CASE PRESENTATION

PLEURAL EFFUSION

PRESENTED BY:
TORLAO, CATHERINE ANN VILLARIA, FIDEL JR VINCO, MA. KARMELA LOUISE ZARAGOZA, EMILENE

INTRODUCTION
Our group chose this case as interesting to us because it is a common disease entity that is usually underestimated as a cause of mortality and morbidity to patients. We would like to make an outlook of what this case is and gather information that can help us learn how it occurs, manifest, develop and cause a disease. It is our goal to identify the risk factors that affects people making them at risk for the disease. How is the disease being treated? And by learning from the inputs we gather from out patient.

 We discuss pleural effusion as its definition as the collection of at least 10-20 mL of fluid in the pleural space. Pleural effusion develops because of excessive filtration or defective absorption of accumulated fluid. Pleural effusion may be a primary manifestation or a secondary complication of many disorders. Pleural effusions are usually classified as transudates and exudates. Diseases that affect the filtration of pleural fluid result in transudate formation, such as in congestive heart failure and nephritis. Transudates usually occur bilaterally because of the systemic nature of the causative disorders. Inflammation or injury increases pleural membrane permeability to proteins and various types of cells and leads to the formation of exudative effusion Infectious effusions are usually unilateral. However, a recent large Turkish study revealed bilateral effusion in 5% of 515 children. Its frequency occurs, as in the US: American and international frequencies are similar. The prevalence of pleural infections appears to be increasing in some developed countries; this could be partly due to increased referral of patients with these conditions to tertiary-care pediatric hospitals.

 Nonbacterial infectious agents, such as viruses and Mycoplasma pneumoniae, cause more pleural effusion in children than do bacterial organisms. Although bacteria are more likely than viruses to cause effusion, viral infections in children occur more frequently than bacterial infections, explaining the observation above. As many as 20% of the viral infections can cause small and transient effusions that resolve spontaneously, affects internationally and more frequently on developed nations. Several decades ago, pleural effusion was a complication of 70% of all cases of Staphylococcus aureus pneumonia, with positive cultures resulting from 80% of pleural-fluid specimens. In the late 1970s, pleural effusion occurred in 75% of cases of pneumonia secondary to Haemophilus influenzae type b. In a report by Murphy et al, empyema complicated the course of pneumonia in 9 of 21 patients with Streptococcus pneumoniae pneumonia. Chartrand and McCracken indicated that empyema complicated the course of pneumonia in 57 of 79 patients with S aureus infections. Pleural effusion occurs in 6-12% of all cases of pulmonary tuberculosis (TB) in children. Of 175 Spanish children with pulmonary TB, 39 (22.1%) had pleural effusion.

 Congenital effusions, including chylothorax, occur in 1 per 10,00015,000 live births annually. In a review of 74 patients with intrathoracic lymphomas, Chaignaud et al found pleural effusions in 10 (71%) of 14 children with lymphoblastic lymphoma and in 7 (12%) of 60 children with non-Hodgkin lymphoma. The outcome of this condition affects the morbidity and mortality of patients. Most effusions caused by viral and mycoplasmal infections resolve spontaneously. Empyema has a complicated course if not treated early, especially in children younger than 2 years. Thirty years ago, the mortality rate from empyema was 100%. At present, the mortality rate from empyema is 6-12% in infants younger than 1 year. Malignant effusion worsens the patient's prognosis depending on the underlying tumor. With regards to its ratio. Pleural effusions may be more common in boys than in girls.

THEORETICAL FRAMEWORK
Virginia Henderson Nursing Virginia Henderson viewed the patient as an individual requiring help toward achieving independence. She states that The unique function of the nurse is to assist individual, sick or well, in the performance of those activities contributing to health or its recovery (or peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge and to do this in such a way to help him gain independence as rapidly as possible. Health Virginia Henderson did not state her own definition of health. But in her writing, she equated health with independence. Environment Again, Henderson did not give her own definition of environment. Instead, she used Websters New Collegiate Dictionary, 1961, which defined environment as the aggregate of all the external conditions and influences affecting the life and development of organism. Person Henderson viewed the patient as an individual who requires assistance to achieve health and independence or peaceful death. The mind and body are inseparable. The patient and his or her family are viewed as a unit.

OBJECTIVES
General: After the completion of the case presentation, the student will be able to: Further their knowledge about respiratory system and pleural effusion. Specific: After the completion of the case presentation, the student will be able to: Determine the health profile of the patient using the nursing assessment guide. Discuss the anatomy and physiology of the respiratory disease system that is directly affected in a Pleural Effusion and relates the concept to the actual situation of the patient. Discuss comprehensively the pathophysiology of Pleural Effusion. Relate the diagnostic findings to the pathophysiology of the disease process. Discuss the effect of the therapeutic regimen used. Relate the nursing care plan to the needs and problem of the patient. Discuss comprehensively the nursing care plan. Determine the prognosis of the patient.

The 14 Basic Human Needs Breathe normally.- In our patients case there is presence of difficulty of breathing due to plural effusion the main goal is to secure patients breathing. Eat and drink adequately. There is presence of malnutrition because of sudden weight loss due to having PTB. Our concern is to regain patients desirable body weight. Eliminate body wastes. There is presence or impaired gas exchange in the patient. The nurses responsibility is to correct this problem to provide comfort to the patient. Move and maintain desirable postures. The patient is now bed ridden due to his illness and cant even go to the bathroom by him self. The health care providers responsibility is to take care and give as much care as possible to the patient to give the best care while in recovery.

Sleep and rest. The patient is usually sleeping during his hospitalization period the goal of the health care provider is to give as much comfort as possible to the patient while sick. Select suitable clothes--dress and undress. Give proper clothing to help in breathing and comfort. Health care provider should advise patient to wear the suitable clothing as needed. Maintain body temperature within normal range by adjusting clothing and modifying the environment. The health care providers responsibility is to constantly check the VS of the patient to check if there are abnormalities or significant changes noted and to give proper action as soon as possible. Keep the body clean and well groomed and protect the integument. It is important to maintain the hygiene of the patient to avoid any complication such as infection and to give comfort while sick, recovering or well. Avoid dangers in the environment and avoid injuring others. Make sure that the patient as well as the people surrounding him is safe the health care providers job is to ensure the safety of the patient and the people around him such as advising relatives or visitors to wear mask for precaution and as for the patient putting side rails to avoid falling in from bed. Communicate with others in expressing emotions, needs, fears or opinions.- Proper communication is a good way to show care, Establishing rapport is a good way of better relationship as patient nurse interaction. Worship according to one's faith. Respecting the patients spirituality is an important factor in good relationship between health care provider and patient. Work in such a way that there is a sense of accomplishment. Make sure to finish what you start. Play or participate in various forms of recreation. Learn - Discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities.

Patient History Personal Data Name: S. P Age: 86 years old Nationality: Filipino Gender: Female Adm. Date: August 14, 2011 Chief complaint: DOB Difficulty of Breathing Clinical Impression: Pleural effusion , Status Post CTT History of Present illness: The patient condition started 1 month prior to admission, went the patient was noted to be dyspneic and has decrease in appetite. Patient was then brought to the hospital and was admitted for 5 days. Apparently, patient had improvement. Two weeks prior to admission, patient was to be dyspneic , had inability to communicate. No consult, nor medication taken, persistence of the active signs and symptoms bought consult, hence admitted. Past Health history: Patient was been hospitalized before because of difficulty of breathing and decreased in appetite. Family history: Both of the patients parents have no history of illness.

PHYSICAL ASSESSMENT Date assessed: September 20, 2011 General assessment: lethargic, 6tidy, Initial vital signs: T=36 C, RR=17 BP=100/70 PR=78 Contraptions: (+) NGT, IV fluid of PNSS x 20 gtts/min
Area Assessed Skin Color Technique Inspection Normal Findings Light brown, tanned skin (vary according to race) Actual Findings Light brown, tanned skin (vary according to race) Pale colored palms,soles, lips and nail beds Skin normally dry Normal Evaluation Normal

Soles and palms

Inspection

Lighter colored palms, soles

Moisture

Inspection/ Palpation Palpation Palpation

Skin normally dry

Temperature Texture

Normally warm Smooth and soft

Normally warm with desquamation, presence of lesions in some parts of the upper extremities

Normal Normal for old age

Turgor

Palpation

Skin snaps back immediately

Skin snaps back immediately

Normal

Skin appendages a. Nails Nail beds

Inspection

Transparent, smooth and convex Pinkish

Transparent, smooth and convex Pale

Normal

Inspection

Due to decreased blood flow

Nail base Capillary refill

Inspection Inspection/ Palpation

Firm White color of nail bed under pressure should return to pink within 2-3 seconds

Firm White color of nail bed under pressure should return to pink within 3-5 seconds

Normal Decrease supply in the blood, Nsg Manaagement: MHBR, encourage iron rich foods Normal

b. Hair Distribution Color Texture Eyes Eyes Visual Acuity

Inspection

Evenly distributed

Evenly distributed

Inspection Inspection/ Palpation Inspection

Black Smooth Parallel to each other

Black Smooth Parallel to each other

Normal Normal Normal

Inspection (penlight)

PERRLA- Pupils equally round react to light and accommodation

PERRLA- Pupils equally round react to light and accommodation

Normal

Eyebrows

Inspection

Symmetrical in size, extension, hair texture and movement

Symmetrical in size, extension, hair texture and movement

Normal

Eyelashes

Inspection

Distributed evenly and curved outward

Distributed evenly and curved outward

Normal

Conjunctiva

Inspection

Transparent with light pink color

Pale

Decresed hemoglobin in the blood Nursing management: Encourage to eat iron rich foods

Sclera

Inspection

Color is white

Color is white

Normal

Cornea

Inspection

Transparent, shiny

Transparent, shiny

Normal

Pupils

Inspection

Black, constrict briskly

Black, constrict briskly

Normal

Iris

Inspection

Clearly visible

Clearly visible

Normal

Ears Ear canal opening Hearing Acuity

Inspection

Free of lesions, discharge of inflammation Canal walls pink

Client normally hears words when whispered

Free of lesions, discharge of inflammation Canal walls pink Client doesnt normally hear words when whispered, needs to be repeated and the speaker needs to shout , so the pt will understood what the speaker is telling. Smooth, symmetric with same color as the face Oval symmetric, (+)NGT Pink, moist symmetric Glistening pink soft moist Slightly pink color, moist and tightly fit against each tooth Moist, slightly rough on dorsal surface medium or dull red No teeth Hard palate- domeshaped Soft Palate- light pink

Normal Normal Normalc due to age

Inspection

Nose Shape, size and skin color Nares Mouth and Pharynx Lips Buccal mucosa Gums

Inspection

Smooth, symmetric with same color as the face Oval, symmetric and without discharge Pink, moist symmetric Glistening pink soft moist Slightly pink color, moist and tightly fit against each tooth Moist, slightly rough on dorsal surface medium or dull red Firmly set, shiny Hard palate- dome-shaped Soft Palate- light pink

Normal

Inspection Inspection Inspection Inspection

Lack of fluid intake Normal Normal

Tongue

Inspection

Normal

Teeth Hard and soft palate

Inspection Inspection

Normal

Neck Symmetry of neck muscles, alignment of trachea

Inspection

Neck is slightly hyper extended, without masses or asymmetry

Neck is slightly hyper extended, without masses or asymmetry

Neck ROM

Inspection

Neck moves freely, without discomfort

The neck cant move freely, presence of discomfort

Thorax and Lungs

Auscultation

Clear breath sounds

(+) crackles (+) pigeon chest (+) CTT in the (Left area of the chest)

Abdomen Bowel sounds

Inspection Auscultation

Skin same color with the rest of the body Clicks or gurling sounds occur

Skin same color with the rest of the body Clicks or gurling sound heard

Normal Normal

Extremities Symmetry Skin color

Inspection Inspection

Symmetrical Same with the color of other parts of the body Evenly distributed Warm to touch No lesions

Symmetrical Same with the color of other parts of the body Evenly distributed Warm to touch Presence of decibitus ulcer in sacrum area

Normal Normal

Hair distribution Skin Temperature Presence of lesion

Inspection Palpation Inspection

Normal Normal Because of immobility, presence of decibitus ulcer at the backNsg management:Rep osition q 2 h , daily wound care
Normal

ROM

Inspection

Moves freely without discomfort

Can move freely

Neurology system Level of consciousness

Inspection

Fully conscious, respond to questions quickly, perceptive of events Makes eye contact with examiner, hyperactive expresses feelings with response to the situation not hyperactive

Lethargic, does not respond to questions, not eptive of events doesnt makes eye contact with examiner, not hyperactive expresses feelings with response to the situation

d/t paralysis

Behavior and appearance

Inspection

d/t patients condition cannot interact with people

GORDONS 11 FUNCTIONAL HEALTH PATTERN

FUNCTION Health Perception Health Management Pattern

BEFORE HOSPITALIZATION Patient S.P. is dependent to her own decision and care. She just go to the doctor when she feels pain. She doesnt go to checkups. regularly. The patient loves to eat vegetables, She also eats salty and fatty foods. Patient doest have any food allergies, and not having any difficulty of swallowing, he drinks a lot of water a day,

DURING HOSPITALIZATION The patient cant decide on how she will manage her health condition. Her family members is now the decision makers regarding her health. The patients food intake was changed to Osteorized feeding

INTERPRETATION d/t to paralysis, she cant decide on her condition . Diagnosis: Ineffective health maintenance related to perceptual/cognitive impairment

Nutrition

The doctor ordered Osteorized feeding since she has difficulty of swallowing Diagnosis: Imbalanced Nutrition : less than body requirements related to inability to absorb nutrients in the body

Elimination

She is able to urinate & defecate normally everyday by herself She doesnt have any problem on her elimination

The patient urinates frequent but scanty urine. The pt s defecation has changed. Sometimes, it takes days to be defeacted again.
She has difficutly of sleeping because of the pain that she felt and some environmental factors such as v/s montioring

Her condition affected her elimination pattern. Diagnosis: Bowel incontinence related to immobility

Sleeping

Accg to the pts brother,The client sleeps 6 to 8 hours every day and has no difficulty of sleeping and not easily awakened.

The patients sleep pattern was affected due to the pain she felt, adherence to time of medication & vital signs monitoring Diagnosis: Sleep deprivation related to sustained environmental stimulation

Cognitive-Perceptual Pattern

Has a normal cognitive perception Can comprehend well She responds appropriately to verbal & physical stimuli

The patient can respond but with the use of hand gestures The patient is unable to understand easily and wasnt able to communicate well.

Due to paralysis , she wasnt able to communicate easily with her family members Diagnosis: Disturbed Sensory Perception related to altered sensory reception

Self- PerceptionSelf concept

He views himself as a healthy and strong individual that could work and function very well

The patient felt useless since he cannot work and provide his familys needs, he became impatient due to his current condition Since she is a widow and a geriatric, sexually reproductive pattern is not applicable. Having her love ones stay on his side makes him comfortable.

Due to her condition, she cant function well Diagnosis: Risk for situation low self esteem related to functional impairment

SexualityReproductive Pattern Coping Stress & Tolerance Pattern

The patient has 5 children. She is now a Widow.

She tell her problems to her family members. She also prays to God, everytime she have problems.

The support of her family, guidance from God makes her stronger and cope with problems/stress.

Activity-Exercise Pattern

She is not fond of exercising . Most of her time was been in in assisting or taking care of her grandchildren.

Patient is paralyzed, she cannot do her routunes. She is mostly lying on bed. Her SO, do ROM exercises to the patient.

Because of her condition, pt is unable to perform her activities. Diagnosis: Impaired physical mobility related tto neuromuscular impairmrnt

Value-Belief Pattern

Patient is a Roman Catholic She believes in superstitions and urban legends.

ANATOMY
The respiratory system consists of all the organs involved in breathing. These include the nose, pharynx, larynx, trachea, bronchi and lungs. The respiratory system does two very important things: it brings oxygen into our bodies, which we need for our cells to live and function properly; and it helps us get rid of carbon dioxide, which is a waste product of cellular function. The nose, pharynx, larynx, trachea and bronchi all work like a system of pipes through which the air is funneled down into our lungs. There, in very small air sacs called alveoli, oxygen is brought into the bloodstream and carbon dioxide is pushed from the blood out into the air. When something goes wrong with part of the respiratory system, such as an infection like pneumonia, it makes it harder for us to get the oxygen we need and to get rid of the waste product carbon dioxide. Common respiratory symptoms include breathlessness, cough, and chest pain.

 Nose A nose is a protuberance in vertebrates that houses the nostrils, or nares, which admit and expel air for respiration in conjunction with the mouth.

Mouth The mouth, buccal cavity, or oral cavity is the first portion of the alimentary canal that receives food and begins digestion by mechanically breaking up the solid food particles into smaller pieces and mixing them with saliva. Pharynx The pharynx (plural: pharynges) is the part of the neck and throat situated immediately posterior to (behind) the mouth and nasal cavity, and cranial, or superior, to the esophagus, larynx, and trachea.

Epiglottis The epiglottis is a flap of elastic cartilage tissue covered with a mucus membrane, attached to the root of the tongue. Larynx The larynx (plural larynges), colloquially known as the voicebox, is an organ in the neck of mammals involved in protection of the trachea and sound production. Trachea The trachea, or windpipe, is a tube that connects to the pharynx or larynx, allowing the passage of air to the lungs. Bronchi The trachea (windpipe) divides into two main bronchi (also mainstem bronchi), the left and the right, at the level of the sternal angle at the anatomical point known as the carina.

 Alveoli An alveolus (plural: alveoli, from Latin alveolus, "little cavity") is an anatomical structure that has the form of a hollow cavity.

ASSESSMENT

NURSING DIAGNOSIS
Ineffective breathing pattern r/t decreased lung volume capacity as evidenced by rapid breathing, difficulty of breathing and crackles on both lung fields

PLANNING

INTERVENTION

RATIONALE

EVALUATION

Subjective: nahihirapan ako huminga as verbalized by the patient Objective: -rapid breathing -presence of crackles on both lung fields upon consultation -use of accessory muscles -RR of 28 -cyanosis -orthopnea -profuse sweating

Inference:
Ineffective breathing pattern occurs when inspiration and expiration does not provide adequate ventilation. Pleural inflammation causes sharp localized pain that increases deep of breathing, coughing and movement. This can result to shallow and rapid breathing pattern. Distal airways and alveoli may not expand optimally with each breath, increasing the possibility of atelectasis and impaired gas exchange.

Short Term: * after 3 hours of nursing intervention the patient will demonstrate appropriate coping behaviors and methods to improve breathing pattern. Long Term * after 1 to2 days of nursing intervention, the patient would be able to apply techniques that would improve breathing pattern and be free from s/ sx of respiratory distress

(INDEPENDENT) -establish rapport -monitor and record vital signs -assess breath sounds, respiratory rate, depth and rhythm -elevate head of the patients bed -provide relaxing environment -assist client in the use of relaxation technique -maximize respiratory effort with good posture and effective use of accesory muscle -Encourage adequate rest periods between activities (DEPENDENT) - Administer supplemental oxygen as ordered -Administer prescribed medications as ordered

- To gain pt/ SOs trust and cooperation - To obtain baseline data - To note for respiratory abnormalities that may indicate early respiratory compromise and hypoxia - To promote lung expansion - To promote adequate rest periods to limit fatigue -To provide relief of causative factors - to limit fatigue -To promote wellness - To maximize oxygen available for cellular uptake - For the pharmacological management of the patients condition

Short tem : *The patient shall have demonstrated appropriate coping behaviors and methods to improve breathing pattern. Long term : *The patient shall have applied techniques that improved breathing pattern and be free from signs and symptoms of respiratory distress AEB respiratory rate within normal range, absence of cyanosis, effective breathing and minimal use of accessory muscles during breathing.

ASSESSMENT

NURSING DIAGNOSIS
Ineffective breathing pattern r/t decreased lung volume capacity as evidenced by rapid breathing, difficulty of breathing and crackles on both lung fields Inference:
Impaired gas exchange is a state in which there is excess or deficit oxygenation and carbon dioxide elimination. The compensatory mechanism of lungs is to lose effectiveness of its defense mechanisms and allow organisms to penetrate the sterile lower respiratory tract where inflammation develops. Disruption of mechanical defenses and ciliary motility leads to colonization of lungs and subsequent infection. Inflamed and fluid-filled alveolar sacs cannot exchange oxygen andcarbon dioxide effectively. The release of

PLANNING

INTERVENTION

RATIONALE

EVALUATION

Subjective: nahihirapan ako huminga as verbalized by the patient Objective: -rapid breathing -presence of crackles on both lung fields upon consultation -use of accessory muscles -RR of 28 -cyanosis -profuse sweating

Short Term: * after 3 hours of nursing intervention the patient will demonstrate appropriate coping behaviors and methods to improve breathing pattern. Long Term * after 1 to2 days of nursing intervention, the patient would be able to apply techniques that would improve breathing pattern and be free from s/ sx of respiratory distress

(INDEPENDENT) -establish rapport -monitor and record vital signs -assess breath sounds, respiratory rate, depth and rhythm -elevate head of the patients bed -provide relaxing environment -assist client in the use of relaxation technique -maximize respiratory effort with good posture and effective use of accesory muscle -Encourage adequate rest periods between activities (DEPENDENT) - Administer supplemental oxygen as ordered -Administer prescribed medications as ordered

- To gain pt/ SOs trust and cooperation - To obtain baseline data - To note for respiratory abnormalities that may indicate early respiratory compromise and hypoxia - To promote lung expansion - To promote adequate rest periods to limit fatigue -To provide relief of causative factors - to limit fatigue -To promote wellness - To maximize oxygen available for cellular uptake - For the pharmacological management of the patients condition

Short tem : *The patient shall have demonstrated appropriate coping behaviors and methods to improve breathing pattern. Long term : *The patient shall have applied techniques that improved breathing pattern and be free from signs and symptoms of respiratory distress AEB respiratory rate within normal range, absence of cyanosis, effective breathing and minimal use of accessory muscles during breathing.

DRUG

ACTION

INDICATION
To prevent and treat gastric and duodenal ulcers, gastroesophageal reflux and stress ulcers; prevention of ulcer recurrence.

COMMON SIDE EFFECTS

Dizziness, headache, rashes, GI disturbances, fatigue, thirst.

NURSING RESPONSILITIES
Assessment 1. Lab Test: Monitor urinalysis for hematuria and proteinuria. Periodic liver function test with prolonged use. Intervention 1. Administer before meals. Caution patient to swallow capsules wholenot to open, chew, or crush them. Administration ORAL -Give before food, preferably breakfast; capsules must be swallowed whole( do not open, chew, or crush) Health Teaching 1.If using oral suspension, empty packet into a small cup containing 2 tbsp of water. 2. Stir and have patient drink immediately; fill cup with water and have patient drink this water. Do not use any other diluents. 3. Report any changes in urinary elimination such as pain or discomfort associated with urination, or blood in urine. 4. Report severe diarrhea, drug may need to be discontinued. 4. Do not breastfeed while taking this drug.

GENERIC NAME: Omeprazole

BRAND NAME: Omepron

Drugs that decrease gastric acid secretion by inhibiting the enzyme hydrogen/potassium ATPase in gastric parietal cells.

CLASSIFICATION: Proton pump inhibitors

DRUG
Generic Name: Ranitidine Hydrochloride Brand Name: Zantac Class: Histamine2 antagonists

ACTION
inhibits the action of histamine at the H2 receptors of the parietal cells of the stomach, inhibiting basal gastric acid secretion and gastric acid secretion that is stimulated by food, insulin, histamine, cholinergic agonists, gastrin and pentagastrin.

INDICATION
Short-term treatment of active, benign gastric ulcer

COMMON SIDE EFFECTS

CNS: headache, malaise, dizziness, somnolence, insomnia, vertigo CV: tachycardia, bradycardia Dermatologic: rash, alopecia GI: constipation, diarrhea, nausea and vomiting, abdominal pain, hepatitis GU: impotence or decreased libido Hematologic: leucopenia, granulocytopenia, thrombocytopenia, pancytopenia

NURSING RESPONSILITIES
Assessment: 1. History: allergy to ranitidine, impaired renal or hepatic function, lactation, pregnancy. 2. Physical: skin lesions, orientation, affect, liver evaluation, abdominal examination, normal output, renal function tests, CBC Interventions: 1. Administer oral drug with meals and at bedtime. 2. Decrease doses in renal and liver failure. 3. Provide concurrent antacid therapy to relieve pain. 4. Administer IM dose undiluted, deep into large muscle group. 5. Arrange for regular follow-up including blood test, to evaluate effects. Administration: 1.Given orally with or without food. Available in 75mg, 150mg, 300mg tablets. 150 and 300 mg capsules; 15/ml syrup; 0.5/ml, 25mg/ml injection.

Maintenance therapy for duodenal ulcer at reduced dosage. Short-term treatment for GERD. Pathologic hypersecretory conditions (Zollinger-Ellison syndrome) Treatment of erosive esophagitis heartburn, acid indigestion, sour stomach

Health Teaching 1. Note long duration of action, provides ulcer pain relief that is maintained through the night as well as the day. 2. Be aware that even if symptoms relief is provided by ranitidine, this should not be interpreted as absence of gastric malignancy. Follow up examinations will be scheduled after therapy is continued. 3. Adhere to schedule periodic laboratory check ups during ranitidine treatment. 4. Do not supplement therapy with OTC remedies for gastric distress or pain without physicians advice. 5.Do not smoke; research shows smoking decreases ranitidine efficacy and adversely affects ulcer healing. 6.Do not breastfeed while taking this drug without consulting physician.

DRUG

ACTION

INDICATION

COMMON SIDE EFFECTS

NURSING RESPONSILITIES

Generic Name: SALBUTAMOL Brand Name: VENTOLIN Classification:

bronchodilators, anti-asthmatic

Is a beta2adrenergic agent which acts on airway smooth muscle resulting in relaxation. Salbutamol relaxes all smooth muscle from the trachea to the terminal bronchioles and protects against all bronchoconstrictor challenges

Treatment/ prevention of bronchospasm

Tachycardia Dizziness Palpitations headache, especially in hypersensitive patients Cough Headache Nervousness Sinus inflammation Sore or dry throat Tremor Trouble sleeping Unusual taste in mouth Vomiting Paradoxical bronchospasm Hypokalemia Immediate hypersensitivtity reaction

Instruct the patient on the how to use the nebulizer. Instruct the patient on the frequency of nebulization. Instruct the patient what to do during the asthma attack. .

DRUG

ACTION

INDICATION

COMMON SIDE EFFECTS

Diarrhea, nausea, abdominal cramps, weakness.

DRUG TO DRUG INTERACTION

Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: antacids containing aluminum and/or magnesium, other laxatives.

NURSING RESPONSILITIES
Assessment 1.Assess condition before therapy and reassess regularly thereafter to monitor drugs effectiveness 2.Monitor pt for any adverse GI reactions, nausea, vomiting, diarrhea, 3.Assess for adverse reactions for pt. with hepatic encelopathy: regularly assess mental condition Intervention 1.Monitor I & O 2. Monitor for Inc. glucose level in diabetic pts. 3. Promote fluid intake (1500-2000ml) during drug therapy for constipation; older adults often self-limit liquids.

GENERIC NAME: Lactulose BRAND NAME: Duphalac CLASSIFICATION; Laxatives

Drugs that promote bowel evacuation by a wide variety of actions.

To treat constipation; also used to prepare bowel for certain diagnostic procedures, like colonoscopy.

Administration ORAL -Give with fruit juice, water or milk to increase palatability. Laxative effect is enhanced by taking with ample liquids. Avoid meal times. RECTAL -Administer as a retention enema via a rectal balloon catheter. If solution is evacuated too soon installation may be promptly repeated. -Do not freeze. Avoid prolonged exposure to temperatures above 30 degrees or to direct light. Health Teaching 1. Laxative action is not instituted until drug reaches the colon, therefore, about 24-48 H is needed. 2.Do not self medicate with other laxative due to slow onset of drug. 3. Notify physician if diarrhea exist. Diarrhea is a sign of overdosage. 4. Do not breastfeed while taking the medication.

M-MEDICATION Explain the purpose,dosage, schedule and route of administration of any prescribed drugs as well as side effects to report to the physician or nurse.Instruct the watcher to refer any abnormalities about the pt. to the nurse or physician toprevent complications. (The patient is not yet discharged and there were no PO medsgiven in the hospital except for IVTT meds).Outpatient medication therapy is directed at the underlying etiology of the effusion.A social services professional should be consulted when a patient cannot affordprescribed medications E-EXERCISE The patient is advised to take rest after discharge in order to prevent injury and toregain strength. The site of effusion needs proper attention and careful not to bestrained. The patient is not advised to do hard and stressful work yet he can still takewalking exercise that he is capable of doing.

T-TREATMENT Patient is advised to consult his physician if he cannot afford the treatment. It is bestthat the health care provider is aware so that he can make adjustments. Instructsignificant others to monitor patients condition. -HEALTH TEACHINGS Teach the significant others on the simple pathology and physiology of the disease tohelp them understand and to clarify misconceptions of the disease. Discuss the possiblecauses of the disease,prognosis,and describe the disorder. Demonstrate to significantothers the proper wound care,administration of medicines and how to care for thepatient. Explain the effects of the treatment of the patient and what to do when sideeffects occur. Aware the patient and significant others the importance of knowing the Do's and Don'ts while the effusion is still present. Determine the patient's expectationsto alleviate fear and anxiety.

OUT-PATIENT CHECK-UP Follow-up with the patient's primary care physician or a pulmonary specialist within 2-3days is advisable ,especially if thoracentesis is deferred.If early follow-up seems unlikely,the patient should be given clear instructions to returnto the ED in 2-3 days for reevaluation.Patient is instructed to have a regular check up in the hospital if there are any signs of complications of risks and if there is also improvement or progress regarding his case. DIET Instruct patient's family,significant other to follow recommended diet provided by her dietician if any. SPIRITUAL Patient's family is very religious that is why we always continue to encourage him toremain that faithful and strong to God. Continue praying and reading the bible and never forget that during times of difficulties ,God carries our burden. It is about putting our trust in him and never giving up.