LA CONSOLACION COLLEGE MANILA

SCHOOL OF NURSING

OSPITAL NG MAYNILA

INTENSIVE CARE UNIT

CASE STUDY

November 8,9,10,15,16,17, 2010

SUBMITTED BY:

Dabbay, Ryan R.
Del Castillo, Philipp Andrew O.
Domingo, Karen Joy D.
Edejer, Kristian Karl M.
Flores, Ryan James A.
Garcia, Maricris V.

SUBMITTED TO:

Ms. Analie R. Grayda

OBJECTIVES
General Objective
 To develop understanding of the proper nursing care for the client who has
coronary artery disease.

Specific Objectives
 Obtain diagnosis and assessment of the patient.

 Know the etiology of coronary artery disease based on patient.

 Discuss GORDON’S NEEDS and Review of System

 Correlate with the laboratory findings and pharmacological treatments

 Discuss Anatomy and Physiology of Urinary Tract System

 Discuss and perform holistic Nursing Care Plan

 Provide a framework of study regarding the subject that serves as the foundation
of future studies and research.

 Provide information regarding care for patient who has coronary artery disease.

 Formulate Nursing Care Plan that may help the patient during its treatment.

 Enhance the student’s skills, knowledge and attitude towards nurse- patient
interaction.
A. HEALTH NURSING HISTORY
1. Personal Data
Date of Admission: November 5, 2010
Name: Mrs. X
Gender: Female
Date of Birth: June 11, 1946
Age: 65 years old
Marital Status: Widowed
Religion: Catholic
Address: 115 Alabat St. Balot Tondo, Manila

2. Chief Complaint
Chest Pain

3. History of Present Illness

Few hours prior to admission, the client experienced chest pain with a
pain scale of 10/10. She took Metropolol but the pain doesn’t relieve. Her
son decided to bring her to Ospital ng Maynila.

4. Past Medical History

The client underwent oopherectomy at Tondo General Hospital. She
cannot remember when it was done.
She has cataract for 3 years and she doesn’t want to undergo surgery
because according to her, if she will undergo such surgery she cannot
able to work.
She takes medicines like Simvastatin, Metropolol, Ferrous Sulfate,
Losartan, Isosorbide-5-Mononitrate that was given to her at UST hospital.
She had no known allergy.
 5. Family History
Her brother had hypertension and diabetes mellitus and died year 2009 at
the age of 50 because of heart attack while her sister has tuberculosis. No
family history of cancer, kidney disease, asthma.

6. Social History
She started as a beautician at the age of 16 in a salon and worked for 15
years. And still she work as a beautician but she do home service for 34
years.
She started to smoke when she was a teenager, one stick per day and
stopped when she was 35 years old. She started to drink a beer when she
had her first menstruation period and did this every time she has a
monthly period.

B. REVIEW OF SYSTEM
Gordon’s Perception to Health and Illness
BEFORE
Health perception and She is aware of her health
management and illness as well as its
maintenance.
Nutrition and metabolism She eats three times a day
plus a snack. She’s fun of
eating fish, vegetables and
fruits.
Elimination Her usual bowel pattern
was almost every AM and
sometimes she had two
bowel elimination in a day.
Activity and exercise She does all household
chores and having ballroom
dancing.
Sleep and rest She sleeps at 10 pm until 6 She sleeps 12 am until 5
am.
AFTER
She becomes more aware
of her health and illness.
Her meal is limited than
usual- frequent small meal-
to minimize triggering chest
pain.
She frequently has bowel
elimination because of
laxative that was give to
her.
She is help by her son in
doing some heavy
household chores and she
rarely does ballroom
dancing. She feels weak.
am. Sometimes she have a
hard time to sleep because
she is easily destructed by
 the noise.
Cognition and perception She was conscious and Still, she is conscious and
coherent. coherent.
Self-perception and self- She was fully alert and Still, she is fully alert and
concept completely oriented and completely oriented and
has good attention span. has a good attention span.

Roles and relationships She spent some of her time She frequently having a
to her grandson. rest but still gives some of
her time to her grandson.
Sexuality and reproduction The client was confused to The client said, “Matagal na
answer the question. patay asawa ko.”
Coping and stress She seldom feels stress She knows how to manage
management because of her work and her illness doing dos and
her illness. don’ts.
Values and beliefs Every time her family had Still, she consults to a clinic
an illness they go or hospital if she feels ill
immediately to a clinic or and not to albularyos.
hospital for consulation or
check up. They don’t
believe in albularyos.

Physical Assessment

SUBJECTIVE: Severe pain on the chest, pain scale of 10/10

OBJECTIVE: Guarding position on the chest, constant irritability, grimace face

HEAD:
• Hair: black
• Eyes: Myopic (near sighted) has a slight cataract on both eyes
• Ears: has normal hearing, EOM intact and functioning well, Pupils are responsive
to light
• Nose: is clear and free from any obstruction, sinus is normal upon palpation
(frontal and maxillary) no signs of tenderness to the patient
• Mouth: has two missing upper canine. Teeth looks not healthy. Tonsils are
normal upon observation and palpation.
• Neck: no protruding veins
THORAX AND LUNGS
• Heart Sounds. Normal heart sounds cardiac rate of 89 beats per minute
• Breathing Sounds: Clear, no cracklings or wheezing sounds
• Blood Pressure of 110/80
• Temperature 36.5 degrees Celsius
• Ribs are protruding

BREAST AND AXILLAE

• Patient was ask to perform BSE. No mass or tumor was found

EXTREMITIES:
• Pulse on extremities at palpable.

REVIEW OF SYSTEM:

• Date and identifying data - name, age, sex, race, place of birth (if pertinent),
marital status, occupation, religion
• Source and reliability of history
• Chief complaint = reason for visit (succinct)
• Past Medical History
o General health: a year old female patient G1P1. cesarian Section delivery.
is always having chest pain on the lower chest and has peptic ulcer
o Childhood illness – Asthma when still young, peptic ulcer
o psychiatric illnesses: NONE
o hospitalizations,
o surgery: Caesarian Section
o immunizations: has complete immunization
o Habits: Watching TV.
o allergies: NONE
• EYES
o Has blurring of vision because of vision because her cataract
o Myopic vision

• NEURO
o Weakness in extremities
• CHEST
o Chest pain. Scale of 10/10
 HEMATOLOGY REPORT

Results Normal

Neutrophils 86.8 55-75

Lymphocytes 7.7 20-30

RBC 2.97 4.6-20

HBG 8.9 12-16

HCT 26.1 37-47

ESR 29 0.0-20

MCV 87.9 80-90

MCH 30 27-31

MCHC 34.1 32-36

NRBC 193 150-400

INTERPRETATION

Neutrophils of the patient are too high from the normal value. Neutrophils are
responsible for fighting infections so you might have an infection going on when it is
high.

Lymphocytes the patient is too low from the normal value. Very low levels of
lymphocytes make patients vulnerable to life-threatening infection. Chronic failure of the
right ventricle of the heart is maybe one of the causes. This chamber of the heart pumps
blood to the lungs.

RBC of the patient is too high from the normal value. A lower than normal RBC can
result from a number of causes, including: Massive RBC loss, such as acute
hemorrhage abnormal destruction of red blood cells, Lack of substances needed for
RBC production, Bone marrow suppression.
HBG of the patient is too high from the normal value. A low hemoglobin count can also
be caused by an abnormality or disease. In these situations, a low hemoglobin count is
referred to as anemia.

HCT of the patient is too high from the normal value. A low hematocrit is referred to as
being anemic.

ESR of the patient is too high from the normal value. A high ESR is cause by low RBC,
HBG, and a low HCT. And it can cause anemia.

CLINICAL CHEMESTRY SECTION

Test Results Normal

FBS 4.5 3.9-6.4mmol/L

BUN 7.4 1.7-8.7

Creatinine 81 45-84umol/L

Cholesterol 4.62 3.8-5.1mmol/L

Triglyceride 0.67 0.4-2.25mmol/L

Total Protein 62.9 66-87g/L

Albumin 40.0 34-48 g/L

Globulin 22.9 20-38 g/L

Na 136 134-145mmol/L

K 4.0 3.4-5mmol/L

Cl 105 93-109mmol/L

URINALYSIS

Physical

Color: light yellow Transparency: clear

Chemical
Albumin :(-) Sugar: (-)

Specific Gravity: 1.005 Ph: 5

Anatomy and Physiology of the Heart

THE HEART

Heart is a hollow muscular organ that pumps blood through the body. The heart, blood,
and blood vessels make up the circulatory system, which is responsible for distributing
oxygen and nutrients to the body and carrying away carbon dioxide and other waste
products. The heart is the circulatory system's power supply. It must beat ceaselessly
because the body's tissues-especially the brain and the heart itself-depend on a
constant supply of oxygen and nutrients delivered by the flowing blood. If the heart
stops pumping blood for more than a few minutes, death will result.
The human heart is shaped like an upside-down pear and is located slightly to the left of
center inside the chest cavity. About the size of a closed fist, the heart is made primarily
of muscle tissue that contracts rhythmically to propel blood to all parts of the body. This
rhythmic contraction begins in the developing embryo about three weeks after
conception and continues throughout an individual's life. The muscle rests only for a
fraction of a second between beats. Over a typical life span of 76 years, the heart will
beat nearly 2.8 billion times and move 169 million liters (179 million quarts) of blood.

STRUCTURE OF THE HEART

The human heart has four chambers. The upper two chambers, the right and left atria,
are receiving chambers for blood. The atria are sometimes known as auricles. They
collect blood that pours in from veins, blood vessels that return blood to the heart. The
heart's lower two chambers, the right and left ventricles, are the powerful pumping
chambers. The ventricles propel blood into arteries, blood vessels that carry blood away
from the heart.

A wall of tissue separates the right and left sides of the heart. Each side pumps blood
through a different circuit of blood vessels: The right side of the heart pumps oxygen-
poor blood to the lungs, while the left side of the heart pumps oxygen-rich blood to the
body. Blood returning from a trip around the body has given up most of its oxygen and
picked up carbon dioxide in the body's tissues. This oxygen-poor blood feeds into two
large veins, the superior vena cava and inferior vena cava, which empty into the right
atrium of the heart.

The right atrium conducts blood to the right ventricle, and the right ventricle pumps
blood into the pulmonary artery. The pulmonary artery carries the blood to the lungs,
where it picks up a fresh supply of oxygen and eliminates carbon dioxide. The blood
that is oxygen-rich returns to the heart through the pulmonary veins, which empty into
the left atrium. Blood passes from the left atrium into the left ventricle, from where it is
pumped out of the heart into the aorta, the body's largest artery. Smaller arteries that
branch off the aorta distribute blood to various parts of the body.
•A. THE HEART VALVES

Four valves within the heart prevent blood from flowing backward in the heart. The
valves open easily in the direction of blood flow, but when blood pushes against the
valves in the opposite direction, the valves close. Two valves, known as atrioventricular
valves, are located between the atria and ventricles. The right atrioventricular valve is
formed from three flaps of tissue and is called the tricuspid valve. The left
atrioventricular valve has two flaps and is called the bicuspid or mitral valve. The other
two heart valves are located between the ventricles and arteries. They are called
semilunar valves because they each consist of three half-moon-shaped flaps of tissue.
The right semilunar valve, between the right ventricle and pulmonary artery, is also
called the pulmonary valve. The left semilunar valve, between the left ventricle and
aorta, is also called the aortic valve.

•B. THE MYOCARDIUM

Muscle tissue, known as myocardium or cardiac muscle, wraps around a scaffolding of

tough connective tissue to form the walls of the heart's chambers. The atria, the
receiving chambers of the heart, have relatively thin walls compared to the ventricles,
the pumping chambers. The left ventricle has the thickest walls-nearly 1 cm (0.5 in)
thick in an adult-because it must work the hardest to propel blood to the farthest
reaches of the body.

•C. THE PERICARDIUM

A tough, double-layered sac known as the pericardium surrounds the heart. The inner
layer of the pericardium, known as the epicardium, rests directly on top of the heart
muscle. The outer layer of the pericardium attaches to the breastbone and other
structures in the chest cavity and helps hold the heart in place. Between the two layers
of the pericardium is a thin space filled with a watery fluid that helps prevent these
layers from rubbing against each other when the heart beats.

•D. THE ENDOCARDIUM

The inner surfaces of the heart's chambers are lined with a thin sheet of shiny, white
tissue known as the endocardium. The same type of tissue, more broadly referred to as
endothelium, also lines the body's blood vessels, forming one continuous lining
throughout the circulatory system. This lining helps blood flow smoothly and prevents
blood clots from forming inside the circulatory system.

•E. THE CORONARY ARTERIES

The heart is nourished not by the blood passing through its chambers but by a
specialized network of blood vessels. Known as the coronary arteries, these blood
vessels encircle the heart like a crown. About 5 percent of the blood pumped to the
body enters the coronary arteries, which branch from the aorta just above where it
emerges from the left ventricle. Three main coronary arteries-the right, the left
circumflex, and the left anterior descending-nourish different regions of the heart
muscle. From these three arteries arise smaller branches that enter the muscular walls
of the heart to provide a constant supply of oxygen and nutrients. Veins running through
the heart muscle converge to form a large channel called the coronary sinus, which
returns blood to the right atrium.

FUNCTION OF THE HEART

The heart's duties are much broader than simply pumping blood continuously
throughout life. The heart must also respond to changes in the body's demand for
oxygen. The heart works very differently during sleep, for example, than in the middle of
a 5-km (3-mi) run. Moreover, the heart and the rest of the circulatory system can
respond almost instantaneously to shifting situations-when a person stands up or lies
down, for example, or when a person is faced with a potentially dangerous situation

THE CARDIAC CYCLE

Although the right and left halves of the heart are separate, they both contract in unison,
producing a single heartbeat. The sequence of events from the beginning of one
heartbeat to the beginning of the next is called the cardiac cycle. The cardiac cycle has
two phases: diastole, when the heart's chambers are relaxed, and systole, when the
chambers contract to move blood. During the systolic phase, the atria contract first,
followed by contraction of the ventricles. This sequential contraction ensures efficient
movement of blood from atria to ventricles and then into the arteries. If the atria and
ventricles contracted simultaneously, the heart would not be able to move as much
blood with each beat.

During diastole, both atria and ventricles are relaxed, and the atrioventricular valves are
open. Blood pours from the veins into the atria, and from there into the ventricles. In
fact, most of the blood that enters the ventricles simply pours in during diastole. Systole
then begins as the atria contract to complete the filling of the ventricles. Next, the
ventricles contract, forcing blood out through the semilunar valves and into the arteries,
and the atrioventricular valves close to prevent blood from flowing back into the atria. As
pressure rises in the arteries, the semilunar valves snap shut to prevent blood from
flowing back into the ventricles. Diastole then begins again as the heart muscle relaxes-
the atria first, followed by the ventricles-and blood begins to pour into the heart once
more.

A health-care professional uses an instrument known as a stethoscope to detect

internal body sounds, including the sounds produced by the heart as it is beating. The
characteristic heartbeat sounds are made by the valves in the heart-not by the
contraction of the heart muscle itself. The sound comes from the leaflets of the valves
slapping together. The closing of the atrioventricular valves, just before the ventricles
contract, makes the first heart sound. The second heart sound is made when the
semilunar valves snap closed. The first heart sound is generally longer and lower than
the second, producing a heartbeat that sounds like lub-dup, lub-dup, lub-dup.

Blood pressure, the pressure exerted on the walls of blood vessels by the flowing blood,
also varies during different phases of the cardiac cycle. Blood pressure in the arteries is
higher during systole, when the ventricles are contracting and lower during diastole, as
the blood ejected during systole moves into the body's capillaries. Blood pressure is
measured in millimeters (mm) of mercury using a sphygmomanometer, an instrument
that consists of a pressure-recording device and an inflatable cuff that is usually placed
around the upper arm. Normal blood pressure in an adult is less than 120 mm of
mercury during systole, and less than 80 mm of mercury during diastole. Blood pressure
is usually noted as a ratio of systolic pressure to diastolic pressure-for example, 120/80.
A person's blood pressure may increase for a short time during moments of stress or
strong emotions. However, a prolonged or constant elevation of blood pressure, a
condition known as hypertension, can increase a person's risk for heart attack, stroke,
heart and kidney failure, and other health problems.
NURSING CARE PLAN

Nursing Diagnoses:

1. Chest discomfort related to myocardial ischemia resulting from coronary

artery occlusion with loss/restriction of blood flow to an area of the
myocardium as evidenced by facial mask of pain and pain scale of 10/10.

2. Activity Intolerance related to imbalance between oxygen supply and

demand as evidenced by weakness and fatigue.

3. Anxiety related to change in environment as evidenced by restlessness

and vague uneasy feeling.

4. Ineffective protection related to the risk of bleeding secondary to

thrombolytic therapy

5. Risk for decreased cardiac output related to altered cardiac rate and
rhythm
 ASSESSMENT NURSING PLANNING NURSING RATIONALES EVALUATION
DIAGNOSIS INTERVENTIONS
SUBJECTIVE Chest discomfort Within 1 hour INDEPENDENT: Within 1 hour
DATA: related to of nursing 1. Maintain bed − To reduce of nursing
“Sumasakit dib – myocardial interventions, rest oxygen interventions,
dib ko.” As ischemia resulting the client will during pain, consumption the client has
verbalized by the from coronary have improved with and improved
patient artery occlusion comfort in chest, position of demand, to comfort in chest,
with as evidenced by: comfort, reduce as evidenced by:
OBJECTIVE loss/restriction of maintain competing
DATA: blood flow to an − States a relaxing stimuli and − States a
• Facial mask of area of the decrease in environment to reduces decrease in
pain myocardium as the rating promote anxiety. the rating
• Pain scale: evidenced by of the calmness. of the
10/10 facial mask of chest pain. chest pain.
• Duration: 30 pain and pain 2. If patient

minutes scale of 10/10. − Is able to rest, complaints of − Is able to rest,

• Quality: displays pain: displays
crushing reduced − Report − Pain causes reduced

• Radiates to: tension, and immediately increased tension, and

jaw and left sleeps for prompt sympathetic sleeps

arm comfortably treatment stimulation, comfortably

which
• Restlessness − Requires increases − Requires
• Increased decrease oxygen decrease
blood analgesia demand on analgesia
pressure: heart
140/100
• Increased PR: − Administer − To increase
133 oxygen at 3 – oxygen supply
5 L/min

3. Prepare for the − Pain control is

administration a priority, as it
of indicates
medications, ischemia.
and monitor
response to
drug therapy.
Notify
physician if
pain does
not abate.

4. Instruct patient − To promote

 in activity knowledge
alterations and and
limitations, compliance
medication with
effects, therapeutic
side-effects, regimen
contraindicatio and to
ns and alleviate fear
symptoms to of unknown.
report.

DEPENDENT: − Serial ECG

1. obtain a 12- and stat
lead ECG on ECGs record
admission, changes
then each time that can give
chest pain recurs evidence
for evidence of of further
further infarction cardiac
as prescribed. damage and
location of MI.
2. Administer − To reduce
 analgesics as pain and
ordered reduce the
workload on
the heart

3. Administer − To block
beta-blockers as sympathetic
ordered. stimulation,
reduce
heart rate and
lowers
myocardial
demand.

REF: Nursing
Care Plan, 6th
edition,
Gulanick/Myers

ASSESSMENT NURSING PLANNING NURSING RATIONALES EVALUATION

DIAGNOSIS INTERVENTIONS
SUBJECTIVE Activity After 2 hours of INDEPENDENT: After 2 hours of
DATA: Intolerance nursing 1. Monitor heart − Changes in VS nursing
“Pag inaatake related to interventions, the rate, rhythm, assist interventions, the
ako, hirap ako imbalance client will be able respirations with client was able to
huminga at between oxygen to tolerate activity and blood monitoring tolerate activity
nanghihina ako.” supply and without excessive pressure for physiologic without excessive
As verbalized by demand as dyspnea and will abnormalities. responses to dyspnea and was
the patient evidenced by be able to utilize Notify increase in able to utilize
weakness and breathing physician of activity. breathing
OBJECTIVE fatigue. techniques and significant techniques and
DATA: energy changes in VS energy
• Fatigue and conservation conservation
weakness techniques 2. Encourage − To help give techniques
• Dyspnea effectively. patient to the patient effectively.

• Increased assist with a feeling of

blood planning self-worth and
pressure: activities, with well-being.
140/100 rest periods as

• Increased PR: necessary.

133
3. Instruct patient − To decrease
in energy energy
 conservation expenditure
techniques. and fatigue.

4. Assist with − To maintain

active or joint mobility
passive ROM and muscle
exercises tone.

5. Turn patient at
least every 2 − To improve
hours, and respiratory
prn. function and
prevent skin
breakdown.
6. Instruct patient
in isometric − To improve
and breathing breathing and
exercises. to increase
activity level.

7. Provide
patient/family − To promote
 with exercise self-worth and
regimen, with involves
written patient and his
instructions. family with
self-care.
DEPENDENT:
1. Assist patient
with − To gradually
ambulation, as increase
ordered, with the body to
progressive compensate
increases as for the
patient’s increase in
tolerance overload.
permits.
REF: Nursing
Care Plan, 6th
edition,
Gulanick/Myers

ASSESSMENT NURSING PLANNING NURSING RATIONALES EVALUATION

DIAGNOSIS INTERVENTIONS
SUBJECTIVE Anxiety related to After 2 hours of INDEPENDENT: After 2 hours of
DATA: change in nursing 1. Establish trust − To gain nursing
“Iba yung ICU environment as intervention, and rapport cooperation intervention,
kumpara s ibang evidenced by the client will and patient’s the client was
ICU n napuntahan restlessness and be able to trust able to
ko.” and “Hindi vague uneasy appear relax appear relax
ako makatulog ng feeling and report 2. Acknowledge − Validates the and report
maayos, anxiety is awareness of feelings and anxiety is
nagugulat ako sa reduced to a patient’s communicates reduced to a
ingay dito” As manageable anxiety acceptance of manageable
verbalized by the level as those feelings level as
patient evidenced by: evidenced by:
3. Reassure that − Presence of a
OBJECTIVE − Is able to rest, the patient is trusted person − Is able to rest,
DATA: displays safe. Stay with assures patient displays
• Restlessness reduced patient if this of his/her reduced
• Vague uneasy tension, and appears security and tension, and
feeling sleeps necessary safety during a sleeps
• Increased comfortably period of comfortably
blood anxiety
pressure: 4. Reduce − To reduce
140/100 sensory stimuli anxiety
• Increased PR: by maintaining
 133 quiet
environment;
keep
threatening
equipment out
of sight

5. Assist in − Enhances
developing patient’s
anxiety- confidence
reducing skills
(relaxation
deep breathing
positive
visualization
reassuring REF: Nursing
self- Care Plan, 6th
statements, edition,
etc) Gulanick/Myers
MEDICATIONS
DRUG NAME MECH.OF ADMINISTRATION INIDICATION CONTRAINDICA ADVERSE NURSING
ACTION TION EFFECT RESPONSIBILITI
ES
CAPTOPRIL Action: Treatment of Allergy to Rash, pruritus, Get your
25mg ½ tab q12 hypertension captopril; scalded mouth prescription
Blocks ACE from Taken on an empty alone or in impaired renal sensation, refilled before you
converting stomach combination function; CHF; exfoliative run out of
angiotensin I to with thiazide- salt/volume dermatitis, medicine
angiotensin II, type diuretics depletion, alopecia, completely. Keep
leading to lactation. Tachycardia, using all of your
decreased blood Treatment of Gastric irritation. other medications
pressure, CHF in as prescribed by
decreased patients who your doctor.
do not
aldosterone Call your doctor
respond
secretion, a small right away if you
adquately to
increase in serum feel that is not
conventional
otassium levels, therapy; used working as well as
and sodium and with diuretics usual, or if it
fluid loss anddigitalis makes your
condition worse. If
. it seems like you
Classifications: need to use more
ACE inhibitor of any of your
medications in a
24-hour period,
talk with your
doctor.
DRUG NAME MECH.OF ADMINIS INIDICATION CONTRAINDIC ADVERSE EFFECT NURSING
ACTION TRATION ATION RESPONSIBILITIE
S
ENOXAPARI Action: 60mg SQ acute (in the use with hematologic – only by deep Sub-
NE q12 hospital) and prosthetic heart thrombocytopenia, q when client is
Anti-coagulant extended (at valves due to thrombocythemia, lying down; DO
home for up possible valve hemorrhage, NOT GIVE IM.
Water-soluble t0 3 weeks) thrombosis, hypochromic continue treatment
vitamin, stable prophylaxis of especially in anemia, throughout the
in acid solution. DVT, which pregnant ecchymosis. At site postsurgical period
Decomposed in may lead to women. of injection – mild until the risk of
neutral or acid pulmonary Hypersensitivit local irritation, pain, DVT has
solutions. with aspirin to y to hematoma, decreased
prevent enoxaparin, GI – nausea. do not mix with
Classification: ischemic pork products CNS – confusion. other injections or
complications and in those Miscellaneous – infusions.
Anticoagulant, of unstable with active fever, pain, edema,
low molecular angina and major bleeding. peripheral edema,
weight heparin non-Q wave spinal hematoma
MI. can be (when
used in spinal/epidural
geriatric anesthesia or spinal
clients. puncture is used
which may lead to
long-term or
permanent
paralysis.
DRUG NAME MECH.OF ADMINI INIDICATION CONTRAINDICA ADVERSE NURSING
ACTION STRATI TION EFFECT RESPONSIBILITIE
ON S

METOPROLOL Mechanism of 50mg 1 alone or with myocardial abdominal CHECK PR

Action: ½ tab other drugs to infarction in cramps,
q12 treat clients with a HR diarrhea, if transient
exerts mainly HYPERTENSI of less than 45 constipation, worsening of heart
beta-1- ON. chronic bpm, in second – fatigue, failure occurs, may
adrenergic mgt of angina or third degree insomnia, be treated with
blocking pectoris. heart block, or if nausea, increased doses of
activity treatment of SBP is less than depression, diurectics. May be
although beta- symptomatic 100 mg Hg. dreaming, necessary to lower
2-adrenergic (NYHA Class 2 Moderate to memory loss, the dose of
receptors are or 3) heart severe cardiac fever, metoprolol or
blocked at high failure or failure. impotence, temporarily
doses. Has no ischemic lightheadedness discontinue.for
membrane hypertensive, , slow heart CHF, do not
stabilizing or or rate, low blood increase dose until
intrinsic cardiomyopathi pressure symptoms of
sympathomime c origin. worsening have
tic effects. been stabilized.
Moderate lipid Initial difficulty with
solubility. titration should not
preclude attempts
Classification: later to use
metoprolol. If CHF
Beta- clients experience
adrenergic symptomatic
blocking agent bradycardia, reduce
the dose.
Assessment

DRUG NAME MECH.OF ADMINI INIDICATION CONTRAINDICA ADVERSE NURSING

ACTION STRATI TION EFFECT RESPONSIBILITIE
ON S

ISDN Mechanism of 10mg Acute angina Marked anemia, Dizziness, acute CHECK PR and BP
Action: 1tab q8 pectoris acute circulatory cutaneous
prophylactic failure, dilation, Bed rest to reduce
peripheral and management hypotension, weakness, the likeliness of
coronary nausea, ortostatic
vasodilator vomiting, hypotension