HISTORY OF PRESENT ILLNESS

I. DEMOGRAPHIC DATA
a. Patient Name : Mr. V
b. Sex : Male
c. Birthdate : July 7, 2001
d. Age : 21 years old
e. Time and date of admission : October 14, 2022 @ 12:00PM
f. Attending physician : Dr. Simbahon
g. Birthplace : Calipayan, Mayorga
h. Permanent Address : Calipayan, Mayorga
i. Nationality : Filipino
j. Religion : Roman Catholic
k. Marital Status : Single
l. Occupation : Student
m. Father’s Name : Mr. B
n. Mother’s Name : Mrs. K
o. Admitting Diagnosis :Neuroschistosomiasis
Encephalitis
p. Healthcare Financing : None

II. CHIEF COMPLAINT

On October 14, 2022 at 12:00 PM, the patient was brought to the ER due to dizziness &
vomiting. “Baga sukot an akon paglingaw ngan paghika suka kun mayda ko ginhihimo tas
nagsuka ako maka duha bago kami magpahospital” as verbalized.

III. HISTORY OF PRESENT ILLNESS

Patient was apparently well, until 1 month prior to admission, experienced

episodes of dizziness aggravated by sudden change of position associated with
non-projectile vomiting of previously eaten food, approximately 2 cups per bout.
The patient reported vomiting thrice in the same day. “Tigda manla adto na higda
ak tas pag tukdaw ko nag lipong nak ulo, hadto gihap na adlaw maka tulo ako
pag suka hin baga diri gud duro ka matubig kay may upod man na akon mga
kinaon han gabi pa” as verbalized. Patient sought consultation at Abuyog District
Hospital and was subsequently admitted for four nights. The patient was then
managed and CT Scan was requested which revealed possible tumor growth
and was then advised to seek consultation in EVMC for further evaluation and
management.
On Sept. 10, 2022, the patient underwent a repeat CT scan at EVMC
requested by Dr. Simbahon. Results showed neuroschistosomiasis encephalitis.
Then consulted in DWH for a scheduled MRI last September 25, 2022, wherein
results confirmed the initial diagnosis. September 28, 2022, the patient went to
Governor Benjamin T. Romualdez General Hospital and Schistosomiasis Center
for a Kato katz test and tested positive, the patient was then prescribed
praziquantel 600 mg QID to be taken once every 6 months. After two days, the
patient started to experience double vision, associated symptoms including
 ringing on the left ear, and headaches centered in the forehead.“ Gin obserbahan
ko la nak lawas hin usa ka semana tas malain na liwat nak ina abat baga ak hit
na duduling tas may ma alingog ngog ako na nababatian ha ak talinga ngan pag
nakaon ako diri ko nararasahan gud'' No pharmacological or non
pharmacological treatment taken. On October 11, 2022 the patient went to
EVMC for a check up and was not yet admitted due to financial problems. On
October 14, 2022 the patient was brought to EVMC due to exacerbation of
symptoms as follows: headache with a pain rating scale of 6 out of 10, “ Nag
hihinigdaon la ako tungod nga maluya ha lawas agi tak pagsinuka ngan lipong hit
ulo, tas it ka ul-ol kay adi gud ha sakob tak ulo tas na abot ha likod” as
verbalized, persistence of double vision, nausea and non-projectile vomiting,
yellowish with remnants of previously eaten food, twice in a single day. As
verbalized by the mother, “Nagcommute kami pabalik kay han pagpakonsulta
nam kan doctor ginpapaadmit na kami pero waray pa namon kwarta pero sige na
pagsinakit han ulo tas pagsinuka tak anak”. The patient was given Mannitol,
Dexamethasone, and Omeprazole.

IV. PAST MEDICAL HISTORY

Patient had no history of previous illnesses prior to admission. Patient was
hospitalized one month PTA at Abuyog District Hospital. Patient also had
complete immunizations by the age of 1 year old given by their RHU “Kumpleto
ito an iya bakuna kay natagan hiya dida han iya pagkaanak tas ha RHU gihapon”
as verbalized by the mother. The patient is vaccinated against covid-19 (Sinovac)
up to the second dose. Patient did not undergo any surgery or operations. Had
common coughs and colds. No history of accidents and any known allergies.

V. FAMILY HEALTH HISTORY

The Patient's paternal side has a history of hypertension and has a history of
arthritis from the maternal side. There were no deaths in the family that
happened during their childhood or infancy. Bernardino G. Vertulfo Jr. (father) is
46 years old, non smoker but drinks alcoholic beverages occasionally.
Katherine L. Vertulfo (mother) 36 years old is a non smoker and a non alcoholic
drinker.
VI. PSYCHOSOCIAL HISTORY
Patient’s household consists of 4 people, the patient’s parents and sister.
Resides in a remote location, specifically on a farm with a semi-concrete house.
“Sakto manla kami didto ha balay ngan upatdidto, madali la liwat limpyohan kay guti
mnla tam balay upat manla liwat kami na na ukoy didto, madali la liwat limpyohan
kay guti manla tam balay”. He described their environment as moderately clean. He
has a good relationship with his parents as well as to his sister. “Okay mnla kami tak
pamilya talgasa la kami baga diri magka arasyahan tas urusa mnla kami ha balay ha
ira la ghp ako madaop kun may problema ak” as verbalized. He relies to his family
for emotional comfort whenever he is stressed out.Described their environment as
moderately clean. No smokers in the family. Support system includes the family, and
has a good relationship with his parents as well as with his sister. Considers his
mother as his best friend. “Okay manla kami tak pamilya talagsa la kami baga diri
mag ka arasyahay tas urusa mnla kami ha balay adya ha ira la gihap ako madaop
kun may problema ak”. Copes by playing mobile games and sleeping. Usual day
consists of playing basketball and mobile games with friends, working in the fields
with the patient’s father, sleeping and going to school.

According to Erik Erikson’s Psychosocial Theory, life is a sequence of 8

developmental stages namely: Trust vs. Mistrust (birth-18 mos.), Autonomy vs.
Shame & Doubt (18 mos.- 3 yrs.), Initiative vs. Guilt (3-5 yrs.), Industry vs. Inferiority
(6-12 yrs.), Identity vs. Role Confusion (12-20 yrs.), Intimacy vs. Isolation (21-39
yrs.), Generativity vs. Stagnation (40-65 yrs.), and Integrity vs. Despair (65 yrs. –
Death). The patient is in the Intimacy vs. Isolation stage. And at this stage, conflicts
centers on forming intimate relationships with other people. Success at this stage
leads to fulfilling relationships. Struggling at this stage, on the other hand, can result
in feelings of loneliness and isolation. Patient has not experienced intimate
 relationships wifh other people. Focused on personal roles in the family. “Waray pa
iton ha akon hunahuna ngan waray pa man ako liwat nagkauyab.” As verbalized.

VII. GORDON'S FUNCTIONAL HEALTH PATTERNS

FUNCTIONAL HEALTH ASSESSMENT
PATTERNS
Health Perception-Health BEFORE ADMISSION:
Management Pattern The patient perceived own health as 10 out of 10. Patient is healthy
and has an active lifestyle which consists of working together with
the patient’s mother regarding chores, working in the fields with the
patient’s father, and playing sports with friends.

DURING ADMISSION:
The patient perceived own health as 5 out of 10, “Hinigdaon la ako
tungod kay nanluluya ak agi tak pagsinuka ngan malipong tak ulo”
as verbalized.

Nutritional-Metabolic BEFORE ADMISSION:

Pattern Patient eats a variety of vegetables together with rice, fish, pork and
chicken. “Nakaon man ako bis ano na luto ni mama, mahilig man
liwat ako kumaon.” As verbalized. Patient’s favourite food is Pakbet.
The patient is able to eat 4 to 5 times a day. The patient is also able
to drink more than 8 glasses of water a day, “Mahilig ako uminom
hin tubig hasta yana.” As verbalized. The patient does not drink
alcoholic and carbonated drinks.

DURING ADMISSION:
The patient has a decreased appetite, but is able to eat 3 times a
day, “Waray gud ako gana pag kakaon, kay di ko gud nararasahan it
mga sura.” As verbalized. The patient is able to drink 6-8 glasses of
water a day.
Elimination Pattern BEFORE ADMISSION:
Patient was able to void without problems, at least twice a day and
is able to urinate at least 4 to 5 times a day, “Mahilig ako umihi kay
sige man tak pagininom hin tubig” as verbalized.

DURING ADMISSION:
Patient is able to void at least twice a day, with stools brown, black
& yellowish in color and is able to urinate at least 3 times a day.

Activity and Exercise BEFORE ADMISSION:

The patient performs jogging with friends early in the morning and
sometimes does walking around their home in past time. The
patient also plays sports and watches tv to pass time. The patient
also take afternoon naps around 3 pm for at least 1 to 2 hours.
Experiences mild headaches upon doing household chores such as
fetching water.

DURING ADMISSION:
Patient passes time by sleeping and using cellphone.
Sleep and Rest Pattern BEFORE ADMISSION:
Patient has no trouble sleeping and sleeps for about 7-8 hours. The
patient usually sleeps at 10 pm and wakes up at 5 am in the
morning.

DURING ADMISSION:
Patient sleeps at around 7 PM and wakes up at 10 pm due to noise,
“Utod utod tak pagkakaturog tungod kay maaringasa didi pero
nangangaturog man ako liwat dayun kun nabalik ak pagkakaturog”
as verbalized.
Cognition and Perception BEFORE ADMISSION:
Pattern The patient experiences pain in the eyes when looking at the phone
for too long. Patient also experiences diplopia, decreased sense of
taste, ringing in the left ear, and headache centered on the forehead
after taking medications for Schistosomiasis “Naduduling na tak
pangitaan pero nagiging okay kun gintatabunan ko tak usa na mata”
as verbalized. Patient can speak clearly and logically.

DURING ADMISSION:
Patient still experiences the same symptoms but lessened pain on
the forehead. ​"Kun mabuhat ak baga ako hit ma tutumba kay
tungod nga nag dodoble tak pangitaan” as verbalized.

Self-Perception and Self- BEFORE ADMISSION:

Concept The patient is healthy and strong, friendly and cheerful and helps
the patient’s mother with their daily chores “Mabuligon ini na akon
anak ngan makusog han waray pa hiya kasakit.” As verbalized.

DURING ADMISSION:
Patient is worried about present condition, “Nababaraka ako tungod
tak mga inaabat ngan permi nala ako naghihinigdaon tikang
pagtikang paginul’ol tak ulo.” As verbalized.

Roles and Relationships BEFORE ADMISSION:

The most important person in the patient’s life is family, especially
the patient’s mother. The patient is close with the family and
considers the patient’s mother as a bestfriend, “Hi mama permi tak
ginyayaknan tak mga problema.” As verbalized. The patient grew up
together with the sister properly. The Patient's role in the family
consists of helping around the house, working in the fields with the
father and going to school.

DURING ADMISSION:
The patient misses the family. “yana adi ako hospital diri na ako
nakakabulig ha paghihingabuhi tak pamilya” as verbalized.
Sexuality and BEFORE ADMISSION:
Reproduction Patient has no problems with genitalia. Has no experience
regarding sex, “Waray pa iton ha akon hunahuna ngan waray pa
man ako liwat nagkauyab.” As verbalized.

DURING ADMISSION:
Patient has no problems regarding reproduction.
Coping and Stress BEFORE ADMISSION:
Tolerance Patient is easily stressed, “Madali ako mastress ngan gindadamdam
ko dayun it mga yakan hit iba parte haak.” As verbalized. Patient
goes out or hangs out with friends in order to combat stress. School
stresses the patient the most prior to admission. Patient
communicates concerns to the mother and when in stress.

DURING ADMISSION:
The patient stresses over the medical condition, “Nastrestress ak
pagpinanhuna huna tak mga magul’ol” as verbalized.
Values and Beliefs BEFORE ADMISSION:
The patient is Roman Catholic. “It pinakaimportante haak yana kay
mawara tak sakit bisan pobre la kami, importante waray namon
mga sakit” as verbalized. The patient goes to church when
remembered and on Sundays.

DURING ADMISSION:
Family and prayers are the patient’s source of strength and hope.
 IX. REVIEW OF SYSTEMS

HEAD, SKIN, & NAILS Reports of dizziness with accompanying headache. Reports of
inflammation in the brain due to infection. Reports no sign of unusual
discoloration of the skin. No signs of hair loss and is dry & frizzy. Denies
presence of lesion, rash, & lumps.

HEAD & NECK Reports of pain starting from forehead radiating to the back of the neck.
Denies experiencing stiff neck. No reports of visible swelling of the head
or neck. Difficulty in swallowing, sore throat, and enlargement of lymph
nodes are also not noted

EYES Reports of using glasses upon reading. Reports of experiencing double

vision & exotropia in the left eye. Denies eye itching, excessive tearing,
unusual discharge, redness, or trauma in the eye.

EARS Reports of ringing in the left ear. Denies difficulty of hearing. Denies pain
in the ears, unusual discharge, & trauma to ears.

MOUTH, THROAT, Denies difficulty in eating, chewing, & swallowing. Denies experiencing
NOSE & SINUSES sore throat, sore tongue. Denies difficulty in smelling & sneezing. Denies
experiencing snoring & nosebleed.

BREAST Denies pain, lumps, uneven texture of the skin, and increase in size.

THORAX & LUNGS Denies experiencing shortness of breath, breathlessness, cough, and
sputum production. Reports of exposure to smoke through peer smoking.

HEART & NECK Denies palpitations, chest pain, & fatigue. No signs of jugular vein
VESSELS distention. No murmurs.

PERIPHERAL Denies experience of cramps & pain in both legs and arms. No signs of
VASCULAR edema in the lower extremities. No swelling or atrophy in both upper and
lower extremities.

ABDOMEN Reports of nausea & vomiting. Denies abdominal pain. Denies presence
of lesions or rashes. No signs of abdominal enlargement.

MUSCULOSKELETAL Denies past problems or injuries to the joint, muscles, or bones. Denies
stiffness and lower back pain. Denies joint pain and swelling in both upper
and lower extremities. Denies inability to do ROM exercises without
assistance.

GENITOURINARY Urinates 4-5 times a day with light yellow coloured urine. Denies pain
while urinating, blood in urine, & excessive amount of urine. Denies
experiencing trouble with urinating & lack of control in urinating

NEUROLOGIC Denies having difficulty with speech and decision making. Denies
experiencing loss of memory. Reports of decrease in sweet & salty taste
sensation Reports of loud ringing in the left ear. Denies experiencing tics
or tremors. Denies experiencing signs of fainting and seizures.
 X. PHYSICAL EXAMINATION

Vital Signs:

● Temp: 36.6
● BP: 110/80
● HR: 73
● RR: 18
● O2 sat%: 98%

Height: 167cm Weight: 50 kg BMI: 17.9

SKIN Skin is generally brown in color, no unusual or prominent

discoloration. Skin is intact, warm to touch, smooth and no lesions
are noted. With good skin turgor and a Capillary refill time of less
than 2 seconds.

HEAD & NECK Head is symmetric, round and in midline, normocephalic. It is also
hard and smooth, without lesions. There is no involuntary
movement such as jerking noted.

Neck is symmetric, centered with no bulging masses noted.

Landmarks (trachea & thyroid gland) are positioned midline. Lymph
nodes are not swollen, not tender and no enlargement is noted.

EYES Upon observation, left exotropia was noted. After testing for
cardinal positions, the left eye was unable to follow the movement
in all directions.

Upper & Lower eyelids close easily and close completely. There is
no redness, swelling or lesion noted. Both bulbar & palpebral
conjunctiva are clear, moist and smooth. Sclera is white.

Upon testing visuals fields for peripheral vision, there is an early

perception on the left eye due to his exotropia. After performing a
cover test, the right eye moved to establish focus when done with
the cover test.

After testing for accommodation, only the right eye converges

towards the center.

EARS Ears are symmetric & equal in size. Skin is smooth, with no lesions,
lumps, or nodules noted. Ears are of the same color as the face.
Upon palpation, the auricle, tragus, & mastoid process are not
tender.

Upon inquiry, there is a ringing sound in the left ear. After

performing Weber’s test, the right ear is sensitive to the vibrations
while the left ear only has ringing instead of hearing the vibrations.
After performing Rinne’s test, the right ear can hear the vibrations
longer in front of the ear canal, indicating a false positive result.
 NOSE External nose is soft, not tender, symmetric, and of the same color
as the rest of the face.

Upon palpation, frontal and maxillary sinuses are not tender. Also,
the sinuses are nontender on percussion.

THROAT Throat is pink in color, with no exudate or lesions. There is no

inflammation in the tonsils or pharynx noted.

LUNGS Nasal flaring is not observed. Outward expansion of the abdomen

and lowers ribs on inspiration is noted. Return to resting position on
expiration is also observed. Scapulae are symmetric and non
protruding. Does not use accessory muscles to breathe.

No tenderness is palpated upon respiration.

HEART No extra sounds are heard upon auscultation. No murmurs are

heard. S1 and S2 heart sounds are normally heard. Heart rate is
within 60-100 per minute with regular rhythm.

ABDOMEN Abdomen is generally brown in color and as of the same color with
the rest of the body. Free of lesions or rashes. Umbilicus is midline
at the lateral line. Abdomen is symmetric and flat in shape.

No palpable masses are present. No rebound tenderness is

present.

Upon auscultation, gurgling sounds (borborygmi) are heard about 8

times per minute.

MUSCULOSKELETAL & Upon observation, the cervical and lumbar spine are concave while
SPINE the thoracic spine is convex. Spine is straight and is midline when
observed from behind.

Ability to do ROM exercises without assistance. Muscle strength of

grade 5.
NEUROLOGIC CN I (Olfactory Nerve): Both nares are patent. Patient has no
problems in smelling aromatic scents.

CN II (Optic Nerve): Doubling of vision noted. “huna ko kanan pag

sinakit la han ak ulo asya nagduduha an ak pangitaan. huna ko
liwat kinanghanglan ko na hin antiyohos pero ngada ko kasi ito
inaabat han nagtikang naak pagtumar han medisina na gin papalit
haak” as verbalized.

CN III, IV, VI (Occulomotor, Trochlear, and Abducens nerve): only

the right eye converges at the center upon performing
accomodation test. Through assessment of the 6 cardinal gaze, it
was noted that the left eye cannot follow the movement in all 6
directions while the right eye can follow without delay. Facial
sensation is present with no sensory difficulties.

CN VII (Facial Nerve): Can smile, frown, wrinkle forehead, puff out
cheeks, purses lips, and raise eyebrows, with no problems or
abnormalities. Decrease in sweet & salty taste sensation. “Diri ako
nakakarasa hin magtamis ngan magpag ad na pagkaon” as
verbalized.

CN VIII (Vestibulocochlear Nerve): After performing Weber’s test,

the right ear is sensitive to the vibrations while the left ear only has
ringing instead of hearing the vibrations. After performing Rinne’s
test, the right ear can hear the vibrations longer in front of the ear
canal, indicating a false positive result (Bone Conduction: 3 secs;
Air Conduction: 5 secs). “ an pag duha duha han pangitaan lapid
na liwat an bagat may dako ak nga alingog ngog nga nababatian
haak talinga” as verbalized.

CN IX & X (Glossopharyngeal & Vagus Nerve): Gag Reflex is

present. Uvula is midline. No difficulties in phonation and
articulation.

CN XI (Spinal Accessory Nerve): Can move neck side to side

against resistance. Can elevate shoulders equally.

CN XII (Hypoglossal Nerve): Tongue is midline on protrusion. Can

move the tongue from side to side.
 ANATOMY & PHYSIOLOGY

ANATOMY & PHYSIOLOGY OF BRAIN

The brain is the part of the central nervous system (CNS) that is contained within
the cranial cavity. It consists of the brainstem, the cerebellum, the diencephalon, and
the cerebrum.

BRAINSTEM
- Connects the spinal cord to
the cerebrum; consists of the
medulla oblongata, pons, and
midbrain, with the reticular
formation scattered
throughout the three regions;
has many important functions,
as listed under each
subdivision; is the location of
cranial nerve nuclei.

MEDULLA OBLONGATA
- The medulla oblongata (ob-long-gah′tă), often called the medulla, is about
3 cm long. It is the most inferior part of the brainstem and is continuous
inferiorly with the spinal cord. The medulla oblongata contains sensory
and motor tracts, cranial nerve nuclei, and related nuclei. Pathway for
ascending and descending nerve tracts; center for several important
reflexes (e.g., heart rate, breathing, swallowing, vomiting)
Pons
- The part of the brainstem just superior to the medulla oblongata is the
pons. The pons contain ascending and descending tracts and several
nuclei. The pontine nuclei, located in the anterior portion of the pons, relay
information from the cerebrum to the cerebellum.Site of reflex centers
Midbrain
- The midbrain, or mesencephalon, is the smallest region of the brainstem.
It is located just superior to the pons. The midbrain contains the nuclei of
cranial nerves III (oculomotor), IV (trochlear), and V (trigeminal)Contains
 ascending and descending nerve tracts; serves as visual reflex center;
part of auditory pathway

CEREBELLUM
- The cerebellum (ser-e-bel′ŭm; little brain) is
attached to the brainstem posterior to the
pons. It communicates with other regions of
the CNS through three large tracts called
cerebellar peduncles. Controls muscle
movement and tone; governs balance;
regulates extent of intentional movement;
involved in learning motor skills.

- Patient’s manifestation: Edema and

multifocal, small, contrast-enhanced lesions in the cerebellum is reported in the
CT and MRI. Hypodensity in the right cerebellar hemisphere and Multiple
border-zone brain infarctions have also been reported. Obstructive
hydrocephalus was also present.

DIENCEPHALON
- The diencephalon (dī-en-sef′ă-lon) is the part of the brain between the brainstem
and the cerebrum. Its main components are the thalamus, subthalamus,
epithalamus, and hypothalamus. Connects the brainstem to the cerebrum; has
many relay and homeostatic functions, as listed under each subdivision

Thalamus
- The thalamus (thal′ă-mŭs) is by far the largest part of the diencephalon,
constituting about four-fifths of its weight. Major sensory relay center;
influences mood and movement
Subthalamus
- The subthalamus is a small area immediately inferior to the thalamus. It
contains the subthalamic nuclei and several ascending and descending
tracts. Contains nerve tracts and nuclei
Epithalamus
- The epithalamus is a small area superior and posterior to the thalamus is
involved in emotional and visceral responses to odors. It consists of the
habenula and the pineal gland. The habenula (hă-ben′ū-lă) is influenced
by the sense of smell and.
Hypothalamus
- The hypothalamus is the most inferior portion of the diencephalon. It
contains a cluster of small nuclei and tracts. The most conspicuous nuclei,
called the mammillary bodies, appear as bulges on the ventral surface of
the diencephalon. They are involved in olfactory reflexes and emotional
responses to odors. They may also be involved in memory. Major control
center for maintaining homeostasis and regulating endocrine function

CEREBRUM
- The cerebrum is the part of the brain that most people think of when the term
brain is mentioned. The cerebrum accounts for the largest portion of total brain
weight, which is Controls conscious perception, thought, and conscious motor
activity; can override most other systems

Basal Nuclei
 - The basal nuclei are a group of functionally related nuclei beneath the
cortex (subcortical). These nuclei are located bilaterally in the inferior
cerebrum, diencephalon, and midbrain. The basal nuclei are involved in
controlling motor functions. Controls muscle activity and posture; largely
inhibits unintentional movement when at rest
Limbic System
- Parts of the cerebrum and diencephalon are grouped together under the
title limbic system. The limbic system plays a central role in basic survival
functions, such as memory, reproduction, and nutrition. It is also involved
in interpreting sensory input and emotions in general. Autonomic response
to smell, emotion, mood, memory, and other such functions

SPINAL CORD

- The spinal cord is the major communication link between the brain and the PNS
inferior to the head. It integrates incoming information and produces responses through
reflex mechanisms.

- The spinal cord extends from the brain at the level of the foramen magnum down to
the level of the second lumbar vertebra.

- It is considerably shorter than the vertebral column because it does not grow as rapidly
during development.

-The spinal cord is composed of cervical, thoracic, lumbar, and sacral segments, named
according to the portion of the vertebral column from which their nerves enter and exit.

- The spinal cord gives rise to 31 pairs of spinal nerves, which exit the vertebral column

through intervertebral and sacral foramina. Each spinal nerve is a bundle of axons,
Schwann cells, and connective tissue sheaths.
 COURSE IN THE WARD

DATE TREATMENT MEDICATION IVF DIET DIAGNOSTICS SPECIAL SIGNIFICANCE

ENDORSEMENT

October 14, 2022 > Mannitol 250 cc IV > PNSS 1L > DAT > CBC ● Please admit to Patient was rushed to the
now as loading dose regulated at Medical Ward nearest hospital with chief
12:00 PM then 100 cc IV q6h 30 gtts/min > BUN, Creatinine, under Internal complaints of dizziness.
RBS Medicine
(+) dizziness > Dexamethasone 6 ● Secure consent Medications:
mg IV q8h first dose > NaKCl, SGPT for care & mgt
now ● Monitor neuro > Mannitol 250 cc IV
> CXR V/S q shift now as loading dose
>Omeprazole 4 mg IV ● Check Vital signs then 100 cc IV q6h was
first dose now, then > Repeat PCR every 4 hours ordered to reduce
q24h ● Monitor I & O cerebral edema or
every shift intracranial pressure
related to disease

> Dexamethasone 6 mg
IV q8h first dose now
was ordered for reduction
of inflammation related to
disease.

> Omeprazole 4 mg IV
first dose now, then
q24h was ordered to
reduce the production of
stomach acid secretions
and prevent heartburn, &
acid reflux.

IVF

> administer IVF PNSS

1L regulated at 30
gtts/min to ensure patient
is taking adequate fluids
and to facilitate
administration of IV
medications

Diet:

> DAT diet as tolerated

due to inability and
intolerance to eat; may or
may not eat solid food

Diagnostics:

> CBC to check

abnormalities within the
blood and if there is
presence of infection

>BUN,Creatinine to
detect acute or chronic
renal disease/failure

>RBS to measure the

level of glucose in the
blood.
>NaKCl to test level of
electrolytes in the body
and presence of protein
that aids in the secondary
active transport of
sodium, potassium, and
chloride into cells

>SGPT to measure the

amount of Glutamate
Pyruvate Transaminase
(GPT) in blood serum.
GPT is an enzyme found
in heart cells, kidney,
muscles and liver. An
SGPT test is needed on a
regular basis to keep the
liver in a healthy state.

>CXR to help detect

organ anomalies within
the chest and for
evaluation.

>Repeat PCR to test for

presence of COVID-19

Special Endorsement:

> Monitor neuro status q

shift to check for
deterioration of CNS
function
 > Checking VS every

4 hours to see if any

abnormalities are

present.

>Monitor I&O

every shift and check

for any abnormalities

present.

4:45 PM · For CT Angiography >CT Angiography to help

(requested attached) diagnose and evaluate
blood vessel disease or
related conditions, such
as aneurysms or
blockages.
 October 15, 2022 IVF to follow: >Cont. on DAT >For CT > Cont. medications > Urinalysis to detect and
PNSS 1L at Angiography manage a wide range of
7:00 pm 20 gtts/min disorders, such as urinary
>For Urinalysis tract infections, kidney
(-) headache disease and diabetes

(-) N&V

BP 100/70

O2 Sat – 05%

7:45 PM · To IM W2

RTPCR (-)

October 16, 2022 > IVF: PNSS > Cont. on DAT >For CT ● NaKCl, RBS, Special Endorsement:
1L at 30 Angiography BUN results
5:00 AM gtts/min requested > Refer to neuro for
>For Urinalysis ● Refer to neuro for eval. & co-management
(+) headache eval. & to monitor mental status
co-management and further care
Dx: ● V/S q4h
Neuroschistosomiasis ● Monitor I&O q
encephalitis shift
● Cont. medications
R/O AV mal.
 8:00 AM IVF to follow: > Cont. on DAT ● Cont. medications
PNSS 1L @ ● Follow up
30 gtts/min requested labs
● Follow up for CT
angiography
● Refer to neuro for
eval. &
co-management
● V/S q4h
● Monitor I&O q
shift

10:00 AM >Cont on DAT >For Cranial CT ● May apply eye Special Endorsement:
angiography patch on R eye >May apply eye patch
No new neurologic (10/21/22) ● Cont. medications on R eye to eliminate
deficit double vision by blocking
the images produced by
one eye.
 LABORATORY FINDINGS WITH CLINICAL SIGNIFICANCE
HEMATOLOGY: COMPLETE BLOOD COUNT
Examination Date Ordered Patient’s Result Normal Value Clinical Significance
Complete Blood Count 10/14/22 Hemoglobin: 147 g/L 140-170 g/L Normal
Hematocrit: 0.41 0.42-0.52 Normal
RBC: 4.97 4.7-6.1x10^12/L Normal
WBC: 8.33 4.8-10.8x10^9/L Normal
Neutrophils: 0.55 0.43-0.65 Normal
Lymphocytes: 0.26 0.20-0.45 Normal
Monocytes: 0.06 0.05-0.12 Normal
Eosinophil: 0.12 0.01-0.03 INCREASED: Eosinophils are
white blood cells whose function
is phagocytosis of
antigen-antibody complexes
and response to allergy
inducing substances and
parasites.
An increase in Eosinophil count
indicates inflammation and
presence of a parasitic infection.
In the case of the patient’s
condition, there is a parasitic
infection of S. Japonicum in the
brain which caused the
inflammation.
Basophil: 0.01 0-0.01 Normal
 MCV: 82.70 fL 80-94 Normal
MCH: 29.6 pG 27-31 Normal
MCHC 358 g/L 320-360 Normal
Platelet: 228x10^9/L 150-400
Blood Type: “A”
RH: Positive

Examination Date Ordered Patient’s Result Normal Value Clinical Significance

Normal
Chemistry Result 10/14/22 Creatinine: 84.72 umol/L 60-115

9:04:36 PM Normal
Sodium: 143.6 mmol/L 135-148
Normal
Potassium: 3.64 mmol/L 3.5-5.3
Normal
Chloride: 102.0 mmol/L 98-107

RBS: 6.39

Normal
SGPT/ALT 25.51 U/L 0-41
Normal
Blood Urea Nitrogen: 3.00 2.9-9.3
mmol/L
 Examination Date Ordered Report Text Impression Clinical Significance
Vasogenic edema is a result of
Cranial Plain CT Scan 9/10/22 ● Multiple axial tomographic sections of ● Vasogenic edema, right the blockage of the CSF flow,
the cranium without contrast media were cerebellum. associated with granulomatous
9:24 AM obtained. ● Mass effects including inflammation in the brain caused
● The CT images reveal an ill-defined obstructive hydrocephalus by the S. Japonicum, resulting in
hypodense focus in the right cerebellum extravasation of fluid and
predominantly involving the white matter intravascular proteins into the
region. Associated partial compression cerebral parenchyma. The
of the 4th ventricle is noted causing extravasated fluid accumulates
dilatation of the 3rd and lateral outside the cells, and the
ventricles. excessive extracellular
● The rest of the cortical and cerebellar accumulation of fluid evokes an
sulci and lateral fissures are normal in increase of brain volume or
pattern. obstructive hydrocephalus.
● The midline structures are not displaced.
● The sella and posterior fossa including
the brainstem, and basal cisterns are
unremarkable.
● No extraaxial fluid collection is noted.
● Paranasal sinuses, mastoid air cells, and
orbits are normal as visualized.
● The calvarium is intact.
● The extracalvarial soft tissues are
unremarkable.
The right cerebellar hemisphere
Cerebral angiogram 10/21/2022 Brain: Pre contrast CT images of the brain still shows the previously seen hypodensity in still shows hypodensity, which is
11:51 PM the right cerebellar hemisphere. No abnormal enhancement or extravasation of the
contrast material is seen.
 associated with the presence of
Gray white matter interface is maintained.No acute intracranial hemorrhage or midline Vasogenic edema.
shift. There is decrease in the previously noted slight right sided compression of the After the administration of
fourth ventricle. Current study exhibits no dilatation of the ventricles. The cisterns, and Dexamethasone, there is a noted
sulci are unremarkable. decrease in the slight right sided
compression of the fourth
The rest of bones and soft tissues: unremarkable ventricle of the brain.
VASCULAR:

Right:
Internal carotid artery:patent
Anterior cerebral artery:patent
middle cerebral artery:patent
Posterior communicating artery: patent
Posterior cerebral artery: patent
Distal vertebral artery: patent
Left:
Internal carotid artery:patent
Anterior cerebral artery:patent
middle cerebral artery:patent
Posterior communicating artery: patent
Posterior cerebral artery: patent
Distal vertebral artery: patent
Anterior communicating artery: basillar artery
No aneurysm or arteriovenous malformation.

IMPRESSION:
1.There is no significant change in the vasogenic edema of the right cerebellum.
Correlate clinically as regards to follow-up, possibly with MRI study
2. Unremarkable cerebral angiogram
 Neuroschistosomiasis

According to Centers for Disease Control and Prevention, schistosomiasis also known as bilharzia, is a disease caused by parasitic worms. Etiology of
schistosomiasis are the schistosoma species also called as blood flukes. According to Harrison et al., schistosomiasis is endemic in places where there are
freshwater habitats suited for the intermediate host snail, areas of human activity, and have climatic conditions favoring for survival of the snails and development
of the parasite inside the snail host. According to WHO, they are prevalent in tropical and subtropical areas especially in poor communities without access to safe
drinking water and adequate sanitation. There are five species medically important Schistosoma, which are S. japonicum, S. mansoni, S. haemotobium, S.
mekongi, and S. intercalatum. Schistosoma species - present in most patient with schistosomiasis are S. japonicum, S. mansoni, and S. haemotobium. The most
predominant species in the Philippines is the Schistoma japonicum also called the oriental blood fluke. Strains of S. japonicum from different geographic regions
are genetically distinct but all require snails of the species Oncomelania hupensis quadrasi as intermediate host.

For non-modifiable factors, we have age. Our patient is a 21-year-old male. Although schistosomiasis affect any age, according to Harrison et al., in some areas
adults have a high occupational risk of exposure, especially that our patient works in the rice field. Schistosomiasis affect between school-age children and are
more common in adults that works as fishermen, canal cleaners, and workers in the rice field. There has also been a prominent evidence that geographical
location plays a vital role in etiology of schistosomiasis. Leyte being endemic due to the presence of the specific intermediate host Oncomelania hupensis
quadrasi. For the modifiable factors, we have lifestyle, our patient works in an agricultural farm since he was a teenager. Hygiene such as sanitation greatly
contributes in contraschistosomiasis since the patient has stated that he does not use boots whenever he’s working or when there’s flood around their house.
Lastly, knowledge, especially he was unaware of the presence of schistosoma in their workplace or the prophylaxis that can be taken for such disease.

Schistosoma infection is acquired when a person comes into contact with infected fresh water and the parasite penetrates the skin. Freshwater snails serve as the
intermediate host for the parasite and release thousands of infective Schistosomala larvae into freshwater. In the snail, this begins with the development of
miracidia into a sporocyst. Sporocysts multiply and grow into cercariae. Larvae, termed cercaria, penetrate human skin with proteolytic enzymes and mechanical
activity. Upon release from the snail, the infective cercariae swim, penetrate the skin of the human host, and shed their forked tails, becoming schistosomulae. The
organisms enter the venous system and migrate to the lungs where they activate complement and bind antibodies on their surface membrane. Therefore, the
structural and biochemical modifications of the schistosomulum’s surface membrane tend to produce immunological camouflage that either prevent antibody
binding or effectively reduce antigen expression. The schistosome cercariae infiltrate the host to begin their invasion. The host's primary defense is its skin. When
it invades, the parasite requires coordination of immune regulation to maintain its survival inside the skin. The schistosomulae migrate via venous circulation to
lungs, then to the heart, and then mature in the liver, exiting the liver via the portal vein system when mature. Schistosomules at the skin-stage are vulnerable to
both humoral as well as cellular immunological reactions. However, the crucial changes in the morphology and biochemical as they produce schistosomula, they
become resistant to the immune system of the host , as evidenced in the lung schistosomulum. After migration to the lungs, Danger-associated molecular patterns
(DAMPs) are tissue derived distress signals released during stress or injury. Therefore, the structural and biochemical modifications of the schistosomulum’s
surface membrane tend to produce immunological camouflage that either prevent antibody binding or effectively reduce antigen expression. Over the course of
one to three weeks, when the schistosomulum successfully evades the host’s immune response, it develops into an adult and enters the liver and portal veins and
develop into an adult over 1-3 weeks. The adult male and female schistosomes pair up, attach to the veins, lay 300–3,000 eggs, and for many years, and escape
host immunity for many years. he vertebral veins are a valveless plexiform network with a longitudinal pattern. The plexus extends the entire length of the vertebral
column and finds a cranial terminus in the dural sinuses.

The vertebral venous plexuses anastamose with the sacral, pelvic and prostatic venous plexus. It is clinically important since it provides a route for the spread of
tumours, infection or emboli. And in this case where it became the route of adult schistosome eggs.Mature Schistosoma then reenter the bloodstream via the
hepatic portal system. The adult worms may enter the intercommunicating Batson’s plexus, which drains into the internal jugular vein, and gain access to the dural
sinus. Physical egg characteristics appear to influence venous access to the CNS: S. japonicum eggs are smaller and are shed in much greater numbers (an adult
worm typically sheds hundreds to thousands of eggs daily); hence, they travel relatively easily to reach the brain. The presence of the eggs trigger an inflammatory
process that will lead to formation of granulomas, a granuloma is an aggregate of white blood cells that comes up as a result of infection and when it occured there
will be pressure effect. When eggs become associated with granulomatous inflammation after extravasation, this would appear as nodular enhancement adjacent
to the arborized/linear/perivascular enhancement which is now a confirmatory diagnosis of cerebral neuroschistomiasis. The main risk factor for infection is
exposure through household, work, or recreational activities that take place in fresh water contaminated by the parasite. For transmission to occur, the water must
be contaminated with infected feces, and a type of freshwater snail, O. Quadrasi (the intermediary host for the parasite) must be present. Children, adolescents,
and adults who are frequently exposed to contaminated water are the populations at the highest risk. The clinical manifestations of brain schistosomiasis are
varied. Common manifestations of cerebral schistosomiasis are: Headache, Papilledema, Visual abnormalities, Seizures. While common manifestations in
cerebellum and brainstem schistosomiasis are: Nausea. Vomiting, Brain hernia, Ataxia.
TOP 5 PRIORITY NURSING DIAGNOSIS

1. Acute Pain related to increased cerebellar vascular pressure.

2. Disturbed Sensory Perception: Auditory, Visual, Gustatory related to nerve damage

3. Risk for Imbalanced nutrition: less than body requirements related to decreased taste sensation and vomiting

4. Risk for injury related to visual impairment

5. Risk for Ineffective coping related to perceived threat of illness

 NURSING CARE PLAN 1

Assessment Nursing Diagnosis Scientific Rationale Planning / Objectives Intervention Rationale Evaluation

Subjective Cues Acute Pain related to Pain is an unpleasant Short Term: Independent Independent Short Term:
● “Nag increased cerebellar sensory and emotional
vascular pressure. experience associated After 6-8 hours of 1. Assess location, 1. Facilitates Goals are partially
hihinigdaon la with slow or sudden nursing intervention, characteristics, diagnosis of met as evidenced by:
onset of mild to severe the patient will be able frequency, problems and
ako tungod initiation of
intensity of pain that is to: severity, and ● After 6-8 hours,
nga maluya ha felt by the patient. onset/duration of appropriate patient reports
Acute pain typically ● Report pain using therapy. Helpful in decreased pain
lawas agi tak results from an injury or decrease in COLDSPA. evaluating on the head
is caused by a specific pain perception effectiveness of with PRS of
pagsinuka
illness. to 3-4 out of 10 therapy. 5/10. “Mayda
ngan lipong hit from 6 out of man kamo mga
In relation to the 10. 2. Demonstration of gin hahatag na
ulo, tas it ka patient’s case, acute 2. Encourage caring can help to medisina haak
pain felt from increased adequate rest decrease anxiety. swero ngan
ul-ol kay adi
cerebral vascular ● Demonstrate periods and napahuway
gud ha sakob pressure related to use of verbalization of manla ak didi,
obstructive nonpharmacolo concern in regard nakabulig ada
tak ulo tas na to pain. iton pag iban
hydrocephalus due to gical techniques 3. Minimize
abot ha likod” partial compression of and diversional han sakit haak
3. Assist patient in a stimulation and
the 4th ventricle is activities as ulo na gin
as verbalized, comfortable promote
noted causing indicated for aabat” as
position and relaxation.
dilatation of the 3rd and individual verbalized.
maintain on a
Objective Cues lateral ventricles. situations such ● Demonstrated.
bedrest during
● PRS: 6/10 as deep non
acute phase.
● CT Scan shows breathing 4. Deep breathing pharmacologica
vasogenic Reference: exercise. 4. Demonstrate and and visualization l methods to
edema @ the encourage use of refocus attention, help relieve
right cerebellum ● Smeltzer, S. C., relaxation promote sense of pain.
and obstructive Bare, B. G., Hinkle, techniques such well-being and
hydrocephalus J. L., & Cheever, K. as deep breathing control or
● Facial grimace H. (2018). Brunner and visualization. decrease
noted and Suddarth's discomfort.
Textbook of
Medical_Surgical 5. Activities that
● Geissier-Murr, A.C., 5. Instruct to increase
Doenges, M.E., & minimize vasoconstriction
Moorhouse, M. vasoconstricting accentuate the
(10th edition) activities that may headache in the
Nursing Care aggravate presence of
Plans: Guidelines headache such as increased
for Individualizing straining at stool cerebellar
Client Care Across and bending over. pressure,
the Life Span.
6. Dizziness and
6. Assist patient with blurred vision
ambulation, as frequently
needed. associated with
vascular
headache. Client
may also
experience
orthostatic
hypotension,
causing dizziness
or lightheadedness
when standing up.

Dependent
Dependent
1. Osmotic
1. Administer diuretics and
Osmotic diuretic corticosteroids
such as to reduce
mannitol, and intracranial
Corticosteroid pressure or
such as
 dexamethasone cerebellar
edema.

Collaborative
Collaborative 1. These
1. If ordered, diagnostic
assist the procedures are
patient with used to
diagnostic determine
procedures, cerebral
such as EEG, pressure and
lumbar puncture the presence of
for CSF, MRI, or potential
a CT scan, pathogens.

NURSING CARE PLAN 2

Assessment Nursing Diagnosis Scientific Rationale Planning / Objectives Intervention Rationale Evaluation

Subjective Cues Disturbed Sensory Change in the amount Short Term: Independent Independent Short Term:
● “ Naduduling ak Perception: or patterning of Auditory
tas may Auditory, Visual, incoming stimuli After 6-8 hours of 1. Assess hearing 1. To establish a Goals are partially
ma-alingog Gustatory related to accompanied by a nursing intervention, ability and how it baseline met:
ngog ako na nerve damage diminished, the patient will be able affects the assessment in
nababatian ha exaggerated, distorted, to: individual. terms of hearing, After 6-8 hours of
ak talinga ngan or impaired response to visual and taste nursing intervention the
pag nakaon ako such stimuli. ● Regain or capacity. patient
diri ko maintain the
nararasahan Increased usual level of 2. Instruct the SO to 2. To promote good ● Maintained
gud.” as cerebrospinal fluid perception. speak slowly and communication baseline level of
verbalized. pressure may affect clearer to the between the perception.
 hearing. It could be a ● Verbalize patient. Encourage patient and the ● Verbalized
Objective Cues direct effect of pressure awareness of them to face the SO. understanding of
● Negative Weber on the cerebral hearing sensory needs. patient while sensory needs.
Test pathways and centers; speaking.
● False-Positive also the effect could
Rinne Test occur by way of an 3. Advise the patient
● Decreased increase of the to inform SO if 3. To monitor if there
sense of taste. intralabyrinthine there are any is worsening of
● Impaired pressure via the worsening ringing in the ears
cardinal canaliculus cochlea. symptoms, such as and if there is a
movement of ear pain, need for further
the left eye Obstruction of the brain discharge, or investigation and
● Left eye can cause diminished worsening of change of hearing
exotropia taste sensation as a hearing ability. aid.
● After testing for consequence of
damage to the nerves Visual
accommodation
and ocular movement 4. Assess visiual
,only the right may be altered as a ability of the 4. To establish a
eye converges result of cerebellar patient. baseline
towards the disease, specifically if assessment in
center. vestibular connections terms of visual
● After performing are involved. capacity.
a cover test, the 5. Ensure the 5. To promote patient
Reference: patient’s caregiver safety and provide
right eye moved
is always present. support in
to establish ● Smeltzer, S. C., performing ADL.
focus when Bare, B. G., Hinkle, 6. Eliminate or 6. The safety of the
done with the J. L., & Cheever, K. minimize environment plays
cover test. H. (2018). Brunner environmental a vital role in
and Suddarth's hazards to ensure providing safety
Textbook of safety by providing and avoiding
Medical_Surgical adequate lighting injuries.
● Geissier-Murr, A.C., and removing hot
Doenges, M.E., & and sharp objects.
Moorhouse, M. 7. Demonstrate to the 7. For better
(10th edition) client and guardian understanding of
Nursing Care how to properly put the procedure and
Plans: Guidelines on eye patches. enhances
for Individualizing Educate the compliance.
Client Care Across importance of
the Life Span. putting on eye
patches.
8. Educate the 8. To facilitate early
patient for the detection and
need to monitor management of
and report any disturbed sensory
visual disturbances perception.
or other sensory
changes.

Gustatory
9. Encourage patient 9. Foods high in zinc
to intake food high are used to treat
in zinc, such as taste disorders, as
poultry, fish, eggs well as several
and dairy products. other diseases by
stimulating
feeding.
10. Instruct patient to 10. Numerous
avoid food with ingredients cause
numerous a blend of different
ingredients. flavors to come
together, often
resulting in an
unpleasant effect
for those with
dysgeusia

Dependent
 1. Administer Dependent
Osmotic diuretic
such as 1. Osmotic
mannitol, and diuretics and
Corticosteroid corticosteroids
such as to reduce
dexamethasone intracranial
pressure or
cerebral edema
that causes
damage in the
cranial nerves.
2. Apply eye patch 2. Placement of
on right eye. eye patch on
the stronger eye
may improve
the vision of the
weaker eye. It is
also used to
Collaborative eliminate
1. Refer to an double vision.
Otolaryngologist Collaborative:
and 1. To monitor
ophthalmologist for hearing, taste,
check up if vision and treat
gustatory, auditory, them accordingly.
and visual
problems
progresses.
 NURSING CARE PLAN 3
Assessment Nursing Diagnosis Scientific Rationale Planning / Objectives Intervention Rationale Evaluation

Subjective Cues Risk for Imbalanced Imbalanced nutrition Short Term: Independent Independent Short Term:
● “Waray gud ako nutrition: less than refers to either nutrition 1. Explore the 1. To create a
gana pag body requirements that is more than or After 6-8 hours of patient’s daily baseline of the Goals are partially
kakaon, kay di related to decreased less than the body’s nursing intervention, nutritional intake patient’s nutritional met:
ko gud taste sensation and requirements and the patient will be able and food habits. status and
nararasahan it vomiting metabolic needs. ​Poor to: preferences. After 6-8 hours, patient
mga sura.” As nutritional status leads 2. Calculate caloric 2. To effectively verbalized decreased
verbalized. to prolonged hospital ● Verbalized intake and monitor the frequency of vomiting
Objective Cues stays, decreased decreased discuss with the patient’s daily due to reduced gastric
● BMI: 17.9 quality of life, and severity or patient the nutritional intake acid secretion from
(18.5-24.9) increased morbidity elimination of short-term and and progress in administration of
● Vomiting, and mortality. nausea and long-term weight goals and omeprazole and patient
yellowish with vomiting. nutrition and identifies demonstrate increased
remnants of weight goals. nutritional in appetite as
previously eaten Reference: ● Identify deficiencies and/or evidenced by increased
food, twice in a appropriate needs. intake.
single day ● Smeltzer, S. C., nutritional 3. Advice diet as 3. To meet nutritional
● Decreased taste Bare, B. G., Hinkle, needs/requirem tolerated. requirements.
sensation J. L., & Cheever, K. ents 4. Divide feedings 4. Enhances
H. (2018). Brunner into small digestion and
and Suddarth's amounts and patient’s tolerance
Textbook of give frequently. of nutrients and
Medical_Surgical ● Demonstrate can improve client
● Geissier-Murr, A.C., increased cooperation in
Doenges, M.E., & appetite. eating.
Moorhouse, M. 5. Educate the 5. To promote
(10th edition) patient to select nutrition and
Nursing Care appropriate healthy food
Plans: Guidelines ● Initiate choices to habits, as well as
for Individualizing behaviors or increase caloric boost the energy
Client Care Across lifestyle intake. levels of the
the Life Span. changes to patient.
regain and to 6. Provide for rest 6. Energy is
maintain periods before conserved to
appropriate and during minimize fatigue at
weight. meals maintain a meals
quiet, unhurried
environment.

Dependent: Dependent:
1. Offer antiemetic 1. Omeprazole
drugs such as suppresses the
Omeprazole, as vomiting center
ordered by the in the medulla.
doctor.

Collaborative: Collaborative:
1. Refer the patient 1. To provide a more
to the dietitian. specialized care
for the patient in
terms of nutrition
and diet.
 NURSING CARE PLAN 4

Assessment Nursing Diagnosis Scientific Rationale Planning / Objectives Intervention Rationale Evaluation

Subjective Cues Risk for injury related Risk for injury is the Short Term: Independent Independent Short Term:
● “ Nagkukuri ak to visual impairment state in which an 1. Assess degree of 1. Identifies
pag lakat kay individual is at risk for After 6-8 hours of impairment in potential risks in Goals are met:
nag dodoble tak harm because of a nursing intervention, ability and the environment
pangitaan ngan perceptual or the patient will be able competence of and heightens After 6-8 hours of
dire ako physiologic deficit, a to: visual-perceptual. awareness of nursing intervention the
papagios gios lack of awareness of risks so SO are patient reduced risk for
kay bangin ako hazards, or ● Verbalize more alert to injury and verbalized
matumba ” as maturational age. understanding dangers. understanding of
verbalized. of individual factors that can
Ocular movement may factors that 2. Ascertain 2. Enables contribute to injuries.
Objective Cues be altered as a result of contribute to the knowledge of patients to
● Left eye cerebellar disease, possibility of safety needs/injury protect
exotropia was specifically if vestibular injury. prevention and themselves
noted connections are ● Demonstrate motivation. from injury and
● Impaired involved. Patients with behaviors such recognize
cardinal cerebellar lesions are as eliminating changes
movement of unable to hold hazards in the requiring
the left eye eccentric positions of environment to healthcare
● After testing for gaze, resulting in a reduce risk providers’
accommodation special type of factors and notification and
,only the right nystagmus and the protect self from further
need to make rapid injury. intervention.
eye converges
repetitive saccades to ● Remain free of
towards the look eccentrically. injuries. 3. Instruct patient to 3. Providing
center. ● Recognize assistance
request assistance
● After performing Reference: sensory keeps the
as needed.
a cover test, the disturbance and patient safe and
right eye moved ● Smeltzer, S. C., compensate avoids the
Bare, B. G., Hinkle, against occurrence of
to establish
J. L., & Cheever, K. changes. an injury.
focus when
done with the H. (2018). Brunner
cover test. and Suddarth's
Textbook of 4. Eliminate or 4. Preventive
Medical_Surgical minimize identified measures can
● Geissier-Murr, A.C., hazards in the contain the
Doenges, M.E., & environment such patient without
Moorhouse, M. as sharp objects constant
(10th edition) supervision.
Nursing Care Activities
Plans: Guidelines promote
for Individualizing involvement
Client Care Across and keep client
the Life Span. occupied.
5. To promote
5. Promote adequate safety measure
lighting in the and support to
patient's room. the patient in
doing ADL's
optimally.
6. Visual-
6. Assist patient and perceptual
SO(s) to identify deficits increase
any risks or the risk of injury
potential hazards and falls
and visual-
perceptual deficits
that may be
present.
Dependent
Dependent: 1. Placement of
1. Apply eye patch eye patch on
on right eye. the stronger eye
may improve
the vision of the
weaker eye. It is
 also used to
eliminate
double vision.

Collaborative Collaborative
1. Refer to an 1. To monitor vision
Opthamologist and treat
for check up if accordingly.
visual problems
progresses.

NURSING CARE PLAN 5

Assessment Nursing Diagnosis Scientific Rationale Planning / Objectives Intervention Rationale Evaluation

Subjective Cues Risk for Ineffective A pattern of invalid Short Term: Independent Independent Short Term:
● “Nababaraka coping related to appraisal of stressors, 1. Assess for the 1. Behavioral and
ako tungod tak perceived threat of with cognitive and/or After 6-8 hours of presence of physiological Goals are partially
mga inaabat illness behavioral efforts, that nursing intervention, defining responses to met:
ngan permi nala fails to manage the patient will be able characteristics stress can be
ako demands related to to: such as cultural varied and After 6-8 hours of
naghihinigdaon well- being, inadequate beliefs, norms, provide clues to nursing intervention the
tikang pagtikang choices of practiced ● Identify their and values on the level of patient still expressed
paginul’ol tak responses, and/or disruptive the patient’s coping difficulty. anxiety; however,
ulo.” as inability to use behaviors and perceptions of verbalized
verbalized. available how they effective coping. understanding of
Resources. prevent them 2. Patients may coping strategies.
Objective Cues from coping 2. Determine the believe that the
● Decrease Patients dealing with effectively patient’s threat is greater “Nababaraka gud la
productivity chronic, life-altering, or ● Verbalize understanding than their gihap ako pero
● Inability to meet even terminal illnesses appropriate of the stressful resources to naintindihan ko man an
role are under additional coping situation. handle it and imo ginpinantutdo,
expectations, stress and are at risk strategies and feel a loss of salamat han bulig.” as
basic needs for ineffective coping. resources to control over verbalized.
This can arise from a prevent solving the
poor understanding of ineffective threat or
their condition, a lack of coping problem. This
financial or social ● Recognize the information
support, or insufficient relationship provides a
skills in handling stress. between foundation for
disease process planning care
(cerebral and choosing
Reference: lesions) and relevant
emotional interventions.
● Smeltzer, S. C., responses and
Bare, B. G., Hinkle, changes in 3. Assist patient 3. Involving
J. L., & Cheever, K. thinking and set realistic patients in
H. (2018). Brunner behavior. goals and decision making
and Suddarth's identify helps them
Textbook of ● Express personal skills move toward
Medical_Surgical confidence in and knowledge. independence.
● Geissier-Murr, A.C., handling their
Doenges, M.E., & stressors and 4. Provide 4. Verbalization of
Moorhouse, M. when to ask for chances to actual or
(10th edition) help. express perceived
Nursing Care concerns, fears, threats can help
Plans: Guidelines feeling, and reduce anxiety
for Individualizing expectations. and open doors
Client Care Across for ongoing
the Life Span. communication.

5. Encourage 5. Participation
patient to make gives a feeling
choices and of control and
participate in increases
planning of care self-esteem.
and scheduled
activities.
 6. Encourage use 6. Relaxation
of cognitive techniques,
behavioral desensitization,
relaxation (e.g., and guided
music therapy, imagery can
guided help patients
imagery). cope, increase
their sense of
control, and
allay anxiety.

Collaborative Collaborative
1. Refer for 1. Arranging for
counseling as referral assists
necessary. the patient in
working with the
system, and
resource use
helps to
develop
problem-solving
and coping
skills.

DRUG STUDY
DRUG NAME MECHANISM OF INDICATION CONTRAINDICATION ADVERSE EFFECT NURSING RESPONSIBILITIES
ACTION

Drug Name: Increases osmotic General: Contraindicated in CNS: seizures, dizziness, BEFORE:
Mannitol pressure of glomerular To reduce intracranial patients hypersensitive headache, fever. ● Verify the doctor’s order.
filtrate, thus inhibiting pressure or cerebral to drugs. ● Check the patient’s identity.
Dose: 100 cc IV tubular reabsorption of edema. CV: edema, ● Ensure the right medication and the given
q6H water and electrolytes. Contraindicated in thrombophlebitis, appropriate dose at the right time
Drug elevates plasma Specific: patients with anuria; hypotension, HTN ● Check the expiration date of the medicine.
Route: Side drip osmolality and This was given to the severe pulmonary ● The nurse on duty should be the one to
infusion increases urine output. patient to lower congestion; frank EENT: blurred vision, give the medication
intracranial pressure by pulmonary edema; active rhinitis. ● Assess the patient’s condition before and
Therapeutic osmotically drawing the intracranial bleeding, starting therapy and regularly thereafter to
class: Diuretics free water out of the severe dehydration; GI: thirst, dry mouth, monitor drug’s effectiveness
brain and into the metabolic edema nausea, vomiting, ● Measure I&O accurately and record to
Pharmacologic circulation where it can diarrhea. achieve proper fluid balance.
class: be eliminated ● Monitor vital signs closely. Assess in BP
Osmotic Diuretics GU: urine retention. for hypotension before administering
drug.
Metabolic: dehydration, ● Monitor for possible indications of fluid
fluid and electrolyte and electrolyte imbalance (e.g., thirst,
imbalance. muscle cramps or weakness,
paresthesia).
Respiratory: pulmonary ● Check patency at the infusion site.
edema. ● Explain the purpose of administering the
drug
Skin: local pain, urticaria, ● If the patient refuses, assess why the
injection-site reaction patient does not want to take medicine.
(infection, phlebitis, Educate on what could happen if they
venous thrombosis). refuse to take their medicine.

Other: chills, thirst. DURING:

● Check patency at the infusion site.
● Ensure to observe and follow the 15 rights
of drug administration
● Watch for signs and symptoms of
infiltration.
● Take care to avoid extravasation. Observe
injection sites for signs of inflammation or
edema.

AFTER:
 ● Monitor any changes in I&O.
● Monitor for any changes in the head
circumference.
● Report if there are manifestations of
oliguria
● Instruct the patient to report any of the
following: Thirst, muscle cramps or
weakness, paresthesia, dyspnea, or
headache.
● Instruct significant others to immediately
report any signs of confusion.
● Be alert to the possibility that a rebound
increase in ICP sometimes occurs about
12 h after drug administration. The patient
may complain of headache or confusion.
● Check weight, renal function, fluid
balance, and serum and urine sodium and
potassium levels daily.
● Document administration after giving the
ordered medication. Chart the time, route,
and any other specific information as
necessary.

Drug Name: Inhibits proton pump General: Contraindicated in CNS: asthenia, dizziness, BEFORE:
Omeprazole activity by binding to Duodenal and gastric patients hypertensive to headache. ● Verify the doctor’s order.
hydrogen-potassium ulcer. drug or its components ● Check the patient’s identity. Ensure the
Dose: 4 mg IV adenosine Gastroesophageal and in patients receiving GI: abdominal pain, right medication and the given
q24h triphosphate, located at reflux disease including rilpivirine-containing constipation, diarrhea, appropriate dose at the right time.
secretory surface of severe erosive products. flatulence, nausea, ● Check the expiration date of the
Route: IV gastric parietal cells, to esophagitis vomiting, acid medicine.
suppress gastric acid Use cautiously in regurgitation. ● The nurse on duty should be the one to
Therapeutic secretion Specific: patients with give the medication
class: Antiulcer To reduce the hypokalemia and Musculoskeletal: back ● Educate patient about the purpose of
drugs production of stomach respiratory alkalosis and pain, weakness. administering the drug.
acids and prevent ulcer, in patients on a ● Assess for hypersensitivity.
Pharmacologic heartburn, and acid low-sodium. Respiratory: cough, URI. ● Obtain VS for baseline data.
class: reflux. ● Monitor I&O
PPls Skin: rash ● If the patient refuses, assess why the
patient does not want to take medicine.
Educate on what could happen if they
refuse to take their medicine.

DURING:
● Observe for adverse reactions
● Check IV site for redness and swelling.
● Ensure to observe and follow the 15
rights of drug administration
● Monitor patients for signs and symptoms
of low magnesium level, such as
abnormal heart rate or rhythm,
palpitations, muscle spasms, tremores, or
seizures

AFTER:
● Check for any hypersensitivity reaction.
● Instruct patient to report any side effects
immediately.
● Caution patients to avoid hazardous
activities of dizziness.
● Report any changes in urinary elimination
such as pain or discomfort associated
with urination, or blood in urine.
● Report severe diarrhea; drug may need
to be discontinued
● Monitor analysis for hematuria and
proteinuria. Periodic liver function tests
with prolonged use.
● Document administration after giving the
ordered medication. Chart the time,
route, and any other specific information
as necessary.
Drug Name: Decreases General: Contraindicated in CNS: euphoria, insomnia, BEFORE:
Dexamethasone inflammation, mainly by To reduce cerebral patients hypersensitive psychotic behavior, ● Verify the doctor’s order.
stabilizing leukocyte edema. For patients to drug or its ingredients, pseudotumor cerebri, ● Check the patient’s identity.
Dose: 6 mg IV lysosomal membranes; with inflammatory in those with systemic vertigo, headache, ● Ensure the right medication and the given
q8h suppresses immune conditions fungal infections, and in paresthesia, seizures, appropriate dose at the right time
response; stimulates those receiving depression. ● Check the expiration date of the
Route: IV bone marrow; and Specific: immunosuppressive medicine.
infusion influences protein, fat, The patient was given doses together with CV: HF, HTN, edema, ● The nurse on duty should be the one to
and carbohydrate this to reduce the live-virus vaccines. IM arrhythmias, give the medication
Therapeutic metabolism granulomatous administration is thrombophlebitis, ● Assess the patient’s condition before and
Class: inflammation in the contraindicated in thromboembolism. starting therapy and regularly thereafter
Corticosteroids brain caused by the S. patients with ITP. to monitor drug’s effectiveness
Japonicum, thus EENT: cataracts, ● Check patency at the infusion site.
Pharmacologic reducing excessive glaucoma. ● Inspect the patient's skin for petechiae.
Class: extracellular Use cautiously in ● Monitor I&O
Glucocorticoids accumulation of fluid patients with recent MI. GI: peptic ulceration, GI ● Check VS
Use cautiously inpatients irritation, increased ● Explain the purpose of administering the
sensitive to sulfites. appetite, drug
pancreatitis, nausea, ● If the patient refuses, assess why the
vomiting. patient does not want to take medicine.
Educate on what could happen if they
GU: menstrual refuse to take their medicine
irregularities, increased
urine glucose and DURING:
calcium levels ● Check IV site for swelling and redness.
● Ensure to observe and follow the 15
Metabolic: hypokalemia, rights of drug administration
hyperglycemia, ● Assess changes in consciousness and
carbohydrate intolerance, headache
hypercholesterolemia,
hypocalcemia, sodium AFTER:
retention, weight gain. ● Check for any hypersensitivity reaction.
● Instruct the patient to report any side
Musculoskeletal: growth effects immediately.
suppression in children, ● Advise the patient receiving long-term
muscle weakness, therapy to consider exercise or physical
 osteoporosis, tendon
rupture, myopathy.
Skin: hirsutism, delayed
wound healing, acne,
various skin eruptions,
atrophy at IM injection
site, thin fragile skin.
Other: cushingoid state,
susceptibility to
infections, acute adrenal
insufficiency after
increased stress or
abrupt withdrawal after
long-term therapy,
angioedema.
therapy. Tell the patient to ask the
prescriber about vitamin D or calcium
supplement.
● Instruct the patient receiving long-term
therapy to have periodic eye
examinations.
● Instruct the patient to avoid people with
contagious diseases.
● Document administration after giving the
ordered medication. Chart the time,
route, and any other specific information
as necessary

After abrupt withdrawal:

rebound inflammation,
fatigue, weakness,
arthralgia, fever,
dizziness, lethargy,
fainting, orthostatic
hypotension, dyspnea,
anorexia, hypoglycemia.
After prolonged use,
sudden withdrawal may
be fatal.

Drug Name: Praziquantel induces a General: Contraindicated in CNS: Dizziness, fainting, BEFORE:
Praziquantel rapid contraction of For the treatment of patients who have lightheadedness, ● Verify the doctor’s order.
(Biltricide) schistosomes by a infections due to all shown hypersensitivity to seizures, sleepiness or ● Check the patient’s identity. Ensure the
specific effect on the species of schistosoma. the drug unusual drowsiness. right medication and the given
Dose: 600 mg permeability of the cell appropriate dose at the right time.
membrane. The drug Specific: Contraindicated in CV: Fast, slow, or ● Check the expiration date of the
Route: PO further causes To treat the patient’s patients with renal irregular heartbeat medicine.
vacuolization and neuroschistosomiasis impairment ● The nurse on duty should be the one to
Therapeutic disintegration of the encephalitis caused by Respiratory: chest give the medication
class: schistosome S. Japonicum In patients receiving tightness, thickening of ● Educate the patient about the purpose of
Antihelminthic tegument.The worms rifampin who need bronchial secretions, administering the drug.
are then either immediate treatment for difficulty breathing ● Assess for hypersensitivity.
completely destroyed in schistosomiasis, ● Obtain VS for baseline data.
the intestine or passed alternative agents for EENT: Blurred or loss of ● If the patient refuses, assess why the
in the stool. schistosomiasis should vision, double vision, patient does not want to take medicine.
be considered. night blindness Educate on what could happen if they
refuse to take their medicine.
GI: upper right abdominal
pain, vomiting, stomach DURING:
pain, difficulty swallowing, ● Let patient swallow tablets whole, do not
nausea, bloody diarrhea, crush, break, dissolve or chew
mouth sores ● Observe adverse reactions.

GU: dark urine, painful or AFTER:

difficult urination
Musculoskeletal: joint
pain, stiffness, muscle
pains
Skin: blistering, peeling,
or loosening of skin
● Check for any hypersensitivity reaction.
● Instruct patient to report any side effects
immediately.
● Instruct patient not to drive or operate
any machinery in the day of the treatment
or the following day due to potential
drug-induced dizziness and drowsiness
● Inform physician if patient develops a
sustained headache or high fever
● Document administration after giving the
ordered medication. Chart the time,
route, and any other specific information
as necessary.

Reference: Lippincott, J.B. (2021). Nursing2021 Drug Handbook

DISCHARGE PLANNING:

MEDICATIONS ● Educate the importance of regularly taking prescribed

medications and the potential side effects of
noncompliance.
● Explain the medication name, action, and side effects in a
way that the patient could understand.
● Instruct to comply with the appropriate dosage, timing, and
route.

EXERCISE ● Instruct to avoid activities that require physical exertion such

as lifting or carrying heavy things to conserve energy.
● Encourage to ambulate as tolerated and stretching as a
form of exercise.

TREATMENT ● Not applicable to the patient.

HEALTH ● Imparted the importance of adequate hydration and body

intake of nutrients.
EDUCATION
● Advise to bring water to a rolling boil for 1 minute or filter
water before drinking it.
● Emphasize the need for adequate rest and sleep, and
lifestyle modifications such as avoiding alcohol and
smoking.
● Stress the significance of maintaining good personal
hygiene.

● Advise that water used for bathing should be brought to a

rolling boil for 1 minute to kill any parasites, and then
cooled before bathing to avoid scalding. Water held in a
storage tank for at least 1 – 2 days should be safe for
bathing.iene to promote a sense of well-being.
● Advise to use personal protective equipment to avoid
reinfection of S. Japonicum.
● Advised to maintain a peaceful, clean and well ventilated
environment.

● Instruct to attend the follow-up check-up as scheduled by

OUTPATIENT the physician.
DEPARTMENT
● Advised to avoid missing meals and it should be
DIET synchronized with time actions of the medication.

● Advise to pray and seek God’s guidance to express

SPIRITUALITY concerns and for recovery.

PROGNOSIS

In the case of the patient, there is a good prognosis. Long-term prognosis for
neuroschistosomiasis largely depends largely on early diagnosis and treatment. The
earlier it is diagnosed and treated, the better the prognosis. It is an underdiagnosed
disorder, but has been increasingly reported in populations in endemic areas and in
tourists. CNS involvement can occur at any time during schistosomal infection. There
are substantial differences in the pathogenesis, clinical presentation, and outcome of
the neurological disorder, depending on the phase and clinical form of schistosomiasis
in which it occurs.

RECOMMENDATIONS
● Follow the treatment plan or regimen the healthcare provider prescribes.
● Provide spiritual support.
● Do counseling.
● Follow up check-up as scheduled when discharged.

References
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Neuroschistosomiasis. Practical Neurology.

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