178423280 pt bcase-1

Get Homework/Assignment Done
Homeworkping.com
Homework Help
https://www.homeworkping.com/
Research Paper help
Online Tutoring
click here for freelancing tutoring sites
INTRODUCTION
UPPER GASTROINTESTINAL BLEEDING
Upper gastrointestinal (GI) bleeding refers to hemorrhage in the upper gastrointestinal tract.
The anatomic cut-off for upper GI bleeding is the ligament of Treitz, which connects the fourth
portion of the duodenum to the diaphragm near the splenic flexure of the colon.
Presentation
Patients with upper GI hemorrhage often present with hematemesis, coffee ground
vomiting, melena, or hematochezia (maroon coloured stool) if the hemorrhage is severe. The
presentation of bleeding depends on the amount and location of hemorrhage.

Patients may also present with complications of anemia, including chest
pain, syncope, fatigue and shortness of breath.
Causes
Upper gastrointestinal bleeding: Upper GI bleeding originates in the first part of the GI tract-
the esophagus, stomach, or duodenum (first part of the small intestine). Most often, upper GI
bleeding is caused by one of the following:
 Peptic ulcers
 Gastritis
 Esophageal varices
 Mallory-Weiss tears
 Gastrointestinal cancers
 Inflammation of the gastrointestinal lining from ingested materials
Peptic ulcer disease: Peptic ulcers are localized erosions of the mucosal lining of the digestive
tract. Ulcers usually occur in the stomach or duodenum. Breakdown of the mucosal lining results
in damage to blood vessels, causing bleeding.
Gastritis: General inflammation of the stomach lining, which can result in bleeding. Gastritis also
results from an inability of the gastric lining to protect itself from the acid it produces. NSAIDs
(nonsteroidal anti-inflammatory drugs), steroids, alcohol, burns, and trauma can cause gastritis.
Esophageal varices: Swelling of the veins of the esophagus or stomach usually resulting from
liver disease. Varices most commonly occur in alcoholic liver cirrhosis. When varices bleed, the
bleeding can be massive, catastrophic and occur without warning.
Mallory-Weiss tear: A tear in the esophageal or stomach lining, often as a result of vomiting or
retching. Mucosal tears also can occur after seizures, forceful coughing or laughing, lifting,
straining, or childbirth. Physicians often find tears in people who have recently binged on
alcohol.
Cancer: One of the earliest signs of esophageal or stomach cancers may be blood in the vomit or
stool.
Inflammation: when the mucous membranes break down, they are unable to counteract the
harsh effects of stomach acid. Nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, alcohol,
and cigarette smoking promote gastric ulcer formation. Helicobacter pylori are a type of bacteria
that also promotes formation of ulcers.
Gastrointestinal Bleeding Symptoms

Acute gastrointestinal bleeding first will appear as vomiting of blood, bloody bowel movements,
or black, tarry stools. Vomited blood may look like "coffee grounds." Symptoms associated with
blood loss can include:
 Fatigue
 Weakness
 Shortness of breath
 Abdominal pain
 Pale appearance
 Vomiting of blood usually originates from an upper GI source.
 Bright red or maroon stool can be from either a lower GI source or from brisk bleeding
from an upper GI source.
 Long-term GI bleeding may go unnoticed or may cause fatigue, anemia, black stools, or
a positive test for microscopic blood.
Diagnosis
The diagnosis of upper GI bleeding is assumed when hematemesis is documented. In the
absence of hematemesis, an upper source for GI bleeding is likely in the presence of at least
two factors among: black stool, age < 50 years, and blood urea nitrogen/creatinine ratio 30 or
more. In the absence of these findings, consider a nasogastric aspirate to determine the source
of bleeding. If the aspirate is positive, an upper GI bleed is greater than 50%, but not high
enough to be certain. If the aspirate is negative, the source of a GI bleed is likely lower. The
accuracy of the aspirate is improved by using the Gastroccult test.

PATIENT’S PROFILE
Name : H.Y.I
Age : 68 years old
Gender : Male
Birthday : November 06, 1944
Address : San Pedro, Laguna
Religion : Roman Catholic
Nationality : Filipino
Civil Status : Married
Occupation : Retired Real Estate Broker
Admitting Date : November 13, 2012
Admitting Time : 12:09pm
Attending Physician : Dr. CF
Final Diagnosis : Upper Gastrointestinal Bleeding, Pulmonary
Tuberculosis ongoing treatment
Chief complaint : Weakness and Difficulty of Breathing
Vital Signs upon Admission
Blood Pressure : 140/80 mmHg
Respiratory Rate : 38 cpm
Pulse Rate : 102 bpm
Temperature : 37.2 ˚C

PATIENT’S HISTORY
General Data
This is a case of H.Y.I., 65 years of age, male, catholic, Filipino, presently residing at San
Pedro, Laguna, admitted for the first time in this institution, on November 13, 2012 at 12:09 in
the afternoon.
Chief complaint: Difficulty of Breathing
History of Present Illness:
Twenty seven days prior to admission, the patient was admitted in Asian hospital due to DOB,
weakness, and persistent fever, history for gastritis, pneumonia, PTB, COPD, DM2, he was
discharged improved EGD done, given Myrine P. Forte, Seretide, but mark only 7 days patient’s
condition return the same with weakness, medications are continued until 4 days prior to
confinement, he was brought for consult at their family physician where he prescribed
Clindamycin, Myrine P. Forte and salbutamol neb.
One day prior to confinement (+) vomiting of coffee ground material, stool looked to be black
and tarry, he was now with distress and (+) DOB when being seated
Past Medical History:
(+) Hospitalization on Oct 20, 2012
 Gastritis
 Pneumonia
 PTB
 COPD
 DM type 2
 Myeloproliferative Disease
Diagnosis: Gastritis, Asthma
Personal and Social History:
 (+) smoker for 25 pack years, stopped at the age of 40
 (-) drinker of any alcoholic beverages
Family History:
The patient has a no history of DM, HPN, asthma, cancer, heart disease, lung disease,
and kidney disease.

PHYSICAL ASSESSMENT
ACTUAL FINDINGS NORMAL FINDINGS
VS: BP – 140/80 PR- 102 RR – 38 T- 37.2 C O2 sat- 98%
 Head
 Skull
 Scalp
 Hair
 Face
 Eyes
 Eyebrows
 Eyelashes
 Eyelids
- Normocephalic
- No lumps
- No nits, lice and dandruff
- No baldness
- Straight, black with white hair,
oily hair
- Symmetrical with movement
- Expressions appropriate to
situations
- Symmetrical
- No cloudiness
- No Lacrimation
- Symmetrical
- Equally distributed
- Curved slightly outward
- Skin intact
- Normocephalic
- Smooth
- No lumps
- Absence of modules or masses
- No area of tenderness
- Symmetrical with protrusions
on the lateral part of parietal
forehead and occipital bone.
- Whitish
- No nits, lice and dandruff
- No baldness
- Black or brown in color
- Hair is evenly distributed
- No area of baldness
- Thick
- Fine
- Curly/kinky/straight
- Dry/oily/shiny hair
- Symmetrical with movement
- Expressions appropriate to
situations
- Symmetrical
- No protrusions
- Dear or no Cloudiness
- No excessive Lacrimation
- Moves symmetrically
- Hair evenly distributed
- Skin Intact
- Equally distributed
- Curved slightly outward
- Skin intact

 Lid margins
 Lower palpebral
conjunctiva
 Sclera
 Iris
 Pupils
 Eye Movement
 Field of vision
*Visual acuity
 Ear
- No discharge
- No discoloration
- Lids close symmetrically
- Approximately 15-20
involuntary blinks per minute;
bilateral blinking
- No secretions
- No erythema
- No redness
- Pink, shiny, with visible blood
vessels
- No discharges
- White in color
- Clear
- No redness
- Flat
- Brown
- Round
- Transparent/Shiny
- PERRLA
- Moves in unison
- coordinated
?
- Same as the color of the face
- No discharge
- No discoloration
- Lids close symmetrically
- Approximately 15-20
involuntary blinks per minute;
bilateral blinking
- No scaling
- No secretions
- No erythema
- No redness
- Pink, shiny, with visible blood
vessels
- No discharges
- White/yellowish in black
Americans
- Clear, no cloudiness
- No redness
- Flat
- Brown
- Even coloration
- Symmetrical
- Round
- Transparent/Shiny
- PERRLA(Pupils Equally Round,
Reactive to Light &
Accommodation
- Moves in unison
- Coordinated
- Good peripheral vision
- 20/20 in both eyes
- Parallel with outer canthus of
the eyes
- Same as the color of the face

 Ear Canal
 Hearing acuity
 Nose
 Lips
 Gums
 Teeth
 Tongue
 Frenulum
- No swelling
- Waxy cerumen
- Presence of cilia
- With good hearing acuity in
both ears
- No lesions
- Presence of cilia
- Darker lips
- Ability to purse lips
- Dry
- Pink, dry
- No swelling
- No tenderness
- No discharges
- Yellowish, 29 in number
- Pink, even, rough dorsal
surface and dry
- Midline
- No swelling
- No tenderness
- Firm cartilage
- Yellowish
- Dry/waxy cerumen
- Presence of cilia
- No foreign body
- With good hearing acuity in
both ears
- Symmetric and straight
- No discharge or flaring
- Uniform color
- No tenderness
- No lesions
- Presence of cilia
- Uniform pink color(darker, e.g,
Bluish hue, in Mediterranean
groups and dark-skinned clients)
- Soft, moist, smooth texture
- Symmetry of contour
- Ability to purse lips
- No tenderness
- Pink, moist
- No swelling
- No tenderness
- No discharges
- No retraction(lower and upper)
- 32 in number
- White
- Upper teeth over-rides lower
teeth
- Pink, even, rough dorsal
surface and moist
- Midline

 Soft Palate
 Hard Palate
 Uvula
 Tonsils
 Neck
 Upper Extremities
 Skin
 Hair
 Nails
- Pinkish
- With visible veins
- Pink, dry, no swelling/no
tenderness
-Bony, light pink in color, dry
-Midline moves when the client
says “Aah”
- Pinkish
- No discharge
- No inflammation
- Same as the skin color
- No lymphs, No mass
- Pale in color, sag and wrinkled
- No abrasions or other lesions
- Black in color, evenly
distributed, dandruff noted
- Nails appeared thickened,
- Pinkish
- With visible veins
- Pink, moist, no swelling/no
tenderness
-Bony, Llght pink in color, moist
-Pink, moist
-Midline moves when the client
says “Aah”
- Pinkish
- No discharge
- No inflammation
- Erect & midline
- Same as the skin color
- No tenderness
- No lymphs, No mass
- Symmetrical
- Muscles equal in size; head
centered
- Coordinated, smooth
movements with no discomfort
- Varies from light to deep
brown; from ruddy pink to light
pink; from yellow overtones to
olive
- No edema
- Freckles, some birthmarks,
some flat and raised nevi
- When pinched, skin springs
back to previous state
- Convex curvature

 Chest and back
 Posterior
Thorax
 Anterior Thorax
 Abdomen
dirty, yellow in color, > 2
capillary refill
- No tenderness
- No masses
- Full expansion
- Tachypnea
- Unblemished skin
- Uniform color
- Smooth texture
- Highly vascular and pink in
light-skinned clients; dark-
skinned clients may have brown
or black pigmentation in
longitudinal streaks
- Intact epidermis
- Prompt return of pink or usual
color(generally less than 4
seconds)
- Chest symmetric
- Skin Intact; uniform
temperature
- Chest wall intact
- No tenderness
- No masses
- Full and symmetric chest
expansion
- Vesicular and bronchovesicular
sounds
- Quiet, rhythmic, and effortless
respirations
- Full symmetric excursion
- Bronchial and tubular breath
sounds in the trachea
- Vesicular and bronchovesicular
breath sounds
- Unblemished skin
- Uniform color
- Silver-white striae or surgical
scars
- Flat, rounded(convex),or
scaphoid (concave)
- Symmetric movements caused
by respiration
- Audible bowel sounds
- No tenderness
- Relaxed abdomen with
smooth, consistent tension

 Lower extremities
 Skin
 Nails
 Motor
functions:
- Brown in color
- Nails appeared thickened,
dirty, yellow in color, > 2
capillary refill
- Repeatedly and rhythmically
touches the nose
- Rapidly touches each finger to
thumb with each hand
- Can readily determine the
position of fingers and toes
- Varies from light to deep
brown; from ruddy pink to light
pink; from yellow overtones to
olive
- No edema
- Freckles, some birthmarks,
some flat and raised nevi
- when pinched, skin springs
back to previous state
- Concave curvature
- Smooth texture
- highly vascular and pink in
light-skinned clients; dark-
skinned clients may have brown
or black pigmentation in
longitudinal streaks
- Intact epidermis
- Prompt return of pink or usual
color (generally less than 4
seconds)
- Has upright posture and steady
gait with opposing arm swing;
walks unaided, maintaining
balance
- May sway slightly but is able to
maintain upright posture and
foot stance.
- Maintain stance for at least 5
seconds
- Maintains heel-toe walking
along straight line
- Repeatedly and rhythmically
touches the nose
- Rapidly touches each finger to
thumb with each hand
- Can readily determine the
position of fingers and toes

Anus and Rectum -Anal opening appear hairless,
moist, and tightly closed, no
redness and swelling noted
- Black stool noted (melena)
about 6 diapers soaked

ANATOMY & PHYSIOLOGY
Anatomy is the scientific discipline that investigates the structure of the body. The word
“anatomy” means to dissect, or cut apart and separate, the parts of the body for study while
physiology is the scientific discipline that deals with the processes or functions of living things.
UPPER GASTROINTESTINAL TRACT
The gastrointestinal (GI), or digestive, tract
extends from mouth to anus. The division of the
GI tract into upper and lower is a matter of
some confusion and debate. On embryologic
grounds, the GI tract should be divided into
upper (mouth to major papilla in the
duodenum), middle (papilla to mid-transverse
colon), and lower (mid-transverse colon to
anus) according to the derivation of these 3
areas from the foregut, midgut, and hindgut,
respectively.
Nevertheless, the GI tract is conventionally
divided into upper (mouth to ileum) and lower
(cecum to anus). From the point of view of GI
bleeding, however, the demarcation between
the upper and lower GI tract is the
duodenojejunal (DJ) junction; bleeding above
the DJ junction is called upper GI bleeding, and that below the DJ junction is called lower GI
bleeding.
For the purposes of endoscopy, the upper GI tract includes the esophagus, stomach and
duodenum (esophagogastroduodenoscopy [EGD] or upper GI endoscopy), and the lower GI
tract includes the anus, rectum, colon, and cecum (anoproctocolonoscopy or lower GI
endoscopy)
Mouth, oral cavity, and pharynx
The mouth leads to the oral cavity, which has a vestibule lying between the lips, the cheeks and
gums (gingivae), and the teeth. The main oral cavity also lies between the hard and soft palate
above, the tongue below, and the alveoli and teeth. The oral cavity leads to the pharynx
through the fauces, which contain pharyngeal tonsils (adenoids) and palatine tonsils. Salivary
glands (parotid, submandibular, and sublingual) open into the oral cavity.
The pharynx extends from the base of the skull above to the cricoid cartilage (at the level of C6)
below. It has 3 parts: the nasopharynx (from the base of the skull above to the soft palate
below), the oropharynx (from the soft palate above to the hyoid bone below), and the
laryngopharynx (from the hyoid bone above to the cricoid cartilage below). The nasal cavity,

oral cavity, and larynx open into the nasopharynx, oropharynx, and laryngopharynx,
respectively. The laryngopharynx also has a piriform fossa on either side.
Esophagus
The esophagus (gullet) is one of the few organs traversing 3 regions of the body--namely, the
neck, thorax, and abdomen. Accordingly, it is divided into 3 parts: cervical, thoracic, and
abdominal. The esophagus is a 25-cm-long vertical muscular tube that which normally remains
collapsed and that runs from the laryngopharynx (throat or hypopharynx) in the neck through
the thorax (chest) to the stomach in the abdomen.
The cervical esophagus begins at the lower border of the cricoid cartilage (at the level of C6); it
is very short (only 5 cm long) and lies in front of C6 and C7 (covered with prevertebral fascia),
slightly to the left of the midline. In the neck, the esophagus, along with the trachea (in front of
the esophagus) and the thyroid (covering the trachea and the esophagus), is enclosed in a
sheath of visceral (deep cervical) fascia.
The carotid sheath (containing the common carotid artery, internal jugular vein, and vagus
nerve) is on the side of the esophagus; the recurrent laryngeal nerves lie in the
tracheoesophageal grooves, and the thoracic duct is to the left of the esophagus.
The cervical esophagus continues as the thoracic esophagus at the suprasternal notch. In the
superior mediastinum, the esophagus continues to run in front of the vertebral column and
behind the trachea and lies behind the aortic arch and to the right of the descending thoracic
aorta. The azygos vein crosses the esophagus on the right.
In the posterior mediastinum, the esophagus continues behind the left main bronchus and right
pulmonary artery and comes to lie in front of the descending thoracic aorta at the esophageal
hiatus of the diaphragm; the thoracic duct lies behind it in the posterior mediastinum and to its
left in the superior mediastinum. Mediastinal pleurae lie laterally, and the pericardial sac lies
anterior to the esophagus.
The thoracic esophagus enters the abdomen via the esophageal hiatus in the diaphragm at the
level of T10 (see the image below) and has a small (2-3 cm) intra-abdominal length. The
esophagogastric junction (cardia), therefore, lies in the abdomen below the diaphragm to the
left of the midline at the level of T11.
Stomach
The cardiac notch (incisura cardiaca gastri) is the acute angle between the intra-abdominal
esophagus and the gastric fundus (the part of the stomach above a horizontal line drawn from
the cardia). The body (corpus) of the stomach leads to the pyloric antrum (at the incisura
angularis), which joins the duodenum at the pylorus, lying at the L1-L2 level (transpyloric plane)
to the right of the midline.

Duodenum
The duodenum has 4 parts: superior, descending, horizontal, and ascending.
The first (superior) part, or bulb (5 cm), is connected to the undersurface of the liver (porta
hepatis) by the hepatoduodenal ligament (HDL), which contains the proper hepatic artery,
portal vein, and common bile duct (CBD); the quadrate lobe of the liver and gallbladder are in
front, and the CBD), portal vein, and gastroduodenal artery (GDA) are behind.
The second (descending) part, or C loop (10 cm), which has an upper and a lower genu (flexure),
is composed of the transverse mesocolon and colon in front and the right kidney and inferior
vena cava (IVC) behind; the head of the pancreas lies in the concavity of the C.
The third (horizontal) part (7.5 cm) runs from right to left in front of the inferior vena cava (IVC)
and aorta, with superior mesenteric vessels (the vein on the right and the artery on the left) in
front.
The fourth (ascending) part (2.5 cm) continues as the jejunum. The duodenum continues into
the jejunum at the duodenojejunal flexure.
The rest of the small bowel is a convoluted tube about 4-6 m long that occupies the center of
the abdomen and the pelvis, surrounded on 2 sides and above by the colon. The ileum
continues into the large intestine at the ileocecal junction.
Gastrointestinal physiology
Gastrointestinal physiology is a branch of human physiology addressing the physical function
of the gastrointestinal (GI) system. The major processes occurring in the GI system are that of
motility, secretion, regulation, digestion and circulation. The function and coordination of each
of these actions is vital in maintaining GI health, and thus the digestion of nutrients for the
entire body.
Motility
The GI tract generates motility using smooth muscle subunits linked by gap junctions. These
subunits fire spontaneously in either a tonic or a phasic fashion. Tonic contractions are those
contractions that are maintained from several minutes up to hours at a time. These occur in the
sphincters of the tract, as well as in the anterior stomach. The other type of contractions, called
phasic contractions, consist of brief periods of both relaxation and contraction, occurring in the
posterior stomach and the small intestine, and are carried out by the muscularis externa.

Stimulation
The stimulation for these contractions likely originates in modified smooth muscle cells called
interstitial cells of Cajal. These cells cause spontaneous cycles of slow wave potentials that can
cause action potentials in smooth muscle cells. They are associated with the contractile smooth
muscle via gap junctions. These slow wave potentials must reach a threshold level for the
action potential to occur, whereupon Ca2+ channels on the smooth muscle open and an action
potential occurs. As the contraction is graded based upon how much Ca2+ enters the cell, the
longer the duration of slow wave, the more action potentials occur. This in turn results in
greater contraction force from the smooth muscle. Both amplitude and duration of the slow
waves can be modified based upon the presence of neurotransmitters, hormones or other
paracrine signaling. The number of slow wave potentials per minute varies based upon the
location in the digestive tract. This number ranges from 3 waves/min in the stomach to 12
waves/min in the intestines.
Contraction Patterns
The patterns of GI contraction as a whole can be divided into two distinct patterns, peristalsis
and segmentation. Occurring between meals, the migrating motor complex is a series of
peristaltic wave’s cycles in distinct phases starting with relaxation followed by an increasing
level of activity to a peak level of peristaltic activity lasting for 5–15 minutes.This cycle repeats
every 1.5–2 hours but is interrupted by food ingestion. The role of this process is likely to clean
excess bacteria and food from the digestive system.
Peristalsis
Peristalsis Animation
Peristalsis is one of the patterns that occur during and
shortly after a meal. The contractions occur in wave
patterns traveling down short lengths of the GI tract
from one section to the next. The contractions occur
directly behind the bolus of food that is in the system,
forcing it toward the anus into the next relaxed section of
smooth muscle. This relaxed section then contracts,
generating smooth forward movement of the bolus at
between 2–25 cm per second. This contraction pattern
depends upon hormones, paracrine signals, and the
autonomic nervous system for proper regulation.
Segmentation
Segmentation also occurs during and shortly after a
meal within short lengths in segmented or random patterns along the intestine. This process is

carried out by longitudinal muscles relaxing while circular muscles contract at alternating
sections thereby mixing the food. This mixing allows food and digestive enzymes to maintain a
uniform composition, as well as to ensure contact with the epithelium for proper absorption.
Secretion
Every day, seven liters of fluid are secreted by the digestive system. This fluid is composed of
four primary components: ions, digestive enzymes, mucus, and bile. About half of these fluids
are secreted by the salivary glands, pancreas, and liver, which compose the accessory organs
and glands of the digestive system. The rest of the fluid is secreted by the GI epithelial cells.
Ions
The largest component of secreted fluids is ions and water, which are first secreted and then
reabsorbed along the tract. The ions secreted primarily consist of H+, K+, Cl-, HCO3
- and Na+.
Water follows the movement of these ions. The GI tract accomplishes this ion pumping using a
system of proteins that are capable of active transport, facilitated diffusion and open channel
ion movement. The arrangement of these proteins on the apical and basolateral sides of the
epithelium determines the net movement of ions and water in the tract.
H+ and Cl- are secreted by the parietal cells into the lumen of the stomach creating acidic
conditions with a low pH of 1. H+ is pumped into the stomach by exchanging it with K+. This
process also requires ATP as a source of energy; however, Cl- then follows the positive charge in
the H+ through an open apical channel protein.
HCO3
- secretion occurs to neutralize the acid secretions that make their way into the duodenum
of the small intestine. Most of the HCO3
- comes from pancreatic acinar cells in the form of
NaHCO3 in an aqueous solution.This is the result of the high concentration of both HCO3
- and
Na+ present in the duct creating an osmotic gradient to which the water follows.
Digestive Enzymes
The second vital secretion of the GI tract is that of digestive enzymes that are secreted in the
mouth, stomach and intestines. Some of these enzymes are secreted by accessory digestive
organs, while others are secreted by the epithelial cells of the stomach and intestine. While
some of these enzymes remain embedded in the wall of the GI tract, others are secreted in an
inactive proenzyme form. When these proenzymes reach the lumen of the tract, a factor
specific to a particular proenzyme will activate it. A prime example of this is pepsin, which is
secreted in the stomach by chief cells. Pepsin in its secreted form is inactive (pepsinogen).
However, once it reaches the gastic lumen it becomes activated into pepsin by the high H+
concentration, becoming an enzyme vital to digestion. The release of the enzymes is regulated
by neural, hormonal, or paracrine signals. However, in general, parasympathetic stimulation
increases secretion of all digestive enzymes.

Mucus
Mucus is released in the stomach and intestine, and serves to lubricate and protect the inner
mucosa of the tract. It is composed of a specific family of glycoproteins termed mucins and is
generally very viscous. Mucus is made by two types of specialized cells termed mucus cells in
the stomach and goblet cells in the intestines. Signals for increased mucus release include
parasympathetic innervations, immune system response and enteric nervous system
messengers.
Bile
Bile is secreted into the duodenum of the small intestine via the common bile duct. It is
produced in liver cells and stored in the gall bladder until release during a meal. Bile is formed
of three elements: bile salts, bilirubin and cholesterol. Bilirubin is a waste product of the
breakdown of hemoglobin. The cholesterol present is secreted with the feces. The bile salt
component is an active non-enzymatic substance that facilitates fat absorption by helping it to
form an emulsion with water due to its amphoteric nature. These salts are formed in the
hepatocytes from bile acids combined with an amino acid. Other compounds such as the waste
products of drug degradation are also present in the bile.
Regulation
The digestive systemhas a complex system of motility and secretion regulation which is vital for
proper function. This task is accomplished via a system of long reflexes from the central
nervous system (CNS), short reflexes from the enteric nervous system (ENS) and reflexes from
GI peptides working in harmony with each other.
Long Reflexes
Long reflexes to the digestive system involve a sensory neuron sending information to the
brain, which integrates the signal and then sends messages to the digestive system. While in
some situations, the sensory information comes from the GI tract itself; in others, information
is received from sources other than the GI tract. When the latter situation occurs, these
reflexes are called feed forward reflexes. This type of reflex includes reactions to food or danger
triggering effects in the GI tract. Emotional responses can also trigger GI response such as the
butterflies in the stomach feeling when nervous. The feed forward and emotional reflexes of
the GI tract are considered cephalic reflexes.
Short Reflexes
Control of the digestive system is also maintained by ENS, which can be thought of as a
digestive brain that can help to regulate motility, secretion and growth. Sensory information
from the digestive system can be received, integrated and acted upon by the enteric system

alone. When this occurs, the reflex is called a short reflex. Although this may be the case in
several situations, the ENS can also work in conjunction with the CNS; vagal afferents from the
viscera are received by the medulla, efferents are affected by the vagus nerve. When this
occurs, the reflex is called vagovagal reflex. The Myenteric plexus and Submucosal plexus are
both located in the gut wall and receive sensory signals from the lumen of the gut or the CNS.
GI peptides
GI peptides are signal molecules that are released into the blood by the GI cells themselves.
They act on a variety of tissues including the brain, digestive accessory organs, and the GI tract.
The effects range from excitatory or inhibitory effects on motility and secretion to feelings of
satiety or hunger when acting on the brain. These hormones fall into three major categories,
the gastrin and secretin families, with the third composed of all the other hormones unlike
those in the other two families. Further information on the GI peptides is summarized in the
table below.
RESPIRATORY SYSTEM
Breathing is necessary because all living cells of the body require oxygen and produce
carbon dioxide. The respiratory system allows the exchange of these gases between the air and
the blood. And the cardiovascular system transports them between the lungs and the cells of
the body. The capacity to carry out normal activity is reduced without healthy respiratory and
cardiovascular systems.
Function:
1. Gas Exchange. The respiratory system allows oxygen from the air to enter the blood and
carbon dioxide to leave the blood and enter the air. The cardiovascular system
transports oxygen from the lungs to the cells of the body and carbon dioxide from the
cells of the body to the lungs. Thus, the respiratory and cardiovascular systems work
together to supply oxygen to all cells and to remove carbon dioxide.
2. Regulation of blood pH. The respiratory system can alter blood pH by changing blood
carbon dioxide levels.
3. Voice Production. Air movement past the vocal folds makes sound and speech possible.
4. Olfaction. The sensation of smell occurs when airborne molecules are drawn into the
nasal cavity.
5. Protection. The respiratory system provides protection against some microorganisms by
preventing their entry into the body and by removing them from the respiratory
surfaces.

Upper Respiratory system
The upper respiratory system consists of the nostrils (external nares), nasal cavity, nasal
vestibule, nasal septum, both hard and soft palate, nasopharynx, pharynx, larynx and
trachea. Within the nostrils, course hairs protect us from dust, insects and sand. The
hard palate serves to separate the oral and nasal cavities. There is a protective mucous
membrane that lines the naval cavities and other parts of the respiratory tract. It is
secreted over the exposed surfaces and then the cilia sweep that mucus and any
microorganisms or debris to the pharynx, so it is swallowed and then destroyed in
stomach acids.
Lower Respiratory system
The trachea branches off into what is known as the bronchi (more commonly called
bronchial tubes). These two main bronchi have branches forming the bronchial tree.
Where it enters the lung, there is then secondary bronchus. In each lung, the secondary
bronchi divide into tertiary bronchi and in turn these divide repeatedly into smaller
bronchioles. The bronchioles control the ratio of resistance to airflow and distribution of
air in our lungs. The bronchioles open into the alveolar ducts. Alveolar sacs are at the
end of the ducts. These sacs are chambers that are connected to several individual
alveoli, which make up the exchange surface of the lungs.
The Lungs

The human respiratory system has two lungs, which contain lobes separated by deep
fissures. Surprisingly, the right lung has three lobes while the left one has only two
lobes. The lungs are made up of elastic fibers that gives it the ability to handle large
changes in air volume. The pleural cavity is where the lungs are located. The diaphragm
is the muscle that makes up the floor of the thoracic cavity and plays a major role in the
pressure and volume of air moving in and out of the lungs.
How they work
Air enters your lungs through a system of pipes called the bronchi. These pipes start from the
bottom of the trachea as the left and right bronchi and branch many times throughout the
lungs, until they eventually form little thin-walled air sacs or bubbles, known as the alveoli. The
alveoli are where the important work of gas exchange takes place between the air and your
blood. Covering each alveolus is a whole network of little blood vesselcalled capillaries, which
are very small branches of the pulmonary arteries. It is important that the air in the alveoli and
the blood in the capillaries are very close together, so that oxygen and carbon dioxide can move
(or diffuse) between them. So, when you breathe in, air comes down the trachea and through
the bronchi into the alveoli. This fresh air has lots of oxygen in it, and some of this oxygen will
travel across the walls of the alveoli into your bloodstream. Travelling in the opposite direction
is carbon dioxide, which crosses from the blood in the capillaries into the air in the alveoli and is
then breathed out. In this way, you bring in to your body the oxygen that you need to live, and
get rid of the waste product carbon dioxide.

Blood Supply
The lungs are very vascular organs, meaning they receive a very large blood supply. This is
because the pulmonary arteries, which supply the lungs, come directly from the right side of
your heart. They carry blood which is low in oxygen and high in carbon dioxide into your lungs
so that the carbon dioxide can be blown off, and more oxygen can be absorbed into the
bloodstream. The newly oxygen-rich blood then travels back through the paired pulmonary
veins into the left side of your heart. From there, it is pumped all around your body to supply
oxygen to cells and organs.
The Pleurae
The lungs are covered by smooth membranes that we call pleurae. The pleurae have two layers,
a 'visceral' layer which sticks closely to the outside surface of your lungs, and a 'parietal' layer
which lines the inside of your chest wall (ribcage). The pleurae are important because they help
you breathe in and out smoothly, without any friction. They also make sure that when your
ribcage expands on breathing in; your lungs expand as well to fill the extra space.

The Diaphragm and Intercostal Muscles
When you breathe in (inspiration), your muscles need to work to fill your lungs with air.
The diaphragm, a large, sheet-like muscle which stretches across your chest under the ribcage,
does much of this work. At rest, it is shaped like a dome curving up into your chest. When you
breathe in, the diaphragm contracts and flatten out, expanding the space in your chest and
drawing air into your lungs. Other muscles, including the muscles between your ribs
(the intercostal muscles) also help by moving your ribcage in and out. Breathing out (expiration)
does not normally require your muscles to work. This is because your lungs are very elastic, and
when your muscles relax at the end of inspiration your lungs simply recoil back into their resting
position, pushing the air out as they go.

MEDICAL MANAGEMENT
DATE &
TIME
PROGRESS
NOTES
DOCTOR’S ORDER RATIONALE NURSING
RESPONSIBILITIES
November
13, 2012
(1:30pm)
BP: 100/70
mmHg
PR: 135 bpm
RR: 30 cpm
T: 37 ˚C
CBG: 183
 Please admit to ICU under
the service of Dr. CF
 Please secure consent for
admission and management
 TPR q shift and record please
 NPO temporarily
 IVF: PNSS 1L x 40 cc/hr
 Informed
consent stems
from the legal
and ethical
right the
patient has to
decide what is
done to his or
her body, and
from the
physician's
ethical duty to
make sure that
the patient is
involved in
decisions
about his or
her own health
care to
monitor vital
signs
 To obtain
baseline data
and to know
the present
condition of
the patient
 To maintain
balance
between the
 Make sure that
the patient
understood the
consent and he
signed it.
 Check patient’s
vital signs
accurately and
record. Relay any
abnormalities to
the physician
 Maintain the flow
of the IV Fluid.
Place the patient

Impression:
UGIB prob 2°
DM 2, newly
diagnosed
 Labs:
 CBC with PLT,
 Na
 K
 Creatinine
 ALT
 PT& PTT
 ABO blood typing
 CBC now then q 4 hours
while on NPO, UA, 12L ECG,
CXR PA
 Medications:
- Give Pantoloc 80mg IV now
then start Pantoloc drop: D5W
200cc + 80mg Pantoloc x 12
hours
- Sucralfate g/tab
- Humulin N 10 “u” SC 30mins
BS, hold for CBG < 100
- Humulin N 6 “u” SC 30mins
BS, hold for CBG <110
 Continue pt. meds: myrin p
forte 4 tabs BB
 Transfuse 4 units FWB
properly typed and cross
matched to run for 4 hours
fluid and
electrolytes.
To prevent
dehydration.
 To help the
physician
confirm
diagnosis and
to check other
patients
condition
 For
pharmacologic
management
and continuity
of care
 For the rapid
and effective
restoration of
an adequate
blood volume
and to
maintain blood
composition
within safe
limits with
on the proper
position to
prevent
obstruction on the
IV flow.
 Assist and inform
patient about the
needed
preparation in
every procedure.
Relay the samples
needed to medical
technologist and
inform the doctor
once the result is
available or if
there is any
abnormalities
 Observe the ten
rights in giving
medications
 The nurse is
responsible for
insuring that the
right unit of blood
is to be
administered to
the right patient
after typing and
crossmatching by
the lab. Before

 Stand by 3 “u” PRBC properly
typed and cross matches
 O2 inhalation via nasal
cannula @ 2lpm
 Hook to cardiac monitor and
pulse oxymeter
regard to
homeostasis,
oxygen
carrying
capacity,
oncotic
pressure and
biochemistry
 For possible
blood
transfusion
 Provide
adequate
oxygen
administering the
unit, the nurse has
to get consent
forms signed by
the patient or a
qualified
representative of
the patient. The
nurse has to take
a complete set of
vital signs for a
baseline. After
starting the
transfusion, the
vital signs must be
checked after 15
minutes, then 30
minutes from
then, then at one
hour. Then vital
signs must be
checked every
hour. If a reaction
occurs, then the
transfusion must
be stopped
immediately and
normal saline
infused.
 Properly identify
the patient and
check for proper
blood type and
crossmatching
 Administer O2
with caution and
carefully assess its
effect on patient

3:00pm
 V/S q 1 hour
 Accurate I & O q shift and
record please
 WOF hypotension, change in
sensorium
 Insert NGT do gastric lavage
 Complete patient database
c/o MICC
 AP informed of this
admission via phone call
 Refer accordingly.
 For PBS (save smear pls.)
prior to BT
 Repeat CXR
 To assess any
changes in the
patient’s
condition
 Maintaining
fluid balance
 Signs that
patient is in
shock
 For cleaning
out the
contents of
stomach and
for collecting
stoma acid for
test
 For proper
documentatio
n
 To treat any
possible
complications
or problems
 To check if
there is any
 Obtained and
record v/s ; report
if there are some
changes
 Report for any
abnormal findings
 Assess patient’s
blood pressure
and level of
consciousness
 Explain to patient
the need and the
procedure to be
done on him.
 Refer to the
physician properly
and have the right
documentation
towards the
patient
 Inform the patient
about the

 Transfuse 1 “u” FWB & 3 ”u”
PRBC properly typed and
cross matched to run for 4
hours
changes in
patients
condition and
compare it to
the previous
result
 For the rapid
and effective
restoration of
an adequate
blood volume
and to
maintain blood
composition
within safe
limits with
regard to
haemostasis,
oxygen
carrying
capacity,
oncotic
pressure and
biochemistry
procedure and
properly drape
the patient during
the procedure for
patient’s privacy.
 The nurse is
responsible for
insuring that the
right unit of blood
is to be
administered to
the right patient
after typing and
crossmatching by
the lab. Before
administering the
unit, the nurse has
to get consent
forms signed by
the patient or a
qualified
representative of
the patient. The
nurse has to take
a complete set of
vital signs for a
baseline. After
starting the
transfusion, the
vital signs must be
checked after 15
minutes, then 30
minutes from
then, then at one
hour. Then vital
signs must be
checked every
hour; If a reaction
occurs, then the
transfusion must
be stopped

5:20pm
 Tranexamic acid 500mg IV q
8 hours
 CBR with no BRP
 Increase IVF rate to 80cc/hr,
decrease KVO during BT
 For Hgba1c – defer (+)
anemia
 Facilitate blood transfusion
ASAP
 Facilitate BT stat
 Repeat CBC with platelet at
12mn
 NPO
 Vitamin K 1amp IV q 8 hours
x 3 doses
 Salbutamol nebulization q 1 x
 To decrease
oxygen
demand of
body
 To check if
there is any
changes in
patients
condition and
compare it to
the previous
result
 For
immediately and
normal saline
infused.
 Instruct properly
the patient
of the IV Fluid.
Place the patient
on the proper
position to
prevent
obstruction on the
IV flow.
 Advise patient not

6:00pm
10:10pm
(+) melena
120cc
PR: 130 bpm
RR: 20 cpm
(-) DOB,
crackles
Flat neck veins
3 doses
 Repeat K at 12mn
 Instead of Salbutamol, use
Ipratropium + salbutamol
nebulization
 2 more “u” PRBC on standby
@ all time
 Increase IVF rate to 12-cc/hr
KVO during BT
 NPO except meds
 Amoxicillin 500mg 2 caps BID
 Clorithromycin 500mg/tab
BID
 Intensive PPI
 Transfuse next blood product
after 2 hours
 Coralan 5mg ½ tab BID hold
for HR <60
 IVF to ff: D5NSS 1L x 60cc/hr
shift to PNSS 500cc x KVO
during BT
bronchodilatio
n
 For possible
blood
transfusion
 To maintain
balance
between the
fluid and
electrolytes.
To prevent
dehydration.
to eat before and
after nebulization
 Properly identify
the patient and
check for proper
blood type and
crossmatching
of the IV Fluid.
Place the patient
on the proper
position to
prevent
obstruction on the
IV flow.

November
14, 2012
(7:00am)
BP: 130/90
mmHg
PR: 115 bpm
RR: 20 cpm
(+) pallor
(-) epigastric
pain
(+) melena 5x
total of 200cc
Dry lips
Ongoing 3rd unit
of blood (1st
FWB, 2nd PRBC)
 Start Humulin R sliding scale
o Hum R SC CBG
o 2 “u” > 160
o 3 “u” > 180
o 4 “u” > 200
o 5 “u” > 250
 Relay labs at 12mn. Please
facilitate
 Pantoprazole drip TF: D5W
250cc + 80mg Pantoprazole x
12 hours
 Save smear for PBS for future
review pls.
 Refer
 Please give another
Pantoprazole 40 mg IV now
 Insert another line and hook
PNSS 1L x 40cc/hr
 Monitor Hgb, Hct q 12 hours,
start serial monitoring after
3rd unit of blood was
transfused
 Increase IVF with PNSS 1L to
120cc/ht
 ALL IVF to KVO during BT
 To maintain
balance
between the
fluid and
electrolytes.
To prevent
dehydration.
of the IV Fluid.
Place the patient
on the proper
position to
prevent
obstruction on the
IV flow.

12:10pm
6:15pm
 Fast drip 200cc PNSS now
 Make stand by PRBC 4 “u”
instead of 2”u” PRBC
 Refer
 AP updated
 Hold Humulin N temporarily
 IVF TF: D5NSS 1L x 10 “u”
Humulin R to run for
100cc/hr
 Give Humulin R 4 “u” SC for
CBG >200 mg/dL
 D/C Humulin R sliding scale
 Decrease CBG to q 6 hours
 Maintain on NPO strictly
 Transfuse another 2 units
PRBC properly typed and
cross matches
 Will assessed pt. first after
the 3rd PRBC BT before BT of
another unit
 Rounds with Dr. B.
 Go ahead with 2 “u” PRBC BT
 Maintain on NPO – shift
antibiotic to:
o Levofloxacin 500g IV OD

November
15, 2012
(7:30am)
8:30am
BP: 150/90
mmHg
PR: 107 bpm
Total of “5”
- FWB
- PRBC
(-) chest pain,
abdominal pain
BP: 150-170/80-
90 mmHg
PR: 103 bpm
RR: 20 cpm
Clear breath
sounds
Decrease pallor
Hgb 85-93
o Metronidazole 500mg IV
q 8 hours ANST (-)
 Stand by another 2 “u” PRBC
(4 “u”) PRBC
 Transfuse another 2 “u”
PRBC each unit to run for 4
hours with blood of 2 hours
 Stand by 4 “u” PRBC
 Refer for BT reaction or
congestion
 AP updated
 Refer accordingly
 Start of T160 C200 P80 F53
divided into 4 equal feedings
 Once OF is started
o Shift mainline IVF to PNSS
1L x 60cc/hr
o BT line to keep on KVO
o Continue Hum R 4 “u” SC q
6 hours to CBG >200
o Start Humulin N 10 “u” SC
BB, BS, hold for CBG <120
mg/dL
 Start Losartan 25mg OD hold
for SBP <110
 Hold Ampicillin,
Clorithromycin
 Follow up PBS present and
relay - done

LABORATORY EXAMINATION
November 13, 2012
 URINALYSIS
o Also known as Routine and Microscopy (R&M) is an array of tests performed
on urine, and one of the most common methods of medical diagnosis.
TEST RESULT NORMAL VALUES INTERPRETATION
Color Yellow Clear – Straw
Yellow
NORMAL
Transparency Slight Hazy Clear - Hazy NORMAL
Reaction (pH) 5.0 4.5 - 8 NORMAL
Protein Negative Negative NORMAL
Glucose Negative Negative NORMAL
Specific Gravity 1.020 1.003 – 1.030 NORMAL
Pus cells 1 – 3 / HPF 0 -10 mm3 NORMAL
RBC 0 - 2 / HPF 0 – 3 HPF NORMAL
Mucus Threads Few
 BLOOD TYPING AND CROSSMATCHING
o Blood typing is a laboratory test done to determine a person's blood type. If
the person needs a blood transfusion, another test called cross matching is
done after the blood is typed to find blood from a donor that the person's
body will accept.
Patient’s name: H.Y.I
Patient’s Blood Type: “O” Rh (D) Positive
Donor’s Blood Type: “O” Rh (D) Positive
Blood Component: Whole Blood
Blood Serial #: UPH-12-1490
Date of Extraction: 10-31-12 @ 10:30am
Date of Expiration: 12-05-12 @ 10:30am
Date Crossmatched: November 13, 2012
Cross matched by: D. RMT
Major Cross matching: No agglutination seen/compatible
Minor Cross matching: No agglutination seen/compatible

 ARTERIAL BLOOD GAS
o ABGs measure how well the lungs can provide adequate oxygen to the body
and subsequently remove carbon dioxide. Analysis of blood gases helps
evaluate a person's respiratory and metabolic status. ABGs also measure
blood pH and the integrity of the body's acid-base balance.
 12:00nn
COMPLETE BLOOD COUNT AND PLATELET
 HEMATOLOGY
o The branch of internal medication that is concerned with the study of blood.
It is used to determine any abnormalities in the patient’s blood components.
 1:19pm
TEST NAME RESULT NORMAL VALUES INTERPRETATION
Hemoglobin 57.4 gm/L 120 – 150 gm/L
DECREASED (patient suffers
from anemia due to upper GI
bleeding)
Hematocrit 0.176 L/L 0.400 – 0.540 L/L
bleeding)
TEST RESULT NORMAL VALUES INTERPRETATION
RR 35 cpm
Temperature 38.3 °C
Site RBA
pH 7.580 7.35 – 7.45
Respiratory Alkalosis Partially Compensated
pCO2
21.4 mmHg
DECREASED
35 – 45 mmHg
pO2
135
NORMAL
80 – 100 (<60y/o)
HCO3
19.9 mmol/L
DECREASED
22 – 26 mmol/L
BE -2 +/-3
O2Sat 99 95 - 100 NORMAL

RBC 2.19 x 1012/L 4 – 5.6 x 1012/L
bleeding)
WBC 8.24 x 109/L 5.0 – 10.0 x 109/L NORMAL
Segmenters .78 x 109/L 0.50 - 0.70 x 109/L
INCREASED (due to a presence
of bacterial infection)
Neutrophils 6.61 x 109/L
1.63 – 6.96 x
109/L
NORMAL
Eosinophils 0.002 x 109/L
0.030 – 0.440 x
109/L
DECREASED (due to a presence
Lymphoctyes 1.43 x 109/L
1.09 – 2.99 x
109/L
NORMAL
Monocytes 0.133 x 109/L
0.240 – 0.790 x
109/L
Basophils 0.060
0.00 – 0.80 x
109/L
NORMAL
MCV 80.4 fl 80 – 98 fl NORMAL
MCH 26.2 pg 26 – 32 pg NORMAL
MCHC 326 g/L 32 – 360 g/L NORMAL
Platelet 835 x 109/L 150 - 400 x 109/L
INCREASED (indicates that
there is a systemic response
that forms clot to the bleeding
site
 FECALYSIS
o Fecalysis is also known as stool analysis. It refers to a series of laboratory
tests done on fecal samples to analyze the condition of a person's digestive
tract in general. Among other things, a fecalysis is performed to check for the
presence of any reducing substances such as white blood cells (WBCs),
sugars, or bile and signs of poor absorption as well as screen for colon
cancer.
 1:48pm
TEST NAME RESULT NORMVAL VALUES INTERPRETATION
Color Reddish brown Brown Due to upper gastro
intestinal bleeding
Cosistency Watery Soft and bulky, small
and dry, depends on
diet
Due to diarrhea
Ova/Parasite None found None NORMAL
Prese 0 – 3 / HPF 0 HPF Presence of infection

RBC 1 – 2 / HPF 0 HPF Indicates bleeding
CLINICAL CHEMISTRY REPORT
 BLOOD CHEMISTRY
o Part of a diagnostic work up with the blood being analyzed to check for
specific elements which could contribute clues to the diagnostic
 3:14pm
TEST NAME RESULT NORMAL RANGE INTERPRETATION
BUN 15.07 mmol/L 2.5 – 6.4 mmol/L
INCREASED (BUN
level because of
absorption
of degraded blood
during intestinal
transit)
Creatinine 99.88 mmol/L 53 – 133 mmol/L NORMAL
Potassium 5.59 mmol/L 3.5 – 5.1 mmol/L
INCREASED
(indicates
hyperkalemia)
Sodium 133.24 mmol/L 136 – 145 mmol/L
DECREASED
(indicates
hyponatremia and
body weakness)
ALT 21.00 u/L 10 – 40 NORMAL
November 14, 2012
COMPLETE BLOOD COUNT AND PLATELET
 HEMATOLOGY
 1:04am
Hemoglobin 58 gm/L 120 – 150 gm/L
DECREASED patient suffers
bleeding)
Hematocrit 0.174 L/L 0.400 – 0.540 L/L

bleeding)
RBC 2.17 x 1012/L 4 – 5.6 x 1012/L
bleeding)
WBC 10.2 x 109/L 5.0 – 10.0 x 109/L
SLIGHTLY INCREASED (due to a
presence of bacterial infection)
Neutrophils 7.48 x 109/L
1.63 – 6.96 x
109/L
Eosinophils 0.036 x 109/L
0.030 – 0.440 x
109/L
NORMAL
Lymphoctyes 0.14 x 109/L
1.09 – 2.99 x
109/L
Basophils 0.111
0.00 – 0.80 x
109/L
Normal
Monocytes 0.220 x 109/L
0.240 – 0.790 x
109/L
MCV 80.4 fl 80 – 98 fl NORMAL
MCH 26.8 pg 26 – 32 pg NORMAL
MCHC 333 g/L 320 – 360 g/L NORMAL
Platelet 746 x 109/L 150 - 400 x 109/L
CLINICAL CHEMISTRY REPORT
 BLOOD CHEMISTRY
o Part of a diagnostic work up with the blood being analyzed to check for
specific elements which could contribute clues to the diagnostic
 1:27am
Potassium 4.54 mmol/L 3.5 – 5.1 mmol/L NORMAL
 HEMATOLOGY
Hemoglobin 93.5 gm/L 120 – 150 gm/L
bleeding)
Hematocrit 0.315 L/L 0.400 – 0.540 L/L

DRUG NAME ACTION INDICATION CONTRAINDICATION ADVERSE REACTION
NURSING
CONSIDERATION
Genericname:
pantoprazole
Brand name:
Pantoloc
Classification:
Protonpump
inhibitor
Dosage:40 mg
Route:IV
Frequency:Stat
Inhibitsbothbasal
and stimulated
gastric acidsecretion
by suppressingthe
basicstepin acid
production,through
the inhibitionof the
protonpumpby
bindingtoand
inhibitinghydrogen-
potassiumATP,the
enzyme system
locatedat the
secretorysurface of
the gastric parietal
cell.
Duodenal andgastric
ulcer,moderate and
severe reflux
esophagitis.
Symptomatic
improvementand
healingof mildreflux
esophagitis.
Preventionof gastro-
duodenal ulcers
inducedbyNSAIDin
patientsatriskwitha
needforcontinuous
NSAIDtreatment.
Hypersensitivity.
Moderate to severe
hepaticor renal
dysfunction.
Headache,insomnia,
diarrhea,abdominal
pain,flatulence,rash,
hyperglycemia
 Monitor hepatic
enzymes:AST,ALT,
alkaline
phosphatase during
treatment.
 Instructpatientto
take drug as
prescribedand
approximatelythe
same time each
day.
 Tell patientto
swallowtablet
whole,notcrushed,
splitor chewed.
 Informpatientthat
antaciddo not
affectdrug
absorption.
 Advice patientto
reportpersistence
of symptoms
diarrhea,bleeding
and tarry stools.
 Advice patientnot
to drinkalcohol,eat
foodor take drugs
(aspirin,NSAIs)that
couldcause gastric
irritation.

NURSING
CONSIDERATION
Genericname:
Metronidazole
Brand name:
Flagyl
Classification:
Antiprotozoals;
Amebicides
Dosage:500 mg
Route:IV
Frequency:q8
Direct-acting
trichomonacide and
amebicide thatworks
inside andoutside
the intestines. It’s
thoughtto enterthe
cellsof
microorganismsthat
contain
nitroreductase,
formingunstable
compoundsthatbind
to DNA and inhibit
synthesis,causingcell
death.
Infectionsinthe
intra-abdominal,skin
structure,bacterial
septicemia,lower
respiratorysystem
and endocarditis.
Treatmentof
susceptibleprotozoal
infectionsinthe
treatmentand
prophylaxisof
anaerobicbacterial
infections.
Blooddyscrasias.
Hypersensitivityto
imidazole
Headache,seizure,
fever,dizziness,
edema,nausea,
abdominal cramping,
vomiting,diarrhea
 Assessforallergic
reactions:rash,
uticaria,pruritus.
 Monitorrenal
functionandbowel
pattern.
 Informclientthat
drug can cause
metallictaste and
urine mayappear
dark.
 Instructpatientnot
to take alcohol or
drugsthat contain
alcohol during
therapyand at least
48 hrs aftertherapy
iscompleted
because of
disulfiram-like
reactionto alcohol
ingestion.
 Reportsevere GI
upset,dizziness,
unusual fatigue or
weakness,feveror
chills.

DRUG NAME ACTION INDICATION CONTRAINDICATION ADVERSE REACTION NURSING
CONSIDERATION
Genericname:
Levofloxacin
Brand name:
Levox
Classification:
Quinolones
Dosage:500 mg
Route:IV
Frequency:OD
Semisynthetic
antibacterial agent
that inhibitsanti
bacteriaDNA gyrase,
necessaryfor
supercoilingof the
DNA,thereby
preventingDNA
replication,
transcription,repair
and recombinationin
susceptiblebacteria.
Infectionscause by
susceptiblestrainsof
microorganismsin
acute maxillary
sinusitis,acti-
bacterial
exacerbationof
chronicbronchitis,
CAP,nosocomial
pneumonia,
uncomplicatedskin
and uncomplicated
urinarytract infection
and acute
pyelonephritis.
Epilepsy
Historyof tendon
disordersrelatedto
fluoroquinolone
therapy.
Hypersensitivityto
levofloxacin
Nausea, Diarrhea,
Headache,Dizziness,
Insomnia,
Musculoskeletal
effects,Pain,
Reddeningof infusion
site , Phlebitis,
increase infungal
overgrowth
continue taking
drug as prescribed
for the lengthof
time ordered.
take drug with
plentyof fluidsat
least2 L perday
toxicitymayresult
if drug isusedwith
theophylline.
rinse mouth
frequentlyanduse
sugarlesscandyor
gum fordry mouth
 Instructdiabetic
patienttomonitor
glucose levels,
hypoglycemic
reactionmay
indicate needto
stopmedications.
avoidsunexposure
to prevent
phototoxicity.

NURSING
CONSIDERATION
Genericname:
Losartan
Brand name:
Lifezar
Classification:
Antihypertensive;
angiotensinII
antagonist
Dosage:25 mg
Route:PO
Frequency:OD
Selectivelyblocksthe
bindingof
angiotensinIIto
receptorsitesin
manytissues,
especiallythe
vascularsmooth
musclesandadrenal
glands. Thisprevents
the vasoconstricting
and aldosterone-
secretingeffectsof
angiotensinIIon
these tissues.
Treatmentof
hypertension.Renal
protectionintype 2
diabeticpatientswith
protenuria.
Renal arterystenosis,
hyperkalemia,
hypersensitivity,
anuria,
Dizziness,orthostatic
hypotension,
impairedrenal
function,
hyperkalemia,facial
edema,fever,angina
pectoris
 Assesspatient’s
bloodpressure,
holdforSBP <110
 Obtainbaseline
liverandrenal
functionbefore
therapy
 Assessfor
hydrationstatus
 Tell patientsto
avoidsodium
substitutesbecause
theymay contain
potassiumwhich
can cause
hyperkalemiain
takingthe drug
drug maycause
dizziness,fainting
or light
headedness,
cautionpatientto
rise slowlytositting
or standingto
preventorthostatic
hypotension

NURSING
CONSIDERATION
Genericname:
Ivabradine
Brand name:
Coralan
Classification:
Anti-anginal
Dosage:5 mg,½ tab
Route:PO
Frequency:BID
Ivabradine isapure
heartrate-lowering
agent,actingby
selectiveandspecific
inhibitionof the
cardiac
pacemaker If current
that controlsthe
spontaneousdiastolic
depolarizationinthe
sinusnode and
regulatesheartrate.
The cardiac effects
are specifictothe
sinusnode withno
effectonintra-atrial,
atrioventricularor
intraventricular
conductiontimes,nor
on myocardial
contractilityor
ventricular
repolarization.
Treatmentof CAD:
Symptomatic
treatmentof chronic
stable angina
pectorisincoronary
arterydisease
patientswithnormal
sinusrhythm.
Indicatedinpatients
unable totolerate or
witha
contraindicationto
the use of β-blockers
or in combination
withβ-blockersin
patientsinadequately
controlledwithan
optimal β-blocker
dose and whose heart
rate is>60 bpm.
Hypersensitivityto
ivabradine ortoany
excipientsof Coralan;
restingheartrate of
<60 bpmpriorto
treatment;
cardiogenicshock;
acute myocardial
infarction;severe
hypotension(<90/50
mm Hg); severe
hepaticinsufficiency;
sicksinussyndrome;
sino-atrial block
Luminous
Phenomena,
Bradycardia,Sinus
arrhythmia,unstable
angina,aggravated
anginapectoris,atrial
fibrillation,
myocardial ischemia,
myocardial infarction
and ventricular
tachycardia,Nausea,
constipationand
diarrhea
 Assesspatient’sHR,
holdforHR
<60bpm
 Monitorregularly
for atrial flutter
occurrence while
takingthis
medication.
thisdrug may cause
blurredvision,do
not drive acar or
operate machinery
while takingthis
medication.

NURSING
CONSIDERATION
Genericname:
Amoxicillin
Brand name:
Amoxil
Classification:
Antibiotics;penicillin
Dosage:500mg,
2caps
Route:PO
Frequency:BID
Preventsbacterial cell
wall synthesisduring
replication.
Bactericidal
Treatmentof
infectionsof
respiratorytract,skin
structures,GUT and
bacterial endocarditis
prophylaxis
Hypersensitivityto
penicillins,
cephalosporins.Not
usedto treatsevere
pneumonia,
empyema,
pericarditis,purulent
or septicarthritis
suringacute stage.
Dizziness,fatigue,
insomnia,reversible
hyperacidity,
urticaria,
maculopapularto
exfoliativedermatitis,
neuropathy,anorexia,
nausea,vomiting,
abdominal
pain/cramps,bloody
diarrhea
 Obtainpatient’s
historyof allergy
signsand
symptomsof
infection
 Assessforbowel
patternsfor
possible bloody
diarrhea
watch forand
reportsignsof
superinfection like
loose foulssmelling
stoolsor furry
tongue
 If GI upsetoccur,
take thisdrug with
meals

NURSING
CONSIDERATION
Genericname:
Phytomenadione
Brand name:
KonakionMM
Classification:
Hemostatics
Dosage:1 amp
Route:IV
Frequency:q8hrs x 3
doses
Syntheticanalogof
VitaminKwhchis
essential inclotting
factors II,VII,IX,X.
VitaminKcompounds
are usedinthe
treatmentand
preventionof
hemorrhage
associatedwith
vitaminKdeficiency.
The dose of VitaminK
shouldbe carefully
controlledby
prothrombin-time
estimations.Itisthe
onlyvitaminK
compoundusedto
reverse
hypoprothrombinemia
and hemorrhage
causedby
anticoagulanttherapy.
Pronouncedallergic
diathesis.
Hypotension,
cyanosis,headache,
dizziness.
 Assessbleeding:
bruising,
hematuria,black
tarry stoolsand
hematemesis
 Monitor
prothrombin-time
suringthe
treatment
 Stressthe needfor
periodiclabteststo
monitor
coagulationlevels
avoiduse of hard
toothbrush,
flossing,razorsand
sharp objectsuntil
treatmentid
terminated
reportsymptomsof
bleeding:bruising,
nosebleed,bloodin
urine or blacktarry
stool

NURSING
CONSIDERATION
Genericname:
Rifampicin/isoniazid/
Pyrazinamide/
ethambutol
Brand name:
Myrin-Pforte
Classification:
Anti tuberculois
Dosage:4 tabs
Route:PO
Frequency:Before
breakfast
Ethambutol
interfereswithRNA
synthesis,causing
suppression
of Mycobacteria
multiplication.Italso
has bacteriostatic
actionagainst
M tuberculosis
by actingonrapidly
growingpathogensin
cavitywallsandis
alsoeffectiveinslow-
growingpathogens
Initial phase
treatment& re-
treatmentof all forms
of TB incategory I & II
patientscausedby
susceptiblestrainsof
mycobacteria.
Hypersensitivity.
Alcoholism,optic
neuritis,impaired
hepaticfunction,
severe renal
insufficiency,
hyperuricemia,gouty
arthritis,jaundice,
retrobulbarneuritis.
Leukopenia,
thrombocytopenia,
hypersensitivity
syndrome,
eosinophilia,
fever, anorexia,
elevationsof serum
uric acidconc;
dizziness,
paresthesia;
epigastricdistress,
constipation,nausea,
vomiting,anorexia;
hepaticimpairment,
jaundice;pruritus,
rash, acute gout;
malaise;headache
 Performvisual
acuityand
colordiscrimination
testbefore and
duringthe therapy.
 Assessliverand
renal function
before andduring
the therapy.
 Assesspatient
mental status
often:affectmood,
behaviorchange.
watch out
for confusionand
hallucination
 Assesspatient
for visual
disturbance that
may indicate optic
neuritis.

NURSING
CONSIDERATION
Genericname:
Salbutamol
Brand name:
Activent
Classification:
Sympathomimetics
Dosage:
Route:neb
Frequency:q1 hr x 3
doses
Stimulatedbeta2
receptorsof
bronchiolesby
increasinglevelsof
cAMP whichrelaxes
smoothmusclesto
produce
bronchodilation.
Relief of
bronchospasmin
bronchial asthma,
chronicbronchitis,
emphysemaand
otherreversible,
obstructive
pulmonarydiseases.
Alsouseful for
treating
bronchospasmin
patientswithco-
existingheartdisease
of hypertension.
Hypersensitivytyto
salbutamol,also
atropine andits
derivatives.Cardiac
arrhythmia
associatedwith
tachycardiacausedby
digitalisintoxication.
Fine skeletalmuscle
tremor,legcramps,
palpitations,
tachycardia,
hypertension,
headache,nausea,
vomiting,dizziness,
insomnia,
hypotension,
peripheral
vasodilation,flushing,
feelingof
nervousness,mouth
and throat irritation
 Assesscardio-
respiratory
function:BP,HR,
rhythmand breath
sounds
 Monitorfor
evidence of allergic
reactionsand
paradoxical
bronchospasm
 Teach patientto
use inhaler;to
avoidgetting
aerosol ineyesor
blurringmayresult
 Instructpatientnot
to eat 30 mins
before andafter
the nebulization
 Instructthe patient
to limitcaffeine
productssuch as
chocolate,coffee,
tea,cola, avoid
smoking.

NURSING
CONSIDERATION
Genericname:
TranexamicAcid
Brand name:
Hemostan
Classification:
Cardioactive drugs;
Hemostatics
Dosage:500 mg
Route:IV
Frequency:q8 hrs
Inhibitsbreakdownof
fibrinclots.Itacts
primarilybyblocking
the bindingof
plasminogenand
plasminfibrin;direct
inhibitionof plasmin
to fibrin;direct
inhibitionof plasmin
occurs onlyto a
limiteddegree.
Treatmentand
prophylaxisof
hemorrhage
associatedwith
excessivefibrinolysis.
Prophylaxisof
hereditary
angioedema.
Hypersensitivity.
Patientswithactive
intravascularclotting
because of the riskof
thrombosis.Severe
renal insufficiency.
Patientswith
microscopic
hematuria.
GI disturbances.
Nypotension,
particularlyafter
rapidIV
administration.
Thrombotic
complicationshave
beenreported,
transient
disturbancesincolor
visionassociatedwith
itsuse.
historyif with
active intravascular
clotting,
predisposed
thrombosis,and
hemorrhage.
 Monitor
anticoagulantcover
 Performeye exams
 Performliver
functiontests
 Performbloodtests
 Obtain
prothrombintime
of the patient
 May be mixedwith
mostsolutionsbut
not withpenicillins
reportvisual
abnormalities

NURSING
CONSIDERATION
Genericname:
Clarithromycin
Brand name:
Claranta
Classification:
Antibiotics;
macrolides
Dosage:500mg
Route:PO
Frequency:BID
Inhibitsorinterferes
withbacterial protein
synthesisbybinding
to the 50s ribosomal
subunitsof bacterial
chromosome.
Treatmentof
respiratorytract
infections.Treatment
of leprosyandfor
prophylaxisand
treatmentof
opportunistic
mycobacterial
infections.
Hypersensitivityto
macrolides.
Concomitanttherapy
withcisapride,
primozide and
terfenadinein
patientswithpre-
existingcardiac
abnormalitiesof
electrolyte
disturbances.Severe
leverdamage.
Impairedkidney
function.
Hypokalemia.
GI disturbances
(nausea,diarrhea,
abnormal taste,
dyspepsia).Taste
disturbances,
stomatitis,tooth
discoloration.
infectionbefore
therapyand
regularly
thereafter.
 Monitorhepatic
and hematologic
status.
 Assessbowel
pattern,
discontinue drugif
severe diarrhea
occurs.
 Advice patientnot
to chewor crush
extendedreleased
tablets.
reportany adverse
reaction.
contact physicianif
loose foul-smelling
stoolsor furry
tongue isobserved
thismay indicate
superinfection.

NURSING
CONSIDERATION
Genericname:
Sucralfate
Brand name:
Iselpin
Classification:
Acid- pepticdisease
drugs;cytoprotective
Dosage:
Route:
Frequency:
ProtectsGI lining
againstpepticacid,
pepsinandbile salts
by bindingwith
positively-charged
proteinsinexudates
forminga viscous
paste-likeadhesive
substance thus
forminga protective
coating.
Prophylaxisof
gastrointestinal
hemorrhage from
stressulceration
Contraindicatedwith
allergytosucralfate,
chronicrenal failure
or dialysis,not
intendedforIV
administration
Constipation,
diarrhea,nausea,
dizziness,drymouth,
GI disturbances,rash,
pruritus,headache,
vertigo,backpain,
drowsiness.
 Monitorgastric pH,
bloodinstools
 Monitorpatientfor
severe constipation
 Monitorpatient
withrenal
insufficiencyfor
aluminumtoxicity.
 Give drug onempty
stomach1 to 2 hrs.
before meals
 Monitorpain; use
antacidto relieve
pain
 Reportsevere
gastric pain
 Do not crush,chew
tablets.
avoidcigarette
smokingwhichmay
increase gastricacid
secretionsand
worsendisease.

NURSING
CONSIDERATION
Genericname:
Insulin,human
isophane suspension
(recombinantDNA
origin)
Brand name:
HumulinN
Classification:
Intermediateacting
insulin
Dosage:10 “u”
Route:SC
Frequency:30 mins
BS
Increase glucose
transportacross
muscle andfat cell
membranestoreduce
bloodglucose level.
Promotesconversion
of glucose toits
storage form,
glycogen;triggers
aminoacid uptake
and conversionto
proteininmuscle
cellsandinhibits
proteindegradation;
stimulates
triglyceride formation
and inhibitsreleaseof
free fattyacidsfrom
adipose tissue;and
stimulateslipoprotein
lipase activity,which
convertscirculating
lipoproteinstofatty
acids.
Diabeticketoacidosis,
Type I diabetes,
adjunctto type II
diabetes
inadequately
controlledbydietand
oral antidiabetic
agents.
Hypoglycaemia,
insulinoma,
hypersensitivity
reactions,diabetic
coma.
Lipoatrophy,
lipohypertrophy,
rash, hypoglycemia,
ketoacidosis,redness,
swelling,pruritus
 Hold for CBG
<100mg/dl
 Do not give insulin
injection
concentrated IV
 Be aware that some
patients may develop
insulin resistanceand
require largeinsulin
doses to control
symptoms of
diabetes.
 To mix insulin
suspension,swirl vial
gently or rotate
between palms or
between palmand
thigh. don’t shake
vigorously:this
causes bubblingand
air in syringe
 Note that switching
from separate
injections to a
prepared mixture
may alter patient
response. Whenever
NPH or lente in mixed
with regular insulin in
the same syringe,
give it immediately to
avoid loss of potency.

NURSING
CONSIDERATION
Genericname:
Regularinsulin
Brand name:
HumilinR
Classification:
Short – acting insulin
Dosage:4 “u”
Route:SC
Frequency:PRN
Short-acting,clear,
colorless solution of
exogenous
unmodifiedinsulin
extractedfrombeta
cellsinporkpancreas
or synthesizedby
recombinantDNA
technology(human).
Enhances
transmembrane
passage of glucose
across cell
membranesof most
bodycellsandby
unknownmechanism
may itself enterthe
cell to activate
selectedintermediary
metabolicprocesses.
Promotesconversion
of glucose to
glycogen.
It indicatedasan
adjunctto dietand
exercise toimprove
glycemiccontrol in
adultsand children
withtype 1 and type
2 diabetesmellitus.
Hypersensitivityto
insulinanimal
protein, renal
impairment, hepatic
impairmentandolder
adults. Safetyand
efficacyinchildren<2
y are notestablished.
Sweating,hunger,
headache,nausea,
tremulousness,
tremors,palpitation,
tachycardia,
weakness,fatigue,
nystagmus,localized
allergicreactionsat
injectionsite;
generalizedurticaria
or bullae,
lymphadenopathy.
 Give Humilin R for
cbg >200mg/dl
 Give maintenance
doses
subcutaneously,
rotatinginjection
sites regularly to
decrease of
lipodystrophy.
 Do not give insulin
injection
concentrated IV
 Use caution when
mixingtwo types of
insulin,In general,
when an
intermediate-acting
insulin (e.g., NPH
insulin isophane
suspension) is mixed
with short-acting
solubleinsulin (e.g.,
regular),the short-
actinginsulin should
be drawn into the
syringefirst.
 Carry some form of
fast-acting
carbohydrate(e.g.,
lump sugar,Life-
Savers or other
candy) at all times to
treat hypoglycemia.

178423280 pt bcase-1

Recommended

Recommended

More Related Content

Similar to 178423280 pt bcase-1

Similar to 178423280 pt bcase-1 (20)

Recently uploaded

Recently uploaded (20)

178423280 pt bcase-1