Viii. Medical Management

VIII.
MEDICAL MANAGEMENTs
MEDICAL MANAGEMENT
Date and Progress Doctors Order Rationale

Time Note
October BP: 160/100  Please Admit to  To be able to provide the
24, 2018 mmHg Medicine ward patient with the specific
PR: 94 care needed.
RR: 30
Temperature:
36.1 C
Diagnosis  Secure Consent  Informed consent is an

CHF agreement by a client to
secondary to accept a course of treatment
CKD or a procedure after being
provided complete
information, including the
benefits and risks of
treatment, alternatives to the
treatment and prognosis if
not treated by a health care
provider. (Reference:
Fundamentals of Nursing 8th
Edition of 2008 Volume 1 of
2008 Chapter 4 legal Aspects
of Nursing, page 59)
 The vital signs are body

 TPR every shift temperature, pulse,
respirations and blood
pressure, which should be
looked at in total, are
checked to monitor the
function of the body which
may alter the normal
function of the body.
(Reference: Fundamentals of
Nursing 8th Edition of 2008
Volume 1 by Berman, Synder,
Kozier and Erb Chapter 29
Vital signs page. 527)
37
VIII. MEDICAL MANAGEMENTs
 Diet: Low salt,  Moderate sodium

Low fat Diet restriction may reduce rise
in BP and can lower blood
pressure. An
excessive/excess of sodium
accumulates principally in
extracellular fluid and may
result in edema. This
usually occurs in certain
condition like hypertension
and kidney disorders. In
these cases, it is important
to restrict the amount of
sodium in diet depending
upon the condition.
(Reference: Basic Nutrition
and Diet therapy Textbook
for Nursing students of 2008
by Maria Lourdes C. Caudal
RND, Chapter 3
Micronutrients page. 93)
 Intravenous  Intravenous fluid used to
Fluid: PNSS 1 maintain health, the
Liter x Keep balance of fluids and
Vein Open electrolytes in the
intravascular system.
Isotonic splution such as
NS it usually remain in the
vascular compartment,
expanding
- Sodium helps regulatevascular
the
volume.
amount of fluidKVO
in yourratebody.is
If your blood contains too at a
ordered to run an IV
rate that is just fast enough
much sodium, it triggers your
to overcome vascular
kidneys to retain water,
resistance and keep which
the
increases
vein youropen. blood(Reference:
volume
andBrunner
can increase andyourSuddarth’s
blood
Textbook of
pressure. High blood pressure Medical
th
Surgical Nursing 10 Edition,
putsVol
excess strain on your
1, page 283)
kidneys, worsening your
kidney disease. If you have
glomerulonephritis, your
-IVF: D5W 500 cc x
dietitian may recommend a
KVO mgtts
sodium restriction
Source:
http://www.livestrong.com/article/48
0513-diet-plan-with-
glomerulonephritis/
38
BP=110/80
mmHg
-Intravenous Fluids restore
tissue perfusion by (1)
LABS:  Complete blood count is

 Complete blood basic screening test and
count one of the most
frequently ordered blood
test which includes
hemoglobin, hematocrit,
red blood cells count,
morphology, indices and
distribution width index;
platelet count and size;
and white blood cell
(WBC) count and
differential.
(Reference: Nursing care
plan, Edition 8 of 2010 by
Marlynn E. Doenges,
mary Frances Moorhouse,
Alice C. Murr Chapter 10
Reanl and Urinary Tract
page.
539)
 Urinalysis is done in
 Urinalysis evaluating disorders of
the urinary tract. This
test may provide
information about
possible abnormalities,
indicated what further
studies need to be done,
and supply information
on the progression of
diagnosed disorder.
(Reference: Medical
Surgical Nursing 7th
Edition of 2008 Volume 2
by Lewis, Heitkemper,
Dirksen, O’Brien, Bucher
Chapter 45 Urinary System
page 1150)
 Record the electrical

activity of the heart.
 12 Lead ECG (Reference: Nursing Care
Plan Edition 8 of 2010 by
Marlynn E. Doenges, Mary
Frances Moorhouse, Alice
C. Murr Chapter 10 Renal
and Urinary Tract page.
541)
39
 Glucose results from

carbohydrates
 RBS metabolism. Glucose is
essential to the
maintenance of body
energy, especially in
muscle and nerves.
Increase blood glucose
levels occur with
impaired glucose
metabolism and kiney
inflammation or kidney
failure. (Reference:
Nursing Diagnosis and
intervention in Nursing
practice by Claire
Campbell page. 1503)
 BUN measure the

 Blood Urea product or protein
Nitrogen and metabolism in the liver,
Creatinine filtered by the kidney
and excreted in urine.
And creatinine is end
product of muscle and
protein metabolism;
filtered by the kidney
(Reference: Nursing Care
540)
 Sodium helps to
evaluate hydration status
and progression of renal
 Serum Sodium, failure. And potassium
Potassium fluctuation in levels can
create life threatening
situations, affecting
therapeutic situations,
affecting therapeutic
choices. (Reference:
Nursing Care Plan Edition
8 of 2010 by marlynn E.
Doenges, Mary Frances
40
Moorhouse, Alice C. Murr

Chapter 10 Renal and
Urinary Tract page. 540)
 Blood gas analysis is

often used to identify the
specific acid-base
disturbance and the
degree of compensation
 ABG that has occurred.
Results of arterial blood
gas analysis provide
information about
alveolar ventilation,
oxygen, and acid-base
balance. (Reference;
Brunners and Suddarth’s
Textbook of Medical
Surgical Nursing, page
281)
 Uric acid study is used

as a screening test
primarily for disorders of
purine metabolism but
can indicate kidney
disease as well. Values
 Uric Acid
depend on renal function
and rate of purine
metabolism and dietary
intake of food rich in
purines. (Reference;
Medical Surgical Nursing
7th Edition of 2008 Volume
2 by Lewis, Heitkemper,
Dirksen o’Brien, Bucher
Chapter 45 Urinary System
page 1147)
 In uremia, pulmonary
congestion may occur
even in the absence of
fluid overload. This
congestion shows a
characteristics “but
 Chest x-ray wing” or “butterfly
anteroposterior wing” pattern on
radiologic examination.
It is sometimes called
uremic lung or uremic
pneumonitis. (Reference:
41
Focus on pathophysiology
by Barbara L. Bullock and
Reet L. Henze page. 626)\
 Serum lipid consist of

triglycerides cholesterol
and phospholipids they
circulating the blood
bound to protein. They
are often referred to as
lipoprotein. (Reference:
 Lipid profile Medical-Surgical Nursing
7th edition of 2008 volume
1 by lewis, Heitkemper,
Dirksen, O’Brien, Bucher
Chapter 32 Cardiovascular
System page 751)
 A loop diuretics; use to

treat mild hypertension
which inhibits
reabsorption of sodium
and chloride from the
proximal and distal
tubules and ascending
limb of the loop of
Henle, leading to a
 Medications: sodium-rich diuresis.
 Furosemide (Reference: 2011
40mg every 8 Lippicotts’s Nursing Drug
hours Guide of 2011 by Amy M.
Karch page. 565)
 A anti-infectives;
treatment of skin and
skin structure infections,
bone and joint
infections, urinary and
gynecologic infections
including gonorrhea or
respiratory tract
infections. (Reference:
 Ceftriaxone 1gm David’s drug guide tenth
every 12 hours edition Judith Hopfer April
Hazard Vallerand pg.260-
266
 A lipid-lowering agents;
Adjunct to dietary
therapy in the
42
management of primary
hypercholesterolemia
and mixed. Reduction of
lipids/cholesterol
reduces the risk of MI
and stroke sequelae and
 Rosuvastatin decreases the need for
10mg once a day bypass
procedures/angioplasty.
(Reference: David’s drug
guide tenth edition Judith
Hopfer April Hazard
Vallerand pg.598-602)
 Gerd maintenance of
healing in erosive
esophagitis. Duodenal
ulcers. Short tern
treatment of active
benign gastric ulcer.
Binds to an enzyme on
gastric parietal cells in
the presence of acidic
gastric pH, preventing
 Omeprazole
the final transport of
40mg OD
hydrogen ions into the
gastric lumen.(Reference:
David’s drug guide tenth
edition Judith Hopfer April
886)
 Nitroglycerin patch is a
nitrate. It works by
relaxing (widening)
blood vessels. Chest pain
occurs when the heart
needs more oxygen than
it can get. Relaxing
blood vessels allows
blood to flow more
easily. This reduces the
heart’s workload and the
 NTG patch amount of oxygen
needed by the heart.
(Reference:
(+) DOB http://www.drugs.com/cdi/
nitroglycerin-patch.html)
43
 Administration of
oxygen helps increase
the percentage of oxygen
in inspired air.
The goal of oxygen
administration is to
supply the patient with
adequate oxygen to
maximize oxygen
carrying ability of the
blood. Oxygen
 O2 at 3LPM inhalation is given to the
patient because of
difficulty of breathing as
manifested by 30cpm.
(References: Medical-
Surgical Nursing 5th
edition by Lewis,
Heitkemper & Dirksen
page 689)
 Accurate input and

output is necessary for
determining fluid
replacement needs and
reducing risk of fluid
overload and reflects
circulating fluid shifts,
and response to therapy.
 Monitor Input C. Murr Chapter 10 Renal
and Output and Urinary Tract page.
every 4 hours 542)
and record
 The vital signs are body
temperature, pulse,
respirations and blood
pressure, which should
be look at in total, are
checked to monitor the
function of the body
which may alter the
normal function of the
body. (Reference:
Fundamentals of Nursing
8th edition of 2008 Volume
1 by Berman Synder,
 Vital signs Kozier and Erb Chapter
44
every 2 hours 29Vital signs page. 527)
 An indwelling foley
catheter is a tube placed
in the body to drain and
collect urine from the
bladder.
(Reference:https://www.nl
m.nih.gov/medlineplus/enc
y/article/003981.htm)
 Refer
accordingly  Imdur (isosorbide
mononitrate) belongs to
a group of drugs called
nitrates. Isosorbide
mononitrate dilates
(widens) blood vessels,
 Insertion of
making it easier for
Foley Catheter
blood to flow through
October them and easier for the
25, 2018 heart to pump.
(Reference:
http;//www.drugs.com/imd
ur.
html)
 Antigout, it is used to
 Discontinue prevent recurrent attacks
NTG patch then of gout or gouty arthritis
shift to ISMN which decreases uric
30mg 1 Tab OD acid production.
(Reference: Straight A’s in
Nursing Pharmacology 2nd
Edition of 2008 by
Lippincott Williams &
Wilkins Chapter 6 Drugs
and the Muscoskeletal
system page 112-113)
 Treatment of CHF. It
 Allopurinol Increases the force of
100mg BID myocardial contraction.
Prolongs refractory
period of the AV node.
Decreases conduction
through the SA and AV
45
nodes. (Reference:
390)
 Record the electrical
 Digoxin 0.25mg activity of the heart.
IV (Reference: Nursing Care
541)
 Dialysis is used to
remove fluid and uremic
waste products from the
 Repeat ECG when the kidneys are
unable to do so.it may
also be used to treat
patients with edema that
does not respond to other
treatment, hepatic coma,
hyperkalemia,
hypercalcemia,
hypertension, and
uremia.
 Refer (Reference: Brunner &
Suddarth’s Textbook of
Medical-Surgical Nursing
 For dialysis 11th Edition Volume 2
1531)
October  Reduction of
26, 2018 atherosclerosis events
(Mi, stroke, vascular
death) in patient at risks
for such events including
recent MI, acute
coronary syndrome
(ubstable angina/non-Q-
wave MI), stroke, or
peripheral vascular
disease. (Reference:
298)
46
 For supportive Drug;

 Clopidogrel 75 supports body function
mg Once a day until other treatments or
the body’s response can
take over; because
medication is a
substance administered
for the diagnosis, cure
treatment or relief of
symptoms of for
prevention of disease.
(Reference: Fundamentals
of Nursing 8th Edition of
2008 by Berman, Synder
Medications page 830)
 Complete blood count is

 Continue
basic screening test and
Medications
one of the most
frequently ordered blood
test which includes
hemoglobin, hematocrit,
red blood cells count,
morphology, indices and
distribution width index;
platelet count and size;
and white blood cell
(WBC) count and
differential.
(Reference: Nursing care
plan, Edition 8 of 2010 by
Marlynn E. Doenges, mary
C. Murr Chapter 10 Reanl
 For repeat CBC 539)
 For supportive Drug;

supports body function
until other treatments or
the body’s response can
take over; because
medication is a
substance administered
for the diagnosis, cure
treatment or relief of
47
symptoms of for
prevention of disease.
(Reference: Fundamentals
of Nursing 8th Edition of
2008 by Berman, Synder
Medications page 830)
 BUN measure the

 Refer
product or protein
metabolism in the liver,
 Continue
Medications
October product of muscle and
protein metabolism;
27, 2018
540)
 For repeat Blood

 BUN measure the
Urea Nitrogen
product or protein
and Creatinine
metabolism in the liver,
product of muscle and
protein metabolism;
540)
 A loop diuretics; use to

 MGH as treat mild hypertension
ordered: which inhibits
reabsorption of sodium
48
1. ISMN 30mg 1 and chloride from the

October Tab OD proximal and distal
28, 2018 tubules and ascending
limb of the loop of
Henle, leading to a
sodium-rich diuresis.
(Reference: 2011
Lippicotts’s Nursing Drug
Guide of 2011 by Amy M.
Karch page. 565)
 Antigout, it is used to
prevent recurrent attacks
of gout or gouty arthritis
which decreases uric
acid production.
(Reference: Straight A’s in
Nursing Pharmacology 2nd
2. Furosemide Edition of 2008 by
40mg every 8 Lippincott Williams &
hours Wilkins Chapter 6 Drugs
and the Muscoskeletal
system page 112-113)
 A lipid-lowering agents;
Adjunct to dietary
therapy in the
management of primary
hypercholesterolemia
and mixed. Reduction of
lipids/cholesterol
reduces the risk of MI
and stroke sequelae and
decreases the need for
3. Allopurinol 100 bypass
mg BID procedures/angioplasty.
(Reference: David’s drug
guide tenth edition Judith
Hopfer April Hazard
Vallerand pg.598-602)
4. Rosuvastatin 10
mg Once a day
49
50

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VIII.

Date and Progress Doctors Order Rationale

Diagnosis  Secure Consent  Informed consent is an

 The vital signs are body

 Diet: Low salt,  Moderate sodium

LABS:  Complete blood count is

 Record the electrical

 Glucose results from

 BUN measure the

Moorhouse, Alice C. Murr

 Blood gas analysis is

 Uric acid study is used

 Serum lipid consist of

 A loop diuretics; use to

 Accurate input and

every 2 hours 29Vital signs page. 527)

 For supportive Drug;

 Complete blood count is

 For supportive Drug;

 BUN measure the

 For repeat Blood

 A loop diuretics; use to

1. ISMN 30mg 1 and chloride from the

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