BRONCIAL ASTHMA: ASSESSMENT Subjective: Nahihirapan ako huminga as verbalized by the patient. Objective: Use of accessory muscle.

Abnormal breath sounds. V/S taken as follows: T: 37.3 P: 82 R: 25 BP: 110/80 DIAGNOSIS Ineffective airway clearance related to increased production of secretions. INFERENCE Bronchial asthma is a chronic inflammatory disease of the airways, associated with recurrent, reversible airway obstruction with intermittent episodes of wheezing and dyspnea. Bronchial hypersensitivity is caused by various stimuli, which innervate the vagus nerve and beta adrenergic receptor cells of the airways, leading to bronchial smooth muscle constriction, hypersecretion of mucus, and mucosal edema. PLANNING After 3 days of nursing interventions, the patient will demonstrate behaviors to improve airway clearance. INTERVENTION Independent: Auscultate breath sounds. Note adventitious breath sounds like wheezes, crackles and rhonchi. Elevate head of the bed, have patient lean on overbed table or sit on edge of the bed. Keep environmental pollution to a minimum like dust, smoke and feather pillows, according to individual situation. Encourage or assist with abdominal or pursed lip breathing exercises. Assist with measures to improve effectiveness of cough effort. Increased fluid intake to 3000 ml/ day. Provide warm or tepid liquids. Collaborative: Administer bronchodilators as prescribed. RATIONALE Some degree of bronchospasm is present with obstructions in airway and may or may not be manifested in adventitious breath sounds. Elevation of the bed facilitates respiratory function by use of gravity. Precipitators of allergic type of respiratory reactions that can trigger or exacerbate onset of acute episode. Provides patient with some means to cope with or control dyspnea and reduce air tapping. Coughing is most effective in an upright position after chest percussion. Hydration helps decrease the viscosity of secretions, facilitating expectoration. Using warm liquids may decrease bronchospasm. To reduce the viscosity of secretions. EVALUATION After 3 days of nursing interventions, the patient was able to demonstrate behaviors to improve airway clearance. HYPERTENSION ASSESSMENT SUBJECTIVE: Bakit kaya madalas ako mahilo? as verbalized by the patient. OBJECTIVE: Request for information. Agitated behavior Inaccurate follow through of instructions. V/S taken as follows:T: 37.2 P: 84 R: 18 BP: 180/110 DIAGNOSIS Risk for prone behavior related to lack of knowledge about the disease PLANNING After 8 hoursof nursing interventions, the patient will verbalize understanding of the disease process and treatment regimen. INTERVENTION INDEPENDENT: Define and state thelimits of desired BP.Explain hypertension and its effect on the heart,blood vessels,kidney, and brain. Assist the patient inidentifyingmodifiable risk factors like diet highin sodium, saturatedfats and cholesterol. Reinforce the importance of adhering to treatment regimen and keeping follow up appointments. Suggest frequent position changes,leg exercises when lying down.

Help patient identify sources of sodium intake. Encourage patient to decrease or eliminate caffeine like in tea, coffee,cola and chocolates. Stress importance of accomplishing daily rest periods. COLLABORATIVE: Provide information regarding community resources, and support patients in making lifestyle changes. RATIONALE Provides basis for understanding elevations of BP,and clarifies misconceptions and also understanding that high BP can exist without symptom or even when feeling well. These risk factors have been shown to contribute to hypertension. Lack of cooperation is common reason for failure of anti hypertensive therapy. Decreases peripheral venous pooling that may be potentiated by vasodilators and prolonged sitting or standing. Two years on moderate low salt diet may be sufficient to control mild hypertension. Caffeine is a cardiac stimulant and may adversely affect cardiac function. Alternating rest and activity increases tolerance to activity progression. Community resources like health centers programs and check ups are helpful in controlling hypertension. EVALUATION After 8 hours of nursing interventions,the patient was able to verbalize understanding of the disease process and treatment regimen. PNEUMONIA ASSESSMENT Subjective: Nahihirapan akong huminga as verbalized by the patient. Objective: -Restlessness -Use of accessory muscle -RR = 55 DIAGNOSIS Ineffective breathing pattern r/t increased mucus PLANNING After 30 mins of nursing intervention, the patient will be able to demonstrate behaviours of improve airway. INTERVENTION 1.Positioned head midline w/ flexion appropriate for age/condition. 2.Monitored the pt. for feeding intolerance, abdominal distention and emotional stressors. 3.Kept environment allergen free. 4.Auscultated breath sounds and assess air movement. 5.Observed for signs of respiratory distress. 6.Evaluated changes in sleep pattern, nothing insomnia or daytime somnolence. 7.Documented response to drug therapy and/or development of adverse side effects or intervention w/ antimicrobials. 8.Administered analgesics asprescribed by the physician. 9.Provided supplemental humidification. 10.Monitored serial xrays, ABG's and pulse oximetry readings. 11.Assisted w. Monitored effects of nebulizer treatments, chest physio therapy and incentive spirometry. EVALUATION Goal Met. After 30 mins of nursing intervention, the patient demonstrated improve airway through observed behaviour. 1. DRUG NAME Generic Name: cefuroxime Brand Name:Xorimix Pharmalogical Class: 2nd generation cephalosporin Therapeutic Class: Cephalosporin DRUG ACTION Inhibits cell wall synthesis promoting osmotic instability usually bactericidal INDICATION/ DOSAGE Perioperative prevention 750 mg 1 tab BID CONTRAINDICATIONS -Contraindicated in patients hypersensitive to drug or other cephalosporin.

-Use cautiously in patients hypersensitive to penicillin because of possibility of cross-sensitivity with other beta lactam antibiotics ADVERSE EFFECTS -CV: phlebitis, thrombophlebitis -GI: diarrhea, anorexia, vomiting -Hematologic: hemolytic anemia, thrombocytopenia, transient neutropenia, eosinophilia DRUG INTERACTIONS Aminoglycosides: May cause synergistic activity against some organisms.May increase nephrotoxicity. Monitor patients renal function closely. NURSING CONSIDERATIONS Before giving dug. ask patient if she is allegic to penicillin or cephalosporin. Obtain specimen for culture and sensitivity tests before giving first dose. absorption of oral drug is induced. 2. Metformin Hydrochloride (Metformin HCl) originally sold as glucophage, is an oral anti-diabetic drug. It is the first-line drug of choice for the treatment of type 2 diabetes. Common brand names for Metformin are Formet, Fornidd, Glucoform, Glucophage, Glucopres, and Humamet. Metformin is classified as an Antihyperglycemic and Antidiabetic. Indication for Metformin HCl Management of type 2 diabetes mellitus as monotheraphy or concomitantly with an oral sulfonylurea or insulin. Unlabeled indication: Treatment of metabolic complications of AIDS, weight reduction, prediabetes. Action of Metformin HCl Decreases liver production of glucose, decreases absorption of glucose, improves insulin sensitivity. Therapeutic Effect: provides improvement in glycemic control, stabilizes/decreases body weight, improves lipid profile. Adverse Reaction Adverse Reactions or Toxic Effect of Metformin HCl Lactic acidosis occurs rarely (0.03 cases/ 1,000 patients) but s a serious, often fatal (50%) complication. Characterized by increase in blood lactate levels (more than 5 mmol/L), decrease in blood pH, electrolyte disturbances. Symptoms include unexplained hyperventilation, myalgia, malaise, and somnolence. May advance to cardiovascular collapse (shock), acute CHF, acute MI, and prerenal azotemia. Nursing Considerations for Clients Taking Metformin HCl Inform the patient of potential risks/advantages of therapy and of alternative modes of therapy. Assess Hemoglobin, hematocrit, red blood cellsm and serum creatinine prior to initiation of therapy. Monitor fasting blood glucose, hemoglobin a, and renal function. Monitor renal function test for evidence of early lactic acidosis. If patient is on oral sulfonylureas, assess for hypoglycemia. Be alert to conditions that alter glucose requirements: fever, increased activity or stress, surgical procedure. Patient Teaching for Clients Taking Metformin HCl Discontinue metformin and contact the physician immediately if evidence of lactic acidosis appears (unexplained hyperventilation, muscle aches, extreme tiredness, unusual sleepiness). Prescribed diet is principal part of treatment; do not skip or delay meals. Diabetes Mellitus requires lifelong control. Avoid alcohol. Inform physician if headache, nausea, vomiting, diarrhea, skin rash, unusual bruising or bleeding, and change in color of urine or stool occurs. 3. Losartan potassium Brand Name: Cozaar Drug classes: Angiotensin II receptor blocker (ARB), Antihypertensive Therapeutic actions Selectively blocks the binding of angiotensin II to specific tissue receptors found in the vascular smooth muscle and adrenal gland; this action blocks the vasoconstriction effect of the renin-angiotensin system as well as the release of aldosterone leading to decreased blood pressure. Indications -Treatment of hypertension, alone or in combination with other antihypertensive agents -Treatment of diabetic neuropathy with an elevated serum creatinine and proteinuria in patients with type 2 diabetes and a history of hypertension Contraindications -Contraindicated with hypersensitivity to losartan, pregnancy (use during the second or third trimester can cause injury or even death to the fetus), lactation. Adverse effects Headache, dizziness, syncope, insomnia, Hypotension, Rash, urticaria, pruritus, alopecia, dry skin,

Diarrhea, abdominal pain, nausea, constipation, dry mouth, URI symptoms, cough, sinus disorders, Cancer in preclinical studies, back pain, fever, gout, muscle weakness Drug Interactions: -Decreased serum levels and effectiveness if taken concurrently with phenobarbital -Losartan is converted to an active metabolite by cytochrome P450 3A4. Drugs that inhibit 3A4 (ketoconazole, fluconazole, diltiazem) may decrease the antihypertensive effects of losartan Nursing considerations Administer without regard to meals. Ensure that patient is not pregnant before beginning therapy, suggest the use of barrier birth control while using losartan; fetal injury and deaths have been reported. Find an alternative method of feeding the baby if given to a nursing mother. Depression of the reninangiotensin system in infants is potentially very dangerous. Alert surgeon and mark patient's chart with notice that losartan is being taken. The blockage of the reninangiotensin system following surgery can produce problems. Hypotension may be reversed with volume expansion. Monitor patient closely in any situation that may lead to a decrease in blood pressure secondary to reduction in fluid volume--excessive perspiration, dehydration, vomiting, diarrhea--excessive hypotension can occur. 4.Generic Name: Salbutamol Sulfate Albuterol Sulfate Brand Name: AccuNeb, Airomir, Proventil, Proventil HFA, Proventil Repetabs, Ventolin, Ventolin HFA, Ventolin Obstetric Injection, Ventolin Rotacaps, Volmax, VoSpire ER Indications: * To prevent or treat bronchospasm in patients with reversible obstructive airway disease * To prevent exercise-induced bronchospasm * Acute asthma * Symptom relief during maintenance therapy of asthma and other conditions with reversible or irreversible airways obstruction (including COPD and bronchitis) * Can be aerosolized with a nebulizer for patients with cystic fibrosis, along with ipratropium bromide, acetylcysteine, and pulmozyme. * Subtypes of congenital myasthenic syndromes associated to mutations in Dok-7. * May be used as a tocolytic to relax the uterine smooth muscle to delay premature labour. * To treat or improve muscle paralysis in patients with a condition that causes occasional paralysis. * To treat high potassium levels in patients with kidney failure. Contraindications: * Contraindicated in patients hypersensitive to drug or its ingredients. * Use with caution in patients with CV disorders (including coronary insufficiency and hypertension), hyperthyroidism, diabetes mellitus, and those who are unusually responsive to adrenergics * Use extended-release tablets cautiously in patients with GI narrowing. Adverse Reactions: CNS: tremor, nervousness, dizziness, insomnia, headache, hyperactivity, weakness, CNS stimulation, malaise CV: tachycardia, palpitations, hypertension EENT: dry and irritated nose and throat with inhaled form, nasal congestion, epistaxis, hoarseness GI: heartburn, nausea, vomiting, anorexia, altered taste, increased appetite Metabolic: hypokalemia Musculoskeletal: muscle cramps Respiratory: bronchospasm, cough, wheezing, dyspnea, bronchitis, increased sputum Other: hypersensitivity reactions