SYSTEMS PLUS COLLEGE FOUNDATION Balibago, Angeles City College Of Nursing S.Y.

2012-2013

In Partial Fulfillment Of the Requirements in NCM 104 RLE

Drug Study
Submitted To: ARISTOTLE A. PARICO, RN, MAN

Submitted By: MA. CRESENCIA S. BUENAFE NUR60A

1. Captopril
NAME OF THE DRUG DATE ORDERED DATE STARTED DATE CHANGED DATE DISCONTINUED DO: February 12,2012 DS: February 12, 2012 ROUTE OF ADMINISTRATION DOSAGE AND FREQUENCY OF ADMINISTRATION 25mg/tab tab BID given at 8am GENERAL ACTION INDICATION CLIENTS RESPONSE WITH ACTUAL ADVERSE REACTIONS The patient maintained the BP of 90/70

GENERIC NAME: Captopril BRAND NAME: Capoten

angiotensin converting enzyme (ACE) inhibitors

It is given to the patient to manage hypertension and heart failure

Nursing Responsibilities: Assess for history of allergy to captopril and history of angioedema. Monitor BP and PR before administer Monitor for sudden blood pressure drop Watch out for excessive perspiration, or diarrhea; may cause hypotension Monitor vital signs. Record medication after administering.

2. Metoprolol
NAME OF THE DRUG DATE ORDERED DATE STARTED DATE CHANGED DATE DISCONTINUED DO: February 12,2012 DS: February 12, 2012 ROUTE OF ADMINISTRATION DOSAGE AND FREQUENCY OF ADMINISTRATION 50 mg tab BID given @ 8am GENERAL ACTION INDICATION CLIENTS RESPONSE WITH ACTUAL ADVERSE REACTIONS The patient did not experience angina pectoris.

GENERIC NAME: Metoprolol BRAND NAME: Lopressor

Metoprolol is a beta-adrenergic blocking agent that is used for treating high blood pressure, heart pain, abnormal rhythms of the heart, and some neurologic conditions.

It was given to Marimar because of heart pain (angina pectoris) Since it occurs when oxygen demand of the heart muscle exceeds the supply of oxygen, metoprolol, by reducing the demand for oxygen, is helpful in treating heart pain.

Nursing Responsibilities: Take drug with meal if GI upset occurs. Do not discontinue drug if not told to do so by a health care provider. Avoid driving or dangerous activities if dizziness occurs. Side effects include dizziness, light-headedness, and loss of appetite, nightmares, depression and sexual impotence. Report difficulty breathing, night cough, swelling of extremities, slow pulse, confusion, depression, rash, fever and sore throat.

3. Morphine Sulfate
NAME OF THE DRUG DATE ORDERED DATE STARTED DATE CHANGED DATE DISCONTINUED DO: February 12,2012 DS: February 12, 2012 ROUTE OF ADMINISTRATION DOSAGE AND FREQUENCY OF ADMINISTRATION 0.4 cc/IV PRN GENERAL ACTION INDICATION CLIENTS RESPONSE WITH ACTUAL ADVERSE REACTIONS The patient was relieved from chest pain after the administration of the st 1 dose

GENERIC NAME: Morphine Sulfate BRAND NAME:

Opioid agonist analgesic

Astramorph PF, Duramorph

It is given to the patient for the Relief of moderate to severe acute and chronic chest pain.

Nursing Responsibilities: Avoid alcohol and any CNS depressants while receiving morphine. Do not use OTC drugs unless approved by a physician. Do not smoke or ambulate w/o assistance after receiving drugs. Bedside rails are advised. Use caution or avoid tasks requiring alertness (e.g. driving a car) until response to drug is known since morphine may cause dizziness, drowsiness or blurred vision. Do not breast feed while taking this drug.

SYSTEMS PLUS COLLEGE FOUNDATION Balibago, Angeles City College Of Nursing S.Y. 2012-2013

In Partial Fulfillment Of the Requirements in NCM 104 RLE

Nursing Care Plan

Submitted To: ARISTOTLE A. PARICO, RN, MAN

Submitted By: MA. CRESENCIA S. BUENAFE NUR60A

Problem: Activity Intolerance Related to Imbalance between Oxygen Demand and Supply
Cues Nursing Diagnosis Subjective: Madali ako mapagod. Konting galaw ko lang nanghihina ako. Activity intolerance related to imbalance between Scientific Explanation Due to the altered function of the heart, there is decreased After 6 hours of Nursing Interventions, the patient will achieve measurable increase in activity intolerance evidenced by reduced fatigue and weakness and by vital signs within acceptable limits. 2. Provided assistance in performing morning care. Intersperse activity periods with rest periods. 2. Meet patients personal care needs without undue myocardial stress/excessive oxygen demand. 2. The patient was refreshed and felt relieved and did not have increased oxygen demand 1. Monitored Vital signs and cardiopulmonary 1. Compromised myocardium/ 1. The patients BP was 90/70 RR of 24 Objectives Nursing Interventions Rationale Evaluation

response to activity and inability to increase rest. stroke volume during activity may cause an increased amount in heart rate and oxygen demand thereby aggravating weakness and fatigue.

oxygen demand tissue perfusion and supply as evidence by to the systemic circulation resulting to decreased oxygen supply leading to decreased activity intolerance.

Objective: -With pallor -with muscle grade of 2/5 -with RR of 24 cpm -with ECG result of: PR- 0.30 seconds QRS - 0.06 seconds

verbal report of weakness and easy fatigability.

QT - 0.26 seconds

3. Administered medications like Captopril 25mg tab BID Metoprolol 50mg tab BID

3. Pain medications were given for relief from chest pain.

3. The patient did not experience chest pain.

4. Assessed for other precipitators/causes of fatigue e.g. treatments, pain and medications

4. Fatigue is a common side effect of medications. Pain and stressful regimens also extract energy and produce fatigue.

4. The patient did not manifest fatigue but appears weak

5. Assisted on ECG @ 9:20am

5. To Monitor for any dysarrythmias.

5. The ECG results were interpreted as follows: PR- 0.30 seconds QRS - 0.06 seconds

6. Provided gradual cardiac rehabilitation/ activity program like breathing exercises, sitting while brushing teeth and use wheelchair when going to the bathroom.

6. Strengthens and improves cardiac function under stress. If cardiac function is irreversible. Gradual increase in activity avoids excessive myocardial workload and oxygen consumption.

6. The patient cooperated with the activity program.