I.

PATIENT’S PROFILE

Name: Patient TJB

Sex: Female
Birth date: April 17, 1989
Birth place: Baguio City, Philippines
Ethnicity: Ibaloi
Educational Attainment: College level
Home Address: San Carlos Heights Baguio City
Religion: Roman Catholic
Civil Status: Single
Nationality: Filipino
Occupation: Not applicable
Chief Complaint: Body weakness
Admitting Diagnosis: Non-Hodgkin’s Lymphoma
Date of Admission: August 01, 2010

A. History of Present Illness

On the second week of May 2010, the client and her family noticed that she lost a significant
amount of weight. The amount however cannot be recalled. She also noticed that her abdomen has
bloated and felt that it has hardened. Aside from these, her older brother noticed a mass behind her left
ear. These prompted her to seek consultation at the Baguio General Hospital and Medical Center. The
mass behind her left ear was removed for biopsy. After 4 days of confinement, she was diagnosed with
Non-Hodgkin’s Disease.
She has had 2 cycles of Chemotherapy in the past months. The specific dates of which cannot be
recalled.
On July 29, 2010, the client went to her private physician for regular check-up. Complete Blood
Count and Urinalysis were done and it was found out that her RBC and WBC counts were extensively
low. Her doctor then advised her for Blood Transfusion and Granulocyte-colony stimulating factor.
Consequently, she was admitted on August 01, 2010 at the Baguio General Hospital and Medical Center.

B. Past History of Illness

According to the client, she has not been confined for any other illness before. She verbalized
however, that her mother told her that she had Asthma as a child but does not recall if she has been
confined because of it.

C. Family Health History

The client’s mother died in 2009 because of breast cancer. According to the client and her sister,
no other members of their family have had or have Non Hodgkin’s Disease. Also their paternal
grandmother has Hypertension. Other than these, both sides of her family has no history of any other
hereditary disease such as Diabetes Mellitus or Asthma.
II. THIRTEEN AREAS OF ASSESSMENT

1. Psychosocial Status

a. General Social Status

The client is a native of Baguio City and belongs to the Ibaloi tribe. She was supposed to be a
fourth year Education student at the University of the Cordilleras.
The client is compensated by her father’s and older siblings’ income.
She is a member of the Catholic Church. Their religion does not pose any objections in health
care interventions. The client and her family are open to conventional medical practices such as blood
transfusions, immunizations and surgery. She and her family do not practice traditional medicine such as
hilot.
She is currently confined in the Medical Ward. She is not a PhilHealth member.

b. Family/ Peer Group Social Status

The client is single. She is the third child of 4 siblings. She lives with her father and her siblings. It
has been observed that all of the client’s family members are involved in her care. Her father, older
siblings and other relatives help with the finances. The client’s younger sister even asks the student
nurses and other members of the health care team about the client’s condition, appropriate foods her
sister must eat, and what other things they can do to help the client.

c. Social Development Status

The client is a 21 year old female. Prior to illness, she was able to perform ADLs independently.
She was a full time student and was an active member of the church.
Now however, she is able to perform ADLs with assistance and is unable to ambulate. She
spends her time mostly at home and in the hospital.
The client often prefers lying on bed, taking naps and reading newspapers. She however
exchanges stories with her brothers and sisters whenever she is in the mood.
She has never been pregnant.

2. Mental and Emotional Status

a. Mental Status
The client is conscious and responds coherently to questions. She is well oriented to date, time
and place. She is able to develop leisure time activities in her own way such as reading and chatting with
siblings and members of the health team. She is able to relate to her siblings and other individuals and
is able to adjust to psychological changes that come with age. She is good in carrying out instructions
and has excellent memory when it comes to medical and nursing regimen. She fully understands the
purpose of the interventions done. She adheres to her physicians’ orders. She listens to teachings from
the health team and adds relevant data that she knows. The client has no apparent fear of
hospitalization.

b. Emotional Status
She is friendly and cooperative to other members of the health team. She has appropriate
affect. She is approachable and responds respectfully when asked questions but does not hesitate to
express discontent or irritation whenever she is dissatisfied, disturbed or feels uncomfortable.

3. Environment Status

a. Safety Factors
The client is unable to ambulate and she needs assistance in doing ADLs. There were no side
rails present on her bed. Supervision and assistance must be provided by relatives and members of the
health care team. She must be placed on a wheelchair when transported to one place to another.
 b. Infection Control
The client is immunosuppressed and thus was ordered by the physician to be on reverse
isolation. She is exposed to a lot of other patients and individuals with communicable diseases. The
client’s family members and members of the health care team wear masks and make sure that they
practice aseptic techniques when handling the client such as proper hand washing before and after
handling the client and using disinfected equipment on the client (thermometer).

c. Environmental Effects of Illness

Due to her illness, the client’s pattern of activities has been modified. Before, she was an active,
full-time student. Her activities were limitless. Now however, she has weakened and must comply with
the treatment regimen. She spends most of her days lying or sitting on her bed since she is unable to
ambulate, and as her past time, she reads or converses with her family members and the health team.

4. Sensory Status

The client has verbalized no difficulties seeing, hearing, smelling, tasting, or perceiving
sensations.

a. Visual Status
She does not wear any eye glasses. She does not complain of any blurring of vision, blind spots
or flashing lights. Her pupils are equally round and reactive to light and accommodation.
b. Auditory Status
She is able to distinguish sounds on both ears. She can hear and understand what a person is
saying about 10 feet away. No discharges have been noted, aside from few amounts of cerumen.
She does not hear any ringing or buzzing and does not use any hearing aids or any other corrective
devices.

c. Olfactory Status
The client is also able to discriminate odors. There were no reports of diminished ability to
smell, heightened sensitivity to smell, or smelling odors with no stimulus/stimuli present. No lesions
are seen on or in the nose.

d. Gustatory Status
She is able to discriminate different tastes (sweet, sour, salty, and bitter). She does not report
any unusual sensations such as lack of taste, after taste or that substances taste alike.

e. Tactile Status
There are no reports of numbness in any part of the body. She is able to discriminate light and
firm touch. She is able to perceive heat, cold and pain in proportion to stimulus.

f. Speech Formulation and Perception

The client’s speech organs are intact. Her words are audible and her sentences are easily
comprehensible. No stammering or slurring has been noted.

5. Motor Status
The client has a motor strength of 2/5 in her lower extremities. She is able to move with support
against gravity. She is unable to ambulate. She needs to be carried or placed on a wheelchair when she
needs to be transferred from one place to another. She cannot stand alone and cannot stand upright.
She must be helped when assuming a sitting or other positions. She however can maintain a sitting
position on her own.
On the other hand, the client has a motor strength of 3/5 in her upper extremities. She is able to
move against gravity. She is able to feed herself using a spoon and a fork. She is able to lift light objects
for a short period of time such as newspapers, other reading materials, and a cup or a juice container
containing about 150-250mL of fluids.
 3/5 3/5

2/5 2/5
6. Nutritional Status
Prior to illness, the client was able to eat 3 full meals a day with snacks in between. Her meals
were composed of bread, rice, fish, meat and vegetables. She was able to consume 100% of food
served.
Now however, she is still able to eat 3 meals a day with snacks in between. Some of her meals
are prepared in the hospital and some are prepared at home. These are composed of meat or fish and
vegetables. She sometimes eats fruits for snacks. She drinks about 800-1000mL of fluids per day. She is
only able to consume about 50-80% of food served. She eats very slowly. It takes her about 1-2 hour/s
to finish what she can.
She appears emaciated. From her last check-up, her weight went down from 47kg to 36kg.
She does not report any difficulties in swallowing. All her teeth are intact. She is able to brush
her teeth at least twice a day while she is assisted by her sister.
She does not complain of any difficulties in digestion, nausea and vomiting.
In the hospital, she was administered 5% Dextrose in Normal Saline Solution and Plain Normal
Saline Solution together with packed RBCs when doing blood transfusions.
During the course of confinement, she has received 2 units of packed RBCs.

7. Elimination Status
Prior to illness, the client was able to urinate about 2-4 times a day. She was able to defecate
once every day or every other day.
The client verbalized that her illness has not affected her elimination pattern. Her stools are
formed and are dark brown in color.
In her previous and latest urinalysis results, her urine appears dark yellow, and bacteria, protein,
pus cells and Albumin are present.
She is able to defecate and urinate using a bedpan or a toilet. She does not have any artificial
orifice such as an ileal conduit, a colostomy or an ileostomy.
She does not complain of any difficulties with elimination such as incontinence, urinary
retention, constipation or diarrhea.

8. Fluid and Electrolyte Status

She is able to eat 3 meals a day and snacks in between. Some of her meals are prepared in the
hospital and some are prepared at home. These are composed of meat or fish and vegetables. She
sometimes eats fruits for snacks. She is only able to consume about 50-80% of food served. She drinks
about 800-1000mL of fluids per day; this includes juices and milk in cartons. She is given about 2000ml
of D5NSS in 24 hours. During the 3 days of exposure however, this has not been maintained since there
has been interruptions in the administration such as blood transfusion and need for reinsertion after the
I.V. catheter has been dislodged and has caused extravasation.
The client perspires whenever she feels uncomfortable with the warmth in the room. She does
not sweat profusely.
In 24 hours, she is able to eliminate about 750-1000mL of urine.
She eliminates formed, brownish stools.
Her skin is slightly dry but she has good skin turgor. Her mouth and mucous membranes are
moist.
There was no edema noted except for her left forearm which was a result of extravasation
during the second day of exposure. However, it was observed that this has subsided the following day.
Her veins are not distended.
Her latest Clincal chemistry result (August 03, 2010) that she has decreased Potassium levels, at
2.3 mmol/L (N= 3.5-5.1 mmol/L).
During the course of confinement, she was administered 2 units of packed RBCs.
9. Circulatory Status

August 03, 2010 August0 4, 2010 August 05, 2010

PR (bpm) 106 98 100
BP (mmHg) 90/60 80/60 80/50

Her radial pulses are strong and irregular in rate and rhythm.
Her blood pressure readings were all taken while lying. Her blood pressure is below normal
limits (N= 120-140/80-90). Thus, the physician prescribed Albumin 20% once a day, 30 minutes per
bottle on the third day of confinement.
Her capillary refill is at 1-2 seconds.

10. Respiratory Status

August 02, 2010 August 03, 2010 August 04, 2010

RR (bpm) 26 25 30

Her respirations are irregular in rate and rhythm. She does not report any difficulties in
breathing. The use of accessory muscles such as sternocleidomastoid and abdominal muscles were not
observed. She is not coughing. She does not have any secretions and no abnormal breath sounds were
heard upon auscultation.
Her nail beds, skin and lips are not cyanotic.
She does not require any use of supportive devices such as nebulizers, assisted or controlled
ventilation and respiration and tracheostomy.
She does not have a history of smoking.

11. Temperature Status

August 03, 2010 August 04, 2010 August 05, 2010

T˚ (C˚) 36.5 35.0 37.0

Her temperature was taken per axilla. She did not exhibit any fever during the shifts, however,
she was febrile during previous shifts. Her skin is warm to touch.

She is able to distinguish warm from cold. She perspires occasionally, whenever the room gets
warm. She wears a jacket and long flannel pants whenever she feels cold.

12. Integumentary Status

Her skin is Tan. Her skin is slightly dry but has good skin turgor. No wounds, pressure sores,
rashes or lesions were observed. A mass however was removed from behind her left ear last May for
biopsy.
During the second day of exposure, it was observed that the client’s forearm bulged due to
extravasation. The IV cannula was removed aseptically and was referred for reinsertion.
Her hair is black, short, thin and unequally distributed. This is a side-effect of previous
chemotherapies. No lice or dandruff were seen.
She has clean and well trimmed nails.
She has no unusual odors.

13. Comfort and Rest Status

Prior to confinement, she is able to sleep 7-8 hours a night. In the hospital, she is also able to
sleep 7-8 hours a night however, her sleep is often interrupted by noise in the ward and disturbances
from some interventions. She also gets 1-2 hour/s of afternoon naps.
She verbalized that she does not feel any pain or discomfort.
III. Laboratory Results

A. Prior to confinement:

1.) X-RAY, HIP JOINT (BILATERAL): July 29, 2010

Result:
Lucent areas seen in the medial aspect of the superior and inferior pubic rami bilaterally,
adjacent to symphysis pubis.
Intact joint spaces
Soft tissue shadows unremarkable
Note: Probability of a metastatic lesion has to be ruled out, suggest correlation with bone scan

Significance: An x-ray is crucial to identify the extent of lymphadenopathy. 1

Interpretation of Results: A lucency on an X-ray image represents an area absorbing less radioactive
energy than the surrounding tissue.2 This means that the medial aspect of the superior and inferior pubic
rami bilaterally adjacent to the symphysis pubis have become soft. A bone scan has been suggested to check
for metastasis to the bones.

2.) URINALYSIS: July 29, 2010

Results:

Color: dark yellow Appearance: turbid

Reaction: alkaline Mucus threads: occasional
Specific gravity: 1.015 Epithelial cells: occasional
Pus cells: 0-3/ hpf Bacteria: many
RBC: 1-4/ hpf Albumin: (+)

Significance:
A urinalysis is a group of chemical and microscopic tests. They detect the byproducts of normal
and abnormal metabolism, cells, cellular fragments, and bacteria in urine. Urine is produced by the kidneys,
two fist-sized organs located on either side of the spine at the bottom of the ribcage. The kidneys filter
wastes out of the blood, help regulate the amount of water in the body, and conserve proteins, electrolytes,
and other compounds that the body can reuse. Anything that is not needed is excreted in the urine,
traveling from the kidneys to the bladder and then through the urethra and out of the body. Urine is
generally yellow and relatively clear, but each time someone urinates, the color, quantity, concentration,
and content of the urine will be slightly different because of varying constituents. 3

Interpretation of Results:
The presence of RBCs in the urine may indicate bleeding in the urinary tract or the client just
had her menstruation. The presence of bacteria shows infection in the urinary tract and indicates the
body’s inadequate defenses against bacteria due to current immunosuppression. Ideally albumin should
not be present in the urine, but when the kidneys are not working properly, some amounts of this protein
might pass through the glomeruli and therefore, can be found in the urine. 4
3.) HEMATOLOGY: July 29. 2010

Results:

Normal Values:
Erythrocyte volume: 0.261 0.37-0.47
Hemoglobin mass concentration: 85.9g/l 110-150g/l
Leukocyte: 0.697 g/l 5-10x10g/l

Significance:
The CBC is a very common test. Many patients will have baseline CBC tests to help determine their
general health status and if they are healthy and they have cell populations that are within normal limits. If
a patient is having symptoms such as fatigue or weakness or has an infection, inflammation, then the
doctor may order a CBC to help diagnose the cause. 5
 Interpretation:
There is decreased Hemoglobin in the blood, a a protein used by red blood cells to distribute oxygen to
other tissues and cells in the body, predisposing the patient to have decreased oxygenation to tissues in
the capillary level. Also, below average white blood cell counts show that the client is at high risk of
infection.

B. During Confinement

1.) HEMATOLOGY: August 03, 2010

Results:
Normal Values:
Hemoglobin 99g/L 120-160g/L
Hematocrit 0.29L/L 0.37-0.47 L/L
White Blood Cells 20.4 x 109/L 5.0-10.0 x 109/L
Differential Count:
Neutrophils 0.94 0.50-0.70
Lymphocyte 0.03 0.20-0.40
Mid Cells 0.03 0.03-0.09
Platelet Count 338 150-400 x 109/L

Significance:
A Complete Blood Count is a general survey of bone marrow function. It evaluates all three cell lines
(WBC’s,RBC’s,platelets). Hemoglobin is the protein molecule in RBC’s that carries oxygen from the lungs to
the body’s tissues and returns carbon dioxide from the tissues to the lungs. It is important to note changes
over time, many hematologic conditions show changes in CBC long before patient becomes symptomatic.
This test is done to the patient to reveal how much hemoglobin is in the patient’s blood, help diagnose and
monitor anemia, protein deficiency and hydration status. Hematocrit is the percentage per volume of
packed RBC in a whole blood sample. It also aids in diagnosing anemia, polycytemia and abnormal state of
hydration. Leukocytes and differential count was done to the patient to determine the percentage of each
type of granulocytes.  It is used to evaluate infection or potential infection or inflammation and their ability
to function correctly, and the ability to control bleeding.

Interpretation:
The result shows low Hemoglobin which suggests symptoms of anemia. Decreased Hematocrit may also
suggest anemia, hemorrhage, or blood loss. The increased amount of white blood cells implies that the
patient may be suffering from acute infection, malignant disease or necrosis. The increased neutrophils may
explain the client’s malignant disease or signify that she may be suffering from bacterial infections, stress or
trauma. The decrease in lymphocytes, may imply bone marrow destruction that occurs in aplastic anemia or
as a result of her illness which is cancer of lymphocytes or Non-Hodgkin’s lymphoma.

2.) Clinical Chemistry: August 03, 2010

Results:

Potassium 2.3 mmol/L 3.5-5.1 mmol/L

Albumin 14.6 g/L 34-50 g/L
Creatinine 60-80 mmol/L 53-88.4 mmol/L

Significance:
The Clinical Chemistry was done specifically to measure: Potassium, to detect any abnormalities
with its concentration and kidney function; Albumin to detect abnormalities in serum protein in the
body, also an essential measure for protein deficits in adults and for severe malnutrition; and Creatinine,
to check renal function.

Interpretation:
The results revealed below normal serum potassium concentration or hypokalemia which is
indicative of an actual deficit in total potassium stores. It also reflects alteration in acid-base balance or
hyperaldosteronism that increases renal potassium wasting and can lead to severe potassium depletion.
Not eating a normal diet for prolonged period of time, magnesium depletion and kidney disease can also
induce hypokalemia.
The result also revealed below normal Albumin indicating protein deficit or can also indicate
malnutrition.
 3.) Urinalysis: August 03, 2010

Results:

Physical exam
Color: dark yellow
Appearance: Turbid

Chemical exam
pH: 8.0
Specific gravity: 1.005
Sugar : negative
Protein : +1

Microscopic exam:
Pus cells: 30-40 /hpf
RBC: 0-3
Yeast cells: none
Bacteria : many
Epithelial cells: Occasional
Mucus threads: rare
Amorphous materials: occasional

Significance:
Urinalysis identifies the presence of glucose, ketones, proteins, red and white blood cells,
sediments and bacteria. This checks for any abnormalities related to the urinary tract and to the kidney’s
function.

Interpretation:
The patient’s urine contained many bacteria which is indicative of bacteria related illness or
bacterial infection. The pus in the urine may also indicate infection. The infection may signify the body’s
weak defenses on combating bacteria and other foreign bodies. The protein in the urine may imply
impaired kidney function.

IV. DRUG STUDY

1.) GENERIC NAME: Celecoxib
BRAND NAME: Celebrex
PHARMACOLOGIC CLASSIFICATION: Cyclooxygenase-2 (COX-2) inhibitor
THERAPEUTIC CLASSIFICATION: Non steroidal anti-inflammatory drug
ACTION: Thought to inhibit prostaglandin synthesis, impeding cyclooxygenase-2   (COX-2), to
produce anti-inflammatory, analgesic and antipyretic effects.
INDICATION: acute pain
CONTRAINDICATION:
Patients hypersensitive to drug.
Patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or
other NSAIDs.
Treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery
ROUTE: per orem
DOSAGE: 400mg 1 cap
ADVERSE EFFECT:
          CNS: headache, dizziness, insomnia
          CV: hypertension, peripheral edema
          EENT: pharyngitis, rhinitis, sinusitis
GI: abdominal pain, diarrhea, dyspepsia, flatulence, nausea
METABOLIC: hyperchloremia
MUSCULOSKELETAL: back pain
RESPIRATORY: upper respiratory tract infection
SKIN: rash, exfoliative dermatitis, erythema, multiforme
OTHER: accidental injury
NURSING CONSIDERATIONS:
· Watch for signs and symptoms of overt and occult bleeding.
· Assess patient for cardiovascular risk factors before therapy.
· Watch for signs and symptoms of liver toxicity.
· Before starting therapy, rehydrate dehydrated patient.
· Drug can be given without regard to meals but may decrease GI upset.
· Instruct patient to take drug with meals if GI upset occurs.
· Instruct patient to promptly report signs of  GI bleeding such as blood in vomit, urine or stool
or black tarry stool.

2.) GENERIC NAME:  Piperacillin sodium- Tazobactam sodium

BRAND NAME: Zosyn
PHARMACOLOGIC CLASSIFICATION: Extended spectrum penicillin, beta lactamase inhibitor
THERAPEUTIC CLASSIFICATION: Penicillin
ACTION: inhibits cell wall synthesis during bacterial multiplication
INDICATION: Empirical therapy in febrile neutropenia
CONTRAINDICATION:
· Patients with history of allergic reactions to any of the penicillins, cephalosporins, or β-lactamase
inhibitors.
ROUTE: Intravenous
DOSAGE: 4.5 gram
ADVERSE EFFECT:
          CNS: headache, insomnia, fever, seizures, dizziness, anxiety
          CV: hypertension, tachycardia, chest pain, edema
          EENT: rhinitis
GI: diarrhea, nausea, vomiting, pseudomembranous colitis, constipation, abdominal pain
GU: candidiasis, interstitial nephritis
HEMATOLOGIC: leucopenia, neutropenia, anemia, eosinophilia, thrombocytopenia
RESPIRATORY: dyspnea
SKIN: rash, pruritus
OTHER: anaphylactic reaction, pain, phlebitis at IV site
NURSING CONSIDERATIONS:
· Before giving medication, ask patient about allergic reactions to penicillins.
·Monitor patients sodium intake because piperacillin contains 2.79 mEq (64 mg) sodium/g .
·Monitor hematologic and coagulation parameters.
· Instruct patient to report any adverse reaction promptly.

3.) GENERIC NAME:  Tramadol hydrochloride

BRAND NAME: Ultram, Ultram ER
 PHARMACOLOGIC CLASSIFICATION: Opioid agonist
THERAPEUTIC CLASSIFICATION: Analgesic
ACTION: Inhibits reuptake of serotonin and norepinephrine in CNS
INDICATION: Moderate to moderately severe pain
CONTRAINDICATION:
 Hypersensitivity to drug, its components
 Acute intoxication with alcohol, sedative- hypnotics, centrally acting analgesics, opioid
analgesics, or psychotropic agents
 Physical opioid dependence
ROUTE: per orem
DOSAGE: 1 tab, TID
ADVERSE EFFECT:
CNS:Dizziness, Headache, Seizures
CV: Vasodilation
EENT: Visual disturbances
GI: Nausea, Vomiting, Diarrhea, Abdominal pain
GU: Urinary retention and frequency
Respiratory: Respiratory depression
Skin: Pruritus, Sweating
Other: Physical dependence
NURSING CONSIDERATIONS:
 Supervise ambulation, especially in elderly patients
 Inform patient he may take drug with or without food; recommend taking it with food if it
causes stomach upset.
 Caution patient to avoid driving and other hazardous activities until he knows how drug
affects concentration and alertness.
 Instruct patient to move slowly when sitting up or standing, to avoid dizziness. Advise him to
dangle legs briefly before getting out of bed.
 Instruct patient to immediately report seizure.
 Inform patient that drug can cause physical or psychological dependence. Urge him to take it
only as prescribed and needed.
 Monitor respiratory status. Withhold drug and contact prescriber if respirations become
shallow or slower than 12 breaths/ minute.
 Assess patient’s response to drug 30 minutes after administration.

4.) GENERIC NAME:  Potassium Chloride

BRAND NAME: K-tab, K +8, Micro-K
PHARMACOLOGIC CLASSIFICATION: Mineral, Electrolyte
THERAPEUTIC CLASSIFICATION: Electrolyte replacement, Nutritional supplement
ACTION: Maintains acid- base balance, isotonicity, and electrophysiological balance throughout
body tissues; crucial to nerve impulse transmission and contraction of cardiac, skeletal,
and smooth muscle. Also essential for normal renal function and carbohydrate metabolism.
INDICATION: to prevent potassium depletion
CONTRAINDICATION: Hypersensitivity to tartrazine or alcohol, Acute dehydration, Heat cramps,
Hyperkalemia, Severe tissue trauma, Severe renal impairment
ROUTE: per orem
DOSAGE: 1 tab, TID
ADVERSE EFFECT:
CNS: Confusion, Restlessness, Unusual fatigue, Absent reflexes
CV: Hypotension, Arrhythmias
GI: Nausea, Vomiting, Diarrhea, Abdominal discomfort
Metabolic: Hyperkalemia
Muskuloskeletal: Weakness and heaviness of legs
Respiratory: Respiratory paralysis
Other: Irritation at I.V site
  NURSING CONSIDERATIONS:
 Give P.O form with meals and a full glass of water or juice, to minimize GI upset.
 Advise patient to report nausea, vomiting, confusion, numbness and tingling, unusual
fatigue or weakness, or a heavy feeling in legs.
 Tell patient to minimize GI upset by eating frequent, small servings of food and drink plenty
of fluids.
 Advise patient not to use salt substitutes.
  Make sure that patient is well- hydrated and urinating before starting therapy.

5.) GENERIC NAME:  Acetaminophen/ Paracetamol

BRAND NAME: Acephen, Aceta, Actimol
PHARMACOLOGIC CLASSIFICATION: Synthetic non-opioid p-aminopherol derivative
THERAPEUTIC CLASSIFICATION: Analgesic, Antipyretic
ACTION: Pain relief may result from inhibition of prostaglandin synthesis in CNS, with subsequent
blockage of pain impulses. Fever reduction may result from vasodilation and
increased peripheral blood flow in hypothalamus, which dissipates heat and lowers body
temperature.
INDICATION: Mild to moderate pain caused by headache, muscle ache, backache,., minor arthritis,
common cold, toothache, or menstrual cramps, Fever
CONTRAINDICATION: Hypersensitivity to drug
ROUTE: Per orem
DOSAGE: 500mg, 1 tab, PRN
ADVERSE EFFECT:
Hematologic: Thrombocytopenia, Hemolytic anemia, Neutropenia
Hepatic: Jaundice, Hepatotoxicity
Metabolic: Hypoglycemia, Coma
Skin: Rash, Urticaria
Other: Hypersensitivity reactions ( such as fever)
NURSING CONSIDERATIONS:
 Caution parents or other caregivers not to give acetaminophen to children younger than age 2
without consulting prescriber first.
 Advise patient, parents, or other caregivers to contact prescriber if fever or other symptoms
persist despite taking recommended amount of drug.
 Inform patients with chronic alcoholism that drug may increase risk of severe liver damage.
 Observe for acute toxicity and overdose. Signs and symptoms of acute toxicity are as follows
nausea, vomiting, anorexia, malaise, liver enlargement, oliguria, and jaundice.

 
 

References:

NURSING 2008 DRUG HANDBOOK BY: LIPPINCOTT, WILLIAMS AND WILKINS

Schull, Patricia
Causes:Dwyer 2010 Spectrum Drug Handbook
-unknown, although, as with the
V. PATHOPHYSIOLOGY
leukemias, substantial evidence
suggests a viral cause (eg, human T-
cell leukemia-lymphoma virus,
Epstein-Barr virus, hepatitis C virus,
HIV).
 Risk factors:
-immunodeficiency (secondary to posttransplant
immunosuppression, AIDS, primary immune
disorders, sicca syndrome, RA)\
-Helicobacter pylori infection
-certain chemical exposures -previous treatment
for Hodgkin lymphoma.

Body produces too many abnormal white blood cells:

B-Cells
T-Cells
Histiocytes (macrophage-monocytes)

Painless, superficial lymphadenopathy:

Swollen left postauricular lymph node

Widespread lymphadenopathy:
Peritoneum

Extranodal involvement:
Abdominal structures
Probable metastasis to the bones

Hypogammaglobulinemia and
poor humoral antibody response

2 cycles of chemotherapy Constitutional symptoms:

Neutropenia Anemia

Pathogen invasion Fever loss of appetite weight loss

Leukocytosis

Decreased Potassium Levels

Impaired physical mobility
related to body weakness
Infection related to decreased
immunity related to decreased
immunity secondary to Imbalanced nutrition: Less than
chemotherapy and Non- body requirements related to
Hodgkin’s Lymphoma loss of appetite and disease
process

References:
1 Porth, Carol Mattson. “Pathophysiology Concepts of Altered Health States”. Philadelphia:Lippincott Williams & Wilkins.2002. pp 302-303.
2 Smeltzer, Suzanne C. “Textbook of Medical-Surgical Nursing”. 11th Ed, Vol. 1. Philadelphia: Lippincott Williams & Wilkins. 2008. Pp 1080-1082.
3 Porlock, Carol S., M.D. “Non-Hodgkin Lymphoma”. Merck & Co., Inc. Whitehouse Station, N.J., U.S.A., 2008. Web. 08 September 2010.
<http://www.merck.com/mmpe/sec11/ch143/ch143c.html>.
4 Vinjamaram, Sanjay, M.D., M.P.H. “Lymphoma, Non-Hodgkin”. MedScape. 2010. Web. 08 September 2010. <http://emedicine.medscape.com/article/203399-overview>.
5“Non-Hodgkin Lymphoma”. National Cancer Institute.2010. Web. 08 September 2010. Web. <http://www.cancer.gov/cancertopics/types/non-hodgkin>.
6“Non-Hodgkin’s Lymphoma”. Mayo Foundation for Medical Education and Research, 2010. Web. 08 September 2010. <http://www.mayoclinic.com/health/non-hodgkins-
lymphoma/DS00350>.
7 Ignoffo, Robert, M.D. “Preventing Chemotherapy Toxicities And Other Issues On Drugs Used In Oncology” Cancer Supportive Care Programs. 08 Spetember 2010.Web.
<http://www.cancersupportivecare.com/chemotherapy.html>.

VI. PRIORITIZATION OF PROBLEMS