: SEVERE ANEMIA
Nursing Responsibilities:
-Obtain history of bowel disorder, GI status, fluid
intake, nutritional status, exercise habits, and
normal patterns of elimination
-Monitor effectiveness by checking frequency and
characteristics of stools
-Be alert for adverse reactions and drug interactions
-Auscultate bowel sounds at least once per shift
-Check for pain and cramping
Mechanism of Action
Chemical effect: Causes potent and selective stimulation of
uterine and mammary gland smooth muscle.
Therapeutic effect: Induces labor and milk ejection and
reduces postpartum bleeding
Indications:
To induce or stimulate labor
To reduce postpartum bleeding after expulsion of placenta
Incomplete or inevitable abortion
Oxytocin challenge test to assess fetal distress in high-risk
pregnancies greater than 31 weeks gestation
Adverse effects:
Maternal
CNS
Coma form water intoxication, seizures, subarachnoid
hemorrhage from hypertension
CV
Arrhythmias; hypertension; increased hear rate,
systemic venous return, and cardiac output
A CASE PRESENTATION: SEVERE ANEMIA
GI
Nausea and vomiting
GU
Abruptio placentae, increased uterine motility, impaired uterine
blood flow, pelvic hematoma, tetanic uterine contractions,
uterine rupture
Hematologic
Afibrinogenemia (may be related to postpartum bleeding)
Fetal
CV
Bradycardia, PVCs, tachycardia
Hematologic
Hyperbilirubilinemia
Respiratory
-anoxia, asphysia
A CASE PRESENTATION: SEVERE ANEMIA
Nursing Responsibilities:
-Assess patients condition before starting therapy and
regularly thereafter
-Monitor and record uterine contractions, heart rate,
BP, intrauterine pressure, fetal heart rate, and blood
loss every 15 minutes.
-Be alert for adverse reactions and drug interactions
-Monitor fluid intake and output. Antidiuretic effect
may lead to fluid overload, seizures, and coma
Mechanism of Action
Chemical effect: Restores bodys buffering capacity and
neutralizes excess acid.
Therapeutic effect: Restores normal acid-base balance and
relieves acid indigestion.
Indications:
-Adjunct to advanced cardiovascular life support during
cardiopulmonary resuscitation
-Severe metabolic acidosis
-Less urgent metabolic acidosis
-Urine alkalization
Antacid
A CASE PRESENTATION: SEVERE ANEMIA
Contraindications:
-Contraindicated in patients with metabolic or
respiratory alkalosis; patients who are losing
chlorides from vomiting or continuous GI suction;
patients taking diuretics known to produce
hypochloremic alkalosis; and patients with
hypocalcemia in which alkalosis may produce tetani,
hypertension, seizures, or heart failure. Oral Sodium
bicarbonate is contraindicated in patients with acute
ingestion of strong mineral acids.
-Use cautiously in patients hypertension, heart failure
or other edematous or sodium-retaining conditions
or renal insufficiency.
Metabolic
Hypernatremia, hyperosmolarity (with overdose),
hypokalemia, metabolic alkalosis
Other:
Irritation and pain at injection site
Mechanism of Action
Chemical effect: Inhibits sodium-potassium-activated
adenosine triphosphatase, thereby promoting
movement of calcium form extracellular to intracellular
cytoplasm and strengthening myocardial contraction
Therapeutic effect: Strengthens myocardial contractions
and slows conduction thru SA and Av nodes.
Indications:
-Heart failure
-Paroxysmal supraventricular tachycardia
-Atrial fibrillation
-Flutter
CV
Arrhythmias, heart failure, hypotension
EENT
Blurred vision, diplopia, light flashes, photo phobia,
yellow-green halos around visual images
GI
Anorexia, diarrhea, nausea and vomiting
Mechanism of Action
Chemical effect: Inhibit vagally mediated reflexes by
antagonizing acetylcholine.
Therapeutic effect: bronchospasms and symptoms of
seasonal allergic rhinitis.
Indications:
To prevent or threat bronchospasm in patients with
reversible obstructive airway disease
Adverse effects
CNS
Tremor, nervousness, dizziness, insomnia, headache,
hyperactivity, weakness, CNS stimulation, malaise.
CV
Tachycardia, palpitation, hypertension.
EENT
Dry and irritated nose and throat with inhaled form,
nasal congestion, epistaxis, hoarseness.
A CASE PRESENTATION: SEVERE ANEMIA
GI
Heartburn, nausea, anorexia, altered taste, increased appetite.
Metabolic- hypokalemia.
Musculuskeletal
Muscle cramps.
Respiratory
Bronchospasm, cough, wheezing, dyspnea, bronchitis,
increase sputum
Nursing Responsibilities:
- Monitor closely for signs and symptoms for toxicity.
- Warn patient about risk of paradoxical
bronchospasm and to stop drug immediately after it
occurs.
- Teach patient to perform oral inhalation correctly.
Home Teaching:
Teach the patient/folks the importance of monitoring
the progress and compliance with the treatment
regimen.
Patient needs ongoing education and reinforcement on
the multiple dietary requirement she needs.
Patient needs health promotion activities and health
screening.
Emphasize to the patient the importance of having
regular check-up to know her present condition.
A CASE PRESENTATION: SEVERE ANEMIA
Out patient Follow-up
After discharged, patient may go to clinic for follow-up
check-up after a week.
As part of this follow-up care, she should receive blood
test to check for the level of her RBC and Hgb.
Diet:
Encourage intake of high biologic value protein foods
such as eggs, dairy products and meats (causes
positive nitrogen balance needed for growth and
healing).
Encourage high calorie and high iron containing foods
like liver, red meat, seafood, poultry, eggs, beans
and peas, dark green leafy vegetables such as
spinach and raisins, nuts, and seeds.
Encourage the patient to adhere to fluid restrictions. Suggest that
she suck on ice chips or hard candies to relieve thirst.
A CASE PRESENTATION: SEVERE ANEMIA
Sexuality and Spirituality
Sexual intercourse is not advisable as it may be may
have a complication on the condition of the patient.
Encourage a closer relationship with God through
praying and attending any religious activity that we
have.
-Group 1