1. A care for client with Malabsorption Syndrome
In partial fulfillment of Related Learning Experience (R.L.E)
Submitted By:
Roderos, Mitch Angela
BSN 4C GROUP II S.Y 2011-2012
Clinical Instructor
Sir. Oliver Virata

2. INTRODUCTION
The human gastrointestinal (GI) tract is the site of absorption of a wide variety of
ingested nutrients,including vitamins, proteins, carbohydrates and fats.Much of this absorption
occurs in the small intestine(SI), where the high surface area provided by thevillous and
microvillous architecture optimizes uptake of dietary substances. The specialized SI mucosa
contains numerous digestive enzymes on its surface,as well as an intricate network of lymphatics
and blood vessels providing access to the bloodstream. Adequate digestion and absorption
depend on a multitude of factors, including mechanical mixing, enzyme production and activity,
proper mucosal function, adequate blood supply, intestinal motility and even normal microbial
ecology.
Accordingly, malfunctions in any of these components can lead to failure to absorb
nutrients from the diet, often resulting in some combination of diarrhoea,steatorrhoea,
malnutrition, weight loss and anaemia. The resultant symptoms are known as the malabsorption
syndrome(s), which can be grouped bytheir aetiology into three broad categories.
Thus,malabsorption may result from maldigestion, such as occurs in inadequate mixing (e.g.
after gastrectomy) or in enzyme or bile salt deficiencies, from mucosal or mural problems, such
as various enteropathies or neuromuscular conditions, or from microbial causes,such as bacterial
overgrowth and various infections ⁄infestations. The vast number of causes of intestinal
malabsorption precludes an exhaustive review. Therefore, we will attempt an overview of the
most common and interesting aetiologies in the three categories, with a morecomplete discussion
of a handful of entities in each,along with a review of current concepts. Special emphasis will be
afforded to mucosal problems, as well as to several microbial conditions.

3. DEMOGRAPHIC DATA
1. Client’s name : Patient A.D
2. Gender: Male
3. Age, Birth date and Birth place: 21 years old, September 2,1990 at Zamboanga City
4. Marital Status: Single
5. Nationality: Filipino
6. Religion: Roman Catholic
7. Address: 15 Natividad St. Bangkal Quezon City
8. Educational Background: College Undergraduate
9. Occupation: Student
10. Usual Source of Medical Care:
A. SOURCE AND RELIABLITY OF INFORMATION
 Patient’s Chart
 Patient’s father
B. REASON FOR SEEKING CARE
“Ang sakit sakit ng tsyan ko” As verbalized by the patient
C. HISTORY OF PRESENT ILLNESS
2 years prior to admission (September 2009) – Patient had his appendectomy last 2009,
abdominal surgery done the same year. A tumor was marked visible in the colon and
likewise excised.
1 year and 8 months prior to admission (January 2009) – Patient was operated due to
dehiscense of his intestines
10 weeks prior to admission – Patient complaints of abdominal pain, with presence of
nausea and vomitting and associated with on and off fever.
D. PAST MEDICAL HISTORY
Pediatric/Childhood/ Adult Illness: Mumps (7 y/o); Chiken Pox (17 y/o)
Injuries or accidents: The client recieved multiple injuries due to stampede (10 y/0)
Serious/ Chronic Illnesses: The client has Hypertension X4, HBP of 200/100 UBP 150/80

4. Hospitalizations: The client’s father verbalized of frequent admission for the previous
months and up to present. The client’s father was not able to recall the recent of his
son’s admission
Operations: The client undergone appendectomy last 2009 and was operated due to
intestinal dehiscence after 4 months of previous surgery around January of 2009
Immunizations: The client verbalized of having complete immunization of DPT, OPV,
BCG and Measles vaccine.
Allergies: No known Allergies
Medications prior to confinement:
Last Examination Date: December 13, 2011
E. FAMILY HISTORY
Father Mother
(+) HPN (+) HPN
(+) DM (+) Asthma
(
25 y/o 21 y/o 18 y/o
LEGEND
Male Female Client

5. 1.) Heredo-Family Illness:
Maternal –
Patient B’s mother is known to have High blood pressre and Asthma. Currently,
his older sister next to him has asthma and so as his only daughter started when
she was 2 years old.
Father-
Patient’t B’s father has no known family illness running in their blood.
F. SOCIO-ECONOMIC
The client consists of a nuclear family and lives together with his parents and
three siblings. His father works as a sea man and presently at home due to expiration of
contract, however, they are able to generate income from their previous savings and from
managing a computer shop at Zamboanga, and the client’s father obtains an approximate
per month, adequate enough for a living. The client’s eldest brother works in a call center
which also helps in shouldering some of their expenses. The client states that he
contributes for the family financial expenses.
DEVELOPMENTAL HISTORY
Erik Erickson Age Task Patient’s Description
Psychosocial Theory
IntimacyVs. 19 – 30 Young adults need to form The client is presently
Isolation y/o intimate, loving relationships stopped from studying
with other people. Success college and known to have
leads to strong relationships, frequent admission at
while failure results in hospitals.
loneliness and isolation. The client is evidenced to
have activity intolerance due
to poor nutrition that he is
not able to interact from
other people and to perform
activitiees of daily living by
himself. The Client at risk
for isolation from social
peers that will affect his
Pyschosocial development if
the problem still persists.

6. G. REVIEW OF SYSTEMS
1. Regional Examinations
(December 1, 2011 9:30 am)
Vital Signs:
Temp : 37.1°c RR: 18 cpm PR: 105 cpm BP: 100/80mmHg
General Assessment:
 Patient is seen conscious and coherent; garbed clothing appropriate for weather and
occasion.sitting on wheel chair with facial grimace, the client cannot fully perform
activities and requires assistance. Skin is clean and smooth with normal skin turgor.
Nails are long but not dirty and with normal capillary refill. Patient is with ongoing
IVF of D5 NSS 1 L X 8 hr Infusing well at his left matacarpal vein.
Date of Assessment System Normal Findings Actual Findings
December 14 ,2011 Integumentary Smooth and good I:
skin turgor, no
lesions or any  Brown color, no lesion, no swelling
discoloration, no and edema.
clubbing, no breaks  Weak Looking
&abnormal  Visible veins on both arms
curvature.  Has a temperature of 37.1°c.
 With visible longitudinal scar
below the umbillicu
In nails:
 Long and clean nails and round
nails. Pale Nail beds
P:
 Cold,dry scaly skin,normal
capillary refill. Good skin turgor
December 14 ,2011 Hair and Head No lesion, no I:
tenderness, no pain
on palpation, no -His hair color is black, hair is evenly
masses, no lumps, distributed,

7. no nodules or -Has thick hair.
depression,
symmetrical -No presence of parasite and dandruff.
-In scalp: Symmetrical and round and
no lesion.
P:
-Hair texture is smooth and soft.
-In head the texture is smooth and
firm.
December 14,2011 Eyes Eyelid intact, no I:
redness, swelling,
discharge or lesions. -Lid margins moist and light pink,
Eyeballs are moist & lashes short, evenly spaced and curled
glossy, conjunctiva outward.
numerous small -Bulbar conjunctiva is clear with tiny
blood vessels. Sclera vessels visible, palpebral conjunctiva
white. Good eye is pale with no discharge, white sclera.
contact.
- In PERRLA:
*Cornea is transparent and the shape
of the iris and pupil is round and
equal.
*The left and right eye has a good
reaction to light (constrict and dilate)
-In extra ocular movements:
*Both eyes coordinated well in all
directions.
December 14,2011 Ears Ears are symmetrical I:
with 10 degrees
angle. Color is same -Equal size and similar appearance.
in facial with no -No lesions, brown in color same with

8. tenderness or any his complexion.
nodule and without
any presence of P:
discharge. -Warm, smooth, no nodules and no
tenderness in auricle and tragus.
December 14,2011 Mouth and 32 adult teeth are I & P:
Throat present with moist
and pink mucous -Lips and surrounding tissue relatively
membrane without symmetrical.No lesions, swelling and
any lesions or drooping.
swelling. -Lip is pale pink; moist, smooth and
with no lesions.
-Buccal mucosa is light pink, moist
and without lesions.-Gums are light
pink, and moist.
-In tongue:
*Moist, some papillae present,
symmetrical appearance, midline
fissures present and the color is pink
and color white at the center and no
lesions as well as the sides of the
tongue.
*Hard palate: slightly pink. *Soft
palate: pink, -Has 32 teeth and stained
with a hint of yellow color.
December 14,2011 Neck No tenderness on I: -Neck is symmetric with head
palpation, no pain, centered and without bulging masses.
symmetrically align,
no enlarged lymph P:-Smooth skin, firm, and none tender
nodes, no tracheal and none enlarged nodules.
lateral deviation.
December 14,2011 Breast and No palpable nodules I:
Axillae and lesions. Breast is -Nipples have no discharges and not
firm and round. cracked.

9. December 14,2011 Respiratory Intercostals spaces I:
are even and
relaxed; chest -The color of his chest is similar to his
symmetry is equal, complexion.
no pain or -Visible Rib Cage
tenderness, and no
abnormal breath -Chest symmetry is equal
sound.
-Respiratory rate of 18.
P: No pain or tenderness.
A: Lung is clear to auscultation on
inspiration and expiration.
December 14,2011 Cardiovascular No fatigue on simple PR : 105
activities, no
arrhythmias and BP: 100/80 mmHg
heart murmurs. I:-Neck veins are not distended.
PR=60-100bpm.
P:-No vibrations or palpitation in
aortic, pulmonic, or tricuspid area.
A:-No murmur sound heard.
December 14,2011 Abdominal No pain, No I:
palpable masses and
tenderness, Flat and -With
round. P:
-(+) Tenderness, with inflammation on
intestines as observed in Lab Result
December 14,2011 Musculoskeletal Have good range of -Requires assistance to stand and toes
motion and no point straight ahead.
limitation of
movements. With marked activity intolerance
-With marked muscle waisting
December 14,2011 Neurologic Have no tremors -No presence of tremors, oriented, no
paralysis. Oriented, history of seizures,without mental
no history of dysfunction or hallucinations.
seizures, mental -Slow and low soft voice

10. dysfunction or -Weak looking
hallucinations. Lethargic, slow response
December 14,2011 Lympathic Has no bleeding No swollen lymph nodes.
tendencies, normal
lymph nodes.
2. Laboratory Studies/Diagnostics
12/15/11 Clinical Chemistry Section
Test Name Range Unit Result Interpretation
Albumin 3.92 – g/dL 2.05 Below Normal
4.94
Indicates poor nutritional state, poor protein intake,
Renal/Kidney Dysfunction
H. FUNCTIONAL ASSESSMENT
HEALTH PERCEPTION-HEALTH MANAGEMENT
Prior to admission, patient’s father sasys the his son sees health being able to do everyday
things well according to the manner he wants it. The client stated he doesn’t easilly get sick and
when he does, he just let it subside not until if his condition worsens, that’s the time when he
would visit the hospital. The client does not use any vitamins and medications. Client has not
experienced colds in the past month.
SELF-ESTEEM, SELF CONCEPT/SELF PERCEPTION PATTERN
Prior to confinement, the client’s father states that his son has a good concept at
himself and describes himself like any typical normal college boy. He says that his child
perceives good self-concept as evidenced by being active in the activities held in his institution.
Presently, the client stopped schooling due to persistent abdominal pain. The client
permanently resides in Zamboanga and went to Cavite from a relative’s house to sought for
treatment.
ACTIVITY/EXERCISE PATTERN

11. Prior to confinement, the patient father remarks that his son used to have an active
lifestyle, the client is once a varsity player in Basketball. The patient engages in sports such as
Basket Ball, Volley Ball and Badminton. The patient studied college last semester but now
stopped due to present situation.
Presently, the patient is admitted in ward 3A, under bed rest. The client assistance from another
person or device in terms of the following indicated below:
Feeding III Grooming III
Bathing III Gen. Mobility III
Toiling III House III
maintenance
Bed mobility III Dressing III
Legends:
Level 0 – Self Care
Level I – Use of equipments
Level II– Assistance from another person
Level III –Requires assistance from another person or device
Level IV – Dependent and does not participate
SLEEP/REST PATTERN
Before the client was admitted, the client’s father stated that his son usually sleeps around 10:00
pm and wakes up around 6:00 am with an average sleep of 8 hours without any use of sleepint
aids
Presently, the client’s father describes that his son is experiencing difficulty in sleeping due to
persistence of pain that he experiencing because of that the client frequently naps in the morning
and still feels tiped upon waking up
NUTRITIONAL-METABOLIC PATTERN
The client presently eats in small frequent feeding at an average of 5 times a day. the
client has poor appetite and usually eats in soft-non-seasoned food or broths. The client cannot
tolerate to eat regular meals as observed from vomiting. The client’s father frequently observes
his child to vomit usually after eating. There is an observed muscle wasting as evidenced from a
weight loss of 48 kg to 32 kg. The client has no dental problems and without foul odors.

12. ELIMINATION PATTERN
The client states that he defecates every other day usually in the morning in scanty soft
brown stool. The client’s father believe that his son’s bowel pattern due to his poor fluid and
food intake. The client urinates 2X a day or varies in his fluid intake without no difficulty
SEXUALITY/REPRODUCTIVE
The patient is not sexually active and was circumcised at the age of 12
.
INTERPERSONALRELATIONSHIPS/RESOURCES
The client is the second son among his 3 siblings. The client previously attended college but
presently stops due to persistence of abdominal pain affecting his studies. The patient’s father
says that his son attends to school trying to tolerate his abdominal pain The client’s father
verbalized that their family has an open and harmonious relationship. The client’s father states
that he would allow his son to decide by himself to promote independence but would be there to
guide and support him. In terms of major decisions affecting the client’s health, the father states
the he will use his authority as a father to intervene.
COPING & STRESS MANAGEMENT/ TOLERANCE PATTERN
The client states the he feels discomfort from his abdominal pain. The client’s father
verbalized that travelling far from home, unable to do his daily activities and being isolated and
stopped from school has been the client’s stress factors. However, the client’s father remarked
that his son has high tolerance from the pain, they would use ointment to help the client relieve
from pain
VALUES/ BELIEFS
The Client is a Roman Catholic. The client stated that he barely attends the church
because of his studies and presently because of his abdominal pain.
PERSONAL/SOCIAL HISTORY

13. Habits: The client is known an athletic student. The client prefers to do anything just to keep
him from being bored. Despite of eating, the client ignores to rest but goes straight from doing
such activities, that may be the reason why the client acquired appendicitis dated on year 2009
Vices: The client stated does not consume alcoholic beverages and does not smoke.
Lifestyle: The client was known to live in an active lifestyle.
Client’s usual daily life: The client’s typical day is studying in school at the morning, and
would plau basketball for his varsity in the afternoons. The patient’s states that his son prefers to
beat home watching television or taking siesta during his free time.
Rank/Order in the family: the Client is ranked as the second son from his 3 siblings.
Travel: The client previous travel was from Zamboanga to Cavite
I. ENVIRONMENTAL HISTORY
The client lives together with his family composed of 5 house hold members. A
bungalow type of house with 209 square meters is owned by the patient residing near the
highway. The client narrated that it is a cemented house with 2 bedrooms and 1 bath
room. The house is fully ventilated and well lit of 12 windows. Their doors for about the
size of 180X1 meter. The client stated that their surroundings are well-sanitized. Their
electricity supply comes from Meralco and their water supply are from Deep well. They
order Mineral water for drinking. The client’s residence is advantageous, since it is near
the public market, transportation, at school and Hospital.
J. PEDIATRIC HISTORY
K. MATERNAL AND BIRTH HISTORY
Birth date: September 2, 1990 Hospital: Not assessed
Birth weight: Unrecalled
Type of delivery: Normal Spontaneous Delivery

14. Condition after birth: In fine stable condition
Mother:
Complications of delivery: None
Anesthesia drug guring labor: Unrecalled
Exposure to Teratogenic Agents during Pregnancy: None

15. PATHOPHYSIOLOGY
MALABSORPTION
(Book Based)
PREDISPOSING PRECIPITATING
FACTORS FACTORS
Age Family history of Intestinal Excessive Alcohol Use of Mineral
Malabsorption Surgery Intake Oil or laxatives
Maldigestion
Inadequate mixing Insufficient digestive Mucosal Problems Bacterial Infections
mediators
Of gastric juices
MALABSORPTION
SYNDROME

16. CONCEPT MAPPING
1. Acute Pain related to
gastrointestinal inflammation as
evidenced by pain scale of 7/10
Malabsorption Syndrome
2. Imbalanced Nutrition
3. Activity Intolerance related
Patient A.D 21 y.o/ Male related to impaired absorption
to failure to nourish muscle
adequately as evidenced by Temp : 37.1°c RR: 18 cpm PR: 105 cpm BP: 100/80mmHg Wt: 32 kg of nutrients from the GI tract
generalized weakness as evidenced by weight loss of
 Facial Grimace
 Painscale of 7/10 48 kg to 32 kg
 Guarding behavior
 Abdominal distention
 Weight loss from 48 kg to 32 kg
 Hypoalbuminemia (2.95 n=3.92-4.94 g/dl)
 Muscle waisting
 Generalized body weakness
 Slow movement
 Slow response
 Inaility to perfrom activities by himself
 Verbal reports of wearines

17. I. PROBLEM LIST
Actual
Problem Number Problem Remarks
Acute Pain related to The client presently complaints of
1 gastrointestinal inflammation as prsistent abdominal pain due to the
evidenced by pain scale of 7/10 inflammation from malabsoprtion.
Pain is prioritized for it is the 5th
vital sign, and knwn to be the
chief complaint likewise.
Imbalanced Nutrition related to The body is unable to absorb the
2 impaired absorption of nutrients nutrients well due to occurence of
from the GI tract as evidenced an imflammed GI tract. Thus, the
by weight loss of 48 kg to 32 kg client is unable to be provided of
proper nutirion approrpiate for his
development thus manifested by
weigh loss
Activity Intolerance related to Due to failure of the client to have
3 failure to nourish muscle adequate nutrition for the body to
adequately as evidenced by recieve it’s energy that is
generalized weakness manifested by generalized
weakness.

18. II. NURSING CARE PLAN
Cues/Needs Nursing Planning Implementation Rationale Evaluation
Diagnosis
Subjective: Acute pain By the end of  Monitored Vital signs q 30 until the Baseline data is important to By the end
“Masakit ang related to 8 hours of patient stable especially respiratory rate help Determine patient’s current of 8 hours of
tsyan ako” as inflammation nursing and blood pressure health status and evaluate nursing
intervention, efficacy of nursing interventions intervention,
verbalized by the and swelling
the rendered the
patient of the liver as Patient will Patient will
evidenced by verbalize a  Assess the patient’s pain by using the 10 The client’s report of pain is the verbalized a
Objective: pain in right decrease in point pain rating scale q4 hrs or PRN single most reliable indicator of decrease in
 Pain Scale of upper pain scale during the 2-10pm shift. pain. pain scale
7/10 quadrant from 6/10 to from 76/10
 Facial grimace 0/10 to 3/10
 Gurading  Performed comprehensive assessment to Pain is a subjective experience
behavior pain include location , characteristic, and must be described by the “Mejo
 With abdominal onset, duration, frequency, client in order to plan effective natitiis ko na
distention quality, intensity or severity treatment yung kirot”
as verbalized
by the patient
 Provided nonpharmacologic pain relief Relaxation techniques decrease
methods, such as breathing exercises, oxygen consumption, respiratory
music therapy, distraction and progressive rate, heart rate, and muscle
relaxation before, after, and if possible tension, which interrupt the
during painful activities. cycle of pain–anxiety–muscle
tension.
 Kept side rails up and bed in low position. To reduce likelihood of falls and
to promote a safe environment.
 Administered Pain medications as ordered To promote pharmacologic
such as Tramadol measures in relieving pain

19. Cues/Needs Nursing Planning Implementation Rationale Evaluation
Diagnosis
Subjective: Imbalanced After 8 hours of Assessed the present weight of the Provides baselinedata about the After 8 hours
“Ang lake na nga Nutrition Nursing client by the use of weighing scale client. of Nursing
ng pinangayat ng related to intervention, the intervention,
anak ko” as impaired client will Determined the client’s attitude towards Psychological factors towards the client
eating. eating may affect one person’s
verbalized by the absorption of demonstrate Participated
appetite and also to know the
patient’s father nutrients from behaviors to client’s eating habits. and
the GI tract as regain and enumerated
Objective: evidenced by maintain proper To promote and sustain Ways to
 Weight loss weight loss of weight Encourged the client tomash the foods adequate nutrition needed by regain and
from 48 kg to 48 kg to 32 kg mechanically and to eat in small the body and minimizing the maintain
32 kg frequent feeding occurance of malabsorption proper
 Hypoalbumine
weight
mia (2.95 Instructed the client to avoid To decrease the likelihood of
n=3.92-4.94 caffeineated beverages like coffee, tea, GI upset
g/dl) softdrinks, chocolates and foods rich in
 Muscle waisting fats To keep the client hydrated and
 Generalized to monitor the fluid intake of
body weakness Monitored and regulated IV fluid patient
To provide pharmacological
Administered medications as ordered means of reducing occurance
of abdominal pain thereby
promoting the patient to eat.
Cues/Needs Nursing Planning Implementation Rationale Evaluation

20. Diagnosis
Subjective: Activity After 8 hours Determine factors contributing to The client marks to have After 8 hours
“Hinang hina ang Intolerance of nursing fatigue pulmonary congestion and under of nursing
pakiramdam ko” as related to intervention, observation to have acute intervention,
verbalized by the failure to the client will coronary syndrome the client
patient nourish participate participated
muscle willingly in Evaluate client’s percieved limitations To provide comparative baseline willingly in
adequately as necessary and by asking past activities and present data and to provide information necessary
Objective: evidenced by desired activities about needed intervention and desired
generalized activities. activities.
 Generalized body weakness Assess cardiopulmonary response to Manifestations results
weakness physical activity, including vital signs intolerance of activity The client
 Slow movement verbalized of
before, during and after activity
 Slow response
incorporating
 Inaility to perfrom
activities by Assist client wit activities when To protect the client from injury such
himself walking to the wash room, getting up in exercises and
 Verbal reports of bed and lying back to bed exposure to
wearines sunlight in
Provide intervals of rest between To minimize occurrences of his daily
activities fatigue living
Encourage and acknowledge the
difficulty of the situatio of the clientHelps to minimize frustration
and rechannel energy
Sunlight is rich in Vitamin D and
Encouraged patient to expose himself in
will help the client to increase
sun light around 7-8 am
vitality
Assist and provide passive and active
To maintain and enhance muscle
ROM
tone of client

21. MEDICAL-SURGICAL MANAGEMENT
i. Pharmacotherapeutics
DRUG NAME CLASSIFICATION INDICATION ACTION SIDE/ADVERSE NURSING PATIENT TEACHING
EFFECTS RESPONSIBILITIES
Hydrocortisone Therapeutic: Management of Supress CNS: depression, _Assess patient for _Instruct patient on correct
Antiasthmatics, adrenocortical inflammation euphoria,headache,increased swigns of adrenal technique of medication
Brand Name: corticosteroids insufficiency; and the normal intracranial pressure insufficiency. administration.
Cortef chronic use in immune (Children only),personality _Monitor intake and _Caution patient to avoid
Dosage: Pharmacologic other situations is response. changes, pyschoses, output ratios and daily vaccinations without first
5 mg I.V q8 Corticosteriods limited because Replacement restlessness weights. Observe consulting health care
(systemic) of theraphy in EENT: cataracts, increased patient for peripheral prifessionals.
mineralocorticoid adrenal intraocular pressure. CV: edema, steady weight _Review side effects with
activity. insufficiency. hypertension GI: Peptic gain, rales/crackles, or patient. Instruct patient to
Ulcer, anorexia, nausea, dyspnea. inform health care
vomitting. Derm: acne, _Children should professional promptly if
decreased wound healing, have periodic severe abdominal pain or tarry
ecchymoses, fragility, evaluation of growth. stools occur. Patient should
hirsutism, petichiae Endo: _Assess involvrd also report unusual swelling,
Adrenal suppresion, systems before and weight gain, and tiredness,
hyperglycemia. Hemat: periodically during bone pain, bruising, none
Thrombophlebitis, Metab: theraphy healing sores, visual
Weight gain MS: Muscle disturbances, or behavior
wasiting. Misc: Cushingoid changes.
apperance

22. DRUG NAME CLASSIFICATION INDICATION ACTION SIDE/ADVERSE NURSING PATIENT TEACHING
EFFECTS RESPONSIBILITIES
hyoscine butylbromide Therapeutic: Paroxysmal pain Acts by Agranulocytosis, _Patients who have Asthma, _Instruct patient to take
Gastro/ in diseases of interfering with pancytopenia. aspirin-induced allergy, and medication exactly as
Brand Name: Antispasmodics stomach & the transmission Bronchospasm, nasal polyps are at increased directed. Take missed dose
Buscopan Pharmacologic: intestine. Spastic of nerve Constipation, dry risk for developing as soon as remembered if
Dosage: Pyrroziline pain & functional impulses by mouth, trouble hypersensitivity reactions. not almost time for next
5 mg I.V q8 carboxylic acid disorders in acetylcholine in urinating, nausea, fast Assess for rhinitis, asthmas dose. Do not double dose
biliary & urinary the heart rate and urticaria _Instruct Patient to notify
tracts, female parasympathetic _Assess pain (note type, health
genital organs nervous system location, and intensity) prior Health care professional if
(specifically the to 1 -2 hr following allergic reactions occurred
vomiting center). administration (rash, pruritus, laryngeal
_Evaluate liver function edema, wheezing).
tests, especially AST and _Ask for your doctor's
ALT, periodically in patients advice if you are
receiving prolonged therapy. breastfeeding or likely to
May cause inccreased levels breastfeed during the
_May cause prolonged course of your medication
bleeding time that may persist _Special care is
for 24-48 hour following recommended during
discontinuation of therapy pregnancy, particularly in
_May cause increased BUN, the first three months.
serum, creatinine or Ask for your doctor's
potassium concentrations advice if you are pregnant,
or likely to become
pregnant during your
course of medication.

23. DRUG NAME CLASSIFICATION INDICATION ACTION SIDE/ADVERSE NURSING PATIENT TEACHING
EFFECTS RESPONSIBILITIES
Prednisone Therapeutic: Paroxysmal pain in Acts by Agranulocytosis, _Patients who have _Instruct patient to take
Gastro/ diseases of stomach interfering with pancytopenia. Asthma, aspirin-induced medication exactly as
Brand Name: Antispasmodics & intestine. Spastic the transmission Bronchospasm, allergy, and nasal polyps are directed. Take missed dose as
Buscopan Pharmacologic: pain & functional of nerve impulses Constipation, dry at increased risk for soon as remembered if not
V q8 Pyrroziline disorders in biliary & by acetylcholine mouth, trouble developing hypersensitivity almost time for next dose. Do
carboxylic acid urinary tracts, female in the urinating, nausea, reactions. Assess for not double dose
genital organs parasympathetic fast heart rate rhinitis, asthmas and _Instruct Patient to notify
nervous system urticaria health
(specifically the _Assess pain (note type, Health care professional if
vomiting center). location, and intensity) prior allergic reactions occurred
to 1 -2 hr following (rash, pruritus, laryngeal
administration edema, wheezing).
_Evaluate liver function _Ask for your doctor's
tests, especially AST and advice if you are
ALT, periodically in breastfeeding or likely to
patients receiving prolonged breastfeed during the course
therapy. May cause of your medication
inccreased levels _Special care is
_May cause prolonged recommended during
bleeding time that may pregnancy, particularly in the
persist for 24-48 hour first three months.
following discontinuation of Ask for your doctor's advice
therapy if you are pregnant, or likely
_May cause increased to become pregnant during
BUN, serum, creatinine or your course of medication.
potassium concentrations

24. DRUG NAME CLASSIFICATION INDICATION ACTION SIDE/ADVERSE NURSING PATIENT TEACHING
EFFECTS RESPONSIBILITIES
Pantoprazole Therapeutic: Paroxysmal pain in Acts by Agranulocytosis, _Patients who have _Instruct patient to take
Gastro/ diseases of stomach interfering with pancytopenia. Asthma, aspirin-induced medication exactly as
Brand Name: Antispasmodics & intestine. Spastic the transmission Bronchospasm, allergy, and nasal polyps directed. Take missed dose as
Buscopan Pharmacologic: pain & functional of nerve impulses Constipation, dry are at increased risk for soon as remembered if not
V q8 Pyrroziline disorders in biliary & by acetylcholine mouth, trouble developing hypersensitivity almost time for next dose. Do
carboxylic acid urinary tracts, female in the urinating, nausea, reactions. Assess for not double dose
genital organs parasympathetic fast heart rate rhinitis, asthmas and _Instruct Patient to notify
nervous system urticaria health
(specifically the _Assess pain (note type, Health care professional if
vomiting center). location, and intensity) allergic reactions occurred
prior to 1 -2 hr following (rash, pruritus, laryngeal
administration edema, wheezing).
_Evaluate liver function _Ask for your doctor's advice
tests, especially AST and if you are breastfeeding or
ALT, periodically in likely to breastfeed during the
patients receiving course of your medication
prolonged therapy. May _Special care is
cause inccreased levels recommended during
_May cause prolonged pregnancy, particularly in the
bleeding time that may first three months.
persist for 24-48 hour Ask for your doctor's advice if
following discontinuation you are pregnant, or likely to
of therapy become pregnant during your
_May cause increased course of medication.
BUN, serum, creatinine or
potassium concentrations

25. DRUG NAME CLASSIFICATION INDICATION ACTION SIDE/ADVERSE NURSING PATIENT TEACHING
EFFECTS RESPONSIBILITIES
Tramadol Therapeutic: Paroxysmal pain in Acts by Agranulocytosis, _Patients who have _Instruct patient to take
Gastro/ diseases of stomach interfering with pancytopenia. Asthma, aspirin-induced medication exactly as
Brand Name: Antispasmodics & intestine. Spastic the transmission Bronchospasm, allergy, and nasal polyps directed. Take missed dose as
Buscopan Pharmacologic: pain & functional of nerve impulses Constipation, dry are at increased risk for soon as remembered if not
V q8 Pyrroziline disorders in biliary by acetylcholine mouth, trouble developing hypersensitivity almost time for next dose. Do
carboxylic acid & urinary tracts, in the urinating, nausea, reactions. Assess for not double dose
female genital parasympathetic fast heart rate rhinitis, asthmas and _Instruct Patient to notify
organs nervous system urticaria health
(specifically the _Assess pain (note type, Health care professional if
vomiting center). location, and intensity) allergic reactions occurred
prior to 1 -2 hr following (rash, pruritus, laryngeal
administration edema, wheezing).
_Evaluate liver function _Ask for your doctor's advice
tests, especially AST and if you are breastfeeding or
ALT, periodically in likely to breastfeed during the
patients receiving course of your medication
prolonged therapy. May _Special care is
cause inccreased levels recommended during
_May cause prolonged pregnancy, particularly in the
bleeding time that may first three months.
persist for 24-48 hour Ask for your doctor's advice if
following discontinuation you are pregnant, or likely to
of therapy become pregnant during your
_May cause increased course of medication.
BUN, serum, creatinine or
potassium concentrations

26. DISCHARGE HEALTH TEACHING
Content Strategy
M-medication To adhere in prescribed  Instruct patient to take the prescribed
therepautic regimen for medications as ordered by the physician.
health maintainance and  Instruct patient to avoid taking OTC drugs
resistance. unless given with medical advice
 Assist patient in performing passive ROM
E-exercise To promote a healthy exercises to maintain muscle tone and increase
lifestyle, maximizing the blood circulation.
level of health and increase  Provide schedules of minimal activites tolerable
the body’s immunity. by the patient to incease self-reliance.
T-treatment Attending the follow up  Educate client by adhering maintainance
check up. theraphy.
 Teach patient of non-pharmacological treatment
Health teaching about the for occurences of abdominal pain such as deep
H-health disease, exercise and diet. breathing exercises, plinting with a pillow,
teaching applying warm compress, and utilizing
diversional activitities
 Encourage patient to expose self from the sun
early morning for good source of Vitamin D
Instruct that they need to
O-OPD have a health check up.  Emphasize the importance of adhering to
medications and attending follow-up check up.
Maintain and ensure  Instruct patient to avoid consumption highly
D-diet adequate intake for seasoned foods, high in salt, fath, caffeneited
noursihment, beverages, and chocolates
 Instructed patient to mash the foods well and eat
in small frequent feeding to reduce likelihood of
gastric upset
 Encourage patient to drink energy drink as
adjuct supplement from client’s undernutrition
S-signs and If any signs of symptoms are  Advise patient to refer to health care
symptoms present go to the nearest professional for persistence of abdominal pain,
hospital for check up. fever, vomitting, diarhea, and occurence of
black stools.

27. III. ONGOING APPRAISAL
Patient A.D a 21 year old male, has been admitted to St, Dminic Medical Center last December
14,2011 with a chief complaint of abdominal pain. Hence was admitted with initial diagnosis of
to consider colon cancer and and hooked of D5 NSS 1 L X 8 hr. Vital signs shows Temp :
37.1°c RR: 18 cpm PR: 105 cpm BP: 100/80mmHg Wt: 32 kg
Patient was orderd for Albumin Test and ordered medication of Hyrocortisone 100 mg TIV,
Buscopan 1 amp TIV q* RTC, Prednisone 250 mg/ Tab BID PO, Pantoprazole 40 mg 1 tab OD
PO and Tramadol 50 mg TIV q8.
Preesently, a final diagnosis of Malabsorption Syndrome was confirmed and the client is still
undergoing treatment, the client’s latest vital signs of Temp.: 37.5°c RR: 19cpm PR: 86 cpm
BP: 100/70mmHg. And for endoscopy