A Clinical Paper Presented the the Faculty of the College of Nursing Cebu Normal University

In Partial Fulfillment of the Requirements for the Degree Bachelor of Science in Nursing

Laura Suzanne K. Suarez October 2011


The researcher would like to express her deepest gratitude to the following for their overall contribution to the success of this study. Without them, this study may not have been conducted nor would it have been finished. To ³L´, my client, my ³thank you´ is not enough to express my heartfelt gratitude for allowing me to come into her life. Without her, this study will not have tackled such a fascinating disorder. Her story will forever be embedded in my memory. To Ms. Bertilia F. Pragados, R.N. our research consultant, who has offered her time and effort in conducting consultations and answering questions. She has patiently guided and taught me in how to compose this case study and how to go about in interacting with the client. Her expertise in the field of psychiatric nursing has greatly contributed to the success of this study. To the Staff of Ward 12, for allowing the fourth year students of Cebu Normal University to enter their institution and extending their warm welcome when we first arrived. Without their kindness and their patience, the experience may have lacked its luster. To Mrs. Antonietta Obiedo R.N., our year level coordinator, for giving the us the opportunity to conduct this study therefore enabling me to enhance my nursing skills especially in the field of psychiatric nursing. Without her dedication to the development of skills of the level four students, this case study will not have been conducted. To my Groupmates, Group 3, section A., for being themselves and making this experience worthwhile. Without them, I may not have had as much fun as I did. To my Parents, for simply being there. Without their presence and their support emotionally, and financially, I would have never had the strength and courage to tackle this study. Lastly and most importantly, To God, our Almighty Father, the creator of all things. His love for everything and everyone has immensely helped mold me into the person that I am today. The very fact that my faith in Him has greatly influenced how I live my life makes Him the one who has most significantly contributed to the success of this study.

Table of Contents TITLE PAGE i DEDICATION ii ACKNOWLEDGMENT iii TABLE OF CONTENTS LIST OF TABLES iv LIST OF FIGURES List of tables ABSTRACT CHAPTER 1 INTRODUCTION 1 Rationale and Background of the Study Statement of the Problem Objectives of the Study Significance of the Study Research Methodology Research Locale Research Design Research Design Research Instrument Research Data Gathering Procedure .

CHAPTER 2 PATIENT¶S PROFILE Background/History Patient¶s Vitae Functional Health Patterns Physical Assessment Organ System Assessment Interpretation of findings CHAPTER 3 ANATOMY AND PHYSIOLOGY CHAPTER 4 PSYCHOPATHOPHYSIOLOGY AND PSYCHODYNAMICS CHAPTER 5 MANAGEMENT Medical Laboratory and Diagnostic Procedures: Ideal and Actual Drug Study: Ideal/Actual Surgical Perioperative: Ideal and Actual Nursing Summary of Nursing problems Individualized NCP (Physiologic. Psychologic) Independent Nursing Strategies Dependent Collaborative FDAR Charting Discharge Summary with collaborative Nursing Function CHAPTER 6 EVALUATION AND RECOMMENDATION Extent of Goal Achievement Recommendations .

Assessment Tool B. Clinical Pathway C. Research Articles CURRICULUM VITAE .BIBLIOGRAPHY APPENDICES A.

No. 1.2 1st dx na results 2nd dx na resuls Title Page .1 1.List of Tables Table No.

1 1. 1.List of Figures Table No.2 Schematic Diagram of the Pathophysiology of Tuberculosis Pathophysiology of Tuberculosis 25 20 Title Page . No.

a female client. MAN Year Completed: School Year 200-2012 Statement of the Problem: This case study aims to give a comprehensive information to the readers about Rubeola infection. Nemenzo School: Cebu Normal University Degree: Bachelor of Science in Nursing Adviser: Mr. Blah blah blah blah.Abstract Title: Care of a Patient with Rubeola Infection Author: Endrex P. Methodology: The study was conducted at VSMMC. Ragay. Blah blah blah blah blah blah.Q. . Alain Kenneth S. married. And everything follows. Findings: C.A. Conclusion: How you conclude your study Recommendations: The researcher recommends strict compliance to the treatment plan. And everything follows. RN.

What are the nursing interventions appropriate for the patient based on assessed needs? Objectives of the Study .1 Actual nursing needs 3. What are the medical and surgical management of the patient¶s disease? 5.2 Potential nursing needs 4. What factors have caused the client¶s condition? 2. What is the pathophysiology of the disease as presented by the patient¶s clinical manifestations? 3. from its causes to the signs and symptoms as manifested by the client.Chapter I Introduction Rationale and Background of the Study (include everything you wish to) Statement of the Problem This study is designed to understand the nature and course of the disease process. this study aims to answer the following questions: 1. It is designed to identify the different managements applicable for the patient¶s case. What are the responses of the patient towards the disease in terms of : 3. Specifically.

Furthermore. the medical and surgical management and the specific nursing care to be implemented to alleviate the patient¶s condition. This study is specifically aimed to give thorough discussion of Status Asthmaticus identifying its definition. It delves further into the core of the illness. conducting this study would prove beneficial to the following people: Patient Patient¶s Significant Others Nurses Student nurses Society . its causes and effects and the problems that arise from this disease ad the appropriate nursing management of such problem. its pathophysiology.The main goal of this study is to give comprehensive information the readers about Status Asthmaticus. anatomy and physiology of the organs involved. the etiologic and precipitating factors. its presenting signs and symptoms. Significance of the Study The client suffering from status asthmaticus is aimed at deriving enough knowledge of the said disease thereby increasing the awareness and skill in dealing with client.

Future researchers CHAPTER 2 PATIENT¶S PROFILE <INTRO TEXT> Background/History Patient¶s Profile History of Present Illness Assessment Findings Patient¶s Vitae Functional Health Patterns Physical Assessment Organ System Assessment Interpretation of findings .

CHAPTER 3 ANATOMY AND PHYSIOLOGY <INTROTXT> Narrative nya ktung with diagram.:) .ang diagram kai I reflect nya sa list of figures.


Individualized NCP (Physiologic. Psychologic) Independent Nursing Strategies Dependent (2-3) Collaborative (1) FDAR Charting Discharge Summary with collaborative Nursing Function . <explanation kung ngano> with citations <and everything sa NCP in narrative form> Ineffective Breathing Pattern related to progressive bronchoconstriction secondary to Status Asthmaticus <same> ********five kabuok ang iyang DIAGNOSIS diri..CHAPTER 5 MANAGEMENT <introtext> Medical Laboratory and Diagnostic Procedures: Ideal Actual Drug Study: Ideal Actual Surgical : Ideal Actual Nursing Summary of Nursing problems Ineffective Airway Clearance related to excessive secretions in the tracheobronchial tree secondary to underlying disease condition. basin 5 jud pud ibutang.

CHAPTER 6 EVALUATION AND RECOMMENDATION (INTROTXT) This case study was conducted to essentially focus on an extensive presentation of the nature and therapeutic management of Status Asthmaticussustained by a 54 year old female client. <explain2 lng niya diri> Extent of Goal Achievement Recommendations .

CCEMT-P. Inc. Unpublished Articles Page. 2010 at http://www. Mind/Body Solutions for Surgery retrieved September 04. 2nd ed. Asthma Pathophysiology.Bibliography Books Ackley et al. Louis Mosby ±yearbook. Bob (2004) ³Nursin Diagnoss Handbook´. Michigan EMS Expo 2004 NREMTP. 2010. NF. St.html . I/C Internet Sources Neimark.

Patient¶ s perception of reason for admission: ___________________________________________________________ _____________________________________________________________ 2. Patient¶s symptoms as he/she sees them: _____________________________________________________________ _____________________________________________________________ 3. Problems in daily living created by symptoms (as patient views them) _____________________________________________________________ _____________________________________________________________ . Admission Interview 1.Appendix A Assessment Tool PHYSICAL ASSESSMENT FORM NURSING ADMISSION AND ASSESSMENT Name of Student: ______________________Clinical Assignment: ________________ Name of Clinical Instructor: __________ Inclusive Dates: _______________________ A. General Admission Information Name of Patient: ______________________Age: _________ Sex: ____________ Date: __________ Time: _________ Mode: _____________Allergies: __________ TPR: _________ BP: _________ HT: _____ WT: _______Diet: ________________ Sleeping Habits: _____________ CBC: Yes___ No___ Urinalysis: Yes___ No___ Property: Glasses _____ Contact Lenses _______ Dentures ___ Prosthesis ______ Ring __________ Watch Money ______ Other _____________________________________________________ Valuable to Business Office ____________________________________ Physical Appearance: _________________________________________________ ___________________________________________________________________ __________________________________________________________________ Behavior Exhibited: ____________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Content of Conversation: _______________________________________________ ____________________________________________________________________ _________________ Physician In-charge B.

Family History: Heart Disease. Other (psychiatric. Medication _________________________________________________ e. Medical ___________________________________________________ b.4. Habits a. TB. Eating _____________________________________________________ c. Mental Illness and Others (specify) _____________________________________________________________ _____________________________________________________________ 8. etc. Civil Status: Married_____ Single ______ Divorced ______ Widow ______ f. Social Activity _______________________Physical Exercise _________ d. Living Situation: Lives alone _________________________ Live with others (specify): _________________ 7. Traumatic Injuries ____________________________________________ f. Native Language: __________________ b. Smoking _________________Alcohol ____________Drugs _________ b.) _______________________________________ 5. Sexual ____________________________________________________ __________________________________________________________ f.I. Occupation ______________________________________________ d. Primary Physician¶s Admitting Diagnosis (indicate P = Probable and C = Confirmed) . Elimination ________________________________________________ 6. Cancer.) a. Education: ________________________ c. Rest/ Sleeping ______________________________________________ __________________________________________________________ e. Allergies ___________________________________________________ d. Orthopedic _________________________________________________ g. Financial Status (what is the impact of current hospitalization) _______________________________________________________ _______________________________________________________ e. Past Medical History (especially as it relates to P. Surgical ___________________________________________________ c. Social Economic History a.

HEENT: Headaches Eye pain Sinus pain Sore throat Hearing Loss Visions Diplopia Eye infection Blurring Epistaxis Facial pain Bleedinggums Dentures Nasal-tracheal pain Other____________ 2. Nursing Review of Systems (circle the appropriate symptoms) 1. Male Genital Tract Penile discharges Lesions Pain Testicular swelling Other ______________________________ Last Serology Test __________________ 5. NERVOUS Convulsions Syncope Dizziness Vertigo Tremor Speech difficulty Limp paralysis Paresthesia Muscle atrophy EEG _________________________________________________________ Other _______________________________________________________ . CARDIO-RESPIRATORY: Chest pain (site) ________________________ Chest pain with exertion Dyspnea on exertion Nocturnal dyspnea Edema Hypertension Palpation Known murmur Cough Sputum Hemoptysis Pleuritic pain Diaphoresis Last X-ray _______________________ EKG _________________________ 3. Female Genital Tract ± Menstrual History: Age of onset ____________ Frequency ____________Regulation __________ Duration __________ Date of last period ______________ Post menopausal bleeding _______ Age __________ Symptoms _________________________________ b. GASTRO-INTESTINAL Thirst Nausea Vomiting Hematemesis Heartburn Difficulty Swallowing Flatulence Constipation Abdominal pain Jaundice Diarrhea Tarry Stool Hemorrhoids Hernia Other__________________________ 4.C. GENITO-URINARY Dysuria Polyuria Frequency Urgency Nocturia Burning Hematuria Stones a. MUSCULO-SKELETAL Muscle pain Extremity pain Joint pain Back pain Joint swelling Neck pain Stiffness Limited motion Redness Sprains Deformity Others _______________________________________________ X-rays _______________________________________________________ 6. G ________________ P __________________ Ab ________________ c.

EMOTIONAL Anxiety Depression Fear Anger Frustration Other (specify) _____ Notes:________________________________________________________ _____________________________________________________________ _____________________________________________________________ D. Breath Sounds ______________________________________________ c. Breasts ___________________________________________________ 1. Symmetry _________________________________________________ b. Nursing Observation 1. Apical pulse rate and regularity _________________________________ c. Depth and Rate _______________________________________________________ b. GASTRO-INTESTINAL a. Posterior Thorax _________________________________________ 5. CARDIO. Mouth and Throat ___________________________________________ e. Posterior chest ______________________________________________ c. Chest expansion ____________________________________________ 3. URINARY a.7. Ears ______________________________________________________ d. Pedal pulses rate per minute (R)________________(L)______________ d. Bowel Sounds ______________________________________________ b. Neck vein distension _________________________________________ 4. Anterior Thorax __________________________________________ 3. Blood Pressure (R)_____(L)______ Lying _______Standing __________ b.VASCULAR a. Eyes and Pupils _____________________________________________ c. Tenderness or rigidity _______________________________________________________ 6. Anterior chest _______________________________________________ b. CHEST a. Breasts and Axillae _______________________________________ 2. Lymph nodes _______________________________________________ 2. Bladder ____________________________________________________ Tremor Voice change Infertility Heat or Cold Polydipsia Other ____________ . RESPIRATORY a. HEENT a. ENDOCRINE Goiter intolerance Exopthalmus Change in body contour 8.

Knees ________________________Arms_____________________ 9. Extremities ______________________________________________ b.1 Right eye _______________ 1. Reflexes (equal or not equal) 1. CRANIAL NERVE FUNCTION a. Trochlear: (motor) 1. Facial Expression 2. Etc. upward and downward movement of eyeball _______________________________________________________ e. Balance ________________________________________________ 2.1 Salty ___________________1.2 Sweet ____________________ 2. SKELETAL a. Olfactory nerve: (sensory) 1.7.1 Right eye ________________ 1. Oculomotor: (motor) 1.4 Raise lower eyebrows __________ h. Assess direction of gaze. Presence of corneal reflexes ___________________________ 1. Finger to nose ___________________________________________ d.2 Hyperosmia ___________________________________ b. Sense of hearing 1.2 Hyperopia ____________________________________________ c. Sensory Function (equal or not equal) c.2 Puff out cheeks ______________ 2. Motor Function 1. Facial: (Sensory and motor) 1.1 Myopia ______________________________________________ 1. Extra-ocular movements/ Pupil reaction to light 1. Optic nerve: (sensory) 1.1 Smile _______________2. Joints _______________________________________________________ b.2 Left eye _____________ d.2 Left eye ___________________ g.2 Left ear ____________________ .3 Frown _______________2. Facial __________________________________________________ 2.2 Left eye__________________ 2. Auditory nerve: (motor) 1.1 Right eye _______________ 1. Range of Motions _______________________________________________________ 8. Sense of vision (Snellen¶s chart. lateral movements of the eyeballs 1.) 1. Sense of smell (coffee. Sense of taste: Using back of tongue 1. Trigeminal: (motor) 1. newspaper) 1. Equilibrium 1.1 Anosmia ______________________________________ 1.1 Right ear _______________1. Assess direction of gaze. Ability to clench teeth ____________________________________ f. NEURO a. Abducens: (motor) 1. vanilla.

Nursing Problems (in priority) 1. Ability to swallow (Use tongue blade to elicit gag reflex) _____________________________________________________ j. EMOTIONAL a. Hoarseness of voice _______________________________________ 2.Glossopharyngeal: (Sensory and motor) 1. Learning Limitations ___________________________________________ _____________________________________________________________ 2. Transportation _________________________________________________ 4. _____________________________________________________________ 2. Anticipated problems ____________________________________________ 10. Diet __________________________________________________________ 6. Probable Date _________________________________________________ 2. _____________________________________________________________ H. _____________________________________________________________ 4. Spinal accessory: (motor) 1. Medications ___________________________________________________ 7. Communication _____________________________________________ b. Movement of: 1. Persons responsible for patient ____________________________________ 8.2 Sweet _______________ 2.1 Salty _____________________ 1. Hypoglossal: (motor) 1. _____________________________________________________________ 3. Family conference ______________________________________________ 9. _____________________________________________________________ 5. Agencies and Equipment involved __________________________________ _____________________________________________________________ 5. . Home visit ____________________________________________________ i. Behavior __________________________________________________ E.1 Head ________________________1. Sensation of pharynx ______________________________________ Let patient say ³ah´ and observe movement of palate and pharynx k. Able to stick tongue to midline ______________________________ 10. Sense of taste: Using back of tongue 1. Vagus: (Sensory and motor) 1. Mood/ Effect _______________________________________________ c. Nursing Impressions ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ G. Discharge Planning 1. Destination ____________________________________________________ 3.2 Shoulder _____________ l. Knowledge of Illness 1. Learning Needs_________________________________________________ _____________________________________________________________ F.

Appendix B Clinical Pathway .

R: ³ Nalipay ko´. encouraged to express personal feelings before and after dance therapy. guided client to mess hall. A: Encouraged client to join the dance therapy. monitored reaction of client. Focus: Dance Therapy D: Received client sitting on bench near entrance. client is cooperative. cooperativeness noted. accompanied client to her position in the group. 2010 FDAR 1. established contract with client in proper behavior during therapy. most recent episode Mixed Psychotic Features Suicide. encouraged to express personal feelings before and after music therapy. good mood noted. instructed to follow therapist¶s instructions. Focus: Music Therapy D: Received client sitting in mess hall. accompanied client to proper sitting. as verbalized May Go Home 2. most recent episode Mixed Psychotic Features May Go Home with referral For pregnancy test this morning September 01. good mood noted. 2010 Bipolar disorder. monitored reaction of client. Appendix C . A: Encouraged client to join the dance therapy. established contract with client in proper behavior during therapy. escape precaution Do not allow near stairs August 31. instructed to follow therapist¶s instructions. desire to express self noted. desire to express self noted. 2010 Bipolar disorder.Endorsement August 20. R: Client participated in music therapy and rendered her own version of a song she wanted to sing. homicide.

moreover. Pisa. University of Pisa. Conclusion Half of our older manic inpatients consisted of "classic" bipolar patients with an extension of clinical manifestations into later life. Maria Liberti. Results Seven percent of the whole inpatient elderly people suffered from mania. Jeste DV: Bipolar disorder in middle-aged and elderly adults: is age of onset important? J Nerv Ment Dis 2004 . Francesco Casamassima. psychosis and irritability between the elderly group and a matched group of 20 younger manic inpatients. Neurobiology. Resistance to treatment and concomitant neurological lesions are frequent correlates of elderly mania. The aim of this study was to investigate the prevalence of hospitalizations due to mania in patients older than 64 years through a period of 5 years in an Italian public psychiatric ward. even though it was not possible to identify clearly which patients may have had vascular lesions related to the onset of mania. we compared age at onset. . Source: Depp CA. Pharmacology and Biotechnologies. Methods A retrospective chart review was conducted in order to describe clinical presentation of 20 elderly patients hospitalized for manic episode.Research Articles Research Articles Title: Bipolar disorder in late life: clinical characteristics in a sample of older adults admitted for manic episode Authors: Alessandra Benedetti. Geriatric. Moreover. Italy Abstract Background Although manic episodes in older adults are not rare.and adulthood mania showed similar clinical presentation but younger people had more frequently a mood disorders family history. Pietro Scarpellini. Moore DJ. Kaskow J. 192(11):796-9. little published data exist on late-life manic episodes. 67. Via Roma. Lorenzo Lattanzi. Laura Musetti and Giovanni Battista Cassano Department of Psychiatry. we aimed at describing clinical presentation of elderly manic episodes. Jin H. Mohamed S. the presence of family history for mood disorders. Half of those patients had a mood disorder age at onset after 50 years and 5 patients were at their first manic episode. the other half of our sample was heterogeneous.

calcium (550 mg).Title: Nutritional supplement effective against bipolar disorder . as it may potentiate the effect of antipsychotic drugs. L-glutamine. improvement began within two weeks of starting the nutritional supplement. possibly increasing their toxicity. . Additional research is needed to determine the optimal way to transition patients from psychotropic drugs to nutritional therapy. thiamine (5 mg).01). manganese (4 mg). zinc (20 mg). choline. In general. the mean YMRS score decreased (improved) by 60% (p < 0. grape seeds. riboflavin (5.05). and the need for psychotropic medications decreased by 63% (p < 0. Effective mood stabilization with a chelated mineral supplement: an open-label trial in bipolar disorder. Source: Kaplan BJ. Although there was no control group in this study. The monthly retail cost is $68. At baseline and periodically thereafter.62:933-935). magnesium (250 mg).Literature Review & Commentary Author: Townsend Letter for Doctors and Patients. and transient.333 IU). folic acid (400 mcg). Gaby Abstract: Fourteen patients (aged 19-46 years) with a DSM-IV diagnosis of bipolar disorder. containing the following (daily doses): vitamin A (3. In two cases. niacinamide (25 mg). the mean BPRS score decreased (improved) by 79%.4 at the last visit (71% improvement. phosphorus (350 mg).7 psychotropic medications each. and the Young Mania Rating Scale (YMRS). which was infrequent. vitamin B12 (250 mcg). copper (3 mg).M. the Brief Psychiatric Rating Scale (BPRS). who were taking a mean of 2. May. pantothenic acid (6 mg). biotin (25 mcg).M. This product should be used cautiously. Comment: This open-label study suggests that a broad-spectrum nutritional supplement can reduce the severity of illness in some patients with bipolar disorder. Power was originally manufactured by Evince International. minor. inositol. boron. the magnitude of the improvement was greater than one might expect from a placebo effect alone. Power ). The only reported side effect was nausea. For the 11 patients who completed the trial. patients were assessed with the Hamilton Rating Sc ale for Depression (HAM-D). p < 01). vitamin E (100 IU). vanadium. Other investigators have also found this supplement to be effective for bipolar disorder (J Clin Psychiatry 2001. p < 0. potassium (100 mg).00. J Clin Psychiatry 2001. citrus bioflavonoids.5 mg). L-methionine. molybdenum (66 meg). et al. vitamin C (250 mg). it is currently manufactured by Synergy Group of Canada (1-888-878-3467). vitamin D (400 IU). chromium (250 meg). E. the supplement replaced psychotropic medication and the patients remained well. iodine (75 meg). the mean HAMD decreased (improved) from 19. Ginkgo biloba.0 at baseline to 5. 2003 by Alan R. selenium (100 meg). and nickel. pyridoxine (7 mg). iron (6 mg). germanium.62:936-944. and a proprietary blend (doses not specified) of DL-phenylalanine. were treated for 6 months with a broad-based nutritional supplement (E.01).

 Results: We identified approximately 100 studies that addressed the associations between antecedent environmental factors and a later risk for BPD. bipolar disorder. Nakazawa 2. little is known about other risk factors in the aetiology of BPD. and history of medical conditions. Childbirth is likely to be a risk factor.  Methods: We conducted a literature search using the MEDLINE. social and family backgrounds. Preben B Mortensen Abstract: Keywords: y y y y y y affective disorder. risk factors of BPD other than family history of affective disorders have generally been neither confirmed nor excluded.  Conclusion: Owing to a paucity of studies and methodological issues. factors related to birth. We call for further research Source: Kenji J Tsuchiya. Japan. winter±spring birth. however. .1. The inconsistency across studies and methodological issues inherent in the study designs are also discussed. demographic factors. MD Tokyo Metropolitan Tama Center for Mental Health. risk factor. traumatic brain injuries and multiple sclerosis. evidence is still inconclusive. Our aim was to review the literature on such risk factors ± risk factors other than family history of affective disorders ± as predictors for the initial onset of BPD. However. We selected factors of interest including demographic factors. stressful life events. personal. The relevant studies were extracted systematically according to a search protocol. Tokyo 2060036. Tama.Title: Risk factors in relation to an emergence of bipolar disorder: a systematic review Author: Kenji J TsuchiyaMajella Byrne. epidemiologic methods.3. socioeconomic factors  Objective: There is a consensus that genetic factors are important in the causation of bipolar disorder (BPD). PsycINFO and EMBASE databases. Suggestive findings have been provided regarding pregnancy and obstetric complications.

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