REPUBLIC OF THE PHILIPPINES

TARLAC STATE UNIVERSITY

COLLEGE OF SCIENCE
DEPARTMENT OF NURSING
LUCINDA CAMPUS, BRGY. UNGOT, TARLAC CITY

________________________________________________________________

NCM-116 LABORATORY:
ORTHO WARD

INDIVIDUAL REQUIREMENTS

Submitted by:
Jia Laurice P. Barandino
BSN 3-2

Submitted to:
Mrs. Adora N. Obregon
 CHARTING

06/16/21 Shift: 7 AM- 1PM

 Subjective: “Masakit paa ko. Hindi na ako makatayo o makalakad ng maayos.” As

verbalized by the patient.
 Objective:
 Reluctance to attempt movement.
 Limited range of motion.
 Decreased muscle strength.
 Vital signs taken as follows:
BP: 150/90mmHg
PR: 24 bpm
RR: 102 rpm
T: 37.8

 Analysis: Impaired physical mobility related to pain as manifested by reluctance to

attempt movement.

 Planning: Within 3 days of nursing interventions, the patient will maintain or increase
strength and function of affected or compensatory body part.

 Intervention:
• Evaluated or continuously monitored degree of joint inflammation or pain.
• Instructed the patient to maintain bed or chair rest. Scheduled activities providing
frequent rest periods and uninterrupted night time sleep.
• Encouraged patient to have adequate fluid intake.
• Assisted the patient with active or passive range of motion.
• Encouraged patient to maintain upright and erect posture when sitting, standing, or
walking
• Encouraged the patient to avoid alcohol.
• Educated the patient with his food intakes such as avoiding rich in purines like sardines,
anchovies, and shellfish and organ meats.
• Provided safety needs of the patient

Dependent:
• Administered anti-inflammatory drugs and also colchicine as prescribed.
• Administered hypertensive drugs as ordered.
•Administered oxygen as needed.

 Evaluation: After 3 days of nursing interventions, the patient will maintain or increase
strength and function of affected or compensatory body part.
NURSING CARE PLAN: #1

ASSESSMENT NURSING DIAGNOSIS PLANNING NURSING INTERVENTION RATIONALE EVALUATION

Subjective: Impaired physical mobility Within 3 days of nursing Independent: After 3 days of nursing
“Masakit paa ko. Hindi na related to pain as interventions, the patient • Evaluate or continuously • Level of activity or interventions, the patient
ako makatayo o manifested by reluctance will maintain or increase monitor degree of joint exercise depends on will maintain or increase
makalakad ng maayos.” As to attempt movement. strength and function of inflammation or pain. progression and resolution strength and function of
verbalized by the patient. affected or compensatory of inflammatory process. affected or compensatory
body part. • Maintain bed rest or • Systemic rest during body part.
Objective: chair rest when indicated. acute attacks and
- Reluctance to Schedule activities important throughout all
attempt providing frequent rest phases of disease to
movement. periods and uninterrupted reduce fatigue and
- Limited range of night time sleep. improve strength.
motion.
- Decreased muscle • Encourage adequate • To assist with excretion
strength. fluid intake. of uric acid and decrease
- Vital signs taken as likelihood of stone
follows: formation.
BP: 150/90mmHg • Assist with active or •Maintains or improves
PR: 24 bpm passive range of motion. joint function, muscle
RR: 102 rpm strength, and general
T: 37.8 stamina.
• Encourage patient to •Maximizes joint
 maintain upright and erect function,maintains
posture when sitting, mobility.
standing, or walking

• Encourage the patient to •That can precipitate

avoid alcohol. acute attack.
• Review foods that are •To avoid foods that
rich in purines like precipitate acute attacks.
sardines, anchovies, and
shellfish and organ meats.
• Provide safety needs. •Help prevent accidental
injuries or falls.

Dependent:
• Administer anti- •To relieve pain and
inflammatory drugs and swelling during acute
also colchicine as attacks.
prescribed.
• Administer hypertensive • To decrease blood
drugs as ordered. pressure.
•Administer oxygen as • To normalize the
needed. increased respiration.

DRUG STUDY #1
NAME OF DRUG DOSAGE, ROUTE AND MECHANISM OF INDICATION CONTRAINDICATION SIDE EFFECTS NURSING
FREQUENCY ACTION RESPONSIBILITY

Generic Name: Dosage: 6 mg, 1 tabFacilitates reduction of Symptomatic treatment - Serious - GI disturbances Priority Nursing
Colchicine inflammation due to of acute attacks of gastrointestinal, - Large doses cause Intervention:
Brand name: Frequency: BID x 3 urate crystals, through gouty arthritis. cardiac or renal profuse diarrhea
days - GI hemorrhage
Rhea Colchicine decreased lactic acid disorder.
Route: P.O. - Rashes
Classification: production of - Be cautious on - Observe patients 10
- Renal damage
Anti-gout leucocytes resulting patient who may - Rarely peripheral rights in drug
from drug’s inhibition have early neuritis Administration
of leucocyte migration manifestation of - Alopecia
and phagocytosis. It these disorder. - Blood dyscrasias - Assess the patient
may also inhibit the - Blood dyscrasia on prolonged before and after giving
treatment.
synthesis of kinins and - Combined the medication
leuktrines. Although hepatic and renal
colchicines is not an disease. -Tell the patient to
analgesics, reduction - Hypersensitivity report any adverse
of inflammation to sulfonamides. reaction.
results to pain relief.
As an anti-osteolytic, it
apparently inhibit - Lab tests: Baseline
mitosis of and periodic
determinations of
osteoprogenitor cells serum uric acid and
and decrease creatinine are
osteoclast activity. advised, as well as
CBC, including
Hgb, platelet count,
 serum electrolytes,
and urinalysis.
- Monitor for dose-
related adverse
effects; they are
most likely to
occur during the
initial course of
treatment.
- Monitor for early
signs of colchicine
toxicity including
weakness,
abdominal
discomfort,
anorexia, nausea,
vomiting, and
diarrhea, regardless
of administration
route. Report to
physician.
- Monitor I&O ratio
and pattern (during
acute gouty attack):
High fluid intake
promotes excretion
and reduces danger
of crystal
formation in
kidneys and
ureters.
- Keep physician
 informed of
patient's progress.
Drug should be
stopped when pain
of acute gout is
relieved.
- Therapeutic
response: articular
pain and swelling
generally subside
within 8–12 h and
usually disappear
in 24–72 h after PO
therapy, and 6–12
h after IV
administration.

Patient & Family

Education

- If taking colchicine
at home, withhold
drug and report to
the physician the
onset of GI
symptoms or signs
of bone marrow
depression (nausea,
sore throat,
bleeding gums,
sore mouth, fever,
fatigue, malaise,
unusual bleeding or
 bruising).
- Keep colchicine on
hand at all times to
start therapy or
increase dosage, as
prescribed by
physician, at the
first suggestion of
an acute attack.
- Avoid fermented
beverages such as
beer, ale, and wine
as they may
precipitate gouty
attack. The
physician may
allow distilled
alcoholic beverages
in moderation.
DRUG STUDY # 2

NAME OF DRUG DOSAGE, ROUTE AND MECHANISM OF INDICATION CONTRAINDICATION SIDE EFFECTS NURSING
FREQUENCY ACTION RESPONSIBILITY

Generic Name: Dose: 100mgs, 1 tab Inhibits xanthine Treatment of primary - Severe renal - Drowsiness Priority Nursing
Allopurinol oxidase, an enzyme or secondary gout, impairment Intervention: Monitor
Frequency: BID hyperurecemia - Headache
Brand name: involved in the - Children except the uric acid level of
Route: P.O resulting from
Allomaron, Allurase, synthesis of uric acid those with the patient.
chemotherapy for - Neuritis
Elavil, Llanol, Lopric, without disrupting the hyperurecemia
malignancies,
Loricid, Purinase, essential urine. Results recurrent calcium secondary to - Paresthesia - Observe patients 10
Puristen, Synol, in decreased uric acid oxalate, renal calculi. malignancy rights in drug
Zelcron, Zyloprim level. Recurrent tophaceous - Idiopathic - Allergic vasculitis Administration
Classification: deposit or uric acid hemochromatosis
stones. - Ecchymosis
Xanthine oxidase - Acute gouty attack - Assess the patient
inhibitor; anti-gout - Hypersensitivity - Skin rash before and after giving
drug - Lactation the medication
- Alopecia
-Tell the patient to
- Gastritis report any adverse
- Diarrhea reaction.

- Nausea and -Assess patient's

vomiting history, gout may be
secondary to disease
- Uremia
such as acute or
 chronic leukemia,
- Leucopenia polycythemia vera,
multiple myeloma or
- Renal failure
psoriasis.
- Acute gouty
attacks -Assess for pain
including location,
- Necrotizing angitis characteristics,
onset/duration,
frequency, quality,
intensity or severity of
pain, precipitating
factors.

-Monitor uric acid

levels every 2 weeks.

-Monitor renal
function; check intake-
output ratio, increase
fluids to 2 L/day to
prevent stone
formation, toxicity,
BUN, creatinine.

-Monitor CBC and

hepatic function at the
start of therapy and
periodically thereafter.

-Be alert for adverse

reaction and drug
interaction, anemia,
hepatitis.

-Advice patient to
avoid hazardous
activities requiring
mental alertness until
CNS effect are known.

-Advice patient to
avoid taking large dose
of vitamin C, it may
cause kidney stone
formation.

-Maintain a diet
enhancing urine
alkalinity, and if taking
drug for calcium
oxalate stones, reduce
dairy products and
refined sugars.
DRUG STUDY # 3

NAME OF DRUG DOSAGE, ROUTE MECHANISM OF INDICATION CONTRAINDICATION SIDE EFFECTS NURSING
AND FREQUENCY ACTION RESPONSIBILITY

Generic Name: Dose:25 mgs, 1 Potent non-steroidal Palliative treatment - Allergy to Hypersensitivity (rash, Priority Nursing
Indomethacin cap compound with in active stages of indomethacin, purpura, pruritus, urticaria, Intervention:
Brand name: anti-inflammatory, moderate to severe aspirin, or angioedema, angiitis, rapid
Frequency: TID rheumatoid fall in blood pressure,
Indocin analgesic, and other NSAID - Observe patients 10
Route: P.O arthritis, ankylosing dyspnea, asthma syndrome in
Classification: antipyretic effects - Nasal polyps rights in drug
rheumatoid aspirin-sensitive patients),
NSAIDs similar to those of spondylitis, acute associated with edema, weight gain, flushing, Administration
aspirin. Appears to gouty arthritis, and angioedema sweating. 
reduce motility of osteoarthritis of hip - History of GI - Assess the patient
polymorph nuclear in patients lesions CNS: Headache, dizziness, ver before and after giving
leukocytes, intolerant to or tigo, light-headedness, the medication
unresponsive to syncope, fatigue, muscle
development of
adequate trials with weakness, ataxia, insomnia,
cellular exudates, salicylates and other nightmares, drowsiness, -Tell the patient to report
and vascular therapy. confusion, coma, convulsions, any adverse reaction.
permeability in peripheral neuropathy,
injured tissue psychic disturbances
resulting in its anti- (hallucinations, - Monitor for
inflammatory depersonalization, therapeutic
depression), aggravation of effectiveness: In acute
effects. gouty attack, relief of
epilepsy, parkinsonism. 
joint tenderness and
CV: Elevated BP, palpitation, pain is usually
chest pains, tachycardia, apparent in 24–36 h;
bradycardia, CHF.  swelling generally
disappears in 3–5 d. In
Special Senses: Blurred rheumatoid arthritis:
vision, lacrimation, eye pain, Reduced fever,
visual field changes, corneal increased strength,
deposits, retinal disturbances reduced stiffness, and
including relief of pain,
macula, tinnitus, hearing swelling, and
disturbances, epistaxis.  tenderness.
- Question patient
GI: Nausea, carefully regarding
aspirin sensitivity
vomiting, diarrhea, anorexia,
before initiation of
bloating, abdominal
therapy.
distention, ulcerative - Observe patients
stomatitis, proctitis, rectal carefully; instruct to
bleeding, GI ulceration, report adverse
hemorrhage, perforation, reactions promptly to
toxic hepatitis.  prevent serious and
sometimes irreversible
Hematologic: Hemolytic or fatal effects.
anemia, aplastic - Lab tests: Monitor
anemia (sometimes renal function, hepatic
fatal), agranulocytosis, function, CBC with
leukopenia, differential, BP and
thrombocytopenic purpura, HR, visual and hearing
inhibited platelet acuity periodically.
aggregation.  - Monitor weight and
observe dependent
Urogenital: Renal function areas for signs of
impairment, hematuria, edema in patients with
urinary frequency; vaginal underlying
cardiovascular disease.
bleeding, breast changes. 
- Monitor I&O closely
 and keep physician
Skin: Hair loss, exfoliative informed during IV
dermatitis, erythema administration for
nodosum, tissue irritation patent ductus
with extravasation.  arteriosus. Significant
impairment of renal
Metabolic: Hyponatremia, function is possible;
hypokalemia, hyperkalemia, urine output may
decrease by 50% or
hypoglycemia or
more. Also monitor
hyperglycemia, glycosuria
BUN, serum
(rare).
creatinine, glomerular
filtration rate,
creatinine clearance,
and serum
electrolytes.

Patient & Family

Education

- Notify physician of
S&S of GI bleeding,
visual disturbance,
tinnitus, weight gain,
or edema.
- Do not take aspirin or
other NSAIDs; they
increase possibility of
ulcers.
- Note: Frontal
headache is the most
frequent CNS adverse
effect; if it persists,
 dosage reduction or
drug withdrawal may
be indicated. Take
drug at bedtime with
milk to reduce the
incidence of morning
headache.
- Do not drive or engage
in other potentially
hazardous activities
until response to drug
is known.
 TARLAC STATE UNIVERSITY

COLLEGE OF SCIENCE

DEPARTMENT OF NURSING

Awarded Level III Status by the Accrediting Agency of Chartered Colleges and Universities in the Philippines

CLINICAL CASE ANALYSIS

Name of Patient Patient X Age: 50 yrs. Gender:

old Male
Address Capas, Tarlac Date 6/16/21
Admitted:
Diagnosis Gouty Arthritis

NURSING HISTORY:
A 50 year old male with who is a construction worker for almost 17 years. He got married
when was 23 years old and being blessed with 4 children (2 boys & 2 girl) .

Nursing history was taken from the patient. At the end of every working the usually have
drinking session with his coworkers in their barracks with often having “kilawin dilis”, liver or
blood and chicken gizzard barbecue as their “pulutan” relayed by the patient. Until a clinical
manifestation was presented as on and off pain in the big toe for almost 2 months. The
manifestation became worse  which made him sought consultation and hence admitted for 2
two days to have the diagnostic procedures be done.

PATHOPHYSIOLOGY:
Risk Factors:

 Age: 50 years old

 Gender: Male
 Excessive alcohol
consumption
 Diet: High in purine

Dysfunction in purine metabolism

Hyperurecemia: serum uric acid at >7mg/DL or >400mmol/L

Urate crystal deposited in synovial fluid (due to low solubility or uric acid) of afftected joint (most
commonly the big toe)

Inflammatory response within joints occurs

Gouty Arthritis

Repeated attack of gouty arthistis

Degenerative arthritis.

DIAGNOSTIC PROCEDURES:
  Joint fluid test. Your doctor may use a needle to draw fluid from your affected joint.
Urate crystals may be visible when the fluid is examined under a microscope.

 Blood test. Your doctor may recommend a blood test to measure the levels of uric
acid in your blood. Blood test results can be misleading, though. Some people have high
uric acid levels, but never experience gout. And some people have signs and symptoms
of gout, but don't have unusual levels of uric acid in their blood.

 X-ray imaging. Joint X-rays can be helpful to rule out other causes of joint
inflammation.

 Ultrasound. This test uses sound waves to detect urate crystals in joints or in tophi.

 Dual-energy computerized tomography (DECT). This test combines X-ray images

taken from many different angles to visualize urate crystals in joints.

MEDICAL MANAGEMENT:

 Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include over-the-counter

options such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), as
well as more-powerful prescription NSAIDs such as indomethacin (Indocin, Tivorbex) or
celecoxib (Celebrex). NSAIDs carry risks of stomach pain, bleeding and ulcers.

 Colchicine. Your doctor may recommend colchicine (Colcrys, Gloperba, Mitigare), an

anti-inflammatory drug that effectively reduces gout pain. The drug's effectiveness may
be offset, however, by side effects such as nausea, vomiting and diarrhea.

 Corticosteroids. Corticosteroid medications, such as prednisone, may control gout

inflammation and pain. Corticosteroids may be in pill form, or they can be injected into
your joint. Side effects of corticosteroids may include mood changes, increased blood
sugar levels and elevated blood pressure.

Name of Student: Jia Laurice P. Barandino

Date Submitted: June 16, 2021 C.I.’s Signature

Form No.: TSU-COS-SF-04 Revision No.: 00 Effectivity Date: June 22, 2016 Page 1 of 1