Case Presentation Format

Table of Contents

• Introduction
• Chief Complaint or Clinical Syndrome
• Patient’s Profile
• Nursing History ( Gordon’s Functional Pattern of Assessment)
• Physical Examination
• Diagnostic and Laboratory Examination
• Clinical Findings, Significant Signs and Symptoms
• Pathophysiology

• Problem List ( Prioritization of Problems )

• Nursing Diagnosis ( 3 actual and 2 potential )
o Related to Physiological Concern
o Related to Psychological Concern
• Nursing Care Plan
• Drug Study
• Discharge Planning (METHODS)
o Medicines
o Exercise/Activity
o Treatment
o Health Teaching
o Outpatient (follow-up)
o Diet
 o Spiritual Counselling
• References/Bibliography

Introduction:

At the beginning of these guidelines we suggested that we need to have a clear idea of what is
particularly interesting about the case we want to describe. The introduction is where we convey
this to the reader. It is useful to begin by placing the study in a historical or social context. If
similar cases have been reported previously, we describe them briefly. If there is something
especially challenging about the diagnosis or management of the condition that we are
describing, now is our chance to bring that out. Each time we refer to a previous study, we cite
the reference (usually at the end of the sentence). Our introduction doesn’t need to be more than
a few paragraphs long, and our objective is to have the reader understand clearly, but in a general
sense, why it is useful for them to be reading about this case.
Chief Complaint or Clinical Syndrome
A chief complaint is a concise statement in English or other natural language of the symptoms
that caused a patient to seek medical care. A triage nurse or registration clerk records a
patient's chief complaint at the very beginning of the medical care process. A Chief complaint is
the medical term used to describe the primary problem of the patient that led the patient to seek
medical attention and of which they are most concerned.

The chief complaint is obtained by the Physician in the initial part of the visit when the medical
history is being taken.
It is not the part of the history that deals with chronic medical problems or family history of
disease.It focuses the physicians attention on what the priority should be in the evaluation of the
patient. It helps to direct the additional history taking and it helps to lead to the appropriate
physical exam of the pertinent organ systems of the patient that are relevant to the problem.
Patient’s Profile
BRIEF description of the patient in terms of age, sex, race, height, weight, marital status,
occupation, social/cultural history, previous hospital admissions, chief complaint on current
admission, and all diagnoses with indication of primary diagnosis. This serves as to orient the
reader to the case study patient and provide overview of clinical issues pertaining to the patient.

PATIENT’S PROFILE

Patient’s Name: Patient X

Address: 065 Gatid, Santa Cruz (Capital) (26) Laguna

Gender: Female
Birthday: June 3, 1984
Age: 30 y/o
Birthplace: Manila
Nationality: Filipino

Civil Status: Single

Religion: Roman Catholic
Educational Attainment: High School Graduate
Occupation: Waitress when she was 18 y/o
Allergies: Seafood
LMP: 11/06/13
EDC: 08/13/14

AOG: 37 weeks and 5 days

OB Score: G3 P2 37 5/7 Weeks

ADMISSION

Admitting Time: 4:05 am

Admitting Date: 08/2/14

Admitting Clerk: Jane Mae H. Nolasco

Other Diagnosis: Still Birth
Abruptio Placenta
Pre- eclampsia Severe
Procedure: Cesarean

Admitting Physician: Dra. Marila T. Vilalon

Chief Complaint: Her reason why she was admitted on the hospital is because she suddenly saw
a moderate bleeding from her vagina and felt a severe pain on her low back and abdomen with
rapid contractions.

GENOGRAM

A genogram is graphical representation of a person's family relationship and medical history. It is

a unique type of family research diagram. It not only records family members and their
relationships to each other, but also many of their physical and physiological attributes by utilizing
an elaborate system of symbols.

Medical genograms enable practitioners to evaluate an individual's health risks. Knowledge of

pre-existing health conditions can help physicians accurately diagnosis and provide the
appropriate treatment of health problems. For the individual, having knowledge of diseases or
illnesses common to the family can give an individual a head start in taking preventive measures.
Documenting four generations may prove to be sufficient detail.
Nursing History ( Gordon’s Functional Pattern of Assessment )
Gordon’s Functional Health Patterns

1. Health-Perception and Health Management Pattern

• Perception of own health and well-being?
• How does he keep self healthy?
• Understand and aware of diagnosis and prognosis?
• Complies with treatment regimen? If not, reasons for not complying?
• Plans for faster recovery

2. Nutrional – Metabolic Pattern

• Appetite in general? Usual eating pattern? Likes? Dislikes? Dietary Restrictions?
• Effects of illness and hospitalization to appetite and nutritional intake?
• 24-hour diet recall
• Weight loss or gain?
• Uses vitamins or supplements, slimming aids?

3. Elimination Pattern
• Urination (frequency, urine characteristics, discomforts felt)
•Defecation(frequency, urine characteristics, discomforts felt)
• Effects of illness and hospitalization to urination and defecation patterns?
• Last urination and bowel movement
• Use of laxatives or diuretics
4. Activity-Exercise Pattern
• Ability to perform activities of daily living (ADLs)?
• Type of exercise? Frequency?
• Tires easily?
• Occasions of dizziness, shortness of breath? Triggers?
• Perceived benefit of exercise
• Use of energy-giving supplements
• General mobility since hospitalized?
• Effects of illness and hospitalization to general mobility and self-care?

5. Sleep-Rest Pattern
• Usual hours of sleep? Intermittent or continuous?
• Sleeping problems? Describe
• Use of coffee, tea, caffeinated beverages, and alcohol? Amount per day?
• Difficulty falling asleep?
• Wakes up during the night?
• Feels rested after sleeping?
• Snoring? Sleep walking? Sleep apnea?
• Use of sleeping aids or medications?
• Effects of illness and hospitalization to sleeping pattern?

6. Cognitive-Perceptual Pattern
• Sensory deficits?
• Memory lapses?
• Pain perception? (tolerance, threshold)
• Ability to understand instructions
• Learning patterns
• Use of pain medications
• Effects of illness and hospitalization to memory and perception?

7. Self- Perception and Self-Concept Pattern

• Description of personal characteristics?
• How does he see self as a person?
• Feeling about appearance?
• Effect of illness and hospitalization to self-concept?

8. Role-Relationship Pattern
• Roles and responsibilities in the family?
• Relationship with spouse/partner/significant others?
• Availability of support persons?
• Significant others?
• Effect of illness and hospitalization to role performance and relationships with significant
persons?

9.Sexuality – Reproductive Pattern

• Sexually-active? With men, women, or both?
• With one or more than one partner?
• Positive and negative aspects of sexual functioning?
• Difficulty with sexual desire? Arousal? Orgasm?
• Pain with sexual intercourse?
• Problems affecting sexual relationship with partner?
• Illness altered sexual functioning?
• Concern of partner about future sexual functioning?
• Other sexual concerns?
• Gravida? Parity?
• Use of family planning? Method? Reason?

10. Coping and Stress Tolerance Pattern

• Usual stressors
• Coping strategies? Effective?
• Feelings about illness? Coping?
• Stress with illness and hospitalization? Coping?

11. Value-Belief Pattern

• Important religious practice
• Illness interferes with religious practices?
• Perceived help of faith?
• Ways that could support spirit?
• Effect of illness and hospitalization to faith and beliefs?
Example:

1. Health Perception-Health Function

Before:
-poor health status

-vulnerable to common colds and fever.

-monthly check-ups
-NaHCO3 and Al(OH3) and vitamins (stress tabs)
-self-medication
During:
-very poor, and worse than before
- unable to move and perform ADLs.

2. Nutritional Metabolic Pattern

Before:
-eats 3 to 4 times a day
-usually eats rice, vegetables and fried fish.
-drinks 5-6 glasses of water a day at about 1200-1400cc.
- fond of eating salty foods and foods high in cholesterol.
During:
-restricted to eat foods high in sodium and cholesterol
-blenderized feeding via nasogastric tube with 1600 kcal in 2000cc volume and 60 grams protein
(50% MBV), low purine, high fiber at 170cc every 4 hours
-strict aspiration precaution.
3. Elimination Pattern
Before:
-voided about 5 to 6 times a day with an amount of approximately 500-800 ml/day.
-assess out stool once every other day.
During:
-In the first week of care, the patient had a urinary catheter and voided about 500-600 ml/day.
-In the second week, the patient was wearing a diaper
-voided about 400cc/shift.
4. Activity Exercise Pattern
Before:
-did not exercise
-worked as a stock keeper at a company.
-does washing of the clothes, plates and the rest of the household chores.
-During strenuous activities, the patient experienced fatigue as verbalized by the SO.
During:-unable to perform any exercises at all-needs assistance in performing activities of daily
living (ADLs) such as eating and moving.
5. Sleep-Rest Pattern
Before:
-slept for about 5 to 6 hours a day
-Sometimes patient does not feel rested well after sleeping -usually sleeps at around 10 PM and
wakes up at 4 AM.

During:
-intermittent sleep and been very lethargic
-usually opens her eyes and closes after a few minutes.

6. Cognitive-Perceptual Pattern
Before:
-did not have any sensory deficits.
-College level is her highest educational attainment
-did not use a hearing aid or eye glasses
-sensitive to superficial pain and is able to read and write.
During:
-difficulty communicating due to aphasia accompanied by weakness and presence of
endotracheal tube.

7. Self-Perception Pattern
Has a positive sense of self.

8. Role-Relationship Pattern
Before:
-Bisaya as a primary dialect
-knows how to speak in English and Tagalog
-lives with her husband and child.
During:
-unable to perform her role effectively as a wife because of her illness.
-very dependent on her SO and family

9. Sexuality-Reproductive Pattern
Not sexually active.

10. Coping-Areas Management Pattern

Before:
-when there was a stressful event, the patient took stress tabs
-diverting her attention to watching television.
During:
-stressful and debilitating
11. Value belief system
-Roman Catholic
-went to church regularly
 Nursing Head-to-toe Physical Assessment

Nursing assessment is an important step of the whole nursing process. Assessment can be called the
“base or foundation” of the nursing process. With a weak or incorrect assessment, nurses can create an
incorrect nursing diagnosis and plans therefore creating wrong interventions and evaluation.

PHYSICAL EXAMINATION

GENERAL APPEARANCE

Area Assessed Technique Actual Findings Normal Findings Analysis

Used
Body built Inspection Proportionate
Posture and gait Inspection Coordinated and
erect

Hygiene and Inspection Clean and neat

grooming

Body odor Inspection No body odor

Signs of distress Inspection No distress

Effect of mood Inspection Cooperative

Speech Inspection Coherent

VITAL SIGNS

Area Technique Actual Findings Normal Findings Analysis

Assessed Used
Temperatur Measured 36-37.5 degree
e using a Celsius
thermometer
Pulse rate Palpation 60-100 bpm
Respiratory Inspection 12-20 cpm .
rate
 Blood Measured 90/60 – 120/80
Pressure using a mmHg
sphygmomano
meter and
stethoscope

SKIN
Area Assessed Technique Actual Findings Normal Analysis
Used Findings
Color Inspection Light brown

Symmetry of Inspection Symmetrical

color
Skin lesions Inspection No lesions
Moisture Inspection Moist

Temperature Palpation Warm to touch

Skin Turgor Palpation Good skin

turgor

NAILS
Area Assessed Technique Actual Normal Analysis
Used Findings Findings
Nail curvature Inspection Convex
Texture Inspection and Firm
palpation
Nail bed color Inspection Pinkish

Surrounding Inspection Intact

tissue
Capillary refill Palpation Less than 2-3
sec
 HEAD
Area Assessed Technique Actual Findings Normal Analysis
Used Findings
Shape Inspection Normocephalic
with smooth
contour
Nodule/Masses Palpation Absence of
nodule/masses
Facial features Inspection Symmetrical
Facial Inspection Symmetrical
movements

EYES
Area Assessed Technique Actual Findings Normal Analysis
Used Findings
Pupils Inspection Black, pupils
equal, round,
reactive to light
accommodation
(PERRLA)
Peripheral Inspection Intact
vision

Extra ocular Inspection Coordinated

movement

Visual acuity Inspection Able to read

printed
handwriting
Eyebrows Inspection Evenly
distributed
Eyelids Inspection Intact skin,
bilateral blinking

Conjunctiva Inspection Pinkish

Cornea Inspection Clear
Sclera Inspection White
Lacrimal gland Palpation No tenderness
 Eye lashes Inspection Evenly
distributed
EARS

Area Assessed Technique Used Actual Findings Normal Findings Analysis

Pinna Inspection Uniform in color,
symmetrical
Ear canal Inspection Presence of
cerumen/earwax
Hearing acuity Inspection Responds when
called

NOSE
Area Assessed Technique Used Actual Findings Normal Analysis
Findings
External nose Inspection Absence of nasal
flaring
Nasal cavity Inspection Dark pink, dry,
free of exudates.
Sinus tenderness Palpation No tenderness
Nasal mucosa Inspection Intact and
midline

PHARYNX
Area Assessed Technique Used Actual Normal Analysis
Findings Findings
Uvula Inspection In midline
Oropharynx Inspection Pinkish
With the use of a Intact
tongue depressor

MOUTH
Area Assessed Technique Used Actual Findings Normal Analysis
Findings
Lips Inspection Moist, and pale,
lip pits are
normal
Teeth Inspection 32 pearly normal
teeth
 Gums Inspection Pink, moist, firm,
intact
Tongue Inspection Midline, pinkish,
movable
Palate Inspection Light pink, intact

NECK
Area Assessed Technique Used Actual Findings Normal Analysis
Findings
Muscles Palpation Symmetrical
Movement Inspection Coordinated
Range of motion Inspection Full
Muscle strength Inspection Equal
Lymph nodes Palpation Not palpable
Trachea Inspection In midline

CHEST AND LUNGS

Area Assessed Technique Used Actual Findings Normal Analysis
Findings
Breathing Inspection Regular
pattern
Symmetry Inspection Symmetrical
Spinal alignment Inspection and Aligned, in
palpation midline
Skin Inspection Smooth, no
tenderness and
lesions
Breath sounds Auscultation Clear

HEART
Area Assessed Technique Used Actual Findings Normal Analysis
Findings
Rhythm Auscultation Regular
Heart sounds Auscultation S1 louder at
apex, S2 louder
at base

ABDOMEN
Area Assessed Technique Used Actual Findings Normal Analysis
Findings
 Skin integrity Inspection Unblemished
Contour Inspection Flat/Rounded
Symmetry Inspection Symmetrical
Bowel sounds Auscultation With bowel
sounds. High
pitched, irregular
gurgles, 5-35
times/min in all
quadrants
Percussion Percussion Generalized
tympanic over
bowels
Palpation Palpation No tenderness

EXTREMETIES
Area Assessed Technique Actual Normal Analysis
Used Findings Findings
Color Inspection Equal
Edema Inspection Absent
Muscle Inspection Equal
strength
Bones Palpation No tenderness
Joints Palpation No tenderness
Range of Inspection Full
motion

PHYSICAL EXAMINATION
General Appearance

Body Built __Proportionate __thin __obese

Posture and Gait __Relaxed and erect __Coordinated __tensed __Slouched __Bent
__Uncoordinated

Hygiene and Grooming __Clean and neat __dirty __unkept

Body Odor __No odor __foul body odor __foul breath __ammonia odor
__acetone breath

Signs of distress __No distress __ tending over __grimacing __frowning __labored

breathing
Affect or Mood __Cooperative __negative __hostile __withdrawn

Speech __Understandable __rapid __slow __overly loud __lacks association

Vital Signs
Temperature __ C __axillary __oral __rectal __tympanic
Pulse rate __ bpm __ regular __irregular __strong bounding thread
Respiratory Rate __ cpm __regular __irregular __deep __shallow
Blood Pressure __ mmhg __sitting __ lying __standing

Skin
COLOR __Light __deep __brown __ruddy __pink __pallor __cyanosis
__jaundice __erythema __bronze
Symmetry of Color __Uniform __ uneven __hypopigmentation __hyperpigmentation
Edema __No edema __edema __grade 1 2 3 4 5
Skin Lesions __Smooth __Freckles __Birthmark __Flat nevi __ raised
nevi __ abrasions __warts __ vitiligo __tags __ telanglectasias _ ring
worm
Moisture __Moist __Dry __Excessive moisture __Excessively Dry
Temperature __Uniform __warm to touch __ localized hyperthermia __localized
hypothermia
Skin Turgor __Good Poor
Nail Curvature __Convex 160^ __Spoon nail __clubbing
Texture __Smooth __grooves __furrows __Beau’s Lines __discolored
__detached
Nailbed color __Pinkish __Bluish __Purplish __Pallor
Surrounding Tissue __Intact __Hangnails __ paronychia
Capillary Refill __Less than 4 seconds __delayed

Head
Distribution __Evenly distributed __alopecia
Thickness __Thick __thin
Texture and oiliness __Silky __resilient __ brittle __dry
Infestations __Infestation __ flaking __sores __lice __ nits __ringworm
Body hair __Hirsutism __sparse leg hair __absent leg hair
Size and shape __Normocephalic __asymmetrical __ increased skull size
__longer mandible
Contour __Smooth __nodules __masses __cysts __ deformities
Facial Features __Symmetrical __asymmetrical __Increased facial hair __thin
eyebrows
Edema/Hollowness __Periorbital __edema __Sunken Eyes
Facial Movements __Symmetrical __Asymmetrical __Drooping eyelid and mouth
__tica __tremors

Eyes
Eyebrows __Evenly distributed __ hair loss __scaling __flaking
Eyelashes __Equally distributed __curled outward __curled inward
Eyelids __Intact Skin __Close symmetrically __ectropion __entropion
__15-20 involuntary blinks __rapid blinking __bilateral blinking
__discharge __Discoloration __redness __swelling __flaking
__crusting __plaques __nodules __lesions
Conjunctiva __Transparent __pinkish __ shiny __smooth __pale __reddish
__nodules
Lacrimal Gland __Edema __tenderness __swelling
Cornea __Transparent __smooth opaque __arcus senilis __corneal
reflex
Pupils __Black __ equal in size __PERRLA __ mydriasis __miosis
__anisocoria
Peripheral Vision Intact tunnel vision one-half vision
Extra Ocular Movement Coordinated strabismus nystagmus
Visual Acuity Able to read newsprint difficulty

Ears
Pinna __Uniformed color with skin __cyanosis __pallor __ redness
__Symmetrical __aligned __ low-set ears __mobile __firm
__lesions __ flaking __ scaling __ tenderness
Ear Canal __Dry cerumen __wet cerumen __ impacted cerumen __grayish
tan __redness __scaling __discharge
Tympanic membrane __Pearly gray __Semi Transparent __Reddish __Yellowish
__White __Bluish
Hearing Acuity __
Intact __Sluggish

Nose
External Nose __Symmetric __Asymmetric __Uniform color __discharge
__flaring __tenderness __lesions
Nasal Cavity __Patent __Septum in midline __ lesions __masses __
polyps __septal deviation
Sinus tenderness __Tender specify:___________
 Pharynx
Uvula __In midline __deviation
Oropharynx __Pink __smooth __redness __edema __ lesions
Tonsils __Pink __ smooth __ inflammation __enlarged __grade 1 2 3
45
Gag reflex __Intact __absent

Mouth
Lips __Pinkish __soft __moist __smooth __symmetrical
__movable __cyanosis __ pallor __blisters __fissures
__crusts __scaling __cracked __ulcers __ nodules __cysts
__abrasions
Teeth __Complete __smooth __shiny white __missing __ill-fitting
dentures __dental carries
Gums __Pinkish __moist __firm __reddish __spongy __bleeding
__tenderness __retraction
Tongue __Midline __pinkish __ smooth __movable __deviated
__reddish __dry __furry __white-coating __ulcers
__nodules __tender __restricted mobility
Palate __Light pink __smooth __jaundice __ pallor __exostoses

Neck
Muscles __Equal in size __swelling __tilted to side
Movement __Coordinated __tremors __ spasm __stiffness
Range of Motion __Full __limited
Muscle strength __Equal __unequal
Lymph nodes __Not palpable __enlarged __ palpable __tenderness
Trachea __In midline __deviated
Thyroid gland __Not visible __enlarged __ nodules __bruit
Carotid pulse __Symmetrical pulse __strong __symmetrical __ decreased
__bruit
Jugular Veins __Not visible __distended

Chest and Lungs

Breathing pattern __Quiet __regular __effortless __cheyne-strokes __dyspnea
__orthopnea
Coastal angle __Less than 90^ __ widened
Shape and symmetry __APL ratio 1:1 __symmetrical __barrel chest __asymmetrical
Spinal alignment __Aligned __kyphosis __lordosis __lateral
Skin __Smooth __tenderness __masses __lumps __bulges
__hyperthermia __retractions
Respiratory Excursion __Full __symmetric __decreased __asymmetric
Fremitus __Bilateral __increased __ decreased __absent
Percussion sounds __Resonant __ dull __ flat
Breath sounds __Clear __Crackles __Gurgles __Wheeze __Friction Rub
__stridor __stertor
Breast size and shape __Rounded __ Unequal __Marked Asymmetry
Skin __Smooth __striae __discolorations __dimpling __swelling
__nodules __tenderness __masses
Areola __Round __Oval __pink __ brown __asymmetric __mass
__lesions
Nipples __Round __evened __Symmetrical __discharge __ inverted
__crusts __ cracks
Axillary lymph nodes __Tenderness __masses __nodules

Heart
Precordium __Pulsations __heave ___thrills
Heart Sounds __S1 louder at S2 at base __S2 louder at S1 at apex __S3 __S4
Murmur

Abdomen
Skin Integrity __Unblemished __Tensed __Glistening __Rashes __Purple
Striae
Contour __Flat __Rounded __Scaphoid __distended
Symmetry __Symmetrical __Protrusions __hernia __visible ristalsis
__marked aortic pulsations
Bowel Sounds __Normoactive __hypoactive (borborygmi) __hyperactive
absent
Other sounds __Bruit __friction rubs
Percussion Tympanitic dull
Palpation Tenderness relaxed guarded bladder distention

Genio-Urinary System
Pubic Hair __Kinky __ straight __thin __ inverse triangle distribution
__scant
Pubic Skin __Intact __ lesions lice erythema swelling excoriations
Labial folds Round Symmetric
Clitoris Not bigger than 1 cm width and 2 cm length lesions
inflammation
Vaginal orifice Inflammation swelling lesions discharge
Penile shaft and glans Lesion inflammation phimosis tenderness
Urethral meatus Hypospadia epispadia lesion inflammation tenderness
Scrotum Discolorations marked asymmetry nodules masses
bulges swelling
Lymph nodes __enlargement __tenderness
 Anus __intact __increased pigmentation __fissures __ulcers
__excoriations __hemorrhoids __abscess __tumors __fistula
__rectal prolapsed
Anal sphincter __good tone __hypertonicity __hypotonicity
Rectal wall __smooth __tenderness _nodules
Discharges __brownish __mucoidal __bloody __black tarry

Back and extremities

Muscle Size __Equal __Unequal __atrophy __hypertrophy _contractures
__foot drop __tremors
Muscle Tone __Firm _Atony __flaccid __spastic
Muscle Strength __Equal __Unequal __grade 1 2 3 4 5
Bones __Tenderness __Swelling __misalignment
Joints __Deformities __Swelling __tenderness __crepitus
Range of motion __full __limited

DIAGNOSTIC AND LABORATORY EXAMINATION

- The entire laboratory test.
- Always put the latest laboratory test in the beginning.
- Dates are important.
HEMATOLOGY SECTION
Specimen: Blood (Complete Blood Count) DATE: September 25, 2015
EXAMINATION RESULTS NORMAL ANALYSIS/INTERPRETATION
VALUE

Red Blood Cell 3.89 4.50 – 5.50 X Cancer and alteration of kidneys
10^12/L causes decrease production of
RBC.

Hematocrit 0.31 0.37 – 0.47 L Cancer and alteration of kidneys

causes decrease production of
RBC.

Hemoglobin 102 110 – 150 G/L Cancer and alteration of kidneys

causes decrease production of
RBC.

White Blood Cell 8.7 4.50 – 10.00 X Normal

10^9/L
 Segmenters 0.78 0.50 – 0.70 High levels of neutrophils usually
represent malignancy;
lymphoma.

Eosinophils 0.01 0.00 – 0.05 Normal

Lymphocytes 0.17 0.20 – 0.40 Cancer and chemotherapy

treatments leading to further
dropping of the lymphocyte
count.

Monocytes 0.04 0.00 – 0.07 Normal

Platelet Counts 362 150 – 400 X Normal

10^9/L

MCV: 81 (NV: 80-100 ft)

MCH: 26.4 (26-34 pg)
MCHC: 327 (320-360 g/L)
DATE: September 24, 2015
EXAMINATION RESULTS NORMAL ANALYSIS/INTERPRETATION
VALUE

Red Blood Cell 4.16 4.50 – 5.50 X Cancer and alteration of kidneys
10^12/L causes decrease production of
RBC.

Hematocrit 0.34 0.37 – 0.47 L Cancer and alteration of kidneys

causes decrease production of
RBC.

Hemoglobin 110 110 – 150 G/L Normal

White Blood Cell 16.7 4.50 – 10.00 X Hematologic disorders such as

10^9/L lymphoma that spread to bone
marrow and Chemotherapy can
cause an increase in WBC.

Segmenters 0.72 0.50 – 0.70 High levels of neutrophils usually

represent malignancy;
lymphoma.
 Eosinophils 0.01 0.00 – 0.05 Normal

Lymphocytes 0.23 0.20 – 0.40 Normal

Monocytes 0.04 0.00 – 0.07 Normal

Platelet Counts 494 150 – 400 X Cancer lymphoma is associated

10^9/L with increased platelet counts.
Notably, the presence of an
elevated platelet count is often an
indicator of poor long-term
prognosis among people with
cancer.

MCV: 81 (NV: 80-100 ft)

MCH: 26.4 (26-34 pg)
MCHC: 327 (320-360 g/L)

DATE: September 09, 2015

EXAMINATION RESULTS NORMAL ANALYSIS/INTERPRETATION
VALUE

Red Blood Cell 4.02 4.50 – 5.50 X Cancer and alteration of kidneys
10^12/L causes decrease production of
RBC.

Hematocrit 0.36 0.37 – 0.47 L Cancer and alteration of kidneys

causes decrease production of
RBC.

Hemoglobin 120 110 – 150 G/L Normal

White Blood Cell 7.2 4.50 – 10.00 X Normal

10^9/L

Segmenters 0.64 0.50 – 0.70 Normal

Eosinophils 0.07 0.00 – 0.05 Hematologic disorders such as

lymphoma and mediastinal mass
can cause an increase in
eosinophils.

Lymphocytes 0.21 0.20 – 0.40 Normal

 Monocytes 0.08 0.00 – 0.07 The use of some medications may
lead to a low monocyte count.
Chemotherapy drugs is the most
likely to have this side effect.

Platelet Counts 381 150 – 400 X Normal

10^9/L

MCV: 84 (NV: 80-100 ft)

MCH: 25.8 (26-34 pg)
MCHC: 333 (320-360 g/L)

DATE: September 07, 2015

EXAMINATION RESULTS NORMAL ANALYSIS/INTERPRETATION
VALUE

Red Blood Cell 3.83 4.50 – 5.50 X Cancer and alteration of kidneys
10^12/L causes decrease production of
RBC.

Hematocrit 0.31 (2X 0.37 – 0.47 L Cancer and alteration of kidneys

DONE) causes decrease production of
RBC.

Hemoglobin 100 110 – 150 G/L Cancer and alteration of kidneys

causes decrease production of
RBC.

White Blood Cell 4.9 4.50 – 10.00 X Normal

^9/L

Segmenters 0.66 0.50 – 0.70 Normal

Eosinophils 0.05 0.00 – 0.05 Normal

Lymphocytes 0.12 0.20 – 0.40 Cancer and chemotherapy

treatments leading to further
 dropping of the lymphocyte
count.

Monocytes 0.17 0.00 – 0.07 The use of some medications may

lead to a low monocyte count.
Chemotherapy drugs is the most
likely to have this side effect.

Platelet Counts 493 150 – 400 X Cancer lymphoma is associated

10^9/L with increased platelet counts.
Notably, the presence of an
elevated platelet count is often an
indicator of poor long-term
prognosis among people with
cancer.

MCV: 81 (NV: 80-100 ft)

MCH: 26.1 (26-34 pg)
MCHC: 321 (320-360 g/L)

Specimen: Body Fluids DATE: September 09, 2015

Remarks: LEFT
EXAMINATION RESULTS ANALYSIS/
INTERPRETATION

WBC (other fluids) Approx. 700mL of yellowish, turbid Pleural Fluid analysis
showed presence of
Pleural Fluid received for examination. RBC and WBC wherein
RBC: 480 CELLS/CUMM this indicates that there
is presence of bleeding
WBC: 320 CELLS/CUMM and infection in the
lungs

Defferential Count All lymphocytes seen Lymphocytes is

(fluids) produced in the body in
order to fight infection
from foreign bodies.
There are presence of
lymphocytes that
indicates infection in
 the respiratory system
of the client

Specimen: Body Fluids DATE: September 08, 2015

Remarks: RIGHT
EXAMINATION RESULTS ANALYSIS/
INTERPRETATION

WBC (other fluids) Approx. 400mL of reddish, turbid Pleural Fluid analysis
showed presence of
Pleural Fluid received for examination. RBC and WBC wherein
RBC: 1,120CELLS/CUMM this indicates that there
is presence of bleeding
WBC: 800 CELLS/CUMM and infection in the
lungs.

Defferential Count All lymphocytes seen Lymphocytes is

(fluids) produced in the body in
order to fight infection
from foreign bodies.
There are presence of
lymphocytes that
indicates infection in
the respiratory system
of the client.

XRAY SECTION RESULT DATE: September 09, 2015

Examination: Chest x-ray portable adult
FINDINGS
 Interval decrease in the degree of pleural effusion, bilaterally.
 Wedge shape opacity in the left parahilar region which may relate to segmental pneumonia
and/or atelectasis.
 CTT tip noted at the 533.th right posterior interspace.
 No other significant findings noted.
XRAY SECTION RESULT DATE: September 12, 2015
Examination: Chest x-ray portable adult
FINDINGS
 Marked resolution of pleural effusion, bilaterally.
 EDT tip seen at the level of T3.
 CTT tip noted at the 6th right posterior interspace.
 Rest of the findings are unchaged.
CLINICAL FINDINGS, SIGNIFICANT SIGNS AND SYMPTOMS
- Signs and symptoms present in the patient
Example:
PCAP-B
o Persistent Cough
o Fever
o Episodes of Vomiting

PATHOPHYSIOLOGY

- Step by step process how manner how the patient got the disease. It can be general or
specific.
- It is categorized: modifiable and non-modifiable.
- Modifiable – can be change. Example: Lifestyle and Environment
- Non-modifiable – cannot be change. Example: Age, Gender and Family Background.

Example:

PATHOPHYSIOLOGY

Modifiable:

Non-Modifiable:  Stress
 S/P Lymph node Biopsy:
 Age (23) Lymphoma Stage 4 (2015)
 Gender(F)  S/P Chemotherapy (2015)
 Family History (2nd cycle)
Paternal:
Carcinogenesis

Hodgkin Lymphoma Non-Hodgkin Lymphoma

(B-cells morphs to (malignant tumor

RS cells) formation)
Mediastinal Mass
 Lab. Chest X-ray & CT scan:
Right Anterior

Compression

Multi-System Alteration
 KIDNEYS: BRAIN: SKIN:
 Increased creatinine: CARDIOVASCULAR:
 Metastasis  Localized edema
178 umol/L  Cardiomegaly (upper extremities)
(CXR) (CXR)
 Proteinuria  Blisters (L foot)
 Hematuria

LUNGS:
METABOLIC:
 Bilateral
 Electrolyte
Pleural
Imbalance
Effusion
 DOB

PATHOPHYSIOLOGY

Non-modifiable Modifiable

 Age  Environment (having

 Weather relatives with cough
and colds)
 Lifestyle

Droplets: Airborne

Inhalation of droplets passes

through the pharynx, larynx, trachea

Microorganisms enters and affects

both the lungs

Immune system responds to Infection lodges and stimulates the

Prioritization of the Problem
 Objectives:

 Define prioritization and the concepts surrounding prioritization of patient care

 Compare and contrast ways to base the prioritization of patient care

 Utilize principles of prioritization to determine which patient needs to be seen first

 What is prioritization?

Prioritization is the organization of activities according to the order in which they should be
done.

( Marquis, B. L. & Huston, C. J., 2009)

Definition

Ways to base the prioritization

 Emergency first: ABCD

 Respond to trends vs. isolated findings

 Actual before potential

 Systemic before local

  Acute before chronic

 Maslow’s Hierarchy

 Time Management

 Infection control issues

Emergency First: A B C D

A: AIRWAY

 Assess for patent airway

 Establish airway, if indicated

 3-5 minute window for oxygenation

B: BREATHING

 Assess breathing and its effectiveness

 Intervene as appropriate

C: CIRCULATION

 Identify circulation concern

 Act as appropriate to reverse circulatory problem.

D: DISABILITY

 Assess for disability

 Act to slow down development of disability

Breathing – once we have established that the airway is open then we move on to the
breathing pattern. Is it effective? Is the pt apneic? How can we fix it? Do we need to
reposition? Do we need narcan to reverse the narcotics on board? Think of anything that
could be effecting that breathing pattern

Circulation – assess for the circulation issue. Is there an arrythmia? is the limb cool to touch?
If you have a client who needs help ambulating to the bathroom and a client who reports his
heart is running away with him, we would see the cardiac issue first.
 Disability is a wide variety of things it could be. Our main focus is to slow down the
development of disability. For example, A patient with a high blood pressure who is
beginning to have vision changes. We need to get the BP down so we do not have permanent
damage. We could have a stroke in progress.

Trends vs. Isolated Findings

 Vital signs

 Pain scale

 Level of consciousness

 Glasgow Coma Scale

 Recognizing the gradual change or deteriorization is key. One low blood pressure that has
resolved is not as important as a client whose blood pressure has continually risen over
the last 12 hours without coming down.

 Someone’s pain that is not being resolved with current treatments should be seen before
someone whose pain pill is effective each time it is given.

 A trend usually signifies something deeper or more serious is going on. Further
assessment needs to be performed, the healthcare provider probably needs to be informed
if they have not already. Further testing/diagnostics need to be ordered

Actual Problem vs. Potential Problem

Generally we treat an actual problem before a potential one. Yes there are always exceptions to
every rule, however, in general – the problem that is already here should be taken care of before
a problem that is not here and potentially may never get here. For example, 2 clients come in
with rule out GI bleed. Both have a low hemoglobin. One, however, is also vomiting blood due
to the active GI bleed. We are going to care for the one that has the vomiting blood before we
care for the one that is bleeding somewhere, but not serious enough to need an NG tube and large
bore IVs as the first client needs.

System vs. Local

“Life over Limb”

System over local falls under that old adage life over limb. We need to fix the systemic issue
over the localized issue. In emergency situations where the client has a broken arm and is not
breathing. We fix the breathing first. There is no need to fix the broken arm if the patient dies
due to lack of oxygenation. We treat shock over a laceration. Those type of situations.

Acute Problem vs. Chronic Problem

New injuries are always less predictable than an existing disease process. Existing disease
processes are usually known by the pt and the pt has developed some level of adaptation. A new
diagnosis such as confusion or chest pain needs to be cared for immediately. We need to assess
and get to the route of the new diagnosis and ensure something serious is not emerging.
Something chronic like diabetes, the pt often knows how to handle their hypo or hyperglycemia.
A person with blood sugars out of control that has never had an issue with blood sugars before
needs to be seen first to assess the etiology of the change.

Bottom line see new and unpredictable before something you have been seeing and need to
continue to work on.

Maslow’s Hierarchy

Physiological – food, sleep, oxygen, sex, excretion

Safety – shelter, removal from danger

Social – some call this love and belonging – love, affection, being part of a group

Esteem- self esteem, being well liked

Self actualization – achieving one’s individual potential

Time Management

 Immediately

 Within a specific time frame

 By the end of the shift

 Least amount of time to complete

 Immediately- whats needs to be done immediately. Is there someone calling for

antiemetic or analgesic? Is the OR waiting for the pt to get pre op order? Is a unit waiting
to give you report on a pt being transferred to you? What needs to be done before
anything else can be done for that patient? Do we need a consent before we send him to
the cath lab?

 Within a specific time frame – What needs to be done by 11:30? What needs to be done
before bkfst? When does the blood need to be infused by? When should the chemo be
finished so the next bottle is on time?

 By the end of the shift- what is a priority but not right now? The teaching just has to be
done before you leave your shift. The I&O needs to be done by the end of shift.

 Least amount of time- sometimes it is as simple as what can I get done quickly? I can
give this pain med in 2 minutes before I go in to perform a dressing change on a
bedridden patient that will take me 30 minutes or more.

 Still remember your other ways of looking at the same material. ABCD will take
precedence over time management. But if all of your patients are stable then sometimes
time management is the best way to go.

Infection Control Issues

See the most infectious patient last whenever possible.

Nursing Diagnosis
P-roblem
E-tiology
S-upporting data

Basic Three-Part Diagnostic Statement – composed of Problem + Etiology + Signs and

Symptoms
 Signs and
Problem Related To Etiology As Manifested Symptoms
by

Constipation related to prolonged as manifested by Hypoactive

laxative use bowel sounds

1. Constipation related to medication side effects as manifested by hard formed stools.

2. Impaired physical mobility related to pain in lower back as manifested by limited physical
activity.
3. Disturbed sleep pattern related to medication side effects as manifested by nocturia.
4. Potential for Enhanced visual sensory perception.
5. Possible feelings of hopelessness related to unknown deteriorating physiologic condition.
6. Social isolation related to absence of peers as manifested by loneliness.
7. Disturbed body image related to changes in physical appearance (aging) as manifested by poor
eye contact.
8. Risk for Ineffective coping related to an inadequate support system.
9. Readiness for Enhanced spiritual well-being.

NURSING CARE PLAN

The purpose of a nursing care plan is to identify problems of a client and find solutions to the
problems. This is done in five steps: assessment, diagnosis, planning, intervention, and
evaluation. All five of these steps must be complete in order to have a true care plan.

2. Choose a priority nursing diagnosis approved by the North American Nursing Diagnosis
Association (NANDA). Do not choose a potential nursing diagnosis. The diagnosis column will
include some assessment data. Ask yourself, "why did I choose this particular diagnosis?" The
answer should lie in the assessment data. Your diagnosis should read: nursing diagnosis…
related to... as evidenced by.... The "as evidenced by" (AEB) should include your assessment
data of how you decided on that particular diagnosis. The "related to" is the etiology or cause of
the NANDA (and may be secondary to part of the medical diagnosis). The nursing diagnosis
needs to be in Problem-Etiology-Supportive Data (PES) format.
3. The planning column is really a goal column. Here is where you put what you would like to
see from the client by the end of your shift, clinical week or whatever your timeframe is. Goals
address the NANDA. Goals should read “Client will…(turn around NANDA)… (time and
measureable factors) AEB (outcome). The most important thing about your goals is that you
must make them MEASURABLE. Use numbers where possible. Stay away from words like "a
decrease in, an increase in, to look somewhat better, normal, etc." Your evaluation should
include exactly what the changes were. They should also be verifiable by someone else, so the
nurses that read your nursing care plan know exactly what has been achieved in the plan of care.
For example, if your client is in pain and rates his pain as an 8 on a scale of 1-10 and you want
him, by the end of the day, to rate it as a 3. Or, client will walk around nurses’ station 3 times by
the end of the shift. How many times? Three! This is a very measurable goal that another person
could verify. Remember, measurable, measurable, measurable!

4. Your interventions must be appropriate to help solve the etiology (cause of the NANDA).
Your book has many sample nursing care plans. Take a look through them to get some ideas
about nursing interventions. Remember the nursing care plan must be individualized to your
client and what is written in the book may not apply to your client. Some interventions that you
use will be tried and true ones that nurses have been using forever. Others may be from your own
imagination. As long as they will help your client to achieve his or her goals, they are worth
doing! Think about looking at old photographs of family with your clients to help them to take
their minds off of what is happening to them. Maybe you could watch TV with your client and
just spend some time with them. Be creative!

5. You'll need to include scientific rationale for each and every intervention. Rationales answer
how and why you are doing the intervention with science and research. You can usually find
these in your Harkreader and occasionally in your Lewis book. The question here is, "why are
we using this particular intervention?" Be sure to number and line up your interventions to
match your scientific rationale when you are writing them, so the nursing care plan is easy to
understand.

6. The evaluation column will not be filled out until after you have completed your
interventions. The question here is, "was my goal accomplished? Why or why not?" You may
not always achieve your goals. That's OK. If you didn't, why not? Was the goal unrealistic for
this client? Was the client out of the room most of the day? Did he just refuse your interventions?
The lesson here is to learn what works best with different types of clients so that you can better
take care of the next client down the line with the same problems. You are building something
like a "database" in your head regarding nursing care. Sometimes, the same interventions won't
work on the same kinds of clients. Again, this is a learning experience for you.
 7. One important thing to do in the mornings (or afternoons) when you are first talking to your
client is to let them know what the plan of care for the day is going to be. This will be a very
abbreviated version of your care plan. Let them know what you want to see them accomplish for
the day and how together you can accomplish it. Remember that even the best care plan is
useless unless the client also believes in the same goals.

DRUG STUDY

DRUG ACTION DRUG INTERACTION ADVERS NURSING

E INTERVENTIONN
EFFECT
Generic Name: Second- Indication: Body as a Determine history
Ceforoxime generationcephalospori Pharyngitis, Whole: of hypersensitivityreac
n that inhibits cell-wall tonsillitis,infections of Th tions
Brand Name: synthesis, the urinary andlower ,burning, tocephalosphorins,peni
ZOLTAX promotingosmotic respiratory tracts, cellulitis( cillins and historyof
instability; andskin and skin- IMsite);su allergiesparticularly to
Classification: usuallybactericidal. structureinfections perinfectio drugsbefore therapy
ANTIBIOTIC caused byStreptococcus ns,positive isinitiated.
pneumoniaeand S. Coombs'te
Frequency: pyogenes,Haemophillus st. Report onselt of
BID influenzae,Staphylococc GI: loosestools
us aureus,Escherichia
Dosage: coil. antibiotic- Absorption
1 tab 500 mg associated of cefuroxime
Contraindicated: colitis. isenhanced by
Route: * Contraindicated in Sk
in: food.
PO patientshypersensitive to Rash,
drug.* Use cautiously in pruritus, Notify prescriberabout
patientshypersensitive to urticaria. rashes orsuperinfectio
penicillinbecause of Urogenital:
possibility of cross-
 sensitivity with other Increased
beta-lactam antibiotics.* serum
Use with caution cretonneand
in breast-feeding women BUN,decreased
and inpatients with creatinineclearan
history of colitisor renal c
sufficiency.

DISCHARGE PLANNING

Discharge planning helps to make sure that you leave the hospital safely and smoothly and get
the right care after that. You, the person who is caring for you, and your discharge planner work
together to address your concerns in a discharge plan.

DISCHARGE PLANNING

DICHARGE GOALS

Dealing with current situation realistically.

Complications prevented/minimized.

General function regained or compensated.

Nursing procedure and therapeutic regimen understood.

Plan in place to meet the needs for discharge.

MEDICATIONS:
Name of Drug Dosage,Route and Side effects
Frequency
Celestamine 2.5 ml, TID, PO Headache,Diarrhea
 Cefuroxime 5ml, BID, PO Diarrhea, Vomiting

EXERCISE / ACTIVITY
Type of Activity allowed / to be continued:
Deep Breathing Exercises
Steps:1.) Sit up straight as you prepare to do these exercises. Keep your backbone fully
upright with your shoulders pulled back as you get into position.
2.) Inhale slowly and deeply. Slowly fill your lungs with air. Think about how pure, fresh and
cleansing this “new” air is for your body.
3.) Focus on how your lungs feel as they fill with air. Notice how they expand. Pay attention
to how your diaphragm moves to make room for more air in your lungs.
4.) Exhale slowly. Release the air from your lungs until they are completely empty. Feel your
lungs contracting as your expel all of the “old” air from your body.

Use of Equipment (if any): No Equipments necessary Restrictions: Strenuous Activites

TREATMENT

Comply with medications

Increase Fluid Intake

Utilize Deep Breathing Exercise for at least twice a day

HEALTH TEACHING

Provide client’s relative written and verbal information regarding the following:

Seek medical advice if complication occurs.

Indicate adequate bed rest

Compliance to follow-up checkups.

Providing support. The patient and family needs assistance, explanation and support every time

the patient requires treatment.

OUT PATIENT
Regular check-ups with her physician to ensure that any changes in patient’s health are

monitored and evaluated.

Patient is advised to strictly follow treatment regimen.

DIET

Inform client’s relative for the client not to skip meals .

Continue present diet as prescribed.

SPIRITUAL

Encourage both client and relative to build strong faith and intimacy with God through prayers.

Encourage family, relatives and friends to pray and remain on the client’s side.

Writing a Bibliography: APA Format

Basics

Your list of works cited should begin at the end of the paper on a new page with the centered
title, References. Alphabetize the entries in your list by the author's last name, using the letter-
by-letter system (ignore spaces and other punctuation.) Only the initials of the first and middle
names are given. If the author's name is unknown, alphabetize by the title, ignoring any A, An,
or The.

For dates, spell out the names of months in the text of your paper, but abbreviate them in the list
of works cited, except for May, June, and July. Use either the day-month-year style (22 July
1999) or the month-day-year style (July 22, 1999) and be consistent. With the month-day-year
style, be sure to add a comma after the year unless another punctuation mark goes there.

Underlining or Italics?

When reports were written on typewriters, the names of publications were underlined because
most typewriters had no way to print italics. If you write a bibliography by hand, you should still
underline the names of publications. But, if you use a computer, then publication names should
be in italics as they are below. Always check with your instructor regarding their preference of
using italics or underlining. Our examples use italics.

Hanging Indentation

All APA citations should use hanging indents, that is, the first line of an entry should be flush
left, and the second and subsequent lines should be indented 1/2".

Capitalization, Abbreviation, and Punctuation

The APA guidelines specify using sentence-style capitalization for the titles of books or articles,
so you should capitalize only the first word of a title and subtitle. The exceptions to this rule
would be periodical titles and proper names in a title which should still be capitalized. The
periodical title is run in title case, and is followed by the volume number which, with the title, is
also italicized.

If there is more than one author, use an ampersand (&) before the name of the last author. If
there are more than six authors, list only the first one and use et al. for the rest.

Place the date of publication in parentheses immediately after the name of the author. Place a
period after the closing parenthesis. Do not italicize, underline, or put quotes around the titles of
shorter works within longer works.

Format Examples
 Books
Format:
Author's last name, first initial. (Publication date). Book title. Additional information. City of
publication: Publishing company.

Examples:

Allen, T. (1974). Vanishing wildlife of North America. Washington, D.C.: National Geographic
Society.

Boorstin, D. (1992). The creators: A history of the heroes of the imagination. New York:
Random House.

Nicol, A. M., & Pexman, P. M. (1999). Presenting your findings: A practical guide for creating
tables. Washington, DC: American Psychological Association.

Searles, B., & Last, M. (1979). A reader's guide to science fiction. New York: Facts on File, Inc.

Toomer, J. (1988). Cane. Ed. Darwin T. Turner. New York: Norton.

  Encyclopedia & Dictionary
Format:
Author's last name, first initial. (Date). Title of Article. Title of Encyclopedia (Volume, pages).
City of publication: Publishing company.

Examples:

Bergmann, P. G. (1993). Relativity. In The new encyclopedia britannica (Vol. 26, pp. 501-508).
Chicago: Encyclopedia Britannica.

Merriam-Webster's collegiate dictionary (10th ed.). (1993). Springfield, MA: Merriam-Webster.

Pettingill, O. S., Jr. (1980). Falcon and Falconry. World book encyclopedia. (pp. 150-155).
Chicago: World Book.

Tobias, R. (1991). Thurber, James. Encyclopedia americana. (p. 600). New York: Scholastic
Library Publishing.

 Magazine & Newspaper Articles

Format:
Author's last name, first initial. (Publication date). Article title. Periodical title, volume
number(issue number if available), inclusive pages.

Note: Do not enclose the title in quotation marks. Put a period after the title. If a periodical
includes a volume number, italicize it and then give the page range (in regular type) without
"pp." If the periodical does not use volume numbers, as in newspapers, use p. or pp. for page
numbers.
Note: Unlike other periodicals, p. or pp. precedes page numbers for a newspaper reference in
APA style.

Examples:

Harlow, H. F. (1983). Fundamentals for preparing psychology journal articles. Journal of

Comparative and Physiological Psychology, 55, 893-896.

Henry, W. A., III. (1990, April 9). Making the grade in today's schools. Time, 135, 28-31.

Kalette, D. (1986, July 21). California town counts town to big quake. USA Today, 9, p. A1.

Kanfer, S. (1986, July 21). Heard any good books lately? Time, 113, 71-72.

Trillin, C. (1993, February 15). Culture shopping. New Yorker, pp. 48-51.
  Website or Webpage
Format:
Online periodical:
Author's name. (Date of publication). Title of article. Title of Periodical, volume number,
Retrieved month day, year, from full URL

 Online document:
Author's name. (Date of publication). Title of work. Retrieved month day, year, from full
URL

Note: When citing Internet sources, refer to the specific website document. If a document
is undated, use "n.d." (for no date) immediately after the document title. Break a lengthy
URL that goes to another line after a slash or before a period. Continually check your
references to online documents. There is no period following a URL.
Note: If you cannot find some of this information, cite what is available.

Examples: Devitt, T. (2001, August 2). Lightning injures four at music festival. The Why? Files.
Retrieved January 23, 2002, from http://whyfiles.org/137lightning/index.html

Dove, R. (1998). Lady freedom among us. The Electronic Text Center. Retrieved June 19, 1998,
from Alderman Library, University of Virginia website:
http://etext.lib.virginia.edu/subjects/afam.html

Note: If a document is contained within a large and complex website (such as that for a
university or a government agency), identify the host organization and the relevant program or
department before giving the URL for the document itself. Precede the URL with a colon.
Hilts, P. J. (1999, February 16). In forecasting their emotions, most people flunk out. New York
Times. Retrieved November 21, 2000, from http://www.nytimes.com