INTRODUCTION

ESRD-end-stage renal disease secondary to chronic glomerulonephritis in anemia

More than 500,000 people in the United States live with end-stage renal disease (ESRD). The
development of chronic kidney disease (CKD) and its progression to this terminal disease
remains a significant cause of reduced quality of life and premature mortality. Chronic kidney
disease (CKD) is a debilitating disease, and standards of medical care involve aggressive
monitoring for signs of disease progression and early referral to specialists for dialysis or
possible renal transplant. The Kidney Disease Improving Global Outcomes (KDIGO) foundation
guidelines define CKD using kidney damage markers, specifically markers that determine
proteinuria and glomerular filtration rate. By definition, the presence of both factors (glomerular
filtration rate [GFR] less than 60 mL/min and albumin greater than 30 mg per gram of creatinine)
along with abnormalities of kidney structure or function for greater than three months signifies
chronic kidney disease. End-stage renal disease is defined as a GFR of less than 15 mL/min.
According to KDIGO 2012 clinical practice guideline, CKD is classified into five stages
considering the GFR level.
 Stage 1: Kidney damage with normal GFR (greater than 90 ml/min)
 Stage 2: Mild reduction in GFR (60-89 mL/min)
 Stage 3a: Moderate reduction in GFR (45 to 59 mL/min)
 Stage 3b: Moderate reduction in GFR (30 to 44 mL/min)
 Stage 4: Severe reduction in GFR (15 to 29 mL/min)
 Stage 5: Renal failure (GFR less than 15 mL/min)
Normochromic normocytic anemia develops from the decreased renal synthesis of
erythropoietin, the hormone responsible for bone marrow stimulation for red blood cell (RBC)
production. Other causes of anemia in CKD include the following:
 Chronic blood loss: Uremia-induced platelet dysfunction enhances the bleeding tendency
 Secondary hyperparathyroidism
 Inflammation
 Nutritional deficiency
End-stage renal disease is a terminal illness with a glomerular filtration rate of less than 15
mL/min. The most common cause of ESRD in the US is diabetic nephropathy, followed by
hypertension. Other etiologies can include glomerulonephritis, cystic kidney disease, recurrent
kidney infection, chronic obstruction, etc. The disease can present with nausea, vomiting,
metabolic, hematologic, electrolyte derangements, seizures, coma, bleeding diathesis, refractory
fluid overload, hypertension unresponsive to pharmacotherapy, uremic pericarditis, etc.
NURSING THEORY
Watson Human Caring Theory in the care of patient with end - stage renal disease. This was
conducted at Sacred Heart Hospital Male Ward for 48 hours. Findings: Significant assessment
findings during the physical assessment of the patient include the presence nasal flaring, increase
respiratory rate, and presence of rales upon auscultation, decreased urine output, edema on legs
and verbalization of being a burden to family members. Laboratory results revealed above
normal creatinine, blood glucose, and cholesterol levels. Formulated nursing diagnoses which
arranged to priority and include difficulty in breathing related to water retention on lungs;
Ineffective family coping: Feeling of being burden to family related to situational crisis; and
Fluid volume excess related to damaged kidneys. Nursing interventions based on the identified
health problems were done using Watson's human caring theory, which include concepts about
the clinical caritas processes, caring occasion/moment, transpersonal caring and caring/healing
consciousness. The goals of the interventions were met and the patient was discharged from the
hospital for home care management after his condition was stabilized. Conclusion: Watson's
caring theory was effective in the care of patient with end-stage renal disease.
Recommendations: The proposed health guide brochure in the prevention of kidney disease is
recommended for dissemination.
It is believed that Roy’s Adaptation Model of Nursing can guide nursing care to patients with
chronic kidney disease undergoing dialysis, in an attempt to find ways to support these people in
their adaptation to the limitations of the disease, in order to improve their quality of life. The use
of nursing theories such as the Roy’s Adaptation Model of Nursing adopted in the present study
also represents an effort to validate such theories, of work organization, of production of
knowledge and use of nursing specific terms. Likewise, offering high quality care, based on
systematic assistance and nursing theories, also contributes to professional development and to a
better relationship between the patient and family members. In the theoretical model proposed by
Roy, the individual is perceived as a holistic adaptive system, which issues adaptive or inefficient
responses; the environment is understood as all the conditions, circumstances and influences that
surround and affect the individual’s development and behavior. Health is revealed as a state and a
process of being and becoming an integrated and whole person. And finally, the goals of nursing
are seen as the promotion of adaptive responses of the individual in the universe of the four
adaptive modes (7). The four adaptive modes are: physiological mode, self-concept, role playing
and interdependence, and were developed to serve as a framework for assessing the behavior
generated by the stimuli. The practice of nursing is accomplished by the nursing process (NP).
The NP described in Roy’s adaptation model has six steps: behavioral assessment, evaluation of
stimuli, nursing diagnosis, goal setting, intervention and evaluation.

CHAPTER I-ASSESSMENT
 A. Nursing Health History
1. Identifying Data and Source of History
 Psychosocial and Cultural History
Name of Patient: Mrs. DJ
Date Admitted: January 23, 2024
Age: 41
Birthdate: March 25, 1982
Marital Status: Single
Sex: Female
Occupation: NA
Religious Affiliation: Roman Catholic
Country of Origin: Philippines
Place of Residence: Sitio Bucana, Iwahig (POB), Puerto Princesa City
Primary Language: Tagalog
 Date and Time of History: November 25, 2024
 Source of History: Chart Reading, Interviewing Patient and SO
 Reliability: Primary and Secondary Source
2. Reason for seeking health care/ or the Chief complaint(s)
- Body weakness, Vomiting, and Weight loss

3. Reason for seeking health care/ or of the Present illness

- According to the patient few days ago she had experience of generalized body weakness,
and noted elevated creatinine, and then few hours prior to admission patient had several
episodes of vomiting and abdominal pain. (-) fever, (+) poor appetite, (+) HPN (-) DM.
Medications:
FENNOVITA TAB AMLODIPINE 5MG
NAHCO3 650MG OMEPRAZOLE 40MG
CACON 500MG TAB EPO 4000IV
Tabacco Use: Patient stated that she used to smoke during his young age and stopped when she
got older.
Alcohol and Drug Abuse: Patient stated that she always drinks alcohol before especially when
they have occasion like bonding, outing, or achievement to celebrate with her family, friends,
and co-workers.
4. Past Health History
Childhood illness: Patient was not having experiences a serious illness only mild or other
tolerated condition that did not caused her to be hospitalized.
Injuries/Accidents: Patient was not encountering any injuries or accident.
Previous Hospitalization: Patient have a lot of previous hospitalization due to her hypertension
and ESRD.
Medical: Patient have a hypertension and ESRD.
Surgical: Patient was undergone surgery before which is the oophorectomy @ left side.
Psychiatric: Patient had no history of mental illness
Health Maintenance Practices
Immunizations: Patient have immunization before like covid vaccinations.
Screening test: Patient undergo a various screening test during her hospitalization as part of
therapeutic management.
5. Family Health History: According to patient and her SO their family had the history
of hypertension on both mother and father side.
6. Review of System (Person- Gordon Approach)

Health Perception and Patient was not always prioritized her health before, according to
Management Pattern patient health is very important to maintain because being healthy
is one of the good things to achieved, but at her younger age she
was careless in her lifestyle. Now in her current condition she
taking all of her prescribed medications.

Nutritional Metabolic Patient have not good appetite, but she eats three times a day and
Patterns she love eating vegetables and fruits sometimes, she consumes less
than 8 glasses a day. During his hospitalization she is not able to eat
frequent meals a day due to decreased of his appetite because
sometimes she doesn’t feel like eating.

Elimination Pattern Patient urinates more than 3 times a day in yellowish color without
having discomfort, and she defecates 1 or 2 times a day, her stool is
soft to firm in texture without having any discomfort.
 Activity and Exercise Patient loves doing exercise/stretching every morning when she
Pattern wakes up. But in her current condition she is not often doing
exercise because of the pain she felt.

Cognition and Patient has no sensory impairment, she is able to hear, see people
Perception Pattern and make a conversation to significant others and the medical staff.

Sleep-Rest Pattern Patient was having good enough of sleep and rest in the day and
night prior to her condition, but now she feels irritable to the pain
that cause her having insufficient sleep and rest specially in the day.

Self-Perception and Patient has no sensory deficiencies, she can hear, see, talk nicely,
Self-Concept Pattern and oriented to the people, time and place.

Roles and Relationship Patient is single, she has part time job on their church to support her
Pattern needs and her parents. He speaks Filipino and understand English
slightly.

Sexuality and Patient said she is not active when it comes to sex.
Reproduction Pattern

Coping and Stress Patient said when it comes to handling stress, she always prays, she
Tolerance Pattern also eats her favorite food such as macaroni salad, and more
spending time with the family and communicate with them and
make a solution together to solve it.

Values and Belief Patient was mentioned she is Roman Catholic and her source of
Pattern strength is God aside from her family. She realized the importance
of having a close relationship to God is important specially with her
current situation. Before she did not communicate well to God and
attend mass irregularly.

B. Physical Examination
General Health Patient is a well-developed, and have light skin it looks
(Appearance and yellowish in color. swelling via feet and ankles, dry, itchy skin,
Mental Status) trouble sleeping, urinating either too much or too little.
SKIN Patient is warm to touch, and have light skin it looks yellowish
in color.
HAIR Patient hair is evenly distributed, the color is black and slightly
dry
NAILS Patient nails are convex in shape with clubbed fingernails.
swelling via feet and ankles. They’re uniform in color and
consistency and free of spots or discoloration,
 SKULL AND FACE Patient skull is proportionate to body size.
EYE STRUCTURES Patient both eyes are symmetrical in shape and size (-)
AND VISUAL swelling, her eyebrows are thin and evenly distributed and the
ACUITY eyelashes are black in color, the eyelids is normal and
symmetrical, conjunctiva is pale, the sclera appears white, iris
is dark brown in color and is equally round with no
abnormalities and last is the pupil is black and symmetrical in
shape.
EARS AND HEARING Patient auricle is normal racial tone, symmetrical in shape and
elastic, the pinna is recoils when folded, external canal and her
hearing activity can respond to normal voice.

NOSE AND SINUSES Patient nose is a bit sharp, smooth and symmetrical and has
same colon as the face, no palpable mass no pain. Felt by the
patient maxillary sinuses no pain felt by the patient mass or
nodules and no pain felt.
MOUTH AND Patient lips is dry, his teeth is clean and he stated that there is no
OROPHARYNX problem in his oropharynx.

NECK Patient neck is proportional to the size of the head and is

symmetrical, no enlargement of the lymph nodes. (+)
Intrajugular catheter @ left.
THORAX AND Patient muscle that are symmetric has symmetrical chest shape
LUNGS from side to side with no visible deformities such as barrel
chest, kyphosis or scoliosis has no muscle retraction when
breathing, skin color that matches the rest of the body
complexion and a respiratory rate are 18beats/min. he had
clear breath sounds may appear relax and the breathing is quiet
and easy without apparent effort, the facial expression and
limb movements are relax, has smooth and regular breathing
pattern and has symmetric and chest expansion.
HEART AND Patient heart is normal no past history of heart attack and there
CENTRAL VESSELS are no obvious, scars chest wall deformity and the central
vessels had inflamed. listened heart sound, no mucous.
PERIPHERAL Patient is warm to touch, and have light skin it looks yellowish
VASCULAR SYSTEM in color, radial pulse is bilaterally and brachial pulse have
equal strength and his legs is light white no lesion or scars.
BREAST AND Patient breast and axillae are not assessed.
AXILLAE
ABDOMEN Patient have experienced abdominal pain and negative masses
 and no bowel sound but it is bloated, Flat, Normoactive bowel
sounds, soft non tender no genital
MUSCULOSKELETAL Patient is with Erect posture with good balance and normal
SYSTEM gait. Joints and muscles are symmetrical with no swelling,
redness, or deformity. Active range of motion of all joints
without difficulty. No spine curvature from posterior view.
NEROLOGICAL There is no problem with his eyes, he can wake up or blink
SYSTEM well without pain and feels negative swelling. Moves all
extremities symmetrically, appropriate tone.
FEMALE GENITALS Patient female genitals and inguinal area are not assessed.
AND INGUINAL
AREA
RECTUM AND ANUS Patient rectum and anus are not assessed.

A. Diagnostic Procedure

Name of the Definition/description Specific indication of Nursing

diagnostic of the procedure the procedure responsibilities for
procedure the procedure (at
least 4)

Ultrasound An ultrasound is an  Chronic - Go over a brief

imaging test that uses Kidney Disease medical history with
sound waves to make  abdominal pain patients, answer any
pictures of organs, or flank questions about the
procedure.
tissues, and other pain. - Explain to patient the
structures inside your  detection and procedure and its
body. It allows your follow-up of purpose.
health care provider to cysts and -Tell the patient the test
see into your body tumors. usually takes 5 to10
without surgery.  post-operative minutes and that more
Ultrasound is also evaluation, than one bone marrow
called ultrasonography such as specimen may be
or sonography. oophorectomy required.
Ultrasound images may left side. - -encourage oral
be called sonograms fluids to decrease
blood viscosity.
Name of the Date Normal values Values obtained Interpretation and Analysis
Procedure ordered (according to (result of the test)
Hospital
Standard)
1. CBC 01/22/2024
HEMOGLOBIN F- 120-160g/dL 97 (L) A decrease hemoglobin concentration indicates an
absence of red blood cells, which results in a oxygen-
deprived environment inside the body, which causes
weakness or exhaustion.
HEMATOCRIT F- 0.370-0.470 0.300 (L) A decreased hematocrit means that there are not
sufficient quantities of healthy red blood cells in the
body.
RED CELL F- 3.50-5.50x1 3.45 (L) A decreased RBC count has an impact on the body’s
COUNT capacity to carry nutrients and oxygen throughout the
circulatory system.
MCV 80.0- 100.0 fL 79 (L) A low MCV is usually related to anemia and for that
reason, the hemoglobin level in the blood will be below
the normal range. A low MCV (microcytosis) along
with anemia is called microcytic anemia.
MCH 27.0-34.0 pg 25.9 (L) A low MCH value typically indicates the presence of
iron deficiency anemia. Iron is important for the
production of hemoglobin. Your body absorbs a small
amount of iron that you eat to produce hemoglobin.
MCHC 320-360 g/L 318(L) The most common cause of low MCHC is anemia.
Hypochromic microcytic anemia commonly results in
low MCHC. This condition means your red blood cells
are smaller than usual and have a decreased level of
hemoglobin.
RDW-CV 11.0-16.0% 11.7 A normal red blood cell is shaped like a disk with a
depressed center. It is very flexible, which enables it to
change shape – this is needed for a red blood cell to
squeeze through the narrowest of blood vessels called
capillaries
RDW-SD 35.0-56.0 fL 40.6 RDW results help your provider understand how much
your red blood cells vary in size and volume. Even if
your RDW results are normal, you may still have a
medical condition that needs treatment.
WHITE CELL 4.3-10.0X10 9/ 14.40 (H) The WBC increases can be a sign of some blood cancer
COUNT or problems with the bone marrow in addition to
showing that the blood be inflamed or infected/

NEUTROPHILS 50.0-70.0% 74.O (H) High neutrophils means the body is under stress.
Infection, inflammation, stress, and vigorous exercise
can cause increased neutrophil levels (neutrophilia). In
response to these insults, neutrophil reserves in the
bone marrow are released. These spikes are generally
short-term.
LYMPHOCYTES 20.0-40.0% 17.0 (L) If you have low numbers of lymphocytes
(lymphopenia), you are at higher risk of infection.

MONOCYTES 00.0-7.0% 6.0 (L) Low monocyte levels may mean your body is more
susceptible to infection.

CREATININE 0.50-1.00 12.69 (H) High creatinine levels most often mean you
have kidney damage that prevents your kidneys from
working as well as they should.

B. ANATOMY AND PHYSIOLOGY

C. PATHOPHYSIOLOGY

CHAPTER II- PLANNING

Nursing Number of Supporting Data Justification

diagnosis Priority
Infection 1 The diagnosis of NSTIs is still
related to Necrotizing infections are more commonly primarily a clinical one. Imaging
Necrotizing present with excruciating pain out of proportion may be useful in providing data
fasciitis as to presenting symptoms and systemic septic signs when the diagnosis is uncertain. The
evidenced by than non-necrotizing infections. most common plain film finding is
positive Physical findings of necrotizing soft tissue similar to cellulitis with increased
tissue biopsy infections may include tenderness to palpation soft tissue thickness and opacity.
result, beyond the erythematous border, crepitus, and Computed tomography (CT) has
temperature cellulitis. The presence of bullae, ecchymotic greater sensitivity than plain film in
of 39.5 changes to the skin, and dysesthesia or identifying necrotizing soft tissue
degrees paresthesia should also be treated as a necrotizing infections. Plain x-rays have no
Celsius, infection. Subcutaneous emphysema and crepitus value in the diagnosis. Sometimes
erythema and are almost always present. Anesthesia may also under local anesthesia, one may
pain on the be present in some areas due to injury to the probe the area with a finger for signs
affected site, nerve fibers. The infection can spread rapidly of necrotizing tissue. In most cases,
flu-like within hours; hence suspicion should be high for the necrotic tissue can be penetrated
symptoms, necrotizing fasciitis in the presence of intense with little resistance. Aspiration and
myalgia, and pain. gram stain can also be done.
fatigue

Hyperthermia 2 From a physiological perspective,

related to  Fever occurs when either endogenous or hypothermia can be regarded as a
infective exogenous pyrogens cause an elevation in part of the late phase syndrome,
process the body's thermoregulatory set-point. In which represents the systemic
secondary to hyperthermia, the set-point is unaltered, response to infection when the
necrotizing and the body temperature becomes disease has already progressed, thus
fasciitis as elevated in an uncontrolled fashion due to damaged and weakened the
evidenced by exogenous heat exposure or endogenous organism.
temperature heat production.
of 39.5  Hyperpyrexia is the term for exceptionally
degrees high fever (greater than 41 C), which can
Celsius, rapid occur in patients with severe infections.
and shallow
breathing,
flushed skin,
profuse
sweating, and
weak pulse.
Impaired skin 3 Skin integrity data is very important in the The skin is the body’s outermost
integrity evaluation of outcomes and treatments. The defense system that keeps pathogens
related to assessments should include information about the from entering and causing illness.
inflammatory skin’s color, temperature, texture, moisture, When the skin is compromised due
response integrity and also document any open or healing to cuts, abrasions, ulcers, incisions,
secondary to wounds and their locations. and wounds, it allows bacteria to
infection enter causing infections. It is
 important that nurses understand
how to assess, prevent, treat, and
educate patients on impaired skin
integrity.

A. Nursing Care Plan

Assessment Nursing Scientific Planning Implementation Scientific Evaluation

Diagnosis Explanation Rationale
Subjective: Infection Necrotizing The patient - Assess vital signs - To establish After 8 hours of
NONE related to fasciitis is a will be able to and monitor the baseline nursing
Necrotizing subset of avoid the signs of infection. observations intervention the
Objective: fasciitis as aggressive spread of and check the patient was be
-Warm to evidenced by skin and soft infection in his - Prepare the progress of the able to avoid the
touch positive tissue body as well as patient for surgical infection as the spread of
-Irritability tissue biopsy infections the debridement. patient receives infection in his
-Petechiae result, (SSTIs) that contamination medical body as well as
-V/S taken temperature cause to other - Ensure that the treatment. the
Temp: 38.5 of 39.5 necrosis of people. staff performs contamination
degree degrees the muscle double gloving - It involves the to other people.
Celsius. Celsius, fascia and before doing any resection of the
erythema and subcutaneous wound care gangrenous
pain on the tissues. This procedure. tissue to prevent
affected site, infection further spread of
flu-like typically - Place silver- the condition to
symptoms, travels along containing other vital
myalgia, and the fascial dressings on the organs. It
fatigue plane, which affected site/s after involves
has a poor each debridement. extensive and
blood supply, complete
leaving the - Administer the removal of dead
overlying prescribed tissue even
tissues antibiotics. beyond the area
initially of necrosis.
unaffected, - Inform the patient
potentially or caregiver that - This is
delaying there is no need to performed to
diagnosis and avoid direct social prevent
surgical contact. exposure of
intervention. staff, rendering
The wound care, to
infectious serious blood
process can infections that
rapidly may be present
spread, in the necrotic
causing tissues.
infection of
the fascia, - Dressings
peri-fascial containing silver
planes and compounds are
causing a helpful in
secondary addressing
infection of topical and
the overlying direct antibiotic
and treatment of the
underlying affected tissues.
skin, soft
tissue, and - To treat the
muscle underlying
bacterial cause
of necrotizing
fasciitis.

- Necrotizing
fasciitis is not
contagious and
is rarely
transmissible.
Assessment Nursing Scientific Planning Implementation Scientific Evaluation
Diagnosis Explanation Rationale
Subjective: Hyperthermia Patients with Within 4 - Assess the - To assist in After 4 hours of
NONE related to NF are usually hours of patient’s vital creating an nursing
infective systemically nursing signs at least accurate intervention the
Objective: process toxic, interventions, every hour. diagnosis and patient was
-Warm to secondary to presenting the patient Increase the monitor demonstrate
touch necrotizing with fever will have a intervals effectiveness temperature
-Irritability fasciitis as (temperature stabilized between vital of medical within normal
-Petechiae evidenced by greater than temperature signs taking as treatment, range and
-V/S taken temperature of 38°C), within the the patient’s particularly experienced no
Temp: 38.5 39.5 degrees tachycardia, normal vital signs the antibiotics associated
degree Celsius, rapid diaphoresis, range. become stable. and fever- complications.
Celsius. and shallow and even an reducing
breathing, altered mental - Remove drugs
flushed skin, state or excessive administered.
profuse diabetic clothing,
sweating, and ketoacidosis. blankets and - To regulate
weak pulse. The physical linens. Adjust the
examination the room temperature of
should include temperature. the
all parts of the environment
body to search - Administer and make it
for skin the prescribed more
inflammation. antibiotics and comfortable
This is anti-pyretic for the patient.
important in medications.
patients - Use the
presenting - Offer a tepid antibiotics to
with sepsis sponge bath. eradicate the
with no bacteria that
obvious skin - elevate the caused
lesions. head of the necrotizing
bed. fasciitis. Use
the anti-
pyretic
medication to
 stimulate the
hypothalamus
and normalize
the body
temperature.

- To facilitate
the body in
cooling down
and to provide
comfort.

- Head
elevation
helps improve
the expansion
of the lungs,
enabling the
patient to
breathe more
effectively.

Assessment Nursing Scientific Planning Implementation Scientific Evaluation

 Diagnosis Explanation Rationale
Subjective: Impaired skin Altered skin -The patient - Inspect the - Regular After 4 hours of
Reports of integrity related integrity will maintain affected site at assessments nursing
itching, pain, to increases the an intact tissue least once per allow the interventions the
numbness of inflammatory chance of integrity day. Note healthcare patient was able
affected or response infection, changes such team to catch to:
surrounding secondary to impaired -The patient as color deteriorating -To maintain an
area. infection mobility, and will verbalize a changes, wound intact tissue
decreased plan of care to redness, conditions integrity.
function and maintain swelling, early and
Objective: may result in uncompromised temperature, adjust - To verbalize a
Patient the loss of tissue integrity. and pain. Pay treatment as plan of care to
appears limb or, attention if the necessary. maintain
comfortable sometimes, -The patient patient notices uncompromised
with no life. Skin is will be free of change in - Items such tissue integrity.
distress noted. affected by pain. sensation and as specialty
Wound both intrinsic pain. mattresses, -To be free from
dressing and extrinsic -The patient body aligners, pain
changed. factors. will experience - Use friction pillows, -To experience
Wound Intrinsic an improved and pressure- moon boots, an improved
dressing factors can wound healing reducing items cushions, and wound healing
changed. include process. to help with the sliding aids process.
Moderate altered prevention of can help
order due to nutritional -The patient pressure sores. reduce -To verbalize
necrotic status, will verbalize pressure and and demonstrate
tissue. vascular and - Clean the friction, wound care
disease issues, demonstrate patient’s reducing the correctly
and diabetes. wound care wounds risk for tissue
Extrinsic correctly according to injury.
factors hospital policy
include falls, and orders. - Wound
accidents, cleaning
pressure, - Administer usually
immobility, antibiotics as requires an
and surgical ordered. aseptic
procedures. technique.
tools to assist Sterile
with optimal technique
treatment reduces the
plans. spread of
infection.

- To reduce
the spread of
infection or to
treat an
 existing
infection,
either topical
agents or
intravenous
medications
are used.

CHAPTER III- IMPLEMENTATION

A. Medical Management

1. DRUG STUDY

Name of Classification Dose, Mechanism of Contraindication Side Effect Nursing

the Drug & Indication Route & Action Responsibilities
Frequency
Oxacillin Classification: Dose: Oxacillin The use of Oxacillin may cause BEFORE:
Oxacillin is a 120mg inhibits oxacillin is serious side effects Always wash
penicillinase- bacterial cell contraindicated including: hands thorough
resistant β- Route: IV wall synthesis in individuals  hives, and disinfect
lactam. It is by binding to 1 that have  difficulty breathing, equipment
similar to Frequency: or more of the experienced a  swelling of your (whirlpools,
methicillin and Q8 penicillin- hypersensitivity face, lips, tongue, electrotherapeu
has replaced binding reaction to any or throat, devices,
methicillin in proteins medication in  itching, treatment tables
clinical use. (PBPs); which the penicillin  wheezing, and so forth) to
Other related in turn inhibits family of  lightheadedness, help prevent the
compounds are the final antibiotics.[3]  fever, spread of
nafcillin, transpeptidation Cross-  skin rash, infection. Use
cloxacillin, step of allergenicity has  swollen glands, universal
dicloxacillin, peptidoglycan been  joint pain, precautions or
and synthesis in documented in  stomach pain, isolation
flucloxacillin. bacterial cell individuals  feeling ill, procedures as
Since it is walls. Bacteria taking oxacillin  diarrhea that is indicated for
resistant to eventually lyse that experienced watery or bloody, specific patients
penicillinase due to ongoing a previous  nausea,
enzymes, such activity of cell hypersensitivity  vomiting, -
as that wall autolytic reaction when  bruising or swelling
produced by enzymes given around the IV
Staphylococcus (autolysins and cephalosporins needle,
aureus, it is murein and  little or no
widely used hydrolases) cephamycins. urination,
clinically in the while cell wall  painful or difficult
US to treat assembly is urination,
penicillin- arrested.  red or pink urine,
 resistant  upper stomach pain,
Staphylococcus  tiredness,
aureus.  loss of appetite,
 dark urine,
 clay-colored stools,
 yellowing of the
Indication: skin or eyes
Used in the (jaundice),
treatment of  chills,
resistant  sore throat,
staphylococci  swollen gums,
infections.  mouth sores,
 pain when
swallowing,
 skin sores,
 cold or flu
symptoms, and
 cough

Date Name of Classification Dose, Mechanism of Contraindication Side Effect Nursing

Ordered the Drug & Indication Route & Action Responsibilitie
Frequency
Gentamicin Classification: Dose: 8mg Gentamicin Hypersensitivity This
Gentamicin passes through to gentamicin is medication
injection is Route: IV the gram- a can cause
used to treat negative contraindication serious
serious Frequency: membrane in an to its use. A kidney
bacterial Q8 oxygen- history of problems and
infections in dependent active hypersensitivity nerve
many different transport. As or serious toxic damage,
parts of the oxygen is reactions to resulting in
body. required, this is other permanent
Gentamicin why aminoglycosides hearing loss
belongs to the aminoglycosides may (including
class of are not effective contraindicate deafness or
medicines in anaerobic use of decreased
known as bacteria. gentamicin hearing) and
aminoglycoside Gentamicin, like because of the balance
antibiotics. It all known cross- problems.
works by aminoglycosides, sensitivity of The risk is
killing bacteria exhibit patients to drugs increased if
or preventing concentration- in this class. you are older,
their growth. dependent already have
killing. kidney
 Indications: disease, or if
gentamicin is you have a
indicated in severe loss of
bacteraemia, body water
urinary tract (dehydration).
infections,
chest
infections,
severe neonatal
infections and
other serious
systemic
infections due
to susceptible
organisms, in
adults and
children
including
neonates.

Name of Classification Dose, Mechanism Contraindication Side Effect Nursing

the Drug & Indication Route & of Action Responsibilities
Frequency
Ranitidine Classification: Dose:2mg Ranitidine Ranitidine is Gastrointestinal Before:
-Refer to competitively contraindicated for disorders: Abdomina -Assess heart
specific Route: IV and reversibly patients known to l pain or discomfort, rate, ECG, and
product inhibits have hypersensitivity constipation, heart sounds,
guidelines. Frequency: histamine at to the drug. diarrhea, nausea, especially during
A02BA02 - Q8 the histamine Symptomatic vomiting. Rarely, exercise Report
ranitidine; H2-receptors response to therapy acute pancreatitis. any rhythm
Belongs to the of the gastric with Ranitidine General disorders disturbances or
class of H2- parietal cells, Injection does not and administration symptoms of
receptor thereby preclude the site conditions: increased
antagonists. inhibiting presence of gastric Transient pain (IM), arrhythmias,
Used in the gastric acid malignancy. local burning or including
treatment of secretion and Ranitidine is itching (IV) at the palpitations, chest
peptic ulcer gastric excreted primarily site of inj. Rarely, discomfort,
and gastro- volume and by the kidney dosage malaise. shortness of
esophageal reducing should be adjusted in breath, fainting,
reflux disease hydrogen ion patients with and
(GERD). concentration. impaired renal fatigue/weakness.
Duration: 12 function.
 Indications: hours (oral). During:
-Ranitidine -Preparing and
Injection is Administering
indicated for Medications and
the treatment Using the Rights
of duodenal of Medication
ulcer, benign Administration.
gastric ulcer, -Reviewing
post-operative Pertinent Data
ulcer, reflux Prior to
oesophagitis, Medication
Zollinger- Administration.
Ellison
syndrome, After:
Prophylaxis -Report signs of
of stress agranulocytosis
ulceration in and neutropenia
seriously ill, (fever, sore
Prophylaxis throat, mucosal
recurrent lesions, signs of
hemorrhage infection,
from peptic bruising), aplastic
ulcer, anemia (unusual
Prophylaxis fatigue,
of Medelson weakness), or
syndrome. thrombocytopenia
(bruising,
bleeding gums,
nose bleeds).

Name of Classification Dose, Route Mechanism of Contraindication Side Effect Nursing

the Drug & Indication & Action Responsibilities
Frequency
Ceftazidime Classification: Dose:160mg Ceftazidime binds Hypersensitivity Significant: Before:
-Ceftazidime; to 1 or more of to ceftazidime Diarrhea, -Observe for signs
Belongs to the Route: IV the penicillin- and other increased INR; of renal, hepatic or
class of third- binding proteins cephalosporins, overgrowth of haematological
generation Frequency: (PBPs) which or history of non-susceptible dysfunction during
cephalosporins. Q8 inhibits the final severe organisms prolonged therapy.
Used in the transpeptidation hypersensitivity (prolonged use).
systemic step of to any other Blood and During:
treatment of peptidoglycan type of β-lactam lymphatic -Observe site
infections. synthesis in antibacterial system closely for
bacterial cell agents (e.g., disorders: extravasation
Indications: wall. This results penicillins, Eosinophilia, during
-Ceftazidime in the inhibition monobactams, thrombocytosis. administration.
for injection is of cell wall carbapenems). General
indicated for biosynthesis, Patient with disorders and After:
the treatment leading to history of administration -Watch for
of patients with bacterial cell lysis gastrointestinal site conditions: seizures; notify
infections and death. disease, Phlebitis or physician
caused by particularly thrombophlebitis immediately if
susceptible colitis; history (IV); pain or patient develops or
strains of the of seizure inflammation increases seizure
designated disorder. Renal (IM). activity. Monitor
organisms in impairment. signs of
the following pseudomembranous
diseases: colitis, including
Lower diarrhea, abdominal
Respiratory pain, fever, pus or
Tract mucus in stools,
Infections, and other severe or
including prolonged Gi
pneumonia, problems (nausea,
caused by vomiting,
Pseudomonas heartburn).
aeruginosa and
other
Pseudomonas
spp.;
Haemophilus
influenzae.

2. Treatment

Name of Treatment Indication/Purposes Nursing Responsibilities

3. Diet

4. Activity/Exercise
 5. Surgical Management
Debridement of Left Auricle & Sub
Debridement is the medical removal of dead, damaged, or infected tissue to improve the healing
potential of the remaining healthy tissue.[2][3] Removal may be surgical, mechanical, chemical,
autolytic (self-digestion), and by maggot therapy. In podiatry, practitioners such as chiropodists,
podiatrists and foot health practitioners remove conditions such as calluses and verrucas.

Debridement is an important part of the healing process for burns and other serious wounds; it is
also used for treating some kinds of snake and spider bites. Sometimes the boundaries of the
problem tissue may not be clearly defined. For example, when excising a tumor, there may be
micrometastases along the edges of the tumor that are too small to be detected, but if not
removed, could cause a relapse. In such circumstances, a surgeon may opt to debride a portion of
the surrounding healthy tissue to ensure that the tumor is completely removed.

Surgical or "sharp" debridement and laser debridement under anesthesia are the fastest methods
of debridement. They are very selective, meaning that the person performing the debridement has
complete control over which tissue is removed and which is left behind. Surgical debridement
can be performed in the operating room or bedside, depending on the extent of the necrotic
material and a patient's ability to tolerate the procedure. The surgeon will typically debride tissue
back to viability, as determined by tissue appearance and the presence of blood flow in healthy
tissue.
REFERENCES:

1. Jin DC, Yun SR, Lee SW, Han SW, Kim W, Park J, Kim YK. Lessons from 30
years' data of Korean end-stage renal disease registry, 1985-2015. Kidney Res
Clin Pract. 2015 Sep;34(3):132-9. [PMC free article] [PubMed]