IV.

MEDICAL MANAGEMENT
a. Medical Orders with Rationale
Date

Order

Rationale

12/2/14

Pls. Admit to Rec under the

service of DR. Gamolo

-For constant monitoring by hospital staff and

for prompt rendering of nursing care and
isolation

Secure consent to care and

mgt.

-For legal purposes which provides and

protects patients with his due right

Diet as tolerated

-To maintain nutritional supplementation

IVF: D5LR @ 20gtts/min

- Provides some calories; replace electrolytes

and extracellular fluid losses; mild to
moderate acidosis

Monitor V/S q4 until stable

-For constant monitoring of cardinal

measurements, especially patients RR

LABS:
CBC
Platelet count

12/2/14

-CBC is ordered to determine blood

component levels including platelet, the
clotting factor of the blood.

Chest X ray PA

-In primary TB, an X-ray will show an

abnormality in the mid and lower lung fields,
and lymph nodes may be enlarged.

Sputum Acid-Fast Bacilli x 2

- The test is ordered to detect infections

caused by acid-fast bacteria in a person.
Several species of the mycobacterium family
cause TB in humans and animals.

MEDICATIONS:
Paracetamol 500 mg tab q4
for fever
Acetylcysteine 600mg 1 tab to
dissolve in glass water OD
@hs

- Treatment of fever.
- Used for treatment of respiratory affections
characterized by thick and viscous hyper
secretions

Hook O2 @2lpm via nasal

cannula

Oxygen therapy
supplemental oxygen to
breathing disorders

provides
people
with

I&O q shift

-To monitor body fluid status.

Refer Accordingly

- For further care & management

10

Date
12/3/14

12/4/14

Order
Start Cefriaxone (Noxoram) 1g
IVTT q8 ANST ( )

Rationale
- For the treatment of the infections
(respiratory, skin, soft tissue, UTI, ENT)

Start QUADTAB 3tabs

pc breakfast

- For the initial phase treatment of all forms of

pulmonary and extrapulmonary tuberculosis.

Mosegor Vita 1 tab OD

- Lack of appetite associated w/ vitamin B

deficiency secondary to impaired dietary
intake or absorption

Secure 2U of PRBC of
patients blood type & after
proper cross matching, run for
4 hours for each unit

- Replacing and maintaining oxygen carrying

capacity of the blood

Sputum C/S

- To detect bacteria and fungi (yeasts, molds)

Creatinine

- A serum creatinine test measures the level of

creatinine in your blood and gives you an
estimate of how well your kidneys filter
(glomerular filtration rate)

Serum
glutamic
pyruvic
transaminase (SGPT)

- Measures the level of ALT enzyme in your

blood

Na

- Measures the amount of sodium in the blood.

Potassium

- To measure the amount of potassium in your

blood.

Alkaline Phosphatase
Continue other meds

- Measures the amount of the enzyme ALP in

the blood.

Patient to wear mask at all

times

- To contain the micro-organisms

IVFTF: D5LR1L @20gtts/min

- To continue to provide some calories;

replace electrolytes and extracellular fluid
losses; mild to moderate acidosis
- Benefits of treatment on individual patient
morbidity and mortality

For HIV Testing

For Counseling prior to test

- Provides a frame of reference

Dr. Oporto to cover for me

while Im out of town

- For further care & management

IVFTF: D5LR1L @20gtts/min

- Provides some calories; replace electrolytes

11

and extracellular fluid losses; mild to moderate

acidosis
12/5/14

- No new Doctors Order yet - Last day of Duty -

b. Laboratory / Diagnostic Exam

HEMATOLOGY REPORT - December 2, 2014
Test

Results

Normal Value

Analysis

Hemoglobin

7.0 g/dL

13.70 16.70

Decreased
Insufficient oxygen circulating in the
bloodstream; Indicates Anemia;
Hyperhydration

Hematocrit

21.0

40.00 49.70

Decreased
Insufficient oxygen circulating in the
bloodstream; Indicates Anemia
Hyperhydration

WBC

13.3
x10^9/L

5.0 10.0

Increased Leukocytosis indicates infection

RBC

2.4
x10^12/L

3.69 - 5.90

Decreased; Anemia;
Hyperhydration

Platelet Count

320

150 - 450

Normal

Neutrophils

87.80

54.0 - 62.0

Increased; Acute bacterial infection

Lymphocytes

5.30

20.0 - 40.0

Decreased; Low absolutely lymphocyte

concentration, associated with increase rates
of infection

Eosinophils

0.00

1.0 - 6.0

Initial stage of inflammation

Severe septic infection; State of shock

CHEMISTRY REPORT - December 3, 2014

12

Test

Results

Normal Value

Analysis

Potassium

110 g/L

140 170 g/L

Low:
Hypokalemia can occur
if someone has diarrhea
and vomiting or if is
sweating excessively

Sodium

0.33

0.40 0.50

low level of blood

sodium is usually due to
loss of too much
sodium, too much water
intake or retention, or to
excess fluid
accumulation in the
body (edema).

SGPT (ALT)

15.2 x 10

5.0 10.0 x 10

High:
due to a viral infection

Creatinine

0.78

0.45 0.65

Increased creatinine
levels in the blood
suggest diseases or
conditions that affect
kidney function

Alkaline
Phosphatase

0.21

0.25 0.40

Low:
Malnutrition
Protein Deficiency

XRAY REPORT December 3, 2014

Impression: Minimal right pleural effusion and/or thickening. Intercurrent

pneumonia not totally ruled out. Convex Density, right Paratracheal area,
which could be vascular.

13

HISTOPATHOLOGY REPORT November 22, 2014

Impression:

Cellular findings suggestive of granulomatous lymphadenopathy with

caseation necrosis.
Comment: To consider tuberculous etiology.

CT-SCAN REPORT November 1E, 2014

Impression:

Multiple matted lymph nodes in the right supraclavicular region,

partially compressing the right internal jugular vein with enlarged mediastinal
lymphadenopathies. The findings may represent a chronic granulomatous
infection such as tuberculosis versus that of malignancy such as lymphoma.
Suggest clinical correlation.

Pansinusitis
SONOGRAPHY REPORT November 12, 2014

Impression:
Multiple Cervical Lymphadenopathy, Bilateral

14

DRUG STUDY
GENERIC
NAME OF
ORDERE
D DRUG
Paraceta
mol

BRAN
D
NAME

DATE
ORD
ERE
D:

CLASSIFI
CATION

DOSE/F
REQUE
NCY
ROUTE

MECHANISM OF
ACTION

SPECIFIC
INDICATIO
N

CONTRA
INDICATI
ON

SIDE
EFFECTS/TOXIC
EFFECTS

NURSING
PRECAUTION

12/02
/14

Analgesic
s

500 mg.
1 tab q4

Decreases fever
by inhibiting the
effects
of
pyrogens on the
hypothalamus
heat
regulating
centers & by a
hypothalamic
action leading to
sweating
&
vasodilatation.

Relief
of
mild-tomoderate
pain;
treatment
of fever.

Hypersen
sitivity

Stimulation,
drowsiness, nausea,
vomiting, abdominal
pain, hepatotoxicity,
hepatic
seizure(overdose,
Renal failure(high,
prolonged doses),
leucopenia,
neutropenia,
hemolytic
anemia
(long
term
use)
thrombocytopenia,
pancytopenia, rash,
urticaria,
hypersensitivity,
cyanosis,
anemia,
jaundice,
CNS,
stimulation, delirium
followed by vascular
collaps, convulsions,
coma, death.

Assess
patients
fever or pain: type of
pain,
location,
intensity,
duration,
temperature,
and
diaphoresis.

Muscle
Relaxants

Relieves pain by
inhibiting
prostaglandin
synthesis at the
CNS but does not
have
antiinflammatory
action because of
its minimal effect
on
peripheral
prostaglandin
synthesis.

intoleran
ce
to
tartrazine
(yellow
dye #5),
alcohol,
table
sugar,
saccharin
Contrain
dicated
with
allergy to
acetamin
ophen

Assess
allergic
reactions:
rash,
urticaria; if these
occur, drug may have
to be discontinued.
Teach
patient
to
recognize signs of
chronic
overdose:
bleeding,
bruising,
malaise, fever, and
sore
throat.
Tell patient to notify
prescriber for pain/
fever lasting for more
than 3 days.

GENERIC
NAME OF
ORDERE
D DRUG

BRAN
D
NAME

DATE
ORD
ERE
D:

CLASSIFI
CATION

DOSE/F
REQUE
NCY
ROUTE

MECHANISM OF
ACTION

SPECIFIC
INDICATIO
N

CONTRAINDI
CATION

SIDE
EFFECTS/TO
XIC EFFECTS

NURSING
PRECAUTION

ACETYLC
YSTEINE

FLUIM
UCIL

12/2/
14

Antidote,
Mucolytic

600mg
Exerts an intense
1tab OD mucolytic action
HS
on mucous and
mucopurulent
secretions,
by
depolymerizing
the mucoproteic
complexes
and
the nucleic acids,
which
confer
viscosity to the
vitreous
and
purulent
component of the
sputum and of
other secretions.

used
for
treatment
of
respiratory
affections
characteriz
ed by thick
and
viscous
hyper
secretions,
chronic
bronchitis
and
exacerbati
on;
pulmonary
emphysem
a,
mucoviscid
osis
and
bronchiect
asis.

>MAO inhibitor
therapy within
14days
initiating
therapy.

stomatitis, nau
sea,
vomiting, fever
, rhinorrhea,
drowsiness,
clamminess, c
hest tightness
and
bronchoconstri
ction.

monitor effectiveness
of
therapy
and
advent of adverse
effects.

>severe
hypertension

>Coronary
artery disease,
hypersensitivit
y
due
to
pseudoedephri
ne, acrivastine
or
any
component.

>instruct patient in
appropriate use and
adverse effects to
report.

>assess the patients

vital signs

>bronchial

tapping

>monitor
bronchospasm
>renal
impairment

for

GENERI
C NAME
OF
ORDERE
D DRUG

BRA
ND
NAM
E

DATE
ORD
ERE
D:

CLAS
SIFIC
ATION

DSE
/FQ
Y/RT
E

MECHANISM OF ACTION

SPECIFIC
INDICATI
ON

CONT
RAINDI
CATIO
N

SIDE
EFFECTS/TO
XIC EFFECTS

NURSING
PRECAUTIO
N

Rifampici
n
+
isoniazid
+
Pyrazina
mide
+
Ethambut
ol HCl

Qua
dtab

12/03
/14

Antitu
bercul
osis

3tab,
pc
brea
kfast

Rifampicin

For
the
initial
phase
treatment
of
all
forms of
pulmonary
and
extrapulm
onary
tuberculos
is.

Hypers
ensitivit
y
to
any
ingredi
ent in
the
product

fever,
chills,
sometimes
with headache,
dizziness, and
bone
pain);
hematopoietic
reactions (i.e.,
leukopenia,
thrombocytope
nia, and acute
hemolytic
anemia);
cutaneous;
gastrointestinal
and
hepatic
reactions;
dyspnea,
wheezing;
shock;
and
acute
renal
failure.

Read
the
medication
label 3 times

Rifampicin, a semisynthetic antibiotic

derivative of Rifamycin, suppresses bacterial
RNA synthesis by binding to the b subunit of
DNA-dependent RNA polymerase, thus
inhibiting the attachment of the enzyme to
DNA, blocking RNA transcription, elongation,
and subsequent translation to protein. It
does not inhibit the counterpart mammalian
enzyme.
Rifampicin has bactericidal action and potent
sterilizing effect against both intracellular
and extracellular tubercle bacilli. Cross
resistance has been shown only with other
rifamycin derivatives.
Isoniazid
Isoniazid kills actively growing tubercle
bacilli by inhibiting the biosynthesis of
mycolic acid which is the major component
of
the
cell
wall
of Mycobacterium
tuberculosis. It is active against susceptible
bacteria only when they are undergoing cell
division.
Pyrazinamide
Pyrazinamide is the pyrazine analog of
nicotinamide. The precise mechanism of

Jaundic
e
or
severe
liver
disease

Acute
gout

Preexisting
optic
neuritis
from
any
cause

headache,
drowsiness,
fatigue,
dizziness,
Seizures,
convulsions,
toxic
encephalopath

Provide
adequate
information
about
the
drug

Assess
for
any condition
which
requires
precaution or
contraindicati
on

Assess
for
any possible
interaction

Provide
adequate
information

action of pyrazinamide is unknown. Its

metabolite, pyrazinoic acid, which is less
active in vitro, may possibly be involved in
pyrazinamides in vivo activity.
Pyrazinamide is an effective bactericidal
antituberculosis drug, and has a specific
sterilizing action against Mycobacterium
tuberculosis in the intracellular environment
of macrophages. The acid environment
presumably
in
some
way
makes Mycobacterium
tuberculosis more
susceptible to pyrazinamide, but this does
not occur with Mycobacterium bovis which is
resistant to the drug. As with other
antituberculous
drugs,
resistance
to
pyrazinamide develops rapidly if it is used
alone to treat human tuberculosis.
Ethambutol HCl
Ethambutol HCl diffuses into actively
growing Mycobacteria cells such as tubercle
bacilli. It inhibits the synthesis of one or
more metabolites resulting in impaired
cellular
metabolism,
arrested
cell
multiplication and cell death. It is active
against susceptible bacteria only when they
are undergoing cell division. No crossresistance with other agents has been
demonstrated.

y, stupor,

about
drug

the

GENERIC
NAME OF
ORDERE
D DRUG

BRAN
D
NAME

DATE
ORD
ERE
D:

CLASSIFI
CATION

DOSE/F
REQUE
NCY
ROUTE

MECHANISM OF
ACTION

SPECIFIC
INDICATIO
N

CONTRAI
NDICATIO
N

SIDE
EFFECTS/TOXIC
EFFECTS

NURSING
PRECAUTION

Pizotifen
hydrogen
maleate,
Vitamin B
complex,
Nicotinami
de

Moseg
or Vita

12/03
/14

Appetite
enhancers

1
OD

A coenzyme that
stimulate
metabolic
function and is
needed for cell
replication,
hematopoiesis,
nucleoprotein and
myelin synthesis.

Lack
of
appetite
associated
w/ vitamin
B
deficiency
secondary
to impaired
dietary
intake
or
absorption

Contraindi
cated in
patient
hypersens
itivity
to
products
derived
from
mammal
cells
or
albumin
(human)
and
in
those with
uncontroll
ed
hypertensi
on.

CNS:
asthenia,
dizziness, fatigue,
headache,
paresthesia,
seizures.

Obtain sensitivity test

history
before
administration

tab

CV:
edema,
hypertension,
increased clotting
of
arteriovenous
grafts.

Avoid
IV
administration
because
faster
systemic elimination
will
reduce
the
effectiveness
of
vitamin.

GI: abdominal pain

and constipation (in
children) diarrhea,
nausea, vomiting.

Dont
give
large
doses of vitamin B 12
routinely; drug is lost
through excretion.

MUSCKULOSKEL
ETAL: arthralgia
RESPIRATORY:
cough, shortness of
breath.
SKIN: infection site
reactions,
rash,
urticaria

GENERIC
NAME OF
ORDERE
D DRUG

BRAN
D
NAME

DATE
ORD
ERE
D:

CLASSIFI
CATION

DOSE/F
REQUE
NCY
ROUTE

MECHANIS
M
OF
ACTION

SPECIFIC
INDICATION

CONTRAIN
DICATION

SIDE
EFFECTS/TOXIC
EFFECTS

NURSING
PRECAUTION

Ceftriaxon
e

Noxora
m

12/03
/14

Antibiotic

1gram

Bactericidal;

Allergy

CNS: Lethargy

>check IV site for

IVTT q8

inhibits

ANST

synthesis of

(-)

bacteria

For
the
treatment of the
infections
(respiratory,
skin, soft tissue,
UTI,
ENT)
caused by S.
pneumoniae, H.
influenzae,
staphylococci,
S.
pyogenes
(group A betahemolytic
streptococci), E.
coli, P. mirabilis,
Klebsiella
sp,
coagulasenegative staph

on

the cell wall

causing
death

cell

to

cephalospor
ins

CV: heartfailure
GI: gastritis
Hypersensitivity:
Rashes, fever

signs of thrombosis
>culture infected area
>check for reaction of
allegy to drug
> check the site of
infection.