In Partial Fulfilment for the Requirement In

Related Learning Experience (RLE)

MPI- Medical Center of Muntinlupa

ICU

CAD, NSTEMI

Submitted by:

Ibay, Justine Mae

Inoc, Jason
Jareola, Sylviana Yvette
Jandicala, Abba Shani
Joson, Mae
Jover, Rowena Marie
Lacambra, John Paul
Lacambra, Ma. Carlene
Lazaro, Trisha
Liberato, Joey
Marin, Alvin

Submitted to:

Mr. Wilfred Tanyag R.N.

 LEARNING OBJECTIVE

– To assess a patients physiologic manifestations with regards to his disease conditions.

– To identify signs and symptoms of the Disease Process.
– To understand the implications of diagnostic procedures.
– To identify and understand the medications of patient condition.
– To understand the anatomy and physiology of the, Gallbladder, and, and its role in the
digestion and absorption of nutrients in our body and it’s relation to the Gastro -
intestinal Tract as a whole.
– To formulate a Nursing Care Plan appropriate to the disease process of the patient.
GORDON’S FUNCTIONAL HEALTH PATTERN

1. PATTERN OF HEALTH PERCEPTION & HEALTH MANAGEMENT

How do you describe your current health? Poor

What do you do to improve or maintain your health? None
ADL/ Independent / Dependent (level): Just seating and occasional walking independently with
his grandsons.
(Mobility, feeding, hygiene, dressing, grooming, toileting)
Preferred time for personal care / bath: Any time
Assistance required / provided by: Family member
How do you link lifestyle choices and health?
How big is the problem in financing health care for you? No we have health care card so it is not
much a problem on our part.
Can you name current medications you are taking and their purpose? Can’t remember
Do allergies, what do you do to prevent these problems? No I have none so I don’t do anything.
What do you know about medical problems in your family? When my father consulted a family Doctor
then we found out about my Dad health problem. HPN
Have there been any important illnesses or injuries in your life? None

DOB affects the patient’s current health status which is poor. He was a independent person regarding
his hygiene and grooming. Since ,this is his first major illness, he thinks that he cant see his love one
again.

2. NUTRITIONAL METABOLIC PATTERN

What is your usual diet (type) pork, fatty foods, chicharon bulaklak and a glass of beer.
Are there cultural / religious restrictions? No cultural and religious restrictions
Can you recall and state your meal composition and feeding pattern?
Carbohydrates / Proteins / Fats: rice, pork and beef, fruits, mineral water 1.5-2 liters a day
most of all vegestables.
Water / Vitamins and minerals: Centrum
Food supplements: Yes Vitamins
How’s your appetite? Are there any changes you observed? Yes, my father is weak.
Do you experience nausea / vomiting / heartburn / ingestion? Yes
How do you manage it, is it relieved or not? We consulted a physician
Can you recall and state the highest / lowest weight you have? Before admission my father weight
was 110 lbs my highest weight upon admission is 130 lbs
Last Meal/ intake: OF as prescribed by the Doctor

3.PATTERN OF ELIMINATION

Usual voiding pattern? Frequency? Characteristics : Color / Odor? Broun 2 to 3 times a Day aromatic
in nature.
Do you experience any discomforts: pain, burning, and difficulty voiding? How do you manage it?
None
Usual bowel pattern? Frequency? Characteristics: color/ consistency/ odor? 2 to 3 times a day
Do you experience any discomforts diarrhea, constipation, bleeding and hemorrhoids? How do you
manage it? Laxative used? None just drink water
Do you perspire heavily, in what occasion/condition? No
Do you have any disease of the digestive system, urinary system or skin? None

4. PATTERN OF ACTIVITY & EXERCISE

System or musculoskeletal system

How do you describe your weekly activity and leisure, exercise and recreation?
Do you have any disease that affects cardio-respiratory system or musculoskeletal system? Not that
were aware of.
Do you experience fatigue/ weakness, pain after the activity?

Patient associate a lot with grandchildren, and stay most of the time outside looking the street.
5. COGNITIVE – PERCEPTUAL PATTERN

Do you have sensory deficit (sight, smell, auditory, taste and vision)? Are they corrected?
Can this person express her/himself clearly and logically?
Does the person have any disease that affects mental sensory functions?
Do you experience pain? How do you manage it?
If this person has pain, describe it and its causes:

The patient had no sensory deficit so far, but he experienced DOB that’s why he was
subsiquently admitted here @ MCM.

6. PATTERN OF SLEEP AND REST

Describe your sleeping pattern? Hours/naps/aids/insomia related to:

Do you feel tired upon waking up?
Do you experience any problem falling asleep? What do you think caused it?
Do you feel rested and relaxed?

Patient usually sleep 3 to 4 hours of sleep during the night and 1 to 2 hours during the day.

7. PATTERN OF SELF PERCEPTION & SELF CONCEPT

Do you think that is anything about your appearance and self?

Are you comfortable with your appearance?
Describe what you feel right now?
What are the traits that you’re proud of?
What are the traits that you think that needs changes and improvements?
Are you open for changes? In what condition and How?

At his age I can say that my father is contented with his self and don’t have any problem at all,
We as his children are all professionals now and have our own carrier that we can say that he strive
harder for us to have a better future in life.

8. ROLE-RELATIONSHIP PATTERN

How do you describe various roles in life (family, friends, community)?

Has, or does this person now have positive role models for these role?
Which relationships are most important to you at present?
Are you currently going through any big changes in role or relationship?
What are they?

At this time we as his children were here for him and this is the only way we can say we loved
him.

9.SEXUALITY-REPRODUCTIVE PATTERN

Are you in a relationship? How many child you wish/have? Can you say that you are sexually active?
Do you use protection?
Do you use birth control method? Do you have sexual concern/difficulties?
Recent change in frequency/interest?
Female : age of menarchy, cycle, duration, no of pad, LMP, pregnant now, menopause, vaginal
mammogram pap test.
Male: Penile discharge, prostate disorder, circumcised, vasectomy, practicing self examination:
Breast/testicle, last proctoscopic/prostate examination.

Male : At the age of my father I think that he is contented with his sex life when his still strong person
to be sexually active were a huge family and my parents don’t believe in the family planning program.

10. PATTERN OF COPING & STREES TOLERANCE

Have you experienced any discomforts in life? What condition brought it?
How do you usually cope with problems?
Do these actions help or make things worse?
To whom would you go if you have problems?
Have you undergone treatment for emotional distress?
We were saddened when we lost my mother many years ago. I believe that my father accepted it on
a saddest part of his life and we as his children he was able to recover on a timely manner now I
realized that his health is deteriorating so ,I should’ve of given it more importance. Emotional
distress? Not necessary.

11. PATTERN OF VALUES AND BELIEF

What principle in life did you learn as a child? Do you think that it’s still important? On what
condition/s?
Do you belong in any cultural, ethnic, religious, regional, or other groups?
Does this give any influence on your health behavior/s?
What support systems so you have currently?

My father taught me a lot that life is not easy where we should strive harder and set some goals and
priorities in life. We also have plenty of friends that are very supportive and helped us a lot , yes I
think so having a large group of family made . My family and friends have never left at the side of my
father during this time of crises.

PHYSICAL EXAMINATION

1. General Information

Name of client: Mr. Spartan Age:83 Date: 01/19/09

Unit: ICU Examiner:
Cc: DOB
Admitting diagnosis: CAD NSTEMI
2. Vital Signs

T 36 C (oral/ axilla/ rectal) HR_112 / min // regular// irregular//

PR / min // regular// irregular RR28/ min // regular // irregular //
BP220/110 / mmHg sitting / lying/ standing

3. General Survey

Anthropometric Measurement Height: 5”7 inches cm/feet/inches

Weight:110lbs kg/lbs
IBW: ____________
Head Circumference: __55____cm
Chest Circumference: __82_____cm
Abdominal Circumference: _70_____cm
General Appearance: / / No sign of distress /x/With sign of distress
/ / Cardiorespiratory / / Pain
Level of Consciousness: / / Conscious / / Drowsy / / Comatose
/x / Others: __Agitated________________
Coherence: /x / Coherent / / Incoherent /x / Others: _ respond to command_
Orientation: /x/ Oriented / / Disoriented to (time), (place), (Person)
Development: / / Endomorph / / Mesomorph / / ectomorph
/x/ Well developed / / fairly developed / / poorly developed
/ / looks according to age / / Appears older/ younger than stated age
Nutrition: / / Well-nourished / / Obese /x/ Cachexic
Emotional State: / / Calm / / Worried / / Restless / / Tense
/x / others: Anxious

4. Skin

General Color: / / Pinkish / / Pallor // Jaundice / / Flushed / / Cyanotic

Others: /x / specify: _Rashes to unspecified part of the body
Texture: / / Smooth /x/ Rough / /Others: ___________________
Turgor: / / Good / / Fair /x/ Poor
Temperature: / / Warm /x/ Cool / / Others: _____________________
Moisture: /x/ Dry / / Wet/ Clammy / / Oily

5. Head

Configuration: /x/ Normocephalic / / Masses / / Others: ___________

Fontanelles: /x/ Closed / / Open / / Sunken / / Bulging
Hair: / / Fine / / Coarse / / Dry / / Normal/ Even Distributor
/x/ Alopecia
Scalp: /x/ Clean / / Dandruff / / Lice / / Wound/Scar/ Lesions
Lids: /x/ Symmetrical / / RL Edema/Swelling / / RL Ptosis
Periorbital Region:
/ / Edema /x/ Sunken / / Discoloration
Conjunctiva: /x/ Pink / / Pale / / Lesions / / Yellowish
Sclera: / / Anicteric / / Subicteric /x / Leteric / / Hemorrhages
Cornea/Lens: /x/ Smooth / / Clear / / Lesions
/ / Opacity / / Arcus Senilla
Pupil Size: /x/ Equal / / Unequal R: 3 mm L: 3 mm
Reaction to Light:
R: /x / Brisk / / Sluggish / / Fixed
L: /x/ Brisk / / Sluggish / / Fixed
Reaction to Accomodation:
: /x/ Uniform dilataion of pupils
Convergence: /x/ Intact / / Others: _________________________
Visual Acuity:/ / Grossly Normal /x / Farsighted / / Nearsighted

6. Ears

External Pinnae: /x/ Normoset / / Symmetrical

/ / Gross Abnormalities / /Tenderness
External Canal: /x/ Impact cerumen / / Clean
Discharge: / / Foul smelling /x /Serous / / Prulent / / Mucoid
Gross Hearing: /x/ Symmetrical / / RL Deafness

7. Nose

Nasolabial Fold: /x/ Symmetrical / / RL Shallow

Septum: /x/ Midline / / Deviated / / Perforated
Mucosa: / / Pinkish /x/ Pale / / Reddish
Discharge: / / Serous /x/ Mucoid / / Purulent / / Bloody
Patency: /x/ Both Patent / / RL Obstructed Exhalation
Gross smell: // Symmetrical /x / RL Olfactory Deficiency
Sinuses: /x/ Non-tender / / Tender

8. Mouth

Lips: / /Pinkish / / Cyanosis /x/ dryness/cracks / /lesion

Tongues: /x/ Midline / / RL Deviation / / Atrophy / / Fasciculation
Teeth: / / Complete /x / Missing teeth / / Caries
/x/ Dentures / / Braces/ retainers Specify:_________
Gums: /x/Pinkish / / Pallor / / Bleeding
Mucosa: /x/ Pinkish / / Pallor / / Cyanotic
Speech: / / Intact /x/ Slurred / / Aphasic / / Others:________

9.Pharynx

Uvula: /x/ Midline / / RL Deviation

Mucosa: / / Pinkish /x/ Pallor / / Reddish
Tonsils: /x/ Not inflamed / / RL inflamed / / with exudates

10. Neck

Trachea: /x/ Midline / RL Deviation

Cervical Lymph Nodes: /x/ Non palpable / / Palpable / / Palpable
Thyroid: /x/ non palpable / / Enlarged
Others: /x/ Normal ROM / / Neck Rigidity engorgement
/ / Neck vein engorgement visible upright / / masses

11. Chest and Lungs

 Inspiration/ Exhalation Rratio: 1:1 ratio
Breathing Pattern / / regular (eupnea) / / effortless / / hyperpnea
/x / tachynea / / dsypnea / / use of accessory muscle / /
other:______
Shape of chest: Anterior-posterior-Lateral ratio AP 38 cm L 38 cm
/ / barrel chested / / funnel / / pigeon / / other_________
Lung expansion: /x/ symmetrical / /RL Decreased/Lag
Vocal/ tactile fremitus: /x/ symmetrical / / Decreased increased at________
Percussion: Resonance at over lung tissue and sometimes over the abdomen /
Hyper-resonance at Base of the left lung
Liver dullness at over solid organs adjiacent to air filled structures
Breath Sounds: Bronchial at trachea Bronchovesicular at main bronchus
Vesicular at most lung field/ Crackles at end of inspection,
Wheezes at inspection or expiration/ Pleural friction rub heard
usually caused by inflammation of pleural surfaces.

12. Heart

Precordial: / / Flat / / Bulging / / Tenderness / / Heave / / Thrill

/x / Normo-dynamic pre cordium / / Hyper-dynamic pre cordium

Points of Maximal impulse at: 5th intercostal space Apical beat at: 5th intercostal
space
Heart sounds: / / Distinct / / Regular / / Faint / x/Irregular
S1 _____ S2 at the base
S1______S2 at the apex
Other: / / S3 / / S4 / / murmurs beat heart at _____
Other: Tackycardic

13. Breast and Axille

Size: /x/ Equal / / Unequal

Shape: /x/ Symmetrical / / Asymmetrical
Color: / / Pinkish / / Striac / / Blue hue / / Increased vein engorgement
Surface:/x/ Smooth / / Retraction / / Dimpling / / Edema / / Lesions
/ / Tenderness / /M asses at: _______ Other at:_______

14. Abdomen

General: / / Specific vein / / Striac / / Scars/ Lesions

Configuration: / / Symmetrical / / Asymmetrical
/x / Flat /x/ Globular / / Protuberant / / Scaphoid
Bowel Sounds: / / Normoactive / / Hyperactive /x/ Hypoactive / / Absent
Percussion: / / Tymphanic / / Hypertymphanic
/x/ Fluid wave / / Shifting Dullness
Palpation: /x/ Muscle guarding / / Direct Tenderness
Tenderness: / / Organomely / / Liver (RUQ) / / Spleen

15. Genito – Urinary System

External Genitalia

Female: Labia: / / Symmetrical / / Asymmetrical / / Lesion_______

/ / Pinkish / / discoloration / / Edema
Urethra: / / midline / / Pink / / red inflemmed
Vaginal Orifice: / /discharge / / purulent / / bloody / / foul smelling
Others: / /swelling / /lumps or nodules
Male Penis: / /discharge / /nodules/growth/ lesions / / tenderness
Scrotum: /x/equal shape with / / lower than / / tenderness
/ / RL enlargement / /RL understands testes /
/tenderness
/ /nodules/growth/lesions / /others: / /hernia /
/hydrococic
16. Back and Extremities:

Extremities: Peripheral pulses: / / Symmetrical / /Regular /x/

Warm
/ / Absent / /Faint /x /weak / /Strong /
/Bounding
Nails and Nail beds: / /Pinkish / /Pallor / /cyanosis
/ /inflammation / / clubbing
/x/delayed capillary refill/ Blanching sign
Range of Motion: /x/ Full / / symmetrical
/ /decreased ROM upon ____________/ / tenderness/pain
/ /joint swelling
Muscle Tone and Strength:
/x/equally strong / /symmetrical in muscle
cell
RL upper lower weakness / /RL lower atrophy
Spine: /x/midline / /kyphosis / /Lordosis / /Scoliosis
Others: / /Costovertebral angle (CVA) Tenderness
Gait: /x/coordinated / /smooth / /uncoordinated
/ /stagerring / /shuffling / /stumbling

Glasgow Coma Scale

ACTION BEST RESPONSE SCORE

Eyes Open Spontaneously 4

Verbal Oriented 5

Motor Obeys Command 6

TOTAL 15

Anatomy and Physiology

Anatomy of the Heart

Your heart is located under the ribcage in the center of your chest between your right and left lung. It’s
shaped like an upside-down pear. Its muscular walls beat, or contract, pumping blood continuously to
all parts of your body.
The size of your heart can vary depending on your age, size, or the condition of your heart. A normal,
healthy, adult heart most often is the size of an average clenched adult fist. Some diseases of the
heart can cause it to become larger.

Coronary Arteries
Because the heart is composed primarily of cardiac muscle tissue that continuously contracts and
relaxes, it must have a constant supply of oxygen and nutrients. The coronary arteries are the
network of blood vessels that carry oxygen- and nutrient-rich blood to the cardiac muscle tissue.
The blood leaving the left ventricle exits through the aorta, the body’s main artery. Two coronary
arteries, referred to as the "left" and "right" coronary arteries, emerge from the beginning of the aorta,
near the top of the heart.
The initial segment of the left coronary artery is called the left main coronary. This blood vessel is
approximately the width of a soda straw and is less than an inch long. It branches into two slightly
smaller arteries: the left anterior descending coronary artery and the left circumflex coronary artery.
The left anterior descending coronary artery is embedded in the surface of the front side of the heart.
The left circumflex coronary artery circles around the left side of the heart and is embedded in the
surface of the back of the heart.
Just like branches on a tree, the coronary arteries branch into progressively smaller vessels. The
larger vessels travel along the surface of the heart; however, the smaller branches penetrate the
heart muscle. The smallest branches, called capillaries, are so narrow that the red blood cells must
travel in single file. In the capillaries, the red blood cells provide oxygen and nutrients to the cardiac
muscle tissue and bond with carbon dioxide and other metabolic waste products, taking them away
from the heart for disposal through the lungs, kidneys and liver.
When cholesterol plaque accumulates to the point of blocking the flow of blood through a coronary
artery, the cardiac muscle tissue fed by the coronary artery beyond the point of the blockage is
deprived of oxygen and nutrients. This area of cardiac muscle tissue ceases to function properly. The
condition when a coronary artery becomes blocked causing damage to the cardiac muscle tissue it
serves is called a myocardial infarction or heart attack.
Superior Vena Cava
The superior vena cava is one of the two main veins bringing de-oxygenated blood from the body to
the heart. Veins from the head and upper body feed into the superior vena cava, which empties into
the right atrium of the heart.
Inferior Vena Cava
The inferior vena cava is one of the two main veins bringing de-oxygenated blood from the body to
the heart. Veins from the legs and lower torso feed into the inferior vena cava, which empties into the
right atrium of the heart.
Aorta
The aorta is the largest single blood vessel in the body. It is approximately the diameter of your
thumb. This vessel carries oxygen-rich blood from the left ventricle to the various parts of the body.
Pulmonary Artery
The pulmonary artery is the vessel transporting de-oxygenated blood from the right ventricle to the
lungs. A common misconception is that all arteries carry oxygen-rich blood. It is more appropriate to
classify arteries as vessels carrying blood away from the heart.
Pulmonary Vein
The pulmonary vein is the vessel transporting oxygen-rich blood from the lungs to the left atrium. A
common misconception is that all veins carry de-oxygenated blood. It is more appropriate to classify
veins as vessels carrying blood to the heart.
Right Atrium
The right atrium receives de-oxygenated blood from the body through the superior vena cava (head
and upper body) and inferior vena cava (legs and lower torso). The sinoatrial node sends an impulse
that causes the cardiac muscle tissue of the atrium to contract in a coordinated, wave-like manner.
The tricuspid valve, which separates the right atrium from the right ventricle, opens to allow the de-
oxygenated blood collected in the right atrium to flow into the right ventricle.
Right Ventricle
The right ventricle receives de-oxygenated blood as the right atrium contracts. The pulmonary valve
leading into the pulmonary artery is closed, allowing the ventricle to fill with blood. Once the ventricles
are full, they contract. As the right ventricle contracts, the tricuspid valve closes and the pulmonary
valve opens. The closure of the tricuspid valve prevents blood from backing into the right atrium and
the opening of the pulmonary valve allows the blood to flow into the pulmonary artery toward the
lungs.
Left Atrium
The left atrium receives oxygenated blood from the lungs through the pulmonary vein. As the
contraction triggered by the sinoatrial node progresses through the atria, the blood passes through
the mitral valve into the left ventricle.
Left Ventricle
The left ventricle receives oxygenated blood as the left atrium contracts. The blood passes through
the mitral valve into the left ventricle. The aortic valve leading into the aorta is closed, allowing the
ventricle to fill with blood. Once the ventricles are full, they contract. As the left ventricle contracts, the
mitral valve closes and the aortic valve opens. The closure of the mitral valve prevents blood from
backing into the left atrium and the opening of the aortic valve allows the blood to flow into the aorta
and flow throughout the body.
Papillary Muscles
The papillary muscles attach to the lower portion of the interior wall of the ventricles. They connect to
the chordae tendineae, which attach to the tricuspid valve in the right ventricle and the mitral valve in
the left ventricle. The contraction of the papillary muscles opens these valves. When the papillary
muscles relax, the valves close.
Chordae Tendineae
The chordae tendineae are tendons linking the papillary muscles to the tricuspid valve in the right
ventricle and the mitral valve in the left ventricle. As the papillary muscles contract and relax, the
chordae tendineae transmit the resulting increase and decrease in tension to the respective valves,
causing them to open and close. The chordae tendineae are string-like in appearance and are
sometimes referred to as "heart strings."
Tricuspid Valve
The tricuspid valve separates the right atrium from the right ventricle. It opens to allow the de-
oxygenated blood collected in the right atrium to flow into the right ventricle. It closes as the right
ventricle contracts, preventing blood from returning to the right atrium; thereby, forcing it to exit
through the pulmonary valve into the pulmonary artery.
Mitral Value
The mitral valve separates the left atrium from the left ventricle. It opens to allow the oxygenated
blood collected in the left atrium to flow into the left ventricle. It closes as the left ventricle contracts,
preventing blood from returning to the left atrium; thereby, forcing it to exit through the aortic valve
into the aorta.
Pulmonary Valve
The pulmonary valve separates the right ventricle from the pulmonary artery. As the ventricles
contract, it opens to allow the de-oxygenated blood collected in the right ventricle to flow to the lungs.
It closes as the ventricles relax, preventing blood from returning to the heart.
Aortic Valve
The aortic valve separates the left ventricle from the aorta. As the ventricles contract, it opens to allow
the oxygenated blood collected in the left ventricle to flow throughout the body. It closes as the
ventricles relax, preventing blood from returning to the heart.

Blood Flow
The arrows in the drawing show the direction that blood flows through your heart. The light blue
arrows show that blood enters the right atrium of your heart from the superior and inferior vena cavae.
From the right atrium, blood is pumped into the right ventricle. From the right ventricle, blood is
pumped to your lungs through the pulmonary arteries.
The light red arrows show the oxygen-rich blood coming in from your lungs through the pulmonary
veins into your heart’s left atrium. From the left atrium, the blood is pumped into the left ventricle,
where it’s pumped to the rest of your body through the aorta.
For the heart to function properly, your blood flows in only one direction. Your heart’s valves make this
possible. Both of your heart’s ventricles has an “in” (inlet) valve from the atria and an “out” (outlet)
valve leading to your arteries. Healthy valves open and close in very exact coordination with the
pumping action of your heart’s atria and ventricles. Each valve has a set of flaps called leaflets or
cusps, which seal or open the valves. This allows pumped blood to pass through the chambers and
into your arteries without backing up or flowing backward.

Pathophysiology
MODIFIABLE NON-MODIFIABLE
Age – 83 y/o HPN
Gender – Male
CAD

Plaque builds in the wall of artery

The plaques harden and become stiffer

Atherosclerosis
Sign and Symptoms:

Complication:
1. Chest Pain Decreased blood flow to the area
2. DOB
3. Nausea &
Vomitting
It will form blood clots
4. Fatigue

Complication: Blood clot fills the lumen of the artery

1. Death
Artery blocked and narrowed

Decrease blood flow to the heart

 Myocardial ischemia

Decrease oxygen supply to the heart muscle

Cells starvation secondary to a lack of oxygen

Myocardial cells die from lack of oxygen

Heart muscle damage, heart muscle death

Myocardial Infarction

Drug Study
 Name of Drug Classificatio Dosage/frequency Route Mechanism of Indication Nursing
(Generic and Brand n Action Responsibility
name)
1. Furosemide Loop diuretic 40mg BID IV inhibit Treatment Observe for signs
Diotec reabsorption of of edema of fluids &
sodium and associated electrolyte
water in the w/ heart imbalance.Impaired
ascending limb failure hepatic or renal
of the loop of including function, DM,
Henle by pulmonary adrenal disease.
interfering with edema & Abrupt withdrawal
the chloride w/ renal & may precipitate
Analgesics 1mg (PRN for IV binding site of hepatic withdrawal
(Opioid) severe pain) the 1Na+, 1K+, disorders. syndrome.
2Cl- cotransport Prolonged use may
system. Loop produce
diuretics dependence. Acute
2. Morphine increase the Pain, Pain ulcerative colitis.
Morin amp rate of delivery associated Reduced
of tubular fluid with MI, circulation volume
and electrolytes Acute pain impaired
to the distal myocardial
sites of function.
hydrogen and Hypothyroidism,
potassium ion adrenocortical
secretion, while insufficiency,
plasma volume prostatic
contraction hypertrophy &
increases urethral stricture.
aldosterone Elderly or
production. debilitated patients.

Relieves pain
by stimulating
opiate
receptors in
CNS; also
causes
respiratory
depression,
peripheral
vasodilation,
inhibition of
intestinal
peristalsis,
sphincter of
Oddi spasm,
stimulation of
chemoreceptor
s that cause
vomiting and
increased
bladder tone.
 Name of Drug Classification Dosage/Frequency Mechanism Indication Nursing
(Generic and Brand of Action Responsibility
name)
3. Lactulose Laxatives 30cc at bedtime Lactulose Constipation, Monitor
Duphalac promotes hepatic electrolyte
peristalsis by encephalopathy. imbalance.
producing an Lactose
osmotic intolerance;
effect in the diabetics.
colon with
4. Enoxaparin resultant
Sodium Anticoagulants, 0.4cc SQ BID distention. Treatment of
Clexane Antiplatelets & deep vein
Fibrinolytics Clexane is thrombosis w/ or History of
(Thrombolytics indicated for w/o pulmonary heparin-induced
) the embolism; thrombocytopenia
prophylaxis prevention of w/ or w/o
of deep vein thrombus thrombosis. Do
thrombosis, formation in not administer by
which may extracorporeal IM route
lead to circulation
pulmonary during
embolism, hemodialysis;
and also for treatment of
the unstable angina
prophylaxis & non-Q wave
of ischemic MI,cardiac
complications insufficiency.
of unstable
angina and
non-Q-wave
myocardial
infarction,
when
concurrently
administered
with aspirin.
Clexane
inhibits
reactions that
lead to the
clotting of
blood.

Name of drug Classification Dosage/Frequency Mechanism Indication Nursing

(Generic and Brand of Action Responsibility
name)
5. Diazepam Anxiolytics, 5mg PRN for anxiety long-acting Short-term Impaired renal
Valium amp Anticonvulsants and restlessness benzodiazepi treatment for and hepatic
IV ne with anxiety. function; chronic
anticonvulsa pulmonary
nt, anxiolytic, insufficiency;
sedative, organic cerebral
muscle changes; elderly;
relaxant and psychotic
amnestic patients;
properties. epileptics; history
of alcohol or drug
addiction.
75mg now
6. Clonidine Antihypertensives SL Hypertension of Gradual
Catapres Stimulates any etiology. withdrawal is
alpha2- needed (over 1
adrenoceptor week for oral, 2-4
s in the brain days with
stem, thus epidural) if drug
activating an needs to be
 inhibitory stopped. Patients
neuron, should be
resulting in instructed about
reduced abrupt
sympathetic discontinuation
outflow from (causes rapid
the CNS, increase in BP
producing a and symptoms of
decrease in sympathetic
peripheral overactivity). In
resistance, patients on both
renal a beta-blocker
vascular and clonidine
resistance, where withdrawal
heart rate, of clonidine is
and blood necessary,
pressure; withdraw the
epidural beta-blocker first
clonidine and several days
may produce before clonidine.
pain relief at Then slowly
spinal decrease
presynaptic clonidine.
and Use with caution
postjunctiona in patients with
l alpha2- severe coronary
adrenoceptor insufficiency;
s by conduction
preventing disturbances;
pain signal recent MI, CVA,
transmission; or chronic renal
pain relief insufficiency.
occurs only
for the body
regions
innervated by
the spinal
segments
where
analgesic
concentration
s of clonidine
exist

Name of drug Classification Dosage/Frequency Mechanism Indication Nursing

(Generic and Brand of Action Responsibility
name)
Moxifloxacin Avelox Antibacterial IV/400 mg > Inhibits > For respiratory Should be
bacterial infections. avoided in
topoisomeras patients with
e II (DNA known
gyrase) IV. prolongation of
Topoisomera the QT interval,
ses are patients with
essential uncorrected
enzymes hypokalemia
which play a
crucial role in
the
replication
and repair of
bacterial
DNA.
> Monitor for
severe allergic
Captopril reaction rash;
Ace Inhibitors PO/25mg ¼ tab BID >Competitive > Treating high hives; itching;
ly inhibits blood pressure, difficulty
angiotensin I heart failure. breathing;
– converting tightness in the
enzyme, chest ; swelling of
preventing the mouth, face,
conversion of lips, or tongue.
angiotensin I
to
angiotensin
II, a potent
vasoconstrict
or that also > Monitor Vital
stimulates sign
aldosterone
secretion

Nitroglycerin Patch
Vasodilator Transdermal/ 8hrs > primarily > Relaxation of
nfi metabolized vascular smooth
in the liver by muscle and
nitrate dilation of
reductase; peripheral
known sites arteries and
of veins.
extrahepatic
metabolism
include red
blood cells
and vascular
walls.
Metabolized
to in organic
nitrate and
the active 1,2
and 1,3
dinitroglycero
ls