NURSING CASE STUDY(Myocardial Infarxtion

8/6/2019 NURSING CASE STUDY(Myocardial Infarxtion

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University of Perpetual Help Molino Campus

C O L L E G E O F N U R S I N G

Nursing Case Study

Admission/ Final Diagnosis

I. Health History

A. DEMOGRAPHICAL DATA

Clients Initials: D. G. B

Gender: Female

Age: 80

Religion: Iglesia ni Cristo

Occupation: Self - employed

Usual Source of Medical Care: Hospital

Date of Admission: June 18, 2011

Initial Diagnosis: T/C AMI, DM Type 2

B. SOURCE AND RELIABILITY OF INFORMATION

Information that was obtained came from the patient's chart. The patient at the time

was unconscious and unable to speak.

C. REASONS FOR SEEKING CARE OR CHIEF COMPLAINTS

Chest Pain

Difficulty in breathing

Infection

D.HISTORY OF PRESENT ILLNESS/ OR PRESENT HEALTH

The patient was admitted on June 18, 2011. The initial diagnosis of the patientwas Acute Myocardial Infarction, DM Type 2. The patient was

E. DEVELOPMENTAL HISTORY

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Erik Erikson labeled the crisis of this period as Integrity vs Despair. Rather thanfocus on the external adjustments related to the series of physical social lossesexperienced by the elderly, Erikson focused on an internal struggle. As death

approaches, people begin a life review that involves deciding whether or not their liveshave been worthwhile. This opens them to the ultimate despair in the view that theirlives have not been what it could or what should have been, and that it is now too lateto do anything about it. The resulting disgust is actually contempt for themselves, whenfacing such despair invokes the search for ego integrity. Ego integrity involvesacceptance of one and only life cycle as something that had to be and that, whennecessity permitted no substitution. It includes accepting the mistakes that were made,while recognizing the good things that were accomplished, developing a sense ofinevitable order of the past it also involves a feeling of companionship, with anordering way of distant times and different pursuits or a detached, philosophicalwisdom about life in general rather than only ones own in particular.

F. REVIEW OF SYSTEM AND PHYSICAL EXAMINATION

1. ROS and PE

SYSTEM

REVIEW

OFSYSTEM

PHYSICAL EXAMINATION

SIGNIFICANCEOBJECTIVEDATA

COMMON SIGNSAND SYMPTOMS

A. General/Overall healthstatus

No verbalcues

Unconscious

Cyanotic

Weakness

Fatigue

Unconsciousness: Inadequatecerebralperfusion andcardiogenicshock

Cyanosis:

Inadequateoxygenatedblood circulation

B. Integument(skin, hair,nail)

No verbalcues

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C. HeadNo verbalcues

D. Eyes No verbalcues

E. EarsNo verbalcues

F. Nose andSinuses

No verbalcues

G. Mouth andThroat

No verbalcues

H. Neck No verbalcues

I. Breast andAxillary

No verbalcues

J. RespiratoryNo verbalcues

(+) GaspingShortness ofBreath

Gasping:associated witha drop of thebodys oxygenlevel

K.Cardiovascular

No verbalcues

Weak Heartrate

(+) Chest pain

Heartburn

Weak Heart rate:Not enoughblood beingpumped by theheart.

L.Gastrointestinal

No verbalcues

M. UrinaryNo verbal

cues

N. GenitaliaNo verbalcues

O.Musculoskeletal

No verbalcues

(+) Edema

(+) Infectedwound (Left

Musculoskeletal

Arm pain(Commonly on left

Edema: Fluidretention in thebody

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Foot)

arm)

Upper Back Pain

General Malaise

Infection:Increased WBC

P. NeurologicNo verbalcues

Q.Hematologic

No verbalcues

R. EndocrineNo verbal

cues(+) DM Type 2

High bloodglucose in thecontext of insulin

resistance andrelative insulindeficiency.

2. LABORATORY STUDIES / DIAGNOSTICS

Procedure

ProcedureDate

Indication Normal ValuesActual Findings/Results

Implications

Chest X-ray

6/23,25/11

7/3/11

A projectionradiograph ofthe chest usedto diagnoseconditionsaffecting the

chest, itscontents, andnearbystructures.Chestradiographsare among themost common

The lungs looknormal in sizeand shape,and the lungtissue looksnormal. No

growths orother massescan be seenwithin thelungs.The pleuralspaces (thespaces

FurtherProgression inPulmonaryEdema withpossibleunderlying

pneumonia.

Evidence ofconsolidationon the leftupper lobe,subcutaneausemphysema as

ABNORMAL

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http://en.wikipedia.org/wiki/Projectional_radiographyhttp://en.wikipedia.org/wiki/Projectional_radiographyhttp://en.wikipedia.org/wiki/Chesthttp://www.health.com/health/library/mdp/0,,zm2208,00.html#zm2208-sechttp://www.health.com/health/library/mdp/0,,zm2208,00.html#zm2208-sechttp://en.wikipedia.org/wiki/Projectional_radiographyhttp://en.wikipedia.org/wiki/Projectional_radiographyhttp://en.wikipedia.org/wiki/Chesthttp://www.health.com/health/library/mdp/0,,zm2208,00.html#zm2208-sechttp://www.health.com/health/library/mdp/0,,zm2208,00.html#zm2208-sec


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films taken,beingdiagnostic ofmanyconditions.

surroundingthe lungs) alsolook normal.

The heartlooks normalin size, shape,and the hearttissue looksnormal. Theblood vesselsleading to andfrom the heartalso are

normal in size,shape, andappearance.

The diaphragm looksnormal inshape andlocation.

All tubes,catheters, or

other medicaldevices are intheir correct

positions inthe chest.

seen with thetracheostomytube in place.

Heart is enlargein size, with leftventricularprominence.

GramStaining

6/23/11 An empirical method ofdifferentiating bacterial species

into two largegroups (Gram-positive and Gram-negative)based on thechemical,primarily thepresence of

Negativeinfection

Positive cocci insingly +1

ABNORMAL

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high levelsofpeptidoglycan, and physical

properties oftheircell walls.[1] The Gramstain is almostalways the firststep in theidentification ofa bacterialorganism.

ABG 7/5/11

A blood

test that isperformedusing blood from an artery. Itinvolvespuncturing anartery with athin needle andsyringe anddrawing a smallvolume of

blood. Themost commonpuncture site isthe radialartery atthe wrist, butsometimesthe femoralartery inthe groin orother sites are

used.

pH 7.35

7.45

pO2 80 100 mm Hg

pCO2 35 35 mm Hg

HCO3 22-26 mEq/liter

BE - -2 - +2

mEq/liter

O2 Sat. 95 100%

pH = 7.62

pO2 = 111.2mm Hg

pCO2 = 23.2mm Hg

HCO3 = 23.3mEq/liter

BE= 3.9

02 sat. = 98.9%ABNORMAL

CBC 7/3/11 Also knownas full bloodcount (FBC)or full bloodexam(FBE)or blood panel,

Hemoglobin(g/dl) - 12.0 -15.0

Hematocrit(%) - 36 44

Hgb = 9.60 g/dl

Errythrocytes =28.40%

WBC = 9400

ABNORMAL

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http://en.wikipedia.org/wiki/Peptidoglycanhttp://en.wikipedia.org/wiki/Peptidoglycanhttp://en.wikipedia.org/wiki/Cell_wallhttp://en.wikipedia.org/wiki/Gram_staining#cite_note-Bergey_1994-0http://en.wikipedia.org/wiki/Blood_testhttp://en.wikipedia.org/wiki/Blood_testhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Arteryhttp://en.wikipedia.org/wiki/Radial_arteryhttp://en.wikipedia.org/wiki/Radial_arteryhttp://en.wikipedia.org/wiki/Wristhttp://en.wikipedia.org/wiki/Femoral_arteryhttp://en.wikipedia.org/wiki/Femoral_arteryhttp://en.wikipedia.org/wiki/Groinhttp://en.wikipedia.org/wiki/Peptidoglycanhttp://en.wikipedia.org/wiki/Peptidoglycanhttp://en.wikipedia.org/wiki/Cell_wallhttp://en.wikipedia.org/wiki/Gram_staining#cite_note-Bergey_1994-0http://en.wikipedia.org/wiki/Blood_testhttp://en.wikipedia.org/wiki/Blood_testhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Arteryhttp://en.wikipedia.org/wiki/Radial_arteryhttp://en.wikipedia.org/wiki/Radial_arteryhttp://en.wikipedia.org/wiki/Wristhttp://en.wikipedia.org/wiki/Femoral_arteryhttp://en.wikipedia.org/wiki/Femoral_arteryhttp://en.wikipedia.org/wiki/Groin


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is a testpanel requested by a doctoror

othermedicalprofessional that givesinformationabout the cellsin a patient'sblood. Ascientist or labtechnicianperforms therequested

testing andprovides therequestingmedicalprofessionalwith the resultsof the CBC.

AlexanderVastem iswidely

regarded asbeing the firstperson to usethe completeblood count forclinicalpurposes.

RBC's ( x106 /ml) - 4.0 -4.9

WBC(cells/ml) -4,500 - 10,000

Basophils - 0 -1 (0 - 0.75%)

Eosinophils - 0- 3 (1 - 3%)

Lymphocytes -24 - 44 (25 -33%)

Monocytes - 3- 6 (3 - 7%)

RBC = 2.97

Neutrophil =82%

Lymphocyte =9%

Monocyte = 4%

Eosinophil =4%

Basophil = 1%

Urinalysis 7/2/11 An array of tests performed

on urine andone of the mostcommonmethodsofmedicaldiagnosis. Apart of aurinalysis can

Color - Paleyellow to

amber

Turbidity -Clear toslightly hazy

SpecificGravity -

Color = Yellow

Transperancy =Hazy

Reaction = 6.0

Gravity = 1.030

ABNORMAL

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be performedby usingurinedipsticks,in which thetest results canbe read ascolor changes.

1.015-1.025

pH - 4.5-8.0

Glucose Negative

RBC Negative

Albumin Negative

Epithelial cells

Negative orRare

Chem. Exam.

Albumin =

Trace

Sugar =Regular

Pus = 12-15HPF

RBC = 4-6 HPF

Epithelial cells= Moderate

Others = Yeastcells Abundant

3. OTHER ASSESSMENT TOOLS

Date Taken Comprehensive Actual Content/ Legend Actual Result

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June 18, 2011

Eyes Response Eye openingspontaneously

(4)

VerbalResponse Noverbal response(1)

Motor Response

No response(1)

GCS 6 Severehead injury

ANATOMY AND PHYSIOLOGYTHE HEART

Function and Location of the Heart

The heart's job is to pump blood around the body. The heart is located in between thetwo lungs. It lies left of the middle of the chest.

Structure of the Heart

The heart is a muscle about the size of a fist, and is roughly cone-shaped. It is about12cm long, 9cm across the broadest point and about 6cm thick. The pericardium is a

fibrous covering which wraps around the whole heart. It holds the heart in place butallows it to move as it beats. The wall of the heart itself is made up of a special type ofmuscle called cardiac muscle.

Chambers of the Heart

The heart has two sides, the right side and the left side. The heart has four chambers.The left and right side each have two chambers, a top chamber and a bottom chamber.

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The two top chambers are known as the left and right atria(singular: atrium). The atriareceive blood from different sources. The left atrium receives blood from the lungs andthe right atrium receives blood from the rest of the body. The bottom two chambers are

known as the left and right ventricles. The ventricles pump blood out to different partsof the body. The right ventricle pumps blood to the lungs while the left ventricle pumpsout blood to the rest of the body. The ventricles have much thicker walls than the atriawhich allows them to perform more work by pumping out blood to the whole body.

Blood Vessels

Blood Vessel is tubes which carry blood. Veinsare blood vessels which carry bloodfrom the body back to the heart. Arteries are blood vessels which carry blood from theheart to the body. There are also microscopic blood vessels which connect arteries andveins together called capillaries. There are a few main blood vessels which connect to

different chambers of the heart. The aorta is the largest artery in our body. The leftventricle pumps blood into the aorta which then carries it to the rest of the body throughsmaller arteries. The pulmonary trunk is the large artery which the right ventricle pumpsinto. It splits into pulmonary arteries which take the blood to the lungs. The pulmonaryveins take blood from the lungs to the left atrium. All the other veins in our body draininto the inferior vena cava (IVC) or the superior. These two large veins then take theblood from the rest of the body into the right atrium.

Valves

Valves are fibrous flaps of tissue found between the heart chambers and in the bloodvessels. They are rather like gates which prevent blood from flowing in the wrong

direction. They are found in a number of places. Valves between the atria andventricles are known as the right and left atrioventricular valves, otherwise known asthe tricuspid and mitral valves respectively. Valves between the ventricles and thegreat arteries are known as the semilunar valves. The aortic is found at the base of theaorta, while the pulmonary valveis found the base of the pulmonary trunk. There arealso many valves found in veins throughout the body. However, there are no valvesfound in any of the other arteries besides the aorta and pulmonary trunk.

What is the Cardiovascular System

The cardiovascular system refers to the heart, blood vessels and the blood. Bloodcontains oxygen and other nutrients which your body needs to survive. The body takes

these essential nutrients from the blood. At the same time, the body dumps wasteproducts like carbon dioxide, back into the blood, so they can be removed. The mainfunction of the cardiovascular system is therefore to maintain blood flow to all parts ofthe body, to allow it to survive. Veins deliver used blood from the body back to theheart. Blood in the veins is low in oxygen (as it has been taken out by the body) andhigh in carbon dioxide (as the body has unloaded it back into the blood). All the veinsdrain into the superior and inferior vena cava which then drain into the right atrium. Theright atrium pumps blood into the right ventricle. Then the right ventricle pumps blood

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to the pulmonary trunk, through the pulmonary arteries and into the lungs. In the lungsthe blood picks up oxygen that we breathe in and gets rid of carbon dioxide, which webreathe out. The blood is becomes rich in oxygen which the body can use. From the

lungs, blood drains into the left atrium and is then pumped into the left ventricle. Theleft ventricle then pumps this oxygen-rich blood out into the aorta which then distributesit to the rest of the body through other arteries. The main arteries which branch off theaorta and take blood to specific parts of the body are:

Carotid arteries, which take blood to the neck and head

Coronary arteries, which provide blood supply to the heart itself

Hepatic artery, which takes blood to the liver with branches going to the stomach

Mesenteric artery, which takes blood to the intestines

Renal arteries, which takes blood to the kidneys

Femoral arteries, which take blood to the legs

The body is then able to use the oxygen in the blood to carry out its normal functions.This blood will again return back to the heart through the veins and the cycle continues.

Blood Flow of the Heart

The heart is completely divided into aright and left halves. These 2 halves ofthe heart act as separate pumps, andthere is no mixing of blood betweenthem. Each is in charge of pumpingblood through one of the two bloodvessel circuits.

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The right heart pumps blood to the

pulmonary circuit, where the blood picksup oxygen from the lungs. The left heartthen pumps it into the systemic circuit,where the blood delivers oxygen to thetissues that need it. Finally, the bloodreturns to the right heart and the cyclerepeats itself.

Blood always leave the heart througharteries, which include the aorta andpulmonary arteries. Conversely, blood

enters the heart through the veins, thelargest being the pulmonary veins thevena cava.

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PATHOPHYSIOLOGY of Myocardial infarction

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MEDICAL SURGICAL MANAGEMENT

1. Procedure (Surgery)

Procedure/ Date Indication/ Analysis

Tracheostomy / July 5 2011 A tracheostomy is a surgically createdopening in the neck leading directly tothe trachea (the breathing tube). It is

maintained open with a hollow tubecalled a tracheostomy tube.

A tracheostomy is usually done for oneof three reasons: (1) to bypass anobstructed upper airway (an objectobstructing the upper airway will preventoxygen from the mouth to reach thelungs); (2) to clean and remove

secretions from the airway; and (3) tomore easily, and usually more safely,deliver oxygen to the lungs.

Need for further and moreaggressive surgery

Infection

Air trapping in the surroundingtissues or chest. In raresituations, a chest tube may be

required Scarring of the airway or erosion

of the tube into the surroundingstructures (rare).

Need for a permanenttracheostomy. This is most likelythe result of the disease processwhich made the a tracheostomy

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necessary, and not from theactual procedure itself.

Impaired swallowing and vocal

function Scarring of the neck

NURSING RESPONSIBILITIES

Preparatory Nursing Measures. Inaddition to routine preparation of thepatient unit for postoperative care, thefollowing measures should be planned inadvance.

(1) The patient will require constantattendance for at least the first 48hours.The nursing personnel must remembertwo important things: the patient's lifedepends upon a clear airway and thepatient will have a temporary loss ofvoice. Therefore, the patient must beobserved closely for airway patency andimmediate action taken when anyadverse signs or symptoms are present.The patient wills feel anxious about his

inability to communicate with his voice.Always have the call bell available to thepatient. Devise a temporary means of

(2) For the first few dayspostoperatively, the patient should bekept in a room where the temperatureand humidity can be maintained atoptimum levels. Increased temperatureand humidity will help to reduce thetracheal irritation that results when

inspired air has bypassed the naturalwarming and moisturizing of thenasopharyngeal airway.

(3) The patient's room should besupplied with a variety of equipmentnecessary to the care of the patient.Such things include suction equipment,a sparetracheostomy tube set, and

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sterile dressing material.

b. Postoperative Nursing Measures. In

addition to routine postoperative nursingcare, the following nursing actionsshould be noted.

(1) Always apply basic principles ofaseptic technique when caring for theincision and the airway. Whensuctioning, use separate set-ups forpharyngeal and tracheostomysuctioning.(2) Constantly observe thepatient for signs of respiratory

obstruction such as restlessness,cyanosis, increased pulse, or gurglingnoises during respiration

Central Venous Pressure / July 5 2011

Central venous pressure is considered adirect measurement of the bloodpressure in the right atrium and venacava. It is acquired by threading acentral venous catheter (subclaviandouble lumen central line shown) intoany of several large veins. It is threaded

so that the tip of the catheter rests in thelower third of the superior vena cava.The pressure monitoring assembly isattached to the distal port of amultilumen central vein catheter.

Wound debridement / July 5 2011 An open wound or ulcer can not beproperly evaluated until the dead tissueor foreign matter is removed. Woundsthat contain necrotic and ischemic (lowoxygen content) tissue take longer toclose and heal. This is because necrotictissue provides an ideal growth medium

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for bacteria, especiallyforBacteroides spp. and Clostridium

perfringens that causes the gas

gangrene so feared in military medicalpractice. Though a wound may notnecessarily be infected, the bacteria cancause inflammation and strain the body'sability to fight infection. Debridement isalso used to treat pockets of pus calledabscesses. Abscesses can develop intoa general infection that may invade thebloodstream (sepsis) and leadto amputationand even death. Burnedtissue or tissue exposed to corrosive

substances tends to form a hard blackcrust, called an eschar, while deepertissue remains moist and white, yellowand soft, or flimsy and inflamed. Escharsmay also require debridement topromote healing.

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Generic Name/Brand Name,Classification,Stock

Indication,Frequency,Dosage

Side-effects/ AdverseReaction

SpecialConsideration/NursingResponsibility

Diazepam(VALIUM)

Anti-anxietyagent, Anti-convulsant

INDICATION:

-Adjunct inthemanagementof:

Anxiety, Pre-operativesedation,conscioussedation.

-Provide lightanesthesiaandAnterogradeamnesia.

-Treatment ofstatusepilepticus/uncontrolledseizures.

-Skeletalmusclerelaxant.

-Managementof thesymptoms of

-Dizziness

-Drowsiness

-Lethargy

-Hangover

-Headache

-Paradoxical Excitation

-Blurred Vision

-Respiratory Depression

-Hypotension

-Monitor BP, PR, RRprior to periodically

throughout therapyand frequentlyduring IV therapy.- Assess IV sitefrequently duringadministration,diazepam maycause phlebitis andvenous thrombosis.- Prolonged high-dose therapy may

lead topsychological orphysicaldependence.Restrict amount ofdrug available topatient. Observedepressed patientsclosely for suicidaltendencies.- Observe and

record intensity,duration andlocation of seizureactivity. The initialdose of diazepamoffers seizurecontrol for 15-20 minafter administration.

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Alcoholwithdrawal.

- IM injections arepainful anderratically absorbed.

If IM route is used,inject deeply intodeltoid muscle formaximumabsorption.- Caution patient toavoid taking alcoholor other CNSdepressantsconcurrently withthis medication.

- Effectiveness oftherapy can bedemonstrated bydecrease anxietylevel; control ofseizures; decreasedtremulousness.

Omeprazole(LO

SEC)

Proton-pumpInhibitors, Anti-ulcer Agent

INDICATION:

-Maintenanceof healingerosiveesophagitis.-DuodenalUlcers.

-Short-termtreatment of

active benigngastric ulcer.-Pathologichyposecretory condition,includingzollinger-ellison

-Dizziness

-Drowsiness

-Fatigue

-Headache

-Weakness

-Chest pain

-Abdominal Pain

-Acid Regurgitation-Constipation

-Diarrhea

-Flatulence

-Nausea and Vomiting.

Assessment:

1. History:Hypersensitivity toOmeprazole or anyof its components;pregnancy, lactation2. Physical: skinlesions; reflexes;urinary output;abdominalexamination;respiratory

auscultation

Interventions:1. Administer beforemeals.2. Administer

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syndrome.

-Reduction ofrisk of GIbleeding incritically illpatient.

antacids with, ifneeded.3. Have regular

medical follow-upvisits.4. Report severeheadache,worseningof symptoms, fever,chills.

Lasix(FUROSEMIDE)

Diuretics

INDICATION:

-Edema dueto: CHF,Hepatic orRenalDisease.

-Hypertension.

-Dizziness,

-Encephalopathy

-Headache

-Insomnia

-Nervousness

-Hearing loss

-Tinnitus

-Hypotension-Constipation

-Diarrhea

-Dry mouth

-Dyspepsia

-Nausea and Vomiting.

Furosemide is a

very potentmedication. Usingtoo much of thisdrug can lead toserious water andsalt/mineral loss.Therefore, it isimportant that youare closelymonitored by yourdoctor while taking

this medication. Tellyour doctor rightaway if you becomevery thirsty orconfused, ordevelop musclecramps/weakness.

Nursing Case Study
http://www.medicinenet.com/script/main/art.asp?articlekey=772http://www.medicinenet.com/script/main/art.asp?articlekey=2024http://www.medicinenet.com/script/main/art.asp?articlekey=2024http://www.medicinenet.com/script/main/art.asp?articlekey=772http://www.medicinenet.com/script/main/art.asp?articlekey=2024http://www.medicinenet.com/script/main/art.asp?articlekey=2024


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Ciprofloxacin(CIPROBAY)

GI DrugLaxative

INDICATION:

Infections ofthe resp.tract, middleear, paranasal sinuses,eyes,kidneys,urinary tract

Common:

-Nausea-Diarrhea

-Vomiting

-Rash

Uncommon:-Anorexia

-Headache

-Dizziness

-Fever

-GI and Abdominal pain,

-Flatulence

-Confusion

-Vertigo

-Assess pt forprevioussensitivity

reaction.

-Assess pt forany s/s ofinfection before& duringtreatment.

-Assess foradversereactions.

-Assess pt. &familysknowledge of drugtherapy.

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Imdur INDICATION:

Imdur Tabletsare indicatedfor theprevention ofanginapectoris dueto coronaryarterydisease. Theonset of

action of oralisosorbidemononitrateis notsufficientlyrapid for thisproduct to beuseful inaborting anacute anginalepisode.

Imdur Tablets arecontraindicated in patientswho have shown

hypersensitivity oridiosyncratic reactions toother nitrates or nitrites.

Discontinued:

Autonomic NervousSystem Disorders: Drymouth, hot flushes.

Body as a Whole:Asthenia, back pain, chestpain, edema, fatigue,fever, flu-like symptoms,malaise, rigors.

Cardiovascular Disorders,General: Cardiac failure,hypertension,hypotension.

Central and Peripheral

Nervous SystemDisorders: Dizziness,headache, hypoesthesia,migraine, neuritis, paresis,paresthesia, ptosis,tremor, vertigo.

Gastrointestinal SystemDisorders: Abdominalpain, constipation,diarrhea, dyspepsia,

flatulence, gastric ulcer,gastritis, glossitis,hemorrhagic gastric ulcer,hemorrhoids, loose stools,melena, nausea, vomiting.

Hearing and VestibularDisorders: Earache,

-Patients should betold that theantianginal efficacy

of Imdur Tablets canbe maintained bycarefully followingthe prescribedschedule of dosing.

For most patients,this can beaccomplished bytaking the dose onarising.

-Most patientsdevelop truephysicaldependence whichcan be severe.

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tinnitus, tympanicmembrane perforation.

Heart Rate and RhythmDisorders: Arrhythmia,arrhythmia atrial, atrialfibrillation, bradycardia,bundle branch block,extrasystole, palpitation,tachycardia, ventriculartachycardia.

Liver and Biliary SystemDisorders: SGOT

increase, SGPT increase.Metabolic and NutritionalDisorders: Hyperuricemia,hypokalemia.

Musculoskeletal SystemDisorders: Arthralgia,frozen shoulder, muscleweakness,musculoskeletal pain,myalgia, myositis, tendon

disorder, torticollis.

Myo-, Endo-, Pericardialand Valve Disorders:Angina pectorisaggravated, heart murmur,heart sound abnormal,myocardial infarction, Qwave abnormality.

Platelet, Bleeding andClotting Disorders:

Purpura,thrombocytopenia.

Psychiatric Disorders:Anxiety, concentrationimpaired, confusion,decreased libido,depression, impotence,

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insomnia, nervousness,paroniria, somnolence.

Red Blood Cell Disorder:Hypochromic anemia.

Reproductive Disorders,Female: Atrophic vaginitis,breast pain.

Resistance MechanismDisorders: Bacterialinfection, moniliasis, viralinfection.

Respiratory SystemDisorders: Bronchitis,bronchospasm, coughing,dyspnea, increasedsputum, nasal congestion,pharyngitis, pneumonia,pulmonary infiltration,rales, rhinitis, sinusitis.

Skin and AppendagesDisorders: Acne, hair

texture abnormal,increased sweating,pruritus, rash, skin nodule.

Urinary System Disorders:Polyuria, renal calculus,urinary tract infection.

Vascular (Extracardiac)Disorders: Flushing,intermittent claudication,leg ulcer, varicose vein.

Vision Disorders:Conjunctivitis,photophobia, visionabnormal.

Pharmaton CONTRAINDICATIONS:

-There are no known sideeffects.

A yellow colorationof the urine after

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-In

disturbancesof calciummetabolism,such ashypercalcaemia andhypercalciuria

-In case ofhypervitamin

osis D

-In renalinsufficiency

-Duringtherapy withvitamin D

-In case ofphenylketonuria

-In case ofknownhypersensitivi

ty to anyingredients ofthecompound.

-Up to now no interactionswith other drugs or foodsare known.

Overdose

The toxicity of the productin large overdoses will bethat of the liposolublevitamin D. Prolonged dailyintake of larger amountscan cause symptoms ofchronic toxicity such as

vomiting, headache,drowsiness and diarrhoea.Acute symptoms are onlyseen at even higherdoses.

taking is caused bythe vitaminB2 content (naturalcolor of vitamin B2).Such staining isabsolutely harmless.

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Diflucan(FLUCONAZOLE)

INDICATION:

Fluconazoleis used forthe treatmentoforopharyngeal,esophageal,and vaginalcandidiasis;serioussystemiccandidainfections;Cryptococcusneoformansmeningitis. Itis also usedas apreventivemeasure forcandidiasis inbone marrowtransplants.Fluconazoleis used in thetreatment ofcoccidioidomycosis,cryptococcosis,onychomycosis, fungalpneumonia,septicemia,and ringwormof the hand.

Side Effects:

-Hypersensitivity reaction

(fever, chills, rash,pruritus)

-Dizziness

-Drowsiness

-Headache

-Constipation

-Diarrhea

-Nausea

-Vomiting

-Abdominal pain

ADVERSE REACTION:

-Exfoliative skin disorders

-Serious hepatic effects

-Blood dyscrasias(eosinophilia,thrombocytopenia,anemia, leukopenia)

-Give withoutregards to meals.

-PO and IV therapyequally effective.

-Do not useparenteral form ifsolution is cloudy,precipitate forms,seal is not intact, oris discolored.

-Establish baselinefor CBC potassium,

and hepatic functionstudies.

-Assess forhypersensitivityreaction (chills,fever).

-Monitor for liver orrenal function tests,potassium, CBC,

and platelet count.

-Report rash oritching promptly.

-Monitortemperature at leastdaily.

-Determine patternof bowel activity andstool consistency.

-Assess fordizziness; provideassistance asneeded.

PATIENT

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TEACHINGS:

-Do not drive car or

use machinery ifdizziness ordrowsiness occurs.

-Notify physician ofdark urine, palestool, yellow skin oreyes,rash with orwithout itching.

-Patients withoropharyngeal

infections should betaught good oralhygiene.

-Consult physicianbefore taking anyother medication.

Documents

NURSING CASE STUDY(Myocardial Infarxtion