V. The Patient And His Care 1u2x1d

c







c !



# "



# "

%

"

# "

#

$ #

# #





c &

Date ordered:

D5 0.3NaCl is a

To compensate

The treatment

January 22, 2011

hypertonic solution

cellular dehydration

resulted to a good

owing to the higher

and corrects

skin turgor and

Date performed:

than normal amount

moderate fliud loss,

capillary refill and

January 22, 2011

of Na and Cl ions. It

prevents alkalosis

decreased risk for

pulls fluid and

provides calorie and

deficient fluid

Time Started:

electrolytes from

NaCl.

volume.

11:15AM

the intracellular and

D5 0.3NaCl 500cc x 30 ugtts/min



interstitial Time Consumed:

compartments into

5:45AM

the intravascular compartments.

c '

Date ordered:

D5 0.3NaCl is a

To compensate

The treatment

January 23, 2011

hypertonic solution

cellular dehydration

resulted to a good

owing to the higher

and corrects

skin turgor and

Date performed:

than normal amount

moderate fliud loss,

capillary refill and

January 23, 2011

of Na and Cl ions. It

prevents alkalosis

decreased risk for

pulls fluid and

provides calorie and

deficient fluid

electrolytes from

NaCl.

volume.

D5 0.3NaCl 500cc x 30 ugtts/min

Time Started: 5:45AM

the intracellular and Time Consumed:

interstitial

12:45PM

compartments into the intravascular compartments.

c (

Date ordered:

D5 0.3NaCl is a

To compensate

The treatment

January 24, 2011

hypertonic solution

cellular dehydration

resulted to a good

owing to the higher

and corrects

skin turgor and

D5 0.3NaCl 500cc x

Date Performed:

than normal amount

moderate fliud loss,

capillary refill and

30 ugtts/min

January 24, 2011

of Na and Cl ions. It

prevents alkalosis

decreased risk for

pulls fluid and

provides calorie and

deficient fluid

Time Started:

electrolytes from

NaCl.

volume.

12:45PM

the intracellular and

interstitial Time Consumed:

compartments into

8:30AM

the intravascular compartments.

c )

Date Ordered:

D5 IMB is a

It is used to supply

The patient was

January 25, 2011

hypertonic solution,

the necessary

compliant to the

which makes the

nutrients to the

treatment given.

Date Performed:

cell shrink. It is

patient.

January 25, 2011

composed of water

D5IMB 500cc x 4041 ugtts/min

and carbohydrates Time Started: 8:30AM

as source of energy

Time Consumed: N/A

and both cations and anions.



$ # * + *,+ 1. the doctor¶s order indicating the type of solution, the amount to be istered, the rate of flow of the infusion and any allergies. 2. Explain the procedure and prepare the client. 3. Prepare the equipments needed. 4. Wash hands thoroughly. 5. Obtain IV solution and check for the sediments and any crack or leak from the container. 6. Check also for the expiration date. 7. Check fluid discoloration or defect. If noted, dispose the defected tubing and get another. 8. Assess client¶s vital signs for baseline data, skin turgor, bleeding tendencies, disease, or injury to the extremities, status of vein to determine the appropriate puncture site.

-+ 1. Explain the importance and purpose of IVF. 2. Place the patient in a comfortable position to facilitate easy insertion of the IV line. 3. Use the smallest gauge needle possible. 4. Maintain aseptic technique throughout the procedure. 5. Follow proper procedures in infusing IV solution. 6. Watch out for fluid overload. 7. Secure the needle properly after insertions. Always check the needle of the IV, if it is in the vein: -

Bring the IV bottle lower than the patient arm.

-

Pinch the IV tubing.

-

Observe the backflow of the blood in the distal portion of

the IV tubing. 8. Avoid or remove air from the tubing as it may cause embolism. ,+ 1. Check for swelling around the site for IV infiltration. Assess for any signs of edema or bulging of vein if it is not properly inserted. 2. Regulate IVF as ordered. Apply a medication label on the solution if a medication is added. 3. Observe for the reaction of the patient to the solution given. 4. Document related data. 5. Chart the procedure including time, name, dosage and the patient response to the istration. 6. Properly dispose used materials after insertion

] -

#



$ "

# "

."

#$#

#2

#/

#2

# /

#!

%

# $ #

#

!

#

##

"

c"

0$1#



#

*



#

!

3$













4

#+

Cefazolin (Ilocef)

5+

January 22,

250mg q°6 ANST(-)

Cefazolin

2011

4+

It was ordered

The client was

,7 is a first-

to

complaint with

generation cephalosporin antibiotic.

infection

Route: IV *

6+

5+

January 22-24,

Ilocef

2011

caused

January 24,

the medication by

45,4+

—

It inhibits bacterial cell wall

—

synthesis by binding to one or

— —.

more of the penicillin-binding 4+

treat

proteins (PBPs) ,thus inhibiting cell wall biosynthesis.

2011 Bacteria eventually lyse due to ongoing activity of cell wall autolytic

prescribed.

enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.



$ # * +

*,+ ë

Check doctor¶s order.

ë

Right drug, dosage and frequency must be observed.

ë

Explain the purpose of the drug.

ë

Assess patient allergy to penicillin or cephalosporin.

ë

Assess patient for infection (vital signs; appearance of surgical site, urine; WBC) at beginning and during therapy.

ë

Culture infection site before the therapy.

-+ ë

Maintain aseptic technique.

ë

Avoid or remove air to prevent embolism.

ë

Observe patient for signs and symptoms of anaphylaxis (rash, pruritis, laryngeal edema, wheezing).

ë

Change sites every 48-72 hr to prevent phlebitis.

ë

Instruct patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or

,+

discharge, loose or foul-smelling stools) and allergy. ë

Document related information.

#



#$#

#2

#

%

$ "

# "

#



#2

!#

# #



."

/ # /



##

$ # !



"

c"

0$1#



#

*



#

!

3$



















4+

For

Antiemetic

treatment

compliant

vomiting

the

4 5+ Metoclopra

#+

½ amp q°8 PRN

January 22,

for vomiting

2011

mide

Route: IV 6+

vomiting

was

smooth

noted

after

muscle

relaxation

5:

2011

increasing cholinergic response



medication

Metoclopramide inhibits gastric

produced by dopamine, therefore



with

and no further

January 22-24,

of the gastrointestinal smooth

the The client was

45,4+

*

Reglan



muscle.

istration.

$ # * +

*,+ ë

Check doctor¶s order.

ë

Right drug, dosage and frequency must be observed.

ë

Explain the purpose of the drug.

ë

Assess patient for allergy to metaclopramide.

ë

Check the medication¶s compatibility with IV.

-+ ë

Monitor for extrapyramidal reactions, and consult physician if the occur.

ë

Give IV doses slowly over 1-2 minutes.

ë

Avoid or remove air to prevent embolism.

ë

Dispose used materials properly.

ë

Observe patient for any adverse reaction to therapy.

ë

Tell the patient to take sugarless candies or gums to relieve dry mouth.

ë

Instruct patient to take drug exactly as prescribed.

ë

Chart the time drug was given.

ë

Document properly.

,+



#



#$#

#2

#

%

$ "

# "

#



#2



!#

# #



."

/ # /

##

$ # !



"

c"

0$1#



#

*



#

!

3$

















4+

4 5+ Ampicillin

#+

250 mg q°8

January 24,

ANST(-)

2011

*

6+

5:

January 24,

Omnipen

2011



Route: IV

Antibiotic; Penicillin

The patient To treat

reported relief

patient

from abdominal

45,4+

gastrointestina pain caused by

Destroys bacteria by inhibiting

l infection

Bacteria.

bacterial





cell-wall synthesis during



microbial multiplication. Addition



of sulbactam enhances drug¶s



resistance to beta-lactamase, an enzyme that can inactivate ampicillin.



$ # * +

*,+ ë

Check doctor¶s order.

ë

Prepare medication and materials needed.

ë

Perform necessary hand hygiene before istering drugs.

ë

Check the medication¶s compatibility with IV.

ë

Calculate medication dosage properly.

ë

Assess patient allergy to penicillin or cephalosporins.

-+ ë

Explain the procedure and purpose of the medication.

ë

Clean the port and maintain aseptic technique.

ë

Inject medication slowly.

ë

Observe for any signs of hypersensitivity.

ë

Assess client¶s reaction.

ë

Properly dispose materials used.

ë

Document all relevant data.

,+







#



#$#

#2

#

%

$ "

# "

#



#2



!#

# #



."

/ # /

##

$ # !



"

c"

0$1#



#

*



#

!

3$



















4+

To

#+

Amebicide, Antibacterial,

patient

January 24,

Antibiotic, Antiprotozoal

gastrointestina from abdominal

4 5+

2011

Metronidazo

30cc q°8 x 3 doses

treat The acute reported

l infection with pain

(IV) then shift to

45,4+

6+

250mg/5ml 3ml

Inhibits DNA synthesis in specific anaerobe

caused

*

January 24,

TID(ORAL)

anaerobes causing cell death

bacteria

5:

2011

le

Flagyl



susceptible

organisms.

patient relief

and

cramping by

$ # * + *,+ ë

Check doctor¶s order.

ë

Prepare medication.

ë

Check the medication¶s compatibility with IV.

ë

Calculate medication dosage properly.

-+ ë

Explain the purpose of medication and how it will help; Include relevant information about the effects of medication

ë

Inject medication slowly.

ë

For Oral medication, take it with foods to prevent GI upset.

ë

Instruct not to drink alcohol (beverages, or preparations containing alcohol, cough syrups), severe reactions may occur.

,+ ë

Instruct that urine may be a darker color than usual.

ë

Assess patient reaction to the medication.

ë

Document all relevant information.





#



#$#

#2

#

%

$ "

# "

#



#2



!#

# #



."

/ # /

##

$ # !



"

c"

0$1#



#

*



#

!

3$

















4+

Prevention

Antihistamine

and treatment compliant

4 5+ Diphenhydr

#+ January 24, 2011

12.5 mg/5ml TID

45,4+

receptor site, thus preventing or

de

January 24,

Oral

reversing the effect of histamine.

Benadryl

Patient

didn¶t

further vomiting.

Route:



vomiting

experience

6+

5:

with

It competes with histamine at H1

Hydrochlori

*

The patient was

of nausea and the medication.

amine

2011



$ # * +

*,+ ë

Check doctor¶s order.

ë

Explain the use of the medicine.

ë

Compute for the right dose.

ë

Do hand hygiene before istering the drug.

-+ ë

Give the medication on time.

ë

Take each dose with a full glass of water.

ë

It can also be taken with or without food.

ë

Assess patient for drowsiness, dry mouth, and motion-sickness.

ë

Monitor and observe patient reaction or response to the medicine.

ë

Document the time, and date of istration.

,+

#



#$#

#2

#

%

$ "

# "

#



#2



!#

# #



."

/ # /

##

$ # !



"

c"

0$1#



#

*



#

!

3$

















4+

Treatment

Anti-helminthic; Anti-infectives

patient¶s

reported

bacterial

from abdominal

4 5+ Pyrantel

#+ January 24, 2011

10 cc HS

45,4+ Pyrantel

*

6+

Route:

5:

January 24-25,

Oral

Quantrel

2011

is

a

neuromuscular

patient relief

and

depolarizing gastrointestina cramping

blocking

—

—— —

invasion in the pain

agent l tract

that causes spastic paralysis of

—

of The

and

caused bacteria.

by

$ # * +

*,+ ë

Check doctor¶s order.

ë

Explain the use of the medicine.

ë

Culture for ova and parasites,

ë

Strict hand washing and hygiene measures are important.

-+ ë

ister drug with fruit juice or milk.

ë

Ensure that entire dose is taken once.

ë

Disinfect toilet facilities after patient use.

ë

Advise SO to launder bed linens, towels, nightclothes, and undergarments (pinworms) of the patient

,+

daily. ë

Instruct the SO that he should also be treated for total eradication of the pinworms.

4 1#

# " ."



#!

# # $ # !







%

##

#

.

"#

!

##

& # -

#+ January 22, 2011

No food in any

It was ordered to

form and

prevent gastric

complied by not

+

liquids will be

irritation and

eating or having any

January 22, 2011

taken by

secretions related

food by mouth or

mouth.

to pain; to

per Orem.

#5"- ] !



4+

eliminate nausea

January 23, 2011

and vomiting.

None

The patient

$ # * + *,+ ë

Check doctor¶s order.

ë

Assure IV fluid therapy if patient is NPO>

ë

Instruct SO not to give anything through the mouth.

-+ ë

Assess client¶s condition.

ë

Assure that nothing is taken through the mouth( either liquid or solid.

ë

Place ³NPO´ sign on bed where the patient or SO can always see it.

ë

Remove foods or drinks on patient¶s bedside.

,+ ë

Observe patient¶s response on the diet.

ë

Monitor client¶s condition.







1#



#





#

%

# /

#

##

#



$ #

.

"#

/

##











' , *

+

This diet includes foods that

To prepare the Lugaw,

Client easily

January 23,2011

are moderately low in

clients

Water,

tolerated the



fiber, have a soft texture and

stomach after

Milk,

ordered die and

+

are moderately seasons.

eating nothing

Biscuit,

was relieved

January 23,

It does not contain whole grain

by mouth and

from hunger and

2011

cereals or salads with raw,

to limit foods,

thirst.



fresh fruits and vegetables.

that stimulate

4+

Serving sizes are small to

the production

January 25,

provide a gradual increase in

of gastric acid

2011

the amount of food from the

that causes

NPO diet.

irritation.

$ # * + *,+ ë

Check doctor¶s order.

ë

Inform patient and the SO that the client may have a soft diet.

ë

Explain the purpose of the Bland diet.

ë

Provide the SO with some examples of soft diet foods.

ë

Inform SO that foods may be softened by cooking or mashing.

-+



ë

Assess the patient¶s condition.

ë

Assure that the patient or SO eliminates food that are hard to chew or swallow such as raw fruits and vegetables, tough meat.

ë

Restrict the patient not to drink highly acidic beverages such as coffee, chocolate, carbonated sodas.

ë

Instruct patient to have small frequent meals (6 meals/day) to help reduce gastric irritation.

ë

Instruct patient to eat slowly and chew foods well.

,+

If the patient had reflux, instruct not do to lie down after eating and eat the last small meal at east two hours

ë

before bedtime.

1#

(





#!



%

# "

#

# $ #

## .

#

."

!

"#





##

!



#+

Regular diet of

It was ordered

January 25, 2011

an individual as

because the

long as it is

client can now

+

tolerated and

tolerate any food

regular eating

January 25, 2011

appropriate to

he desires that is

pattern

individual¶s

nutritious, that

consisting of

health.

will not lead to

healthy foods

any

and fruits.

!

Date Changed: -------

complications.

Rice

with

dish(Sinigang)

The patient was able to eat in his

$ # * + *,+ ë

Check the Doctor¶s Order.

ë

Explain the Indication and purpose of the diet to the patient.

ë

Explain the Importance of Right Nutrition to the patient / SO.

ë

Check the client¶s choice of food.

-+ ë

Encourage the patient to eat nutritious foods and fruits.

ë

Recommend the patient to avoid eating junk foods and not to drink carbonated beverages.

,+ ë

Recommend the Patient to perform Oral Hygiene every after meal.

84









1 #

# /



##

%

9

# /

#

$ # !

# #











5] + :*5

January 22, 2011

- ,5+ January 22-25, 2011





A medical treatment

It

helps

to

conserve The

patient

was

involving a period of

energy, promote recovery seen

on

bed

consistent

and rest, and prevent throughout the day

recumbence in bed.

fatigue.

and was able to

It is used as a

regain energy as

treatment for an

evidenced

by

illness or medical

becoming

non-

condition by relaxing

irritable

the body to enhance

nurse-patient

during

recovery of health. $ # * + *,+ ë

Assessed the patient¶s condition before introducing the exercise

ë

Explain the type and how the exercise should be done.

ë

Explain the need and purpose of the exercise.

-+ ë

Observe the patient.

ë

Provide comfort with the aid of pillows.

ë

Provide safety measures to facilitate health.

interaction.

,+ ë

Report any abnormal findings.

ë

Take note of the patient¶s improvement on her health