Case Presentation for INP
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Transcript of Case Presentation for INP
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INTRODUCTION
There were many factors considered in choosing the case for this case presentation. First, Iwanted to choose a case that will show the correlation of disease entities amongst each other and
showcase their relatedness to each other. Also, I have always found cardiopulmonary cases to be
very interesting due to the fact that the lungs and the heart are vital organs and are important inthe normal functioning of the body. It has always interested me how these two organs can affect
the different organs of the body once they fail. In addition, I have a soft spot for these diseases
because my grandmother died because of these diseases and my family has a history of
hypertension and with this case study, I am able to enlighten myself on the things to avoid andthe appropriate interventions needed if one of my family members or me is affected by these
diseases.
The patient was assessed on November 8, 2011 on the 18th day of hospitalization and the 5th daypost operation day. During the assessment, the patient already, had stable vital signs. The
pneumothorax was already resolved but difficulty of breathing was still pronounced.
Concepts involved in the discussion of the case include concepts in.1. Cardiology: most especially concepts in valvular diseases of the heart and heart failures.
2. Hematology: most especially concepts in triglyceride levels which may have precipitated
the case of the patient.3. Pumonology: most specifically concepts in lung problems such as pneumothorax.
4. Endocrinology: most specially concepts in diabetes mellitus.
NURSING ASSESSMENT- Patients Profile
Name: Sedi Noel Onajo
Age: 76
Birthdate: April 28, 1935Address: 3 Malaya Street, Dominican Hill, Baguio City
Occupation: Retired Company Driver
Marital Status: MarriedSpouse: Aticap Onajo
Religion: Methodist
- Admission Details
Admission Date: October 21, 2011Ward: Coronary Ward
Chief Complaint: difficulty of breathing and dyspnea
Medical diagnosis: Spontaneous pneumothorax, coronary artery disease, impaireddiastolic relaxation, left ventricular failure
- History of Present Illness: 2 weeks prior to admission, patient experienced dyspnea but
with no accompanying fever. Still, patient did not consult. 1 week prior to admission,
dyspnea persisted but was not acted upon. 1 day prior to admission, patient consulted at aprivate physician and was advised to consult to a professional. 2 hours prior to admission,
patient consulted at Saint Louis University Hospital of the Sacred Heart and was advisedadmission.
- History of Past Hospitalization: Patient has no previous hospitalizations but patient has a
know history of hypertension since 2009
- Socio-Cultural History: The patient is an Ilocano. Upon assessment, patient expressed
that he has a very strong affinity to his roots as an Ilocano and practices in marriage,
death and other occasions are done following the Ilocano practices. The patients religionis Methodist. Upon assessment, patient expressed that he is actively practicing and that he
has no religious concerns
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M/S TOOL
ACTIVITY/RESTThe patient is a retired driver and in the hospital, he was unable to participate in usual
activities. Leisure time includes watching television, chatting with wife and with friends.
The patient is not ambulatory in the hospital. Gait was not assessed. The patient is active,needing minimal help from his significant others. The muscles are flaccid and hypotonic
with strength of 4/5 in all extremities. Because of the condition, the patient experienced
weakness, breathlessness and inability to transfer. The patient, also, has feelings of
exhaustion. Patient usually has 6-8 hours of sleep with no insomnia and is rested uponawakening. The patient usually takes 1-2 naps a day lasting for 1-2 hours. Bedtime rituals
include doing hygiene needs and relaxation technique is sleep. The patient sleeps with 2
pillows and oxygen is utilized per nasal cannula at 4 LPM uses during dyspnea. Thereare no medications used affecting sleep. Patient was asked to sit up on bed to test his
response to activities. Before the activity, heart rate was 86 beats per minute, respiratory
rate was 24 cycles per minute and blood pressure was 130/80 millimeters mercury.Immediately after the activity, heart rate was 87bpm, respiratory rate was 26cpm and
blood pressure was 130/80mmHg. 5 minutes after the activity, patients heart rate was
84bmp, respiratory rate was 23cpm and blood pressure was 130/80mmHg. Pulseoximetry reading was at high 80s and low 90s. Patient was alert and active, muscle was
hypotonic and flaccid. There were no tremors noted and there were restrictions on rangeof motion in all extremities. Muscle strength was 4/5 all over. Due to this, nursing
diagnosis formulated was ACTIVITY INTOLERANCE RELATED TO DECREASEDENERGY AND WEAKNESS.
CIRCULATIONThere were no history of head injury, stroke, hemoptysis, syncope, spinal cord
injury/dysreflexia, palpitations, bleeding tendencies, varicosities, thrombophlebitis, leg
pain, and slow healing. On 2009, patient was diagnosed to have high blood pressure andthis year, patient was diagnosed with coronary artery disease, left ventricular failure and
impaired systolic relaxation. Skin assessment revealed that skin is pale, mucous
membrane is pinkish, lips are dark, sclerae are non-icteric, conjunctivae are pale, nailbedsare pale, skin is moist. Blood pressure while lying down was 130/80mmHg on the rightand left arm. Pulse pressure was 50mmHg. There were no auscultatory gaps. Pulse was
86bpm on all pulse points and are all strong +2. There were no cardiac thrills and heaves
and heart rate was 86bpm. There was arrhythmia and quality is strong. There were also,friction rubs. At the point of maximal impulse, murmurs were noted. There were no
vascular bruit and jugular vein distention. There were no adventitious breath sounds but
there was a decrease breath sounds in the right lung. Extremities are 36.2C, pale,capillary refill of 2-3 secons, no homans sign, no varicosities, no nail abnormalities, no
edema. Hair is thin. No lesions. Due to this, nursing diagnosis formulated was
IMPAIRED TISSUE PERFUSION RELATED TO DECREASED OXYGEN
CARRYING CAPACITY OF THE BLOOD.
EGO INTEGRITY
The patient is married. Patient did not express any concern. Stress factor was thehospitalization. Usual ways of handling stress includes verbalizing problems to the wife.
Patient stated that he does not get angry too much. When anxious, patient thinks.
Patient usually cries when there is grief. No other feelings such as hopelessness,helplessness and powerlessness were said. Patient is and Ilocano and religious affiliation
is Methodist. He is actively practicing the religion and usually prays. There are no
spiritual concerns and patient did not desire visits from clergies. No specifies expression
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of sense of connectedness/harmony with self and others. Patient was calm, and patient
becomes pale as a response.
ELIMINATION
Patient has regular bowel elimination which is usually characterized as semi formed andbrownish. Last bowel movement was on November 8, 2011 and was characterized as
semiformed, brownish, about 50 ml and non fowl smelling. There was no history of
bleeding, no hemorrhoids, constipation, diarrhea and bowel incontinence. Hence, there is
no use of laxatives nor enemas and suppositories. Patient usually voids once ever 3 hoursat around 100-150 ml. there were no difficulty voiding, urgency, bladder spasm,
frequency, retention and burning feeling. There was no urinary retention, history of
bladder or kidney diseases. There was diuretic use after surgery with furosemide 40 mg tablet. Abdomen was soft upon palpation, non tender, non distended, size is about 34-35
inches, bowel sounds are normoactive, no costovertebral angle tenderness, bladder is
nonpalpable and there are no hemorrhoids. There is usage of IFC afgter surgery. Noostomy devices.
FOOD/FLUIDPatient usually has 3 meals per day with 1-2 snacks eaten during the morning and late
afternoon. Patients usual food intake during breakfast is coffee and bread, lunch isusually rice and a viand and snacks are usually breads and juices. Last meal consumed
was rice and viand. Food preference is meat and there are no known food allergies. Thereare no special cultural food preparations specified. Patient consumes 80-95% of food
served and after the operation, patients appetite decreased. Usual weight was 180-190lbs
and there are no unexpected or undesired weight loss or gain. There are no nausea,vomiting, heartburn and indigestion. Gag and swallow reflex are intact, there are no facial
injury or surgery and there are no neurological deficit. Patient was diagnosed with type II
diabetes controlled with diet. There are no vitamin or food supplements. Current weightwas 187lbs, height is 57, body built is endomorph and BMI is n ormal. There is good
skin turgor, and mucous membrane is moist. There are no edema. Breath sounds are clear
except for the decreased in breath sounds at the right lung. Gums and teeth are in goodcondition, there are partial dentures and absent teeth at the molars and incisors areobserved. There is no sore mouth or tongue, tongue is midline and reddish and abdomen
has normoactive bowel sounds all over.
HYGIENE
The patient's functional level is at 3 meaning that he is dependent to the caregiver to
provide for the hygiene needs. The patient only requires human assistance provided bythe wife and nurses. He needs help in food preparation and with eating utensils and needs
help in getting supplies for hygiene, washing body parts, regulating bath water, getting in
and out alone and dressing. He also needs assistance in toileting such as getting in and
out of the commode. The patient's manner of dressing was not assessed because he was ina hospital gown. Still, patient was able to meet hygiene needs such as shampooing, oral
care, bathing, etc. Hence, there were no body odor and vermins. Diagnosis: self care
deficit related to inability to perform activities secondary to weakness.
NEUROSENSORY
The patient has no history of injury, trauma and stroke and the patient has no dizzinessand weakness. There is tingling and numbness of upper extremities. There are not seizure
episodes, hearing loss, vision changes, smell changes. There is no change in mental status
and the patient is alert and oriented. There are no delusion and hallucinations and affect iseuthymic. Speech is slightly soft and slurred but comprehensive. Recent and remote memory
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and intact. Glasgow coma scale revealed a 15/15 score. Cranial nerves are all normal and
intact. Mini mental status examination revealed a score of 23/23 since patient refused toperform some of the examination items. All deep tendon reflexes are normal scored at 2.
there are no tremors or paralysis.
PAIN/DISCOMFORT.
There was mild pain located at the right lung and precipitated by movement with an
intensity of 3, non radiating and intermittent, relieved by tramadol and relaxation. Diagnosis:
Mild pain related to ongoing inflammatory process.
RESPIRATION
there was dyspnea related to decreased capacity of the lungs to expand precipitated bytalking and movement. It is relieved by oxygen inhalation and administration of bronchodilators.
Cough was non productive. Patient was a smoker with 20 pack years. There was usage of oxygen
and medications used affecting respiration were bronchodilators and anti inflammatory drugs.Respiratory rate ranged from 24-26cpm and was shallow and assisted. Parameters include an
IRV of 600cc. 02 inhalation was per nasal cannula at 4LPM. Chest excursion was unequal and
there is decreases fremitus on the right. There was no use of accessory muscles but there wasnasal flaring and decreases lung sounds on the right. Pulse oximetry read at high 80s to low 90s.
Client was calm. NURSING DIAGNOSIS: impaired breathing pattern related to decreased lungexpansion.
SAFETY
Pertinent data about safety stated that patient has altered /suppressed immune system due
to corticosteroid therapy. There were 2 whole blood transfusion but with no reactions. Patient isalso oriented. There is an incision site at the right thoracic region connected to a thorabottle
draining to reddish, blood tinged fluid. Nursing Diagnosis: impaired skin integrity related to
tissue trauma, risk for infection related to tissue trauma.
*No significant findings concerning sexuality.
*No significant findings in social interactions*no significant findings in teaching/learning*patient was discharged after 2 days.
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LIST OF PRIORITIZED NURSING DIAGNOSES
Nursing Diagnoses Actual/Potential Overt/Covert Justification
1. Impaired breathing
pattern related to
decreased/inadequate
lung expansion
Actual Overt Latest assessment
revealed that patient is
suffering from
difficulty of breathing
with a respiratory rateranging from 24-
26cpm, has shallow
breathing, uses the
sternocleidomastoid
muscle for breathing,
with nasal flaring, on
oxygen inhalation at 4
LPM, and with
verbalization of air
hunger. The ABC's of
life states that
problems in breathing
should be prioritized.
Also, according to
Abraham Maslow,
oxygenation is an
important part of a
person's biologic
needs. Fundamentally,the chief complaint of
the patient must be
prioritized.
2. Impaired peripheral
tissue perfusion related
to inadequate
circulating oxygen and
decreased oxygen
carrying capacity ofthe blood.
Actual Overt Latest assessment
revealed that patient
has pale palpebral
conjunctivae, pale nail
beds and skin, cold
skin and obviousweakness manifested
by muscle strenght of
3/5 on lower
extremities and 4/5 in
upper extremities and
usage of soft voice.
According to the abc's
of life, circulation is
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prioritized after
breathing. Again,
abraham maslow states
that oxygenation must
be prioritized. The fact
that the patient's
problem concerns
breathing more, this
should be least
prioritized.
3. activity intolerance
related to decreased
energy secondary to
poor oxygenation
(clustered with
problem 4)
Actual Overt Because of the
decreased circulating
0xygen in the body,
there is decreased
energy due to the fact
that 02 is integral in
the kreb's cycle for atp
production. This is
least prioritized
because this can be
prevented with the
resolution of other
problems like the first
two prioritzed.
4. self care deficitrelated to inability to
perform self care
needs from decreased
energy.
Actual Overt Because the patientcannot tolerate certain
activities such as
standing up and also
due to the contraptions
attached to the patient,
the patient is unable to
perform necessary self
care needs in order to
function as a holistic
being. Also, this isleast prioritized
because it depends on
the 3rd problems in
order for this problem
to be resolved.
5. impaired skin
integrity related to
Actual Overt Because of the
surgical procedures
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tissue trauma
secondary to ctt
insertion.
performed such as the
ctt insertion and the
thoracotomy, patient's
skin integrity is
impaired. There are no
signs of infection
present hence, this is
least prioritized.
6. mild pain related to
ongoing inflammatory
process
Actual Overt Not prioritized
because the pain is
mild and tolerable
7. risk for infection
related to tissue
trauma
Potential Covert Because of the
incisions brought
about by the insertion
and open thoracotomy,
there is a greater
chance for bacterial
invasion and growth.
Still, this is a risk
problem and must be
least prioritized.
8. risk for imbalanced
nutrition, less than
body requirement
related to poor oral
intake.
Potential Covert Risk problem
9. risk for fall related
to weakness
Potential Covert Risk problem
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DRUG STUDY
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Name of Drug Indication MOA Nursing Responsibility
1. Piperacillin +
trazobactam
Prophylaxis for
respiratoryinfection
Piperacillin has an
antimicrobial activity against awide range of gm-ve
organisms including K.
pneumoniae, P.aeruginosa, Enterobacteriacea
e and against gm+ve
organisms eg E. faecalisand B. fragilis. Tazobactam isa penicillanic acid sulfone
derivative with beta-lactamase
inhibitory properties. Incombination, tazobactam
enhances the activity of
piperacillin against beta-lactamase-producing bacteria.
Give full dose of drug
Assess hematopoieticfunction periodically.
Perform periodic
electrolytedeterminations in
patients with low K
reserves. Increasedrisk of fever and rashin patients with cystic
fibrosis. Increased risk
of bleedingmanifestations.
Prolonged treatment
may increase risk ofsuperinfections.
Convulsions or
neuromuscular
excitability may occurwhen high doses are
used, especially in
renally impairedpatients. Renal
impairment.
CEFIXIME Prophylaxis for
infection
Cefixime binds to one or more
of the penicillin-binding
proteins (PBPs) which inhibitsthe final transpeptidation step
of peptidoglycan synthesis in
bacterial cell wall, thusinhibiting biosynthesis andarresting cell wall assembly
resulting in bacterial cell death
Give full dose of drug,
History of allergy to
penicillins; pregnancy,lactation; renal failure;
GI disease.
PARACETAMOL PRN for fever Paracetamol exhibits analgesic
action by peripheral blockage
of pain impulse generation. Itproduces antipyresis by
inhibiting the
hypothalamic heat-regulating
centre. Its weak anti-
inflammatory activity isrelated to inhibition of
prostaglandin synthesis in theCNS
Watch out for Nausea,
allergic reactions, skin
rashes, acute renaltubular necrosis.
Potentially
Fatal: Very rare,
blood dyscrasias (e.g.
thrombocytopenia,leucopenia,
neutropenia,agranulocytosis); liver
damage.
Give with food.
Tramadol PRN for pain Tramadol inhibits reuptake of
norepinephrine, serotonin andenhances serotonin release. It
alters perception and response
Watch out for
Sweating, dizziness,nausea, vomiting, dry
mouth, fatigue,
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to pain by binding to mu-opiate receptors in the CNS.
asthenia, somnolence,confusion,
constipation, flushing,
headache, vertigo,tachycardia,
palpitations, miosis,
insomnia, orthostatichypotension, seizures,
CNS stimulation e.g.hallucinations.Potentially
Fatal: Respiratory
depression.
Levofloxacin Prophylaxis for
infection
Levofloxacin exerts
antibacterial action by
inhibiting bacterialtopoisomerase IV and DNA
gyrase, the enzymes required
for DNA replication,
transcription repair andrecombination. It has in vitro
activity against a wide range
of gram-negative and gram-positive microorganisms
Watch out for Nausea,
diarrhoea,
constipation,headache, insomnia,
inj site reactions (IV).
Ophthalmic: Transient
decrease in vision,ocular burning, ocular
pain or discomfort,
foreign bodysensation, headache,
fever, pharyngitis,
photophobia.Potentially
Fatal: Anaphylaxis.
Give full course ofmedications and give
with food.SALBUTAMOL For bronchospasm Salbutamol is a direct-acting
sympathomimetic with -
adrenergic activity and
selective action on2 receptors, producing
bronchodilating effects. It also
decreases uterine contractility.
Watch out for Fineskeletal muscle tremor
especially hands,
tachycardia,palpitations, muscle
cramps, headache,
paradoxicalbronchospasm,
angioedema, urticaria,
hypotension and
collapse.Potentially
Fatal: Potentially
serious hypokalaemiaafter large doses.
AMLODIPINE Hypertension Amlodipine relaxes peripheraland coronary vascular smooth
muscle. It produces coronary
vasodilation by inhibiting theentry of Ca ions into the
Headache, peripheraloedema, fatigue,
somnolence, nausea,
abdominal pain,flushing, dyspepsia,
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voltage-sensitive channels ofthe vascular smooth muscle
and myocardium during
depolarisation. It alsoincreases myocardial
O2 delivery in patients with
vasospastic angina.
palpitations, dizziness.Rarely pruritus, rash,
dyspnoea, asthenia,
muscle cramps.Potentially
Fatal: Hypotension,
bradycardia,conductive system
delay and CCF.Monitor BP 15
minutes beforeadministration and 15
minutes after
administration.
CARVEDILOL Hypertension and
Chest Pain
Carvedilol causes vasodilation
by blocking the activity of -blockers, mainly at alpha-1
receptors. It exerts
antihypertensive effect partly
by reducing total peripheralresistance and vasodilation. It
is used in patients with renal
impairment, NIDDM orIDDM
Watch out for
Bradycardia, AVblock, angina pectoris,
hypervolaemia,
leucopenia,
hypotension,peripheral oedema,
allergy, malaise, fluid
overload, melena,periodontitis,
hyperuricaemia,
hyponatraemia,increased alkaline
phosphatase,
glycosuria,prothrombin time,
SGPT and SGOTlevels, purpura,
somnolence,impotence,
albuminuria,
hypokinesia,nervousness, sleep
disorder, skin reaction,
tinnitus, dry mouth,anaemia, sweating,
fatigue, arthralgia,
aggravation, dizziness.Diarrhoea, nausea,vomiting, insomnia,
hypercholesterolaemia,
weight gain, abnormalvision, rhinitis,
pharyngitis and
hypertriglyceridaemia.
Telmisartan (Pritor) Hypertension Telmisartan is a nonpeptide
AT1 angiotensin II receptorantagonist. Exerts
Watch out for URTI,
dizziness, back pain,sinusitis, pharyngitis
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antihypertensive activity bypreventing angiotensin II from
binding to AT1receptors thus
inhibiting the vasoconstrictionand aldosterone-secreting
effects of angiotensin II.
and diarrhoea. Slightelevations in liver
enzymes.Potentially
Fatal: Rarely
angioedema, rash,
pruritus and urticariMonitor BP frequently
Zykast (Levocetirizine+ Montelukast)
Bronchospasm Levocetirizine: Levocetirizine,an active isomer of cetirizine,selectively inhibits histamine
H1-receptors. Montelukast:
Montelukast is a selectiveleukotriene receptor antagonist
that blocks the effects of
cysteinyl leukotrienes in theairways.
Watch out forAsthenia, fatigue,fever, abdominal pain,
trauma, dyspepsia,
infectiousgastroenteritis, dental
pain, dizziness,
headache, nasalcongestion, cough &
influenza.
CELECOXIB For pain
management postop
Celecoxib has COX-2 specific
inhibitory activity. It inhibitsthe conversion of arachidonic
acid to prostaglandins whilehaving no effect on the
formation of prostaglandins
that mediate the normalhomeostasis in the GI tract,
kidneys and platelets catalysed
by COX-1.
Watch out for
Abdominal pain,diarrhea, nausea,
oedema, dizziness,headache, insomnia,
upper respiratory tract
infections; rash.Potentially
Fatal: Serious skin
reactions such asexfoliative dermatitis,
Stevens-Johnson
syndrome, and toxicepidermal necrolysis.Give after meals or
with a full glass
of water or milk.
HYDROCORTISONE Prevention of
bronchialinflammation after
surgery.
Hydrocortisone is a
corticosteroid used for its anti-inflammatory and
immunosuppressive effects. Its
anti-inflammatory action is
due to the suppression of
migration ofpolymorphonuclear leukocytes
and reversal of increasedcapillary permeability. It may
also be used as replacement
therapy in adrenocorticalinsufficiency.
Do not give for a long
period of time. Watchout for signs of
infection. Watch out
for signs and
symptoms of
Cushings syndrome.Avoid crowded places
when in steroidtherapy.
MEDROL Prevention of Methylprednisolone is a Watch out for
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(methylprednisolone) bronchialinflammation
synthetic corticosteroid withmainly glucocorticoid activity
and minimal mineralocorticoid
properties. It decreasesinflammation by suppression
of migration of
polymorphonuclear leukocytesand reversal of increased
capillary permeability.
Oedema, hypertension,arrhythmia; CNS,
endocrine, metabolic
and GI effects;hirsutism, acne, skin
atrophy, bruising,
hyperpigmentation;transient leukocytosis;
arthralgia, muscleweakness,
osteoporosis, fractures,cataracts, glaucoma;
infections,
hypersensitivityreactions, avascular
necrosis, secondary
malignancy,intractable hiccups.
Avoid crowded places
Loricid (Allopurinol) Hyperuricemia(Resolved)
Allopurinol is an inhibitor ofthe enzyme xanthine oxidase
which converts hypoxanthine
to xanthine then uric acid. Thereduced production of uric
acid relieves all symptoms
associated withhyperuricaemia and gout.
Inhibition of xanthine oxidase
leads to accumulation of itssubstrates hypoxanthine and
xanthine but since their renalclearance is more than 10
times that of uric acid, there isno risk of nephrolithiasis.
Watch out for Rash;alopoecia; GI
disorders, taste
disturbances, nausea,vomiting, abdominal
pain, diarrhoea;
paraesthesia,peripheral neuropathy,
vertigo, headache,
hepatic necrosis,drowsiness, neuritis,
arthralgia;hypertension.Potentially
Fatal: Stevens-
Jonhson and/or Lyell's
Syndrome (urticaria,fever,
lymphadenopathy,
arthralgia).Occasionally,
thrombocytopaenia,
agranulocytosis andaplastic anaemia.
Elartan (Isosorbide
Mononitrate)
Chest pain Isosorbide mononitrate relaxes
vascular smooth muscles bystimulating cyclic-GMP. It
decreases left ventricular
pressure (preload) and arterialresistance (afterload).
Watch out for
Hypotension,tachycardia, flushing,
headache, dizziness,
palpitation, syncope,confusion. Nausea,
vomiting, abdominal
pain. Restlessness,weakness and vertigo.
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Dry mouth, chest pain,back pain, oedema,
fatigue, abdominal
pain, constipation,diarrhoea, dyspepsia
and flatulence.Potentially
Fatal: Severe
hypotension andcardiac failure.
SPIRIVA
(ipratropium bromide)
For
bronchoconstriction
Ipratropium bromide blocks
the action of acetylcholine at
parasympathetic sites inbronchial smooth muscle
causing bronchodilation.
Watch out for Dry
mouth, urinary
retention, buccalulceration, paralytic
ileus, headache,
nausea, constipation,paradoxical
bronchospasm,
immediate
hypersensitivityreactions (urticaria,
angioedema), acute
angle-closureglaucoma, nasal
dryness and epistaxis
(nasal spray).Potentially
Fatal: Anaphylactic
reactions, atrialfibrillation,
supraventriculartachycardia.
Ipratropium,
Salbutamol (Duaven)
For
bronchoconstriction
Salbutamol is a direct-acting
sympathomimetic with -
adrenergic activity andselective action on
2 receptors, producing
bronchodilating effects. It alsodecreases uterine contractility.
Ipratropium bromide blocks
the action of acetylcholine at
parasympathetic sites inbronchial smooth muscle
causing bronchodilation.
Zykast (theophylline)
Watch out for
Headache, pain,
influenza, chest pain,nausea. Bronchitis,
dyspnea, coughing,
pneumonia,bronchospasm,
pharyngitis, sinusitis,
rhinitis. Edema,
fatigue, Hypertension,dizziness, nervousness,
paresthesia, tremor,
dysphonia, insomnia,diarrhea, dry mouth,
dyspepsia, vomiting,
arrhythmia,palpitation,
tachycardia, arthralgia,
angina, increasedsputum, taste
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perversion andUTI/dysuria. Allergic-
type reactions
Zykast (theophylline) For bronchospasm Theophylline competitively
blocks phosphodiesterase
which increases cAMP tissueconcentrations causing
bronchodilatation, diuresis,
CNS and cardiac stimulation,and gastric acid secretion.
Watch out for Nausea,
vomiting, abdominal
pain, diarrhoea,headache, insomnia,
dizziness, anxiety,
restlessness, tremor,palpitations.Potentially
Fatal: Convulsions,
cardiac arrhythmias,hypotension and
sudden death after too
rapid IV inj.
Diagnostic Examinations and Laboratory Results
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Diagnostic/LabExam
Result/Interpretation Indication/Significance
XRAY Both lung fields are hyperinflated withlightly flattened diaphragmatic leaflets.
An area of 810 lucency devoid of
vascular markings seen at the rightlower peripheral hemithorax. Cardiac
shadow is unenlarged with AAR right
sided CTTThere is near complete resolution ofsubcutaneous emphysema in the right
lateral chest wall
Mid to lwer reticular and hazy densitiesprobably pneumonic, minimal pleural
effusion with probably lamellar and
interlobar componentRight apical pleural reaction
PNEUMOTHORAX RIGHT
Indicated for the patient as an initialinvestigation of the pneumothorax to
assess the location, the amount and
the gravidity of the insult. Also, thisis to serve as baseline for the
assessment and evaluation of the
effectivity of the surgical, medicaland nursing procedures. This is alsoto determine if the CTT is inserted at
the correct area.
CBC Hemoglobin: 103g/L (decreased)
Erythrocyte: 0.31 (decreased)Leukocytes: 16700 mm/L (increased)
This is important as baseline before
surgery to determine the amount ofhematocrit, RBC, Hemoglobin and
WBC which are all integral in therecovery of the patient. Also, this is
significant in order to assess the
amount of oxygen being delivered tothe body as per hemoglobin count to
reveal the degree of perfusion
problems. Also, the increase inleukocytes may also indicate an
ongoing bacterial invasion from the
surgical interventions.