UNIVERSITY OF CEBU LAPU-LAPU AND MANDAUE

COLLEGE OF NURSING

TOPIC:
General Objective: After 4 hours of lecture-discussion, the level II students will be able to enhance basic knowledge, apply basic procedures and appreciate
interventions rendered to patient with massive right pleural effusion secondary metastatic adenocarcinoma of the lung; cholelithiasis.
 SPECIFIC CONTENTS METHODOLOGY TIME RESOURCES
ALLOTMENT EVALUATION
OBJECTIVES

Specifically, the
BSN II students
will be able to:

1. Discuss the INTRODUCTION/OVERVIEW

overview about Lecture 5 minutes A. Materials Question and
massive right discussion - books, Answer
pleural effusion Lung cancer is a disease of uncontrolled cell growth in tissues of laptop
secondary the lung. This growth may lead to metastasis, which is the invasion of B. Human
metastatic adjacent tissue and infiltration beyond the lungs. The vast majority of resources
adenocarcinoma primary lung cancers are carcinomas of the lung, derived -students
of the lung; from epithelial cells. the main types of lung cancer are small cell lung -clinical
cholelithiasis; carcinoma and non-small cell lung carcinoma. Patients with squamous cell instructors
carcinoma of the lung may notice: Coughing (8-75%),w eight loss (0-
68%), shortness of breath (3-60%), chest pain (20-49%): often ill-defined C. Books
and aching, haemoptysis (coughing up blood): sputum may be streaked with -Nursing care
blood, non-specific symptoms: fever, weakness, lethargy. Rarely, patients plans
may present with difficulty swallowing or wheezing. This distinction is - Student
important, because the treatment varies; non-small cell lung carcinoma Drug guide
(NSCLC) is sometimes treated with surgery, while small cell lung carcinoma handbook
(SCLC) usually responds better to chemotherapy and radiation. -Mims
Cigarette smoking is the main predisposing factor. In recent years, it handbook
has been recognized that passive smoking can also put people at risk. -Maternal and
Generally, the risk increases with the number of cigarettes smoked. Exposure Child Health
to asbestos increases the risk of developing this tumour. The combination of Nursing
asbestos exposure plus cigarette smoking is particularly harmful. Other
occupational exposures such as exposure to metals including arsenic, D. Electronics
chromium and nickel can also increase risk. Some studies have suggested
that diet can play a role in lung cancer risk. Though it is not known how it
works, diets high in fruits and vegetables seem to decrease risk. Radiation
exposure damages the DNA material within the cells and can also cause lung
cancer. Radon (a radioactive gas) exposure from our normal surrounding
environment, if higher than normal, can predispose to lung cancer. This
evidence is mainly based upon population studies which show that people
living in areas with high radon content are prone to increased incidences of a
variety of cancers.
When an individual is diagnosed with lung cancer, it is a common
thing to detect pleural effusions in him too. Pleural effusions are obviously
not a safe thing to be diagnosed but it is not dangerous if it is dealt with
immediately. It is important the doctor states whether or not the pleural
effusion is cancerous. But what exactly is pleural effusion? It is the extra
 APPENDIX A
(SCHEMATIC DIAGRAM OF PATHOPHYSIOLOGY)
APPENDIX B
(HEREDOFAMILIAL HISTORY)
Heredofamilial Disease
Legend:
APPENDIX C
(NCP)
Name: Date of Admission: Time: \
Age: Room Number: Bed No.
Diagnosis Hospital Number:
Attending Physician:

CLINICAL PORTRAIT PERTINENT DATA

Assessment: Chief Complaint:

Significant Findings:

Vital Signs during first contact with the patient:

BP=
P= History of present illness:
R=
T=

Past Health History Relevant to Present Illness:

Vital Signs during Admission:
T=
P=
R=
BP=

Diagnostic Procedures Done:

 CUES NURSING SCIENTIFIC GOAL & OUTCOME NURSING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS BASIS CRITERIA
SUBJECTIVE: INDEPENDENT:
\” as
verbalized by
the patient.

OBJECTIVE:
\
DEPENDENT:

CUES NURSING SCIENTIFIC BASIS GOAL & NURSING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS OUTCOME
CRITERIA
SUBJECTIVE: INDEPENDENT:

OBJECTIVE:
DEPENDENT:

COLLABORATIVE:
 CUES NURSING SCIENTIFIC BASIS GOAL & OUTCOME NURSING RATIONALE EVALUATION
DIAGNOSIS CRITERIA INTERVENTION
SUBJECTIVE: INDEPENDENT:

OBJECTIVE:
 Nursing Goal and Outcome
Scientific Basis Nursing Intervention Rationale Evaluation
Diagnosis Criteria
CUES
Subjective: Independent:

Collaborative:

Objectives:
 Nursing Goal and Outcome
CUES Scientific Basis Nursing Intervention Rationale Evaluation
Diagnosis Criteria
Subjective: Independent:

Objectives:

Dependent:
APPENDIX D
(DRUG STUDY)
 DRUG STUDY

DRUG NAME DOSAGE MECHANISM INDICATION CONTRAINDICATI SIDE EFFECTS NURSING RESPONSIBILITIES
AND OF ACTION ON
FREQUENCY

Generic name: Give 500mg May potentiate Anxiety, panic Contraindicated in CNS; BEFORE:
tablet P.O. O.D. effects of disorders, social patient hypersensitive Agitation, akathisia, - Assess patient’s anxiety before
Alprazolam GABA,an phobias. to drug or other anxiety, ataxia, therapy.
inhibitory benzodiazepines, those confusion, - In patient receiving repeated or
Brand name: neurotransmitte with acute angle- depression, difficult prolonged therapy, monitor liver,
r and depressed closure glaucoma, and speaking, dizziness, renal, and hematopoietic function
Xanos CNS at limbic those taking azole drowsiness, test results periodically
and subcortical antifungals. dyskinesia. DURING:
Classification: level of brain. CV: Chest pain, - Make sure patient has swallowed
Use cautiously in hypotension, tablet after giving.
Anxiolytic Decrease patients with hepatic, palpitations. - Drug shouldn’t be given for
anxiety. renal or pulmonary EENT: allergic longer than 4 months.
How supplied: diseases and in patients rhinitis, blured AFTER:
with cardiac disease vision, nasal - Watch for paradoxic excitation,
Tablet because hypotension congestion, sore hostility, mania, hypomania,
may occur. throat. insomia may occur.
Other form: GI: Abdominal - Watch for withdrawal symptoms
Oral solution; pain, anorexia, include seizures, status
concentrated constipation, epilepticus, impaired
diarrhea, dry mouth, concentration, muscle cramps or
dyspepsia, increase twitch, diarrhea, blurred vision,
or decrease appetite, decreased appetite, and weight
nausea and loss.
vomiting. HEALTH TEACHING:
Metabolic: - Warn patient to avoid hazardous
increased or activities that require alertness
decreased weight. and psychomotor coordination
Musculoskeletal; until CNS effects of drug are
Back pain, known.
arthralgia, limb - Tell patient to avoid alcohol and
pain, muscle smoking while taking the drug.
rigidity, cramps, - Advise patient to take drug as
twitching myalgia. prescribed, and not to stop
Respiratory; without prescriber’s approval.
URTI, dyspnea, - Instruct patient to swallow
hyperventilation. extended-release tablet, whole
Skin; dermatitis, and not to chew or crush them.
Increased sweating, - Advise patient to discard any
pruritus. cotton from the bottle of orally
Other; sexual disintegrating tablets and to keep
dysfunction,decreas it tightly sealed to prevent
ed or increased moisture from entering the bottle
libido dependence, and dissolving the tablets.
hot flushes, - Teach patient how to manage or
influenza, injury. avoid adverse reactions, such as
constipation and drowsiness.
 DRUG STUDY

DRUG NAME DOSAGE MECHANISM INDICATION CONTRAINDICATI SIDE EFFECTS NURSING RESPONSIBILITIES
AND OF ACTION ON
FREQUENCY

Generic name: Give 100mg Decreases Severe Patient with CNS: insomnia, BEFORE:
IVTT via inflammation, inflammation, hypersensitive to drug phychotic behavior, - Determined wether patient is
Hydrocortisone Na hepluck 30min mainly by adrenal or its ingredients, vertigo, headache. sensitive to other corticosteroids.
Succinate prior to stabilizing insufficiency, With systemic fungal CV: heart failure, - Get patient weight, BP, and
contrast. leukocyte Shock, infection, Those who hypertension, electrolytes level and sugar level,
Brand name: lysosomal Adjunct treatment are receiving edema, and temperature
membranes, for ulcerative colitis immunosuppressive thromboembolism, - Assess skin turgor.
Solo –Cortef suppresses and proctitis. doses together with arrhytmias. DURING:
immune live virus vaccines, EENT: cataract, - Identify the client.
Classification: response, Premature infants. glaucoma. - Explain the purpose.
stimulate bone GI: nausea and -
Corticosteriod marrow, and vomiting AFTER:
influences GU; Increase urine - Monitor patient blood pressure,
How supplied: protein. Fat and calcium level. glucose level, temperature,
CHO Hematologic; Easy electrolytes level and weight
IVTT metabolism. bruising after administration.
Metabolic: HEALTH TEACHING:
Other form: Hypokalemia, - Tell patient not to stop abruptly
hyperglycemia, or without prescriber’s content.
none Hypocalcemia. - Instructed patient to take oral
Musculoskeletal; form of drug with milk or food.
Youth suppression - Warn patient or long-term
in children, muscle therapy abrupt cushingoid
weakness effects, and the need to notify
SKIN; Delayed prescriber about sudden weight
wound healing, skin gain and swelling.
eruption. - Teach patient abrupt sign and
OTHER; Abrupt symptoms of early adrenal
withdrawal, insufficiency; fatigue, muscle
rebound weakness, joint pain, fever
inflammation, anorexia, nausea, shortness of
fatigue, weakness, breath, dizziness, and fainting.
arthralgia, fever, - Advise patient receiving long
dizziness, lethargy, term therapy to have periodic eye
depression, fainting, examination.
orthostatic - Instruct patient to carry a card
hypotension, with his prescriber name, and
dyspnea, anorexia. name, dosage of drug indicating
his need for supplemental
systemic glucocorticoids during
stress.
 DRUG STUDY

DRUG NAME DOSAGE MECHANISM INDICATION CONTRAINDICATI SIDE EFFECTS NURSING RESPONSIBILITIES
AND OF ACTION ON
FREQUENCY

Generic name: Give one Stimulates beta To prevent Contraindicated in CNS: insomnia, BEFORE:
nebule for 2 receptor of the exercise-induced patients hypersensitive headache, dizziness, - Assess symptom
Salbutamol nebulization. bronchi, leading bronchospasm, to to drug or its nervousness, characteristics, onset, duration,
to prevent or treat component. tremor. frequency,and any precipitating
Brand name: bronchodilation brochospasm in Use Cautiously in CV: Hypertension, factor.
causes less patients with patient with palpitation, - Determine if able to self
Ventolin tachycardia and reversible Cardiovascular tachycardia. administer medication.
is longer acting obstructive airway disorders (including EENT: Drying and DURING:
Classification: than disease, coronary insufficiency. irritation of nose - When given by nebulization,
isoroterenol has Cardiac arrhythmias, and throat. either a face mask or a
Bronchodilator minimal beta 1 and hypertension), GI: Heartburn, mouthpiece may be used.
activity. hyperthyroidism, or nausea and - Take extended release tablet
How supplied: Available as an diabetes mellitus and vomiting. whole with aid of liquids, do
inhaler that in those unusually Metabolic: not chew or crush
Inhaler contains no responsive to Hypokalemia, AFTER:
chloroflourocar adrenergic. weight loss. - Document PFTs, CXR, and
Other form: bons. Use extended-release Musculoskeletal; lung sound. Note any anxiety
Tablet tablets cautiously in Muscle cramps. - Monitor pulmonary status
Syrup patients with GI Respiratory; HEALTH TEACHING:
narrowing. Bronchospasm. - Instruct patient do not store
near hear open flames and do not
puncture the container
- Warn patient to stop drug
immediately if paradoxical
bronchospasm occurs.
- Give these instructions for
 using metered-dose inhaler;
clear nasal passages and throat.
Breathe out, expelling as much
air from lungs as possible.
Place mouthpiece well into
mouth, and inhale deeply as
dose is released. Holds breathe
for several seconds, remove
mouthpiece and exhale slowly.
- Advice patient to wait at please
2 minutes before repeating
procedure if more than one
inhalation is ordered.
- Warn patient to avoid
accidentally spraying inhalant
into eyes, which may cause
temporary blurred vision.
- Tell patient to reduce intake of
foods and herbs containing
caffeine, such as coffee, cola
and chocolate, when using a
bronchodilator.
- Show patient how to take his
pulse. Instruct him to check
pulse before and after using
bronchodilator and to call
prescriber if pulse rate
increases more than 20-30 bpm
 DRUG STUDY

DRUG NAME DOSAGE MECHANISM INDICATION CONTRAINDICATI SIDE EFFECTS NURSING RESPONSIBILITIES
AND OF ACTION ON
FREQUENCY

Generic name: Give 250mg Seretide Reversible Patients with a history CNS; Headache. BEFORE:
tablet B.I.D. contains Obstructive of hypersensitivity to CV: Palpitations, - assess patient for any drug
Salmeterol, salmeterol and Airways Disease salmeterol xinafoate, Cardiac allergies
fluticasone fluticasone (ROAD): Regular fluticasone propionate arrhythmias,
propionate treatment of or to any of the Musculoskeletal; DURING:
Brand name: which have ROAD, including excipients of Seretide Arthralgia, tremors, - give medication as prescribed.
different modes asthma in children Diskus. muscle cramps. - withhold the medication if
Seretide of action. and adults, where Skin; sings of allergies noted.
Salmeterol use of a Hypersensitivity
Classification: protects against combination reactons. AFTER:
symptoms, (bronchodilator and - watch for any hypersensitivity
Adrenergic fluticasone inhaled reaction to the drug.
propionate corticosteroid) is
How supplied: improves lung appropriate. This HEALTH TEACHING:
function and may include - instruct patient to take the
tablet prevents patients on drugs as prescribed.
exacerbations of effective - Notify the physician if signs of
Other form: the condition. maintenance doses hypersensitivity noted.
Seretide can of long-acting β-
offer a more agonists and
convenient inhaled
regimen for corticosteroids;
patients on patients who are
concurrent β- symptomatic on
agonist and current inhaled
inhaled corticosteroid
corticosteroid therapy; and
therapy. patients on regular
bronchodilator
therapy who require
inhaled
corticosteroids.
 DRUG NAME DOSAGE MECHANISM INDICATION CONTRAINDICATI SIDE EFFECTS NURSING RESPONSIBILITIES
AND OF ACTION ON
FREQUENCY

Generic name: Give 50mg Unknown Used to treat Contraindicated in CNS; Anxity, BEFORE:
IVTT centrally acting moderate to patient hypersensitive confusion, CNS - Assess patient pain before
Tramadol synthetic moderately severe to the drug or any of stimulation, starting the therapy.
Hydrochloride analgesic pain and most types its components and in disturbance, - Give drug before the onset of
compound not of neuralgia, those with acute dizziness, headache, pain.
Brand name: chemically including intoxication from malaise, DURING:
related to trigeminal alcohol, hypnotics. nervousness, - Identify the patient.
Tramal opioids that is neuralgia.It has seizure, sleep - Give the drug before he onset of
to bind that is been suggested that disorder, vertigo. intense pain.
Classification: through to bind tramadol could be CV: Vasodilation. - If respiratory rate decreases or
the opioid effective for EENT; Visual falls below 12bpm, withhold dose
Analgesic receptors and alleviating disturbances. and notify prescriber.
inhibit reuptake symptoms of GI: Abdominal AFTER:
How supplied: of depression, anxiety, pain, anorexia, - Tell patient to swallow tablet
norepinephrine and phobias. constipation, whole and do not crush.
IVTT and serotonin. diarrhea, dry mouth, - Tell ambulatory patient to be
dyspepsia, careful when getting out of bed
Other form: Relieves pain. flatulence, nausea and walking.
and vomiting. - Be alert for adverse reaction and
Tablet Respiratory; drug interaction.
Respiratory HEALTH TEACHING:
depression. - Tell patient to take drug as
Musculoskeletal; prescribe and not to increase
Hypertonia. dosage interval unless added by
Skin; Pruritus, rash, prescriber.
sweating. - Warn patient not to stop the drug
abruptly.
- Advise patient to check with
prescriber before taking Over the
counter drug because drug
interactions can occur.
DRUG NAME DOSAGE MECHANISM INDICATION CONTRAINDICATI SIDE EFFECTS NURSING RESPONSIBILITIES
AND OF ACTION ON
FREQUENCY
Generic name:
Give 100mg IV Bind with Use to treat Contraindicated to CNS: confusion, Before:
Nalbuphine prior to OR opioid receptors moderate to severe patients crying delusions, - Assess patients pain or
hydrochloride in CNS, altering pain, and adjunct in hypersensitivity to depressions, anesthetic requirement before
pain perception balanced drugs or sulfites dizziness, euphoria, starting therapy and regularly
Brand name: and response to anesthesia. present in some hallucinations, there after to monitor drug
pain by preparations of drug. headache hostility, effectiveness.
Nubain unknown nervousness, - Assess patient’s and family’s
mechanism. Use cautiously in restlessness, knowledge of drug therapy.
Classification: Thus relieves substance abusers and sedation, speech During:
pain and in those with difficulty, unusual - Give stool softener or other
Analgesic enhances emotional instability, dreams, vertigo. laxatives to prevent
anesthesia. head injury, increased constipation.
How supplied: intracranial pressure, CV: bradycardia, - Encourage patient to drink
impaired ventilation, hypertension, fluids and eat fiber.
IVTT MI accompanied by hypotension, - If patient’s respirations are
nausea and vomiting, bradycardia. shallow or rates is below
Other forms: upcoming biliary 12bpm, withhold dose and
surgery, and hepatic EENT: blurred notify prescriber.
Injection and renal disease. vision. After:
- Observe for sings of
GI: bitter taste, withdrawal I patient receiving
constipation, long-term opioid therapy.
cramps, dry mouth, - Monitor patient closely for
dyspepsia, nausea, respiratory depression.
vomiting - Monitor patient for signs and
symptoms of constipation.
GU: urinary urgency - Be alert for adverse reaction
Respiratory: and drug interactions.
pulmonary edema, Heath teaching:
respiratory - Warn ambulatory patient about
depression getting out of bed or walking.
- Instruct outpatient to avoid
Skin: burning, hazardous activities until
itching, sweaty, drug’s CNS effects are known.
clammy feeling,
urticaria.
 DOSAGE MECHANISM INDICATION CONTRAINDICATI SIDE EFFECTS NURSING RESPONSIBILITIES
DRUG NAME AND OF ACTION ON
FREQUENCY

Generic name: Give 50mg May inhibit Short-term Contraindicated to CNS: dizziness, Before:
slow IVTT now prostaglandin management of patients hypersensitive drowsiness, - Assess patient’s pain before
ketorolac synthesis, pain, to drugs or any of its headache, insomnia, and after drug therapy.
tromethamine relieves pain Ocular itching components; in those Syncope - Assess patient’s and family’s
and cause by seasonal with a history of nasal CV: edema, knowledge of drug therapy.
Brand nam inflammation. allergic rhinitis, polyps, angioedema, hypertension, During:
Kortezor Postoperative bronchospastic palpitations - If pain persists or worsen,
inflammation reactivity, or allergic EENT: corneal notify prescribers.
Classification: following cataract reaction to aspirin or edema, After:
surgery, other NSAIDs; in keratitis(ocular - Be alert for adverse reaction
Analgesic Pain and burning or those with advanced form), ocular and drug interactions.
stinging following renal impairment; and irritation, transient Health teaching:
How supplied: corneal refractive in those at risk for stinging and - Teach patient to recognize and
surgery. renal as a result of burning. immediately report signs and
IVTT volume depletion. GI: diarrhea, symptoms of GI bleeding.
In patients with high dyspepsia, GI pain, Explain that serious GI
Other forms: risk in bleeding and in nausea. toxicity, even without any
those with suspectedor GU: hematuria, symptoms can occur.
Ophthalmic confirmed polyuria, renal - Advise patient to report
solution, cerebrovascular failure. persistent or worsen ing pain.
Tablet bleeding , Hematologic: - Explain that drug is intended
hemorrhagic diathesis, anemia, only for short term use.
and incomplete eosinophilia,
hemostasis. purpura.
Contraindicated in Skin: sweating
perioperative pain in Other: pain at
patients requiring injection site.
coronary artery bypass
graft surgery.
 Dosage and Mechanism of
Drug Name Indication Contraindication Side Effects Nursing Responsibilities
Frequency Action

Generic Name: 1 mg PO OD Inhibits enzymes Infections due to ß-lactamase- Penicillin Allergic - During:
involved in resistantinfections where hypersensitivity reactions
Amoxicillin and formation of amoxycillin alone is inappropriate - - itching, rashes, - Assess patients infection,
cluvalanate peptidoglycan e.g. staphs, E. coli strains, H. fever ask about past allergic
potassium layer of bacterial influenzaestrains - angioneurotic reactions to penicillin ,
cell wall Bacteroides andKlebsiellaspecies oedema obtain specimen for
Brand Name: No effect on Respitratory tract infections - anaphylaxis (1 culture and sensitivity
human cell walls Genito-urinary infections in 50,000 to test.
Augmentin Bactericidal; Abdominal infections 100,000)
- Assess patient’s and
only works on Cellulitis Cross-allergy
family’s knowledge of
dividing bacteria Animal bites with other
drug therapy.
Classifaication: Well absorbed Severe dental infections penicillins
enterally Partial cross- - During:
antibiotic Clavulanic allergy with
acidinhibits cephalosporins - Drug with food to
bacterial ß- (10%) prevent GI distress.
lactamase
How Supplied: Hepatitis, - Give drug at least 1 hour
cholestatic before bacteriostatic
Tablet jaundice antibiotics.
Erythema - After:
Other forms: multiforme
(including - Monitor hydration status
Oral suspension Stevens- if adverse GI reactions
Johnson) occur.
Toxic epidermal
necrolysis; - Be alert for adverse
exfoliative reactions and drug
dermatitis interactions.

Diarrhoea,
Health teaching:
vomiting
Rashes
- Tell patient to take the
Neutropenia
entire quantity of drug
Anaemia
exactly as prescribed,
Source of
even after he feels better.
sodium (when
- Tell patient to call
given by
prescriber if rash
injection)
develops.
- Instruct patient to take
 DRUG NAME DOSAGE MECHANISM INDICATION CONTRAINDICATI SIDE EFFECTS NURSING RESPONSIBILITIES
AND OF ACTION ON
FREQUENCY

Generic name: Give 400mg 1 - may - Relief of signs Contraindicated in CNS; BEFORE:
cap. P.O. O.D. selectively and symptoms of patient hypersensitive Dizziness, - Assess patient’s for
Celecoxib inhibit COX-2, osteoarthritis. to drug, sulfonamides, headache, insomnia, appropriateness of therapy.
decreasing - Relief of sign and aspirin, or other strock. - Drug must be cautiously in
Brand name: prostaglandin symptoms of NSAIDs, patients with CV: hypotension, patient’s with history of ulcers or
synthesis. rheumatic arthritis. severe hepatic or renal M.I, peripheral GI bleeding, advanced renal
Celebrex - relief of sign and impairment and edema. disease, dehydration, anemia,
- relieves pain symptoms of patients with EENT: pharyngitis, symptomatic liver disease,
Classification: and juvenile rheumatoid pereoperative pain rhinitis, sinusitis. hypertension, edema, heart
inflammation in arthritis. after coronary artery GI: Abdominal failure, asthma.
Anti-inflammatory joints and - relief of sign and bypass graft sergury. pain, diarrhea, - Assess patient’s drug allergies.
smooth muscle symptoms of dyspepsia, nausea, DURING:
How supplied: tissue. ankylosing- flatulence, G.I - Instruct patient to take the drugs
spondylitis. bleeding. with or without food.
Capsule - A junk to familial Metabolic: AFTER:
adenomatous hyperchloremia, - Instruct patient to immediately
Other form: polyposis to reduce hypophosphatemia, report to prescriber signs of
None the number of Musculoskeletal; bleeding (bloody vomitous, blood
adenomatous Back pain in urine, stool, and black tarry
coleteral polyps. Respiratory; stool.)
- Acute pain and URTI. - Advise patient to immediately
primary Skin; erythema, report rash, unexplained weight
dysmenorrhea. multiform, gain or edema to prescriber.
exfoliative HEALTH TEACHING:
dermatitis, rash, - Tell patient to report history
toxic epidermal, allergic reaction to
necrolysis, stevens- sulfonamides, aspirin, or other
johnson syndrome. NSAIDs before therapy.
Other; - Instruct patient to promptly
accidental injuries. report signs of GI bleeding.
- Advise patient to immediately
report rash, unexplained weight
gain or swelling.
- Tell patient that drug may harm
the liver.
- Advise patient to stop therapy
and notify the prescriber
immediately if he experiences
signs and symptoms of liver
toxicity, lethargy, itching,
yellowing of skin or eyes, right
upper quadrant tenderness, and
flulike syndrome.
APPENDIX E
(IVF STUDY)
Type of IVF Content Classification Indication Contraindication How supplied Nursing Responsibilities
Each 100 ml Hypertonic Provide Renal failure, 1000 ml in plastic bottles. Before:
Dextrose 5% contains: electrolytes Liver dysfunction, • Check the IVF sheet.
Lactated Sodium chloride and calories DM, • Check the doctor’s order.
Ringer's 600 mg, and is a Lactic acidosis, • Prepare the IVF to be
1L Sodium lactate source of Alkalosis, followed up.
anhydrous 310 mg, water for Hyperkalemia and • Do Handwashing.
Potassium chloride hydration. It is hypervolemia. • Prepare the equipments
30 mg, capable of Hypernatremia, needed.
Calcium chloride 20 inducing fluid overload During:
mg, 273 dieresis
• Observe for sterility when
nOsm/ml. depending on
assisting IV insertion.
the clinical
condition of • Hang the IVF bottle slowly.
the patient. • Regulate IVF at desired rate
This solution as ordered by the physician.
also contains After:
lactate which • Asses for any redness or
produces a swelling and inflammation.
metabolic • After care
alkalinizing • Hand washing
effect. • Documentation or chart the
IVF that is being hooked.

(Broyles., Mosby. Mosby.

et.al,2007) Nursing Nursing (Broyles., (Broyles., et.al,2007)
Practical Practical et.al,2007)
Detailed Detailed
Quick. P. 68- Quick. P. 68-
69. 69.
 Type of IVF Content Classification Indication Contraindication How supplied Nursing Responsibilities

Plain Normal Each 100mL Isotonic For replacement Renal/ circulatory 1000 ml in plastic bottles. Before:
Saline Solution contains 900mg of or maintenance impairment, older • Check the IVF sheet.
sodium chloride. of fluid and adults, sodium • Check the doctor’s order.
Electrolytes in electrolytes. retention. • Prepare the IVF to be followed
1000 mL sodium up.
154 mmol and • Do Handwashing.
chloride 154 mmol • Prepare the equipments needed.
During:
• Observe for sterility when
assisting IV insertion and IV
follow-up.
• Hang the IVF bottle slowly.
• Regulate IVF at desired rate as
ordered by the physician.
After:
• Asses for any redness or swelling
and inflammation.
• After care
• Hand washing
• Documentation or chart the IVF
that is being hooked

(Langford, 2004) (Langford, (Langford, (Langford, 2004) (Langford, 2004)

2004) 2004)
Type of IVF Content Classification Indication Contraindication How supplied Nursing responsibilities

D5 NM Each 1000 mL Hypertonic For Allergy to sodium Each 1000 ml in plastic Before:
contains 5 gram of maintenance metabisulfite. bottles • Check the IVF sheet.
dextrose of fluid and • Check the doctor’s order.
monohydrate, 234 electrolytes. • Prepare the IVF to be followed
mg of sodium up.
chloride, 128 mg • Do Handwashing.
of Potassium • Prepare the equipments needed.
acetate, 32.2 mg of During:
magnesium acetate
• Observe for sterility when
tetrahydrate and 30
assisting IV insertion.
mg (approx. 1.6
mmol/L) of • Hang the IVF bottle slowly.
sodium • Regulate IVF at desired rate as
metabisulfate. ordered by the physician.
Electrolyte in 1000 After:
mL. Sodium:40 • Asses for any redness or
mmol, potassium swelling and inflammation.
13 mmol, • After care
magnesium:115 • Hand washing
mmol, Chloride : • Documentation or chart the
40 mmol and IVF that is being hooked.
acetate: 16 mmol.

(Broyles., (Broyles., (Broyles., (Broyles., (Broyles., et.al,2007)

et.al,2007) et.al,2007) et.al,2007) et.al,2007)
APPENDIX F
(IDP)
 INTERDISCIPLINARY DISCHARGE PLAN

Recapitulation of Stay

Diagnosis

Medical Status
T- P- R- BP-

Laboratory and Diagnostic Test Summary

Functional Status

ADL INDEPENDENT REQUIRES ASSISTANCE TYPE OF ASSISTANCE

Ambulation

Transfer

Toileting

Eating

Dressing

Bathing
Grooming

Nutritional Status
Diet

Height

Weight

Sensory and Physical Impairment

No Type of Impairment Complete Loss Describe Impairment Type of Prosthesis

Impairment
Sight
Hearing
Speech
Paralysis
Bladder
Incontinence

Psychosocial Status
Special Treatment and Procedures

Dental Status:
Teeth Yes No Upper Lower
Dentures Yes No Upper Lower

Activity Potential and Rehabilitative Potential

Cognitive Status

Discharge Drug Therapy

Medication Dosage Frequency Rationale

Post Discharge Plan of Care

M- Modification of Lifestyle

E- Environment
T- Treatment

H- Health Teaching

O- Outpatient

D- Diet

S- Spiritual

Aid Provided to Client or Family in Arranging Post-Discharges Services

Client/Patient Name Medical Record No. Attending Physician

APPENDIX G
(LABORATORY RESULTS)
 X-RAY REPORT

Examination : CHEST X-RAY- PA OR AP DATE:09/16/2010

Clinical Data TIME: 07:50:38

REPORTS
Follow-up examination of the chest when compared with the previous study of 9/11/2010 shows minimal reduction of the homogenous density at the inferior
half of the right hemithorax, still obliterating the right cardiac border, heniodiaphargm and costophrenic sulcus. Nodular, coarse linear and hazy densities are again
seen at the inferior aspect of the aerated right upper lobe. The rest of the lugs are clear. The left hemidiaphragm and costophrenic sulcus are intact. The tracheal air
column is at the midline. Aorta is tortuous and sclerotic. The visualize bony structure unremarkable.

=====[CONCLUSION]======

1. INTERVAL MINIMAL REDUCTION OF THE RIGTH PLEURAL EFFUSION. A CONTAMINANT INFLAMMATORY PROCESS IS STILL NOT
TOTALLY RULED OUT.
2. TORTUOUS AND ATHEROMATOUS AORTA
 ELECTROCARDIOGRAPHIC REPORT

DATE: 09/14/2010 TIME: 07:02 PM

Examination
ECG

Standardization Rhythm Heart Rate 95/ min

10 mm sinus 95/min (0.626sec)

QRS Axis QRS Interval Atrial rate Ventricular rate

41 deg 0.0908 sec

PR Interval RV5 SV1 QT/QTCc

0.152 sec 1.37mV 0.27mV 0.338 sec/ 0.424

QRS Complexes ST- segments

Low QRS voltage limb leads isoelectric

P- Waves T- Wave
Upright Upright

INTERPRETATION
Sinus rhythm within normal limits.

CLINICAL CHEMISTRY REPORT

DATE AND TIME PERFORMED:

09/14/2010 06:32 PM

TEST RESULT REFERENCE UNIT

GLUCOSE 130 MG/DL

(RBS)

CREATININE 1.1 0.6-1.5 MG/DL

SGPT – ALT 42 5.0-50.0 U/L

ALBUMIN 3.6 3.5-5.0 G/DL

SODIUM 135.0 134.0-148.0 MMOL/L

(SERUM)

POTASSIUM 3.7 3.3-5.3 MMOL/L

 HEMATOLOGY REPORT
DATE AND TIME PERFORMED:
09/14/2010 06:32 PM

COMPLETE BLOOD
RESULT REFERENCE UNIT
COUNT

BLOOD COUNT

WHITE BLOOD CELS 9.70 4.8-10.8 10^3/uL

RED BLOOD CELLS 5.07 4.7-6.1 10^6/Ul

HEMOGLOBIN 14.8 14.0-18.0 g/dl

HEMATCRIT 44.4 42.0-52.0 %

PLATELET 296 130-400 10^3/uL

BLOOD INDICES
MCV 88.0 80-94 fL

MCH 29.2 27.0-31.0 pg

MCHC 33.3 33.-37.0 g/dL

RDW 11.6 11.-16 %

PDW 11.8 9.0-14.0 %

MPV 8.8 7.2-11.1 fL

RELATIVE DIFFERENTIAL COUNT

NEUTROPHIL (%) 72.8 40-74 %

LYMPHOCYTE (%) 16.0 19-48 %

MONOCYTE (%) 2.6 3.4-9.0 %

EOSINOPHIL (%) 8.5 0.0-7.0 %

BASOPHIL (%) 0.1 0.0-1.5 %

ABSOLUTE DIFFERENTIAL COUNT

NEUTROPHIL (#) 7.O4 I.9-8.0 10^3/uL

LYMPHOCYTES (#) 1.55 0.9-5.2 10^3/uL

MONOCYTE (#) 0.25 0.16-1.00 10^3/uL

10^3/uL
 EOSINOPHILS (#) 0.82 0.0-0.8
10^3/uL
BASOPHILS (#) 0.01 0.0-0.2

CLINICAL CHEMISTRY REPORT

DATE AND TIME PERFORMED:
09/14/2010 07:43 PM
TEST RESULT REFERENCE UNIT

GLUCOSE 130 MG/DL

(RBS)

CREATININE 1.1 0.6-1.5 MG/DL

SGPT – ALT 42 5.0-50.0 U/L

ALBUMIN 3.6 3.5-5.0 G/DL

SODIUM 135.0 134.0-148.0 MMOL/L

(SERUM)

POTASSIUM 3.7 3.3-5.3 MMOL/L

 HEMATOLOGY REPORT
DATE AND TIME PERFORMED:
09/14/2010 08:46 PM

COMPLETE RESULT REFERENCE UNIT

BLOOD
COUNT

BLOOD
COUNT

WHITE BLOOD 9.70 4.8-10.8 10^3/uL

CELS
5.07 4.7-6.1 10^6/Ul
RED BLOOD
CELLS 14.8 14.0-18.0 g/dl

HEMOGLOBIN 44.4 42.0-52.0 %

HEMATCRIT 296 130-400 10^3/uL

PLATELET

BLOOD
INDECES

MCV 88.0 80-94 fL

MCH 29.2 27.0-31.0 pg

MCHC 33.3 33.-37.0 g/dL

RDW 11.6 11.-16 %

PDW 11.8 9.0-14.0 %

MPV 8.8 7.2-11.1 fL

RELATIVE
DIFFERENTIAL
COUNT

NEUTROPHIL 72.8 40-74 %

(%)
1 19-48 %
LYMPHOCYTE 6.0 ↓
(%) 3.4-9.0 %
2.6↓
MONOCYTE 0.0-7.0 %
(%) 8.5↑
0.0-1.5 %
EOSINOPHIL 0.1
(%)

BASOPHIL (%)

ABSOLUTE
DIFFERENTIAL
COUNT

NEUTROPHIL 7.04 1.9-8.80 10^3/Ul

(#)
1.55 0.9-5.2 10^3/uL
LYMPHOCYTE
(#) 0.25 0.16-1.00 10^3/uL

MONOCYTE 0.82↑ 0.0-0.8 10^3/uL

(#) 0.01 0.0-0.2 10^3/uL
EOSINOPHILS
(#)

BASOPHILS (#)

HEMATOLOGY REPORT
DATE AND TIME PERFORMED:
09/14/2010 09:26 PM
PROTHROMBIN RESULT REFERENCE UNIT
TIME

PATIENT 13.4 Sec.

ACTIVITY 95.0 >70% %

INR 1.03 <=1.21

CONTROL 13.2 Sec

CONTROL 100.0 %
ACTIVITY
 LABORATORY REPORT
DATE PERFORMED:
09/15/2010
EXAMINATION: GRAM STAIN
SPECIMEN: PLEURAL FLUID
REPORT:
Occasional pus cells
No microorganism seen

Clinical chemistry Report

Date and time performed:
09/15 2010 02:30 PM

Test Result Reference Unit

Protein, 6.3 6.0-8.4 G/Dl

Total(Serum)
 CLINICAL CHEMISTRY REPORT
DATE AND TIME PERFORMED:
09/15/2010 02:09 PM

TEST RESULT REFERENCE UNIT

GLUCOSE, 12 MG/DL
PLUERAL
FLUID

PROTEIN, 5.6 G/DL

TOTAL
(PLEURAL)
784 U/L
LDH,
PLEURAL
FLUID
 HEMATOLOGY
DATE AND TIME PERFORMED:
09/15/2010 04:05 PM
PLEURAL RESULT REFERENCE UNIT
FLUID- CELL &
DIFFERENTIAL
COUNT

COLOR REDDISH

CHARACTER BLOODY

RBC COUNT 155, 000 /cumm

WBC COUNT 4, 000 /cumm

DIFFERENTIAL
COUNT
17 %
POLYS
83 %
LYMPHOCYTES
 HEMATOLOGY REPORT
DATE AND TIME PERFORMED:
09/17/2010 10:15 AM
COMPLETE BLOOD RESULT REFERENCE UNIT
COUNT

BLOOD
COUNT

WHITE BLOOD 10.70 4.8-10.8 10^3/uL

CELLS
5.18 4.7-6.1 10^6/uL
RED BLOOD
CELLS 14.8 14.0-18.0 g/dL

HEMOGLOBIN 44.2 42.0-52.0 %

HEMATOCRIT 320 130-400 10^3/uL

PLATELET

BLOOD
INDICES

MCV 85.0 80-94 FL

MCH 28.5 27.0-31.0 Pg

 MCHC 33.4 33.0-37.0 g/dL

RDW 15.7 11-16 %

PDW 13.3 9.0-14.0 %

MPV 7.9 7.2-11.1 fL

RELATIVE
DIFFERENTIAL
COUNT

NEUTROPHIL (%) 75.4↑ 40-74 %

%
LYMPHOCYTE (%) 9.5↓ 19-48 %
%
MONOCYTE (%) 7.6 3.4-9.0
%
EOSINOPHIL (%) 7.3↑ 0.0-7.0

BASOPHIL (%) 0.2 0.0-1.5

ABSOLUTE
DIFFERENTIAL
COUNT

NEUTROPHIL (#) 8.08↑ 1.9-8.0 10^3/uL

LYMPHOCYTE (#) 1.02 0.9-5.2 10^3/uL

MONOCYTE (#) 0.81 0.16-1.00 10^3/uL

EOSINOPHILS (#) 0.78 0.0-0.8 10^3/uL

10^3/uL
BASOPHILS (#) 0.02 0.0-0.2
X- RAY REPORT
DATE TIME PERFORMED
09/17/2010 09:12:00

EXAMINATION CHEST X-RAY – PA OR AP

CLINICAL DATA

REPORTS

Follow- up examination of the chest when compared with the previous study of 09/16/2010 shows minimal clearing of the homogenenous density in the
inferior aspect of the right hemithorax still obliterating the right lower cardiac border, hemi diaphragm costophrenic sulcus. Nodular, hazy and confluent densities
are now seen in the inferior aspect of the aerated right lung. The rest of the lugs are clear. True cariac size still cannot be evaluated due to obliteration of the right
cardiac border. The left hemi diaphragm is intact. The left costophrenic sulcus is now blunted. The structures are unremarkable. A right sided lead line CTT tube is
now seen with its tip directed superiorly at the level posterolateral aspect of the right 5th rib. Linear radiolucencies are also seen at the right lower lateral chest wall.

CONCLUSION

1. INTERVAL MINIMAL CLEARING OF THE RIGHT PLEURAL EFFUSION WITH INTERVAL DEVELOPMENT OF MINIMAL LEFT PLEURAL EFFUSION.

2. INTERVAL VISUALIZATION OF NODULAR, HAZY AND CONFLUENT DENSITIES AT THE LOWER ASPECT OF THE AERATED RIGHT LUNG. WHETHER THIS IS DUE TO CONSOLIDATION,
ATELECTASIS OR EVEN MASS LESION IS NOT DIFFERENTIATED.

3. TORTUOUS AND ATHEROMATOUS AORTA.

4. MINIMAL SUBCUTANEOUS EMPHYSEMA IN THE LOWER LATERAL CHEST WALL.

5. INTERVAL INCERTION OF A RIGHT-SIDED LEADLINE CTT TUBE IN PLACE

CT-SCAN REPORT
DATE TIME PERFORMED
09/22/2010 16:52:18
EXAMINATON CHEST WITH CONTRAST-CT64
CLINICAL DATA
REPORTS
Axial slices of the CHEST where done before and after administration of intravenous contrast
There are no enlarged supraclavicular nor axiallary lymph nodes. The thyroid glands show reasonable symmetry. There is a small hypodensity in the right lobe of the
thyroid gland which may represent a small colloid cyst.
There is a chest drainage catheter inserted into the right pleural cavity. There is no pleural effusion seen. No pneumothorax is demonstrated.
There is a large consolidation in the right lower lobe. This should heterogenous enhancement on the post contrast study indicating areas of necrosis. There is a CT
angiogram sign noted. The margins are ill-defined. There are multiple satellite nodules in the adjacent lung with slight thickening of the adjacent interlobular septae in the right
middle and right lower lobes as well as part of the right upper lobe. There are tiny sub pleural blebs in both lung apices. There are two tiny 1mm non calcified nodules in the
pheriphery of the left upper lobe. The trachea is normal in caliber. There is no endotracheal mass.
The heart is not enlarged. The pericardium is not thickened. There is no pericardial effusion. The thoracic aorta is normal in caliber. The pulmonary trunk is not dilated.
The pulmonary arteries show homogenous enhancement.
There are multiple enlarge preaortic, subaortic, pretracheal, right hilar and subcarinal lymph nodes. The esophagus is partly outlined be gas. There is no esophageal mass
lesion.
The visualized liver is normal in size. The hepatic contours are smooth. The visualized intrahepatic and extrahepatic bile ducts are not dilated. The gallbladder is
distended fluid. There is at least one calcified stone within the gallbladder. The gallbladder wall is not thickened.
The pancreas is normal in shape. The pancreatic duct is not obstructed. There are no calcifications within the pancreatic parenchyma.
The spleen is normal in size.
The adrenal glandars are not enlarged and normal in configuration. The visualized upper poles of both kidneys are normal in size. There is a partially viasualized larged
cyst in the left kidney and a small one in the upper pole of the kidney.
The bone setting shows marginal osteophytes in the lower cervical, dorsal, and upper lumbar vertebrae. There is no definite evidence of bone destruction.

CONCLUSION:
PRESENCE OF A LARGE FOCAL ONSOLIDATION/ MASS IN THE RIGHT LOWER LOBE WITH AREAS OF NECROSIS ANS SATELLITE NODULES
IN THE ADJACENT LUNG. THERE ARE ASSOCIATED ENLARGED RIGHT HILAR, SUBCRANIAL AND MEDIASTINAL LYMPHADENOPATHIES. THE
FINDINGS ARE SUSPICIOUS FOR MALIGNANCY.
TINY 1 MM NONCALCIFIED NODULES IN THE PERIPHERY OF THE LEFT UPPER LOBE ARE SUSPICIOUS SES.
TINY HYPODENSITY IN THE RIGHT LOBE OF THE THYROID GLAND MAY REPRESENT A COLLOID CYST.
INCIDENTAL FINDINGS OF A LARGED CYST IN THE LEFT KIDNEY AND THIS IS ONLY PARTIALLY VISUALIZED ANS SMALL ONES IN THE
RIGHT KIDNEY.
SPONDYLOSIS OF THE LOWER CERVICAL, DORSAL AND UPPER LUMBAR SPINE.

CLINICAL CHEMISTRY REPORT

DATE AND TIME PERFORMED
9/21/2010 03:15 PM

TEST RESULT REFERENCE UNIT

CREATININE 1.0 0.6-1.5 MG/DL

IMMUNOLOGY REPORT
DATE AND TIME PERFORMED
9/22/2010 06:41 AM

TEST RESULT REFERENCE UNIT

TUMOR MARKER
PSA TOTAL 0.293 0-4 NG/ ML

X-RAY REPORT
DATE AND TIME PERFORMED
9/20/2010 @ 09:04:55 AM

EXAMINATION: CHEST X-RAY – PA OR AP

CLINICAL DATA
REPORT
FOLLOW-UP EXAMINATION OF THE CHEST WHEN COMPARED WITH THE PREVIOUS STUDY OF 9/17/2010 SHOWS SIGNIFICANT REDUCTION OF THE BILATERAL PLEURAL EFFUSION . THERE IS ALSO MINIMAL
CLEARING OF THE PREVIOUSLY NOTED HOMOGENOUS DENSITY AT THE INFERIOR ASPECT OF THE RIGHT HEMITHORAX. THERE IS ALSO INTERVAL WELL DEMONSTRATED OF THE NODULAR AND HAZY
DENSITIES IN THE RIGHT LOWER LUNG FIELD . THE REST OF THE LUNGS ARE CLEAR. T HE RIGHT CARDIAC BORDER IS STILL OBLITERATED. THE RIGHT HEMIDIAPHRAGM AND COSTOPHRENIC SULCUS ARE
STILL HAZY . THE LEFT HEMIDIAPHRAGM AND COSTOPHRENIC SULCUS ARE INTACT . THE TRACHEAL AIR COLUMN IS AT THE MIDLINE . A ORTA IS TORTUOUS AND SCLEROTIC . THERE IS COMPLETE
RESOLUTION OF THE LINEAR RADIOLUCENCIES AT THE RIGHT LOWER LATERAL CHEST WALL . THE RIGHT - SIDED LEADLINED CTT TUBE IS AGAIN NOTED IN PLACE.

CONCLUSION:
1. INTERVAL SIGNIFICANT REDUCTION OF THE BILATERAL PLEURAL FFUSION.

2. INTERVAL MINIMAL CLEARING OF THE PNEUMONIC PROCESS IN THE RIGHT MIDLUNG FIELD WITH INTERVAL WELL VISUALIZATION OF
THE PNEUMONIC PROCESS IN THE RIGHT LOWER LUNG FIELD.

3. COMPLETE RESOLUTION OF THE MINIMAL SUBCUTANEOUS EMPHYSEMA IN THE RIGHT LOWER LATERAL CHEST WALL.

4. THE REST OF THE FINDING ARE STATIONARY.

 = TORTUOUS AND ATHEROMATOUS AORTA.

= PRESENCE OF A RIGHT-SIDED LEADLINED CTT TUBE IN PLACE.

ULTRASOUND REPORT
DATE AND TIME PERFORMED:
9/21/2010 @ 03:47 PM
EXAMINATION: WHOLE ABDOMEN
CLINICAL DATA
REPORT
MEASUREMENTS :
GB INTRALUMINAL DIAMETER : 3.9 CM
GB WALL THICKNESS: 0.2 CM (N=<0.4 CM)
COMMON DUCT: 0.2 CM (N=<0.6 CM)
PANCREAS: 2.1 X 1.4 X 1.7 CM (H, B, T)
PANCREATIC DUCT: 0.2 CM
LIVER SPAN: 15.6 CM
SPLEEN: 9.5 X 5.0 CM (LW)
RIGHT KIDNEY: 11.1 X 5.5 X 5.0 CM (LWH) CORTICAL THICKNESS: RK: 1.5 CM
LEFT KIDNEY : 11.7 X 5.1 X 5.9 CM (LWH) CORTICAL THICKNESS: LK: 1.8 CM
PROSTATE : 3.1.X 3.7 X 3.3 CM (20.0 GMS) NORMAL: 20-30 GMS

ELABORATIONS: (ABNORMAL FINDINGS/ AREAS OF CONCERN )

THE GALLBLADDER IS PHYSIOLOGICALLY DISTENDED . ITS WALLS ARE NOT THICKENED . A FEW CALCULI ARE SEEN WITHIN, THE AVERAGE SIZE BEING 0.8 CM. THE COMMON DUCT AND
INTRA HEPATIC BILIARY RADICLES ARE NON ECSTATIC .
A 6.9 X 7.3 X 7.3 CM OR APPROXIMATELY 193.3 ML IN VOLUME CORTICAL CYST WITH EXOPHYTIC COMPONENT IS SEEN IN THE INFERIOR POLE OF THE LEFT KIDNEY . ITS WALL IS THIN
AND SMOOTH AND THE FLUID WITHIN CLEAR . NO SOLID COMPONENTS NOTED . CORTICAL MANTLES ARE OTHERWISE FREE OF ABNORMAL SOLID MASSES OR OTHER FOCAL CYSTIC
LESIONS .
CONCLUSION:
CHOLELITHIASIS, NON OBSTRUCTING AT PRESENT.
UNREMARKABLE CBD AND BILIARY RADICLES.
ESSENTIALLY NORMAL RIGHT KIDNEY, LIVER, SPLEEN AND PANCREAS.
EXOPHYTIS CORTICAL CYST, OTHERWIDE UNREMARKABLE LEFT KIDNEY.
NORMAL SIXED PROSTATE GLAND APPROXIMATELY 20.0 RGRAMS.
STRUCTURALLY UNREMARKABLE URINARY BLADDER.

MICROBILOGY REPORT
DATE AND TIME PERFORMED:
9/15/2010 @ 01:37 PM

EXAMINATION: CULTURE – PLEURAL FLUID

CULTURE:
SPECIMEN: PLEURAL FLUID
REPORT: FINAL
(A) NO GROWTH AFTER 5 DAYS OF INCUBATION.

CELL BLOCK / CYTOLOGY REPORT

DATE AND TIME PERFORMED
9/ 15 / 10 1:46:56 PM

DIAGNOSIS
RIGHT PLEURAL FLIUID: CONSISTENT WITH METASTATIC ADENOCARCINOMA
GROSS DESCRIPTION:
RIGHT PLEURAL FLUID : SPECIMEN CONSIST OF 14 ML, RED, SLIGTHLY CLOUDY AND SEROUS FLUID. SEDIMENTS ARE COLLECTED AND RUN AS CELL BLOCK AND CYTOLOGY
PREPARATION .

MICROSCOPIC DESCRIPTION:
RIGHT PLEURAL FLUID : CYTOSPIN SMEAR AND CELL BLOCK SECTION SHOW NUMEROUS SMALL CLUSTERS OF MALIGNANT TUMORS CELL OCCURRING IN THE SMALL COHESIVE CLUSTERS,
MICROGLANDULAR STRUCTURES OR PAPILLARY STRUCTURES . T HE TUMOR CELL EXHIBITS LARGE , HYPECHROMATIC AND PLEOMORPHIC NUCLEI WITH CONSPICUOUS NUCLEOLI AND
OCCASIONALLY VACUOLATED CYTOPLASM . IN THE BACKGROUND ARE MIXED INFLAMMATORY CELLS , RED BLOOD CELLS AND PROTIENACEOUS MATERIAL . T HE FINDINGS ARE CONSISTENT
WITH METASTATIC ADENOCARCINOMA . RECOMMEND CLINICAL AND RADIOPATHIC CORRELATION .

CELL BLOCK / CYTOLOGY REPORT

DATE AND TIME PERFORMED
9/ 15 / 10 1:47:17 PM

DIAGNOSIS
RIGHT PLEURAL FLIUID : METASTATIC ADENOCARCINOMA
GROSS DESCRIPTION:
RIGHT PLEURAL FLUID: SPECIMEN CONSIST OF 300 ML. SLIGTHLY CLOUDY CYTOLOGY PREPARATION

MICROSCOPIC DESCRIPTION:
RIGHT PLEURAL FLUID : CYTOSPIN SMEAR AND CELL BLOCK SECTION SHOW NUMEROUS SMALL CLUSTERS OF MALIGNANT TUMORS CELL OCCURRING IN THE SMALL COHESIVE CLUSTERS,
MICROGLANDULAR STRUCTURES OR PAPILLARY STRUCTURES . T HE TUMOR CELL EXHIBITS LARGE , HYPECHROMATIC AND PLEOMORPHIC NUCLEI WITH CONSPICUOUS NUCLEOLI AND
OCCASIONALLY VACUOLATED CYTOPLASM . IN THE BACKGROUND ARE MIXED INFLAMMATORY CELLS , RED BLOOD CELLS AND PROTIENACEOUS MATERIAL . T HE FINDINGS ARE CONSISTENT
WITH METASTATIC ADENOCARCINOMA . RECOMMEND CLINICAL AND RADIOPATHIC CORRELATION .
BIBLIOGRAPHY: