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8/8/2019 Grand Case Power Point

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LANOXINClassificationInotropics


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Indications:Heart

failure,paroxysmal

supraventricular

tachycardia

DOSA

GE:

0.25mg/ta

b 1/2tab

OD Action:


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Action:

Inhibits sodium-potassium-activatedadenosinetriphosphatase,

promotingmovement of

calcium from

CNS i i


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: CNS: agitation,

fatigue, generalizedmuscle weakness,

hallucinations,

dizziness, headache,

malaise,

paresthesia, stupor,

vertigo

an


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an

caution

s:

Contraindicated in

patientshypersensitive to

drug and thosewith digitalis

induced toxicity,ventricular

fibrillation, or v-

Nursing Considerations:


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Nursing Considerations:

Observe the ten rights in giving

the medication. Teach patient and a responsible

family member about drug action,dosage regimen, how to take

pulse, reportable signs, and

follow-up care.

Tell patient to report pulse less

than 60 beats/min or more than


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PotassiumChloride

Clasification:

Electrolytes andreplacement

solutions


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Patients

dosage:

10 meq x

2 hours x

8 cycle

diluted to

90cc

Indicati

on:Hypok

A i Ad


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Action:

Replaces

potassium and

maintains

Adverse

reaction:

CV:arrhythmia

s, heartblock,

CNS


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effects:

CNS:

paresthesia oflimbs,

listlessness,confusion,

weakness orheaviness of


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and cautions:

Contraindicated in patientswith severe renal

impairment with oliguria oranuria; with untreated

Addison disease; or acutedehydration, heat cramps,

hyperkalemia, hyperkalemic


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es: Observe ten rights in giving the

medication. Monitor ECG and electrolyte levels

during therapy.

Patient may be sensitive to

tartrazine.

Tell patient to take with or aftermeals with full glass of water or fruit

juice to lessen GI distress.


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PTUpropylthiouracil

Classificaation:

Thyroid hormoneantagonist

Indications


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Indications:

Hyperthyro

idism,

Thyrotoxic

crisis

Action:

Inhibits oxidation

of iodine in

thyroid gland,

blocking activity

of iodine tocombine with

Patients

dosage:

50 mg 1

tab 12

Hematologic: Agranulocyto


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reacti

on:

Hematologic: Agranulocyto

, leukopenia,

thrombocytopenia, aplastic

anemia

Hepatic: hepatotoxicity

CNS: Headache, drowsine

vertigo, paresthesia, neuritineuropathies, CNS

stimulation, depression,


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cautions

: Contraindicated

to patientshypersensitive

to drug.

Use cautiously

in patient with

mg and 10

mg

Observe the ten rights in giving


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es: Observe the ten rights in giving

the medication.

Patients older than 40 may

have an increased risk of

Agranulocytosis.

Give drugs with meals to

reduce adverse GI reactions. Watch for hypothyroidism

(mental depression, cold


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Instruct patient to take drugs

with meals Warn patients to report fever,

sore throat, mouth sores, and

skin eruptions

Tell patient to report unusual

bleeding and bruising. Tell patient to ask prescriber

about using iodized salt and


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Methimazole(Tapazole)

Clasification:

Thyroid hormoneantagonists

Availability:Availability:


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Dosage

20mg/tab

1 tab/TID

Dosage

20mg/tab

1 tab/TID

Availability:

Adults: if mild, 15mg P.O. daily. If

moderately severe,

30 to 40 mg daily. Ifsevere, 60 mg

daily. Daily amountis divided into three

equal doses and

-

Availability:

Adults: if mild, 15mg P.O. daily. If

moderately severe,

30 to 40 mg daily. Ifsevere, 60 mg

daily. Daily amountis divided into three

equal doses and

-


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Indicatio

n:

hyperth

yroidism

Action:

Inhibits

oxidation of

iodine inthyroid gland,

blocking withtyrosine to form

T4. Also may

se CNS: headache drowsiness


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reacti

on

CNS: headache, drowsiness,

vertigo, paresthesia, neuritis,

neuropathies, CNS stimulation,depression and fever

GI: diarrhea, nausea, vomiting,

salivary gland enlargement,

loss of taste, epigastric distress

GU: nephritis Hematologic: agranulocytosis,

leucopenia, thrombocytopenia,


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and cautions:

Contraindicated in

patients

hypersensitive to

drug.Availability

Tablet forms: 5 mgand 10 mg

es:es:


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es:es:

Administer mediation

observing the ten rights

in giving the

medication.

Monitor CBC

periodically to detectimpending leupenia,

thrombocytopenia, and

Administer mediation

observing the ten rights

in giving the

medication.

Monitor CBC

periodically to detectimpending leupenia,



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Stop drug and notify

prescriber if severe rash orenlarged cervical lymph

nodes develop

Instruct patient to take drug

with meals to adverse GI

reactions. Warn patient to report fever,

sore throat, mouth sores, skin

Stop drug and notify

prescriber if severe rash orenlarged cervical lymph

nodes develop


with meals to adverse GI

reactions. Warn patient to report fever,

sore throat, mouth sores, skin


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Omeprazole

(prilosec)

Omeprazole

(prilosec)Classification:

Antiulcer drugs

Classification:

Antiulcer drugs

I di i


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Indication:

Adjuncttreatment

withAzithromyci

n

(dual therapy)

Action:

Inhibits activityof acid (proton)

pump and bindsto hydrogen-

potassium

adenosine

triphosphatase

reacti CNS: headache


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reacti

on:

CNS: headache,

dizziness and

asthenia

GI: diarrhea,

abdominal pain

nausea, vomiting,

constipation andflatulence

Muskuloskeletal:


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es:


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es: Administer medication

observing the 12 rights ingiving the medication.

Instruct patient to swallowtablets or capsules whole

and not to open, crush orchew them.



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Propanolol

(Inderal)Classificati

on:

Antiangina

D


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Dosage

10 mg/tab1 tab

OD

Indications:

adjunctivemanagement

ofthyrotoxicosis

and ThyrotoxicSupressess the

convertion of

A ti


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Action: A nonselective

beta blockers that

reduces cardiac

oxygen demand byblocking

catecholamine-induced increases in

heart rate, blood

rea CNS: fatigue lethargy feve


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rea

ction

CNS: fatigue, lethargy, feve

vivid dreams, hallucinations,

mental depression, light

headedness, insomnia

GI: abdominal cramping,

constipation, diarrhea,

nausea, vomiting CV: bradycardia, hypotensi

heart failure,intermittent

cautions:


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cautions:

Contraindicated in patientswith bronchial asthma, sinus

bradycardia, and heart block

greater than first-degree.Cardiogenic shock, and hear

failure (unless failure is issecondary to a

tachyarrhythmia that can be

ions: Administer mediation observing the


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ions:Administer mediation observing theten rights

in giving the medication.

Monitor vital signs especially the

apical pulse before giving the drug. Ifextreme in pulse rates occur, withhold

drug and notify prescriber

immediately. Give or instruct the patient to take the

drug consistently with meals. Food

F id


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Furosemid

e

Classification:

Loop Diuretic


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Action:

A potent drug

that inhibits

sodium andchloride

reabsorptionat the

proximal and

Indicati

on:

Edem

a

Dosage

andAvailabilit

y:

40 mg ivtt

now

Injection:10mg/ml

S i l


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Contraindica

tion:Contraindica

ted inpatients

hypersensiti

ve to drug

and in those

with n ri .

Special

Precaution:Use

cautiously

in patients

with

hepaticcirrhosis

and in

e ec s CNS: Vertigo, headache,


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:CNS: Vertigo, headache,

dizziness, paresthesia,

weakness, restlessness,fever.

CV: Orthostatichypotension

EENT: Transient deafness,blurred or yellowed vision,

tinnitus.

ties:1 Ob 15 Ri ht i i i


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ties: 1. Observe 15 Rights in giving

medications. 2. Monitor weight, blood pressure,

and pulse rate routinely with long-

term use and during rapid diuresis.Use can lead to profound water

and electrolyte depletion.

3. Monitor fluid intake and output

and electrolyte, BUN, and carbon


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Action:


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Action:

Unknown. A

centally acting

synthetic

analgesiccompound not

chemically

related to

opioids.

Thou ht to

Indicatio

n:

Moderate

tomoderatel

y severe

pain.

Avialability:

Contraindicatio Special


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Contraindicatio

n:

Contraindicated

in patients

hypersensitiveto drug or other

opioids.Serious

hypersensitivity

Special

Precaution:

Use cautiouslyin patients at

risk forseizures or

respiratory

depression; in

patients with

Reaction:


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Reaction: CNS; dizziness, headache,

somnolence, vertigo, seizures,anxiety, asthenia, CNS

stimulation, confusion,

coordination disturbance,

euphoria, malaise, nervousness,

sleep disorder. EENT: Visual disturbances

GI: Constipation, nausea,

s:


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1. Observe 15 rights in giving

medications.

2. Reassess patients level of

pain at least 30 minutes afteradministration.

3. Monitor CV and respiratorystatus.

Withhold dose and notify

Azithromyci


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Azithromyci

n

ClassificationMacrolide anti-

infectives

Dosage/


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Dosage/

Availabili

ty

Tablet

forms: 5mg and

10 mgPatients

dru

Indication

Community-

acquired

pneumoniacaused by

Chlamydiapneumonia,

H. influenza,

Action tionand


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Action

Binds to the50S subunit of

bacterial

ribosomes,

blocking

proteinsynthesis,

bacteriostatic

tionand

Cautions Contraindi

cated inpatients

hypersensitive to

drug

Reaction


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CNS: headache, drowsiness,vertigo, paresthesia, neuritis,

neuropathies, CNS

stimulation, depression and

fever

GI: diarrhea, nausea, vomiting,salivary gland enlargement,

loss of taste, epigastric

Reaction

Nursing Management


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Administer mediation observing

the 12 rights in giving the

medication.

Monitor CBC periodically todetect impending leupenia,


agranulocytosis; also monitor

hepatic function.

I t t ti t t t k


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Instruct patient to take

drug with meals toadverse GI reactions.

Warn patient to reportfever, sore throat, mouth

sores, skin eruptions,anorexia, itching, right

upper quadrant pain,


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Ambroxol(Ambrolex)

Classificatio

n

Mucolytics

I di tiAction


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Indication

Acute andchronic

disorder ofthe

respiratorytract

associated

Increasesproduction

of

respiratory

tract fluids

to helpliquefy and

Dosage/


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Dosage/

Availability

Tablets:

100mg,

200mg,

400mg Patients

dosage:

Contraindication

Contraindicated in

patientshypersensiti

Reaction


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Reaction

CNS: dizziness,

headache

GI: nausea and

vomiting

SKIN: rash

Management


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Management

Administer mediation observingthe 12 rights in giving the

medication.

Monitor cough type and

frequency.

Inform patient that drug shouldnot be use for chronic or

persistent cough such as with


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Test Result Normal Values Clinical

Significance

SGPT 97.09 kat/L 4.0 36.0

kat/L

hepatocellular

disease,

alcoholic

cirrhosis,

jaundice, biliary

obstruction

SGOT 12. 24 kat/L 8.0 33.0

kat/L

NormaL


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Result Clinical Significance

Ph i l P ti


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Physical Properties

Color Dark Straw Alcohol/caffeine intake

Transparency Hazy Presence of bilirubin

Reaction Acidic Normal

Specific Gravity 1.010 Normal

Chemical Test

Sugar Negative Normal

Protein (Albumin, Globulin) Negative Normal

Other Test

Bile Positive hyperthyroidism, cirrhosis,

hepatitis

Nitrate Positive Indicates UTI

Microscopic Examination

RBC 14 15 (++) Acute inflammatory

disorders

Pus Cells 5 6 (+) Indicative of infection and

inflammatory conditions of

the lower urinary tract

Others

Bilirubin Crystals Positive hyperthyroidism, cirrhosis,

hepatitis


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Result Normal Values Clinical

Significance

Sodium 136.1 135 145 mEq/L Normal

Potassium .1 3.5 5.3 mEq/L alco olism, I

distur ances


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DISCHARGE


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PLAN

Knowledgeabout illnessPersonal

HygieneNutritio

nMedicat

Follow up

Activities ofDaily Living

GENERAL OBJECTIVE


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To provide continuity ofcare and the appropriate

needs to the client athome in the absence of a

professional health caregiver and health care

OBJECTIVES


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1. To provide knowledgethrough health teachingregarding Diffuse ToxicGoiter, its causes, clinicalmanifestations, and its

management. 2. Teach client and folkson good hygienic

4. Discuss to the client the


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importance of proper andhealthy nutrition.

5. Inform client andsignificant others about the

need for compliance to her

prescribed medication as

well as its action and side

KNOWLEDGE ABOUT THE DISEASE

H th idi i th


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Hyperthyroidism is the

second most prevalent

endocrine disorder after

Diabetes Mellitus. The mostcommon type of

hyperthyroidism results froman excessive output of

th roid hormone cause b

The antibodies activate the

receptor and lead to the increase


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receptor and lead to the increase

production of thyroid hormone

and there is usually an increase

in size of the thyroid gland(Goiter). It affects women 8 times

more than men.

It is characterized by weight

It may appear after an


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emotional shock, stress or aninfection, but the exact

significance of the

relationships is not

understood.

Health maintenance andrestoration activities include

monitorin of th roid tumors

PERSONAL HYGIENE

1 Ad i li t t t k b th d il


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1. Advise client to take a bath daily

in order to minimize the

accumulation and spread of

microorganisms.2. Emphasize the importance of

wearing clean and comfortable

cotton clothes, good oral hygiene

and trimming of nails to its

LIVING

Instruct folks to provide client with


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Instruct folks to provide client with

cool environment, comfortable

temperature, and if needed, change

beddings and cotton clothingbecause patient with

hyperthyroidism frequently finds a

normal room temperature warmbecause of an exaggerated

metabolic rate and increased heat

NUTRITION


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Instruct client to increase oralfluid intake 2-3 liters/day or

within cardiac tolerance in

order to restore bowel

movement, to replenish

sensible and insensible fluidloss and to prevent

Avoid consumption of goitrogens

which could be found in raw


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which could be found in raw

vegetables such as cabbage,raddish, soy beans, carrots,

turnips and cassava.

Rationale: Goitrogens inhibit iodide

metabolism by the thyroid gland

and inhibit thyroid hormonesynthesis.

Instruct client to reduce caffeine

MEDICATIONS

E l i l l t th li t d f lk


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Explain clearly to the client and folksthe proper administration of drugsprescribed by the physician includingthe right time, dosage, route and

timing in order to prevent underdosing nor overdosing of medications.

Inform the client or folks about the

mechanisms and actions of drugs, itsindications and side effects so thatthey will be aware of the need andimportance to take the medicine and

Furo +KCL I tab OD x 5 daysLevofloxacin 250 mg OD x 7 days

MTV + Ph h li id I OD


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MTV + Phospholipids I cap OD

Metronidazole 30 mg TID

Omeprazole 40 mg I cap OD x 7days

Propanolol 10 mg/cap ODDigoxin 0.25 mg OD

KCL I tab TID x 5 days

Rationale: to facilitate fasterrestoration of bodily functions and

effective drug regimen.

FOLLOW UP VISIT

Instruct the client to


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Instruct the client to

come back at the

Western Visayas

Medical Center Out

Patient Department

(WVMC OPD) after

one week (September

Follow up laboratory


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request: CBC

UrinalysisChest X-ray PA view

Serum K determinationRationale: to monitor

ro ress and for immediate


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