I. PATIENT ASSESSMENT DATA BASEA. GENERAL DATA

PATIENTS NAME: Mr. ADADDRESS: Tarlac City, TarlacAGE: 43 years old SEX: Male BIRTH DATE: November 15, 1969 RANK IN THE FAMILY: 2nd in the familyNATIONALITY: Filipino CIVIL STATUS: MarriedDATE OF ADMISSION: July 17, 2013ORDER OF ADMISSION: DIAGNOSIS: ATTENDING PHYSICIAN: Dr. De LeonCHIEF COMPLAINT: Difficulty of breathing, Body weakness and pain on the left chest area.

B. HISTORY OF PRESENT ILLNESS4 days prior to admission, the patient had suffered from motorcycle accident, fell into a ditch sustaining injuries on the chest and left lung. Patient was brought to E.R after he had experienced difficulty of breathing and thereby admitted. C. PAST HEALTH HISTORY/STATUS

Childhood Illnesses: The patient already experienced having chickenpox and measles.Immunization: The patient cant remember when he had received his dose of BCG and Hepa B.Major Illnesses: NoneCurrent medications: Patient was prescribed

D. FAMILY ASSESSMENT

NAMERELATIONAGESEXOCCUPATIONEDUCATIONAL ATTAINMENT

LDWife42Female HousewifeHigh School graduate

MDSon26MaleService CrewCollege Undergraduate

EDDaughter20FemaleNONECollege Graduate

E. SYSTEM REVIEW

1. HEALTH PERCEPTION

Clients perception of health: Dapat kumain kanang masusustansyang pagkain para maging malakas ka at healthyClients perception about Illness: Kagaya ngayon mahina ako diko na kayang gawin ang ginagawa ko dati

2. NUTRITIONAL-METABOLIC PATTERN

Food: The patient usually drinks coffee and eats bread at breakfast and usually had a combination of meat, vegetables and rice for lunch and dinner; he drinks coffee two times a day.Water: He usually drinks 8 10 glasses of water every day.Beverages: He drinks alcoholic beverages 2-3 times a week.

3. ELIMINATION PATTERNDuring hospitalization, he defecates every day, brown in color and foul in odor. With indwelling folley catheter connected to urine bag, the urine color is pale yellow and has aromatic odor.

4. ACTIVITY-EXERCISE PATTERNDURING HOSPITALIZATION III Feeding III Dressing III Grooming III Bathing III Toileting IV Cooking III Bed mobility IV Home maintenance

Legend0 full careI requires use of equipmentII requires assistance or supervision from othersIII requires assistance or supervision from another, and equipment and a deviceIV dependent; doesnt participates

5. COGNITIVE-PERCEPTUAL PATTERN

Mr. AD can see objects clearly with the aid of his eyeglasses. He can taste food as its taste. He can hear well since he answers our questions upon interview.

6. SLEEP-REST PATTERN

He usually sleeps 7:00 PM. Patient stated some sleeping alterations because at times he felt in pain in breathing. He is not using any sleeping aids. Client also complains of difficulty in breathing and pain in breathing.

7. SELF PERCEPTION PATTERN

During hospitalization, the clients perception about himself is, Mahina ako, malaki ang pinagbago ko .Regardless of his situation, Mr .A.D was disappointed of what happen because they spend a lot of money for his treatment. As stated by Mr. A.D his weakness and strength is his family. The patient stated that Dapat bumalik na ang dati kong lakas dahil kailangan kong magtrabaho para sa pamilya ko.

8. ROLE RELATIONSHIP PATTERN

According to the Mr. A.D, because he is the head of the family, he is the one who provides the needs of his family and sometimes gives some to his mother.9. SEXUALITY REPRODUCTIVE PATTERN

Client stated that he engages in sexual activity with his wife. In connection with their sexuality-productive pattern they both established good relationship. Mr. A.D and his wife dont have any reproductive problems. He did not experience any sexual abuse likewise.

10. COPING-STRESS TOLERANCE PATTERNHe states that stress and problems in life as sakit sa ulo, Mr. A.D manages his problem together with his wife.

11. VALUE BELIEF PATTERN

Mr. AD is a Roman Catholic Christian valuing the word of Christ and believes he is there.

F. HEREDO-FAMILIAL ILLNESS

PATERNALMATERNAL

No Known IllnessNo Known Illness

G. DEVELOPMENTAL HISTORYTHEORISTAGESEXPATIENTS DESCRIPTION

Erick Erickson

Middle Adulthood: 65 to deathMaleEgo Development Outcome: Generativity vs. Self absorption or StagnationBasic Strengths: Production and CareNow work is most crucial. Erikson observed that middle-age is when we tend to be occupied with creative and meaningful work and with issues surrounding our family. Also, middle adulthood is when we can expect to "be in charge," the role we've longer envied.

PiagetFormal operational(11 years and up)MaleThe patient Can solve hypothetical problems with scientific reasoning, understands causality and can deal with the past, present and future.

Sigmund Freud

Puberty to Death

MaleThe GenitalStageErogenous Zone: Maturing Sexual InterestsDuring the final stage of psychosexual development, the individual develops a strong sexual interest in the opposite sex. This stage begins during puberty but last throughout the rest of a person's life. Where in earlier stages the focus was solely on individual needs; interest in the welfare of others grows during this stage. If the other stages have been completed successfully, the individual should now be well-balanced, warm and caring. The goal of this stage is to establish a balance between the various life areas.

II. PHYSICAL ASSESSMENT

A. General Survey1. Overall appearance and grooming: Upon assessment Mr.LMQ is conversant and conscious; he also appears weak.2. Symptoms of distress: Mr. AD has symptoms of distress.3. Posture and gait: On his condition, he cant stand and move independently.4. Affect and mood: Upon our interview, Mr. AD is showing unhappy mood and is irritable.5. Vital signs of the day of physical examinationTemperature: 36.5C Respiratory rate: 28 breaths per minutePulse rate:95 bpm Blood pressure: 110/80 mmHg6. Height and weight: Height: 5 feet 1 inchesBMI: 22.86 = Normal Weight: 121 lbs

B. Regional Exam IPPA technique was utilized1. Hair, head and face: Hair: Upon inspection Mr.ADs hair are evenly distributed. Its texture is dull, rough and thick. There is no presence of infection.Head and face: The clients head is rounded, smooth skull contour, and normocephalic. His face is symmetric in facial movement and there is no presence of any nodules or masses upon inspection and palpation. 2. Eyes: Upon inspection of the clients eyes, its eyebrows and eyelashes are symmetrically aligned and hair is evenly distributed. The palpebral conjunctivae are pale in color. The pupils are equally round and reactive to light and accommodation. 3. Nose: Upon assessment Mr. AD nose is symmetric and straight, no discharge, no tenderness, no lesions, nasal septum intact and in midline. Client is receiving oxygen inhalation via nasal cannula. The client complains difficulty in breathing.4. Ears: Both ears are same in color with the facial skin, symmetrical, auricle aligned with the outer canthus of the eyes 10 from vertical, not tender, pinna recoils after it is folded.5. Mouth and throat: The clients mucous membrane is pink in color, slightly dry, smooth in texture, complete teeth and client can swallow.6. Neck and Lymph nodes: The clients neck muscles are equal in size, no visible nodules nor masses upon palpation.7. Skin: Mr. has tan skin complexion and has good skin turgor.8. Nails: Well cut and clean nail tips, and has normal blanch test with good capillary refill and pale.9. Thorax and lungs: Clients respiration is 28 bpm; abnormal breaths with paradoxical breathing10. Cardiovascular: With PR of 95 bpm, regular heartbeat and no swishing sounds heard. Blood pressure is 110/80 mmHg.11. Breast and axilla: Breasts skin even with the chest wall. No nodules noted on axilla upon palpation13. Extremities: Left and right upper extremities are equal in size and length; no deformities noted14. Genitals: Not assessed15. Rectum and anus: Not assessedIII. PERSONAL/SOCIAL HISTORY0. Habits/Vices: Client doesnt smoke.0. Caffeine: The patient drinks coffee trice a day.0. Smoking The patient doesnt smoke0. Alcohol The patient drinks alcohol. 0. Tea The patient doesnt drink tea.0. Drugs The patient doesnt take prohibited drugs0. Social Affiliation - none0. Rank in the family 2nd in the family0. Travel (within 6 mos.) Has not traveled 6 months before hospitalization0. Educational Attainment High School graduate

IV. ENVIRONMENTAL HISTORYClient resides in a semi-concrete house. His family lives with them. They had a congested neighborhood.

V. LABORATORY RESULTS

1. ULTRASOUND

Date: 01/31/2013Examination

IMPRESSION

Whole Abdomen Ultrasound Abdominal sonography reveals the liver, homogenous, with normal in abdominal size and echogenecity with no mass or cyst noted. The gallbladder is demonstrated with no calculus seen, Gallbladder is not dilated, and pancreas and abdominal aorta are obscured bowel gas. The spleen is not enlarged with none evident laceration noted. The kidneys are with normal size and echogenecity with no solid mass or cyst or calculus or

hydronephrosis seen. No free fluid seen in the amount of pleural effusion is seen in the left. There is solid tissue noted in the left lung. No urinary bladder mass or calculus seen. The prostate measures 30%2.1x2.2 cm with an estimated weight of 7.8 g.

Normal size homogenous liver with no mass or cyst noted no calculus seen in the gallbladder. The common duct and the intrahepatic duct are not dilated. No renal solid mass or cyst or calculus or hydronephrosis is seen Small amount of left pleural effusion Solid tissue in the lung, contusion changes

No free fluid seen in the abdomen and pelvis at the time of exam. No urinary bladder mass or calculus seen Prostate is not enlarged.

2. BLOOD COUNT

Date: 01/30/2013COMPONENT AND QUANTITYRESULTNORMAL VALUESIGNIFICANCE

WBC13.0(4.0-10.0)10^3/ulIncreased: Possible infection

Lymphocytes1.7(1.0-5.0) 10^3/ulIncreased: Indicative of possible infection

Monocytes0.9(0.1-1.0) 10^3/ulIncreased: Inflammatory Response

Granulocytes10.5(2.0-8.0) 10^3/ulIncreased: Indicative of possible infection

RBC5.62(4.00-6.20) 10^6/ulNormal

HGB15(12.0-18.0)9/dlNormal

HTC47.737.0-55.0%Normal

3. ARTERIAL BLOOD GAS

COMPONENTSRESULTSNORMAL VALUESSIGNIFICANCE

pH7.393(7.35-7.45)Normal

pCo248.8 mmHg(35-45mmHg)Increased: Indicates Underventilation

Po280.8mmHg(80-100 mmHg)Normal

HCO329.1 meq/dl(22-26 meq/dl)Increased: Indicative of Metabolic Acidosis

Oxygen saturation93%95-100%Decreased: Indicative of hypoxemia

VIII. PATHOPHYSIOLOGY OF FLAIL CHEST

PRECIPITATING FACTORS:AgeGenderPREDISPOSING FACTORS:Diet Trauma (Motorcycle accident)

Diet: Decreased Calcium and minerals needed for healthy bones in the dietDecreased bone density (Fragile and weak bone) and higher affinity to sustain fracture Men are tend to have higher and heavier workload

Force or direct blow exerted against rib cage stronger than structurally withstand

In upper rib, potential injury to the pleural or intra-abdominal visceraPotential injury to the lung parenchyma by direct penetrationInjury and fracture to the rib cage

Interfere with normal costovertebral and diaphragmatic muscle excursion, potentially causing ventilatory insufficiencyHematoma formation at fracture site. Tissue inflammation resulting in pain.

VI. INTRODUCTION Aflail chestis a life-threatening medical condition that occurs when a segment of therib cagebreaks under extreme stress and becomes detached from the rest of thechest wall. It occurs when multiple adjacent ribs are broken in multiple places, separating a segment, so a part of the chest wall moves independently. The flail segment moves in the opposite direction as the rest of the chest wall: because of the ambient pressure in comparison to the pressure inside the lungs, it goes in while the rest of the chest is moving out, and vice versa. This so-called "paradoxical motion" can increase the work and pain involved in breathing. Flail chest is invariably accompanied bypulmonary contusion, a bruise of the lung tissue that can interfere with blood oxygenation. The constant motion of the ribs in the flail segment at the site of the fracture is extremely painful, and, untreated, the sharp broken edges of the ribs are likely to eventually puncture the pleural sac and lung, possibly causing apneumothorax. Typical paradoxical motion is associated with stiff lungs, which requires extra work for normal breathing, and increased lung resistance, which makes air flow difficult.

VII. ANATOMY AND PHYSIOLOGY OF THE AFFECTED BODY PART

PHYSIOLOGY OF THE LUNGS LUNGS The lung is the essential respiration organ. The right lung is divided into 3 lobes (upper, middle and lower) whereas the left has only 2 (upper and lower).

BRONCHIAL TREE When people inhale, air moves down the trachea or windpipe. The trachea splits into two pipes called the right and left main stem bronchus. Each bronchus provides an air passageway to a lung. Each bronchus continues to divide into many bronchi, or small pipes, which further divide throughout the lungs into millions of tiny branches called bronchioles. This system of bronchi and bronchioles is referred to as the bronchial tree. The bronchial tubes are lined with very small hair-like structures called cilia. Cilia use a constant wave-like motion to carry mucus up the airway to the throat where it is either swallowed or coughed out.

ALVEOLI At the end of each bronchiole are small sacs called alveoli. Alveoli are responsible for exchanging oxygen and carbon dioxide. This process helps remove foreign substances and germs from the respiratory system to reduce the risk of infection.

LOBES The right lung is divided into three sections called lobes. This tissue contains the bronchioles, alveoli, and capillaries necessary for oxygenation of the blood. The left lung has only two lobes because of its anatomical position (next to the heart) in the chest cavity.

PLEURA The lungs are surrounded by a membrane called the pleura. This membrane wraps around each lung and helps to separate them from the wall of the chest cavity. A very small amount of fluid is present between the pleural linings. It acts as a lubricant during lung inflation and deflation, easing inspiration and expiration.

RIB CAGE Also known as the thoracic cage, is a bony and cartilaginous structure which surrounds the thoracic cavity and supports the pectoral girdle, forming a core portion of the human skeleton. A typical human rib cage consists of 24 ribs, the sternum (with Xiphoid process), costal cartilages, and the 12 thoracic vertebrae. It, along with the skin and associated fascia and muscles, makes up the thoracic wall and provides attachments for the muscles of the neck, thorax, upper abdomen, and back.

DIAPHRAGM The diaphragm is the muscle responsible for inflating and expanding the lungs. When your inhale, the diaphragm muscle contracts and presses the bottom parts of the left and right lung, causing the lungs to inflate. When you exhale, the diaphragm relaxes

ASSESSMENTNURSING DIAGNOSIS

SCIENTIFIC BACKGROUNDPLANNINGNURSING INTERVENTIONRATIONALEEVALUATION

Subjective:Hirap akong makahinga

Objective: Restlessness Abnormal ABGs result Nasal Flaring Irritability Weakness Use of accessory muscles in breathing

Vital Signs:BP: 110/80 mmHgPR: 110 bpmRR: 28 bpmTEMP.: 36.8oCOXYGEN SATURATION: 93%Impaired gas exchange related to alveolar capillary membrane injuryFlail Chest is invariably accompanied by pulmonary contusion, a bruise of the lung tissue that can interfere with blood oxygenation.Patient will demonstrate improved adequate tissue oxygenation after 30 minutes of rendering nursing interventions. Monitor vital signs

Monitor pulse oximetry

Note effectiveness of cough mechanism

Elevate head of bed

Assist client in position changes and breathing exercises

Encourage adequate rest and limit activities to within client tolerance

Provide psychological support

DEPENDENT:

Administer supplemental oxygen as ordered- Indicative of respiratory distress and used as a baseline data

-To determine oxygenation and levels of carbon dioxide retention

-To evaluate degree of compromise

-To improve breathing when pain is inhibiting effort and promote lung expansion

-To increase normal breathing, to allow the chest wall to reposition itself back to normal conditions.

-To help limit oxygen needs or consumption

-To reduce anxiety for maximum cooperation in interventions

-To offset increased oxygen demands and consumptionsGOAL METAfter 30 minutes of rendering nursing interventions the patient had demonstrated adequate tissue oxygenation and improved ventilation.

Vitals Signs:BP: 110/80 mmHgPR: 98bpmRR: 23 bpmTEMP.: 36.5oCOXYGEN SATURATION: 98%

ASSESSMENTNURSING DIAGNOSISSCIENTIFIC BACKGROUND

PLANNINGNURSING INTERVENTIONRATIONALEEVALUATION

Subjective:Nahihirapan akong gumalaw gaya ng dati

Objective: Slowed movement

Needs support in moving

Experience difficulty in doing certain actions because of pain

Activity intolerance related to multiple rib fractureIt is a state in which a person has insufficient physical or psychological energy to endure or perform desired physical activities this could be related to any pain or discomfort that a patient feels. Rib fracture may induce pain and may hinder in performing an activity.After 2 hours of nursing interventionsthe patient will be able to tolerate simple activities.Identify the activities thepatient canperform which are very essential torefrain patientfrom doingnonessentialactions

Assist with activities of daily living.

Encourage to perform deep breathing exercise.

Encourage adequate rest periodsespeciallybefore ambulation and meals-To assess activities that he can perform when in pain

-To reduce energyexpenditure but avoid doing things for patient when he can stillperform toincrease patients self-esteem

-To help reduce the pain by relaxation of muscles

-To reduce cardiac workload

GOAL MET

After 2hours rendering of nursing intervention the patient can tolerate simple activities.

ASSESSMENTNURSING DIAGNOSISSCIENTIFIC BACKGROUND

PLANNINGNURSING INTERVENTIONRATIONALEEVALUATION

Subjective:Sobrang sakit ng dibdib ko Pain Scale: 8/10

Objective: Weak in appearance Restlessness Guarding behavior Facial grimace noted Irritability Use of accessory muscle in breathingVital Signs:BP: 110/80 mmHgPR: 110 bpmRR: 28 bpmTEMP.: 36.8oC

Acute pain related to 6th-9th segmented rib fracture The constant motion of the ribs in the flail segment at the site of the fracture is extremely painful.The patient will establish relief of pain and decrease in pain scale of 8/10 to 2/10 after 1 hour of rendering nursing interventions.INDEPENDENT:Monitor vital signs

Determine clients acceptable level of pain or pain control goals.Assess fro referred pain as possible

Instruct use of relaxation technique such as: focus breathing.Assist in repositioning

Assist client to learn proper breathing techniquesObserve for non verbal cues and pain behaviors

Encourage adequate rest periods

Provide and discuss with individual exercise program if toleratedDEPENDENT:Administer analgesics as ordered.

-To establish baseline data and this is usually altered in acute pain.-Pain perception varies with individual and situation.-To help determine the underlying condition or organ dysfunction -To distract attention and reduce tension.

-Repositioning may decrease pain

-To assist in muscle and generalized relaxation-Observation may not be congruent with the verbal report

-To prevent fatigue and oxygen consumption

-To promote active rather than passive role and enhances sense of control- reduces the oxidized form of the COX enzyme, preventing it from forming pro-inflammatory chemicals. This leads to a reduced amount of prostaglandin E2 in the CNS, thus lowering the hypothalamic set-point in the thermoregulatory centre

GOAL METAfter 1hour of nursing intervention patient had established relieved of pain and had a pain scale of 2/10

X. LIST OF IDENTIFIED PROBLEMS ACCORDING TO PRIORITY1. Acute Pain Related to respiratory muscle injury due to ineffective breathing.2. Impaired gas exchange related to alveolar capillary membrane changes.3. Activity intolerance related to multiple rib fracture.

XII. ONGOING APPRAISAL:

August 30, 20137:00 -7:00 pmMr. LMQ is lying on bed, conscious and conversant; he is slightly weak in appearance. He has ongoing Intravenous fluid of 5% Dextrose on Water Solution in 10-15 drops per minute at 500 cc level. Vital signs taken: BP: 160/90 mmHg, Temp.: 37. 0 C, RR: 20 bpm, RR: 78 bpm. Physical assessment and history taking was done.

XIII. DISCHARGE PLAN:Medications: Instruct patient to continue taking the prescribe drugs .

Exercise: Instructed the patient to avoid extraneous work.

Treatment: Instruct patient to continue medications. And avoid crowded places most especially places have high level of irritants.

Clinic Follow up: Instruct patient to have their follow up check up after one week and follow the scheduled given.

Diet: The diet should be high caloric. Always drink a lot of water. Also eat fruits and vegetables. Eat vitamin c rich food to strengthen immune systems.Danger Signs: Instruct patient to seek medical attention if problem occurs.

SUBMITTED BY:

GROUP 2CASTILLO, JANNINE KAYCASTISIMO, MARK CHRISTIANCRUZ, MARIONNE CARLENCUARESMA, WENDY PRECIOSACUSION, EMIL JOHNDOCTOR, LAI MAEDOMINGO, LADY LYNELEGADO, PRINCESSGANDIA, JARIYAGODOY, ERLINE BELLE

Generic Name: Ketorolac Brand Name: KetomedDrug Classification: NSAIDsIndication: Short-term management of pain.

Mechanism of ActionAdverse EffectContraindicationSide EffectsNursing Consideration

Anti inflammatory and analgesic activity; inhibits prostaglandin and leukotriene synthesis.

CV: MI

GI: GI Bleeding, Perforation

GU: NephrotoxicityDysuria, Hematuria, Oliguria

HEMA: Blood Dyscrasias

Renal impairment Aspirin allergy Concurrent use of NSAIDs. Active peptic ulcer disease. Dizziness, Drowsiness,Nausea

Vomiting, Diarrhea Instruct the patient that avoids driving and other activities.

Increase fluid intake, Administer Anti emetic if Vomiting Anti diarrheal if Diarrhoea occurs Instruct the patient to report chest pain Check for the Stool of the patient if theres presence of melena Check for Renal Studies: BUN, Creatine, Protein Check for urine output, Check for Urinalysis if theres a presence blood in the urine Check for the result of CBC for blood dyscrasias Check the Chart/History of the patient of Peptic Ulcer disease, if the patient has PUD, Dont administer Discontinue if allergy persists Notify the Physician

Generic Name: Morphine So4Brand Name: MorphitecDrug Classification: OpiodsIndication: To relieve acute or chronic moderate to severe pain

Mechanism of ActionAdverse EffectContraindicationSide EffectsNursing Consideration

Binds with and activates opiod receptors in brain and spinal cord to produce analgesia and euphoria.

CV: Ortho Hypotension

GI: Abdominal cramps, Nausea, Vomiting

Acute alcoholism Withdrawal syndromeBlurred visionBradycardiaHypotensionAnemiaDry Mouth

Instruct the patient limit ambulation Monitor cardiac rate

Instruct the patient to rise to bed slowly and dangle feet before standing up Monitor Complete blood count result Instruct the patient to frequently sip water Instruct the patient to rise to bed slowly and dangle feet before standing up Monitor borborygmy sounds Discontinue if allergy persists Notify the Physician

GENERIC NAME: nalbuphineBRAND NAME:NubainCLASSIFICATION: AnalgesicDOSAGE: 5mg intravenously as needed for severe painINDICATION: Relief of moderate to severe pain

MECHANISM OF ACTION

CONTRAINDICATIONSIDE EFFECTNURSING CONSIDERATION

Binds with opiate receptors in the CNS: ascending pain pathways in limbic system, thalamus, midbrain, hypothalamus, altering perception of and emotional response to pain. History of hypersensitivity to nalbuphine, opiate agonists; pregnancy ( category C ) CV: TachycardiaGI: Nausea VomitingSKIN: Sweaty Clammy skin

Obtain drug history Monitor vital signs after parenteral route Monitor allergic reactions: rash, pruritus, and urticaria. Monitor ambulatory patients; nalbuphine may produce drowsiness. Watch for respiratory depression. Avoid abrupt termination of nalbuphine following prolonged use, which may result in symptoms similar to narcotic; abdominal cramps, nasal congestion, restlessness, anxiety.

Generic name: CefuroximeBrand Name: MefoxinDrug classification: CephalosporinsIndication: Gram- Negative Bacilli

MECHANISM OF ACTIONADVERSE REACTIONCONTRAINDICATIONSIDE EFFECTSNURSING CONSIDERATION

Bind to bacterial cell wall membrane, causing cell death

GI: Pseudomembranous colitis

GU: Nephrotoxicity, Renal Failure

HEMA: Leukopenia, Thrombocytopenia, Agranulocytosis, Neutropenia, Lymphocytosis, EosinophiliaINTEG: Steven-Johnsons SyndromeContraindicated in patients who have shown hypersensitivity to cefoxitin and the cephalosporin group of antibiotics. Dizziness Headache

Nausea

Diarrhea, Vomiting

Cramps Instruct the patient that avoid driving Instruct The patient that the drug will cause headache Instruct the patient that avoid drivingAnd other activities. Increase fluid intake, Administer Anti Emetic for vomiting and Anti diarrheals for Diarrhea Monitor if theres increase borborygmy sounds Monitor patient for signs and symptoms of Pseudomembranous colitis Monitor Urine Output, Assess for Renal Studies: Protein, BUN, Creatinine results Check for the Complete Blood Count Results of the patient

Monitor patient for signs and symptoms of SJS.