PTB

Asthma

H-mole

COPD
(emphyse
ma)

Mild stroke

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German
Measles

Broncho
Pneumoni
a

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DM

Hypertensi
on

PTB

Administrat
ive
Clinical
History
Laboratory

Radiology
Pharmacy
Nursing
Apps

ASTHMA

Administrat
ive
Clinical
History
Laboratory

Radiology
Pharmacy
Nursing
Apps

EMPHYSEMA

Administrat
ive
Clinical
History
Laboratory

Radiology
Pharmacy
Nursing
Apps

H-MOLE

Administrat
ive
Clinical
History
Laboratory

Radiology
Pharmacy
Nursing
Apps

MILD STROKE

Administrat
ive
Clinical
History
Laboratory

Radiology
Pharmacy
Nursing
Apps

GERMAN MEASLES

Administrat
ive
Clinical
History
Laboratory

Radiology
Pharmacy
Nursing
Apps

BRONCHO PNEUMONIA

Administrat
ive
Clinical
History
Laboratory

Radiology
Pharmacy
Nursing
Apps

DM

Administrat
ive
Clinical
History
Laboratory

Radiology
Pharmacy
Nursing
Apps

SYPHILIS

Administrat
ive
Clinical
History
Laboratory

Radiology
Pharmacy
Nursing
Apps

HYPERTENSION

Administrat
ive
Clinical
History
Laboratory

Radiology
Pharmacy
Nursing
Apps

PTB
Patients
name:
Address:
Age:
Gender:

Angelica E. Natividad
Brgy. Balite, Rodriguez, Rizal
18
Female

ADMISSION
Date:
Time in:

9:20am

Date of
discharge:

August 28, 2011

Time out:

4:00pm

Diagnosis:

Pulmonary Tuberculosis

V/S:

BACK

August 26, 2011

Temp:36.0,CPR: 90 bpm, RR: 29 bpm, BP:

100/70mmHg

Complaint:

Cough 3mos, night sweats, Hemoptysis,

Fatigue

Attending
Physician:

Joseph Quiday, MD

Patients
name:
Address:

Asthma

Age:
Gender:

Catherine C. Santos
Burgos, Rodriguez, Rizal
21 yrs old
Female

ADMISSION
Date:
Time in:

10:00am

Date of
discharge:

February 28, 2010

Time out:

11:00am

Diagnosis:

Asthma

V/S:

BACK

February 24, 2010

BT: 37c, PR: 140, RR: 44 BP: 130/90

Complaint:

Cough, wheezing, shortness of breath,

sputum production, nocturnal cough or
wheezing.

Attending
Physician:

Benedict V. Rivera, MD

Nurse on duty: Jasmine Briones, RN

COPD (Emphysema)
Patients
name:
Address:
Age:
Gender:

Paulo Cabuhat
Christine Ville, Tagumpay, Quezon
63
Male

ADMISSION
Date:
Time in:

12:00nn

Date of
discharge:

June 7, 2012

Time out:

1:00pm

Diagnosis:

Chronic Obstructive Pulmonary Disease

V/S:

BACK

June 2, 2012

BT: 37.5c PR: 113 RR: 31 BP: 130/100

Complaint:

Difficulty of breathing

Attending
Physician:

Catherine Giva, MD

Nurse on duty: Steigerwald Sunga, RN

H-MOLE
Patients
name:
Address:
Age:
Gender:

Niezel O. Garcia
San Jose, Rodriguez, Rizal
29
Female

ADMISSION
Date:
Time in:

6:00am

Date of
discharge:

April 18, 2012

Time out:

8:00am

Diagnosis:

H-mole

V/S:

BACK

April 15, 2012

BT: 37c PR: 103 RR: 21 BP: 130/80

Complaint:

Abdominal cramps

Attending
Physician:

Arlene Villanueva, MD

Nurse on duty: Maria Tabs, RN

MILD STROKE
Patients
name:
Address:
Age:
Gender:

Bernardo Castro
Tondo, Manila
58
Male

ADMISSION
Date:
Time in:

7:30pm

Date of
discharge:

September 25, 2011

Time out:

2:00pm

Diagnosis:

Mild stroke

V/S:

BACK

September 20, 2011

BT: 37c PR: 88 RR: 17 BP: 140/90

Complaint:

Asymmetric smiling face, paralysis of right hand, nausea.

Attending
Physician:

Manelita Dita, MD

Nurse on duty: Oscar Ramos, RN

Examination:

CBC, urinalysis, CT scan, ECG, 2d echo

GERMAN MEASLES
Patients
name:
Address:
Age:
Gender:

John Lardi
Mendez, Quezon City
8
Male

ADMISSION
Date:
Time in:

6:00pm

Date of
discharge:

October 22, 2012

Time out:

6:00pm

Diagnosis:

German Measles

V/S:

BACK

October 18, 2012

BT: 38.6 PR: 70 RR: 16

Complaint:

4 days Fever, rashes

Attending
Physician:

Jervie Macapagal, MD

Nurse on duty: Aubrey Garcia, RN

BRONCHO PNEUMONIA
Patients
name:
Address:
Age:
Gender:

Calvin Bautista
Taytay, Rizal
7
Male

ADMISSION
Date:
Time in:

1:20pm

Date of
discharge:

May 12, 2013

Time out:

10:00am

Diagnosis:

Broncho pneumonia

V/S:

BACK

May 8, 2013

BT: 37.7 PR: 117 RR: 48

Complaint:

Difficulty of breathing and tachypnea

Attending
Physician:

Kyla Sison, MD

Nurse on duty: Enrique Dunca, RN

DM
Patients
name:
Address:
Age:
Gender:

Celso Lagman
Bahay Toro, Quezon City
41 y/o
Male

ADMISSION
Date:
Time in:

1:00pm

Date of
discharge:

December 10, 2011

Time out:

5:00pm

Diagnosis:

Diabetes Mellitus

V/S:

BACK

December 3, 2011

BT: 36.3c PR: 87 RR: 17 BP: 140/100

Complaint:

Blurring of eye vision, weight loss, bullae of the left

foot dorsum

Attending
Physician:

Edward Fuentes

Nurse on duty: Bella Tabucanon

Syphilis
Patients
name:
Address:
Age:
Gender:

Xavier Saludo
Commonwealth, Quezon City
40 y/o
Male

ADMISSION
Date:
Time in:
Date of
discharge:
Time out:
Diagnosis:
V/S:

BACK

Syphilis
BT: 37.7c PR: 85 RR: 22 BP: 120/90

Complaint:

Painful urination

Attending
Physician:

Maggy Cza Rapa, MD

Nurse on duty: Rich Bernal, RN

Hypertension
Patients
name:
Address:
Age:
Gender:

Hermano Calumpay
Marilao, Bulacan
34 y/o
Male

ADMISSION
Date:
Time in:
Date of
discharge:
Time out:
Diagnosis:
V/S:

BACK

High Blood Pressure

BT: 36.8C PR: 85 RR: 19 BP: 150/100

Complaint:

Nausea, headache (nape)

Attending
Physician:

Joseph dela Cruz, MD

Nurse on duty: Sheena Hao, RN

Nursing Interventions for

PTB
Monitor sputum for changes indicating infection
Monitor vital signs
Teach patient and family the purpose and techniques for infection control such as hand
washing, patient covering mouth when coughs, maintaining isolation if necessary
Teach patient the purpose, importance and how to take medications as prescribed
consistently over the long term therapy
Auscultate lungs for wheezing, decreased breath sounds, coarse sounds
Use universal precautions if secretions are purulent even before culture reports

Assess cough for effectiveness and productivity

Note sputum amount, color, odor, consistency
Send sputum specimens for culture as prescribed or prn
Institute appropriate isolation precautions if cultures are positive
Use humidity to help losen sputum
Administer medications, noting effectiveness and side effects
Teach effective deep breathing and coughing techniques
Side effects of medication include orange in color of urine and even sweats.
They have to take the medication remediosly.

Nursing Interventions for

Asthma
Monitor Vitas signs; respiration, pulse,
blood pressure, temperature
To maintain the cleanliness of airway
Monitor the chest wall retraction
Monitor respiration rate
Give a semi-Fowlerposition
Auscultate to lung sounds
Encourage the patient to drink warm
Monitor oxygen delivery

Nursing Intervention for COPD

(Emphysema)
If ordered, postural drainage and chest persussion and vibration
several times daily.
Perform CPT BID (morning and afternoon or before sleep)
Provide high calorie-protein richdietto promotehealth and healing.
Make sure the patient receives adequate fluids at least 3 liters per day
to loosen secretions.
Administer medications as ordered and record the patients response.
Monitor the patients respiratory function regularly.
Monitor the patients RBC count for increases (warning signsof
increasing lung and vascular congestion).
Watch for complications, such as respiratory tract infections,
spontaneous pneumothorax, and respiratory failure.
Include the patient and his family in care-related decision.
Provide supportive care, and help the patient adjust to lifestyle
changes imposed by a chronic illness.

Nursing Interventions for Hmole

Stabilize the patient, monitor vital signs.
Evacuation of the uterus by dilation and curettage is always
necessary. Suction curettage: amethod of curettage in which a
specimen of the endometrium or the products of conception
areremoved by aspiration.
Intravenousoxytocinshouldbestartedwiththedilationofthec
ervixandcontinuedpostoperatively to reduce the likelihood of
hemorrhage.
Pelvic rest is recommended for 4-6 weeks after evacuation of
the uterus, and the patient isinstructed not to become pregnant
for 12 months. Adequate contraception is recommendedduring
this period.
Future pregnancies should undergo early sonographic evaluation
because of the increased risk ofrecurrence of a molar gestation.

Nursing Interventions for Mild Stroke

Monitor Vital signs.
Provide theraphy.
Arrange mealtimes so that he is sitting up by the window in
a clean and private environment.
Provide passive ROM exercises for his right arm and leg;
schedule active ROM exercises for his right extremities as
well as quadriceps and gluteal sets every 4 hours during
waking hours.
Keep his skin clean and dry at all times.
Establish and maintain a regular schedule for turning
when he is in bed.
Place objects (e.g., call bell, tissues) on unaffected side and
approach him from that side.

Nursing Interventions for German

Measles

Monitor vital signs

Increase fluid intake
Take medication religiously
Keep isolated to prevent physical
contact with other people.
Increase immune system to prevent
other illness such as cough and
colds.

Nursing Interventions for

Bronchopneumonia

Monitor vital sign.

Take medication religiously.
Limit fluid intake to avoid aspirations.
Increase immune system to prevent
severity of the disease.

Nursing Interventions for

DM

Monitor vital signs.

Assess peripheral pulses, capillary refill, skin turgor, and mucous
membranes. This is an indicator of the level of dehydration, or an adequate
circulating volume.
Monitor input and output, record the specific gravity of urine. To provide
estimates of the need for fluid replacement, renal function, and
effectiveness of the therapy given.
Provide fluid therapy as indicated. The type and amount of liquid depends
on the degree of lack of fluids and the response of individual patients.
Determine the patient's diet and eating patterns and compared with food
that can be spent by the patient. Identify deficiencies and deviations from
the therapeutic needs.
Weigh weight per day or as indicated. Assessing an adequate food intake
(including absorption and utilization).
Identification of preferred food / desired include the needs of ethnic /
cultural. If the patient's food preferences can be included in meal
planning, this cooperation can be pursued after discharge.
Involve patients in planning the family meal as indicated. Increase the
sense of involvement; provide information on the family to understand the
patient's nutrition.
Give regular insulin treatment as indicated.
Rational: regular insulin has a rapid onset and quickly and therefore can

Nursing Interventions for

Syphilis

Assess the historyof painand response to pain

Create a comfortable environment
Reduce unpleasant stimulus
Collaboration with physicians in providing analgesic
Observation of general condition of the client with vital signs
every 2 hours
Give antipyretics as recommended by your doctor and
monitor the effectiveness of 30-60 minutes later
Give a compress on the forehead and arm
Recommend that clients use a thin and loose clothing
Give the drink a lot
Tell clients about the disease and actions to be carried out
simply.

Nursing Interventions for

Hypertension
Monitor and measure blood pressure in both hands, using a
cuff and proper techniques in terms of measuring blood
pressure.
Maintain restrictions on activities such as rest in bed or chair.
Assist in performing self-care activities as needed.
Provide a quiet environment, convenient, and therapeutic and
reduce activity. Note the general edema.
Monitor response to medication to control blood pressure.
Give fluid and dietary sodium restriction as indicated.
Medical collaboration in the provision of drugs as indicated.
Observe the sudden hypotension.

CLINICAL HISTORY: PTB

Patients condition started about
3mos prior to consultation as onset
of cough, non productive, and
intermittent fever usually in the
afternoon. 1 wk prior to admission,
she experienced worsening of the
condition, blood streaks in the
sputum, night sweats, fatigue. She
also experienced difficulty of
breathing.

CLINICAL HISTORY: ASTHMA

Pt. was in usual state of good health
1 wk ago; at that time had increase
in shortness of breathing with
tightness in the chest and mild
wheezing; had been used albuterol
inhalation TID-QID, usually makes
breathing easier; no other meds
taken.

CLINICAL HISTORY:
EMPHYSEMA
Patient experienced difficulty of
breathing, chronic cough, sputum
production and was rushed to the
hospital. 3 days prior to admission,
pt was diagnosed with emphysema.
(With history of smoking since 15 y/o
up to present).

CLINICAL HISTORY: H-mole

The patient was apparently well until 2
months prior to admission when the
patient noted hyperactive pain with
associated profuse vaginal bleeding.
Consult was done into anotherinstitution
where the patient was a manifest as a
cause of abortion. On follow-up, ultrasound
was done revealing H mole. The patient
was then referred into this institution for
further management and work-up.

CLINICAL HISTORY: MILD

STROKE
A 52-year-old police officer, with a history of
hypertension and smoking, is having dinner
with his wife when he develops sudden onset
of difficulty speaking, with drooling from the
right side of his mouth, and weakness in his
right hand. The family noted that the
symptoms began just as the evening news was
starting. His wife asks him if he is all right and
the patient denies any difficulty. His symptoms
progress over the next ten minutes until he
cannot lift his arm and has trouble standing.

CLINICAL HISTORY: German Measles

The patient experienced an intermittent fever for
four days, he was given by her mother a
paracetamol once to relieve the fever. Four days
prior to admission, his mother noticed the rashes
around his body began his tummy. Then the
mother of the patient decided to seek the doctor.

CLINICAL HISTORY: Broncho

Pneumonia
The patient has 3days of fever, and
experienced difficulty of breathing. His
mother brought him to the hospital
because of his sons complaint and cant
completely talk.

CLINICAL HISTORY: DM
Twenty days prior to admission,
patient noted onset of bullae at left
foot dorsum about the size of one
pesocoin.A days priorto admission,
spontaneouslyruptured, applied
Betadine once a daywith no
relief.Wound noted to ulcerate
spreading over foot dorsum up to
proximal tibia.

CLINICAL HISTORY: SYPHILIS

The client first noticed the rash on his hands one
week before the consultation it then progressed
from his arms to his torso. His last sexual contact
occurred two weeks before presenting where he
had receptive and insertive oral sex with a casual
male sexual partner. The last episode of
unprotected anal intercourse (receptive) was 2
months ago with a casual male sexual partner. No
new medications had been recently commenced
nor had there been any changes in use of hygiene
products such as body wash.

CLINICAL HISTORY:
HYPERTENSION
A week prior toadmission, client
experienced generalized body
weakness and occasional radiating
chest pain related to stress and
fatigue. A day prior to admission he
claimed ofsame symptoms.

RADIOLOGY: PTB
X-ray

RADIOLOGY: ASTHMA
X-ray
Spirometry

RADIOLOGY: EMPHYSEMA
X-ray
Spirometry

RADIOLOGY:H-mole
Utrasound

RADIOLOGY: MILD STROKE

CT Scan
ECG
2d echo

RADIOLOGY: GERMAN
MEASLES
None

RADIOLOGY: BRONCHO PNEUMONIA

Chest Xray

RADIOLOGY: DM

Utz of liver
ECG
2d echo
Chest X-ray (if having complication to
PTB)

RADIOLOGY: SYPHILIS
Chest X-ray if has tabis dorsalis.

RADIOLOGY: HYPERTENSION
None

PHARMACY: PTB

For initial empiric treatment of TB, start patients on a 4-drug regimen:

isoniazid, rifampin, pyrazinamide, and either ethambutol or streptomycin.
Once the TB isolate is known to be fully susceptible, ethambutol (or
streptomycin, if it is used as a fourth drug) can be discontinued.[1]
Patients with TB who are receiving pyrazinamide should undergo baseline
and periodic serum uric acid assessments, and patients with TB who are
receiving long-term ethambutol therapy should undergo baseline and
periodic visual acuity and red-green color perception testing. The latter can
be performed with a standard test, such as the Ishihara test for color
blindness.
After 2 months of therapy (for a fully susceptible isolate), pyrazinamide can
be stopped. Isoniazid plus rifampin are continued as daily or intermittent
therapy for 4 more months. If isolated isoniazid resistance is documented,
discontinue isoniazid and continue treatment with rifampin, pyrazinamide,
and ethambutol for the entire 6 months. Therapy must be extended if the
patient has cavitary disease and remains culture-positive after 2 months of
treatment.
Directly observed therapy (DOT) is recommended for all patients. With
DOT, patients on the above regimens can be switched to 2- to 3-times per
week dosing after an initial 2 weeks of daily dosing. Patients on twiceweekly dosing must not miss any doses. Prescribe daily therapy for
patients on self-administered medication.

PHARMACY: ASTHMA
Albuterol (short-acting beta
agonist)
SABAs are a type of drug class
commonly used rescue for quickrelief asthma medication. This type
of asthma medication is the drug of
choice for the acute relief of asthma
symptomsand is also used to
prevent exercised induced asthma.

PHARMACY: EMPHYSEMA
Bronchodilators. beta-2 agonist
anticholinergics theophyllines.
Inhaled steroids. Pulmicort
Flexhaler
generic name:budesonide

PHARMACY: H-mole
Prostin E2 Vagl
Dinoprostone Vagl

PHARMACY: MILD STROKE

Abilify Oral
Catapres or calciblock for
hypertension.

PHARMACY: GERMAN
MEASLES
Paracetamol and or ibufropen to
relieve fever or muscle or joint pains.

PHARMACY: BRONCHO PNEUMONIA

Antibiotics for bacterial pneumonia
Inhalers forwheezing
AlbuterolInhaler
Proventil Inhaler
VentolinInhaler

Coughmedications
Dextromethorphan

Decongestantmedications:
Only for use in older children and adults
Pseudoephedrine(Sudafed)
Phenylephrine (Neo-Synephrine)

Acetaminophenfor pain andfever control

Nonsteroidal anti-inflammatory medicationsfor pain andfever control
Ibuprofen (Motrin,Advil,Nuprin,NeoProfen)
Ketoprofen(Actron,Orudis,Oruvail)
Naproxen(Anaprox,Naprosyn,Aleve)

Oxygen therapy
Respiratory therapy for pneumonia
Mechanical ventilation:
Use of a ventilator to support breathing in severe pneumonia

PHARMACY: DM

GLYBURIDE-METFORMIN HCL
ACEBUTOLOL HCL
Vit. A
Regular Insulin

PHARMACY: SYPHILIS
Penicillin (inj)

PHARMACY: HYPERTENSION

CATAPRES-TTS 2 & TTS 3

Furosemide
Dosartan 50mg OD
Atenolol 50mg
Lasix 2mg (if + edema)
Simbaxatin crestor 2mg (if
cholesterol more than 190)

LAB: PTB
(+) AFB- Sputum exam
(+) Skin test- In duration of PPD

LAB: ASTHMA
Spirometry- obstructive, which is
connected with the airways asthma
is one such type.

LAB: EMPHYSEMA
ABG
CBC
Sputum test

LAB: H-MOLE
CBC
Pregnancy testing
Urinalysis

LAB: MILD STROKE

CBC
Urinalysis

LAB: GERMAN MEASLES

CBC
Urinalysis
Fecalysis

LAB: BRONCHO PNEUMONIA

Sputum test
CBC
Urinalysis
PPD

LAB: DM

HBAIc
Blood chemistry
ECG
2d echo
Wound culture
Tonometry

LAB: SYPHILIS
CBC
Urinalysis
Culture discharge

LAB: HYPERTENSION

Lipid profile
Blood chemistry
CBC
Urinalysis

 THANK YOU!!!

Gypsy Kaye Pineda

BSN II