Nephrotic Syndrome

Group 57
 Introduction
Nephrotic syndrome is a nonspecific disorder in which the kidneys are
damaged, causing them to leak large amounts of protein
(proteinuria at least 3.5 grams per day per 1.73 m2 body surface
area) from the blood into the urine. Other symptoms include
hypoalbuminemia (decrease in albumin in the blood), edema,
hypercholesterolemia (high serum cholesterol), and normal renal
function.

* The most common sign is excess fluid in the body. This may take
several forms:
o Puffiness around the eyes, characteristically in the morning.
o Edema over the legs which is pitting (i.e., leaves a little pit when
the fluid is pressed out, which resolves over a few seconds).
o Fluid in the pleural cavity causing pleural effusion. More
commonly associated with excess fluid is pulmonary edema.
o Fluid in the peritoneal cavity causing ascites.
• The following are baseline, essential
investigations

• * Urine sample shows proteinuria (>3.5g

per 1.73 m2 per 24 hour).
• * Comprehensive metabolic panel (CMP)
shows Hypoalbuminemia: albumin level
≤2.5g/dL (normal=3.5-5g/dL).
• * High levels of cholesterol
(hypercholesterolemia), specifically elevated
LDL, usually with concomitantly elevated
VLDL
• * Electrolytes, urea and creatinine (EUCs):
 Causes:
Nephrotic syndrome has many causes and may either be
the result of a disease limited to the kidney, called
primary nephrotic syndrome, or a condition that
affects the kidney and other parts of the body, called
secondary nephrotic syndrome.
Primary causes of nephrotic syndrome are usually
described by the histology, i.e., minimal change
disease (MCD), focal segmental glomerulosclerosis
(FSGS) and membranous nephropathy (MN), sickle cell
disease, diabetes mellitus and malignancy such as
leukemia.
Secondary causes of nephrotic syndrome occurs after an
infectious disease, such as infection with group A beta-
hemolytic streptococci, syphilis, malaria, tuberculosis,
 Epidemiology:
• Nephrotic syndrome is often described
as a disease of children and is relatively
rare. It is 15 times more common in
children than in adults. The reported
annual incidence rate is 2 to 5 per
100,000 children younger than 16
years. The cumulative prevalence rate
is approximately 15.5 per 100,000
individuals. Nephrotic syndrome
prevalence is difficult to establish in
 Case Study Format

I. PATIENT DEMOGRAPHIC DATA

Name: Rose Nina Francisco Age/Sex: 14/Female Status: Single Religion: Roman Catholic
Home Address: Cogon, Pardo Nationality: Filipino Occupation: N/A

II. HEALTH HISTORY PROFILE

A. Past Medical History
1. Pediatric and Adult Illness
Date Illness Medication Remarks

NONE NONE NONE NONE

2. Immunization
Immunization Doses Dates Remarks

BCG 1 Can’t Recall Complete

DPT 3 Can’t Recall Complete
OPV 3 Can’t Recall Complete
 3. Hospitalization
Date/Year Hospital Diagnosis Duration

2007 Cebu City Medical Center Nephrotic Syndrome 1 week

2008 Cebu City Medical Center Nephrotic Syndrome 1 week

4. Injuries and Accidents- The patient did not experience any injuries and
accidents.
5. Transfusions- The patient did not undergo any transfusions such as blood
transfusion.
6. Allergies(specify)- The patient has no any allergies .
B. Family History

Rodrigo Francisco
Nelia Francisco

Legend:

Father
Mother
Patient
Rose Nina Francisco
 C. Social and Personal History

1. Occupation-N/A
2. Number of Children-N/A
3. Military experiences, foreign travel-N/A
4. Habits (tobacco, alcohol, non-prescription drugs, others)-N/A
5. Diet-fruits, vegetables, pork chop, dried fish
6. Type of Family-Extended Family
7. Cultural and Religious Beliefs-N/A
8. Brief description of average day:

5:30 am-wake up
6:00 am-breakfast
7:00-9:00 am-class hours
9:15-9:30 am-recess
9:30-12:00 am-class hours
12:00-1:00 pm-lunch
1:00-5:00 pm-class hours
5:30 pm-do homework
6:00 pm-dinner
7:00-8:00 pm-watch T.V
8:00 pm-sleeping time
 D. Review System (for the past 6 months). Physical Assessment
General Weight loss Fatigue Anorexia Night sweats
Chills Fever Weakness
The patient experienced fever due to cough and colds.
The patient experienced fatigue due to illness and lack of sleep.
The patient experienced weakness due to fatigue.
Skin Itch Rash Lesions Bruising
Bleeding Color change
NONE

Eyes Pain Discharge Itch Vision loss Diplopia

Excessive tearing Glasses/Contact lens Date of last exam
NONE

Ears Earaches Discharges Tinnitus Hearing loss

NONE

Nose Obstruction Discharges Epistaxis

NONE

Throat and Mouth Sore throats Bleeding gums Toothache Dentures

NONE

Neck and Head Swelling Dysphagia Hoarseness

NONE

Chest Cough Sputum: Amount and Character Hemoptysis

Wheeze Pain on respiration Dyspnea
The patient experienced dyspnea due to obstruction of the airway.
Cardiovascular Precordial pain Palpitation Dyspnea on exertion Orthopnea
Dyspnea Paroxysmal nocturnal Edema Heart murmur
Claudication Thrombophlebitis
NONE

Gastrointestinal Heartburn Nausea Vomiting Diarrhea Food intolerance

Excessive gas or indication Constipation Jaundice Bloating
Change in Bowel movement Melena Hemorrhoids Hernia
NONE

Genitourinary Heartburn Nausea Vomiting Diarrhea Food intolerance

Excessive gas or indication Constipation Jaundice Bloating
Change in Bowel movement Melena Hemorrhoids Hernia
NONE

Extremities Joint pains Varicose veins Claudication Back pain

Edema Stiffness Deformities
The patient experienced edema due to illness which is nephrotic syndrome.

Endocrine Hot flashes Hair loss Temperature intolerance

Polydipsia Goiter
NONE

Neurology Numbness Tingling Tremor Fainting

Headaches Muscle weakness Ataxia Seizure Unconsciousness
Paralysis/Paresis Memory loss Dizziness
The patient experienced headaches due to fever.
 Psych Anxiety Depression Sexual problems Insomnia
Nightmares
NONE

Others NONE

III. CURRENT HEALTH PROFILE

A. Presenting complaints and medical diagnosis to include intervention done prior to
hospitalization.
Rosa Nina Francisco was diagnosed for Nephrotic Syndrome. She Complain of
difficulty in breathing.
B. Application of the Nursing Process
1. Assessment Finding (Head –to-Toe)
Skin Uniform skin color, no jaundice, cyanosis
Skin intact
Skin warm and dry
Hair Hair is evenly distributed over scalp
Hair color black and thin
No lesions or pediculosis
Nails Color pink, well groomed ad convex, smooth and firm
Head Normocephallic, erect and midline
Head symmetrical, no masses, nontender
Face Facial expression appropriate, no abnormal movements or lesions
Facial bones smooth, intact,symmetrical,nontender
Ears Ears aligned with eyes, symmetrical, no redness, lesions or drainage
Eyes Eyes clear and bright, equal parallel alignment
Eyelids color consistent with clients complexion
Eyelashes evenly distributed, no excessive tearing or dryness
Nose Nose midline, symmetrical, no deviation, no flaring
No deformities or nasal tenderness
Sinuses Sinuses clear, nontender
Mouth Lips pink, moist, no lesions
Oral mucosa pink, moist, no lesions, intact
Teeth complete
Tongue pink, moist,midline
Neck Neck symmetrical, skin intact, no masses
Upper Extremities Skin color uniform; no erythema, edema
Abdomen Skin color consistent, no lesions, rashes, scars or discoloration.
Hair distribution appropriate for client’s age and gender.
Abdomen flat and symmetrical, no bulges or hernias
Umbilicus midline
Abdomen soft, nontender, no masses
Lower Extremities Leg hair evenly distributed; color uniform; no edema or lesions
Laboratory/Diagnostic Results

Date Lab Exam Patient Results Normal Interpretation/Significant

Findings

09-01-09 Protein to 1.55 0.5-0.9 Suggests the presence of

Creatinine ratio nephrotic range proteinuria.

Serum albumin 0.9g/dl 3.4-5.4g/dl Hypoalbuminemia can be

caused by Excess excretion by
the kidneys.
 Parts of the
human kidney
 Kidney anatomy and
excretion
• The most basic structures of the kidneys,
are nephrons. They are responsible for filtering the
blood.
• The renal artery delivers blood to the kidneys each
day. Over 180 liters (50 gallons) of blood pass
through the kidneys every day. When this blood
enters the kidneys it is filtered and returned to the
heart via the renal vein.
• The process of separating wastes from the body
fluids and eliminating them, is known
as excretion. The urinary system is one of the organ
systems responsible for excretion. The kidneys are
the main organs of the urinary system.
 Kidney anatomy and blood
vessels
• The kidney is full of blood vessels. Every
function of the kidney involves blood,
therefore, it requires a lot of blood vessels
to facilitate these functions.
• Together, the two kidneys contain about
160 km of blood vessels.
 Renal capsule
• is a tough fibrous layer surrounding
the kidney and covered in a thick layer
of adipose tissue. It provides some
protection from trauma and damage
 Renal cortex

• is the outer portion of the kidney between

the renal capsule and the renal medulla. In
the adult, it forms a continuous smooth
outer zone with a number of projections
(cortical columns) that extend down
between the pyramids.
• ultrafiltration occurs.
 Renal medulla

• is the innermost part of the kidney

• split up into a number of sections, known
as the renal pyramids
• contains the structures of the nephrons
responsible for maintaining the salt and
water balance of the blood
• is hypertonic to the filtrate in the nephron
and aids in the reabsorption of water.
 Renal pyramids
• are cone-shaped tissues of the kidney
• made up of 8 to 18 of these conical
subdivisions
• The broad base of each pyramid faces
the renal cortex, and its apex, or papilla,
points internally
• The base of each pyramid originates at the
corticomedullary border and the apex
terminates in a papilla, which lies within a
minor calyx, made of parallel bundles of urine
collecting tubules
 Minor calyx

• surrounds the apex of the malpighian

pyramids. Urine formed in
the kidney passes through a papilla at the
apex into the minor calyx then into the
major calyx.
• Peristalsis of the smooth muscle
originating in pace-maker cells originating
in the walls of the calyces propels urine
through the pelvis and ureters to
the bladder.
 Major calyx
• surrounds the apex of the malpighian
pyramids. Urine formed in
the kidney passes through a papilla at the
apex into a minor calyx then into major
calyx before passing through the renal
pelvis into the ureter.
• Peristalsis of the smooth muscle
originating in pace-maker cells originating
in the walls of the calyces propels urine
through the pelvis and ureters to
the bladder.
 Renal papilla
• is the location where the
Medullary pyramids empty
urine into the renal pelvis
 Renal column
• is a medullary extension of the
renal cortex in between the renal
pyramids. It allows the cortex to
be better anchored.
• Each column consists of lines of
blood vessels and urinary tubes
and a fibrous material.
 Renal pelvis
• is the funnel-like dilated proximal part
of the ureter in the kidney.
• It is the point of convergence of two or
three major calyces. Each renal
papilla is surrounded by a branch of the
renal pelvis called a calyx.
• The major function of the renal pelvis is
to act as a funnel for urine flowing to
the ureter.
 Ureter
• are muscular ducts that
propel urine from
the kidneys to urinary
bladder. In the adult, the
ureters are usually 25–30 cm
(10–12 in) long.
 Pathophysiology:
• Nephrotic syndrome results from damage to the kidney’s glomeruli,
the tiny blood vessels that filter waste and excess water from the
blood and send them to the bladder as urine. They consist of
capillaries that are fenestrated, that is, have small openings, which
allow fluid, salts, and other small solutes to flow through but normally
not proteins. Damage to the glomeruli from diabetes,
glomerulonephritis, or even prolonged hypertension, causes the
membrane to become more porous, so that small proteins, such as
albumin, pass through the kidneys into urine. As protein continues to
be excreted, serum albumin is decreased, which in turn decreases
the serum osmotic pressure. Capillary hydrostatic fluid pressure
becomes greater than capillary osmotic pressure, which results in
generalized edema. As fluid is lost into the tissues, the plasma
volume decreases, stimulating secretion of aldosterone to retain
sodium and water, which decreases the glomerular filtration rate to
retain water. This additional water also passes out of the capillaries
into the tissue, leading to even greater edema.
 NURSING CARE PLAN

Name of Patient: Rose Nina Francisco Patient’s Health Profile: Received the patient lying in bed with Dopamine 67ml at
Age: 14 yrs. old Sex: Female 31 gtts/min, unconscious, uncoherent and afebrile.
Occupation: N/A
Date of Admission: September 1, 2009 Initial Complaint: dyspnea
Status: Single Religion: Roman Catholic Diagnosis/Impression: Nephrotic Syndrome

Needs/Nsg. Nursing Problem/

Scientific Analysis Objective Rationale Evaluation
Diagnosis/Cues Interventions
I. Physiologic Nephrotic syndrome is a After 8 hours of nurse-  Assess and  Identifies Goals met. After 8 hours
II. Imbalanced nonspecific disorder in patient interaction, the monitor food/fluid nutritional deficits/ of nurse-patient
Nutrition, less which the kidneys are patient will be able to: ingested. therapy needs. interaction, the patient
than body damaged, causing them a. Identify the  Monitor weight  To assess the was able to:
requirements to leak large amounts of appropriate diet daily at same time, health status of a.Identify the
related to poor protein from the blood for her condition. same clothing and patient. Same appropriate diet
appetite, restricted
into the urine. Damage (Low-sodium diet) same scale. clothing, same for her condition.
diet, and protein to the glomeruli causes b.Follow the diet time and same (Low-sodium diet)
loss the membrane to become prescribed. scale makes the b.Follow the diet
III. Cues: more porous, so that c.Verbalize realization weight equal/fair prescribed.
small proteins, such as of the importance of than yesterday. c.Verbalize realization
S: “Wala koy gana albumin, pass through proper diet.  Recommend  Smaller portions of the importance of
mukaon.”, as verbalized the kidneys into urine. small, frequent may enhance proper diet.
by the patient. meals. intake.
O: protein-creatinine (Rick Daniels,  Restrict sodium as  This electrolyte
ratio of 1.55 Contemporary Medical- indicated, and can
Serum albumin of Surgical Nursing, limit fluid intake quickaccumulate,
0.9g/dl Thomson Learning Asia, to 100ml. causing fluid
volume 2, 2007, page retention, and
1784) weakness.
 Administer  Replaces
multivitamins, as vitamin/mineral
indicated. deficits resulting
from malnutrition.
 Needs/Nsg. Nursing Problem/
Scientific Analysis Objective Rationale Evaluation
Diagnosis/Cues Interventions
Because of the  Administer  Reduces
leaking proteins medications stimulation of
from the blood to as the vomiting
the urine, the appropriate. center.
nutrients needed in  Monitor
 To assess
her body are being laboratory
development
excreted. This studies
and status.
causes her to lose
the nutrients in the
body, making her
nutrition less than
body requirements.
 NURSING SCIENTIFIC OBJECTIVES NURSING RATIONALE EVALUATION
DIAGNOSIS ANALYSIS INTERVENTIONS

Excess fluid volume Nephrotic syndrome is a After 8 hrs of  Record accurate intake  Accurate intake and output is After 8 hrs of
related to compromised clinical disorder of nursing and output of the necessary for determining the nursing
regulatory mechanism unknown cause interventions, the patient renal function and fluid interventions, the
with changes in characterized by patient will display replacement needs and patient was able to
hydrostatic or oncotic proteinuria, stable weight, vital reducing risk of fluid overload display stable
vascular pressure and hypoalbuminemia, signs within  Monitor urine specific  Measures the kidneys ability weight, vital signs
increased in activation edema and patient’s normal gravity to concentrate urine. within patient’s
of rennin angiotensin hyperlipidemia. This range, and nearly  Weight daily at same  Daily body weight is the best normal range, and
aldosterone system conditions result from absence of edema. time of the day, on monitor of fluid status. A nearly absence of
S: “murag nanghupong excessive leakage of same scale, with same weight gain of more than 0.5 edema.
aq anak sa iya bitiis” as plasma proteins into the equipment and clothing kg/day suggest fluid retention.
verbalized by the mother urine because of the  Assess skin, face,  Edema occurs primarily in
O: edema, impairment of the dependent areas of dependent tissues of the body.
weight gain, glomerular capillary edema It will serve as a parameter the
changes in vital signs membrane. severity of fluid excess

 Monitor heart rate and  Tachycardia and hypertension

blood pressure. can occur because of failure of
the kidneys to excrete urine
 NEEDS/NSG
SCIENTIFIC NURSING PROBLEM/
DIAGNOSIS/C OBJECTIVE RATIONALE EVALUATION
ANALYSIS INTERVENTIONS
UES
•Assess level of •May reflect
consciousness: fluid shifts and
investigate electrolyte
changes in imbalances
mentation,
presence of
restlessness.
 NURSING CARE PLAN
Name: Rose Nina Francisco Patient’s Health Profile: Received the patient lying in bed with
Age: 14 Sex: Female Dopamine 67ml @ 31 gtts/min, unconscious, uncoherent, and a
Date of Admission: September 1, 2009 febrile.
Occupation: N/A Initial complaint: Dyspnea
Status: Single Religion: Roman Catholic Diagnosis: Nephrotic Syndrome

Needs/Nursing Scientific Analysis Objectives Nursing Rationale Evaluation

Diagnosis Interventions
Cues
I. Self- Nephrotic After 4 hours of •Assess •To facilitate Goal was met.
Actualization Syndrome is a nurse-patient readiness to successful The patient and
II.Knowledge set of symptoms and significant learn. learning, it is the significant
deficit related that are caused others important to others were able
to chronic by many different interaction, the assess to identified the
illness problems, most patient and the readiness to interferences to
commonly significant others learn. learning and
glomerulonephriti will be able to: made specific
s or some •Assess ability to •Physical actions to deal
systemic disorder •Identify perform desired limitations or with it. And they
such as diabetes interferences to health-related cognitive were to
or lupus learning and care. limitations must performed
erythematosus. specific actions be identified and necessary
The symptoms to deal with it. considered when procedures
are heavy loss of establishing correctly and
protein in the treatment plan. they explained
urine, resulting in the
hypoalbuminemi •Perform •Provide an •Environment reasons for the
a and massive necessary environment that should be free of actions they
edema. There procedures is conducive to distractions and made.
may also be a correctly and learning. noise. And they were
high blood explain reasons able to initiated
cholesterol level. for the actions. •Provide written •Reinforces necessary
Medical-Surgical information/guid learning lifestyle changes
Nursing elines and self- process, allows and participated
Philadelphia/Lon •Initiate learning client to proceed in treatment
don/Toronto necessary modules for at own pace. regimen by
W.B Saunders lifestyle changes client to refer to allowing them to
Company and participate as necessary. practice and
Vol.1, 1974 in treatment demonstrate the
Page 728 regimen. •Allow practice •To ensure treatment
and accurate regimen.
Knowledge demonstrations. learning and
deficit result accurate
when an evaluation of
individual ability to perform
experiences an desired skills,
inability to state repeat
or explain demonstrations
information or need to be
demonstrate a observed.
required skill
related to health
care measures
necessary to
maintain or
improve
wellness.
Nursing
Diagnosis in
Critical Practice
United States of
America
Delmar
Publishers /, Inc
1992
Pages 339-342
 DRUG STUDY

Name of patient : Rose Nina Francisco Patient’s health profile: Received patient lying in bed with dopamine 67 ml at
Age: 14 years old Sex: Female 31 gtts/min unconscious, uncoherent and afebrile.
Occupation: none
Date of admission: September 1 ,2009 Initial Complaint : dyspnea
Status: single Religion: Catholic Diagnosis: Nephrotic Syndrome
Name of drug: Classification Mechanism Contraindication Route Side Nursing
generic name of and effects responsibilities
brand name action dosage

Captopril Antihypertensive, Competitive Hypersensitivity to 50 mg Dermatologic: >Do not

(NuCapto) inhibitor of inhibitor of captopril or any rash with pruritus discontinue without
angiotensin angiotensin- component of the and occasionally the providers
synthesis converting enzyme formulation; fever, Stevens- consent.
(ACE); prevents angioedema related Johnson Syndrome >obtain baseline
conversion of to previous CV: MI, CVA, hematologic and
angiotensin I to treatment with an CHF, cardiac renal finction test.
angiotensin II, a ACE inhibitor; arrest, >observe for
potent idiopathic or bronchospams, precipitous drop in
vasoconstrictor; hereditary pulmonary BP within 3 hr after
results in lower angioedema; embolism, initial dose if client
levels of bilateral renal pulmonary has been on
angiotensin II artery stenosis; infarction. diuretic therapy
which causes an pregnancy (2nd or Hematologic: and a low-salt diet.
increase in plasma 3rd trimester) aplastic or >take 1 hr before
renin activity and a hemolytic anemia meals, on an empty
reduction in stomach; food
aldosterone interferes with drug
secretion absorption.
>report any fever,
skin rash, sore
throat, mouth sores.
 Name of drug: Classification Mechanism Contraindication Route Side Nursing
generic name of and effects responsibilities
brand name action dosage

Ranitidine GASTROINTESTI Competitive >Hypersensitivity 50 g IVTT q 8 allergic reaction: >Potential toxicity

Zantac, Zantac NAL AGENT; inhibition of to ranitidine or any hives; difficulty results from
EFFERdose, ANTISECRETOR histamine at H2- component of the breathing; swelling decreased clearance
Zantac GELdose, Y (H2-RECEPTOR receptors of the formulation of your face, lips, (elimination) and
Zantac-75 ANTAGONIST) gastric parietal tongue, or throat. therefore prolonged
cells, which >chest pain, fever, action; greatest in
inhibits gastric acid feeling short of the older adult
secretion, gastric breath, coughing up patients or those
volume, and green or yellow with hepatic or
hydrogen ion mucus; renal dysfunction.
concentration are >easy bruising or >Lab tests: Periodic
reduced. Does not bleeding, unusual liver functions.
affect pepsin weakness; fast or Monitor creatinine
secretion, slow heart rate; clearance if renal
pentagastrin- problems with your dysfunction is
stimulated intrinsic vision; present or
factor secretion, or suspected. When
serum gastrin. >fever, sore throat,
clearance is <50
and headache with
mL/min,
a severe blistering,
peeling, and red manufacturer
recommends
skin rash; or n
reduction of the
>nausea, stomach dose to 150 mg
pain, low fever, once q24h with
loss of appetite, cautious and
dark urine, clay- gradual reduction
colored stools, of the interval to
jaundice (yellowing q12h or less, if
of the skin or eyes). necessary.
 CLASSIFICATION & SIDE-EFFECTS/
NAME OF INDICATION AND CONTRAINDICATIO NURSING
MECHANISM OF ADVERSE
DRUG DOSAGE N RESPONSIBILITIES
ACTION REACTIONS
>Be alert for early
signs of
hepatotoxicity
(though low and
thought to be a
hypersensitivity
reaction): jaundice
(dark urine, pruritus,
yellow sclera and
skin), elevated
transaminases
(especially ALT) and
LDH.
>Long-term therapy
may lead to vitamin
B12 deficiency.
 Name of drug: Classification Machanism Contraindication Route Side Nursing
generic name of and effects responsibilities
brand name action dosage

Furosemide ELECTROLYTIC Inhibits >Hypersensitivity 30 g IVTT q 12 allergic reaction: >Take this

Fumide , Furomide AND WATER
, Lasix, Luramide BALANCE
AGENT; LOOP chloride in the
DIURETIC
reabsorption of to furosemide, any hives; difficulty medication exactly
sodium and component, or breathing; swelling as it was prescribed
sulfonylureas; of your face, lips, for you. Do not
ascending loop of anuria; patients tongue, or throat. take the medication
Henle and distal with hepatic coma dry mouth, thirst, in larger amounts,
renal tubule, or in states of nausea, vomiting; or take it for longer
interfering with the severe electrolyte feeling weak, than recommended
chloride-binding depletion until the drowsy, restless, or by your doctor.
cotransport system, condition improves light-headed; fast Follow the
thus causing or is corrected or uneven directions on your
increased excretion heartbeat; muscle prescription label.
of water, sodium, pain or weakness; >Avoid becoming
chloride, urinating less than dehydrated. Follow
magnesium, and usual or not at all; your doctor's
calcium easy bruising or instructions about
bleeding, unusual the type and
weakness; a red, amount of liquids
blistering, peeling you should drink
skin rash; hearing while you are
loss; or nausea, taking furosemide.
stomach pain, low
fever, loss of
appetite, dark
urine, clay-colored
stools, jaundice
(yellowing of the
skin or eyes).
 CLASSIFICATION SIDE-EFFECTS/
NAME OF INDICATION AND CONTRAINDICATI NURSING
& MECHANISM OF ADVERSE
DRUG DOSAGE ON RESPONSIBILITIES
ACTION REACTIONS
>It is important that
patients be closely
followed for
hypokalemia,
hypomagnesemia, and
volume depletion
because of significant
diuresis. If given the
morning of surgery, it
may render the patient
volume depleted and
blood pressure may be
labile during general
anesthesia.
 Name of drug: Classification Mechanism Contraindication Route Side Nursing
generic name of and effects responsibilities
brand name action dosage

Prednisone hormones and >Decreases >Hypersensitivity to 10 mg 6 OD allergic reaction: >Establish baseline

Apo-Prednisone , synthetic inflammation by prednisone or any hives; difficulty and continuing data
Deltasone, substitutes; adrenal suppression of component of the breathing; swelling regarding BP, I&O
Meticorten, corticosteroid; migration of formulation; serious of your face, lips, ratio and pattern,
Orasone, Panasol, glucocorticoid polymorphonuclear infections, except tongue, or throat. weight, and sleep
Prednicen-M, leukocytes and tuberculous problems with your pattern. Start flow
Sterapred, Winpred reversal of increased meningitis; systemic vision; swelling, chart as reference
capillary fungal infections; rapid weight gain, for planning
permeability; varicella feeling short of individualized
suppresses the breath; severe pharmacotherapeuti
immune system by depression, unusual c patient care.
reducing activity thoughts or
and volume of the behavior, seizure >Check and record
lymphatic system; (convulsions); BP during dose
suppresses adrenal bloody or tarry stabilization period
function at high stools, coughing up at least 2 times
doses. Antitumor blood; pancreatitis daily. Report an
effects may be (severe pain in your ascending pattern.
related to inhibition upper stomach >Report symptoms
of glucose transport, spreading to your of GI distress to
phosphorylation, or back, nausea and physician and do not
induction of cell vomiting, fast heart self-medicate to find
death in immature rate); low potassium relief.
lymphocytes. (confusion, uneven
Antiemetic effects heart rate, extreme
are thought to occur thirst, increased
due to blockade of urination,
cerebral innervation
of the emetic center
via inhibition of
 CLASSIFICATION & SIDE-EFFECTS/
NAME OF INDICATION AND CONTRAINDICATIO NURSING
MECHANISM OF ADVERSE
DRUG DOSAGE N RESPONSIBILITIES
ACTION REACTIONS

prostaglandin leg discomfort, muscle >Take drug as prescribed and

synthesis. weakness or limp do not alter dosing regimen or
feeling); or stop medication without
dangerously high consulting physician.
blood pressure (severe >Be aware that a slight weight
headache, blurred gain with improved appetite is
vision, buzzing in your expected, but after dosage is
ears, anxiety, stabilized, a sudden slow but
confusion, chest pain, steady weight increase [2 kg
shortness of breath, (5 lb) per wk] should be
uneven heartbeats, reported to physician.
seizure).
 Name of drug: Classification Machanism Contraindication Route Side Nursing
generic name of and effects responsibilities
brand name action dosage

Ampicillin antiinfective; >Inhibits bacterial >Hypersensitivity 1500 g q 6 ANST allergic reaction: >Determine
Unasyn antibiotic; cell wall synthesis to ampicillin, any hives; difficulty previous
aminopenicillin by binding to one or component of the breathing; swelling hypersensitivity
more of the formulation, or of your face, lips, reactions to
penicillin binding other penicillins tongue, or throat. penicillins,
proteins (PBPs); fever, sore throat, cephalosporins, and
which in turn and headache with a other allergens prior
inhibits the final severe blistering, to therapy.
transpeptidation peeling, and red >Lab tests: Baseline
step of skin rash; diarrhea C&S tests prior to
peptidoglycan that is watery or initiation of
synthesis in bloody; fever, therapy; start drug
bacterial cell walls, chills, body aches, pending results.
thus inhibiting cell flu symptoms; easy
wall biosynthesis. bruising or >Report promptly
Bacteria eventually bleeding, unusual unexplained
lyse due to ongoing weakness; urinating bleeding (e.g.,
activity of cell wall less than usual or epistaxis, purpura,
autolytic enzymes not at all; agitation, ecchymoses).
(autolysins and confusion, unusual >Monitor patient
murein hydrolases) thoughts or carefully during the
while cell wall behavior; or seizure first 30 min after
assembly is (black-out or initiation of IV
arrested. convulsions). therapy for signs of
hypersensitivity and
anaphylactoid
reaction (see
Appendix F).
 CLASSIFICATION & SIDE-EFFECTS/
NAME OF INDICATION AND CONTRAINDICATIO NURSING
MECHANISM OF ADVERSE
DRUG DOSAGE N RESPONSIBILITIES
ACTION REACTIONS
Serious anaphylactoid
reactions require immediate
use of emergency drugs and
airway management.
>Observe for and report
symptoms of superinfections
(see Appendix F). Withhold
drug and notify physician.
>Monitor I&O ratio and
pattern. Report dysuria, urine
retention, and hematuria.
 Name of drug: Classification Machanism Contraindication Route Side Nursing
generic name of and effects responsibilities
brand name action dosage
]
Nifedipine cardiovascular >Inhibits calcium >Hypersensitivity 10mg tab TID >an allergic >Keep a record of
Adalat, Adalat CC, agent; calcium ion from entering to nifedipine or any reaction (difficulty nitroglycerin use
Procardia, channel blocker; the "slow channels" component of the breathing; closing and promptly report
Procardia XL antiarrhythmic or select voltage- formulation; of the throat; any changes in
(class iv); sensitive areas of immediate release swelling of the lips, previous pattern.
nonnitrate vascular smooth preparation for tongue, or face; or Occasionally,
vasodilator. muscle and treatment of urgent hives); unusually people develop
myocardium during or emergent fast or slow increased
depolarization, hypertension; acute heartbeats; severe frequency, duration,
producing a MI dizziness or and severity of
relaxation of fainting; psychosis; angina when they
coronary vascular yellowing of the start treatment with
smooth muscle and skin or eyes this drug or when
coronary (jaundice); or dosage is increased.
vasodilation; swelling of the legs >Monitor BP
increases or ankles. carefully during
myocardial oxygen titration period.
delivery in patients Patient may
with vasospastic become severely
angina hypotensive,
especially if also
taking other drugs
known to lower BP.
Withhold drug and
notify physician if
systolic BP <90.
 CLASSIFICATION SIDE-EFFECTS/
NAME OF INDICATION AND CONTRAINDICATI NURSING
& MECHANISM OF ADVERSE
DRUG DOSAGE ON RESPONSIBILITIES
ACTION REACTIONS
>Monitor blood sugar in
diabetic patients. Nifedipine
has diabetogenic properties.
>Monitor for gingival
hyperplasia and report
promptly. This is a rare but
serious adverse effect (similar
to phenytoin-induced
hyperplasia).
 Name of drug: Classification Machanism Contraindication Route Side Nursing
generic name of and effects responsibilities
brand name action dosage

Cephalexin antiinfective; >Inhibits bacterial >Hypersensitivity 75 g q 8 ANST allergic reaction: >Determine history
Cefanex, antibiotic; first- cell wall synthesis to cephalexin, any hives; difficulty of hypersensitivity
Ceporex_A, Keflet, generation by binding to one component of the breathing; swelling reactions to
Keflex, Keftab, cephalosporin or more of the formulation, or of your face, lips, cephalosporins and
Novolexin_A penicillin-binding other tongue, or throat. penicillin and
proteins (PBPs) cephalosporins diarrhea that is history of other
which in turn watery or bloody; drug allergies
inhibits the final before therapy is
 seizure
transpeptidation (convulsions) initiated.
step of  fever, sore >Lab tests:
peptidoglycan throat, and Evaluate renal and
synthesis in
headache hepatic function
bacterial cell walls, with a severe periodically in
thus inhibiting cell blistering, patients receiving
wall biosynthesis. peeling, and prolonged therapy.
Bacteria eventually red skin rash; >Monitor for
lyse due to ongoing  pale or
activity of cell wall manifestations of
yellowed
autolytic enzymes hypersensitivity
skin, dark
(autolysins and (see Signs &
colored urine,
murein hydrolases) Symptoms,
fever,
while cell wall Appendix F).
confusion or Discontinue drug
assembly is
weakness;
arrested. and report their
 easy bruising appearance
or bleeding, promptly.
unusual
weakness;
 CLASSIFICATION SIDE-EFFECTS/
NAME OF INDICATION AND CONTRAINDICATI NURSING
& MECHANISM OF ADVERSE
DRUG DOSAGE ON RESPONSIBILITIES
ACTION REACTIONS
 confusion, >Take medication for the
agitation, full course of therapy as
hallucinations directed by physician.
(seeing things >Keep physician
that are not informed if adverse
there); or reactions appear.
 urinating less
than usual or
not at all.
S:
SOAPIE
O:
A: Knowledge deficit related to chronic illness
P: After 4 hours of nurse-patient and significant others interaction,
the patient and the significant others will be able to:
•Identify interferences to learning and specific actions
to deal with it.
•Perform necessary procedures correctly and explain reasons
for the actions.
•Initiate necessary lifestyle changes and participate in treatment
regimen.
I:•Assessed readiness to learn.
•Provided an environment that is conducive to learning.
•Provided written information/guidelines and self-learning modules
for client to refer to as necessary.
•Allowed practice and demonstrations.
E: Goal was met. After 4 hours of nurse-patient and significant others
interaction, the patient and the significant others will be able to
identified the interferences to learning and made specific actions to
deal with it. And they were to performed necessary procedures
correctly and they explained the reasons for the actions they made.
And they were able to initiated necessary lifestyle changes and
participated in treatment regimen by allowing them to practice and
demonstrate the treatment regimen.
 SOAPIE
S- “Wala koy gana mukaon.”, as verbalized by the patient.
O- : protein-creatinine ratio of 1.55
Serum albumin of 0.9g/dl
A- Imbalanced Nutrition, less than body requirements
related to poor appetite, restricted diet, and protein loss.
P- After 8 hours of nurse-patient interaction, the patient
will be able to:
a.Identify the appropriate diet for her condition. (Low-
sodium diet)
b.Follow the diet prescribed.
c.Verbalize realization of the importance of proper diet.
I- Assessed and monitored food/fluid ingested and
calculate caloric intake.
•Monitored weight daily at same time, same clothing and
same scale.
•Recommended small, frequent meals.
•Restricted sodium as indicated, and limited fluid intake to
100ml
•Administered multivitamins, as indicated.
•Administered medications as appropriate.
•Monitored laboratory studies.
E- Goals met. After 8 hours of nurse-patient interaction,
the patient was able to identify the appropriate diet for her
condition. (Low-sodium diet). Follow the diet prescribed.
Verbalize realization of the importance of proper diet.
 SOAPIE
S- “Murag nanghupong akong anak sa iya bitiis.”, as
verbalized by the mother.
O- Edema, weight gain, changes in vital signs
A- Excess fluid volume related to compromised
regulatory mechanism with changes in hydrostatic
vascular pressure and increased activation of rennin
angiotensin aldosterone system.
P-After 5 hrs of nursing interventions, the patient will
be able to:
•display stable weight
•vital signs within patient’s normal range
•nearly absence of edema.
I-Record accurate intake and output of the patient
Monitor urine specific gravity
Weight daily at same time of the day, on same scale, with
same equipment and clothing
Assess skin, face, dependent areas of edema
Monitor heart rate and blood pressure
Assess level of consciousness: investigate changes in
mentation, presence of restlessness.
E-Goals were fully met. After 5 hrs of nursing
interventions, the patient was able to display stable weight,
vital signs within patient’s normal range, and nearly
absence of edema.