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7/29/2019 Powerpoint Medical Mngement

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On January 11, 2013 at 7:30 in the evening, the patient was broughtat Northern Mindanao Medical Center, emergency room. In there,the client was assessed thoroughly through series of laboratorytests obtained to him such as Complete Blood Count to detectdeviation on patients blood components where there were signsand symptoms manifested. Urea leve was also tested to evaluatekidney function and to monitor patient with kidney failure due to

chronic circulation problem where sodium test also was checkedto know how much sodium is in the blood. Potassium was alsotested to measures its amount in the patients blood. Blood, Urea,Nitrogen test measures the level of urea nitrogen in a sample ofthe patient's blood in relation to circulation problem. Urinalysis

was done to support screening in helping to detect substances orcellular material in the urine associated with different metabolicand kidney disorders that might encountered by the patient, andelectrocardiogram, checking patients heart electricalactivity through small electrode patches attached to the skin of

patients chest, arms, and legs because of the tendency of heartproblem.


2/12

The client also undergone for CT-scan of his brain because of his

stroke symptoms and he was then diagnosed with

Cerebrovascular disease, hemorrhagic. Client was then brought to

Stroke ward at P1F3 so that the medical staff and personnel willbe able to monitor the patients condition with orders of Consent to

care and management was secured to ensure that all procedures

and treatment done are in accordance to patients will adhering to

his rights. Venoclysis of Plain normal saline solution 1L at 30 drops

per minute was ordered as it is indicated as a source of water and

electrolytes in general, and used for fluid replenishment or

medication administration to the patient. The doctor ordered for

client on NPO (nothing per orem) status temporarily except

medications because patient is still for blood chemistry to identify

the numerous chemical substances found in the blood and to

identify any possible disease


3/12

Orders of medications such as Nicardipine ampule in 20cc at 10cc

per hour via soluset to control patients blood pressure of

180/130mmHg during admission. Along with Nicardipine is

Captopril 25 mg per nasogastric tube (NGT) every 6 hours and

hold for blood pressure below 160/100 mmHg, Citicoline 500mg 1

tablet twice a day was ordered since there was brain injuhry,

Simvastatin 40 mg after meal to reduce the risk of another

cerebrovascular accident, Omeprazole 40 mg 1 tablet every 8

hours for the relief of possible hypersecretion of acid in the gastric

surface, Lactulose 30cc after meal to soften stool aiding in easyevacuation preventing valsalva maneuver of the patient. Celecoxib

200mg 1 cap twice a day per nasogastric tube (NGT) to control

inflammation and possible pain felt due to vasospasm of the

affected arteries and veins in the injured area of the brain.


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January 11, 2013, the doctr ordered to monitor vital signs, oxygen

saturation every 4 hours to monitor level of oxygen saturation inside the

patients system and was done through pulse oximetry. The readingwas 100 beats per minute then gets highr to 60 beats per minute, the

doctor then ordered to refer for blood pressure higher than 160/100

mmHg or lower than 90/60 mmHg to monitor client for further

examination. Refer if heart rate is greater than 100 beats per minute or

lower than 60 beats per minute, and sodium level if higher than 30millimoles per liter or lower than 12 millimoles per liter. And also monitor

the oxygen saturation if lower than 95%. These will be evaluated for

further observation and could be a sign of danger when occurred

because these were not within normal values.


5/12

These were the diagnostic examinations results of client; the bloodchemistry revealed that the client had 223mg/dL glucose which ishigher than the normal range of 100mg/dL which leads toviscosity of the blood due to dehydration in the intravascular

space that could double up the working of the heart making theblood pressure more higher than usual readings, and the rest ofthe results were within normal ranges.

For the Complete blood count, the following were the results ofthe examination, white blood cells is 12.2 10^3/uL indicates

higher level due to immunity response of inflammation,eosinophils was increase due to hematologic disorders. Red bloodcount was at 5.52 10^6/dL higher than the normal range of 4.5 5.4 1^6/dL which indicates that the body compensated from theblood loss due to rupture of blood vessel and the otherhematology results was identified as normal.

Prothrombin time, Prothrombin activity, and activated partialthromboplastin time were all normal and found to be no problemin clotting factors. Platelet count was 256 %, which is within thenormal range of 150-400%


6/12

On January 14, 2013 at 6:30am the doctor ordered to increase nicardipine

drip to 20cc per hour to manage hypertension in which the clients blood

pressure was 210/130mmHg, and repeat blood pressure monitoring for 30

minutes to monitorclients blood pressure since his blood pressure was high.

And also, it was ordered by the physician to terminate mgSO4 side drip onceconsumed. Vital signs was ordered to monitor every 4 hours to check the status

of the client if his vital signs were stable and monitor any abnormalities to

continue medications to treat underlying condition of client. Capillary blood

glucose was ordered to monitor every 2 hours. At 8:00 in the morning his

capillary blood glucose result was 110 mg/dL which is in normal range of (100-

140 mgdL).At 10:00 in the morning his capillary blood glucose result was 105

mg/dL which is in normal range of 100-140 mg/dL. Monitor clients capillaryblood glucose every two hours. Fasting blood sugar was ordered to measureblood glucose level and lipid profile to check clients cholesterol level. These

laboratory tests were ordered to be done for further examination of clientscondition, but were not obtained from the chart. Sodium level was checked lastJanuary 16, 2013 with result of 142.8 mmol/l which is in normal range of 153-148mmol/l. And also ordered to check Potassium level with the result of 3.98 mml/lwhich is in normal range of 3.5-5.3 mml/l. Creatinine was checked with the resultof result of 0.8 mg/dL which is also in normal range of 0.6-1.5mg/dL for further

examination of the clients status. Client was then referred accordingly.


7/12

At 12:30 in the afternoon on the same date,

orders of chest x-ray for further examination of the

client status to check if there was accumulation of fluid

in the lungs related to consistent high blood pressure,

and result was not seen in the chart. Orders of c-

reactive protein to detect very-low-grade inflammatory

responses that may result to cardiovascular disease or

myocardial infarction, and the result was also not seenin the chart.


8/12

An ultrasound of the kidney, urinary bladder and prostate gland were

also ordered to check if there were complications due to consistent of high

blood pressure. The tests were done on January 16, 2013 and the findingswere as follows: The right and left kidney measures 11.36cm x 5.52cm and

11.36cm x 6.06cm which is in normal range of (10-13 cm) respectively with

parenchymal thickness of 2.0cm both which is also in normal range of (2-2.5 cm

thick). The central echo complexes are intact. No calcification, lithiasis or

caliectasia seen. The urinary bladder is well filled. No intralumind echoes seen.Its wall is hot thickness. Prostate gland measures 4.08cm x 2.69cm

(approximately 17.07 grams) which is in normal range it is typically weighs

about 20 grams. And the diagnosis was unremarkable ultrasound findings of the

kidney, urinary bladder and prostate gland. Client was for repeat complete

blood count to check if there is any change in the previous result. 2D echo wasordered to assess the hearts function and determine the presence of disease

of the heart muscle, valves and pericardium. It is used to provide pictures of the

hearts valves and chambers and help the sonographer evaluate the pumping

action of the heart.


9/12

On January 12, 2013 the doctor ordered to remove

nasogastric tube, this is to prevent aspiration and the patient

was able to swallow and the doctor ordered to continue the

medication to promote wellness. The doctor ordered soft diet

with low salt and fat, this is to decrease levels of cholesterol in

clients blood and decrease blood pressure then refer.


10/12

On January 16, 2013 the doctor ordered to facilitate 2D echo, a

technique that is used to see the actual motion of the heart structures and to

the patient who presenting for acute chest pain. The doctor ordered to facilitatethe complete blood count at 7:30pm, the results were increased for White Blood

Cell which was 12.86 cells/mm3 (normal range 5.0-10 cells/mm3) , this is a

normal immunity response to combat pathogenic invasion, the Red Blood Cell

was now within the normal range of 5.39 106/mm3 (normal range 4.2 5.4

106/mm3), the hemoglobin that carries oxygen and gives the blood cell its redcolor with the result of 16.5 g/dL (normal range 12.0-16.0 g/dL), a high

hemoglobin level indicates abnormal clotting and be bad for circulation.

Hematocrit test is a ratio of red blood cells to the total volume of blood and a

result of 48.5 % (normal range 37.0 - 47.0 %) which indicated dehydration.


11/12

The doctor ordered to facilitate troponin I and CK-MB, to

evaluate if the patient is having chest pain , CKMB levels, are tested

in persons who have chest pain to diagnosed whether they have had

a heart attack, and the doctor ordered to facilitate Electrocardiogram

12 leads a test that records the electrical activity of the heart.

The doctor ordered to continue all medication regimens to

help promote or maintain mental, physical, and psychosocial well-

being, at the same day the doctor ordered uptitrate nicardipine drip

to D5W 50ml which demonstrates a relatively rapid onset/offset of

actions requiring the rapid control of blood pressure.

The doctor ordered to give captopril 25mg 1 tablet per orem

now, and then to recheck blood pressure to be used to treat high

blood pressure and heart failure. This decreases certain chemicals that

tighten the blood vessels, so blood flows more smoothly and the heartcan pump blood more efficiently. The doctor ordered blood pressure

monitoring every two hours to check if the patients vital signs were

within normal range, and refer for any unusualities if the patient

manifested side effects to the drug like tachycardia, etc.
http://labtestsonline.org/understanding/conditions/heart-attackhttp://labtestsonline.org/understanding/conditions/heart-attack


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January 17, 2013 at 7:00am the doctor ordered to follow up 2D echo

result to know if there are some unusualities to the heart movement and

structure. The doctor ordered to continue medication to promote wellness and

to repeat electrocardiogram 12 leads, to check if there is cardiac arrhythmia,blood pressure monitoring for every 4 hours and refer for any unusualities to

detect if there is some abnormality manifested by the patient.

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