I. Introduction A.

Overview of the disease A gallstone is a crystalline concretion formed within the gallbladder by

accretion of bile components. These calculi are formed in the gallbladder, but may pass distally into other parts of the biliary tract such as the cystic duct, common bile duct, pancreatic duct, or theampulla of Vater. Presence of gallstones in the gallbladder may lead to acute cholecystitis, an inflammatory condition characterized by retention of bile in the gallbladder and often secondary infection by intestinal microorganisms, predominantly Escherichia coli and Bacteroides species. Presence of gallstones in other parts of the biliary tract can cause obstruction of the bile ducts, which can lead to serious conditions such asascending cholangitis or pancreatitis. Either of these two conditions can be life-threatening, and are therefore considered to be medical emergencies.

As a final point, I aspire to discuss the condition of my client and talk about how I apply the nursing process and utilize the concepts of medical and surgical nursing, specifically in managing T/C Obstructed CBD stones vs. Hepatoma.

B. OBJECTIVE AND PURPOSE OF THE STUDY This study is designed to identify health problems encountered by our client and further understand the extent of the case. As student nurse, this would serve as a tool for my ground training from what I have learned in classroom discussions and be able to apply these in a real hospital setting such as this case. This case study focuses to accomplish the following objectives:

a. To establish rapport with the client.

b. To ascertain the content on the nursing assessment, diagnosis, planning, implementation, and evaluation for this specific disease condition; c. To comprehend on the underlying causes and health history on the clients medical diagnosis; d. To compare & contrast the ideal and actual nursing care management for this specific disease condition: and

e. To evaluate the effectiveness of the interventions and detect any progress or regression of the clients condition. The purpose of the study is to understand thoroughly the clients disease condition and the factors involving the processes of the disease condition, which is T/C Obstructed CBD stones vs. Hepatoma. In general, this study aims to develop the skills and learning of the student, wherein I am exposed and able to learn the genuine hospital setting in every case that they encounter. Enhancing ones understanding and competence is important to impart the best possible care to client B. Scope of the Study

The study focuses on Station 1, room 22, medical patient, admitted at Bukidnon Provincial Medical Hospital at Malaybalay City, Bukidnon. Nature, causes, signs & symptoms, pathophysiology, medical management, and nursing management.

Involves the ideal and actual nursing intervention appropriate to address the needs of Mrs. Macadag-um, the drug study of the medications given to her, the health teachings as well as referrals for Mrs. Macadag-um.

Assessment of Mrs. Macadag-ums personal health history, and history of present illness. C. Limitation of study Limited only to the history of the patient which is comprised of the patients profile, family and personal health history, chief complaint and history of present illness.

Information being collected from the patient during the patient assessment and 2 days of duty, each in 12 hours. Limited only to admitting diagnosis and no final diagnosis because the patient havent been discharged yet.

II- Health History A. Patient Profile Name: Birth date: Age: Mrs. Macadag-um November 4, 1956 54 yrs. old

Sex: Religion: Civil Status: Address: Nationality: Date Admitted: Time Admitted: Temperature: Pulse rate: Resp. Rate: BP: Height: Weight: Chief Complaint: Admitting Diagnosis:

Female Roman Catholic Married Mabuhay, Valencia City Filipino January 20, 2011 5:10pm 36.8C 82bpm 20cpm 130/80 mmHg 52 40kg Abdominal Pain T/C Obstructed CBD stones vs. Hepatoma

B. Family and Personal History Mrs. Macadag-um, Female, Filipino, 54 years old, is a resident of Mabuhay Valencia City. She has received all vaccinations during his childhood years. She had a family history of hypertension on both mother and father side. She also has no known drug and food allergies. She graduated at the Mabuhay National High school. Unfortunately Mrs. Macadag-um did not proceed to college due to financial constraint. At present, Mrs. Macadag-um is a farmer and is independent from his children. She is a wife of Mr. J, and they had three (3) children. Her eldest, Maris, is helping them in their farm. And the family has an income of 5000 per month. Mrs. Macadag-um gave birth to her 3 children through normal spontaneous delivery. She was admitted last Decembe 2010 due to having jaundice in the hospital of Valencia City. C. History of Present Illness:

1 month prior to admission, Ms C experienced abdominal pain at the upper quadrant and was having jaundice and ignored it because of the lack of knowledge about health and diseases. 1 day prior to admission she experience on and off severe abdominal pain which she then decided to have a check up. On the day which she was admitted, she experienced severe abdominal pain which she cant bear; she said that it feels like she is dying every time her stomach was touch. According to the patient, last year she was having a symptom of jaundice but ignored it for a month. Due to her unbearable pain Mrs. Macadag-um decided to be admitted through the assessment of Dr. Exile. III. Developmental Data A. Erick Erickson (Psychosocial Theory) Mrs. MAcadag-um age belongs to the adulthood stage of Erik Erikssons theory of stages of development. The central task that she ought to resolve at this stage is to resolve generativity versus stagnation. With Mrs. Macadag-ums case, she verbalized that drinking and smoking is bad in our health. With this, she was able to accept ones own lifes uniqueness and worth. The patient shows signs of positive resolution because whenever she was asked to do something she is very eager to cooperate and respond to the questions given to her. Furthermore, she also said that she was happy to raise her children and watch them grow with them. She also verbalized that she is not afraid to die at this point in his life because according to her, the task of being a mother to her children and a wife to her husband has been done.

B.

Jean Piaget (Cognitive Developmental Theory) It refers to the manner in which people learn to think, and use language. It

involves a persons intelligence, perceptual ability, and ability to process information. Cognitive development represents a progression of mental abilities from illogical to logical thinking, from simple to complex problems solving, and from understanding concrete ideas to understanding abstract concepts.

As I have observed, Mrs. Macadag-um could talk and communicate well, able to answers our questions correctly, she was still able to think logically and she lives with her good moral standards. C.Robert Havighurst (Developmental Task) According to Robert Havighursts Developmental Theory, the client belongs to the late maturity stage wherein in there is adjustment to decreasing physical strength and health. Theres an adjustment to retirement and reduced income. Establishing an explicit affiliation with ones age group is one of the major highlights of this stage. Adapting social roles in a flexible way. Establishing satisfactory physical living arrangements which are all held true to the client. Since she is a farmer, she was able to adjust to the life she is having now especially with the physical works, and is even open to the possibilities that might happen, like things beyond our control. D. Sigmund Freud (Psychosexual Theory) According to Freuds psychosocial theory, he belongs to the Genital Stage. During this final stage of psychosexual development, the individual develops a strong sexual interest in the opposite sex. Where in earlier stages the focus was solely on individual needs and, interest in the welfare of others grows during this stage. If the other stages have been completed successfully, the individual should now be well-balanced, warm, and caring. And this is true to the client. The client was very warm and caring, as verbalized by her husband. Although she lost already that sexual urge towards the opposite sex, she was able to fulfill those things during the earlier stage of her married life.

IV. Medical Management a. Medical Orders and Rationale

Date/ Time January 20,2011 5:10pm

Order Pls. admit

Secure consent to care Monitor V/S every 4hrs then record NPO

LABS : CBC,UA,total bilirubin,HBS,Aq, SGPT,SGOT,whole abdomen USD. Venodusis with D5LR 1liter at 30gtts/min. MEDS. Ketorolac 30mg. amp 1 amp every 8hrs. IVTT Jan. 21,2011 Jan.27,2011 Jan.27,2011 Monitor I and O every shift Will inform Dr. Generalao done Refer for unusualities Refer to Internal medicine for evaluation Refer accordingly IVF to follow : D5LR 1L at 30gtts/min. Ff/up labs Continue meds IVF to ff: D5LR at SR To secure 3 units of FWB of patients blood type, properly crossmatched still for UTZ UA Pls ff-up procurement of blood Continue meds IVF TF: D5LR1Lat 30gtts/min Follow-up UTZ result TRAMADOL 1 amp IVTT now then every 8hrs.

Rationale For proper management and by request of the patient since the doctor is specialized in the field For legal purposes For monitoring patients health status For lab accurate result Basis in planning for treatment

A vehicle for transportation of IVTT meds To relieve pain stimulus and decreases ontraocular inflammation To monitor pt. health status To Keep pt. safe To be evaluated and be assessed for treatment A vehicle for transportation of IVTT meds To know results For treatment To compensate for low RBC, hemoglobin, and hematocrit count of the patients CBC exam result

Jan.27,2011

For treatment Alter perception of and emotional response to pain

Laboratory Results with Implications

B.Drug Study

Diagnostic Exam Generic Name CBC Brand Name 6/29/10 Date Ordered White blood cells Classification Dose/ Frequency/ Hemoglobin Route

Results Ketorolac

Normal values

Significance of the result

Toradol January 14,700 20,2011 5,000-10,000/mm Indication of infection Nonesteroidal anti-inflammatory, Analgesic 30mg. 1amp every 8hrs.IVTT 8.4 13.7-16.7 g/dl Indication of anemia

Mechanism of An NSAID that inhibit prostaglandin synthesis and reduces Hematocrit 25.0 40.5-49.7vols% Indication prostaglandin levels in the aqueous humor of severe anemia Action Specific Indication Adequate pain and stimulus and reduces intraocular Relieves Platelet 144,000-372,000 Normal range inflammation Contraindication Non- Active peptic ulcer diseas,chronic inflammation of HBsAg Normal range reactive GI tract, hypersensitivity to NSAIDS. CLINICAL Side Effects Headache CHEMISTRY Nausea ALKALINE Abdominal cramps PHOSPHATE Dyspepsia 0-3 IU/L Increased SGOT 110.6 0-3 IU/L Increased Nursing If GI upset occur take with food or milk. SGPT 49.1 Avoid aspirin or alcohol during therapy. Precaution Asses RADIOLOGIC Extrahepatic onset, type, location duration of pain OPINION Biliary REPORT obstruction secondary to a Gallbladder and CBD new growth Consider carcinoma. Suggest abdominal CT

Generic Name of the Ordered Drug Brand Name Date Ordered Classification Dose/ Frequency/ Route Mechanism of Action

Tramadol Ultram January 28,2011 Analgesic 30mg. 1amp every 8hrs.IVTT An analgesic that binds to mu-opioid receptors and inhibit re-uptake of norepeniphrine and serotonin.Reduces the 9

Specific Indication Contraindication

intensity of pain stimuli reaching sensory nerve endings. Management of moderate to moderately severe pain. Hypersensitivity to opioids. Concurrent use of centrally acting analgesics,acute alcohol intoxication Dizziness, vertigo, nausea, constipation, headache Monitor pulse and BP Sips of tepid water may relieve dry mouth Monitor daily pattern of bowel activity.

Side Effects Nursing Precaution

V. Pathophysiology with Anatomy and Physiology

10

Bile is a greenish substance produced by the cells of the liver (hepatocytes) which aids in the digestion of fats. It emulsifies fats, causing the fats to accumulate into droplets which can be easily absorbed in the small intestine. It also aids in the absorption of so call fat soluble vitamins, vitamins A, D, E and K. Bile is also the way the body disposes of hemoglobin from old red blood cells which are no longer functional. This is what makes bile green and stool brown. Once hepatocytes have made bile it is transported to the duodenum, the segment of small intestine right after the stomach, where it is secreted through a small hole known as the Ampulla of Vater. It can then form droplets with fat exiting the stomach. The bile also goes to the gallbladder where it can be stored. The network of ducts which transport the bile is known as the biliary system. This system can be broken down into several sections. The first section is comprised of the ducts which are inside of the liver, also known as the intrahepatic ducts. Small bile ductules in the liver combine with each other to form larger ducts known as intrahepatic bile ducts. The liver can be grossly divided into two lobes, the left and the right. As the intrahepatic ducts combine with each other they form two large ducts known as the right and left hepatic ducts. The left and right hepatic ducts come together to form the common hepatic duct. The segment of ducts immediately outside of the liver is known as the perihilar ducts. The gallbladder sits on the underside of the liver and the cystic duct delivers bile into and out of the gallbladder. As the common hepatic duct exits the liver it connects with 11

the cystic duct to form the common bile duct. The common bile duct enters the pancreas and combines with the pancreatic duct and secretions from both the pancreas and the common bile duct exit into the duodenum through the ampulla of Vater. These areas of ductal system are known as the distal biliary tree. The Liver and Gallbladder

The digestive function of the liver is to produce bile, which is then delivered to the duodenum to emulsify fats. Emulsification is the breaking up of fat globules into smaller fat droplets, increasing the surface area upon which fat-digesting operate. help neutralize the HCl in the chyme. enzymes (lipases) does can not Because bile

chemically change anything, it is not an enzyme. Bile is also alkaline, serving to

Bile consists of bile salts, bile pigments, phospholipids (including lecithin), cholesterol, and various ions. The primary bile pigment, bilirubin, is an end product of the breakdown of hemoglobin from expended red blood cells. Although some of the bile is lost in the feces (bilirubin gives feces their brown color), much of the bile is reabsorbed by the small intestine and returned to the liver via the hepatic portal vein.

The liver performs numerous metabolic functions. Some of the most important follow:
Bile

is produced.

12

 Blood

glucose is regulated. When blood glucose is high, the liver converts

glucose to glycogen (glycogenesis) and stores the glycogen. When blood glucose is low, glycogen is broken down (glycogenolysis), and glucose is released into the blood.
Proteins

(including plasma proteins) and certain amino acids are synthesized. (which is toxic) is converted to urea (less toxic) for elimination by

Ammonia

the kidneys.
Bacteria

and expended red and white blood cells are broken down. From the (A, D, and B12) and minerals (including Fe from expended red blood

red blood cells, Fe and globin are recycled, and bilirubin is secreted in the bile.
Vitamins

cells) are stored.

Toxic

substances (drugs, poisons) and hormones are broken down.

The liver is composed of numerous functions units called lobules. Within each lobule, epithelial cells called hepatocytes are arranged in layers that radiate out from a central vein. Hepatic sinusoids are spaces that lie between groups of layers, while smaller channels called bile canaliculi separate other layers. Each of (usually) six corners of the lobule are occupied by three vessels: one bile duct and two blood vessels (a portal triad). The blood vessels are branches from the hepatic artery (carrying oxygenated blood) and from the hepatic portal vein (carrying deoxygenated but nutrient-rich blood from the small intestine). Blood enters the liver through the hepatic artery and hepatic portal vein and is distributed to lobules. Blood flows into each lobule by passing through the hepatic sinusoid and collecting in the central vein. The central veins of all the lobules merge and exit the liver through the hepatic vein (not the hepatic portal vein). Within the sinusoids, phagocytes called Kupffer cells (stellate reticuloendothelial cells) destroy bacteria and break down expended red and white blood cells and other debris. Hepatocytes that border the sinusoids also screen the incoming blood. They remove various substances from the blood, including oxygen, nutrients, toxins, 13

and waste materials. From these substances, they produce bile, which they secrete into the bile canaliculi, which empty into bile ducts. Bile ducts from the various lobules merge and exit the liver as a single common hepatic duct. The common hepatic duct merges with the cystic duct from the gallbladder to form the common bile duct, which, in turn, merges with the pancreatic duct to form the hepatopancreatic ampulla. This last duct delivers the bile to the duodenum. The gallbladder stores excess bile. When food is in the duodenum, bile flows readily from the liver and gallbladder into the duodenum. When the duodenum is empty, a sphincter muscle (sphincter of Oddi) closes the hepatopancreatic ampulla, and bile backs up and fills the gallbladder.

PATHOPHYSIOLOGY
PREDISPOSING FACTOR: Age: 54yrs. Old Sex: female

PRECIPITATING FACTOR: Viral Hepatitis Contaminated foods 14 Lifestyle

: Hepatocyte Damage Increased WBC : 14,700 Liver Inflammation Fatigue Alteration in blood and Lymph flow Pain

Anorexia/wg t Loss:40kg.

Nausea and Vomiting

Liver Necrosis

Decreased bilirubin Metabolism And/or biliary tree obstruction (extrahepatic biliary obstruction ) (Gallbladder and CBD new growth)

Hepatomegal y

Legend:
Pathophsiology

Conjugated hyperbilirubinemia

Signs and Symptoms

JAUNDICE
VI. Nursing Assessment Nursing System Review Chart
Name: Mrs. Macadag-um Vital Signs: Pulse: 82 bpm BP: 130/80 mmHg Temp: 36.8C Date: January 26-27-28 2011; RR: 20 cpm Height: 52 Weight: 40 kls.

EENT:

15

 impaired vision blind pain reddened drainage gums hard of hearing deaf burning edema lesion teeth Assess eyes, ears, nose throat for abnormality no problem

blind; Right eye Jaundice on both eyes___

RESP:
asymmetric tachypnea apnea rales cough barrel chest bradypnea shallow rhonchi sputum diminished dyspnea orthopnea labored wheezing pain cyanotic Asses resp, rate, rhythm, depth, pattern, breath sounds, comfort no problem

__IVF D5LR at 30 gtts/min._ _ IVF D5LR at 30gtts/min. IVF D5LR at 30 gtts/min._ __________________ IVF PNSS 1L @ KVO rate _____________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ _____________________ _____________________ ______________________ ______________________ ______________________ ______________________ Dry and Yellow color skin_ Wt = 40kgs._____________ Pain noted Scale 7

CARDIO VASCULAR
arrhythmia tachycardia numbness diminished pulses edema fatigue irregular bradycardia murmur tingling absent pulses pain Asses heart sounds, rate rhythm, pulse, blood pressure, clrc., fluid retention, comfort no problem

GASTRO INTESTINAL TRACT

obese distention mass dysphagia rigidly pain Assess abdomen, bowel habits, swallowing, bowel sounds, comfort no problem

GENITO-URINARY and GYNE

pain urine color vaginal bleeding hermaturia discharge noctoria Assess urine freq., color, control, odor, comfort/ Gyn-bleeding, discharge no problem

body weakness(01-26-10)
__BP = 100/80__110/70___ __T=36.8______36.3_____ __PR=82_______83______ __RR=20_______25______ ______________________ ______________________ ______________________ ______________________ _Vomitted________ _Gums bleeding _no pain noted_________ ______________________ Dry and Yellow skin; ______________________ ______________________ ______________________

NEURO
paralysis stuporous unsteady seizures lethartic comatose vertigo tremors confused vision grip Assess motor function, sensation, LOC, strength, Grip, gait, coordination, orientation, speech, no problem

MUSCULOSKELETAL and SKIN

appliance stiffness itching petechiae hot drainage prosthesis swelling lesion poor turgor cool deformity wound rash skin color flushed atrophy pain ecchymosis diaphoretic moist Asses mobility, motion. Galt, alignment, joint function skin color, texture, turgor, integrity no problem

NURSING ASSESSMENT II

16

SUBJECTIVE glasses COMMUNICATIO N: hearing Loss visual Changes denied OXYGENATION : dyspnea smoking history occassional smoker cough sputum denied
Comments: Wala ko problema sa pangdungog. as verbalized by the patient.

OBJECTIVE
contact lens aide languages hearing

Comments: ok raman akong paginhawa.ga panigarilyo ko sauna pag maginum ra as verbalized by the patient.
Comments: Wala man na siya problema sa high blood. Pero iyang mama ug papa naa . as verbalized by the husband.

speech difficulties Pupil Size: R=0; L=3mm Reaction: briskly reactive Pupils Equally Round and Reactive to Light and Accomodation and Coordianted Resp. regular

irregular Describe: breathing normaly and no abnormal sounds upon inhaling and exhaling; equal lung expansion Right lung symmetrical to the left lung. Left lung symmetrical to the left lung. Heart Rhythm regular irregular Ankle Edema: no ankle edema present. Pulse Car. Rad. DP Fem R + 82bpm + not obtained L + 82bpm + not obtained Comments: pulses are palpable Dentures None Upper: Lower: FULL PARTIAL

CIRCULATION : Chest pain Leg pain Numbness of extremities Denied

NUTRITION : Diet: Diabetic Diet N V Character Recent change in weight, appetite Swallowing difficulty denied ELIMINATION : Usual bowel pattern once a day constipation remedy no constipation Date of last BM Janaury 26, 2010 Diarrhea character: not applicable

Comments: dili nako ganahan mo kaun sugod atong sige sakit akong tiyan. as verbalized by the patient.

urinary frequency four times a day urgency dysuria hematuria incontinence polyuria foley in place denied

Comments: No problem in bowel and urination.

Bowel Sounds: Patient has Normal bowel sounds upon ausculation Abdominal DIstention Present: yes no Not applicable, no foley bag in place.

17

MGT. OF HEALTH ILLNESS Alcohol denied

Briefly describe the patients ability to follow treatments for chronic health problems.

VII. Nursing Management a. Ideal Nursing Care Plan

18

NURSING DIAGNOSIS
Altered Nutrition: Less than Body Requirements r/t decreased Intake and loss of appetite

INTERVENTION
Independent: 1. Obtain a thorough nutritional assessment. 2. Provide a pleasant atmosphere at mealtime; remove noxious stimuli. 3. Provide oral hygiene before meals. 4. Provide the feedings in the prescribed amount and on time. 5. Ambulate and increase activity as tolerated

RATIONALE
- Identifies deficiencies/ needs to aid in choice in intervention. - Useful in promoting appetite.

EVALUATION
After the Nursing Interventions, the goals were partially met. 2days after the day of assessment, the patient was discharged; the group was not able to evaluate the long term goal. However, before he was discharged, he has shown slight increase in energy level.

- A clean mouth enhances appetite. -May reduce fatigue and thus enhance intake while preventing gastric distention. - Helpful in expulsion of flatus. Reduction of abdominal distension contributes to overall recovery and sense of well- being and decreases possibility of secondary problems.

19

NURSING DIAGNOSIS
Knowledge deficit treatment related to unfamiliarity of treatment and lack of resources

INTERVENTION
Independent 1.Provide information relevant to the situation. 2.Identify information that needs to be remembered. 3.Begin with information the client already knows and move to what the client does not know, progressing from simple to complex. Dependent 1. Identify available community resources and support groups (e.g. health center).

RATIONALE
1. Provides relevant knowledge. 2. Establishes the content to be included. 3. Facilitates learning.

EVALUATION
After the Nursing interventions, the goals were partially met. The patient and his SO were able to verbalize understanding of condition and treatment. He also able to initiate lifestyle changes and participate in treatment regimen

1. For continuity of care and to promote wellness.

20

B. Actual Nursing Management

S O A P

No subjective cues High WBC Weak Hepatomegaly (+) Infection related to inadequate secondary defenses (decrease Hgb and Increased WBC) At the end of 12 hours, the patient will be able to identify interventions to reduce infection and to understand the risk factors. Independent: Placed in a semiprivate room. Limit visitors as indicated. To protect patient from potential sources of pathogens/infection. Instructed proper hand washing To prevents cross contamination and reduces infection Proper hygiene

To protect patient from potential sources of pathogens/infection. Encouraged deep breathing exercises

Monitored skin color, notify pallor Proliferation of WBC can reduce oxygen carrying capacity of the blood.

At the end of 12hours, patient was able to identify interventions to reduce infection and understand the risk factors.

21

22

S O A

Sakit kayo akong tiyan O= with facial grimace, with guarding behaviors, pain scale of 7/10, at abdominal area, with quality of dull Acute Pain related to inflammation of the liver Long term: After 3 days of nursing intervention, pt will demonstrate technique to alleviate pain

Short term: After 2 hr of nursing intervention the pt will verbalize relieve of pain from 7/10 to 4/10

Established rapport To gain pts therapeutic relationship Monitored v/s To obtain baseline data Assessed pts general condition To note for the etiology or precipitating factors that can lead to fever. Encouraged rest opportunities To overcome pain at rest Encouraged diversional activities such as talking to S.O. to divert the pts attention Encouraged deep breathing exercises Helps to lessen the feeling of pain. Provided comfort measures and safety To let pt feel safe and comfortable Provided Health information regarding the occurring problem To lessen the pts feeling of anxiety

. At the end of 8 hours, the patient pain scale was lowered to 4 out of 10.and had understanding on how to alleviate pain.

23

VIII. Refferals and Follow-up

24

 Determined recommended dietary plans and provided dietary education as appropriate. Reinforced to patient the importance of keeping follow-up appointments with the health care provider. Explained to the patient the rationale for, side effects of, importance of taking medications as prescribed. Informed patient's parents/family/caretaker of pertinent food and drug interactions. Implemented measures to the patient's family to improve compliance: included significant others in all discharge teaching sessions. Encouraged questions and allowed more time for reinforcement and clarifications of information provided. Provided written instructions regarding scheduled appointments with health care provider, medications prescribed, and signs and symptoms to report. Referred to the nearest health center for check-up and monitoring of condition. But for emergency cases the patient was advised to go to the nearest hospital for monitoring of condition.

25

IX. Health Teachings

Medication:

The patient was instructed that compliance of taking the medications would improve his condition and treat it in the long run. He was instructed to continue taking pain reliever with the right dose, and at the right route. He was instructed to comply in all the medications being allotted for her or to maintain taking the drugs that are for maintenance. During her stay in the hospital, the client was assisted in doing ROM exercises to promote circulation; He was also assisted in walking, when he would go to the bathroom. Avoid strenuous activities to avoid over consumption of oxygen. she can also perform activities of daily living with minimal effort. The patient was instructed to cooperate in planned interventions for his condition. Cooperate with doctors treatment plan such as routine and scheduled blood transfusion, weekly check-up and monthly CBC exam. she was also encouraged to ask question about her condition and the treatment she was undergoing If discharge, the client was instructed to have a follow-up check up 1 week after discharge for evaluation of her condition and her compliance to the home medications given. she can have routine check-up to the hospital or to the nearest health care center for his condition to be monitored and evaluated. she was advised to repeat CBC after 1 month. Diet as tolerated was advised by the doctor. Patient was

Exercise:

Treatment

Out Patient(Checkup)

Diet

encouraged to take nutritious food rich in protein,Vit.A, Iron and minerals. For health maintenance and recovery

26

X. Prognosis

Severity she now has decreased physical, physiological and emotional coping mechanism. She is more prone to infection and complication because of his increasing

27

age. For this reason his body is not at its optimum functioning which explains the poor prognosis. Age she is now at the peak age of his life. At this age, his organ and body function is not the same before. At this age deteriorating organs are present. Some of it has decreased its function level. With this info, you could say that his body wont cope up easily with the treatment and recovery; especially she has a rare disease condition at this age. Medication and Compliance Compliance to medication is vital for the prompt improvement of our patients condition. Her medications were being administered per IVTT. The client received a good prognosis for he showed willingness to follow or comply with her medication treatment. But medication alone is not enough for the recovery and treatment. The body should accept the treatment and should improve her condition. Family Support The patients family showed full emotional, physical, and financial support towards the patient, thus, she is given a good rating in this criterion. The group observed how well the clients daughter personally took good care of her and attended to all of her needs during her entire stay in the hospital. They also provided the patient with all her needs in the ward such as medications, and other supplies as well.

XI. Evaluation

Prompt medical treatment coupled with quality nursing care; will improved prognosis of the client diagnosed with hepatoma

28

Thorough and accurate physical assessment enabled the students to identify priority actual and potential problems and provide nursing interventions appropriate for the clients specific medical condition. Furthermore, this study provided the students a venue to practice learned skills and impart valuable health teachings to enhance clients knowledge regarding her health condition in order to prevent complications and hasten recovery.

XII. Bibliography

Besa,

E.(Mar

16,

2010)

Chronic

Myelogenous

Leukemia

from

http://emedicine.medscape.com/article/199425-overview

29

Chronic myelogenous leukemia and related disorders: An overview. In: Lichtman MA, et al. 2008. Cliffs Notes(n.d) The Fastest way to learn. Lymphatic System Components from http://www.cliffsnotes.com/study_guide/Lymphatic-System-Components.topicArticleId22032,articleId-21980.html#ixzz0tZxAy0PI Doenges, M., Moorhouse M.F., Murr, A.(2008), Nurses Guide:Diagnoses,Prioritized Interventions, and Rationales. Philadelphia, Pennsylvania:F.A Davis Company Pocket Williams Hematology. 7th ed. New York, N.Y.: McGraw-Hill; 2006.http://www.accessmedicine.com/content.aspx?aID=2148618. Accessed Sept. 11,

Integrative medicine and complementary and alternative therapies as part of blood cancer care. The Leukemia & Lymphoma Society. http://www.leukemialymphoma.org/attachments/National/br_1150734030.pdf. Accessed Sept. 17, 2008. Medline Plus(2010) Chronic myelogenous http://www.nlm.nih.gov/medlineplus/ency/article/000570.htm leukemia a from personal

Nowell PC (2007). "Discovery of the Philadelphia chromosome: perspective". Journal of Clinical Investigation : 20332035. Schull, P.,(2009), Nursing Spectrum Drug Handbook.USA. McGraw-Hill

Smeltzer, S., Bare, B.,(2004), textbook of Medical-Surgical Nursing. Philadelphia. Lippincott Williams & Wilkins

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