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TETANUS

A HEALTHCARE
PROBLEM

Presented by:
Adult Infectious Disease Critical
Care Unit
D Calidad Brothers

History
Greek word:
Tetanos = taut/rigid
teinein = stretched

History
Tetanus was first described in Egypt over
3000 years ago(1600 B.C.)
The first Surgical
Documents found in
Ancient Egypt.
Edwin Smith is an
Antique dealer,
Wherein her daughter
Sold this papyrus to New York Academy of
Science.

History

Arthur Nicolaier, (1884)


isolated the strychnine-like toxin of tetanus
from free-living, anaerobic soil bacteria.

Kitasato Shibasaburo,
(1891) show that the organism could
produce diseases when injected into
animals, and that the toxin could be
neutralized by specific antibodies.

History

Edmond Nocard, (1897)


showed that tetanus antitoxin induced
passive immunity in humans and could be
used for prophylaxis and treatment.
1924 Tetanus toxoid was developed by
P. Descombey and widely used to
prevent
tetanus from wounded soldiers during
WW-I
and WW-II.

What Is Tetanus???
(W.H.O.) as an illness which characterized by
an acute onset of hypertonia, painful muscular
contractions (usually of the muscles of the jaw
and neck), and generalized muscle spasms
without other apparent medical causes.
(C.D.C.) an acute, often fatal, disease caused
by the exotoxin produced by the bacterium
Clostridium tetani. It characterized by
generalized rigidity and convulsive spasms of
skeletal muscles. The muscle stiffness usually
involves the jaw and neck and the becomes
generalized.
Sources: http//:WHO/tetanus/definition.net
http//:CDC/tetanus/definition.com

Cont:
According to Dr. Dionesia Navales,
RN, MaEd, defined as an acute
toxin mediated infection caused by
Clostredium tetani which
produces potent exotoxin with
prominent systemic neuromuscular
efforts manifested by generalized
spasmodic contractions of the
skeletal musculature.

Cont:
According to the SLH infection control
committee; they define as an acute
disease cause by the tetanus bacillus
Clostridium tetani whose spores are
introduced into the body when an injury
become contaminated with soiled,
street dust, or animal or human feces.

Source: Compilation of Communicable Disease in Nursing, 2005

Epidemiological
Determinant
Agent Factor
a. Agent
. Clostridium tetani is a gram
positive, anaerobic, spore-bearing
organism which is drum stick like in
appearance.
. The spores are resistance to number
of agents (boiling, phenol, cresol,
autoclaving for 15 mins. at 120C).

Cont:
The spore germinate under anaerobic
condition and produce exotoxin
tetanospasmin
b. Reservoir of Infection
The natural habitat of organism is soil and
dust. The bacilli is found in intestine of
many herbivorous animals and are
excreted in their feces. The bacilli may also
be found in human intestine without
causing illness.

Cont:
c. Exotoxin
. It is highly lethal.
. Man can only maintain at least 0.1mg of
exotoxin in the body.
. More than this, can be deadly.
. The toxin acts on nervous system.
Example:
a. Motor end plate in skeletal system
b. Brain, spinal cord and sympathetic
system

Cont:
Host Factor
a. Age
. It is disease of active age from 0 12 months
to
5 y/o up to 40 years old.
b. Sex
. Males there is higher incidence
. Female are more exposed to risk of tetanus
during delivery or abortion leading to
puerperal tetanus

Cont:
c. Rural-Urban Difference
More in Rural Area
d. Immunity
No age is immune unless previously
immunized
Injection of tetanus vaccines can provide
immunity which can last for several years.
An immunity less than 6 month can be
transferred to baby if mother is immunized
during pregnancy.

Global and Local Issues


Tetanus is an international health problem,
as spores are ubiquitous. The disease occurs
almost exclusively in persons who are
unvaccinated or inadequately immunized.
Tetanus occurs worldwide but is more
common in tropical climates with soil rich in
organic matter.
More common in developing and under
developing countries like India, Uganda, and
others.

Cont:
More prevalent in industrial
establishment, where agriculture
workers are employed.
Example:
a. Farmers
b. Fruit pickers
c. Fishermen
d. others

Mortality and Morbidity


There are between 800,000 and 1
Million deaths globally due to Tetanus
each year because of parental or
individual objection to vaccination.
Wherein there is no method for
prevention of tetanus other than
immunization.

Cont:

United States

In US (1947-2008), 80% or more of


these deaths occur in US.
The Survey shows the height of not
receiving vaccination compared to
receiving tetanus vaccine for men
and women.
lesser deaths for tetanus cases
including adult, elderly and
neonates.

Statistical Finding
Annual rate* of tetanus cases and tetanus deaths --- National Notifiable
Diseases Surveillance System, United States, 19472008

Source: W.H.O. National Notifiable Disease Surveillance System, 2008

Cont:

Globally

In 2014, the National Notifiable Disease


Surveillance System World Wide featured
that Clinical tetanus is less severe
among patients who have a history of
receiving primary series of tetanus
vaccine compared with patients who are
inadequately or unvaccinated.
US, Africa and South East Asia including the
Philippines and it remains endemic in all 90
countries world wide until now.

Statistical Finding
Annual rate* of tetanus cases and tetanus deaths --- National Notifiable
Diseases Surveillance System World Wide, 2014. (192 countries)

Source: W.H.O. National Notifiable Disease Surveillance System, 2014

Cont:

S.L.H.

All tetanus cases especially adult (Male


and Female) were reviewed according to
their general data and admitting history.
A comparison between nontracheostomy tube and with
tracheostomy tube based on the
mortality and morbidity of tetanus cases
from 2013 up to 2014 in San Lazaro
Hospital.

Statistical Finding
Annual rate* of admitted tetanus cases and tetanus deaths
in SLH, Hospital Statistical Report (2013-2014)

300 27 2/1
250
200
150
100
50
0

104
28

Male
Female
Tracheostomy

12 8/1
39

23

4 5/1
7 11

4 6/1
11 8

Source: SLH Statistical Report Survey for Tetanus, 2013 & 2014

Retrospective
Wherein, there is a clear
evidence that tetanus disease
has been reduced because of
public health programs including
giving immunization and it has
been maintained world wide.

Objective
General Objective:
To render quality standard healthcare services and
management among tetanus patient at AIDCCU and
reduced the risk of complications based on the
Nursing Practice.
Specific Objective:
To deliver optimum nursing standards of care among
tetanus patient.
To promote quality healthcare services in providing
medical assistance among tetanus patients.
To eliminate the risk of complications based on
hospital policies and guidelines.
To provide quality education and trainings to all
AIDCCU personnel for new trends and issues in

Scope and Limitation


The scope of these work is based on the
nursing standards and practices.
The nursing staff shall conduct their
preliminary work review at AIDCCU where
there are tetanus patients catered, but not
limited to the following:
a. Number of tetanus admitted
b. Number of tetanus patient with or without
mechanical ventilator
c. Number of mortality and morbidity

Cont:
Wherein, the nursing staff shall conduct the
second work review in assessing the patient
general data, but not limited to the following:
a. Age
b. Gender
c. Occupation
d. History of past and present illness
e. Socioeconomic history
f. Demographical history

Cont:
Wherein, the nursing staff shall provide the
following assessment tools needed in the third
work review, but not limited to the following:
a. Medical Chart
b. Interview
c. Questionnaires
. Wherein, the nursing staff shall used the
quasi-analysis method of research based on
the second and third work review, but not
limited to the following:
a. chi-square analysis
b. ANOVA analysis

Clinical Summary

Clinical Summary
General Data:
Name:

RODOLFO DE ROJAS SEMILLANO

Address:

49 San Pascual, Obando, Bulacan

Age:

56 years old

Religion:

Roman Catholic

Civil Status:

Married

Nationality:

Filipino

Date of Birth:

08/22/1958

Date/Time of Admission:

01/20/2015

Ward Room:

ICCU-2

Attending /Tentative
Diagnosis:

TETANUS

Revised Diagnosis:

Final Diagnosis:

TETANUS STAGE III SECONDARY TO DENTAL CARRIES

Date of Discharge:

February 18, 2015

Attending Physician:

DR.
RETUERMA/WONG/LUGTU/ALMERO/ARCHES/ANTONIO

Sources of Information:

JOY SEMILLANO (daughter)

Cont:
Chief Complaint:

Namamanhid ang panga

History of Present
Illness:

4 days PTC, the patient was


slashed by yero in his left
hand. Washed and treated with
betadine. No subjective
complaints. Also complained of
right foot, big toe was infected,
smashed by hollow block. Self
medicated with Amoxicillin. Few
hours PTC, cannot tolerated to
eat, hoarseness, feeling of
numbness in the jaw area upon
swallowing associated with nape
pain. Prompted consulted in SLH.

Past Medical History:

The patient has no previous


hospitalization. He do not
recalled his history of DPT
immunization during his
childhood days.

Family History:

Has the history of liver disease


with in the family most especially
on his father side. No

PHYSICAL
ASSESSMENT,
CLINICAL
MANIFESTATION,
AND
PATTERN OF
FUNCTIONING

Physical Assessment
Measurem
ent

Findings

Normal

Analysis and
Interpretation

Height

57 (1.7m)

No specific
height

Weight

145.86 lbs.
(66.3 kg.)

151 lbs. (68.63


kg.)

Unremarkably, the
height of the
patient is within
the normal state.
However, the
weight of the
patient is based
on the body mass
index chart and
BMI formula, he is
underweight upon
admission. After
confinement the
patient weight has
been improved:
147.97 lbs.
(67.26kg.)

Physical Assessment
Measurem
ent

Findings

Normal

Analysis and
Interpretation

Vital signs

T= 36.6C

T= 35.9-37.4C
(96.6-99.3F)

Unremarkable
vital signs,
however BP is
lower than is
expected due to
the action of
depressant
drugs like
diazepam.

Avera
ge

Range

PR= 65 ppm

80

60100

RR= 19 bpm

16

12-20

BP= 110/70
mmHg

120/80 120/80

140/90
mmHg

Source: SLH Nursing Standard Operating Procedure, 2012


Fundamentals of Nursing, 2014

Clinical Manifestation

Body
Parts

Normal Findings

Actual Findings

Analysis and
Interpretation

Skull

Rounded
(normocephalic and
symmetric, with
frontal, parietal,
and occipital
prominences);
smooth skull
contour.

Rounded and
symmetrical in
appearance with
smooth skull contour.

Unremarkably, the
skull is normal in size
and shape.

Hair

Resilient, silky hair


and evenly
distributed, no
infection or
infestation and
variable.

Hair is thick and


evenly distributed
from the scalp to
extremities, no
presence of infection
or infestation in the
scalp and other parts
of the body except in
wound area.

Unremarkably, hair is
black in color, the
hair line grows
evenly within normal
appearance, there is
mild to moderate loss
of hair in the axillary
and the eyebrows,
ears and nostrils hair
texture is bristlelike
coarse and silky dry
hair to touch.

HEAD:

Cont:
Body Parts

Normal
Findings

Actual
Findings

Analysis and
Interpretation

EYE and
VISION:
Eyeball

Symmetrically
round in shape;
nasolacrimal
duct intact and
no edema or
tear.

No presence of
coloboma, normal
and no signs of
edema or tear on
nasolacrimal ducts.

Unremarkably, eye
muscular and
nasolacrimal ducts
are intact.

Lid margin

Skin intact; no
discharges; no
discoloration,
lids close
symmetrically

no discharges or
discoloration.

Unremarkably, skin
intact; there is no
signs of discharges
and normal in
color.

Conjunctiva

Shiny, smooth
and pink or red
in color.

Pink palpebral
conjunctivae

Unremarkably,
normal in
appearance.

Sclera

Transparent;
capillaries
sometimes
evident; sclera

Anicteric sclerae.

Unremarkably,
normal in
appearance.

Cont:
Body Parts

Normal
Findings

Actual
Findings

Analysis and
Interpretation

Pupils

Black in color;
equal in size;
normally 3-7mm.
in diameter;
round, smooth
border, iris flat
and round;
illuminated pupil
constricts/dilate
(direct or in-direct
response).

Black in color with


a size of 3-6mm in
diameter, iris flat
and round smooth
border.

Unremarkably, Pupils
equally round and
reacts to light and
accommodation.

Eyebrow,
lashes,
color,
symmetry,
quality of
hair,
placement

Hair evenly
distributed; no
discoloration of
hair; eyebrows
symmetrically
aligned; curled
slightly outward.

No discoloration
and slightly curled
eyelashes, and
with symmetry
distribution of
eyebrow.

Unremarkably, no
loss of hair and
flakiness of skin and
there is slight
unequal movement
of eyebrows.

EYE and
VISION:

Cont:
Body Parts

Normal
Findings

Actual
Findings

Analysis and
Interpretation

VISION
TESTING:
Visual Field

Client can see


objects in the
periphery;

Light reflection
appears at
symmetric spots
in both eyes.

Unremarkably,
there is no signs
of peripheral
vision deformity.

Visual Acuity

Able to read
newsprint;
20/20 vision on
Snellen chart.

No signs of visual
deterioration
(performing
functional vision
test like: light
perception; hand
movement &
counting fingers).

Unremarkably, no
signs of visual
disorientation.

Cont:
Body Parts

Normal
Findings

Actual
Findings

Analysis and
Interpretation

EARS:
Pinna

Pinna recoils
after it is folded;
Symmetry in
color, position,
elasticity, firm,
and tenderness.

External Canal Dry cerumen,

grayish-tan
color; or sticky,
wet cerumen in
various shades
of brown.

Hearing
Acuity

Normal voice
tones audible.

No infection seen.

Unremarkably, the
pinna is intact and
no signs of
deformity or
infection seen.

No infection
(tinnitus) seen.

Unremarkably,
normal in position
and no signs of
scaling, or infection
indicated.

No signs of
deafness.

Unremarkably, able
to repeat
nonconsecutive
words and
numbers, sound is
heard in both ears

Cont:
Body parts
NOSE:

Normal
Findings

Actual
Findings

Analysis and
Interpretation

Symmetric and
straight, no
discharge or
flaring, uniform
in color, not
tender; no
lesions; sinuses
are well
outlined, contain
air, and light up
equally.

No nasoaural
discharge

Unremarkably,
there is no signs of
discharge, or
lesion; sinuses are
well intact and
equal in color.

Pink gums
(bluish or dark
patches in darkskinned clients),
moist, firm
texture ; no
retraction of
gums (pulling
away from the
teeth).

Dark-brown in
color,

Unremarkably, it is
normal indication
to heavy smoker.

MOUTH/LIPS:
Gums

Cont:
Body parts

Normal
Findings

Actual
Findings

Analysis and
Interpretation

Tongue

Central
position, pink in
color, moist,
slightly rough;
thin whitish
coating;
smooth, lateral
margins and
base with
prominent
veins; no
lesions; no
tenderness; no
palpable
nodules.

Normal in
appearance.

Unremarkably, no
signs of deformity
or lesion; normal
in appearance.

Palatehard/soft

Light, pink,
smooth, soft
palate

Normal in
appearance.

Unremarkably, no
signs of deformity.

Cont:
Body
parts

Normal Findings

Actual Findings

Analysis and
Interpretation

CHEEKS:

Symmetrical in
bony shape
structure, no
lesion.

Normal in
appearance

NECK:

Muscle equal in
size, lymph nodes
not palpable,
thyroid lobes not
palpable.

(+) Trismus, No signs Unremarkably,


of lesions and
indicates no signs of
nodules upon
thyroid dysfunction
palpation.
or cardiopulmonary
distress.

Anterior

Normal chest
symmetry
expansion (3-5cm);
spine vertically
aligned; no
tenderness; no
masses; fremitus is
heard at the apex
of the lungs;
adventitious breath
sounds.

Symmetrical chest
expansion, no
retraction, clear
breath sounds.

Unremarkably, no
signs of respiratory
distress.

Posterior

Full symmetric

Symmetrical chest

Unremarkably, no

Unremarkably,
normal in size and
shape and no signs
of lesion.

CHEST:

Cont:
Body parts

Normal
Findings

Actual
Findings

Analysis and
Interpretation

HEART:

No pulsation,
lift or heave
(visible in 50%
of adults); PMI
in fifth LICS at
or medial to
MCL; aortic
pulsations (S1:
usually heard at
all sites, S2:
usually heard at
base of heart);
carotid artery:
no sound heard
on auscultation;
jugular vein:
veins are visible
(normally
functioning).

Adynamic
precordium,
normal rate,
regular rhythm,
no murmur.

Unremarkably, no
signs of
hypertension, or
prominent in any
heart diseases.

BREAST:

Male: breast
are even with

Normal,
symmetrical level

Unremarkably,
there is no signs

Cont:
Body
parts

Normal Findings

ABDOMEN Unblemished skin;


flat, rounded or
:

scaphoid in size; no
evidence of
enlargement of liver
or spleen; no
appearance of
bulges or marked
ridges; no
tenderness; bladder
is not palpable.

Actual
Findings

Analysis and
Interpretation

Flabby, firm,
normoactive bowel
sounds, non-tender
upon palpation but
(+) firm and tense.

Unremarkably,
normal signs and
symmetric in size
and shape; a
contracture noted
indicating abdominal
rigidity due to
spasmodic process
involving
parasympathetic
system.
Unremarkably, there
is no signs of
deformity.

UPPER
EXTREMIT
IES:

Equal size on both


sides of body; no
contractures,
fasciculation or
tremors; smooth
coordinated
movements; equal
strength on both
sides of body.

Grossly normal
extremities.

LOWER

Equal size on both

(+) Open wound on There is a present of

Pattern of Functioning
Nutrition:

Before
Hospitalizatio
n

During
Hospitalizatio
n

Analysis and
Interpretation

PTA, Unable to
eat. (1/20/15).

Inserted an NGT
(1/23/15).

Osteorized
feeding was
started, for
nutritional buildup.

Coffee ground
output/NGT
(1/27/15).

This indicate that


the patient is
having gastric
irritation.

Elimination:

PTA, No signs of
bowel
movement.

Defecate in small
amount (softchocolate brown,
non-odorous
smell).

It indicates that
the patient is
having side effect
on Anti-TB
medication.

Exercise:

PTA, stiffness
and spasm
where

PTD, Advice
patient to do
simple ROM

It indicates the
circulation of
blood in the entire

Cont:
Before
Hospitalization
Hygiene:

PTA, unable to
bath and
grooming.

During
Hospitalization

Analysis and
Interpretation

Do oral, wound, and


tracheostomy care.

To prevent from
further infection.

Do simple sponge
bath daily.

To improve body
circulation. Simple
touch may relieve
stress and pain (D.
Jonson et, at.
2001).

Rest:

PTA, patient is
irritable and
restless.

Unable to rest
properly d/t spasmic
attack.

Patient may
develop bilateral
ptosis (lazy eye)
because it affects
the motor nerve of
the persons brain.

Sleep:

PTA, patient is
unable to sleep
well.

Unable to sleep
properly d/t noisy
environment.

Patient may
develop
hallucination
because it affects

Course
In the Ward

Course in the Ward


Medical Management

Nursing Management

Date: 1/20/15
On admission, patient was
placed on NPO and hydrated
with PLR i L. CXR, CBC, U/A,
serum electrolytes, FBS,
BUN, Crea., AST/ALT was
requested. The following
medication were prescribed:
Metronidazole, Paracetamol,
Diazepam, Tetanus toxoid
and ATS was also given.

Date: 1/20/15
Upon admission, patient brought to ER
Department by her daughter. PE
finding shows (-) signs of respiratory
distress,
(-) spasm, (+) mild trismus, (+) open
wound on Right big toe, (+) dental
carries.
Hence, admitted to Pavilion-6 w/
diagnosis of Tetanus. Patient was
placed on an NPO & hydrated w/ PLR i
L to run for 8 hours regulated. CXR (PA
view) was done prior to admission.
CBC, FBS, BUN, Crea, AST/ALT, U/A was
requested. ATS 40,000 unit, Tetanus
Toxoid 0.5 ml. and Metronidazole
500mg TIV every 6 hours was given.
VS every 4 hours was maintained.

Course in the Ward


Medical Management
Date: 1/21/15
On the 1st HD, a foley
catheter was inserted.
Patient had abdominal
rigidity. IVF was shifted to
DNM i L.

Nursing Management
Date: 1/21/15
On the 1st HD;
9:20AM (+) abdominal rigidity.
Diazepam 10mg bolus/IV every 4
hours and Diazepam drip IV every 4
hours was started. Foley catheter was
inserted connected to urine bag & IVF
was shifted to DNM i L to run for 8
hours regulated. CBC result seen. No
further ordered by
Dr. Retuerma.
VS every 4 hours; promote safety and
comfort; avoid any stimuli advised to
watcher; & provide calm & quiet
environment. Continued present
management.

Course in the Ward


Medical Management
Date: 1/22/15
On the 2nd HD, patient
had spasms and muscle
rigidity. Ceftriaxone was
started. Tracheostomy
was done, ketorolac
30mg/IV was given, on
patient was hooked to O.

Nursing Management
Date: 1/22/15
On the 2nd HD;
9:15AM patient had (+) spasm, (+)
trismus.
Ceftriaxone 2 gm. TIV OD was started at
around 10:25am. Ketorolac 30mg IV
ANST(-) every 8 hours for 6 doses then
PRN for pain was started at around
12noon. Emergency tracheostomy
referred to surgery. For tracheal aspirate
GS/CS requested. No further ordered by
Dr. Wong.
1:00PM Patient brought to OR/DR
Complex for Emergency Tracheostomy
procedure.
Brought back to Pavilion-6; Maintained
tracheal mask at 10 LPM; VS every 4

Course in the Ward


Medical Management
Date: 1/23/15
On the 3rd HD, there was
in rigidity, present
management continued.

Nursing Management
Date: 1/23/15
On the 3rd HD;
8:00AM there was occasional spasm
occasional, (+) open mouth @ 2-3 FB, (+)
abdominal rigidity.
Send specimen for tracheal aspirate CS
requested. Continued diazepam drip and
bolus. No further ordered by Dr. Wong.
1:20PM ET Aspirate result was confirmed:
Few growth of Acinetobacter baumannii
not referred.
VS every 4 hours; Suction secretion as
needed; Promote safety and comfort;
Provide calm & quiet environment;
Maintain tracheal mask @ 10 LPM.
Continue present management.

Course in the Ward


Medical Management
Date: 1/24/15
On the 4th HD, Clindamycin
was started. Repeat CBC,
Na, K, Crea & ET Aspirate
GS/CS was requested.

Nursing Management
Date: 1/24/15
On the 4th HD;
10:30AM Clindamycin 300mg TIV
every 6 hours ANST (-) was started at
around 7:30pm. Repeat CBC, Na, K,
Crea, & ETA GS/CS was requested. For
NGT insertion (+) consent signed by
watcher (daughter). Diazepam 10mg IV
bolus 30 minutes prior to NGT insertion.
No further ordered by Dr. Retuerma.
VS every 4 hours; Suction secretion as
needed; Promote safety and comfort;
continue present management.

Course in the Ward


Medical Management
Date: 1/25/15
On the 5th HD,
Nasogastric tube was
inserted.

Nursing Management
Date: 1/25/15
On the 5th HD;
8:10AM may insert NGT today. Diazepam
10mg IV bolus given 30 minutes prior to
NGT insertion. OF @ 1,400 kcal in 4
divided feeding. For CXR (PA view) on
1/26/15 as scheduled. For transfer to
IDCCU once with vacancy. No further
ordered by Dr. Retuerma.
VS every 4 hours; Suction secretion as
needed; Promote safety and comfort;
continue present management;
Maintained tracheal mask at 10 LPM.

Course in the Ward


Medical Management
Date: 1/26/15
On the 6th HD, patient
was to be transferred to
IDCCU, present
management was
continued. Patient has
afebrile w/ (+) trismus
(can open mouth) but
limited, (+) crackles on
BLF. Sputum AFB was
requested.

Nursing Management
Date: 1/26/15
On the 6th HD;
8:30am Patient developed crackles on
BLF, (+) secretion production, (-) unable
to open mouth 2-3 FB, (-) fever.
Patient was transferred to IDCCU. CXR
(PA view) facilitated prior to transfer. CXR
result referred to Dr. Wong. Baclofen 1 tab
TID. For tracheal aspirate GS/CS and
sputum AFB x2 requested. No further
ordered by Dr. Wong.
VS every 2 hours; I & O every shift;
Suction secretion as needed; Promote
safety and comfort; Continue present
management; Maintained tracheal mask
at 10 LPM.

Course in the Ward


Medical Management

Nursing Management

Date: 1/27/15
On the 7th HD, coffee
ground fluid was
aspirated from NGT,
patient was then placed
on NPO. Present
management was
continued. Coffee ground
aspirate per NGT was still
noted. Spasm was
further
but crackles were
still present. Ketorolac
was discontinued. IV
Meropenem was started
w/ Omeprazole,
Diazepam was
decreased. Gastric
lavage was done.
Ceftriaxone was also

Date: 1/27/15
On the 7th HD;
1:25AM patient developed coffee ground
output per NGT, (+) secretion production.
Referred via telephone and ordered was
made by Dr. Wong: for NPO.
7:30AM a 50cc coffee ground output per
NGT. Gastric lavage w/ cold water was
done for 2 times. Still with coffee ground
output. Referred to Dr. Wong.
8:00AM (+) coffee ground per NGT, (-)
spasm, (+) crackles BLF, (+)
Acinetobacter.
=Cont.=

Course in the Ward


Medical Management

Nursing Management
=Cont.=
Do gastric lavage w/ cold water until fluid
is clear. NPO temporarily. Meropenem
1gm. TIV every 8 hours ANST (-) to run for
4 hours; Omeprazole 40mg. IV started at
10:00am, then 80mg. + DW 250cc to run
for 5 hours started at 2:10pm. Decrease
Diazepam 10mg. IV every 8 hours;
diazepam drip to every 6 hours and
discontinue Ketorolac. No further ordered
by Dr. Wong.
4:00PM ETA GS/CS result was referred
and ordered was made by Dr. Bartolome:
D/C Ceftriaxone.
=Cont.=

Course in the Ward


Medical Management

Nursing Management
=Cont.=
6:30PM clear NGT aspirate noted.
Omeprazole drip to consume, resume OF
as ordered, Sucralfate 1gm. Every 6
hours started at 6:00pm. Omeprazole
40mg./vial every 12 hours. No further
ordered by Dr. Lugtu.
VS every 2 hours; I & O every shift; NPO
temporarily until clear NGT aspiration;
Suction secretion as needed; oral, trache
& wound care; Promote safety and
comfort; Maintained tracheal mask at 10
LPM; Continue present management.

Course in the Ward


Medical Management
Date: 1/28/15
On the 8th HD, patient had
clear aspirate but still had
crackles on BLF. He was
afebrile w/ stable VS.
omeprazole & Diazepam
were decreased.
Furosemide & Salbutamol
neb was given. ETA AFB
culture was requested.
Acetylcystein was also
given.

Nursing Management
Date: 1/28/15
On the 8th HD;
7:05AM (+) crackles BLF, (-) coffee
ground/NGT, (+) secretion production.
Omeprazole 40mg OD, Sucralfate tablet
for 3 doses then D/C, Diazepam every 8
hours, Furosemide 20mg. IVP now then
every 6 hours for 2 more doses, decrease
IVF to 60cc/hour, Salbutamol neb. every 8
hours, Acetylcystein 600mg. 1 tab OD
dissolve in 100ml. water. For U/A, ETA AFB
x2 requested. No further ordered by Dr.
Lugtu.
=Cont.=

Course in the Ward


Medical Management

Nursing Management
=Cont.=
ET aspirate AFB (-) result for 2 consecutive
examination; Tracheal Aspirate result:
Moderate growth of Stenotrophomonas
Maltophilia not referred.
VS every 2 hours; I & O every shift; OF
feeding maintained; Suction secretion as
needed; oral, trache & wound care;
Promote safety and comfort; Maintained
tracheal mask at 10 LPM; Continue present
management.

Course in the Ward


Medical
Management

Nursing Management

Date: 1/29/15
On the 9th HD, ABG
was requested. Patient
was allowed General
Liquid as tolerated &
once fully awake.
Repeat CBC & Crea.
was also requested.

Date: 1/29/15
On the 9th HD;
8:20AM (+) occasional spasm, (+) trismus,
(+) secretion production.
May have General Liquid diet if tolerated in
fully awake. d/C Furosemide, decrease
diazepam bolus to every 12 hours. For repeat
CBC, Crea, requested. For ABG today. No
further ordered by
Dr. Retuerma.
2:45PM CBC result and referred to Dr.
Wong.
VS every 2 hours; I & O every shift; Change
IV site; OF feeding maintained; Suction
secretion as needed; oral, trache & wound
care; Promote safety and comfort; Continue

Course in the Ward


Medical
Management
Date: 1/30/15
On the 10th HD, patient
had occasional spasms
& had 1 episode of
fever. Present
management was
continued.

Nursing Management
Date: 1/30/15
On the 10th HD;
2:00AM (+) occasional spasm, stable vital
signs, 1 episode of fever, (+) secretion
production.
decrease Diazepam drip to 12 hours. As
ordered by Dr. Almero.
4:20PM ABG result and referred to
Dr. Wong.
5:20PM ET Aspirate result: Moderate
growth of Stenotrophomonas Maltophilia
was referred to Dr. Arches.
Paracetamol IV was given; VS every 2 hours;
I & O every shift; OF feeding maintained;
Suction secretion as needed; oral & trache

Course in the Ward


Medical Management
Date: 1/31/15
On the 11th HD,
Cotrimoxazole was
started due to (+)
tracheal aspirate for
Stenotrophomonas
Maltophilia. Fecalysis
was requested.

Nursing Management
Date: 1/31/15
On the 11th HD;
7:25AM afebrile, (+) occasional spasm,
(+) abdominal rigidity, w/ heavy growth of
Stenotrophomonas Maltophilia.
decrease Diazepam drip every 24 hours,
Maintain diazepam bolus at same rate, to
complete Metronidazole IV for 10 days then
D/C, Cotrimoxazole 1 tablet BID started at
6:00pm. No further ordered by
Dr. Arches.
D/C Metronidazole IV; VS every 2 hours; I &
O every shift; OF feeding maintained;
Suction secretion per trache and orem as
needed; oral & trache care; Promote safety
and comfort; Continue present
management.

Course in the Ward


Medical
Management
Date: 2/1/15
On the 12th HD,
patient is afebrile w/
stable VS, still w/
crackles on BLF.
Repeat CBC, BUN, NA,
K was requested.
Present management
was continued.

Nursing Management
Date: 2/1/15
On the 12th HD;
7:30AM (+) crackles BLF, (+) abdominal
rigidity, (+) BM 2x, (+) sputum production.
Baclofen 10mg. every 6 hours started at
12:00noon, Salbutamol neb. every 6 hours
started at 7:30am. For repeat CBC w/ APC,
BUN, Crea, K, Na. No further ordered by Dr.
Lugtu.
4:30PM CBC w/ APC, BUN, Crea, Na, K
result referred to Dr. Retuerma. No further
ordered.
VS every 2 hours; I & O every shift; oral &
trache care; Suction secretion as needed; OF
feeding maintained; Promote safety and

Course in the Ward


Medical
Management
Date: 2/2/15
On the 13th HD,
patient was afebrile w/
(-) fluid balance. IVF
was
& patient was
given Furosemide.
There was no more
spasm but still (+)
crackles. Kalium
Durule was given.

Nursing Management
Date: 2/2/15
On the 13th HD;
7:00AM (-) spasm, (+) abdominal rigidity.
For ETA AFB X1 requested. Continue
medication. No further ordered by Dr.
Retuerma.
1:30PM ETA result & was referred to
Dr. Almero with no further ordered.
7:30PM patient seen awake to drowsy,
minimal abdominal rigidity, (-) spasm, on
crepts bibasal.
=Cont.=

Course in the Ward


Medical Management

Nursing Management
=Cont.=
May decrease nebulization every 8 hours,
main IVF to KVO regulated, Furosemide
20mg. IV once SBP > 100mmHg. No
further ordered by Dr. Almero.
Furosemide 20mg. IV given at around
9:00pm. Nebulization every 8 hours given
according to the hospital policy standard
time.
VS every 2 hours; I & O every shift; OF
feeding maintained; Suction secretion per
trache and orem as needed; oral & trache
care; Promote safety and comfort; may put
pillow at sides with assistance every 2-3
hours; Bronchial tapping emphasis every
after nebulization; Maintain tracheal mask

Course in the Ward


Medical Management
Date: 2/3/15
On the 14th HD, was
unremarkable.

Nursing Management
Date: 2/3/15
On the 14th HD;
6:00AM awake to drowsy, (-) spasm,
(+) abdomen soft, non-tenderness,
(+) crackles bibasal, (+) sputum secretion,
K=3.34.
D/C Diazepam drip, decrease Diazepam
bolus OD, Acetylcystein 600mg. 1 tablet
OD, Kalium durule 1 tablet OD for 2 days
started at 8:00am, IVF to follow: DLR i L to
run at 60cc/hours, Furosemide 20mg. IV
SBP > 100mmHg was given at around 12
noon. No further ordered by
Dr. Almero.
=Cont.=

Course in the Ward


Medical Management

Nursing Management
=Cont.=
3:00pm (+) Edema on IV site, (+)
redness, (+) resistance (-) backflow. Reinsert new IV line.
5:15PM U/A result referred to Dr. Almero.
No further ordered.
VS every 2 hours; I & O every shift; OF
feeding maintained; Suction secretion per
trache and orem as needed; oral & trache
care; Promote safety and comfort; turn to
sides with pillow at interval w/ assistance;
Bronchial tapping emphasis every after
nebulization; Continue present
management.

Course in the Ward


Medical Management
Date: 2/4/15
On the 15th HD,
unremarkable.

Nursing Management
Date: 2/4/14
On the 15th HD;
7:30AM afebrile, awake, (-) spasm, soft
abdomen, (-) tenderness, (+) crackles BLF.
Complete diazepam bolus for 2 more
doses then D/C. No further ordered by Dr.
Almero.
Give Colestin 1.2 Mil. Unit TIV every 8
hours ANST ( ). As ordered by Dr. Antonio.
8:00PM (+) BM (soft brown) perineal
care and change diaper; VS every 2 hours;
I & O every shift; OF feeding maintained;
Suction secretion as needed; oral & trache
care; Promote safety and comfort; may
turn sides at interval with assistance;
Bronchial tapping emphasis every after

Course in the Ward


Medical Management
Date: 2/5/15
On the 16th HD, Colestin
was given. Patient was
referred to PMAP.

Nursing Management
Date: 2/5/15
On the 16th HD;
8:00AM afebrile (+) sputum production,
(-) spasm, decrease ronchi, awake,
coherent.
Continue meds. As ordered by Dr. Antonio.
8:30AM shift trache mask to Nasal
Cannula at 2-3 LPM and apply 1 ply of OS
to tracheal opening, Monitor SPO every 1
hour and refer to undersigned as ordered
by Dr. Antonio.
1:00PM O Sat=89-92% was referred to
Dr. Antonio. Seen and ordered to give O
at 5-6 LPM via trache mask and remove
ply.

Course in the Ward


Medical Management

Nursing Management
=Cont.=
3:30PM for referral to PMAP for
assistance in procurement of medication
as ordered by
Dr. Antonio.
Referred patients medication
procurement at PMAP; VS every 2 hours;
oral & trache care; I & O every shift;
Suction secretion per trache and orem as
needed; OF feeding maintained; Promote
safety and comfort; turn sides at interval
with assistance; Bronchial tapping
emphasis every after nebulization;
Maintain tracheal mask at 5-6 LPM;
Continue present management.

Course in the Ward


Medical Management
Date: 2/6/15
On the 17th HD, patient
was afebrile w/ (+)
secretions. Present
management was
maintained. IVF
was
. Repeat CBC,
Na, K, Ca, Mg was
requested.

Nursing Management
Date: 2/6/15
On the 17th HD;
7:30AM (+) secretion, (-) spasm.
Maintain on O inhalation via tracheal
mask, Suction secretion as ordered by
Dr. Retuerma.
10:00PM alert, crepts R-L, (-) DOB.
Decrease IVF DLR i L to KVO, Suction
secretion. Repeat CBC w/ APC, Na, K, Ca,
Mg. as ordered by Dr. Almero.
CBC w/ APC, Na, K was requested and
serum Ca, Mg was send outside c/o
relative.
=Cont.=

Course in the Ward


Medical Management

Nursing Management
=Cont.=
VS every 2 hours; oral & trache care; I & O
every shift; OF feeding maintained; Suction
secretion per trache and orem as needed;
Promote safety and comfort; turn to sides
at interval with assistance; Bronchial
tapping emphasis every after nebulization;
Maintain tracheal mask at 5-6 LPM;
Continue present management.

Course in the Ward


Medical Management

Nursing Management

Date: 2/7/15
On the 18th HD, patient is
afebrile, awake to drowsy.
Levofloxacin was started
w/ Erdostein & Potassium
Chloride. Present
management was
maintained.

Date: 2/7/15
On the 18th HD;
8:20AM awake to drowsy, on crepts
bibasal, (+) trachea secretion, afebrile, (-)
spasm, (-) abdominal tenderness.
May try 1 ply gauze cover on
tracheostomy. Suction secretion prior to
gauze cover. Put nasal cannula at 2-3 LPM
O inhalation. Decrease Baclofen every 8
hours, increase IVF DLR i L at 60cc/hour.
No further ordered by Dr. Almero.
Erdostein 300mg. 1 cap OD and
Levofloxacin 750mg. 1 tablet OD was
given at 8:30am in lieu of Colestine
tablet.
=Cont.=

Course in the Ward


Medical Management

Nursing Management
=Cont.=
12:10PM CBC, Na, K was referred via
telephone to Dr. Lazaro and ordered for
Potassium Chloride 1 tablet TID which
was started at around 12:30pm.
10:25PM (+) sputum production, (+)
crackles BLF.
Remove gauze, CPT each neb. O
inhalation at 1-2 LMP via trache mask as
ordered by Dr. Arches.
VS every 2 hours; oral & trache care; I &
O every shift; OF feeding maintained;
Suction secretion per trache and orem as
needed; Promote safety and comfort;
may sit on bed with assistance; Bronchial
tapping emphasis every after

Course in the Ward


Medical Management
Date: 2/8/15
On the 19th HD, for repeat
serum K after correction
was requested after KCL
tablet has been
completed for 3 more
days then discontinued.
Present management was
maintained.

Nursing Management
Date: 2/8/15
On the 19th HD;
8:00AM afebrile, awake, (+) sputum
production (+) crackles BLF, (-)
desaturation OSat=95%-98%.
Complete KCl tablet for 3 more days then
D/C, repeat serum K after correction was
requested on 2/10/15. No further ordered
by Dr. Arches.
VS every 2 hours; oral & trache care; I &
O every shift; OF feeding maintained;
Suction secretion per trache and orem as
needed; Promote safety and comfort;
may sit on bed with assistance; Bronchial
tapping emphasis every after
nebulization; maintain tracheal mask at
1-2 LPM; Continue present management.

Course in the Ward


Medical Management
Date: 2/9/15
On the 20th HD, (+)
sputum production, fully
awake. Furosemide IV and
Baclofen tablet was
discontinued. Shift
Omeprazole capsule OD.
Present management was
maintained.

Nursing Management
Date: 2/9/15
On the 20th HD;
7:17AM (+) sputum production, fully
awake.
Discontinue Furosemide IV, shift
Omeprazole IV to 40mg/capsule OD, D/C
Baclofen tablet once consumed was done
and carried out. No further ordered by Dr.
Lugtu.
VS every 2 hours; oral & trache care; I &
O every shift; OF feeding maintained;
Suction secretion per trache and orem as
needed; Promote safety and comfort;
may sit on bed with assistance; Bronchial
tapping emphasis every after
nebulization; maintain tracheal mask at
1-2 LPM; Continue present management.

Course in the Ward


Medical Management
Date: 2/10/15
On the 21st HD, (+)
crackles BLF, afebrile.
Continued present
antibiotics and
management.

Nursing Management
Date: 2/10/15
On the 21st HD;
8:00AM (+) crackles BLF, (-) fever.
Suction secretion, continue present
antibiotics. No further ordered by Dr.
Retuerma
VS every 2 hours; oral & trache care; I &
O every shift; OF feeding maintained;
Suction secretion per trache and orem as
needed; Promote safety and comfort;
may sit on bed with assistance; Bronchial
tapping emphasis every after
nebulization; maintain tracheal mask at
1-2 LPM; Continue present management.

Course in the Ward


Medical Management
Date: 2/11/15
On the 22nd HD, hx. Of
PTB treated last 2oo6 at
Obando, Bulacan RHU.
Treatment of 2HRZE/4HR
was completed. For
referral to NTP for TBDC
and Gene-Xpert analysis
requested. Continued
present management.

Nursing Management
Date: 2/11/15
On the 22nd HD;
11:00PM awake, coherent, BP=100/70,
RR=24, T=36.2C, HR=88 SPO=98% on
tracheal mask @ 2 LPM, SCE (+) rales,
crepts R>L lung field, increase secretion
on tracheostomy opening.
Patient has a history of PTB which was
treated last 2006 at Obando, Bulacan
RHU.
For possible HRZE (Cat II) regimen once
with GeneXpert analysis result.
Shift IVF to heplock done, increase
oral/NGT feeding 2,200kcal/day in 6
divided doses, referred for GeneXpert,
TBDC at NTP was requested. No further
ordered by Dr. Almero

Course in the Ward


Medical Management

Nursing Management
=Cont.=
VS every 2 hours; oral & trache care; I &
O every shift; OF feeding maintained;
Suction secretion per trache and orem as
needed; cover 1 ply OS on tracheostomy;
Promote safety and comfort; may sit on
bed with assistance; Bronchial tapping
emphasis every after nebulization;
maintain tracheal mask at 1-2 LPM;
Continue present management.

Course in the Ward


Medical Management
Date: 2/12/15
On the 23rd HD, Patient
was afebrile, (-) DOB,
with occasional rales R>L,
no episode of
desaturation, (+) sputum
production. For
tracheostomy cover of 3
ply gauze was done and
CPT after each
nebulization. Continued
present management.

Nursing Management
Date: 2/12/15
On the 23rd HD;
7:35AM afebrile, (-) DOB, (+) sputum
production, (+) occasional rales R>L, (-)
desaturation. Cover tracheostomy with 3
ply OS was done. No further ordered by
Dr. Arches
VS every 2 hours; oral & trache care; I &
O every shift; OF feeding maintained;
Suction secretion per trache and orem as
needed; cover 3 ply OS on tracheostomy;
Promote safety and comfort; may sit on
bed with assistance; Bronchial tapping
emphasis every after nebulization;
maintain tracheal mask at 1-2 LPM;
Continue present management.

Course in the Ward


Medical Management

Nursing Management

Date: 2/13/15
On the 24th HD, stable
vital signs, (+) rales R>L,
(+) sputum production.
Complete 21 days of
Meropenem.
Tracheostomy capping
was done. Continued
present management.

Date: 2/13/15
On the 24th HD;
6:40AM stable vital signs, (+) rales BLF,
(+) sputum production.
Complete 21 days of Meropenem. For
tracheostomy capping was done. No
further ordered by Dr. Lugtu.
VS every 2 hours; oral & trache care; I &
O every shift; OF feeding maintained;
Suction secretion per trache and orem as
needed; cover 3 ply OS on tracheostomy;
Promote safety and comfort; may sit on
bed with assistance; Bronchial tapping
emphasis every after nebulization;
maintain tracheal mask at 1-2 LPM;
Continue present management.

Course in the Ward


Medical Management
Date: 2/14/15
On the 25th HD, (+) rales
, (+) difficulty in
expectoration. Remove
NGT was done, OF
feeding was shifted to
soft diet with SAP, for
possible decannulation.
Continued present
management.

Nursing Management
Date: 2/14/15
On the 25th HD;
8:00AM (+) rales decrease, (+) difficulty
to expectorate.
May remove NGT was done, for possible
decannulation tomorrow. Increase
Erdostein 300mg/cap BID. For Soft diet
with SAP done. No further ordered by Dr.
Retuerma
11:00PM alert, afebrile, (+) Crepts
bibasal.
Continued soft diet, chest clapping TID,
Deep breathing exercise done and
instructed to patient. For repeat CXR-PA
view was requested. For possible
decannulation. Increase oral feeding give
Ensure 1 glass in between meals. No

Course in the Ward


Medical Management

Nursing Management
=Cont.=
VS every 2 hours; oral & trache care; I &
O every shift; maintained on Soft diet
with SAP and give Ensure 1 glass every
meal; Suction secretion per trache and
orem as needed; cover 3 ply OS on
tracheostomy; Promote safety and
comfort; may sit on bed with assistance;
Chest clapping emphasis every after
nebulization/TID; encourage patient to do
deep breathing exercise; maintain
tracheal mask at 1-2 LPM; Continue
present management.

Course in the Ward


Medical Management
Date: 2/15/15
On the 26th HD, alert,
(+) secretion,
crepts/crackles bibasal,
(-) DOB afebrile. For CXR
requested. Still for
possible decannulation.
Continued present
management.

Nursing Management
Date: 2/15/15
On the 26th HD;
9:00AM alert, (+) secretion,
crepts/crackles bibasal, afebrile, (-) DOB.
Secure GeneXpert result was facilitated.
For possible decannulation tomorrow
morning. No further ordered by Dr.
Almero
VS every 2 hours; oral & trache care; I &
O every shift; maintained on Soft diet
with SAP and give Ensure 1 glass every
meal; Suction secretion per trache and
orem as needed; cover 3 ply OS on
tracheostomy; Promote safety and
comfort; may sit on bed with assistance;
Chest clapping emphasis every after
nebulization/TID; encourage patient to do
deep breathing exercise; maintain

Course in the Ward


Medical Management
Date: 2/16/15
On the 27th HD, afebrile,
(-) DOB. For tracheostomy
decannulation was
deferred d/t (+)
tachypneic, (+) crackles
BLF. For ABG was
requested. Continued
present management.

Nursing Management
Date: 2/16/15
On the 27th HD;
7:00AM afebrile, (-) DOB.
For decannulation @ 10:00AM.
8:30AM (+) tachypneic, (+) crackles
BLF, OSat=94%.
Defer decannulation of tracheostomy.
ABG was done. Follow-up CXR and
GeneXpert
result was facilitated.
No further ordered by Dr. Arches.
=Cont.=

Course in the Ward


Medical Management

Nursing Management
=Cont.=
VS every 2 hours; oral & trache care; I &
O every shift; maintained on Soft diet
with SAP and give Ensure 1 glass every
meal; Suction secretion per trache and
orem as needed; cover 3 ply OS on
tracheostomy; Promote safety and
comfort; may sit on bed with assistance;
Chest clapping emphasis every after
nebulization/TID; encourage patient to do
deep breathing exercise; maintain
tracheal mask at 1-2 LPM; Continue
present management.

Laboratory
and
Diagnostic Findings

HEMATOLOGY

WBCs
RBCs
Hemoglobin
Hematocrit
Platelet Count

Laboratory and Diagnostic Findings


Date

Findings

Normal
Values

Analysis and Interpretation

WBC (White Blood Cell)


01/21/15

5.55

01/24/15

13.83 (H)

01/29/15

8.02

02/01/15

10.61

02/06/15

7.49

4.8 10.8 x109/L

WBCs are our bodys first line of defence


against invading bacteria and most other
harmful organisms. It measures the total
number of all types of WBCs in the body.
The WBCs differential count evaluates
the distribution and morphology of WBC.
Therefore, it provides more specific
information about the patients immune
system than the WBC count alone.

Laboratory and Diagnostic


Findings
WBCs defence system
Types:

1/2
1

1/2
4

1/2
9

2/1

2/6

Normal
Values

Neutroph
il

54.3
0

86.9
0
(H)

69.4
0

76.3
0
(H)

67.5
0

40-70%

Lymphocy
te

29.8

6.70
(L)

16.5
(L)

11.4
(L)

16.9
0
(L)

19-48%

Eosinophi
l

6.60

0.50
(L)

4.70

4.20

7.10

2-8%

Monocyte

8.40

5.70

9.20

7.80

7.60

0-15%

Basophils

0.90

0.20

0.20

0.30

0.90

0-5%

Npl: (Increase): Infection, Metabolic


disorder, Stress Response, Inflammatory
diseases. (Decrease): Bone marrow
depression, Infections, Collagen Vascular
Diseases, Deficiency of Vit. & Minerals.
Lyp: (Increase): infections, immune
diseases. (Decrease): Severe
debilitating illness (adv. PTB) , Defective
lymphatic circulation.
Epl: (Increase): Allergic disorder,
Parasitic infection, Skin disease,
Neoplastic disease, Collagen vascular
disease.
(Decrease): Stress Response d/t
trauma, shock, burns, surgery, mental
distress, Cushing syndrome.
Myt: (Increase): Infection, Collagen
vascular disease, Carcinomas.
Bpl: (Increase): Chronic myelocytic
leukemia, PCV, Chronic hemolytic

Laboratory and Diagnostic


Findings
Date

Findings

Normal
Values

Analysis and Interpretation

RBC (Red Blood Cell)


01/21/15

4.60

01/24/15

4.86

01/29/15

4.67

02/01/15

4.60

02/06/15

4.23

4.1-5.1 x109/L

This are corpuscles, non-nucleated cells which


are capable of carrying oxygen. This is used to
indicate anemia. If abnormal findings are
present, the anemias can be defined as
macrocytic, microcytic, hypochromic and
others. A Reticulocyte count, it indicates
immature number of RBCs. An increases of
Relic ct. indicates the body is responding to
such pathologies as hemorrhage, anemia,
hemolysis or other such disease process. Sicklecell indicates abnormality in the oxygencarrying blood (hgb).

Laboratory and Diagnostic


Findings
Date

Findings

Normal
Values

Analysis and
Interpretation

RBCs Indices (Wintrobe Indice)


Types:

1/2
1

1/2
4

1/2
9

2/1

2/6

RDW

13.
20

13.
00

12.
00

14.
40
(H)

12.
40

11.414.0%

90.
00

89.
00

89.
90

89.
60

89.
60

82-98fL

30.
70

29.
50

30.
10

30.
40

30.
00

28-33pg

34.
10

33.
20

33.
50

33.
90

33.
50

33-36g/L

(RBC
Distribution
Width)

MCV
(Mean
Corpuscular
Volume)

MCH
(Mean
Corpuscular
Hemoglobin)

MCHC
(Mean
Corpuscular
Hemoglobin
Concentration)

Normal
Values

RDW indicates the cell diameter (6-8um).


Higher values indicate greater variation in
size. Example: Vit. B12 deficiencies or iron
deficiency anemia, but not all anemias have
elevated RDW like aplastic anemia,
hereditary spherocytosis, & acute blood loss.
MCV indicates the relative size of the RBCs.
it does not indicate anything else about the
cell. It also indicate the different types of
anemia that can be classified as: micro &
macro. Increase amount: Macrocytic (large
cells); Decrease amount: Microcytic (small
cells).
MCH indicates the weight of hemoglobin in
each cell. Therefore, a normal values of
matured cells in the entire coarse therapy.
MCHC indicates the dependent upon the
size of the RBC as well as the amount of
hemoglobin in each cell. Certain diseases
and anemia will alter the RBC count and/or
the amount of hemoglobin in the cell. This
means that, they can be used to help
diagnose the less common cause like
hemorrhage, malnutrition etc.

Laboratory and Diagnostic Findings


Date

Findings

Normal
Values

Analysis and Interpretation

Hemoglobin
01/21/15

141

01/24/15

143

01/29/15

141

02/01/15

140

02/06/15

127 (L)

140-175 x g/L

Hemoglobin is the pigment part of the


Erythrocyte , and the oxygen-carrying
part of the blood. A low hemoglobin level
indicates anemia or hemorrhage.
Hemoglobin is obviously important for
diagnosing many lesser known diseases.
for example: malnutrition (low iron
level), would be the diagnosis of the
patient, not just the anemia. The
secondary diagnosis would be anemia,
but malnutrition must be treated in order
to cure the anemia.

Hematocrit
01/21/15

0.41

01/24/15

0.43

01/29/15

0.42

02/01/15

0.41

02/06/15

0.38

0.359-0.446 %

Hematocrit measures percentage by


volume of packed RBCs in a whole blood
sample. The value of the hematocrit is
dependent upon the number of RBCs .
The result of the Hct of the patient is
within the normal range. Any
abnormality can be support as to the
following: shock, hemorrhage,

Laboratory and Diagnostic Findings


Date

Findings

Normal
Values

Analysis and Interpretation

Platelet Count
01/21/15

258

01/24/15

285

01/29/15

369

02/01/15

419 (H)

02/06/15

394

150-400 x 109/L

Platelets are the smallest formed elements in


the blood. They are vital to the formation of the
hemostatic plug in vascular injury. They
promote coagulation by supplying phospholipids
to the intrinsic thromboplastin pathway. When
platelet count is abnormal, there are further
studies to be dealt with. A hemolysis d/t rough
handling or to excessive probing at the
venipuncture site may alter the result or
application of medication. Platelet normally
increase in persons with persistent cold
temperature, excitement or living in high
altitudes for extended period of times.

CHEMISTRY

BUN
Creatinine
Sodium
Potassium

Laboratory and Diagnostic Findings


Date

Findings

Normal
Values

Analysis and Interpretation

(BUN) Blood Urea Nitrogen


01/21/15

4.20

02/01/15

2.51
2.50-6.43 mmol/L

Urea is the end product of detoxified by


the liver and excreted by the kidney in
the formed of urine. A Decrease BUN
level may indicate a low-protein level. If
Elevated BUN level , a kidney function is
impaired and/or may also indicate
severe dehydration or malnutrition like
starvation or excessive protein intake.
The patient BUN level is within the
normal state.

Creatinine
01/21/15

77.36

01/24/15

83.25

01/29/15

60.82

02/01/15

65.50

53-115 umol/L

Creatinine is removed from the


bloodstream by the kidneys and
excreted in the form of urine. An
Increase Creatinine level indicates that
the patient is having a renal impaired or
kidney failure. The patient Creatinine
level is within the normal state.

Laboratory and Diagnostic Findings


Date

Findings

Normal
Values

Analysis and Interpretation

Serum Sodium
01/21/15

145.30

01/24/15

146.70

02/01/15

141.50

02/07/15

140.30

139-149 mmol/L

Hypernatremia: Adrenal gland


problem, Diabetes insipidus, excessing
sweating, diarrhea, use of diuretics, and
use of birth control pills, corticosteroids,
laxatives, NSAIDs (ibuprofen/naproxen).
Hyponatremia: Adrenal problem
(Addison dis.), dehydration, vomiting,
diarrhea, ketonuria, and use of diuretics.
The patient is within the normal
laboratory state.

Serum Potassium
01/21/15

3.63

01/24/15

3.49 (L)

02/01/15

3.43 (L)

02/07/15

3.18 (L)

02/10/15

4.95

3.5-5.5 mmol/L

Hyperkalemia: Addisons dis., blood


transfusion, medications crushed tissue
injury, kidney failure, metabolic or
respiratory acidosis, red blood cell
destruction. Hypokalemia: chronic
diarrhea, Cushing syndrom, diuretics,
renal artery stenosis renal tubular
acidosis (rare), vomiting and not enough
potassium in the diet.

Laboratory and Diagnostic Findings


Date

Findings

Normal
Values

Analysis and Interpretation

Serum Calcium

2/11/15

9.95

8.5-10.4 mg/dL

Hypercalcemia: being on bed rest for a


long time, consuming calcium or vit.D,
HIV/AIDS, Hyperparathyroidism,
infections (TB or mycobacterial
infection), metastatic bone
tumor,multiplemyeloma, sarcoidosis,
medication (tamoxifen, thiazides).
Hypocalcemia: Kidney failure, low
albumin level, liver dis., magnesium
deficiency, pancreatitis, and vit.D
deficiency.
The patient laboratory result is within
normal range.

Serum Magnesium

2/11/15

1.96

1.2-2.1 mg/dL

Hypermagnesemia: Addison dis., CRF,


dehydration, diabetic acidosis, abd
oliguria.
Hypomagnesemia: alcoholism, chronic
diarrhea, HD, cirrhosis,
hyperaldosteronism,
hypoparathyroidism, pancreatitis, too

MICROBIOLOGY

Endotracheal Aspirate GS/CS


Transtracheal Aspirate GS/CS
Transtracheal Aspirate AFB
Endotracheal Aspirate AFB

Laboratory and Diagnostic Findings


Date

Findings

Normal
Values

Analysis and Interpretation

Endotracheal Aspirate GS/CS


01/23/1
5

FEW GROWTH
of
Acinetobacter
Baumannii
ISOLATED

No growth
in
ISOLATED
disc.

Have several properties that allow


them to be more successful as
pathogens because of their
virulence factors wherein they
inhibit the synthesis of the bacterial
cell wall creating a barrier potential
to resist certain antibiotics related
to penicillin/beta-lactam antibiotics
(like Ceftriaxone). Therefore,
reducing their sensitivity to
antibiotics must be alter the
metabolism of microorganism
within the biofilm ( cover-structured
cell wall). Introducing COLISTIN
antibiotic is considered a last resort
because it often causes kidney
damage among other side effects.
Rendering hand-washing and more
diligent sterilization procedures

Laboratory and Diagnostic Findings


Date

Findings

Normal
Values

Analysis and Interpretation

Transtracheal Aspirate GS/CS


01/28/1
5

MODERATE
GROWTH of
Stenotrophom
onas
maltophilia
ISOLATED

No growth
in
ISOLATED
disc.

It frequently colonizes breathing


tubes (like ET, tracheostomy & even
indwelling urinary catheters).
Infection of this should be treated
with TIGECYCLINE or POLYMYXIN B
which they inhibit the biofilm to
breakdown the molecular density
structure and contained the cell
nucleus which may cause death of
the bacterial.
Another management should be
address is to remove their
prosthesis (plastic or metal) that
attached to the patient so that it
may reduce the infection; or
rendering hand-washing and more
diligent sterilization procedures
should be focused and maintained.

Laboratory and Diagnostic Findings


Date

Findings

Normal
Values

Analysis and Interpretation

Transtracheal Aspirate AFB


01/28/1
5

Gram (-) bacilli Acid fast


+1-9/LPF
bacilli
++10-19/LPF
NOT seen
+++>20/LPF

The influence of the numbers of


infecting bacilli to the patient may
remain a dormant. In this case,
patients defences may be lowering
and may allow the dormant TB to
multiply and cause disease. In most
people their host defences either
kill off all the bacilli or, perhaps
more often, keep them suppressed
and under long-term control.

Endotracheal Aspirate AFB


01/28/1
5

Sputum/Saliva
ry
Acid fast
bacilli NOT
seen

02/02/1

Acid Bacilli

Acid fast
bacilli
NOT seen

01/29/15 and 02/02/15 result was


released with the findings of (-) AFB
present during 1st , 2nd and 3rd
sputum examination. A patient has
completed treatment but has not
met the criteria for cure or failure.
And was referred to TBDC on

MISCELLANEOUS
Fecalysis
Arterial Blood Gas
Chest X-ray

Laboratory and Diagnostic Findings


Date

Findings

Normal
Values

Analysis and
Interpretation

Fecalysis
02/03/
15

Color: Dark
Brown
Consistency:
Semi-Formed
Microscopy:
Leukocytes:
1-3/HPF
RBC:
1-4/HPF
Yeast cell: FEW,
hyphal elements
present

Color:
Light-brownbrown
Consistency:
Formed
Microscopy:
Leukocytes:
0-1/HPF
RBC:
0-1/HPF
Yeast cell: NONE

A stool examination
analysis seen with a
presence of Leukocyte,
RBC and Yeast cell in the
specimen which may
suspected the patient of
having amoebiasis d/t 1-3
times greenish-brownish
watery stool last 01/29/15.
hence, the result was
unremarkable, a presence
of blood strick in the stool
may indicate a post GI
bleeding last 01/27/15 d/t
(+) coffee ground GI
output or it may also
cause some friction during
BM d/t abdominal rigidity.

Laboratory and Diagnostic Findings


Date

Findings

Normal
Values

Analysis and
Interpretation

Arterial Blood Gas (ABG)


01/29/1
5

pH
:
7.44
PaCO:
35.70
PaO :
113(H)
HCO :
23.9

pH
: 7.35-7.45
PaCO: 35-45
mmHg
PaO : 80105mmHg
HCO : 2226mmol/L

The PaO level is very high


which may indicate an over
corrected hypoxia with
beginning of primary
alkalosis d/t patient has (+)
crackles BLF which significant
to the bodys compensatory
mechanism.

Laboratory and Diagnostic Findings


Date

Findings

Normal
Values

Analysis and
Interpretation

Chest X-ray (CXR)


01/20/1
5

PTB both
lungs with:
bilateral
apical
pleural
thickening
Atelectasis,
upper lobes
pulmonary
Hyperaeratio
n, Right.

01/26/1
5

PTB both
lungs with:
1. Bilateral
apicopleural

No hazed in
the curvilinear
opacities seen
in both apices,
heart is not
enlarged,
Diaphragm &
Sulci are intact
the visualized
osseous
structures are
unremarkable.

A comparative chest film


dated 01/20/15 and 01/29/15
showed significant interval
changes wherein there is an
increase in the fibrohazed
reticular infiltrates seen in
Both lung field.

NURSING
DRUG STUDY

DRUG STUDY

Acetylcystein
Anti-Tetanus Serum (ATS)
Baclofen
Ceftriaxone
Clindamycin
Colestin
Cotrimoxazole
Diazepam
Erdostein
Furosemide

DRUG STUDY
Kalium Durule
Ketorolac
Levofloxacin

Meropenem
Metronidazole
Omeprazole
Paracetamol
Salbutamol
Sucralfate
Tetanus Toxoid

Drug Study
Classifica
tion

Dosages,
Frequenc
y, Route

Action

Side Effects

Nursing
Consideration
Alert

ACETYLCYSTEINE (N-acetylcysteine)
Is a
pharmaceutical
drug and
nutritional
suppleme
nt used
primarily
as a
mucolytic
agent and
in the
managem
ent of
Paracetam
ol

Dosage:
200 mg.
per sachet
&
600 mg.
per tablet
Frequenc
y:
Once a
day (OD)
or
Twice a
day (BID)
Route:

A dietary
supplement
commonly
claiming
antioxidant
and liver
protecting
effects. Used
as a cough
medicine
which
breaks
disulfide
bonds in
thick mucus
in cystic &

IV:
It also displays
Anaphylact
significant
oid
antiviral
reactions:
activity against
rash,
influenza A
hypotension,
viruses.
wheezing/sho Used for
rt of breath.
treatment of
Inhalation:
Paracetamol
stomatitis,
(acetaminophe
fever,
n) overdose.
rhinorrhea,
Used as a
drowsiness,
nephroprotecti
bronchove agent.
constriction.
Oral:

Drug Study
Classifica
tion

Dosages,
Frequenc
y, Route

Action

Side Effects

Nursing
Consideration
Alert

ANTI-TETANUS SERUM (ATS)


This drug
is a
passive
vaccine
used for
protection
of tetanus
exposure.

Dosage:
1,500 unit
per mL per
ampule
Frequenc
y:
Single
dose
Route:
Intramuscular
injection

ATS is a
preparation
of tetanus
antibodies
administere
d for the
prevention
caused by
neurotoxin
produced by
anaerobic
bacterium
Cl.tetani &
for the
treatment of
tetanus.

Injection
site: pain,
redness,
swelling,
warmth,
discomfort.
Other:
Fever,
malaise, joint
pain,
myalgia,
fainting,
nausea.

Fatal
anaphylaxis
may occur in
hypersensitive
individuals.

Drug Study
Classifica
tion

Dosages,
Frequenc
y, Route

Action

Side Effects

Nursing
Consideration
Alert

BACLOFEN
Is a
muscle
relaxer
and an
antispastic
agent.

Dosage:
10 mg per
tablet
Frequenc
y:
OD, BID,
TID, q6,
q8, q12
Route:
Oral

Is used to
treat muscle
symptoms
caused by
multiple
sclerosis,
including
spasm, pain
and
stiffness.

Serious
Becareful if
Side Effect:
you drive or do
Seizure,
anything that
confusion,
requires you to
and
be alert, it may
hallucination.
impair your
Less
thinking or
serious:
reactions.
drowsiness,
dizziness,
weakness,
headache,
sleep
problem,
nausea,
constipation

Drug Study
Classifica
tion

Dosages,
Frequenc
y, Route

Action

Side Effects

Nursing
Consideration
Alert

CEFTRIAXON
Is a longacting,
broad
spectrum
cephalosporin
antibiotic .

Dosage:
1-2 gram
per vial
Frequenc
y:
Once a
day (OD)
Route:
Slow I.V.
Push or
place in a
100 ml
DW
soluset to
run for 30
minutes or

Inhibits
bacterial cell
wall
synthesis by
means of
binding to
the
penicillinbinding
proteins.

Gastrointesti This drug is


nal: diarrhea,
contraindicate
nausea,
d to patients
vomiting, &
with known
stomatitis.
hypersensitivit
Skin reaction:
y reaction.
allergic
Watch for
dermatitis,
pruritus, &
phlebitic
urticaria.
reaction after
I.V.
administration.

Drug Study
Classifica
tion

Dosages,
Frequenc
y, Route

Action

Side Effects

Nursing
Consideration
Alert

CLINDAMYCIN
Is a
lincosamid
e class,
which
blocks the
ribosomes
of microorganism.

Dosage:
150mg/via
l;
300mg/via
l;
150mg/tab
150mg/tab
Frequenc
y:
OD, BID,
TID, q6,
q8, q12
Route:
Oral

A bacterial
protein
synthesis
inhibitor by
ribosomal
translocatio
n binding to
50S rRNA
subunit.

Nausea,
This drug is not
vomiting,
used for
abdominal
Meningitis. An
pain or
overgrowth of
cramps or
nonrash. A
susceptible
metallic taste
organisms
for high
particularly
dose.
yeasts in stool.
Treatment w/
this med.
Alters the
normal flora of
the colon &
may permit

Drug Study
Classifica
tion

Dosages,
Frequenc
y, Route

Action

Side Effects

Nursing
Consideration
Alert

COLISTIN
Is a
polymyxin
antibiotic
produced
by certain
strains of
Bacillus
polymyxa.

Dosage:
1 Mil.unit
per vial
Frequenc
y:
OD
Route:
Slow I.V.
push
I.V. drip

These
polycation is
regions
interact w/
bacterial
outer
membrane,
by
displacing
bacterial
counter ions
in the lipopolysacchari
de. This is
bactericidal
in

A
nephrotoxicit
y which is
rare for very
high level of
doses given.

Watch out for


early
nephrotoxicity
signs and
symptoms.

Drug Study
Classifica
tion

Dosages,
Frequenc
y, Route

Action

Side Effects

Nursing
Consideration
Alert

COTRIMOXAZOLE
A
combinati
on of
trimethopr
im &
sulfameth
oxazole,
which
eliminates
bacteria
that cause
various
infection.

Dosage:
Trimethopri
800mg/tab m inhibits
the
Frequenc synthesis of
y:
nucleic acids
OD, BID,
and proteins
TID, q6,
in
q8, q12
susceptible
bacteria.
Route:
oral

Nausea,
Caution should
vomiting,
be exercise in
loss of
patients w/
appetite,
history of
decrease
liver/kidney
blood cell
diseases,
count, skin
asthma, severe
inflammation
allergies and
, liver
avoid exposure
inflammation
to sunlight.
, kidney
failure, low
blood sugar,
joint/muscle
pain, cough,
shorthness of

Drug Study
Classifica
tion

Dosages,
Frequenc
y, Route

Action

Side Effects

Nursing
Consideration
Alert

DIAZEPAM
Is an
anxiolytic,
anticonvulsant
and
spasmolyti
c

Dosage:
5 mg/ 2 ml
per
ampule

Is used in
short-term
treatment of
severe
anxiety
Frequenc disorders, as
y:
a hypnotic
q6, q8,
or sedative
q12, OD or and
STAT dose premedicant
, as an antiRoute:
convulsant
I.V. push
in the
I.M. or an
control of
Infusion
spasm and
withdrawal

Drowsiness,
muscle
weakness,
and ataxia,
CNS
depression.
Less effects:
vertigo,
headache,
confusion,
slurred
speech,
change in
libido,
tremor,
visual

Caution is
required in
patient with
muscle
weakness, or
impaired
liver/kidney
functions.
Monitoring of
cardiopulmona
ry function is
generally
recommended.

Drug Study
Classifica
tion

Dosages,
Frequenc
y, Route

Action

Side Effects

Nursing
Consideration
Alert

ERDOSTEIN
Is a
mucolytic
agent.

Dosage:
300 mg
per
capsule
Frequenc
y:
OD, BID
Route:
Oral

A treatment
for acute &
chronic
bronchopulmonary
diseases,
rhinosinusiti
s, laryngopharyngitis,
or
exacerbatio
n of these
chronic
diseases
assoc. w/
mucus

Gastrointesti In case of
nal effect:
appearance of
gastric
classical
burning,
hypersensitivit
nausea, &
y signs &
diarrhea
symptoms, the
(rare).
treatment with
Hypersensitiv
erdostein must
ity reaction:
be
rash,
immediately
urticaria, &
suspended.
hyperpyrexia
(rare).
Contraindicat
ed: hepatic
and renal

Drug Study
Classifica
tion

Dosages,
Frequenc
y, Route

Action

Side Effects

Nursing
Consideration
Alert

FUROSEMIDE
Is a loop
diuretic
agent.

Dosage:
10mg/2ml
per
ampule;
20mg,
40mg,
80mg/tabl
et
Frequenc
y:
OD, BID,
TID, q6,
q8, q12,
STAT dose

A loop
diuretic
which
inhibits
water
reabsorption
in the
nephron by
blocking the
sodiumpotassiumchloride cotransporter
in the thick
ascending
limb of loop

Ringing in
Check blood
ears, hearing
sugar regularly
loss, itching,
(for diabetic
loss of
patients).
appetite,
dark-urine,
Have increase
clay-colored
potassium in a
stool, severe
diet d/t
pain in upper
reduction of
stomach
potassium
spreading to
level in the
back, nausea
blood.
& vomiting.
Contraindicat Watch for any
ed to kidney
allergic
and liver
reaction.

Drug Study
Classifica
tion

Dosages,
Frequenc
y, Route

Action

Side Effects

Nursing
Consideration
Alert

KALIUM DURULE
Is a serum
electrolyte

Dosage:
40mg per
100mEq;
40mg/tab
Frequenc
y:
OD, BID,
TID
Route:
oral
I.V. push

Intracellular
cation,
transmission
of nerve
impulses,
contraction
of cardiac,
skeletal &
smooth
muscle,
maintenanc
e of renal
function &
plays a role
in CHO &
various
enzymatic

Rash,
nausea,
vomiting,
diarrhea,
hyperkalemia
, ECG
changes
(peak T
waves,
depression
ST segment
& prolong
QRS
interval).
Contraindicat
ed:
tartrazine,

Assess history
of allergy to
aspirin.
Administer oral
drug after
meals.
Monitor I.V.
injection sites
regularly for
necrosis, tissue
sloughing,
phlebitis,
Monitor cardiac
rhythm during

Drug Study
Classifica
tion

Dosages,
Frequenc
y, Route

Action

Side Effects

Nursing
Consideration
Alert

KETOROLAC
Toradol is
in group of
drugs
called
nonsteroid
al antiinflammat
ory drugs.

Dosage:
30mg per
ampule
Frequenc
y:
OD, PRN
Route:
I.V. push

It works by
reducing
hormones
that causes
inflammatio
n and pain
in the body.
Toradol is
used shortterm t tret
moderate to
severe pain,
usually after
surgery.

Rash, ringing Watch for


in ears,
hepatotoxicity,
headaches,
nephrotoxicity
dizziness,
and
drowsiness,
anaphylactic
abdominal
reactions.
pain, nausea,
Should not be
diarrhea,
constipation,
used by
heartburn.
breastfeeding
mothers.

Drug Study
Classifica
tion

Dosages,
Frequenc
y, Route

Action

Side Effects

Nursing
Consideration
Alert

LEVOFLOXACIN
A group of
antibiotics
called
Fluoroquinolones
.

Dosage:
250mg/tab
;
500mg/tab
;
750mg/tab
;
500mg per
100ml per
vial
Frequenc
y:
Once a
day (OD)

It inhibits
the bacterial
topoisomera
se IV and
DNA gyrase,
enzymes
required for
DNA
replication,
transcription
, repair and
recombinati
on.

Nausea,
vomiting,
diarrhea,
headache,
constipation,
difficulty
sleeping,
dizziness,
abdominal
pain, rash,
abdominal
gas, &
itching.

Watch for
allergic or
anaphylactic
reaction.
Watch out for
develop any
signs of liver
problem;
tendinitis,
ruptured
tendon
(Achilles),
which may
require surgical
repair; .

Drug Study
Classifica
tion

Dosages,
Frequenc
y, Route

Action

Side Effects

Nursing
Consideration
Alert

MEROPENEM
A -lactam
and
belongs to
the
subgroup
of
carbapene
m.

Dosage:
500mg to
1 gram
per vial.
Frequenc
y:
OD, BID,
TID, q6,
q8, q12
Route:
I.V. push
I.V. drips

Active
against
grampositive &
Gramnegative
bacteria. It
exerts its
action by
penetrating
bacterial
nucleus
(DNA) cell
readily and
interfering
w/ the

Redness &
swelling in
the injection
site. Less
common:
bluish lips,
cold clammy
skin,
confusion,
dizziness,
fever, itching
skin,
wheezing.
Rare: abdo.
cramps,
black, bloody

Watch for any


anaphylactic
reaction; or
hepato and
nephro toxicity
signs and
symptoms.

Drug Study
Classifica
tion

Dosages,
Frequenc
y, Route

Action

Side Effects

Nursing
Consideration
Alert

METRONIDAZOLE
An
antibiotic
effective
against
anaerobic
bacteria
and
certain
parasites.

Dosage:
500mg/tab
;
500mg per
100ml per
vial
Frequenc
y:
OD, BID,
TID, q6,
q8, q12
Route:
Oral
I.V. push

Inhibits
nucleic acid
synthesis by
disrupting
the DNA of
microbial
cells. This
function only
occur when
the med.is
partially
reduced &
bec. this
reduction
usually
happens in

Very seldom
may occur:
GI upset:
nausea,
vomiting,
diarrhea,
burning
sensation in
the tongue,
metallic
taste.
Central
disorder:
headache,
dizziness,
somnolence,

Avoid alcoholic
beverages
when taking
this med.
@1st trimester
of pregnancy,
should only be
administered
in vital
situation. d/c
med. for
lactating
mothers.

Drug Study
Classifica
tion

Dosages,
Frequenc
y, Route

Action

Side Effects

Nursing
Consideration
Alert

OMEPRAZOLE
Is an acid
pump
inhibitor.

Dosage:
40mg/vial;
40mg/tabl
et
Frequenc
y:
OD, BID,
TID, q6,
q8, q12
Route:
Oral
I.V. push
I.V. drip

It inhibits
the acid
pump. (This
effect on the
gastric acid
formation
process) W/c
inhibit both
basal acid
secretion &
stimulated
acid
secretion,
irrespective
of stimulus.

Rash,
pruritus,
urticaria,
arthralgia,
headache,
dizziness,
paresthesia,
somnolence,
insomnia &
vertigo.

Watch for
hypersensitivit
y reaction
angioedema,
fever,
bronchspasm,
interstitial
nephritis, &
anaphylactic
shock.

Drug Study
Class
orificatio
n

Dosages,
Frequenc
y, Route

Action

Side Effects

Nursing
Consideration
Alert

PARACETAMOL
It is an
Acetaminophen
agent. Is
a pain
reliever
and fever
reducer.

Dosage:
500mg/tab
;
300mg per
ampule
Frequenc
y:
OD, BID,
TID, q12,
q4
Route:
Oral
I.V. push
I.V. drip

Analgesic
effect that is
mediated
through
activation of
descending
serotonergic
pathways.
Inhibiting PG
synthesis or
through an
active
metabolite
influencing
cannabinoid
receptors.

rash, or
swelling;
hypotension
or liver and
kidney
damage.

Watch for signs


and symptoms
of anaphylactic
shock.
Watch for
hypotension
and/or
hepatotoxicity
&
nephrotoxicity
when infusing
this type of
drug.

Drug Study
Classifica
tion

Dosages,
Frequenc
y, Route

Action

Side Effects

Nursing
Consideration
Alert

SALBUTAMOL NEBULES
Is a
Bronchodilator and
inhibits
the 2adrenergic
agonist.

Dosage:
2mg/tab;
500mcg/m
l;
(DPI):
100mcg/m
l;
200mcg/m
l
Frequenc
y:
OD, BID,
TID, q6,
q8, q12
Route:
Oral

High level of
cyclic AMP
relaxes
bronchial
smooth
muscle &
decreases
airway
resistance
by lowering
intracellular
ionic Ca. It
relaxes the
smooth
muscle &
dilates the

Tremor,
Overdose of
nervousness,
this medicine
palpitation,
(tremor,
tachycardia,
palpitation, &
headache,
tachycardia)
muscle
can be treated
cramps,
w/ Atenolol or
hypokalemia,
Metoprolol
paradoxical
injection.
bronchospas
m.
Monitor K
level.

Drug Study
Classifica
tion

Dosages,
Frequenc
y, Route

Action

Side Effects

Nursing
Consideration
Alert

SUCRALFATE
Pepsin
inhibitor.
Anti-ulcer
medicatio
n.

Dosage:
500mg/tab
;
1 gm/tab
Frequenc
y:
OD, BID,
TID, q6,
q8, q12
Route:
Oral

Healing of
duodenal
ulcers
remains to
be fully
defined, it is
known that
it exerts its
effect
through a
local, rather
than
synthetic
action.

Nausea,
vomiting,
upset
stomach,
stomach
pain, mild
itching, skin
rash,
insomnia,
dizziness,
drowsiness,
spinning
sensation,
headache or
back pain.

Take this on an
empty
stomach.
Do not
combined w/
other
medicine, it
may interact
with it.
Do not take
extra medicine
to make up the
missed dose.

Drug Study
Classifica
tion

Dosages,
Frequenc
y, Route

Action

Side Effects

Nursing
Consideration
Alert

TETANUS TOXOID
This drug
is an
active
vaccine
used for
protection
of tetanus
exposure.

Dosage:
To provide
0.5 mL per active
ampule
immunity
against in
Frequenc the
y:
prevention
Single
caused by
dose
neurotoxin
produced by
Route:
anaerobic
Intrabacterium
muscular
Cl.tetani &
injection
for the
treatment of
tetanus.

Injection
site: pain,
redness,
swelling,
warmth,
discomfort.
Other:
Fever,
malaise, joint
pain,
myalgia,
fainting,
nausea.

Fatal
anaphylaxis
may occur in
hypersensitive
individuals.

NURSING
DISCHARGE PLAN

Medication

Exercise

Treatment

Health Teaching

The
following
medicine
shall be
advised and
follow
according
to
instruction:

Promote
circulation:
(by exercising
the lower and
upper
extremities)

Proper
teaching on
how to do the
following:

Avoid an open
wound to exposed
to dirt,
contaminated
water wherein it
might cause an
infection.
Washing/cleaning
of wound .
Brush teeth every
3 times a day after
meal.
Visit your dentist
or nearest dental
clinic.
Immunization
status shall be
followed based on
the exact date of
the Tetanus Toxoid
immunization
scheduled.

Wound care
on Right big
toe.

Anterodorsal flexion
ROM both
Comply the
Levofloxa
upper &
tetanus
cin
lower
toxoid
750mg/tab
extremities
schedule:
.
Date: 2/20/15
1 tab,
Date: 8/20/15
once a
Date: 8/20/16
day for
Date: 8/20/17
14 days.
Erdostein
e
300mg/ca

Out-Patient
Follow-up
For OPD
Consultatio
n:
February 26,
2015
Time of
Consultatio
n: 1:30PM

Diet

Spiritual
Practice

Visit your
Eat
a
nearest
well balanced
church:
diet
every
Wednesday or
Sundays to
hear the daily
gospel.
Read the
holy bible
and teach
your family
and friends:
the value of
being
Christians
of God.

Sex
Be faithful to your
wife and No other
woman.
(do not involved or
having relationship)

References

Compilation of Communicable Disease in Nursing, 2005.


Fundamentals of Nursing, 2009.
Fundamentals of Nursing, 2014.
Handbook of Common Communicable and Infectious
Diseases, 2009.
http//:WHO/tetanus/definition.net.
http//:CDC/tetanus/definition.com.
http//:WHO National Notifiable Disease Surveillance
System, 2008; 2014.
San Lazaro Hospital Statistical and Logistic on tetanus
patients record, 2013; 2014.
San Lazaro Hospital Nursing Standard Operating
Procedure, 2012.