CASESTUDY IN GASTRIC ULCER

SUMITTED BY:

DEVIE MARIE AGUSTINSHERYL CABELIZA

MABEL DEL ROSARIOREGINA MARIE GRANDE

RIA LUCY QUERALBLENDINA TEMPORAL

SUBMITTED TO:

MR. JAKE B. CANAPI

CLIENTS PROFILE

Name: C.Z

Age: 71 y/o

Gender: Female

Address: Maluyo, Allacapan Cagayan

Birthday: October 25, 1939

Religion: Iglesia Ni Cristo

Occupation: Housekeeping

Admission date: September 30, 2011

Time: 1: 25 a.m.

Chief complaints: abdominal pain

Admitting Diagnosis: Gastric Cancer

Admitting Physician: Dr. Tiangco

NURSING HEALTH HISTORY

Present health history

One day PTA, the patient complain abdominalPain of her RUQ, hence admitted to CVMC.

Past health history

6 months PTa,patient complain of severe abdominal pain at the RUQ,patient was noted to tondo hospital and one medical intervention done was bloob transfusion,1 day PTA, patient with the recurrence of the condition patient was brought to CVMC.She also have no vaccination at all.

Social health history

According to the patient she is a housewife and a smoker.she has a11siblings but 9 are still alive,5 boys and 4 girls ,their house is made of wood with 2 rooms and 3 windows,they have an animals like chicken,pig and duck.they poultry is near their house and

for their drinking water is purified.

Family historyAccording to t he patient ,she has a history of brain cancer with her father side

ANATOMY AND PHYSIOLOGY

INTRODUCTION

Gastric cancer was once the second most common cancer in the world. In most developed countries, however, rates of stomach cancer have declined dramatically over the past half century. In the United States, stomach malignancy is currently the 14th most common cancer.

Decreases in gastric cancer have been attributed in part to widespread use of refrigeration, which has had several beneficial effects: increased consumption of fresh fruits and vegetables; decreased intake of salt, which had been used as a food preservative; and decreased contamination of food by carcinogenic compounds arising from the decay of unrefrigerated meat products. Salt and salted foods may damage the gastric mucosa, leading to inflammation and an associated increase in DNA synthesis and cell proliferation. Other factors likely contributing to the decline in stomach cancer rates include lower rates of chronic Helicobacter pylori infection, thanks to improved sanitation and use of antibiotics, and increased screening in some countries.

Nevertheless, gastric cancer is still the second most common cause of cancer-related death in the world, and it remains difficult to cure in Western countries, primarily because most patients present with advanced disease. Even patients who present in the most favorable condition and who undergo curative surgical resection often die of recurrent disease. However, 2 studies have demonstrated improved survival with adjuvant therapy: a US study using postoperative chemoradiation and a European study using preoperative and postoperative chemotherapy.

Anatomy

The molecular biology responsible for carcinogenesis, tumor biology, and response to therapy in stomach cancer are active areas of investigation but are not addressed in this review. Instead, this article focuses on clinical management, which first requires a thorough understanding of gastric anatomy.

An image depicting stomach anatomy can be seen below.

Stomach and duodenum, coronal section.

The stomach begins at the gastroesophageal junction and ends at the duodenum. The stomach has 3 parts: the uppermost part is the cardia; the middle and largest part is the body, or fundus; and the distal portion, the pylorus, connects to the duodenum. These anatomic zones have distinct histologic features. The cardia contains predominantly mucin-secreting cells. The fundus contains mucoid cells, chief cells, and parietal cells. The pylorus is composed of mucus-producing cells and endocrine cells.

The stomach wall is made up of 5 layers. From the lumen out, the layers include the mucosa, the submucosa, the muscularis layer, the subserosal layer, and the serosal layer. The peritoneum of the greater sac covers the anterior surface of the stomach. A portion of the lesser sac drapes posteriorly over the stomach. The gastroesophageal junction has limited or no serosal covering. The right portion of the anterior gastric surface is adjacent to the left lobe of the liver and the anterior abdominal wall. The left portion of the stomach is adjacent to the spleen, the left adrenal gland, the superior portion of the left kidney, the ventral portion of the pancreas, and the transverse colon.

The site of stomach cancer is classified on the basis of its relationship to the long axis of the stomach. Approximately 40% of cancers develop in the lower part, 40% in the middle part, and 15% in the upper part; 10% involve more than one part of the organ. Most of the decrease in

gastric cancer incidence and mortality in the United States has involved cancer in the lower part of the stomach; the incidence of adenocarcinoma in the cardia has actually shown a gradual increase.

Pathophysiology

There are 3 oncogenic pathways that are deregulated in the majority (>70%) of gastric cancers: the proliferation/stem cell, NF-kappa β, and Wnt/beta-catenin pathways. Their study suggests that interactions between these pathways may play an important role in influencing disease behavior and patient survival.

Understanding the vascular supply of the stomach allows understanding of the routes of hematogenous spread. The vascular supply of the stomach is derived from the celiac artery. The left gastric artery, a branch of the celiac artery, supplies the upper right portion of the stomach. The common hepatic artery branches into the right gastric artery, which supplies the lower portion of the stomach, and the right gastroepiploic branch, which supplies the lower portion of the greater curvature.

Understanding the lymphatic drainage can clarify the areas at risk for nodal involvement by cancer. The lymphatic drainage of the stomach is complex. Primary lymphatic drainage is along the celiac axis. Minor drainage occurs along the splenic hilum, suprapancreatic nodal groups, porta hepatis, and gastroduodenal areas.

GORDON’S 11 FUNCTIONAL HEALTH PATTERN

HEALTH PERCEPTION-HEALTH MANAGEMENT PATTERN

Before hospitalization:The patient views health as an important matter. She said that absence of disease means wellness which is contributive to her satisfying performance of ADL’ s. She believes in doctors and nurses but takes OTC meds except ibuprofen because according to her she has allergy on it.

During Hospitalization

The patient and her SO’s acquired help from the hospital when she experience pain on her abdomen. She was admitted because they believed that her condition is a serious matter.

NUTRITIONAL METABOLIC PATTERN

Before hospitalization

The patient has no allergy on food. She usually eats 3x a day but sometimes losses her appetite. Her usual meals is composed of coffee, rice, while her lunch and dinner composed of rice, vegetables , meat or fish. She drink 5-6 glasses a day.

During Hospitalization

The patient is NPO for 2 days prior to her operation.

ELIMINATION PATTERN

Before Hospitalization

The patient has irregular bowel function. she sometimes defecate once or twice a week and sometimes she defecates everyday with a dark brown stool. She urinates 5-6 times a day with a yellow ambered urine.

During Hospitalization

The patient was on IFC intact and draining well. She had a dark yellow orange urine. She did not yet defecate.

SLEEP REST PATTERN

Before Hospitalization

According to the patient, she has trouble in sleeping. She sleeps 10 in the evening and wakes up 1 in the morning. Then if she feels sleepy in the morning even if she was doing her household chores she goes to bed and sleeps. She doesn’t take naps in the afternoon .She only sits and stays at home and sometimes she watch TV.

During Hospitalization

. According to her, she cannot sleep well due to the pain she feels. She usually get her sleep at 8 in the evening but wakes at 10 then she gets her sleep at 1 and wakes up at 5 am.

ACTIVITY EXERCISE PATTERN

Before Hospitalization

The patient considers he daily household chores to be a form of her exercisers. She cleans the house, washed the clothes, and washed the dishes.

During Hospitalization

The patient almost stays on her bed lying flat. According to her she cannot do bathing alone. She needs assistance of her grandson and his husband in going to the C.R

COGNITIVE PERCEPTUAL PATTERN

Before Hospitalization

The client is in good mental status. She just finish grade 2. She knows a little in reading and writing .She can understand tagalog, ilokano and itawis. She knows how to compute.

During hospitalization

The client has a good communication skills. She interacts with us actively and happily .She answers our question immediately and comprehensively. But she is not aware of her disease she only that she has a serious disease and needs a prompt treatment.

ROLE-RELATIONSHIP PATTERN

Before hospitalization

According to the patient, she lives with her husband and stays their daughter at Allacapan Cagayan. She has 2 children but only one are alive. She has 17 grandsons and granddaughters. They have a good relationship with each other. They sometimes have misunderstanding but they settle it immediately.

During hospitalization

Her husband and her grandson are there to care for her. They are very supportive and they provide all her needs in her hospitalization

SELF PERCEPTION-SELF CONCEPT PATTERN

Before Hospitalization

She considers herself as a strong person and she do her best to provide the needs of their family. She considers herself as helpful especially in doing their household chores. She often socialized with her neighbors but she was friendly and accommodating when neighbors came to their house .She was a loving parent as well as being a grandmother to her grandsons and granddaughters.

During Hospitalization

She considers herself as a burden to her family due to her condition. But she still believes that she can still help her family by helping herself to recover from her illness.

COPING-STRESS TOLERANCE PATTERN

Before Hospitalization

According to the patient, dirty house, quarrels and noisy environment predispose her mostly to stress. When she encounters problems she solve it herself. As much as possible, she doesn’t want to tell it to her family. But if he can no longer bear it, she tells it to her husband, and her children.

During Hospitalization

She feels stress all the time because of her condition. But she was able to manage it by talking to her husband and taking rest.

SEXUALITY-REPRODUCTIVE PATTERN

Before Hospitalization

According to the patient, she had her menarche when she was 12 years old and menopause at the age of 40. She was married when she was 17 years old. She has 11 children, 5 boys and 6 girls, 2 are now dead due to rabies and unknown disease. Her children were all married and she had also 17 grandchildren.

During hospitalization

According to the patient, she can no longer engage in sexual activity because they are too old enough to do it.

VALUES- BELIEF PATTERN

Before Hospitalization

She was an active member as well as a deaconess of the Iglesia ni cristo since 1982 . she attends mass every Thursday and Saturday . She has a strong faith in God and she considers as a powerful instrument on her daily life.

During Hospitalization

The clients faith was still very strong even if she has illness. She hopes that through the help of God, she will get soon. She always pray and trust God that He will be there for her. She entrusted her life to God.

PHYSICAL ASSESSMENT

AREA ASSESSED METHOD USED NORMAL FINDINGS ACTUAL FINDINGS REMARKSSKIN

Color

Temperature

Mobility and turgor

Inspection

Palpation

Palpation

Varies from light to deep brown, from ruddy pink to light pink, from yellow overtone to olive.

Uniformity of warmth and within the normal rangeVaries with environmental temp. And humidity, body temp. And activity.

Springs back to normal when pinched.

With pallor

37.1

Varies with environmental temp. and humidity, body temp. and activity.

Thin legs and feet.

Slightly Normal

Normal

Normal

Normal

HAIR Color Texture Distribution

InspectionPalpationinspection

BlackFine, straight, silky and resilientEvenly distributed hair

BlackFine but dryEvenly distributed hair

NormalNormalNormal

NAIL Shape and contour inspection Nail surface is slightly curved or flat Surface is slightly curved Normal Color Blanch test

Inspectionpalpation

Nail edges are smooth, rounded and cleanPink, highly vascularized

Prompt return of usual color(1sec.)

Edges are rough and dirtyYellowish-whitishPrompt return of usual color

Due to poor hygieneNormalNormal

Head Size and shape Inspection Normocephalic and symmetrical facial

movementNormocephalic and symmetrical facial movement

Normal

Facial structures Inspection No abnormalities in structure, no involuntary muscle movement in facial muscles

No abnormalities in structure, no involuntary muscle movement in facial muscles

Normal

EYES Eyebrows

Eyelashes

Eyelids

Conjunctiva

Pupil

Sclera

Inspection

Inspection

Inspection

Inspection

Inspection

inspection

Hair evenly distributed, skin intactSymmetrically aligned, equal movementEqually distributed, curved slightly outwardClear, no discharge

PERRLA

Clear and unicteric

Hair evenly distributed, skin intactSymmetrically aligned, equal movementEqually distributed, curved slightly outwardClear, no discharge

PERRLA

Clear and unicteric

Normal

Normal

Normal

Normal

Normal

NormalNOSE

Size, shape and color

Discharge Nares Septum

InspectionInspectionInspection

Inspection

Symmetric and straight, color brown same as facial colorNo dischargeNo nasal flaringIntact and in midline

Symmetric and straight, color redNo dischargeNo nasal flaringIntact and in midline

NormalNormalNormal

NormalMOUTH

Lips

Teeth

Gums

Inspection and palpationInspection

Inspection

Pink color, soft, moist, smooth

Smooth, white, shiny tooth enamel

Pink gums, moist, firm in texture

Dry lips

Smooth, yellowish enamel, incomplete teethPink gums, moist, firm in texture

Due to possible dehydration

Normal

Normal

NECK Head movement

Inspection Coordinated smooth movements without discomfort

Coordinated smooth movements without discomfort

Normal

TH0RAX AND LUNGS Posterior and

anterior thorax Lungs

Inspection

Auscultation

Chess wall intact, no tenderness

Chest symmetric

Elevated chest wall

Chest symmetric

Due to abnormalities in lungs

NormalABDOMEN

symmetry umbilicus

tenderness

Inspection

Palpation

Symmetrical bilaterally midline and inverted, no sign of discoloration, inflammation

No tenderness

Symmetrical bilaterally midline, with discoloration and inflammation

Rigid and tender

Normal

Associated with gastroinstestinal abnormalities

EXTREMITIES upper

lower

Inspection and palpation

Inspection and palpation

No edemaNo lesions

No edemaNo lesions

No edemaNo lesions

No edema on her feet and legs nor lesions on legs

Normal

Normal

LABORATORY ANALYSIS

HEMATOLOGY RESULT

Hemoglobin in mass concentration - 129 (120 – 160 g/L)Erythrocyte Volume Fraction - 0.37 (0.38 – 0.47)Erythrocyte Number Concentration - 3.82 (4.5 to 6.0 x 109 /L)Thrombocyte Number Concentration - 175 (150 – 400 x 109 /L)Mean Corpuscular Volume (MCV) - 98.2 (80 – 100 fL)Mean Corpuscular Hemoglobin (MCH) - 37. 7 (26 – 32 pg)Mean Corpuscular Hemoglobin Content - 343 (320 – 360 g/L)Leukocyte Number Concentration - 15.2 (4.5 – 11 x 109 /L)

WBC Differential Count:

Neutrophils - 96.9 (35 – 65)Lymphocytes - 2.6 (20 – 40)Monocytes - 0.5 (2 – 8)

URINALYSIS RESULT

Physical Test:Color - amberTransparency - turbidpH - 5.0Specific Gravity - 1.030

Chemical TestAlbumin - TraceSugar - NegativeKetone - PositiveBlood - PositiveBilirubin - NegativeNitrite - NegativeLeukocytes - Negative

DRUG STUDY

D5LRS + BIOMIX

CELEMIN ½ x 12⁰ OD

KETOROLAC 30 mg IV q 8⁰

GENERIC NAME:KetorolacBRAND NAME:ToradolCLASSIFICATION:Nonsteroidal anti-inflammatory agents, nonopioid analagesicsDOSAGE:30mg/amp1 amp IMMECHANISM OF ACTION:- Inhibits prostaglandin synthesis, producing peripherally mediated analgesia- Also has antipyretic and anti-inflammatory properties.- Therapeutic effect:Decreased painINDICATION:Short term management of pain (not to exceed 5 days total for all routes combined)

CONTRAINDICATIONS:- Hypersensitivity- Cross-sensitivity with other NSAIDs may exist¨Pre- or perioperative use- Known alcohol intoleranceUse cautiously in:1) History of GI bleeding2) Renal impair-ment (dosage reduction may be required)3) Cardiovascular diseaseSIDE EFFECTS/ ADVERSE EFFECTS:- CNS:1) drowsiness2) abnormal thinking3) dizziness4) euphoria5) headache-- RESP:1) asthma2) dyspnea- CV:1) edema2) pallor3) vasodilation- GI:1) GI Bleeding2) abnormal taste3) diarrhea4) dry mouth5) dyspepsia6) GI pain7) nausea- GU:1) oliguria2) renal toxicity3) urinary frequency- DERM:1) pruritis2) purpura3) sweating4) urticaria- HEMAT:1) prolonged bleeding time- LOCAL:1) injection site pain- NEURO:1) paresthesia- MISC:1) allergic reaction, anaphylaxisNURSING IMPLICATIONS/RESPONSIBILITIES:- Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria.- Assess pain (note type, location, and intensity) prior to and 1-2 hr following administration.- Ketorolac therapy should always be given initially by the IM or IV route. Oral therapy should be used only as a continuation of parenteral therapy.

- Caution patient to avoid concurrent use of alcohol, aspirin, NSAIDs, acetaminophen, or other OTC medications without consulting health care professional.- Advise patient to consult if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headche, or influenza-like syndromes (chills,fever,muscles aches, pain) occur.- Effectiveness of therapy can be demonstrated by decrease in severity of pain. Patients who do not respond to one NSAIDs may respond to another.

HYDROCORTISONE 100 g IV q 8⁰ x 1 dose more

HYDROCORTISONE ACETATEAnusol HC, CaldeCort, Carmol HC, Colifoam, Cortaid, Cortamed, Cort-Dome, Cortef Acetate, Corticaine, Cortifoam, Cortiment , Epifoam, Hydrocortone AcetateHYDROCORTISONE CYPIONATECortef FluidHYDROCORTISONE SODIUM PHOSPHATEHydrocortone PhosphateHYDROCORTISONE SODIUM SUCCINATEA-Hydrocort, Solu-CortefHYDROCORTISONE VALERATEWestcortClassifications: skin and mucous membrane agent; antiinflammatory; synthetic hormone;adrenal corticosteroids; glucocorticoid; mineralocorticoidPregnancy Category: CNURSING IMPLICATIONS

Assessment & Drug Effects Establish baseline and continuing data on BP, weight, fluid and electrolyte balance, and blood

glucose. Lab tests: Periodic serum electrolytes blood glucose, Hct and Hgb, platelet count, and WBC

with differential. Monitor for adverse effects. Older adults and patients with low serum albumin are especially

susceptible to adverse effects. Be alert to signs of hypocalcemia (see Appendix F). Ophthalmoscopic examinations are recommended every 2–3 mo, especially if patient is

receiving ophthalmic steroid therapy. Monitor for persistent backache or chest pain; compression and spontaneous fractures of long

bones and vertebrae present hazards. Monitor for and report changes in mood and behavior, emotional instability, or psychomotor

activity, especially with long-term therapy. Be alert to possibility of masked infection and delayed healing (antiinflammatory and

immunosuppressive actions). Note: Dose adjustment may be required if patient is subjected to severe stress (serious

infection, surgery, or injury). Note: Single doses of corticosteroids or use for a short period (<1 wk) do not produce

withdrawal symptoms when discontinued, even with moderately large doses.Patient & Family Education Expect a slight weight gain with improved appetite. After dosage is stabilized, notify

physician of a sudden slow but steady weight increase [2 kg (5 lb)/wk]. Avoid alcohol and caffeine; may contribute to steroid-ulcer development in long-term

therapy. Do not ignore dyspepsia with hyperacidity. Report symptoms to physician and do NOT self-

medicate to find relief. Do NOT use aspirin or other OTC drugs unless prescribed specifically by the physician. Note: A high protein, calcium, and vitamin D diet is advisable to reduce risk of corticosteroid-

induced osteoporosis. Notify physician of slow healing, any vague feeling of being sick, or return to pretreatment

symptoms. Do not abruptly discontinue drug; doses are gradually reduced to prevent withdrawal

symptoms. Report exacerbation of disease during drug withdrawal.

Carry medical identification at all times. It needs to indicate medical diagnosis, drug therapy, and name of physician.

Apply topical preparations sparingly in small children. The hazard of systemic toxicity is higher because of the greater ratio of skin surface area to body weight.

Check shelf-life date on topical corticosterone during long-term use. Do not breast feed while taking/using this drug without consulting physician.

FUROSEMIDE 40 mg IV q 8⁰ with BP precaution

GENERIC NAME: furosemide

BRAND NAME: Lasix

DRUG CLASS AND MECHANISM: Furosemide is a potent diuretic (water pill) that is used to eliminate water and salt from the body. In the kidneys, salt (composed of sodium and chloride), water, and other small molecules normally are filtered out of the blood and into the tubules of the kidney. The filtered fluid ultimately becomes urine. Most of the sodium, chloride and water that is filtered out of the blood is reabsorbed into the blood before the filtered fluid becomes urine and is eliminated from the body. Furosemide works by blocking the absorption of sodium, chloride, and water from the filtered fluid in the kidney tubules, causing a profound increase in the output of urine (diuresis). The onset of action after oral administration is within one hour, and the diuresis lasts about 6-8 hours. The onset of action after injection is five minutes and the duration of diuresis is two hours. The diuretic effect of furosemide can cause depletion of sodium, chloride, body water and other minerals. Therefore, careful medical supervision is necessary during treatment. The FDA approved furosemide in July 1982.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS: Tablets: 20, 40, and 80mg. Oral solution: 10 mg/ml, 40 mg/5 ml. Injection: 10 mg/ml

STORAGE: Furosemide should be stored at room temperature in a light resistant container.

PRESCRIBED FOR: Furosemide is a powerful diuretic that is used to treat excessive accumulation of fluid and/or swelling (edema) of the body caused by heart failure, cirrhosis, chronic kidney failure, and the nephrotic syndrome. It is sometimes used alone or in conjunction with other blood pressure pills to treat high blood pressure.

DOSING: The usual starting oral dose for treatment of edema in adults is 20-80 mg as a single dose. The same dose or an increased dose may be administered 6-8 hours later. Doses may be increased 20-40 mg every 6-8 hours until the desired effect occurs. The effective dose may be administered once or twice daily. Some patients may require 600 mg daily. The starting oral dose for children is 2 mg/kg. The starting dose may be increased by 1-2 mg/kg every 6 hours until the desired effect is achieved. Doses greater than 6 mg/kg are not recommended. The recommended dose for treating hypertension is 40 mg twice daily.

DRUG INTERACTIONS: Administration of furosemide with aminoglycoside antibiotics (for example, gentamicin) or [ethacrynic acid (Edecrin) - another diuretic] may cause hearing damage. Furosemide competes with aspirin for elimination in the urine by the kidneys. Concomitant use of furosemide and aspirin may, therefore, lead to high blood levels of aspirin and aspirin toxicity. Furosemide also may reduce excretion of lithium (Eskalith, Lithobid) by the kidneys, causing increased blood levels of lithium and possible side effects from lithium. Sucralfate (Carafate) reduces the action of furosemide by binding furosemide in the intestine and preventing its absorption into the body. Ingestion of furosemide and sucralfate should be separated by two hours.

PREGNANCY: There are no adequate studies of furosemide in pregnant women.

NURSING MOTHERS: Furosemide is secreted in breast milk. Nursing mothers should avoid breastfeeding while taking furosemide.

SIDE EFFECTS: Common side effects of furosemide include low blood pressure, dehydration and electrolyte depletion (for example, sodium, potassium). Less common side effects include jaundice, ringing in the ears (tinnitus), sensitivity to light (photophobia), rash, pancreatitis, nausea,diarrhea, abdominal pain, and dizziness. Increased blood sugar and uric acid levels also may occur.

IPATROPINE + SALBUTAMOL q 6⁰

CEFTRIAXONE 1g IV q 12⁰

cephalosporin. It preferentially binds to one or more of the penicillin-binding proteins (PBP) located on cell walls of susceptible organisms. This inhibits third and final stage of bacterial cell wall synthesis, promoting osmotic instability, thus killing the bacterium.

Dosage: 1 g IM, 7 gms IVTT every 24 hours

This drug is indicated in patients with neurologic complications, carditis and arthritis. It is also effective in Gram negative infections; Meningitis, Gonorrhea. It is also for Bone and joint infections, Lower respiratory tract infections, middle ear infection, PID, Septicemia and Urinary Tract infections.

Contraindications:

Patients hypersensitive to cephalosporins, penicillins and related antibiotics. Pregnancy (Category B). Breastfeeding women.

Side effects:

CNS: fever, dizziness CV: phlebitis GI: diarrhea, abdominal cramps, pseudomembranous colitis, biliary sludge URO: Genital pruritus; moniliasis HEM: eosinophilia, thrombocytosis, leukopenia SKIN: pain, indurations, tenderness, rash other: hypersensity reactions

Drug Interactions:

Probenecid decreases renal elimination of ceftriaxone Aminoglycosides may cause synergistic effects Alcohol use causes disulfiram like reactions

Nursing Responsibilities:

determine hypersensitivity reactions periodic coagulation studies (PT and INR) should be done. inject in large muscles, such as gluteus maximus or lateral aspect of thigh and rotate sites. report signs such as petechiae, ecchymotic areas, epistaxis or other forms of unexplained

bleeding. avoid alcohol use

OMEPRAZOLE 40mg @V q 8⁰

GENERIC NAME: omeprazole, omeprazole/sodium bicarbonate

BRAND NAME: Prilosec, Zegerid

DRUG CLASS AND MECHANISM: Omeprazole is in a class of drugs called proton pump inhibitors (PPI) that block the production of acid by the stomach. Other drugs in the class include lansoprazole (Prevacid),rabeprazole (Aciphex), pantoprazole (Protonix), and esomeprazole (Nexium). Proton pump inhibitors are used for the treatment of conditions such as ulcers, gastroesophageal reflux disease (GERD) and the Zollinger-Ellison syndrome, which are all caused by stomach acid. Omeprazole, like otherproton-pump inhibitors, blocks the enzyme in the wall of the stomach that produces acid. By blocking the enzyme, the production of acid is decreased, and this allows the stomach and esophagus to heal. Zegerid contains omeprazole and an antacid (sodium bicarbonate). The FDA approved omeprazole in September 1989.

GENERIC AVAILABLE: Yes (Prilosec)

PRESCRIPTION: Yes; No (Prilosec OTC, Zegerid OTC)

PREPARATIONS: Capsules: 10, 20 and 40 mg. Tablets: 20 mg (Prilosec OTC). Powder for oral suspension: 20 and 40 mg

STORAGE: Capsules should be stored at 15 to 30 C (59 to 86 F) and tablets at 20 to 25 C (68 to 77 F). They should be kept away from moisture and light.

PRESCRIBED FOR: Omeprazole is used for treating acid-induced inflammation and ulcers of the stomach and duodenum; gastroesophageal reflux disease (GERD); erosive esophagitis, heartburn; prevention of upper gastrointestinal bleeding in critically ill patients; and Zollinger-Ellison Syndrome. It also is used in combination with antibiotics for eradicating H. pylori infection of the stomach.

DOSING: For ulcers, GERD, erosive esophagitis and eradication of H. pylorithe recommended dose for adults is 20-40 mg daily. Ulcer healing usually occurs within 4-8 weeks.

H. pylori infections are treated for 10-28 days.

The usual dose for prevention of upper gastrointestinal bleeding in critically ill patients is 40 mg daily for 14 days.

Prilosec OTC is used for treating heartburn for up to two weeks, and the usual dose is 20 mg daily.

For the management of Zollinger-Ellison Syndrome the starting dose for adults is 60 mg daily, and the dose is adjusted based on either the response of symptoms or the actual measurement of acid production. Doses greater than 80 mg should be divided. Doses up to 120 mg three times a day have been used in the treatment of Zollinger-Ellison Syndrome.

For maximal efficacy, omeprazole tablets should be taken before meals, swallowed whole and should not be crushed, chewed or opened.

DRUG INTERACTIONS: Omeprazole potentially can increase the concentrations in blood of diazepam (Valium), warfarin (Coumadin), andphenytoin (Dilantin) by decreasing the elimination of these drugs by the liver.

The absorption of certain drugs may be affected by stomach acidity. Therefore, omeprazole as well as other PPIs reduce the absorption and concentration in blood of ketoconazole (Nizoral) and increase the absorption and concentration in blood of digoxin (Lanoxin). This may reduce the effectiveness of ketoconazole or increase digoxin toxicity.

Through unknown mechanisms, omeprazole may increase blood levels of saquinavir and reduce blood levels of nelfinavir and atazanavir, drugs that are used for treating patients with infection caused by the human immunodeficiency virus (HIV). Accordingly, the dose of saquinavir may need to be reduced to avoid toxicity, and the doses of nelfinavir and atazanavir may need to be increased to maintain efficacy.

ASSESSMENT NURSING DIAGNOSIS PLANNING NURSING INTERVENTION

RATIONALE EVALUATION

Subjective:“Nasakit unay toy sugat ko.” As verbalized by the patient.

Objective:- facial grimacing- guarded movement-moaning-irritability-pain scale 9/10

Altered comfort:-pain r/t presence of surgical incision

At the end of the shift as evidence by pain scale of 5/10, the client will be able to verbalized relief from pain

Assessed pain, note location, character, severity

Kept at rest in semi fowler’s position

Encouraged early ambulation

Provided diversional activities

Use in monitoring effectiveness of care

Gravity localized inflammatory exudates into lower abdomen/pelvis

Promote normalization of organ function

Refocuses attention, promote relaxation and may enhance coping abilities

Relief of pain facilitates cooperation with therapeutic intervention

The goal was partially met because client wasn’t able to have relief pain as evidenced by client’s pain scale of 7/10

Objective:Surgical incision

Risk for infection r/t surgical incision

At the end of the shift, the client will achieved timely wound belching and be afebrile

Observed for localized signs at insertion of invasive lines, sutures, surgical incision wounds

Proper handwashing techniques by all caregiver between therapies.

Encouraged early ambulation, deep breathing, couging, position change and emphasize necessity taking antibiotics as

To assess causative / contributing infection

A first-line defense against nosocomial infection/cross contamination

Prevent exposure of client to reduce / correct existing risk for infection

For mobilization of respiratory secretions

Goal met, the pt. achieve timely wound with febrile

directed Premature discontinuation of treatment when client begins to feel well may result in return of infection

Subjective:“Nanghihina talaga ako.”

Objective:Always in bed

Drowsy

listless

Fatigue r/t poor physical condition

After 2 days of rendering interventions, the client will improve sense of energy as evidence by good physical condition, unlistless, undrowsy and can move out of bed.

Measure physiological response to activity

Establish realistic activity goals with client

Provide environment conducive to relief of fatigue

Assist client to identify appropriate coping behavior

To determine degree of fatigue

Enhance commitment to promote optimal outcomes

Temperature and level of humidity all known to affect exhaustion

Promote sense of control and improves self-esteem

Goal unmet due to pain and old age.