DISEASE OVERVIEW:

CEREBROVASCULAR DISEASE

Cerebrovascular disease (CVD) includes all disorders in which an area of the brain is transiently or permanently affected by ischemia or bleeding and one or more of the cerebral blood vessels are involved in the pathological process.

Classification:o Ischemic Stroke – cerebrovascular accident (CVA) or “brain attack” is a sudden loss of function resulting from

disruption of the blood supply to the part of the brain. Risk Factors:

Hypertension Heart disease History of TIA Increase hematocrit Age (older) Alcohol use Smoking Diabetes Mellitus

Symptoms occur suddenly and may include muscle weakness, paralysis, lost or abnormal sensation on one side of the body, difficulty speaking, confusion, problems with vision, dizziness, and loss of balance and coordination. Diagnostic Exam:

Physical Examination – history of event and identification of which artery is blocked based on symptoms.

CT Scan - helps distinguish an ischemic stroke from a hemorrhagic stroke, a brain tumor, an abscess, and other structural abnormalities.

Blood sugar levels – to rule out hypoglycaemia which can cause similar symptoms. Electrocardiography (ECG) – to look for abnormal heart rhythms.

Blood tests – to check for anemia, polycythemia, blood clotting disorders, vasculitis, and some infections (such as heart valve infections and syphilis) and for risk factors such as high cholesterol levels or diabetes.

Managements: First priority is to restore the person's breathing, heart rate, blood pressure (if low), and temperature to

normal. Maintain adequate tissue oxygenation: May require airway support and ventilatory assistance. Check for

possible aspiration pneumonia. Intravenous line for medication and fluids. Acetaminophen or Ibuprofen for fever – increase in body temperature by even a few degrees can

dramatically worsen brain damage due to an ischemic stroke. Mannitol – to reduce swelling and increased pressure in the brain Thrombolytic (Fibrinolytic) Drugs – drug called tissue plasminogen activator (tPA) is given

intravenously to break up clots and help restore blood flow to the brain. Before tPA is given, CT is done to rule out bleeding in the brain.

Antiplatelet Drugs and Anticoagulants – Antiplatelet drugs make platelets less likely to clump and form clots. Anticoagulants inhibit proteins in blood that help it to clot (clotting factors).

Surgical interventions like:Carotid Endarterectomy (CEA) – surgical removal of the atheromatous plaque.

Reserved for patients with an ulcerated lesion or clot that occludes > 70% of blood flow in the carotid artery.

A general anesthetic or a local anesthetic (to numb the neck area) may be used. If people remain awake during the operation, the surgeon can better evaluate how the brain is functioning. The surgeon makes an incision in the neck over the area of the artery that contains the blockage and an incision in the artery. The blockage is removed, and the incisions are closed. For a few days afterwards, the neck may hurt, and swallowing may be difficult. Most people can stay in the hospital 1 or 2 days. Heavy lifting should be avoided for about 3 weeks. After several weeks, people can resume their usual activities.

Carotid endarterectomy can trigger a stroke because the operation may dislodge clots or other material that can then travel through the bloodstream and block an artery. However, after the operation, the risk of stroke is lower for several years than it is when drugs are used.

It also reestablishes the blood supply to the affected area, but it cannot restore lost function because some brain tissue is dead.

Stent Placement - A wire mesh tube (stent) with an umbrella filter may be placed in the carotid artery. The stent helps keep the artery open, and the filter catches blood clots and prevents them from reaching the brain and causing a stroke.

After a local anesthetic is given, a catheter is inserted through a small incision into a large artery near the groin or in the arm and is threaded to the internal carotid artery in the neck. A dye that can be seen on x-rays (radiopaque dye) is injected, and x-rays are taken so that the narrowed area can be located. After the stent and filter are placed, the catheter is removed.

o Hemorrhagic Stroke - include bleeding within the brain (intracerebral hemorrhage) and bleeding between the inner

and outer layers of the tissue covering the brain (subarachnoid hemorrhage). Intracerebral Hemorrhage – Non-traumatic or spontaneous intracerebral hemorrhage (ICH) occurs

when a diseased blood vessel within the brain bursts, allowing blood to leak inside of the brain (the name means within the cerebrum or brain). The sudden increase in pressure within the brain can cause damage to the brain cells surrounding the blood. If the amount of blood increases rapidly, the sudden build up in pressure can lead to unconsciousness or even death. Intracerebral hemorrhage usually occurs in selected parts of the brain including the basal ganglia, cerebellum, brainstem or cortex.

Risk Factors: Chronic Hypertension – weakens the small artery that causes it to burst. Use of Cocaine Alcohol consumption High doses of anti-couagulants and antiplatelets

Signs and Symptoms: Severe headache – may be present or absent.

Weakness, paralysis, loss of sensation, and numbness, often affect only one side of the body.

Dysarthria – difficulty in speaking Vision may be impaired or lost Nausea, vomiting, seizures, and loss of consciousness are common and may occur within

seconds to minutes ↑ ICP

Diagnostic Exam: Neurological exam may indicate increased intracerebral pressure such as swelling of the

optic nerve or changes in eye movement. Localized abnormalities in the brain function are detected by observing abnormal reflexes or movement.

CT Scan and MRI - helps distinguish an ischemic stroke from a hemorrhagic stroke, a brain tumor, an abscess, and other structural abnormalities.

Blood sugar levels – to rule out hypoglycaemia which can cause similar symptoms. Blood tests – to check for anemia, polycythemia, blood clotting disorders, vasculitis, and

some infections (such as heart valve infections and syphilis) and for risk factors such as high cholesterol levels or diabetes.

Management:o First priority is to restore the person's breathing, heart rate, blood pressure (if low), and

temperature to normal.o Maintain adequate tissue oxygenation: May require airway support and ventilatory

assistance. Check for possible aspiration pneumonia.o Intravenous line for medication and fluids.

o Acetaminophen or Ibuprofen for fever – increase in body temperature by even a few

degrees can dramatically worsen brain damage due to an ischemic stroke.o Mannitol – to reduce swelling and increased pressure in the brain

o Anticoagulants (such as heparin and warfarin), thrombolytic drugs, and antiplatelet drugs

(such as aspirin) are not given because they make bleeding worse.

o Tracheal intubation is indicated in patients with decreased level of consciousness or other

risk of airway obstructiono Surgery:

Surgery to remove the accumulated blood and relieve pressure within the skull, even if it may be life-saving, is rarely done because the operation itself can damage the brain. Also, removing the accumulated blood can trigger more bleeding, further damaging the brain and leading to severe disability. However, this operation may be effective for hemorrhage in the pituitary gland or in the cerebellum. In such cases, a good recovery is possible.A catheter may be passed into the brain vasculature to close off or dilate blood vessels, avoiding invasive surgical procedures.Aspiration by stereotactic surgery or endoscopic drainage may be used in basal ganglia hemorrhages, although successful reports are limited.

Subarachnoid Hemorrhage - A subarachnoid hemorrhage is bleeding into the space (subarachnoid space) between the inner layer (pia mater) and middle layer (arachnoid mater) of the tissue covering the brain (meninges).

Risk Factors: Head injury Aneurysm or weakened blood vessels Hypertension Smoking

Signs and Symptoms: Headache, which may be unusually sudden and severe (sometimes called a thunderclap

headache) Facial or eye pain Double vision Loss of peripheral vision Weakness or paralysis on one side of the body (most common) Loss of sensation on one side of the body

Difficulty understanding and using language (Aphasia) Within 24 hours, blood and cerebrospinal fluid around the brain irritate the layers of tissue

covering the brain (meninges), causing a stiff neck as well as continuing headaches, often with vomiting, dizziness, and low back pain.

Diagnostic Exams:o Computed tomography (CT) – is done to check for bleeding.

o A spinal tap (lumbar puncture) is done if CT is inconclusive or unavailable. It can detect any

blood in the cerebrospinal fluid. A spinal tap is not done if doctors suspect that pressure within the skull is increased.

o Cerebral angiography – is done as soon as possible to confirm the diagnosis and to identify the

site of the aneurysm or arteriovenous malformation causing the bleeding. Management:

o Bed rest with no exertion is essential

o Analgesics such as opioids (but not aspirin or other nonsteroidal anti-inflammatory drugs, which

can worsen the bleeding) are given to control the severe headaches.o Stool softeners are given to prevent straining during bowel movements.

o Nimodipine, a calcium channel blocker, is usually given by mouth to prevent vasospasm and

subsequent ischemic stroke.o Doctors take measures (such as giving drugs and adjusting the amount of intravenous fluid

given) to keep blood pressure at levels low enough to avoid further hemorrhage and high enough to maintain blood flow to the damaged parts of the brain.

o A piece of plastic tubing (shunt) may be placed in the brain to drain cerebrospinal fluid away

from the brain. This procedure relieves pressure and prevents hydrocephalus.o Surgery:

For people who have an aneurysm, a surgical procedure is done to isolate, block off, or support the walls of the weak artery and thus reduce the risk of fatal bleeding later.Neuroendovascular surgery, involves inserting coiled wires into the aneurysm. The coils are placed using a catheter that is inserted into an artery and threaded to the aneurysm.

Thus, this procedure does not require that the skull be opened. By slowing blood flow through the aneurysm, the coils promote clot formation, which seals off the aneurysm and prevents it from rupturing. Neuroendovascular surgery can often be done at the same time as cerebral angiography, when the aneurysm is diagnosed.

CLINICAL SUMMARY

A. General Information

Name: O.A Room/ Bed No.: 3202

Age: 49 years old Gender: Male

Religion: Roman Catholic

Residence: Parian, Calamba, Laguna

Date /Time Admitted: September 3, 2010 9:30am

Chief Complaint

*Slurring of Speech and left-sided weakness

B. History of Present Illnesso 4hrs prior to admission, the patient allegedly woke up from his sleep and had 1 episode of vomiting and then was

noted to have left-sided weakness and loss of consciousness for about 5 minutes and was rushed to the hospital.C. Past Medical History

Allergies: none

Illnesses: Hypertension

Operations: none.

Injuries: ----

Adverse Drug Reaction: none

E. Familial History

O.A

Patient:

CVD; Intracerebral Hemorrhage

Father:

(+) HPN

(+)DM

(-) Asthma

(-) Cancer

(-) Thyroid disease

Mother

(-) HPN

(-)DM

(-) Asthma

(-) Cancer

(-) Thyroid disease

LABORATORY RESULTS

Shoulder AP portable (X-Ray) – no joint abnormalities noted in the visualized structure of the left shoulder.CT Scan – Right capsulothalamic acute hemorrhagic with intraventricular extension and mild communicating hydrocephalus most possibly due to hypertension.Blood Chemistry: September 15, 2010

Result Interpretation Sodium 137-145mmol/L 129.4 CSWS is defined as

“true” hyponatremia which occurs when there

is a primary loss of sodium into the urine without an increase in

total systemic volume. It is related to acute or

chronic damage of the central nervous system

(commonly seen in intracerebral hemorrhage).

Can also be the result when the pituitary gland is affected which causes

overproduction ADH that causes accumulation of

fluids in the brain

Potasium 3.6-5.0mmol/L 4.99 normal

September 19, 2010

Result Interpretation Sodium 137-145mmol/L 131.0 CSWS is defined as

“true” hyponatremia which occurs when there is a primary loss of sodium into

the urine without an increase in total

systemic volume. It is related to acute or chronic damage

of the central nervous system

(commonly seen in intracerebral hemorrhage).

Can also be the result when the pituitary gland is affected which

causes overproduction ADH

that causes accumulation of

fluids in the brain

Hematology:

September 15, 2010

Urinalysis

Color yellow Normal Transparency clear Normal

pH 8.0 NormalSpecific gravity 1.015 Normal

Values Normal values

Interpretation

Hemoglobin levels are low therefore the

client is anemic

149 140-170 g/L Normal

Hematocrit levels are low therefore the

client is anemic

.44 0.42-0.50 g/L

Normal

Red Blood cells levels are low therefore the

client is anemic

4.9 4.0-5.0 g/L Normal

WBC 10.8 5.0-10.0 g/L Can be a cause of inflammation or inflammation.

Albumin Trace Can mean that there is glomerular damage

Sugar Negative Normal

DRUG STUDY

DRUG INDICATION MECHANISM OF ACTION

CONTRAINDICATION SIDE EFFECTS

NURSING CONSIDERATIONS

Drug name:

-telmisartan, hydrochlorothiazide

Brand name:

-micardis plus

Doctor’s order:

-10mg 1tab OD

Anti-hypertensive

-blocks the vasoconstrictive and aldosterone-secreting effects of angotensin II by binding angiotensin II to the AT I receptor in many tissue.

-hypersensitivity to the drug

-diarrhea

-anorexia

-loss of appetite

-gastric irritation

-constipation

-special precaution in patients with impaired hepatic and renal impairment

-special precaution with volume and/or Na-depleted patients

-may impair ability to drive or operate machineries

DRUG INDICATION MECHANISM OF ACTION

CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATIONS

Drug name:

-amlodipine

Brand name:

-vasalat

Doctor’s order:

-10mg 1tab OD

Anti-hypertensive

-inhibits influx of calcium ion across cell membranes to produce relaxation of coronary vascular smooth muscle, decrease peripheral vascular resistance of smooth muscle (↓BP)

-low BP

-CHF

-hypersensitivity

-hepatic impairment

-headache

-edema

-dizziness

-flushing

-palpitation

-fatigue

-nausea

-abdominal pain

-monitor v/s especially the BP

-should be administered with food or after eating

DRUG INDICATION MECHANISM OF ACTION

CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATIONS

Drug name:

Ranitidine

Histamine2antagonist

-Short-termtreatment ofactive duodenalulcer

Maintenancetherapy forduodenal ulcerat reduceddosage

Short-termtreatment ofactive, benigngastric ulcer

Short-termtreatment ofGERD

Treatment of

Competitivelyinhibits theaction ofhistamine atthe H2 receptorsof the parietalcells of thestomach,inhibiting basalgastric acidsecretion andgastric acidsecretion that isstimulated byfood, insulin,histamine,cholinergicagonists,gastrin, andpentagastrin

Contrainidicated

with allergy to

ranitidine,

lactation

Use cautiously

with impaired

renal or hepatic

function,

pregnancy

-CNS: headcahe,malaise,dizziness,somnolence,insomia,vertigo

CV:tachycardia,bradycardia

GI:constipation,diarrhea,nausea,vomiting,abdominal pain

LOCAL: pain atIM site, localburning oritching at IV

-Administer

oral drug with

meals and at

bedtime.

2. Decrease

doses in renal

and liver failure.

3. Provide

concurrent

antacid therapy

to relieve pain.

4. Adminsiter IM

dose undiluted,

heartburn, acidindigestion,sour stomach

site

deep into large

muscle group.

5. Arrange for

regular follow-

up, including

blood tests to

evaluate

effects.

DRUG INDICATION MECHANISM OF ACTION

CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATIONS

Drug name:

ciprofloxacin

AntibacterialFluoroquinolones

For the treatment of infections caused by susceptible gram-negative bacteria, including E. coli, P. mirabilis, K. pneumoniae, Enterobacter cloacae, P. vulgaris, P. rettgeri, M. morganii, P. aeruginosa, Citrobacter freundii, S. aureus, S. epidermidis, group D streptococci

Bactericidal; interferes with DNA replication in susceptible gram-negative bacteria preventing cell reproduction

Contraindicated with allergy to ciprofloxacin, norfloxacin, pregnancy, lactation

-headache

-edema

-dizziness

-flushing

-palpitation

-fatigue

-nausea

-abdominal pain

Arrange for culture and sensitivity tests before beginning therapy.

Continue therapy for 2 days after signs and symptoms of infection are gone.

Ensure that patient is well hydrated.

Give antacids at least 2 hr after dosing.

Monitor clinical response; if no improvement is seen or a relapse occurs, repeat culture and sensitivity.

Encourage patient to complete full course of therapy.

BRAND NAME

DOSAGE INDICATION MECHANISM OF ACTION

CONTRAINDICATION ADVERSE EFFECT NURSING RESPONSIBILITIES

Generic Name

gabapentin

Trade Name

Neurontin

Classification

analgesic adjuncts

Why is your patient getting this medication

Chronic neck pain.

Mechanism of action and indications

Mechanism of action is not known. May affect transport of amino acids across and stabilize neuronal membranes.

Nursing Implications (what to focus on) Contraindications/warnings/interactions

Hypersensitivity. Geriatric patients (because of age-related ↓ in renal function).

Common side effects

Confusion, depression, drowsiness, ataxia.

Be sure to teach the patient the following about this medication

Be sure to teach the patient the following about this medication. Instruct patient to take medication exactly as directed. Take missed doses as soon as possible; if less than 2 hr until next dose, take dose immediately and take next dose 1-2 hr later, then resume regular dosing schedule. Do not double doses. Advise patient not to take gabapentin within 2 hr of an antacid. Gabapentin may cause dizziness and drowsiness. Caution patient to avoid driving or activities requiring alertness until response to medication is known. Instruct patient to notify health care professional of medication regimen before treatment or surgery. Advise patient to carry identification describing disease process and medication regimen at all times.

GENERIC NAMECiticoline Zynapse 100mg/cap

q12°Cerebrovascular Diseases, accelerates the recovery of consciousness and overcoming motor deficit.

Citicoline activates the biosynthesis of structural phospholipids in the neuronal membrane, increases cerebral metabolism and increases the level of various neurotransmitters, including acetylcholine and dopamine. Citicoline has shown neuroprotective effects in situations of hypoxia and ischemia.

Patients with parasympathetic hypertonia.

Citicoline may exert a stimulating action of the parasympathetic, as well as a fleeting and discrete hypotensor effect

Watch out for hypotensive effects

Somazine must not be administered along with medicaments containing

Name of Drug

Classification Indication Contra-indication

Side-effects Nursing Responsibilities

Generic:Mannitol

Brand:Osmitrol, Resctisol

Route:

Dose:

Frequency:

Diuretic

Action: Mannitol increases urinary output by inhibiting tubular reabsorption of water and electrolytes. It raises the osmotic pressure of the plasma allowing water to be drawn out of body tissues.

Promotion of diuresis in the prevention or treatment of the oliguric phase of acute renal failure before irreversible renal failure becomes established. Reduction of intracranial pressure and brain mass. Reduction of high intraocular pressure when the pressure cannot be lowered by other means. Promotion

of urinary excretion of toxic materials.

Edema

Pulmonary congestion or oedema; intracranial bleeding; CHF; metabolic oedema with abnormal capillary fragility; anuria due to severe renal disease; severe dehydration.

Fluid and electrolyte imbalance; acidosis (with high doses). Nausea, vomiting, thirst; headache, dizziness, convulsions, chills, fever; tachycardia, chest pain; blurred vision; urticaria and hypotension or hypertension; acute renal failure; skin necrosis; thrombophloebitis.

The cardiovascular status of the patient should be carefully evaluated before rapidly administering mannitol since sudden expansion of the extracellular fluid may lead to fulminating congestive heart failure.

Shift of sodium-free intracellular fluid into the extracellular compartment following mannitol infusion may lower serum sodium concentration and aggravate pre-existing hyponatremia.

By sustaining diuresis, mannitol administration may obscure and intensify inadequate hydration or hypovolemia.

Electrolyte-free mannitol solutions should not be given conjointly with blood. If it is essential that blood be given simultaneously, at least 20 mEq of sodium chloride should be added to each liter of mannitol solution to avoid pseudoagglutination.

When exposed to low temperatures, solutions of mannitol may crystalize. If crystals are observed, the container should be warmed to redissolve, then cooled to body temperature before administering. See NOTE under how supplied. When infusing 20% or 25% mannitol concentrations, the administration set should include a filter. Do not infuse mannitol solution if crystals are present.

Do not administer unless solution is clear and container is undamaged. Discard unused portion. Do not administer Mannitol 25% if the Fliptop vial seal is not intact.

DISEASE OVERVIEW:

CELLULITIS

Cellulitis is the infection of the skin and soft tissues typified by swelling, redness, warmth, and pain in the affected areas. The severity of the infection depends on its opportunity to spread and affect other parts of the skin or body.

Cellulitis usually follows a break in the skin, such as a fissure, cut, laceration, insect bite, or puncture wound Types:

o Facial cellulitis of odontogenic origin may also occur.

o Patients with Tinea Pedis - athlete's foot is a skin infection caused by a kind of mold called a fungus

o Patients with Lymphatic Obstruction

Risk Factors:o Diabetes

o Lymphedema

o Skin wounds

o Chronic lower leg swelling (edema)

o Athlete's foot (tinea pedis)

o Bites from insects, animals, or other humans

o Obesity

o Poor circulation in the legs (peripheral vascular disease)

o Weakened immune system due to underlying illness or medication

o Intravenous drug abuse or alcoholism

Signs and Symptoms:o Cellulitis initially appears as pink to red, minimally inflamed skin. The involved area may rapidly become deeper red,

swollen, warm, tender, and increase in size as the infection spreads. Occasionally, red streaks may radiate outward from the cellulitis. Blisters or pus-filled bumps may also be present.

Diagnostic Studies:o Medical History Review

o Physical Exam

The goal in cellulitis diagnosis process is examining the affected area. Affected area will probably be: red, swollen, warmth and painful. Medical adviser must look for eventually breaks in the skin (bruises, cuts, scrapes, ulcers), the place where bacteria could may entered into patient's organic structure.

o Blood test

o Culture and Gram stain of draining material is helpful if blisters or abscesses are present.

Management:

o Oral, topical (skin applied), or IV ( intravenous) antibiotics drugs may be used for cellulitis treatment.

Treatment with antibiotics also calling treatment of choice. It depends on the severity and body region involved by infection, medicines are given in the infirmary, at household, or combination both locations. Hardness of infection will also determine whether antibiotics drugs are distributed through IV or orally.

LYMPHATIC OBTRUCTION

Lymphatic obstruction is a blockage of the lymph nodes -- vessels that drain fluid from tissues throughout the body and allow immune cells to travel where they are needed.

Lymphatic obstruction is also called lymphedema, which means swelling of the lymph passages. Lymph nodes may be enlarged for any reason.

Causes, incidence, and risk factors:o Infections with parasites such as filariasis

o Injury (trauma)

o Radiation therapy

o Skin infections such as cellulitis (more common in obese patients)

o Surgery

o Tumors

Signs and Symptoms:o Swollen lymph vessels

o Swollen lymph nodes

o Chronic arm swelling

o Chronic leg swelling

o Chronic swelling

o Skin hyperkeratosis - in long-standing cases

o Increased skin pigmentation - in long-standing cases

o Warts - in long-standing cases

o Papillomas - in long-standing cases

Diagnostic Exams:o Doctors frequently discover enlarged lymph nodes as part of a routine physical exam. Doctors who suspect enlarged

lymph nodes may order CT or MRI scans. A biopsy may be necessary if cancer is a possibility. Management:

o Manual lymph drainage is a light massage therapy technique in which the skin is moved in certain directions based on the structure of the lymphatic system. This helps the fluid and waste drain through the right channels.

o Treatment also includes skin care to prevent injuries, infection, and skin breakdown, as well as light exercise and

movement programs. Exercise should be carefully designed by a physical therapist. It should help drainage without leading to swelling from overexertion, which could make your condition worse.

o Wearing compression stockings on the affected area or using a pneumatic compression pump on and off may be

helpful. Your doctor and physical therapist will decide which compression methods are best.o Surgery is used in some cases, but it has limited success. The surgeon must have a lot of experience with this type of

procedure. You will still need physical therapy after surgery to reduce lymphedema. Types of surgery include:

Liposuction Removal of abnormal lymphatic tissue Transplant of normal lymphatic tissues to areas with abnormal lymphatic drainage (less common)

o Rarely, the surgeon will bypass abnormal lymph tissue using vein grafts. These procedures are not usually successful,

and are often done experimentally.

CLINICAL SUMMARY

D. General Information

Name: A.M Room/ Bed No.: 3203

Age: 43 years old Gender: Male

Religion: Roman Catholic

Residence: Timugan, Los Banos, Laguna

Date /Time Admitted: September 22, 2010 9:30am

Chief Complaint

*swelling at the left side of the face

E. History of Present Illnesso 1 day prior to admission the patient complained of swelling at the left side of his face and dizziness thuc prompted to

consult and admission at CMC.F. Past Medical History

Allergies: none

Illnesses: none

Operations: none.

Injuries: ----

Adverse Drug Reaction: none

E. Familial History

Father:

(-) HPN

(-)DM

(-) Asthma

(-) Cancer

(-) Thyroid disease

A.M.

Patient:

Cellulitis with Lymphatic obstruction

Mother:

(+) HPN

(-)DM

(-) Asthma

(-) Cancer

(-) Thyroid disease

LABORATORY RESULTS

CT Scan – Left nasal deviation; left maxillary sinus mucosal thickening with opacified left ethmoid complexes, left frontal recess and left frontal sinus concha bullosa , left middle turbinate.Blood Chemistry: September 22, 2010

Result Interpretation Chloride 98-107mmol/L 110.0 Increased levels of blood

chloride (called hyperchloremia) usually

indicate dehydration

Hematology:

September 23, 2010

Values Normal values

Interpretation

Haemoglobin 149 140-170 g/L NormalHematocrit .44 0.42-0.50

g/LNormal

RBC 5.3 4.0-5.0 g/L Can be a result of renal problem and tissue hypoxia

WBC 16.8 5.0-10.0 g/L Can be a cause of inflammation or inflammation.

Urinalysis September 23, 2010

Color Dark yellow Normal Transparency clear Normal

pH 8.0 NormalSpecific gravity 1.010 Can mean that there is renal

problemAlbumin +1 Can mean that there is

glomerular damageSugar Negative Normal

DRUG STUDY

Brand name: SercGeneric name: Betahistine dihydrochlorideIndication: Meniere’s disease, Meniere-like syndrome (with symptoms of vertigo,

tinnitus and sensorineural deafness) and vertigo of peripheral origin.

Drug Classification: Anti emetics and Anti vertigo

Mechanism of Action: Betahistine was found to have a histamine-like action in animals.

Betahistine mesylate has a long persistent peripheral vasodilating activity. It particularly increases blood flow of the vertebral-basilar arteries’system, by which micro-circulations at the labyrinthine and vestibular apparatus of the ears, are improved (guinea pigs). Beside them, Betahistine mesylate has a vasodilating effect on the carotid artery and thereby improves cerebral blood flows

Adverse Effects: Gastrointestinal: rarely, nausea and vomiting; Hypersensitivity including eruption

Contraindication: Gastro intestinal Ulcer, asthma

Nursing Responsibilities: Assist with ambulation; raise bed rails; institute safety measure

DRUG ORDER PHARMACOLOGIC ACTION

INDICATIONS CONTRAINDICATIONS ADVERSE EFFECTS DESIRED ACTION

NURSING RESPONSIBILITIES

Clindamycin hydrochloride (Cleocin) 300 mg/cap; 1 cap TID PO

Pharmacologic class:Lincomycin derivative

Inhibits protein synthesis in susceptible bacteria, causing cell death.

TE: Hinders or kills susceptible bacteria.

Treatment of infections caused by susceptible strains of bacteria.

Contraindicated with allergy to clindamycin, history of asthma or other allergies.

CV: hypotension, cardiac arrestGI: nausea, vomiting, diarrheaDermat: urticaria

To treat infection.

Culture infection before therapy. Administer oral drugs with a full glass of water or with food to prevent esophageal irritation. Check the patient's vital signs frequently to determine if low blood pressure is

constant or intermittent. Keep the patient's room clean-smelling by removing bedpans and emesis basins promptly after use.

Name of Drug Classification Indication CONTRAINDICATIONS Side Effects Nursing Responsibilities

Co-Amoxiclav Anti-Infectives Infections of GUT Contraindicated with allergy to Antibiotics, history of asthma or other allergies.

Diarrhea, nausea, vomiting, dizziness and headache. Mucocutaneous candidiasis.

>Obtain patient’s history of allergy>Assess patient for signs and symptoms of infection, wound characteristics, sputum, urine stool, fever and WBC count>Assess patient for previous sensitivity reaction to penicillin or other cephalosporins>Obtain C&S before beginning drug therapy for assessment

>Assess for allergic reactions during treatment>Monitor for signs of nephrotoxicity>Assess for bowel patterns>Assess for signs of dehydration>Monitor for bleeding>Assess for overgrowth of infection