Beruflich Dokumente
Kultur Dokumente
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ACKNOWLEDGMENT
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INTRODUCTION
Contact with urine (or other body fluids, except saliva) from
infected animals.
Contact with water, soil, or food contaminated with the urine of
infected animals
The bacteria can enter the body through skin or mucous membranes
(eyes, nose, or mouth), especially if the skin is broken from a cut or
scratch. Drinking contaminated water can also cause infection.
Outbreaks of leptospirosis are usually caused by exposure to
contaminated water, such as floodwaters. Person to person transmission
is rare. Without treatment, Leptospirosis can lead to kidney damage,
meningitis (inflammation of the membrane around the brain and spinal
cord), liver failure, respiratory distress, and even death. In
relation, acute kidney (renal) failure happens when your kidneys
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suddenly lose the ability to eliminate excess salts, fluids, and waste
materials from the blood. This elimination is the core of your
kidneys’ main function. Body fluids can rise to dangerous levels when
kidneys lose their filtering ability. The condition will also cause
electrolytes and waste material to accumulate in your body, which can
also be life-threatening.
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REVIEW OF RELATED LITERATURE
Causes
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Blood clot from cholesterol (cholesterol emboli)
Symptoms
Bloody stools
Bruising easily
Decreased appetite
Hand tremor
Heart murmur
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High blood pressure
Nosebleeds
Persistent hiccups
Prolonged bleeding
Seizures
Shortness of breath
BUN
Creatinine clearance
Serum creatinine
Serum potassium
Urinalysis
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Treatment
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Call your provider if your urine output slows or stops or you
have other symptoms of acute kidney failure.
Prevention
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NURSING HEALTH HISTORY
Biographic Data:
Admission Data:
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HISTORY OF PRESENT ILLNESS
II – Childhood Immunization
HISTORY OF HOSPITALIZATION
III- Medical History
No major problem experience regarding diseases, haven’t been
admitted to hospitals ever since the recent admission as verbalized
by Mr. A
IV – Surgical History
VII-Sexual History
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VIII-Allergies
X- Personal Habits
XI – Diet
XIII-Elimination Pattern
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SOCIAL DATA
XIV-Family Relationship/Friendship
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REVIEW OF SYSTEM
INTEGUMENTARY SYSTEM
No history of skin infection as claimed by the patient
With history of dandruff
Brown skin complexion
Patient has intact skin with good skin turgor
Slightly swelling on her lower extremities and part of her
faces
Skin is warm to touch
Patient has no lesion and bruises.
RESPIRATORY SYSTEM
No complaints of weaknesses and being exhaust on simple
activity.
No appearance of difficulty in breathing
Has no history of pneumonia, asthma or emphysema.
No abnormality sounds upon auscultation
CARDIOVASCULAR SYSTEM
GENITOURINARY SYSTEM
Urinates 2 times a day as claimed by the patient.
No pain upon voiding.
Color of the urine yellow
No history of UTI.
GASTROINTESTINAL SYSTEM
With no complaints of constipation as stated by the patient.
Patient has no abnormality in defecating
No abnormal bowel sounds, as claimed
Patient With no history of hemorrhoids and rectal bleeding.
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REPRODUCTIVE SYSTEM
No erectile dysfunction
Penis has no any lesion or any wound
Scrotum is symmetrical
Never engaged with sex.
MUSCULOSKELETAL SYSTEM
With complaints of weakness
With complaints of fatigue
With complaints of lower back pain
With complaints of pain in the lower extremities
No history of fracture or any injury
ENDOCRINE SYSTEM
Patient has no history of thyroid problem
CIRCULATORY SYSTEM
With no history of painful tonsils
With no history of having nodules on the neck
No history of bleeding problems
No history of hypertension
With low blood pressure
NEUROLOGIC SYSTEM
Patient is conscious to time, place and people
Has no history of seizure
Coherent and responsive
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PHYSICAL EXAMINATION
Skin
Inspection
skin is yellow in color or Jaundice
Has closed intact skin
No lesions
Slightly swelling in the lower extremities and past of her
face
Palpation
Skin is warm to touch
Has a good skin turgor
Hair
Inspection
Color of hair is black
No infestation of parasites
With dandruff
Has a short and straight hair
Nails
Inspection
Pink nail bed
Nails are completely distributed in her fingers
Patient has no cracked or nail injuries
Eyes
Inspection
Both eyes are symmetrical
Eyelashes equally distributed, curled slightly outward
Pupils are equally rounded
The pupil was brown in color with yellow conjunctiva
Blinking reflex was normal and functional
Peripheral reflexes are normal and functional
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Vision acuity is in normal range and can read the Snellen
chart
Patient is not using any glasses and contact lenses as
visional aid
Ears
Inspection
Auricles yellow in color as facial skin, symmetrical and are
aligned with outer canthus of eye
Pinna recoils after it is folded
No cerumen
Able to hear spoken words clearly
No discharges
Nose
Inspection
Has the same color as facial skin
Not tender, no lesion
No discharges
Straight and symmetrical
Able to identify odors like alcohol, cologne and coffee
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CLINICAL LABORATORY
Hematology
DIFFERENTIAL COUNT
BANDS % 0-5
SEGMENTERS 79.8 % 50-70 neutrophilia
LYMPHOCYTES 11.7 % 20-40 lymphocytopenia
MID CELLS 8.5 % -------
MONOCYTES % 0-7
EOSINPHILS % 0-5
BASOPHILS % 0-1
BLOOD TYPE
CLOTTING TIME 3-6 MINUTES
BLEEDING TIME 1-3 MINUTES
ESR mm/hr MALE<10 FEMALE<20
RETICULOCYTE % 0.5-1.5 ADULT
COUNT
1.5-2.5 NEWBORN
REMARKS: DONE @6AM 1/09/17
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Patient Name: Date: Jan. 10, 2017
Room No. : MW-G3 Age : 17 y/o
Hematology
DIFFERENTIAL
COUNT
BANDS % 0-5
SEGMENTERS 83.9 % 50-70 neutrophilia
LYMPHOCYTES 9.0 % 20-40 lymphocytopenia
MID CELLS 7.1 %
MONOCYTES % 0-7
EOSINPHILS % 0-5
BASOPHILS % 0-1
BLOOD TYPE
CLOTTING TIME 3-6 MINUTES
BLEEDING TIME 1-3 MINUTES
ESR mm/hr MALE<10 FEMALE<20
RETICULOCYTE % 0.5-1.5 ADULT
COUNT
1.5-2.5 NEWBORN
REMARKS: DONE @ 7:50 AM
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Patient Name: PATIENT M. Date : Jan.9,2017
Room No. : MW-G3 Age : 17 y/o
Gender: M
BLOOD CHEMISTRY
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ANATOMY AND PHYSIOLOGY OF THE LIVER AND KIDNEY
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reinforced by the peritoneum of the abdominal cavity, which
protects the liver and holds it in place within the abdomen.
The peritoneum connects the liver in 4 locations: the coronary
ligament, the left and right triangular ligaments, and the
falciform ligament. These connections are not true ligaments in
the anatomical sense; rather, they are condensed regions of
peritoneal membrane that support the liver.
The left and right lobes are the largest lobes and are separated
by the falciform ligament. The right lobe is about 5 to 6 times
larger than the tapered left lobe.
The small caudate lobe extends from the posterior side of the
right lobe and wraps around the inferior vena cava.
The small quadrate lobe is inferior to the caudate lobe and
extends from the posterior side of the right lobe and wraps
around the gallbladder.
Bile Ducts
The tubes that carry bile through the liver and gallbladder are
known as bile ducts and form a branched structure known as the
biliary tree. Bile produced by liver cells drains into
microscopic canals known as bile canaliculi. The countless bile
canaliculi join together into many larger bile ducts found
throughout the liver.
These bile ducts next join to form the larger left and
right hepatic ducts, which carry bile from the left and right
lobes of the liver. Those two hepatic ducts join to form the
common hepatic duct that drains all bile away from the liver.
The common hepatic duct finally joins with the cystic duct from
the gallbladder to form the common bile duct, carrying bile to
the duodenum of the small intestine. Most of the bile produced
by the liver is pushed back up the cystic duct by peristalsis to
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arrive in the gallbladder for storage, until it is needed for
digestion.
Blood Vessels
The blood supply of the liver is unique among all organs of the
body due to the hepatic portal vein system. Blood traveling to
the spleen, stomach, pancreas, gallbladder,
and intestines passes through capillaries in these organs and is
collected into the hepatic portal vein. The hepatic portal vein
then delivers this blood to the tissues of the liver where the
contents of the blood are divided up into smaller vessels and
processed before being passed on to the rest of the body. Blood
leaving the tissues of the liver collects into the hepatic
veins that lead to the vena cava and return to the heart. The
liver also has its own system of arteries and arterioles that
provide oxygenated blood to its tissues just like any other
organ.
Lobules
The internal structure of the liver is made of around 100,000
small hexagonal functional units known as lobules. Each lobule
consists of a central vein surrounded by 6 hepatic portal veins
and 6 hepatic arteries. These blood vessels are connected by
many capillary-like tubes called sinusoids, which extend from
the portal veins and arteries to meet the central vein like
spokes on a wheel.
Each sinusoid passes through liver tissue containing 2 main cell
types: Kupffer cells and hepatocytes.
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emulsification of fats by bile turns the large clumps of fat
into smaller pieces that have more surface area and are
therefore easier for the body to digest.
Bilirubin present in bile is a product of the liver’s digestion
of worn out red blood cells. Kupffer cells in the liver catch
and destroy old, worn out red blood cells and pass their
components on to hepatocytes. Hepatocytes metabolize hemoglobin,
the red oxygen-carrying pigment of red blood cells, into the
components heme and globin. Globin protein is further brokendown
and used as an energy source for the body. The iron-containing
heme group cannot be recycled by the body and is converted into
the pigment bilirubin and added to bile to be excreted from the
body. Bilirubin gives bile its distinctive greenish color.
Intestinal bacteria further convert bilirubin into the brown
pigment stercobilin, which gives feces their brown color.
Metabolism
The hepatocytes of the liver are tasked with many of the
important metabolic jobs that support the cells of the body.
Because all of the blood leaving the digestive system passes
through the hepatic portal vein, the liver is responsible for
metabolizing carbohydrate, lipids, and proteins into
biologically useful materials.
Our digestive system breaks down carbohydrates into the
monosaccharide glucose, which cells use as a primary energy
source. Blood entering the liver through the hepatic portal vein
is extremely rich in glucose from digested food. Hepatocytes
absorb much of this glucose and store it as the macromolecule
glycogen, a branched polysaccharide that allows the hepatocytes
to pack away large amounts of glucose and quickly release
glucose between meals. The absorption and release of glucose by
the hepatocytes helps to maintain homeostasis and protects the
rest of the body from dangerous spikes and drops in the blood
glucose level. (See more about glucose in the body.)
Fatty acids in the blood passing through the liver are absorbed
by hepatocytes and metabolized to produce energy in the form of
ATP. Glycerol, another lipid component, is converted into
glucose by hepatocytes through the process of gluconeogenesis.
Hepatocytes can also produce lipids like cholesterol,
phospholipids, and lipoproteins that are used by other cells
throughout the body. Much of the cholesterol produced by
hepatocytes gets excreted from the body as a component of bile.
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acids and convert them into ammonia and eventually urea. Urea is
less toxic than ammonia and can be excreted in urine as a waste
product of digestion. The remaining parts of the amino acids can
be broken down into ATP or converted into new glucose molecules
through the process of gluconeogenesis.
Detoxification
As blood from the digestive organs passes through the hepatic
portal circulation, the hepatocytes of the liver monitor the
contents of the blood and remove many potentially toxic
substances before they can reach the rest of the body. Enzymes
in hepatocytes metabolize many of these toxins such as alcohol
and drugs into their inactive metabolites. And in order to keep
hormone levels within homeostatic limits, the liver also
metabolizes and removes from circulation hormones produced by
the body’s own glands.
Storage
The liver provides storage of many essential nutrients,
vitamins, and minerals obtained from blood passing through the
hepatic portal system. Glucose is transported into hepatocytes
under the influence of the hormone insulin and stored as the
polysaccharide glycogen. Hepatocytes also absorb and store fatty
acids from digested triglycerides. The storage of these
nutrients allows the liver to maintain the homeostasis of blood
glucose. Our liver also stores vitamins and minerals - such as
vitamins A, D, E, K, and B12, and the minerals iron and copper -
in order to provide a constant supply of these essential
substances to the tissues of the body.
Production
The liver is responsible for the production of several vital
protein components of blood plasma: prothrombin, fibrinogen, and
albumins. Prothrombin and fibrinogen proteins are coagulation
factors involved in the formation of blood clots. Albumins are
proteins that maintain the isotonic environment of the blood so
that cells of the body do not gain or lose water in the presence
of body fluids.
Immunity
The liver functions as an organ of the immune system through the
function of the Kupffer cells that line the sinusoids. Kupffer
cells are a type of fixed macrophage that form part of the
mononuclear phagocyte system along with macrophages in the
spleen and lymph nodes. Kupffer cells play an important role by
capturing and digesting bacteria, fungi, parasites, worn-out
blood cells, and cellular debris. The large volume of blood
passing through the hepatic portal system and the liver allows
Kupffer cells to clean large volumes of blood very quickly.
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ANATOMY OF KIDNEY
Structure
The kidneys are bean-shaped with the convex side of each organ
located laterally and the concave side medial. The indentation
on the concave side of the kidney, known as the renal hilus,
provides a space for the renal artery, renal vein, and ureter to
enter the kidney.
A thin layer of fibrous connective tissue forms the renal
capsule surrounding each kidney. The renal capsule provides a
stiff outer shell to maintain the shape of the soft inner
tissues.
Blood Supply
1. The renal arteries branch directly from the abdominal aorta and
enter the kidneys through the renal hilus.
2. Inside our kidneys, the renal arteries diverge into the smaller
afferent arterioles of the kidneys.
3. Each afferent arteriole carries blood into the renal cortex,
where it separates into a bundle of capillaries known as a
glomerulus.
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4. From the glomerulus, the blood recollects into smaller efferent
arterioles that descend into the renal medulla.
5. The efferent arterioles separate into the peritubular
capillaries that surround the renal tubules.
6. Next, the peritubular capillaries merge to form veins that merge
again to form the large renal vein.
7. Finally, the renal vein exits the kidney and joins with
the inferior vena cava, which carries blood back to the heart.
The Nephron
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5. From the renal pelvis urine from many collecting ducts combines
and flows out of the kidneys and into the ureters.
Excretion of Wastes
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osmotic pressure pushes water from the dilute, hypotonic
filtrate back into the concentrated, hypertonic blood.
3. From the proximal convoluted tubule, the tubular fluid next
enters the loop of Henle, where water and ions are reabsorbed.
The descending limb of the loop of Henle is permeable to water
and carries the filtrate deep into the medulla of the kidney.
Tissues in the medulla surrounding the tubule contain a high
concentration of ions and very little water compared to the
filtrate. Osmotic pressure between the hypotonic filtrate and
hypertonic medullary cells pushes water out of the filtrate and
into the cells. The cells of the medulla return this water to
the blood flowing through nearby capillaries.
4. Filtrate next passes through the ascending limb of the loop of
Henle as it exits the medulla. The tissues surrounding the
ascending limb are not permeable to water but are permeable to
ions. The filtrate is very concentrated after passing through
the descending limb, so ions easily diffuse out of the filtrate
and into the cells lining the ascending limb. These ions are
returned to the blood flowing through nearby capillaries.
5. Tubular fluid exiting the loop of Henle next passes through the
distal convoluted tubule and the collecting duct of the nephron.
These tubules continue to reabsorb small amounts of water and
ions that are still left in the filtrate. The tissues
surrounding the collecting duct actively absorb excess potassium
and hydrogen ions from the nearby capillaries and secrete these
excess ions as waste into the filtrate.
6. When filtrate reaches the end of the collecting duct, almost all
of the valuable nutrients, ions, and water have been returned to
the blood supply while waste products and a small amount of
water are left to form urine. The urine exits the collecting
duct and joins with urine from other collecting ducts in the
renal pelvis.
Water Homeostasis
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the blood. Aldosterone functions by increasing the reabsorption
of Na+ and Cl- ions, causing more water to move into the blood
via osmosis.
Acid/Base Homeostasis
Electrolyte Homeostasis
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Chloride (Cl-): Chloride is the most important anion (negatively
charged ion) in the body. Chloride is vital to the regulation of
factors such as pH and cellular fluid balance and helps to
establish the electrical potential of neurons and muscle cells.
The proximal convoluted tubule and ascending loop of Henle
reabsorb about 90% of the chloride ions filtered by the kidneys.
Calcium (Ca2+): Calcium is not only one of the most important
minerals in the body that composes the bones and teeth, but is
also a vital electrolyte. Functioning as an electrolyte, calcium
is essential for the contraction of muscle tissue, the release
of neurotransmitters by neurons, and the stimulation of cardiac
muscle tissue in the heart. The proximal convoluted tubule and
the ascending loop of Henle reabsorb most of the calcium in
tubular filtrate into the blood. Parathyroid hormone increases
the reabsorption of calcium in the kidneys when blood calcium
levels become too low.
Magnesium (Mg2+): Magnesium ion is an essential electrolyte for
the proper function of enzymes that work with phosphate
compounds like ATP, DNA, and RNA. The proximal convoluted tubule
and loop of Henle reabsorb most of the magnesium that passes
through the kidney.
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the capillaries in the glomerulus. If blood pressure becomes too
low, cells of the kidneys release renin into the blood. Renin
starts a complex process that results in the release of the
hormone aldosterone by the adrenal glands. Aldosterone
stimulates the cells of the kidney to increase their
reabsorption of sodium and water to maintain blood volume and
pressure.
Hormones
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been excreted as urine. The target cells also remove potassium
ions from the blood and excrete it into urine.
Atrial natriuretic peptide (ANP) is a hormone produced by
cardiac muscle cells in the atria of the heart. These cells
produce ANP in response to high levels of sodium in the blood or
increased blood pressure. In the kidneys, ANP increases the
glomerular filtration rate so that more blood plasma is forced
into the glomerular capsule and into the renal tubules. ANP also
removes some solutes from the cells of the renal medulla, making
the loop of Henle less efficient in reabsorbing water and ions
from the filtrate. The net result of ANP is that more sodium and
water end up being excreted into urine, blood volume decreases,
and blood pressure decreases as well.
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PATHOPHYSIOLOGY
Predisposing Factor:
Rainy Season Leptospire from
Home town is near to infected animals
rice field
Capillary vascularitis
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Skeletal muscle involvement is secondary
to edema and vessels damage
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DRUG SUTDY #1
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DRUG STUDY #2
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- Taper doses when discontinuing high-dose or long-term
therapy.
- Arrange for increased dosage when patient is subject to
unusual stress.
- Ensure that adequate amount of Ca2+ is taken if prolonged
administration of steroids.
- Use alternate-day maintenance therapy with short-acting
corticoids whenever possible.
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DRUG STUDY #3
Contraindications:
- Hyperkalemia
- Chronic renal Disease
- Acute dehydration
- Heat cramps.
- Severe tissue destruction
- Adrenal insufficiency
- Familial periodic paralysis
- Acidosis (potassium chloride products)
- Alkalosis (potassium bicarbonate products)
- Tablets: Esophageal compression due to enlarged left
atrium. Decreased GI motility.
Adverse Effects :
Dermatologiv: Rash (rare)
GI: Nausea, vomiting, diarrhea, abdominal discomfort, GI
obstruction, GI bleeding, GI ulceration or perforation.
Hematologic: Hyperkalemia – increased serum potassium,
ECG changes (peaking of T waves, loss of P waves,
depression of ST segment, prolongation of QTc interval)
Interactions:
- Increased risk of hyperkalemia with potassium-sparing
diuretics, salt substitutes using potassium.
Nursing Considerations
Assessment
- Assess for signs and symptoms of hypokalemia. (weakness,
fatigue, U wave on ECG, arrhythmias, polyuria, polydipsia)
and hyperkalemia.
- Treatment includes discontinuation of potassium,
administration of sodium bicarbonate to correct acidosis,
dextrose and insulin to facilitate passage of potassium
into cells, calcium salts to reverse ECG effects (in
patients who are not receiving digoxin), sodium polystyrene
used as an exchange resin, and/or dialysis for patient with
impaired renal function.
Interventions:
Arrange for serial serum potassium levels before and
during therapy.
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Administer liquid form to any patient with delayed GI
emptying
Administer oral drug after meals or with food a full glass
of water to decrease GI upset.
Caution patient not to chew or crush tablets; have patient
swallow tablet whole.
Arrange for further dilution or dose reduction if GI
effects are severe.
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DRUG STUDY #4
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DRUG STUDY #5
Brand Name: Fer -In-Sol, Slow Fe, Feosol, Feratab and many more.
Generic Name: Ferrous sulfate
Classification: Iron Preparation
MECHANISM OF ACTION:
•Elevates the serum iron concentration which then helps to
form High or trapped in the reticuloendothelial cells for
storage and eventual conversion to a usable form of iron.
INDICATIONS:
•Prevention and treatment of iron deficiency anemias.
Dietary supplement for iron.
CONTRAINDICATIONS:
•Hypersensitivity
•Severe hypotension.
ADVERSE EFFECT:
• Dizziness
• N & V
• Nasal Congestion
• Dyspnea
• Hypotension
• CHF
• MI
• Muscle cramps
• Flushing
NURSING CONSIDERATION
• Advise patient to take medicine as prescribed.
• Caution patient to make position changes slowly to
minimize orhtostatic hypotension.
• Instruct patient to avoid concurrent use of alcohol or OTC
medicine without consulting the physician
• Advise patient to consult physician if irregular
heartbeat, dyspnea, swelling of hands and feet and
hypotension occurs.
• Inform patient that angina attacks may occur 30 min. after
administration due reflex tachycardia.
• Encourage patient to comply with additional intervention
for hypertension like proper diet, regular exercise,
lifestyle changes and stress management.
Precautions:Before taking this medication, tell your doctor or
pharmacist if you are allergic to it; or if you have any
other allergies. This product may contain inactive ingredients,
which can cause allergic reactions or other problems. Talk to
your pharmacist for more details.
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Drug Study #6
Overdose:
If someone has overdosed and has serious symptoms such as
passing out or trouble breathing, call 911. Otherwise, call a
poison control center right away. US residents can call their
local poison control center at 1-800-222-1222. Canada residents
can call a provincial poison control center.
Uses:
Vitamin K is used to treat and prevent low levels of
certain substances (blood clotting factors) that your body
naturally produces. These substances help your blood to thicken
and stop bleeding normally (e.g., after an accidental cut or
injury). Low levels of blood clotting factors increase the risk
for unusual bleeding. Low levels may be caused by
certain medications (e.g., warfarin) or medical conditions
(e.g., obstructive jaundice). Vitamin K helps to treat and
prevent unusual bleeding by increasing the body's production of
blood clotting factors.
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Indications and Usage:
Vitamin K1 Injection (Phytonadione Injectable Emulsion,
USP) is indicated in the following coagulation disorders which
are due to faulty formation of factors II, VII, IX and X when
caused by vitamin K deficiency or interference with vitamin K
activity.
Vitamin K1 Injection is indicated in:
•anticoagulant-induced prothrombin deficiency caused by
coumarin or indanedione derivatives;
•prophylaxis and therapy of hemorrhagic disease of the
newborn;
•hypoprothrombinemia due to antibacterial therapy;
•hypoprothrombinemia secondary to factors limiting absorption
or synthesis of vitamin K, e.g., obstructive jaundice, biliary
fistula, sprue, ulcerative colitis, celiac disease, intestinal
resection, cystic fibrosis of the pancreas, and regional
enteritis;
•other drug-induced hypoprothrombinemia where it is definitely
shown that the result is due to interference with vitamin K
metabolism, e.g., salicylates.
Contraindications:
Vitamin K is an important nutrient that aids in blood
clotting and helps your body develop strong, healthy bones. Your
age and gender dictate how much vitamin K your body needs daily,
with recommended daily intakes ranging from 2 micrograms in
infants to 90 in pregnant or breast-feeding women. Despite the
importance of this vitamin, certain people shouldn't take
vitamin K supplements and should limit their dietary intake of
vitamin K-rich foods, such as green leafy vegetables.
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Drug Study #7
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Drug Study #8
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Drug Study #9
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INDICATIONS AND USAGE:
MEPRON Suspension is indicated for the prevention of
Pneumocystis carinii pneumonia in patients who are intolerant to
trimethoprim-sulfamethoxazole (TMP-SMX). MEPRON Suspension is
also indicated for the acute oral treatment of mild-to-moderate
PCP in patients who are intolerant to TMP-SMX
CONTRAINDICATIONS:
MEPRON Suspension is contraindicated for patients who
develop or have a history of potentially life-threatening
allergic reactions to any of the components of the formulation.
PRECAUTIONS:
General: Absorption of orally administered MEPRON is
limited but can be significantly increased when the drug is
taken with food. Plasma atovaquone concentrations have been
shown to correlate with the likelihood of successful treatment
and survival. Therefore, parenteral therapy with other agents
should be considered for patients who have difficulty taking
MEPRON with food (see CLINICAL PHARMACOLOGY). Gastrointestinal
disorders may limit absorption of orally administered drugs.
Patients with these disorders also may not achieve plasma
concentrations of atovaquone associated with response to therapy
in controlled trials.
Drug Interactions:
Atovaquone is highly bound to plasma protein (>99.9%).
Therefore, caution should be used when administering MEPRON
concurrently with other highly plasma protein-bound drugs with
narrow therapeutic indices, as competition for binding sites may
occur. The extent of plasma protein binding of atovaquone in
human plasma is not affected by the presence of therapeutic
concentrations of phenytoin (15 mcg/mL), nor is the binding of
phenytoin affected by the presence of atovaquone.
Adverse reaction:
22% 31% 31% Infection
•Diarrhea
•Headache
•Cough increased
•Rhinitis
•Asthenia
•Abdominal Pain
•Dyspnea
•Vomiting
Patients discontinuing therapy due to an adverse experience
,Patients reporting at least 1 adverse experience.
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Drug Study #10
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etc.). Some health conditions may make you more susceptible to
the side-effects of the drug. Take as directed by your doctor or
follow the direction printed on the product insert.
Drug Interactions:
If you take other drugs or over the counter products at the
same time, the effects of Kremil-S Advance Tablet may change.
This may increase your risk for side-effects or cause your drug
not to work properly. Tell your doctor about all the drugs,
vitamins, and herbal supplements you are using, so that you
doctor can help you prevent or manage drug interactions. Kremil-
S Advance Tablet may interact with the following drugs and
products:
•Alcohol
•Alendronate
•Calcium acetate
•Ciprofloxacin
•Digoxin
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Drug Study # 11
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•Tachycardia
•megacolon
•myasthenia gravis
•IM inj in patients on anticoagulants.
Precautions: Avoid driving & operating machinery after
parenteral administration.
Adverse Reactions
•Xerostomia
•Tachycardia
•Urinary retention
•Allergic & skin reactions
•Rarely dyspnea (in patients w/ history of bronchial asthma
or allergy).
•Inj: Visual accommodation disturbance
•Infrequently inj site pain (after IM inj)
•Rarely anaphylactoid reactions & anaphylactic shock.
Interactions:
Intensifies anticholinergic effects of TCAs, antihistamines,
quinidine, amantadine, disopyramide& other anticholinergics
(egtiotropium, ipratropium). Enhanced tachycardiac effects of β-
adrenergic agents. Dopamine antagonists reduce effects of both
drugs on GIT.
Mechanism of Action: View Buscopan mechanism of action for
pharmacodynamics and pharmacokinetics details.
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NURSING CARE PLAN # 1
Assessment
Objetive:
Diagnosis:
Planning:
Intervention:
INTERVENTION RATIONALE
Assess level of client’s Identifies extent of problem/
knowledge about condition and concern and necessary
treatment and anxiety related interventions.
to current situation.
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accept and deal with them more
effectively.
Determine clients role in Long-tem /permanent illness
family constellation and and disability alters clients
clients perception of ability to fulfill usual roles
expectation of self and others in family/ school setting.
Unrealistic expectations can
undermine self-esteem and
affect outcomes of illness.
Recommend SO treat client Conveys expectation that
normally and not as an client is able to manage
invalid. situation and helps maintain
sense of self-worth and
purpose in life
Identify strengths, past Focusing on these reminders of
success, previous methods own ability to deal with
client has used to deal with problems can help client deal
life stressors. with current situation
Assist and encourage the Proper hygiene can enhance
client and the SO to provide client’s physical appearance
and practice proper hygiene. and can help gain self-esteem.
Evaluation:
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NURSING CARE PLAN #2
Assessment:
Objective:
Diagnosis:
Planning:
Nursing Intervention:
INTERVENTION RATIONALE
introduce self, ask patient Established rapport
name check name tag to determine
the right patient to perform
correct procedure and to gain
cooperation
Vital signs checked and For monitoring purposes and to
recorded be able to know if there is any
unusual happened to the patient
and can provide care.
Provided comfort and bed To be able to promote comfort
rest by stretching and and rest to the patient through
avoiding linens folds or proper positioning.
patient bed.
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Encouraged patient to To be able to provide care
verbalized any concerns immediately if there will be any
unusual happen and needs.
Divert attention Like let Diverting attention of the
the patient watch TV or patient to other things can
listen to music lessen the pain because his
attention will not be focus to
his feeling of pain.
Dependent
Evaluation:
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NURSING CARE PLAN # 3
Assessment:
Subjective: “Ma’am waya man gud anay namo tambaya ang ako samad,
amo pa kami ni lihok pag adto nag yellow nako, nan ya ako mag
tuo na masakit baja ako” as verbalized by the patient.
Objective:
Planning:
Nursing Intervention:
INTERVENTION RATIONALE
Review disease process and Provides knowledge base from
precipitating factors if known. which client can make informed
choices.
Explain level of renal function Client may experience residual
after acute episode is over. defects in kidney function which
may/ may not be permanent.
Review dietary plan/ Adequate nutrition is necessary
restrictions. Include fact sheet to promote healing/tissue
listing food restrictions. regeneration; adherence to
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restrictions may prevent
complication.
Discuss reality of continued Decreased metabolic energy
presence of fatigue. production, presence of anemia
and state of discomfort commonly
results in fatigue.
Determine/prioritize ADLs and Helps client manage lifestyle
personal responsibilities. change and meet personal/family
Identify available resources/ needs.
support systems.
Recommend scheduling activities Prevents excessive fatigue and
with adequate rest periods. conserves energy for healing,
tissue generation.
Identify symptoms requiring Prompt evaluation and
medical intervention; e.g., intervention may prevent serious
decreased urinary output, sudden complications/ progression to
weight gain, presence of edema, CRF.
lethargy, bleeding, signs of
infection, altered mentation.
Convey acceptance and listen to Proving interest to the patient
client’s statements and problems. allows him to share and interact
to the activity.
Evaluation:
Goal met. After 1 hour of doing nursing intervention the
patient was able to verbalized understanding of condition or disease
process and initiate necessary lifestyle changes and participate in
treatment regimen.
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NURSING CARE PLAN #4
Assessment:
general weakness
Jaundice skin (entire body)
Irritable
Restless
Disturbed sleep (presence of eye bags)
BP:80/50
PR:94
RR:24
TEMP:38 c
Increased segmenters
Decreased lymphocyte
Decreased hemoglobin of 8.8g/dl
Increased WBC of 15.0x10^9/L
Increased creatinine of 2.03
Increased blood Urea nitrogen of 9.32
Leptospirosis
DIAGNOSIS:
PLANNING:
INTERVENTION:
INTERVENTION Rationale
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Establish rapport to the client Introduce self to gain
cooperation and trust, asking
the name of the patient to
assure the right client and to
perform the given procedure.
Vital signs monitored and For monitoring purposes and to
recoded. be able to know if there is
any unusual happened to the
patient and can provide care.
I and O monitored and recorded Helps estimate fluid
replacement needs. Fluid
intake should approximate
losses through urine,
nasogastric or wound drainage
and insensible losses.
Checked and individually To be able to administer
assesse medication prepared to medication properly
be administered according to
time and proper dose needed by
the patient.
Comfort provided To provide rest and comfort to
the patient and proper
position.
Assessed the patient visitation
of AP and check for new orders.
DEPENDENT RATIONALE
Administered IVF D5LR 1000mL at This is to maintain patient
15gtts/min in right metacarpal fluid and for medication
as ordered. administration purposes.
Administered This is administered to
medication of eliminate or lessen the
bacterial infection in the
Atovaquone Mepron as body.
ordered
Cefuroxime
EVALUATION:
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NURSING CARE PLAN #5
ASSESSMENT:
Objective:
Body weakness
Skin is warm to touch
Dry skin
Flushed skin
Restless
WBC 15.0x10^9/L
Temperature 38.9 c
BP-80/50
Leptospirosis
DIAGNOSIS
Hyperthermia related to infection process.
PLANNING:
Within 4 hours of nursing intervention patient
temperature will be decreased from 38.9 c to 37.0 c
INTERVENTION:
INTERVENTION Rationale
Establish rapport to the Introduce self to gain
client cooperation and trust,
asking the name of the
patient to assure the right
client and to perform the
given procedure.
Provided comfort and To be able to promote comfort
bed rest and rest to the patient
through proper positioning.
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I and O monitored and Helps estimate fluid
recorded replacement needs. Fluid
intake should approximate
losses through urine,
nasogastric or wound
drainage and insensible
losses.
Provide tipid sponge bath This allows the temperature
to decrease because this
provides fresh feeling and
bath to the patient.
Ventilate environment This allows the environment
to be cool and not to be
compressed with high
temperature. This could
allow patient to feel fresh
and ventilated.
Encouraged patient to So that the patient will not
increased oral fluid intake be dehydrated.
Vital signs monitored and For monitoring purposes and
recoded. to be able to know if there
is any unusual happened to
the patient and can provide
care.
Checked and individually To be able to administer
assesse medication prepared medication properly
to be administered according
to time and proper dose
needed by the patient.
Administer Paracetamol To be able to decrease
BIOGESIC 500mg as ordered. patient temperature.
EVALUATION:
Goal met. Within 4 hours of doing nursing intervention
patient temperature was decreased from 38.9 c to 37.0 c.
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DISCHARGE PLAN
Upon discharge from the hospital, the patient and her
significant others will be given home care instructions
containing in the following:
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DIET Advised the patient’s SO to let the
patient eat nutritious food like
fruits, vegetables and green leafy
Instructed SO to control or limit the
food of the patient which contain
sodium
SPIRITUAL Encourage patient to be more faithful
and have trust in God
Encourage patient and SO to pray for
the patients early recovery
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IVF SHEET
3 1L PNSS 50 gtts/min
4 1L PNSS 50 gtts/min
5 1L PNSS 50 gtts/min
11 1L PNSS 30 gtts/min
13 1L PNSS 15 gtts/min
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14 1/8/17 1L PNSS 30 gtts/min
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DEFINATION OF TERMS
Leptospirosis - is a bacterial disease that affects humans and
animals. It is caused by bacteria of the genus Leptospira.
alveoli- any of the many tiny air sacs of the lungs which allow
for rapid gaseous exchange.
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VITAL SIGNS
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6pm 110/60 86 22 36.2
8pm 120/80 82 22 36.8
10pm 110/80 75 20 36.2
12mn 120/80 78 20 36.6
2am 140/70 77 20 36.7
4am 130/80 70 20 36.3
6am 110/80 36 20 36.7
1-5-17
8am 120/80 83 26 36
10am 130/70 78 23 36.4
12nn 130/80 77 26 36.4
4pm 130/60 77 26 36.5
5pm 120/70 70 26 36.8
6pm 122/54 72 22 36
7pm 120/60 77 20 36
8pm 120/60 76 21 36
9pm 120/90 70 21 36
10pm 120/60 74 22 36
11pm 100/80 78 20 36
12mn 120/80 82 20 36.7
2am 120/70 80 20 36.7
4am 110/70 76 20 37
6am 100/60 80 20 37
1-9-17
11pm 120/60 80 20 37
12pm 100/60 84 20 27
4pm 110/70 78 20 36.6
8pm 120/70 82 20 37
12mn 110/60 76 20 37.3
2am 100/60 70 20 37
4am 110/60 69 20 37
1-10- 36.6
17
8am 110/70 71 20 36.7
10pm 110/70 82 20 36
12pm 110/80 84 20 36
4am 110/70 84 20 36
8am 120/80 26 20 36.5
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REFERENCES
(https://medlineplus.gov/ency/article/000501.htm)
(http://www.medicinenet.com/script/main/art.asp?articlekey=30776
)
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