Davao Doctors College, Inc.

College of Allied Health Sciences

Nursing Program

NRG 301: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND

ELECTROLYTES, INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC RESPONSE,
CELLULAR ABERRATIONS, ACUTE AND CHRONIC
All a Nurse Needs to Know about Medical-Surgical
Nursing

Getting to Know the Course Instructor

Hello! I am (CI name), and I will be your instructor for
NRG301: Care of Clients with Problems in
Immunologic Response. Before we begin, allow me
to introduce myself. I Ma’am/Sir _______________, a
faculty member of the Nursing Program of Davao
Doctors College, Inc. for (no. of years in DDC as
faculty). I garnered by BS Nursing degree from
(school) last (year) and I earned my Master of Arts in
Nursing degree from (school) last (year). I am
currently earning my Doctor of Philosophy in
Education, major in Educational Leadership from the
(school). I serve many hats in Davao Doctors College,
Inc., but, as a college instructor, I teach the following subjects: (subject load).

For this week, I will be your instructor for NRG301: Care of Clients with Problems in
Immunologic Response. I am looking forward to guiding you in learning this course well. If you
want to reach me for any academic-related concerns, you can reach me through the following:

Contact No: Available upon request

Facebook account: ____________________
E-mail address: _______________________
Consultation hours: ___________________

Introduction to the Course

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Nursing Program

The course NRG301 with concepts, principles, theories, and techniques of nursing care of at-risk
and sick adult clients in any setting with alterations / problems in nutrition, and gastro-intestinal,
metabolism and endocrine, perception, and rehabilitation. The learners are expected to provide
safe, appropriate, and holistic nursing care to at-risk and sick adult clients utilizing the nursing
process. Presented below are the specific details of this course:

Course Number: NRG 301

Course Credits 14 units (8 units Lecture, 6 units RLE)

Placement: Third year, First Semester

Prerequisite: NRG 204

Schedule: MTW 7am-3pm

Classroom: Google Classroom Code: (class code here)

Requirements in Completing the RLE Activities

Since most of our sessions for this semester will be delivered through distance learning activities,
the submissions will also be primarily done online, albeit considerations will be extended to those
with extreme limitedness in. To do this, you need to have access to the following applications:

1. Microsoft Office/Google Docs

2. Google Classroom or Quipper (Will depend on the instructor in-charge)
3. Google Meet (or any other teleconferencing app, duly agreed by the whole group)
4. Internet connectivity
Access to a printer and/or scanner is also a plus, but not a requirement.

Daily Activities
Every week, you are expected to follow through the following deliverables:
Day 1 (Monday/Thursday) Day 2 (Tuesday/Friday) Day 3 (Wednesday/Saturday)

Virtual Circle Virtual Circle Virtual Circle

Completion of Module, to be Receiving of Handover Case Presentation (cont.)

submitted within the day
Case Presentation Weekly Quiz and Discussion of
Preparation of PPT Module and Quiz Answers
Presentation
Orientation of Next Week’s Activity

Now that you are done acquainting yourself with the instructor and the course itself, please proceed
to Module 5: Care of Clients with Problems in Immunologic Function.

Term: First Semester S.Y. 2024-2025

Davao Doctors College, Inc.
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Nursing Program

Dates: Week 11 – October 21 to 26, 2024

Class Schedule: MTW: 7:00AM – 3:00PM
No. of Hours: 8 hours per meeting

Instructions
The case analysis manuscript may be handwritten, or computer written. Observe pagination.
Once done, send the compilation of your group’s answers to your clinical instructor.

After the submission, prepare a PPT presentation for your case presentation slated for Days 2 and 3
of your RLE classes. Each member of the group is expected to present during the case
presentations.

Learning Outcomes
At the end of this module, you are expected to:
1. Utilize the nursing process in the care of a client with problems in immunology.
2. Perform a comprehensive health history and assessment based on the case scenario
presented.
3. Utilize assessment information to formulate a patient-centered plan of care.
4. Discuss the therapeutics done for the simulated patient.
5. Explain appropriate nursing interventions per problems identified.
6. Document the care rendered to assigned patient in the simulated health care record
accurately.

As you start with this module, you are free to consult and coordinate with your assigned clinical
instructor. Be sure to get his/her email address and contact number for collaboration and
assistance. Just keep going, you can do it! 😊

_____________
Davao Doctors College, Inc.
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Nursing Program

CASE ANALYSIS:
HIV/AIDS
_____________
A Case Study on the Concept of Immunologic Disorders
HIV/AIDS

Case Scenario: Patient with HIV AIDS

Patient Diane a 31-year-old Filipina Female went to the

hospital on October 9, 2024, due to nausea, vomiting
and diarrhea, she also complains of cough, shortness of
breath and fever.

Upon interviewing her family history she stated that her

father is a diagnosed diabetic and has hypertension.
Her mother is diagnosed with gouty arthritis and also
has hypertension. She is the only daughter and she is
currently engaged to her fiancé.

Upon interviewing her Social history she looked anxious

and displayed signs of depression, sometimes giving a blank expression on her face, her shoulders
are slumped and head is down. She is able to follow instructions and is cooperative. She states that
she was a party girl and really knew how to enjoy life. She started to drink and smoke when she
was in college and liked to party every time possible. She would also go out with boys a lot. She
stated that she first had sex when she was 18 years old with her classmate. Since then she had
been going out with different boys and having sex with or without condom. She stated “i really don’t
mind if the guy doesn’t use condom because I have an irregular menstrual period” When asked how
many sexual partners she already had, she stated that she already lost count but gave an answer of
“maybe around 30 or more.” She stated that she was really a “YOLO” and “enjoy life” kind of person
but insisted that she never did any kind of drugs especially drugs with injections, because she was
afraid of needles.

Upon interviewing her she stated that she had an irregular menstrual cycle. Her past medical
history; that she was diagnosed with HIV 5 years ago when she was 26 years old around 2015. She
has been in and out of the hospital since then. She was admitted again last year 2019 due to
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Pneumonia and in 2018 due to severe diarrhea and dehydration. She was also admitted last 2017
due to severe weight loss and fatigue. She had no surgical procedures done.

October 9, 2024, upon admission, you noticed that the patient appears to be a bit older in her age.
She looked weak and has a thin body built which looks malnourished. She is wearing a sleeveless
shirt. Her height was 5’4’’ and her current weight is 45kg. She stated that before she was 60kgs in
weight. She tells you she lost her appetite “Wala na akong ganang kumain ng marami. Minsan, din
na ako kumakain ng breakfast kasi matamlay pakiramdam ko at nahihirapan akong lumunok kaya
natutulog na lang ako” You ask her for her normal diet and she tells you, she doesn’t eat a lot.
“kalahating cup ng kanin lang ang pinaka marami kong nakakain.” she doesn’t eat vegetables and
drink milk or take vitamins and mostly only eats fried food like fried chicken. Her go to meal is
chicken pruben that you can buy on the sidewalk. She also drinks a lot of soda with every meal. You
noticed that her skin was dry and had a poor skin turgor. No presence of ulcerations or redness
noted. She looks flushed and was warm to touch with temperature of 39.5°C. Hear head is
normocephalic in size. Her face looks thin, cheeks are a bit sunken. Her eyes look sunken also. Her
ears both looked symmetrical and her nose and throat were located at the midline of her head. Her
neck was a little bit thin with slight neck vein distensions noted and the trachea was located midline.
No palpable masses were noted. Her breasts where symmetrical with the left breast slightly bigger
than the right, her nipples and areola were light brown in color. She is having difficulty breathing
with shortness of breath, nasal flaring and uses her accessory muscles in breathing. Her RR IS
28cpm. Her SpO2 was 90%. She sometimes complains of chest pain “Minsan, sumasakit ang dibdib
ko tuwing humihinga ako”. She states that the pain is 8/10 and shows guarding behaviour with her
chest with a grimace look to her face. Her heart rate is 120bpm with a blood pressure of
90/60mmHg. The pulses on her extremities are weak and thready. She has a CRT of 4seconds. She
states she doesn’t have problem in urinating. Her urine output is 40ml/hour. She didn’t want you to
assess her genitals but she stated that it looks normal. She feels weak and needs assistance in
doing activities of daily living. Her GCS is 15/15 Conscious, awake and coherent.

Upon further interview you ask how she is dealing with the illness; she stated that she was given
ART (antiretroviral therapy) but was hesitant to take the drugs because she feels her kidney might
be damaged. She told you “nag ti-take ako ng garlic at naglalagay ako ng cabbage sa breast at
vagina kasi ang sabi nila nakakawala daw ng HIV”. She also stated that she did not tell her fiancé of
her status because she did not want him to leave her because of that. You asked her if they are
wearing condom during sex, and she answers “di talaga ako nagpapagamit ng condom para mas
enjoy, ang dugo lang naman ang dahilan ng pagkakahawa ng HIV kaya di kami nagtatalik pag
dinudugo ako”.

Upon further conversation with the patient she states “Noong di ko pa alam na may sakit ako, parati
kami nag paparty, gala, at inuman, pero ngayon, natatakot na akong lumabas kasi baka malalaman
ng mga tao na may sakit ako. Hindi na ako nagpaparty at walwal at hindi na rin ako nakikipagusap
Davao Doctors College, Inc.
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sa mga katrabaho at kahit sa mga magulang ko kasi nahihiya na ako”. You notice that she has a
sad affect. She states that now she just stays in her room and watch Netflix and only goes out to
buy food and garlic and cabbage. She also has this anxious look on her face when she told you “sa
totuo lang, kinakabahan talaga ako sa buhay ko. Ramdam ko, mamamatay na siguro ako”. her
hands shaking and you notice her sweating.

After assessment you referred the patient to Dr. Sabido, Ken who is a specialist in this type of
illness. His orders were Diet on DAT and CBR without BRP. Insert IV line with gauge 18 to run PNSS
@ 120ml/hr using a macrodrip with drop factor of 15gtts/ml. Place patient on O2 via nasal cannula
@ 4L. Attach patient to cardiac monitor and VS q2hrs. Monitor I and O q hourly with cc per cc fluid
replacement. For TPN (total parenteral nutrition) insertion @ subclavian vein.

3377890 Diane 9/9/1990 RM 213 Dr. Sabido NKFDA

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Nursing Program

October 9, 2024, 11:00am Please admit patient under the service of Dr. Sabido
(Infectious Disease Specialist) at Isolation Room
Vital Signs: Secure consent for admission and care
Temp: 39.5 Seen and examined
Respiratory Rate of 28 cpm 90% History and PE reviewed
oxygen saturation Diet: DAT
Heart Rate of 120bpm place on MHBR
Blood Pressure of 90/60mmHg Hook to O2 at 4lpm via cannula
Monitor I and O q hourly with cc per cc fluid replacement
Assessment:
height: 5’4” Diagnostics:
weight: 45 kgs -Stat Chest Xray (PAL)
(+) weight loss - 12-Lead ECG
(+) Sunken Eye Balls -Start CBC, Lipid Profile, FBS, BUN, Crea, BUA
(+) Multiple Sex Activity -AST, ALT, Hepa B, HBSAG, VDRL ,
(+) nausea & vomiting -kindly retrieve HIV DNA & RNA Testing result & pls attach
(+) Diarrhea to the chart
(+) cough - CD4 Count, Viral Load
(+) shortness of breath - S. Elec: S. Na, S. K, S. Ca, S. Mg, Phosphate, Alkaline
(+) Fever Phosphatase, Total Bilirubin, Amylase
-Sputum GS/CS
GCS- 15/15
Pain Scale- 8/10 Therapeutics:
1. Start IVF of PNSS 1L at 120cc/hr as initial venoclysis
then regulate
at KVO rate once TPN is hooked via triffuse
IVF TF: D5LR 2 Litres at Same Rate
Diagnosed with HIV last 2015 2. Start TPN 1400kcal via subclavian vein for 24-36 hours
per bag x 3 bags

3. Ceftriaxone 2grams OD via soluset ANST ( ) x 7 days

then step down antibiotics of Co-trimoxazole
800mg/160mg/tab q12

4. Paracetamol 300 mg IVTT q4 PRN for Temp 38 and

above

5. Nebulize with Salbutamol + Ipratropium 1 nebule q6

then Budesonide 1 neb BID in between Salbutamol +
Ipratropium

6. Erceflora 1 vial TID for 5 days

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11. Nystatin Oral Suspension 5ml swirl and gargle 3x a day

for 7 days

Dr. Sabido/ Nurse Kobe

3377890 Diane 9/9/1990 RM 213 Dr. Sabido NKFDA

Pls refer to TCVS Surgeon, Dr. Lumiguid for further

evaluation and insertion of central line catheter
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Pls refer to Nutrition Department for Nutrition build up and

counselling

- Refer to the AP once admitted to Isolation ward

Dr. Sabido/ Nurse Kobe

October 10, 2024 11:00AM
Vital Signs: VS Q4H
Temp: 38.5 pH: 7.42 1 and O Q shift
Respiratory Rate of 28 cpm pcO2: Therapeutics:
26mmHg Please continue above medicines and start the following:
90% oxygen saturation
HCO3:25mmoL 1. Abacavir 300mg/tab 1tab q12
Heart Rate of 120bpm SaO2: 90% 2. Agazanir 300mg/tab 1tab OD
Blood Pressure of 90/60mmHg 3. Efaviranz 600mg/tab 1tab OD
4. Rategravir 400mg/tab 1tab BID
Assessment: 5. Maraviroc 300mg/tab 1tab BID
ECG done: Sinus Tachycardia 6. Cobistat 150mg/tab 1tab PO OD
CXray: Bilateral air-space consolidation of 7. Dapsone 100mg/tab 1tab PO OD
Pneumocystis carinii pneumonia 8. Filgrastin 10mcg/kg SQ injfection OD
Sputum GS/CS: 9. Metronidazole 500mg/tab 1tab QID
+ Pneumocystis carinii 10. Zofran 8mg/tab 1tab q12
Urinalysis shows no sign of infection
Her stool test is negative for occult blood. Refer for any untoward signs and symptoms.

Attending Physician: Dr. Sabido/ Nurse Kobe

TCVS NOTES:
Thank you, Dr Sabido, for referring the patient for subclavian
catheter insertion

Seen and examined

History and PE reviewed
October 11, 2024 10:00AM Secure consent for central line placement

(+) anorexic/ cachectic Prepare minor set for the insertion and medical supplies
(+) severe muscle wasting, sudden weight needed, kindly inform me once available.
loss
For stat Xray after the insertion, pls notify the Radiology
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Co-trimoxazole 800mg/160mg/tab q12

Abacavir 300mg/tab 1tab q12
Agazanir 300mg/tab 1tab OD
Efaviranz 600mg/tab 1tab OD
Rategravir 400mg/tab 1tab BID
Maraviroc 300mg/tab 1tab BID
Cobistat 150mg/tab 1tab PO OD
Dapsone 100mg/tab 1tab PO OD
October 15, 2024 8:00AM
Daily hygiene and care
(-) Fever Increase OFI
(-) Dyspnea Follow up check-up at OPD clinic after 7days
(-) Dysuric Advised.

Dr. Sabido / Nurse Kobe

3377890 Diane 9/9/1990 RM 213 Dr. Sabido NKFDA

Laboratory and Diagnostic Results:

A 12-lead electrocardiogram (ECG, EKG) shows sinus tachycardia with a heart rate of 120 beats per
minute.

A chest X-ray;
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ABG result shows;

pH – 7.42
pCO2 – 26mmHg
HCO3 – 25mmol/L
SaO2 – 90%

SPUTOM GC/CS : + Pneumocystis carinii

Urinalysis shows no sign of infection
Her stool tests is negative for occult blood.

HIV laboratories and results

CD4 Cell count
Viral Load Count
Chem-Screen (CS) test
Complete Blood Count (CBC)

CD4 Cell count

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Viral Load Count

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Complete Blood Count (CBC)

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Davao Doctors College, Inc.
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Chem-Screen (CS) test

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Throughout the course of her admission, the following medications were ordered:

• Abacavir 300mg/tab 1 tab q12

• Atazanavir 300mg/tab 1 tab OD
• Efaviranz 600mg/tab 1 tab OD
• Rategravir 400mg/tab 1 tab BID
• Maraviroc 300mg/tab 1 tab BID
• Cobistat 150mg/tab 1 tab PO OD

• Dapsone 100mg/tab 1 tab PO OD

• Filgrastin 10 mcg/kg SQ injection once a day
• Metronidazole 500mg/tab 1 tab QID
• Co-trimoxazole 800 mg/160 mg/tab 1 tab q12
• Zofran 8mg/tab 1 tab q12
• Folic Acid 400 MCG OD
• Ferrous Sulfate 100mg/tab 1 tab PO q12hr
• Metoclopramide 5mg/ml 1ml IVTT q6 PRN for N/V
• Neurobion 1 tab TID
• Paracetamol 500mg/5ml IVTT q6hrs PRN for fever
• Ceftriaxone 2grams OD via soluset ANST ( ) x 7 days
• Paracetamol 300mg IVTT q4 PRN for Temp 38 and above
• Salbutamol + Ipratropium 1 nebule q6
• Budesonide 1 neb BID in between Salbutamol + Ipratropium
• Erceflora 1 vial TID for 5 days
• Nystatin Oral Suspension 5ml swirl and gargle 3x a day for 7 days
Davao Doctors College, Inc.
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Nursing Program

What to do:

1. Fill-up the needed data based on the given scenario/case. Note: Assessment findings of all
other areas must be filled up using fictional data BUT should be within the scope of the case
scenario given.
2. Conduct a history taking and physical assessment of your patient. Use BLUE pen for
normal findings and RED for abnormal findings under Review of Systems (ROS).
3. Develop a Concept Map of your patient’s condition using the Concept Map Format.
4. Present your drug study and IVF data.
5. Prior to administering a patient’s medications, you are required to make a drug study of all
medications required by your patient in oral or parenteral form and document it. Select one
drug. No duplications of selected drugs for study should be made.
6. Formulate a patient-centered care plan for your patient.

7. Clinical Reasoning Questions - Collaboration: You are coming in on your 7-3 shift duty.
During your nursing rounds, you noticed that the patient is anxious and tells you “I feel
obsessed with thoughts about dying. Do you think I am just being morbid?”

What would be your nursing action in this situation?

What ethical principle is applicable in this scenario? Justify?

Knowing that this is a safety concern, how would you tell the staff nurse? Follow the CUS
method.

8. Clinical Reasoning Questions - Ethico-Moral-Legal: Patient Diane is reluctant to

disclose her diagnosis or choose to never reveal her status to her family and especially her
partner. She was very anxious when she told you about this and asked for your advice.
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Communication: Using ISBAR as a model for structured clinical communication and ensure
accurate handover of information between shifts, write down your end of the shift report for the
incoming nurse/student nurse guided by the following questions:

 Identify: Identify yourself, who you are talking to and who you are talking about
 Situation: What is the current situation, concerns, observations, etc.
 Background: What is the relevant background information? This helps to set the
scenario to interpret the situation accurately
 Assessment: What do you think the problem is? This requires the interpretation of
the situation and background information to make an educated conclusion about
what is going on

Recommendation: What do you need them to do? What do you recommend should be done to
correct the current situation?

Reference: http://www.inmo.ie/tempDocs/ISBAR