Copd Final B

i.
INTRODUCTION
COPD, or chronic obstructive pulmonary (PULL-mun-ary) disease, is a progressive
disease that makes it hard to breathe !Progressive! means the disease gets "orse over time
COPD can cause coughing that produces large amounts o# mucus (a slimy substance),
"hee$ing, shortness o# breath, chest tightness, and other symptoms
Cigarette smoking is the leading cause o# COPD %ost people "ho have COPD smoke or
used to smoke Long-term e&posure to other lung irritants'such as air pollution, chemical #umes,
or dust'also may contribute to COPD
COPD is a ma(or cause o# disability, and it)s the third leading cause o# death in the United
*tates Currently, millions o# people are diagnosed "ith COPD %any more people may have the
disease and not even kno" it
COPD develops slo"ly *ymptoms o#ten "orsen over time and can limit your ability to do
routine activities *evere COPD may prevent you #rom doing even basic activities like "alking,
cooking, or taking care o# yoursel#
%ost o# the time, COPD is diagnosed in middle-aged or older adults +he disease isn)t
passed #rom person to person'you can)t catch it #rom someone else
COPD has no cure yet, and doctors don)t kno" ho" to reverse the damage to the air"ays
and lungs ,o"ever, treatments and li#estyle changes can help you #eel better, stay more active,
and slo" the progress o# the disease
+his is a case o# patient C*, -. years old, male, /oman Catholic, #rom 0aga"asan,
Dimataling 1D*2 admitted at 1amboanga del *ur %edical Center on 3uly 45, 4657 "ith chie#
complaints o# di##iculty breathing, chest pain ,is previous diagnosis #rom last hospitali$ation
includes hypertension
II. ASSESSMENT
Dates of Assessment:
July 21, 21! " fi#st assessment $ay
July 22, 21! " se%on$ assessment $ay
I. &ATIENT'S &RO(I)E
Name of &atient: C* A*e: -. yo
A$mittin* Dia*nosis: COPD 8cute e&acerbation
)atest Dia*nosis: P+9 :::
Reli*ion: /oman Catholic
Name of Atten$in* &+ysi%ian: Dr %ondarte Ci,il Status: %arried
Date an$ Time of A$mission: 3uly 45, 46572 ;<5- 8%
)an*ua*e-Diale%t S.o/en: Cebuano
July 21, 21!
+emperature =>7
o
C Pulse .4 bpm /espiration 7? cpm
9lood Pressure 546@;6 mm,g
July 22, 21!
+emperature =;
o
C Pulse ?- bpm /espiration =6 cpm
9lood Pressure 556@;6 mm,g
,eight< -A7B Ceight -- kls
C0IE( COM&)AINT-REASON (OR 0OS&ITA)I1ATION: Ceakness2 Di##iculty o# breathing
0ISTOR2 O( &RESENT I))NESS: Patient C*, -. years old, male, /oman Catholic, #rom
0aga"asan, Dimataling 1D*, admitted at 1amboanga del *ur %edical Center on 3uly 45, 4657 at
;<5- am "ith chie# complaints o# "eakness and di##iculty o# breathing
Last 3uly 46, 4657, the patient e&perienced dyspnea and verbali$ed to his daughter,
Dnaglisod kayo sya ug ginha"aB "hich alarmed the *O to seek medical assistance at 1amboanga
del *ur %ediacal Center and "as then admitted ,e "as then discharged on 3uly 4=, 4657, "ith
discharge diagnosis o# P+9 cat ::: Patient discharged "ith home medications< Eit 9 Comple&
OD a#ter 9reak#ast, Calvit OD ?8m, *olmu& 9roncho 5 cap +:D, Candesartan Cele&itil 5>mg OD,
8$ithromycin -66mg OD
(OOD AND DRU3 A))ER3IES: Pls speci#y< no kno"n #ood and drug allergy
&AST MAJOR I))NESS, O&ERATIONS, AND 0OS&ITA)I1ATIONS
ILLNESS/HOSPITALIZATION DATE
Hypertension 2012
Family %edical ,istory
(G) ,eart disease< Paternal side (-) /enal Disease
(G) ,ypertension< 9oth maternal and paternal side (-) Cancer
(G) *troke< %aternal side (-) *ubstance 8buse
(-) Lung Disease ( ) Others
Others< HHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH
II. (UNCTIONA) &ATTERN
A. NUTRITION-META4O)IC &ATTERN
Initial
%eal Pattern< Patient normally eats three times a day (break#ast, lunch and dinner) /eports o#
patientAs #ondness o# eating #atty #ood (eg humba, chicharon)
8ppetite< ( ) Iood ( G ) Fair ( ) Poor
Changes in Jating ,abitsK ( ) Lo ( G ) Mes
8ppetite ChangesK ( ) Lo ( G ) Mes
Ceight < --kls *pecial Diet< D8+
0os.itali5ation Days
D Dili (ud sya p"ede makakaon ug konrta sir kay mo kalit lang sya ka hangak inig human niya
kaon, mao mamili nalag mi ug pagkaon na p"ede sa iyaha D N as verbali$ed by the *O
8ppetite< ( ) Iood ( ) Fair ( G ) Poor
Changes in Jating ,abitsK ( ) Lo ( G ) Mes
8ppetite ChangesK ( ) Lo ( G ) Mes
Ceight < --kls- -=kls *pecial Diet< ,ypoallergenic Diet
4. E)IMINATION &ATTERN
Initial
9L8DDJ/ (G) Lo di##iculty ( ) Dysuria ( ) Oliguria
( ) :ncontinence ( ) Locturia ( ) 8nuria
( ) U+: ( ) *tones
9OCJL ( G ) Lo di##iculty ( ) Constipation
D%akaihi ra biya pod ug makalibang sir pero ginagmay ra man na iyang ihi, dili pod sya mag lisod
kana lang (ud mahago sya mao ran a iyang problema kay mo hangak daun na syaB as verbali$e
by the signi#icant others
C S)EE&-REST &ATTERN
Initial
( G ) Lo di##iculty ( ) Mes
Use o# sleeping aids< (G ) Lo ( ) Mes
Comments@Lursing Problem :denti#ied<
DDiretso-diretso man iyang tulog *a iya sa kapoy sa iyang sakit mao tingali diretso-diretso iyang
tulogB 8s verbali$ed by *O
8ctivities o# Daily Living (: O :ndependent, 8 O Cith 8ssistance, D O Dependent)
Jating (D) 9athing (D) Dressing (D)
Irooming (D) +oileting (D) 8mbulating (D)
8C+:E:+M LJEJL ( ) 8ctive (G) *edentary
D0adtong "ala pa siya nagsakit, maglihok-lihok man pod siya sa balayB D0aron dili man niya
kaayo malihok iya kamot kay luyaB D0aron kay magghigda ug matulog ra gyud siyaBN as
verbali$ed by the *O +he patient is very dependent to his *O due to his condition D0aron na
naa siya sa hospital, maghigda ra gyud na siya kay luya man gud pod siyaB N as verbali$ed by
the *OD0ami man gyud ga ilis ug gapakaon niya kay maglisod man siya ug lihok-lihokB N as
verbali$ed by the *OD%akaya-kaya naman niya nga maglihok-lihok nga siya ra Pero amo ra
gihapon siya i-assist kay basin ma-unsa bahB Nas verbali$ed by the *O
D. CO3NITI6E &ERCE&TION &ATTERN
Initial
Ilasses ( ) Lo (G) Mes Contact Lens ( ) Mes ( )
/ight
( ) Le#t
,earing 8ids (G) Lo ( ) Mes Prosthesis ( ) Mes ( ) /ight
( ) /ight ( ) Le#t ( ) Le#t
D %akakita pa man pod siya gamay pero kung magbasa siya kay gagamit siya ug antipara 0aron
naa siya sa hospital kay dili man niya ginagamit iyang antipara %akadungog pa man pod na
siyaB N as verbali$ed by the *O
E. 4E0A6IOR &ATTERN 7CO&IN3-6A)UES8
Initial
9J,8E:O/ (G) /ela&ed ( ) %ildly 8n&ious
( ) %oderately an&ious ( ) Eery an&ious
Psychiatric ,istory< none
*U9*+8LCJ 89U*J (:# yes, pls indicate #rePuency@Q o# packs@glasses per day)
+obacco (G ) Lo ( ) Mes HHHHHHHHHHHHHHHHHHHHHHHHHHHHH
Drugs (G) Lo ( ) Mes HHHHHHHHHHHHHHHHHHHHHHHHHHHHH
8lcohol ( ) Lo ( G ) Mes appro&imately t"ice a "eekHHHHHH
Cigarette@Cigar@Pipe ( ) Lo ( G ) Mes appro&imately 5 pack per day

D0usog (ud na sya manigarilyo sir sa bata bata pana sya, ga inom siya usahay ra pod dayon
ginagmay ra podB N as verbali$ed by the *O
(. &AIN
Initial

( ) Lo (G) Mes (describe) D*akit akong dughan sir basta hangakon koB as verbali$ed by the
patient
Present Pain %anagement< rela&ation techniPue, deep breathing e&ercises
Muing on
na siya na
sakit
iyahang dughan. Sauna ga reklamo naman siya nga musakit iyang dughan labaw na
kanang mahago siya. as verbalied by the S!.
3. SE9UA)IT2-RE&RODUCTION &ATTERN
Initial
Date o# last menstrual period (L%P)< L@8
Date o# Last Pap *mear< L@8
:s the patient pregnantK ( ) Lo ( ) Unsure ( ) Mes, no o# "eeks HHHHHHHHHHHHH
9reast (cyst, lump, discharge) ( ) Lo ( ) Mes
+esticular@prostate problem< ( ) L8 (G) Lo() Mes
9irth Control< (G) L8 ( ) Lo
( ) Mes (describe) HHHHHHHHHHHHHHHHHHHHHHHHHHHHHH
DOk ra man sir "ala mana sya sakit kung mangihiB as verbali$ed by the signi#icant others DDili
man ko mag lisod ug ihi sir dili pod sakit kung mangihiB as verbali$ed by the patient
0. RO)E RE)ATIONS0I& &ATTERN
Initial
Occupation< none
Cith "hom does patient liveK Family (one son, one daughter and 4 grandchildren)
8nticipating to return homeK (G) Mes ( ) Lo (speci#y the reason)
HHHHHHHHHHHHHHHHHHHHHHHH
Person(s) available to assist at home< children
+he patient is taken care o# by his children
DCala man gyud lain makatabang ug makabantay ni papa mao na kami ra gyud magbantayB N as
verbali$ed by the *O
III. &02SICA) ASSESSMENT
(:ndicate sub(ective and ob(ective cues #or abnormalities noted)
A. NEUROLOGICAL ASSESSMENT
Alert and oriented to person pla!e and ti"e#
"he patient is oriented to time pla#e and person.
P$pils e%$all& ro$nd ' rea!ti(e to li)*t#
$upils e%ually round rea#tive to light and a##ommodation.
No di+!$lt& in spee!* or s,allo,in) noted#
"he patient has negative signs o& di'#ulty is spee#h but positive signs o& di'#ulty
swallowing.
-. RESPIRATOR. ASSESSMENT
Resp. /0 to 00 1reat*/"in$te at rest#
DIi o&ygen man siya kay maglisod siya ug ginha"a Ii ubo man gud siyaB, as verbali$ed by the
*O
DLaay plema iyang ubo, medyo "hite na stickyB, as verbali$ed by the daughter

(()*+ #pm, shallow breathing, use o& a##essory mus#les
Respirations %$iet ' re)$lar#
-reat* so$nds in 1ot* l$n) 2elds are !lear#
(ales and ron#hi present at both lung -elds upon aus#ultation.
$ositive &or lung #ongestion based upon #hest ./ray result, produ#tive #ough noted.
Nail 1eds and lips pin3.
0ail beds and lips are pale.
C. CARDIO4ASCULAR ASSESSMENT
Re)$lar api!al p$lse. Heart rate 56 to /66 1eats/"in$te#
H() 12 bpm, regular rhythm
2theros#leroti# 2orta based upon #hest ./ray result.
No !o"plaints o7 !*est pain#
DIareklamo man siya nga sakit iyang dughan usahayB, as verbali$ed by the *O
Musakit iyang dughan usahay. Sauna ga reklamo naman siya nga musakit iyang
dughan labaw na kanang mahago siya. as verbalied by the S!.
Sighing with no intent to move unless absolutely ne#essary3 very slow movement
with &a#ial grima#e3 shortness o& breath upon pain onset asso#iated with &a#ial
grima#e and sighing
No Ede"a#
0one noted
D. PERIPHERAL84ASCULAR ASSESSMENT
E9tre"ities are pin3 ,ar" and "o(a1le ,it*in nor"al ROM#
$ale e.tremities and #old.
4pper and lower e.tremities movable within (!M with assistan#e but there weakness
on the right side o& the body.
Perip*eral p$lses palpa1le. No ede"a. No !o"plaints o7 n$"1ness or !al7
tenderness#
!.ygen Saturation )1*5
6apillary re-ll7 2 se#
E. GENITOURINAR. ASSESSMENT
4oidin) ,it*o$t dis!o"7ort or di+!$lt&#
Urine !lear 7re%$en!& ,it*in o,n pattern#
D Dili man mag lisod sir ang color sa akong ihi usahay sir kay mag depende man mo yello" kayo
usahay pod tina" ra manB N as verbali$ed by the patient
No $n$s$al penile irritation/dis!*ar)e noted#
0o unusual penile dis#harges.
:. MUSCOLUS;ELETAL ASSESSMENT
A1sen!e o7 <oint s,ellin) and tenderness no e(iden!e o7 in=a""ation#
Nor"al ROM o7 all <oints#
8inahanglan gyud namo siya tabangan kung mulihok kay luya man gyud siya.,
verbalied by the S!.
No "$s!le ,ea3ness#
9eneralied body weakness noted.
No !o"plaints o7 1a!3 pain#
0o #omplaints o& ba#kpain
G. INTEGUMENTAR. ASSESSMENT
S3in !olor ,it*in patient>s nor" s3in ,ar" dr& ' inta!t#
Skin is #old, pale and saggy.
$ale mu#ous membranes.
S#alp #ondition7 oily.
De!$1iti/1$rns present# ? @ .es ? : @ No
Me$i%ations In$i%ations
*albutamol Leb Used
in asthma, bronchitis, bronchospasm and
treatment o# reversible air"ays obstruction
Ce#uro&ime e##ective against susceptible bacteria
causing in#ections
*olmu& 9roncho /elie# o# tight cough "ith thick phlegm
accompanying air"ay disorders ie, acute
and chronic bronchitis, bronchial asthma
and bronchiectasis
8$ithromycin use#ul #or the treatment o# bacterial
in#ections
Do&o#ylline used in the treatment o# asthma
%yrin P Forte :nitial phase treatment and re-treatment o#
all #orms o# tuberculosis
Eit b Comple& Dietary supplement
Calvit Calcium supplement
)A4ORATOR2 RESU)TS
C)INICA) C0EMISTR2
Lormal Ealues<
*odium < 5=--57- mmol@L
Potassium < =>--5 mmol@L
Creatinine < .6. ?.-567 mmol@l
Urea Litrogen< 4?>- 464=-75>- mmol@l
8L+ < - - 45-;4 U@L
URINA)2SIS
Color < Mello"
+ransparency < Clear
*peci#ic Iravity < 5666
p, < =
*ugar < RR
Protein < +rack
%icroscopic Findings
/9C <
Pus Cells < 6-5@ hp#
Jpithelial Cells < /are
9acteria < Fe"
4)OOD C0EMISTR2
Parameters /esult Lormal Ealues
COMPLETE BLOOD COUNT
+otal C9C 55= =6-566 & 56.@liter
+otal /9C =6 4>6--=6 & 5654@liter
,emoglobin 574 54;6-5>;6mmol@L
,ematocrit 7=6 766-7.;6S
%CE ;66-.;6 #l
%C, 4?6-=76 pg
%C,C =4-=>S
Platelet Count 5-66-=.66 & 56.@liter
DIFFERENTIAL COUNT
Leutrophils ?. --->- S
Lymphocytes > 46-=- S
%onocytes 7 4-? S
Josinophils 5 6--5 S
9asophils 66-56 S
/DC-CE 55-6-57-6 S
9:RA2 RE&ORT
:mpression< 9:L8+J/8L LULI :LF:L+/8+J*, L:0JLM P+P
8+,J/O*CLJ/O+:C 8O/+8
8PP/OP/:8+J FU/+,J/ CO/0-UP :* *UIIJ*+JD
EC3
:nterpretation<
J&treme tachycardia
*uspect L%:
*+ abnormality
III. ANATOM2 AND &02SIO)O32
Res.i#ato#y T#a%t
+he respiratory system is an organ system "hich is used #or gas e&change the respiratory
system generally includes tubes, such as the bronchi, used to carry air to the lungs, "here gas
e&change takes place 8 diaphragm pulls air in and pushes it out
+he respiratory system can be conveniently subdivided into a conducting $one and a
respiratory $one +he conducting $one starts "ith the nares (nostrils) o# the nose, "hich open into
the nasopharyn& (nasal cavity), "hich in #act opens into the oropharyn& (behind the oral cavity)
+he oropharyn& leads to the laryn& (voicebo&), "hich contains the vocal cords, and connects to
the trachea ("ind pipe) "hich leads do"n to the thoracic cavity (chest) "here it divides into the
right and le#t !main stem! bronchi, "hich continue to divide up to 5> more times into even smaller
bronchioles +he bronchioles lead to the respiratory $one o# the lungs "hich consists o#
respiratory bronchioles, alveolar ducts and the alveoli, the multi-lobulated sacs in "hich most o#
the gas e&change occurs Eentilation o# the lungs is carried out by the muscles o# respiration
:nhalation is initiated by the diaphragm and supported by the e&ternal intercostal muscles During
vigorous inhalation (at rates e&ceeding =- breaths per minute), or in approis #iltered, "armed,
and humidi#ied as it #lo"s to the lungsaching respiratory #ailure, accessory muscles o# respiration
are recruited #or support +hese consist o# sternocleidomastoid8ir moves through the body in the
#ollo"ing order< Lostrils, Lasal cavity, Oropharyn& Laryn& (voice bo&), +rachea ("ind pipe),
+horacic cavity (chest), 9ronchi (right and le#t), 8lveoli (site o# gas e&change) +he ma(or #unction
o# the respiratory system is gas e&change /espiration consists o# a mechanical cycle o#
inhalation and e&halation, "ith gaseous e&change occurring in bet"een
:nhalation is driven primarily by the diaphragm Chen the diaphragm contracts, the ribcage
e&pands and the contents o# the abdomen are moved do"n"ard +his results in a larger thoracic
volume, "hich in turn causes a decrease in intrathoracic pressure 8s the pressure in the chest
#alls, air moves into the conducting $one ,ere, the air is #iltered, "armed, and humidi#ied as it
#lo"s to the lungs
J&halation, on the other hand, is typically a passive process +he lungs have a natural
elasticity2 as they recoil #rom the stretch o# inhalation, air #lo"s back out until the pressures in the
chest and the atmosphere reach ePuilibrium
During #orced inhalation, as "hen taking a deep breath, the e&ternal intercostal muscles
and accessory muscles #urther e&pand the thoracic cavity
During #orced e&halation, as "hen blo"ing out a candle, e&piratory muscles including the
abdominal muscles and internal intercostal muscles, generate abdominal and thoracic pressure,
"hich #orces air out o# the lungs
Upon inhalation, gas e&change occurs at the alveoli, the tiny sacs "hich are the basic
#unctional component o# the lungs +he alveolar "alls are e&tremely thin (appro& 64
micrometres), and are permeable to gases +he alveoli are lined "ith pulmonary capillaries, the
"alls o# "hich are also thin enough to permit gas e&change 8ll gases di##use #rom the alveolar air
to the blood in the pulmonary capillaries, as carbon dio&ide di##uses in the opposite direction,
#rom capillary blood to alveolar air 8t this point, the pulmonary blood is o&ygen-rich, and the
lungs are holding carbon dio&ide J&halation #ollo"s, thereby ridding the body o# the carbon
dio&ide and completing the cycle o# respiration
I6. &AT0O&02SIO)O32
COPD is a comple& syndrome comprised o# air"ay in#lammation, mucociliary dys#unction and
consePuent air"ay structural changes
5
Ai#;ay inflammation
COPD is characteri$ed by chronic in#lammation o# the air"ays, lung tissue and pulmonary blood
vessels as a result o# e&posure to inhaled irritants such as tobacco smoke
+he inhaled irritants cause in#lammatory cells such as neutrophils, CD?
R
+-lymphocytes, 9 cells
and macrophages to accumulate
4
Chen activated, these cells initiate an in#lammatory cascade
that triggers the release o# in#lammatory mediators such as tumour necrosis #actor alpha (+LF-T),
inter#eron gamma (:FL-U), matri&-metalloproteinases (%%P->, %%P-.), C-reactive protein (C/P),
interleukins (:L-5, :L->, :L-?) and #ibrinogen +hese in#lammatory mediators sustain the
in#lammatory process and lead to tissue damage as "ell as a range o# systemic e##ects +he
chronic in#lammation is present #rom the outset o# the disease and leads to various structural
changes in the lung "hich #urther perpetuate air#lo" limitation +he chronic in#lammatory cascade
#or COPD is illustrated in Figure 5
St#u%tu#al %+an*es
8ir"ay remodeling in COPD is a direct result o# the in#lammatory response associated "ith
COPD and leads to narro"ing o# the air"ays +hree main #actors contribute to this< peribronchial
#ibrosis, build-up o# scar tissue #rom damage to the air"ays and over-multiplication o# the
epithelial cells lining the air"ays
=,7
Parenchymal destruction is associated "ith loss o# lung tissue elasticity, "hich occurs as a result
o# destruction o# the structures supporting and #eeding the alveoli (emphysema) +his means that
the small air"ays collapse during e&halation, impeding air#lo", trapping air in the lungs and
reducing lung capacity (Figure 4)

(i*u#e 1: Inflammato#y an$ immune %ells in,ol,e$ in CO&D.
2

8dapted #rom 9arnes, P3 Nat Rev Immunol 2<2?<5?=-.4

(i*u#e 2: Ai#flo; limitation in CO&D.

Mu%o%ilia#y $ysfun%tion
*moking and in#lammation enlarge the mucous glands that line air"ay "alls in the lungs, causing
goblet cell metaplasia and leading to healthy cells being replaced by more mucus-secreting
cells
-
8dditionally, in#lammation associated "ith COPD causes damage to the mucociliary
transport system "hich is responsible #or clearing mucus #rom the air"ays 9oth these #actors
contribute to e&cess mucus in the air"ays "hich eventually accumulates, blocking them and
"orsening air#lo" (Figure =)

(i*u#e =: Mu%o%ilia#y effe%ts in t+e CO&D ai#;ay.
6. Me$i%al Mana*ement
A. 3ene#al Mana*ement
IDEA) MEDICA) MANA3EMENT
/ationale
I. )a>o#ato#y Test
5 Complete 9lood Count
4 8rterial 9lood Iases
= Pulmonary Functions +ests (PF+s)
7 Pulse O&imetry
- *putum Culture
> Chest &-ray
; Jchocardiography
? Jlectrocardiography (JCI)
II. Me$i%ations
8 complete blood count (C9C) "ill alert the doctor to an
in#ection as "ell as telling him, among other things, ho"
much hemoglobin is present in your blood ,emoglobin is
the iron-containing pigment in your blood that carries the
o&ygen #rom your lungs to the rest o# your body
:n COPD, the amount o# air that you breathe into and out o#
your lungs is impaired 8rterial blood gases (89Is) measure
the o&ygen and carbon dio&ide levels in your blood and
determine your body)s p, and sodium bicarbonate levels
89Is are important in #orming a diagnosis o# COPD as "ell
as in ad(usting o&ygen therapy
PF+s are used to evaluate lung #unction and determine the
e&tent o# the damage "ithin your lungs +he most common
PF+ is spirometry
8 noninvasive method, pulse o&imetry measures ho" "ell
your tissues are being supplied "ith o&ygen 8 probe or
sensor is normally attached to the #inger, #orehead, earlobe
or bridge o# the nose
Pulse o&imetry can be continuous or intermittent 8
measurement o# .-S to 566S is considered normal
*putum or mucus #rom your lungs can be obtained by
coughing it up or suctioning Mour sputum specimen "ill be
evaluated in a laboratory and "ill provide your doctor "ith a
guide in both the diagnosis and treatment o# your lung
disease
+o assess heart si$e and presence or absence o# heart
#ailure and pulmonary edema %ay also assist in di##erential
diagnosis
+he doctor "ill per#orm an initial chest G-ray "hen trying to
reach a diagnosis o# COPD, and then throughout your
treatment to monitor your progress
is help#ul i# the diagnosis is in Puestion, can de#ine the e&tent
o# the in#arction and can identi#y complications, such as
acute mitral regurgitation, le#t ventricular rupture or
pericardial e##usion
Features that increase the likelihood o# in#arction are< ne"
*+ segment elevation2 ne" V "aves2 any *+ segment
elevation2 ne" conduction de#ect Other #eatures o# ischemia
are *+ segment depression and + "ave inversion
Patients "ho have COPD are o#ten prescribed medications
called bronchodilators 9ronchodilators "ork by rela&ing and
e&panding the smooth muscle o# the air"ays, making it
5 4#on%+o$ilato#s
4 3lu%o%o#ti%oi$s
= Anti>ioti%s
7 O?y*en T+e#a.y
- (lu 6a%%ine
> Pneumonia Eaccine
::: Ieneral %anagement
A. Diet
5 %onitor Mour 9ody Ceight
4 Drink Plenty o# Fluids
= Decrease *odium :ntake
7 8void Overeating and Foods that
Cause Ias
easier to breath
# you have COPD, your doctor may have prescribed
glucocorticoids, or steroids, as part o# your COPD treatment
plan +his drug is liPue#y the mucus in your lungs "hich
reduce the s"elling in your breathing tubes
People "ith COPD are more prone to bacterial lung
in#ections than most 8nd, i# you have a bacterial lung
in#ection, then chances are your doctor "ill have prescribed
you an antibiotic
*upplemental o&ygen is a very help#ul treatment that
enables many patients "ith severe COPD lead a more
normal and productive li#e
Flu shots not only help prevent the #lu, they can help COPD
patients #ight o## potential e&acerbations o# symptoms, "hich
are periods o# time "hen your COPD may "orsen
People "ith COPD are at greater risk #or developing
pneumococcal pneumonia, a serious lung in#ection that kills
5 out o# every 46 people "ho get it 8nd, even i# you have
already had a pneumonia vaccine, the Centers #or Disease
Control recommend that certain high-risk groups have a
second dose
Ceighing yoursel# at least once a "eek "ill help you keep
your "eight under control :# you are taking diuretics or
steroids, ho"ever, your doctor may recommend daily "eigh-
ins :# you have a "eight gain or loss o# 4 pounds in one day
or - pounds in one "eek, you should contact your doctor
Unless your doctor tells you other"ise, you should drink > to
?, eight-ounce glasses o# non-ca##einated beverages daily
+his helps to keep your mucus thin, making it easier #or your
body to cough it up *ome people #ind it easier to #ill a
container #ull o# their daily #luid rePuirement in the morning
and spread it out during the day :# you try this method, it is
best to slo" do"n your intake o# #luids to"ards evening so
you are not up all night urinating
Jating too much salt causes your body to retain #luid +oo
much #luid can make breathing more di##icult +o reduce
sodium intake, don)t add salt "hen you cook and make sure
you read all #ood labels :# the sodium content in #ood is
greater than =66 milligrams o# sodium per serving, don)t eat
it :# you are thinking o# using salt substitutes, make sure you
check "ith your doctor #irst, as some ingredients in them
may be (ust as harm#ul as salt
Chen you overeat, your stomach can #eel bloated making
breathing more di##icult Carbonated beverages or gas-
producing #oods such as beans, cauli#lo"er or cabbage can
also cause bloating Jliminating these types o# beverages
and #oods "ill ultimately allo" #or easier breathing
:# you are under"eight, eating smaller, more #rePuent meals
that are higher in calories can help you meet your caloric
needs more e##iciently +his can also help you #eel less #ull
making it easier to breathe 8void lo"-#at or lo"-calorie #ood
- Jat *maller, %ore FrePuent %eals that
8re ,igh in Calories
> :nclude Jnough Fiber in Mour Diet
4. E?e#%ise
7 +ypes o# J&ercises #or COPD
1. *tretching e&ercises
2. 8erobic e&ercises
=. *trengthening e&ercises
!. 9reathing e&ercises #or COPD
Pursed lip breathing<
5 /ela& your neck and shoulder
muscles
4 9reathe in #or t"o seconds through
your nose, keeping your mouth
closed
= 9reathe out #or #our seconds
through pursed lips :# this is too
long #or you, simply breathe out
t"ice as long as you breathe in
products *upplement your meals "ith high-calorie snacks
like pudding or crackers "ith peanut butter
,igh #iber #oods such as vegetables, dried legumes, bran,
"hole grains, rice, cereals, pasta and #resh #ruit aid in
digestion by helping your #ood move more easily through
your digestive tract Mour daily #iber rePuirement should be
bet"een 46 to =- grams o# #iber each day
+hese #our types o# e&ercises can help you i# you have
COPD ,o" much you #ocus on each type o# e&ercise may
depend upon the COPD e&ercise program your health care
providers suggests #or you
lengthen your muscles, increasing your #le&ibility *tretching
can also help prepare your muscles #or other types o#
e&ercise, decreasing your chance o# in(ury
Use large muscle groups to move at a steady, rhythmic
pace +his type o# e&ercise "orks your heart and lungs,
improving their endurance by "orking your respiratory
muscles +his helps your body use o&ygen more e##iciently
and, "ith time, can improve your breathing Calking and
using a stationary bike are t"o good choices o# aerobic
e&ercise i# you have COPD
:nvolve tightening muscles repeatedly to the point o# #atigue
Chen you do this #or the upper body, it can help increase the
strength o# your breathing muscles
,elps you strengthen breathing muscles, get more o&ygen,
and breathe "ith less e##ort ,ere are t"o e&amples o#
breathing e&ercises you can begin doing #or #ive to 56
minutes, three to #our times a day
Use pursed-lip breathing "hile e&ercising :# you e&perience
shortness o# breath, #irst try slo"ing your rate o# breathing
and #ocus on breathing out through pursed lips
*moking is the underlying cause o# the ma(ority o# cases o#
emphysema and chronic bronchitis 8nyone "ho smokes
should stop, and, although Puitting smoking "ill not reverse
the symptoms o# COPD, it may help preserve the remaining
lung #unction
J&posure to other respiratory irritants, such as air pollution,
dust, to&ic gases, and #umes, may aggravate COPD and
should be avoided "hen possible
4. D#u* Stu$y
Name of
D#u*
Date
O#$e#e$
Classifi%ation
Dose-
(#e@uen%y
Me%+anism of
A%tion
S.e%ifi%
In$i%ation
Cont#ain$i%ation
Si$e Effe%ts-
A$,e#se Effe%ts
Nu#sin* Res.onsi>ilities
Citi%oline
$#o.s
2:A:1 CNS Stimulant 2%% TID Citi%oline
in%#eases >loo$
flo; an$ O2
%onsum.tion in
t+e >#ain. It is
also in,ol,e$ in
t+e >iosynt+esis
of le%it+in.
Use$ to
t#eat
%e#e>#o,a
s%ula#
$isease.
Cont#ain$i%ate$
to any alle#*ies
7es.e%ially $#u*
alle#*ies8, /i$ney
.#o>lems, li,e#
.#o>lems, +ea#t o#
>loo$ ,essel
$iseases, +isto#y
of an*ioe$ema,
$ia>etes.
0ea$a%+e, $#y
%ou*+, nausea,
Unusual
;ea/ness, >a%/
.ain, $ia##+ea,
%#am.s, %+est
.ain, one:si$e$
a#m o# le*
;ea/ness, ,ision
%+an*es,tin*lin*
of t+e +an$s o#
feet, fe,e#,
.e#sistent so#e
t+#oat, $i55iness,
faintin*, unusual
%+an*e in amount
of u#ine,
yello;in* of t+e
eyes o# s/in, $a#/
u#ine, stoma%+-
a>$ominal .ain,
.e#sistent fati*ue,
.e#sistent nausea,
May >e ta/en ;it+ o#
;it+out foo$. 7Ta/e ;-
o# >et;een meals.8
4est ta/en on an
em.ty stoma%+ at t+e
same time ea%+ $ay.
To a,oi$ $i55iness an$
li*+t+ea$e$ness ;+en
#isin* f#om a seate$ o#
lyin* .osition, *et u.
slo;ly.
)imit you# inta/e of
al%o+ol
Use %aution ;+en
e?e#%isin* o# $u#in*
+ot ;eat+e# as t+ese
%an a**#a,ate
$i55iness an$
li*+t+ea$e$ness.
(ollo; all $i#e%tions
e?a%tly an$ ta/e t+e
me$i%ation as
$i#e%te$.
Do not sto. ta/in* t+is
$#u* ;it+out
%onsultin* you#
$o%to#. Some
%on$itions may
>e%ome ;o#se ;+en
t+e $#u* is a>#u.tly
sto..e$.
&e#in$o.#i
l
2:A:1 an*iotensin:
%on,e#tin*
en5yme 7ACE8
in+i>ito#s
Bm C ta>
OD .e# 4(
4lo%/ t+e a%tion
of a %+emi%al in
t+e >o$y %alle$
an*iotensin
Use$ to
t#eat +i*+
>loo$
.#essu#e
Cont#ain$i%ate$ in
.atients /no;n to
>e +y.e#sensiti,e
to t+is .#o$u%t o#
Cou*+, fati*ue,
ast+enia,
+ea$a%+e,
$istu#>an%es of
C+e%/ 4& >efo#e
*i,in* t+e me$i%ation
an$ $o not *i,e t+e
me$i%ation if .ulse is
%on,e#tin*
en5yme 7ACE8.
No#mally ACE
.#o$u%es
anot+e#
%+emi%al,
an*iotensin.
An*iotensin +as
t;o a%tions:
(i#stly it
a%ts on
>loo$
,essels
to ma/e
t+em
na##o;
Se%on$l
y it a%ts
on t+e
/i$ney
to
.#o$u%e
less
u#ine
As .e#in$o.#il
sto.s t+e
.#o$u%tion of
an*iotensin,
t+ese a%tions
a#e #e,e#se$.
T+e#efo#e mo#e
u#ine is
.#o$u%e$ >y t+e
/i$neys, ;+i%+
#esults in less
flui$ in t+e
>loo$ ,essels.
T+e >loo$
,essels also
;i$en. T+e
Essential
+y.e#tensi
on.8, an$
#e$u%tion
of #is/ of
%a#$ia%
e,ents in
.atients
;it+ a
+isto#y of
myo%a#$ia
l infa#%tion
to any ot+e# ACE
in+i>ito#. It is also
%ont#ain$i%ate$ in
.atients ;it+ a
+isto#y of
an*ioe$ema.
moo$ an$-o#
slee., taste
im.ai#ment,
e.i*ast#i%
$is%omfo#t,
nausea,
a>$ominal .ain,
an$ #as+,
$i55iness,
$ia##+ea,
>elo; D>.m.
Comes as a ta>let to
ta/e >y mout+. It is
usually ta/en on%e o#
t;i%e a $ay. (ollo; t+e
$i#e%tions on you#
.#es%#i.tion.
&e#in$o.#il %ont#ols
+i*+ >loo$ .#essu#e
>ut $oes not %u#e it.
Continue to ta/e
.e#in$o.#il e,en if you
feel ;ell. Do not sto.
ta/in* .e#in$o.#il
;it+out tal/in* to you#
$o%to#.
Tal/ to you# $o%to#
>efo#e usin* salt
su>stitutes %ontainin*
.otassium. If you#
$o%to# .#es%#i>es a
lo;:salt o# lo;:so$ium
$iet, follo; t+ese
$i#e%tions %a#efully
o,e#all effe%t of
t+is is a $#o. in
>loo$ .#essu#e
an$ a $e%#ease
in t+e ;o#/loa$
of t+e +ea#t.
Ea#fa#in
7coumadin
)
2:A:1 anti%oa*ulant
7>loo$
t+inne#8
2.Bm*
1-2ta> OD
It #e$u%es t+e
fo#mation of
>loo$ %lots. It
;o#/s >y
>lo%/in* t+e
synt+esis of
%e#tain %lottin*
fa%to#s. Eit+out
t+ese %lottin*
fa%to#s, >loo$
%lots a#e una>le
to fo#m.
Use$ to
.#e,ent
+ea#t
atta%/s,
st#o/es,
an$ >loo$
%lots in
,eins an$
a#te#ies.
Cont#ain$i%ate$ in
any lo%ali5e$ o#
*ene#al .+ysi%al
%on$ition o#
.e#sonal
%i#%umstan%e in
;+i%+ t+e +a5a#$
of +emo##+a*e
mi*+t >e *#eate#
t+an t+e .otential
%lini%al >enefits of
anti%oa*ulation.
4lee$in* an$
ne%#osis
7*an*#ene8 of t+e
s/in. 4lee$in* %an
o%%u# in any
o#*an o# tissue.
4lee$in* a#oun$
t+e >#ain %an
%ause se,e#e
+ea$a%+e an$
.a#alysis.
4lee$in* in t+e
Foints %an %ause
Foint .ain an$
s;ellin*. 4lee$in*
in t+e stoma%+ o#
intestines %an
%ause ;ea/ness,
faintin* s.ells,
>la%/ ta##y stools,
,omitin* of >loo$,
o# %offee *#oun$
mate#ial. 4lee$in*
in t+e /i$neys %an
%ause >a%/ .ain
an$ >loo$ in
u#ine, .u#.le,
.ainful toes, #as+,
+ai# loss,
>loatin*, $ia##+ea,
an$ Faun$i%e.
May >e ta/en ;it+
o# ;it+out foo$.
(#e@uent >loo$
tests a#e .e#fo#me$ to
measu#e >loo$
%lottin* time 7.#otime8
$u#in* Couma$in
t#eatment.
Sin%e it is
meta>oli5e$ >y t+e
li,e# an$ e?%#ete$ >y
t+e /i$neys, %aution is
nee$e$ in *i,in* t+is
$#u* to .atients ;it+
li,e# an$ /i$ney
$ysfun%tion.
Inst#u%t t+e
.atient to see/
imme$iate me$i%al
%a#e if sym.toms of
o,e#$ose ;ill
manifest, t+ese
in%lu$es: >lee$in*
*ums, >#uisin*,
nose>lee$s, +ea,y
menst#ual >lee$in*,
an$ .#olon*e$
>lee$in* f#om %uts.
Di*o?in
2:A:1 Di*italis
*ly%osi$e
2Bm* C
ta>
In%#eases t+e
fo#%e of
%ont#a%tion of
t+e mus%le of
t+e +ea#t >y
in+i>itin* t+e
a%ti,ity of an
en5yme
7AT&ase8 t+at
%ont#ols
mo,ement of
%al%ium, so$ium
an$ .otassium
into +ea#t
mus%le. Cal%ium
%ont#ols t+e
fo#%e of
%ont#a%tion.
In+i>itin*
AT&ase
in%#eases
%al%ium in +ea#t
mus%le an$
t+e#efo#e
in%#eases t+e
fo#%e of +ea#t
%ont#a%tions.
Di*o?in also
slo;s ele%t#i%al
%on$u%tion
>et;een t+e
at#ia an$ t+e
,ent#i%les of t+e
+ea#t an$ is
useful in
t#eatin*
a>no#mally
#a.i$ at#ial
#+yt+ms su%+
as at#ial
Use$ in
t#eatin* an
a>no#mal
+ea#t
#+yt+m
Cont#ain$i%ate$
to Di*italis
to?i%ity,
,ent#i%ula#
ta%+y%a#$ia-fi>#ill
ation, o>st#u%ti,e
%a#$iomyo.at+y.
A##+yt+mias $ue
to a%%esso#y
.at+;ays 7e.*.
Eolff:&a#/inson:
E+ite syn$#ome8.
S.e%ial
&#e%autions on
Ca#$ia%
$ys#+yt+mias,
+y.o/alaemia,
+y.e#tension,
I0D,
+y.e#%al%aemia,
+y.oma*nesaemi
a,
ele%t#o%on,e#sion
, %+#oni% %o#
.ulmonale, ao#ti%
,al,e $isease,
a%ute myo%a#$itis,
%on*esti,e
%a#$iomyo.at+ies
, %onst#i%ti,e
.e#i%a#$itis, +ea#t
>lo%/, #enal
im.ai#ment,
a>no#malities in
t+y#oi$ fun%tion
E?t#a >eats,
ano#e?ia, nausea
an$ ,omitin*,
%onfusion,
$i55iness,
$#o;siness,
#estlessness,
ne#,ousness,
a*itation an$
amnesia, ,isual
$istu#>an%es,
*ynae%omastia,
&eo.le of Asian $es%ent
may a>so#>
#osu,astatin at a +i*+e#
#ate t+an ot+e# .eo.le.
Ma/e su#e you# $o%to#
/no;s if you a#e Asian.
2ou may nee$ a lo;e#
t+an no#mal sta#tin*
$ose.
Ta/e $i*o?in e?a%tly as
.#es%#i>e$ >y you#
$o%to#. Do not ta/e it in
la#*e# amounts o# fo#
lon*e# t+an
#e%ommen$e$.
May >e ta/en ;it+ o#
;it+out foo$.
Ta/e it ;it+ full *lass of
;ate#.
Ta/e t+e me$i%ation at
t+e same time of t+e
$ay.
Do not sto. ta/in*
$i*o?in ;it+out fi#st
tal/in* to you# $o%to#.
Sto..in* su$$enly may
ma/e you# %on$ition
;o#se.
Sto#e $i*o?in at #oom
tem.e#atu#e a;ay f#om
moistu#e an$ +eat.
fi>#illation, at#ial
flutte#, an$ at#ial
ta%+y%a#$ia.
Rosu,asta
tin
2:A:1 %+oleste#ol:
lo;e#in*
me$i%ation
1m* 1ta>
OD
4lo%/s t+e
.#o$u%tion of
%+oleste#ol 7a
ty.e of fat8 in
t+e >o$y. It
;o#/s >y
#e$u%in* le,els
of G>a$G
%+oleste#ol
7lo;:$ensity
li.o.#otein, o#
)D)8 an$
t#i*ly%e#i$es in
t+e >loo$, ;+ile
in%#easin*
le,els of G*oo$G
%+oleste#ol
7+i*+:$ensity
li.o.#otein, o#
0D)8.
Use$ to
t#eat +i*+
%+oleste#o
l.
Do not ta/e t+is
me$i%ation if you
a#e alle#*i% to
#osu,astatin, if
you +a,e li,e#
$isease.
S.e%ial
.#e%aution on
.atients ;it+
/i$ney $iseaseH
un$e#a%ti,e
t+y#oi$H mus%le
$iso#$e#H e.ile.sy
o# ot+e# sei5u#e
$iso#$e#H an
ele%t#olyte
im>alan%e 7su%+
as +i*+ o# lo;
.otassium le,els
in you# >loo$8H a
se,e#e infe%tion
o# illness.
Mus%le .ain,
ten$e#ness, o#
;ea/ness ;it+
fe,e# o# flu
sym.toms an$
$a#/ %olo#e$
u#ineHu#inatin*
mo#e o# less t+an
usual, o# not at
allH nausea,
stoma%+ .ain, lo;
fe,e#, loss of
a..etite, $a#/
u#ine, %lay:
%olo#e$ stools,
Faun$i%e
7yello;in* of t+e
s/in o#
eyes8H%+est .ainH
o# s;ellin* in
you# +an$s o#
feet.
Ta/e t+is
me$i%ation e?a%tly as
it ;as .#es%#i>e$ fo#
you. Do not ta/e t+e
me$i%ation in la#*e#
amounts, o# ta/e it fo#
lon*e# t+an
#e%ommen$e$ >y you#
$o%to#.
2ou may ta/e t+e
me$i%ine ;it+ o#
;it+out foo$. Ta/e
#osu,astatin at t+e
same time ea%+ $ay.
It is >est to ta/e
t+is $#u* in t+e
e,enin*.
Ta/e t+is me$i%ation
;it+ a full *lass of
;ate#.
A,oi$ $#in/in*
al%o+ol ;+ile ta/in*
t+is me$i%ation.
Al%o+ol %an in%#ease
t#i*ly%e#i$e le,els, an$
may also $ama*e you#
li,e# ;+ile you a#e
ta/in* #osu,astatin.
Call you# $o%to# at
on%e if you +a,e
une?.laine$ mus%le
.ain o# ten$e#ness,
mus%le ;ea/ness,
fe,e# o# flu sym.toms,
an$ $a#/ %olo#e$
u#ine.
Rosu,astatin is
only .a#t of a
%om.lete .#o*#am of
t#eatment t+at also
in%lu$es $iet,
e?e#%ise, an$ ;ei*+t
%ont#ol. (ollo; you#
$iet, me$i%ation, an$
e?e#%ise #outines ,e#y
%losely.
Do not sto. usin*
#osu,astatin ;it+out
fi#st tal/in* to you#
$o%to#.
Sto#e #osu,astatin
at #oom tem.e#atu#e
a;ay f#om moistu#e
an$ +eat.
T#ane?ami
% a%i$
2:I:1 antifi>#inolyti%
a*ent
Bm*,
&RN
T#ane?ami% a%i$
is a man:ma$e
fo#m of an
amino a%i$
7.#otein8 %alle$
lysine. It ;o#/s
>y >lo%/in* t+e
>#ea/$o;n of
>loo$ %lots,
;+i%+ .#e,ents
>lee$in*.
s+o#t:te#m
%ont#ol of
>lee$in*
Do not use
Tranexamic
Acid if: you
are allergic
to any
ingredient
in
Tranexamic
Acid, you
have blood
clots,
bleeding
within the
brain, or
eye
problems
(retinal
disease),
you are
colorblind,
you are
Nausea, ,omitin*,
$ia##+ea mi*+t
o%%u#. If t+ese
.e#sist o# ;o#sen,
notify you# $o%to#
.#om.tly. 6e#y
unli/ely >ut #e.o#t
.#om.tly: ,ision
%+an*es,
$i55iness. If you
noti%e ot+e#
effe%ts not liste$
a>o,e, %onta%t
you# $o%to# o#
.+a#ma%ist.
Dia##+eaH
*i$$inessH
nauseaH ,omitin*.
Se,e#e alle#*i%
#ea%tions 7#as+H
+i,esH $iffi%ulty
Ta/e t+is me$i%ation
e?a%tly as .#es%#i>e$
>y you# $o%to#. Do not
ta/e it in la#*e#
amounts o# fo# lon*e#
t+an #e%ommen$e$.
To >e su#e t+is
me$i%ation is not
%ausin* +a#mful
effe%ts, you# ,ision
may nee$ to >e
%+e%/e$ ;+ile you a#e
usin* t#ane?ami% a%i$.
Sto#e t+is me$i%ation
at #oom tem.e#atu#e
a;ay f#om moistu#e
an$ +eat.
using factor
I complex
concentrate
s or anti!
inhibitor
coagulant
concentrate
s"
>#eat+in*H
ti*+tness in t+e
%+estH s;ellin* of
t+e mout+, fa%e,
li.s, o# ton*ue8H
%alf .ain,
s;ellin*, o#
ten$e#nessH
%+an*es in ,ision
7$istu#>an%e of
%olo#, s+a#.ness,
o# fiel$ of ,ision8H
%+est .ainH
$e%#ease$
u#inationH one:
si$e$ ;ea/nessH
.ain, s;ellin*, o#
#e$ness at t+e
inFe%tion siteH
se,e#e +ea$a%+eH
s+o#tness of
>#eat+H s.ee%+
.#o>lems.
Tiot#o.ium
4#omi$e
7S.i#i,a
Rota%a.8
2:=:1 Mus%a#ini%
#e%e.to#
anta*onist
1 %a. OD O.ens t+e
#es.i#ato#y t#a%t
an$ ma/es
>#eat+in*
easie#.
Tiot#o.ium a%ts
on t+e lun*s,
;+e#e it >lo%/s
mus%a#ini%
#e%e.to#s on t+e
mus%le
su##oun$in* t+e
ai#;ays. T+e
natu#al %+emi%al
in t+e >o$y t+e
A%etyl%+oline
no#mally a%ts
Use$ in
t#eatment
of
>#on%+ial
s.asms
7;+ee5in*8
asso%iate$
;it+
%+#oni%
o>st#u%ti,
e
.ulmona#y
$isease.
Tit#o.ium is
%ont#ain$i%ate$ in
0y.e#sensiti,ity.
S.i#i,a s+oul$ not
>e use$ fo# t+e
initial t#eatment of
a%ute e.iso$es of
>#on%+os.asm.
D#y mout+, $#y
t+#oat, in%#ease$
+ea#t #ate, >lu##e$
,ision, *lau%oma,
u#ina#y $iffi%ulty,
u#ina#y #etention,
na##o;:an*le
*lau%oma,
.#ostati%
+y.e#.lasia o#
>la$$e#:ne%/
o>st#u%tion an$
%onsti.ation.
S.i#i,a %a.sules
a#e .a%/a*e$ as a
>liste# %a#$ %ontainin*
t;o st#i.s. Ea%+ st#i.
+as t+#ee %a.sules.
E+en #emo,in* a
%a.sule f#om t+e
>liste# %a#$, .eel >a%/
only t+e foil t+at is
%o,e#in* t+e %a.sule
you a#e a>out to use.
T+e %a.suleJs
effe%ti,eness may >e
#e$u%e$ if it is not
use$ imme$iately afte#
t+e foil is o.ene$. If
on t+ese
#e%e.to#s,
%ausin* t+e
mus%le in t+e
ai#;ays to
%onst#i%t an$
t+e ai#;ays to
na##o;.
Tiot#o.ium
>lo%/s t+e
mus%a#in%
#e%e.to#s in t+e
lun*s an$
t+e#efo#e sto.s
t+e a%tion of
a%etyl%+oline on
t+em. T+is
allo;s t+e
mus%le a#oun$
t+e ai#;ays to
#ela? an$ t+e
ai#;ays to o.en.
you a%%i$entally
#emo,e t+e foil
%o,e#in* any of t+e
ot+e# %a.sules, you
must t+#o; t+em
a;ay.
Allo.u#ino
l
2:=:1 ?ant+ine
o?i$ase
in+i>ito#
1m* C
ta> OD &O
Re$u%es t+e
.#o$u%tion of
u#i% a%i$ in you#
>o$y. U#i% a%i$
>uil$u. %an lea$
to *out o#
/i$ney stones.
It #e$u%es
t+e
.#o$u%tio
n of u#i%
a%i$ in
you# >o$y.
Cont#ain$i%ate$
to alle#*i% to any
t+ese $#u*s, o# if
you +a,e: /i$ney
$iseaseH li,e#
$iseaseH $ia>etesH
%on*esti,e +ea#t
failu#eH +i*+ >loo$
.#essu#e
Dia##+ea, nausea,
#as+ an$ it%+in*,
an$ $#o;siness,
s/in #as+.
Ta/e ea%+ $ose
;ate#. To #e$u%e you#
#is/ of /i$ney stones
fo#min*, $#in/ < to 1
full *lasses of flui$
e,e#y $ay, unless you#
$o%to# tells you
ot+e#;ise.
A,oi$ $#in/in*
al%o+ol. It %an ma/e
you# %on$ition ;o#se.
Allo.u#inol %an
%ause si$e effe%ts t+at
may im.ai# you#
t+in/in* o# #ea%tions.
4e %a#eful if you $#i,e
o# $o anyt+in* t+at
#e@ui#es you to >e
a;a/e an$ ale#t.
Allo.u#inol %an
lo;e# t+e >loo$ %ells
t+at +el. you# >o$y
fi*+t infe%tions. T+is
%an ma/e it easie# fo#
you to >lee$ f#om an
inFu#y o# *et si%/ f#om
>ein* a#oun$ ot+e#s
;+o a#e ill, so
a$,ise$ .atient to
>oost immune system
>y ta/in* ,itamin s
su..lements an$
eatin* nut#itious foo$.
Allo.u#inol s+oul$
>e $is%ontinue$
imme$iately at t+e
fi#st a..ea#an%e of
#as+, .ainful u#ination,
>loo$ in t+e u#ine, eye
i##itation, o# s;ellin*
of t+e mout+ o# li.s,
>e%ause t+ese %an >e
a si*ns of an
im.en$in* se,e#e
alle#*i% #ea%tion t+at
%an >e fatal.
Dutaste#i$
e
7Avodart)
2:=:1 1ta> OD
&O
A,o$a#t
.#e,ents t+e
%on,e#sion of
testoste#one to
$i+y$#otestoste#
one 7D0T8 in t+e
>o$y. D0T is
in,ol,e$ in t+e
$e,elo.ment of
>eni*n .#ostati%
+y.e#.lasia
74&08.
Dutaste#i$e
+el.s im.#o,e
u#ina#y flo; an$
may also #e$u%e
you# nee$ fo#
.#ostate su#*e#y
late# on.
A,o$a#t is
use$ to
t#eat
>eni*n
.#ostati%
+y.e#.lasi
a 74&08 in
men ;it+
an
enla#*e$
.#ostate.
Cont#ain$i%ate$
to %lini%ally
si*nifi%ant
+y.e#sensiti,ity
7e.*., se#ious s/in
#ea%tions,
an*ioe$ema8 to
A6ODART o#
ot+e# BK:
#e$u%tase
in+i>ito#s.
De%#ease$ li>i$o
7se? $#i,e8H
$e%#ease$
amount of semen
#elease$ $u#in*
se?H im.oten%e
7t#ou>le *ettin* o#
/ee.in* an
e#e%tion8H o#
>#east ten$e#ness
o# enla#*ement.
Ta/e 1 %a.sule
on%e a $ay.
Do not %+e;,
%#us+, o# o.en an
A,o$a#t %a.sule. T+e
%a.sule s+oul$ >e
s;allo;e$ ;+ole.
Dutaste#i$e %an
i##itate you# li.s,
mout+, o# t+#oat if t+e
%a.sule +as >een
>#o/en o# o.ene$
>efo#e you s;allo;s
it. It may ta/e u. to D
mont+s of usin* t+is
me$i%ine >efo#e you#
sym.toms im.#o,e.
(o# >est #esults, /ee.
usin* t+e me$i%ation
as $i#e%te$.
Can >e ta/en ;it+
o# ;it+out meals.
Ta/e t+is me$i%ine
;ate#.
Do not sto. ta/in*
A,o$a#t ;it+out
To >e su#e t+is
me$i%ation is +el.in*
you# %on$ition, you#
.#ostate ;ill nee$ to
>e %+e%/e$ on a
#e*ula# >asis.
Sto#e A,o$a#t at
#oom tem.e#atu#e
a;ay f#om moistu#e
an$ +eat. A,o$a#t
%a.sules may >e%ome
soft an$ lea/y, o# t+ey
may sti%/ to*et+e# if
t+ey *et too +ot. Do
not use any %a.sule
t+at is %#a%/e$ o#
lea/in*.
)ACTU)O
SE
2:=:1 la?ati,e 2%% OD )a%tulose is a
synt+eti% su*a#
use$ to t#eat
%onsti.ation. It
is >#o/en $o;n
in t+e %olon into
.#o$u%ts t+at
.ull ;ate# out
f#om t+e >o$y
an$ into t+e
%olon. T+is
;ate# softens
stools.
)a%tulose is
also use$ to
#e$u%e t+e
amount of
ammonia in t+e
>loo$ of
.atients ;it+
li,e# $isease. It
;o#/s >y
$#a;in*
ammonia f#om
t+e >loo$ into
t+e %olon ;+e#e
Use$ to
t#eat
%onsti.ati
on.
T+is me$i%ation
%ontains
*ala%tose an$
la%tose. 4e su#e
to tell you# $o%to#
if you +a,e
$ia>etes. An$ if
you a#e +a,in*
su#*e#y o# tests
on you# %olon o#
#e%tum, tell t+e
$o%to# t+at you
a#e ta/in*
la%tulose.
3as, >el%+in* o#
stoma%+ %#am.s,
$ia##+ea, nausea,
,omitin*.
T+is me$i%ation is
ta/en >y mout+. To
im.#o,e t+e taste, t+e
$ose may >e mi?e$ in
a *lass of f#uit Fui%e,
;ate# o# mil/.
Ta/e t+is
me$i%ation as
.#es%#i>e$. Ta/e t+is
me$i%ation e?a%tly as
.#es%#i>e$ >y you#
$o%to#. Do not ta/e it
in la#*e# amounts o#
fo# lon*e# t+an
#e%ommen$e$.
T+e li@ui$ fo#m of
la%tulose may >e%ome
sli*+tly $a#/en in
%olo#, >ut t+is is a
+a#mless effe%t.
0o;e,e#, $o not use
t+e me$i%ine if it
>e%omes ,e#y $a#/, o#
if it *ets t+i%/e# o#
t+inne# in te?tu#e.
it is #emo,e$
f#om t+e >o$y.
Inst#u%t t+e
.atient t+at it may ta/e
u. to !< +ou#s >efo#e
you +a,e a >o;el
mo,ement afte# ta/in*
la%tulose.
Sto#e la%tulose at
#oom tem.e#atu#e
a;ay f#om moistu#e
an$ +eat.
To.ama? 2-=-1 Anti%on,ulsan
t
Sulfamate
su>stitute$
monosa%%+a#i
$e
2Bm* C
ta> 4ID
&O
May >lo%/ a
so$ium %+annel,
.otentiate t+e
a%ti,ity of 3A4A
an$ in+i>it
/ainate's a>ility
to a%ti,ate an
amino a%i$
#e%e.to#.
To .#e,ent
mi*#aine
+ea$a%+e
0y.e#sensiti,ity
to $#u*
Di55iness,
Ne#,ousness,
C+est .ain,
&al.itations,
Ano#e?ia, Mus%le
Eea/ness.
Tell .t. to $#in/ .lenty of
flui$s $u#in* t+e#a.y to
minimi5e #is/ of fo#min*
/i$ney stones.
Info#m .atient t+at $#u*
%an >e ta/en ;it+out
#e*a#$ to foo$.
Dol%et 2-=-1 Anal*esi% 1 ta> TID In+i>its
.#osta*lan$in
synt+esis
#e$u%in*
sensiti,ity of
.ain #e%e.to#s
Mo$e#ate
to se,e#e
.ain.
A%ute into?i%ation
;- al%o+ol,
0y.e#sensiti,ity
CNS L 3I
$istu#>an%es.
Nausea,
$i55iness,
somnolen%e.
Ast+enia, fati*ue,
+ot flus+es,
%onsti.ation,
$ia##+ea,
flatulen%e,
$#y mout+,
.#u#itus,
in%#ease$
s;eatin*, tinnitus.
Assess fo# le,el of .ain
#elief an$ a$ministe#
$ose as nee$e$ >ut not
to e?%ee$ t+e
#e%ommen$e$ total
$aily $ose.
Dis%ontinue $#u* an$
notify .+ysi%ian if S-S?
of +y.e#sensiti,ity
o%%u#.
Ta/e $#u* ;it+ foo$ to
a,oi$ 3I $istu#>an%es.
Me..#a 2-=-1 Anti%on,ulsan
t
Bm*-ta>
1ta> TID
May a%t >y
in+i>itin*
a$Fun%ti,e
t+e#a.y in
0y.e#sensiti,ity
to $#u*
0ea$a%+e,
emotional la>ility,
D#u* %an >e ta/en ;it+
o# ;it+out foo$
&y##oli$ine
$e#i,ati,e
simultaneous
neu#onal fi#in*
t+at lea$s to
sei5u#e a%ti,ity
t+e
t#eatment
of .a#tial
onset
sei5u#es in
a$ults
Immuno%om.#omi
se$ .atients
,e#ti*o,
leu/o.enia,
neut#o.enia,
ano#e?ia
Ea#n .atient to use
e?t#a %a#e ;+en sittin*
u. o# stan$in* u. to
a,oi$ fallin*
&i.e#a%i
llin N
Ta5o>a%
tam
2-=-1 Anti infe%ti,es !.B* I6TT
@ <+
In+i>its %ell ;all
synt+esis
$u#in* >a%te#ial
multi.li%ation
Mo$e#ate
to se,e#e
noso%omi
al
.neumoni
a
0y.e#sensiti,ity
to $#u*
Caution to .ts.
;it+ >lee$in*
ten$en%ies
0ea$a%+e,
sei5u#e, fe,e#,
+y.e#tension,
a>$ominal .ain,
$ys.nea
As/ .atient a>out
alle#*i% #ea%tions .#o# to
me$ a$minist#ation
Monito#
+ematolo*i% an$
%oa*ulation .a#amete#s
Tell .atient to
#e.o#t a$,e#se #ea%tions
.#om.tly
Com>i,
ent
2-=-1 >#on%+o$ilato
#
%om>inations
1-2ne>
N1%%
NSS @
D+
Re$u%es
>#on%+os.asm
t+#ou*+ t;o
$istin%tly
$iffe#ent
me%+anisms,
anti%+oline#*i%
7.a#asym.at+ol
yti%8 an$
sym.at+omimet
i%.
Simultaneous
a$minist#ation
of >ot+ an
anti%+oline#*i%
an$ a >eta2:
sym.at+omimet
i% is $esi*ne$ to
>enefit t+e
.atient >y
.#o$u%in*, a
*#eate#
>#on%+o$ilato#
effe%t t+an ;+en
To .#e,ent
>#on%+os.
asm in
.eo.le
;it+
%+#oni%
o>st#u%ti,
e
.ulmona#y
$isease
7CO&D8
;+o a#e
also usin*
ot+e#
me$i%ines
to %ont#ol
t+ei#
%on$ition.
0y.e#sensiti,ity
to $#u*
0ea$a%+e, C+est
&ain, Dys.nea,
Cou*+in*,
4#on%+os.asm,
&al.itations
Aus%ultate >#eat+
soun$s >efo#e an$ afte#
ne>uli5ation
Monito# 0R an$
RR
Do %+est an$ >a%/
ta..in* afte#
ne>uli5ation
eit+e# $#u* is
utili5e$ alone at
its
#e%ommen$e$
$osa*e.
Su%#alfate 2-=-1 Anti ul%e# 1 ta> @D+
N3T
An antiul%e# t+at
fo#ms an ul%e#:
a$+e#ent
%om.le? ;it+
.#oteina%eous
e?u$ates su%+
as al>umin, at
ul%e# site. Also
fo#ms a ,is%ous,
a$+esi,e >a##ie#
on t+e su#fa%e
of inta%t
mu%osa of t+e
stoma%+ o#
$uo$enum.
&#ote%ts
$ama*e$
mu%osa f#om
fu#t+e#
$est#u%tion >y
a>so#>in*
*ast#i% a%i$,
.e.sin an$ >ile
salts.
S+o#t te#m
t#eatment
of
$uo$enal
ul%e#.
Alle#*y to
su%#alfate
Consti.ation, D#y
mout+, 4a%/a%+,
Dia##+ea,
Di55iness,
Nausea, Ras+,
A>$omina,
$is%omfo#t.
Ta/e me$i%ation
on an em.ty stoma%+
Monito# .atte#n of
>o;el a%ti,ity an$ stool
%onsisten%y
In%#ease flui$
inta/e as in$i%ate$.
Monito# fo#
+y.e#sensiti,ity
#ea%tions.
(luimo%il 2-=-1 Cou*+ an$
%ol$
.#e.a#ations
,
Mu%olyti%
Dm*-ta
> 1 ta> in
1%%
02O @
12+ N3T
N:a%etyl%ysteine
7NAC8 is t+e N:
a%etyl $e#i,ati,e
of t+e natu#ally
o%%u##in* amino
a%i$ l:%ysteine.
NAC +as an
intense
flui$ifyin*
a%tion, t+#ou*+
(o# a%ute
L %+#oni%
#es. t#a%t
affe%tions
;-
a>un$ant
mu%us
se%#etions
.
0y.e#sensiti,it
y to any of t+e
in*#e$ients.
Caution in
ast+ma
.atients.
nausea,
+ea$a%+e,
tinnitus,
stomatitis,
%+ills, fe,e#,
>#on%+os.asm
O%%asional %ases
of nausea an$
$ys.e.sia
Dilute ;it+ no#mal
saline solution o# ste#ile
;ate# fo# inFe%tion
Info#m .atient t+at
ne>uli5ation may
.#o$u%e an initial
$isa*#eea>le solution
>ut ;ill soon $isa..ea#
its f#ee
sulf+y$#yl
*#ou., on t+e
mu%oi$ o#
mu%o.u#ulent
se%#etions >y
%lea,in* t+e
int#a: an$
inte#mole%ula#
$isulfi$e >on$s
in *ly%o.#otein
a**#e*ates.
Ra#e %ases of
u#ti%a#ia
Meto.#olol 2-=-1 4eta:4lo%/e# Bm* C
ta> 4ID
Com.eteti,ely
>lo%/s >eta:
a$#ene#*i%
#e%e.to#s in t+e
+ea#t an$
Fu?ta*lome#ula#
a..a#atus,
$e%#easin* t+e
influen%e of t+e
sym.at+eti%
ne#,ous system
of t+ese tissues
an$ t+e
e?%ita>ility of
t+e +ea#t,
$e%#easin*
%a#$ia% out.ut
an$ t+e #elease
of #ennin, an$
lo;e#in* 4&H
a%ts in t+e CNS
to #e$u%e
sym.at+eti%
outflo; an$
,aso%onst#i%to#
tone
Myo%a#$ia
l Infa#%ion
0y.e#sens
iti,ity to
$#u*
4#on%+os
.asm o#
ast+ma
0isto#y of
o>st#u%ti,
e ai#;ay
$isease
Sinus
>#a$y%a#$i
a o# .a#tial
+ea#t>lo%/
L C0(
0ea#tfailu#e,
+ea#t>lo%/ L
>#on%+os.asm,
fati*ue L
%ol$ness of
e?t#emities,
>#a$y%#$ia, C0(
.neumonitits,
$e.#ession,
+allu%ination,3I
#et#o.e#itoneal
fi>#osis,
s%le#osin*
.ento#itis
Monito# 0R .#io#
to a$minist#ation of
$#u*
0ol$ $#u* if
0ROD >.m
3i,e $#u* ;it+
foo$ to fa%ilitate
a>so#.tion
Inst#u%t .atient to
s;allo; ta>let ;+oleH $o
not %#us+ o# %+e;
Di*o?in 2:I:
1:
$is%onti
nue$ on
2:A:1
Di*italis
3ly%osi$e
2B m* C
ta>
In%#eases t+e
fo#%e of
%ont#a%tion of
t+e mus%le of
t+e +ea#t >y
in+i>itin* t+e
a%ti,ity of an
en5yme
7AT&ase8 t+at
%ont#ols
mo,ement of
%al%ium, so$ium
an$ .otassium
into +ea#t
mus%le. Cal%ium
%ont#ols t+e
fo#%e of
%ont#a%tion.
In+i>itin*
AT&ase
in%#eases
%al%ium in +ea#t
mus%le an$
t+e#efo#e
in%#eases t+e
fo#%e of +ea#t
%ont#a%tions.
Di*o?in also
slo;s ele%t#i%al
%on$u%tion
>et;een t+e
at#ia an$ t+e
,ent#i%les of t+e
+ea#t an$ is
useful in
t#eatin*
a>no#mally
#a.i$ at#ial
#+yt+ms su%+
as at#ial
Use$ in
t#eatin* an
a>no#mal
+ea#t
#+yt+m
Cont#ain$i%ate$
to Di*italis
to?i%ity,
,ent#i%ula#
ta%+y%a#$ia-fi>#ill
ation, o>st#u%ti,e
%a#$iomyo.at+y.
A##+yt+mias $ue
to a%%esso#y
.at+;ays 7e.*.
Eolff:&a#/inson:
E+ite syn$#ome8.
S.e%ial
&#e%autions on
Ca#$ia%
$ys#+yt+mias,
+y.o/alaemia,
+y.e#tension,
I0D,
+y.e#%al%aemia,
+y.oma*nesaemi
a,
ele%t#o%on,e#sion
, %+#oni% %o#
.ulmonale, ao#ti%
,al,e $isease,
a%ute myo%a#$itis,
%on*esti,e
%a#$iomyo.at+ies
, %onst#i%ti,e
.e#i%a#$itis, +ea#t
>lo%/, #enal
im.ai#ment,
a>no#malities in
t+y#oi$ fun%tion
E?t#a >eats,
ano#e?ia, nausea
an$ ,omitin*,
%onfusion,
$i55iness,
$#o;siness,
#estlessness,
ne#,ousness,
a*itation an$
amnesia, ,isual
$istu#>an%es,
*ynae%omastia,
&eo.le of Asian
$es%ent may a>so#>
#osu,astatin at a
+i*+e# #ate t+an ot+e#
.eo.le. Ma/e su#e
you# $o%to# /no;s if
you a#e Asian. 2ou
may nee$ a lo;e# t+an
no#mal sta#tin* $ose.
Ta/e $i*o?in
e?a%tly as .#es%#i>e$
>y you# $o%to#. Do not
ta/e it in la#*e#
amounts o# fo# lon*e#
t+an #e%ommen$e$.
May >e ta/en ;it+
o# ;it+out foo$.
Ta/e it ;it+ full
*lass of ;ate#.
Ta/e t+e
me$i%ation at t+e
same time of t+e $ay.
Do not sto. ta/in*
$i*o?in ;it+out fi#st
Sto..in* su$$enly
may ma/e you#
%on$ition ;o#se.
Sto#e $i*o?in at
#oom tem.e#atu#e
a;ay f#om moistu#e.
fi>#illation, at#ial
flutte#, an$ at#ial
ta%+y%a#$ia.
%a.to.#il 2:<:1
:
$is%onti
nue$
an*iotensin
%on,e#tin*
en5yme 7ACE8
in+i>ito#s
2Bm* P
ta> @12+
An*iotensin II is
a ,e#y .otent
%+emi%al t+at
%auses t+e
mus%les
su##oun$in*
>loo$ ,essels to
%ont#a%t,
t+e#e>y
na##o;in* t+e
,essels. T+e
na##o;in* of t+e
,essels
in%#eases t+e
.#essu#e ;it+in
t+e ,essels
%ausin* +i*+
>loo$ .#essu#e
7+y.e#tension8.
An*iotensin II is
fo#me$ f#om
an*iotensin I in
t+e >loo$ >y t+e
en5yme
an*iotensin
%on,e#tin*
en5yme o# ACE.
ACE in+i>ito#s
a#e me$i%ations
t+at slo;
7in+i>it8 t+e
a%ti,ity of t+e
en5yme ACE
an$ $e%#ease
t+e .#o$u%tion
of an*iotensin
II. As a #esult,
use$ fo#
t#eatin*
+i*+ >loo$
.#essu#e
Cont#ain$i%ate$
to alle#*i% to itH o#
to ot+e# ACE
in+i>ito#s 7e.*.,
>ena5e.#il,
lisino.#il8H o# if
you +a,e any
ot+e# alle#*ies
7in%lu$in*
alle#*ies to >ee o#
;as. stin*s, o#
e?.osu#e to
%e#tain
mem>#anes use$
fo# >loo$
filte#in*8.
S.e%ial
.#e%aution on
.atients ;it+
s.e%ially of:
/i$ney $isease,
li,e# $isease, +i*+
>loo$ le,els of
.otassium, +ea#t
.#o>lems, se,e#e
$e+y$#ation 7an$
loss of
ele%t#olytes su%+
as so$ium8,
$ia>etes 7.oo#ly
%ont#olle$8,
st#o/es, >loo$
,essel $isease
7e.*., %olla*en
,as%ula# $iseases
su%+ as lu.us,
$#y, .e#sistent
%ou*+, a>$ominal
.ain,
%onsti.ation,
$ia##+ea, #as+,
$i55iness, fati*ue,
+ea$a%+e, loss of
taste, loss of
a..etite, nausea,
,omitin*, faintin*
an$ num>ness o#
tin*lin* in t+e
+an$s o# feet.
Ta/e t+is
me$i%ation >y mout+,
usually t;o to t+#ee
times a $ayH o# as
$i#e%te$ >y you#
$o%to#.
Ta/e t+is $#u* on
an em.ty stoma%+,
one +ou# >efo#e a
meal.
Use t+is
me$i%ation #e*ula#ly
in o#$e# to *et t+e
most >enefit f#om it.
Remem>e# to use
it at t+e same time7s8
ea%+ $ay.
Do not ta/e
.otassium
su..lements o# salt
su>stitutes %ontainin*
.otassium ;it+out
tal/in* to you# $o%to#
o# .+a#ma%ist fi#st.
>loo$ ,essels
enla#*e o#
$ilate, an$
>loo$ .#essu#e
is #e$u%e$. T+e
lo;e# >loo$
.#essu#e ma/es
it easie# fo# t+e
+ea#t to .um.
>loo$ an$ %an
im.#o,e t+e
fun%tion of a
failin* +ea#t.
s%le#o$e#ma8.
NaCl 2:I:
1:
$is%onti
nue$ on
2:A:1
NaCl
su..lement
1 ta> TID T#eatment of
$efi%ien%ies of
so$ium an$
%+lo#i$e ions.

&#e,ention
o#
t#eatment
of
$efi%ien%ie
s of
so$ium
an$
%+lo#i$e
ions 7e.*.,
%ause$ >y
e?%essi,e
$iu#esis o#
e?%essi,e
salt
#est#i%tion
8.
Cautious to
.atient ;it+
%on*esti,e +ea#t
failu#e, se,e#e
#enal
insuffi%ien%y, an$
in %lini%al states
in ;+i%+ t+e#e is
so$ium #etention
;it+ e$ema.
&e#i.+e#al
e$emas,
.ulmona#y
e$ema.
C+e%/ an$ limit
so$ium inta/e to
$e%#ease a$,e#se
effe%t #ea%tion.
C+e%/s si*ns of
e$ema an$ see/
me$i%al a$,i%e if it is
manifestin*.
6I. NURSIN3 MANA3EMENT
Nursing Care Plan #1
Cues Nursing Dx Objectives Intervention Rationale Evaluation
Subjective:
Gi oxgen !an sia "a
!agliso# sia ug
gin$a%a& Gi ubo !an
gu# sia&'( as verbali)e#
b t$e SO&
Naa *le!a iang ubo(
!e#o %$ite na stic"&'(
as verbali)e# b t$e
#aug$ter&
Objective:
+*ro#uctive coug$ %it$
co*ious bronc$ial
secretions
+ #s*nea
+ res*irator rate:
,- c*! .as o/ ,010123
,1 c*! .as o/ ,040123
,5 c*! .as o/ ,0120123
+ abnor!al breat$
soun#s .Rales an# ronc$i
*resent at bot$ lung
/iel#s u*on auscultation3
+c$anges in res*irator
#e*t$
Ine//ective air%a
clearance relate# to
co*ious bronc$ial
secretions secon#ar
to c$ronic obstructive
*ul!onar #isease as
evi#ence# b
*resence o/
*ro#uctive coug$
S$ort ter!:
6t t$e en# o/ , $ours o/ nursing
intervention t$e *atient %ill be
able to :
a& $ave t$e abilit to e//ectivel
coug$ u* secretions
b& #e!onstrate be$aviors to
i!*rove or !aintain clear
air%a
c& #e!onstrate i!*rove#
oxgen exc$ange( re#uction
%it$ breat$ soun#s an#
res*irations noiseless
#& verbali)e un#erstan#ing o/
cause 7 t$era*eutic
!anage!ent regi!en
8ong ter!:
6t t$e en# o/ 1- $ours o/ nursing
intervention( t$e *atient %ill be
able to:
a& !aintain air%a /ree o/
secretions
b& s$o% evi#ence o/ clear lung
soun# an# eu*nea
c& #e!onstrate absence o/
congestion %it$ breat$ing(
absence o/ canosis( 69G0
*ulse oxi!etr results %it$in
In#e*en#ent:
1& Re!in# *atient to #rin"
/lui#s *er car#iac
tolerance& Provi#e %ar! or
$ot #rin"s instea# o/ col#
/lui#s
,& 6ssist t$e *atient in
coug$ing( $u//ing( an#
breat$ing e//orts to !a"e
t$e! !ore *ro#uctive
5& 6ssist %it$ cu**ing an#
cla**ing activities :1$
%$ile a%a"e& ;eac$ t$e
/a!il t$ese *roce#ures&
1& 6ssist t$e *atient %it$
clearing secretions /ro!
!out$ or nose b:
+Provi#ing tissues
+<sing gentle suctioning i/
necessar
Collaborative:
1& 6#!inister !e#ications
suc$ as antibiotics as
+=#ration $el*s #ecrease
t$e viscosit o/ secretions
/acilitating ex*ectoration&
+ Dee* breat$ing an#
#ia*$rag!atic breat$ing
allo% /or greater lung
ex*ansion an# ventilation
as %ell as a !ore e//ective
coug$
+Cu**ing an# cla**ing
loosen secretions an#
assist ex*ectoration&
+;eac$ing t$e /a!il allo%s
t$e! to *artici*ate in care
un#er su*ervision an#
*ro!otes continuation o/
t$e *roce#ure a/ter
#isc$arge&
+;$is ai#s t$e *atient in
recovering /ro! t$e
S$ort ter!:
6t t$e en# o/ , $ours( t$e
*atient:
a& e//ectivel
ex*ectorate#
secretions&
b& !aintaine# air%a
*atenc
c& #e!onstrate#
i!*rove# oxgen
exc$ange as
evi#ence# b
re#uction o/ breat$
soun#s an# noiseless
res*irations
#& verbali)e#
un#erstan#ing o/
cause 7 t$era*eutic
!anage!ent regi!en
8ong ter! objectives %ere
not !et&
s$allo%.as o/ ,01 an#
,043
+Positive /or lung
congestion base# u*on
c$est x+ra result
clients nor!s&
#& De!onstrate be$aviors to
!aintain clear air%a&
or#ere#& Noting
e//ectiveness an# si#e
e//ect
#isease *rocess an#
eli!inate signs an#
s!*to!s
Nursing Care Plan #,
Cues Nursing Diagnosis Objectives Interventions Rationale Evaluation
Subjective:
Galiso# gu# sia ug
gin$a%a tungo# sa iang
ubo&'( as verbali)e# b t$e
SO&
Objective:
+>ul ,1( ,212
RR?51 c*!(
PR: @@ b*!
+*ro#uctive coug$
+Oxgen Saturation: @5A
.%it$ Oxgen in$alation3
+*ale s"in
I!*aire# Gas Exc$ange
relate# to alveolar+ca*illar
!e!brane c$anges
secon#ar to c$ronic
obstructive *ul!onar
#isease
S$ort ;er!:
9 t$e en# o/ 1 $ours o/
nursing interventions( t$e
client an# $is SOs !ust be
able to:
a& Berbali)e un#erstan#ing
o/ causative /actors an#
a**ro*riate interventions
b& Partici*ate in treat!ent
regi!en %it$in level o/
abilit
c& De!onstrate an
i!*rove!ent in ventilation
an# a#e:uate gas
exc$ange&
8ong ter!:
9 t$e en# o/ 1- $ours(
*atient !ust !aintain
o*ti!al gas exc$ange as
evi#ence# b arterial bloo#
gases an# oxgen
saturation %it$in t$e
*atientCs usual range( alert
an# res*onsive !entation
or no /urt$er re#uction in
!ental status( an# no
signs o/ res*irator
In#e*en#ent:
1& Daintain oxgen
a#!inistration #evice
as or#ere#(
atte!*ting to !aintain
O, Saturation at @2A
or greater&
6voi# $ig$
concentration o/ O, in
*atients %it$ COPD
unless or#ere#&
,& Position t$e *atient
%it$ *ro*er bo#
align!ent /or o*ti!al
res*irator excursion
.i/ tolerate#( $ea# o/
be# at 1EF&3
5& Position *atient to
/acilitate ventilation+
*er/usion !atc$ing
%$en a si#e+ling
*osition is use#&
1& Pace activities an#
sc$e#ule rest *erio#s
to *revent /atigue&
6ssist %it$ 6D8s&
+;$is *rovi#es /or
a#e:uate tissue
oxgenation& =*oxia
sti!ulates t$e #rive to
breat$e in t$e c$ronic CO,
container *atient& G$en
a**ling O,( close
!onitoring is i!*erative to
*revent unsa/e increases
in t$e *atientCs PaO,
%$ic$ coul# result in
a*nea&
+;$is *revents t$e
ab#o!inal contents /ro!
cro%#ing t$e lungs an#
*reventing t$eir /ull
ex*ansion&
+G$en t$e *atient is
*ositione# on t$e si#e( t$e
goo# si#e #o%n&
+Even si!*le activities
#uring be# rest can cause
/atigue an# increase O,
#e!an#( resulting in
S$ort an# long ter! goals
%ere /ull !et as
evi#ence# b:
a& 6 #ecrease in t$e RR
an# PR o/ t$e client a/ter
interventions&
b& 6n increase in t$e
oxgen saturation o/ t$e
client&
c& Client alrea# $as alert
an# res*onsive !entation
but still %it$ slurring o/
s*eec$&
#istress&
E& C$ange *osition
ever , $ours&
-& Encourage #ee*
breat$ing&
#s*nea&
+;$is /acilitates secretion
!ove!ent an# #rainage&
+;$is re#uces alveolar
colla*se
Cues Nursing Dx Objectives Intervention Rationale Evaluation
Subjective:
Gi oxgen !an sia "a
!agliso# sia ug gin$a%a&'(
as verbali)e# b t$e SO&
Gasa"it !an gi$a*on ia
#ug$an usa$a&'( as
verbali)e# b t$e SO&
Objective:
+ra#iating *ain on t$e c$est
%it$ a *ain scale level o/:
50E
,0E
+#s*nea
+use o/ accessor !uscles
+ca*illar re/ill: 1 secon#s
+9loo#+tinge# s*utu!
+*rescence o/ atrial /ibrillation
an# S57 S1 base# on ECG
result
Ine//ective
car#io*ul!onar
tissue *er/usion
relate# to i!balance
bet%een !ocar#ial
oxgen #e!an#
an# su**l
S$ort+ter!:
6t t$e en# o/ 52 !inutes
nursing interventions( *atient
%ill be able to #e!onstrate
tec$ni:ues to i!*rove
circulation suc$ as *assive
ROD exercises an#
*ositioning
8ong+ter!:
6t t$e en# o/ 1- $ours nursing
interventions( *atient %ill be
able to #e!onstrate i!*rove#
car#io*ul!onar tissue
*er/usion as evi#ence# b
absence o/ #s*nea an#
res*irator #istress
In#e*en#ent:
1& Elevate $ea# o/ be#&
,& Encourage *assive leg
exercise( avoi#ance o/
iso!etric exercises&
5& Prevent straining at stools&
1& Re*osition /re:uentl&
E& Provi#e a#e:uate rest&
De*en#ent:
1& 6#!inister su**le!ental
oxgen .1+,8PD3as in#icate#
+;$is is to re#uce oxgen
consu!*tion 7 *ro!otes
!axi!al lung /unction&
+;$is is to en$ance
venous return( re#uce
venous stasis an# re#uce
ris" o/ t$ro!bo*$lebitisH
$o%ever( iso!etric
exercises can a#versel
a//ect car#iac out*ut b
increasing !ocar#ial
%or" an# consu!*tion&
+ ;$is avoi#s an increase
car#iac overloa#&
+;$is *revents s"in
brea"#o%n an#
*ul!onar co!*lications
associate# %it$ be# rest&
+to conserve energ an#
lo%er oxgen #e!an#&
+ ;$is increases a!ount
o/ oxgen available /or
!ocar#ial u*ta"e(
;$e S$ort ter! goal
%as !et /or *atient
%as able to *er/or!
*assive ROD
exercises an#
*ositioning as %as to
i!*rove circulation&
;$e 8ong ter! goal
%as not !et&
+Pul!onar congestion re#ucing isc$e!ia an#
#sr$t$!ias
Subjective:
Durag gi+"u!ot& 50E&'
Re*lie# t$e client %$en
as"e# b t$e SN regar#ing
t$e #escri*tion o/ *ain an#
t$e *ain rate scale&
Duingon na sia na sa"it
ia$ang #ug$an& Sauna ga
re"la!o na!an sia nga
!usa"it iang #ug$an
laba% na "anang !a$ago
sia&' I as verbali)e# b
t$e SO&
Objective:
+sig$ing %it$ no intent to
!ove unless absolutel
necessar
+ver slo% !ove!ent %it$
/acial gri!ace
+ s$ortness o/ breat$ u*on
*ain onset %it$ /acial
gri!ace an# sig$ing
6cute c$est *ain
relate# to re#uce#
coronar bloo#
/lo% resulting to
!ocar#ial
isc$e!ia
S$ort ;er!:
6t t$e en# o/ 52 !inutes t$e
*atient %ill be able to:
a& Re*ort t$at *ain0#isco!/ort
is alleviate# or controlle#( as
evi#ence# b a #ecrease in
*ain rating t$e scale&
b& Dis*la a relaxe#
a**earance an# be able to
slee*0rest co!/ortabl an#
engage in #esire# activities
s$e can tolerate&
c& De!onstrates abilit to co*e
%it$ *artiall relieve# *ain&
.e&g&( #ee* breat$ing exercises
an# *osition c$anges3
#& De!onstrate use o/
relaxation s"ills an#
#iversional activities as
in#icate# /or in#ivi#ual
situation an# verbali)e non+
*$ar!acologic !et$o#s t$at
*rovi#e relie/&
8ong ;er!:
6t t$e en# o/ /our #as(
client %ill re!ain /ree /ro!
*ain as evi#ence# b no
In#e*en#ent:
1& 6ssist t$e *atient to
a co!/ortable
*osition& Daintain be#
rest( at least #uring
*erio#s o/ *ain&
,& Provi#e co!/ort
!easures( :uiet
environ!ent an# cal!
activities
5& Encourage use o/
relaxation tec$ni:ues(
suc$ as /ocuse#
breat$ing an#
i!ager&
1& Eli!inate a##itional
stressors or sources
o/ #isco!/ort %$en
*ossible&
E& Provi#e rest
*erio#s to /acilitate
co!/ort( slee* an#
relaxation&
De*en#ent:
1&6#!inisters
analgesics as or#ere#
+6 se!i+/o%lerCs is usuall !ost
co!/ortable& Restricte# activit
re#uces oxgen #e!an#s o/
t$e $eart&
+;ec$ni:ues are use# to bring
about a state o/ *$sical an#
!ental a%areness an#
tran:uillit& ;$e goal o/ t$ese
tec$ni:ues is to re#uce tension(
subse:uentl( re#ucing *ain&
+;$is $eig$tens oneCs
concentration u*on non*ain/ul
sti!uli to #ecrease oneCs
a%areness an# ex*erience o/
*ain&
+Patient !a ex*erience an
exaggeration in *ain or a
#ecrease# abilit to tolerate
*ain/ul sti!uli i/ environ!ental(
intra*sc$ic( intra*ersonal
/actors are /urt$er stressing
$i!&
+PatientCs ex*erience o/ *ain
!a beco!e exaggerate# #ue
to /atigue&
6t t$e en# o/ 52 !inutes o/
nursing interventions( *atient
%as able to ex*erience relie/
/ro! *ain as evi#ence# b a
#ecrease in t$e Pain Scale
Rate: ,0E( %it$ E as t$e !ost
*ain/ul
+ S$ort ter! goal %as /ull !et
2,012012
6t t$e en# o/ J $ours o/
nursing interventions *atient
%as able to #e!onstrate use o/
relaxation s"ills to $el*
alleviate *ain&
8ong ter! goal %as /ull !et:
2,012012
re*orts o/ *ain( an# nor!al
vital signs&
+6nalgesics are given to
alleviate *ain&
Nursing Care Plan #E
Subjective:
Kebruar 1( ,212
Ga$a*on( #ili na sia
"abalo "ung a$a sia&
<na !urag ga+tanga ra
sia *ir!inti& Naa *u#
usa$a na #ili sia "aila sa
a!o& Dag"abali+bali na
a!ong ngalan& Pero "arun(
o"a na!an& Lung
!ustura lang( #ili *a
"aao "laro'( as verbali)e#
b t$e SO&
De#o lua na iang tuo
nga si#e sa la%as&'( as
Ine//ective cerebral tissue
*er/usion relate# to
interru*tion o/ bloo# /lo%
as evi#ence# b slurring o/
s*eec$( rig$t+si#e#
%ea"ness an# #ecrease#
!entation
S$ort ;er!:
9 t$e en# o/ 1 $ours o/
nursing interventions(
*atient an# SOs %ill be
able to:
a& Berbali)e un#erstan#ing
o/ causative /actors o/
suc$ *roble! an#
a**ro*riate interventions
nee#e# to be #one&
b& Partici*ate in treat!ent
regi!en&
8ong ;er!:
9 t$en en# o/ 1- $ours(
client !ust be able to
In#e*en#ent:
1& Daintain o*ti!al
car#iac out*ut&
,& 6voi# !easures t$at
!a trigger increase ICP
.ex& Straining( strenuous
coug$ing( *ositioning %it$
nec" in /lexion( $ea# /lat3
5& Reorient to
environ!ent as nee#e#&
De*en#ent:
1& 6#!inister anti+
coagulants(
t$ro!boltics
+;$is ensures a#e:uate
*er/usion to t$e brain&
+Increase# intracranial
*ressures %ill /urt$er
re#uce cerebral bloo# /lo%&
+Decrease# bloo# /lo%
!a result in c$anges in
t$e 8OC&
+;$ese /acilitate *er/usion
%$en obstruction to bloo#
/lo% exists or %$en
Goals *artiall !et&
Client an# $is SO %ere
able to *artici*ate in t$e
treat!ent regi!en&
Client alrea# $as
res*onsive !entation but
$is slurring o/ s*eec$ is
still *resent&
Objective:
+Slurring o/ s*eec$
+Decrease# !entation
+Rig$t+si#e# %ea"ness
+GCS Score
,01012?1, .!o#erate brain
injur3
,04012?15.!inor brain
injur3
,012012?11.!il# brain
injur3
+arteriosclerosis o/ t$e
!i##le+cerebral arteries
.C; scan result3
obtain o*ti!al *er/usion to
vital organs( as evi#ence#
b alert level o/
consciousness( clearer
an# !ore un#erstan#able
s*eec$ an# gra#ual
recover o/ $is rig$t+si#e#
%ea"ness&
an# anti+
convulsants as
*rescribe#&
*er/usion $as #ro**e# to
suc$ a #angerous level
t$at isc$e!ic #a!age
%oul# be inevitable %it$out
treat!ent& 6nti+convulsants
re#uce ris" o/ sei)ures
%$ic$ !a result /ro!
cerebral e#e!a or
isc$e!ia&
Cues Nursing Dx Objectives Intervention Rational Evaluation
Subjective:
La*o "aao a"o
*anla%as' as verbali)e#
b t$e *atient
Laron na naa sia sa
$os*ital( !ag$ig#a ra
gu# na sia "a lua
!an gu# *o# sia&' I as
La!i !an gu# ga ilis
ug ga*a"aon nia "a
!agliso# !an sia ug
li$o"+li$o"&' I as
>ul ,,( ,212 IDa"aa+
"aa na!an nia nga
!agli$o"+li$o" nga sia
ra& Pero a!o ra gi$a*on
6ctivit Intolerance
relate# to generali)e#
%ea"ness
S$ort ter!:
nursing interventions( t$e *atient
%ill be able to:
a& I#enti/ negative /actors
a//ecting activit tolerance&
b& Berbali)e un#erstan#ing o/
tec$ni:ues to en$ance activit
tolerance&
8ong ter!:
6t t$e en# o/ ,1 $ours o/ nursing
intervention t$e *atient %ill be
able to:

a& Partici*ate %illingl in
In#e*en#ent:
1& 6ssess car#io*ul!onar
res*onse to *$sical activit(
inclu#ing vital signs be/ore(
#uring an# a/ter activit&
,& Re#uce intensit level or
#iscontinue activities t$at
cause un#esire#
*$siological c$anges&
5& 6ssist %it$ 6D8Cs as
in#icate#H $o%ever( avoi#
#oing /or *atients %$at
t$e can #o /or
t$e!selves&
1& Encourage active ROD
exercisesH i/ /urt$er
+6ssessing
car#io*ul!onar notes
*rogression or accelerating
#egree o/ /atigue&
+6#just activities to *revent
overexertion&
+6ssisting t$e *atient %it$
6D8Cs allo%s /or
conservation o/ energ&
+Exercise !aintains
!uscle strengt$ an# joint
6/ter 52 !inutes( t$e
*atient:
a& i#enti/ie# t$e /actors
t$at a//ecte# $er
activities o/ #ail
living&
b& use# i#enti/ie#
tec$ni:ues to en$ance
activit tolerance&
8ong ;er!:
6/ter 1- $ours( t$e *atient
a& *articate# %illingl in
necessar or #esire#
activities&
b& re*orte# increase in
activit tolerance
sia i+assist "a basin
!a+unsa ba$&' Ias
Lina$anglan gu# na!o
sia tabangan "ung
!uli$o" "a lua !an
gu# sia&'( verbali)e# b
t$e SO&
Objective:
+generali)e# bo#
%ea"ness note#&
+ see"s $el* in 6D8
necessar activities&
b& Re*ort !easurable increase in
activit tolerance&
c&De!onstrate a #ecrease in
*$siologic signs o/ intolerance
.PR( RR( an# 9P %it$in *atientCs
nor!al range3&
recon#itioning is nee#e#(
con/er %it$ re$abilitation
*ersonnel&
De*en#ent:
1& 6#!inister O, in$alation
as *rescribe#&
ROD&
+Provi#ing oxgenation
re#uces /atigue an#
anxiet /or *atient&
Cues Nursing Diagnosis Objectives Intervention Rationale Evaluation
Subjective:
Kebruar 4( ,212 I La!i
!an gu# ga ilis ug
ga*a"aon nia "a
!agliso# !an sia ug
li$o"+li$o"&' I as verbali)e#
b t$e SO&
Objective:
+Scale /or !easuring
RIG=; $an# !uscle score:
,01012? gra#e1. no active
range o/ !otion an#
*al*able !uscle
contraction onl3
,04012?gra#e,. re#uce#
I!*aire# *$sical !obilit
relate# to #ecrease#
!uscular control an#
/unction as evi#ence b
generali)e# %ea"ness
S$ort ;er!:
nursing intervention t$e
*atient %ill be able to :
a& verbali)e un#erstan#ing
o#/ situation( in#ivi#ual
treat!ent an# regi!en an#
sa/et !easures&
b& De!onstrate tec$ni:ues
an# be$aviors t$at enable
resu!*tion o/ activities
*artici*ate in 6D8s an#
#esire# activities&
8ong ;er!:
6t t$e en# o/ 5, $ours o/
Nursing intervention t$e
In#e*en#ent:
1& 6ssist *atient re*osition
sel/ on a regular sc$e#ule
as #ictate# b in#ivi#ual
situation&
,& Ins*ect s"in regularl
*articularl over bon
*ro!inences& Gentl
!assage an re##ene#
areas as necessar&
5& Per/or! *assive ROD
exercises o/ u**er an#
lo%er extre!ities&
1& Encourage *artici*ation
in sel/ care an# ot$er
activities&
+;$is is to *ro!ote *ro*er
circulation an# *revent
/or!ation o/ s"in0#ecubitus
ulcer&
+;$is *revents s"in
brea"#o%n an# #ecubitus
ulcer #evelo*!ent&
+;$is $el*s
!aintain0en$ance
!axi!u! neuro!uscular
control an# /unction&
+ ;$is en$ances sel/
conce*t an# sense o/
in#e*en#ence&
Goals !et as evi#ence#
b:
a& Patient able to verbali)e
i!*rove!ent o/ con#tion&
b& Dotor control on all
u**er an# lo%e extre!ities
%oul# return to nor!al as
*re/erre# b t$e *atient&
c& No signs an# s!*to!s
o/ *aralsis&
active range o/ !otion an#
no !uscle resistance3
,012012?gra#e1 ./ull active
range o/ !otion an#
nor!al !uscle resistance3
a& Daintain *osition o/
/unction an# s"in integrit
as evi#ence# b absence
o/ contractures( /oot #ro*(
#ecubitus an# t$e li"es&
b& Daintain or increase
strengt$ an# /unction o/
a//ecte# an# co!*ensator
*art&
E& Provi#e sa/et !easure
suc$ as raising t$e si#e
rails as in#icate# b
in#ivi#ual situation&
De*en#ent:
1& 6#!inister !e#ications
*rior to activities as
nee#e# /or *ain&
,& 6#!inister laxative as
or#ere#&
+;$is *revents injur /ro!
/alling&
+;$is *er!its !axi!al
e//ort0involve!ent in
activit&
+
Nursing Care Plan #J
Subjective:
8uga% ra gu# ia *%e#e
"aonon "a galiso# *a sia
ug tulon& Du"aon !an *o#
sia *ero ga!a ra "a
!urag %ala !an sia
gana& Dao !an sab ang
ingon sa #octor na luga%
lang sa ang i*a"aon sa
ia& I as verbali)e# b
t$e SO&
Objective:
+Geig$t loss+ EE"g+E2"g
+Git$ NG;
I!balance# Nutrition: 8ess
t$an bo# re:uire!ents
relate# to inabilit to ingest
a#e:uate nutrients
secon#ar to #s*$agia as
evi#ence# b %eig$t loss
o/ E "g
S$ort ;er!:
a& Receive a#e:uate an#
#esire# a!ount o/ calories
*er /ee#ing
8ong ;er!:
6t t$e en# o/ $ours o/
a& Receive a#e:uate
a!ount o/ caloric
re:uire!ent *er J $ours in
relation to *atientCs status
In#e*en#ent:
1&Discuss %it$ t$e
signi/icant ot$ers t$e nee#
o/ $aving rig$t #iet /or t$e
*atient an# intro#uce t$e
/oo# *ra!i#&
,&Place *atient in
!o#erate $ig$ bac" rest
#uring /ee#ing&
5&C$ec" t$e tubeCs *atenc
be/ore /ee#ing .auscultate
/or bubbling soun# using
stet$osco*e just above t$e
sto!ac$ area3
+ Success rates are $ig$er
%$en t$e /a!il
incor*orates a $ealt$
eating *lan&
+ ;$is *ro!otes co!/ort
#uring /ee#ing an# allo%
/lo% o/ /oo# b gravit&
+ ;$is ensures correct tube
*lace!ent in t$e sto!ac$&
6t t$e en# o/ ,2 !inutes o/
*atient %as able to:
a& Receive a#e:uate an#
#esire# a!ount o/ calories
*er /ee#ing
8ong ;er!:
6t t$e en# o/ J $ours o/
*atient %as able to:
a& Receive a#e:uate
a!ount o/ caloric
re:uire!ent *er J $ours in
relation to *atientCs status
+Gea"ness o/ !uscle
re:uire# /or !astication
relate# to rig$t+si#e#
%ea"ness

+Ds*$agia
+Pale an# #r !ucous
!e!branes
+Dr li*s
1&Klus$ 52 cc o/ %ater
be/ore an# a/ter /ee#ing&
De*en#ent:
1& 6#!inister OK 1-22 "cal
in 1 #ivi#e# /ee#ings via
NG;&
+ ;$is is to rinse tubing(
*rovi#e /lui# source to
!aintain a#e:uate
$#ration an# to ensure
t$at all /ee#ing goes into
t$e sto!ac$&
+;o !eet nutritional
#e!an#s o/ t$e *atient *er
#a&
Nursing Care Plan #@
Subjective:
Kebruar 1(,212
Dagliso# !an ni sia ug
stora& Dili "ao !i
"asabot'( as verbali)e# b
SO&
Kebruar 4(,212
Gaa*ason nia iang
gin$a%a "ung !agstora
sia&'( as verbali)e# b
SO&
Kebruar 12(,212
Da"astora na sia ug
tarong *ero #ili "ao
"laro&'( as verbali)e# b
I!*aire# Berbal
Co!!unication relate# to
loss o/ /acial or oral !uscle
control as evi#ence# b
slurring o/ s*eec$
S$ort ter!:
6/ter an $our o/ nursing
intervention t$e *atient %ill
be able to #e!onstrate
i!*rove# abilit to ex*ress
sel/
8ong ;er!:
6/ter J $ours o/ nursing
intervention t$e *atient %ill
be able to:
a& =ave #ecrease#
/rustration an# isolation
%it$ co!!unication&
b& Establis$ !et$o# o/
co!!unication in %$ic$
In#e*en#ent:
1&Provi#e alternative
!et$o#s o/ co!!unication
li"e *ictures or visual cues(
gestures or #e!onstration
,& 6ntici*ate an# *rovi#e
/or *atients nee#s
5& ;al" #irectl to t$e
*atient( s*ea"ing slo%l
an# clearl& <se es or no
:uestions to begin %it$&
1& S*ea" in nor!al tones
+Provi#e co!!unication
nee#s or #esires base# on
in#ivi#ual situation or
un#erling #e/icits&
+;$is is $el*/ul in
#ecreasing /rustration
%$en #e*en#ent on ot$ers
an# unable to
co!!unicate #esires&
+It re#uces con/usion an#
anxiet at $aving to
*rocess an# res*on# to
large a!ount o/
in/or!ation at one ti!e
+Patient is not necessaril
;$e S$ort ter! objectives
%ere *artiall !et because
%as still $aving a $ar# ti!e
%it$ $is s*ea"ing abilit
alt$oug$ $e alrea#
!anage# to use non+
verbal cues
;$e 8ong ter! objectives
%ere /ull !et& Patient %as
able to s$o% #ecrease#
/rustration an#
co!!unicates %ell using
non verbal !o#e o/
co!!unication&
SO
Objective:
+rig$t+si#e# %ea"ness
+Kacial as!!etr
+Slurre# s*eec$
+%it$ #i//icult in
*ronouncing %or#s
nee#s can be ex*resse# an# avoi# tal"ing too /ast&
Give *atient ti!e an a!*le
ti!e to res*on#&
E& Encourage /a!il
!e!bers to *ersist e//ort
to co!!unicate %it$ t$e
*atient&
$earing i!*aire# an#
raising voice !a irritate or
anger t$e *atient&
+It is i!*ortant /or /a!il
!e!bers to continue
tal"ing to t$e *atient to
re#uce *atient isolation(
*ro!ote establis$!ent o/
e//ective co!!unication
an# !aintain sense o/
connecte#ness or bon#ing
%it$ t$e /a!il
Cues Nursing Dx Objectives Intervention Rational Evaluation
Ris" Kactors:
+age: J@ ears ol#
+ina#e:uate secon#ar
#e/enses
+c$ronic #isease
+!alnutrition
+*resence o/ in#%elling
cat$eter
+invasive *roce#ures
+insu//icient "no%le#ge to
avoi# ex*osure to *at$ogens
Note: 6 ris" #iagnosis is not
evi#ence# b signs an#
s!*to!s( an# t$e *roble!
$as not occurre# an# nursing
interventions are #irecte# at
Ris" /or in/ection S$ort ter!:
Nursing intervention( t$e
a& Berbali)e un#erstan#ing o/
in#ivi#ual ris" /actors
b& I#enti/ interventions to
*revent ris" o/ in/ection
8ong ter!:
6t t$e en# o/ one %ee" o/
Nursing intervention( t$e
a& De!onstrate tec$ni:ues
an# li/estle c$anges to
In#e*en#ent:
1& =el* *atient %as$ $an#s
be/ore an# a/ter !eals
a/ter using bat$roo!(
be#*an or urinal&

,& =el* t$e *atient turn to
si#es ever t%o $ours&
Provi#e s"in care(
*articularl over bon
*ro!inences&
5& Ensure a#e:uate
nutrition inta"e& O//er $ig$
*rotein su**le!ents suc$
egg %$ite&
1& 6rrange *rotective
isolation /or co!*ro!ise#
+ =an# %as$ing *revents
s*rea# o/ *at$ogens to
ot$er objects an# /oo#&
+ ;o $el* *revent venous
stasis an# s"in brea"#o%n
+ ;$is $el*s stabili)e
%eig$t( i!*roves !uscle
tone an# !ass( ai#s in
%oun# $ealing& 6lso
serves to !ini!i)e e#e!a&
+ ;$ese !easures *revent
*atient *at$ogens in t$e
S$ort ter! goal %ere !et
because t$e *atient an#
$is SO %ere able to
verbali)e un#erstan#ing o/
in#ivi#ual ris" /actors an#
i#enti/ interventions to
*revent ris" o/ in/ection
8ong ter! goal %as !et
since *atient %as able to
*ro!ote sa/e environ!ent
an# #i# not s$o% an signs
o/ in/ection&
*revention *ro!ote sa/e environ!ent
b& S$o% no signs o/ in/ection
suc$ as /ever
i!!une /unction& Donitor
/lo% an# nu!bers o/
visitors&
E& ;eac$ *atients about
goo# $an# %as$ing
tec$ni:ue( /actors increase
in/ection ris"( in/ection sign
an# s!*to!s&
De*en#ent:
1& 6#!inister *ro*$lactic
antibiotics as or#ere#&
environ!ent an# *rotect
/ro! s"in brea"#o%n&
+ ;$ese !easures allo%
*atient to *artici*ate in
care an# $el* *atient
!o#i/ li/estle to !aintain
o*ti!u! $ealt$ level&
+ ;o *revent in/ection
cause# b *at$ogen&
DISC0AR3E &)ANNIN3
Me$i%ations
Jncourage strict medication compliance and to take medications as
directed to attain therapeutic e##ects
:nstruct patient and signi#icant others to keep a list o# medications
"ith their respective dosage and #rePuency o# intake to prevent
medication errors and their purpose
Eit 9 Comple& OD
Calvit OD
*olmu& 9roncho 5 Cap +:D
Candesartan 5> mg OD
8$ithromycin -66mg OD
:n#orm patient regarding side e##ects o# medication to allay patient
an&iety i# said side a##ects mani#est
Jncourage patient to discuss "ith health care provider concerns
regarding medications
E?e#%ise
+each patient and his signi#icant others to do passive and active
range o# motion "ith slo" progressions in #rePuency
8dePuate rest periods must be given in bet"een e&ercises to
prevent straining
8l"ays bear in mind that one has to start on easy-to-do e&ercises
#irst and must rest #rePuently, building up strength is essential as
one goes on until hard e&ercises are tolerated
%oderate e&ercise such as "alking should be encouraged
T#eatment
:nstruct patientAs *O to seek medical advice and immediately treat
in#ections o# the upper respiratory system, and oral cavity
0ealt+ Tea%+in*s
Provide patient and relative "ritten and verbal in#ormation
regarding the #ollo"ing<
5 J&plain the indications o# the prescribed medications, their
actions, dosages, contraindications and side e##ects
4 :mmediate noti#ication o# physician #or presence o# adverse
reactions in medicines and home care complications
= Contacting the healthcare provider "hen signs o# recurrence
or complications o# the disease appear, especially shortness o#
breath and chest tightness
7 *eek medical advice #rom healthcare provider #or immediate
treatment o# upper respiratory system, and oral cavity
in#ections
- Compliance to #ollo" up e&aminations
> Providing support +he patient and #amily need assistance,
e&planation, and support every time patient rePuires treatment
to prevent serious complications and improve condition
; :ndicate enough bed rest to reduce e&ertion and to avoid all
strenuous activities that has not been approved by the
physician
Out.atient (ollo;:u.
8ssert importance o# #ollo" up visits to physician
8dvise patient and #amily to report to the physician i# any
recurrence or severity o# symptoms, any adverse e##ects o# the
medication, and any development o# complication
Patients should be encouraged to keep a record o# their daily
"eights 8n action plan should be developed so that i# the patient
e&periences une&plained "eight gain o# greater than = pounds
since their last clinical evaluation the patient can take action (call
physician or take additional medication)
Promote the use o# the communityAs available resources such as
carrying out regular visits to the nearest health center #or continuing
monitoring o# clientAs over all status
:# there are things that are unclear, advise patient and *O to re#er
concerns to physician
Diet
5 8lcohol use should be discouraged
4 Depending on the health care provider a diet that is
lo" in sodium content, about 4 grams per day is
recommended
= :t is advisable that cholesterol intake be limited
7 *ources o# #iber are to be added to the diet to aid in
digestion
- Protein intake is recommended but must not be #rom
#atty sources Fish, chicken and beans are good
sources o# protein so long as it is not contraindicated
by the patientAs physician
> :ntake o# vitamin supplements and other sources o#
minerals are recommended
; J&cessive #luid intake should be discouraged, but #luid
restriction is rarely indicated
S.i#itual Ca#e
Jncourage signi#icant others to contact the #amily pastor
to provide spiritual guidance
Participating in religious ceremonies together can be a
#orm o# #amily bonding and can strengthen the #amily
internally
Jncourage patient to verbali$e an&ieties to spiritual guide
(ie pastor, priest) to relieve pent up #rustrations
8sk the signi#icant others to constantly remind patient that
the disease is not a #orm o# punishment #rom Iod and that
it is not the patients #ault #or getting the disease in the #irst
place
&RO3NOSIS
CRITERIA
3OOD
&RO3NOSIS
&OOR
&RO3NOSIS
ANA)2SIS-IM&)ICATION
Onset o#
:llness
@
+he patientAs severe mani#estations occurred
very late to be able to be treated
Duration o#
:llness
@
+here "as a late detection o# the disease o# the
patient, thus contributes to a late prevention
Precipitating
and
Predisposing
Factors
@
+he old age o# the patient, his gender, #amily
history o# having heart disease, stroke and
hypertension, sedentary li#estyle, and his diet that
is rich in cholesterol and #ats predisposes him
and puts him at risk #or acPuiring such disease
*uch #actors mani#ested by the patient cannot
already be altered and prevented 9ut
mani#estations sho"ed by the patient may be
improved through the medication regimen
prescribed and provided by the healthcare team
8ttitude W
Cillingness to
take
+reatment
@
+he patientAs admission and adherence to
medication treatment may someho" sho" that
patient is very "illing to take treatment in order
#or him to recover #rom the disease
:t is very important to note that prognosis #or patients having such diseases vary greatly
depending on a personAs health, the e&tent o# the damage, the treatment given and the patientAs
adherence to it, and most importantly, the early detection o# the disease %ost o# the prognosis
in the chart e&hibited poor prognosis especially that the patient mani#est important #actors that
may lead to li#e-threatening complications Patient is responsive to the treatment given as
evidenced by diminished symptoms o# the disease "hich also suggest a good prognosis #or the
patient 9ut still, long term prognosis may suggest that the clientAs problem may not lead to a #ull
recovery o# the patient as such that the patient is already in the late stage o# treating the
disease
CONC)USION
8t the end o# this case study "e "ere able to attain goals that "e have set #rom the start
o# this study +hrough the gathered data "e "ere able to #ormulate nursing care plans that "e
"ere able to apply to our patient 9y studying on the patientAs prescribed medication "e "ere
able to understand its e##ects "hich could aid in his recovery 8 revie" on the a##ected anatomy
and physiology o# the body enabled us to create interventions that could alleviate pain and any
discom#orts #rom the patient, i# not completely prevent it Cith the help o# the patientAs #amily,
"e "ere able to e&plore part o# the patientAs personality and this in#ormation "as used on the
#ormulation o# the interventions
+oday it is but promising to note that the number o# heart related diseases a##ecting aged
people are increasing %yocardial :n#arction is the interruption o# blood supply to part o# the
heart, causing some heart cells to die+here are a lot o# #actors "hich may lead to the
development o# such disease one o# the most noticeable #actor is poor or unhealthy li#estyle
"hich the patient practiced #or many years Chronic Obstructive Pulmonary Disease re#ers to
chronic bronchitis and emphysema, a pair o# t"o commonly co-e&isting diseases o# the lungs in
"hich the air"ays become narro"ed+his leads to a limitation o# the #lo" o# air to and #rom the
lungs causing shortness o# breath +his is caused by no&ious particles or gas, most commonly
#rom tobacco smoking, "hich triggers an abnormal in#lammatory response in the lung
RECOMMENDATION
+he recommendations made by the proponents #or this grand case presentation are
necessary #or a patient "ho is diagnosed "ith 9enign Prostatic ,yperplasia2 %yocardial
:n#arction2 and Chronic Obstructive Pulmonary Disorder 8lthough the data presented are #actual
and relevant, the paperAs aspect is limited to the patientAs case and the data gathered +he
recommendations "ill serve as a guided care #or the "ell being o# the patient +hese involve the
patient, her signi#icant others and the health care providers
/ecommendations made #or the patient are as #ollo"s< First, cooperation in his
treatment therapy is needed ,e should continue to report any abnormalities she "ill e&perience
or mani#est that could be a sign o# a more serious problem *econd, the patient should be able
to adhere "ell "ith the medication regimen as prescribed +hird, the patient must be set to
#ollo" dietary guidelines #or metabolic needs and his daily nutritional rePuirement Fourth, he
should be able to establish in his mind a positive outlook regarding her condition Fi#th, spiritual
health should also be strengthened "ith his condition since it is important #or his holistic care
and in maintaining a healthy status
For the signi#icant others, it is encouraged that they continue to provide com#ort and care
measures to the patient throughout the disease process +heir presence is also an important
#actor #or the emotional and mental stability o# the patient +hey can convince and supervise the
patient in the adherence to the treatment regimen and providing the daily needs o# the patient
either "ith personal necessities or adePuate rest
For the health care providers, they should be able to provide Puality health care to the
patient by being ePuipped "ith kno"ledge and skills necessary #or the appropriate interventions
needed by the patient and also by being sensitive to the needs and being observant to possible
mani#estations o# the patient Constant monitoring is also very important as to the critical status
o# the patient
For us, since availability o# time and length o# duty is limited, #urther care and
interventions "as not done to the patient +he sources o# data used "ere also based only on the
patientAs chart, assessment tools and te&tbooks +hus, ample time to do #urther research and
interaction o# the patient is recommended
G: 9:9L:OI/8P,M
9ook sources<
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#or Positive Outcomes ?
th
Jd Philippines *aunder-Jlsevier, :nc,466?
9runner , *uddarth +e&tbook o# %edical-*urgical Lursing volume 5 W 4 55
th
edition,
Lippincott Cilliams and Cilkins, 466;
Doenges, %arilynn J et al LurseAs Pocket Iuide Diagnosis, Prioriti$ed :nterventions W
/ationales 56
th
edition, F8 Davis Company, 466>
0arch, 8my % Focus on Lursing Pharmacology =
rd
edition, Lippincott Cilliams and
Cilkins, 466>
0indersley, Dorling 9ritish %edical 8ssociationAs Le" Iuide to %edicines and Drugs
Ireat 9ritain< Dorling 0indersley>
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