Monday, August 11, 2008
NEUROGENIC BLADDERI. BIOGRAPHIC DATA
Name: Mr. URAGON
Address: Sucat, Paranaque
Age: 88 years old
Gender: Male
Religious Affliation: Catholic
Marital Status: Widow
Occupation: Retired farmer
Room and Bed #: Room 130 Bed A
Chief Complaint: Pain on his catheterization
Provisional Diagnosis: Neurogenic Urinary Bladder secondary to CerebroVascular Accident
Attending Physician: Dr.Marbella and Dr.Perez
II. NURSING HISTORY:
A. Past Health History
The client had experienced measles, chickenpox, and typhoid fever way back then on her adolescent years. He had no childhood immunizations but had anti-rabies virus and anti-tetanus vaccination when he was 50 years old. He does not have any allergies on foods and drugs .During the Japanese regime on the Philippines, he had Japanese friends who tattoed him with unknown means of procedure, uncertain if his Japanese tattoo artist friends used toxic-free ink and sterile needles. He encountered minor injuries and falls during his midlife but he viewed it as less serious malady. He was hospitalized last year for pain in urinating and was diagnosed having Benign Prostatic Hyperplasia. Last May 2008, he was hospitalized because of CerebroVascular Accident. He was given stool softeners and multivitamins. Currently, he is medicating Ciprofloxacin, Ceftriaxone and Arcoxia. Originally, he resides at Camarines Sur, Bicol but moved in Paranaque, Metro Manila last year.
B. History Of Present Illness
Upon his admission on Medical Center Paranaque, The client was complaining about the pain on his catheterization on his penis so his attending physician elected him to have Suprapubic Cystostomy tube insertion. He was diagnosed having Neurogenic Bladder secondary to CVA. The catheter is now draining his urine directly from his bladder.
C. FAMILY HISTORY
According to the client, he does not remember any familial or hereditary disease that runs in their family. His parents died due to “old age” as he stated.
D. OCCUPATIONAL HISTORY
The client worked as a farmer since he was 17 years old and retired at the age of 65. As far as the client can still remember, he’s been using fertilizer since it became popular on the Bicol region. His fertilizer container tank lodges on his back as if it was a backpack and then he pumps up and down using his arms.
III. PATTERNS OF FUNCTIONING
A. Psychological Health
Mr. Uragon describes himself as a strong and out-going kind of person. He is well-satisfied with his life and his family.
The client’s highest educational attainment is Elementary. His family usually makes decisions when it comes to his health and body. However, whenever it comes to his health he chooses to go to a physician whenever he feels sick. The client easily understands and answers questions clearly, simple and precise. At present the client has no problem with writing or reading but speaks with a little clarity since the muscles on his left side body is weak.
Interpretation and Analysis:
Over all, the client is currently happy and contented with his life. Even though he goes through physical “wear and tear” condition, he still views himself as a very strong man. His family gives him the overall support that he needed and highly prioritize his health.
B. Socio-Cultural Patterns
Mr. Uragon finds enjoyment in watching TV and playing with his grandkids. His grandkids often visit him with chocolates to give to their “Daddy”. They find leisure in going out, sharing thoughts and telling stories. According to him, he enjoys his stay at Paranaque as much as he enjoy his stay on Bicol
Interpretation and Analysis:
The client has a sound relationship on his family and environment.
C. Spiritual Patterns
The client is a Roman Catholic. He use to go to church weekly but stopped when he was catheterized. However, he often prays.
Interpretation and Analysis:
During this age, a person may not be an active member of the church because of the physical constraints.
IV. ACTIVITIES OF DAILY LIVING
ADL BEFORE HOSPITALIZATION DURING HOSPITALIZATION INTERPRETATION AND ANALYSIS
1. Nutrition No food restriction. Diet as tolerated. Low salt and low fat diet. To prevent water retention and plaque formation.
2. Elimination The client is catheterized and has stool softeners. . The client is catheterized and has stool softeners. Due to the pharmacologic effects of the drugs administer, it alleviate his burdens of urinating. Stool-softeners prevent him from straining during defecation.
3. Exercise The client undergoes physical therapy. The client is provided with ROM exercises. Due to hospitalization, he was unable to pursue his physical therapy session. But he still mobilizes his muscle by means of ROM exercise.
4. Hygiene The client takes a bath once a day cleans his dentures daily. The client is given Bed bath every day. Lessens the risk of acquiring infectious disease.
5. Substance Abuse The client drinks alcohol occasionally. The client used to be a smoker but last May 2008. The client stopped due to hospitalization. His pack years were unknown.
6. Sleep and Rest The client sleeps 4-6 hours a day. The client sleeps almost 9 hours. Due to hospitalization.
7. Sexual Activity Not Active. Not Active. The client chose not to be active.
V. PHYSICAL ASSESSMENT
Vital Signs Normal Findings Findings Analysis
Temperature 36.5 – 37.5 degrees Celsius 37.2 degrees Celsius Normal since it is in the usual range. (Kozier, Barbara et al. Fundamentals of Nursing. 7th edition. 2004. pge 488)
Respiratory rate 15-20 cpm 18 cpm Normal since it is in the usual range. (Kozier, Barbara et al. Fundamentals of Nursing. 7th edition. pge 506)
Pulse rate 60-100 bpm 96 bpm (radial) Normal since it is in the usual range. (Kozier, Barbara et al. Fundamentals of Nursing. 7th edition. 2004. pge 499)
Blood pressure 120/80 mm/Hg 120/80 mm/Hg Normal
Appearance and Mental Status
Body build, height and weight Proportionate, varies with lifestyle. Endomorph Normal
Client’s posture, gait: sitting, walking and standing The client is relaxed and has a coordinated movement. The client cannot walk straightly or directly Due to the client’s general medical condition
Client’s overall hygiene and grooming. Relates these to the client’s activities prior to assessment. Clean, neat. Clean, neat. Normal
Body and breath odors No body odor or minor body odor relative to work or exercise; no breath odors. No body and breath odor Normal
Signs of distress No distress noted. Distress noted Not Normal- a highly stressed or anxious client could have an elevated body temperature. (Kozier, Barbara et al. Fundamentals of Nursing. 7th edition. 2004. pge 488)
Signs of health or illness Healthy appearance. Sign of stress noted Not Normal- a highly stressed or anxious client could have an elevated body temperature. (Kozier, Barbara et al. Fundamentals of Nursing. 7th edition. 2004. pge 488)
Client’s attitude Cooperative. Cooperative. Normal
Affect or mood Appropriate to situation. Appropriate to situation. Normal
Speech quantity, quality, and organization Understandable, moderate pace; exhibits thought association. Understandable, moderate pace; exhibits thought association. Normal
Thought relevance and organization Logical sequence; makes sense; has sense of reality. Logical sequence; makes sense; has sense of reality. Normal
Integumentary system
Skin • varies from light to deep
brown; from ruddy pink to
light pink; from yellow
overtones to olive • light brown Normal
• Generally uniform except in
areas exposed to the sun;
areas of lighter pigmentation
(palms, lip, nail, beds) in dark-
skinned people • Generally uniform except in
areas exposed to the sun; presence of tattoos on some body parts Sterility of the needles used is questionable
• No edema • No edema Normal
• Freckles, some birthmarks,
some flat and raised nevi; no
abrasions or other lesions • No Freckles, some birthmarks,
some flat and raised nevi; no
abrasions or other lesions Normal
• Moisture in skin folds and the
axillae (varies with the
environment temperature and
humidity, body temperature,
and activity) • Has moisture in skin folds and the
axillae Normal
• Uniform temperature; within
normal range • Uniform; Warm to touch Not Normal-a highly stressed or anxious client could have an elevated body temperature. (Kozier, Barbara et al. Fundamentals of Nursing. 7th edition. 2004. pge 488)
• When pinched, skin springs
back to previous state • When pinched, skin springs
Slowly back to previous state. Normally seen in geriartric patients
Hair • Evenly distributed hair • (+) alopecia Normally seen in geriartric patients
• Thick hair • Thin hair Normally seen in geriartric patients
Nails • Convex curvature; angle of nail about 160 degrees • Convex curvature; angle of nail about 160 degrees Normal
• Smooth texture • Smooth texture Normal
• Highly vascular and pink and
light-skinned client; dark-
skinned clients may have
brown or black pigmentation in
longitudinal streaks • Highly vascular and pink Normal
• Intact epidermis • Intact epidermis Normal
• Prompt return of pink or usual color (generally before 4 sec.) • Prompt return of pink or usual color before 4 sec. Normal
Head
Skull • Rounded ( normocephalic and
symmetrical, with frontal,
parietal, and occipital
prominences); smooth skull
contour • Rounded ( normocephalic and
symmetrical, with frontal,
parietal, and occipital
prominences); smooth skull
contour Normal
• Smooth, uniform consistency;
absence of nodules or masses • Smooth, uniform consistency;
absence of nodules or masses Normal
Face • Symmetric or slightly
symmetric facial features;
palpebral fissures equal in
size; symmetric nasolabial
folds • Symmetric symmetric facial features;
palpebral fissures equal in
size; symmetric nasolabial
folds Normal
• Eyes have no edema or
hollowness • Eyes have no edema or
hollowness normal
• Symmetric facial movements • Unilateral facial weakness Due to client’s general medical condition
Eyes
Eyebrows • Hair evenly distributed; skin
intact • Hair evenly distributed; skin
intact Normal
• Eyebrows symmetrically
aligned; equal movement • Eyebrows symmetrically
aligned; equal movement Normal
Eyelashes • Equally distributed; curled slightly
outward • Equally distributed; curled slightly
outward Normal
Eyelids • Skin intact; no discharges; no
discoloration • Skin intact; no discharges; no
discoloration Normal
• Lids close symmetrically • Lids close symmetrically Normal
• Approximately 15-20
involuntary blinks per minute;
bilateral blinking • Approximately 15-20
involuntary blinks per minute;
bilateral blinking Normal
• When lids open, no visible
sclera above corneas, and
upper and lower borders of the
cornea are slightly covered • When lids open, no visible
sclera above corneas, and
upper and lower borders of the
cornea are slightly covered Normal
Bulbar conjunctiva • Transparent; capillaries
sometimes evident • Transparent; capillaries
sometimes evident Normal
Palpebral conjunctiva • Shiny, smooth; pink or red • Shiny, smooth; pink Normal
Sclera • Appears white (yellowish in
dark-skinned clients) • Appears white Normal
Cornea • Transparent, shiny and
smooth; details of the iris are
visible • Transparent, shiny and
smooth; details of the iris are
visible Normal
Anterior chamber • Transparent; no shadows of
light on the iris; depth of
about 3 mm • Transparent; no shadows of
light on the iris; depth of
about 3 mm Normal
Pupils • Black in color; equal in size;
normally 3 to 7 mm in
diameter; round smooth
border
• Illuminated pupil constricts
(direct response);
Non- illuminated pupil
constricts (consensual
response).
• Pupils constricts when looking
at near object; pupils dilated
when looking at far objects
• Pupils converge when near
object is moved toward the
nose • Black in color; equal in size;
normally 3 to 7 mm in
diameter; round smooth
border
• Illuminated pupil constricts
(direct response);
Non- illuminated pupil
constricts (consensual
response).
• Pupils constricts when looking
at near object; pupils dilated
when looking at far objects
• Pupils converge when near
object is moved toward the
nose
• Pupils are equally round and reacts to light and accommodation Normal
Iris • Flat and round • Flat and round Normal
Lacrimal Gland, Lacrimal Sac, Nasolacrimal Duct • No edema or tenderness over
lacrimal gland • No edema or tenderness over
lacrimal gland Normal
Visual Fields • When looking straight ahead,
client can see objects in the
periphery. • When looking straight ahead,
client can see objects in the
periphery. Normal
Extraocular Muscle Tests • Both eyes coordinated, move
in unison, with parallel
alignment • Both eyes coordinated, move
in unison, with parallel
alignment Normal
Ears
Auricles • Color same as facial skin • Color same as facial skin Normal
• Symmetrical • Symmetrical Normal
• Auricles aligned with the outer
cantus of the eyes, about 10o
from vertical • Auricles aligned with the outer
cantus of the eyes, about 10o
from vertical Normal
• Mobile, firm, and not tender;
pinna recoils after it is folded • Mobile, firm, and not tender;
pinna recoils after it is folded Normal
Gross Hearing Acuity Test • Normal voice tone audible • Normal voice tone audible Normal
• Able to hear the ticking of
watch in both ears • Able to hear the ticking of
watch in both ears Normal
• The sound of the tuning fork is
heard in both ears or is
localized at the center of the
head (Weber negative) • The sound of the tuning fork is
heard in both ears or is
localized at the center of the
head (Weber negative) Normal
• Air-conducted (AC) hearing is
greater than bone-conducted
(BC) hearing (Rinne positive) • Air-conducted (AC) hearing is
5 seconds and bone-conducted
(BC) hearing is 3 seconds (Rinne positive)
• Air-conducted (AC) hearing is
greater than bone-conducted
(BC) hearing (Rinne positive) Normal
Nose
External Nose • Symmetrical and straight • Symmetrical and straight Normal
• No discharges or flaring • No discharges or flaring Normal
• Uniform color • Uniform color Normal
• No displacement of bone or
cartilage • No displacement of bone or
cartilage Normal
• No tenderness • No tenderness Normal
• No lesions • No lesions Normal
• No presence of masses • No presence of masses Normal
Nasal Cavities • Air moves freely when
breathing through the naris • Air moves freely when
breathing through the naris
• Nasal cavities are patent Normal
• Mucosa pink • Mucosa pink Normal
• Clear watery discharges • Clear watery discharges Normal
Normal
• No lesions • No lesions Normal
Nasal Septum • Intact and in the midline • Intact and in the midline Normal
Facial sinuses • Not tender • Not tender Normal
Mouth
Lips • Uniform pink color (freckled
brown pigmentation in dark
skinned clients) • Uniform pink color with a darker shade in the border of the lips Normal
• Soft, moist, smooth texture • dry Not normal since dry lips could indicate dehydration. (Kozier, Barbara, et al. Fundamentals of Nursing, 7th edition. 2004 pg. 679)
• Symmetry of contour • Symmetry of contour Normal
• Ability to purse lips • Ability to purse lips Normal
Buccal Mucosa • Moist, smooth, soft, glistening,
and elastic texture (drier oral
mucosa in elderly due to
decreased salivation. • Moist, smooth, soft, glistening,
and elastic texture Normal
Teeth • 32 adult teeth • 20 adult teeth Not normal since he has missing teeth due to tooth extraction which is considered to be a deviation from normal (Kozier, Barbara, et al. Fundamentals of Nursing, 7th edition. 2004 pg. 564)
• Smooth, white, shiny tooth
enamel • Smooth, yellowish, shiny tooth but with some black discoloration of enamel Not normal since black discoloration may indicate staining/ presence of caries (Kozier, Barbara, et al. Fundamentals of Nursing, 7th edition. 2004 pg. 564)
• No dental caries, permanent fillings, and missing teeth • Positive for permanent fillings and missing teeth Not normal – teeth enamel should be white, shiny and free from dental carries. Kozier, Barbara, et al. Fundamentals of Nursing, 7th edition. 2004 pg. 564)
• Use of dental apparatus • (+) dentures Normally seen in geriartric patients
Gums • Pink gums (bluish or dark
patches in dark-skinned client) • Pink gums Normal
• Moist, firm texture to gums • Moist, firm texture to gums Normal
• No retraction of gums (pulling
away from the teeth) • No retraction of gums (pulling
away from the teeth) Normal
• Smooth, intact dentures • Smooth, intact dentures Normal
Tongue • Central position • Central position Normal
• Raised papillae (taste buds) • Raised papillae (taste buds) Normal
• Smooth lateral margin; no
lesions • Smooth lateral margin; no
lesions Normal
• Pink color (some brown
pigmentation on tongue
borders in dark-skinned
clients); rough; thin whitish
coating • Pink color; rough; thin whitish
coating Normal
• Moves freely; no tenderness • Moves freely; no tenderness Normal
• Smooth tongue base with
prominent veins • Smooth tongue base with
prominent veins Normal
Floor of the mouth • Smooth with no palpable
nodules • Smooth with no palpable
nodules Normal
Salivary glands • Same as color of buccal
mucosa and floor of mouth • Same as color of buccal
mucosa and floor of mouth Normal
Palates • Light pink, smooth, soft
palate; Lighter pink hard
palate, more irregular texture • Light pink, smooth, soft
palate; Lighter pink hard
palate, more irregular texture Normal
Uvula • Positioned in the midline of
soft palate • Positioned in the midline of
soft palate Normal
Oropharynx • Pink and smooth posterior wall • Pink and smooth posterior wall Normal
Tonsils • Pink, smooth • Pink, smooth Normal
• No discharge • No discharge Normal
• Normal Size • Normal Size (Grade 1) Normal
Gag reflex • Present • Present Normal
Neck
Neck muscle • Muscle equal in size; head
centered • Unilateral body paralysis Due to client’s general medical condition
Head movement • Coordinated, smooth
movements with no discomfort • With a little weakness Due to client’s general medical condition
Muscle Strength • Equal in strength
(sternocleidomastoid;
trapezius) • Unequal in strength
(sternocleidomastoid;
trapezius) Due to client’s general medical condition
Lymph Nodes • Not palpable • palpable Indicates infection or inflammatory process
Trachea • Central placement in midline of
neck; space are spaces are
equal on the both • Central placement in midline of
neck; space are spaces are
equal on the both Normal
Thyroid Gland • Not visible • Not visible Normal
• Gland ascends during
swallowing but is not visible • Gland ascends during
swallowing but is not visible Normal
• Lobes may not be palpated. If palpated, lobes are small,
smooth, centrally located,
painless, and rise freely with
swallowing • Lobes are not palpable Normal
Thorax
Posterior Thorax • Anteroposterior to transverse
diameter in ratio of 1:2 • Anteroposterior to transverse
diameter in ratio of 1:2 Normal
• Chest symmetric • Chest symmetric Normal
• Spine vertically aligned • Spine vertically aligned Normal
• Spinal column is straight, right
and left shoulder and hips are
at same height • Spinal column is S in shape Indicates scoliosis
• Skin intact; uniform
temperature • Skin is crumpled; uniform
temperature Normally seen in geriartric patients
• Full symmetric chest
expansion • Full symmetric chest
expansion Normal
• Bilateral symmetry of vocal
fremitus • Bilateral symmetry of vocal
fremitus Normal
• Fremitus is heard most clearly
at the apex of the heart • Fremitus is heard most clearly
at the apex of the heart Normal
• Percussion notes resonate ,
except over scapula • Percussion notes resonate ,
except over scapula Normal
• Lowest point of resonance is at
the diaphragm • Lowest point of resonance is at
the diaphragm Normal
• Vesicular and bronchovesicular
breath sounds • Vesicular and bronchovesicular
breath sounds Normal
Anterior Thorax • Quiet, rhythmic and effortless
respirations • Quiet, rhythmic and effortless
respirations Normal
• Costal angles is less than 900
and the ribs insert into the
spine at approximately a 45
angle • Costal angles is less than 900
and the ribs insert into the
spine at approximately a 45
angle Normal
• Full symmetric excursion;
thumbs normally separate 3 to
5 cm • Full symmetric excursion;
thumbs separate about 3 cm Normal
• Same as posterior vocal
fremitus; fremitus is normally
decreased over the heart and
breast tissue • Same as posterior vocal
fremitus; fremitus is normally
decreased over the heart and
breast tissue Normal
• Percussion notes resonate
down to the sixth rib at the
level of the diaphragm but are
flat over the areas of heavy
muscle and bone, dull on areas
over the heart and the liver,
and tympanic over the
underlying stomach. • Percussion notes resonate
down to the sixth rib at the
level of the diaphragm but are
flat over the areas of heavy
muscle and bone, dull on areas
over the heart and the liver,
and tympanic over the
underlying stomach. Normal
• Bronchial and tubular breath
sounds over the trachea • Bronchial and tubular breath
sounds over the trachea Normal
• Bronchial and tubular breath
sounds over the anterior
thorax • Bronchial and tubular breath
sounds over the anterior
thorax Normal
Cardiovascular
Precordium • No pulsations (aortic and
pulmonic areas) • No pulsations (aortic and
pulmonic areas) Normal
• No pulsations; no lifts or
heaves (tricuspid area) • No pulsations; no lifts or
heaves (tricuspid area) Normal
• Pulsations in the apical • Pulsations in the apical Normal
• Aortic pulsations in the
epigastric • Aortic pulsations in the
epigastric Normal
Carotid arteries • Symmetric pulse volumes • Irregular pulse volumes Could suggest an underlying cardiovascular problem
• Full pulsations; thrusting
quality • irregular rhythm and quality Could suggest an underlying cardiovascular problem
• No sound heard on
auscultation • No sound heard on
auscultation Normal
Jugular Vein • Veins not visible • Veins not visible Normal
Abdomen
Abdomen • Unblemished skin • Unblemished skin Normal
• Uniform in color • Uniform in color Normal
• Silver white striae (stretch
marks) or surgical scars • No silver white striae (stretch
marks) or surgical scars Normal
• Flat, round (convex), or
scaphoid (concave) • Scaphoid (concave) Normal
• No evidence of enlargement of
liver or spleen • No evidence of enlargement of
liver but spleen is palpable and enlarge Normally, spleen is unpalpable. Elargement of the skin indicated infection
• Symmetric contour • Symmetric contour Normal
• Symmetric movements caused
by respiration • Symmetric movements caused
by respiration Normal
• Visible peristalsis in very lean
people • No visible peristalsis in very lean
people Normal
• Aortic pulsations in thin
persons at epigastric pattern • No aortic pulsations at epigastric pattern Normal
• No visible vascular pattern • No visible vascular pattern Normal
• Audible bowel sounds • Audible bowel sounds Normal
• Absence of arterial bruit • Absence of arterial bruit over the aorta, renal artery, iliac artery, and femoral arteries Normal
• Absence of friction rub • Absence of friction rub Normal
• Tympany over the stomach
and gas-filled bowels; dullness
especially over the liver and
spleen, or a full bladder • Tympany over the stomach
and gas-filled bowels; dullness
especially over the liver and
spleen, or a full bladder Normal
• No tenderness; relaxed
abdomen with smooth,
consistent tension • No tenderness; relaxed
abdomen with smooth,
consistent tension Normal
Liver • May not be palpable • Not palpable Normal
Bladder • Not palpable • Not Applicable to palpate due to presence of suprapubic cystostomy. N/A
Musculoskeletal System
Muscles • Equal in size on both sides of
body • Equal in size on both sides of
body Normal
• No contractures • No contractures Normal
• No fasciculation or tremors • With fascuculations on the left arm Due to general medical conditon
• Normally firm • Normally firm Normal
• Smooth coordinated
movements • Uncoordinated body movements Due to general medical conditon
• Equal strength on each body
side • Unequal strength on each body
side Due to general medical conditon
Bones • No deformities • No deformities Normal
• No tenderness or swelling • No tenderness or swelling Normal
Joints • No deformities • No deformities Normal
• No tenderness or swelling • No tenderness or swelling Normal
LABORATORY RESULTS:
A. Urinalysis
Routine Actual Findings Normal Findings Analysis/ Interpratation
Color
Transparency
Specific Gravity
Sugar
Protein
Pus cells
Red cells
Epithelial cells
Amorphous Urates
Bacteria
Yellow
Hazy
0.015
Negative
Trace
Many
3/hpf
Few
Few
Many
Staw- dark yellow
Clear
1.016 – 1.022
Negative
Negative
Occasional
Female: 0-2/hpf
Male: 0/hpf
Occasional
Occasional
Negative
NORMAL
Turbidity or smokiness may be due to RBC. The presence of increased number of epithelial cells may also account for turbidity. Spermatozoa and Prostatic fluid may cause turbidity.
(Prostatic fluid normally contains a few leukocytes and other formed elements.)
Urines of low specific gravity are called HYPOSTHENUEIC.
The measurement of Specific Gravity should give an indication of Urinary total solute concentration.
Normal
Trace amounts doesn’t necessarily indicates glumerular or tubular diseases in kidney.
Indicates bacterial infection.
Increased RBC may indicate Renal disease or UTI or extrarenal disease or toxic reactions.
Normal
Normal
Confirms bacterial infection.
B. CBC (prior to blood transfusion)
Blood Component Actual Findings Normal Findings Interpretation/Analysis
Hgb
Hct
RBC
WBC
Platelet
Differential count:
Segmmenters
Lymphocyte
Eosinophils 109
0.33
3.88
4.70
Adequate
0.75
0.25
0.01 140-170 gm/L
0.41-0.51 gm/L
4.6-5.2 x 10 /L
4.5 X 10 /L
200-400 mg/dl
0.55-0.65
0.25-0.35
0.00-0.05 Decreased oxygenation in tissues.
Anemia
Anemia
Normal
Normal
Indicates infection
Normal
Normal
DRUG STUDY
Generic/Trade name Dosage/ Frequency Classification Indication Contraindication Side effects Nursing responsibilities
ciprofloxacin
Ceftriaxone
ETOROCOXIB
(Arcoxia)
500 mg/tab
BID
PO
Chronic bacterial prostatitis: 500 mg PO q 12 hr for 28 days or 400 mg IV q 12 hr for 28 days.
Complicated UTIs: 500 mg PO q 12 hr for 7–14 days or 400 mg IV q 12 hr or 1,000 mg (ER tablets) PO daily for 7–14 days
1 gram IV OD
60mg/tab
PO
BID Antibacterial
Fluoroquinolone
Anti bacterial
3rd greneration cephalosporin
Analgesic Indications
• 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
Treatment of uncomplicated UTIs caused by E. coli, K. pneumoniae as a one-time dose in patients at low risk of nausea, diarrhea (Proquin XR)
Otic: Treatment of acute otitis externa
Treatment of chronic bacterial prostatitis
IV: Treatment of nosocomial pneumonia caused by Haemophilus influenzae, K. pneumoniae
Oral: Typhoid fever
Oral: STDs caused by N. gonorrheae
Prevention of anthrax following exposure to anthrax bacilla (prophylactic use in regions suspected of using germ warfare)
Acute sinusitis caused by H. influenzae, Streptococcus pneumoniae, or Moraxella catarrhalis
Lower respiratory tract infections caused by E. Coli, Klebsiella, Enterobacter species, P. mirabilis, P. aeruginosa, H. influenzae, H. parainfluenzae, S. pneumoniae
Unlabeled use: Effective in patients with cystic fibrosis who have
pulmonary exacerbations
UTIs caused by S. pneumoniae, P. vulgaris, P.mirablis, Morganella Morganii,
Perioperative prophylaxis for Pts. Undergoing CABG and contaminated or potentially contaminated surgical procedures.
Tx of
Acute and chronic OA and RA.
Tx of acute gouty arthritis and primary dysmenorrheal.
For PostOperative pain.
• Contraindicated with allergy to ciprofloxacin, norfloxacin or other fluoroquinolones, pregnancy, lactation.
Use cautiously with renal dysfunction, seizures, tendinitis or tendon rupture associated with fluoroquinolone use.
Contraindicated with allergy to cephalosporins or penicillins
Use cautiously with renal failure, lactation and pregnancy.
Do not take Arcoxia if:
• you have an allergy to Arcoxia or any of the ingredients listed at the end of this leaflet
• the packaging is torn or shows signs of tampering
• the expiry date on the pack has passed.
If you take this medicine after the expiry date has passed, it may not work.
• You have had heart failure, a heart attack, bypass surgery, chest pain (angina), narrow or blocked arteries of the extremities (peripheral arterial disease), a stroke or mini stroke (TIA or transient ischaemic attack).
• You have high blood pressure that is not well controlled on blood pressure medication.
• You are having major surgery and have conditions which increase your risk of coronary artery disease or atherosclerosis such as high blood pressure, diabetes, high cholesterol or smoking.
• You are having major surgery on you heart or arteries.
Contraindicated with allergy to ciprofloxacin, norfloxacin or other fluoroquinolones, pregnancy, lactation.
Use cautiously with renal dysfunction, seizures, tendinitis or tendon rupture associated with fluoroquinolone use.
CNS: headache, dizziness, lethargy
G.I: Pseudomembranous colitis
Hematologic: Bone marrow depression- decreased WBC, decreased platelets, decreased Hct
Hypersensitivity: Anaphylactic shock
Other: Superinfections
• feeling sick (nausea), vomiting
• heartburn, indigestion, uncomfortable feeling or pain in the stomach
• diarrhoea
• swelling of the legs, ankles or feet
• high blood pressure
• dizziness
• headache
Additionally, the following have been reported:
• allergic reactions including rash, itching and hives
• severe skin reactions, which may occur without warning
• taste alteration
• wheezing
• insomnia
• anxiety
• drowsiness
• mouth ulcers
• diarrhoea
• severe increase in blood pressure
• confusion
• hallucinations
• platelets decreased
Assessment
History: Allergy to ciprofloxacin, norfloxacin or other quinolones; renal dysfunction; seizures; lactation
Physical: Skin color, lesions; T; orientation, reflexes, affect; mucous membranes, bowel sounds; LFTs, renal function tests
Interventions
Arrange for culture and sensitivity tests before beginning therapy.
Continue therapy for 2 days after signs and symptoms of infection are gone.
Be aware that Proquin XR is not interchangeable with other forms.
Ensure that the patient swallows ER tablets whole; do not cut, crush, or chew.
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.
ASSESSMENT
Liver and renal dysfunction, lactation and pregnancy.
Use cautiously with renal failure, lactation and pregnancy
INTERVENTION:
GCSC
DO NOT MIX WITH ANTIMICROBIAL DRUG
Have vitamin K available in case hypoprothrombenia occurs
DC if reaction occurs.
Before you start to taking Arcoxia tell your nurse or doctor if:
• you are pregnant or intend to become pregnant
Arcoxia is not recommended for use during late pregnancy. If there is a need to consider using Arcoxia during your pregnancy, your doctor will discuss with you the benefits and risks of using it.
• you are breast-feeding or plan to breast-feed
It is not known if Arcoxia passes into breast milk. You and your doctor should discuss whether you should stop breast-feeding or not take Arcoxia.
• you have or have had any medical conditions, especially the following:
history of angina, heart attack or a blocked artery in your heart
narrow or blocked arteries of the extremities
kidney disease
liver disease
heart failure
high blood pressure
• you have had an allergic reaction to aspirin or other anti-inflammatory medicines (commonly known as NSAIDs)
Symptoms of an allergic reaction may include asthma, pinkish itchy swellings on the skin (hives), runny or blocked nose.
• you have an infection
If you take Arcoxia while you have an infection, it may hide fever and may make you think, mistakenly, that you are better or that your infection is less serious than it might be.
• you have any allergies to any other medicines or any other substances, such as foods, preservatives or dyes.
• you have a history of stroke or mini stroke
• you have conditions which increase your risk of coronary artery disease or atherosclerosis such as high blood pressure, diabetes, high cholesterol or smoking.
Ecologic Model
The disease was caused by the patient’s pre-existing medical condition, CEREBROVASCULAR ACCIDENT. Prolonged lack of blood supply to the brain caused lesion/s to the central nervous system or peripheral nervous system.
Host- The host is a geriatric patient. Because of the theory of physical WEAR AND TEAR, the host has been more susceptible to the underlying cause of the disease.
Agent- The main agent is the client’s previous medical condition, which is CEREBROVASCULAR ACCIDENT. CVA produced the lesion/s in the cortico-regulatory particularly in upper motor neuron part of the Nervous system. The end results of the CVA cause lesion and so it produce bladders that are SPASTIC.
Environment- Stressors present in the environment may aggravate the symptom.
Conclusion:
The term neurogenic bladder refers to several dysfunctions caused by lesions of the central or peripheral nervous system. Their manifestation depends on the site of lesion. An upper motor neuron lesion (above S2 to S4) causes spastic neurogenic bladder, with spontaneous contractions of the detrusor muscles, elevated intravesical voiding pressure, bladder wall hypertrophy with trabeculation, and urinary sphincter spasms. On the patient’s case, it us classified as SPASTIC NEUROGENIC BLADDER. SPASTIC NEUROGENIC BLADDER may produce involuntary or frequent scanty urination without a feeling of bladder fullness and possibly spontaneous spasm of the arms and legs. Anal sphincter tone may be increased.
(SOURCE: Springhouse’s HANDBOOK OF DISEASES 2nd edition. Pages 582-583)
Ranking Nursing Problems Identified Cues Justification
1 Acute pain and discomfort related to surgical incision as manifested by restlessness and verbalization of pain at the operative site.
- The client stated that his cystostomy site really hurts and he feels uncomfortable. The problem is ranked number one among the problems presented since this is the most life-threatening among all.
2 Risk for infection due to impaired skin integrity. Flabby, soft, with four postoperative incisions:
First incision through the abdominal wall in the umbilicus.
Second and third incision is through the abdominal wall in the right upper quadrant right subcoastal.
Fourth incision is through th abdominal wall left lower quadrant.
All post operative dressings dry and intact.
This problem is ranked second because if infections increase there may be a possibility to cause more problems
3
Activity intolerance r/t bedrest and post surgical incision The client has limited physical mobility because of his flat on bed position that was ordered by the physician after the operation and he has physical limitations; she cannot do strenuous activities for the mean time.
The only exercise the client performed were the deep breathing exercises after her operation. The problem is highly prioritized because her personal and hygienic needs must be taken care of.
Labels: NCM
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