Gerontology Body of The Case Study

I.
INTRODUCTION
A. BACKGROUND
Adenomas are the most commonly encountered intracranial neoplasms. In 1999,
autopsy studies in the United States showed that 8-20% of humans have pituitary
adenomas and most are unrecognized anteromortem. Today, at our present time,
advances in the diagnosis and management of tumors over the past decades have resulted
an increasing awareness and early detection.
Although seemingly simple, pituitary adenoma are variable and presets variety of
clinical manifestations because of its vast and complex manifolds that includes signs and
symptoms caused by excessive hormone secretion, symptoms caused by impairment of
normal pituitary function and symptoms related to mechanical effects of tumor mass.
At the Armed Forces of the Philippines Medical Center, the prevalence rate of
Macroadenoma accounts to 4.6% of the total 239 admissions at the Neuro-Surgical Ward
from 01 January 2010 to 07 January 2011. Success rate for transsphenoidal approached
garnered 99% of the total patients who have undergone the procedure.
This case study was chosen because of its interesting demonstration of signs and
symptoms. That a single mass in the brain measuring only about one (1) cm or a size of a
pea can change an individuals’ normal anatomical functioning.
B. OBJECTIVE OF THE STUDY
1. GENERAL OBJECTIVE:
This case study aims to enhance the skills, knowledge and attitude of nurses in the
care of patients with Pituitary Macroadenoma.

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2. SPECIFIC OBJECTIVES:
At the end of the study, the presentor will be able to:
1. Conduct a comprehensive history taking to client with pituitary macro adenoma.
2. Discuss the pathophysiology of pituitary macro adenoma.
3. Discuss the medical and surgical management of pituitary macro adenoma.
4. Formulate a comprehensive nursing care plan to client with pituitary macro
adenoma.
5. Develop a discharge plan to clients with pituitary macro adenoma.
C. SIGNIFICANCE OF THE STUDY:
Due to the complexity of Pituitary Macro Adenoma, the author prompted to have an
in depth study of the case to benefit the following:
PATIENT AND FAMILY – will gain understanding regarding the disease.
NURSES – will broaden their knowledge and understanding about the disease and
enhance their skills and attitudes in the delivery of nursing care.
OTHER HEALTH PROFESSIONALS – will enable them to work together as a
team in providing comprehensive care and management for the patient.
NURSING RESEARCH – will serve as a reference for research.
D. SCOPE AND LIMITATION
This case study will cover the duration of VR’s confinement at the Neurosurgical
Ward of AFP Medical Center from 14 September 2010 to 05 November 2010.
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Sources of information were gathered from the patient, his family, medical records
and neurosurgery health care staff. Additional source of references were taken from local
and international literatures, books, journals and internet.
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II. HISTORY TAKING
A. PATIENTS PROFILE
Name : VR
Age : 41 years old
Sex : Male
Rank / BOS : Petty Officer 3rd Class (PO3) / Philippine Navy
Religion : Roman Catholic
Civil Status : Married
Date of Birth : 27 November 1968
Place of Birth : Catanduanes
Attending Physician : M AJ GASCON MC (Inact), CPT MILLARES MC CPT DE LEON MC
Date Admitted : 14 September 2010
Chief Complaints : Blurring of vision, Loss of peripheral vision
Initial Diagnosis : Optic Neuropathy, Left, probably central
Operation Performed: Transphenoidal Excision of Sellar Mass Sublabial Approach (08
October 2010)
Date of Retro-evac : 27 October 2010, Manila Naval Hospital
Final Diagnosis : Pituitary Macroadenoma, S/P Transphenoidal Excision of Sellar
Mass, Sublabial Approach (08 October 2010)
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B. SOCIO- DEMOGRAPHIC CHARACTERISTICS
VR is the eldest in the brood of four (4), he is the only one in the family that is in the
Armed Forces of the Philippines. His father is 68 years old and his mother is 65 years old.
Both are still alive.
VR’s family lived in a bungalow house with two (2) bedrooms and a comfort room
near the sandy area of Rawis, Legaspi City, Albay. It is well lighted and well ventilated. He
has two siblings ages nine (9) and twelve (12). Water availability is twenty four (24) hours
via pipeline supplied by Legaspi Water District. Economic stature is average. There are no
other sources of income except VR’s salary.
C. CONCEPT OF HEALTH, ILLNESS AND HOSPITALIZATION
VR views health as general well being of an individual free from any illness, while
illness is a situation of undesirable choice. Hospitalization for VR is a frightening thought
that is unfavorable.
D. COMMON HEALTH PRACTICES AT HOME
VR’s family practiced self medication at home. In instances of fever and colds, they
do not consult a physician for prescription. They avail of over the counter drugs which are
also readily available from their local sari-sari store like Paracetamol and Amoxicillin. The
family also uses alternative supplements that may bring wellness to the whole household.
E. IMMEDIATE FACTOR THAT BROUGHT ABOUT ILLNESS
VR’s illness was predominantly brought about by his lifestyle and food preferences.
He is habitually indulged into a drinking spree with buddies and can consume about seven
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(7) to eight (8) bottles of beer. His choices of foods are those that are high fats and those
that are high in cholesterol.
F. COMPREHENSIVE HISTORY:
1. History of Present Illness
History of present illness started two months ago when patient experienced frequent
blurring of vision. His job was greatly affected. He consulted an ophthalmologist at AGO
Medical Center and was advised to have a visual perimetry. Result of the ophthalmologic
procedure suggested consultation to a higher level of health care. He then seek assistance
at the Naval Forces Naval Dispensary. By this reason, he was tagged for evacuation to
AFPMC prompting his admission for further evaluation and management.
2. Past Medical History
VR cannot remember any hospitalization from the past nor have received any
previous immunization except for shots of tetanus toxoid every reenlistment.
3. Family and social history
No recollection of other heredo-familial disease except for hypertension. His great
grandfather died of stroke.
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FAMILY GENOGRAM
LEGEND:
HYPERTENSIVE-
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4. Nursing History
1. Health-Perception/ Health Management Pattern
The patient is almost generally the same as how every Filipino seeks health
assistance. Without any problem regarding his health, he would not approach health
workers not unless it is life-threatening. VR has the proper perception whether he is being
treated correctly as with the management done to him at the hospital at AGO Medical
Center in Albay.
2. Nutritional/ Metabolic Pattern
The patient eats three times a day. He says that he eats a balanced diet. Although
he is fond of eating those high in fats and cholesterol such as fried chicken skin, murcon,
lechon and the likes. He usually drinks coffee every morning. He prefers to drink water than
carbonated beverages. During his hospital stay, he is instructed with diet as tolerated prior
to operation.
3. Elimination Pattern
According to the patient, when he is at home or even at work he usually defecates
for at least once a day, same as with his stay in the hospital. He urinates more frequently
(average of five times daily) during his stay at the hospital than the time prior to his
admission.
4. Activity/ Exercise Pattern
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For his leisure time, the patient likes to have drink with friends. He often does this almost
twice or thrice a week, drinking five to six bottles of beer or sometimes nine to ten shots of
brandy. Aside from drinking, he does not have any other vises. He started drinking 28 years
ago even before he entered the service. He is not fond of playing physical games. He
implied that his only exercise is the jogging or road run every Tuesday and Thursday
because it is required in the military.
5. Sleep-rest Pattern
The patient sleeps for an average of 5-6 hours per day. He usually takes nap in the
afternoon. He had a difficulty of moving around sometimes due to loss of peripheral vision
and blurring of vision. He cannot have a good 8 hour sleep due to headache prior to
hospitalization.
6. Cognitive/ Perceptual Pattern
From his point of view, he has a good memory. He says that he can still remember
things of great importance especially with regards to his family and loved ones. His hearing
ability is also in normal condition but not his sense of sight.
7. Self Perception/ Self-Concept Pattern
VR says that he is very much comfortable with his body image prior to his illness.
Even if sometimes he loses his peripheral vision and oftentimes his blurring of vision, he
still feels optimistic about regaining his old functionality and image.
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8. Role/ Relationship Pattern
VR’s spouse is a plain housewife. He have a daughter and a son and spends time
during weekends at the mall or the beach. Reports that they have a good time together.
9. Sexuality & Reproductive Pattern
Being the eldest among the brood of four wherein three of them are females, he
managed to have a stable gender identity during his growing years.
10. Coping/ Stress-tolerance Pattern
As part of his stress-tolerance activity, the patient likes to listen to soothing music to
relieve him from anxiety. He relaxes his body by taking a time off his work and spending
time with his friends.
11. Value/ Belief Pattern
The patient is a Roman Catholic, but not really the type of follower who goes to the
church every Sunday to hear mass. He makes his decision in accordance to his principles
in life and how he perceives it.
G. PHYSICAL ASSESSMNENT:
General Survey
1. Appearance
VR is 5’7” in height and weighs 85.8 kilograms. Suitably dressed and well groomed.
He had a good eye contact and cooperative behavior. Graded 15 on Glasgow Coma
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Scale for spontaneous eye opening (E4), obeys command (do simple things when asked)
(M6), responds coherently and appropriately to questions (V5). There are no signs of
respiratory distress and appears calm. Had a medium framed body and a well
coordinated gait.
2. Head to Toe Assessment
HEENT: The skull is generally round with prominences in the frontal area anteriorly and
the occipital area posteriorly; the face is normocephalic, no involuntary movement, no
lumps, lesion or tenderness; (-) ptosis, with pink palpebral conjunctiva, anicteric sclera,
EOM’s are intact, (+) blurring of vision and (+) peripheral vision loss as reported (bitemporal
hemianopsia), PERRLA, nares are patent, no septal deviation or perforation. Whispered
words are heard bilaterally. Mucosa and gingiva are pink, uvula raises in midline on
phonation. Tongue protrudes in midline.
Neck: Carotid pulses are at 2+, equal bilaterally, no bruits, no significant lympadenopathy
or masses; trachea is at midline; neck with full ROM and no pain with movement.
Lungs and Thorax: Respiration at 18/minute, with symmetrical chest expansion,

resonant to percussion over lung field, no adventitious sounds bilaterally.
Heart: PMI 5th ICS at left MCL, no heaves or thrills, S1loudest at mitral and S2 loudest at
pulmonic, no clicks, gallops nor murmurs noted.
Abdomen: Flat and symmetric with no apparent masses upon inspection, skin is smooth
with no striae, scars or lesions; bowel sounds are normoactive; no hums or bruits, tympany
noted upon percussion in all four (4) quadrants, soft and non tender upon light palpation.
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Upper Extremities: Skin is warm to touch, dry and smooth; no bruises nor lesions; no
scaling, hair is normally distributed; capillary refill < 2 seconds, no clubbing or deformities in
fingernails; pulse rate at 82 bpm; hand grip strength is grade 5 and equal bilaterally.
Lower Extremities: Skin is warm to touch, dry and smooth; no bruises nor lesions; no
scaling, hair is normally distributed; capillary refill < 2 seconds, no tenderness in palpation
of joints, no heat, swelling or mass noted; joints and muscles are symmetric with full ROM;
(-) Homan’s sign, (-) Babinski; muscle strength is 5 in 0-5 scale; skin sensation intact at all
dermatome levels.
3. Neurological Examination
A. Cranial Nerves
CN I Olfactory: Able to identify familiar odors on each nostril.
CN II Optic: Reduced temporal field vision. Visual acuity at OD is 20/25-2 and OS is 20/80-
2, Ischihara color test OD is 10/10 and OS is 7/10.
CN III Oculomotor: Symmetrical pupil at 2-3 mm in size. PERRLA
CN IV Trochlear: Can follow finger without moving the head. Good upward and downward
movement of the eyeball.
CN V Trigeminal: Full control in holding the mouth open and in clenching teeth, (+) corneal
reflex, (+) sensation to light pain and touch across the skin of face.
CN VI Abducens: Can follow finger without moving the head. Good lateral movement of the
eyeballs.
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CN VII Facial: No facial asymmetry, full control in frowning, smiling, puffing out cheeks, in
raising and lowering eyebrows. Able to identify sweet or salty taste on the front area of the
tongue.
CN VIII Auditory: Able to hear finger snap and spoken words on both ears. Able to stand
with both feet together, arms at side with eyes closed for 5 seconds.
CN IX Glossopharyngeal: (+) gag reflex, able to identify sour or sweet taste on back of the
tongue.
CN X Vagus: No hoarseness in speech, able to say “ah” with no identifiable abnormality of
the palate and pharynx.
CN XI Spinal Accessory: Can shrug shoulders and turn head against passive resistance.
CN XII Hypoglossal – Can stick out tongue to midline and able to move it from side to side.
B. Muscle Strength
In the upper extremities, grip strength and proximal strength is normal at 5/5 and
demonstrated good coordination, balance and strength in heel to toe walking.
C. Sensory
There is a symmetrical sensation by two-point discrimination. Able to identify objects in both
hand by stereognosis.
D. Reflexes
Deep tendon reflexes for the biceps, triceps, quadriceps, brachioradialis and achilles
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elicited a double ++ , normal muscle contraction by percussion hammer.
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III. CLINICAL DISCUSSION
ANATOMY AND PHYSIOLOGY
The pituitary gland, or hypophysis lies just below the brain, protected within the
sella turnica of the sphenoid bone. Despite its relatively small size, the pituitary releases
nine or more hormones, many of which trigger other endoctrine glands to release hormones
of their own. For that reason, the pituitary gland is often referred as the “maestro of the
endoctrine orchestra” because it affects the activities of many other endoctrine glands. It
is, in fact, itself under control of the hypothalamus, a part of the brain to which the pituitary
is directly connected. Together, the hypothalamus and the pituitary gland provides a direct
link between the two coordinating and control system of the body – the nervous and
endoctrine glands.
Structures of the Pituitary Gland
The pea –sized pituitary gland is attached to the hypothalamus superiorly by a stalk
called the infundibulum. It is consist of two lobes, one glandular (anterior) and the other
made of neural tissue (posterior). The anterior lobe or adenohypophysis makes up about
70% of the pituitary gland. It originates from the oral mucosa and is therefore composed of
epithelial tissue. The hypothalamus gland communicates with the anterior lobe by way of
hypophyseal portal veins in the infundibulum. Neurons in the hypothalamus secrete
hormones commonly polypeptides that enter the primary capillary plexus in the
superior infundibulum and are carried by the hypophyseal portal veins to the
secondary capillary plexus in the anterior pituitary where they regulate secretions of
hormones. Together, the hypophyseal portal vein and the secondary capillary plexus forms
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the hypophyseal portal system; a portal system is an arrangement of blood vessels
where, unusually, capilliaries merge to form veins which then branch into cappiliaries.
The posterior lobe (neurohypophysis) is part of the brain and is connected to the
hypothalamus to a bundle of nerve fibers called the hypothalamic-hypophyseal tract, that
runs to the infundibulum. The tract arises from the neurons in the hypothalamus called the
neurosecretory cells. They make two hormones known as neuro-hormones because of their
mode of production called antidieuretic hormone (ADH) and oxytocin which are
transported along nerve fibers to the posterior lobe. When hormones are required, the
neurosecretory cells “fire” and hormones are released from the axon terminal into blood
capilliaries in the posterior lobe and thence to the target tissue.
Anterior- lobe Hormones
The anterior lobe of the pituitary gland synthesizes and releases its hormones in
response to releasing hormones received from the hypothalamus. Two of the six anterior
lobe hormones – growth hormone and prolactin- caused a direct effect on the target
organs; the other four- thyroid stimulating hormone (TSH), adenocorticotropic hormone
(ACH), follicle stimulating hormone (FSH) and luteinizing hormone (LH) – are referred to as
tropic hormones because they regulate the action of other endoctrine glands. The action
of these six hormones are summarized;
1. Growth Hormone (GH)- also called somatotropin, targets body cells especially those
in bone and muscle to stimulate growth, in children and repair by stimulating cell division.
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2. Thyroid Stimulating Hormone (TSH)- also called thyrotropin, targets the thyroid
gland and stimulate the release of two homones, thyroxin and triiodothyronine, that, in turn,
accelerates metabolic rate.
3. Adenocorticotropic Hormone (ACTH)- targets the cortex (outer part) of the

adrenal glands and stimulates the release of corticosteroid hormones that helps regulate
metabolism and paly an important part in helping the body resist stress.
4. Follicle Stimulating Hormone (FSH)- in women, it targets the ovaries and

stimulates maturation of an ovum and production of sex hormone oestrogen. In men, it
targets the testes and stimulates sperm production.
5. Luteinizing Hormone (LH)- in women, it targets the ovaries and triggers ovulation, it
also triggers the release of sex hormones called the oestrogen and progesterone. In men, it
stimulates the production of sex hormone called testosterone.
6. Prolactin- targets the mammary gland in a women’s breast and stimulate milk
production during pregnancy.
Posterior- lobe Hormone
As described, the posterior lobe receives its hormone from the hypothalamus. Both
affect target organs directly and their actions are outlined;
1. Antidieuretic Hormone (ADH)- also called vasopressin, targets the kidneys and
increases the amount of water returned to the blood during urine production, thereby
reducing urine volume, conserving water and helping the body to maintain its water
balance.
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2. Oxitocin- in women, it targets the uterus and stimulates muscle contraction at birth; it
also stimulates the mammary gland to release milk during breastfeeding.
PATHOPHYSIOLOGY
There are several types of pituitary macroadenomas. The functioning and non
functioning macroadenoma. The cause of pituitary Macroadenoma remains unknown but
the most favored theory attributes monoclonal neoplastic transformation of pituitary cells or
the inactivation or loss of the tumor suppressor genes as the cause of tumor initiation and
growth. The suppressor genes can be defined as genes which encodes proteins that inhibit
the formation of tumor. Their normal function is to inhibit cell growth or act as “BREAK” for
the cell cycle. Predisposing factors involved in pituitary tumors are pathogenesis, inherited
traits, environmentasl factors (e.g. irradiation, environmental estrogens), Alterations in
transcription factors or cytokines (e.g. Pit-1,LIF) Mutations in pituitary signal transducing
units (e.g. gsp,CREB, ras)Hypothalamic factor excess (e.g. GHRH, CRH) Hormonal
imbalance (e.g. ovarian, thyroid or adrenalfailure) Disrupted paracrine growth factor control
of local angiogenesis (e.g. FGF, hst), Intrapituitary paracrine hypothalamic hormone action
(e.g.tumoral SRIF, GHRH, TRH). Pituitary tumors occur more frequently in women than in
men. They usually develop between the ages of 30 and 40.
The cell cycle consists of four distinct phases: G1 phase, S phase (synthesis), G2
phase (collectively known as interphase) and M phase (mitosis). M phase is itself

composed of two tightly coupled processes: mitosis, in which the cell's chromosomes are
divided between the two daughter cells, and cytokinesis, in which the cell's cytoplasm
divides in half forming distinct cells. Activation of each phase is dependent on the proper
progression and completion of the previous one. Cells that have temporarily or reversibly
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stopped dividing are said to have entered a state of quiescence called G0 phase. During
the G1 and G2 phases, cells grow and make sure that conditions are proper for DNA
replication and cell division. During the G 1 phase, cells monitor their environment and
determine if conditions, including the availability of nutrients, growth factors and hormones,
justify DNA replication. The decision to initiate replication is made at a specific "checkpoint"
in G1 called the "restriction point.". If the restriction point cannot control the cell replication,
the cells will grow and divide rapidly to form a tumor.
A pituitary macroadenoma that does not make hormones is called a
nonfunctioning pituitary adenoma. Symptoms of a pituitary macroadenoma can

range from simple, common complaints, such as tiredness or restlessness, to more
serious symptoms, such as headaches, vomiting, or dizziness because it compresses the
nearby structure and the intracranial pressure increases, also when the tumor grow, it will
compress the optic chiasm and visual field deficits may be demonstrable. Further, it can
also lead to pituitary apoplexy. Pituitary apoplexy results from infarction of a pituitary tumor
or sudden hemorrhage within. This presents as a medical emergency with a headache,
sudden collapse, shock, and death if not treated emergently. This tends to occur in
macroadenomas.
A pituitary macroadenoma that makes one or more of the pituitary hormones is
called a functioning pituitary macroadenoma. Each type of functioning pituitary
macroadenoma causes different symptoms, depending on the type of hormone that is being
produced. Examples of functioning pituitary macroadenomas include:
 Prolactin-producing macroadenomas
 Growth hormone-producing macroadenomas
 ACTH-producing macroadenomas
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C. SCHEMATIC DIAGRAM
BUT
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Rapid replication in the M Phase
Rapid replication in the M Phase
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Rapid replication in the M
Phase
Signs and Symptoms Diagnostic ProcedureFactor
Precipitating
Predisposing factors
Tiredness/restlessness A) Cranial MRILiquor
with Gadolinium
Pathogenesis Lack of rest
Headache
inherited traits B)VisualUndesirable
UncontrolledField Perimetry
lifestyle
environmentasl factors (e.g. radiation,
Dizziness
environmental estrogens) C) Hormonal
proliferation Work-up (FT3, FT4, TSH, LH,
Alterations
Blurring transcription factors or cytokinesGH, ACTH)
ofinVision
(e.g. Pit-1,LIF)
Mutations in pituitary signal transducing units
(e.g. gsp,CREB, ras) TUMOR FORMATION
Hypothalamic factor excess (e.g. GHRH, CRH)
Hormonal imbalance (e.g. ovarian, thyroid or Pituitary
adrenalfailure)
Disrupted paracrine growth factor control of local Macroadenoma
angiogenesis (e.g. FGF, hst)
Intrapituitary paracrine hypothalamic hormone IF TUMOR is…
Managed
action (e.g.tumoral SRIF, GHRH, TRH) Not Managed
more frequently in women than in
men
usually develop
< 10 CM between the ages Cause is unknown > 10 CM
of 30 and 40.
MICROADENOMA MACROADENOM
Surgical Medical Nursing Compression of nearby vessels
A
Management Management Management
Most
LOCALfavored
MASS Theory
EFFECT
inactivation of the tumor suppressor genes during cellICPcycle
Elevation
(Non Functional
Transphenoidal a) Radio Monitor
Macro
Surgery
Adenoma)
Therapy a) VS Endoctrine Effect
b) Gamma b) CSF Leak (Functional Infarction of
Knife Surgery Cellc)Cycle Macroadenoma)
Bleeding tumor
d) I & O Prolactin-producing
Penetrates adjacent
e) Medication macroadenomas
structures
The control mechanism f) Health
ensures that Tumor will burst
everything is ready forTeaching
synthesis. Growth hormone-
and bleed
producing “Apoplexy”
macroadenomas
Compresses the
Optic Chiasm
G1 cannotGOOD
Prognosis: pointACTH-producing
control the restrictionReduceddue to supply to the brain
oxygen
loss of suppressor genes which encodes the
macroadenomas
DNA protein
Shock Death
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D. COMMUNITY VISIT
14 September 2010- day 1: Admission
A 41 years old male was admitted at 4:00 p.m last 14 September 2010,
accompanied by her wife at W4A (Neurosurgery Ward), with chief complaint of loss of
peripheral vision. He was admitted under the service of M AJ GASCON MC (Inact), CPT
MILLARES MC and CPT DE LEON MC and following orders were given. Diet as tolerated,
temperature, pulse rate and respiratory rate to be recorded every shift, for chest x-ray AP
view, for electrocardiogram x 12 leads, for complete hematology and blood chemistry. ECG
and CXR were done at the same day except for blood work-ups. Routine admission care
was done. Neurological assessment was performed by Glasgow coma scale and graded 6
on his motor ability to obey commands, 5 on verbal clarity and 4 for spontaneous eye
movement. Likewise, a comprehensive nursing history was taken. At 1830H, nothing per
orem temporarily was ordered for blood chemistry and hematology in AM.
15 September 2010 – day 2
Blood extraction made to right median cubital (RMC) vein for blood chemistry and
hematological analysis for baseline reference. Food intake resumed to DAT after extraction.
VR is ambulatory. No new orders made that day. Vital signs are monitored
and recorded.
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Referred to Social Service for a discounted rate of MRI with Gadolinium care of
Cardinal Santos Medical Center.
18-19 September 2010 – day 5 & 6
VR was still waiting for the approval of the medical social service for a discounted
rate of MRI.
A repeat chest X-ray in apicolordotic view was requested due to the result of
previous chest x-ray taken from his date of admission. (see diagnostics and procedures:
radiologic report dated 14 September 2010)
Social Service approved the discounted rate of Cranial MRI of the head with
Gadolinium. Coordination for the procedure was made to Cardinal Santos Medical Center
(CSMC).
VR was sent to Cardinal Santos Medical Center for MRI accompanied by a Medical
Intern via wheelchair assisted by corpsman. Creatinine and CT scan result were attached to
chart as required.
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24 September 2010– day 11
Official MRI result was forwarded from CSMC to this station suggestive of a 3.5 cm
heterogeneously contrast enhancing sellar and suprasellar mass causing marked
compression of the overlying optic apparatus.
25-26 September 2010– day 12 and 13
A request for a cardio-pulmonary clearance was made for VR to undergo trans-
sphenoidal excision of suprasellar mass, sublabial approach.
Referral was made to Nuclear Medicine for FT3, FT4 and TSH determination. An
order for special test and immunology was carried out. Coordinated with VLGH Laboratory
but reagent is not available. Secondary option to expedite hormonal analysis was
coordinated at BEST Diagnostic Center.
03 October 2010– day 21
Result of chest x-ray (apicolordotic view) yielded with the same findings from
previous chest x-ray (AP View). An order for sputum AFB were made and carried out.
Receptacle for sputum sample was given and instructions for collection were explained and
understood by VR.
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Collected sputum sample (1/3) and sent to laboratory for sputum microscopy.
Second series of sputum sample (2/3) were again collected ND sent to laboratory for
sputum microscopy. VR was placed on NPO post midnight for nuclear and hormonal work-
up in AM.
Third and final sputum sample (3/3) was collected and sent to laboratory. Blood
sample was taken via venipuncture from left median cubital vein for FT3, FT4 and TSH by
VLGH Nuclear Medicine Department personnel. Likewise, a blood sample was also taken
and sent to BEST Diagnostics Center via transport media for hormonal study.
Cardio-Pulmonary clearance was granted to VR to undergo operation. Pre-
anesthetic and pre-operative orders were given and carried out. Consent was properly
signed and instructed to be on NPO after dinner. At 2300H, Hydrocortisone 50 mg IM was
given as ordered.
08 October 2010 – day 26
At 0435H, an access for a peripheral intravenous line was made to VR’s right
metacarpal vein using gauge 18 cannula. Intravenous fluid was PNSS 1liter regulated at
41-42 gtts/ minute. Routine head to toe hygiene was rendered. Cefazoline 1 gram was
given intravenously at 0518H after yielding a negative skin test result. Ranitidine 50mg IV
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was given at 0520H. Reviewed pre-op checked –list and pre-transfer assessment was
made and recorded as follows: BP- 130/80 mmhg, PR- 98 bpm, RR- 20 rpm, temperature is
36.5 degrees Celcius and weight is at 75 kg.
A telephone order to send VR to PACU was received at 0445H. 0555H,
Hydrocortisone 50 mg was given via IM route. Affixed wrist tag with complete entry and was
placed on a stretcher and sent to PACU assisted by corpsman at 0600H.
Received from PACU at 2200H. VR was placed at Neurosurgical Intensive Care
Unit. Post transfer assessment was done and noted for the following contraptions; PNSS 1
liter at 30 gtts/ minute with a side drip of 234 cc PNSS + 300 mg Tramadol at 10 mcgtts/
minute, with oxygen inhalation via face mask at 5-6 lpm, with lumbar drain and a foley
catheter connected to a urine bag draining yellow colored urine in an equable expected
output. Nasal packing are intact with no bleeding and there are also no signs of ICP leak
that is apparent. Vital signs are taken as follows: BP- 140/90 mmhg, RR-22 rpm, PR- 100
bpm, temperature is 36.8 degrees Celsius. Client was continuously monitored with his vital
signs every hour until stable. Intake and Output were monitored and recorded hourly. Pulse
oximeter was hooked for oxygen saturation monitoring. Maintained on NPO and observed
for signs of respiratory distress and nasal bleeding. VR was placed on urine specific
gravity monitoring twice daily at 6 am and 6 pm as ordered. Cefazoline 1 gram IV every 6
hour was continued as ordered.
VR was noted to have an elevation in blood pressure at 170/120 mmhg. He was
immediately referred to Neurosurgery resident on duty. An order to start Nicardipine drip at
5 ugtts/mg/kg body weight was carried out and was placed on strict BP monitoring every 15
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minutes until stable. A systolic blood pressure of 130mmhg was to be maintained as
ordered. Intake & Output were recorded hourly and collected urine specimen twice daily at
6 am and 6 pm for urine specific gravity. A referral was sent to Cardiology service for co-
management. Facilitated12 lead ECG and blood chemistry per referral suggestion from
Cardiology Service. Specific urine gravity monitoring was still in effect.
Oxygen administration via face mask was discontinued. He was advised to take
clear liquids with aspiration precaution. Intravenous fluid was decreased and regulated to
run for 12 hours. Hydrocortisone, 50 mg were given every 12 hours via IV route. Positioned
on high back rest and started bladder training. CBC with QPC and serum electrolytes was
done and revealed a dropped in Potassium level amounting to only 3.3 millimoles per liter.
Incorporated 40 mEqs KCL to one liter of 0.9 Sodium Chloride and regulated for 8 hours for
3 consecutive cycles. Oral tablet of Kalium Durule was given three times a day for 3 days to
augment IV drip.
VR began with his soft diet with strict aspiration precaution. Three (3) cycles of 1 liter
PNSS + 40 mEqs KCL was completed and terminated.
Intravenous fluid was decreased to KVO rate. Nasal packing was removed and was
advised to start a progressive diet with strict aspiration precaution. Watcher informed of
precautionary food intake.

28
An order from Cardiology Service to restrict VR to a low salt and low fat diet was
carried out due to hypertension. BP reading is 160/110 mmhg.
Lumbar drain was removed. VR was advised to remain in a supine position in four
(4) hour. He was closely monitored for headache. Lumbar dressing was checked once
every hour for the 1st 4 hours for any CSF leak.
Soft diet was very well tolerated and was placed on DAT with aspiration precaution.
Blood pressure reading was 140/90 mmhg. Nicardipine drip was discontinued. Intravenous
access line was terminated. Cefazoline 1 gram IV was discontinued and shifted to Co-
amoxiclav 625mg/ capsule twice a day for 2 weeks. Blood extraction was done and sent to
laboratory four (4) hours post serum electrolyte correction. Result showed normal
potassium, low sodium and low chloride levels. Sodium chloride tablets were given, three
times (3x) a day for three days. Encourage ambulation.
Requested repeat serum electrolyte and showed normal electrolyte level particularly
sodium, thus, Sodium Chloride tablets were discontinued.
29
A final run on all laboratory test were conducted (Hematology, Blood Chemistry and
urine specific gravity). Results revealed no deviation or inconsistency on all test.
Arranged and facilitated papers for retro-evac.
VR was retro-evac to Manila Naval Hospital.
1. LABORATORY AND DIAGNOSTIC PROCEDURES
 MRI OF THE HEAD WITH GADOLINIUM (23 September 2010)
Impression:
Approximately 3.5 cm heterogeneously contrast enhancing sellar and suprasellar mass
causing marked compression of the overlying optic apparatus. Imaging findings are
consistent with a pituitary adenoma.
 Analysis: More than 1cm of mass in the pituitary is MACRO ADENOMA. The loss of
peripheral vision was brought about by the compression of the optic chiasm.
 ELECTROCARDIOGRAPHIC RESULT (14 September 2010)

30
Impression :
Normal Tracing
 Analysis:
Heart condition is within normal limits.
 RADIOLOGIC REPORT - Chest x-ray: PA view (14 September 2010)
Impression:
PTB MINIMAL LEFT; ATHEROMATOUS AORTA, Suggested Apicolordotic View
 Analysis:
Indicates a contagious bacterial infection caused by mycobacterium tuberculosis.
Atheromatous aorta indicates fatty deposits on the inner walls of aorta. Considered
common in people over 40 years of age.
 Chest x-ray : Apicolordotic View (20 Sept 2010)
Impression:
PTB, MINIMAL, LEFT; ATHEROMATOUS AORTA
 Analysis: Refer to chest x-ray analysis; both views yielded same result. Suggested
sputum microscopy for PTB confirmation.
 SPUTUM MICROSCOPY RESULT
SPECIMEN DATE OF SPECIMEN 1 2 3
COLLECTION
1 04 Oct 10 Visual Mucopurulent Mucopurulent Mucopurulent
Appearance
2 05 Oct 10 Reading 0 0 0
31
3 06 Oct 10 Laboratory Negative Negative Negative
Diagnosis
 Analysis: Negative AFB indicates that VR is not infectious nor have an active PTB.
Result of chest x-rays is suggestive of previous PTB infection.
 SURGICAL PATHOLOGY REPORT (08 Oct 2010)
GROSS AND MICROSCOPIC DESCRIPTION : Specimen consist of several tan brown soft
tissue fragments measuring 1.0 cm in aggregate diameter.
 Analysis: The size of sample tissue indicates macroadenoma and tissue specimen is
benign.
 VISUAL FIELD PERIMETRY (04 Sept 2010)
Single Field Analysis; Right and Left Eye
GHT: outside normal limits
 Analysis : Peripheral vision deficit, without glaucoma findings indicates that the origin
of peripheral sight problem is due to compression of the optic chiasm.
 HEMATOLOGY
Date Normal Value 15 Sept 08 Oct 10 Oct 23 Oct Interpretation
2010 2010 2010 2010

Hemoglobin M:140-170gms/ 150 139 142 134
L WNR
Hematocrit M: 0.41-0.51 .43 .41 .44 .40 WNR
RBC Count M: 4.6-5.2X10/L 4.57 4.26 4.69 4.41 WNR
WBC Count 5.0-10.0X10/L 4.7 19.6 11.6 5.70 Increase in
WBC dated
08 & 10
32
October
Platelet Count 150-400X10/L 341 312 327 600 WNR
Segmenters 0.55-0.65 .69 .89 .77 .55 WNR
Lympocytes 0.25-0.35 31 .09 .18 .40 WNR
Eosinophils 0.02-0.04 .00 .02 WNR
Prothrombin 10-14 seconds 10.1 11.2 10.8 WNR
Time
INR 22-35 seconds .84 .93 .90 WNR
Activated 25.3-32.3 29.5 29.3 WNR
Thrombo- seconds
plastin Time
Clotting Time 2-7 minutes 3 min. 45 4 min. 30 2 min. WNR
sec. sec. 45 sec.

Bleeding Time 2-4 minutes 2 min. 15 3 min. 45 1 min. WNR
sec. sec. 15 sec.

MCV 30-100 fL 96.4 96 94.2 91.3 WNR
MCH 27-21 pg 33 33 30.3 30.3 WNR
MCHC 31-36 g/dl 343 33.8 32.1 33.3 WNR
RDW 11.0-15.0 13.3 13.7 13.9 13.3 WNR
 Analysis: An increase in WBC indicates an active infection.
 NUCLEAR MEDICINE DIAGNOSTIC REPORT (06 Oct 2010)
Functional Studies: FT3 RIA, FT4 RIA and TSH are within normal range.
 Analysis: Indicates that the thyroid is functioning normally.
 BLOOD CHEMISTRY REPORT
Test Normal 15 Sept 10 Oct 23 Oct
Value 10 10 10 Remarks
Glucose 70-110 mg/ 87.12 116.1 176.6
(Fasting) dL mg/dl mg/dl mg/dl High

Creatinine 0.6-1.2 mg/ 0.81 mg/ 0.498m 6.0 WNR
dL dl mg/dl mg/dl
Albumin 3.8-5.0 3.9.0 WNR
g/dL g/dL
33
Globulin 2.3 - 3.5 3.5 WNR
g/dL g/dL
Total Protein 6-8 g/dL 6.95 g/dL WNR
Urea/BUN 7-18 mg/dL 5.53 WNR
mmol
Cholesterol 120-220 171.69 WNR
mg/dL mg/dl
27 Oct WNR
10
ALT 20-70 U/L 45.7 U/L WNR
AST 0-41 U/L 24.4 u/L WNR
HbA1c 4.50-5.70 % 5.90 % High
 Analysis: Elevated blood glucose level from 100-125 mg/dL may indicate impaired
fasting glucose or prediabetic.
-blood glucose of above 126 mg/dL on more than 1 testing occasion may indicate
diabetis.
- Elevated HbA1c: Generally, a result of 7.0 (7%) or lower usually means that blood
glucose is under control. If HbA1c is 8.0 (8%) or higher, it means that blood glucose may
be too high and you there is an increased risk for developing diabetes complications
 Serum Electrolytes
DATE SODIUM POTASSIUM CHLORIDE Remarks

15 Sep 2010 139.2 mmol 4.13 mmol 106.5 mmol
03 Oct 2010 146.7 mmol 3.96 mmol 109.1 mmol
10 Oct 2010 145 mmol 3.3 mmol low
16 Oct 2010 132.4 mmol 3.24 mmol 96.5 mmol Low
18 Oct 2010 137.9 mmol 3.81 mmol
Repeat 139 mmol 3.8 mmol 108.7 mmol
Normal Values 135-148 mmol 3.5-5.3 mmol 98-107 mmol
Easylyte
34
 Analysis: Low serum potassium indicates hypokalemia which may be due
breakdown or destruction of cells due to surgery, electrolyte potassium moves from inside
of the cell to outside of the cell wall. The shift of potassium into the cells causes
hypokalemia.
 Low serum sodium indicates hyponatremia which may indicate sudden change in
metabolism condition due to surgery that involves the pituitary gland.
 Low serum chloride indicates hypochloremia which may indicate sudden change in
metabolism condition due to surgery that involves the pituitary gland.
 URINE SPECIFIC GRAVITY
Normal Value: 1.020 -1.030 g/ml
Sep 15 Oct 08 09 10 11 12 13 14 23 Remark

AM 1.020 1.025 1.020 1.01 1.015 1.015 1.015 1.005 1.015 WNR
0
PM 1.020 1.020 1.010 1.01 1.015 WNR
 Analysis: Indicates that the concentrating and diluting ability of the kidneys are normal.
 SPECIAL TEST AND IMMUNOLOGY
Hormone Result Range Remarks

Luteinizing 3.54 miU/ml Male: 1.70-8.60 miU/ml WNR
Hormone
Growth Hormone 0.09 ng/ml 0.01-1.00 ng/ml WNR
ACTH 51.60 pg/ml 5.00-46.00 pg/ml WNR
35
 Analysis: Results indicate that there are no hyper nor hypo secretions of the hormones
which denotes that the pituitary adenoma is non-functional.
III.2. DRUG STUDY/ MAINTENACE MEDS
1. Hydrocortisone 50 mg IV q 8 hours
Classificatio Indication Mechanism of Contraindication Nursing
n Action Responsibilit
y
Corticostiroid Severe Decreases -Idiopathic - Monitor I &
36
s Inflammatio inflammation by thrombocytophenia O, be alert for
n suppression of . decreasing
migration of urinary output
polymorphonuclea -Fungal infections or increasing
r leukocytes, edema.
fibroblast, reversal -Non-asthmatic - Monitor
of increased bronchial desease weight gain of
capillary > 5 pounds.
permeability and - Monitor for
lysosomal potassium
stabilization. depletion
- Monitor WBC
for drug mask
infection.
2. Ranitidine Hydrochloride 50 mg IV q 8 hours
Classification Indication Mechanism of Contraindication Nursing
Action Responsibility
H2 Histamine -Duodenal and Inhibits Hypersensitivity - Assess for GI
receptor gastric ulcers histamine at H2 complaints such
antagonist - Stress ulcers receptor site in as nausea,
and parietal cells vomiting,
hypersecretory which inhibits diarrhea and
conditions gastric acid cramps.
secretion.
3. CEFAZOLINE SODIUM 1 gm IV q 6 hours
37
Antiinfective -Pre- Inhibits bacterial Hypersensitivity to IV- check for
1st Generation operative wall synthesis, cephalosphorins irritation,
Cephalosporin prevention of rendering cell extravasation is
contaminated wall osmotically very often
surgery. unstable, leading IV push- give
- For surgical to cell death by slow in 3-5
prophylaxis binding to cell minutes (diluted
wall membrane. in 10 ml sterile
water for
injection )
Y Port/tube-
dilute in 50-100
cc PNSS or
D5W solution
and run over 30
minutes.
4. CO-AMOXICLAV 62O mg/ capsule; 1 capsule BID for 2 weeks
Antiinfective Skin and Prevents bacterial Creatinine IV- check for
skin wall synthesis clearance below irritation,
structure during replication 30 ml per minute extravasation is
infection very often
IV push- give
slow in 3-5
38
minutes (diluted
in 10 ml sterile
water for
injection )
5. KALIUM DURULE 40 mEq / tablet; 1 tablet BID for 3 days
Electrolyte and Prevention Maintains Hyperkalemia -must be given
mineral and potassium with meals or
replacement treatment of chloride level pc
hypokalemia needed for - If IV route; to
adequate be given very
transmission of slowlyand with
nerve impulses, large bore
cardiac needles to
contraction, renal prevent or
function and decrease vein
intracellular ion inflammation.
maintenance - must not
exeed 150
mEq/ day .
6. SODIUM CHLORIDE 1 tablet TID for 3 days
Electrolyte and Fluid Replaces sodium Patients with renal -must be given
39
mineral electrolyte and chloride and dysfunction and with meals or
replacement replacement maintain its level. hypoproteinemia. pc
in - Instruct not to
hyponatremia crush or chew
cause by tablet.
electrolyte
loss or severe
salt depletion.
7. CELCOXX 200 mg/ tablet; 1 tablet BID
Nonsteroidal Acute pain Inhibits Hypersensitivity to -must be given
anti- prostaglandin aspirin with food or
inflammatory synthesis by milk to
(NSAID) decreasing decrease
COX-2 enzymes needed gastric
Inhibitor for biosynthesis, symptoms
impending
cyclooxigenase to
produce anti-
inflammatory
analgesic and
antipyretic
effects.
8. HEMOSTAN 500 mg IV q 8 hours X 6 doses
40
Classificatio Indication Mechanism of Contraindication Nursing
n Action Responsibility
Antihemophili Antihemorrhagic Forms an Patient predispose -Watch out for
c agent and reversible to thrombosis any signs of
antifibrinolytic complex that bleeding
for effective displaces
hemostasis in plasminogen
various surgical from fibrin
and clinical resulting in
cases and in inhibition of
traumatic fibrinolysis.
injuries. Also inhibits the
proteolytic
activity of
plasmin.
9. NICARDIPINE 2.5 mg/ ml in 10 ml ampoule
Calcium Hypertension Inhibits calcium Sick sinus -give slowly and
channel ion reflux across syndrome; 2nd and must not exeed
blocker cell membrane 3rd degree heart 15 mg/ hour
during cardiac block - watch out for
depolarization; irregular heart
produces beat; shortness
relaxation of of breath;
coronary vascular swelling of feet
smooth muscle; and hands;
41
dilates coronary pronounce
vascular arteries dizziness;
nausea and
hypotension.
10. ACETAZOLAMIDE 250 mg/ tablet; 1 tablet BID
Dieuretic; Epilepsy; -Inhibits carbonic Electrolyte -monitor for
carbonic open and anhydrase activity imbalance hypotension
antihydrase narrow in proximal renal -monitor I & O
inhibitor glaucoma; tubules to daily to
drug decrease determine fluid
induced reabsorption of loss.
edema and water, sodium and -monitor for
edema in potassium. dehydration
CHF -Decreases
carbonic
anhydrase in CNS,
increase seizure
threshold.
IV. NURSING MANAGEMENT
A. Problem List
Approximate Date Nursing Active Inactiv Date
Date of onset Identified Problem e Resolved

42
14 July 2010 14 Sep 2010 Disturbed 
Sensory;
Visual
08 Oct 2010 08 Oct 2010 Tissue 
Integrity,
impaired
08 Oct 2010 08 Oct 2010 Risk for 
Infection
B. Long Term Objective
Upon discharge, VR with the help of significant others will achieve optimum level of
functioning without complication.
C. Nursing Care Plan
Problem Nr 1
Diagnosis Objectives Intervention Evaluation

14 September 2010 After a week of - observed for After a week of
1600H nursing evidences of CSF nursing
intervention, client leak from sublabial intervention, client
Tissue Integrity, will display a post-operative displayed a
impaired progressive lesion progressive
improvement in - observed for any improvement in
S- “Sir madalas na wound healing as exudates from the wound healing as
itong nangyayari, evidence by: incision wound evidence by:
parang lumalabo - inspected lesion
ang mata ko at daily for any signs
hindi ko makita ng of inspection
claro ang nasa gilid - encouraged
ko” adequate periods of
rest and sleep
including
O- damaged tissue uninterrupted
on periods of sufficient
duration
43
- elevated HOB at 30
degree angle
- assisted in passive
exercises
- monitored WBC
result in laboratory
studies
- promoted good
nutrition with
adequate protein
and caloric intake
- administered
CONZACE
multivitamin, 1
capsule OD as
ordered.
-
Problem Nr 2
Nursing Nursing Nursing Evaluation
Diagnosis Objectives Intervention

08 October 2010 After 4 hours of - Assessed reported After 4 hours of
2330H nursing or referred pain nursing
intervention VR’s -Performed intervention, VR’s
Pain, Acute; related reported post- comprehensive post-surgical
to disruption of surgical incision assessment of pain incision pain was
normal tissue pain will be including location, controlled as
integrity controlled as onset/duration, evidenced by;
evidenced by; frequency, quality
S- Sir “masakit ang and severity at 0-10 - Absence of
ilalim ng labi ko” - Absence of pain scale. antalgic behavior
antalgic behavior -Accepted clients - Absence of facial
-pain scale reported - Absence of facial description of pain mask and no sleep
at 9/10 mask no sleep -Observed for non- disturbance
disturbance verbal cues of pain - Absence of
O- with sub-labial - Absence of -provided back-rub expressive
post-surgical incision expressive as non behaviors
wound behaviors pharmacologic - Displays no
- guarded/protective - Displays no measure for pain autonomic
behavior autonomic - Monitored v/s alteration in
- with facial grimace alteration in - Provided a calm muscle tone
- restless and irritable muscle tone and quiet - Absence of self
- moaning to pain - Absence of self environment. focusing behavior
- flaccid focusing behavior - Instructed to - Pain scale
44
- diaphoretic - Pain scale report pain as it reported at 1-3
-reduced interaction reported rating at occurs categorized as
-RR: 28 breaths/ min 1-3 categorized as - Instructed/ mild pain.
-BP:160/110 mmhg mild pain Encouraged deep
breathing exercises
Pain Scale Rating -encouraged
Legend: diversional activities
0 = no pain such as radio using a
1-3 = mild pain head set device
4-6 = moderate pain -Regulated
7-10 = severe pain Tramadol drip (300
mg Tramadol + 234
cc PNSS) at 10
mcgtts/ minute as
ordered.
-Administered
Tramadol 25 mg IV
for breakthrough
pain as ordered
-continued to
administer celcoxx
200mg, 1 cap BID
post anesthesia
order to lift
tramadol medication
thru IV
Problem Nr 3
Nursing Nursing Nursing Evaluation
Diagnosis Objectives Intervention

08 October 2010 After 2 weeks of 1. Assessed and After 5 days of
2330H nursing documented skin nursing
intervention, client condition noting intervention, client
Risk for Infection will achieve a inflamma- achieved a timely
related to timely wound tion and drainage. wound healing free
traumatized tissue. healing free from from infection as
infection as 2. Observed for evidenced by;
O- Broken skin and evidence by; localized signs of
traumatized tissue infection at invasive - free from purulent
-S/P - free from lines of surgical drainage at incision
purulent drainage incision site
TRANSPHENOIDA
at incision site
L EXCISION OF 3. Assessed and -Afebrile at 36.5
SELLAR MASS -Afebrile at 36.5 documented skin degrees Centigrade
45
SUBLABIAL degrees condition noting
APPROACH Centigrade inflammation and -WBC at 7.0 X
drainage. 10/L
- WBC within
normal range at 4. Emphasized
5.0-10. X 10/L proper hand -
washing technique
to watcher in every
client engagement
5. Maintained
adequate hydra-
tion
5. Provided
isolation at neuro-
surgical ICU
6. Encouraged early
ambulation
7.Administered
Cefazolin Sodium
1g IV q 6 hours
D. HOME CARE PLAN
Upon discharge VR will recognize and understand the importance of the following:
Medicine - Home Medication:
ACETAZOLAMIDE 250 mg/ tablet; 1 tablet BID (8:00 am – 6:00 pm)
C0-AMOXICLAV 625 mg/ capsule; 1 capsule BID X 2 weeks (8:00 am – 6:00 pm) until 29
October 2010
CONZACE Multivitamin Capsule; 1 capsule once a day (8:00 am)
46
Exercise – advise VR to continue light physical exercises like slow walking and stretching
at home. Discourage exercises that requires bending until fully recovered
Treatment - VR will come back on 08 January 2011 for repeat MRI and possible
radiotherapy depending on MRI result.
Health Teaching – taught VR to avoid the following:
1. Lifting heavy objects until fully recovered.
2. Drinking liquors and smoking.
3. Bending forward until fully recovered.
Out-Patient Services – Reminded VR to come back at Neurosurgery OPD on 08

December 2010, Wednesday between 0900H- 1200H for a follow-up check- up.
Diet – Advised VR to drink plenty of fluids and eat foods rich in vitamin A, vitamin C and
fiber such as carrots, potatoes, mangoes, tomatoes, lemons, oranges, guavas, cereals and
whole grain breads.
Spiritual – Encouraged to engage in spiritual activities according to their belief. Advise to

attend mass regularly.
47
V.CONCLUSION/ APPLICATION OF GERONTOLOGY
NURSING
The case study presented provides a written account of the care delivered to the
patient.
This also shows the interrelation of the disease process to the medical and nursing
intervention that took place at each stage, in the whole duration of VR’s confinement. The
theoretical observations and management provides an understanding to broaden the
knowledge and enhance the skills in the nursing practice.
48
BIBLIOGRAPHY
A. Books
Judith Hopfer Deglin, April Hazard Vallerand, “Davis Drug Guide for Nurses” Ninth
Edition, Copyright © 2005 by F. A. Davis Company
Lenette Owens Burrell, RN, EdD, CCRN,” Adult Nursing in Hospital and Community
Settings” Copyright © 1992 by Appleton and Lange, A Publishing Division of Prentice
Hall
Lippingcott “Manual of Nursing Practice Hanbook” Third Edition, Copyright ©
Lippingcott Williams and Wilkins
Nursing™, The Series for Clinical Exellence, Interpreting Signs and Symptoms,
Wolters Kluwer/ Lippingcott Williams and Wilkins, Copyright © LippingcottWilliams
and Wilkins
49
Richard Walker, “Guide to the Human Body” 2006 Bounty Books, A Division of
Octopus Publishing Group LTD, 2-4 Heron Quays, London E14 4JP Reprinted 2008
Copyright © 2003, 2006 Philip’s
B. Welliography
Retrived from http://endoctrine-system.emedtv.com/pituitary-macroadenoma.html
Retrived from http://en.wikipedia.org/wiki/Pituitary_adenoma
50

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I.

Adenomas are the most commonly encountered intracranial neoplasms. In 1999,

an increasing awareness and early detection.

symptoms caused by excessive hormone secretion, symptoms caused by impairment of

pea can change an individuals’ normal anatomical functioning.

B. OBJECTIVE OF THE STUDY

care of patients with Pituitary Macroadenoma.

At the end of the study, the presentor will be able to:

1. Conduct a comprehensive history taking to client with pituitary macro adenoma.

2. Discuss the pathophysiology of pituitary macro adenoma.

3. Discuss the medical and surgical management of pituitary macro adenoma.

4. Formulate a comprehensive nursing care plan to client with pituitary macro

5. Develop a discharge plan to clients with pituitary macro adenoma.

C. SIGNIFICANCE OF THE STUDY:

in depth study of the case to benefit the following:

PATIENT AND FAMILY – will gain understanding regarding the disease.

OTHER HEALTH PROFESSIONALS – will enable them to work together as a

team in providing comprehensive care and management for the patient.

NURSING RESEARCH – will serve as a reference for research.

D. SCOPE AND LIMITATION

Ward of AFP Medical Center from 14 September 2010 to 05 November 2010.

and international literatures, books, journals and internet.

Age : 41 years old

Rank / BOS : Petty Officer 3rd Class (PO3) / Philippine Navy

Religion : Roman Catholic

Civil Status : Married

Date of Birth : 27 November 1968

Place of Birth : Catanduanes

Attending Physician : M AJ GASCON MC (Inact), CPT MILLARES MC CPT DE LEON MC

Date Admitted : 14 September 2010

Chief Complaints : Blurring of vision, Loss of peripheral vision

Initial Diagnosis : Optic Neuropathy, Left, probably central

Operation Performed: Transphenoidal Excision of Sellar Mass Sublabial Approach (08

Date of Retro-evac : 27 October 2010, Manila Naval Hospital

Final Diagnosis : Pituitary Macroadenoma, S/P Transphenoidal Excision of Sellar

Mass, Sublabial Approach (08 October 2010)

Both are still alive.

other sources of income except VR’s salary.

C. CONCEPT OF HEALTH, ILLNESS AND HOSPITALIZATION

illness is a situation of undesirable choice. Hospitalization for VR is a frightening thought

D. COMMON HEALTH PRACTICES AT HOME

E. IMMEDIATE FACTOR THAT BROUGHT ABOUT ILLNESS

that are high in cholesterol.

1. History of Present Illness

AFPMC prompting his admission for further evaluation and management.

2. Past Medical History

previous immunization except for shots of tetanus toxoid every reenlistment.

3. Family and social history

No recollection of other heredo-familial disease except for hypertension. His great

grandfather died of stroke.

1. Health-Perception/ Health Management Pattern

2. Nutritional/ Metabolic Pattern

According to the patient, when he is at home or even at work he usually defecates

4. Activity/ Exercise Pattern

because it is required in the military.

6. Cognitive/ Perceptual Pattern

ability is also in normal condition but not his sense of sight.

7. Self Perception/ Self-Concept Pattern

9. Sexuality & Reproductive Pattern

managed to have a stable gender identity during his growing years.

10. Coping/ Stress-tolerance Pattern

time with his friends.

11. Value/ Belief Pattern