Anemia Seconday UGIB

8/10/2019 Anemia Seconday UGIB

1/65

De La Salle Health Sciences InstituteCollege of Nursing and School of Midwifery

Dasmarias, Cavite

NUSIN!C"S#

S$UD%

Su&mitted &y' ALDRIN D. SAMSON BSN 3-1

Su&mitted to' Prof. Regiebie Vicencio RN, MAN


2/65

(IN"L DI"!N)SIS

Anemia secondar !""er #as$ro In$es$ina% B%eeding

I H#"L$H HIS$)%

A DEMOGRAPHIC (BIOGRAPHICAL DATA)

* Client+s Initial'A.&.P

!ender' 'ema%e

- "ge, .irthdate, and .irth/lace' () ears o%d *Oc$ober 13,1+3( *Samar

0 Marital(Civil)Status' idoed

1 ace and Nationality' 'i%i"ino

2 eligion' Roman &a$o%ic

3 "ddress, $ele/hone Num&er, #4mail "ddress' B%oc/ )0. Lo$ +.Baranga S$o. &ris$o, &i$ of Dasmarias *2+(444444

5 #ducational .ac6ground' 5%emen$ar !ndergrad6a$e

7 )ccu/ation 8usual and /resent9' None

*: ; Usual Source of Medical Care' 7os"i$a%s

**; Date of "dmission'A6g6s$ 32, 218

B SOURCE AND RELIABILITY OF INFORMATION

&%ien$ erse%f o seems re%iab%e b6$ s"ea/s in a sof$, ea/, ard% a6dib%e

9oice&%ien$:s niece o seems re%iab%e

&%ien$:s medica% record*car$

C CHIEF COMPLAINTS

;D6mi a/o ng d6mi "ero indi naman s6masa/i$ 6ng $ian /oa$i9e as an ini$ia% medica$ion and se re"or$ed a $o$a% of 8 boe%

mo9emen$s i$ a "resence of b%ac/ $arr s$oo%. Se as immedia$e%

admi$$ed for f6r$er e9a%6a$ion.

E PAST MEDICAL HISTORY OR PAST HEALTH

&%ien$ A.&.P as diagnosed as 7"er$ensi9e for more $an 12 ears andas diagnosed i$ Diabe$es for abo6$ 0 ears of d6ra$ion. Se can:$ reca%%ere 9accina$ion record beca6se of o%d age. Se a%so 9erba%i?ed $a$ se

didn:$ a9e an s6rgica% o"era$ions before.

Se 9erba%i?ed $a$ se is $a/ing 'e%odi"ine 0mg*$ab once a da,&%ic%a?ide )2mg*$ab $ice a da, @e%misar$an 82mg*$ab once a da, and

A$or9as$a$in 2mg*$ab once a da. @ere as no I%%nesses no$ed and se9erba%i?ed $a$ se ad no a%%ergies $o food and medica$ions. Se is $a/ingNa"ro>en ene9er se fe%$ oin$ "ains on $e /nees and fee$.

F FAMILY HISTORY


4/65


5/65

&%ien$ A.&.P %i9es Baranga S$o. &ris$o, &i$ of Dasmarias i$ er niece

and son in %a. @e main "ro9ider of $eir fami% is er da6g$er o is

or/ing as a n6rse in D6bai. @e c%ien$:s son-in-%a ref6sed $o disc%ose

$e amo6n$ of $eir mon$% income b6$ re"or$ed $a$ i$ is eno6g $o

s6""or$ a%% of $eir needs and $ere is %i$$%e b6dge$ a%%o$$ed for emergenc

ea%$ needs. A%$o6g $is as $e case, $e a%so sared $a$ $e are

a$$em"$ing $o mee$ $eir ea%$ financia% demands $a$ is $e ere

se$$ing aside a reasonab%e amo6n$ of mone for $e ea%$ needs of $e

c%ien$.

H PSYCHOSOCIAL ASSESSMENT>atient+s "ge' ()

Develo/mental StageO%der Ad6%$C)0 ears and o%der

Develo/mental $as6' 5go In$egri$ 9s. Des"air

O%der ad6%$s "%a a ro%e in ci%drearing $oda beca6se man

of $em gi9e ci%dcare $o o6ng ci%dren i%e "aren$s or/. @e

de9e%o"men$a% $as/ of o%der ad6%$s is in$egri$ 9ers6s des"air. An o%der

ad6%$ i$ in$egri$ fee%s good abo6$ $e %ife coices e or se as madeE

one i$ a fee%ing of des"air ises %ife o6%d begin o9er again so $a$

$ings co6%d $6rn o6$ differen$%. A sense of in$egri$ is e%"f6% in a

grand"aren$ o does ci%dcare, as i$ e%"s ci%dren de9e%o" a sense of

$r6s$ and %earn ac$i9i$.

On $e case of $e "a$ien$, se ad de9e%o"ed a sense of

con$en$men$ since $ro6go6$ er () ears of e>is$ence se ad a%as

been a a"" "erson and %i9ing as "rod6c$i9e as se co6%d. Se a%so

s$a$ed $a$ se:s a%as %oo/ing bac/ a$ er %ife and ana%?ing a%% er

accom"%ismen$s and fai%6res $o a9e a mo$i9a$ion $o be a be$$er "erson.

@6s, $e c%ien$ is in $e s$age of in$egri$.

H# RE$IE% OF SYSTEM AND PHYSICAL E&AMINATION

*; )S < ># ? Se"$ember 2 and 23 218


6/65

S%S$#M ;);S; >;#;

a.

#enera%*O9era%%

7ea%$ S$a$6s

;7indi na a/o nangiina

di $6%ad ng da$i.."ress er fee%ings.C- %oss of a""e$i$e

V*S 7er 9i$a% signs ere @em".3).F degrees &e%si6s, PR F0

bea$s "er min6$e, RR 1 cc%es

"er min6$e and BP 12*F2

mm7g

b. In$eg6men$ SGIN

;Ma/a$i 6ng bin$i /o sa

/a%iagen carringca"abi%i$ of $e b%ood.

7ema$ocri$ is $e"ro"or$ion of b%ood

9o%6me $a$ iscom"osed b red

b%ood ce%%s. @is $es$indica$es re%a$i9e

"ro"or$ion of RB& andP%asma in b%ood.

Abnorma% %e9e%s maindica$e anemia*%e6/emia.

i$e B%ood ce%%s areb%ood ce%%s $a$ %ac/s

emog%obin andf6nc$ions as $e bod:s

defense agains$foreign bodies. @is$es$ o6%d de$ermine

$e amo6n$ ofcirc6%a$ing B&. @is

can be a g6ide inde$ermining $e

se9eri$ of disease"rocess. B& co6n$ inb%ood 6s6a%% e%e9a$es

i$ infec$ion.

Male'2.8-2.0

(emale'2.3)-2.8)

0 -12 >12+* L

2.CLo

18.2 LC7ig

and is fami% of $e

"roced6re and i$s

"6r"ose $o a%%a

an>ie$.

Inform $e "a$ien$and is fami% $a$

%abora$or "ersonne

i%% come $o $e

ard for $e

e>$rac$ion of b%ood

sam"%e.

In case $a$ no

%abora$or "ersonne

is a9ai%ab%e, $ea$$ending n6rse i%

be e>$rac$ing $e

b%ood sam"%e

Inform $e "a$ien$

and is fami% of $e

$ime en b%ood

e>$rac$ion i%% be

"erformed.

Prac$ice ase"$ic$ecni6e b

asing ands and

earing g%o9es if $o

be "erformed b $e

a$$ending n6rse.

During the

/rocedure'

Pro9ide s6""or$

for $e c%ien$.

If $e a$$ending


14/65

L+m,-'c+te

Semente*

E'in',-il

@is $"e of B&

"rod6ces an$ibodiesand res"onsib%e fordes$roing

microorganisms $a$en$ers $e bod. @is

$es$de$ermines "resenceof 9ira% and bac$eria%

infec$ions, $o>icme$abo%ic "rocesses,

e9en diagnose

%e6/emia s$ages

@is $es$ de$ermines

$e amo6n$ of

segmen$ed ne6$ro"i%s

in $e b%ood ic

"agoc$i?es

microorganism and

o$er s6bs$ances.

@is $es$ is done $o

de$ermine $e amo6n$

of eosino"i%s in $e

b%ood ic is

res"onsib%e for

comba$ing m6%$ice%%6%ar

"arasi$es and cer$aininfec$ions in

9er$ebra$es. A%ong i$

mas$ ce%%s, $e a%so

con$ro% mecanisms

associa$ed i$ a%%erg

and as$ma.

2. 2.82

2.3)

2.))

2.21 2.28

2.2CLo

2.(8

C7ig

2.21

CNorma%

n6rse i%% e>$rac$ $e

sam"%e, "erform $e

"roced6re as

efficien$% as

"ossib%e.

"fter the

/rocedure'

Doc6men$ $e

"roced6re on $e

"a$ien$:s car$.

Doc6men$ $e

"a$ien$:s res"onse

and $o%erance $o $e

"roced6re.

Assess $e

9eni"6nc$6re si$e for

b%eeding or

ema$oma

forma$ion.

Inform $e

"sician of $e

res6%$s.

Inform $e c%ien$

and is fami% $a$

$e "sician i%

e>"%ain $e res6%$s of

$e "roced6re and

i$s im"%ica$ions on

is condi$ion.

Prac$ice ase"$ic

$ecni6e b

asing ands and

dis"osing g%o9es in


15/65

Ba',-il

Platelet c'.nt

-@o de$ermine $eca"abi%i$ of $e b%ood$o c%o$ $6s "re9en$ing

b%eeding

@is $es$ is done $o

de$ermine $e n6mber

of "%a$e%e$s circ6%a$ing

in $e b%ood $a$

ref%ec$s $e ca"abi%i$

of $e b%ood $o c%o$

$6s "re9en$ing

b%eeding.

2.22 2.2

102-802>12+*

L

2.21

CNorma%

FF

CNorma%

"ro"er as$e bin if

$o be "erformed b

$e a$$ending n6rse.

Hematology ?>$ A >$$

A6g6s$ 32, 218

>rothrom&in$ime

$ime

B "ctivity

IN

1 18.0

seconds

(2 122

2.2F 1.3

13.2 seconds

12)

2.+(

.efore the

/rocedure'

&ec/ for

"sician:s orders.

&onfirm $e

iden$i$ of $e c%ien$

for sam"%e

e>$rac$ion.

Inform $e "a$ien$

and is fami% of $e

"roced6re and i$s

"6r"ose $o a%%aan>ie$.

Inform $e "a$ien$

and is fami% $a$

%abora$or "ersonne

i%% come $o $e


16/65

>artial$hrom&o/lastin

$ime

Ra$io2.()

CQ* $o

1.

3.) secondsC8-3)

seconds

ard for $e

e>$rac$ion of b%ood

sam"%e.

In case $a$ no

%abora$or "ersonne

is a9ai%ab%e, $e

a$$ending n6rse i%

be e>$rac$ing $e

b%ood sam"%e

Inform $e "a$ien$

and is fami% of $e

$ime en b%ood

e>$rac$ion i%% be

"erformed.

Prac$ice ase"$ic

$ecni6e b

asing ands and

earing g%o9es if $o

be "erformed b $ea$$ending n6rse.

During the

/rocedure'

Pro9ide s6""or$

for $e c%ien$.

If $e a$$ending


sam"%e, "erform $e

"roced6re as

efficien$% as


17/65

"ossib%e.

"fter the

/rocedure'

Doc6men$ $e

"roced6re on $e

"a$ien$:s car$.

Doc6men$ $e

"a$ien$:s res"onse

and $o%erance $o $e

"roced6re.

Assess $e


b%eeding or

ema$oma

forma$ion.

Inform $e

"sician of $eres6%$s.

Inform $e c%ien$

and is fami% $a$

$e "sician i%


$e "roced6re and

i$s im"%ica$ions on

is condi$ion.

Prac$ice ase"$ic

$ecni6e b

asing ands and

dis"osing g%o9es in


18/65

"ro"er as$e bin if

$o be "erformed b

$e a$$ending n6rse.

.lood Chemistrytest

A6g6s$ 32, 218

Se*.mC*eatinine

S'!i.m

P'tai.m

&rea$inine is a non

"ro$ein end "rod6c$ of

crea$ine

me$abo%ism.@es$ing for

crea$inine assesses

rena% g%omer6%ar

fi%$ra$ion ra$e and

screens for rena%

damage.

Sodi6m is $e maor

ca$ion in $e

e>$race%%6%ar Cfo6nd in$e 9esse%s and $iss6e

s"aces f%6id. @es$ing

for %e9e%s of sodi6m

e9a%6a$es a$er %oss or

a$er re$en$ion,

e"a$ic fai%6re and

o$ers.

Po$assi6m is an

im"or$an$ ce%%6%ar

ca$ion $a$ is "re9a%en$

in $e in$race%%6%ar

f%6ids. Po$assi6m is

needed for $e

03.22

+(6mo%*

L

13).22

180.22

mmo%*L

3.0 0.1

mmo%*L

18).2C7ig

130

CLo

8.1CNorma%

.efore the

/rocedure'

&ec/ for

"sician:s orders.

&onfirm $e

iden$i$ of $e c%ien$

for sam"%e

e>$rac$ion.

Inform $e "a$ien$

and is fami% of $e

"roced6re and i$s

"6r"ose $o a%%a

an>ie$.

Inform $e "a$ien$

and is fami% $a$%abora$or "ersonne

i%% come $o $e

ard for $e

e>$rac$ion of b%ood

sam"%e.

Inform $e "a$ien$

and is fami% of

$e $ime en b%ood

e>$rac$ion i%% be

"erformed. In case

$a$ no %abora$or

"ersonne% are

a9ai%ab%e, $e

a$$ending n6rse i%


19/65

.lood Urea

Nitrogen

$ransmission and

cond6c$ion of ner9e

im"6%ses and for $e

con$rac$ion of s/e%e$a%,

cardiac, and smoo$

m6sc%es. @es$ing for

"o$assi6m assesses

rena% fai%6re, cirrosis,

"ro$rac$ed 9omi$ing

and o$ers.

@o e9a%6a$e /idnef6nc$ionE an increased

%e9e% ma indica$e an6nder%ing disease

s6c as /idne fai%6re.

3.2 +.

mmo%*L

.3C7ig

.

be e>$rac$ing $e

b%ood sam"%e.

Assess c%ien$ if e

as ea$en a mea

i$ 9er igsodi6m con$en$ in

$e "as$ 8 o6rs.

Assess c%ien$ for

9i$a% signs es"ecia%%

$e cardiac and

men$a% s$a$6s.

Prac$ice ase"$ic

$ecni6e basing ands and

earing g%o9es if $o

be "erformed b $e

a$$ending n6rse.

During the

/rocedure'

Pro9ide s6""or$

for $e c%ien$.

If $e a$$ending


sam"%e, "erform $e

"roced6re as

efficien$% as

"ossib%e.

"fter the

/rocedure'


20/65

Doc6men$ $e

"roced6re on $e

"a$ien$:s car$.

Doc6men$ $e

"a$ien$:s res"onseand $o%erance $o $e

"roced6re.

Assess $e


b%eeding or

ema$oma

forma$ion.

Inform $e"sician of $e

res6%$s.

Inform $e c%ien$

and is fami% $a$

$e "sician i%


$e "roced6re and

i$s im"%ica$ions on

is condi$ion.

Prac$ice ase"$ic

$ecni6e b

asing ands and

dis"osing g%o9es in

"ro"er as$e bin if

$o be "erformed b

$e a$$ending n6rse.

ChemistryA6g6s$ 32, 218

Uric "cid

-De$ermines $eamo6n$ of 6ric acid in

$e b%oodE i$ is anindica$or of go6$

ar$ri$is

2.10

2.80

mmo%*L

2.8+C7ig

.efore the

/rocedure'

&ec/ for

"sician:s orders.

&onfirm $e iden$i$


21/65

"L$8S!>$92 00

!*L

1CNorma%

of $e c%ien$ for sam"%e

e>$rac$ion.

Inform $e "a$ien$

and er fami% of $e

"roced6re and i$s

"6r"ose $o a%%a

an>ie$.

Inform $e "a$ien$

and er fami% $a$

%abora$or "ersonne

i%% come $o $e ard

for $e e>$rac$ion of

b%ood sam"%e.

Inform $e "a$ien$

and er fami% of $e

$ime en b%ood

e>$rac$ion i%% be

"erformed.

Assess c%ien$ if se

as ea$en a mea% i$

9er ig sodi6m or

s6gar con$en$ in $e

"as$ 8 o6rs.

Assess c%ien$ for

9i$a% signs es"ecia%%

$e cardiac and

men$a% s$a$6s.

Prac$ice ase"$ic

$ecni6e b asing

ands and earing

g%o9es if $o be


22/65

"erformed b $e

a$$ending n6rse.

During the

/rocedure'

Pro9ide s6""or$ for

$e c%ien$.

If $e a$$ending


sam"%e, "erform $e

"roced6re as

efficien$% as "ossib%e.

Be ones$ abo6$

discomfor$ $a$ ma

be fe%$.

&o$$on or a bandage

ma be a""%ied $o $e

"6nc$6re si$e if $ere is

con$in6ed b%eeding.

"fter the /rocedure'

Doc6men$ $e

"roced6re on $e

"a$ien$:s car$.

Doc6men$ $e

"a$ien$:s res"onse and

$o%erance $o $e

"roced6re.

Assess $e



23/65

b%eeding or ema$oma

forma$ion.

Inform $e "sician

of $e res6%$s.

Inform $e c%ien$ and

er fami% $a$ $e

"sician i%% e>"%ain

$e res6%$s of $e

"roced6re and i$s

im"%ica$ions on er

condi$ion.

Prac$ice ase"$ic

$ecni6e b asing

ands and dis"osing

g%o9es in "ro"er as$e

bin if $o be "erformed

b $e a$$ending

n6rse.

Inform "a$ien$ $a$er "sician i%disc6ss $e $es$sres6%$s.

SerologyA6g6s$ 32, 218

H."*C

refers $o g%ca$edaemog%obin. I$de9e%o"s enaemog%obin, a "ro$ein

i$in red b%ood ce%%s$a$ carries o>gen$ro6go6$ o6r bod,

oins i$ g%6cose in$e b%ood, becomingg%ca$ed.

B meas6ring g%ca$ed

8.(

).2

).8

C7ig


24/65

aemog%obin C7bA1c,c%inicians are ab%e $oge$ an o9era%% "ic$6reof a$ o6r a9erageb%ood s6gar %e9e%s

a9e been o9er a"eriod of ee/s*mon$s.

/# OTHER ASSESSMENT TOOLS

Date $a6en Com/rehensive "ctual

ContentALegend

"ctual esult

None $a/en None $a/en None $a/en

I FUNCTIONAL ASSESSMENT

*; Health >erce/tion4Health Management >attern

Se be%ie9es $a$ ea%$ is 9er im"or$an$. Prior $o admission, se said

$a$ se fe%$ o/a and did no$ no$ice an signs $a$ ma "er$ain $o er c6rren$condi$ion. Se 9erba%i?ed d6ring $e in$er9ie se as been no$icing $a$ se is

e>"eriencing bod ea/ness since se ad been admi$$ed. @e c%ien$ said $a$

i%e se as a$ $e os"i$a%, $e mos$ im"or$an$ $ing for er $o do is $o

rec6"era$e and e9en$6a%% go o6$ of $e os"i$a%. Se as/ed for $e assis$ance of

n6rses and doc$ors $o e%" er go bac/ $o er 6s6a% ac$i9i$ies so $a$ se co6%d

go ome.


25/65


26/65

Le9e% 1 Re6ires 6se of de9ices

Le9e% Re6ires 6se of assis$ance from

ano$er "erson

Le9e% 3 Re6ires 6se of assis$ance from

ano$er "erson or de9ice

Le9e% 8 I$ de"ends and does no$ "ar$ici"a$e

0; Slee/4est >attern

@e "a$ien$ norma%% s%ee"s 8 $o ) o6rs a da. Se 6s6a%% "rac$ices

sies$a in $e af$ernoon for a$ %eas$ 32 min6$es a da. Se 6s6a%% fee%s good andfee%s re%a>ed en se a/es 6". Se does no$ $a/e an medica$ions $o aid in

er s%ee"ing.

1; NutritionalA#limination

@e "a$ien$ 6s6a%% ea$s 3 $imes a da. Se $"ica%% an$s Vege$ab%es

and mea$s. Se "refers drin/ing a$er ra$er $an 6ices and sof$ drin/s. Se

9erba%i?ed $a$ since se a%as ad a good a""e$i$e, se is recei9ing eno6g

n6$rien$s for s6fficien$ energ. @e "a$ien$ does no$ a9e an a%%ergies or

in$o%erance "er$aining $o food. @e "a$ien$ a%so added $a$ se ne9er ad an

den$a% "rob%ems. Se 6s6a%% 9oids abo6$ 0 $imes a da and mo9es er boe%

once a da.

2; Seuality4e/roductive >atterns

@e c%ien$ "referred no$ $o be 9oca% regarding $is ma$$er.

3; Inter/ersonal relationshi/sAesources


27/65

@e "a$ien$ norma%% 9ies er ro%e as a so%e mo$er $o er ci%dren and

an 6nders$anding grandmo$er. Se a%so s$a$ed $a$ se easi% ge$s a%ong i$

o$er "eo"%e.

5; Co/ing and Stress ManagementA$olerance >attern

'inancia% crisis is er ea9ies$ s$ress in %ife. 'or er, i$o6$ s6fficien$

mone, one co6%d no$ s6r9i9e in $is or%d and one canno$ "ro9ide for is or er

basic needs. Se be%ie9es $a$ d6e $o $is "ar$ic6%ar s$ress, er ea%$ as been

com"romised. @o dea% i$ er s$ress se $a/es a na" $o someo re%ie9e er

an>ie$ en i$ comes $o mone. Se a%so 9erba%i?ed $a$ se of$en come $o $e

o6se of er da6g$ers ene9er se fee%s bored. Se does no$ 6se an

medica$ions $o re%ie9e er s$ress.

7; >ersonal Ha&its

@e "a$ien$ s$a$ed $a$ se is a non-a%coo%ic, a non-smo/er "erson and

se does no$ $a/e i%%ici$ dr6gs. 'or er, se does no$ e9en consider $ring $o $a/e

a%coo%, cigare$$es or i%%ici$ dr6gs beca6se i$ is agains$ er 9a%6es.

*:; #nvironmental Haards

@e "a$ien$ and er fami% a9e been %i9ing in Baranga S$o. &ris$o. @e are

"resen$% residing in a s6bdi9ision in $e said m6nici"a%i$. According $o $e

"a$ien$, $e s6bdi9ision $e are %i9ing in as a %arge "o"6%a$ion and i$ is 6i$e

im"ossib%e $o a9e /no%edge of a%% $e neigbors. Se a%so added $a$ se and

er fami% enco6n$ered minor "rob%ems in $e comm6ni$ s6c as $oo m6c noisei$in $eir neigborood. @e "a$ien$ s$a$ed $a$ $e a9e no "rob%em in

accessing $e mar/e$ $o b6 $eir needs since i$:s a a%/ing dis$ance $o $eir

o6se.


28/65

II >).L#M LIS$

" "ctual or "ctive

P*'lem N'# P*'lem Date I!enti0ie! Date

Re'lve!1Rema*2

1 An>ie$ Se"$ember 2,

218

Se"$ember 23,

218 @e c%ien$

9erba%i?ed $a$ se

fe%$ o/a and more

re%a>ed a$ $e endof $e sif$.

Ac$i9i$ In$o%erance Se"$ember 2,

218

No$ e$ reso%9ed.

@e c%ien$ said $a$

se s$i%% fe%$ ea/ a$

$e end of $e sif$.

. is6 or >otential

>ro&lem No; >ro&lem Date identified


29/65

1 Ris/ for Im"aired S/in In$egri$ Se"$ember 2, 218


30/65

III NUSIN! C"# >L"N

CU#S NUSIN!DI"!N)SIS

L)N! $#M!)"LS

SH)$$#M

!)"LS

IN$#@#N$I)N "$I)N"L# #@"LU"$I)N

S ;#6s$o /ona 6m6i e.Gaa %ang a%a

"a si doc, di$6%o namina%am /6ng/e%an a/oma/a/a6i.ie$ of$e c%ien$

@o de$erminein$er9en$ionsre6ired $o bedone

#oa% me$. @ec%ien$ 9erba%i?ed$a$ se fe%$ o/a

and a""earedre%a>ed a$ $e endof $e sif$.


31/65

Pro9ided a 6ie$ and

re%a>ing en9ironmen$

cond6ci9e for res$ing

5nco6raged

di9ersiona% ac$i9i$ies

s6c as s%ee"ing

C'lla'*ative

Assis$ed in addressing

financia%

considera$ions as

a""ro"ria$e.

@o decreasefac$ors ic maincrease $es$ress fe%$ b $ec%ien$

@o a9er$ $ec%ien$:s foc6s on

er an>ie$

@o e%" $e c%ien$red6ce e>"enseson os"i$a%i?a$ionand medica%$rea$men$snecessar

S ;Nangiina

ang /a$aan

/o.gen

s6""% anddemand

@e c%ien$ i%%be ab%e $o"erformo"$ima%ac$i9i$,

e>ercise, res$and s%ee"$ro6go6$

@e c%ien$i%% be ab%e$o manifes$no signs offa$ig6e s6cas sor$nessof brea$,di??iness

In!e,en!entAssessed $e c%ien$:sabi%i$ $o "erformac$i9i$ies of dai% %i9ingCADLs

@o de$ermine $ea""ro"ria$ecoices of in$er9en$ions *neededassis$ance

#oa% no$ me$. @ec%ien$ 9erba%i?ed$a$ a%$o6g seas ab%e $oamb6%a$e $o $ecomfor$ room i$assis$ance i$o6$sor$ness of


32/65

a""earance of

$e ees

CH "a%%or of

con6nc$i9a and

bo$ e>$remi$ies

ca"i%%ar refi%%

3 seconds

CH

genera%i?ed

bod ma%aise

Vi$a% signs a$

FAM

@em". 3).F

degrees

&e%si6s,

PR F0 bea$s

"er min6$e,

RR 1 cc%es"er min6$e and

BP 12*F2

mm7g

er $rea$men$regimen

andincreasedear$ ra$eenamb6%a$ingi$assis$ancefrom bed $ocomfor$

room i$in$e sif$.

5nco6raged $e c%ien$$o 9erba%i?e er fee%ings and concerns

Pro9ided a 6ie$ andre%a>ing en9ironmen$cond6ci9e for res$ing

Assis$ed $e c%ien$ in"erforming ac$i9i$iesen necessarE

5nco6raged $e c%ien$$o cange "osi$ions%o%

Pro9ided ea%$

$eacings abo6$ $eim"or$ance of "ro"er"osi$ioning d6ring res$"eriods

C'lla'*ativeAdminis$eredmedica$ions as"rescribed

@o de$erminein$er9en$ionsre6ired $o bedone

@o enance res$and %oer bod:so>genre6iremen$s,

and red6cess$rain on $eear$ and %6ngs@o "romo$ec%ien$:s se%f re%iance

@o a9oid "os$6ra%"o$ension orcerebra% "o>iaic ma ca6sedi??iness, fain$ingand increasedris/ of in6r

@o enance %6ng

e>"ansion $oma>imi?eo>gena$ion force%%6%ar 6"$a/e

@o im"ro9ec%ien$:s condi$ionas "ar$ of $rea$men$regimen

brea$, se s$i%%fe%$ er bod asea/ a$ $e end of$e sif$.


33/65

S ;Dr ang

ba%a$ /o a$

nanganga$i

a/o.$remi$iesE

CH sca%ing of

s/in on $e %egs

and fee$

bi%a$era%%E

CH

genera%i?ed

bod ma%aise

Ris/ forIm"aired

S/in In$egri$re%a$ed $o

acc6m6%a$ionof $o>ins in

$e s/in

@e c%ien$ i%%be ab%e $omain$ainsafe$ $ro6g"re9en$ion ofin6r or o$er$ra6ma$ro6go6$

er $rea$men$regimen

@e c%ien$i%%demons$ra$ebea9io6rs$o "re9en$s/inbrea/donor in6r

i$in $esif$.

In!e,en!ent

Assessed $e s/in for

canges in co%or,

$6rgor and 9asc6%ari$E

Moni$ored f%6id in$a/e

and o6$"6$ s$ric$% as

e%% as $e dra$ion

of s/in and m6co6s

membranes

5ns6red $a$ %inens

are dr and rin/%e

free

Recommended $e

c%ien$ $o /ee"

fingernai%s sor$ and

r6b i$c areas ins$ead

of scra$cing.

@o de$ermineareas of "oorcirc6%a$ion

@o de$ermine $e"resence of dedra$ion $a$

affec$s circ6%a$ionand $iss6ein$egri$ a$ $ece%%6%ar %e9e%

@o red6ce derma%irri$a$ion and ris/of brea/don

@o a%%e9ia$ediscomfor$ andred6ce ris/ ofderma% in6r

@o a%%e9ia$ec%ien$:s discomfor$

#oa% no$ me$. @e

c%ien$ 9erba%i?ed

$a$ er s/in s$i%%

fe%$ 9er i$c and

$a$ se con$in6ed

$o scra$c er s/in

$ro6go6$ $e

sif$.


34/65

i$ a die$ of

mea$ free,

decrease

"ro$ein and %imi$

ora% f%6id in$a/e

$o 1 Li$er "er

da. 9i$a%

signs a$ FAM

@em". 3).Fdegrees

&e%si6s, PR F0

bea$s "er

min6$e, RR 1

cc%es "er

min6$e and BP

12*F2 mm7g

C'lla'*ative

5nco6raged c%ien$ $o

as/ er "sician if

se can a""%

"ar$ic6%ar oin$men$s *

creams on $e i$c

areas of $e s/in


35/65

I@ "N"$)M% "ND >H%SI)L)!%

Main O*an 1 S+tem Inv'lve! B%ood and b%ood "rod6c$sE #as$roIn$es$ina%

.L))D

B%ood is a $"e of connec$i9e

$iss6e $a$ consis$s of ce%%s and ce%%

fragmen$s s6rro6nded b a %i6id ma$ri>.

@e ce%%s and ce%% fragmen$s are $e

formed elements, and $e %i6id is $e

plasma. @e formed e%emen$s acco6n$

for s%ig$% %ess $an a%f and "%asma

acco6n$s for s%ig$% more $an a%f $e

$o$a% b%ood 9o%6me. @e $o$a% b%ood9o%6me in $e a9erage ad6%$ is abo6$ 8-0

%i$ers in fema%es and 0-) in ma%es. B%ood

ma/es 6" abo6$ F of $o$a% bod eig$.

Figu Figure 1: Blood

F.ncti'n

B%ood is "6m"ed b $e ear$ $ro6g b%ood 9esse%s, ic e>$end $ro6go6$$e bod. B%ood e%"s $o main$ain omeos$asis in se9era% as

1. Transport of gases, nutrients and waste products. O>gen en$ers b%ood in $e

%6ngs and is carried $o $e ce%%s. &arbon dio>ide, "rod6ced b $e ce%%s, is

carried in $e b%ood $o $e %6ngs, from ic i$ is e>"e%%ed. Inges$ed n6$rien$s,

ions, and a$er are $rans"or$ed b $e b%ood from $e diges$i9e $rac$ $o ce%%s,

and $e as$e "rod6c$s of $e ce%%s are $rans"or$ed $o $e /idnes for

e%imina$ion.

. Transport of processed molecules. Man s6bs$ances are "rod6ced in one

"ar$ of $e bod and $rans"or$ed in $e b%ood $o ano$er "ar$, ere $e are

modified. 'or e>am"%e, $e "rec6rsor $o 9i$amin D is "rod6ced in $e s/in and

$rans"or$ed b $e b%ood $o $e %i9er and $en $o $e /idnes for "rocessing in


36/65


37/65


38/65

Figure

':Hematopoiesis

@e

"rocess of

b%ood ce%% "rod6c$ion is ca%%ed %ematopoiesis. In $e fe$6s, ema$o"oiesis occ6rs in

se9era% $iss6es s6c as $e %i9er, $m6s g%and, s"%een, %m" nodes, and red bone

marro. Af$er bir$, ema$o"oiesis is confined "rimari% $o red bone marro, b6$

some i$e b%ood ce%%s are "rod6ced in %m"a$ic $iss6es. A%% $e formed e%emen$s

of b%ood are deri9ed from a sing%e "o"6%a$ion of ce%%s ca%%ed stem cells or

%emocytoblast. @ese s$em ce%%s differen$ia$e $o gi9e rise $o differen$ ce%% %ines,

eac of ic ends i$ $e forma$ion of a "ar$ic6%ar $"e of formed e%emen$. @e

de9e%o"men$ of eac ce%% %ine is reg6%a$ed b s"ecific gro$ fac$ors. @a$ is, $e

$"es of formed e%emen$ deri9ed from $e s$em ce%%s and o man formed

e%emen$s are "rod6ced are de$ermined b $e gro$ fac$ors.

ed .lood Cells

Norma% red b%ood ce%%s are dis/-sa"ed ce%%s i$ edges $a$ are $ic/er $an$e cen$er of $e ce%%. @e biconca9e sa"e increases $e s6rface area of $e red

b%ood ce%% com"ared i$ a f%a$ dis/ of $e same si?e. @e grea$er s6rface area

ma/es i$ easier for gases $o mo9e in$o and o6$ of $e red b%ood ce%%. In addi$ion,

$e red b%ood ce%% can bend or fo%d aro6nd i$s $in cen$er, decreasing i$s si?e and

enab%ing i$ $o "ass more easi% $ro6g sma%% b%ood 9esse%s.


39/65

Figure (: Red blood cells

D6ring $eir de9e%o"men$, red b%ood ce%%s

%ose $eir n6c%ei and mos$ of $eir organe%%es.

&onse6en$%, $e are 6nab%e $o di9ide. RB&s

%i9e for abo6$ 12 das in ma%es and 112 das in

fema%es. @e main com"onen$ of a red b%ood ce%% is $e "igmen$ed "ro$ein

%emoglobin, ic acco6n$s for abo6$ a $ird of $e ce%%:s 9o%6me and is

res"onsib%e for i$s red co%or.

@e "rimar f6nc$ions of red b%ood ce%%s are $o $rans"or$ o>gen from $e%6ngs $o $e 9ario6s $iss6es of $e bod and $o assis$ in $e $rans"or$ of carbon

dio>ide from $e $iss6es $o $e %6ngs. O>gen $rans"or$ is accom"%ised b

emog%obin, ic consis$s of 8 "ro$ein cains and 8 eme gro6"s. 5ac "ro$ein

ca%%ed a globin, is bo6nd $o one %eme, a red "igmen$ed mo%ec6%e. 5ac eme

con$ains one iron a$om, ic is necessar for $e norma% f6nc$ion of emog%obin.

5ac iron in a eme mo%ec6%e can re9ersib% associa$e i$ an o>gen mo%ec6%e.

7emog%obin "ic/s 6" o>gen in $e %6ngs and re%eases o>gen in o$er $iss6es.

7emog%obin $a$ is bo6nd $o o>gen is brig$ red in co%or, ereas emog%obin

i$o6$ bo6nd o>gen 6s a dar/er red co%or. 7emog%obin is res"onsib%e for +F.0

of $e o>gen $rans"or$ed in b%ood. @e remaining 1.0 is $rans"or$ed disso%9ed in

"%asma. Beca6se iron is necessar for o>gen $rans"or$, i$ is no$ s6r"rising $a$ $o

$irds of $e bod:s iron is fo6nd in emog%obin. Sma%% amo6n$s of iron are re6ired

in $e die$ $o re"%ace $e sma%% amo6n$s %os$ in $e 6rine and feces. omen need

more die$ar iron $an men do beca6se omen %osses iron as a res6%$ of

mens$r6a$ion.

=hite .lood Cells

i$e b%ood ce%%s or %e6/oc$es are s"erica% ce%%s $a$ %ac/ emog%obin.

B&s form $in i$e %aer of ce%%s be$een "%asma and RB&s en $e

com"onen$s of b%ood are se"ara$ed from eac o$er. @e are %arger $an RB&s

and eac as a n6c%e6s. A%$o6g B&s are com"onen$s of $e b%ood, $e b%ood

ser9es "rimari% as a means of $rans"or$ $ese ce%%s $o o$er $iss6es of $e bod.


40/65

B&s can %ea9e $e b%ood and mo9e b ameboid mo9emen$ $o6g $e $iss6es. In

$is "rocess, $e ce%% "roec$s a c$o"%asmic e>$ension $a$ a$$aces $o an obec$.

@en $e res$ of $e ce%%:s c$o"%asm f%os in$o $e e>$ension. @o f6nc$ions of

B&s are $o "ro$ec$ $e bod agains$ in9ading microorganisms and $o remo9e

dead ce%%s and debris from $e $iss6es b "agoc$osis.

Figure ): *%ite blood cell

5ac B& $"e is named according $o i$s a""earance in s$ained

"re"ara$ions. @ose con$aining %arge c$o"%asmic gran6%es are granulocytes, and

$ose i$ 9er sma%% gran6%es $a$ canno$ be easi% seen i$ $e %ig$ microsco"e

are agranulocytes.

@ere are 3 /inds of gran6%oc$es ne6$ro"i%s, baso"i%s, and eosino"i%s.

Ne6$ro"i%s, $e mos$ common $"e of B& a9e sma%% c$o"%asmic gran6%es $a$

s$ain i$ bo$ acidic and basic des. @eir n6c%ei are common% %obed, i$ $en6mber of %obes 9aring from $o $o fo6r. Ne6$ro"i%s 6s6a%% remain in $e b%ood

for a sor$ $ime, mo9e in$o o$er $iss6es, and "agoc$i?e microorganisms and

o$er foreign s6bs$ances. Dead ne6$ro"i%s, ce%% debris, and f%6ids can acc6m6%a$e

as "6s a$ si$es of infec$ion.

Baso"i%s, $e %eas$ common of a%% B& con$ain %arge c$o"%asmic gran6%es

$a$ s$ain b%6e or "6r"%e i$ basic des. Baso"i%s re%ease is$amine and o$er

cemica%s $a$ "romo$e inf%amma$ion. @e a%so re%ease e"arin, ic "re9en$s

$e forma$ion of c%o$s.

5osino"i%s con$ain c$o"%asmic gran6%es $a$ s$ain brig$ red i$ eosin, an

acidic s$ain. @e of$en a9e $o-%obed n6c%e6s. 5osino"i%s re%ease cemica%s


41/65

$a$ red6ce inf%amma$ion. In addi$ion, cemica%s from eosino"i%s are in9o%9ed i$

$e des$r6c$ion of cer$ain orm "arasi$es.

@ere are /inds of agran6%oc$es %m"oc$es and monoc$es.Lm"oc$es are $e sma%%es$ of $e B&s. @e %m"oc$ic c$o"%asm consis$s of

on% a $in, some$imes im"erce"$ib%e ring aro6nd $e n6c%e6s. @ere are se9era%

$"es of %m"oc$es, and $e "%a a ro%e in $e bod:s imm6ne res"onse. @eir

di9erse ac$i9i$ies in9o%9e $e "rod6c$ion of an$ibodies and o$er cemica%s $a$

des$ro microorganisms, con$rib6$e $o a%%ergic reac$ions, reec$ graf$s, con$ro%

$6mors, and reg6%a$e $e imm6ne ss$em.

Monoc$es are $e %arges$ of $e B&s. Af$er $e %ea9e $e b%ood and en$er

$e $iss6es, monoc$es en%arge and become macro"ages, ic "agoc$i?e

bac$eria, dead ce%%s, ce%% fragmen$s and o$er debris i$in $e $iss6es. In addi$ion,

macro"ages can brea/ don "agoc$i?ed foreign s6bs$ances and "resen$ $e

"rocessed s6bs$ances $o %m"oc$es, ic res6%$s in ac$i9a$ion of $e

%m"oc$es.

>latelets

P%a$e%e$s or $romboc$es are min6$e

fragmen$s of ce%%s, eac consis$ing of a sma%%

amo6n$ of c$o"%asm s6rro6nded b a ce%%

membrane. @e are "rod6ced in $e red

bone marro from mega/aroc$e, ic are

%arge ce%%s. Sma%% fragmen$s of $ese ce%%s

brea/ off and en$er as "%a$e%e$s, ic "%a

an im"or$an$ ro%e in "re9en$ing b%ood %oss.

@is "re9en$ion is accom"%ised in as

$e forma$ion of "%a$e%e$ "%6gs, ic sea%

o%es in sma%% 9esse%s, and $e forma$ion ofc%o$s, ic e%" sea% off %arger o6nds in $e 9esse%s.

Figure +: latelet Middle-


42/65

P*eventin Bl''! L'

en a b%ood 9esse% is damaged, b%ood can %ea/ in$o o$er $iss6es and in$erfere

i$ norma% $iss6e f6nc$ion, or b%ood can be %os$ from $e bod. A sma%% amo6n$ of

b%ood %oss from $e bod can be $o%era$ed, and ne b%ood is "rod6ced $o re"%ace i$. If

a %arge amo6n$ of b%ood is %os$, dea$ can occ6r. 'or$6na$e%, en a b%ood 9esse% isdamaged, 9asc6%ar s"asm, "%a$e%e$ "%6g forma$ion, and b%ood c%o$$ing minimi?e $e

%oss of b%ood.

"; @ascular S/asm

Vasc6%ar s"asm is an immedia$e b6$ $em"orar cons$ric$ion of a b%ood 9esse%

res6%$ing from con$rac$ion of smoo$ m6sc%e i$in $e a%% of $e 9esse%. @is

cons$ric$ion can c%ose sma%% 9esse%s com"%e$e% and s$o" $e f%o of b%ood $ro6g

$em. Damage $o b%ood 9esse%s can ac$i9a$e ner9o6s ss$em ref%e>es $a$ ca6se

9asc6%ar s"asm. &emica%s a%so "rod6ce 9asc6%ar s"asms. 'or e>am"%e, "%a$e%e$s

re%ease t%romboanes ic are deri9ed from cer$ain "ros$ag%andins, and

endo$e%ia% ce%%s %ining b%ood 9esse%s re%ease $e "e"$ide endot%elin.

.; >latelet >lugs

A "%a$e%e$ "%6g is an acc6m6%a$ion of "%a$e%e$s $a$ can sea% 6" a sma%% brea/

in a b%ood 9esse%. P%a$e%e$ "%6g forma$ion is 9er im"or$an$ in main$aining $ein$egri$ if $e circ6%a$or ss$em beca6se sma%% $ears occ6r in sma%%er 9esse%s and

ca"i%%aries man $imes eac da, and "%a$e%e$ "%6g forma$ion 6ic/% c%oses $em.

Peo"%e o %ac/ $e norma% n6mber of "%a$e%e$s $end $o de9e%o" n6mero6s sma%%

emorrages in $eir s/in and in$erna% organs.


43/65


44/65

reac$ions res6%$s in ic eac c%o$$ing fac$ors ac$i9a$es $e ne>$ in $e

series 6n$i% $e c%o$$ing fac$orprot%rombinaseis formed.. Pro$rombinase ac$s on an inac$i9e c%o$$ing fac$or ca%%ed prot%rombin $o

con9er$ i$ $o i$s ac$i9e form ca%%ed t%rombin.3. @rombin con9er$s $e inac$i9e c%o$$ing fac$or fibrinogen in$o i$s ac$i9e

form, fibrin ic is a $read-%i/e "ro$ein. A c%o$ is a ne$or/ of fibrin $a$$ra"s b%ood ce%%s, "%a$e%e$s, and f%6id.

A$ eac s$e" of $e c%o$$ing "rocess, eac c%o$$ing fac$or ac$i9a$es man

addi$iona% c%o$$ing fac$ors. &onse6en$%, a %arge 6an$i$ of c%o$$ing fac$ors is

ac$i9a$ed, res6%$ing in $e forma$ion of $e c%o$.

Mos$ c%o$ fac$ors are man6fac$6red in $e %i9er, and man of $em re6ire

9i$amin G for $eir sn$esis. In addi$ion, man of $e cemica% reac$ions of c%o$

forma$ion re6ire ca%ci6m ions and $e cemica%s re%eased from "%a$e%e$s. Lo

%e9e%s of 9i$amin G, %o %e9e%s of ca%ci6m ions, %o n6mber of "%a$e%e$s, of red6cedsn$esis of c%o$$ing fac$ors beca6se of %i9er dsf6nc$ion can serio6s% im"air $e

b%ood-c%o$$ing "rocess.

D; Control of Clot (ormation

i$o6$ con$ro%, c%o$$ing o6%d s"read from $e "oin$ of i$s ini$ia$ion $ro6go6$

$e en$ire circ6%a$or ss$em. @e b%ood con$ains se9era% anticoagulants, ic"re9en$ c%o$$ing fac$ors from c%o$s. "ntit%rombin and %eparin inac$i9a$e $rombin.

i$o6$ $rombin, fibrinogen is no$ con9er$ed $o fibrin, and no c%o$ forms. Norma%%

$ere are eno6g an$icoag6%an$s in $e b%ood $o "re9en$ c%o$ forma$ion. A$ $e in6r

si$e, oe9er, $e ac$i9a$ion of c%o$$ing fac$ors is 9er ra"id. 5no6g c%o$$ing

fac$ors are ac$i9a$ed so $a$ $e an$icoag6%an$s can no %onger "re9en$ a c%o$ from

forming. Aa from $e in6r si$e $ere are eno6g an$icoag6%an$s $o "re9en$ c%o$

forma$ion from s"reading.

#; Clot etraction and (i&rinolysis

Af$er a c%o$ as formed, i$ begins $o condense in$o a more com"ac$ s$r6c$6re

b a "rocess /non as clot retraction. P%a$e%e$s con$ain $e con$rac$i%e "ro$eins,

ac$in and mosin, ic o"era$e in a simi%ar fasion $o $e ac$in and mosin in

m6sc%e. P%a$e%e$s form sma%% e>$ensions $a$ a$$ac $o fibrin $ro6g s6rface

rece"$ors. &on$rac$ion of $e e>$ension "6%%s on $e fibrin and is res"onsib%e for c%o$


45/65

re$rac$ion. Ser6m, ic is "%asma i$o6$ $e c%o$$ing fac$ors, is s6ee?ed o6$ of

$e c%o$ d6ring c%o$ re$rac$ion.

Re$rac$ion of $e c%o$ "6%%s $e edges of $e damaged b%ood 9esse% $oge$er,

e%"ing $o s$o" f%o of b%ood, red6cing $e "robabi%i$ of infec$ion, and enancing

ea%ing. @e damaged 9esse% in re"aired b $e mo9emen$ of fibrob%as$s in$o $edamaged area and $e forma$ion of ne connec$i9e $iss6e. In addi$ion, e"i$e%ia%

ce%%s aro6nd $e o6nd di9ide and fi%% in $e $orn area.

&%o$s are disso%9ed b a "rocess ca%%ed fibrinolysis. An ac$i9e "%asma "ro$ein

ca%%es plasminogen is con9er$ed $o i$s ac$i9e form, plasmin. @rombin, o$er

c%o$$ing fac$ors ac$i9a$ed d6ring c%o$ forma$ion, and tissue plasminogen acti/ator

re%eased from s6rro6nding $iss6es can s$im6%a$e $e con9ersion of "%asminogen $o

"%asmin. O9er a "eriod of fe das, "%asmin s%o% brea/s don $e fibrin.

".) .lood !rou/

@e ABO b%ood gro6" ss$em is 6sed $o recogni?e 6man b%ood. ABO

an$igens a""ear on $e s6rface of $e red b%ood ce%%s. @"e A b%ood as $"e A

an$igens, $"e B b%ood as $"e B an$igens, $"e AB b%ood as bo$ $"es of

an$igens, and $"e O b%ood as nei$er A nor B an$igens. In addi$ion, "%asma from

$"e A b%ood con$ains an$i-B an$ibodies, ic ac$ agains$ $"e B an$igenE ereas

"%asma from $"e B b%ood con$ains an$i-A an$ibodies, ic ac$ agains$ $"e A

an$igens. @"e AB b%ood "%asma as nei$er $"e of an$ibod, and $"e O b%ood

"%asma as bo$ an$i-A and an$i-B an$ibodies.

An$ibodies do no$ norma%% de9e%o" agains$ an an$igen 6n%ess $e bod is

e>"osed $o $a$ an$igen. One "ossib%e e>"%ana$ion for $e "rod6c$ion of an an$i-A

and*or an$i-B an$ibodies is $a$ $"e A or B an$igens on bac$eria or food in $e

diges$i9e $rac$ s$im6%a$e $e forma$ion of an$ibodies agains$ an$igens $a$ are

differen$ from one:s on an$igens. In s6""or$ of $is e>"%ana$ion is $e obser9a$ion

$a$ an$i-A and an$i-B an$ibodies are no$ fo6nd in $e b%ood 6n$i% abo6$ mon$s

af$er bir$. 'or e>am"%e, an infan$ i$ $"e A b%ood o6%d no$ "rod6ce an$ibodies

agains$ $e A an$igen on bac$eria or food beca6se mecanisms e>is$ in $e bod $o

"re9en$ $e "rod6c$ion of an$ibodies $a$ o6%d reac$ i$ $e bod:s on an$igens.


46/65


47/65


48/65


49/65

B $e $ime diges$i9e "rod6c$s reac $e %arge in$es$ine, a%mos$ a%% of $e

n6$ri$iona%% 6sef6% "rod6c$s a9e been remo9ed. @e %arge in$es$ine remo9es a$er

from $e remainder, "assing semi-so%id faeces in$o $e rec$6m $o be e>"e%%ed from

$e bod $ro6g $e an6s. @e m6cosa 8M9is arranged in$o $ig$%-"ac/ed s$raig$

$6b6%ar g%ands8!9ic consis$ of ce%%s s"ecia%ised for a$er absor"$ion and m6c6s-

secre$ing gob%e$ ce%%s $o aid $e "assage of faeces. @e %arge in$es$ine a%so con$ains

areas of %m"oid $iss6e 8L9E $ese can be fo6nd in $e i%e6m $oo Cca%%ed eyer2s

patc%es, and $e "ro9ide %oca% imm6no%ogica% "ro$ec$ion of "o$en$ia% ea/-s"o$s in

$e bods defences. As $e g6$ is $eeming i$ bac$eria, reinforcemen$ of $e

s$andard s6rface defences seems on% sensib%e.

@ >"$H)>H%SI)L)!%

Non Modifia&le factors

#ene$ic

Race African

Age

Modifia&le factors

Diabe$ic Ne"ro"a$

7"er$ension

#%omer6%one"ri$is


50/65

Decreased rena% "erf6sion

B%ood $es$

Rena% Bio"s

!rina%sis

@iss6e a$ro" d6e $o %ac/ of b%ood s6""%

&om"%ica$ions

&VD

Anemia

Pericardi$is

Decrease /idne f6nc$ion

Process of scarring

@rea$men$

Rena% re"%acemen$ $era"

7emodia%sis

Gidne @rans"%an$

B%ood $ransf6sions

Dea$ of ce%%s res"onsib%e for

man6fac$6ring er$ro"oie$in

Inf%amma$or c$o/ines

Inf%amma$or c$o/ines

s6""ress $e "ro%ifera$ion of

er$roid "rec6rsors in $e

bone marroE

inf%amma$or c$o/ines inibi$

$e re%ease of er$ro"oie$in

C5PO from $e /idneE and

Affec$s o$er im"or$an$ e%emen$s

of iron me$abo%ism,

Increased amo6n$s

of e"cidin

Promo$e $e

"rod6c$ion of i$e

b%ood ce%%s - Decreased

ferro"or$in e>"ression,

'eer s$em ce%%s $o

differen$ia$e in$o red b%ood

ce%%s

Decreased er$ro"oiesis

and red b%ood ce%%"rod6c$ion

- &B&

- S$oo% 7gb $es$

- Peri"era% b%ood

smear

- Iron %e9e%

- 'erri$in

- 'o%a$e

- Vi$amin B1

-

'a$ig6e

ea/ness

SOB

Lig$eadedness

Pa%"i$a$ions

Pa%%or

&es$ "ain

AN5MIA


51/65


52/65

sn$esi?e s6fficien$

amo6n$ of b%ood or b%ood

com"onen$s d6e $o

cer$ain i%%ness s6c as

/idne disorders

"sician.

Assess for c%ien$:s

base%ine 9i$a% signs,

6rine o6$"6$, s/in co%or,

and is$or of

$ransf6sion reac$ion.

Ob$ain 9eno6s access

6sing a #1+ need%e if

"ossib%e.

Sec6re informed

consen$.

Ob$ain b%ood "rod6c$s

from b%ood ban/ and

$ransf6se immedia$e%.

Verif c%ien$:s nameand n6mber, cec/

b%ood com"a$ibi%i$, and

no$e e>"ira$ion $ime.

Prac$ice ase"$ic

$ecni6e b asing

ands if $o be

"erformed b $e

a$$ending n6rse.

Pro9ides6""%emen$ar

informa$ion $o $e c%ien$

regarding $e side

effec$s of b%ood

$ransf6sion s6c as

a%%ergic reac$ions.

Inform $e c%ien$ $a$

$e "roced6re 6s6a%%

$a/es 1 $o 8 o6rs.

Intra'

Adminis$er $e b%ood


53/65


54/65


55/65

>harmacothera/eutics A Medicines

!eneric Name 8.rand Name9

Classification

Stoc6 Dose

Indication 8client4s/ecific9

Dosage

(reGuency

Nursing es/onsi&ilities

AIm/lication

8/re,intra,/ost9

(elodi/ine 8Ca&ren9

Calcium Channel .loc6ers

0mg*@ab

!sed $o $rea$ ig b%ood

"ress6re. I$ ma be 6sed

a%one or in combina$ion i$

o$er dr6gs. 'e%odi"ine a%so

is 6sed $o $rea$ "a$ien$s

i$ anginaa%$o6g i$ is no$

'DA a""ro9ed for $is 6se.

Dosage'0mg*@ab

oute < (reGuency' PO

OD

>re'

&ec/ $e doc$or:s order.Moni$or 9i$a% signs.Obser9e $e 12 rig$s of

dr6g adminis$ra$ion.

Intra'

Pro9ide dr6g i$ mea%s $o

"re9en$ #I 6%cera$ions

>ost'

F5>"%ained $o "a$ien$ $a$

e*se ma e>"erience $e

fo%%oing side effec$s

Peri"era% edemaCso%%en

an/%es and fee$, eadace,

f%6sing, di??iness, and

increased ear$ ra$e, %o

b%ood "ress6re

.

!liclaide 8Diamicron9

An$i Diabe$ic

)2mg*$ab

I$ s$im6%a$es $e "ancreas,

ic e%"s in more ins6%in

secre$ion.

Dosage')2mg*$ab

>re'

FAssess an is$or of %i9er

and /idne "rob%ems

Assess for an a%%erg

d6ring "regnanc
http://www.medicinenet.com/high_blood_pressure_hypertension/article.htmhttp://www.medicinenet.com/high_blood_pressure_hypertension/article.htmhttp://www.medicinenet.com/angina_symptoms/article.htmhttp://www.medicinenet.com/edema/article.htmhttp://www.medicinenet.com/swollen_ankles_andor_swollen_feet/symptoms.htmhttp://www.medicinenet.com/swollen_ankles_andor_swollen_feet/symptoms.htmhttp://www.medicinenet.com/headache/article.htmhttp://www.medicinenet.com/dizziness_dizzy/article.htmhttp://www.medicinenet.com/low_blood_pressure/article.htmhttp://www.medicinenet.com/low_blood_pressure/article.htmhttp://www.medicinenet.com/angina_symptoms/article.htmhttp://www.medicinenet.com/edema/article.htmhttp://www.medicinenet.com/swollen_ankles_andor_swollen_feet/symptoms.htmhttp://www.medicinenet.com/swollen_ankles_andor_swollen_feet/symptoms.htmhttp://www.medicinenet.com/headache/article.htmhttp://www.medicinenet.com/dizziness_dizzy/article.htmhttp://www.medicinenet.com/low_blood_pressure/article.htmhttp://www.medicinenet.com/low_blood_pressure/article.htmhttp://www.medicinenet.com/high_blood_pressure_hypertension/article.htmhttp://www.medicinenet.com/high_blood_pressure_hypertension/article.htm


56/65

oute < (reGuency'PO

BID

Intra'

FMoni$or Pa$ien$ B%ood

S6gar

>ost'

5>"%ain $o "a$ien$ $a$ se

ma e>"erienced #I

dis$6rbances, decreased in

b%ood ce%% co6n$, a6ndice,

na6sea and 9omi$ing,

diarrea and s$omac

inf%amma$ion

$elmisartan 8>ritor9

Angio$ensin-II rece"$or

an$agonis$

F2mg*$ab

'or 7"er$ension

Dosage'82mg*$ab

outes < (reGuency' PO

OD

>re'

&ec/ $e doc$or:s order.Moni$or 9i$a% signs.Obser9e $e 12 rig$s of


Intra'

Adminis$er as ordered.

Moni$or $e c%ien$:s

res"onse and $o%erance

d6ring adminis$ra$ion of $e

dr6g.

>ost'

Ad9ice $e c%ien$ $o re"or$

diffic6%$ brea$ing or

na6sea.

"torvastatin 8Li/itor9

An$i"er%i"idimic

Ad6nc$ $o $rea$men$ of

e%e9a$ed $o$a% co%es$ero%,

red6c$ion in $e ris/ of fa$a%

>re'

&ec/ $e doc$or:s order.Obser9e $e 12 rig$s of


57/65


58/65

and 9omi$ing and diarrea.Doc6men$

)me/raole 8>rilosec9

An$acid, An$i6%ceran$

2 mg*$ab

Par$ of an ad6nc$i9e $era"

$o an$icoag6%an$s

Dosage' 82mg*$ab

oute < (reGuency' PO

ODAM

>re'

&ec/ $e doc$or:s order.5ns6re $a$ c%ien$ as no$

e$ ea$en.Inform c%ien$ $o sa%%o $e

$ab%e$ o%e.Obser9e $e 12 rig$s of


Intra'

Adminis$er an$acids

concomi$an$%, as ordered.Moni$or $e c%ien$:s



dr6g.

>ost'

Raise side rai%s and

accom"an "a$ien$ d6e $o

"ossib%e di??iness.

Ins$r6c$ "a$ien$ $o a9oid

dri9ing or "erforming

a?ardo6s $as/s.Lactulose 8!eneralac9

La>a$i9es

32cc

- Pre9en$ion and $rea$men$ of

"or$a%-ss$emicence"a%o"a$.

Dosage'32cc

oute and (reGuency' PO

OD7S

>re'

&ec/ $e doc$or:s order.Moni$or 9i$a% signs.&ec/ for %abora$or e>am

res6%$s.5>"%ain $o "a$ien$ $e dr6g

$o be adminis$ered.


59/65

Obser9e $e 12 rig$s of


Intra'

Adminis$er as ordered.Moni$or $e c%ien$:s



dr6g.

>ost'

Moni$or c%ien$ for an side

effec$s and ad9ersereac$ions s6c as na6sea

and 9omi$ing and diarrea.Moni$or in$a/e and o6$"6$.Doc6men$ $e

adminis$ra$ion of dr6g on $e

"a$ien$:s car$.

Doc6men$ $e "a$ien$:s

res"onse and $o%erance $o

$e dr6g adminis$ered.Mucosta 8e&a/imide9

An$acids, An$i !%ceran$s

82mg

@rea$men$ of #as$ric

m6cosa% %esionsCerosion,

b%eeding, redness, edema

in ac6$e gas$ri$is

e>arba$ion of cronic

gas$ri$is

Dosage'82mg @ID

oute and (reGuency'PO

@ID

>re'

&ec/ $e doc$or:s order.Moni$or 9i$a% signs.&ec/ for %abora$or e>am

res6%$s.5>"%ain $o "a$ien$ $e dr6g

$o be adminis$ered.

Obser9e $e 12 rig$s of

dr6g adminis$ra$ion

Intra'


60/65

Moni$or $e c%ien$:s



dr6g.

>ost'

Moni$or for signs of an

ad9erse reac$ion

ii >)!#SS N)$#S

Day #isting CuesA>ro&lems

Interventions "ctually Done 8Nursing and Colla&orative9

Client es/onses

Day *

Se"$ember ,218

On $e firs$ da of con$ac$, "a$ien$ as recei9ed aa/e,

conscio6s and coeren$ %ing on bed in a Semi - 'o%er:s

"osi$ion. as on an NPO die$. !"on in$er9ie, se 9erba%i?ed

$a$ er bod fee%s ea/ and $a$ se an$ed $o go omeE

oe9er, er "sician as no$ 9isi$ed er on $a$ da e$. @6s,

se is no$ s6re of er ea%$ s$a$6s and if se can go ome soon.

Se a%so men$ioned $a$ er s/in is dr and i$ fee%s 9er i$c.

7er 9i$a% signs ere @em". 3).F degrees &e%si6s, PR F0 bea$s

"er min6$e, RR 1 cc%es "er min6$e and BP 12*F2 mm7g.

@e doc$or ordered 06ni$s of 76m6%in R ins6%in and &B# as


61/65

$a/en af$er 32 min6$es of adminis$ra$ion, $e res6%$ as

22mg*dL.

@e "riori$ n6rsing "rob%ems iden$ified d6ring $e sif$ ereAn>ie$ re%a$ed $o 6n/non o6$comes of ea%$ managemen$E

Ac$i9i$ In$o%erance re%a$ed $o imba%ance be$een o>gen s6""%

and demandE and Ris/ for Im"aired S/in In$egri$ re%a$ed $o

acc6m6%a$ion of $o>ins in $e s/in.

@o re%ie9e er an>ie$, $e fo%%oing in$er9en$ions ere

"erformed ra""or$ as es$ab%ised i$ $e c%ien$ and er

fami%E enco6raged $e c%ien$ $o 9erba%i?e er fee%ings and

concernsE assessed $e c%ien$:s %e9e% of an>ie$E e>"%ained

"roced6res * care as de%i9eredE "ro9ided a 6ie$ and re%a>ing

en9ironmen$ cond6ci9e for res$ingE and enco6raged di9ersiona%

ac$i9i$ies s6c as s%ee"ing. &o%%abora$i9e in$er9en$ion done as

b assis$ing in addressing financia% considera$ions as

a""ro"ria$e.

Since $e c%ien$ fe%$ ea/ in genera%, $e fo%%oing in$er9en$ions

ere "erformed enco6raged $e c%ien$ $o 9erba%i?e er fee%ingsand concernsE assessed $e c%ien$:s abi%i$ $o "erform ac$i9i$ies of

dai% %i9ing CADLsE "ro9ided a 6ie$ and re%a>ing en9ironmen$

cond6ci9e for res$ingE assis$ed $e c%ien$ in "erforming ac$i9i$ies

en necessarE enco6raged $e c%ien$ $o cange "osi$ion

s%o%E and "ro9ided ea%$ $eacings abo6$ $e im"or$ance of

com"%ing i$ "a$ien$:s medica$ions and "ro"er "osi$ioning

d6ring res$ "eriods. &o%%abora$i9e in$er9en$ion done as

adminis$ering medica$ions as "rescribed.

@o address $e c%ien$:s ris/ for im"aired s/in in$egri$, $e

fo%%oing in$er9en$ions ere "erformed assessed $e s/in for

canges in co%or, $6rgor and 9asc6%ari$E moni$ored f%6id in$a/e

and o6$"6$ s$ric$% as e%% as $e dra$ion of s/in and m6co6s

membranesE ens6red $a$ %inens are dr and rin/%e freeE and


62/65

recommended $e c%ien$ $o /ee" fingernai%s sor$ and r6b i$c

areas ins$ead of scra$cing. &o%%abora$i9e in$er9en$ion done as

recommending $e c%ien$ $o cons6%$ er "sician if $ere are

oin$men$s * creams ic se can a""% $o $e i$c areas of er

s/in.

A$ $e end of $e sif$, $e c%ien$ 9erba%i?ed $a$ se fe%$ o/a and

as more re%a>ed. A%$o6g in$er9en$ions ere done $o im"ro9e

ac$i9i$ $o%erance and a9oid im"airmen$ of s/in in$egri$, $e c%ien$

s$i%% fe%$ $a$ se as ea/E er s/in as 9er i$c and

con$in6ed $o scra$c er s/in.

Day

Se"$ember 3, 218

On $e second da of con$ac$, "a$ien$ as recei9ed aa/e,

conscio6s and coeren$ %ing on bed in a Semi - 'o%er:s

"osi$ion. i$ IV' of D0NSS

7er 9i$a% signs ere @em". 3).0 degrees &e%si6s, PR F) bea$s

"er min6$e, RR 2 cc%es "er min6$e and BP 132*F2 mm7g

Adminis$ered 'eb6>os$a$ 82mg and #%ic%a?ide )2mg a$ F22 and

M6cos$a a$ 1132am

Performed &B# a$ 1132am i$ a res6%$ of 1Fmg*dL

Remo9ed T8 Pac/ed RB& a$ 1132am

@I; DISCH"!# H#"L$H $#"CHIN! >L"NS

Content Strategy


63/65

*; Com/liance

Medication

Diet

#ercise

"ctivityALifestyle

- Ins$r6c$ $e c%ien$ and er

fami% $o $a/e a%% medica$ions as

"rescribed.

-Ad9ise $e fami% members $o

a9oid 6sing non-"rescri"$ion

dr6g 6n%ess 6se is a""ro9ed b

$e "sician.

-5nco6raging $e fami%

members $o adminis$er

medica$ions e>ac$% as

"rescribed b $e "sician

-5nco6raging $e fami%

members $o fo%%o $e die$ and

f%6id in$a/e recommended $o $e

"a$ien$.

-Ins$r6c$ $e "a$ien$:s re%a$i9es

abo6$ o $o assis$ $e "a$ien$

do sim"%e ROM e>ercises %i/e

f%e>ion of 6""er and %oer

e>$remi$ies

-Ins$r6c$ $e re%a$i9es abo6$ $e

im"or$ance of e>ercise in $e

bod and i$s benefi$s $o one:s

ea%$.

.

- 7ea%$ @eacing

- 7ea%$ @eacing

- 7ea%$ @eacing


64/65


65/65

Date' Se"$ember 23, 218

Recei9ed c%ien$ aa/e, conscio6s and coeren$ %ing on bed in Semi 'o%er:s "osi$ion.

@e %a$es$ 9i$a% signs e%ici$ed a$ 1 noon ere @em" 3)U&E PR )2 b"mE RR 10 c"m and BP

132 * F2 mm7g.

@e "rob%em regarding an>ie$ as reso%9ed on Se"$ember 23, 218 $ro6g $e c%ien$:s

9erba%i?a$ion $e se fe%$ o/a and more re%a>ed a$ $e end of $e sif$. On $e o$er and, $e

$o o$er "rob%ems ere no$ reso%9ed. @e c%ien$ 9erba%i?ed $a$ se s$i%% fe%$ ea/ and se a%so

con$in6ed $o scra$c er s/in $ro6go6$ $e sif$.

In genera%, $e c%ien$ and er fami% ere coo"era$i9e es"ecia%% d6ring "roced6res. A%$o6g

se 9erba%i?ed $a$ se fe%$ o/a and more re%a>ed, $e c%ien$ said $a$ se con$in6ed $o fee%

ea/ and $a$ er s/in as 9er i$c. @6s, $e c%ien$ con$in6ed $o e>"erience $e "rob%ems

iden$ified ear%ier on $e %as$ da of con$ac$.

)ther eferences'

$$"**.%e.ac.6/*"a*$eac*9a*ana$om*case)*frms$).$m%

$$"**.n%m.ni.go9*med%ine"%6s*enc*ar$ic%e*223FFF.$m

$$"**.medsca"e.com*

$$"**.s6rgerencc%o"edia.com*&e-'i*5so"agogas$rod6odenosco".$m%

$$"**.conema6g.org*$em"%a$ear$ic%e.as">JidF)(2

$$"**.ebmd.com*a-$o-?-g6ides*"ro$rombin-$ime

"LDIN D; S"MS)N, SN*2
http://www.le.ac.uk/pa/teach/va/anatomy/case6/frmst6.htmlhttp://www.nlm.nih.gov/medlineplus/ency/article/003888.htmhttp://www.medscape.com/http://www.surgeryencyclopedia.com/Ce-Fi/Esophagogastroduodenoscopy.htmlhttp://www.conemaugh.org/template_article.aspx?id=8670http://www.webmd.com/a-to-z-guides/prothrombin-timehttp://www.le.ac.uk/pa/teach/va/anatomy/case6/frmst6.htmlhttp://www.nlm.nih.gov/medlineplus/ency/article/003888.htmhttp://www.medscape.com/http://www.surgeryencyclopedia.com/Ce-Fi/Esophagogastroduodenoscopy.htmlhttp://www.conemaugh.org/template_article.aspx?id=8670http://www.webmd.com/a-to-z-guides/prothrombin-time

Anemia Seconday UGIB

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