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: ___________________
 Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

Introduction to the Course

The course NRG304 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
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

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. 2021-2022

Dates: Week 13 – November 8 to 10, 2021
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.
College of Allied Health Sciences
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

November 9, 2020 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 specially drugs with injections, because she was afraid of needles.
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

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 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.

November 9, 2021, 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 naman koy gana mo kaon ug daghan karun, usahay dili na gani ko
magbreakfast kay luya ako lawas ug lisod etulon mao matulog nalang ko.” You ask her for her normal
diet and she tells you, she doesn’t eat a lot. “pinakadaghan nako nga rice kay half cup lang” 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 “usahay nagasakit ako dughan pag mo ginhawa ko” 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 “naga take ko karun ug garlic ug nagabutang ko ug cabbage sa ako breast and
vagina kay makawala daw na sa 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 “wala man gyud ko nagapa condom para enjoy, sa dugo ra bitaw na
makatakod ang HIV. Dili lang me mag sex basta dug.on ko.”

Upon further conversation with the patient she states “Sa una kadtong wala pa ko kabalo nga naa koy
sakit permi ko nagaparty ug laag ug inum. Karun mahadlok nako mo gawas basi makabalo ang mga tao
sa ako sakit. Dili nako naga party party ug naga walwal. Dili napud gani ko kayo naga storya sa ako mga
co-workers pati sa ako parents kay maulaw nako sa ila.” 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 tinood lang gi kulbaan jud ko
sa ako life karun. Mamatay naman cguro ko” 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
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

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.

November 9, 2021, 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
Seen and examined
Temp: 39.5 ℃
History and PE reviewed
Respiratory Rate of 28 cpm 90% oxygen Diet: DAT
saturation place on MHBR
Heart Rate of 120bpm Hook to O2 at 4lpm via cannula
Blood Pressure of 90/60mmHg Monitor I and O q hourly with cc per cc fluid replacement

Assessment: Diagnostics:
-Stat Chest Xray (PAL)
height: 5’4”
- 12-Lead ECG
weight: 45 kgs -Start CBC, Lipid Profile, FBS, BUN, Crea, BUA
(+) weight loss -AST, ALT, Hepa B, HBSAG, VDRL ,
(+) Sunken Eye Balls -kindly retrieve HIV DNA & RNA Testing result & pls attach to the chart
(+) Multiple Sex Activity - CD4 Count, Viral Load
(+) nausea & vomiting - S. Elec: S. Na, S. K, S. Ca, S. Mg, Phosphate, Alkaline Phosphatase, Total
Bilirubin, Amylase
(+) Diarrhea -Sputum GS/CS
(+) cough
Therapeutics:
(+) shortness of breath 1. Start IVF of PNSS 1L at 120cc/hr as initial venoclysis then regulate
(+) Fever at KVO rate once TPN is hooked via triffuse
IVF TF: D5LR 2 Litres at Same Rate
2. Start TPN 1400kcal via subclavian vein for 24-36 hours per bag x 3
GCS- 15/15 bags
Pain Scale- 8/10
3. Ceftriaxone 2grams OD via soluset ANST ( ) x 7 days then step down
antibiotics of Co-trimoxazole 800mg/160mg/tab q12

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

Diagnosed with HIV last 2015 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

7. Metoclopramide 5mg/ml 1 ml IVTT q6 PRN for nausea and vomiting

8. Ferrous Sulfate 100mg 1 tab po q12

9. Folic Acid 400mg mcg OD

10. Neurobion 1 tab TID

11. Nystatin Oral Suspension 5ml swirl and gargle 3x a day for 7 days
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

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

Pls refer to TCVS Surgeon, Dr. Jerome Franz Miñoza Bayaquin for further
evaluation and insertion of central line catheter

Pls refer to Nutrition Department for Nutrition build up and counselling

- Refer to the AP once admitted to Isolation ward

Dr Peter Duhaylungsod Pascua/ Nurse Garcia

VS Q4H
November 10,2021 11:00AM 1 and O Q shift
Vital Signs: Therapeutics:
Temp: 38.5 ℃ pH: 7.42 Please continue above medicines and start the following:
Respiratory Rate of 28 cpm pcO2: 26mmHg
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
5. Maraviroc 300mg/tab 1tab BID
Assessment: 6. Cobistat 150mg/tab 1tab PO OD
ECG done : Sinus Tachycardia 7. Dapsone 100mg/tab 1tab PO OD
CXray: Bilateral air-space consolidation of 8. Filgrastin 10mcg/kg SQ injfection OD
Pneumocystis carinii pneumonia 9. Metronidazole 500mg/tab 1tab QID
Sputum GS/CS: 10. Zofran 8mg/tab 1tab q12

+ Pneumocystis carinii Refer for any untoward signs and symptoms.

Urinalysis shows no sign of infection
Attending Physician: Dr. Sabido/ Nurse Even
Her stool tests is negative for occult
blood.

November 11, 2021 10:00AM TCVS NOTES:

Thank you Dr Sabido for referring the patient for subclavian
(+) anorexic/ cachectic catheter insertion
(+) severe muscle wasting, sudden weight loss
(-) signs of infection at the site Seen and examined
(-) bleeding tendencies
History and PE reviewed

Secure consent for central line placement

Prepare minor set for the insertion and medical supplies needed,
kindly inform me once available.

For stat Xray after the insertion, pls notify the Radiology
Department
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

Dr. Jerome Franz Miñoza Bayaquin/ Nurse Even

May Go Home
November 15, 2021 8:00AM DAT
Home Meds as ordered
(-) Fever
Co-trimoxazole 800mg/160mg/tab q12
(-) Dyspnea
Abacavir 300mg/tab 1tab q12
(-) Dysuric
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

Daily hygiene and care

Increase OFI
Follow up check up at OPD clinic after 7days
Advised.

Dr. Sabido / Nurse Even

Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

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;
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

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

Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

Viral Load Count

Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

Complete Blood Count (CBC)

Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

Chem-Screen (CS) test

Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

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

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?”
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

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.

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