CAPITOL MEDICAL CENTER COLLEGES, INC

#4 Sto. Domingo Avenue, Quezon City

COLLEGE OF NURSING

CHRONIC KIDNEY DISEASE

Case Study

Submitted by:

Acierto, Venus Merica E.

BSN – 4A
Group 1

Submitted to:

Mrs. Felomina Mercado, RN. MAN

May 8, 2019

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Chronic Kidney Disease: A Case Study|

TABLE OF CONTENTS

Introduction………………………………………………………………………

Client's Profile …………………………………………… ……………………..

11 Gordon’s Functional Health Pattern……………………

Physical Assessment……………………………………………………………

Pathophysiology…………………………………………………...............................

Clinical Discussion……………………………………………………………………

Drug Study……………………………………………………………

Chronic Kidney Disease: A Case Study

INTRODUCTION

A Chronic Kidney Disease (CKD) is a long-term condition where the kidneys do not work as

well as normal. The kidneys are two bean-shaped organs located on either side of the body, just

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underneath the ribcage. The main role of the kidneys is to filter out waste products from the

blood before converting them into urine. Kidneys also help maintain blood pressure, maintain the

correct level of chemicals in your body which in turn, will help the heart and muscles function

properly, produce a type of vitamin D that keep bones healthy and produce a substance called

erythropoietin, which helps stimulate the production of red blood cells.

Chronic kidney disease (CKD), also known as chronic renal disease, is a progressive loss of

renal function over a period of months or years. CKD is very common and is mainly associated

with aging. The older you get, the more likely you are to have some degree of kidney disease. It

is estimated that about one in five women and one in four men between the ages of 65 and 74 has

some degree of CKD. The symptoms of worsening kidney function are unspecific, and might

include feeling generally unwell and experiencing a reduced appetite. Often, chronic kidney

disease is diagnosed as a result of screening of people known to be at risk of kidney problems,

such as those with high blood pressure or diabetes and those with a blood relative with chronic

kidney disease. Chronic kidney disease may also be identified when it leads to one of its

recognized complications, such as cardiovascular disease, anemia or pericarditis.

CKD is a potentially serious condition. People with CKD are known to have an increased risk of

a stroke or heart attack because of the changes that occur to the circulation.

In some people, CKD may cause kidney failure, which is also known as established renal failure

(ERF) or end-stage kidney disease. In this situation, the usual functions of the kidney stop

working. In order to survive, people with ERF may need to have artificial kidney treatment,

called dialysis. However, if the condition is diagnosed at an early stage, further damage to the

kidneys can be prevented with a combination of lifestyle changes and medication. These changes

can also reduce your risk of a stroke or heart attack. It is, therefore, very important to help

yourself as much as you can.

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Kidney diseases rank as the number 10 killer in the Philippines causing death to about 7,000

Filipinos every year, DOH reported. The DOH stepped up the advocacy on kidney disease

prevention in observance of the 25th year of Kidney month with theme "25 Taong Pangungunasa

Serbisyo para sa Kalusugan ng Bato ng Sambayanang Pilipino".

Chronic kidney disease is a worldwide public health problem. In the United States, there is a

rising incidence and prevalence of kidney failure, with poor outcomes and high cost. There is an

even higher prevalence of earlier stages of chronic kidney disease.

Recent reports from the United States estimate that nearly half a million patients in the United

States were treated for end-stage renal disease (ESRD) in 2004 and by 2013 this figure is

expected to increase by approximately 40%. The number of people with renal replacement

therapy has increased from 426,000 in 1990 to 1.5 million in 2000 and is expected to rise to 2.5

million by 2013. An Estimated 26 Million Adults in the United States have Chronic Kidney

Disease (CKD). In 2011, CKD was responsible for the death of nearly 45,000 people, ranking as

the ninth leading cause of death in the United States.

CLIENT’S PROFILE

Name: S.N

Age: 61 years old

Gender: Female

Date of Birth: May 20, 1968

Religion: Jehova’s Witnessed

Marital Status: Widowed

Educational Attainment: 2nd Year High School

Occupation: None

Religion: Jehovas Witnessed

Date and Time of Admission: April 1 2019 at 2:50 AM

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Attending Physician: Dr. Reyes

Admitting Diagnosis: Anemia Of Chronic Diagnosis; Hyponatremia

Final Diagnosis: Anemia probably secondary to Chronic Disease; Chronic Kidney Disease

Chief Complaint: Generalized Weakness

HISTORY OF PRESENT ILLNESS

PAST MEDICAL HISTORY

Patient S.N when she was a child, she doesn't often have a serious illness. Sometimes she also

got some common illness like fever, cough, and cold. Her childhood vaccines were unrecalled.

She had chicken pox and mumps when she was a child. The patient was diagnosed of having

hypertension since 2008, diabetes 2 since 2015, and Chronic Kidney Disease since 2019. She

was hospitalized because of difficulty of breathing. She has no known allergies to food and

drugs.

FAMILY HISTORY

Patient S.N’s father is already deceased at unknown age. Her mother was also deceased She has

2 siblings, she also has 1 daughter and living healthy. The family has other heredo-familial

diseases such as bronchial asthma, malignancies, thyroid, lung, liver and kidney.

PERSONAL AND SOCIAL HISTORY

Patient S.N. is a 2nd year high school graduate. She is widowed for 10 years. She is not smoker,

occasional alcoholic beverage drinker. No food preference, no exercise. Drinking source is

mineral water and water source is from NAWASA. She drinks 1-2 cups of coffee and 1.5 liters

of water a day, lives in a well-lit, well ventilated rented single story house. Garbage collection

occurs once a week and is properly segregated.

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 GORDON’S FUNCTIONAL HEALTH PATTERN

Functional-Health Before During Analysis

Pattern hospitalization
Hospitalization

Health Perception- Patient rates her Client rated his health Client’s health
Health Management health 7/10 since she a 4/10 due to his perception decreased
Pattern. can still do non- current situation. due to his admission
strenuous ADLs like Client is compliant to and current condition.
washing the dishes the orders and
and cooking. Patients medications
have regular check prescribed by the
physicians.
ups.

Nutritional Client eats 5 small Client is currently on Client’s nutritional

Metabolic Pattern meals usually a soft diet. Client’s and metabolic pattern
consists with meat appetite decreased changed due to his
and fatty foods.sh e due to stress about current condition and
seldom drinks juice her situation. She appetite.
but drink water all only drinks 1-3
the time. Patient glasses of water a
claims that her day. With an oral
favorite snack is input of 300-500 ml.
almond nuts.

Elimination Pattern Bowel Elimination Patient is on Foley Client’s elimination

catheter. His output pattern changed due
Patient has no usually ranges from to hospitalization and
problems with 100-500 ml a day. she has a Foley
defecating. Usually Patients doesn’t have catheter.
defecates 1-2 times a bowel movement for
day. 3 days
Urinary Elimination

Client usually urinate

5 to 6 times a day.
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 There is no burning
sensation and
difficulty in voiding.

Activity and Patients jog every Client can only Due to presence of
Exercise Pattern morning in their perform limited illness client is
place, patient was activities due to her unable to perform
active. She prefer condition. She’s on extraneous activity
doing chores like bed most of the time and often requires
washing her clothes, and complains that he assistance.
washing dishes and is stress about their
cleaning the house. business, because he
can no longer
monitor it.

Sleep-Rest pattern Client usually sleeps Patient sleeps a lot Patient sleeps
for 7-8 hours per day and naps frequently. excessively.
without medication. He still has no
He often sleeps difficulty in sleeping.
around 10pm and He also has no
wakes up at 6am. He trouble falling asleep
watches Tv if he has even after the nursing
trouble falling asleep. and physician’s
rounds.

Sexuality and Patient refuses to Patient refuses to Patient refuses to

Reproduction give data. give data. give data.
Pattern

Cognition and Patient wears reading Patient still wears There is no notable
Perception Pattern glasses. He has also reading glasses and changes in the
no difficulty with his shows no changes in client’s cognition and
senses such as his senses. perception.
hearing, taste, touch
and smell.

Role and Relation She is the major Client is currently Client exhibits a good
Pattern decision maker in the confiding in his roles and relation
family and considers family for emotional pattern. She has a
her family the most support. Her family good relationship
important people in are still the most with his family.
the world since they important people in
support each other her life.
physically and
emotionally

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Coping and Stress The patient copes up The patient’s family Patient’s stress level
Tolerance Pattern with stress by being has been supportive increased due to
with her loved one to her during her thinking about his
especially with her hospitalization She hospital bill, their
daughter and wister gets a little bit business and her fate.
stressed out thinking
about the hospital bill
and being unable to
monitor their
business. She also
appears concerns
about what could
possibly happen to
her.

Values and Patient is Jehovas Patient still displays Patient is still

Belief Pattern witnessed by faith the same values and confiding to his
and goes to church belief as before belief.
with his family hospitalization but is
regularly. not able to go to
church regularly.

COMPLETE PHYSICAL ASSESSMENT - ( Cephalocaudal Pattern )

Upon physical assessment the patient is conscious, coherent, not in cardio respiratory

distress. Vital signs taken and recorded as follows:

Vital signs:

BP: 130/80 mmHg

Pulse: 67 bpm

Respiration: 22 cpm

Temperature: 36.5C

O2 SAT: 99%

Patient is seen asleep, GCS 15. She is 5’6 in height and 60kgs in weight with an
endomorph body type. She has indwelling foley catheter and was removed in the morning as
ordered by the physician. During vital signs or any procedures patient was able to partivipate
in any procedures. Patient seems stress.

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 Technique Normal Findings Actual Findings Analysis & Interpretation
Used

Skin Inspection Light to deep brown, Patient’s skin is light No deviations from normal.
generally uniformed skin brown and uniform in
Palpation color, no edema, no abrasions color, has no edema.
or lesions, temperature is He has a good skin
within the normal range, good turgor, normal skin
skin turgor, no edema temperature, and moist
skin. No lesions and
abrasions noted.

Hair and Inspection Evenly distributed, thick Patient has an evenly No deviations from normal.
Scalp resilient, no infection, has distributed short hair.
variable amount of body hair Gray in color and no
infestation noted

Eyes and Inspection Eyebrows and eyelashes are Eyebrows and Patients’ eyes are
vision evenly distributed and eyelashes are evenly symmetrical and use reading
symmetrical no infections distributed and glasses due to his age.
noted. Eyelids have no symmetrical, no
discharges; no discoloration lesions noted. Eyelids
and lids close symmetrically. have no discharges, no
Client also blinks when discoloration, and
cornea was touched. Pupils Eyelids close
are black and equal in size, symmetrically. Pupils
constrict when looking at near are black and are equal
object and dilate at far objects in size. Patients’ pupils
and converge when object is are 2mm in size
moved towards the nose. Iris equally rounded,
is flat and round. PERRLA constrict to light and
(pupils equally round respond dilate to dark. Patient
to light accommodation) is using reading glasses
illuminated and non-
illuminated pupils

Skull and Inspection & Symmetrical Facial Patient has a No deviations from normal.
Face Palpation Movements symmetrical facial
structure and
Symmetrical facial features
movements. No lesions
No edema and edema noted.

Ears and Inspection Skin color same as facial skin. The ears of the patient Patient can hear clearly but
Hearing Symmetrical. are uniform in skin due to his age his hearing
Auricle aligned with outer color as facial skin. deteriorates.
canthus of eye, about 10° Symmetrical and
from vertical; mobile firm and normal voice tones are
not tender; pinna recoils after
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 it is folded. mostly audible. Pinna
External ear canal contains recoils after it is
hair follicles and glands. Dry folded.
cerumen, grayish tan color.
Normal voice tones audible.
Nose and Inspection Nose is Symmetric, no Nose of the patient is No deviations from normal
Sinuses discharges or flaring. Not symmetric, no
Tender, no lesions, air moves discharges or flaring.
freely when breathing. Nasal Not tender and no
cavity mucosa is pink lesions.

Mouth and Inspection Symmetrical, able to purse Patient is able to purse Patient’s lips are slightly
Oropharynx lips, moist, have a smooth lips. No discoloration pale and dry. due to his old
texture. No discoloration noted. Patient has no age he has no teeth and uses
on the enamels, no difficulty in opening dentures to eat
retraction of gums, mouth. Palates are
pinkish color of gums. smooth and light pink
Buccal mucosa uniformly in color. Lips are
pink, moist, slightly
slightly pale and dry.
rough. Smooth palates
Patient wears dentures
light pink and smooth.
Neck Inspection Color same as facial skin. Skin color of the neck No deviations from normal.
Muscles are equal in size; is the same as the
facial sin. Head
head centered.
centered. No difficulty
Coordinated, smooth and discomfort when
movements with no turning the head but
get tired quickly.
discomfort.

Thorax and Inspection Intact Chest wall, No Chest wall is intact Patient has difficulty in
Lungs tenderness and masses. with no tenderness and breathing and has crackles
Palpation Full symmetric expansion, masses. Crackles on on both of her lungs.
2-3 cm separation of both of her lungs
Percussion thumbs during deep
inspiration. quiet,
Auscultation rhythmic and effortless
respiration's. Spine
vertically aligned. Right,
left shoulders and hips are
of the same height

Upper Inspection Varies from light to deep Patients’ skin is Uniform skin color and skin
Extremities and brown skin color. Generally uniformly light brown is warm to touch. No edema
Palpation uniform skin color. No in color. No edema was noted and limited range
edema. Moisture in skin folds. was noted. Hands are of motion due to difficulty
Uniform skin temperature cold to touch. Poor of standing up from the
within normal range. When skin turgor. Limited bed.Poor skin turgor due to
pinched, skin springs back to range of motion. anemia.
previous state. Patient has heplock on

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 Brachial and radial pulses: her right metacarpal
Symmetric pulse volumes. vein
Full pulsations.
Abdomen Inspection Unblemished and uniform Patient’s abdomen is Patient is wearing diapers
skin color. Flat, rounded or unblemished, and due to being unable to go to
Palpation scaphoid abdominal contour. patients abdomen the bathroom. Patients
Percussion Audible bowel sounds. slightly bigger due to waived insertion of IJ
Auscultation accumulation of fluid catheter for dialysis due to
in her abdomen financial constrained

Nails Inspection Nails are pink, clean, short Nails are pink, short Patient advised to have
and smooth. Good Capillary and smooth. Poor blood transfusion due to
refill time of 2 seconds upon capillary time of less religion patient wasn’t able
examining. than 4 seconds. to have blood transfusion.

Neurological Inspection & No difficulty in expressing Patient can express No deviations from normal
oneself in speech, writing, or himself freely by
Observation signs. Level of Consciousness verbalizing needs.
is 15 out of 15 in GCS. In GCS15. Equal
Sensory function test, able to sensations on both
recognized touch sensation. extremities

Lower Inspection Varies from light to deep Legs are uniform in Patients’ feet were raised
Extremities brown skin color. Generally skin color and edemas due to edema in the morning
uniform skin color. No on both feet were and edema was reduced in
edema. Moisture in skin folds. noted. Uniform skin the afternoon
Uniform skin temperature temperature and good
within normal range. When skin turgor and has
pinched, skin springs back to socks on both feet
previous state.

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Chronic Kidney Disease: A Case Study |

Pathophysiology
Predisposing factors: Precipitating factors:
Female Sedentary lifestyle
Filipino Environment
Elderly people
Hypertension
DM2

Initial pathogenic injury

Glomerular injury

Reduced filtration area Arteriosclerosis

Adaptive hemodynamic changes

Systemic hypertension
Increased glomerular blood flow Increased glomerular capillary
pressure

Glomerular Hypertrophy Epithelial injury Endothelial injury

Mesangial injury

Focal detachment of Proteinuria

epithelial foot processes

Glomerular hyaline Microthrombi occluding Mesangial expansion

deposition glomerular capillaries

Glomerulosclerosis
Microneurysm formation

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Progression of CKD
 CHRONIC RENAL FAILURE (END STAGE RENAL DISEASE)

Chronic renal failure, or ESRD, is a progressive, irreversible deterioration in renal function in which the body’s
ability to maintain metabolic and fluid and electrolyte balance fails, resulting in uremia or azotemia.

Chronic Renal Failure

Progressive, irreversible kidney injury; kidney function does not recover

Predisposing factors
Recurrent infections
Exacerbations of nephritis
Urinary tract obstruction
Diabetes
Hypertension

CAUSE

Condition the cause ESRD include systemic diseases such as;

Diabetes mellitus (leading cause)

Hypertension
Chronic glomerulonephritis
Pyelonephritis (Inflammation of the renal pelvis)
Obstruction of the urinary tract
Hereditary lesions (POLYCYSTIC KIDNEY DIEASE)
Vascular orders
Infections
Medications or toxic agents
Comorbid conditions

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Clinical Manifestations

Neurologic
Peripheral neuropathy, burning feet, nystagmus, twitching, seizure
Cardiovascular
Hypertension, left ventricular hypertrophy, CHF
Respiratory
Fluid overload, pulmonary edema, uremic lung
Hematologic
Anemia, decreased erythropoietin, increased hematocrit and bleeding tendencies

Gastrointestinal
Anorexia and N&V
Electrolyte Imbalances
Orthopedic
Increased Ca elimination, decreased serum Ca
Reproductive
Irregular menstruation, impotence, testicular atrophy and decreased sperm count
Psychological
Behavioral and personality changes
Impaired Immunologic System
Increased susceptibility to infection
Skin
Excoriation or dry skin, uremic frost

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ASSESSMENT AND DIAGNOSTIC FINDINGS

Glomerular Filtration Rate

The GFR is the amount of the plasma filtered through the glomeruli per unit of time. Creatinine
clearance is measured by obtaining a 24-hour urine, obtaining a serum creatinine and using a
formula to estimate the amount of creatinine the kidneys can clear in 24-hour period.

Sodium and Water Retention

The kidneys cannot concentrate or dilute the urine normally in ESRD. Appropriate responses by
the kidney to changes in the daily intake of water and electrolytes, therefore, do not occur. Some
patients retain sodium and water, increase the risk for edema, heart failure, and hypertension.

Acidosis

IN advance renal disease, metabolic acidosis occurs because the kidneys are unable to excrete
increased loads of acid. Decreased acid secretions result from the inability of the sodium
bicarbonate (HCO3-). There is also decreased excretion of phosphate and other organic acids.

Anemia

Develops as a result of inadequate erythropoietin production, the shortened the life span of
RBC’s, nutritional deficiencies, and the patient’s tendency to bleed, particularly from GI tract.
Erythropoietin, a substance normally produced by the kidneys, stimulates bone marrow to
produce RBC’s.

Calcium and Phosphate Imbalance

Another major abnormally seen in chronic renal failure is a disorder in calcium and phosphorus
metabolism. Serum calcium and phosphate levels have a reciprocal relationship in the body; as
one increases, the other decreases.

COMPLICATIONS;

Hyperkalemia – due to decrease excretion, metabolic acidosis, catabolism, and excessive

intake (diet, medications, fluid)
Pericarditis – pericardial effusion and pericardial tamponade due to retention of uremic
waste products and inadequate dialysis
Hypertension – due to sodium and water retention and malfunction of the renin-
angiotensin- aldosterone system
Anemia – due to decrease erythropoietin production, decrease RBC life span, bedding in
the GI tract from irritating toxins and ulcer formation, and blood loss during hemodialysis

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 Bone disease and metastatic and vascular calcification due to retention of phosphorus,
low serum calcium levels, abnormal Vitamin D metabolism, and elevated aluminum
levels.

Stages of Chronic Renal Failure

1. Renal impairment - means that your kidneys are not functioning normally.
2. Renal insufficiency - is poor function of the kidneys that may be due to a reduction in
blood-flow to the kidneys caused by renal artery disease. Normally, the kidneys regulate
body fluid and blood pressure, as well as regulate blood chemistry and remove organic
waste.
3. Renal failure - is the last stage of chronic kidney disease. When your kidneys fail, it
means they have stopped working well enough for you to survive without dialysis or
a kidney transplant.
4. End-stage renal disease - is the last stage (stage five) of chronic kidney disease (CKD).
This means kidneys are only functioning at 10 to 15 percent of their normal capacity.
When kidney function is this low, they cannot effectively remove waste or excess fluid
from your blood.

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Nursing Management:

1. Conservative
Assess uremia
mental function
avoid undue fatigue
2. Advance renal failure
Peritoneal dialysis
Hemodialysis
Kidney transplant
3. Dietary
Early – no restriction
Advanced – low protein

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Chronic Kidney Disease: A Case Study |

DRUG STUDY
Name of Mechanism Indication Contraindication Side Effects Nursing Responsibility
Drug of Action

Generic Action: Associated effects Serious Hypotension, dizziness, Monitor for therapeutic effectiveness which is
Name: in hypertensive hypersensitivity to fatigue, hyperglycemia, indicated by lessening of S&S of CHF and
As a racemic patients include carvedilol or any weight, gain and weakness improved BP control.
Carvedilol mixture, reduction of component of the
carvedilol has cardiac output, formulation;
nonselective exercise or beta decompensated Lab tests: Monitor liver function tests
Brand Name: beta agonist induced cardiac failure periodically; at first sign of hepatic toxicity stop
adrenorecepto tachycardia, requiring
Coreg r and alpha- drug and notify physician.
reduction or reflex intravenous
adregernic orthostatic inotropic therapy;
blocking tachycardia, bronchial asthma or
Dosage and activity. No Monitor for worsening of symptoms in patients
vasodilation, related
routes: intrinsic with PVD.
decreased bronchospatic
sympathomim peripheral vascular conditions ; second
Oral: PO 6.25 etic activity
resistance , – or third- degree
mg BID has been Monitor digoxin levels with concurrent use;
decreased renal AV block, sick
documented vascular resistance, sinus syndrome, plasma digoxin concentration may increase.
reduced plasma and severe
. renin activity, and bradycardia;
increased levels of cardiogenic shock;
atrial natriuretic severe hepatic
peptide. In CHF,
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 associated effects impairment
include decreased
pulmonary
capillary wedge
pressure, decrease
pulmonary artery
pressure ,decrease
heart rate
,decreased systemic
vascular resistance,
increased stroke
volume index, and
decreased right
atrial pressure

Name of Mechanism Indication Contraindication Side Effects Nursing Responsibility

Drug of Action

Generic Elevates the Prevention and Hypersensitivity Dizziness Advice patient to take medication as prescribed
Name: serum iron treatment of iron and severe
concentration deficiency and hypotension Nausea and vomiting
Ferrous which then dietary supplement
sulfate CHF Caution patient to make position changes slowly to
helps to form for iron minimize orthostatic hypotension
Muscle cramps
Classification high or
: trapped in the
Hypotension
retriculoendot

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Iron helial cells for Flushing Instruct patient to avoid concurrent use of alcohol
preparation storage and
eventual Myocardial Infarction
Dosage/ conversion to Advice patient to consult physician if irregular
Route: usable from of heartbeat, dyspnea, swelling of hands and feet and
PO, BID iron hypotension occurs

Inform patient to comply with additional

intervention for hypertension like proper diet ,
regular exercise , lifestyle changes, and stress
management

NAME OF DRUG MODE OF INDICATIONS CONTRAIND ADVERSE NURSING INTERVENTION

ACTION ICA-TIONS REACTIONS

Generic: Pantoprazole Inhibits proton Maintenance of Hypersensitivity CNS: anxiety, asthenia, -Advise patient that drug can be taken without meal.
pump activity by healing of erosive to drug and its dizziness, headache
Brand: Pantoloc binding to esophagitis formulation. -Tell patient to take drug exactly as prescribed every
hydrogen- CV: chest pain day at the same time
Dosage: 40 mg
potassium
EENT: pharyngitis, -Do not crush or chew drug.
Frequency: OD adenosine rhinitis, sinusitis
triphosphatase,
Route: PO located at secretory GI: abdominal pain,
surface of gastric constipation, diarrhea,
Pharmacologic
parietal cells to dyspepsia, flatulence,
classification: Proton
suppress acid
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pump inhibitor secretion. nausea

Therapeutic GU: urinary frequency,

classification: Anti- UTI
ulcer drug
Metabolic:
hyperglycemia,
hyperlipidemia

Musculoskeletal: back
pain, hypertonia, neck pain

Respiratory: bronchitis,
dyspnea, increased cough

Skin: rash

Generic: Salbutamol Blocks action of Bronchodilator History of Worsening of angle- -Increase fluid intake
acetylcholine at hypersensitivity closure glaucoma, acute
Brand: Duavent parasympathetic to atropine eye pain, hypotension (but -Do not take 2 doses in 1 time
sites in bronchial occurs rarely) -Rinse mouth with water immediately after
Dosage: 1 neb
smooth muscle inhalation.
Frequency: every 4
hours

Route: Inhalation

Pharmacologic
classification: Beta 2-
adrenergic agonists

Therapeutic
classification:

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Bronchodilator

Generic: Paracetamol Generally Pyrexia of Hypersensitivity Hematological, skin and Monitor signs and symptoms of hepatotoxicity.
considered to be a unknown origin, other allergic reactions
Dosage: 300 mg weak inhibitor of fever and pain
the synthesis of
Frequency: every 4
prostaglandins
hours if fever is 37.8*C
(PGs). However,
and up
the in vivo effects
Route: IV of paracetamol are
similar to those of
Pharmacologic the selective
classification: cyclooxygenase-2
Acetaminophen (COX-2) inhibitors.
Therapeutic
classification:
Analgesic, Antipyretic

Generic: Lactulose Produces an Constipation -Use cautiously Abdominal cramps, -Monitor sodium level for hyponatremia.
osmotic effect in in patients with belching, diarrhea,
Brand: Lilac colon; resulting in diabetes mellitus flatulence, gaseous -Monitor mental status and potassium levels when
distention promotes and in patients distention, nausea, giving to patients with encephalopathy.
Dosage: 30ml
peristalsis. Also on a low vomiting -Replace fluid loss.
Frequency: ODHS decreases galactose diet.
ammonia, probably
Route: PO as a result of
bacterial
Pharmacologic
degeneration,
classification:
which lowers the
Disaccharides
pH of colon
Therapeutic contents.

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classification: Laxative

Generic: Clopidogrel Inhibits the To reduce - CNS: Confusion, - Advise patient that it may take longer than
binding of thrombotic events Hypersensitivity
Brand: Plavix Hallucination usual to stop bleeding.
adenosine in patients with
Dosage: 75 mg diphosphate atherosclerosis CV: Hypotension -Instruct patient to notify prescriber if unusual
(ADP) to its documented by
Frequency: OD bleeding or bruising occurs.
platelet receptor recent stroke. EENT: Epistaxis,
Route: PO rhinitis -Inform patient that drug can be taken without
Pharmacologic regard to meals
classification: GI: Abdominal pain
Platelet Aggregation
inhibitors GU:UTI, hernia

Therapeutic Musculoskeletal:
classification:
Anti-platelet arthralgia, myalgia

Respiratory:
Respiratory tract
bleeding

Skin: rash, bruising,

eczem

Generic: Enoxaparin Accelerates to prevent ischemic - CNS: Confusion, fever, -Draw blood to establish baseline coagulation
formation of complications of Contraindicated pain. parameters before therapy.
Brand: Clexane antithrombin III- unstable angina and to patients
thrombin complex non-Q-wave hypersensitive CV: Edema, peripheral -Avoid I.M injections of other drugs to prevent
Dosage: 0.4 cc
and deactivates myocardial to drug, heparin
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Frequency: BID thrombin, infarction or pork products edema. hematoma.
preventing
Route: SC conversion of GI: Nausea, diarrhea -Monitor platelet counts regularly.
fibrinogen to fibrin. Hema: Bleeding -Regularly inspect patient for bleeding.
Pharmacologic
classification: complication
Anti-thrombotics
Respiratory: Dyspnea
Therapeutic
classification: Skin: irritation, pain,
Anti-cougulant hematoma.

Generic: Ascorbic Increases - Dietary - GI:Nausea, vomiting, - Secure doctor’s order

Acid supplement Hypersensitivity heartburn, diarrhea, or
protection to vitamin C abdominal cramps (high - Give medication on right timing
Brand: Cecon doses).
mechanism of - Inform patient about the
Dosage: 500 mg Hema:Acute hemolytic
the immune possible side
anemia (patients with
Frequency: TID
system, thus deficiency of G6PD); effects of the
Route: PO sickle cell crisis.
supporting drugs.
Pharmacologic CNS:Headache or
classification: Wound healing. insomnia (high doses).
Water soluble vitamins
Other: Mild soreness at
Therapeutic injection site; dizziness
classification: and temporary faintness
Vitamins with rapid IV
administration.

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Generic: Carvedilol - Hypertension - History of CNS: dizziness, fatigue, w - Monitor BP and pulse frequently during dose
serious eakness, anxiety, adjustment period and periodically during
Brand: Carvid -Heart failure with hypersensitivity depression, drowsiness, therapy.Assess for orthostatic hypotension when
digoxin, diuretics reaction insomnia, memory loss, assisting patient up from supine position.
Dosage: 6.25 g and ACE inhibitor (Stevens- mental status changes,
Johnson nervousness, nightmares - Monitor intake and output ratios and daily weight.
Frequency: Q8 - Left ventricular
syndrome, Assess patient routinely for evidence of fluid
dysfunction after EENT: blurred vision, dry overload (peripheral edema, dyspnea, rales/crackles,
Route: PO angioedema,
myocardial eyes, intraoperative floppy fatigue, weight gain, jugular venous distention).
infarction anaphylaxis);
Pharmacologic iris syndrome, nasal Patients may experience worsening of symptoms
classification: - Pulmonary stuffiness during initiation of therapy for HF.
Beta-Blockers edema;
Resp: bronchospasm, - Hypertension: Check frequency of refills to
Therapeutic - Cardiogenic wheezing determine adherence.
classification: shock;
CV: BRADYCARDIA, H
Anti-hypertensive - Bradycardia, F, PULMONARY
heart block or EDEMA
sick sinus
syndrome GI: diarrhea, constipation,
(unless a nausea
pacemaker is in GU: erectile dysfunction,
place); ↓ libido
- Derm: STEVENS-
Uncompensated JOHNSON
HF requiring IV
SYNDROME, TOXIC
inotropic agents EPIDERMAL
(wean before NECROLYSIS, itching,
starting rashes, urticaria
carvedilol);
Endo: hyperglycemia,
- Severe hepatic

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 impairment; hypoglycemia

- Asthma or MS: arthralgia, back pain,

other muscle cramps
bronchospastic
disorders. Neuro: paresthesia

Misc: ANAPHYLAXIS,
ANGIOEDEMA, drug-
induced lupus syndrome

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 SIDE EFFECTS
AND ADVERSE
DRUG NAME MECHANISM OF INDICATION CONTRAINDICATION EFFECTS NURSING RESPONSIBILITIES
ACTION

Generic Name:  Acute and  Severe hepatic  Side Effects  Assess patient for allergy to NSAIDs drugs.
The mechanism of 
Celecoxib long-term impairment Headache  Monitor for fluid retention and edema especially
Brand Name: action of celecoxib is 
treatment  hypersensitivity to Dizziness in those with a history of hypertension or CHF.
believed to be due to
Rocephin of signs celecoxib  Sinusitis  Take drug with food or meals if GI upset occurs.
Classification: inhibition of
and  asthmatic patients  Nausea  Establish safety measures if CNS, visual
Anti- prostaglandin
synthesis. Unlike symptoms with aspirin triad  Diarrhea disturbances occur.
inflammatory 
Route and most NSAIDs, which of rheumat  advanced renal Rash  Report sore throat, fever, rash, itching, weight gain,
inhibit both types of oid disease  flatulence swelling in ankles or fingers; changes in vision.
dosage:
cyclooxygenases arthritis and  concurrent use of  Adverse  If overdose occurs, institute emergency
100 mg BID
(COX-1 and COX-2), osteoarthrit diuretics and ACE effects: procedures—gastric lavage, induction of emesis,
celecoxib is a is inhibitors  peripheral supportive therapy
selective  edema
Reduction  anemia
noncompetitive of the
inhibitor of number of
cyclooxygenase-2 colorectal
(COX-2) enzyme. It polyps in
binds with its polar familial ade
sulfonamide side nomatous p
chain to a hydrophilic
olyposis (F
side pocket region
AP)
close to the active
 Managemen
COX-2 binding site.
Both COX-1 and t of
COX-2 catalyze the acute pain
conversion of  Treatment
arachidonic acid to of
prostaglandin (PG) primary dys
H2, the precursor of menorrhea
PGs and thromboxane

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