Disease

Cues / clues

Diagnosis

Pathophysiology

Objective

Intervention

Rationale

Evaluation

S : Nanghihina ako, pakiramdam ko lagi akong inaantok as verbalized by the patient. Hypothyroidism

Risk for Injury related to the client response to the drug therapy.

Decrease secretion of thyroid hormone.

At the end of the nursing intervention the patient will :

Understand how to take medication.

O:

( + ) wondering ( + ) anxiety

Prepare the client for self care at home by teaching him to monitor his pulse rate. Tell him to notify the physician if the rate exceeds 100 bpm.

Rapid pulse rate may indicate drug toxicity.

At the end of the nursing intervention the pt was understand how to take the medication.

Disease

Cues / clues

Diagnosis

Pathophysiology

Objective

Intervention

Rationale

Evaluation

. S : Palagi akong nahihilo pag may ginagawa ako as verbalized by the patien At the end of nursing intervention the patient will: Report feeling of rest and relaxation. Use vasopressin To maintain vascular tone and perfusion.

Pheochromocytoma

Sympathetic nervous system over activity in association with marked elavated blood pressure.

Use of sedative as prescribe.

At the end of nursing intervention the patient report feeling of rest and relaxation.

O: v/s B/ P : 160 / 140 mmHg T : 37.2 C RR: 32 bpm ( + ) facial grimace

To promote relaxation and rest.

Disease

Cues / clues

Diagnosis

Pathophysiology

Objective

Intervention

Rationale

Evaluation

Cushing Syndrome

S : pagmarami akong iniinom na tubig, ihi lang ako ng ihi as verbalkized by the patient.

After nursing intervention patient will: Fluid vomune excess related to sodium and water retention. Commonly cause by use of corticosteroid medication and frequently due corticosteroid production by the adrenal cortex. Improve urination will be free from injury and complications Regain emotional stability.

Check carefully for sign of infection. Replace potassium as needed.

O : u / o 50 cc / hr. Bp : 70 / 90 mmHg

Signs of infection may be masked as a small temperature elevation assumes increase significance. Cushing syndrome decreases serum potassium level.

At the end of nursing intervention the patient improve the urination.

Disease

Cues / clues

Diagnosis

Pathophysiology

Objective

Intervention

Rationale

Evaluation

Serum pO4 level are increased, S : cramps in the extremeties and stiffness in the hands. As verbalized by the patient.

Caused by a deffeciency of parathormone that results in elevated blood PO4.

At the end of the nursing intervention the patient will Feel comfortable.

Asses respiratory status Institute seizure precautions.

To know if the respiration is normal.

At the end of nursing intervention the patient will feel comfortable.

Hypoparathyroidism

To prevent injury.

O: V / S taken as follows : B/ P 90 / 70 mmHg T: 37.5 C

Disease

Cues / clues

Diagnosis

Pathophysiology

Objective

Intervention

Rationale

Evaluation

Hyperparathyroidism

S: madali akong mapagod, pakiramdam ko hinanghina ako, as verbalized by the patient.

Fatigue related to hypermetabolic stated with increase energy requirement

Overgrowth of hyparathyroid gland as primary disorders of the parathyroid gland or secondary condition occurring with failure as the result of renal retention of phosphorus.

After 8 hour of nursing intervention the patient will: Display improve ability to participate in desire activities.

Monitor vital sign noting pulse rate at rest and when active.

Pulse is typically elevated and even at rest tachycardia up to 160 bpm maybe noted.

After 8 hours of nursing intervention the patient was able to display improve ablility to participate in desire activities.

O: ( + ) decrease performance ( + ) jittery behavior ( + ) irritability. Vital sign taken as follow: T : 37.1 C P : 108 bpm RR : 22 bpm B/p 120 / 80 mmHg

Disease

Cues / clues

Diagnosis

Pathophysiology

Objective

Intervention

Rationale

Evaluation

DIABETES MELLITUS

S : Matagal gumaling ang sugat ko as verbalized by the patient.

Risk for infection related to effect of the disease as manifested by skin lesion.

Chronic disturbance in the production, action or rate of use of insulin, resulting in disturb metabolism of CHO, CHON, and fats.

At the end of nursing intervention patient will manifest :

Provide isolation as indicated.

Reduce for risk of cross contamination . Infectious indicate an impaired ability to form antibodies and a disturb CHON metabolism, blood glucose presents a good culture medium.

At the end of nursing intervention the patient was manifested.

Verbalize understanding individual causative factors.

Check for infection

O: ( + ) wound @ L & R lower extremeties. ( + ) decrease Leukocytes Identify intervention to prevent risk of infection. Demonstrate technique lifestyle changes to promote safe environment.

Disease

Cues / clues

Diagnosis

Pathophysiology

Objective

Intervention

Rationale

Evaluation

HYPERTHYROIDISM

S: Kapag nakakrinig ako ng malakas na boses, bumilibilis ang tibok ng puso ko, as verbalized by the patient.

Ineffective Individual Coping related to nervousness and excitability.

Serum T3. Serum T4.

After 8 hour of nursing intervention the patient will: Feel relax and Relieve the nervousness Feel rested and comfortable.

Maintain a calm quite environment calm and a cool room temperature.

calm and quite reduces stimulation that unduly excite the patient. .a cool room temperature is most comfortable with patient with heat intolerance.

At the end of nursing intervention the patient was relieve the nervousness..

O: Vital sign taken as follow: T : 37.1 C P : 108 bpm RR : 22 bpm B/P 190 /80 mmHg

Maintain adequate nutrition.

Be free of Toxic effects of thyroid hormone.

Disease

Cues / clues

Diagnosis

Pathophysiology

Objective

Intervention

Rationale

Evaluation

ADDISSONS DISEASE

S: Taking Cortisone pills for my severe contact dermatitis, as verbalized by the patient.

Decrease cardiac output related to hypovolemia

Result from lack of ACTH.

After 8 hour of nursing intervention the patient will: Manifest Blood pressure controlled..

O: Vital sign taken as follow: T : 37.3 C B/p 160 / 120 mmHg

Provide hormone replacement w/ hydrocortisone or another steroid with the medication with milk or antacids administer larger dose in the morning than in the afternoon.

Milk or antacids will reduce gastric irritation, the larger morning dose concides with the diurnal peak of the bodies cortisoneproduc tion..

At the end of nursing intervention the patient was manifested.