Divine Word College of San Jose NURSING DEPARTMENT
A CASE STUDY About Exacerbation of Chronic Obstructive Pulmonary Disease
NCM 103 Respiratory Medical Ward Batangas Regional Hospital Batangas City September 12-16, 2011
Presented By: Group II Leader: Alvin Bonilla Members: Amira Alorro
Philip Luis Benoza Cindy Joy Dela Cruz Ruth Sanchez Mary Abegail Tesalona
Presented To: AGNES B. DOTE, RN, MAN
Clinical Instructor/ Coordinator Bernadeth Aguila RN, MAN
Clinical Instructor Sofia Sandra R. Moraleja RN, MAN
Nurse Training Officer
I. INTRODUCTION Our client XXY is a 60 years old resident of Purok 5, Lipa City, Batangas. He was a former mechanic and welder. He worked there at 32 years and stopped on year 2000 because he was hospitalized at Marry Mediatrics Medical Center and was diagnosed of having COPD. He is living with his beloved wife and siblings. He is a cigarette smoker and uses a pack or 20-30 20- 30 sticks of cigarette a day. The Global Initiative for Chronic Obstructive Lung Disease(GOLD) has defined chronic obstructive pulmonary disease (COPD) as “a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized c haracterized by airflow limitation is usually progressive and associated with an ab normal inflammatory response of the lung to noxious particles or gases”(GOLD,2008,p.2). This updated definition is a broad description that explains COPD and its signs and symptoms. Although previous definitions have categorized emphysema and chronic bronchitis as a types of COPD, this was often confusing because most patients with COPD, present with overlapping signs and symptoms of these two distinct disease processes. People with COPD commonly become symptomatic during the middle adult years, and the incidence of the disease increases with age. Although certain aspects of lung function normally decrease with age-for example, vital capacity and forced expiratory volume in second (FEV1), COPD accentuates and accelerates these physiologic changes. This case study aims to learn more and gain knowledge about COPD so we will be able to develop and improve the client’s condition through the use of nursing process, nursing management and different nursing intervention. II. BIOGRAPHIC DATA Name of Patient: PATIENT XXY Address: Purok 5, Lipa City, Batangas Gender: Gender: Male Age: Age: 60 years old Civil Status: Status : Married Date of Birth: November 10, 1950 Place of Birth: Tipakan, Lipa City, Batangas Educational Attainment : High School Graduate Occupation: Former mechanic and welder Religion: Roman Catholic Chief Complaint : Difficulty of breathing Primary Medical Diagnosis: Exacerbation Of COPD Physician: Date of Admission: Admission: September 8, 2011 at around 3:45pm
III. HEALTH HISTORY A. History of Present Illness It was Tuesday afternoon when the client experience difficulty of breathing. He was brought at Batangas Regional Hospital on September 8, 2011 at exactly 3:45pm. He was pale, weak and irritable. His respiration ranges from 27-30cpm. He was dyspneic with production and secretion of sputum with productive cough. B. Past Health Health History History On 1990 he was diagnosed of having PTB and successfully treated within 6 months. On the year 2000 was first time our client hospitalized at Marry Mediatric Medical Center and diagnosed of having COPD. He was stopped in working. According to our client he is always brought to the hospital several times per year. But this year (2011) it is his third time to be hospitalized at Batangas Regional hospital and he was diagnosed to have exacerbation of chronic obstructive pulmonary disease. From year 2000-2011 he only consumes 5-10 sticks of cigarettes per day. C. Family History There is no history of COPD but there is a history of stroke.
IV. PSYCHOLOGICAL HEALTH A.
Coping Pattern Whenever the client has problems, his family is always there to support her if there are problems encountered regarding financial and conflicts.
Analysis: Coping may be described as dealing with changes successfully or unsuccessfully. It is cognitive and behavioral effort to manage external or internal demands that are approved as exceeding resources of the person.(Fundamentals of Nursing Kozier& Erb pg. 1068) Interpretation:
The client has a good relationship to his families and friends.
B. Interaction Patterns The client expresses his feelings and thoughts to his wife and friends. For him it is essential it is increase trust and bonding and for them to know his feelings. He is a kind of person who does not blame others whatever happens. Analysis: This includes the ways of exposing affection of love, sorrow, anger, to note significant family members in person’s life and openness of communication within a family member. (Fundamentals of Nursing Kozier pg. 193) Interpretation: The client is open and very close to his family and friends. This is essential to improve social life.
C. Emotional Pattern If the patient gets angry he tells it frankly to his family and relatives in good manner in order to maintain good relationship to them. Analysis: Emotional pattern includes thoughts and actions that relieve emotional distress. It does not improve the situation, but the person often feels better. (Fundamentals of Nursing Kozier pg. 147) Interpretation: Good relationship to his family is very important to him: He believed that doing good communication is the best way to have good relationship to them.
D. Family Copping Pattern When he encountered problems he tells it to his wife. Analysis: The families have functions that are important in how individual family members meet their needs and maintain their health. The family provides the individual with the necessary environment for development and social interactions. (Lippincott Williams and Wilkins of Nursing page 30) Interpretation: Being open to his wife is a good quality to solve any problems.
E. Cognitive Pattern The client finished elementary and high school. He was attentive in school. He can speak and understand English and Filipino. Analysis: The families have functions that are important in how individual family members meet their needs and maintain their health. The family provides the individual with the necessary environment for development and social interactions. (Lippincott Williams and Wilkins of Nursing page 30) Interpretation: The client can read and understand Filipino and English.
F.Self Concept He loves and accepts who he is physically. Analysis: Self-concept involves all of the perception that is appearance, values, beliefs that influence behavior and that are referred to when using the word I or me. It is over mental image of oneself. (Fundamentals of Nursing, kozier and Erb’s page 957) Interpretation: He accepts things easily.
G. Sexuality He is contended of being a male and accepts responsibility of being a father. Analysis: Sexuality is an individually expressed and highly personal phenomenon whose meaning evolves from life experiences. Satisfying or normal sexual expression can generally be described as whatever behaviors give pleasure and satisfaction to the adults involved, without treat of coercion or injury to self or others (Kozier & Erb’s Fundamentals of Nursing page 1029) Interpretation: He is satisfied with what he had now.
V. Socio-cultural Health A. Cultural Pattern The client instructed his siblings to obey or respect elders and everyone. They have family reunion yearly. They love eating Filipino foods. Analysis: Cultural Pattern refers to cultural beliefs that we are practicing. Culture is a non physical trait such as beliefs, attitudes and customs that is shared by a group. (Kozier and Erb’s Fundamentals of Nursing page206) Interpretation:Their family believes that respecting others is a good quality that Filipinos must have. They love eating Filipino dishes.
B. Significant Relationship The patient significant others give their best to support and give his strength to face his problem. Analysis: Significant relationship is the client’s support systems in times of stress what affects the client illness has on the family and whether family problems are affecting the client. (Kozier and Erb’s Fundamentals of Nursing page 268) Interpretation: His significant others serve as his backbone in every moment of his life especially his family.
C. Recreation The patient loves playing softball and billiards and he spend most of his times by smoking at least 10-30 sticks of cigarettes per day. Doing these made him more relaxed and it became his hobby. He also loves drinking liquors occasionally. Analysis: Recreation or hobbies are an exercise activity and tolerance hobbies and other interest and vocations. (Kozier and Erb’s Fundamentals of Nursing page 263) Interpretation: Clients recreation and hobbies are not good for his health even though it decreases stress. Those hobbies are risk factors for developing much kind of diseases.
D. Environment: The client live in a simple but a clean house together with his beloved family. They have dogs. They can move freely and comfortably in their house. Analysis: Environment is all of the conditions, circumstances and influences surrounding and affecting the development of a person. Physical environment consider the natural boundaries, sizes and population density, types of dwells and incidence of crime and vandal ism. (Kozier and Erb’s Fundamentals of Nursing page 201) Interpretation: He is living in a healthy place. They love pets.
E. Economic He has a enough salary for his family. He is prioritizing foods. Analysis: Economic status identifies the client’s abilit y to pay or afford medical care or health care in order to ensure his or her own health stability. Interpretation:They have slightly enough money to buy and support basic needs.
VI. SPIRITUAL HEALTH A. Religious Beliefs & Practices He is a Roman Catholic. They attend mass occasionally and he prays every night. Analysis: Spiritual and religious belief can signifies that affect health behavior. It also refers to that part of being human that seeks meaningfulness through intra, inter, and transpersonal connection. Spirituality generally involves a belief in a relationship with some higher power, creative, divine being or infinite source of energy. (Kozier and Erb’s Fundamentals of Nursing page 1042) Interpretation: The client has faith in God.
B. Value & Valuing He valued most and keeps treasured all the things he received from others. He also valued of taking care of his family. Analysis: Values are freely chosen enduring belief or attitude about the worth of a person, object idea or action. It is important because it influences decision and actions including nurse’s ethical decision making. (Kozier and Erb’s Fundamentals of Nursing page 6 9) Interpretation: He appreciates all the things that he receives from his friends and family.
VII. ACTIVITIES OF DAILY LIVING Activities of Daily Living
Before Hospitalization
During Hospitalization
Analysis
Interpretation
1. Nutrition
The patient eats 3x a day and he usually eats rice, meat, vegetables and fish and drinks 1.5L of water a day.
During hospitalization his food and water intake was lessen.
Nutrition is the sum of all interaction between organism and the food it consumes. (FON pg.1232)
The client ’s intake was lessen because of problem of hospitalization.
2. Elimination
He experienced 5-6x urination and defecates once a day or six to seven times in one week.
His urine output is 30ml/hr. He defecates once a day.
Defecation refers to the emptying of large intestines. Urination is emptying the urinary bladder.
The client has no problem when it comes to urination and defecation.
(Kozier and Erb’s FON pg.1340) pg.1291) 3. Hygiene
He takes a bath daily and brushed his teeth every after meal.
He was not able to do hygienic practices so his family was the one who provides general hygiene for him.
Cleanliness and grooming promote physical and psychiatric well-being. Improved personal hygiene practices reduce illness rates.
The client has slightly good hygiene.
4.Exercise
He has no extraneous activities. From year 2000-2011 he was suffered from COPD and he has lack of exercise.
He doesn’t have any exercise and is always lying in bed. But the relatives provide massage and stretching to his extremities.
Active exertion of muscles involving the contraction and relaxation of muscle group.
He doesn’t have enough exercises for his body.
5.Rest and Sleep
The client sleeps 6-8 hours per day.
The client sleeps 6-7 hours per day.
Rest connotes a condition in which the body is in a decreased state of activity, with the consequent
The client has a normal sleep pattern.
feeling of being refreshed. Sleep is a state of rest accompanied by altered consciousness and relative inactivity. The average amount of sleep required is 8 hrs. 6. Substance Abuse
He consumes 1 pack of cigarette or 2030sticks a day and drinks alcoholic beverages occasionally.
N/A
Substance He has no substance abuse is a abuse during major threat to hospitalization. the health of young adult. Prolonged use can lead to physical and physiologic dependency and subsequent health problems.
VII. Physical Assessment Vital Signs Measurements
Findings
Normal Findings
Interpretation
Blood Pressure
110/70mmHg
90/60-120/80 mmHg
Normal
Respiratory
27bpm
12-20cpm
He is experiencing DOB and trying to compensate enough oxygen.
Pulse/Heart Rate
100bpm
60-100bpm
Normal
Body Temperature
36.5 C
36.6C-37.5 C
Normal
Head to Toe Physical Assessment Body Part
Findings
Norms
Interpretation
Skin
Dry skin
Normally skin is a uniform whitish, pink or brown, depending on the client’s race. No skin lesions should be present except for freckles, birthmarks or moles which may be flat or elevated. Skin should normally feel smooth, even, firm except where there is significant hair growth. A certain amount of roughness is normal.
Due old age
Skull
Smooth and non-tender
Normal skull is smooth, non-tender and without masses or depression.
Normal
Scalp
No lesions and masses found
The scalp should be shiny, intact and without lesions or masses.
Normal
Hair
Dry hair, and the color is black to gray
Hair varies from dark black to pale brown.
Normal
Face
Around shape no nodules and masses
The shape of the face can be oval, round or slightly square. There should be no edema, disproportionate structures or involuntary movements. Should be smooth and uniform in consistency. Absence of nodules and masses.
Normal
Eyes
moves smoothly and symmetrical
Both eyes should move smoothly and symmetrical.
Is in good condition
Eyebrows
Symmetrical and evenly distributed above the eyelids
Eyebrows are symmetrical and evenly distributed above the eyelids.
Normal
Eyelashes
Spaced along the lid margins and curve outward to protect the eye by filtering particles of dirt and dust from the external
Evenly spaced along the lid margins and curve outward to protect the eye by filtering particles of dirt and dust from the external
Normal
environment.
environment.
Conjunctiva
Shiny, moist pink in color
Shiny, moist, salmon pink in color
Good condition
Sclera
Whitish in color with some superficial vessels
Sclera should be white with some small, superficial vessels.
No deformities found
Pupils
Equally round and reactive to light and accommodation
Pupils equal round reactive to light and accommodation. Average pupil size 3-7 mm.
Normal
Eye Movements
Intact and can move 6 cardinal directions
EOM is intact; can move I 6 cardinal directions
In good condition
Peripheral Vision
Able to see the fields, stimulus at about 60 ۫ temporally, superiorly, 90۫ inferiorly and 50 ۫ 70۫ nasally
Visual Acuity
Able to see.
Able to see and read newspaper’s headline, by lines, detailed newsprint. Normal vision is 20/20
Normal
Nose
Symmetry in the midline of the face, no swelling, bleeding , lesions and masses that found
The shape of the external nose can vary greatly among individuals. Located symmetrically in the midline of the face and is without swelling, bleeding lesions and masses.
No deformities
Internal nares
Clean with a few cilia
Patent, clean and with a few cilia
Normal
Septum
Located in midline
Septum is located midline
Normal
Ears
Match to the color of the body, centrally positioned and proportioned to head, no foreign bodies, deformities and lesions
The ears should match the flesh color of the rest of the body and should be positioned centrally and in proportion to the head. Cerumen should be moist and not obstruct the tympanic membrane. There should be no foreign bodies, redness, drainage, deformities, nodules or lesions.
Normal
Hearing Acuity
Can able to repeat words. ??
The patient is able to repeat words whispered from a distance of 5 feet
Lips
The lips and membranes pink, no inflammation or lesion
The lips and membranes should be pink and moist with no evidence of inflammation or lesion
In a good condition
Gums
Pale-red stipple surface, no bleeding or swelling found
In light-skinned individuals, the gums have a pale-red stipple surface. The gums should have no bleeding or swelling.
Is in good appearance
Teeth
Incomplete teeth
32 permanent teeth (adult)
Due to aging process
Tongue
Symmetry and moves freely, the color is slightly pink, moist, rough w/ lesion
The dorsum of the tongue should be pink, moist, rough and without lesion. The tongue should be symmetrical and moves freely.
Is in good condition
Frenulum
It locate to the floor of the mouth, is in the midline and moist
Located at the floor of the mouth, interiorly, midline, moist
Normal
Buccal Mucosa
Moist, smooth and free of lesion
The buccal mucosa should Normal be moist, smooth and free of lesion.
Neck
Can able to move from side to side and freely movable
Able to move from side to side, freely movable
Normal
Thorax
symmetrical from side to side
Although no individual is absolutely symmetric in both hemispheres, most individual are reasonably similar form side to side. The normal depth of inspiration is non exaggerated and effortless
Good condition
Abdomen
Same color to the body, no presence of lesions, masses and tenderness. Absence of bowel sounds <5x/min.
Should have the same color, as the rest of the body, no presence of lesion, masses and tenderness, liver should not be palpable. Bowel sounds are usually high pitched occurring at 5-30 times/minute.
Client has irregular defecation.
*******
*********
Upper Extremities Hands
Compete fingers in each hand and able to do ROM
There are five fingers in each hand. Able to do ROM.
********
Normal
Nails
Normally nails have pink cast. the capillary refill return to normal w/ in 2- 3 seconds
Lower Extremities
Normally, the nails have a pink cast for light-skinned individuals. The capillary refill may vary with age but color should return to normal within 2-3 seconds.
Due to her disease process
*********
*******
*******
Legs
Knees are in align and able to flex and extend the legs with no audible clicks will be heard during joint movement
Knees are in alignment with each other. The foot is in alignment with the lower leg. The patient will be able to flex and extend the legs with no audible clicks will be heard during joint movement
Normal
Nails
The nails have pink cast capillary refill may vary color should return to normal w/in 2-3 seconds
Normally, the nails have a pink cast for light-skinned individuals. The capillary refill may vary with age but color should return to normal within 2-3 seconds.
Good condition
IX. Laboratory Findings/ Diagnostic Examination Tests
8-26-11
Normal Findings
Interpretations
Hbg
133.4g/L
120 – 170 g/L
Normal
Hct
0.407
0.37 - 0.45
Normal
WBC
MPV 8
5.10 x 10 g/L
Normal
MCV
83.90
80-96 fl
Normal
MCH
27.48
27-31pg
Normal
MCHC
33
33-36g/dl
Normal
Neutrophils
0.778
0.54 - 0.75
increase
Lymphocyte
1.160
0.35 – 0.45
increase
Monocytes
0.048
0.01 – 0.06
normal
Eosinophils
0.011
0.01 – 0.04
normal
Thrombocytes
349
150 - 400
normal
glucose
9.16mmol/L
4.10 – 5.90
increase
BUN
4.52
2. 1 -7.1
increase
Creatine
85.52
53 – 106
normal
Cholesterol
5.53
Up 5.2
increase
LDL
3.80
Up 2.47
increase
HDL
1.14
0.78 –2.21
normal
Triglycerides
1.31
0.68 – 1.88
normal
Sodium
8- 27-11 135- 148
normal
147.7
8-26-11 145.7
XII. Anatomy and Physiology
normal
Raises
High blood
blood
sugar
sugar
Promote s insulin release
Glucagon Stimulates breakdown of glycogen
Glycogen-glucose
Insulin Stimulate formation of glycogen
Promote glucose release
Lower blood sugar
tissue cells
low blood sugar
XIII. Pathophysiology (Flow Chart Format)
Modifiable
Non-modifiable
Obesity- 93kg BMI-34.96 Lifestyle-smoking, drinking liquor, sedentary Diet-high fat, cholesterol, CHO,CHON,
Age -49y/o
I Poor production of Beta cells
Impaired insulin secretions
Insulin Resistance
Intracellular: failure of
Metabolic syndrome
glucose to enter in ICS
(Prevent build-up of
Intravascular: increase glucose in blood
glucose in the blood) Hypergylcemia 9.16mmol L Hypertension
Systemic blood Viscosit
Hypercholesterolemia Sluggish circulation ECF/ICF dehydration
Cell Starvation Increase Osmotic pressure in renal tubules
Beta cells cannot keep up with the
Polydipsi
Polyphagi
increase of glucose
Polyuria
Hyperglycemia
Diabetes Mellitus Type
Scale for ranking health conditions and problems according to priorities
Hyperthermia Criteria 1. Nature of the condition or problem presented Scale Wellness state Health deficit Health threat Foreseeable crisis 2. Modifiability of the condition or problem Scale : Easily modifiable Partially modifiable Not modifiable 3. Preventive potential Scale: High Moderate Low 4 .Salience Scale: A condition or problem needing immediate attention A condition or problem not needing immediate attention Not perceived as a problem or condition needing change
Weight
3/3 x 1
1
1/2 x 2
1
3/3 x 1
1
2/2 x 1
1
ANSWER=5
Hypertension 1. Nature of the condition or problem presented Scale Wellness state Health deficit Health threat Foreseeable crisis 2. Modifiability of the condition or problem Scale : Easily modifiable Partially modifiable Not modifiable 3. Preventive potential Scale: High Moderate Low 4 .Salience Scale: A condition or problem needing immediate attention A condition or problem not needing immediate attention Not perceived as a problem or condition needing change
2/3 x 1
0.67
2/2 x 2
1
2/3 x 1
0.67
2/2 x 1
1
Answer = 3.34
Constipation 1. Nature of the condition or problem presented Scale Wellness state Health deficit Health threat Foreseeable crisis 2. Modifiability of the condition or problem Scale : Easily modifiable Partially modifiable Not modifiable 3. Preventive potential Scale: High Moderate Low 4 .Salience Scale: A condition or problem needing immediate attention A condition or problem not needing immediate attention Not perceived as a problem or condition needing change
2/3 x 1
1
1/2 x 2
1
2/3 x 1
0.67
1/2 x 1
0.5
Answer=3.17
XII. Prioritization of the Problems
Nursing Diagnosis#1: HYPERTHERMIA Interaction:
“mainitaangpakiramdamko” Cues/Clues: ,skin is warm to touch, weak, irritable Nursing Diagnosis#2: HYPERTENSION Interaction:
“nahihiloaq at sumasakitangbatokko” Cues/Clues:
BP=140/90 increased blood pressure
Nursing Diagnosis#3: CONSTIPATION Interaction:
“tatlongarawnasiyahindidumidumi” Cues/Clues: Absence of bowel movement
Nursing Analysis Diagnosis Hyperthermia related to increased metabolic rate I – “mainit ang pakiramdam ko”. O – increase in body temperature -flushed skin -warm to touch M– T -39.5 ®c BP- 140/100 Output – 760 cc
Goal & Objectives
Nursing Intervention
Goal: After 8 hours of continuous intervention the client’s temperature will be lessen or gain within normal range. Objectives: After 3 hours of rendering care, the client will state increased comfort, through either verbal reports or behavior
Established
rapport
Maintained calm
voice on Applied
cold compress over the fore head. body Monitor temperature every 4 hours.
Performed tepid
sponge’s bath. Advised
the to
client maintain adequate rest After 3 hours of
health teachings the client and relatives will demonstrate the behavior in monitoring and promoting
Discuss
precipitating factors w/ patient if known
Ra
normothermia.
GENERIC NAME/BRAND NAME
CLASSIFICATION
PHENYTOIN
CNS drug
RANITIDINE
GI drug
AMLODIPINE
Antihypertensive drug
CEFTRIAXONE
Anti-effectives
ACTION
Limits seizure activity by stabilizesneuronal membranes of hyper excitable cells through decreasing influx of sodium during action potential
Inhibits histamine at h2 receptors site in the gastric parietal cells, which inhibits gastric secretion.
INDICATION
Tonic-clonic and psychomotor seizures
DOSAGE
300g q12 x 3 doses
Si bl
50 mg q8 IV
h
10g 1tab OD
2 d
Used in management of various GI disorders such as dyspepsia
Inhibits influx of calcium ion across cell membranes to produce relaxation of coronary vascular smooth muscle, deceaseBP
Hypertension
Inhibits bacterial cell wall synthesis,
Treatment of
1g IV q12 – (ANST)
H
rendering cell wall osmotically unstable, leading to cell death
CLINDAMYCIN
MANNITOL
Anti-infective
(fluid and electrolytes)
Inhibits bacterial protein synthesis by binding the 50s subunit of the ribosome’s
Increase the osmotic pressure of glomerular filtrate, which inhibits tubular reabsorption of water & electrolyte & increase urinary output
susceptible infections
p
300mg 2tab QID Serious anaerobic infections,
H li a i
H s 100cc q4 Reduction of increased intracranial pressure associated with cerebral edema
OMEPRAZOLE
ACETAZOLAMIDE
GI drug
Cardiovascular drug
Suppress gastric secretion by inhibiting hydrogen/potassium ATpase enzyme system in the gastric parietal cell
40mg IV q12
H c w s p i
250mg IV BID
H s el
750 mg SL
H cl
Short term treatment of active duodenal ulcer, GERD
Inhibits carbonic anhydrase activity Adjunctive treatment of chronic simple(open angle) glaucoma & secondary glaucoma
CLONIDINE Cardiovascular drug
Stimulates central alpha- adrenergic receptors to inhibit sympathetic cardio accelerator& vasoconstrictor centers
Management of all grades of hypertension
LOSARTAN
100 mg 1tab OD Cardiovascular drug
Selectively blocks the binding of angiotensin 2 to receptors sites in many tissue
H Treatment of HPN
LACTULOSE GI drug Causes an influx of fluid in the intestinal tract by increasing the osmotic pressure within the intestinal lumen
300 OD HS
Constipation
P lo
Dexamethasone
Hormones & related drugs
4mg IV q 12 Synthetic glucorticoid with marked antiinflammatory
Testing of adrenal corticol hyperfunction
S in
Ticlodipine Cardiovascular drugs
750 mg tab TID Irreversibly inhibits ADP induced plateletfibrinogen binding & platelet-platelet interactions
Paracetamol
P h d
Reduction of risk of thrombotic stroke in patient who have experienced stroke precursors
500 mg IV 300mg RTC
Antipyretic, analgesic Decreases fever
Relief of mild-tomoderate pain; treatment of fever
H al
Insulin Antidiabetic drugs
Subcutaneous Decrease blood glucose
Management of type 2 DM which cannot be controlled by diet ,exercise or weight reduction alone
H c a in in
Diazepam
CNS drugs
STAT Facilitates, potentiates, the inhibitory activity of the CABA at the limbic system & reticular formation
Basal sedations before stressful therapeutic measures of intervention
H d s al
