INP Check Out - Level Access
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The document outlines various medical conditions and treatments for different patients, including type 2 diabetes, glaucoma, prostatitis, congestive heart failure, angina pectoris, emphysema, Parkinson's disease, and pneumonia. It details the symptoms, risk factors, laboratory values, and recommended medications for each condition. Treatment strategies include lifestyle changes, specific drugs, and monitoring protocols to manage patients effectively.
INP Check Out - Level Access
- 1. Dave Jay S. Manriquez(INP – CHECKOUT) 1. WilliamHonda: Type 2 DiabetesMellitis,Glaucoma,Prostatitis Allergies:Noknownallergies Lab Values:FastingGlucose:5 mmol/L(4-7 mmol/L) Urine C & S: Klebsiellapneumoniaover100 M CFU/L. Patienthaving infection Type 2 DM - Adult onset>30 yrs old,non-insulindependent,mostprevalenttype ofDM - Chronicconditionthataffectsbody’swayof metabolizingglucose - Body eitherresiststhe effectsofinsulinor doesn’tproduce enoughinsulin to maintain a normal blood glucose level - Insulin=a hormone thatregulatesthe movementof sugarintocells - Symptoms = 3Ps - polyphagia,polydipsia,polyuria, Fatigue,frequentinfections,areasof darkenedskin,(armpits/neck) =acanthosis nigricans - Risk factors = overweight,age (older),Race (Hispanics,Asian-Americans),Aboriginal people - Complications= heart and bloodvessel disease (angina,atherosclerosis) Nerve damage (neuropathy) – tingling,numbness,pain Kidneydamage (nephropathy) Eye damage (diabeticretinopathy),glaucoma and cataract – leadstoblindness Footdamage - nerve damage inthe feetbecof poorblood flow tothe feet - Tests= Fastingblood glucose = >=7mmol/L Randombloodglucose = >=11.1 mmol/L Two-hourOGTT = >=11.1 mmol/L HgbA1c = >=6.5% - Treatment = Insulinalone or in combinationwith oral hypoglycemicagents Lifestyle changes Glaucoma - A groupof relatedeye disorderscharacterized by elevatedintraocularpressure (IOP),if untreated, resultsto optic nerve atrophy and peripheral visionloss (blindness) - Primary open-angle glaucoma(POAG) = mostcommon type;outflowof aqueoushumor is decreaseddue to cloggeddrainage channels = developsslowlyandw/osymptoms - Primary angle-closure glaucoma(PACG) = causedby reduction on the outflow ofaqueous humor due to angle closure = symptoms = sudden,intense painin or around the eye,n/v - TONOMETER = usedto measure IOP - Increase IOP = problemwith aqueoushumor eithertoo much fluidis produced or its not draining properly - Normal IOP = 10-21mmHg - Treatment = focus is to keepthe IOP low to preventoptic nerve damage
- 2. Prostatitis - Inflammationof the prostate gland usuallydue to infection - 5-10% caused by bacterial infection - Affect10-14% of men of all ages - 4 Catergories a. Acute bacterial prostatitis b. Chronicbacterial prostatitis c. Chronicprostatitis-chronicpelvicpainsyndrome d. Asymptomaticinflammatoryprostatitis - Commoncausative agents= E. coli,Klebsiella,Pseudomonas,Enterobacter - Clinical Manifestations = fever,chills,backpain,perinealpain,dysuria,urinaryfrequency, urgencyand cloudyurine - Chronicprostatitis=lasts more than3 months; can predispose the patienttorecurrentUTIs - Treatment = antibiotics Meds: 1. Metformin1000 mg PO BID. Available stock is 500 mg tablets. Gluchopage To be given:2 tablets Indication:ManagementofType 2 DM (Biguanides) Action:Lowersblood glucose by helpinginsulintowork better.Increase sensitivityto insulin. Maintenance of bloodglucose. Metabolism:eliminatedalmostunchangedinkidneys Half-life:17.6 hrs N. Dose: 500mg twice daily,may increase by 500mg at weeklyintervalsup to 2000mg/day Contraindicated:hypersensitivity,metabolicacidosis,dehydration S/E: diarrhea,nauseaandvomiting NursingCons:Whencombinedwithsulfonylureas(stimulate the bodytomake more insulin), observe forsignandsymptomsof hypoglycemia,(abdpain,sweating,weakness) 2. Glyburide 5mg PO daily. Diabeta,Glynase (Sulfonylurea) Used:to treat type 2 diabetesnot for type 1, stimulatesthe body to make more insulin N. Dose: 2.5mg to 5mg PO/daily S/E: hypoglycemia,diarrhea,allergicskinreaction NursingCons:Monitorbloodglucose level. Before andaftergiving. 3. CiprofloxacinOral Suspension750mg PO BID x 14 days. Available concentrationis 500mg/5ml. To be given:7.5 ml.Cipro Indication:treatmentof the ff. bacterial infection.(Fluoroquinolones) Action:Deathof susceptible bacteria. Anti-infectives Metabolism:Liver, excretethrukidney Contraindicated:hypersensitivity N. Dose:500mg-700mg q12 hrs S/E: dizziness,headache,insomnia,diarrhea,nausea
- 3. NursingCons:Assessforinfection(v/s,appearance of wound,sputum, urineandstool,WBC, Urinalysis,frequencyandurgencyof urination.) 4. Timolol 0.5% eye drops, 1 drop ineach eye BID. Used: Treatingpressure in the eye (ocular hypertension) andopen-angle glaucoma.Timolol drops are a beta blocker.It works too decrease fluidproductionand pressure inside the eye. N. Dose: 0.25% OR 0.5% Do not use timolol if :allergic,COPD,heartfailure,shockdue toHF Interactwithinsulinororal antidiabetics,mayhide certainsignsof low bloodsugar. NursingCons:Monitorpatientbloodglucose levelandBP.
- 4. 2. PeterDodge: Angina Pectoris,Congestive HeartFailure Allergies–Morphine Lab Values– DigoxinLeve:1.9 mmol/L(1.0 – 2.6 mmol/L) Electrolytes:Potassium4.2(3.5 – 5.0 mmol/L),Sodium142 (134-145 mmol/L) Congestive Heart Failure - Alsoknownas Heart Failure (HF) - Heart muscle weaknessdue to narrowing and constrictionof blood vessel whichresultedto poor functioningvalvescausing dilationof heart chambers and resultedto decreased contractility and increase workload of the heart. Congestionusuallydevelopsbecause the heart is unable to move bloodas quicklyas possible asit shouldto meetthe tissue requirementsforoxygen. Etiology: AtherosclerosisandHypertension(HPN) isa majorcontributingfactor,riskof HF increases progressivelywiththe severityof HPN DM predisposesanindividual toHFregardlessof the presence of concomitantCADorHPN Otherriskfactors – cigarette smoking,obesityandhighserumcholesterol - May be causedby anyinterferencewiththe normal mechanismsregulatingcardiacoutput(CO) - CO dependson1. Preload,2.Afterload,3.Myocardial contractility, 4. Heart rate, 5. metabolicstate of the individual Anyalterationinthese factorscanresultto manifestationsof HF - Types: Left SidedHeart Failure – mostcommonform of initial heartfailure; Resultsfromleftventriculardysfunction,whichcausesbloodtobackup throughthe L atriumand intothe pulmonaryveins,manifestedas pulmonary congestionand edema Right SidedHeart Failure – causesbackwardbloodflow tothe R atriumand venous circulation. Venouscongestioninthe systemiccirculationresultsin peripheral edema,hepatomegaly, splenomegaly, ascitesandjugular venousdistention. - Clinical Manifestations=dependonage,underlyingtype andextentof heartdisease andwhich ventricle isfailingtopumpeffectively Fatigue,Dyspnea,Tachycardia,Edema,Nocturia,Skinchanges,Behavioral Changes,ChestPain, WeightChanges - Treatment: 1. Diuretics 2. Angiotensin-ConvertingEnzyme Inhibitors 3. B-AdrenergicBlockers 4. InotropicDrugs a. SympathomimeticDrugs – dopamine,dobutamine,epinephrineandnorepinephrine b. Phosphodiesterase Inhibitors –Milrinone c. DigitalisPreparations –digoxin(Lanoxin)
- 5. d. Vasodilatordrugs d.1 Nitrates d.2 SodiumNitroprusside Angina Pectoris - Commonlyknownas angina - Sensationof chest pain,pressure or squeezing, due topartial occlusion or narrowing of the coronary artery impedingthe blood flowand causing ischemia of tissuesand myocardium. Main cause is coronaryartery disease whichisanatheroscleroticprocessaffectingthe arteries feedingthe heart. - From Latinword angere “tostrangle”and pectus“chest” - Classification: a. Stable angina – effortangina,classictype,anginarelatedtomyocardial ischemia,precipitatedbysome activity and usually relievedbyrestor after administrationof nitroglycerinSL b. Unstable angina – “crescendoangina”,aform of acute coronarysyndrome, anginapectoristhat worsens Occurs at rest or evenwithminimal exertion. It issevere andof new onset.Occurs with a crescendopattern (more severe,prolonged,frequent).Maybe a seriousindicator of impendingheart attack - Signs and Symptoms = chestdiscomfortdescribedaspressure,heaviness,tightness,squeezing, burning,orchokingsensation - Risk factors = smoking,diabetes,highcholesterol,highBP,sedentarylifestyle,familyhistoryof heartdisease - Treatment(patient):ASA,Antihypertensive,Anticoagulants,CardiacBypass Nitroglycerintransdermal patch Meds: 1. Digoxin0.125mg PO daily. Lanoxin Indication:Heartfailure.Antiarrythmics Action:Increasesthe force of myocardial contraction.Increasedcardiacoutput(positiveinotropic effect) andslowingof the heartrate (negative chronotropiceffect). Metabolism:Kidney Half-life:36-48 hrs N. Dose: 0.125-0.5 mg Adverse/S/E:fatigue,bradycardia,andnauseaandvomiting NursingCons:Monitorapical pulse for1 full minbefore administration.Withholddose andnotify healthcare professional if pulse rate is<60 bpminan adult. 2. Furosemide 20mg PO daily. Lasix (Loop Diuretic) Indication:Edemadue to heart failure,hepaticimpairementorrenal dse.Hypertension Action:Inhibitsreabsorptionof sodiumandchloridefromloopof Henle.Increaserenal excretionof H2O, Na, Cl,Mg, K and Ca. Diuresis(excessfluidedema,pleural effusions).Decrease BP
- 6. Metabolism:Liver Half-life:30-60 mins N. Dose: 20-80 mg Contraindicated:Hypersensitivity S/E: headache,hypotension,dehydration NursingCons:MonitorBP and pulse,watchforfalls,assessfluidstatus. 3. KCL Elixir 20mEq PO daily.Available concentration is20mEq/15 mls. To be given:15 ml Indication:PO/IV: Treatmentofpotassiumdepletion.Arrythmiasdue to digoxintoxicity. Action:Preventionof deficiency. Metabolism:excretiononkidney N. Dose: 20-40 mEq/day Contraindicated:Hyperkalemia,severe renal impairment S/E: adb pain,diarrhea,flatulence,nauseaandvomiting NursingCons:Monitorpulse andBP. Assessforsignandsymptomsof hypokalemiasuchas weaknessandfatigue 4. Nitroglycerin0.4mg/hr transdermal patch. Apply one patch in am and remove at HS Indication:Anti-anginals,mgtofangina pectoris. Action:Increasescoronarybloodflow bydilatingcoronaryarteriesandimprovingimproving collateral flowtoischemicregions.Relief fromanginaattack.Increasedcardiacoutput,reductionof BP. Metabolism:Liver Half-life:1-4min N. Dose: 0.2-0.4 mh/hr Contraindicated:hypersensitivity S/E: dizziness,headache,hypotension NursingCons:Assesspain,monitorBPandpulse
- 7. 3. Sarah Buick: Emphysema,Parkinson’s Disease Allergies:Penicillin Lab Values:CXR(one monthago) hyper-inflatedlungssuggestingemphysema Emphysema - Chronicobstructive pulmonarydisease(COPD) - “pinkpuffers” - Permanentinflammationor destruction inalveoli and as a result impede gasexchange that will leadto increase CO2 retention. - Smoking isthe leadingcause - The innerwallsof the air sacs weaken andeventuallyrupture,reducesthe surface areaof the lungsand the amountof oxygenthatreachesthe bloodstream - Impedesgasexchange leadingtoimpairedrespiratoryfunction - Symptoms = dyspneaonexertionorat rest,cough,orthopnea,wheezes,use of accessory muscles (barrel chestand diminishedlungexpansion),fatigue,CO2retention(confusion, anxiety,feelingsof suffocation,thinonappearance) Parkinson’sDisease - A progressive disease ofthe nervoussystemmarked by tremor,muscular rigidity,and bradykinesia - Associatedwithdegenerationof the basal gangliaof the brainand the deficiencyofdopamine - Extrapyramidal Symptoms = tremor, bradykinesia,rigidmuscles,impairedposture and balance,loss of automatic movements,speechchanges - Causes= unknown - Risk factors = age (60 & older),M>F,Heredity,Exposuretotoxins(pesticides) - Complications= thinking difficulties,depressionandemotional changes,swallowingproblem, sleepproblems,bladderproblems, constipation,BPchanges,smell dysfunction,fatigue,pain, sexual dysfunction - Treatment = Carbidopa/Levodopa, Dopamine agonists, MAO inhibitors,Anticholinergics Meds: 1. Carbidopa/Levodopa CR 50mg/200mg PO QID. Sinemet Indication:ParkinsonDisease.Antiparkinson Action:Levodopais convertedto dopamine in the CNS,where it servesas a neurotransmitter. Carbidopa, a decarboxylase inhibitor,preventsperipheral destructionoflevodopa.Reliefof tremor and rigidity inParkinson’s syndrome. Metabolize:liverandGItract Half-life:Levodopa1hrand Carbidopa1-2hr N. Dose: 25mg carbidopa/100mg levodopa3x daily,max = 8 tabletsof 25mg carbidopa/100mg levodopa/day Contraindicated:Hypersensitivity S/E: involuntarymovements,nauseaandvomiting NursingCons:AssessforParkinsonsymptoms(rigidity,tremors,akinesia).MonitorBPandpulse.
- 8. 2. Entacapone 200mg PO QID. Comtan Indication:withlevodopa/carbidopatotreatidiopathicParkinsondse.Antiparkinson Action:Preventsthe breakdown of levodopa,increasingavailabilityinCNS. Prolongduration response to levodopawith end-to-dose motorfluctuations. Half-life:initial phase 0.4-0.7hr; secondphase 2.4 hr N. Dose: 200mg max to 8x daily Adverse Effects:Psychosis,dizziness,hallucinations Contraindicated:Hypersensitivity NursingCons:Assessparkinsonianandextrapyramidalsymptoms.Monitorfordiarrhea. 3. Docusate Sodium100mg PO daily. Available concentrationis 50mg/5ml. Colace To be given:10ml Indication:Laxative (Stool Softeners).Preventionofconstipation. Action:Promotesincorporation of water into stool,resultingin softerfecal mass. Softeningand passage of stool. N. Dose: 50mg-400mg Adverse Effects:diarrhea NursingCons:Assessforabddistension,presence of bowel sound.Assesscolor,consistency,and amountof stool. 4. Fluticasone Aerosol Inhaler44 mcg, 2 puffsBID. FloventDiskus Indication:Corticosteroids(Inhalation) Action:Decreasedfrequencyandseverityof asthmaattacks.Act as anti-inflammatory. Half-life:7.8hr N. Dose: 88 mcg twice daily Contraindicated:Hypersensitivity Adverse Efffect:headache,dysphonia,hoarseness NursingCons:Monitorrespiratorystatusandlung sounds. Give a cup ofwater to the patientto gargle. It can cause oral trush.
- 9. 4. LillyLotus: Pneumonia,Vaginitis Allergies:Noknownallergies Lab Values:CXR(3 daysago) patchy airspace disease ispresentinbothbasessuggesting pneumonia Pneumonia - Inflammationof the lungcaused by a microbial agent. Virus,bacteria, aspiration. - Resultwhendefence mechanisms become incompetentoroverwhelmedbythe virulence of infectiousagents - Types: Communityacquired pneumonia= onset<48hrs of hospitalization = S. pneumonia,H. influenza,viral Hospital acquiredPneumonia= onset>48hrs of hospitalization = E. coli,Klebsiella,MRSA,Pseudomonas AspirationPneumonia= due to abnormal entryof secretionsorsubstances intothe lower airway - Symptoms = cough productive of purulentsputum,fever,tachypnea,shortnessof breath, feelingverytiredorveryweak, pleuriticchestpain - Diagnostics= CXR,sputumcultures - Treatment = Antibiotics( bacterial pneumonia) Vaginitis - Inflammationof the vagina that can resultin discharge,itching and pain - Occurs whenthe natural defencesof the acidvaginal secretions(maintainedbysufficient estrogenlevels) isdisrupted - Types: 1. Bacterial vaginosis= overgrowthof organismsnormallypresentinvagina 2. Yeast infections=usuallydue toCandidaalbicans 3. Trichomoniasis= causedbya parasite,sexuallytransmitted 4. Vaginal atrophy (atrophic vaginitis) = reducedestrogenaftermenopause - Symptoms = change incolor/odor/amountof vaginal discharge Vaginal itchingorirritation Painduringintercourse Painful urination Light vaginal bleedingorspotting - Causes= dependsonthe type of vaginitis - Risk factors = hormonal changes,sexual activity,STDs,uncontrolledDM,usingIUDsfor birth control - Treatment = dependson the type of vaginosis Meds: 1. Clarithromycin250mg PO dailyx 7 days. Biaxin Indication:Respiratory tract infectionsincludingstreptococcal pharyngitis, sinusitis,bronchitis, and pneumonia.Anti-infectives.
- 10. Action:BacteriostaticAction. Metabolism:liver Half-life:3-4hrs N. Dose: 250mg q 12 hrs for 7-14 days or 1,000mg once daily for 7 days. Adverse Effect:headache,abdpain,diarrhea Contraindicated:hypersensitivity NursingCons:Monitorfor signof infection(redness,vital signs,WBC).Monitorfordiarrhea. 2. Acetaminophen325 mg PO QID. Tylenol Indication:Treatmentofmild to moderate pain. Fever Action:Inhibitsynthesisofprostaglandins that may serve as mediator of pain and feverin CNS. Analgesia.Antipyretic. Non-Opioid Metabolize:Liver Half-life:1-3hr N. Dose: 325mg-650mg q 6 hrs Contraindicated:productscontainingalcoholandhypersensitivity. S/E: headache,nauseaandvomiting, constipation NursingCons:Assessoverall status.Tempforfever. 3. Clotrimazole 200mg vaginal tablets.1 tabletvaginally dailyx 7days. Canesten Indication:Treatmentofvulvovaginal candidiasis.Antifungal Action:Inhibitgrowth and death of susceptible Candida,withdecrease inaccompanyingsymptoms of vulvovaginitis ( vaginal burning,itchingand discharge). Contraindicated:hypersensitivity N. Dose: 100mg at bedtime for7 nights or 200mg at bedtime for 3 nights. Adverse Effect:itching,pelvicpain NursingCons:Inspectareafor inspectionbefore andaftertherapy. 4. PsylliumPowder10ml PO daily. Metamucil Indication:Laxatives.Bulkforming. Managementof simple or chronic constipation,particularly if associatedwith a low-fiberdiet. Action:Combineswithwater in the intestinal contentsto form emollientgel orvicious solution that promotesperistalsisand reduce transient time N. Dose: 1-2 teaspoon or 10ml Contraindicated:hypersensitivity,abdpain Adverse Effect:bronchospasm,cramps NursingCons:Assessforabddistension,presence of bowel sound.Assesscolor,consistency,and amountof stool.
- 11. 5. Matilda Lincoln:Transient IschemicAttack, Peripheral Vascular Diseases.Dementia Allergies:Noknownallergies Lab Values:INR2.7 (normal 2.0-3.0). Detectbleedingandclottingdisorder.Response to anticoagulanttherapy. Electrolytes:Sodium135 (134-143 mmol/L);Potassium3.2 (3.5-5.0 mmol/L) Transient IschemicAttack - Oftenlabeled “mini stroke”,“warningstroke” - Givesa patienttime toact and keepa permanentstroke fromoccuring - Causedby a clot, blockage is transient (temporary) - Symptoms occur rapidly and last a relativelyshort time - Most TIAs lasts lessthan five minutes - Usuallycauses no permanentinjury to the brain - Signsand Symptomsof a stroke = FAST F= face drooping; A= arm weakness;S= speechdifficulty T=time to call 911 Peripheral VascularDisease - Refersto any disease or disorderof the circulatory systemoutside of the brain and heart. - Includesarterial, venous,and lymphatic.Problemwith blood flowthrough peripheral vessel. Causedby narrowing brought by atherosclerosis.Mayhave partial or complete occlusion. - Most commoncause isperipheral arterydisease - Other causes= bloodclot, diabetes,inflammationof the arteries,infection,structural defects, bloodvessel injury - Risk factors = positive familyhistoryof prematureheartattacksor strokes, >50 yo,overweight/obesity,sedentarylifestyle,smoking,DM, HighBP, highcholesterol - Symptoms of Peripheral artery disease dependsuponthe location and the extentofthe blockedarteries - Intermittentclaudication manifestedby calfpainusually while walkingand dissipatesat restis the most common symptom ofperipheral artery disease - Complications= ulcers,gangrene,amputation - Treatment = angioplasty, medications,surgery,supervisedexercises,lifestyle changes Dementia - Progressive decline inmental ability - Affectsabilityto communicate,carry out purposeful movements,recognize commonobjects and familiar people,andjudgementand reasoning - Not a specificdisease,itsanoverall termthat describesa wide range of symptoms associated with a decline inmemory or other thinkingskillssevere enoughto reduce a person’sabilityto performeveryday activities - Alzheimer’sdisease =accounts for 60-80 percentof cases = amyloidplaquesare presentinthe braininabnormal quantities = neurofibrillarytangles are presentinsidenerve cells Vasculardementia=secondmostcommon type of dementia
- 12. - Symptoms = onsetis usuallygradual with progressive deterioration = impaired:memory,communicationandlanguage,abilitytofocusandpayattention, reasoningandjudgement,visual perception - Causes= damage to brain cellswhich interfereswiththe ability of brain cellsto communicate with each other,whenbraincellscannotcommunicate normally,thinking,behaviorandfeelings can be affected Meds: 1. Warfarin 5mg PO daily. Coumadin Indication:VenousThrombosis,PulmonaryEmbolism Action:Interfere withhepatic synthesisofVit K. clotting factors (II,VII, IX, X). Preventionof thromboembolicevents. Metabolism:Liver Half-life:42hr N. Dose: 2mg-5mg/day for 2-4 days Contraindicated:uncontrolledbleeding,openwounds S/E: bleeding NursingCons:Monitorfor bleedingonstool,gums,nosebleed 2. Risperidone 2mg PO daily.Concentration available is1mg/ml. Risperdal Indication:Antipsychotics,moodstabilizers.Shortterm treatment of acute manic or mixed episodesassociatedwithBipolar 1 disorder. Action:Antagonize dopamine and serotoninin the CNS. Decreasedsymptomsof psychosis,bipolar mania. Contraindicated:hypersensitivity Metabolism:Liver Half-life:21hr N. Dose: 1mg twice daily,may increase to 1-2mg/day no more than 24 hrs Adverse Effect:constipation,diarrhea,headache NursingCons:Monitorpatientmoodbefore andafter. 3. Hydrochlorothiazide 100mg PO daily. Microzide Indication:antihypertensive,diuretics.Managementofmildto moderate hypertension. Treatment of edemaassociatedwith HF. Action:Increase excretionofNa, water,Cl, K, Mg and bicarbonate. Lower BP and diuresis Metabolism:excretedinkidney Half-life:1-2hr N. Dose: 12.5mg-100mg/day in 1-2 divideddoses Contraindicated:hypersensitivity Adverse Effect:hypokalemia NursingCons:MonitorBP, intake andoutput,dailyweight,assessfeetandlegsforedema. 4. Betamethasone 0.1% cream. Applysparingly to affectedarea BID until clear. Indication:Corticosteroids(Topical/Local);anti-inflammatory Action:Suppressionofdermatologicinflammationand immune processes.
- 13. Metabolism:Skin Half-life:3-5hrs N. Dose: 0.1% 1-4 timesdaily Contraindicated:hypersensitivity Adverse Effect:allergicdermatitis,dryness NursingCons:Assessaffectedskinbefore anddailyduringtherapy.