DRUG ANALYSIS GENERIC NAME Amlodipine Besylate MODE OF ACTION NURSING RESPONSIBILITIES y CNS: Dizziness, light headedness, y Monitor

r patient headache, asthenia, fatigue, lethargy carefully (BP, cardiac rhythm, and output) y CV: Peripheral edema, arrhythmias while adjusting drug to y Dermatologic: flushing, rash therapeutic dose; use y GI: nausea, abdominal discomfort special caution if patient has heart failure. y Monitor BP carefully if patient is also on nitrates. y Monitor cardiac rhythm regularly during stabilization of dosage and periodically during long term therapy. y Administer drug without regard to meals. SIDE EFFECTS

Inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells; inhibits transmembrane calcium flow, which results in the depression of impulse formation in specialized cardiac pacemaker cells, slowing of the velocity of conduction of the cardiac impulse, depression of myocardial contractility, and dilation of coronary arteries and arterioles and peripheral arterioles; these effects lead to decreased cardiac work, decreased cardiac oxygen consumption, and in patients with vasospastic (Prinzmetals) angina, increased delivery of oxygen to cardiac cells. BRAND NAME INDICATIONS Norvasc Essential hypertension, alone or in combination with other antihypertensives. CLASSIFICATION CONTRAINDICATIONS Antianginal y Contraindicated with allergy to Antihypertensive amlodipine, impaired hepatic or renal Calcium Channel Blocker function, sick sinus syndrome, heart block DOSAGE (second or third degree), lactation. 5mg / tab y Use cautiously with heart failure, OD pregnancy.

GENERIC NAME Metoprolol

MODE OF ACTION Completely blocks beta adrenergic receptors in the heart and juxtaglomerular apparatus, decreasing the influence of the sympathetic nervous system on these tissues and the excitability of the heart, decreasing cardiac output and release of rennin, and lowering BP; acts in the CNS to reduce sympathetic outflow and vasoconstrictor tone. INDICATIONS Hypertension, alone or with other drugs, especially diuretics.

SIDE EFFECTS y Allergic: Pharyngitis, erythematous rash, fever, sore throat, laryngospasm y CNS: Dizziness, vertigo tinnitus, fatigue, emotional depression, paresthesias, sleep disturbances, hallucinations, disorientation, memory loss, slurred speech y CV: Heart failure, cardiac arrhythmias, peripheral vascular insufficiency, claudication, CVA, pulmonary edema, hypotension y Dermatologic: Rash, pruritus, sweating, dry skin, worsening of psoriasis y EENT: eye irritation, dry eyes, conjunctivitis, blurred vision y GI: Gastric pain, flatulence, constipation, diarrhea, nausea, vomiting, anorexia, is chemic colitis, renal and mesenteric arterial thrombosis, retroperitoneal fibrosis, hepatomegaly, acute pancreatitis y GU: Impotence, decreased libido, dysuria, Peyronies disease, nocturia, frequent urination y Musculoskeletal: Joint pain, arthralgia, muscle cramp y Respiratory: Bronchospasm, dyspnea, cough, bronchial obstruction, nasal stuffiness, rhinitis, pharyngitis y Other: Decreased exercise tolerance, development of ANA, hyperglycemia or hypoglycemia, elevated serum transaminase, alkaline phosphatase.

BRAND NAME Lopressor Metoprolol Succinate ER Toprol XL Metoprolol Tartrate CLASSIFICATION CONTRAINDICATIONS Antihypertensive y Contraindicated with sinus bradycardia Beta1 selective (HR less than 45 beats/min), second- or adrenergic blocker third-degree heart block (PR interval more DOSAGE than 0.24 sec), cardiogenic shock, HF, second and third trimesters of pregnancy. 50mg / tab BID y Use cautiously with diabetes or thyrotoxicosis; asthma or COPD; pregnancy.

NURSING RESPONSIBILITIES y Do not discontinue drug abruptly after long term therapy (hypersensitivity to catecholamines may have developed, causing exacerbation of angina, MI, and ventricular arrhythmias). Taper drug gradually over 2 wk with monitoring. y Ensure that patient swallows the ER tablets whole; do not cut, crush, or chew. y Consult physician about withdrawing drug if patient is to undergo surgery. y Give oral drug with food to facilitate absorption. y Provide continual cardiac monitoring for patients receiving IV metoprolol.

NURSING CARE PLAN ASSESSMENT Subjective Cues: The client verbalized: - Iyong ubo , may kasamang plema. DIAGNOSIS RATIONALE Presence of risk factors such as smoking and other environmental pollutants irritate the airways, resulting in the inflammation and hypersecretion of mucus. Constant irritation causes the mucussecreting glands and goblet cells to increase in number leading to increased mucus production. PLANNING INTERVENTION RATIONALE EVALUATION

Ineffective airway clearance r/t retained secretions as manifested by tachypnea, use of accessory muscles in Objective Cues: - Received client breathing, chest in semi retractions and white, thick fowlers position; awake; secretions alert; coherent; cooperative; afebrile; ambulatory; oriented to time, person and place. Postprandial vomiting Weight loss of 4kg for this month Tachypneic (RR=30 to breaths/min)

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(Source: Brunner & Suddarths Textbook of Medical-Surgical Nursing, 12th Edition, 2010)

Goal: Independent: After 30minutes - Assess respiratory of nursing status every hour intervention, the patients airways - Maintain high remain patent. back rest or Semifowlers position. Objectives: After 30 minutes - Teach patient of nursing coughing intervention, the technique patient will: 1. Show no signs - Encourage of pulmonary sputum compromise. expectoration. 2. Demonstrates Provide tissues coughing and and paper bag for DBE hygienic disposal. techniques. 3. Able to - Perform chest expectorate physiotherapy sputum and Monitor sputum, decreased noting amount, adventitious consistency and sounds heard odor. upon auscultation. - Perform aseptic technique (handwashing) -

Goal: - To detect early signs After 30minutes of of compromise nursing intervention, the patients airways - To promote chest remained patent expansion and ventilation Objectives: After 30 minutes of - To facilitate nursing intervention, expectoration of the patient: sputum 1. Showed no signs of pulmonary - To remove pathogens compromise. & prevent spread of 2. Demonstrated infection. coughing and DBE techniques. 3. Expectorated sputum and absence of - Sputum amount and adventitious consistency may sounds was indicate hydration observed. status and . effectiveness of therapy. - To minimize spread of infection

Difficulty in breathing, nasal flaring, and uses accessory

Monitor ABG - To assess oxygenation and ventilator status results and hemoglobin count

muscles breathing. -

in

Productive cough, white sputum Hypertensive (BP=150/90)

Dependent: - Administer antibiotics, expectorants, bronchodilators as indicated. -

- To loosen secretions

Suction and - To enhance clearance perform of secretion from nebulization with airways ordered medications, Administer oxygen, ordered. - To help relieve as respiratory distress

Collaborative:: - Collaborate with - To identify possible the physician-inproblems and plan charge about the appropriate progression of the management. patients respiratory status

NURSING CARE PLAN ASSESSMENT Subjective Cues: The client verbalized: - Lahat ng kinakain ko parang dinudura ko din kaya siguro nabawasan ang timbang ko. DIAGNOSIS Imbalanced Nutrition: less than body requirements r/t inability to ingest food as manifested by decreased appetite, - Medyo perceived nahihirapan ako inability to huminga pati may digest food, plema kapag loss of weight, umubo ko. and postprandial vomiting Objective Cues: - Received client in semi fowlers position; awake; alert; coherent; cooperative; afebrile; ambulatory; oriented to time, person and place. Postprandial vomiting Weight loss of 4kg for this month Tachypneic (RR=30 to breaths/min) RATIONALE Proper nutrition is a vital part of the healing process. Imbalanced nutrition can lead to poor wound healing, heart disease, bone loss and other damage to the body. Recognizing unhealthful eating patterns is part of a nurse's duty. A diagnosis of imbalanced nutrition can be given to a patient who takes in more or less than the body requires. It can also be a risk diagnosis and the cause of another diagnosis. PLANNING INTERVENTION Goal: Diagnostic: After 3-days of - Assess the present nursing weight of the intervention, the client. client will be able to maintain stable - Determine weight, and clients demonstrate nutritional progressive history, including weight gain. her pregnancy diet. Objectives: After 3-days of - Determine the nursing clients attitude intervention, the towards eating. patient: 1. Shows a slow, progressive weight gain Therapeutic: during - Plan with the hospitalization. client her desired 2. Vital signs, meals. blood pressure, and laboratory serum studies will be within normal limits. 3. Verbalizes importance of adequate - Suggest ways that nutrition and may assist the fluid intake. client in eating a. Ensure pleasant environment. b. Facilitate proper EVALUATION Goal: - Provides baseline data After 3days of nursing intervention, about the client. the client had maintained stable and - To assess the usual weight, demonstrated food that she eats. progressive weight gain. Objectives: After 3-days of nursing intervention, the patient: 1. Showed a slow, progressive weight gain during hospitalization. 2. Vital signs, blood pressure, and laboratory serum studies are within normal limits. 3. Verbalized the importance of adequate nutrition and fluid intake. RATIONALE

- Psychological factors towards eating may affect one persons appetite and also to know the clients eating habits. - Involving the client to her plan of care gives the client the feeling of independence. It also personalizes the plan of care since the client does make the choices in some aspects of the plan. - A pleasant environment gives the client a relaxed feeling and will not spoil her appetite and proper positioning reduces the

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positioning. Difficulty in breathing, nasal flaring, and uses accessory muscles in breathing. Productive cough, white sputum Hypertensive (BP=150/90) -

risk of aspiration and heartburn.

Instruct the client - Caffeinated beverages to avoid may decrease the caffeinated appetite and will make beverages. the client feel full easily. Instruct the client - Junk foods have empty to avoid junk calories that provide foods. no nutritional help to the client. Encourage the - To client to maintain nourishment the intake of the client. healthy foods needed by her body. provide to the

- Education provides Health Teaching: ample information that - Educate the client the client may not be regarding the aware of, hence importance of leading to the kind of eating healthy eating habits and diet foods. she is following. Educate the client - For the client to be aware of the needed regarding the nutrients by her body vitamins and to nourish herself. minerals. Also, giving sources of these nutrients helps the client to easier familiarize herself as to what foods she may include in her diet.