Western Mindanao State University

College of Nursing
Zamboanga City

Alternative Learning System

Related Learning Experience
EMERGENCY ROOM

Instructions:
Answer the provided questions comprehensively following the subsequent format.
Use the Times Roman Font Style
Utilize at least three (3) or more references
References should be 2015 and latest
Output should be submitted as posted in the Google Class Assignment in PDF Format
Use the templates as guides in accomplishing your output
You will be graded according to the Rubric given

https://www.123rf.com/photo_57911846_a-motion-blurred-photograph-of-a-senior-female-patient-on-stretcher-
or-gurney-being-pushed-at-speed-.html
SCENARIO: A Case of Medical Emergency in Diabetes Insipidus (Hypernatremia)
A 52 year old female was brought to the emergency room presenting with seizure. Seizure event lasted for less
than 60 seconds. Nurse Jose noted copious amount of secretions in the patient's mouth, patient looking slightly
pale, restless and lethargic with GCS of 11. The sister reports that the patient has been drinking large volume of
water for the past 2 days and complains of being dizzy when standing. Vitals as follows:

Vital Signs
Blood pressure (BP) : 85/60 mmHg
Heart rate (HR) : 130 beats/min
Respiratory rate (RR) : 33 breaths/min
Temperature : 36.50 C
Sp02 : 91%
Height : 154 cm
Weight : 58kg
GCS : 11

The doctor ordered the following medications:

Medications:
Phenytoin, loading dose, 10mg/kg, IV, over 30 minutes, STAT
Chlorothiazide, 500mg, IV, STAT
Dextrose 5% Water solution, 500ml, IV, over 1 hour

Page 1 of 10
History:
Weakness for the last 3 days. Complains of dizziness when standing and having severe thirst.

Lifestyle factors:

The patient habitually self-medicate. She claimed to have “UTI” due to pain in the abdominal area and took the
spare ofloxacin tabs she had from her previous consultation prescription.

Laboratory results:
Examinations Patient’s Result Normal Value Indication
URINE OSMOLALITY 300 mOsm/Kg
SERUM SODIUM 150 mmol/L

Procedure:
MRI SCAN : Shows brain shrinkage

Source: https://n.neurology.org/content/67/5/880

Case Study Questions:

Initial blood gas was ordered for the patient. Result shows the following:

BLOOD GAS
Parameters Result
Blood pH 7.5
pC02 35
p02 67
HC03 35
02 sat 88

Analyze the blood gas result. DETERMINE THE ACID-BASE ISSUE.

Discuss briefly the CAUSE of the acid-base issue in relation to the case scenario.

Your Tasks:

Determine the need for the required laboratory and diagnostic examinations.
Give the indications for the abnormal result/values
Illustrate the organ involved and label accordingly.
Discuss the normal function of the organ involved.
Explain the pathophysiology based on the diagnosis.
Create the pathologic pathway of the pathogenesis (the development of the disease and the chain of events
leading to the illness) contributing to the patient’s illness condition.
Page 2 of 10
Synthesize the life-threatening pathway as a consequence of the patient’s refusal / non-compliance with
treatment
Answer case study questions.
Formulate 2 Nursing Care Plan of according to the case scenario. And this should be based on the NANDA
approved Nursing Diagnosis.
Give 2 nursing problems (2 NCPs)
PRIORITIZE the problems and cite your reference/s
Develop a Drug Study based on your patient’s medications.

Page 3 of 10
EXAMPLE:

Pathogenesis of Appendicitis

Fecaliths / Appendicoliths Intraluminal Scarring Tumors Pathogens Other Disease

Obstruction of the Appendiceal Lumen

Bacterial Overgrowth

Inflammation

Subjective Cues: Objective Cues:

1. Periumbilical Pain 1. Localized tenderness
2. Anorexia, Nausea & Vomiting 2. Rebound tenderness
3. Persistent, Continuous Pain in the RLQ 3. Muscle guarding
localized at McBurney’s point 4. Flexed right leg
5. Low grade fever

Resolved through Surgery (Appendectomy)

Life-Threatening Pathway (Patient’s refusal / non-compliance with treatment)

 Signs & Symptoms of Over 48 hours

 Without Intervention

PERFORATION

Leak of Content into the Omentum and Surrounding Tissues

COMPLICATIONS

Small bowel obstruction Abscess Formation Peritonitis

Escalating diffuse abdominal pain with rapid development

of toxicity as evidenced by:
1. Dehydration
2. Signs of sepsis
 Oliguria
 Hypotension
 Acidosis
 High-grade fever

Page 4 of 10
3. Drug Study

GENERIC NAME: Phenytoin MECHANISM OF ACTION: SIDE EFFECTS/ADVERSE

NURSING RESPONSIBILITY
Stabilizes neuronal membranes in motor REACTION
cortex. Decreases influx of sodium Side Effects: BASELINE ASSESSMENT
during generation of nerve impulses.  Drowsiness  Anticonvulsant: Review history of
 Lethargy seizure disorder (intensity,
Therapeutic Effect: Decreases seizure  Confusion frequency, duration, LOC).
activity.  Slurred speech  Initiate seizure precautions.
BRAND NAME: Dilantin INDICATION:  Irritability  LFT, CBC should be performed
 Management of generalized tonic-  Gingival hyperplasia before beginning therapy and
DRUG ILLUSTRATION: clonic seizures  Hypersensitivity periodically during therapy.
 Complex partial seizures reaction  Repeat CBC 2 wks following
 Status epilepticus  Constipation  initiation of therapy and 2 wks
 Prevention of seizures from head  Dizziness following administration of
trauma/neurosurgery  Nausea maintenance dose.
 Prevention of early post-traumatic
seizures following traumatic brain Adverse Reaction: INTERVENTION/EVALUATION
injury.  Withdrawal may  Observe frequently for recurrence of
precipitate status  seizure activity.
CLASSIFICATION: CONTRAINDICATION: epilepticus  Monitor ECG for cardiac
 Hypersensitivity to Phenytoin or  Blood dyscrasias arrhythmia.
Pharmacotherapeutic: Hydantoin hydantoins  Osteomalacia  Assess for clinical improvement
Clinical: Anticonvulsant  Concurrent use of delavirdine  Toxic phenytoin blood (decrease in intensity/frequency of
DOSAGE/FREQUENCY/ROUTE:  History of acute phenytoin therapy concentration seizures).
 Second and third degree AV blocks  Ataxia  Monitor for signs/symptoms of
Status Epilepticus  Sinoatrial blocks  Nystagmus depression, suicidal tendencies,
IV: ADULTS, ELDERLY,  Sinus bradycardia unusual behavior.
 Diplopia
ADOLESCENTS: Loading dose: 20  Adams-Stokes Syndrome  Monitor CBC with differential, renal
mg/kg at maximum rate of 50 mg/min.  Suicidal thoughts
function, LFT, B/P (with IV use).
May repeat in 10 min after loading  Severe cutaneous
reaction  Assist with ambulation if
dose with dose of 5–10 mg/kg. drowsiness, lethargy occurs.
INFANTS, CHILDREN: Loading  DRESS
 Monitor for suicidal ideation or
dose: 20 mg/kg at maximum rate of 1 behaviors.

Page 5 of 10
mg/kg/min. May give additional dose  Monitor for therapeutic serum level
of 5–10 mg/kg after loading dose. (10–20 mcg/mL).
 Therapeutic serum level: 10–20
Seizure Control (Maintenance) mcg/mL; toxic serum level: greater
Note: Loading dose not used in pts than 20mcg/mL. Free unbound
with history of renal/hepatic disease. levels: Therapeutic: 1–2 mcg/mL;
PO: ADULTS, ELDERLY: Loading toxic: more than 2 mcg/mL.
Dose: 1 g divided into 3 doses given
at 2-hr intervals. Maintenance (begins
24hrs after loading dose): Initially 100 PATIENT/FAMILY TEACHING
mg 3 times/day; adjust at no less than  Pain may occur with IV injection.
7–10-day intervals. Usual dose: 100  To prevent gingival hyperplasia
mg 3–4 times/day up to 200 mg 3 (bleeding, tenderness, swelling of
times/day (may consider 300 mg once gums), maintain good oral hygiene,
daily in pts established on 100 mg 3 gum massage, regular dental visits.
times/day). CHILDREN: Initially, 5  Serum levels should be performed
mg/ kg/day in 2–3 divided doses. every mo for 1 yr after maintenance
Adjust dose at 7- to 10-day intervals. dose is established and q3mos
Maintenance: 4–8 mg/kg/day. thereafter.
Maximum: 300 mg/day.  Report sore throat, fever, glandular
swelling, skin reaction (hematologic
toxicity).
 Drowsiness usually diminishes with
continued therapy.
 Avoid tasks that require alertness,
motor skills until response to drug is
established.
 Do not abruptly withdraw
medication after long-term use (may
precipitate seizures).
 Strict maintenance of drug therapy is
essential for seizure control,
arrhythmias
 Avoid alcohol
 Report changes in behavior, thoughts
of suicide
Page 6 of 10
 Reference/s:
Kizior, R. J., & Hodgson, K. J. (2019).pg 932-935. Saunders nursing drug handbook 2020.

GENERIC NAME: Chlorothiazide MECHANISM OF ACTION: SIDE EFFECTS/ADVERSE

NURSING RESPONSIBILITY
Inhibits sodium reabsorption in distal REACTION
renal tubules, causing excretion of sodium, Side Effects: BASELINE ASSESSMENT
potassium, hydrogen ions, water.  Increased urinary  Check vital signs, esp. B/P for
frequency hypotension, before administration.
Therapeutic Effect: Promotes diuresis;  Potassium depletion Assess baseline electrolytes, esp. for
reduces B/P.  Orthostatic hypotension hypokalemia.
BRAND NAME: Mircrozide INDICATION:  Headache  Evaluate skin turgor, mucous
 Treatment of mild to moderate  GI disturbances membranes for hydration status.
DRUG ILLUSTRATION: hypertension  Photosensitivity Evaluate for peripheral edema.
 Edema in HF  Assess muscle strength, mental
 Hepatic cirrhosis Adverse Reaction: status.
 Renal dysfunction  Water loss/dehydration  Note skin temperature, moisture.
 Treatment of calcium  Acute hypotensive  Obtain baseline weight.
nephrolithiasis episodes  Monitor I&O.
 Hyperglycemia INTERVENTION/EVALUATION
 Pancreatitis  Continue to monitor B/P, vital signs,
 Pulmonary edema electrolytes, I&O, daily weight. Note
 Blood dyscrasias extent of diuresis.
 Allergic pneumonitis  Watch for changes from initial
 Lethargy assessment (hypokalemia may result
in weakness, tremor, muscle cramps,
CLASSIFICATION: CONTRAINDICATION:  Coma
nausea, vomiting, altered mental
 Hypersensitivity to Phenytoin or status, tachycardia; hyponatremia
Pharmacotherapeutic: Sulfonamide chlorothiazude may result in confusion, thirst,
derivative. Thiazide diuretic.  Anuria cold/clammy skin) esp. alert for
Clinical: Antichypertensive  History of hypersensitivity to potassium depletion in pts taking
DOSAGE/FREQUENCY/ROUTE: sulfonamides or thiazide diuretics digoxin (cardiac arrhythmias).
 Potassium supplements are
Hypertension
frequently ordered.
PO: ADULTS: Initially, 12.5–25 mg
 Check for constipation (may occur
once daily. May increase up to 50
with exercise diuresis).
Page 7 of 10
 mg/day in 1–2 divided doses.
ELDERLY: Initially, 12.5 mg once
daily. Titrate in 12.5 mg increments PATIENT/FAMILY TEACHING
up to 50 mg/day in 1–2 divided doses.  Expect increased frequency
(diminishes with continued use),
Usual Pediatric Dosage volume of urination.
(Edema/HTN)  To reduce hypotensive effect, go
PO: CHILDREN 2–12 YRS: 1–2 from lying to standing slowly.
mg/kg/day. Maximum: 100 mg/day.  Eat foods high in potassium, such as
CHILDREN 6 MOS–2 YRS: 1–2 whole grains (cereals), legumes,
mg/kg/day in 1–2 divided doses. meat, bananas, apricots, orange
Maximum: 37.5 mg/day. CHILDREN juice, potatoes (white, sweet),
YOUNGER THAN 6 MOS: 1–3 raisins.
mg/kg/day in 2 divided doses.  Protect skin from sun, ultraviolet
Maximum: 37.5 mg/day. light (photosensitivity may occur).

Dosage in Renal Impairment

Creatinine clearance less than 30
mL/min: Generally not effective.
Avoid use with creatinine clearance
less than 10 mL/min.
Reference/s:
Kizior, R. J., & Hodgson, K. J. (2019).pg 568-570. Saunders nursing drug handbook 2020.

Page 8 of 10
GENERIC NAME: Ciprofloxacin MECHANISM OF ACTION: SIDE EFFECTS/ADVERSE
NURSING RESPONSIBILITY
Inhibits enzyme, DNA gyrase, in susceptible REACTION
bacteria, interfering with bacterial cell Side Effects: BASELINE ASSESSMENT
replication.  Nausea  Question for history of
 Diarrhea hypersensitivity to ciprofloxacin,
Therapeutic Effect: Bactericidal.  Dyspepsia quinolones; myasthenia gravis,
BRAND NAME: Pycip INDICATION:  Vomiting renal/hepatic impairment.
 Treatment of susceptible infection due  Constipation
DRUG ILLUSTRATION: to E. Coli, K. pneumonia, E cloacae,  Flatulence INTERVENTION/EVALUATION
P. mirabilis, P. vulgaris, P.  Confusion  Obtain urinalysis for microscopic
aeruginosaH. influenzae, M. analysis for crystalluria prior to and
 Crystalluria
catarrhalis, S. pneumoniae, S. aureus during treatment. Evaluate food
 Burning and crusting of
(methicillin susceptible), S. tolerance.
eye
epidermidis, S. pyogenes, C. jejuni,  Monitor daily pattern of bowel
 Altered taste
Shigella spp., S. typhi activity, stool consistency.
 Sensation of foreign
 Encourage hydration (reduces risk of
body in eye
crystalluria).
 Eyelid redness
 Monitor for dizziness, headache,
 Itching
visual changes, tremors.
 Assess for chest, joint pain.
Adverse Reaction:
 Ophthalmic: Observe therapeutic
 Superinfection
response.
 Nephropathy
 Cardiopulmonary arrest
PATIENT/FAMILY TEACHING
CLASSIFICATION: CONTRAINDICATION:  Cerebral thrombosis  Do not skip doses; take full course of
 Hypersensitivity ciprofloxacin and  Hypersensitivity therapy.
Pharmacotherapeutic: other qionolones. reaction
 Maintain adequate hydration to
Fluoroquinolone.  Concurrent use of tizanidine  Photosensitivity prevent crystalluria.
Clinical: Antibiotic  Muscle weakness  Do not take antacids within 2 hrs of
DOSAGE/FREQUENCY/ROUTE:  Toxic epidermal ciprofloxacin(reduces/destroys
necrolysis effectiveness).
Usual Dosage Range  Stevens-Johnson
PO: ADULTS, ELDERLY: 250–750  Shake suspension well before using;
Syndrome do not chew microcapsules in
mg q12h. CHILDREN: (Mild to  Hepatotoxicity
moderate infections): 10 mg/kg twice suspension.
 Tendonitis  Sugarless gum, hard candy may
 Tendon rupture relieve bad taste.
Page 9 of 10
 daily. Maximum: 500 mg/dose.  Avoid caffeine.
(Severe infections): 15–20 mg/kg  Report tendon pain or swelling.
twice daily. Maximum: 750 mg/dose.  Avoid exposure to sunlight/artificial
IV: ADULTS, ELDERLY: 200–400 light (may cause photosensitivity
mg q12h. CHILDREN: 10 mg/kg q8– reaction).
12h. Maximum: 400 mg/dose.  Report persistent diarrhea..

Usual Ophthalmic Dosage

ADULTS, ELDERLY, CHILDREN:
(Solution): 1–2 drops q2h while
awakefor 2 days, then 1–2 drops q4h
whileawake for 5 days. (Ointment):
Apply 3 times/day for 2 days, then 2
times/day for 5 days

Usual Otic Dosage

ADULTS, ELDERLY, CHILDREN:
Otic solution 0.2%. Instill 0.25 mL
(0.5 mg) 2 times/day for 7 days.

Reference/s:
Kizior, R. J., & Hodgson, K. J. (2019).pg 253-255. Saunders nursing drug handbook 2020.

Page 10 of 10