COLLEGE OF NURSING

CVD INFARCT, CAP-MR, HUD, RDU, DEMENTIA

October 15, 2021

Friday

Level 4 Section C

Abellana, Mary Catherine T.

Amerol, Juhannah T.

Arcipe, Nathaniel Dean G

Obinwa, Chinaz B.

Oralde, Richie Dianne M.

Pales, Andonee Joy Ygana

Paral, Shienna Ann A.

Pasasadaba, Jessah Lyka B.

Repollo, Quenie Vance D.

Repunte, Maria Maeca Ella

A. Roculas, Pristine Faith P.

Samson, Ana Lorraine G.

Solon, Shein Ann A.

Tagalog, Susiarah R.

Tagimacruz, Nicole Claire D. Tecson, China A.

Trinidad, Trisha Fay Q.

Ultra, Silvan Roy P.

Valencia, Mary Kathlene B.

Vivares, Sophia Magdaleen F.

ADRIEL ARMAN PIZARRA

Clinical Instructor

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 TABLE OF CONTENTS
INTRODUCTION 4
GOALS 6
OBJECTIVE 6
RESEARCH QUESTION: CASE STUDY 7
SIGNIFICANCE OF THE STUDY 7
CVD INFARCT 8
ASSESSMENT OF SIGNS AND SYMPTOMS 9
PREDISPOSING AND PRECIPITATING FACTORS 9
CAP – MR 11
ASSESSMENT OF SIGNS AND SYMPTOMS 12
PREDISPOSING AND PRECIPITATING FACTORS 12
HUD 14
ASSESSMENT OF SIGNS AND SYMPTOMS 15
PREDISPOSING AND PRECIPITATING FACTORS 15
RDU 16
ASSESSMENT OF SIGNS AND SYMPTOMS 16
PREDISPOSING AND PRECIPITATING FACTORS 18
DIMENTIA 19
ASSESSMENT OF SIGNS AND SYMPTOMS 20
PREDISPOSING AND PRECIPITATING FACTORS 20
DEFINITION OF TERMS 21
ANATOMY AND PHYSIOLOGY 22
PATHOPHYSIOLOGY 35
CEPHALO-CAUDAL ASSESSMENT 38
LABORATORY AND DIAGNOSTIC STUDIES 40
HIGH SENSITIVITY PROTEIN TEST 40
CLINICAL CHEMISTRY 41
PROCALCITONIN TEST 45
BLOOD GLUCOSE TEST 45
SARS-CoV-2 VIRUS DETECTION -PCR 46
IMMUNOLOGY: RAPID ANTIBODY TEST 47
HEMATOLOGY: CBC 48
IMMUNOLOGY: THYROID STUDIES 50
HEMATOLOGY: PROTHROMBIN TIME 51
CT- SCAN 52
ECG 53

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NURSING PROBLEM LIST 68
DRUG STUDY
CEFUROXIME 58
AZITHROMYCIN 60
PANTOPRAZOLE 62
COLCHICINE 64
ATOVASTATIN 65
AMPICILLIN + SULBACTAM 67
CETIRIZINE 69
DIPHENHYDRAMINE 71
ALPRAZOLAM 73
CLOPIDOGREL 75
MEMANTINE 77
SULTAMICILLIN 79
LOSARTAN 81
AMLODIPINE 83
NURSING CARE PLAN
Impaired Physical Mobility 85
Ineffective cerebral tissue perfusion 89
Ineffective cerebral tissue perfusion 93
Disturbed thought process 97
Activity Intolerance 101
F-DAR NOTES 104
DISCHARGE PLAN 109
SUMMARY 111
LEARNING OUTCOMES 114
CONCLUSION 114
RECOMMENDATION 116
REFERENCES 117
CURRICULUM VITAE 123

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INTRODUCTION

A stroke is a medical emergency. It occurs when blood flow to an area

of the brain is cut off. When this happens, the brain cells are deprived of
oxygen and begin to die. There are two types of strokes namely ischemic
stroke (CVD infarct) and hemorrhagic stroke (CVD bleed). In this case study,
we will be focusing on ischemic stroke (CVD infarct). A cerebrovascular
disease (CVD) infarct, also called ischemic stroke, is a kind of stroke caused
by interruption or blockage of blood flow to the brain. Stroke is the
Philippines' second leading cause of death. Ischemic stroke comprises 70%
while hemorrhagic stroke comprises 30% of all stroke cases in the
Philippines (Navarro, Baroque, Lokin, Venketasubramanian 2014). Ischemic
stroke is one of three types of stroke. It’s also referred to as brain ischemia
and cerebral ischemia. This type of stroke is caused by a blockage in an
artery that supplies blood to the brain. The blockage reduces the blood flow
and oxygen to the brain, leading to damage or death of brain cells. If
circulation isn’t restored quickly, brain damage can be permanent.
Approximately 87 percent of all strokes are ischemic stroke incidences
(Hersh 2018).

Community-acquired pneumonia (CAP) is one of the most common

infectious diseases and is an important cause of mortality and morbidity
worldwide. Typical bacterial pathogens that cause CAP include Streptococcus
pneumonia, Haemophilus influenzae, and Moraxella catarrhalis. Community-
Acquired Pneumonia, Moderate Risk (CAP – MR) Community- acquired
pneumonia is defined as pneumonia that is acquired outside the hospital.
Typically, pathogens that cause this disease are bacteria. However, with the
advent of novel diagnostic technologies, viral respiratory pathogens are
increasingly being identified as frequent etiologies of CAP. The most common
viral pathogens recovered from hospitalized patients admitted with CAP
include human rhinovirus and influenza (Baer 2019).

Dementia is a general term for loss of memory, language, problem-

solving and other thinking abilities that are severe enough to interfere with
daily life. Alzheimer's is the most common cause of dementia. Prevalence of
dementia in the Philippines was found to be high, with a crude prevalence of
10.6%. The age- standardized prevalence of dementia was 14.2%, the
double of the updated estimate for Southeast Asia in 2015 of 7.6%.
Dementia is not a single disease; it’s an overall term like heart disease that
covers a wide range of specific medical conditions, including Alzheimer’s
disease. Disorders grouped under the general term dementia are caused
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by abnormal brain

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changes. These changes trigger a decline in thinking skills, also known as
cognitive abilities, severe enough to impair daily life and independent
function. They also affect behavior, feelings and relationships. Alzheimer's
disease accounts for 60-80% of cases. Vascular dementia, which occurs
because of microscopic bleeding and blood vessel blockage in the brain, is
the second most common cause of dementia. Those who experience the
brain changes of multiple types of dementia simultaneously have mixed
dementia. There are many other conditions that can cause symptoms of
dementia, including some that are reversible, such as thyroid problems and
vitamin deficiencies.

DEMOGRAPIHC DATA

Patient C.S.N is a male Filipino citizen currently residing at Punta,

Princesa, Cebu, City. He was born on July 20 1939 at Cebu City. The patient
was admitted on August 21 2020 at Southwestern University- Medical Center
at 10:52 in the morning due to vomiting, elevated BP, weakness, and cough.
Upon admission the patient was diagnosed by the attending Physician, Dr.
Yu with Resulting in CVD infarction, CAP- MR, HUD, RDU, Dementia.

CHIEF COMPLAINT

Patient was admitted last August 21, 2020, 10:52 in the morning at
Southwestern Medical Center with a chief complaint of Vomiting, Elevated
BP, Weakness, Cough. Patient’s vital signs upon admission are as follows:
BP- 150/100mmHg, HR- 64bpm, RR- 24bpm, T- 36.3 C, O2 Sat- 95%

CURRENT HEALTH STATUS

Patient C.S.N is an 87-year-old male Filipino citizen who was initially

admitted due to vomiting, elevated BP, weakness and cough by the
admitting Physician, Dr. Yu. Patient’s Diagnosis are CVD infarction, CAP- MR,
HUD, RDU, Dementia.

PAST HEALTH HISTORY

The patient’s past health history was not determined due to the
inadequate data with regards to previous healthcare management and
treatment.

FAMILY HEALTH HISTORY

Patient C.S.N is Married. However, family history beyond the said

information was not evaluated due to the inadequacy of data.

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GOALS

The goal of the case study is to define and understand the medical
diagnosis and the disease process occurring in patient. With adequate
amount of knowledge, this would guarantee proper nursing management
along with proper treatment and management as ordered by the health care
provider. Recognize and point out the affected body parts and functions due
to the prognosis of the disease. Discuss the different laboratory and
diagnostic findings, as well as its normal values and result.

OBJECTIVES

A. General Objective:
After series of case study aided with the concept: Nursing Care of Clients
with Life Threatening Conditions/Acutely III/Multi-Organ Problems/High
Acuity and Emergency Situations, Acute and Chronic, student nurses be able
to gain knowledge from accurate information sources, enhance skills in
providing nursing care, develop positive attitude, and provide utmost level of
health care towards clients with CVD infarct, CAP – MR, HUD, RDU, and
Dementia to sustain and maintain optimal health.

B. Specific Objective:
1. Demonstrate therapeutical approach towards patient with the
concurrent disease in caring, nonjudgmental, and nondiscriminatory
manner to obtain accurate information during health assessments.
2. Obtain knowledge and understanding in a scientific-based and accurate
definition of CVD infarct, CAP – MR, HUD, RDU, and Dementia.
3. Identify its complications and any warning signs of worsening condition
with the aid of anatomy and physiology of the affected body parts and
functions.
4. Identify any changes in the clinical laboratory and diagnostic tests that
would identify appropriate planning for health management, as well as
to evaluate the patient’s condition.
5. Implement nursing prioritization by identifying nursing problems to
patient with CVD infarct, CAP – MR, HUD, RDU, and Dementia.
6. Address management plans to carry out nursing intervention for the
patient, aided with evidence-based practices in treatment and health
care management in addressing patient’s condition.
7. Attend to appropriate nursing response with precautionary measures
during nurse-patient encounter to avoid any cross-contamination and
spread of unwanted variants.

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 8. Discuss important information towards patient and document response
to prescribed and non-prescribed medications, treatments, procedures,
and nursing managements.
9. Impart knowledge to patient for successful health education relevant
to patient’s condition, its lifestyle modification, change of diet, drug
maintenance, and physical and emotional support from the family
and/or S.O. to facilitate palliative care and treatment regimen.
10. Formulate discharge plan for thorough documentation that enables
patient to be guided with appropriate home care practices until follow-
up visits by the health care provider.

RESEARCH QUESTIONS: CASE STUDY

1. Who are most likely to acquire CAP – MR?

2. How can we diagnose patients having CVD Infarction?
3. What are the usual clinical symptoms of patients having Dementia?
4. What are some independent nursing interventions on managing
Hypertensive Urgency Disease?
5. Who are most likely prone to Renal Disease Urgent?

SIGNIFICANCE OF THE STUDY

The conduction and completion of this study will provide sufficient knowledge
and understanding to both readers and listeners about these topics:
1. CVD INFARCT
2. CAP – MR
3. HUD (HYPERTENSIVE URGENCY DISEASE)
4. RDU (RENAL DISEASE URGENT)
5. DEMENTIA

The study can benefit to the following:

Patient. This study will help the patient have better understanding about his
current condition, to be aware of signs and symptoms and to be able to
perform independent interventions.

Significant others. This study will help the significant others to gain
knowledge and awareness about the patient’s condition. This way it can
manage to minimize the reoccurrence of the disease.

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Student nurse. This study could help the student nurse in a way that it
gives additional information that can help them apply necessary
management towards the patient.

Health workers. This study will help health workers acquire additional
information and helpful management about these diseases and can be
applied in their patients.

Clinical instructor. This study helps to foster relationship bond between a

student and teacher in the sense that there is a direct interaction to discuss
the topics.
Future Researchers. This study will help the future researchers to discover
or enhance the current situation of the study as well as their reference for
future study.

CARDIOVASCULAR DISEASE INFARCT

A cerebrovascular disease (CVD) infarct, also called ischemic stroke, is

a kind of stroke caused by interruption or blockage of blood flow to the
brain. Stroke is the Philippines' second leading cause of death. Ischemic
stroke comprises 70% while x stroke comprises 30% of all stroke cases in
the Philippines.

Ischemic stroke is one of three types of strokes. It’s also referred to as

brain ischemia and cerebral ischemia. This type of stroke is caused by a
blockage in an artery that supplies blood to the brain. The blockage reduces
the blood flow and oxygen to the brain, leading to damage or death of brain
cells. If circulation isn’t restored quickly, brain damage can be permanent.
Approximately 87 percent of all strokes are ischemic stroke incidences.

A cerebral infarction is an area of necrotic tissue in the brain resulting

from a blockage or narrowing in the arteries supplying blood and oxygen to
the brain. The restricted oxygen due to the restricted blood supply causes an
ischemic stroke that can result in an infarction if the blood flow is not
restored within a relatively short period of time. The blockage can be due to
a thrombus, an embolus or an atheromatous stenosis of one or more
arteries. Which arteries are problematic will determine which areas of the
brain area affected (infarcted) These varying infarcts will produce different
symptoms and outcomes? About one third will prove fatal.

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Signs and Symptoms
Unusually severe headache - High blood pressure can cause headache.
This occurs when your blood pressure becomes dangerously high.

Confusion, disorientation or memory loss - This is due to the fact the

lungs are not absorbing enough oxygen thus not circulating enough
oxygen in the system. Hence, there deficiency affecting the brain. It
occurs when the brain does not receive enough oxygen even though
blood is still flowing.

Numbness, weakness in an arm, leg or the face, especially on one

side - Over time, elevated blood pressure can develop to heart disease or
microvascular disease (MVD) (MVD). Angina is a frequent symptom.
Atherosclerosis induced by high blood pressure can create a narrowing of
arteries in the legs, arms, stomach and brain, producing discomfort or
tiredness.

Loss of vision or difficulty seeing - In some cases, the retina becomes

swollen due damage to the retina's blood vessels, limit the retina’s
function, and put pressure on the optic nerve, causing vision problems.

PREDISPOSING AND PRECIPITATING FACTORS

Predisposing Factors
Age. Age is a continuous risk factor for the occurrence of stroke and
dementia, with a two-fold increase in the incidence and prevalence
rates for each successive 5 years after age 65 years.

Gender. Overall, men have a higher risk of heart attack than women. But
the difference narrows after women reach menopause. After the age of
65, the risk of heart disease is about the same between the sexes
when other risk factors are similar. Cardiovascular diseases affect
more women than men and heart attacks are generally more severe in
women than in men.

Family history. Family history of stroke in a first-degree relative also

increases the likelihood of suffering from an acute cerebrovascular
event even after adjusting for other vascular risk factors. This
increased risk may be due to different mechanisms, including inherited
predisposition for stroke risk factors, genetic transmission of

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susceptibility to stroke,

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 familial-related lifestyle, cultural and environmental factors, and
interactions between genes and environmental factors

Hypertension. Hypertension together with age are leading risk factors

for silent or symptomatic cerebrovascular disease. The effect of chronic
hypertension on cerebral vessels and tissue also supports a physio
pathological mechanism for the association between hypertension and
cognitive impairment

Diabetes Mellitus. The influence of diabetes upon increasing the stroke

risk is higher in women than in men. Diabetes is the main risk factor
following hypertension of cerebral small vessel disease and has been
identified as a significant independent variable of symptomatic
recurrence in patients with first-ever cerebral infarction of the lacunar
type

Precipitating Factors

Cigarette Smoking. Smoking increases blood viscosity, fibrinogen and

platelet aggregation, and decreases high-density lipoprotein (HDL)
cholesterol, which causes direct damage to endothelium and an
increase in blood pressure.

Alcohol Abuse. Chronic heavy alcohol consumption (> 60 g/d) is

associated with an increase in the relative risk of stroke. Ethanol is a
direct neurotoxin and chronic ethanol abuse causes different
neurodegenerative processes, including dementia.

Overweight and obesity. Increase in fat tissue is associated with a

higher risk of insulin resistance, diabetes, hypertension, dyslipidemia,
vascular diseases and other conditions. Weight and abdominal fat is
associated with an increasing blood pressure, and may thereby
increase the risk of stroke.

Psychosocial Stress. The risk of stroke is also increased in the presence

of stressful live events, including depression

Contraceptive pills. Early types of birth control pills contained high

levels of estrogen and progestin, and taking these pills increased the
risk of
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 heart disease and stroke, especially in women older than 35 who
smoked.

COMMUNITY-ACQUIRED PNEUMONIA

Pneumonia is a form of acute respiratory infection that affects the

lungs. The lungs are made up of small sacs called alveoli, which fill with air
when a healthy person breathes. When an individual has pneumonia, the
alveoli are filled with pus and fluid, which makes breathing painful and limits
oxygen intake.

Community-acquired pneumonia (CAP) is pneumonia that is contracted

in the community rather than in the hospital setting. CAP is a heterogeneous
infection with a variety of potential causative pathogens and is associated
with significant morbidity and mortality. It is more common during the
winter months, in older adults. But it can affect people of any age. It can be
very serious especially in older adults, young children or people with other
health problems.
Typically, pathogens that cause this disease are bacteria. However, with the
advent of novel diagnostic technologies, viral respiratory pathogens are
increasingly being identified as frequent etiologies of CAP. The most common
viral pathogens recovered from hospitalized patients admitted with CAP
include human rhinovirus and influenza. Community-acquired pneumonia
(CAP) is one of the most common infectious diseases and is an important
cause of mortality and morbidity worldwide. Typical bacterial pathogens that
cause CAP include Streptococcus pneumonia, Haemophilus influenzae, and
Moraxella catarrhalis.

To be able to provide the right treatment, doctors also classify community-

acquired pneumonia as mild, moderate or severe.

Pneumonia is considered to be mild with no increased risk if the patient:

 Is younger than 65 years old,
 Is conscious and lucid,
 Has normal blood pressure and pulse,
 Is not breathing too fast (fewer than 30 breaths per minute),
 Has enough oxygen in their blood,
 Has not been in the hospital in the past three months, and
 Does not have any other severe medical conditions

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Signs and Symptoms

Shortness of breath - due to the activation of inflammatory process

leading to fluid/ cellular exudation and edema of mucus membrane

Coughing - due to increased number of goblet cells and size of submucosal

glands which leads to hypersecretion of mucus

Heavy sputum - Irritation of the respiratory system causes both

inflammation of the air passages and a notable increase in mucus secretion.

Fever and chills - This is due to the body’s immune response to the
infection. A fever occurs as your body attempts to eliminate the virus or
bacteria that caused the infection. When your body temperature is normal,
the majority of those bacteria and viruses thrive.

Chest pain that is worse when you breathe or cough - due to the
inflammation and infection if the thin lining between the lung and ribcage

PREDISPOSING AND PREDISPOSING FACTORS

Predisposing Factors

Children < 2 years old. Babies’ immune systems are still developing.
The risk is higher for premature babies.

Older Age. Their immune systems generally weaken as they age. Older
adults are also more likely to have other chronic (long-term) health
conditions that raise the risk of pneumonia.

Immunosuppression. Conditions that weaken your immune system,

such as pregnancy, HIV/AIDS, or an organ or bone marrow
transplant. Chemotherapy, which is used to treat cancer, and long-
term use of steroid medicines can also weaken your immune system.

Respiratory diseases. Having a chronic condition including asthma,

chronic obstructive pulmonary disease, structural lung disease and
heart disease are more likely to get pneumonia. Once these bacteria
invade the lungs and bloodstream, they can cause serious illness.

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Precipitating Factors
Smoking. Smoking is an established risk factor for CAP, probably due to
its adverse effects on the respiratory epithelium and the clearance of
bacteria from the respiratory tract.

Exposure to chemicals. Exposure to harmful chemical vapors and/or

smoke on the job might erode your lungs' defenses. This can make
you more susceptible to pneumonia bacteria.

Poor oral care. Poor oral care has previously been identified as a risk
factor due to the colonization of the oral cavity by respiratory
pathogens.

DEFINITION OF TERMS

Alveoli: The alveoli are where the lungs and the blood exchange oxygen and
carbon dioxide during the process of breathing in and breathing out. Oxygen
breathed in from the air passes through the alveoli and into the blood and
travels to the tissues throughout the body.

Causative agent: A disease causative agent is substance that causes

disease. Examples include biological pathogens (such as a virus, bacteria,
parasites, and fungus).

Diabetes Mellitus: Diabetes mellitus is a disorder in which the body does

not produce enough or respond normally to insulin, causing blood sugar
(glucose) levels to be abnormally high.

Hypertension: High blood pressure, also called hypertension, is blood

pressure that is higher than normal. Your blood pressure changes
throughout the day based on your activities. Having blood pressure
measures consistently above normal may result in a diagnosis of high blood
pressure (or hypertension).

Immunosuppression: Immunosuppression is the state in which your

immune system is not functioning as well as it should. Immunosuppression
can be caused by certain diseases but can also be induced by medications

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that

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 suppress the immune system. Some medical procedures can also cause
immunosuppression.

Influenza: Influenza is a viral infection that attacks your respiratory system

your nose, throat and lungs. Influenza is commonly called the flu, but it's
not the same as stomach "flu" viruses that cause diarrhea and vomiting.

Ischemic stroke: Ischemic stroke is one of three types of strokes. It's also
referred to as brain ischemia and cerebral ischemia. This type of stroke is
caused by a blockage in an artery that supplies blood to the brain. The
blockage reduces the blood flow and oxygen to the brain, leading to damage
or death of brain cells.

Pathogen: A pathogen is usually defined as a microorganism that causes, or

can cause, disease. We have defined a pathogen as a microbe that can
cause damage in a host.

Rhinovirus: Rhinoviruses may also cause some sore throats, ear infections,
and infections of the sinuses (openings in the bone near the nose and eyes).
They may also cause pneumonia and bronchiolitis, but this is less common.

Thrombus: A thrombus is a blood clot that forms in a vessel and remains

there. An embolism is a clot that travels from the site where it formed to
another location in the body. Thrombi or emboli can lodge in a blood vessel
and block the flow of blood in that location depriving tissues of normal blood
flow and oxygen.

HYPERTENSIVE URGENCY DISEASE

Hypertensive urgency is a marked elevation in blood pressure without

evidence of target organ damage, such as pulmonary edema, cardiac
ischemia, neurologic deficits, or acute renal failure. Specific cutoffs have
been proposed, such as systolic blood pressure greater than 180 or diastolic
blood pressure greater than 110, but these are arbitrarily derived numbers
that have not been associated with short-term morbidity or mortality. Given
this, some have proposed reserving the term hypertensive urgency for
patients with severely elevated blood pressure and significant risk factors for
progressive end-organ damage such as congestive heart failure or chronic
kidney disease. However, hypertensive urgencies are associated with a
higher incidence of
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 adverse cardiovascular events over the long term and warrant a nuanced
approach focused on ensuring better blood pressure control, reducing
catalysts for marked elevations of blood pressure, and reliably following up
with primary care. Causes of hypertensive urgency disease include: Causes
of a hypertensive emergency include: Forgetting to take your blood pressure
medication, Stroke, Heart attack, Heart failure, Kidney failure, Rupture of
your body's main artery (aorta), Interaction between medications,
Convulsions during pregnancy (eclampsia)

SIGNS AND SYMPTOMS

Signs and symptoms of a hypertensive crisis that may be life-threatening

may include:

Severe chest pain - Chest discomfort related to a heart attack or

another heart problem may be described by or associated with one or
more of the following: Pressure, fullness, burning or tightness in your
chest. Crushing or searing pain that radiates to your back, neck, jaw,
shoulders, and one or both arms.
Severe headache, accompanied by confusion and blurred vision
Nausea and vomiting - Nausea is an uneasiness of the stomach that
often accompanies the urge to vomit, but doesn't always lead to
vomiting. Vomiting is the forcible voluntary or involuntary emptying
("throwing up") of stomach contents through the mouth.
Severe anxiety - Because patient might be scared that he/she might
die or that he doesn't know what the disease is all about, he could
have anxiety disorder.
Shortness of breath - This is a tight feeling in your chest where you
may not be able to take a deep breath. This is a symptom that can be
linked to many different conditions, like asthma, heart failure and lung
disease.
Seizures: A seizure is a sudden, uncontrolled electrical disturbance in
the brain. It can cause changes in your behavior, movements or
feelings, and in levels of consciousness.
Unresponsiveness - When a patient is not responding or he's dying
because of the heart issues.

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PREDISPOSING AND PRECIPITATING

 Having overweight or obesity

 Eating an unhealthful diet that is high in salt
 Not getting very much physical activity
 Smoking
 Having a history of cardiovascular disease
 Having an underlying health condition, such as diabetes or
kidney disease

DEFINITION OF TERMS

STROKE: A stroke occurs when the blood supply to part of your brain
is interrupted or reduced, preventing brain tissue from getting oxygen and
nutrients. Brain cells begin to die in minutes. A stroke is a medical
emergency, and prompt treatment is crucial. Early action can reduce brain
damage and other complications.

HEART ATTACK: A heart attack occurs when the flow of blood to the
heart is blocked. The blockage is most often a buildup of fat, cholesterol and
other substances, which form a plaque in the arteries that feed the heart
(coronary arteries). Sometimes, a plaque can rupture and form a clot that
blocks blood flow. The interrupted blood flow can damage or destroy part of
the heart muscle.

HEART FAILURE: Heart failure — sometimes known as congestive

heart failure — occurs when the heart muscle doesn't pump blood as well as
it should. When this happens, blood often backs up and fluid can build up in
the lungs, causing shortness of breath.

KIDNEY FAILURE: Kidney failure, also called end-stage renal disease

(ESRD), is the last stage of chronic kidney disease. When one's kidneys fail,
it means they have stopped working well enough for one to survive without
dialysis or a kidney transplant.

ECLAMPSIA: Eclampsia is a severe complication of preeclampsia. It's

a rare but serious condition where high blood pressure results in seizures
during pregnancy. Seizures are periods of disturbed brain activity that can
cause episodes of staring, decreased alertness, and convulsions (violent
shaking).

RENAL URGENCY DISEASE

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 It occurs when your kidneys suddenly become unable to filter waste
products from your blood. When your kidneys lose their filtering ability,
dangerous levels of wastes may accumulate, and your blood's chemical
makeup may get out of balance.

It develops rapidly, usually in less than a few days. It is most common in

people who are already hospitalized, particularly in critically ill people who need
intensive care.
It can be fatal and requires intensive treatment. However, it may be
reversible. If you're otherwise in good health, you may recover normal or
nearly normal kidney function. Potential complications of acute kidney failure
include: fluid buildup, chest pain, muscle weakness, permanent kidney
damage, death.

SIGNS AND SYMPTOMS

Signs and symptoms of acute kidney failure may include:

Decreased urine output - although occasionally urine output remains

normal

Fluid retention - causing swelling in your legs, ankles or feet

Shortness of breath - may lead to a buildup of fluid in your lungs,

which can cause shortness of breath.

Fatigue - A severe decrease in kidney function can lead to a buildup of

toxins and impurities in the blood. This can cause people to feel tired,
weak and can make it hard to concentrate.

Confusion - A common symptom of kidney failure is delirium . This is a

mental state that's marked by confusion and restlessness. It develops
because the toxins that are accumulating are affecting the brain.

Nausea - when your kidneys fail, wastes and extra fluid can build up in
your blood and make you feel sick.

Weakness - A severe decrease in kidney function can lead to a buildup

of toxins and impurities in the blood. This can cause people to feel tired,
weak and can make it hard to concentrate.

Irregular heartbeat - Chronic kidney disease can as much as double a

patient's risk of atrial fibrillation, a quivering or irregular heartbeat that
can lead to stroke or heart failure

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 Chest pain or pressure - if the lining that covers your
(pericardium) becomes inflamed, you may experience chest pain.

Seizures or coma in severe cases - Seizures arise in renal failure due

to toxins accumulation and to complications like sepsis, hemorrhage,
malignant hypertension, pH and hydro electrolytic disturbances.

RISK FACTORS

Acute kidney failure almost always occurs in connection with another

medical condition or event. Conditions that can increase your risk of acute
kidney failure include:

 Being hospitalized, especially for a serious condition that

requires intensive care
 Advanced age
 Blockages in the blood vessels in your arms or legs
(peripheral artery disease)
 Diabetes
 High blood pressure
 Heart failure
 Kidney diseases
 Liver diseases
 Certain cancers and their treatments

DEFINITION OF TERMS
Fluid buildup: Acute kidney failure may lead to a buildup of fluid in
your lungs, which can cause shortness of breath.

Chest pain: if the lining that covers your heart (pericardium) becomes
inflamed, you may experience chest pain.

· Muscle weakness: When your body's fluids and electrolytes —

your body's blood chemistry — are out of balance, muscle weakness can
result. Permanent kidney damage: Occasionally, acute kidney failure
causes permanent loss of kidney function, or end-stage renal disease.
People with end-stage renal disease require either permanent dialysis —
a mechanical filtration process used to remove toxins and wastes from
the body — or a kidney transplant to survive.

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 Death: Acute kidney failure can lead to loss of kidney function and,
ultimately, death.

DEMENTIA

Dementia is not a single illness but a group of symptoms caused by

damage to the brain. The symptoms include loss of memory, mood changes
and confusion. Dementia is caused by a number of diseases of the brain. The
main types of dementia are:

Alzheimer’s disease: small clumps of protein, known as plaques, begin

to develop around brain cells. This disrupts the normal workings of the brain.

Vascular dementia: problems with blood circulation result in parts of the

brain not receiving enough blood and oxygen.

Dementia with Lewy bodies: abnormal structures, known as Lewy

bodies, develop inside the brain.

Fronto-temporal dementia: the frontal and temporal lobes of the brain

begin to shrink. Unlike other types of dementia, fronto-temporal dementia
develops most often in people under the age of 65.

Some people have mixed dementia – more than one of the four types.It is
important that these conditions are identified as early as possible, yet less
than half of people who have dementia have been diagnosed. Dementia
mainly affects people who are older, and the numbers of people with
dementia is forecast to grow as people live longer, but younger people can
sometimes have dementia - this is referred to as early onset dementia.

Causes of dementia may include:

 Alzheimer's disease
 Vascular cognitive impairment
 Dementia with Lewy bodies
 Frontotemporal dementia
 Parkinson’s disease
 Huntington’s disease
 HIV
 Traumatic brain injury

SYMPTOMS OF DEMENTIA

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Different types of dementia can affect people differently, and everyone will
experience symptoms in their own way. However, there are some common
early symptoms that may appear some time before a diagnosis of dementia.

These include:

Memory loss - Since there's a damage to the brain, there could

be presence of a loss in memory in patients with dementia.

Difficulty concentrating - When in patient isn't interested in

what is being done around him or lose focus in things, it could
mean there's a presence of dementia.

Finding it hard to carry out familiar daily tasks - such as

getting confused over the correct change when shopping

Struggling to follow a conversation or find the right word

Being confused about time and place

Mood changes - People living with dementia can experience an

Absence of interest in or concern about emotional, social,
spiritual, philosophical or physical life. They may become
depressed or withdrawn and lose interest in activities they used
to enjoy.

These symptoms are often mild and may get worse only very gradually. It's
often termed "mild cognitive impairment" (MCI) as the symptoms are not
severe enough to be diagnosed as dementia.

PREDISPOSING AND PRECIPITATING FACTORS

Anyone can develop dementia, but some factors appear to contribute to

whether we develop the disease:

Age: you are more likely to develop dementia when you get
older, especially if you have high blood pressure or have a higher
risk of other genetic diseases such as heart attacks and strokes.

Genetics: genetics are known to play play some role in the

development of dementia, but the specific effects vary
considerably.

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 Medical history: having current conditions or having
experienced certain conditions in the past may make us more
likely to develop dementia – such as multiple sclerosis, Down’s
syndrome, diabetes, HIV and metabolic syndrome.

General lifestyle: a poor diet, a lack of exercise and excessive

alcohol or drug consumption can all increase the chances of
developing the disease.

People with Parkinson’s disease have a higher-than-average risk of

developing dementia, although most people are unaffected.

DEFINITION OF TERMS

PARKINSON’S DISEASE: Parkinson's disease is a nervous system disease

that affects your ability to control movement. The disease usually starts out
slowly and worsens over time. If one has Parkinson's disease, one may
shake, have muscle stiffness, and have trouble walking and maintaining
one's balance and coordination.

HUNTINGTON'S DISEASE: Huntington's disease (HD) is a progressive

brain disorder caused by a defective gene. This disease causes changes in
the central area of the brain, which affects movement, mood and thinking
skills.

HIV: HIV (human immunodeficiency virus) is a virus that attacks the body's
immune system. If HIV is not treated, it can lead to AIDS (acquired
immunodeficiency syndrome).

TRAUMATIC BRAIN INJURY: Traumatic brain injury (TBI), a form of

acquired brain injury, occurs when a sudden trauma causes damage to the
brain. TBI can result when the head suddenly and violently hits an object, or
when an object pierces the skull and enters brain tissue.

ANATOMY AND PHYSIOLOGY

CEREBROVASCULAR DISEASE INFARCTION AND DEMENTIA

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 The word cerebrovascular is made up of two parts – "cerebro" which
refers to the large part of the brain, and "vascular" which means arteries and
veins. Together, the word cerebrovascular refers to blood flow in the brain.
The term cerebrovascular disease includes all disorders in which an area of
the brain is temporarily or permanently affected by ischemia or bleeding and
one or more of the cerebral blood vessels are involved in the pathological
process.

Cerebrovascular disease refers to a group of conditions, diseases, and

disorders that affect the blood vessels and blood supply to the brain. If a
blockage, malformation, or hemorrhage prevents the brain cells from getting
enough oxygen, brain damage can result. Cerebrovascular disease can
develop from a variety of causes, including atherosclerosis, where the
arteries become narrow; thrombosis, or embolic arterial blood clot, which is
a blood clot in an artery of the brain; or cerebral venous thrombosis, which
is a blood clot in a vein of the brain. Cerebrovascular diseases include
stroke, transient ischemic attack (TIA), aneurysm, and vascular
malformation. Cerebral infarction – A stroke caused by interruption or
blockage of blood flow to the brain; also called ischemic stroke.

The heart pumps blood up to the brain through two sets of arteries,
the carotid arteries and the vertebral arteries. The carotid arteries are
located in the front of the neck and are what you feel when you take your
pulse just under your jaw. The carotid arteries split into the external and

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internal arteries

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 near the top of the neck with the external carotid arteries supplying blood
the face and the internal carotid arteries going into the skull. Inside the
skull, the internal carotid arteries branch into two large arteries – the
anterior cerebral and middle cerebral arteries and several smaller arteries –
the ophthalmic, posterior communicating and anterior choroidal arteries.
These arteries supply blood to the front two-thirds of the brain.

The vertebral arteries extend alongside the spinal column and cannot
be felt from the outside. The vertebral arteries join to form a single basilar
artery near the brain stem, which is located near the base of the skull. The
vertebrobasilar system sends many small branches into the brain stem and
branches off to form the posterior cerebellar and posterior meningeal
arteries, which supply the back third of the brain. The jugular and other
veins carry blood out of the brain. Because the brain relies on only two sets
of major arteries for its blood supply, it is very important that these arteries
are healthy. Often, the underlying cause of an ischemic stroke is carotid
arteries blocked with a fatty buildup, called plaque. During a hemorrhagic
stroke, an artery in or on the surface of the brain has ruptured or leaks,
causing bleeding and damage in or around the brain.

Whatever the underlying condition and cause are, it is crucial that

proper blood flow and oxygen be restored to the brain as soon as possible.
Without oxygen and important nutrients, the affected brain cells are either
damaged or die within a few minutes. Once brain cells die, they cannot
regenerate, and devastating damage may occur, sometimes resulting in
physical, cognitive and mental disabilities.

When blood supply is cut off from the brain, cells start to die from lack
of oxygen. Within minutes, skills such as reasoning, speech, and some
degree of arm, leg, or facial movement may be lost. The type of skills and
the amount of loss depend on which part of the brain was affected, and how
much tissue was damaged.

• The brain is the body’s control center, which handles communication, motor,
sensory, and processing functions.

• The cerebellum controls the body’s coordination and balance.

• The brain stem links the brain and the spinal cord. It also handles basic body
functions.

• The spinal cord carries messages between the brain and the body.

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PARTS AND FUNCTIONS OF THE BRAIN:

Thalamus - is a small structure within the brain located just above the brain
stem between the cerebral cortex and the midbrain and has extensive nerve
connections to both. The primary function of the thalamus is to relay motor
and sensory signals to the cerebral cortex. It also regulates sleep, alertness,
and wakefulness.

Hypothalamus - a region of the brain, between the thalamus and the

midbrain, that functions as the main control center for the autonomic
nervous system by regulating sleep cycles, body temperature, appetite, and
that acts as an endocrine gland by producing hormones, including the
releasing factors that control the hormonal secretions of the pituitary gland.

Amygdala - the amygdala may be best known as the part of the brain that
drives the so-called “fight or flight” response. While it is often associated
with the body's fear and stress responses, it also plays a pivotal role in
memory.

Hippocampus- Hippocampus is a complex brain structure embedded deep

into temporal lobe. It has a major role in learning and memory. It is a plastic
and vulnerable structure that gets damaged by a variety of stimuli.
Basal Ganglia- is responsible primarily for motor control, as well as other
roles such as motor learning, executive functions and behaviors, and
emotions.

Corpus Callosum- the primary function of the corpus callosum is to

integrate and transfer information from both cerebral hemispheres to
process sensory, motor, and high-level cognitive signals.

Frontal Lobe- are important for voluntary movement, expressive language

and for managing higher level executive functions. Executive functions refer
to a collection of cognitive skills including the capacity to plan, organize,
initiate, self-monitor and control one's responses in order to achieve a goal.

Temporal Lobe- play an important role in processing affect/emotions,

language, and certain aspects of visual perception.

Parietal Lobe- responsible for integrating sensory information, including

touch, temperature, pressure and pain.

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Occipital Lobe- primarily responsible for vision. It is associated with
visuospatial processing, distance and depth perception, color determination,
object and face recognition, and memory formation.

Cerebellum- has an important role in motor control, with cerebellar

dysfunction often presenting with motor signs. In particular, it is active in
the coordination, precision and timing of movements, as well as in motor
learning.

Brainstem- has many basic functions, including regulation of heart rate,

breathing, sleeping, and eating. It also plays a role in conduction. All
information relayed from the body to the cerebrum and cerebellum and vice
versa must traverse the brainstem.

COMMUNITY ACQUIRED PNEUMONIA

THE RESPIRATORY SYSTEM

Mouth and nose - Openings that pull air from outside your body into your
respiratory system.

Pharynx (throat) - cone-shaped passageway leading from the oral and

nasal cavities in the head to the esophagus and larynx. The pharynx
chamber serves both respiratory and digestive functions.

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Larynx (voice box) - a hollow, tubular structure connected to the top of
the windpipe (trachea); air passes through the larynx on its way to the
lungs. The larynx also produces vocal sounds and prevents the passage of
food and other foreign particles into the lower respiratory tracts.

Oropharynx - is the most critical region in swallowing and joins the oral
cavity and nasopharynx with the larynx and hypopharynx.

Trachea - commonly called the windpipe, is the main airway to the lungs. It
divides into the right and left bronchi at the level of the fifth thoracic
vertebra, channeling air to the right or left lung. The hyaline cartilage in the
tracheal wall provides support and keeps the trachea from collapsing.

Bronchi - are the airways that lead from the trachea into the lungs and then
branch off into progressively smaller structures until they reach the alveoli,
the tiny sacs that allow for the exchange of oxygen and carbon dioxide in the
lungs.

Bronchial tubes - Tubes at the bottom of your windpipe that connect into
each lung. When a person breathes, air comes in through the nose or mouth
and then goes into the trachea (windpipe). From there, it passes through the
bronchial tubes, which are in the lungs. These tubes let air in and out of your
lungs, so you can breathe.

Lungs - each of the pair of organs situated within the rib cage, consisting of
elastic sacs with branching passages into which air is drawn, so that oxygen
can pass into the blood and carbon dioxide be removed.

Diaphragm - a dome-shaped muscular partition separating the thorax from

the abdomen in mammals. It plays a major role in breathing, as its
contraction increases the volume of the thorax and so inflates the lungs.

Alveoli - are tiny, balloon-shaped air sacs. Their function is to move oxygen
and carbon dioxide (CO2) molecules into and out of your bloodstream.

Bronchioles - are air passages inside the lungs that branch off like tree
limbs from the bronchi—the two main air passages into which air flows from
the trachea (windpipe) after being inhaled through the nose or mouth. The
bronchioles deliver air to tiny sacs called alveoli where oxygen and carbon
dioxide are exchanged.

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Epiglottis - is a leaf-shaped flap of cartilage located behind the tongue, at
the top of the larynx, or voice box. The main function of the epiglottis is to
seal off the windpipe during eating, so that food is not accidentally inhaled.

Carina - a ridge at the base of the trachea (windpipe) that separates the
openings of the right and left main bronchi (the large air passages that lead
from the trachea to the lungs).

HYPERTENSIVE URGENCY DISEASE (HUD)

ANATOMY OF THE HEART

The heart consists of four chambers:

The atria: These are the two upper chambers, which receive blood.

The ventricles: These are the two lower chambers, which discharge blood.

A wall of tissue called the septum separates the left and right atria and the
left and right ventricle. Valves separate the atria from the ventricles.

The heart’s walls consist of three layers of tissue:

Myocardium: This is the muscular tissue of the heart.

Endocardium: This tissue lines the inside of the heart and protects the
valves and chambers.

Pericardium: This is a thin protective coating that surrounds the other parts.

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Epicardium: This protective layer consists mostly of connective tissue and
forms the innermost layer of the pericardium.

Left and right sides

The left and right sides of the heart work in unison. The atria and ventricles
contract and relax in turn, producing a rhythmic heartbeat.

Right side

The right side of the heart receives deoxygenated blood and sends it to the
lungs. The right atrium receives deoxygenated blood from the body through
veins called the superior and inferior vena cava. These are the largest veins
in the body.

The right atrium contracts, and blood passes to the right ventricle.

Once the right ventricle is full, it contracts and pumps the blood to the lungs
via the pulmonary artery. In the lungs, the blood picks up oxygen and
offloads carbon dioxide.

Left side

The left side of the heart receives blood from the lungs and pumps it to the
rest of the body.

Newly oxygenated blood returns to the left atrium via the pulmonary veins.

The left atrium contracts, pushing the blood into the left ventricle. Once the
left ventricle is full, it contracts and pushes the blood back out to the body
via the aorta.

Gas exchange

When blood travels through the pulmonary artery to the lungs, it passes
through tiny capillaries that connect on the surface of the lung’s air sacs,
called the alveoli. The body’s cells need oxygen to function, and they
produce carbon dioxide as a waste product. The heart enables the body to
eliminate the unwanted carbon dioxide. Oxygen enters the blood and carbon
dioxide leaves it through the capillaries of the alveoli. The coronary arteries
on the surface of the heart supply oxygenated blood to the heart muscle

The heart has four valves to ensure that blood only flows in one
direction:

2
Aortic valve: This is between the left ventricle and the aorta.

Mitral valve: This is between the left atrium and the left ventricle.

Pulmonary valve: This is between the right ventricle and the pulmonary
artery.

Tricuspid valve: This is between the right atrium and right ventricle.

Blood vessels

There are three types of blood vessels:

Arteries: These carry oxygenated blood from the heart to the rest of the
body. The arteries are strong, muscular, and stretchy, which helps push
blood through the circulatory system, and they also help regulate blood
pressure. The arteries branch into smaller vessels called arterioles.

Veins: These carry deoxygenated blood back to the heart, and they increase
in size as they get closer to the heart. Veins have thinner walls than arteries.

Capillaries: These connect the smallest arteries to the smallest veins. They
have very thin walls, which allow them to exchange compounds such as
carbon dioxide, water, oxygen, waste, and nutrients with surrounding
tissues.

RENAL DISEASE URGENT (RDU)

KIDNEY

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Kidneys - remove waste and extra water from the blood (as urine) and help
keep chemicals (such as sodium, potassium, and calcium) balanced in the
body. The kidneys also make hormones that help control blood pressure and
stimulate bone marrow to make red blood cells.

Renal Cortex - The kidneys are surrounded by a renal cortex, a layer of

tissue that is also covered by renal fascia (connective tissue) and the renal
capsule. The renal cortex is granular tissue due to the presence of nephrons
—the functional unit of the kidney—that are located deeper within the
kidney, within the renal pyramids of the medulla. The cortex provides a
space for arterioles and venules from the renal artery and vein, as well as
the glomerular capillaries, to perfuse the nephrons of the kidney.

Ureters - Tubes that transfer urine from the kidneys to the bladder.

Renal Artery - The renal arteries branch off of the abdominal aorta and
supply the kidneys with blood. The arterial supply of the kidneys is variable
from person to person, and there may be one or more renal arteries
supplying each kidney.

Renal Veins - The renal veins are the veins that drain the kidneys and
connect them to the inferior vena cava. The renal vein drains blood from
venules that arise from the interlobular capillaries inside the parenchyma of
the kidney.

Minor Calyx - Any of the initial cuplike collection chambers for receiving
urine released from the papillary ducts at the renal papillae in the medulla of
the kidney; their walls consist of a mucosal lining of transitional

3
epithelium, a

3
submucosa of loose fibrous connective tissue, a muscularis for peristalsis,
and an adventitia; they merge to form the major calyces.

Major Calyx - Any of the cuplike collection chambers for receiving urine
flowing through the minor calyces in the renal medulla of the kidney; their
walls consist of a mucosal lining of transitional epithelium, a submucosa of
loose fibrous connective tissue, a muscularis for peristalsis, and an
adventitia; they merge to form the renal pelvis.

Glomerulus - represents the initial location of the renal filtration of blood.

Blood enters the glomerulus through the afferent arteriole at the vascular
pole, undergoes filtration in the glomerular capillaries, and exits the
glomerulus through the efferent arteriole at the vascular pole.

Efferent arterioles - form a convergence of the capillaries of the

glomerulus, and carry blood away from the glomerulus that has already been
filtered. They play an important role in maintaining the glomerular filtration
rate despite fluctuations in blood pressure.

Proximal tubule - also completes the reabsorption of glucose, amino acids,

and important anions, including phosphate and citrate, because it is the
solesite of transport of these filtered solutes. In addition to solute
reabsorption and secretion, the proximal tubule is also a metabolic organ.

Distal convoluted tubule - connects to the collecting duct system that

fine- tunes salt and water reabsorption and plays a major role in acid–base
balance.

Loop of Henle - is a long U-shaped portion of the tubule that conducts

urine within each nephron of the kidney of reptiles, birds, and mammals.
The principal function of the loop of Henle is in the recovery of water and
sodium chloride from urine.

Renal collecting tubule - is any of the long narrow tubes in the kidney that
concentrate and transport urine from the nephrons and moves it into the
renal pelvis and ureters.

PATHOPHYSIOLOGY
CVD INFARCT

3
CAP – MR

3
HYPERTENSIVE URGENCY DISEASE

3
RENAL DISEASE URGENCY

3
DEMENTIA

3
3
CEPHALO-CAUDAL ASSESSMENT
NEUROLOGICAL

The client was disoriented and conversed. Client appears to have

difficulty speaking and slurred speech. The head of the client is rounded;
there were no nodules or masses palpated. The client appeared lethargic due
to the condition. Client loss of balance and coordination noted.

EYES

The client has trouble seeing on both eyes. Pupil are equal, round,
reactive to light accommodate. The eyelids are symmetrical and has equal
movements. There was no presence of discharges, and no discoloration.

SKIN HAIR NAILS

The client’s skin is pallor. There are minimal rashes noted. No noted
presence of foul-smelling odor. Client has poor skin turgor and skin’s
temperature is within normal limits. Capillary refill returned 3 seconds.

CARDIOVASCULAR

The client is tachycardic upon palpation. Jugular distention of more

than 3cm above the sternal angle.

CHEST

The client is experiencing productive cough. There is asymmetrical

expansion. Presence of wheezing was noted upon auscultation. There is
dullness upon percussion.

WHOLE ABDOMEN

The abdomen is hyperactive upon auscultation. The client has

unblemished skin and is uniform in color. The abdomen has a symmetric
contour. There were symmetric movements caused by the client’s
respirations. No tenderness and pain noted upon palpation.

MUSCULOSKELETAL

The client has drooping on one side of the face. Client is immobile.
Muscles are palpable with the presence of tremors noted. There was no
presence of bone deformities, tenderness and swelling. There is difficulty
moving muscles and joints.

UPPER EXTREMITIES

3
 Extremities are symmetrical in size and length. The client has an
inability to raise left arm. Numbness is felt on the left side of the body.
Capillary refill returns 3 seconds.

LOWER EXTREMITIES

Peripheral edema was noted with 2+ pitting edema. Asymmetric

dorsalis pedis pulse noted upon palpation. Poor skin turgor noted at the
lower extremities. Capillary refill went back after 3 seconds.

GENITALS

Client voids thrice in a day. Pain upon urination is not present. There were no
lesions, inflammation, and swelling in the genitalia.

3
LABORATORIES AND DIAGNOSTIC STUDIES

Diagnostic Procedure Indication of Purpose Results and/or Possible Normal Values Significance or Interpretation Nursing Responsibilities
Results
High-sensitivity C- The high-sensitivity C- CRP HS: 20.70 mg/L CRP HS: 0-5 mg/L CRP HS: A high CRP test result is 1. Explain the procedure and
reactive Protein Test reactive protein (hs-CRP) a sign of acute inflammation. It its rationale to the patient.
test is a blood test that may be due to serious infection, 2. Tell the patient to avoid
finds lower levels of C- injury or chronic disease. The strenuous exercises before
reactive protein (CRP). This doctor will recommend other the test.
protein measures general tests to determine the cause. 3. Inform the patient that a
levels of inflammation in blood sample is required.
your body. The hs-CRP can 4. Note any medications the
be used to find the risk for patient is taking that may
heart disease and stroke in affect the CRP level.
people who don't already 5. If the blood sample will be
have heart disease. used for additional tests,
instruct the patient to
avoid eating or drinking for
a certain amount of time
before the test.
6. Provide accurate and
specific instructions to the
patient in preparation for
the test.
7. Perform care on the
patient’s puncture site.
8. Send the collected sample
to the lab for analysis.
9. Tell the patient that they
can return to their usual
activities immediately after
the test.
10. Relay the results to the
physician once available.

Diagnostic Procedure Indication of Purpose Results and/or Possible Normal Values Significance or Interpretation Nursing Responsibilities
Results
Clinical Chemistry General

3
 1. Verify the physician’s order
Lactate Dehydrogenase An LDH test is most often LDH: 425.21 U/L LDH: LDH: <480 U/L LDH: The patient’s LDH level is for the test.
(LDH) used to find out if you have within normal range. 2. Define each test to the
tissue damage and monitor patient, stating their
disorders that cause tissue specific purposes.
damage. These include 3. Explain the flow of the
anemia, liver disease, lung procedures to the patient.
disease, and some types of 4. Discuss with the patient
infections. the test preparation,
procedure, and posttest
Sodium A sodium blood test is used Sodium: 131.0 mmol/L Sodium: 136-145 mmol/L Sodium: The patient’s sodium care, allowing the patient
to detect an abnormal level is low, indicating to ask questions which
sodium level, including low hyponatremia. In hyponatremia, should then be answered
sodium (hyponatremia) and the level of sodium in blood is promptly.
high sodium too low. A low sodium level has 5. Gather and prepare the
(hypernatremia). It is often many causes, including equipment to be used.
used as part of an consumption of too many fluids, 6. Prepare the patient for
electrolyte panel or basic kidney failure, heart failure, testing.
metabolic panel for a cirrhosis, and use of diuretics. 7. Assist both the patient and
routine health exam. other health care providers
during diagnostic testing.
Potassium A potassium test measures Potassium: 4.50 mmol/L Potassium: 3.5-5.1 mmol/L Potassium: The patient’s 8. Monitor the patient
the amount of potassium potassium level is within normal throughout the procedure.
that is present in a sample range. 9. Monitor the patient’s
of either blood or urine. puncture site for
Potassium is an essential hematoma and bruising.
nutrient that is found 10. Relay the results of the
throughout the body and is tests whenever available.
necessary for healthy cell
activity. Without potassium, Electrolytes
the heart and other muscles 1. Verify the physician’s order
cannot function. for the test.
2. Educate the patient about
Creatinine As a waste product, Creatinine: 0.82 mg/dL Creatinine: 0.51-0.95 mg/dL Creatinine: The patient’s each test, stating their
creatinine is filtered out of creatinine level is within normal specific purposes.
the blood by the kidneys range. 3. Make the patient familiar
and removed from the body with the different
in urine. A creatinine test electrolytes of the body
measures the amount of and how they help in the
this chemical in either the normal physiology of
blood or urine. Creatinine humans.
levels 4. Explain the flow of the
can provide an indication of procedures to the patient.

4
 how well the kidneys are 5. Discuss with the patient
working. the test preparation,
procedure, and posttest
Blood Urea Nitrogen A blood urea nitrogen test BUN: 12.699 mg/dL BUN: 6.0-20.0 mg/dL BUN: The patient’s BUN level is care, allowing the patient
(BUN) can provide insight into how within normal range. to ask questions which
well the kidneys are should then be answered
working. The test may be promptly.
used for diagnosis, 6. Teach patient about
screening, and/or electrolyte imbalances and
monitoring. For these uses, how to spot signs of them.
BUN alone is generally less 7. Monitor patient for
informative than BUN taken presence of symptoms
with other measurements suggesting electrolyte
related to kidney function. imbalances.
8. Monitor patient’s heart rate
Blood Uric Acid (BUA) The uric acid blood test is BUA: 5.19 mg/dL BUA: 2.4-5.7 mg/dL BUA: The patient’s BUA level is throughout the procedure.
used to detect high levels of within normal range. 9. Monitor the patient’s
this compound in the puncture site for
blood in order to help hematoma and bruising.
diagnose gout. The test is 10. Relay the results of the
also used to monitor uric tests whenever available.
acid levels in people
undergoing chemotherapy Kidney Function Test
or radiation treatment for 1. Verify the physician’s order
cancer. Rapid cell turnover for the test.
from such treatment can 2. Educate the patient about
result in an increased uric each test, stating their
acid level. specific purposes.
3. Make the patient familiar
HBA1C An HbA1c test may be HBA1C: 5.70% HBA1C: 4.0-6.0% HBA1C: The patient’s HBA1C with the function of the
used to check for diabetes result is within normal range. kidneys and the waste
or prediabetes in adults. products they excrete.
Prediabetes means your 4. Explain the flow of the
blood sugar levels show you procedures to the patient.
are at risk for getting 5. Discuss with the patient
diabetes. If you already the test preparation,
have diabetes, an HbA1c procedure, and posttest
test can help monitor your care, allowing the patient
condition and glucose to ask questions which
levels. should then be answered
ALT (SGPT) ALT (SGPT): 30.44 U/L ALT (SGPT): 0-41 U/L promptly.
An ALT test measures the
level of alanine

4
aminotransferase, also ALT (SGPT): The patient’s ALT 6. Teach patient about causes
called ALT or SGPT. ALT is (SGPT) level is within normal of kidney damage to make
one of the enzymes range. them more aware of the
that help the liver convert general concept.
food into energy. High 7. Monitor patient for
levels of these enzymes can presence of symptoms
be a sign that the liver is suggesting kidney failure.
injured or irritated, and the 8. Monitor patient’s heart
enzymes are leaking out of rate, respiratory rate, and
the liver cells. blood pressure throughout
the procedure.
9. Monitor the patient’s
puncture site for
hematoma and bruising.
10. Relay the results of the
tests whenever available.

Liver Function Test

1. Verify the physician’s order
for the test.
2. Educate the patient about
each test, stating their
specific purposes.
3. Make the patient familiar
with the function of the
liver.
4. Explain the flow of the
procedures to the patient.
5. Discuss with the patient
the test preparation,
procedure, and posttest
care, allowing the patient
to ask questions which
should then be answered
promptly.
6. Teach patient about causes
of liver damage to make
them familiar with the
concept.
7. Monitor patient for
presence of symptoms
suggesting liver failure.

4
 8. Monitor patient’s vital signs
throughout the procedure.
9. Monitor the patient’s
puncture site for
hematoma and bruising.
10. Relay the results of the
tests whenever available.

Glucose Test
1. Verify the physician’s order
for the test.
2. Educate the patient about
each test, stating their
specific purposes.
3. Make the patient familiar
with the function of
glucose in the body cells.
4. Explain the flow of the
procedures to the patient.
5. Discuss with the patient
the test preparation,
procedure, and posttest
care, allowing the patient
to ask questions which
should then be answered
promptly.
6. Teach patient about causes
of glucose imbalances.
7. Monitor patient for
presence of symptoms
suggesting hyperglycemia
or hypoglycemia.
8. Monitor patient’s vital
signs.
9. Monitor the patient’s
puncture site for
hematoma and bruising.
10. Relay the results of the
tests whenever available.

4
Diagnostic Procedure Indication of Purpose Results and/or Possible Normal Values Significance or Interpretation Nursing Responsibilities
Results
Procalcitonin Test The procalcitonin test is Procalcitonin: 0.302 ng/mL Procalcitonin: <0.3 ng/mL Procalcitonin: The patient’s 1. Verify physician’s order for
useful in helping to detect procalcitonin level is elevated. the test.
sepsis and severe bacterial This means that the patient is at 2. Explain the procedure and
infections in the early a low risk of developing a septic its rationale to the patient.
stages and to distinguish response. 3. Inform the patient that the
between a bacterial test requires a blood
infection and other non- sample.
bacterial causes of signs 4. Inform patient that no
and symptoms in a special test preparations
seriously ill person. are needed prior to the
procedure.
5. Inform the patient that
they may feel a little sting
when the needle goes in or
out.
6. Inform the patient that the
test usually takes less than
five minutes.
7. Inform patient that they
may experience slight pain
or bruising at the sample
site which will go away
quickly.
8. Send the collected sample
to the lab for analysis.
9. Apply pressure to the
puncture site and put
gauze.
10. Relay the results to the
physician once available.

Diagnostic Procedure Indication of Purpose Results and/or Possible Normal Values Significance or Interpretation Nursing Responsibilities
Results
Blood Glucose Test A blood glucose test is a First result: Blood Glucose Level: 70-99 Blood Glucose Level: The 1. Explain the procedure and
(HGT) blood test that screens for mg/dL patient’s first blood glucose level its rationale to the patient.
diabetes by measuring the Blood Glucose Level: 52 is below normal range. This 2. Clean the skin at the
level of glucose (sugar) in a mg/dL means that the patient is sample site and dry it.
person's blood. Normal experiencing hypoglycemia. Low
blood glucose level (while Second result: blood glucose, also called low

4
 fasting) range within 70 to blood sugar or hypoglycemia, 3. Encourage patient to keep
99 mg/dL (3.9 to 5.5 Blood Glucose Level: 119 occurs when the level of glucose hands warm prior to
mmol/L). Higher ranges mg/dL in your blood drops below what sampling.
could indicate pre-diabetes is healthy for you. For many 4. Collect together all the
or diabetes. people with diabetes, this means equipment necessary to
a blood glucose reading lower perform the procedure.
than 70 milligrams per deciliter 5. Ensure that the patient is
(mg/dL). In the second test, the sitting or lying comfortably
patient was hyperglycemic. before the procedure.
Hyperglycemia (high blood 6. Ensure the code strip
glucose) means there is too matches the meter code.
much sugar in the blood because 7. Use lancet device to pierce
the body lacks enough insulin. skin at the side of the
finger and encourage
bleeding by use of gravity.
8. Promptly dispose of lancet
into sharps basin.
9. Report abnormal results,
having taken any
corrective action within
your sphere of
competence.
10. Relay results to physician
whenever available.

Diagnostic Procedure Indication of Purpose Results and/or Possible Normal Values Significance or Interpretation Nursing Responsibilities
Results
SARS-CoV-2 Virus PCR means polymerase Test Result: SARS-CoV-2 Test Result: SARS-CoV-2 Interpretation: The patient’s 1. Explain the procedure and
Detection by chain reaction. It's a test to viral RNA Not Detected viral RNA Not Detected result is negative. This means its rationale to the patient.
Polymerase Chain detect genetic material from that there is no SARS-CoV-2 2. Wear the appropriate PPE
Reaction a specific organism, such as infection in the patient at the when performing the
a virus. The test detects the time of the test. procedure.
presence of a virus if you 3. Uphold the standard
have the virus at the time COVID-19 protocol when
of the test. The test could engaging with the patient.
also detect fragments of the 4. Dispose of the soiled
virus even after you are no equipment and materials
longer infected. properly.
5. Inform the patient that
they may feel discomfort

4
 during the collection of
sample.
6. Send the collected sample
to the lab immediately for
analysis.
7. Instruct the patient to
properly position head to
facilitate easier insertion of
the swab.
8. Observe careful body
mechanics when collecting
the patient’s sample so as
not to cause injury.
9. Routinely disinfect the
area.
10. Relay the results to the
physician once available.

Diagnostic Procedure Indication of Purpose Results and/or Possible Normal Values Significance or Interpretation Nursing Responsibilities
Results
Immunology: COVID-19 A rapid COVID test is a type IgG Antibody: Negative IgG Antibody: Negative IgG: A negative result indicates 1. Explain to the patient the
Rapid Antibody Test of diagnostic test. Rapid that the SARS-CoV2 virus that procedure and its
(Qualitative) tests usually measure viral IgM Antibody: Negative IgG Antibody: Negative causes the COVID-19 disease rationale.
antigens, which are was not found. It is possible to 2. Wear the appropriate PPE
substances that tell your have a very low level of the virus when performing the
body to produce an immune in the body with a negative test procedure.
response to an infection. result. 3. Uphold the standard
Antigens are not the same COVID-19 protocol when
as antibodies, which your IgM: A negative test result engaging with the patient.
immune system produces in means that the antibodies to the 4. Dispose of the soiled
response to signals from virus that causes COVID-19 or to equipment and materials
antigens. Trained personnel the vaccine were not found in properly.
in a variety of settings can the patient’s sample. Some 5. Inform the patient that the
administer a COVID rapid health conditions might make it test requires a blood
antigen test. difficult for the body to produce sample.
antibodies to an infection or 6. Be aware of the margin of
vaccination. error involved in the tests.
7. Monitor the patient for
symptoms of COVID-19
before, during, and after
the procedure.

4
 8. Relay the results to the
physician whenever
available.
9. Firmly instruct the patient
to complete the
recommended isolation
period.
10. Routinely disinfect the
area.

signify internal bleeding,

Diagnostic Procedure Indication of Purpose Results and/or Possible Normal Values Significance or kidney
Results Interpretation
Hematology: Complete Blood A complete blood count WBC: The patient’s WBC
Count (CBC) (CBC) is a blood test. It WBC13.4103/mm3 count is high. This suggests
WBC 4.4- 103/mm3
gives your provider 11 than an infection is ongoing.
information about your blood % #
and overall health. CBCs NEU 87.7 11.74 NEU: The patient’s
% #
help providers diagnose, LYM 7.6 1.02 neutrophil count is high. This
NEU 37-80 1.8-
monitor and screen for a MON 3.7 0.50 suggests the presence of an
7.8
wide range of diseases, EOS 0.8 0.11 infection.
LYM 10-50 1-4.8
conditions, disorders and BAS 0.2 0.03 MON 0-12 0.2-1
infections. The patient’s LYM: The patient’s
EOS 0-7 0-0.5
RBC, WBC, and platelet RBC 4.08 106/mm3 lymphocyte count is low.
BAS 0-2.5 0-0.2
counts are taken into HGB 13.0 g/dL This may indicate a possible
consideration as well as HCT 39.4 % infection or illness.
other parameters that can MCV 97 µm3
be measured using a blood RBC 4.5- 106/mm3 MON: The patient’s
MCH 32.0 pg
sample. 5.9 monocyte
MCHC 33.1 g/dL
HGB 14- g/dL count is within normal range.
RDW 11.4 % 17.5
PLT 281 103/mm3
HCT 41.5- % EOS: The patient’s eosinophil
MPV 8.2 µm3 50.4 count is within normal range.
MCV 80-96 µm3
MCH 27.5- pg BAS: The patient’s basophil
33 count is within normal range.
MCHC 32-36 g/dL
RDW 11.6- % RBC: The patient’s RBC
14.8 count is low. It may indicate
PLT 150- 103/mm3 iron- deficiency anemia. A
450 low RBC count could also
MPV 6-11 µm3 indicate a vitamin B6, B12 or
folate deficiency. It may also

4
 Nursing Responsibilities

1. Explain the procedure

and its rationale to
the patient.
2. Inform patient that
slight discomfort may
be felt when the skin
is being punctured.
3. Inform patient that
this procedure
requires a blood
sample.
4. Encourage to avoid
stress if possible
because altered
psychologic status
influences and
changes
normal hematologic
values.
5. Explain that fasting is
not necessary.
6. Dispose of the used
equipment
appropriately.
7. Apply manual
pressure and
dressings over
puncture site after
the puncture.
8. Monitor the puncture
site for oozing or
hematoma formation.

4
disease or malnutrition 9. Instruct patient to
(where a person's diet resume normal activities
doesn't contain enough and diet.
nutrients to meet their 10. Relay the results to the
body's needs). physician once available.

HGB: The patient’s HGB is

low. Low hemoglobin levels
lead to anemia, which causes
symptoms like fatigue and
trouble breathing.

HCT: The patient’s HCT is

low. A lower than normal
hematocrit can indicate
an insufficient supply of
healthy red blood cells
(anemia), a large number of
white blood cells due to long-
term illness, infection or a
white blood cell disorder
such as leukemia or
lymphoma as well as vitamin
or mineral deficiencies.

MCV: The patient’s MCV is

high. If someone has a high
MCV level, their red blood
cells are larger than usual,
and they have macrocytic
anemia.

MCH: The patient’s MCH is

within normal range.

MCHC: The patient’s MCHC is

within normal range.

RDW: The patient’s RDW is

low. A low RDW means that
the patient’s red blood cells
are all about the same size.

4
 PLT: The patient’s platelet
count is within normal range.

MPV: The patient’s MPV is

within normal range.

Diagnostic Procedure Indication of Purpose Results and/or Possible Normal Values Significance or Interpretation Nursing Responsibilities
Results
Immunology: Thyroid Thyroid function tests are a TSH: 3.400 µIU/mL TSH: 0.25-5.0 µIU/mL TSH: The patient’s TSH level is 1. Verify the doctor’s order for
Studies series of blood tests used to within normal range. Patient’s the test.
measure how well your FT4: 10.06 pmol/L FT4: 12.0-20.0 pmol/L thyroid is functioning properly. 2. Explain the procedure and
thyroid gland is working. its rationale to the patient.
Available tests include the FT4: The patient’s FT4 is low. 3. Note medications the
T3, T3RU, T4, and TSH. The This indicates hypothyroidism patient is taking that might
thyroid is a small gland due to a problem with the affect the results of the
located in the lower-front pituitary gland. test.
part of your neck. 4. Note pregnancy in female
patients.
5. Inform the patient that a
blood sample is required in
this test.
6. Inform the patient that
they may feel a sharp prick
when the needle punctures
their skin.
7. Send the sample to the lab
for analysis.
8. Apply pressure on the
puncture wound until the

5
 bleeding stops and put a
gauze over it.
9. Tell the patient that they
can return to their daily
activities after the test.
10. Relay the results to the
physician once available.

Diagnostic Procedure Indication of Purpose Results and/or Possible Normal Values Significance or Interpretation Nursing Responsibilities
Results
Hematology: 1. Explain the procedure and
its rationale to the patient.
Prothrombin Time A prothrombin time (PT) is Patient: 11.8 seconds Patient: 9.2-13.2 seconds PT: The patient has a normal 2. Notify the laboratory and
a test used to help detect prothrombin time. This means physician of drugs the
and diagnose a Control: 11.2 seconds Control: -- that the patient’s clotting time is patient is taking that may
bleeding disorder or desirable. affect test results.
excessive clotting disorder; INR: 1.05 INR: 0.84-1.11 3. Tell the patient that the
the international INR: The patient’s INR is within test requires a blood
normalized ratio % Activity: 94.92% % Activity: 83-143% normal range. This means that sample.
(INR) is calculated the patient’s clotting function is 4. Perform a venipuncture
from a PT result and is used normal. and collect the sample in a
to monitor how well the 3 to 4 mL siliconized tube.
blood-thinning medication % Activity: The percentage of 5. Completely fill the
(anticoagulant) warfarin activity of the patient’s PT is collection tube and invert it
(Coumadin) is working to normal. There are no problems gently several times to mix
prevent blood clots. with clotting. the sample and the
Activated Partial Patient: 35.3 seconds Patient: 25.4-38.4 seconds anticoagulant thoroughly.
Thromboplastin Time The partial thromboplastin APTT: The patient’s APTT is If the tube isn’t filled to
time (PTT; also known as Control: 33.5 seconds Control: -- normal. There are no problems the correct volume, an
activated partial with clotting. excess of citrate appears
thromboplastin time in the sample.
(aPTT)) is a screening test 6. To avoid hemolysis, avoid
that helps evaluate a excessive probing during
person's ability to venipuncture and rough
appropriately form blood handling of the sample.
clots. It measures the 7. Immediately put the
number of seconds it takes sample on ice and send it
for a clot to form in a to the laboratory.
sample of blood after 8. Apply pressure to the
substances (reagents) are venipuncture site until
added. bleeding has stopped.

5
 9. Tell the patient that they
may resume any
medication that was
discontinued before the
test was ordered.
10. Relay the results to the
physician when possible.

Diagnostic Procedure Indication of Purpose Results and/or Possible Normal Values Significance or Interpretation Nursing Responsibilities
Results
Computed Tomography A CT scan can be used to CT Scan report: CT Scan report: Notable interpretations in the CT 1. Verify doctor’s order for
(CT) Scan visualize nearly all parts of  Multiple axial  No mass, hemorrhage or Scan report: the test.
the body and is used tomographic sections of hydrocephalus.  A focal hypodensity noted in 2. Obtain an informed
to diagnose disease or the head, without  Basal ganglia and the corona radiata and consent from the patient
injury as well as to plan contrast, were obtained. posterior fossa structures confluent low densities in the and make sure it is
medical, surgical or  There is no parenchymal are normal. centrum semiovale and properly signed.
radiation treatment. hemorrhage nor acute  No established major periventricular white matter 3. Explain the procedure and
infarction seen. vessel vascular territory increases the patient’s its rationale to the patient.
 A CSF-like hypodense infarct. chances of experiencing a 4. Assess and note the health
focus is noted in the  No intra or extra axial future stroke. history of the patient.
corona radiata. collection.  The mucosal thickening in 5. Instruct the patient to not
 Confluent low densities  The basal cisterns and the right maxillary sinus eat or drink for a period of
are seen in both centrum foramen magnum are suggests the occurrence of time especially if a
semiovale and patent. sinusitis. contrast material will be
periventricular white  The air cells of the  All other findings were used.
matter. petrous temporal bone normal and age-compatible. 6. Instruct the patient to
 The rest of the brain are non-opacified. remain still during the
parenchyma is intact,  No fracture procedure.
with no focal mass lesion demonstrated. 7. Inform the patient that the
nor abnormal procedure may take 5
calcification seen. IMPRESSION: minutes to 1 hour
 There is normal gray-  NORMAL STUDY depending on the type of
white matter scan and their ability to
demarcation. The relax and remain still.
midline structures are 8. Instruct the patient to
undisplaced. resume the usual diet and
 The ventricles, sulci, activities unless otherwise
Sylvian fissures, and ordered.

5
 cerebellar folia aree 9. Encourage the patient to
widened. increase fluid intake if a
 The brainstem and contrast was given.
cerebelleum are 10. Relay the results to the
unremarkable. physician once available.
 The visualized
sellar/suprasellar
regions, both orbits and
mastoids are
unremarkable.
 There is mucosal
thickening in the right
maxillary sinus. The rest
of the paranasal sinuses
are aerated.
 The calvarium and basal
skull structure are
unremarkable.

IMPRESSION:
 CHRONIC LACUNAR
INFARCT IN THE RIGHT
CORONA RADIATA
 MODERATE
MICROVASCULAR
ISCHEMIC CHANGES IN
BOTH CENTRUM
SEMIOVALE AND
PERIVENTRICULAR
WHITE MATTER.
 AGE-COMPATIBLE
CEREBRO-CEREBELLAR
VOLUME LOSS.
 RIGHT MAXILLARY
SINUSITIS.

Diagnostic Procedure Indication of Purpose Results and/or Possible Normal Values Significance or Interpretation Nursing Responsibilities
Results
Electrocardiogram An electrocardiogram is Possible Results: 1. Verify physician’s order
used to assess causes of 1. Arrhythmias regarding the test.

5
conditions such as chest 2. Pathologic Q-wave  Rhythm: Normal sinus 1. Arrhythmias are seen in 2. Explain the procedure and
pain, palpitations, and other 3. Poor R wave progression rhythm patients with stroke and its rationale to the patient.
related symptoms. It is also 4. Fragmented QRS  Q-wave: Q-waves are even CAP-MR. 3. Note current cardiac
used to assess how complex likely to be present in 2. Pathologic Q-waves have therapy on the test
medications affect the heart 5. ST-segment depression more leads when the been found in patients with request form.
as well as to identify the 6. ST-segment elevation transitional zone is stroke. 4. Note pertinent clinical
signs and symptoms of 7. Prolonged QTc interval located on the right side 3. Poor R wave progression information such as chest
heart disease. Moreover, it 8. Asymmetric tall T-waves of the precordium. The may suggest kidney disease. pain or pacemaker.
is used to assess the 9. Peaked T-wave duration of the Q-waves 4. Fragmented QRS complexes 5. Explain that the test is
performance of the 10. Prominent U-wave is 0.03 second or less. may indicated kidney painless and takes 5 to 10
pacemaker. 11. Left ventricular The amplitude usually disease. minutes.
hypertrophy is less than 0.2 mV, 5. ST-segment depression can 6. Place the patient in a
although it may reach 0.3 be found in patients who supine or semi-Fowler’s
mV or even 0.4 mV. suffered stroke. position.
 R-wave: R-wave should 6. ST-segment elevation can be 7. Make sure that the
be < 26 mm in V5 and found in patients who electrodes are firmly
V6. R-wave amplitude in suffered stroke. attached.
V5 + S-wave amplitude in 7. Prolonged QTc intervals may 8. Disconnect the equipment,
V1 should be <35 mm. R- suggest stroke and kidney remove the electrodes,
wave amplitude in V6 + disease. and remove the gel with a
S-wave amplitude in V1 8. Asymmetric tall T-waves moist cloth towel after the
should be <35 mm. have been observed in procedure.
 S-wave: In the normal patients suffering from 9. If the patient is having
ECG, there is a large S stroke and hypertensive recurrent chest pain or if
wave in V1 that crisis. serial ECGs are ordered,
progressively becomes 9. Peaked T-waves have been leave the electrode
smaller, to the point that observed in patients patches in place.
almost no S wave is suffering from stroke and 10. Relay results to the
present in V6. kidney disease. physician once available.
 QRS complex: The normal 10. Prominent U-waves may
duration (interval) of the indicate the incidence of a
QRS complex is between stroke.
0.08 and 0.10 seconds — 11. Left ventricular hypertrophy
that is, 80 and 100 may suggest kidney disease.
milliseconds
 ST segment: The ST
segment is the interval
between the end of the
QRS complex (J point, or
ST junction) and the
beginning of the T wave.
In the limb leads, the ST

5
 segment is isoelectric in
about 75 percent of
normal adults. ST
segment elevation or
depression up to 0.1
mV generally is
considered within normal
limits.
 QT interval: In general,
the normal QT interval is
below 400 to 440
milliseconds (ms), or 0.4
to 0.44 seconds. Women
have a longer QT interval
than men. Lower heart
rates also result in a
longer QT interval.
 T-wave: A normal T-wave
usually has amplitude of
less than 5mm in the
precordial leads and less
than 10mm in the limb
leads.
 U-wave: The normal U
wave has the same
polarity as the T wave
and is usually less than
one-third the amplitude of
the T wave. U waves are
usually best seen in the
right precordial leads
especially V2 and V3.
 Heart configuration:
Shape is generally
smooth, not notched or
peaked.

5
NURSING PROBLEM LIST

NUMBER REASON/S OR
OF NURSING DIAGNOSIS DISCUSSIONS
PRIORITY

A decrease
Impaired Physical Mobility in muscle function, loss
1 related to neuromuscular of muscle mass,
impairment as evidence by reduction in muscle
immobility strength, gait changes
affecting balance, and
stiffer and limited mobile
joints can significantly
jeopardize the mobility
of
aged patients.

A lack of adequate blood

supply to brain cells
2 Ineffective cerebral tissue deprives them of oxygen
perfusion related to impaired and vital nutrients which
blood flow towards cerebral can cause part of the
tissue secondary to chronic brain to die off.
lacunar infarct.

A decrease in oxygen
resulting in the failure to
nourish the tissues at
Ineffective cerebral tissue the capillary level.
3 perfusion related to Decreased tissue
interruption of blood flow as perfusion can be
evidence by altered mental temporary, with few or
status. minimal consequences to
the health of the patient,
or it can be more acute
or protracted, with
potentially destructive
effects on the patient.
When diminished tissue
perfusion becomes
chronic, it can result in
tissue or organ damage
or death.

5
 The diagnosis Disturbed
Disturbed thought process Thought Processes
4 related head injury as describes an individual
evidence by memory with altered perception
problem. and cognition that
interferes with daily
living.

Generalized weakness
and debilitation from
acute or chronic
Activity intolerance related to illnesses. And for CVD
generalized weakness as the patient is week and
5 evidence by reports of energy reserves are also
fatigue. depleted due to poor
brain functioning
because of stroke

5
DRUG STUDIES

Mechanism of
Drug Names Classification Indication Contraindication Side Effects Nursing Responsibilities
Action

Generic Second Binds to Treatment of Contraindications: Body as a Before

Name: generation bacterial cell susceptible History of Whole: Thrombophl 1. Introduce self to the patient
Cefuroxime cephalosporin; membranes, infections due hypersensitivity/a ebitis (IV site); pain, 2. Establish rapport to the patient
Antibiotic inhibits cell wall to group B naphylactic burning, cellulitis 3. Explain the importance of the drug
Brand Name: synthesis. streptococci, reaction to (IM site); 4. Explain the possible effects of the drug
Zinacef pneumococci, cefuroxime, superinfections, 5. Determine history of hypersensitivity
Therapeutic staphylococci, cephalosporins. positive Coombs' reactions to cephalosporins, penicillin, and
Dosage: Effect: H. influenzae, test history of allergies, particularly to drugs,
15gm Bactericidal E. coli, Cautions: Severe before therapy is initiated.
Enterobacter, renal impairment, GI: Nausea, 6. Lab tests: Perform culture and sensitivity
Route: Klebsiella, history of penicillin diarrhea, antibiotic- tests before initiation of therapy and
IVTT including allergy. Pts with associated colitis periodically during therapy if indicated.
acute/chronic hx of colitis, GI Therapy may be instituted pending test
Frequency: bronchitis, malabsorption, Skin: Pruritus, Rash results.
Q8h ANST gonorrhea, seizures. 7. If patient is a mother, instruct not to
impetigo, early breastfeed while taking this drug
Timing: Lyme disease,
8am,4pm, Adverse Effects
otitis media, During
12am pharyngitis/ton 8. Monitor periodically BUN and creatinine
sillitis, CNS: Headache, clearance.
sinusitis, Insomnia 9. Inspect IM and IV injection sites frequently
skin/skin for signs of phlebitis.
structure, UTI, Skin: Urticaria 10. Report onset of loose stools or diarrhea.
perioperative Although pseudomembranous colitis rarely
prophylaxis Urogenital: Increas occurs, this potentially life-threatening
ed serum creatinine complication should be ruled out as the
and BUN, decreased cause of diarrhea during and after antibiotic
creatinine clearance therapy.

5
 11. Monitor for manifestations of
hypersensitivity. Discontinue drug and
report their appearance promptly.
12. Monitor I&O rates and pattern: Especially
important in severely ill patients receiving
high doses. Report any significant changes.

After
13. Report loose stools or diarrhea promptly.
14. Report any signs or symptoms of
hypersensitivity.
15. Document any reactions of the drug

5
 Mechanism of
Drug Names Classification Indication Contraindication Side Effects Nursing Responsibilities
Action

Generic Anti-infective, A macrolide Pneumonia, Hypersensitivity to CNS: Headache, Before

Name: Macrolide antibiotic that lower azithromycin or dizziness 1. Question for history of hepatitis, allergies to
Azithromycin Antibiotic reversibly binds respiratory other macrolide azithromycin, erythromycins.
to the 50S tract antibiotics. History GI: Nausea, 2. Assess for infection (WBC count, appearance of
Brand Name: ribosomal infections, of cholestatic vomiting, wound, evidence of fever).
Zithromax subunit of pharyngitis/ton jaundice/hepatic diarrhea, 3. Check for GI discomfort, nausea, vomiting.
susceptible sillitis, impairment abdominal pain Monitor daily pattern of bowel activity and stool
Dosage: organisms and gonorrhea, associated with consistency.
500mg/tab consequently nongonococcal prior azithromycin 4. Assess for hepatotoxicity: malaise, fever,
inhibits protein urethritis, skin therapy. abdominal pain, GI disturbances.
Route: synthesis and skin 5. If patient is a mother, instruct not to
PO structure Cautions: breastfeed while taking this drug
Therapeutic infections due Hepatic/renal
Frequency: Effects: to susceptible impairment, Adverse Effects During
OD x 6days Effective for organisms, myasthenia gravis, 6. Monitor LFT, CBC.
treatment of otitis media, hepatocellular 7. Be alert for superinfection: fever, vomiting,
Timing: mild to Mycobacterium and/or cholestatic GI: diarrhea, anal/genital pruritus, oral mucosal
8am moderate avium– hepatitis (with or Hepatotoxicity; changes (ulceration, pain, erythema).
infections intracellular without jaundice), mild elevations in 8. Avoid concurrent administration of aluminum-
caused by complex hepatic necrosis. liver function or magnesium-containing antacids
pyogenic infections, May prolong QT tests. 9. Instruct patient not to take azithromycin with
streptococci, Str acute bacterial interval. food or antacids.
eptococcus sinusitis. 10. Monitor PT and INR closely with concurrent
pneumoniae, Zmax: acute warfarin use.
Haemophilus bacterial 11. Instruct patient that direct sunlight (UV)
influenzae, and sinusitis and exposure should be minimized during therapy
Staphylococcus community with drug.
aureus. acquired 12. Advise patient to use sunscreen and protective
pneumonia. clothing to prevent photosensitivity reactions.
13. May cause drowsiness and dizziness. Caution
patient to avoid driving or other activities
requiring alertness until response to medication
is known

5
After
14. Inform patient to report onset of loose stools or
diarrhea.
15. Advise patients being treated for
nongonococcal urethritis or cervicitis that
sexual partners should also be treated.

6
 Mechanism of
Drug Names Classification Indication Contraindication Side Effects Nursing Responsibilities
Action

Generic Proton Pump Inhibits both Pantoprazole Hypersensitivity to CNS: Change in mood Before
Name: Inhibitor basal and for injection is drug or of the (depression), drowsiness, 1. Observe rights of administration.
Pantoprazole stimulated indicated for combination fatigue 2. Assess for possible contraindications
gastric acid short-term partners, mild and cautions: history of allergy to a
Brand Name: secretion by treatment (7- gastrointestinal GI: Constipation, diarrhea proton
Protonix suppressing 10 days) of complaints e.g., pump inhibitor to reduce the risk of
the final steps in patients having nervous Skin: Pruritus, Hives hypersensitivity reaction and current
Dosage: acid gastroesophag dyspepsia, should status of pregnancy or lactation because
40mg/vial production, eal reflux not be used in of the potential for adverse effects on
through the disease combination the fetus or nursing baby.
Route: inhibition of the (GERD) with a treatment for 3. Perform a physical examination.
IVTT proton pump by history of eradication of H. ADVERSE EFFECTS 4. Assess neurological status.
binding to and erosive pylori in patients 5. Inspect and palpate the abdomen to
Frequency: inhibiting esophagitis, as with CNS: Headache, determine potential underlying medical
STAT hydrogen an moderate to Insomnia conditions.
potassium alternative to severe hepatic or 6. Assess for changes in bowel
Timing: - adenosine oral medication renal dysfunction. Skin: Rash elimination and GI upset.
triphosphatase, in patients who 7. Provide thorough patient teaching,
the are unable to GI: Diarrhea, including the drug name and prescribed
enzyme located continue taking flatulence, abdominal dosage.
at the secretory pantoprazole pain
surface of the delayed- During
gastric parietal release tablets. 8. Administer drug before meals.
cell. Also 9. Ensure that the patient does not open,
for the chew, or crush the capsule.
treatment of 10. Provide appropriate safety and
pathological comfort.
hypersecretory
conditions After
associated with 11. Advise client to report severe
Zollinger- diarrhea; drugs may have to be
Ellison discontinued.
Syndrome or 12. Advise patient that hypoglycemia
other may occur.
neoplastic
conditions.

6
13. Advise patient to avoid hazardous
activities.
14. Advise patient to avoid alcohol,
salicylates, ibuprofen.
15. Document the medication time and
dose

6
 Mechanism of
Drug Names Classification Indication Contraindication Side Effects Nursing Responsibilities
Action

Generic Central Citicoline Treatment Hypersensitivity CV: Fleeting Before

Name: stimulant; consumption for Patients with hypotension, 1. Assess for any allergies on the drug
Citicoline Nootropic promotes brain cardiovascula hypertonic of the chest tightness 2. Check VS for baseline data
agent metabolism by r disease, parasympathetic. 3. Explain the importance of the drug
Brand Name: restoring head trauma, CNS: Headache, 4. Explain the possible effects of the drug
Neurolin phospholipid stroke, Precautions Blurred Vision 5. Caution women who are pregnant or trying to
content in the cognitive For patients with become pregnant should consult with their doctor
Dosage: brain and disorders, acute, severe and GI: Nausea, before taking the supplements.
1gm regulation of Parkinson’s progressive diarrhea
neuronal disease disturbances of During
Route: membrane consciousness due Skin: Rashes 6. Teach the patient that citicoline may be taken with
IVTT/PO excitability. It to head injury and or without food.
also influences brain surgery. 7. Monitor for adverse effects; instruct patient to
Frequency: the In case of persistent ADVERSE report immediately if he/she develops chest
q6hrs/ TID mitochondria or intracranial EFFECTS: tightness, tingling in mouth and throat, headache,
energy factories hemorrhage, the diarrhea and blurring of vision.
Timing: of the brain very slow CV: 8. Inform the patient that the supplement should not
8am, cells and administration (30 Bradycardia, be taken in the late afternoon or at night because
2pm,8pm, 2am found to drops/minute) is Tachycardia it can cause difficulty sleeping
improve recommended After
8am, 1pm, memory because the GI: Epigastric 9. Instruct patient to take the medication as
8pm function. After administration of discomfort prescribed.
several clinical larger doses could 10. Encourage patient to contact the physician
trials, Citicoline provoke an increase immediately if allergic reaction such as hives,
has been shown of the cerebral blood rash, or itching, swelling in your face or hands,
to raise the flow. mouth or throat, chest tightness or trouble
amount of Citicoline may cause breathing are experienced
acetylcholine in hypotension and in 11. Advise patient to follow prescribed medication
the brain. case necessary the 12. Monitor for effectiveness of comfort measures.
hypotensive effect 13. Monitor for compliance to drug therapy regimen.
can be treated with 14. Monitor laboratory tests.
corticosteroids or 15. Document any reactions of the drug.

6
Drug Names Classification Mechanism of Indication Contraindication Side Effects Nursing Responsibilities
Action

Generic Hydroxymethyl Inhibits HMG- Primary Hypersensitivity to Body as a Before

Name: glutaryl CoA CoA reductase, prevention of atorvastatin. Active Whole: Back 1. Monitor for therapeutic effectiveness which is
Atorvastatin (HMG-CoA) the enzyme that cardiovascula hepatic disease, pain, indicated by reduction in the level of LDL-C.
reductase catalyzes the r disease in breastfeeding, asthenia, 2. Lab tests: Monitor lipid levels within 2– 4 weeks
Brand Name: inhibitor; early step in high-risk pts. pregnancy, hypersensitivity after initiation of therapy or upon change in
Lipitor Antihyperlipide cholesterol Reduces risk unexplained reaction, dosage; monitor liver functions at 6 and 12 weeks
mic synthesis. of stroke and elevated LFT results. myalgia, after initiation or elevation of dose, and
Dosage: heart attack rhabdomyolysis periodically thereafter.
40mg/tab Therapeutic in pts with Cautions: . 3. Assess for muscle pain, tenderness, or weakness;
Effect: type 2 Anticoagulant and, if present, monitor CPK level (discontinue
Route: Decreases LDL diabetes with therapy; history of CNS: Headache drug with marked elevations of CPK or if
PO and VLDL, or without hepatic disease; myopathy is suspected).
plasma evidence of substantial alcohol GI: Abdominal 4. Monitor carefully for digoxin toxicity with
Frequency: triglyceride heart consumption; pts pain, concurrent digoxin use.
OD levels; disease. with prior constipation,
increases HDL Reduces risk stroke/TIA; diarrhea, During
Timing: concentration of stroke in concomitant use of dyspepsia, 5. Report promptly any of the following: Unexplained
7am pts with or potent CYP3A4 flatulence, muscle pain, tenderness, or weakness, especially
without inhibitors; elderly increased liver with fever or malaise; yellowing of skin or eyes;
evidence of (predisposed to function stomach pain with nausea, vomiting, or loss of
heart disease myopathy). tests. appetite; skin rash or hives.
with multiple 6. Do not take drug during pregnancy because it
risk factors may cause birth defects. Immediately inform
other than physician of a suspected or known pregnancy.
diabetes. 7. Inform physician regarding concurrent use of any
of the following drugs: erythromycin, niacin,
OFF-LABEL: antifungals, or birth control pills.
Secondary 8. Minimize alcohol intake while taking this drug.
prevention in 9. Do not breast feed while taking this drug.
pts who have
experienced
a After
noncardioem 10. Advise patient that this medication should be used
bolic in conjunction with diet restrictions (fat,
cholesterol, carbohydrates, alcohol), exercise, and

6
stroke/TIA or Adverse cessation of smoking. Atorvastatin/ezetimibe does
following an Effects not assist with weight loss.
acute 11. Instruct patient to notify health care professional
coronary Respiratory: promptly if unexplained muscle pain, tenderness,
syndrome Sinusitis or weakness occurs, especially if accompanied by
(ACS) event. , pharyngitis. fever or malaise
12. Notify health care professional if signs of liver
Skin: Rash problems (feeling tired or weak; loss of appetite;
upper belly pain; dark urine; or yellowing of skin
Cognitive: or whites of eyes).
Forgetfulness, 13. Educate patient to take medication as directed. If
memory loss, a dose is missed, omit and resume usual schedule
confusion with next dose. Do not double up on missed
doses.
14. Report any complications if there is any.
15. Document the findings.

6
 Mechanism of
Drug Names Classification Indication Contraindication Side Effects Nursing Responsibilities
Action

Generic Penicillin; Ampicillin Treatment of Hypersensitivity to Body as a Whole: Before

Name: Antibiotic inhibits bacterial susceptible ampicillin, any Hypersensitivity (rash, 1. Obtain baseline vital signs
Ampicillin cell wall infections, penicillin, or itching, anaphylactoid 2. Explain the importance and effects of the
+Sulbactam synthesis. including intra- sulbactam. reaction), fatigue, drug.
Sulbactam abdominal, Hx of cholestatic malaise, headache, 3. Monitor CBC and liver function test results
Brand Name: inhibits bacterial skin/skin jaundice, hepatic chills, edema. 4. Determine previous hypersensitivity
Unasyn beta-lactamase. structure, impairment reactions to penicillin, cephalosporins, and
gynecologic associated with GI: Diarrhea, nausea, other allergens prior to therapy.
Dosage: Therapeutic infections, due ampicillin/sulbacta vomiting, abdominal 5. Question for history of allergies, esp.
15gm Effect: to beta- m. distention, candidiasis. penicillin, cephalosporins; renal
Ampicillin is lactamase– impairment.
Route: bactericidal in producing Cautions: During
IVTT susceptible organisms, History of 6. Check IM injection site for pain, induration.
microorganisms including H. allergies, esp. 7. Monitor for seizures when giving high doses.
Frequency: . Sulbactam influenzae, E. cephalosporins; 8. Watch for bleeding tendency and
Q6hrs protects coli, Klebsiella, renal hemorrhage.
ampicillin from Acinetobacter, impairment; 9. Monitor I &O, urinalysis, renal function
Timing: - enzymatic Enterobacter, infectious tests.
8am, 2pm, degradation. S. mononucleosis; 10. Advise patient to minimize GI upset by
8pm, 2am aureus, and asthmatic pts. ADVERSE EFFECTS eating small, frequent servings of food and
Bacteroides drinking plenty of fluids
spp. OFF- Hematologic: Neutro After
LABEL: penia, 11. Promptly report rash (although common
Endocarditis, thrombocytopenia. with ampicillin, may indicate
community- hypersensitivity) or diarrhea (fever,
acquired Urogenital: Dysuria abdominal pain, mucus and blood in stool
pneumonia, may indicate antibiotic-associated colitis).
surgical CNS: Seizures 12. Be alert for superinfection: fever, vomiting,
prophylaxis, diarrhea, anal/genital pruritus, oral
pelvic Other: Local pain at mucosal changes (ulceration, pain,
inflammatory injection site; erythema).
disease. thrombophlebitis 13. Advise him to use soft toothbrush and
electric razor to avoid gum and skin injury

6
14. Monitor for CDAD, which can be fatal.
Antibiotic may need to be stopped and
other treatment begun.
15. Evaluate IV site for phlebitis.

6
 Mechanism of
Drug Names Classification Indication Contraindication Side Effects Nursing Responsibilities
Action

Generic Second Competes with Relief of Hypersensitivity to GI: Constipation, Before

Name: generation histamine for symptoms cetirizine, diarrhea, dry 1. Check VS for baseline data
Cetirizine piperazine; H1 (sneezing, hydroxyzine. mouth. 2. Explain the importance of the drug and its
Antihistamine -receptor sites rhinorrhea, effects.
Brand Name: on effector cells postnasal Cautions: Elderly, CNS: Drowsiness, 3. Assess symptoms and record baseline before
Zyrtec in GI tract, discharge, hepatic/renal sedation, and during treatment.
blood vessels, nasal impairment. headache, 4. Assess lung sounds.
Dosage: respiratory pruritus, fatigue 5. Assess severity of rhinitis, urticaria, other
10mg/tab tract. ocular symptoms.
pruritus, During
Route: Therapeutic tearing) of 6. For upper respiratory allergies, increase fluids to
PO Effect: upper ADVERSE maintain thin secretions and offset thirst.
Prevents respiratory EFFECTS Monitor symptoms for therapeutic response.
Frequency: allergic allergies; 7. Provide skin care for urticaria.
OD qhs response, relieves CNS: Depression 8. Do not use in combination with OTC
produces mild itching due to antihistamines.
Timing: bronchodilation, urticaria. GI: Nausea, 9. Take this drug without regard to meals.
9pm blocks Vomiting,
histamine- abdominal pain, After
induced 10. Instruct patient not engage in driving or other
bronchitis. GU: Urinary hazardous activities, before experiencing your
retention responses to the drug Inform patient that the
use of alcohol can increase drowsiness
11. Advise patient to avoid alcohol and other CNS
depressants because of the increased risk of
sedation and adverse effects.
12. Monitor for sedation, especially the older adult
Remind patient who have missed a dose should
take it as soon as they remember. If it is almost
time for the next dose, patients should skip the
missed dose. Double doses should not be taken.
13. Evaluate therapeutic response.

6
14. Instruct patient to report other troublesome side
effects, including severe or prolonged dry mouth
or upper respiratory tract irritation.
15. Document any abnormal reactions of the drug

6
Drug Names Classification Mechanism Indication Contraindication Side Effects Nursing Responsibilities
of Action

Generic Histamine1 Competes Treatment of Hypersensitivity to CNS: Drowsiness, Before

Name: antagonist, 1st with allergic diphenhydrAMINE. dizziness, headache, 1. If pt is having acute allergic reaction,
Diphenhydrami generation. histamine reactions, Neonates or premature fatigue, restlessness obtain history of recently ingested foods,
ne Antihistamine, for H-1 including nasal infants, breastfeeding. drugs, environmental exposure,
anticholinergic, receptor site allergies and GI: dry mouth, emotional stress.
Brand Name: antipruritic, on effector allergic Cautions: Narrow- nausea, anorexia, 2. Monitor B/P rate; depth, rhythm, type of
Nytol antitussive, cells in GI dermatoses; angle glaucoma, vomiting, constipation respiration; quality, rate of pulse.
antiemetic, tract, blood parkinsonism, stenotic peptic ulcer, 3. Assess lung sounds for rhonchi,
Dosage: antidyskinetic. vessels, including drug- prostatic hypertrophy, CV: Palpitation and wheezing, rales.
50mg respiratory induced pyloroduodenal/bladde bradycardia During
tract. extrapyramidal r neck obstruction, 4. Monitor B/P, esp. in elderly (increased
Route: symptoms; asthma, COPD, Respiratory: risk of hypotension).
IVTT Therapeuti prevention/treat increased IOP, wheezing, thickened 5. Monitor children closely for paradoxical
c Effect: ment of nausea, cardiovascular disease, bronchial secretions reaction.
Frequency: Produces vomiting, or hyperthyroidism, 6. Monitor for sedation.
30 min ac anticholiner vertigo due to elderly. 7. Supervise ambulation and use side-rails
Tocilizumab gic, motion sickness; as necessary. Drowsiness is most
administration antipruritic, antitussive; prominent during the first few days of
antitussive, short-term therapy and often disappears with
Timing: antiemetic, management of continued therapy. Older adults are
3:30 antidyskineti insomnia; especially likely to manifest dizziness,
c, sedative adjunct to sedation, and hypotension.
effects. EPINEPHrine in 8. Monitor for adverse effects especially in
treatment of children and the older adult.
anaphylaxis. 9. Encourage patient to increase fluid intake
Topical form to avoid dryness from the drug
used for relief of After
pruritus from 10. Inform patient to avoid tasks that require
insect bites, skin alertness, motor skills until response to
irritations. drug is established.
11. Alert patient that dry mouth, drowsiness,
dizziness may be an expected response
to drug.
12. Encourage patient to avoid alcohol.

7
13. Instruct patient not drive or engage in
other potentially hazardous activities until
the response to drug is known.
14. Instruct patient to avoid using CNS
depressants drug
15. Document the any abnormal reactions of
the drug.

7
 Mechanism of Indicatio
Drug Names Classification Contraindication Side Effects Nursing Responsibilities
Action n

Generic Benzodiazepine Enhances the Manageme Hypersensitivity to CNS: Drowsiness, Before

Name: ; Antianxiety inhibitory nt of Alprazolam. Acute sedation, light- 1. Assess degree of anxiety
Alprazolam effects of the generalize narrow angle headedness, dizziness, 2. Assess for drowsiness, dizziness, light-
neurotransmitte d anxiety closure glaucoma, depression, headache, headedness.
Brand Name: r gamma- disorders concurrent use with confusion, nervousness, 3. Assess motor responses (agitation,
Xanax aminobutyric (GAD). ketoconazole or fatigue, clumsiness, trembling, tension), autonomic responses
acid in the Short-term itraconazole or unsteadiness, rigidity, (cold/clammy hands, diaphoresis). Initiate
Dosage: brain. relief of other potent tremor, restlessness, fall precautions.
500mg/tab symptoms CYP3A4 inhibitors. paradoxical excitement 4. For pts on long-term therapy, perform
Therapeutic of anxiety, Cautions: hepatic/renal function tests, CBC
Route: Effect: panic Renal/hepatic ADVERSE EFFECTS periodically
PO Produces disorder, impairment, 5. Assess for paradoxical reaction, particularly
anxiolytic effect with or predisposition to CNS: syncope, insomnia, during early therapy.
Frequency: due to CNS without urate nephropathy, hallucinations During
STAT depressant agoraphobi obese pts. 6. Monitor respiratory and cardiovascular
action. a. Anxiety Concurrent use of CV: Tachycardia, status.
Timing: associated CYP3A4 hypotension, ECG 7. If dizziness occurs, change positions slowly
1:27pm with inhibitors/inducers changes from recumbent to sitting position before
depression and major CYP3A4 standing.
. OFF- substrates; Special Senses: Blurred 8. Sour hard candy, gum, sips of water may
LABEL: debilitated pts, vision relieve dry mouth
Anxiety in respiratory disease, 9. Monitor for S&S of drowsiness and
children. depression (esp. Respiratory: Dyspnea. sedation, especially in older adults or the
suicidal risk), elderly debilitated;

7
Preoperati (increased risk of they may require supervised ambulation
ve anxiety. severe toxicity). and/or side rails.
History of substance After
abuse. 10. Remind patient not drive or engage in
potentially hazardous activities until
response to drug is known.
11. Inform patient that smoking reduces drug
effectiveness.
12. Advice patient to avoid alcohol consumption
13. Do not abruptly withdraw medication after
long-term therapy
14. Instruct patient not take other medications
without consulting physician.
15. Evaluate for therapeutic response: calm
facial expression, decreased restlessness,
insomnia

7
 Mechanism of
Drug Names Classification Indication Contraindication Side Effects Nursing Responsibilities
Action

Generic Antiplatelet Inhibits binding Reduction of Active bleeding CNS: Headache, dizziness, Before
Name: of enzyme atherosclerosis (e.g.,peptic ulcer, weakness, syncope, 1. Perform platelet counts before drug
Clopidogrel adenosine events (MI, intracranial flushing. therapy.
phosphate stroke, hemorrhage). GI: Nausea, GI distress, 2. Educate the client about the
Brand Name: (ADP) to its vascular death) constipation, diarrhea, GI specific dose and indication
Plogrel platelet in pts at risk bleeding. of the drug
receptor and for such events SKIN: rashes, pruritus 3. Inform patient that drug may be taken
Dosage: subsequent including CV: Hypertension, edema without regard to meals.
75 mg/tab ADP-mediated recent MI, Others: Increased bleeding 4. Warn the patient that this drug can be
activation of a acute coronary risk harmful if she is pregnant or lactating mom.
Route: glycoprotein syndrome 5. Inform the client about the possible side
PO complex. (unstable effects after taking the drug.
Therapeutic angina/non-Q- ADVERSE EFFECTS
Frequency: Effect: Inhibits wave MI), During
OD platelet stroke, or CNS: Depression, confusion, 6. Monitor platelet count for evidence of
aggregation. peripheral fatal thrombocytopenia.
Timing: vascular intracranial bleeding 7. Assess BUN, serum creatinine, bilirubin,
1pm disease. GI: Gastritis AST, ALT, WBC, Hgb, Hct, signs/symptoms of
Hemat: Agranulocytosis, hepatic insufficiency during therapy.
aplastic 8. Instruct patient that if there is any
anemia/pancytopenia, prolonged bleeding time, there is bleeding
thrombotic complications, advice to inform providers.
thrombocytopenic purpura 9. Administer without regard to food.
(TTP) 10. Tell the patient to inform all healthcare
Misc: Fever, providers, including dentist, before
undergoing procedures or starting new drug
hypersensitivity reaction
therapy, about taking this drug.
CV: hemorrhage at any site
EENT: epistaxis, taste
After
Disorder
11. Instruct pt to take medication exactly as
Musculoskeletal: arthralgia,
directed.
myalgia, arthritis
12. Take missed doses as soon as possible
Respiratory: unless almost time for next dose; do not
Bronchospasm, double doses.
respiratory tract bleeding

7
13. Advise pt. to notify health care
professional promptly if fever, chills, sore
throat or unusual bleeding or bruising occurs.
14. Advise pt. to notify health care
professional of medication regimen prior to
treatment or surgery.
15. Educate the patient to avoid alcohol as
very serious interactions can occur.

7
 Mechanism of
Drug Names Classification Indication Contraindication Side Effects Nursing Responsibilities
Action

Generic NMDA Receptor Memantine is Moderate to The use of CNS: dizziness, confusion, Before:
Name: Antagonist believed to be severe memantine is headache, fainting, fatigue 1. Assess cognitive function (memory,
Memantine the blockade of dementia/neur contraindicated in attention, reasoning, language, ability to
current flow ocognitive any patient with a GI: constipation, vomiting perform simple tasks) periodically during
Brand Name: through disorder known therapy.
Memry channels of associated with hypersensitivity SKIN: rashes, pruritus 2. Lab Test Considerations: May cause
Nmethyl-d- Alzheimer’s memantine or anemia.
Dosage: aspartate disease. hypersensitivity to CV: Hypertension 3. Instruct pt on how and when to administer
10mg/tab (NMDA) any inactive memantine.
receptors. A ingredients or Respi: cough, dyspnea 4. Caution pt that memantine may cause
Route: glutamate excipients dizziness.
PO receptor contained within MS: backache 5. Instruct pt to take missed doses as soon
subfamily the products. as remembered but not just before next
Frequency: broadly dose; do not double doses.
OD involved in brain ADVERSE EFFECT
function. During
Timing: CNS: dizziness, fatigue, 6. Instruct pt to take with or without food.
8am headache, sedation, 7. Check for heart failure and signs and
intracranial pressure, symptoms of CVA
Cerebral infarction, stroke 8. Do not mix solution with other liquids and
to take or give oral solution only with
CV: hypertension, DVT included device.
9. As appropriate, review all other significant
SKIN: rash and life-threatening adverse reactions and
interactions.
GI: diarrhea, constipation, 10. Assess for and report S&S of focal
weight gain neurologic deficits (ex. TIA, ataxia, vertigo).

GU: urinary frequency After

Hemat: anemia 11. Report any of the following to the
physician: problems with vision, skin rash,
shortness of breath, swelling in throat or
tongue, agitation or restlessness, confusion,
dizziness, or incontinence.

7
12. Do not drive or engage in other
hazardous activities until reaction to drug is
known.
13. Do not breast feed while taking this drug.
14. Instruct pt to take medication exactly as
directed.
15. Advise pt to notify health care
professional of medication regimen prior to
treatment or surgery.

7
 Mechanism of
Drug Names Classification Indication Contraindication Side Effects Nursing Responsibilities
Action

Generic Antibiotic Inhibits beta Indicated to Contraindicated in CNS: dizziness, headache, Before
Name: lactamases in treat patients with a fatigue 1. Assess pt for at beginning and throughout
Sultamicillin penicillin1 community history of allergy therapy.
resistant acquired to any of the SKIN: itching 2. Obtain specimens for culture and
Brand Name: microorganisms Pneumonia- penicillin and in sensitivity before therapy. First dose may be
Unasyn and it acts MR, and patients with GI: diarrhea/loose stool, given before receiving results.
against Chronic lower infectious nausea/vomiting epigastric 3. Inform patient that drug lowers resistance
Dosage: sensitive respiratory mononucleosis. distress, abdominal to certain infections.
750 mg/tab organisms tract Cramps/pain 4. Assess hypersensitivity to drug or other
during the stage infections. penicillin.
Route: of active Respi: dyspnea 5. Instruct patient to take full course of
PO multiplication therapy; do not stop taking the drug even if
by inhibiting you feel better.
Frequency: biosynthesis of ADVERSE EFFECTS
BID (7 days) cell wall During
mucopeptide. 6. Advise patient to minimize GI upset by
Timing: Therapeutic GI: melena, enterocolitis eating small, frequent servings of food and
8am & 6pm Effect: pseudomembranous colitis, drinking plenty of fluids.
Suscpetible black hairy tongue, 7. Instruct him to report new signs or
bacteria stomatitis, glossitis symptoms of infection, especially in mouth or
rectum.
CNS: Convulsions, seizures 8. Tell patient to promptly report unusual
bleeding or bruising.
Hema: anemia, 9. Observe pt. for signs and symptoms of
thrombophlebitis anaphylaxis.
10. Monitor liver function test results
Resp.: apnea
After
11. Advise him to use soft toothbrush and
electric razor to avoid gum and skin injury.
12. Instruct patient to avoid activities that
can cause injury.
13. Instruct put to take drug with food to
prevent GI upset.

7
14. Inform pt. to be alert for adverse
reactions.
15. Instruct patient to immediately report
signs and symptoms of hypersensitivity
reaction, such as rash, fever, or chills.

7
 Mechanism of
Drug Names Classification Indication Contraindication Side Effects Nursing Responsibilities
Action

Generic Cardiovascular Selectively blocks Treatment of Hypersensitivity to CNS: headache, Before

Name: agent the binding of hypertension, the drug dizziness, 1. Consider the 10 rights of drug
Losartan Angiotensin II angiotensin II to alone or syncope, insomnia administration
receptor specific tissue in 2. Consider the principles in administering
Brand Name: Antagonist receptors found in combination CV: hypotension medications
Cozaar Antihypertensi the vascular smooth with other 3. Assess for contraindications to this drug
ve muscle and adrenal antihypertensiv SKIN: rash, 4. Obtain baseline status for complete blood
Dosage: gland. This action e agents. urticaria, pruritus, count and clotting studies to determine any
50 mg/tab blocks the alopecia, dry skin potential adverse effects.
vasoconstriction of 5. Assess patient's health history.
Route: the renin-angiotensin ADVERSE
PO system as well as EFFECTS During
the release of 6. Monitor patients’ intake and output
Frequency: aldosterone leading CNS: dizziness, 7. Tell the patients to take the drug at
OD to decrease blood asthenia, fatigue, morning to prevent insomnia at night.
pressure. headache, 8. Be alert for adverse reaction.
Timing: insomnia. 9. Take drug without regard to meals.
8pm 10. Monitor patient's sleeping
CV: edema, chest Pattern
pain.
After
EENT: nasal 11. Monitor the patients sleeping pattern.
congestion, 12. Stop medication if adverse reactions
sinusitis, occur, notify the physician immediately.
pharyngitis, sinus 13. Check patient's blood pressure.
disorder. 14. Inform patient not to drive or use
machines.
GI: abdominal pain, 15. Advise patient not to drink alcoholic
nausea, diarrhea, beverages.
dyspepsia.

MS: muscle
cramps, myalgia,
back/leg pain.

8
RS: cough, upper
respiratory
infection.

8
 Mechanism of
Drug Names Classification Indication Contraindication Side Effects Nursing Responsibilities
Action

Generic Calcium It works by Management of Hypersensitivity to CV: Palpitations, Before

Name: Channel relaxing blood hypertension, Amlodipine, and peripheral or facial 1. Confirm physician’s drug order.
Amlodipine Blocker vessels so that angina pregnancy edema 2. Assess baseline renal/hepatic function
blood flow can pectoris, and (category tests, BP, and apical pulse.
Brand Name: flow more vasospastic C). CNS: Lightheadedness, 3. Monitor BP frequently during initiation of
Norvasc easily. (Prinzmetal's) fatigue, headache. therapy. BP reduction is greatest after peak
The main action angina. levels of amlodipine are achieved 6–9 h
Dosage: is to block the GI: Abdominal pain, following oral doses.
5 mg/tab blood pressure nausea, anorexia, 4. Monitor for S&S of dose-related peripheral
raising effect of constipation, or facial edema that may not be
Route: the Renin- dyspepsia, dysphagia, accompanied by weight gain; rarely, severe
PO Angiotensin diarrhea, flatulence, edema may cause discontinuation of drug.
Aldosterone vomiting. 5. Instruct patient not to breast feed while
Frequency: System (RAAS). taking this drug without consulting physician.
OD ADVERSE EFFECTS
During
Timing: RS: Dyspnea 6. Instruct patient to move slowly when
8am assuming a more upright position to
SKIN: Flushing, rash minimize orthostatic hypotension.
7. Assess peripheral edema behind medial
CV: Bradycardia, chest pain, malleolus (sacral area in bedridden patients)
syncope, postural 8. Assess for skin flushing.
hypotension, flushing 9. Inform patient that medication may give
tachycardia with no regard to food
10. Caution patient to report all adverse
Other: Arthralgia, cramps, reactions and to continue taking drug, even
myalgia when feeling better

After
11. Instruct pt to not abruptly discontinue
medication.
12. Avoid tasks that require alertness, motor
skills until response to drug is established.

8
13. Counsel patients about additional
interventions to help control blood pressure
and cardiac dysfunction, including regular
exercise, weight loss, sodium restriction,
stress reduction, moderation of alcohol
consumption, and smoking cessation.
14. Educate and counsel patient to use
caution during aerobic exercise and other
forms of therapeutic exercise.
15. Instruct patient or family/caregivers to
report other troublesome side effects such as
severe or prolonged headache, fatigue,
nausea, or warmth/flushing of the skin.

8
NURSING CARE PLAN

8
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8
8
8
9
9
Defining Nursing Scientific Analysis Goal of Care Interventions Rationale Evaluation
Characteristics Diagnosis
Subjective Data: Ineffective Ineffective tissue Short term Independent Short term
“Wala ko cerebral perfusion, After 8 hours of After 8 hours of nursing
kahibaw asa ko, tissue peripheral nursing intervention 1. Determine factors 1. If the stroke is evolving, intervention the patient
ug di pud ko ka perfusion (ineffective the patient will be related to decrease client can deteriorate was able to:
hinumdom sa related to peripheral. tissue able to: cerebral perfusion quickly and require repeated
ngalan sa ako interruption perfusion) is assessment and progressive  Identify necessary
kauban.” As of blood defined as “a  Identify necessary treatment. If the stoke is lifestyle changes. Goal
verbalized by the flow as decrease in oxygen lifestyle changes. completed, the neurologic met.
patient. evidence by resulting in the deficit is nonprogressive and
altered failure to  Enumerate treatment is geared towards  Enumerate factors that
Objective: mental nourish the tissues factors that rehabilitation and improve circulation.
-altered mental status. at the capillary improve preventing recurrence. Goal met.
status level” circulation.  Verbalize
-disoriented  Verbalize 2. Assess for signs of 2. Assessment provides understanding of
-Converse Decreased tissue understanding of decreased/ ineffective baseline for future condition therapy
perfusion can be condition therapy cerebral tissue perfusion. comparison. regimen side effects of
temporary, with few regimen side (e.g., dizziness, altered medications, and when
or minimal effects of mental status, altered to contact healthcare
consequences to medications, and pupillary response, provider. Goal met.
the health of when to contact speech abnormalities.
the patient, or healthcare  Engage in behaviors or
it can be more provider. action to improve
acute or tissue perfusion. Goal
protracted, with  Engage in met.
potentially behaviors or  Practice and
destructive effects action to improve demonstrate behavior
on the patient. change to improve
When diminished circulation. Goal met.
tissue perfusion

9
becomes chronic, it tissue perfusion. Long term
can result in tissue A/B 3. Check rapid changes or 3. Electrolyte/acid-base After 4 days of nursing intervention the patien
or organ damage or  Practice and continued shifts in mental variations, hypoxia, and
death. demonstrate status. systemic emboli influence Exhibit rowing tolerance to activities. Goal m
behavior change cerebral perfusion. In Displayno
Nursing care to improve addition, it is directly related
planning and circulation. to cardiac output.
management for Long term further
ineffective tissue After 4 days of deterioration of
perfusion is directed nursing intervention condition. Goal met.
at removing the patient will be
vasoconstricting able to: Maintain usual or
factors, improving improve cognition, and motor and sensory
peripheral blood  Exhibit growing
flow, reducing tolerance to
metabolic demands activities.
on the body, 4. Record BP readings for 4. Stable BP is needed to
patient’s  Display no further orthostatic changes (drop keep sufficient tissue
participation, and deterioration of of 20 mm Hg systolic BP perfusion.
understanding the condition. or
disease process and 10 mm Hg diastolic BP
its treatment, and with position changes).
preventing  Maintain usual or
complications. improve
cognition, and 5. Review trend in level of
motor and 5. Check mental status; consciousness (LOC) and
sensory function. perform a neurological possibility for increased ICP
examination. and is helpful in deciding
location, extent and
development/resolution or
central nervous system
(CNS) damage.

6. Establishes arousal ability

6. Evaluate eye opening. or level of consciousness.

9
7. Evaluate motor 7. Measures overall
reaction to simple awareness and capacity to
commands, noting react to external stimuli,
purposeful and and best signifies condition
non-purposeful of consciousness. Absence
movement. Document of spontaneous movement
limb movement and note on one side of the body
right and left sides signifies damage to the
individually. motor tracts in the opposite
cerebral hemisphere.

8. Educate methods to 8. Orthostatic hypotension

decrease dizziness, such results in temporary
as remaining seated for decreased cerebral
several minutes before perfusion.
standing, flexing feet
upward several times
while seated, rising
slowly, sitting down
immediately if feeling
dizzy, and trying to have
someone present when
standing.

9. If ICP is increased, 9. This promotes venous

elevate head of bed 30 to outflow from brain and helps
45 degrees. reduce pressure.

10. Control environmental 10. Fever and shivering can

temperature as further increase ICP.
necessary. Perform tepid
sponge bath when fever
occurs.

11. Reorient to 11. Decreased cerebral

environment as needed. blood flow or cerebral
edema may result in
changes in the LOC.

9
12. Teach patient and the 12. Early assessment
SO how to recognize the facilitates immediate
early signs and symptoms treatment.
that need to be reported
to the nurse.

Dependent

13. Administer 13. Reduces hypoxemia

supplemental oxygen as
indicated.

14. Administer medication 14. This is to maximize

as indicated. (e.g., tissue perfusion.
Anticoagulants,
antihypertensive, etc.)

Collaborative

15. Monitor laboratory 15. Provides information

studies as indicated such about effectiveness and
as PT and aPTT. therapeutic level of
anticoagulant and
antiplatelet drugs when
used.

9
Defining Nursing Scientific Analysis Goal of Care Interventions Rationale Evaluation
Characteristics Diagnosis
Subjective data: Disturbed The diagnosis Disturbed Thought Short term Independent Short term
“wa ko ka ila nimo. thought Processes describes an individual
Ngano nga naa mn ko process related with altered perception and After 8 hours of 1. Assess the 1. Provide the After 8 hours of nursing
diri?” As verbalized head injury as cognition that interferes with daily nursing level of cognitive basis for the intervention the patient
by the patient. evidence by living. intervention the disorders such as evaluation or was able to:
memory patient will be change to comparison that
Objective data: problem. Since there is altered in able to: orientation to will come, and  Recognize changes in
- Disoriented perception and cognition the focus people, places influencing the thinking/ behavior.
- Show signs of of nursing is to reduce disturbed  Recognize and times, range, choice of Goal met
forgetfulness thinking and promote reality changes in attention, intervention.  Verbalize
orientation. Often, confusion in thinking/ thinking skills. understanding of
older adults is erroneously behavior. causative factors.
attributed to aging. Confusion in  Verbalize 2. Identify 2. To assess Goal met
the older adult can be caused by understanding factors present causative/  Identify interventions
a single factor or multiple factors of causative (e.g., contributing to deal effectively with
such as depression, dementia, factors. recent CVA, factors. situation. Goal met
medication side effects, or  Identify increase ICP,  Demonstrate
metabolic disorders. interventions etc.) behavior/ lifestyle
to deal changes/ minimize
effectively 3. Assess 3. Changes in changes to prevent/
with situation. patient’s ability status may minimize changes in
 Demonstrate for thought indicate mentation. Goal met
behavior/ processing every progression of
lifestyle shift. deterioration or
changes/ improvement in
minimize condition. Long term
changes to
prevent/ 4. Assess 4. This After 4 days of nursing
minimize attention span/ determines intervention the patient
changes in distractibility and ability to was able to:
mentation. ability to make participate in
decision or planning/  Maintain reality
problem solve. executing care. orientation and
communicate clearly
with others

9
 5. Monitor and 5. To detect and Goal met
document vital prevent further
signs periodically deterioration. Exhibit normal
Long term as appropriate. mentation. Goal met
6. Assist the 6. To maintain a
After 4 days of patient good quality of
nursing performing life and promote
intervention the activities of daily dignity by
patient will be living. allowing the
able to: patient to
perform their
 Maintain ADLs.
reality
orientation 7. Simplify task 7. Simple words
and for the patient. and instructions
communicate Use simple words can help the
clearly with and instructions. patient perform
others task.

 Exhibit normal 8. Reorient 8. Reality

mentation. patient to orientation
environment, techniques help
time, people, and improve patient’s
event. awareness of self
and environment
9. Allow patient 9. Validates
the freedom to patient’s sense of
sit in a chair near reality and
the window, assists the
utilize books and patient in
magazines as differentiating
desired. between day and
night. Respect
for the patient’s
personal space
allows patient to

9
 exert some
control.

10. Inform 10. Patient with

patient of care to dementia require
be done, with extended time for
one instruction at processing
a time. information.

11. Use a rather 11. Increasing

low voice and the possibility of
spoke slowly in understanding.
patients.
12. Eliminate or 12. Maintain
minimize sources security by
of hazards in the avoiding a
environment confrontation
that could
improve the
behavior or
increase the risk
for injury.

13. Perform 13.Early

neurological recognition of
assessments as changes
indicated and promotes
compare with proactive
baseline. Note modification to
changes in LOC plan of care.
and cognition,
such as increased
lethargy,
confusion,
drowsiness,
irritability;

9
changes in ability
to communicate.

Independent
14. Administer 14. To maximize
and Monitor level of function.
medication
regimen

Collaborative
15. Cognitive
15. Refer patient rehabilitation is a
to appropriate type of therapy
rehab providers that can make
managing
everyday
activities easier
for people with
dementia. It can
help them to
maintain their
independence.

9
Defining Nursing Scientific Goal of Care Interventions Rationale Evaluation
Characteristics Diagnosis Analysis
Subjective: Activity Activity Short term: Independent Short term:
“Kapoy ilihok ug intolerance intolerance can be After 8 hours of 1. Establish 1. Coordinated efforts After 8 hours of nursing
makabatyag dayun related to described as nursing guidelines and are more meaningful intervention the patient
kog kutas”,as generalized insufficient intervention the goals of activity and effective in was able to:
verbalized by the weakness as physiological or patient will be able with the patient assisting the patient
patient. evidence by psychological to: and/or SO. in conserving energy.  Report a measurable
reports of energy to 2. Have the 2. Helps in increasing increase in activity
Objective: fatigue. complete required patient perform the tolerance for the tolerance. Goal met.
- Generalized or desired daily  Report a the activity activity.
weakness activities. measurable more slowly, in 3. Gradual progression  Identify negative
- Need increase in a longer time of the activity factors affecting
assistance in The common activity with more rest prevents activity tolerance. Goal
changing etiology of Activity tolerance. or pauses, or overexertion. met.
positions Intolerance is with assistance 4. Assisting the patient
- Exertional related to  Identify if necessary. with ADLs allows  Eliminate or reduce
dyspnea generalized negative 3. Gradually conservation of negative factors
- Slow weakness and factors increase energy. Carefully affecting activity
movements debilitation from affecting activity with balance provision of tolerance. Goal met.
noted acute or chronic activity active range-of- assistance; facilitatin
Vital signs: illnesses. This is tolerance. motion g progressive  Practice willingly in
RR: 24 cpm mostly observed in exercises in endurance will necessary/ desired
older patients with  Eliminate or bed, increasing ultimately enhance activities. Goal met.
a history of reduce to sitting and the patient’s activity
orthopedic, negative then standing. tolerance and self-  Display and use
cardiopulmonary factors 4. Assist with esteem. effective energy
or diabetic affecting ADLs while 5. Exercise management/
problems. It also activity avoiding patient maintains muscle str conservation technique.
results from tolerance. dependency. ength, joint ROM, Goal met.
obesity, 5. Provide the and exercise
malnourishment, patient with the tolerance.  Utilize identified
anemia, and side  Practice adaptive Physical inactive techniques to enhance
effect medications. willingly in equipment patients need to activity intolerance.
The goal in necessary/ needed for improve functional Goal met.
Activity desired completing capacity through
Intolerance is to activities. ADLs. repetitive exercises Long term
increase tolerance over a long period of
for and endurance time. Strength
of activity.
1
1
  Display and 6. Encourage training is valuable in After 4 days of nursing
Any factors that use effective active ROM enhancing endurance intervention the patient
compromise energy exercises. of many ADLs. will be able to:
effective oxygen management/ Encourage the 6. Appropriate aids will
transport or conservation patient to enable the patient to  Demonstrate a
physical technique. participate in achieve optimal decrease in
conditioning or planning independence for physiological signs of
create excessive  Utilize activities that self-care and reduce intolerance. Goal met.
energy demands identified gradually build energy consumption
that surpass the techniques to endurance. during activity.  Perform basic activities
patient’s physical enhance 7. Assess 7. Stress may increase without excessive
and psychological activity psychological the effects of an exhaustion or loss of
abilities can cause intolerance. factors illness. energy. Goal met.
activity affecting the 8. To prevent
intolerance. Long term current orthostatic
situation. hypotension that may
After 4 days of 8. Advice to avoid cause false injury or
nursing abrupt standing any.
intervention the and moving. 9. Activities should be
patient will be able 9. Instruct patient planned to coincide
to: to plan with the patient’s
activities for peak energy level. If
 Demonstrate a times when the goal is too low,
decrease in they have the negotiate.
physiological most energy. 10. Use of commode
signs of Dependent requires less energy
intolerance. 10. Provide bedside expenditure than
commode as using a bedpan or
 Perform basic indicated. ambulating to the
activities 11. Administer bathroom.
without oxygen at 11. The primary goal of
excessive concentration oxygen therapy is to
exhaustion or indicated. correct alveolar
loss of energy. 12. Administer and/or tissue
prescribed hypoxia.
medications. 12. Type of medication
13. Determine if depends on the
the patient etiological factors of
needs any

1
assistive

1
 devices such as the problem like
a gait belt, a antibiotics.
walker, or 13. These devices may
braces as facilitate activities as
ordered. they compensate for
Collaborative: some limitations
14. Provide referral 14. This is to develop
to other individually
discipline as appropriate
indicated (e.g., therapeutic
exercise regimens.
physiologist, 15. Dietitians can adjust
psychological the nutritional needs
counselling/ to the patient’s
therapy, etc.) situation. Adequate
15. Consult a intake of nutrients
dietitian to helps with
meet the maintaining skin
patient’s integrity, muscle
nutritional strength, and
needs. immune function.

1
F-DAR NOTES

Date Shift Focus Time DAR

10-12-2021 6–2 Receiving 6 D> Received patient lying on bed,
Assessment awake; afebrile and conscious
with the following vital signs: BP:
150/100, PR: 64bpm, RR:24cpm,
Temp. 36.3°C, O2 Sat.:95% with
ongoing PNSS 1L at KVO rate
infusing well
A>Established rapport with the
patient; performed hand hygiene
before and after patient contact;
assessed patient general health;
provided rest and comfort;
provided a calm and quiet
environment; ensured safety;
visited at regular intervals; vital
signs taken and charted. ---------
Ineffective 6:30 D> Patient is dyspneic with RR of
Airway 24cpm and decreased O2 Sat. of
Clearance 95%; seen patient with
productive coughing; lethargic;
restless; pallor skin; uses
accessory muscle; capillary refill
of 3
seconds.
A>Monitored Respirations and
breath sounds, noting rate,
sounds, depth and effort;
monitored for alteration in BP and
HR; observed nail beds and
cyanosis in the skin; monitored
vital signs and neuro vital signs
every 2 hours as indicated;
assessed patient’s hydration
status and I&O; positioned patient
on moderate high back rest as
indicated; encouraged deep-
breathing and coughing exercises;
provided O2 at 2-3 LPM via nasal
prong; administered medications
as ordered.
R>The patient
understood, accepted, and
participated with the different
measures to promote effective
breathing pattern;
improvement of vital signs
Ineffective 7 evidence by RR from 24 cpm to 21
Cerebral cpm and O2 sat of 95% to 96%.
perfusion D>Received patient lying on bed,
afebrile, awake, and conscious,
with the following vital signs: BP:
150/100, PR: 64bpm, RR:24cpm,
Temp. 36.3°C, O2 Sat.:95%, GCS
score of 13/15
A>Frequently assessed and
monitor neurological status and
vital signs every 2 hours as
indicated; investigated client
reports of headache, particularly
when accompanied by a range of
progressive neurological deficits;
evaluated blood pressure;
reviewed pulse oximetry or ABG,
infused and maintained IVF at
desired rate, supplemented
oxygen via nasal pong; provided
1
 moderate high back rest;
provided safety.
R>Patient understood and
participated the nursing
interventions; displayed
neurological signs within client’s
normal range; verbalized the
Disturb thought 8 understanding of the condition.
process D> Received patient lying on bed,
awake, and lethargic; disoriented
and converse as evidenced by
GCS verbal response score of 4
out of 5; easy
distractibility---------------
A>Monitored vital signs and
neurologic vital signs every 2
hours as indicated; reorient to
time, place and people as needed;
assessed patient’s ability for
thought processing; limited
decisions that patient makes; used
low voiced and spoke slowly to the
patient; provided positive
reinforcement and feedback;
encourage SO to not leave the
patient alone;’ provided calm and
quite environment; provided
safety.
R>Patient understood and
participated in nursing and
medical interventions; improved
thought processing as evidence by
Impaired 9 GCS verbal response score from
physical 4/5 to 5/5. -------------------
mobility D>Received patient lying on bed,
awake, and lethargic, immobile
numbness of left side, inability to
raise one arm; left sided
weakness
A>Monitored the lower
extremities for symptoms of
thrombophlebitis; inspected affect
side for color and edema;
changed position every 2 hours;
provided fall precaution and
safety; inspected skin regularly
particularly bony prominences;
provided passive ROME; assessed
degree of pain; monitored
adequate intake of fluids and
nutritious foods---------
R>Patient understood and
participated in treatment
Activity 10 regimen; maintained skin
Intolerance integrity; maintained GCS motor
response score of
6/6-------------------------
D> Patient is lethargic, immobile,
dyspneic, has left sided weakness
with the following vital signs: BP:
150/100mmHg, PR: 64bpm, RR:
24 cpm, O2 sat.: 95%, Temp:
36.3°C, GCS: 13/15. --------------
A>Established rapport with the
patient; monitored changes in
vital signs; decreased
environmental stimulants by
providing dimly lit room to
promote rest, planned care to
carefully balance rest periods;
provided comfort measure and for
relief of pain; refrained from
1
performing nonessential
activities or

1
 procedures; provided fall
precaution and safety at all times.
R>Patient understood and
participated to nursing
interventions, demonstrated a
decrease in physiological signs as
evidence by maintained PR within
Impaired Verbal 11 normal limits and a decrease of
Communication BP from 150/100 to 130/80
----------
D> Received lying on bed, awake,
conscious, and lethargic with a
GCS verbal response score of 5/6
as evidence that patient is
disoriented and converse;
difficulty maintaining
communication
A>Established rapport with the
patient, initiated eye contact, and
introduced by preferred name;
Assured that I have patient’s
attention before communicating;
reduced environmental noise that
interfere with comprehension;
kept communication simple,
spoke in short sentences, and
used appropriate words;
maintained a calm and unhurried
manner; validated the meaning of
nonverbal communication;
provided reality orientation by
responding with simple,
straightforward, honest
statements
R> patient participated to nursing
interventions; uses verbal and
nonverbal communication;
Risk for fluid 12 improvement of GCS score from
volume 4/5 to 5/5 as evidence that
deficient patient is oriented and converse.
D>Received patient awake,
conscious, lethargic; polyuria
observed as evidence by output
exceeds intake.
A> Monitored intake and output in
absolute figure as indicated;
monitored for polydipsia; weight
patient daily; reviewed
medications to identify
medications that can alter fluid
and electrolyte imbalance; assess
oral mucous membranes and skin;
encouraged increase oral fluid
intake.
R>Patient understood and
participated to therapeutic
management; patient increases
Risk for 1 oral fluid intake; mucous
Decreased membranes are moist; fluid
Cardiac Output output still exceeds fluid intake.
----------
D>Patient lying in bed, awake,
conscious, and lethargic; Vital
signs as follow: BP: 150/100,
PR:64bpm; RR: 24 cpm; O2 Sat:
95%, Temp: 36.3°C, pallor skin;
presence of productive cough that
can alter contractility. -------------
A>Evaluated client evidence of
fatigue, swelling in extremities,
progressive shortness of breath;
place client on moderate high
1
back
rest as indicated, provided oxygen

1
 @ 2-3LPM via nasal pong;
administered medications as
ordered (Losartan and
Amlodipine), scheduled activity
and assessment to maximize rest
periods; encouraged and provided
soft, low salt, low fat diet as
indicated.
R>Patient understood and
participated nursing
interventions; improvement of BP
from 150/100mmHg to 130/80
Disturbed sleep 12:30 mmHg; patient followed
pattern recommended diet.
--------------------------------
D> Patient verbalized “wakoy
tarong tog” as evidence of
dissatisfaction of sleep; lethargic;
irritable; lack of energy and
problems with concentration
during health interventions;
patient refused for vital signs
taking
A>Assessed and addressed
environmental factors affecting
sleep; observed signs of fatigue
such as frequent yawning,
restless, and irritable; organized
nursing care to promote minimal
interruption by performing
procedures at regular intervals;
provided relaxation techniques
(e.g., music therapy, guided
imagery); provided a calm and
quite environment; explain to the
patient the importance of vital
sign monitoring
R>Patient understood and
participated to therapeutic
Deficit 1 management; vital signs were
Knowledge taken; patient reported enough
sleep and is less irritable-----------
D>Patient verbalized “ngano mag
sigi mo balik-balik? Okay ra man
ako sakit”; lethargic and
conscious; presence of productive
cough; irritable.
A>Assessed the motivation and
willingness of the patient to learn;
provided a clear, thorough, and
understandable explanations of
the diseases; provided a calm and
peaceful environment without
interruption; Provided respect,
openness, trust, and collaboration
with the patient; provided
information relevant only to the
situation.
R>Patient verbalized
Risk for trauma 1:30 understanding of the diseases and
actively participated to the nursing
interventions.
D>Patient is disoriented and
confused; weak; patient’s SO
verbalized “delikado ma hulog na
siya, usahay di na mag bantay” as
evidence of patient insufficient
knowledge of safety precautions.
A>Frequently oriented patient to
reality and surroundings; used
simple explanation when
performing nursing intervention to
1
1
 provide better understanding;
provided fall precaution as
indicated; locked wheels on bed;
encouraged SO to avoid
cultivation of false ideas; Kept bed
in low position as appropriate;
assisted with activities and
transfer as needed.
R>Patient understood nursing
inventions, patient can identify
End of shift 2 potential risk factors in the
environment.
D> Seen patient lying on bed;
asleep; afebrile; with the following
vital signs: BP: 130/80 mmHg:
PR: 64 bpm, RR:20 cpm, O2 sat:
97%, Temp.: 36 °c with ongoing
D5NSS at KVO rate. -------------
A>Check Patient mental and physical
status; provided comfort and safety.
R>Endorse patient to the next
NOD. //

1
DISCHARGE PLAN

DISCHARGE PLANNING

Subjective “naayo nako nurse, dili na bug-at akong pamati. Ganahan nako muoli” as verbalized by the patient
Data

Objective Data The patient is afebrile, alert, conscious, and cooperative

The patient vital signs are in normal range: temp – 37.5℃, rr-18 cpm, hr- 78 bpm, BP 120/80 mmHg O2 Sat: 98%

INTERVENTIONS

Analysis The patient was experiencing vomiting, elevated BP, weakness and cough. Patient was diagnosed with CVD infarct, CAP-MR, HUD RUD and
dementia. Being provided with quality care during admission, the patient has recovered and is now ready for discharge.

Planning After 15-20 minutes of health teaching, the patient will be able to demonstrate behaviors that will reduce the risk/spread of secondary infection;
report improved sense of energy; enumerate activities that will enhance his independence in regards to his ADLs,safety, and adherence to
medications, diet, and therapy (Low fat (saturated fats), low sodium, high fiber, rich in protein food, exercise at least 5-10 mins daily and DBE).
Activity Advised patient to get plenty of rest until strength is regained/ as needed. Encouraged patient to have a regular exercise (5-10 mins) if not
contraindicated (light exercise such as walking), Advised patients the use of energy-conservation techniques and methods to reduce activity
intolerance (plan and prioritize activities and pursed lip breathing)
Medications Patient is advised to take medication accordingly to the prescription and must adhere to the treatment regimen given in relation to the duration of
time as advised. SO are encourage to actively participate in this regimen. Educate the patient on the strict adherence to the medication given, at the
right time and at the right frequency. Instructed patient, should persistent symptoms or adverse effect manifest, patient or SO should report to
physician accordingly; Educated patient with the purpose of each drug and its side effects; instructed not to take other medications without
consulting with the physician toprevent harmful drug-drug interactions. Instructed patient and SO to comply strictly with the following prescribe
medications:
1. Sultamicillin 750 mg/tsb, 1 tab BID x 7 days
2. Clopidogrel 75 mg/tab, 1 tab OD PO
3. Memantine 10 mg/tab ½ tab OD PO
4. Citicoline 1 gm/tab BID PO x 3 months
5. Atorvastatin 40 mg/tab OD HS
6. Losartan 50 mg/tab OD PO

1
Environment Instructed patient and SO to provide a safe, stress free and clean environment that is conducive to healing as much as possible; Instructed family
member and SO to oversee proper hygienic practices and disinfection; Encouraged SO and family members to promote a calm and safe environment.
An environment of proper social support should also be upheld.

Treatment Instruct the patient to the consistent and continue practice of deep breathing exercise as necessary to promote lung capacity and optimize
oxygenation. Patient diet and fluid intake should be according to the prescribed restrictions and recommendations made the physicians. Encourage
patient to ambulate accordingly to promote proper circulation and prevent further complications. Encourage SO to accommodate patient needs as
needed and to promote a calm and safe environment. Institute measures for fall and other elderly related complications. Emphasized the importance of
home medications prescribed by the physician.
Health Encouraged patient to Keep a fatigue diary. Include anything that makes you feel more tired or less tired. Bring the diary with you to follow-up visits
teaching with your provider; Instructed patient to have early ambulation and exercise as directed. Exercise can help you feel more alert. Exercise can also help
you manage stress or relieve depression. Try to get at least 30 minutes of exercise most days of the week; Encouraged patient to Keep a regular sleep
schedule. Go to bed and wake up at the same times every day. Limit naps to 1 hour each day. A nap can improve fatigue, but a long nap may make it
harder to go to sleep at night. Instructed patient about medicine adherence; Instructed patient to avoid strenuous activities;Instructed patient to keep
the practice of proper hand hygiene and to keep one’s self clean at all time; Encouraged patient to perform oral hygiene accordingly; Encouraged
patient to perform good grooming. Instructed patient about smoking cessation.

Outpatient Instruct patient and SO to continue follow-up check up on continues basis and should report any of the symptoms that may persist; Encourage patient
Referral as well as the SO to observe and monitor for the continuous deterioration or alleviation of the patient symptoms; Contact physician as soon as possible
should emergency distress occur.

Diet Instruct patient to adhere and maintain low fat, low sodium diet; Encourage nutritious foods include fruits, vegetables, whole-grain breads, low-fat
dairy products, beans, lean meats, and fish. Good nutrition can help manage fatigue; Avoid foods that may facilitate respiratory distress; Encourage
patient to stop the intake of liquors and drink enough of water (1500mL/day); Initiate intake of foods various vitamins and minerals to promote
wellness.
Spiritual Emphasize the importance of hope for longevity of life and pray accordingly to patient spiritual needs; Maintain spiritual relationship towards belief and
to balance that belief with family relationship and to engage in acts that may convey a sense of fulfilment.

Evaluation Patient and S.O. verbalized understanding with the implemented intervention.

1
SUMMARY

A cerebrovascular disease (CVD) infarct, also called ischemic stroke,

brain ischemia and cerebral ischemia. This type of stroke is caused by a
blockage in an artery that supplies blood to the brain. The blockage reduces
the blood flow, leading to damage or death of brain cells. Cerebrovascular
disease can develop from a variety of causes, including atherosclerosis,
where the arteries become narrow; thrombosis, or embolic arterial blood
clot, which is a blood clot in an artery of the brain; or cerebral venous
thrombosis, which is a blood clot in a vein of the brain. In which arteries are
problematic will determine which areas of the brain area affected. These
varying infarcts will produce different symptoms and outcomes. Signs and
symptoms include dizziness, nausea, or vomiting, unusually severe
headache, confusion, disorientation, numbness, weakness in an arm, leg or
the face, especially on one side, difficulty with comprehension, loss of vision
or difficulty seeing, loss of balance, coordination or the ability to walk. The
predisposing factors are age, gender, family history, hypertension and
diabetes mellitus, while the precipitating factors are cigarette smoking,
alcohol abuse, overweight, psychosocial stress and contraceptive pills. To
diagnosed a patient with CVD infarct, one must undergo physical
examination, MRI, CT scan and blood test.

Community-acquired pneumonia is defined as pneumonia that is

acquired outside the hospital. When an individual has pneumonia, the alveoli
are filled with pus and fluid, which makes breathing painful and limits
oxygen intake. CAP is a heterogeneous infection with a variety of potential
causative pathogens and is associated with significant morbidity and
mortality. It can affect people of any age but mostly results to further
complications to people with co morbidities. Typical bacterial pathogens that
causes CAP include Streptococcus pneumonia, Haemophilus influenzae, and
Moraxella catarrhalis. Pneumonia is considered to be mild with no increased
risk if the patient: is younger than 65 years old, is conscious and lucid, has
normal blood pressure and pulse, is not breathing too fast (fewer than 30
breaths per minute), has enough oxygen in their blood, has not been given
any antibiotics in the past three months, has not been in the hospital in the
past three months, and does not have any other severe medical conditions.
Predisposing factors are children <2 years old, older age,
immunosuppression, respiratory diseases while the precipitating factors are
smoking, exposure to chemicals and poor oral care. The signs of moderate
pneumonia include drowsiness and confusion, low blood pressure, worsening
1
shortness of breath, and risk factors such as

1
old age and underlying diseases. People with these symptoms need to have
treatment at a hospital. Some will be given a combination of two different
antibiotics, at least at the beginning of the treatment.

Hypertensive crisis is an umbrella term for hypertensive urgency and

hypertensive emergency. These two conditions occur when blood pressure
becomes very high, possibly causing organ damage. Hypertensive urgency
occurs when blood pressure spikes -- blood pressure readings are 180/110
or higher -- but there is no damage to the body's organs. Blood pressure can
be brought down safely within a few hours with blood pressure medication.
The etiology of acute elevations is variable. Noncompliance with
antihypertensive therapy, use of sympathomimetics, and thyroid dysfunction
are among the many possible causes of hypertensive urgencies. Even
anxiety and pain may cause acute elevations in blood pressure and require a
different treatment strategy. Falsely elevated blood pressure due to poor
equipment or technique is another potential etiology of elevated blood
pressure reading that should be evaluated and remedied.

Urgent-start peritoneal dialysis (PD) is defined as initiation of PD in

patients with newly diagnosed end-stage kidney disease who are not yet on
dialysis and who require dialysis initiation less than two weeks (as little as
24 to 48 hours) after PD catheter placement but do not require emergent
dialysis. Indications for emergent dialysis include hyperkalemia, volume
overload, or marked uremia. Urgent-start PD is generally reserved for
patients who have no plan for dialysis modality but are considered good
candidates for PD. Five Indications for urgent dialysis (when condition
refractory to conventional therapy) are: Acid-base disturbance: acidemia
e.g., Severe metabolic acidosis (pH <7.1); Electrolyte disorder: usually
hyperkalemia; sometimes hypercalcemia, tumor lysis; Intoxication:
methanol, ethylene glycol, lithium, salicylates; Overload of volume (CHF);
fluid overload Uremia: signs of uremia such as pericarditis, bleeding,
encephalopathy (an otherwise unexplained decline in mental status)

Dementia is defined by a loss of previous levels of cognitive, executive,

memory function, in a state of full alertness to such an extent that it
interferes with a person's daily life and activities and independent function.
These functions include memory, language skills, visual perception, problem
solving, self-management, and the ability to focus and pay attention. Some
people with dementia cannot control their emotions, and their personalities
may
1
change. Dementia ranges in severity from the mildest stage, when it is just
beginning to affect a person's functioning, to the most severe stage, when
the person must depend completely on others for basic activities of living.
Signs and symptoms of dementia result when once-healthy neurons (nerve
cells) in the brain stop working, lose connections with other brain cells, and
die. While everyone loses some neurons as they age, people with dementia
experience far greater loss. There are different types of dementia, but in the
case of this patient it is the vascular dementia wherein it is caused by
significant cerebrovascular disease.

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LEARNING

1. Identified history, onset, prognostic factors, and symptoms of CVD

Infarct, Community Acquired Pneumonia - Moderate Risk. HUD, RDU, and
Dementia.

2. Described major clinical, etiological, and epidemiological characteristics of

CVD Infarct, Community Acquired Pneumonia - Moderate Risk. HUD, RDU,
and Dementia.

3.Recognized the signs and symptoms of this health problem.

4. Assessed an individual patient’s potential risk for the condition.

5. Recognized the general medical conditions and substances commonly

associated with the current condition of the patient.

6. Explained the anatomy and physiology of the organs or

systems involved and the pathophysiology of the disorder.

7. Assessed a patient’s risk for the said condition and be able to

appropriately respond to high-risk patients.

8. Administered and monitored prescribed pharmacologic treatments used in

treating the condition of the patient.

9. Implemented clinical prevention and health promotion interventions to

provide patient-centered care.

10. Developed appropriate health teaching and treatment plan

for patient

CONCLUSIONS

This case study provides appropriate interventions and information that

serves as a guide to the family, caregivers, medical students, medical
professionals, and health institutions for the treatment of the patient. The
terms CVD and stroke refer to a disturbance in the cerebral blood flow that
results in a transient or permanent change in the function of 1 or more
regions of the brain. CVD is primarily treated by removing the obstruction
and restoring blood flow to the brain. One treatment for ischemic stroke is
the
1
FDA-approved drug, tissue plasminogen activator (tPA), which must be
administered within a three-hour window from the onset of symptoms to
work best.

Community-acquired pneumonia (CAP) is one of the most common

infectious diseases and is an important cause of mortality and morbidity
worldwide. A pneumonia infection is classified based on how it is acquired
and can be categorized into community-acquired, hospital-acquired,
healthcare- acquired, or aspiration pneumonia.

Patients with hypertensive urgency disease are best managed by an

interprofessional team that includes a cardiologist, internist, nephrologist,
specialty cardiac nurse and an ophthalmologist. The key is to educate the
patient on medication compliance. Patients without symptoms or signs of
target organ damage have not been shown to benefit from aggressive
antihypertensive therapy in the acute setting. Rapid lowering of blood
pressure in these patients offers no benefit and carries the theoretical risk of
causing relative hypotension and end-organ hypoperfusion, especially in
those individuals who have long standing severely elevated blood pressure.
However, it may be beneficial to start these patients on oral
antihypertensives with the goal of lowering the blood pressure slowly over
24 to 48 hours.

Renal Disease Urgent is a serious medical condition that could complicate

the course of many of your patients. The mortality rate from acute tubular
necrosis is around 50% and hasn't changed much over the past 3 decades,
despite significant advances in supportive care. Mortality rates differ,
however, depending on the cause of renal failure; rates around 15% in
obstetric patients, around 30% in toxin-related acute renal failure, and
around 60% after trauma or major surgery. Oliguria (<400 mL per day) at
presentation, a rise in serum creatinine of greater than 3 mg/dL, old age,
and multiorgan failure portend a grave prognosis.[8] Patients with acute
renal failure are also at high risk for infections; in fact, infection is the
leading cause of death among these patients. So, limit invasive procedures
and try not to use indwelling urinary catheters.

Dementia is not a specific disease but is rather a general term for the
impaired ability to remember, think, or make decisions that interferes with
doing everyday activities. Alzheimer's disease is the most common type of

1
dementia. Though dementia mostly affects older adults, it is not a part of
normal aging.

RECOMMENDATION

In CVD Infarct, Prevention is the key to living a healthier and longer

life. Prevention starts with educating the public regarding what
cardiovascular disease is, possible risk factors, and ways to prevent the
occurrence from happening. By starting to educate at a young age regarding
eating a healthy diet and maintaining an appropriate exercise regimen, we
will be able to decrease the chance of developing cardiovascular disease and
increasing one’s health and lifespan. Early detection should be initiated at an
early age. One should assess his or hers primary and secondary risks factors
for developing cardiovascular disease. Based on possible risk factors one
may be able to determine if he or she is at an increased risk for
development. Early detection includes checking one’s blood pressure as
recommended, regular doctor check-ups, and lifestyle assessment. If
detected early and controlled it is possible to decrease the risk of further
development and complications. Treatments can vary depending on severity
and degree of risk factor. For example if one is diagnosed with diabetes, this
can sometimes be controlled through diet and exercise versus a prescribed
medication regimen. Anticoagulation therapy may also be a treatment for
stroke and heart attacks, with appropriate aspirin dosing one may prevent
such events. Smoking is a leading cause of both strokes and heart attacks;
one should practice smoking cessation or seek additional assistance for
quitting, there are many programs available to fit every lifestyle. In
advanced cases one may need surgical intervention and procedures to
correct, restore and prevent further damage.

In CAP, you can lower your chances of getting CAP by having a yearly
flu shot. The pneumococcal vaccines protect against S. pneumoniae and
may help in preventing CAP. Smokers and people living in long-term care
facilities should also get this shot before age 65. There are two2vaccines
against S. pneumoniae. Your healthcare provider may advise that you get
both. You may need booster shots of the vaccine if you have your first
pneumococcal vaccine before age 65 or if you have a weakened immune
system. Antibiotics are a key treatment for bacterial CAP. Your healthcare
provider will likely start you on this medicine even before identifying the
type of bacteria (or other germ). The type of antibiotic can vary based on
the germs known to be in your community, as well as your other health
problems. Your healthcare provider

1
 will want to treat you with an antibiotic that is likely to kill whatever germ
causing your illness. But antibiotics don't help in treating viral pneumonia and
can often cause more harm than good. Your treatment may vary based on
your symptoms and the type of germ causing the pneumonia. If you have
severe pneumonia, you will likely need to stay in the hospital for some time.
If you only have mild symptoms, you can probably get treatment at home.

For Dementia, doing regular physical activity is one of the best ways
to reduce your risk of dementia. It’s good for your heart, circulation, weight
and mental wellbeing. It’s important to find a way of exercising that works
for you. You might find it helpful to start off with a small amount of activity
and build it up gradually. Even 10 minutes at a time is good for you and try
to avoid long sitting down for too long. A healthy, balanced diet may reduce
your risk of dementia, as well as other conditions including cancer, type 2
diabetes, obesity, stroke and heart disease. Also, avoid smoking because if
you smoke, you’re putting yourself at much higher risk of developing
dementia. You’re also increasing your risk of other conditions, including type
2 diabetes, stroke, and lung and other cancers. Smoking does a lot of harm
to the circulation of blood around the body, including the blood vessels in
the brain, as well as the heart and lungs. Drinking too much alcohol
increases your risk of developing dementia. At most, you should aim to drink
no more than 14 units each week. If you regularly drink much more than
this, you’re at risk of alcohol-related brain damage. If you drink as many as
14 units in a week, try to spread them out over at least three days.

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PERSONAL DATA
Name: Abellana, Mary Catherine T.
Address: 470 Washington St., Brgy. Cansojong,
Talisay City, cebu
Birthdate: March 30, 1999
Birthplace: Cebu City
Status: Single
Religion: Roman Catholic
Mother’s Name: Maria Catherine T. Abellana
Father’s Name: Wenefredo B. Abellana
Contact Number: 09610858868

EDUCATIONAL BACKGROUND

College Level:
Southwestern University- PHINMA
S.Y. 2018- Present

Secondary Level:
Lawaan National High School
S.Y. 2013-2016
Senior High School:
St Cecilia’s College Inc.
S.Y. 2016-2018
Elementary Level:
Lipata Central School
S.Y. 2006- 2013
Primary/Preparatory/Kindergarten and Nursery Level:
Pardo Elementary school
S.Y. 2004-2006

1
PERSONAL DATA
Name: Amerol, Juhannah T.
Address: 587- D Potat Bagumbayan, Brgy. Tinago,
Cebu City
Birthdate: June 23, 2000
Birthplace: Lanao Del
Sur Status: Single
Religion: Catholic
Citizen: Filipino
Mother’s Name: Zolaica Amerol
Father’s Name: Jimmy Amerol
Contact Number: 09683161400

EDUCATIONAL BACKGROUND

College Level:
SouthWestern University – PHINMA, Urgello Street, Cebu City

Secondary Level:

Senior High School: University of the Visayas – Main Campus, Colon Street,
Cebu City || 2018
Junior High School: University of the Visayas – Main Campus, Colon Street,
Cebu City || 2016
Elementary Level: Tejero Elementary School, M.J. Cuenco Avenue, Cebu
City
Primary/Preparatory/Kindergarten and Nursery Level:
Tejero Elementary School, M.J Cuenco Avenue, Cebu City

1
PERSONAL DATA
Name: Nathaniel Dean G.
Address: Poblacion West, Moalboal, Cebu
Birthdate: April 30, 1999
Birthplace: Poblacion, Badian, Cebu
Status: Single
Religion: Roman Catholic
Mother’s Name: Maria Evelyn G. Arcipe
Father’s Name: Dennis R. Arcipe
Contact Number: 09950624614

EDUCATIONAL BACKGROUND

College Level:
Southwestern University PHINMA
Bachelor of Science in Nursing (2018 – present)

Secondary Level:

Senior High School

University of Cebu – Main Campus
Academic Track, STEM Strand (2016 – 2018)
Junior High School
Badian National High School (2014 – 2016)
Our Lady of Mount Carmel Learning Center (2012 – 2014)

Elementary Level:
Our Lady of Mount Carmel Learning Center (2005 – 2012)

Primary/Preparatory/Kindergarten and Nursery Level:

Our Lady of Mount Carmel Learning Center (2003 – 2005)

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PERSONAL DATA
Name: Obinwa, Chinaza
Address: Urgello, Cebu city
Birthdate: April 2,1999
Birthplace: Ibadan, Nigeria
Status: Single
Religion: Roman Catholic
Mother’s Name: Chinenye Obinwa
Father’s Name: Emeka Obinwa
Contact Number: 09451906376

EDUCATIONAL BACKGROUND

College Level:
Southwestern University Phinma, Urgello Street, Cebu City

Secondary Level:

Senior High School

Federal Government Girls College, Oyo|| 2015
Junior High School
Best Brain College, Ibadan|| 2012

Elementary Level:
Best Brain Primary school || 2009

Primary/Preparatory/Kindergarten and Nursery Level:

Bodmas kiddies college || 2004

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PERSONAL DATA
Name: Oralde, Richie Dianne M.
Address: Exodus Avenue, Brgy.
Panubigan, Canlaon City, Negros Oriental
Birthdate: June 11, 1999
Birthplace: San Carlos City, Negros
Occidental
Status: Single
Religion: Roman Catholic
Mother’s Name: Rizalie Diana M.
Oralde Father’s Name: Ritche Dexter J.
Oralde Contact Number: 09152562422

EDUCATIONAL BACKGROUND

College Level:
Southwestern University- PHINMA, Urgello Street, Cebu city

Secondary Level:

Senior High School

Southwestern University- PHINMA, Urgello Street, Cebu city

Junior High School

Jose B. Cardenas Memorial Highschool, Canlaon City, Negros Oriental

Elementary Level:
Macario Espanola Memorial School, Canlaon City, Negros Oriental

Primary/Preparatory/Kindergarten and Nursery Level: Macario

Espanola Memorial School, Canlaon City, Negros Oriental

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PERSONAL DATA
Name: Pales, Andonee Joy Y.
Address: Poblacion Merida, Leyte
Birthdate: March 02, 1999
Birthplace: Ormoc City
Status: Single
Religion: Pentecostal
Mother’s Name: Lalaine Y. Pales
Father’s Name: Julius B. Pales
Contact Number: 09977935281

EDUCATIONAL BACKGROUND

College Level:
Southwestern University Phinma, Urgello Street, Cebu City

Secondary Level:

Senior High School

LIDE Learning Center, Inc., Isabel Leyte || 2018
Junior High School
LIDE Learning Center, Inc., Isabel Leyte || 2016

Elementary Level:
Merida Central School, Poblacion Merida, Leyte || 2012

Primary/Preparatory/Kindergarten and Nursery Level:

Holy Child School, Poblacion Merida, Leyte || 2005

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PERSONAL DATA
Name: Paral, Shienna Ann A.
Address: Urban Homes Tipolo, Mandaue City
6014 Birthdate: October 18, 1999
Birthplace: Naval, Biliran
Status: Single
Religion: Christian
Mother’s Name: Rose Maria A. Paral
Father’s Name: Rodrigo M. Paral
Contact Number: 09954717423

EDUCATIONAL BACKGROUND

College Level:
Southwestern University – PHINMA – Urgello Street, Cebu City (2018-Present)

Secondary Level:

Senior High School:

University of San Jose- Recoletos – Magallanes Street, Cebu City (2016-2018)

Junior High School:

Naval State University – Laboratory High School – Naval, Biliran (2012-2016)

Elementary Level:
Naval SPED Center – Naval, Biliran (2006-2012)

Primary/Preparatory/Kindergarten and Nursery Level:

Naval Daycare Center – Naval, Biliran (2005-2006)

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PERSONAL DATA
Name: Pasasadaba, Jessah Lyka B.
Address: Poblacion, Madridejos, Bantayan Island
Birthdate: December 23, 1999
Birthplace: Poblacion, Madridejos, Bantayan Island
Status: Single
Religion: Roman Catholic
Mother’s Name: Vicky B. Pasasadaba
Father’s Name: Marlon O. Pasasadaba
Contact Number: 09776471224

EDUCATIONAL BACKGROUND

College Level:
Southwestern University PHINMA, Villa Aznar, Urgello St. Cebu City Bachelor
of Science in Nursing

Secondary Level:

Senior High School

University of Cebu – Main Campus, Sanciangko St, Cebu City || 2016 Science,
Technology, Engineering & Mathematics
Junior High School
Madridejos National High School, Madridejos, Cebu || 2012

Elementary Level:
Madridejos Central Elementary School, Madridejos, Cebu || 2006

Primary/Preparatory/Kindergarten and Nursery Level:

Kawit Elementary School, Medellin, Cebu || 2004

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PERSONAL DATA
Name: Repollo, Quenie Vance D.
Address: Cayam, Colon, City of Naga, Cebu City,
Phils.,6037
Birthdate: January 12, 1999
Birthplace: Cebu City
Status: Single
Religion: Roman Catholic
Mother’s Name: Eva D. Repollo
Father’s Name: Marlito D.
Repollo Contact Number:
09560723396

EDUCATIONAL BACKGROUND

College Level:
Southwestern University Phinma, Urgello Street, Cebu City

Secondary Level:

Senior High School

University of San Jose- Recoletos -Basak Campus, N. Bacalso Avenue, Basak
Pardo Cebu City, Philippines || 2018
Junior High School
University of the Visayas - Minglanilla Campus, National Highway, Tiber –
Poblacion Ward 1, Minglanilla, Cebu || 2016

Elementary Level:
Mary Help of Christians School (Cebu), Inc., Km 17, Tunghaan, Minglanilla,
6046 Cebu || 2012

Primary/Preparatory/Kindergarten and Nursery Level:

Siena School of Naga, Cebu South Road, Naga City, Cebu || 2006

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PERSONAL DATA
Name: Repunte, Maria Maeca Ella A.
Address: Tuyan, City of Naga, Cebu
Birthdate: May 22, 1999
Birthplace: Cebu City
Status: Single
Religion: Roman Catholic
Mother’s Name: Analiza A. Repunte
Father’s Name: Alfonso Repunte JR.
Contact Number: 09952924544

EDUCATIONAL BACKGROUND

College Level:
Southwestern University Phinma, Urgello Street, Cebu City

Secondary Level:

Senior High School

Southwestern University PHINMA Cebu City || 2018
Junior High School
University of the Visayas - Minglanilla Campus, Tiber Minglanilla || 2016

Elementary Level:
Tuyan Central Elementary School, City of Naga, Cebu || 2012

Primary/Preparatory/Kindergarten and Nursery Level:

Tuyan Central Elementary School, City of Naga, Cebu || 2005

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 PERSONAL
Name: Roculas, Pristine Faith P.
Address: Albor Libjo, Dinagat Islands
Birthdate: April 25, 2000
Birthplace: Caraga, Surigao City
Status: Single
Sex: Female
Religion: Roman Catholic
Citizen: Filipino
Mother’s Name: Crisflor P. Roculas
Father’s Name: Romelito R. Roculas

EDUCATIONAL BACKGROUND

College Level:
Southwestern University PHINMA, Urgello Street, Cebu City, Philippines |
2018-present

Senior High School:

Albor Senior High School – Libjo, Dinagat Islands | 2018
Academic Track, HUMSS strand
Junior High School:
Albor National High School– Libjo, Dinagat Islands | 2016

Primary Level:
Albor Central Elementary School – Libjo, Dinagat Islands | 2012
Primary/ Preparatory/ Kindergarten/ and Nursery Level:

Albor Day Care Center – Libjo, Dinagat Islands - 2005

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PERSONAL
Name: Samson, Ana Lorraine G.
Address: 100 J Alcantara Street, Cebu City
Birthdate: September 20, 1999
Birthplace: Dohinob, Roxas Zamboanga del Norte
Status: Single
Religion: Catholic
Mother’s Name: Analiza G. Samson
Father’s Name: Roy U. Samson
Contact Number: 09667364134

EDUCATIONAL BACKGROUND

College Level:
Southwestern University PHINMA
S.Y. 2018 – Present

Secondary Level:

Senior High School

Dipolog Medical Center
S.Y. 2012-2016

Junior High School

Dipolog Medical Center

Elementary Level:
Dohinob Central School

Primary/Preparatory/Kindergarten and Nursery Level:

EMCON Parish School

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PERSONAL
Name: Solon, Shein Ann A.
Address: Canhabagat, Medellin, Cebu

Birthdate: September 23,1999

Birthplace: Canhabagat, Medellin, Cebu
Status: Single
Religion: Roman Catholic
Mother’s Name: Solon, Arlene A.
Father’s Name: Solon, Rustico V.
Contact Number: 09452341039

EDUCATIONAL BACKGROUND

College Level:
Bachelor of Science in Nursing
Southwestern University PHINMA
S.Y. 2018 – Present

Secondary Level:

Senior High School

Medellin National Science and Technology School
S.Y. 2012-2016
Junior High School
Medellin National Science and Technology School
S.Y. 2016-2018

Elementary Level:
Canhabagat Elementary School
S.Y. 2006-2012
Primary/Preparatory/Kindergarten and Nursery Level:
Canhabagat Elementary School
S. Y. 2004

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PERSONAL
Name: Tagalog, Susiarah R.
Address: Tagbilaran City, Bohol
Birthdate: November 21, 1999
Birthplace: Cebu City
Status: Single
Religion: Roman Catholic
Mother’s Name: Reysana R. Tagalog
Father’s Name: Wilfredo L. Tagalog
Contact Number: 09999776252

EDUCATIONAL BACKGROUND

College Level:
Southwestern University Phinma, Urgello Street, Cebu City

Secondary Level:
Senior High School
University of Bohol, Bohol || 2018
Junior High School
University of Bohol, Bohol || 2016

Elementary Level:
Tagbilaran City Central Elementary School, Bohol || 2012

Primary/Preparatory/Kindergarten and Nursery Level:

Cabancalan 1 Elementary School, Cebu || 2005

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PERSONAL
Name: Tagimacruz, Nicole Claire D.
Address: Guadalupe, Cebu City
Birthdate: July 15, 1999
Birthplace: Mandaue City, Cebu
Status: Single
Religion: Roman Catholic
Mother’s Name: Meyla D. Tagimacruz
Father’s Name: Rouel S. Tagimacruz
Contact Number: 09359442624

EDUCATIONAL BACKGROUND

College Level:
Southwestern University – PHINMA, Urgello Street, Cebu City

Secondary Level:
Senior High School
University of Cebu – Private, Urgello Street, Cebu City
Junior High School
Southern Leyte State University – Laboratory High School
Tomas Oppus, Southern Leyte

Elementary Level:
San Vicente ES – Malitbog, Southern Leyte

Primary/Preparatory/Kindergarten and Nursery Level:

Malitbog Central School – Malitbog, Southern Leyte

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PERSONAL

Name: Tecson, China Alleiah A.

Address: Talo-ot, Argao, Cebu

Birthday: July 15, 1999

Birthplace: Cebu City

Status: Single

Religion: Roman Catholic

Citizen: Filipino

Mother’s Name: Jane A. Tecson

Father’s Name: Jerome C. Tecson

Contact Number: 09493293213

EDUCATIONAL BACKGROUND

College Level:
Southwestern University Phinma, Urgello Street, Cebu City

Senior Highschool:
Mother Mary’s Children School, Pob. III, Dapdap, Carcar City, Cebu || 2018

Junior Highschool:
Mother Mary’s Children School, Pob. III, Dapdap, Carcar City, Cebu || 2016

Elementary Level:
Mother Mary’s Children School, Pob. III, Dapdap, Carcar City, Cebu || 2012

Primary/ Preparatory/ Kindergarten/ Nursery Level:

Mother Mary’s Children School, Pob. III, Dapdap, Carcar City, Cebu || 2005

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PERSONAL
Name: Trinidad, Trisha Fay Q.
Address: Zone IV, Lanuza, Surigao del Sur
Birthdate: February 29, 2000
Birthplace: Tandag City
Status: Single
Religion: Roman Catholic
Mother’s Name: Marife Q. Trinidad
Father’s Name: Roman C.
Trinidad Contact Number:
09153376378

EDUCATIONAL BACKGROUND

College Level:
Southwestern University Phinma, Urgello Street, Cebu City

Secondary Level:
Senior High School
Tigao National High School , Tigao, Cortes, Surigao del Sur || 2018
Junior High School
Tigao National High School, Tigao, Cortes, Surigao del Sur || 2016

Elementary Level:
Tigao Elementary School, Tigao, Cortes, Surigao del Sur || 2012

Primary/Preparatory/Kindergarten and Nursery Level:

Lanuza Central Elemantary School, Lanuza Surigao del Sur|| 2005

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PERSONAL DATA
Name: Ultra, Silvan Roy P.
Address: Brgy. Balud, Magsaysay Blvd. Calbayog
City, Samar
Birthdate: September 4, 1999
Birthplace: Calbayog City
Status: Single
Religion: Roman Catholic
Mother’s Name: Araceli P. Ultra
Father’s Name: Esteban B. Ultra
Contact Number: 09971921374

EDUCATIONAL BACKGROUND

College Level:
Southwestern University – PHINMA, Urgello Street, Cebu City

Secondary Level:
Senior High School
Christ the King College
Junior High School
Christ the King College

Elementary Level:
Christ the King College

Primary/Preparatory/Kindergarten and Nursery Level:

Calbayog Christian Faith Academy

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PERSONAL
Name: Valencia, Mary Kathlene B.
Address: Caipilan, Pobalcion 1, Carcar City, Cebu
Birthdate: November 25, 1999
Birthplace: Cebu City
Status: Single
Religion: Roman Catholic
Mother’s Name: Nelfa B. Valencia
Father’s Name: Mario Lord Jundy A. Valencia
Contact Number: 09096681730

EDUCATIONAL BACKGROUND

College Level:
Southwestern University PHINMA

Secondary Level:
Senior High School
St. Catherine’s College
Junior High School
St. Catherine’s College

Elementary Level:
St. Catherine’s College

Primary/Preparatory/Kindergarten and Nursery Level:

St. Catherine’s College
Dunggo-an Day Care Center

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PERSONAL
Name: Vivares, Sophia Magdaleen F.
Address: Sirawai, Zamboanga del Norte
Birthdate: October 26, 1999
Birthplace: Zamboanga City
Status: Single
Religion: Roman Catholic
Mother’s Name: Lineth F. Vivares
Father’s Name: Dioscoro O. Vivares
Contact Number: 09655547617

EDUCATIONAL BACKGROUND

College Level:
Southwestern University Phinma, Urgello Street, Cebu City

Secondary Level:
Senior High School
Pilar College of Zamboanga City, Inc. || 2018
Junior High School
Sirawai National High School || 2016

Elementary Level:
Sirawai Central School || 2012

Primary/Preparatory/Kindergarten and Nursery Level:

Sto. Nino Kindergarten School, Sirawai, Zamboanga del Norte || 2005

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