NATIONAL UNIVERSITY

COLLEGE OF ALLIED HEALTH

DEPARTMENT OF NURSING
551 MF Jhocson Street, Sampaloc, Manila

CLINICAL CASE STUDY

Submitted by:

Group 3 NUR151

Arnista, Lucrecio D.
Dimaporo, Aivy
Ebrahim, Hanan M.
Figueroa, Izelle
Pua, Andrea Lougene G.
Raymundo, Kyle S.
Soberano, Hannah Kathleen

Submitted to:
Tess Santiago RN
Clinical Instructors

March 23, 2018

INTRODUCTION

Our patient is admitted in Intensive Care Unit (ICU) of East Avenue Medical Center and was
diagnosed of Intracranial Hemorrhage Left Frontal secondary to Tumor Bleed

Intracerebral hemorrhage (ICH) is a type of stroke caused by bleeding within the brain tissue
itself, a life-threatening type of stroke. A stroke occurs when the brain is deprived of oxygen and
blood supply. ICH is most commonly caused by hypertension, arteriovenous malformations, or
head trauma. Treatment focuses on stopping the bleeding, removing the blood clot (hematoma),
and relieving the pressure on the brain.

Ten percent of strokes are caused by ICH (approximately 70,000 new cases each year). ICH is
twice as common as subarachnoid hemorrhage (SAH) and has a 40% risk of death. ICH occurs
slightly more frequently among men than women and is more common among young and
middle-aged African Americans and Japanese. Advancing age and hypertension are the most
important risk factors for ICH. Approximately 70% of patients experience long-term deficits after
an ICH.

Once the cause and location of the bleeding is identified, medical or surgical treatment is
performed to stop the bleeding, remove the clot, and relieve the pressure on the brain. If left
alone the brain will eventually absorb the clot within a couple of weeks, however the damage to
the brain caused by ICP and blood toxins may be irreversible.

Generally, patients with small hemorrhages and minimal deficits are treated medically. Patients
with cerebellar hemorrhages who are deteriorating or who have brainstem compression and
hydrocephalus are treated surgically to remove the hematoma as soon as possible. Patients
with large lobar hemorrhages who are deteriorating usually undergo surgical removal of the
hematoma.
THEORETICAL FRAMEWORK

Theory of Comfort

By Katharine Kolcaba

According to Kolcaba, comfort is a product of holistic nursing art. According in the model,
comfort is an immediate desirable outcome of nursing care. According to Kolcaba, theory of
comfort. It consists of 3 forms: relief, ease and transcendence. If specific comfort needs of a
patient are met, the patient experiences comfort in the sense of relief. If the patient is in a
comfortable state of contentment, the person experiences comfort in the ease sense.
Transcendence is described as the state of comfort in which patients are able to rise above their
challenges.

According to Kolcaba, the main premise is that “Comfort is the immediate experience of being
strengthened by having needs for relief, ease and transcendence met in four contexts: physical,
psychospiritual, social and environmental. Through the art and practice of comfort, the patient’s
stress will be minimize for it is the focus of the theory of comfort.

Nursing is described as the process of assessing the patient’s comfort needs, developing and
implementing appropriate nursing interventions and evaluating patient comfort needs following
nursing interventions. Intentional assessment of comfort needs, the design of comfort measures
to address those needs, and the reassessment of comfort levels after implementation. The
patient’s comfort can be assessed by either objective or subjective. Health is considered to be
optimal functioning, as defined by the patient, group, family or community. Any aspect of the
patient, family, or institutional surroundings that can be manipulated by a nurse, or loved one to
enhance comfort.
CHAPTER 1 – ASSESSMENT

A.NURSING HEALTH HISTORY

The Brother of Patient interviewed to gather the data

I. DEMOGRAPHIC DATA

Patient RR is a 28 years old male that lives in Batasan Hills, Quezon City. He was born on the
15th day of November 1989. He is a Filipino and a Roman Catholic. Patient RR is a high school
graduate.

II. ADMISSION DATA:

Patient RR who came to East Avenue Medical Center last due to decreased level of
consciousness And was admitted on March 9, 2018 at 10:40pm to Intensive Care Unit (ICU) as
a case of Intracranial Hemorrhage secondary to Tumor Bleed. His attending Physician: Dr.
Marian.

III. HISTORY OF PRESENT ILLNESS

Two days prior to consultation noted right sided weakness, but no sign of slurring of
speech, no nausea/vomiting and no headache.

Twenty Hours prior to consultation patient is had fever, right side weakness and vomiting.

Thirteen Hours prior to consultation patient Decreased sensorium but no consult done.

Few Hours prior to consultation the patient Decreased sensorium and unarousable.

IV. PAST MEDICAL HISTORY

According to the brother of the patient he never had any serious illnesses during his
childhood days. Does not undergone in any surgery. He is not diagnosed with any psychiatric
problem.
V. FAMILY HEALTH HISTORY
VI. PERSONAL AND SOCIAL HISTORY

Patient RR is a Roman Catholic. He loves to play online games like Rules Of Survival
(ROS) and League Of Legends (LOL), He is spending most of his time playing with those
games. Watcher reveals that the patient is was a drug user, regular alcohol drinker and smoker.
Patient is very close to his brother.

VII. REVIEW OF SYSTEM

REVIEW OF SYSTEM

Health in General
Patient is experiencing lack of energy, loss of appetite, and fatigue.

Integumentary (Skin, Hair, Breast)

Patient’s experiencing a dry skin and pale nails.

Head, Eyes, Ears, Nose, Throat (HEENT)

Head: Patient is experiencing occasional headache and dizziness. He undergone a head
surgery which is the Craniotomy.
Eyes: Patient is experiencing blurred vision occasionally. He doesn’t experience excessive
tearing and he doesn’t have glaucoma or cataracts.
Ears: Patient is not experiencing difficulty in hearing, tinnitus, earache, vertigo, and ear
discharges. He doesn’t use any hearing aids
Nose and sinuses: Patient doesn’t experience colds, He doesn’t also experience nasal
stiffness and nasal discharge. He sometimes experienced facial numbness
Throat (or mouth and pharynx): Patient is not experiencing bleeding gums, dentures, mouth
sores, loose teeth, sore throat, and sore tongue. He is experiencing hoarseness.

Respiratory (Lungs and Breathing)

Patient is not experiencing shortness of breath or cough. He also doesn’t experience chest pain
and SOB. He doesn’t have history of tuberculosis.

Cardiovascular (Heart and Blood Vessels)

Patient is not experiencing chest pain but sometimes discomfort. He is not experiencing
irregular heartbeat, rheumatic fever, heart murmur and palpitations. But there is pain when
moving his extremities.

Gastrointestinal (Kidney and Bladder)

Patient is not experiencing abdominal pain. He doesn’t experience constipation, Hemorrhoids,
jaundice, Hepatitis and heartburn. Sometimes he feels like he wants to vomit.

Genitourinary (Kidney and Bladder)

Patient doesn’t have any problem

Genital
Patient denies having any history of sexually transmitted disease or exposure to HIV infection.
He is not experiencing discharge or sores in his penis

Peripheral Vascular
Patient sometimes experience leg cramps and pain, past clots in veins and color changes in
fingertips and toes during cold weather.
Muscoskeletal (Muscles, Bones, Joints)
Patient is experiencing muscle or joint pain in his lower extremities, he is also experiencing
backache sometimes due to lying in bed for long period of time.

Psychiatric (Mood and Thinking)

Patient is not experiencing insomnia. Sometimes he has irritability, depression, anxiety and
mood swings.

Neurologic (Brain and Nerve)

Patient sometimes experience headaches and blurred vision.

Hematologic
Patient doesn’t experience anemia and easy brushing or bleeding. he has history of blood
transfusion.

Endocrine
Patient is not experiencing excessive sweating, excessive thirst or hunger. He doesn’t have any
history of thyroid problem

Allergic/ Immunologic
Patient is not experiencing any seasonal allergies.

PEARSON’S REVIEW OF SYSTEM

P-sychological
I. Self-Perception – Self Concept Pattern
Patient BT described himself as a friendly person, easy to get along with people around him. He
is happy and contented. We observed that he has an average body and looks weak due to
surgery but keeps on thinking positive to gain more strength, since his illness started, He
sometimes feels pain and he always feel that he just a another responsibility for his family.
When he is feeling fear and anxiety he talks to God and sometimes to his friend to divert his
attention and feeling of pain.

II. Role Relationship Pattern

His family structure is nuclear. Their house is enough for them. Their neighbors are kind and
generous. He loves her mother so much and the rest of his family member.

III. Sexual and Reproductive Pattern

Patient BT is heterosexual. He limited sexual intercourse. He sometimes use condoms bought
in drug stores. He started to have a partner when he was 12 years old.

IV. Cognitive Perceptual Pattern

Patient BT doesn’t have any hearing difficulties but some visual problems. There are times he is
experiencing pain and discomfort. He is now conscious and coherent.

V. Coping Stress Tolerance Pattern

Psychosocial (Erick Erickson): Intimacy vs. Isolation
Patient BT tries to have intimacy with his partner and tries to get along with the people around
him.

Psychosexual (Sigmund Freud): Genital Stage

Patient BT develops a strong sexual interest in people around him. He will choose his family
over anybody. He develops a resolution of which is settling down in a loving one-to-one
relationship with another person but still have a connection and bonding with his family. Sexual
instinct is directed to heterosexual pleasure

Cognitive (Piaget): Formal Operation

Patient BT can reason abstractly and think in hypothetically terms.

VI. Value Belief Pattern

Patient BT is happy when he will be fully cured from his illness. He believes that eating a good
diet and nutritious food such as vegetable and fruits will help him survive and live longer. Also,
with the moral and spiritual support of his family he knew that he will stays longer. He also
believe that God has a plan for everything. He also told us that God gave him that kind of
problem because God is preparing him for a big challenge.

VII. Health Perception and Health Management Pattern

Patient BT feels bored in the hospital and want to be discharged as soon as possible. The only
illness hr experienced in the past are chicken pox, measles, cough, cold and fever. He
exercises minimally. He eats fruit and vegetables and all meats because he believed that it will
maintain her healthy and strong. He sometimes smokes and drinks alcoholic beverages. He
also tried illegal drugs.

B. Physical Assessment

I. Physical Presence
The patient appearance is congruent to its chronological age, The patient body is symmetrical
and no other deformities. Body odor is present at the patient. The patient is with Intravenous
fluid therapy.

II. Psychological Presence

The patient was neatly dress, the clothing choice was appropriate for the weather. He is
uncooperative and hostile when having the assessment. He speaks slowly and sometimes
slurred. He also exhibit flat facial expression.

III. Distress
The patient is breathing effortless. He talks calmly. There is no serious or life threatening
condition in the patient’s mind.

IV. Skin
The patient skin color varies from medium brown to dark brown. There is no skin lesions and
tenderness. The patient skin is also dry maybe due to the cold weather. There is no edema.

V. Hair
There is no presence of hair in the patient’s due to surgery he’d undergone. The scalp is the
same as the color of his skin which is medium brown. Patient’s scalp has a wound or incision
due to surgery. There is also a presence of metal staple in his head.

VI. Nails
The nail surface was slightly rounded. It is also firm when palpated. Patient’s nail is pale. Patient
also have a long nails. Capillary refill of 5 seconds

VII. Skull and Face

The head was not symmetrical. There is also a presence of wounds with metal staple. There is
also a presence of blood clot around his head. The patients face immobile and expressionless.
The left side of his face is a little bit swollen.
 VIII. Eyebrows, Eyes, and Eyelashes
Eyebrows are symmetrical with each other, the eyes evenly placed but slanted, and the pupils
were equally rounded. The eyelashes were evenly distributed.

IX. Ears
Ear lobes were parallel and symmetrical, no lesions noted and no presence of discharges noted
in the ear canal.

X. Nose and Paranasal Sinuses

The nose is in the midline and there is no presence of discharges.

XI. Mouth and Pharynx

Lips are symmetrical in appearance and no presence of edema. The tongue has no lesions.
Lastly the client has yellow teeth.

XII. Neck
The neck is straight and no presence of mass or lumps. There is no lumps or mass. It is also
symmetrical.

XIII. Thorax and Lungs

Moves symmetrically on breathing. No fail chest or rib fracture.

XIV. Heart
The client’s heart rate was normal. There is no chest pain and murmurs.

XV. Breast
The breast of the client was proportionate to his body.

XVI. Abdomen
No lesions noted, the skin color is uniform. It is also flat.

XVII. Extremities
Both extremities are equal in size, The color is evenly distributed. There is no presence of
edema, The temperature is warm and even. But there is a presence of pain when moving the
extremities. The patient is exhibiting right side weakness
 C. Diagnostic Procedure
Name of Procedure
Chemistry test
 Groups of tests that are  Is a waste product that forms
 Creatinine
 Blood urea nitrogen
 Sodium
 Potassium
 Chloride
 Calcium
 Glucose, FBS
 Total Cholesterol
 HDL Cholesterol
 LDL Cholesterol
 VLDL Cholesterol
 Triglycerides
 Total protein
 Albumin
 Globulin
 A/G Ratio
 Hemoglobin A1C
Description Specific Indication of Procedure Nursing responsibilities
CREATININE 1.Explain the procedure to the
patient and their family
routinely ordered to when creatinine breaks down?
determine a person's Creatinine is found in your 2. Ensure the correct labeling,
general health status. They muscle. Creatinine levels in the storage and transportation of
help evaluate, for example, blood can provide your doctor specimen to the laboratory.
the body's electrolyte with information about how well
balance and/or the status of your kidneys are working. 3 .Inform the patient that he may
several major body organs. resume his usual medications that
The tests are performed on BLOOD UREA NIROGEN (BUN) were discontinued before the test, as
a blood sample, usually  Test measures the amount of ordered.
drawn from a vein in the nitrogen in your blood that comes
arm. 4. Monitor the venipuncture site for
from the waste product urea.
bleeding and signs of infection.
SODIUM
 Helps detect the cause and 5.Compare previous and present
monitor dehydration, edema, and result
other variety of symptoms e g.
Weakness.
POTASSIUM
 Can help detect how the
kidney are working, the blood
pH, Amount of potassium
intake, hormone levels in the
body, severe vomiting, and
medications intake such as
for diuretics.

CHLORIDE
 Test the measure how many
 electrolytes that regulates the
amount of water in your body.

CALCIUM
 Test measures how much
calcium is passed out of the
body through urine.

GLUCOSE, FBS
 May be used for screening
and diagnosis of type 1, type
2 or prediabetes.

TOTAL CHOLESTEROL
 Tests to measures the total
cholesterol that is carried in
the body by lipoproteins.

HDL CHOLESTEROL
 To measures the level of
good cholesterol in the blood.

LDL CHOLESTEROL
 It used as part of a lipid
profile to predict an
individual’s risk of developing
heart disease and to help
make decisions about what
treatment may be needed if
there is borderline or high
risk.

VLDL CHOLESTEROL
 Test measure the amount of
very low- density lipoprotein
in your blood.
TRIGLYCIRIDES
 It measures how or what type
of fat found in the blood.

TOTAL PROTIEN
 Measures the total amount of
protein in the blood.

ALBUMIN
 One of the most abundant
proteins in your blood. You
need a proper balance of
albumin to keep fluid from
leaking out of blood vessels.

GLOBULIN
 play an important role in liver
function, blood clotting, and
fighting infection

A/G Ratio
 Used as an index of disease
state, however, it is not a
specific marker for disease
because it does not indicate
which specific proteins are
altered.

HEMOGLOBIN A1C
 Blood test that routinely
performed to know what time
type of diabetes do you have.
Hematology test

Components  Is a blood test used to  One of the most frequently 1. Explain test procedure. Explain
 WBC evaluate your overall ordered laboratory that slight discomfort may be felt
 RBC health and detect a wide procedures. The findings in when the skin is punctured.
 Hemoglobin range of disorders, the CBC give valuable
 Hematocrit including anemia, diagnostic information about 2. Encourage to avoid stress if
infection and leukemia the hematologic and other possible because altered physiologic
Differentiation body systems, prognosis, status influences and changes
 Neutrophil response to treatment, and normal hematologic values.
 Lymphocytes recovery, CBC consists of a
 Monocyte series of tests that determine 3 .Monitor the puncture site for
the number, variety, oozing or hematoma formation.
 Eosinophils
percentage, concentration
 Basophils
and quality of blood cells 4. Instruct to resume normal activities
 Platelet count and diet.
 MCV
 MCH
 MCHC
 RDW

Urinalysis  Used to detect and  A urinalysis involves checking 1. Instruct the patient to void directly
manage a wide range of the appearance, into a clean, dry container. Sterile,
disorders, such as concentration and content of disposable containers are
urinary tract infections, urine. Abnormal urinalysis recommended. Women should
kidney disease and results may point to a disease always have a clean-catch specimen
diabetes. or illness. For example, a if a microscopic examination is
 urinary tract infection can
make urine look cloudy
instead of clear. Increased
levels of protein in urine can
be a sign of kidney disease.
Unusual urinalysis results
often require more testing to
uncover the source of the
problem.
Arterial Blood Gas  It measures the acidity  Uses blood drawn from an
and levels of oxygen artery, where the oxygen and
and carbon dioxide in carbon dioxide levels can be
the blood from an measured before they enter
artery. body tissues.
 Used to check how well
your lungs are able to
move oxygen into the
blood and remove
carbon dioxide from the
ordered. Feces, discharges, vaginal
secretions and menstrual blood will
contaminate the urine specimen.
2.Collect specimens form infants and
young children into a disposable
collection apparatus consisting of a
plastic bag with an adhesive backing
around the opening that can be
fastened to the perineal area or
around the penis to permit voiding
directly to the bag. Depending on
hospital policy, the collected urine
can be transferred to an appropriate
specimen container.
3. Cover all specimens tightly, label
properly and send immediately to the
laboratory.
4. Observe standard precautions
when handling urine specimens.
1. After applying pressure to the
puncture site for 3 to 5 minutes and
when bleeding has stopped, tape a
gauze pad firmly over it.
2. If the puncture site is on the arm,
don’t tape the entire circumference
because this may restrict circulation.
3. If the patient is receiving
 blood. anticoagulants or has a
coagulonopathy, apply pressure to
the puncture site longer than 5
minutes if necessary.

4. Monitor vital signs and observe for

signs of circulatory impairment.

Name of Date
Normal Values According to Hospital Values Obtained Interpretation / Analysis
Procedure Ordered

Arterial blood March 10, PARAMETERS According to the results of

gas 2018 pH 7.35 – 7.45 7.443 the arterial blood gas as you
ABE -2 - +2 -2.8 can see the HCO3 of the
PCO2 35 - 45 30.1 patient is low this indicate
SaO2> 95% 100% there is too much acid in the
PO2 80 - 100 603 blood. Add to this, Low
HCO3 22- 26 21 PCO3 and high PO2 means
that the patients is
METABOLIC hyperventilating to
ACIDOSIS compensate for the acidity of
the blood that gives the
reason why the patient’s Ph
level is in normal range.
 PARAMETERS As of now the result of the
March 12, pH 7.35 – 7.45 7.409 blood chemistry comparing
2018 ABE -2 - +2 -6.7 to the first test conducted the
PCO2 35 - 45 26.3 pH level is still in normal
SaO2 > 95% 99% range while the other
PO2 80 – 100 154 parameters shill gives a
CTCO2 23 - 29 17 result of metabolic acidosis.
HCO3 22- 26 16.3 Although PO2 level is not as
high as the previous result, it
still in abnormal as well as
the result of HCO3 and
PCO2 which is very low.
This indicate that there is
too much acid in the blood
and the patient is still
compensating,
METABOLIC ACIDOSIS

pH 7.35 – 7.45 7.387 The result of the arterial

March 12, ABE -2 - +2 -5.2 blood gas as of now is still in
2018 PCO2 35 - 45 32.3 abnormal values and
SaO2 > 95% 99% indicates that there is too
PO2 80 – 100 119 much acid in the patient’s
blood.
 CTCO2 23 - 29 18.9
METABOLIC ACIDOSIS

Name of Date
Normal Values According to Hospital Values Obtained Interpretation / Analysis
Procedure Ordered

Chemistry Test March 9, CREATININE 0.57 - 1.11 mg/dL 0.73 mg/dL As you can see in the result of the first
2018 BLOOD UREA 10.92 mg/dL blood chemistry the only parameter that is
NITROGEN 9.8 - 20.1 mg/dL 138.8 mmol/L abnormal is the potassium level of the
SODIUM 135 - 148 mmol/L 3.24 mmol/L patient. Low potassium level has many
POTASSIUM 3.6 - 5.2 mmol/L causes but usually results from vomiting,
CHLORIDE 98-107mmo/L 103.50 mmol/L diarrhea, adrenal gland disorders, or use
of diuretics. This can also result to
muscles feel weak, cramp, twitch, or even
become paralyzed, and abnormal heart
rhythms may develop.

March 10, CREATININE 0.57 - 1.11 mg/dL 0.56 mg/dL As you can see in the result the only
2018 BLOOD UREA abnormal parameter is the patient’s
NITROGEN 9.8 - 20.1 mg/dL 12.04 mmol/L sodium level which is below normal
SODIUM 135 - 148 mmol/L 111 mmol/L values. This may indicate that the patient
POTASSIUM 3.6 - 5.2 mmol/L 3.86 mg/dL may have consumption of too many fluids,
CHLORIDE 98-107mmol/L 86.2 mmol/L has kidney failure, heart failure, cirrhosis,
or use of diuretics.

March 11, SODIUM 135 - 148 mmol/L 129.80 mmol/L The sodium level in the blood is in normal
2018 range.
8:00 AM
 March 11, CREATININE 0.57 - 1.11 mg/dL 0.45 mg/dL As you can see the patient’s creatinine
2018 BLOOD UREA and potassium level is in below normal
1:50 PM NITROGEN 9.8 - 20.1 mg/dL 10.08 mg/dL range. Low potassium level has many
SODIUM 135 - 148 mmol/L 138.60 mmol/L causes but usually results from vomiting,
POTASSIUM 3.6 - 5.2 mmol/L 3.38 mmol/L diarrhea, adrenal gland disorders, or use
CHLORIDE 98-107mmol/L of diuretics. This can also result to
muscles feel weak, cramp, twitch, or even
become paralyzed, and abnormal heart
rhythms may develop.

Chemistry Test March 12, GLUCOSE,FBS 4.44 – 6.83 6.55 mmol/L As you can see the patient’s VLDL
2018 mmol/L cholesterol level is too low which may be
TOTAL CHOLESTEROL 0 – 6.22 2.18 mmol/L factor of other medical condition such as
mmol/L cancer, anxiety and depression. Blood
HDL CHOLESTEROL 1.04 – 1.55 1.05 mmol/L uric acid is also lower than the normal
mmol/L values which may indicate kidney disease
LDL CHOLESTEROL 2.49 – 3.96 0.92 mmol/L or the patient’s diet is low in purines.
mmol/L
VLDL 2 – 30 mg/dL 0.21 mg/dL
TRIGLYCERIDES 1.70 – 2.25 0.46 mmol/L
mmol/L
BLOOD URIC ACID 210-420 umol/L 140.20 umol/L
HEMOGLOBIN 4%-6% 5.1%

Name of
Date Ordered Normal Values According to Hospital Values Obtained Interpretation / Analysis
Procedure

Urinalysis January 9, MACROSCOPIC

2018 COLOR YELLOW According to the result of
TRANSPARENCY CLEAR CLOUDY the urinalysis in
SPECIFIC GRAVITY 1.005 – 1.030 1.025 macroscopic transparency
 was not good result due to
result of yellow it means
that the patient was having
an bacteria his / her urine.

CHEMISTRY TEST
pH 5.0 – 8.5 6.0 The result in the chemistry
GLUCOSE NEGATIVE NEGATIVE test as you can see protein
PROTEIN NEGATIVE NEGATIVE was not totally in the limit of
BLOOD / HB NEGATIVE normal ranges for her
KETONE NORMAL result, it may cause
NITRATE NEGATIVE proteinuria that may
BILIRUBIN NEGATIVE damage the kidney of the
UROBILINOGEN NEGATIVE patient.
LEUKOCYTE TRACE

MICROSCOPIC
RBC 0-3 3-4/ HPF For microscopic results as
WBC 0-3 5 – 7/ HPF you can see the RBC and
EPITHELIAL CELLS OCCASIONAL WBC was increasing to the
MUCUS THREADS OCCASIONAL limit of the normal values in
BACTERIA MODERATE this case it may result of
some inflammation of
kidney or urinary tract
infection (UTI).
Name of the Date Normal Values ( Values Obtained (Results of Interpretation Analysis
Procedure Ordered according to the Test)
hospital standards)

HEMTOLOGY March 10, WBC Count: ADULT: WBC Count: 20.5 The patient’s WBC count is higher
5-10 NEWBORN: 9-10 Hemoglobin: 135 than the normal values which means
2018
Hemoglobin: M: 140- Hematocrit: .416 the patient has infection
170 F:120-140 RBC Count: 4.62
NEWBORN:187-201
Hematocrit: M: 0.40-
0.50 F: 0.38-0.48
NEWBORN: .49-.55
RBC Count: 4.5 – 5.9 Neutrophil: 0.97
Lymphocyte: 0.03 The patient’s results of the differential
Neutrophil: ADULT: Monocyte: 0.05 counts was not in the normal results
0.45-0.65 NEWBORN: Eosimophils: such as neutrophils, lymphocytes,
0.40-0.50 Basophils: MCHC, and lastly RDW. For elevating
Lymphocyte: ADULT: Bands: neutrophils can cause any infection to
0.25-0.50 NEWBORN: the patient or acute stress increases
0.31-0.60 Platelet Count: 217 your number of white blood cells. For
Monocyte: 0.02-0.06 MCV: 90.1 decreasing of lymphocytes can cause
Eosimophils: 0.02- MCH: 29.3 also a high risk of infection particularly
0.04 MCHC: 32.5 viral infection.
Basophils: 0.00 – 0.01 RDW: 13.8
Bands: 0.02 – 0.04
Platelet Count: 150-
450
HEMATOLOGY MCV: 80- 100 WBC Count: 15.4
MCH: 27-31 Hemoglobin: 134
March 11, MCHC: 320-360 Hematocrit: .415
2018 RDW: 11.6 – 14.6 RBC Count: 4.57

The patient’s WBC count is higher

WBC Count: ADULT: than the normal values which means
5-10 NEWBORN: 9-10 the patient has infection
Hemoglobin: M: 140- Neutrophil: 0.94
170 F:120-140 Lymphocyte: 0.02
NEWBORN:187-201 Monocyte: 0.04
Hematocrit: M: 0.40- Eosimophils:
0.50 F: 0.38-0.48 Basophils:
NEWBORN: .49-.55 Bands:
RBC Count: 4.5 – 5.9 The patient’s results of the differential
Platelet Count: 195 counts was not in the normal results
Neutrophil: ADULT: MCV: 90.9 such as neutrophils, lymphocytes,
0.45-0.65 NEWBORN: MCH: 29.4 MCHC, and lastly RDW. For elevating
0.40-0.50 MCHC: 32.4 neutrophils can cause any infection to
Lymphocyte: ADULT: RDW: 14.2 the patient or acute stress increases
0.25-0.50 NEWBORN: your number of white blood cells. For
0.31-0.60 decreasing of lymphocytes can cause
Monocyte: 0.02-0.06 also a high risk of infection particularly
Eosimophils: 0.02- viral infection.
0.04
Basophils: 0.00 – 0.01
Bands: 0.02 – 0.04
Platelet Count: 150-
450
MCV: 80- 100
MCH: 27-31
MCHC: 320-360
RDW: 11.6 – 14.6
D. Anatomy and Physiology

The Brain

The brain and the spinal cord are the central nervous system, and they represent the main
organs of the nervous system. The spinal cord is a single structure, whereas the adult brain is
described in terms of four major regions: the cerebrum, the diencephalon, the brain stem, and
the cerebellum. A person’s conscious experiences are based on neural activity in the brain. The
regulation of homeostasis is governed by a specialized region in the brain. The coordination of
reflexes depends on the integration of sensory and motor pathways in the spinal cord.

The Cerebrum

The iconic gray mantle of the human brain, which appears to make up most of the mass of the
brain, is the cerebrum (Figure 8.20). The wrinkled portion is the cerebral cortex, and the rest of
the structure is beneath that outer covering. There is a large separation between the two sides
of the cerebrum called the longitudinal fissure. It separates the cerebrum into two distinct
halves, a right and left cerebral hemisphere. Deep within the cerebrum, the white matter of the
corpus callosum provides the major pathway for communication between the two hemispheres
of the cerebral cortex.

The Diencephalon

The diencephalon is the one region of the adult brain that retains its name from embryologic
development. The etymology of the word diencephalon translates to “through brain.” It is the
connection between the cerebrum and the rest of the nervous system, with one exception. The
rest of the brain, the spinal cord, and the PNS all send information to the cerebrum through the
diencephalon. Output from the cerebrum passes through the diencephalon. The single
exception is the system associated with olfaction, yor the sense of smell, which connects
directly with the cerebrum. The diencephalon is deep beneath the cerebrum and can be
described as any region of the brain with “thalamus” in its name. The two major regions of the
diencephalon are the thalamus itself and the hypothalamus (Figure 8.23).

 Thalamus
The thalamus is a collection of nuclei that relay information between the cerebral
cortex and the periphery, spinal cord, or brain stem. All sensory information, except for
the sense of smell, passes through the thalamus before processing by the cortex. Axons
from the peripheral sensory organs synapse in the thalamus, and thalamic neurons
project directly to the cerebrum. It is a requisite synapse in any sensory pathway, except
for olfaction. The thalamus does not just pass the information on, it also processes that
information. For example, the portion of the thalamus that receives visual information will
influence what visual stimuli are important, or what receives attention. The cerebrum
also sends information down to the thalamus, which usually communicates motor
commands.
  Hypothalamus
Inferior and slightly anterior to the thalamus is the hypothalamus, the other major
region of the diencephalon. The hypothalamus is a collection of nuclei that are largely
involved in regulating homeostasis. The hypothalamus is the executive region in charge
of the autonomic nervous system and the endocrine system through its regulation of the
anterior pituitary gland. Other parts of the hypothalamus are involved in memory and
emotion as part of the limbic system.

Brain Stem

The midbrain, pons, and the medulla oblongata are collectively referred to as the brain stem
(Figure 8.24). The structure connects the brain to the spinal cord. Attached to the brain stem,
but considered a separate region of the adult brain, is the cerebellum. The midbrain coordinates
sensory representations of the visual, auditory, and somatosensory perceptual spaces. The
pons is the main connection with the cerebellum. The pons and the medulla regulate several
crucial functions, including the cardiovascular and respiratory systems and rates. The cranial
nerves connect through the brain stem and provide the brain with the sensory input and motor
output associated with the head and neck, including most of the special senses. The major
ascending and descending pathways between the spinal cord and brain, specifically the
cerebrum, pass through the brain stem.

Midbrain

The midbrain is the most superior portion of the barinstem. It is located posterior to the
hypothalamus and superior to the pons. It contains reflex centers for the head, eye, and body
movements in response to visual and auditory stimuli. For example, reflexively turning the head
to hear better or see better is activated by the midbrain.

Pons

The word pons comes from the Latin word for bridge. It is visible on the anterior surface of the
brain stem as the thick bundle of white matter attached to the cerebellum. The pons is the main
connection between the cerebellum and the brain stem. The bridge-like white matter is only the
anterior surface of the pons; the gray matter beneath that is a continuation of the tegmentum
from the midbrain. Gray matter in the tegmentum region of the pons contains neurons receiving
descending input from the cerebrum and thalamus that is sent to the cerebellum. The pons
works closely with the medulla to regulate respiratory activities.

Medulla

The medulla oblongata is the most inferior portion of the brain, and it’s connecting link with the
spinal cord. It consists of ascending and descending tracts that are entering the brain for
sensory integration and exiting the brain for motor responses. The medulla contains 3
integration centers that are vital for homeostasis: (1) the respiratory center that controls the
rhythm of breathing and reflexes such as coughing and sneezing (2) the cardiac control center
that regulates the rate and force of hear contractions (3) the vasomotor center that regulates
blood pressure through vasoconstriction of blood vessels and vasodilation of blood vessels.
Another area that spreads throughout the brain stem from the medulla up to the thalamus is the
the reticular formation. The reticular formation is responsible for regulating general brain activity
and attention. It is related to sleep and wakefulness.

The Cerebellum

The cerebellum, as the name suggests, is the “little brain.” It is covered in gyri and sulci like the
cerebrum, and looks like a miniature version of that part of the brain. The cerebellum is largely
responsible coordinating the interactions of skeletal muscles. It controls posture, balance, and
muscle coordination during movement. Descending fibers from the cerebrum have branches
that connect to neurons in the pons.

The Spinal Cord

The description of the CNS is concentrated on the structures of the brain, but the spinal cord is
another major organ of the system. The spinal cord is continuous with the brain. It descends
from the medulla through the foramen magnum of the occipital bone and extends to the lumbar
vertebrae. A cross-sectional view of the spinal cord reveals both gray matter and white matter
(Fig. 8.26). The gray matter has the shape of a butterfly with outstretched wings and is centrally
located to the white matter. The spinal cord has two basic functions. It transmits nerve
impulses to and from the brain, and it serves as a reflex center for spinal
CHAPTER II- PLANNING

A. List of Prioritized Nursing Diagnosis

Nursing Diagnosis Number Supporting Data Justification

of Priority
Ineffective Tissue 1 OBJECTIVE: This is the first
Perfusion Capillary Refill of 5 seconds prioritized nursing
>Right side weakness problem because it is
>Vital Signs as Follows: about circulation.
T: 36.7
RR: 19
BP: 130/90
HR: 87
Disturbed Sensory 2 OBJECTIVE This is the second
Perception Right Side weakness prioritized nursing
Slurred speech problem because a
One eye is closed disturbed sensory
perception can cause
injury and may affect
the patient’s safety.
Impaired Verbal 3 OBJECTIVE This is the midline
Communication as Slurring of Speech prioritized problem
evidence by slurring because the patient
of speech needs to verbalize
what he feels and
needs that can aid in
his recovery.
Impaired Physical 4 SUBJECTIVE: This is the fourth
Mobility related to “Nahihirapan ako gawin ang ibang prioritized problem
right side weakness bagay” as verbalized by the client. because mobility is
OBJECTIVE: important in doing
>ADL Level 3 ADLs
>Right side weakness
>Vital Signs as Follows:
T: 36.7
RR: 19
BP: 130/90
HR: 87
>Looks Weak

Self-Care Deficit 5 SUBJECTIVE: This is the least

related to “Nahihirapan na ko alagaan ung sarili prioritized problem
Decreased Strength ko,” as verbalized by the client because the patient
and Endurance this is also need for
OBJECTIVE: recovery
>Weakness
>Vital Signs as Follows:
T: 36.7
RR: 19
BP: 130/90
HR: 87
CHAPTER III – IMPLEMENTATION

A. Medical Management
1. Drug Study

Date Name of Drug Classification Dose, Mechanism of Contraindication Side Effects Nursing
Ordered and Indication Route and Action Responsibilitie
Frequency s
03/10/18 Generic Classification: 500mg It exerts its Allergic reaction headache, sinus Assess:
Name: Anti-fibrinolytic every 8 antifibrinolytic to the drug or and nasal -Monitor
Tranexamic hours effect through the hypersensitivity symptoms, back effectiveness of
Acid Indication: reversible Presence of pain, abdominal drug in relieving
Brand Name: for the prompt blockade of blood clots (eg, in pain, angina.
Hemostan and effective lysine-binding the leg, lung, eye, musculoskeletal -Note:
control of sites on brain), have a pain, joint pain, Headaches tend
hemorrhage in plasminogen history of blood muscle cramps, to decrease in
various surgical molecules. Anti- clots, or are at migraine, intensity and
and fibrinolytic drug risk for blood anemia and frequency with
clinical areas: inhibits clots fatigue continued
endometrial Current therapy but may
plasminogen acti administration of require
vator and thus factor IX complex administration of
prevents concentrates or analgesic and
fibrinolysis and anti-inhibitor reduction in
the breakdown of coagulant dosage.
blood clots. The concentrates -Note: Chronic
plasminogen- administration of
plasmin enzyme large doses may
system is known produce
to cause tolerance and
coagulation thus decrease
defects through effectiveness of
lytic activity on nitrate
fibrinogen, fibrin preparations.
and other clotting
factors. By
 inhibiting the
action of plasmin
(finronolysin) the
anti-fibrinolytic
agents reduce
excessive
breakdown of
fibrin and effect
physiological
hemostasis.
03/09/18 Generic Classification: 150ml IV Increases Active intracranial CNS: dizziness, Monitor vital
Name: Osmotic Diuretic every 4 osmotic pressure bleeding (except headache, signs, intake and
Mannitol hours of plasma in during seizures output.
Brand Name: Indication: glomerular craniotomy), CV: chest pain, -Signs of
Osmitrol Polyol (sugar filtrate, inhibiting anural secondary hypotension, electrolyte
alcohol), Acute tubular re- to severe renal hypertension, imbalance.
oliguric renal absorption of disease, tachycardia, thr -Monitor the
failure, reduction water and progressive heart ombophlebitis, pulmonary artery
of intracranial electrolytes failure, pulmonary heart failure, pressure
pressure (including sodium congestion, renal vascular
and potassium). damage, or renal overload
These actions dysfunction after EENT: blurred
enhance water mannitol therapy vision, rhinitis
flow from various begins, severe GI: nausea,
tissues and pulmonary vomiting,
ultimately congestion or diarrhea, dry
decrease pulmonary mouth
intracranial and edema, and
intraocular severe
pressures. dehydration.
03/10/18 Generic Func. Class: 40mg per IV Suppresses Hypersensitivity CNS: Assess:
Name: Antiulcer, proton every 24 gastric secretion Headache, -GI system
Omeprazole pump inhibitor hours by inhibiting Precautions: dizziness, -electrolyte
Brand Name: hydrogen/potassi Pregnancy (C ), asthenia imbalance
Prisolec Chem Class: um ATPase breastfeeding, -hepatic
Benzimidazole enzyme system children CV: vhest pain, enzymes
 in gastric parietal angina,
Indication: cells, tachycardia, Evaluate:
Gastropharynge characterized as bradycardia, -therapeutic
al reflux disease gastric acid pump palpitations, response
(GERD), severe inhibitor because peripheral
erosive it blocks the final edema Teach patient/
esophagitis, step of acid family:
poorly production EENT: tinbitus, -To report
responsive taste perversion severe diarrhea
system GERD, -to avoid
pathologic GI: diarrhea, hazardous
hypersecretory abdominal pain, activity
conditions vomiting, - to avoid
(zollinger- nausea, alcohol,
ellinson’s constipation, salicylates
syndrome, flatulence, acid
systemic regurgitation,
mastocytosis, abdominal
multiple swelling,
endocrine anorexia,
adenomas); irritable colon,
treatment of esophageal
active duodenal candidiasis, dry
ulcers with or mouth, hepatic
without failure
antiinfectives for
Helicobacter GU: UTI, urinary
pylori frequency,
increased
creatinine,
proteinuria,
hematuria,
glycosuria

HEMA:
pancytopenia,
 thrombocytopen
ia, neutropenia
03/10/18 Generic Func class: 1 gram IV Bactericidal; Hypersensitivity CNS: Assess:
Name: Antiinfective- every 8 interferes with to this product , Headache, -sensitivity to
Meropenem miscellaneous hours cell wall carbapenems, dizziness, cephalosporins,
Brand Name: Chem class: replication of hypersensitivity to drownsiness antibiotics,
Merrem Carbapenem susceptible cephalosporins, penicillin,
organisms penicillins CV: carbapenem
Indication: hypotension. -Renal disease:
Infections Tachycardia Monitor serum
creatinine/ BUN
GI: Nausea,
Vomiting, Evaluate:
Diarrhea, GI -Therapeutic
discomfort response:
Negative C&S.
INTEG: Rash, absence of signs
pruritis, and symptoms
urticarial of infection

RESP: Teach patient/

dyspnea, family:
hyperventila- -To report sore
tion throat, bruising,
bleeding, joint
pain that may
indicate blood
dyscrasias
03/10/18 Generic Func class: 750mg IV Interferes with Hypersensitivity CNS: Assess:
Name: Antiinfective every 24 conversion of to quinolones headache, Previous
Levofloxacin Chem class: hours intermediate insomnia, sensitivity
Brand Name: Fluoroquinolone DNA fragments dizziness, reaction to
Levaquin into high encephalopa- quinolones
Indication: molecular-weight thy -Signs and
Acute sinusitis, DNA in bacteria; symptoms of
acute chronic DNA gyrase CV: chest pain, infection
 bronchitis, inhibitor: inhibits palpitation, -Renal function:
community topoisomerase IV vasodilation, BUN/ Creatinine
acquired hypotension
pneumonia Evaluate
EENT: therapeutic
Dry mouth, response:
visual -absence of
impairment, signs and
tinnitus symptoms of
infection
GI: Nausea,
flatulence,
vomiting,
diarhhea,
abdominal pain

INTEG:
photosensitive-
ty, rash, pruritis
03/09/18 Generic Classification Every 12 Binding of Hypersensitivity -Fast, irregular, -Assess lung
Name: Adrenergic hours albuterol to to fluorocarbons pounding, or sounds, PR and
bronchodilators beta(2)-receptors and adrenergic racing heartbeat BP before drug
Salbutamol in the lungs amines or pulse administration
Brand Name: Indication: results in -shakiness in and during peak
Ventolin used for the relaxation of Precautions: the legs, arms, of medication.
relief of asthma bronchial smooth Asthma control, hands, or feet -Observe fore
symptoms as it muscles pregnant, -trembling or paradoxical
produces rapid, breastfeeding, shaking of the spasm and
short-term children hands or feet withhold
dilation of the -Body aches or medication and
airways (termed pain notify physician
bronchodilation), -Congestion if condition
-fever occurs.
-runny nose -Administer PO
-tender, swollen medications with
glands in the meals to
 neck minimize gastric
-trouble with irritation.
swallowing -Extended-
-voice changes release tablet
should be
swallowed-
whole. It should
not be crushed
or chewed.
-If administering
medication
through
inhalation, allow
at least 1 minute
between
inhalation of
aerosol
medication.
-Advise the
patient to rinse
mouth with water
after each
inhalation to
minimize dry
mouth.

Generic Classification: 600mg/tab Mucolytic that Hypersensitivity Fever, Observe 10

Name: Miscellaneous in half H20 reduces the drowsiness, rights in drug
respiratory glass via viscosity of Abnormal administration
N- drugs NGT at pulmonary thinking,
acetylcysteine bedtime secretions by Hypotension,
Brand Name: Indication: splitting disulfide hypertension,
Mucomyst Patients with linkages between stomatitis,
pneumonia, mucoprotein nausea,
bronchitis, molecular vomiting
primary complexes, also
 amyloidosis of restores liver
the lungs, store of
tuberculosis, glutathione to
and thickened treat
mucus acetaminophen
secretions

Name of Treatment Indications/Purposes Nursing Responsibilities

IV fluid therapy
Oxygen Therapy (Face mask - 6Lpm)
 Source of water and electrolytes
 IV lines should not be started
unless the patient currently, or may
soon need either fluid replenished
or medication administration
Indications:
For patients whose condition has
caused hypoxemia or low levels of
oxygen in the blood.
Purpose:
To achieve target oxygen saturation
levels and respiratory rate, rhythm, and
pattern.
 Check the IV Fluids per monitoring.
 Use sterile technique while insertion/ reinsertion.
 Check the tubing for kinks, blocking and leaking.
 Check the insertion site for backflow, inflammation,
swelling, and/ or bleeding.
 Avoid the use of volatile, flammable materials such
as oils, greases, alcohol, ether, and acetone (e.g.
nail polish remover), near clients receiving oxygen.
 Make known the location of the fire extinguishers,
and make sure personnel are trained in their use.
 Inspect the mucosa of the patient every monitoring
to avoid assess cracking or drying of the mucosa.
Moisten patient lips or mucosa according to hospital
protocol.

Foley Catheter Indications:  Be sure to wash hands before and after caring for a
For patients who can’t control when patient with an indwelling catheter
you urinate or have urinary  Clean the perineal area thoroughly, especially
incontinence
around the meatus, twice a day and after each
bowel movement. This helps prevent organisms for
 entering the bladder
 Use soap or detergent and water to clean the
perineal area and rinse the area well
 Make sure that the patient maintains a generous
fluid intake. This helps prevent infection and
irrigates the catheter naturally by increasing urinary
output
 Encourage the patient to be up and about as
ordered
 Record the patient’s intake and output
 Note the volume and character of urine and record
observations carefully
 Teach the patient the importance of personal
hygiene, especially the importance of careful
cleaning after having bowel movement and
thorough washing of hands frequently
 Report any signs of infection promptly. These
include a burning sensation and irritation at the
meatus, cloudy urine, a strong odor to the urine, an
elevated temperature and chills

Jackson Pratt Drain Purpose:  Emptying the drain

collecting bodily fluids from surgical
sites
Nebulization Nebulization is the process of
medication administration via
inhalation. It utilizes a nebulizer which
transports medications to the lungs by
means of mist inhalation
 Changing the Dressing
 Assess cardio-respiratory function: BP, HR, and
rhythm and breath sounds
 Determine history of previous medication
(theophylline), and ability to self medicate to
prevent additive
 Monitor for evidence of allergic reactions and
paradoxical bronchospasm
3.Diet

Low Salt Low Fat Diet

4. Activity/Exercise

Type of Activity Procedure/ Steps Use of Equipment Restrictions Rationale

Allowed/ to be (if any)
continued
Moderate High Backrest Elevate the Head of the NONE NO RESTRICTION Facilitates the relaxing
bed at the Moderate level. of tension of the
Make sure to ensure the abdominal muscles,
patient’s safety while allowing for improved
adjusting the bed. breathing
B. Client’s Progress

Diagnostic Diet Activity Medication Treatment Surgery

Procedure
3/9/18 Chemistry test NPO SALBUTAMOL NEBULIZATION
Hematalogy MANNITOL IVF
OMEPRAZOLE
MEROPENEM
LOVEFLOXACIN
TRANEXAMIC
3/10/18 Chemistry test NPO MODERATE KETORALAC NEBULIZATION NEUROSURGERY
Hematology HIGH BACK NAC IVF
ABG REST MANNITOL Jackson pratt drain
OMEPRAZOLE
MEROPENEM
LOVEFLOXACIN
DEXAMETHASONE
SALBUTAMOL
TRANEXAMIC
3/11/18 Chemistry test OF MODERATE KETORALAC NEBULIZATION
HIGH BACK NAC IVF
REST MANNITOL
OMEPRAZOLE
MEROPENEM
LOVEFLOXACIN
DEXAMETHASONE
SALBUTAMOL
3/12/18 ABG OF MODERATE KETORALAC NEBULIZATION
Chemistry test HIGH BACK NAC IVF
REST MANNITOL
OMEPRAZOLE
MEROPENEM
 LOVEFLOXACIN
DEXAMETHASONE
SALBUTAMOL
3/13/18 OF MODERATE KETORALAC NEBULIZATION
HIGH BACK NAC IVF
REST MANNITOL CBG
OMEPRAZOLE
MEROPENEM
LOVEFLOXACIN
DEXAMETHASONE
SALBUTAMOL
3/14/18 SOFT DIET MODERATE KETORALAC NEBULIZATION
HIGH BACK NAC IVF
REST MANNITOL
OMEPRAZOLE
MEROPENEM
LOVEFLOXACIN
DEXAMETHASONE
SALBUTAMOL
3/15/18 SOFT DIET MODERATE KETORALAC NEBULIZATION
HIGH BACK NAC IVF
REST MANNITOL
OMEPRAZOLE
MEROPENEM
LOVEFLOXACIN
DEXAMETHASONE
SALBUTAMOL
CHAPTER IV- EVALUATION

Discharge Plan (Hypothetical)

MEDICATION

Name of Dosage and Route Time Curative Side Effects

Drug Frequency Effects

Salbutamol + 1 ampule BID Nebule 8am, 8 pm treat or Feeling a bit

Ipratoprium prevent shaky.
bronchospasm
Headache.

Rapid or
uneven
heartbeat.

Flushing.

Muscle
cramps
(uncommon
with inhaled
salbutamol).

Irritation or
dryness of
the mouth
and throat

EXERCISE/ACTIVITY

Type of Procedure/ Use of Restrictions Rationale

Activity Steps Equipment (if
Allowed/ to be any)
continued

Pursed Lip Relax your neck None it should not be this exercise can
Breathing and shoulder performed by increase the
muscles. patients suffering patient's
Breathe in for from diabetes or sensitivity on
two seconds taking insulin or medication.
through your blood glucose-
nose, keeping lowering
your mouth medication. it slows
closed. Breathe
 out for four breathing,
seconds through reduce work of
pursed lips. If Do not force the air breathing and
this is too long out and always can help the
for you, simply breathe out for patient to be
breathe out longer than you calm. It create
twice as long as breath in and also back-pressure
you breathe in. breathe slowly, inside airways to
easily and relaxed, splint them
in and out, until open, moving air
you are in thus takes less
complete control, work.

Calm Breathing Ask the patient None The patient must it can reduce
Exercise to take a slow have a quiet anxious feelings
breath in through environment. It is and worry
the nose, not applicable for thoughts. It
breathing into some patient who helps in
the lower belly finds that providing
for about 4 concentrating on comfort to the
seconds. Hold their breath patient.
the breath for 1 provokes panic
to 2 seconds. and
Exhale slowly hyperventilation.
through the
mouth. Then
wait for a few
seconds to take
another breath.

TREATMENT

Treatment Indication/ Purposes Nursing Responsibilities

Nebulization Nebulization is the process of

medication administration via
inhalation. It utilizes a  Assess cardio-
nebulizer which transports respiratory function:
medications to the lungs by BP, HR, and rhythm
means of mist inhalation and breath sounds

 Determine history of
previous medication
(theophylline), and
ability to self medicate
to prevent additive
  Monitor for evidence of
allergic reactions and
paradoxical
bronchospasm

HEALTH TEACHING

 Health teaching regarding importance of adequate vitamins and nutritious foods to

strengthen the immune system and increase fluid intake.

 Health teaching about the importance of taking medication as prescribed Medications

 Regular medications such as vitamins, and many other prescription medications will be
continued while the patient is in the hospital and can be continued upon discharge after
surgery.

 Encourage to have adequate rest

OPD

 OPD such as regular follow up checkup should be greatly encouraged.

Call the doctor if the patient:

 Has trouble urinating (peeing)

 Cannot control the timing of urination or a bowel movement

 Is confused or has trouble remembering things

 Has hallucinations

 Has major changes in mood or behavior

 Has difficulty seeing or hearing

 Is much more tired than usual or has difficulty waking up

 Is nauseous or vomits

 Feels weakness in the arms or legs or you has trouble walking

 Has more or worse headaches than usual

 Has a tingling feeling (pins and needles) or numbness (no feeling) in the face, arms or
legs
  Faints or has a seizure

 Has difficulty talking

 Is more sensitive to light, has a stiff neck, or has a fever higher than 100.5º F (38º
Celsius)

 Has a red, swollen or painful calf

DIET

 Eat the foods you normally do, unless your provider tells you to follow a special diet.

 Eat Omega 3 fatty acids also help to lower the oxidative stress damage that happens as
a result of any form of trauma to the brain and is important in speeding up the recovery
and healing process.

 Vitamin E is another very important dietary supplement that can help protect the neurons
in the brain, especially after a brain surgery. It is a powerful antioxidant and helps to
reduce free radicals in the brain that would otherwise slow down the functioning of the
brain neurons. A diet rich in vitamin E is also especially helpful for older people who
have had a brain surgery, as it helps to maintain the health of the neurons of the brain.

SPIRITUAL

 Encourage the patient to attends the mass frequently with him family.

 Encourage to have positive thinking and do what makes him happy