1

University of Perpetual Help System

Cauayan City, Isabela

CASE STUDY
ON

PATENT DUCTUS ARTERIOSUS (PDA)

In partial fulfilment on the subject, NCM101 – RLE

(Grand Case Presentation)

Presented by:

Mabanag, Carrei Cyrell R.

Agustin, Joan Z.
Corpuz, Adela
Borromeo, Karla Mae
Guttierez, Edmhar Allan
Domingo, Marjorie
Manongdo, William Leo
Bayudan, Kelvine
Gumayagay, Mary Grace
Remocal, Neil
Group 3
BSN IIIA

Presented to:

Clinical Instructors
& BSN3 Students
UPHS-IC
 2

INTRODUCTION

Patent ductus arteriosus (PDA) is a congenital heart defect wherein a neonate's ductus arteriosus
close after birth ter birth. Symptoms are uncommon but in the first year of life include increased work of breathing
and poor weight gain. With age, the PDA may lead to congestive heart failure if left uncorrected. A patent ductus
arteriosus can be idiopathic (i.e. without an identifiable cause), or secondary to another condition. Some common
contributing factors in humans include: - Premature infants - Congenital rubella syndrome - Chromosomal
abnormalities such as Down Syndrome.

While still on mother’s womb a baby’s lungs are not needed to supply oxygen because the baby receives
its oxygen via the mother’s lungs and placenta. Since a baby’s lungs do not provide any oxygen, there is no need
for energy to be expended pumping blood to the lungs. The ductus arteriousus is a blood vessel that is present in
all babies while still in the womb that allows the blood to bypass the blood waste to the lungs; it allows blood to
flow from the pulmonary artery to the aorta. When the baby is born and the umbilical cord is cut the lungs are now
needed to supply oxygen.

In the developing fetus, the ductus arteriosus (DA) is the vascular connection between the
artery and the aortic arch that allows most of the blood from the right ventricle to bypass the fetus' fluid-filled
compressed lungs. During fetal development, this shunt protects the right ventricle from pumping against the high
resistance in the lungs, which can lead to right ventricular failure if the DA closes in-utero.

When the newborn takes its first breath, the lungs open and pulmonary vascular resistance decreases. After
birth, the lungs release bradykinin to constrict the smooth muscle wall of the DA and reduce bloodflow through the
DA as it narrows and completely closes, usually within the first few weeks of life. In most newborns with a patent
ductus arteriosus the blood flow is reversed from that of in utero flow, ie. the blood flow is from the higher pressure
aorta to the now lower pressure pulmonary arteries.

In normal newborns, the DA is substantially closed within 12-24 hours after birth, and is completely sealed
after three weeks. The primary stimulus for the closure of the ductus is the increase in neonatal blood oxygen
content. Withdrawal from maternal circulating maternal prostaglandins also contributes to ductal closure. The
residual scar tissue from the fibrotic remnants of DA, called the ligamentum arteriosum, remains in the normal adult
heart.

Patent ductus arteriosus, or PDA, is a heart condition that is normal but reverses soon after birth. In a
persistent PDA, there is an irregular transmission of blood between two of the most important arteries
proximity to the heart. Although the ductus arteriosus normally seals off within a few days, in PDA, the newborn's
ductus arteriosus does not close but remains patent. PDA is common in neonates with persistent respiratory
problems such as hypoxia, and has a high occurrence in premature children. In hypoxic newborns, too little
reaches the lungs to produce sufficient levels of bradykinin and subsequent closing of the DA. Premature children
are more likely to be hypoxic and thus have PDA because of their underdeveloped heart and lungs.

A patent ductus arteriosus allows that portion of the oxygenated blood from the left heart to flow back to the lungs
(following the pressure gradient from the higher pressure aorta to the pulmonary arteries). If this shunt amount is
substantial, the neonate becomes short of breath because there is not only the normal amount of unoxygenated blood
that has returned from the body to go to the lungs but in addition there is the amount shunted through the PDA. The
neonate's work of breathing is increased, using up more calories and often interfering with feeding in infancy. This
Signs and symptoms

While some cases of PDA are asymptomatic, common symptoms include:

 tachycardia or other arrhythmia

 respiratory problems
 shortness of breath
 continuous machine-like murmur
 enlarged heart
 Left subclavicular thrill
 Bounding pulse
 Widened pulse pressure [1]
 Poor growth [2]

Diagnosis

PDA is usually diagnosed using non-invasive techniques. Echocardiography, in which sound waves are used to
capture the motion of the heart, and associated Doppler studies are the primary methods of detecting PDA.
 3
Electrocardiography (ECG), in which electrodes are used to record the electrical activity of the heart, is not
particularly helpful as there are no specific rhythms or ECG patterns which can be used to detect PDA.

A chest X-ray may be taken, which reveals the overall size of neonate's heart (as a reflection of the combined mass
of the cardiac chambers) and the appearance of the blood flow to the lungs. A small PDA most often shows a normal
sized heart and normal blood flow to the lungs. A large PDA generally shows an enlarged cardiac silhouette and
increased blood flow to the lungs.

Treatment

Neonates without adverse symptoms may simply be monitored as outpatients, while symptomatic PDA can be
treated with both surgical and non-surgical methods.[3] Surgically, the DA may be closed by ligation, wherein the
DA is manually tied shut, or with intravascular coils or plugs that leads to formation of a thrombus in the DA. This
was first performed in humans by Robert E. Gross. Because Prostaglandin E-2 is responsible for keeping the ductus
patent, inhibitors of prostaglandin synthesis such as Indomethacin have been used to help close a PDA. This is an
especially viable alternative for premature infants.

In certain cases it may be beneficial to the neonate to prevent closure of the ductus arteriosus. For example, in
transposition of the great vessels, a PDA may prolong the newborn's life until surgical correction is possible. The
ductus arteriosus can be induced to remain open by administering prostaglandin analogs such as alprostadil (a
prostaglandin E1 analog).

Recent days PDA can be closed by percutaneous interventional method, through femoral vein or femoral artery, a
coil can be placed with the help of myocardial forceps to make an embolus, which closes the PDA without open
heart surgery.
 4

Patient’s Profile
Name: Aeg. Bebs
Age: 7 y/o
Birth date: July 2, 2002
Gender: Female
Civil Status: Single
Religion: Latter Day Saint
Nationality: Filipino
Address: Linglingay, Alicia, Isabela
Occupation: ---
Chief Complaint: Fever, Cough and Difficulty of Breathing
Admitting Diagnosis: Pneumonia
Attending Physician: Dra. Cadelina

Date Admitted: August 11, 2009

Time admitted: 9:50 am

Nursing History:

Present Health History

The present health history started 5 days ago prior to admission.

Aeg. Bebs admitted last August 11, 2009 at around 9:50 am with a
chief complaint of fever, cough and difficulty of breathing. Due
to persistence of the said complaint, the patient seeks
consultation and hence admitted at Cauayan Medical Specialist
Hospital (CMSH) under Dr. Cadelina as the attending physician.
The patient has an admitting diagnosis of Pneumonia, a persistent
Physical examination Findings of Congenital Heart Failure 2 with
diagnosis of PDA as manifested by tachypnea, tachycardia,
arrhythmia & paleness. She has also a fever of 39 C

Past History

Prior to hospitalization, Aeg. Bebs was diagnosed with Heart

enlargement last April, 2003 yet they can’t remember the exact
date. Together with her SO she had attended regular check-ups
every 3 months on an outpatient department (OPD) at East Avenue,
Quezon city, Philippine Heart Center. The said schedules are:

OPD APPOINTMENTS
Time Date Clinic
8 am August 10/07
8 am November 19/07
8 am November 21/07
8 am December 14/07
8 am April 23/08
8 am July 14/09
8 am November 05/09
8 am February 23/09

Because of financial matters the SO decided to discontinue

temporarily their regular Check-ups at Philippine Heart Center
and seek for another physician which is situated near to their
permanent address. On April 4, 2008, the patient undergone non
-invasive diagnostic procedures that results with the final
interpretation of Congenital heart disease, PATENT DUCTUS
ARTERIOSUS with pulmonary artery hypertension mild rheumatic
 5
heart disease, Mitral regurgitation, Moderate aortic
Regurgitation, mild. Tricuspid regurgitation.

Social History

According to the SO, Aeg. Bebs is actively playing with her

classmates and siblings. She loves to mingle and socialize with
their neighborhood because almost of their neighbours are their
relatives. Sleeping, playing, and going to school are the common
activities of Aeg. Bebs every day. She and her playmates are
funned of climbing trees such as “santol” and guava tree.

Family history

No hereditary disease can be attributed from her father’s side,

but her mother had a family health history of hypertension, Heart
disease, and Diabetes mellitus.

Gordon’s 11 Functional Pattern

I. Health Perception- Health Management Pattern

Before hospitalization, the SO perceives that their daughter
is healthy when patient bebs doesn’t experience difficulty of
breathing. The SO are aware on the condition of Aeg. Bebs, and
they are also aware that their daughter needs to attend her
regular check-ups as much as possible. They’re also using herbal
medicine such as Oregano if Aeg. Bebs has cough, and every time
the Aeg. experiencing DOB, the SO positions Aeg. in a Tet spell
position.
In terms of hygiene wellness before and during
hospitalization, the SO (mother) said that Aeg. Bebs don’t take a
bath daily, she brushes her teeth seldom and don’t seek for
dental check-up since; there is no occurrence of toothache.

II. Nutritional/ Metabolic Pattern

Before hospitalization, the patient never skip her meals and
don’t have snack in between. The patient preferably eats citrus
fruits and vegetables than eating junk foods. She also drinks
minimum of 5 glasses a day (1 glass of Milo in the morning, 1
glass/pack of orange juice during school break and the remaining
glass was water).
During hospitalization, the patient is in soft diet as ordered
upon admission in relevance to her condition. The amount of water
being intake during confinement is half glass in 3 hrs. of our
duty.

III. Sleep and Rest Pattern

Before Hospitalization, her usual sleeping pattern was 10
hrs. She habitually goes to bed around 8pm after “teleserye” of
abs-cbn entitled “may bukas pa” and wake up at around 6 in the
morning to prepare for her class at around 7 am.

IV. Elimination Pattern

Before confinement, the patient usually urinates at least 3
times a day and defecates at least once a day.
During confinement, August 11, 2009, from 10am to 3pm she
urinated with a colour of yellow and a slightly turbid
transparency and defecated once with soft yellow stool.
 6
V. Activity/ Exercise Pattern
According to the SO (father), before confinement the Aeg.
bebs usually spends her time after class on climbing trees
together with her playmates.
During confinement, Aeg. usual activity is resting or sleeping
due to body weaknesses.

VI. Cognitive Perceptual Pattern

The patient’s cognitive development is low. She is in a
school–age stage yet she was just able to read A-Ba-Ka-Da and
write her name. As the SO mentioned, Aeg. bebs has a passion on
singing and dancing as well.

VII. Self-Perception Pattern

When she was in kinder, she stopped attending her class because
her classmates are always bullying her until she develops low
self esteem that makes her quiet at all times on her class. But
now, patient bebs was able to cope up with her classmates
according to her mother.

VIII. Role Relationship Pattern

The SO (mother) said that Aeg. bebs is a responsible
daughter, because at her young age, she was able to do things
like helping her on washing dishes and sweeping their floor. It
was a big help on her part. She is also a sweet sister to her 3
elder brothers and her younger sister.

IX. Sexuality-Sexual Pattern

At her young age, her level of maturity is low. She was
closer to her mother than her father. Her site of gratification
is phallic according to Sigmund Freud

X. Coping-Stress Management Pattern

In terms of decision making in consideration to
Patient’s age, her parents are the one who decide for what is
good for her and how would she deal with her problems.

XI. Value Belief System

Aeg. bebs was a believer of Latter day saints and
shows religiousness by attending the mass every Sunday with her
parents, brothers & sister.

Physical Examination
General Survey:
General appearance/ health status
Measurements:
Weight: 14kg
Level of consciousness: spontaneous, oriented
Body build: small and scrawny
Grooming: fair
Vital Signs:
-Temperature: 39.3C
- RR: 53 cpm
- PR: 163 bpm
Date of assessment: August 11, 2009 (12:15 pm)
Head to Toe Assessment
Areas Assessed Technique Findings Analysis
Used
) Head      

Skull Palpation Proportional to the size

of the body, round,
 7
symmetrical in all
planes.
Hair Inspection Hair is black, evenly  
distributed, covers the Due to poor
whole scalp and thick hygiene
(+) infestation of lice (bathing) and
and numerous nits transmission
of lice among
her family
members.
Scalp Inspection  Scalp is white, clean,  
Palpation free from masses,
dandruff and lesion.

Face Inspection Symmetrical in four

phases Due to
(+) Facial Grimace discomfort
Eyes & Inspection  Eyes are parallel and  
Vision evenly placed,
symmetrical, both eyes
black and clear. Pupils
equally reactive to
light

Nose & Inspection Nose is in midline,

Sinuses symmetrical
(-) secretions of mucus
Ears Inspection  Ears are parallel,  
symmetrical,
proportional to the size
of the head, bean-shaped Due to poor
and able to hear. hygiene
Ear canal has abundant
amount of cerumen
Cheeks Palpation Pale, smooth and moist  Due to
mixture of
deoxygenated
and
oxygenated
blood
circulates in
the body.

Mouth Inspection (-) swelling on the gums

and bleeding
(+) dental carries Due poor oral
hygiene
Tongue Inspection  In central position,
Palpation freely movable, pinkish,
Smooth tongue base and
with prominent veins.
(-) deviation and
protrusion
(-) Tenderness

Lips Observation  Dry and cracking lips Due to mild

Symmetrical and lip dehydration
margin is well defined

2.) Neck Inspection (-) Rashes

Palpation Good range of motion
 8
3.) Heart Auscultatio (+)tachycardia manifestation
n (+)bounding pulse s of PDA
(+)heart murmur
(+)arrhythmia
4.) Chest and Inspection asymmetrical chest (left Due to
Lungs and part in midsagittal congestion of
Auscultatio section) lungs.
n (+) wheezes and crackles
breath sounds
5.) Abdomen Inspection, Abdominal skin is
Auscultatio unblemished, no scars.
n, Auscultated 19/ min.
Percussion bowel sounds
Palpation (-) masses palpated
6.) Back Inspection unblemished

7.) Upper      
Extremities

Skin Inspection Pale Due to

and Good turgor mixture of
Palpation deoxygenated
and
oxygenated
blood
circulates in
the body.

Arms Inspection Symmetrical, fine hair

evenly distributed

Hands Inspection With complete five

fingers

Palms Inspection Pale Due to

mixture of
deoxygenated
and
oxygenated
blood
circulates in
the body.

Nails Inspection  Smooth, concave with  

palpation pale nail and Clean
fingernails, Due to
Capillary Refill 3-4 mixture of
secs. deoxygenated
and
oxygenated
blood
circulates in
the body.
 9
8.) Lower
Extremities

Skin Inspection pale, Due to

fine hair is evenly mixture of
distributed deoxygenated
and
oxygenated
blood
circulates in
the body.

Legs Inspection Muscles symmetrical,

palpation length symmetrical

Toes Inspection 5 toes in each foot,

sole and dorsal surface
is smooth

Toe nails Inspection with pale nail beds Due to

and mixture of
palpation deoxygenated
and
oxygenated
blood
circulates in
the body.

Laboratory Examination and other Diagnostic Procedures

Finding
Examination Done s Normal Values Analysis
 10
HEMATOLOGY
08/11/’09 Conventional units  
>parameters    
  There is a
- presence of blood
Hematocrit 36.7 37.0-47.0 % streak sputum
- 140-440 x   w/in normal
Platelet 190 10^3/uL range
- WBC  It indicates that
count there is a
bacterial or viral
growth inside the
4.3-10 x body.
4.1 10^3/uL
-
Neutrophils 64 51-67 %  w/in Normal range
 Lymphocytes
increases in
- number due to
Lymphocytes 36 25-33 % infection.
- 12.0-16.0 g/ Oxygen level
Hemoglobin  10.8 dl decreases
       

Chest X-ray 08/11/’09

Chest AP & Lat:

Examination shows hazy and confluent

infiltrate in both lower lung

Fields, more at the left side

Heart and great vessels are w/in normal size
and configuration
Bony thorax is intact
Both sinuses and diaphragms are normal
Other chest structures are not remarkable

Impression:

Pneumonia, both lower lungs

Suggest follow-up to rule out primary
infection
 11

REVIEW OF SYSTEM: CIRCULATORY SYSTEM

Anatomy and Physiology

Functions of the peripheral circulation

The heart provides the major force that causes blood to
circulate, and the peripheral circulation functions to:
1. Carry blood
2. Exchange nutrients
3. Transport
4. Regulate blood pressure
5. Direct blood flow
 12

Circ
ulation in the body

Systemic Circulation
From the lungs, the blood is returned to the heart through
pulmonary veins, two from each lung. From the pulmonary veins the
blood enters the left atrium and then passes through the mitral
valve to the left ventricle. As the ventricles contract, the
mitral valve prevents backflow of blood into the left atrium, and
blood is driven through the aortic valve into the aorta, the
major artery that supplies blood to the entire body. The aortic
valve, like the pulmonary valve, has a semilunar shape.
The aorta has many branches, which carry the blood to
various parts of the body. Each of these branches in turn has
branches, and these branches divide, and so on until there are
literally millions of small blood vessels. The smallest of these
on the arterial side of the circulation are called arterioles.
They contain a great deal of smooth muscle, and because of their
ability to constrict or dilate, they play a major role in
regulating blood flow through the tissues.
 13
Pulmonary Circulation
From the right atrium the blood passes to the right
ventricle through the tricuspid valve, which consists of three
flaps (or cusps) of tissue. The tricuspid valve remains open
during diastole, or ventricular filling. When the ventricle
contracts, the valve closes, sealing the opening and preventing
backflow into the right atrium. Five cords attached to small
muscles, called papillary muscles, on the ventricles' inner
surface prevent the valves' flaps from being forced backward.
From the right ventricle blood is pumped through the
pulmonary or semilunar valve, which has three half-moon-shaped
flaps, into the pulmonary artery. This valve prevents backflow
from the artery into the right ventricle. From the pulmonary
artery blood is pumped to the lungs where it releases carbon
dioxide and picks up oxygen.

Normal Heart and Heart With Patent Ductus Arteriosus

Figure A. shows the interior of a normal heart and normal blood

flow. Figure B shows a heart with patent ductus arteriosus. The
defect connects the aorta with the pulmonary artery. This allows
oxygen-rich blood from the aorta to mix with oxygen-poor blood in
the pulmonary artery.
Before birth, the two major arteries—the aorta and the pulmonary
artery—are connected by a blood vessel called the ductus
arteriosus. This vessel is an essential part of fetal blood
circulation.

Ductus Arteriosus
It is kept widely patent by low arterial oxygen content and
circulating prostaglandins which are produced in part by the
placenta.
Ductus arteriosus partially close within 12-24 hrs. after birth
and DA should be sealed of within 3 weeks after birth, the
closing of vessels is a normal changes occurring on baby’s
circulation after the stimulation.
In some babies, however, the ductus arteriosus remains open
(patent). This opening allows oxygen-rich blood from the aorta to
mix with oxygen-poor blood from the pulmonary artery. This can
 14
put strain on the heart and increase blood pressure in the lung
arteries.
COURSE IN THE WARD

AUGUST 11, 2009

TIME DOCTOR'S ORDER RATIONALE NURSING CONSIDERATIONS
10:00am For further observation and to Let the patient place
let the patient choose an on bed comfortably
please admit environment in which she could
be comfortable
For legal purposes Assess the SO/patient
Secure consent for admission and level of consciousness
management before letting her sign
the consent
To obtain baseline data,and for Monitor every shift to
complications to detect earlier note for changes and
TPR q shift and record
know the condition of
the patient
Instruct the SO to
introduce soft diet to
Soft diet To prevent possible aspiration the patient.
Explain to the SO why
Laboratory test:
she need to undergo for
- CBC, platelet For further exams a test
Explain to the SO why
(14 kg) she need to undergo to
For further chest examination a series of a
CXR (AP.L) diagnostic exam
(t=39 C) Regulate the IVF 50
mggts/min. and check
Hypotonic fluid used to the regulation
IVF D5 0.3 NaCl 1L x 50 cc/hr rehydrate patient. frequently.
meds:  
10:40 am
- Paracetamol 150 mg IV Antipyretic and analgesic drug Assure the 10 rights of
 administering
q4 @ temp.>38 (RTC) medication
Treat edema due to heart Assure the 10 rights of
failure. administering
Furosemide 15 g IV q 12 Diuretic drugs medication
 Assure the 10 rights
- cefuroxime 500 mg IV of administering
q8 Anti-infective and antibiotic medication
Assure the 10 rights of
Bronchodilator,and to liquefy administering
duavent neb. TID secretions medication
Ap informed    
refer for continuation of care
Patient’s meds.

Lanoxin 0.25 mg ¼ tab –am-pm Anti-arrhythmia Assure the 10 rights of

administering
medication
Captopril 25 g ¼ tab ACE blocker Assure the 10 rights of
administering
medication
Patient’s Name: Baladad, Bevirly Age: 7 y/o
CC: fever and cough Attending Physician: Dr
Cadelina
1ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Increased After 30 min. 1. Established To gain trust & Goal partially
“nilalagnat body of nursing rapport through cooperation of met. After 30
siya” as temperature intervention, NPI. the patient and min. of nursing
verbalized by r/t pyrogenic the patient SO in the intervention,
the mother. effect due to will be able succeeding the patient’s
bacterial to decrease nursing temperature
Objective: invasion body interventions. decreases to:
temperature 2. Monitored v/s To established
-body into normal especially baseline data for Temp.: 38.4’C
temperature range of 36.8- temperature. follow up care.
above normal 37 C. To assess for
range (39.3’C) abnormal findings
-looks weak on v/s.
-looks pale 3. Performed TSB. To promote heat
-(+) cough- loss by
productive cough evaporation.
- warm to touch 4. Provided To promote
- dry lips comfortable bed. comfort.
- irritable
-increased 5. Provided cool Promotes heat
RR:53cpm environment. loss.
-increased 6. Discouraged use Promotes heat
PR:163bpm of blankets. loss.
7. Assisted patient To promote
in comfortable comfort.
position
8. Encouraged S.O. To prevent
to increase the dehydration.
patient’s fluid
intake.
8. Encouraged S.O. To provide
to let the patient comfort.
wear loose clothing

10. Encouraged S.O. To reduce

to reduce the metabolic demands
patient’s physical and oxygen
activity. consumption.

12. administered -To reduce body

antipyretics as temperature.
ordered by the
physician.
2 Subjective: Ineffective After the 1. Established To gain After nursing
“nahihirapan airway shift (7-3pm) trust and rapport cooperation in interventions
siyang huminga” clearance of nursing to the patient and the succeeding the patient was
as verbalized by related to interventions S.O. nursing able to
the mother. the excessive the patient interventions. expectorate
production of will be able 2. Monitored V/s To establish mucus secretion.
mucus to expectorate especially RR,T,PR baseline data for Goal partially
Objective: secretions follow up care. met.
Increase RR: readily To assess for
53cpm abnormal findings
(+) cough, if v/s.
productive
(+)wheezes and 3. Provided To promote
crackles comfortable bed. comfort.
Restlessness 4. Positioned To allow greater
pale patient in semi- chest expansion
fowler’s position. and lung
ventilation.
5. Positioned the To facilitate
patient in side secretions
lying position

6. Encouraged S.O. Can help liquefy

to increase the viscous
patient’s fluid secretions.
intake.
7. instructed the To prevent
SO for soft diet possible
aspiration

8. Encouraged Provide wellness

patient to use
relaxation
 technique and
position of
comfort.
9. Assisted patient Promotes optimal
for tet’s spell chest expansion
position which is
appropriate to her
condition

10. Encouraged Helps reduced

adequate rest and oxygen demand.
limit activities.
11. Keep the To reduce
environment irritant effect
allergen/ pollutant of dust and
free. chemicals on
airways.
12. Provided To improve
supplemental secretion
humidification. clearance.
13. performed chest To mobilize
physiotherapy after secretions for
nebulization easy
expectoration

DRUG STUDY
Generic Classificati Availab Indication/ Contraindic Side effect Adverse Nursing
name on ility/ action ation reactions considerations
dosage
         
Cefuroxime Anti- 500 mg Treat Hypersensit Most common CNS: Before giving
Na infective, IV q8 respiratory ivity to side effects: fever drug ask patient
Antibiotic, tract cephalospor diarrhea, headache if he is allergic
2nd infection; in nausea, dizziness to penicillins or
Brand generation inhibits vomiting, . cephalosporins.
name: cephalospori cell wall headaches or CV: Obtain specimen
Profurex n synthesis, migraines, phlebitis for culture and
promoting dizziness and GI: sensitive test
osmotic abdominal pain Diarrhea before giving
instability GU: first dose.
; usually Genital Therapy may begin
bactericida pruritus, before results.
l. candidias Drug is commonly
is used in home
Hematolog antibiotics
ic: programs for
leukaemia outpatient
Skin: treatment of
pain serious infection
induratio Don’t confuse
n drug with other
tendernes cephalosporin
s at that sound like.
injection
site,
rash,
pruritus.

Generic
name: Antiasthmati 1 neb. Management Hypertrophi >serious Hypersens Assess lung
Albuterol c, COPD TID of c side itivity sounds, pulse,
Preparations reversible obstructive effects: reactions and blood
, bronchospas cardiomyopa : pressure before
an allergic
Brand Bronchodilat m thy or Hypokalae administration
name: or associated tachyarryth reaction mia and during peak
Duavent w/ mia. (difficulty Tremor, of medication.
obstructive Hypersensit breathing; headache, Note amount,
airway ivity to closing of your hyperacti colour, and
diseases soya throat; vity, character of
lecithin or swelling of tachycard sputum produced.
related your lips, ia, Withhold
food tongue, or palpitati medication and
products face; or ons, notify physician
(for MDI). hives); or cardiac if paradoxical
chest pain or arrhythmi bronchospasm
irregular a, (wheezing) had
heartbeats. periphera been observed.
>less serious l
side effects: vasodilat
headache; ation,
dizziness or muscle
lightheadedness cramps.
; Pulmonary
insomnia; oedema,
tremor or myocardia
nervousness; l
sweating; ischaemia
nausea, , nausea
vomiting, or &
diarrhea; or vomiting
dry mouth. (IV
infusion)
.
Paradoxic
al
bronchosp
asm,
mouth &
throat
irritatio
n
(inhaled
prep).
Lactic
acidosis
(nebule/I
V
infusion
DISCHARGED PLAN

Encourage the SO to continue the medication of Aeg. Bebs

M at home, also remind her to monitor her condition and
make sure that Aeg. Bebs is taking up her medication on
time for her maintenance of health.
Instruct the SO to encourage patient Bebs to have
basic/simple physical exercises within her
E
limits/capability appropriately for promotion of
wellness.

Emphasize the importance of treatment regimen to the

T
patient and significant others, especially the treatment
given to Patent Ductus Arteriosus.
Instruct the SO to encourage Aeg. Bebs to take a bath
H daily, brush her teeth 2-3 times a day for promotion of
proper hygiene and to lessen the probability of
acquiring diseases.
Inform the SO to continue follow-up check-up of Aeg.
O Bebs at the OPD specifically on the OPD-Philippine Heart
Center every 3 months.
Instruct the SO to encourage Aeg. to eat nutritious
foods such as fruits, rice, meats and vegetables for
D nourishing purposes and to gain weight in preparation
for PDA treatment procedures to be done in the future.

S Encourage to continue their routine of attending mass

every Sunday on LDS church, together with her family.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SUBJECTIVE: Body weakness After the shift Independent: -to gain Goal met.
Nanghihina related to disease (7-3pm) the >established rapport cooperation and After the
siya. As state. patient will be through NPI. trust from the nursing
verbalized by the able to ensure >monitored VS patient and the SO interventions
SO(mother) of the more strength- (PR,RR,T) -to establish the patient
patient gained baseline data and can ensured
to assess early more strength-
OBJECTIVES: >encouraged patient abnormal VS gained as
Paleness to eat foods which -carbohydrates evidenced by:
Increase is high in sustain enough -good looking
RR(53cpm) carbohydrates energy on our -can do things
Weak looking body, serves as such as
Easy >encouraged use of body fuel walking
fatigability relaxation -to facilitate -RR within
techniques(breathing relaxation/ to normal range
technique-tet spell) feel relax
>instructed patient
to have complete
sleep hours(8- -to have rest and
10hours) appropriate gain more strength
to her age
>encouraged patient
to express positive -it can enhance
emotions feelings of power
>instructed the
patient not to show -negative emotions
emotions such as can lessen energy
anger, frowning and
other negative
emotions
>encouraged soft -to prevent
diet aspiration
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION

Subjective: Knowledge At the end of Assessed client’s Learning depends on Goal met. The
”laro lang po deficit the shift, the ability to learn emotional and physical client
ako ng laro un related to client will readiness and is verbalized
pala bawal po”,
Subjective: lack of
Diagnosis: verbalize
Planning: Interventions: achieved Rationale:
at an little
Evaluation:
as verbalized exposure to understanding of individual pace understanding
by siya
Hindi the patient.
araw- information
>Self-care disease, Provided>established Written
After the shift(7- rapport information
-to gain trust andon Goal
his disease
met,
araw kung maligo deficit: process/programs
3am) the instruction and NPI relieves cooperation
through client of the
of theandAfter
prevention
the
tinatamad siya bathing/hygieneand prevention. specific
SO/patient will written burden of having to
patient and the being imposed..
shift(7-3am)
sabi niya saakin. related to agree on the information for
>discussed remember -To
the large amounts
assure the the SO/patient
As verbalized by decreased motivation client to refer to of
purposes of health information.
patient not to be agreed on the
the SO of the motivation. techniques in Repetition
teaching(on bathing) strengthens
offended motivation
patient. bathing the >discussed the learning.-to get knowledge techniques in
patient. Provides
disadvantages and opportunity
about bathing to bathing the
advantages ofcorrect patient.
Objective: Encouraged
bathing misconceptions/alleviate
client/SO to
>guided anxiety. -to
the client Inadequate
maintain or
-(+)infestation of verbalize
in meeting her finances/prolonged
promote a sense of
lice fears/concerns.
needs(bathing) denial may affect coping
wellbeing
-odorous smell Answers questions with managing the task
- dirty finger factually. Note necessary-for
>provided privacy to regain
easy
nail prolonged
anduse of
equipment health
within accessible of the
denial easy reach during patient on the
personal care May indicate progression
equipments needed
activities. of disease or side
>provided foreffects of medications
-Enhances
communication among coordination and
those who are continuity of care
Meeting
involved in caring metabolic needs
for/assistinghelpsthe minimize fatigue
Identified
client. and promote recovery.
symptoms>discussed
that Fluids aid
the -toinpromote
should be reported ofliquefying/expectorating
importance taking cleanliness
to health care daily secretions
a bath
provider,
teachers(e.g.
chest pain, fever, Enhances cooperation
difficulty of with therapeutic regimen
breathing) It is important that
Emphasized the anti-tuberculosis drugs
importance of not to be discontinued
maintaining high- because of nuisance side
protein and effects
carbohydrate diet