PANCREATITIS COMPLICATIONS OF ASCITES AND PLEURAL EFFUSION

Presented to

The Faculty of the School of Nursing

University of Baguio

In Partial Fulfillment

Of the Requirements for the Subject

NPRAC05

2nd Sem., S.Y. 2020-2021

Submitted by:

NDB-2

Bugarin Alvin
Chinanglas Shayannah
Lambino Lyka Mae
Padillion Claudine

Clinical Instructor:

Evangeline Soliba, RN, MAN

June 2021

1
 ACKNOWLEDGMENT

The BSN 4 NDB-2 would like to extend their sincerest

gratitude to the following that have contributed and supported

them in the fulfillment of this case study:

To the Almighty God, for giving strength and courage to

these individuals to face challenges and obstacles in their daily

lives. It is truly a blessing that You give life to these people

to grow and learn from the lessons You give every day.

To their patient and guardians, for allowing these students

to interview them to provide the necessary data needed for this

case study. Without them, they would not be able to complete

their requirements for NPRAC05. Rest assured that confidentiality

and anonymity will be provided.

To the staff of the Pay Ward in Baguio General Hospital and

Medical Center for providing the information through

endorsements, and for entrusting the nursing students on duty to

provide the utmost care and service to the patients who seek

medical help in the institution.

To their clinical instructor, Mrs. Evangeline Soliba, for

guiding the BSN-4 NDB-2 students during their duty. For

continuously teaching and helping the students to learn more

while in the hospital field.

To their families and friends, who continuously supported

them and provided help needed by these individuals. They are

truly grateful to have them in their lives as they serve as

motivation to finish their requirements and become a successful

nurse.

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 TABLE OF CONTENTS

TITLE PAGE . . . . . . . . .1

ACKNOWLEDGMENT . . . . . . . . .2

TABLE OF CONTENTS . . . . . . . .3

CHAPTER I
INTRODUCTION . . . . . . . . .4-6

CHAPTER II
PATIENTS PROFILE . . . . . . . .7-9

CHAPTER III
13 AREAS OF ASSESSMENT . . . . . . .10-15

CHAPTER IV
ANATOMY AND PHYSIOLOGY . . . . . . .16-17

CHAPTER V
PATHOPHYSIOLOGY . . . . . . . .

CHAPTER VI
LABORATORY AND DIAGNOSTICS . . . . . .

CHAPTER VII
NURSING CARE PLAN . . . . . . . .
DRUG STUDY . . . . . . . . .

CHAPTER VIII
SUMMARY OF CARE . . . . . . . .

CHAPTER IX
RECOMMENDATIONS . . . . . . . .
LEARNING INSIGHTS . . . . . . . .

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 INTRODUCTION

The BSN 4 NDB-2 group had their duty last May 15,19, 20, and
21, 2019 in Baguio General Hospital and Medical Center, 3:00 –
11:00 pm shift, under the supervision of Mrs. Evangeline Soliba.
They were exposed in the Pay Ward to render their services to the
patients and develop new knowledge regarding the different
illnesses and diseases in the area. The case chosen was
pancretitis complication of ascites and pleural effusion.

Ascites and pleural effusion are well recognized

complications of pancreatic disease that occur as a result of
disruption of the pancreatic duct, or leak from a pseudocyst.
They occur in 7.3% of patients suffering from
chronic pancreatitis and lead to considerable morbidity and
mortality.

Pancreatic ascites consists in the presence of pancreatic

juice into the peritoneal cavity, coming from pseudocysts or
pancreatic ducts breaches, that produce the accumulation of an
exudate rich in proteins and amylase; these findings certify the
diagnosis. We report a case of pancreatic ascites with pleural
effusion: alcoholic patient, without previous episodes of acute
pancreatitis, with ascites, weight loss, abdominal pain, right
pleural effusion, insidious onset, blood level of amylase.

Since ascites due to other causes, such as cardiac, hepatic,

renal and neoplastic disease, is much more common than pancreatic
ascites, the diagnosis may be missed. Furthermore, pancreatic
enzymes are not activated so digestion does not occur and the
patient experiences no pain. When a patient presents with ascites
or pleural effusion (Ingram & Sheiner 1980), the diagnosis is
made by estimation of aspirated fluid for. amylase content.
Amylase levels will always be markedly elevated in pleural
effusion and/or in ascites due to pancreatic fistula, and the
albumin level in the effusion will usually be over 3 g/100 ml.
Cameron et al. (1976) had no false-positives or negatives using
these diagnostic criteria. The presence of a pseudocyst should be
excluded by ultrasonography before performing an ERCP to search

4
for a leak from the pancreatic ductal system (Rawlings et al.
1977). However, ERCP is by no means always successful in
demonstrating the site of the leak from the pancreas into the
peritoneal cavity.

Inflammatory disease of the pancreas is associated with a

number of well-documented sequelae. Hypocalcemia, hyperglycemia,
abscess, and pseudocyst formation are some of the more common
complications seen with acute attacks. Chronic or recurrent
inflammatory disease can result in exocrine insufficiency with
steatorrhea and endocrine insufficiency, resulting in diabetes.
In addition, in the last decade chronic ascites and chronic
pleural effusion have also been recognized as complications of
chronic pancreatitis. Despite the marked disparity in clinical
presentation and physical findings, the etiologies of pancreatic
ascites and pancreatic pleural effisions are identical and not
infrequently they are seen together in the same patient. In
recent years the pathogenesis of these two entities has been
defined, their diagnosis simplified, and guidelines for
management established.

GOAL AND OBJECTIVES:

Goal:

Our goal is to enhance our understanding and sharpen our

knowledge to render an effective treatment to their patients for

the promotion of health.

Objectives:

After 4 days in the Pay Ward, students would be able to:

Assess and gather essential data from the patient by

respecting the confidentiality;

Formulate a nursing diagnosis by understanding the data

gathered and creating an appropriate treatment plan;

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 Counsel and educate the patient and members involved;

Work with the health care professionals to provide patient-

focused care;

Create a drug study and a nursing care plan to further

enhance the knowledge about the patients’ needs and care.

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 CHAPTER II

PATIENT’S PROFILE

A. Biographical Data

Date of Interview: June 1, 2021

Interviewer: Nurse A

Patient’s Name: Patient X

Age: 53 years old

Address: Tuba, Benguet

Date of Birth: November 20, 1967

Place of Birth: Baguio City

Civil Status: Separated

Occupation: Self-Employed

Religion: Roman Catholic

Number of times admitted to the hospital: 2

Date and time of admission: June 1, 2021

Informant: Patient X 53/M, S/O – Brother 51/M

Chief Complaint: “Grabe sakit nung sa may tyan at likod ko”

Admitting Diagnosis: Pancreatitis with complications of ascites

and pleural effusion.

B. History of Present Illness

5 days prior to admission patient experienced stabbing pain

located in between the epigastric and left hypochondriac region

radiating to the back which lasts for about 3-4 hours aggravated

by eating and drinking alcohol. Patient described pain as an

inconvenience when working or moving around.

1 day prior to admission, patient presented with worsening

stabbing pain in the same area lasting for about 5-6 hours.

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Patient also reported being nauseous and vomits frequently as

intolerable pain worsens hence admission.

Assessment at time of admission reveals blood pressure:

140/100 mmHg; HR: 100bpm; RR: 23cpm; axillary temperature: 38.1C.

Current medication: Paracetamol 500 mg PRN for pain; Amlodipine 5

mg BID for Hypertension.

C. Past Medical History

At the age of 19, the patient was diagnosed with acute

cholecystitis after complains of fever and recurring stabbing

pain, he later was admitted in the hospital for antibiotic

therapy and was later discharged. The client also stated that he

had no known history of any surgical procedures and was admitted

in the hospital twice primarily due to the above-mentioned reason

and secondly due to Hypertension II, diagnosed at age 27, for

which he was prescribed Amlodipine 5mg BID as maintenance.

Patient reported no known allergies. Patient’s vaccination is up

to date.

D. Social/Lifestyle History

The client is self-employed for which for the past 2 decades, he

worked as a liaison officer of a construction company, and at

present he works only if called. Every day during the afternoon,

he with his colleagues goes out on a drinking spree. Patient

stated he usually drinks about 8-10 shots of gin before getting

knocked out. He also stated that if he has a job, he usually eats

outside with fast foods as he has no time to cook.

E. Heredo-Familial History

Grandfather
Died of DKA
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 Father
Died of HTN and
Multi-organ
Grandmother failure
Died of HTN

Brother
Diagnosed with
HTN, DM, and
Cholelithiasis
Grandfather
Died of Unknown
Cause
Mother
Diagnosed with
HTN and on
Grandmother maintenance.
Died of HTN and
Cholelithiasis

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 CHAPTER III

ASSESSMENT

13 Areas of Assessment

I. Psychosocial status

The patient is a 53-year-old male client, born on November

20, 1967, currently residing at Tuba, Benguet. He currently

lives alone. He is a high school graduate. He used to be a

liaison officer for the past 2 decades.

He is separated with his wife after a 5-year marriage. They

have 2 children whom is staying at his wife’s parents house

and has no communication with them. His finances are

supported by his savings alone. He is close to his brother

whom is supportive for his medical treatment.

II. Mental & Emotional Status

The patient is conscious and oriented to the current time,

date, and place. During the interview, patient willingly

cooperated and answered to the tasks and questions we’ve

prepared for him, and was able to respond to them accurately

but with some discomfort. He can speak in Filipino, Ilocano

and Kankana-ey language. The patient has no known head

injuries and history of stroke.

The patient is a very approachable person. However, he also

worries about his current medical condition as he stated he

does not know what future he’ll have ahead after being

diagnosed. The patient is curious as to what treatment may

be done to help alleviate his condition.

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III. Environmental Status

In the hospital, he is placed in the clean ward in a single

bed located approximately 9 meters from the nurse’s station.

His bed is about 7 meters from the comfort room. A table and

a chair are placed at the side of his bed. He is also

provided with complete bed sheets, blanket, and pillow. The

room is well lit and is well-ventilated. The beds are

separated by curtains.

IV. Sensory Status

a. Sense of Sight

The pupils are equally rounded, brown in color, reactive to

light and accommodation. Brows are symmetrical and evenly

distributed. Reddish conjunctiva noted. Eyes are

symmetrical. Patient is not wearing any corrective lenses.

Screen visual acuity is 15/20 measured using the Snellen’s

Chart and by letting the patient read a text. Visual fields

do not exceed above by the brows and medially by the nose.

Extraocular movements are even. Constricts and converge

during confrontation test.

b. Sense of taste

The patient was able to differentiate sweet (table sugar),

sour (orange), salty (chips), and bitter (powdered black

coffee) tastes. He was able to describe the taste of the

foods that his watchers and the dietary department of the

hospital have given. Oral thrush noted on the buccal mucosa

and hard palate. Teeth are generally yellowish to black in

color, abrasion of teeth with notching was also noted.

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 Patient has a total of 15/32 teeth. Gingiva is reddish. Lips

are dry with lesions and cracks observed.

c. Sense of hearing

The auricles have no deformity, lumps or lesions. They are

same in color as the facial skin and symmetrically aligned

with outer canthus of the eye, mobile firm and not tender.

Impacted cerumen noted at the sides of the ear canal.

Patient was able to hear 3 out of 3 words stated using

whisper test about 1-2 feet away. No tingling and ringing in

ears noted as stated by client. Patients’ voice is at normal

range, not shouting.

d. Sense of smell

No external structure deformity and inflammation is noted.

There are no alae tenderness noted. The nares are patent.

There is no swelling, secretions, bleeding or ulcers noted.

Frontal and maxillary sinuses are non-tender. During the CN-

I test, patient was able to smell and identify peach, mango

and orange scents.

e. Sense of touch

The patient was able to tell cold from warm touch. He was

also responsive upon testing using skin pinch at his upper

and lower extremities. He was able to differentiate light

and firm hold. Patient is also able to identify smooth and

rough textures by letting him touch through items given

(bond paper = smooth; crumpled paper = rough).

V. Motor Stability and Gait

At the time of interview, patient complained mild stabbing

pain at his stomach area radiating to his back. The patient

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 has a slightly limited activity, as he is able to bend at

the waist, reach, stretch, run, but has difficulty in

standing, walking, lying down and sitting. Bipedal pitting

edema grade I noted. No crepitus noted. The patient is able

to ambulate.

(Figure A. Muscle Strength of the Patient)

Right Upper Extremity Left Upper Extremity

5/5 5/5

5/5 5/5

Right Lower Extremity Left Lower Extremity

VI. Body Temperature

The body temperature ranges from 37.4°C to 38.5°C taken

either axillary or temporal. Skin is occasionally warm at

touch. At the time of interview, patient’s axillary

temperature is at 37.4°C.

The environmental temperature is comfortable as verbalized

by the patient which is cool and humid.

VII. Respiratory Status

Pleural effusion noted at patients left lung. Respiratory

rate ranges from 16-25cpm with irregular use of accessory

muscles. Crackles noted. Decrease in tactile fremitus noted.

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VIII. Circulatory Status

The patients’ blood type is O+. No paresthesia’s noted.

Jugular venous pulsations are strong. Has blood pressure

ranging from 120/90 mmHg to 140/100 mmHg and a pulse rate

range of 64-108 beats per minute. CBC Lab results of both

hemoglobin and hematocrit are normal, WBC count is elevated

with 22.5g/L from a normal range of 4.5-11.0g/L. With

capillary refill of 2-3 seconds.

IX. Nutritional Status

Prior to admission patient experienced frequent vomiting and

was feeling nauseous. For the patient’s diet, he usually

eats about 1-2 meals a day and takes a snack in between. His

usual viand is pork meat (fried and with soup) mixed with

seasonings such as “Magic Sarap” and MSG, frequently eats

noodles, he was also a hard drinker of gin (Ginebra) and

beer (San Miguel and Red Horse) in which he drinks

frequently after sundown. In the hospital he is given

dietary regulated foods. He consumes only half of his meal

and rarely drinks water. Patient also stated that he usually

drinks coffee about 2-3 times a day.

Patient weighs 65 kilograms weight and 5’2 feet in height.

His skin is noticeably dry, and his muscles are lose. There

are no noted food allergies. Patient is a cigarette smoker

for 20 years and consumes about half pack per day with an

equivalent 10 pack-year, does not do illegal drugs.

X. Elimination Status

Prior to hospitalization patient experienced diarrhea,

steatorrhea, as well as polyuria and oliguria (at about 350

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 mL/day). Urine is amber in color with turbid transparency,

he also defecates about 3-5 times a day, stool is yellow,

greasy, and foul-smelling.

XI. Fluid and Electrolyte

The patient drinks about a maximum of 1.2L of water within

24 hours. In the hospital area he is hooked on IVF of PNSS

1Lx16hours. With lab results of Amylase = 583 U/L; SGOT/AST

= 697 U/L; SGPT/ALT = 503 U/L; LDH = 722 U/L.

XII. Integumentary Status

Skin color is brown in color in the lower and upper

extremities, light brown facial and central body area.

Patient’s skin is warm to touch, extremities are a little

cooler. No rashes noted. Generalized dryness noted. Nail

beds are pale in color with 2-3 second capillary refill. No

cyanosis and jaundice noted.

XIII. Comfort and Rest Status

Normally, the patient sleeps comfortably for about 5-7

hours, in the hospital he sleeps for less than 4-6 hours due

to environmental noise, frequent medical follow ups, and IVF

monitoring. When going to sleep, patient mostly positions

himself in a side-lying position

15
 CHAPTER IV

ANATOMY & PHYSIOLOGY

The pancreas is
located
retroperitoneal,
posterior to the
stomach in the inferior
part of the left upper
quadrant.
Parts:
Head – located near the
midline of the body
Tail – extends to the
left and touches the
spleen
The pancreas acts
both endocrine and
exocrine.
The endocrine part of
the pancreas consists
of pancreatic islets (Islets of Langerhans). The islets’ cells
produce the hormones insulin and glucagon, which enter the blood.
These hormones are very important in controlling blood levels of
nutrients such as glucose and amino acids.
The exocrine part of the pancreas is responsible for
producing digestive enzymes. The acini produce digestive enzymes,
clusters of it are connected by small ducts which join to form
larger ducts and form the pancreatic duct. The pancreatic duct
joins the common bile duct and empties into the duodenum.

Functions of the Pancreas

The exocrine secretions of the pancreas include HCO3-, which

neutralize the acidic chyme that enters the small intestine from
the stomach. The increased pH resulting from the secretion of
HCO3-stops pepsin digestion but provides the proper environment
for the function of pancreatic enzymes. Pancreatic enzymes are
also present in the exocrine secretions and are important for the
digestion of all major classes of food. Without the enzymes
produced by the pancreas, lipids, proteins, and carbohydrates are
not adequately digested.

The major proteolytic (protein-digesting) enzymes are

trypsin, chymotrypsin, and carboxypeptidase. These enzymes
continue the protein digestion that started in the stomach, and
pancreatic amylase continues the polysaccharide digestion that
began in the oral cavity. The pancreatic enzymes also include a
group of lipid-digesting enzymes called pancreatic lipases.
Nucleases are pancreatic enzymes that reduce DNA and ribonucleic
acid to their component nucleotides.

The exocrine secretory activity of the pancreas is

controlled by both hormonal and neural mechanisms. Secretin

16
initiates the release of a watery pancreatic solution that
contains large amount of HCO3 -. The primary stimulus for
secretin release is the presence of acidic chime in the duodenum.
Cholecystokinin stimulates the pancreas to release an enzyme-rich
solution. The primary stimulus for cholecystokinin release is the
presence of fatty acids and amino acids in the duodenum, and the
enzymes secreted by the pancreas digest fatty acids and amino
acids. Parasympathetic stimulation through the vagus nerves also
stimulates the secretion of pancreatic juices rich in pancreatic
enzymes. Sympathetic action potential inhibits pancreatic
secretions.

The gallbladder is a small sac found

just under the liver. It
stores bile made by the liver. Bile
helps you digest fats. Bile moves from
the gallbladder to the small intestine
through tubes called the cystic duct and
common bile duct.

17
 CHAPTER V
PATHOPHYSIOLOGY
A. Schematic

18
 CHAPTER VI
LABORATORY AND DIAGNOSTICS

BLOOD CHEMISTRY
Description Results Normal Analysis and
Values Interpretatio
n
Random Random blood 5.21 3.85-9.0 The result is
Blood Sugar sugar mmol/L mmol/L normal, since
(RBS) (RBS) measur it is within
es blood the normal
glucose range.
regardless
of when you
last ate.
Several
random
measurements
may be taken
throughout
the day.
Random
testing is
useful
because
glucose
levels in
healthy
people do
not vary
widely
throughout
the day.
Blood
glucose
levels that
vary widely
may mean a
problem.
This test is
also called
a casual
blood
glucose
test.
Creatinine Creatinine i 99.7 60-120 The result is
s a break- umo/L umo/L normal, since
down product it is within
of creatine the normal
phosphate in  range.
muscle, and
is usually
produced at
a fairly
constant

19
 rate by the
body
(depending
on muscle
mass).
Lactate Lactate 722 U/L 225-450 The result is
dehydrogena dehydrogenas IU/L high.
se (LDH) e (LDH) is
most often
measured to
check for
tissue
damage.
The enzyme L
DH is in
many body
tissues,
especially
the heart,
liver,
kidney,
skeletal
muscle,
brain, blood
cells, and
lungs.
Amylase Amylase is 583 U/L 30-110 The amylase
an enzyme th IU/L level is
at helps high.
digest In acute panc
carbohydrate reatitis,
s. It is amylase in
produced in the blood
the pancreas often
and the increases to
glands that 4 to 6 times
make saliva. higher than
When the the highest
pancreas is reference
diseased or value,
inflamed, sometimes
amylase called upper
releases limit of
into the normal. The
blood. This increase
test is most occurs within
often used 12 to 72
to diagnose hours of
or injury to the
monitor acut pancreas and
e generally
pancreatitis remains
. It may elevated
also detect until the
some cause is
digestive successfully
tract treated. Then
problems. the amylase

20
 values will
return to
normal in a
few days.
Alkaline An alkaline 161.9 64-306 The result is
phosphatase phosphatase IU/L IU/L normal, since
(ALP) test it is within
measures the the normal
amount of range.
the
enzyme ALP
in
the blood.
ALP is made
mostly in
the liver an
d in bone
with some
made in
the intestin
es and kidne
ys. A test
for alkaline
phosphatase
(ALP) is
done to
check for
liver
disease or
damage to
the liver.
Symptoms of
liver
disease can
include jaun
dice, belly
pain, nausea
, and
vomiting. An
ALP test may
also be used
to check the
liver when
medicines
that can
damage the
liver are
taken.
Serum AST 697 IU/L 10-40 IU/L The result is
Glutamic (aspartate high.
Oxaloacetic aminotransfe
Transaminas rase) or
e (SGOT) SGOT (serum
glutamic
oxaloacetic
transaminase
) is

21
 an enzyme fo
und in high
amounts in
heart muscle
and liver
and muscle
cells. It is
also found
in lesser
amounts in
other
tissues.
This test is
mainly done
along with
other tests
(such
as ALT, ALP,
and
bilirubin)
to diagnose
and
monitor live
r disease.
Serum Alanine 503 U/L 0-39 U/L The result is
Glutamic transaminase high.
Pyruvic (ALT) or
Transaminas serum
e (SGPT) glutamic
pyruvic
transaminase
(SGPT) is
an enzyme fo
und in the
highest
amounts in
the liver.
Injury to
the liver
results in
release of
the
substance
into the
blood. This
test is used
to determine
if a patient
has liver
damage.
Lipase Lipase is an 1980 U/L 23-300 U/L The lipase
enzyme that level is
the body high.
uses to In acute panc
break down reatitis,
fats in food lipase levels
so they can are
be absorbed frequently

22
 in the very high,
intestines. often 5 to 10
Lipase is times higher
primarily than the
produced in highest
the pancreas reference
but is also value (often
in the mouth called the
and stomach. upper limit
Most people of normal).
produce Lipase
enough concentration
pancreatic s typically
lipase, but rise within
people with 24 to 48
cystic hours of an
fibrosis, acute
Crohn's pancreatic
disease, and attack and
celiac remain
disease may elevated for
not have about 5 to 7
enough days.
lipase to Concentration
get the s may also be
nutrition increased
they need with
from their pancreatic
food. The duct
blood test obstruction, 
for lipase pancreatic
is ordered, cancer, and
often along other pancrea
with tic diseases.
an amylase Elevated
test, to amylase
help levels
diagnose and usually
monitor acut parallel lipa
e pancreatit se concentrat
is,chronic p ions,
ancreatitis, although
and other lipase levels
disorders may take a
that involve bit longer to
the rise than
pancreas. blood amylase
levels and
will remain
elevated
longer.
Electrolytes:
Sodium The body 145.3 136-145 The result is
uses sodium mmol/L mmol/L still normal,
to since it is
regulate blo only slightly
od beyond the

23
 pressure and normal range.
blood
volume.
Sodium is
also
critical for
the
functioning
of muscles
and nerves.
Potassium Potassium is 3.15 3.5-5.0 The result is
a mmol/L mmol/L normal, since
mineral invo it is within
lved in the normal
electrical range.
and cellular
body
functions.
In the body,
potassium is
classified
as
an electroly
te.
COMPLETE BLOOD COUNT
Description Results Normal Analysis and
Values Interpretatio
n
Hemoglobin Hemoglobin 148 g/L 125-175 The result is
(Hgb) is the g/L normal, since
protein it is within
molecule the normal
in red blood range.
cells that
carries oxyg
enfrom the
lungs to the
body's
tissues and
returns
carbon
dioxide from
the tissues
to the
lungs. The
hemoglobin
test is
almost
always done
as part of
a complete
blood
count (CBC).
Hematocrit Hematocrit 0.44 g/L 0.40-0.52 The result is
(Hct) is a blood g/L normal, since
test that it is within
measures the the normal

24
 percentage range.
of the
volume of
whole blood
that is made
up of red
blood cells.
This
measurement
depends
on the
number of
red blood
cells and
the size of
red blood
cells.
WBC count A WBC count 10.9x109/L 5-10x109/L The result is
is a blood still normal,
test to since it is
measure the only slightly
number of beyond the
white blood normal range.
cells
(WBCs). Your
doctor will
order this
test to find
out how many
white blood
cells you
have. Your
body
produces
more white
blood cells
when you
have an
infection or
allergic
reaction –
even when
you are
under
general
stress.
Neutrophils Neutrophil 0.78 0.45-0.65 Neutrophil
is a type level is
of white high. In
blood cell, acute
specifically pancreatitis,
a form there is
of granulocy inflammation
te, filled in the
with pancreatic
neutrally- tissues.
staining Damage or
granules, inflammation

25
 tiny sacs of tissues
of enzymes t can lead to a
hat help the high
cell to kill neutrophil
and digest count.
microorganis
ms it has
engulfed
by phagocyto
sis.
Lymphocytes A lymphocyte  0.20 0.20-0.35 The result is
is a type normal, since
of white it is within
blood the normal
cell in range.
the vertebra
te immune
system.
Under
the microsco
pe,
lymphocytes
can be
divided into
large
granular
lymphocytes
and small
lymphocytes.
Large
granular
lymphocytes
include natu
ral killer
cells (NK
cells).
Small
lymphocytes
consist of T
cells and B
cells.
Monocytes Monocyte is 0.02 0.02-0.06 The result is
a type normal, since
of white it is within
blood the normal
cell and is range.
part of
the human
body's immun
e system.
Monocytes
play
multiple
roles in
immune
function.
Such roles
include: (1)

26
 replenish
resident mac
rophages and 
dendritic
cells under
normal
states, and
(2) in
response
to inflammat
ion signals,
monocytes
can move
quickly
(approx. 8-
12 hours) to
sites of
infection in
the tissues
and
divide/diffe
rentiate
into
macrophages
and
dendritic
cells to
elicit an
immune
response.
Half of them
are stored
in
the spleen.
Platelet A platelet 241 x109/L 150-400 The result is
count count is a x109/L normal, since
test to it is within
measure how the normal
many range.
platelets
you have in
your blood.
Platelets
help the
blood clot.
They are
smaller than
red or white
blood cells.
The number
of platelets
in your
blood can be
affected by
many
diseases.
Platelets
may be

27
 counted to
monitor or
diagnose
diseases, or
identify the
cause of
excess
bleeding.
URINALYSIS
Description Results Normal Analysis and
Values Interpretatio
n
Color Yellow Pale The result is
yellow to normal, since
amber it is within
the normal
range.
Transparenc Slightly Clear to The result is
y turbid slightly normal, since
turbid it is within
the normal
range.
Sugar Negative Negative The result is
normal, since
it is within
the normal
range.
Albumin Albumin is a Tracts Absence of The presence
protein made albumin albumin in
by the the urine is
liver. A indication of
serum dysfunction
albumin test of kidneys.
measures the The size of
amount of this albumin
this protein proteins are
big in size.
in the clear
Kidneys
liquid
generally
portion of remove all
the blood. the waste
This test from blood
can help using the
determine if filters which
a patient is called as
has liver glomeruli. As
disease or k these
idney proteins are
disease, or big in size
if the body they are
is not filtered by
absorbing kidneys. When
enough prote the kidneys
in. Albumin are weak
helps move these albumin
many small proteins are
molecules found in the

28
 through the urine which
blood, indicate the
including bi dysfunction
lirubin, of kidneys.
calcium, The condition
progesterone of the
, and kidneys can
medications. be assessed
It plays an by checking
the albumin
important
levels in the
role in
urine. The
keeping the test done to
fluid from check the
the blood level of
from leaking albumin in
out into the urine is
tissues. called as
microalbumin
test. The
presence of
albumin
doesn’t cause
pain but
results in
diagnostic
problem.
Specific Urine 1.030 1.015- The result is
gravity specific 1.025 still normal,
gravity is a since it is
laboratory only slightly
test that beyond the
measures the normal range.
concentratio
n of all
chemical
particles in
the urine.
This test
helps
evaluate
your body's
water
balance and
urine
concentratio
n.
Pus cells Pus cells 4-6/HPF 0-5/HPF The result is
are still normal,
determined since it is
to see if only slightly
there is beyond the
urinary normal range.
tract
infection.
RBC An RBC count 3-4/HPF Negative The result is
is a blood or rare normal, since
it is within
29
test that the normal
tells how range.
many red
blood cells
(RBCs) you
have. RBCs
contain hemo
globin,
which
carries
oxygen. How
much oxygen
your body
tissues get
depends on
how many
RBCs you
have and how
well they
work.

30
 CHAPTER VII
Nursing Care Plan

31
 CHAPTER VIII: SUMMARY OF CARE

A. Medical Management
Patient X’s was admitted at Baguio General Hospital on May 12,
2019 with chief complaint of upper abdominal pain. Then on May
12, 2019 other procedure was doing done that they and some
other test. Patient was given by oral medication. Patient’s
vital signs, hydration, Blood Pressure and Capillary Blood
Pressure was continuously monitored. The patient was admitted
at PAY Ward. Patient X continuously monitored her IV fluid.

B. Nursing Management
Patient X is a 48 year old man , was admitted at Baguio
General Hospital and Medical Center on May 12, 2019 9:00 pm
with the chief complaint of upper abdominal pain. Upon
admission patient was assessed patient was assessed and
referred to the Doctor. Patient X was then referred to the pay
ward where her vital signs were monitored continuously.
Patient X and her watcher was also told about health teachings
on the importance of hydration, infection control and pain
management. Encouraged health teachings about the importance
of a healthy balanced diet.

32
 CHAPTER IX: RECOMMENDATIONS

The BSN 4 NDB-2 would like to recommend the following:

 Education
Further emphasize the standards of creating FDAR charting, NCP,
and drug studies in order for the students to come up with a
uniform way of formulating the said topics.
Promote seminars and that may help the students further
understand lessons concerned with their subjects.
Have a one-on-one discussion to enhance the students’ knowledge
on their patient’s case.

 Practice
Encourage nursing students to voice out their concerns about any
abnormalities noted on the patient.
Enhance the staff-student relationship to help in creating a
better bond to help each other in the ward.

 Research
Update the statistics yearly on cases of the patients nationally,
regionally, and locally.
Create more journals and articles regarding common diseases.
Promote seminars in institutions to capture the attention of
students who are in need of additional learnin

33
34