IDENTIFICATION DATA OF THE CLIENT

Name: Riya Pankajkumar Shah

Age: 14 years

Sex: Female

Ward: trauma ICU

Cot no: 27

Doctor’s unit: SJP

Admission date: 19 feb 2024

Education: not educated

Occupation: -

Income: 5,000

Address: 4/5 kamiya apartment ambawadi, ahmedabad

Nationality: Indian

Marital status: unmarried

Diagnosis: GUILLAIN BARRE SYNDROME

Chief Complaints:

- Fever - since 2-3 days

- Weakness
- Safocation
- Diarrhoea – since 2-3 days
- Rashes and itching
- Retained secretion poor gag reflex
- Lower limb weakness
Present History :

• No any history of hypertension, diabetes, thyroid, TB, COPD and Jaundice

Past History:
Medical History:

• She had no history of TB, hypertension, diabetes mellitus, other medical complains or
surgical history in past.
• She had no history of any surgery in her life.

Personal History:

• No bad habit

Family History:

Name Age Sex Relationship Education Occupation Income Remark

with patient

Pankajkumar 43 male father 12th worker 5000

Komalben 40 female Mother 10th House wife

-

Nandini 15 female Sister 10th Study

-
Family Geonogram :

Pankajkumar Komalben

Nandini
Riyaben

Key term :
Male

Female

Patient

Socioeconomic history:
Patient is belong from lower middle class family, Her father`s annual income is 60,000/- Rs
that is not sufficient to full fill daily requirements of family member.
 PHYSICAL EXAMINATION

Vital Sign :

Vital signs Patient value Normal value

Temperature 100˚ F 98.6˚ F

Pulse 90 bpm 60-80 bpm

Respiration 28 breath per min 16-20 breath per
min
Blood pressure 110/70 mmhg 120/80 mmhg

General Observation:

• Sensorium : conscious
• Body odour : adequate
• Foul breath : absent
• Posture : normal
• Hair : brown

General Apperance:

• Body image : weak

• Health : unhealthy
• Activity : dull

Mental Status:

• Consciousness : conscious
• Language : gujarati
• Look : weak
• Orientation : disoriented
Posture:

• Body curves : no lordosis or kyphosis present

• Movement : weak movement

Height: 110 cm

Weight: 18 kg

Skin Condition:

• Color : brown
• Texture : moist
• Temperature : warm
• Lesions : absent

Head & Face:

• Scalp : clean
• Face : dull

Eyes:

• Eyebrow : present
• Eye lashes : presentt
• Eye lids : no infection
• Eye balls : adequate
• Conjunctiva : pale
• Sclera : dark black
• Pupils : semidilated
• Vision : inadequate

Ear:

• External ear : no discharge

• Hearing : normal
• Tympanic membrane: intact
Nose & sinuses:

• Nostrils : clean
• Nasal cavities : no mucous collected

Mouth & Pharynx:

• Lips : pink
• Odour of the mouth: adequte
• Teeth : adult tooth present
• Mucus membrane : no infection
• Tongue : white coated

Neck:

• Lymph node : palpable

• Thyroid gland : adequate
• Range of motion : adequate

Chest:

• Thorax : bilateral air entry

• Breath sound : whezing

Heart:

• Sound : normal S1 S2 sound heard

Abdomen:

• Observation : no scar present

• Auscultation : bowel sound present
• Palpation : soft
• Percussion : no fluid collection
Extremities:

• Lower extremities : movable

• Upper extremities : movable

Genital and Rectum:

• Observation : adequate
 INVESTIGATION DONE IN THE PATIENT

SR. NAME OF THE NORMAL VALUE PATIENTS

NO. INVESTIGATION VALUE

1. HB 8.7 gm% 12-14 gm%

2. WBC 12.55×10^3/cmm 4- 10×10^3/ cmm

3. Differential Count

❖ Polymophs 75% 40-80%

❖ Lymphocytes 16% 20-40%

❖ Eeosinophil 02% 1-6%

❖ Monocytes 07% 2-10%

00% 0-1%
❖ Basophil
Blood Urea 14 mg / dl 13-40 mg / dl

4.

5. Sr. Creatinine 0.3 mg / dl 0.08-1.4 mg / dl

6. Sr. Na+ 136 m Eq/L 135-149 m Eq/L

7. Sr. K+ 03m Eq/L 3.5 – 5.5 m Eq/L

8. Sr. Bil. Total : 0.25mg% 0.0-0.75 mg%

9. SGPT 14 0-40 U/L

10. RBS 106 mg/dl 70-120 mg/dl

11. HIV Test Non reactive Non reactive

12. HbsAg Non reactive Non reactive

Special Investigation:
CSF Examination : no any infections found

Medical treatment:
Name of Drug Dose Route Action
Inj Tazobactum And 4.5 in 100 ml NS IV infusion Antibiotic
Piperacilin
Inj Pantoprazole 40 mg IV Antacid
500mg IV Antispasmodic
Inj Metronidazole

Inj Ondacetrone 8mg IV Antiemetic

Tab. Metoclopramide 5 mg TDS NG Tube Antiemetic

12 hrly Nebulization Anti-Asthmatic
Neb Budecort
ANATOMY AND PHYSIOLOGY

➢ THE NERVOUS SYSTEM:-

• The Nervous System is the master controlling and communicating system of the
[Link] Nervous System CONTROLS and COORDINATES ALL ESSENTIAL
FUNCTIONS of the Human Body

FUNCTION:-

SENSORY FUNCTION: Nervous system uses its millions of sensory receptors

to monitor changes occurring both inside and outside of the body. Those
changes are called STIMULI, and the gathered information is called Sensory
Input.

INTEGRATIVE FUNCTION: The Nervous System process and interprets the

sensory input ad makes decisions about what should be done at each moment
a process called Integration.

MOTOR FUNCTION: The Nervous System then sends information to muscles,

glands, and organs (effectors) so they can respond correctly, such as muscular
contraction or glandular secretions.
CLASSIFICATION:-

➢ THE NEURON

• Each neuron (consists of a cell body and its processes, one axon and many dendrites.
Neurones are commonly
• Referred to as nerve cells. Bundles of axons bound together are called nerves.
• Neurons cannot divide, and for survival they need a continuous supply of oxygen and
glucose. Unlike many other cells, neurones can synthesis chemical energy (ATP) only
from glucose.
• Neurons generate and transmit electrical impulses called action potentials.
• The initial strength of the impulse is maintained throughout the length of the neurone.
Some neurones initiate nerve impulses while others act as ‘relay stations’ where
impulses are passed on and sometimes redirected. Nerve impulses can be initiated in
response to
• stimuli from:
• Outside the body, e.g. touch, light waves
• Inside the body, e.g. a change in the concentration of carbon dioxide in the blood alters
respiration; a thought may result in voluntary movement.
➢ Cell bodies

• Nerve cells vary considerably in size and shape but they are all too small to be seen
by the naked eye. Cell bodies form the grey matter of the nervous system and are
found at the periphery of the brain and in the centre of the spinal cord. Groups of cell
bodies are called nuclei in the central nervous system and ganglia in the peripheral
nervous system. An important exception is the basal ganglia (nuclei) situated within
the cerebrum
➢ Axons and dendrites
• Axons and dendrites are extensions of cell bodies and form the white matter of the
nervous system. Axons are found deep in the brain and in groups, called tracts, at the
periphery of the spinal cord. They are referred to as nerves or nerve fibres outside the
brain and spinal cord.
➢ Axons
• Each nerve cell has only one axon, which begins at a tapered area of the cell body, the
axon hillock. They carry impulses away from the cell body and are usually longer
than the dendrites, sometimes as long as 100 cm. Structure of an axon.
• The membrane of the axon is called the axolemma and it encloses the cytoplasmic
extension of the cell body.
• MYELINATED NEURONES Large axons and those of peripheral nerves are
surrounded by a myelin sheath. This consists of a series of Schwann cells arranged
along the length of the axon.
• Each one is wrapped around the axon so that it is covered by a number of concentric
layers of Schwann cell plasma membrane. Between the layers of plasma membrane is
a small amount of fatty substance called myelin.
• The outermost layer of the Schwann cell plasma membrane is the neurilemma. There
are tiny areas of exposed axolemma between adjacent Schwann cells, called nodes of
Ranvier which assist the rapid transmission of nerve impulses in myelinated neurones.
• UNMYELINATED NEURONES Postganglionic fibres and some small fibres in the
central nervous system are unmyelinated. In this type a number of axons are
embedded in one Schwann cell. The adjacent
• Schwann cells are in close association and there is no exposed axolemma.
• The speed of transmission of nerve impulses is significantly slower in unmyelinated
fibres.
GUILLAIN BARRE SYNDROME

DEFINITION

• Guillain Barre Syndrome (GBS) is a serious disorder that occurs when the body’s
defense (immune) system mistakenly attacks part of the nervous system. This leads to
nerve inflammation that causes muscle weakness.

• SUBTYPE OF GBS
• 6 different subtypes of GBS and they are
1. Acute Inflammatory demyelinating polyneuropathy
2. Miller Fisher syndrome
3. Acute motor axonal neuropathy
4. Acute motor sensory axonal neuropathy
5. Acute pan autonomic neuropathy
6. Bickerstaff’s brainstem encephalitis
ETIOLIGY

SR NO ETIOLOGY IN BOOK ETIOLOGY IN PATIENT FOUND

PICTURE

1)
Idiopathic

2) Infectious agent like 9( bacteria

Viruse)

3) Autoimmune disorders

4) Gastroenteritis – (campylobacter
jejuni)

5) Influenza viruse

6)
Age 15 to 35 and 60 to 75

7) Resent surgery
PATHOPHYSIOLOGY

➢ Not exactly known however is believed to have a multifactorial cause that is an auto-
immune disease which occurs 3-4 weeks after an onset of gastrointestinal or
respiratory viral infection (campylobacter jejuni, influenza virus, CMV). Sometimes
also seen in after vaccination (1977 swine flu pandemic).
➢ GBS onset is rapid, it can be from a few days to 4 [Link] molecular mimicry
the immune system attacks gangliosides.(GM1) Ganglioside-like epitopes exist in the
bacterial wall of C. jejuni.
➢ This leads to inflammation and demyelination of the peripheral nerves there isn’t any
damage to the brain or spinal cord. (80% is myelin loss, 20% axon loss).

CLINICAL MENIFESTATION

SR. CLINICAL MENIFESTION IN CLINICAL MENIFESTATION IN

NO. BOOK PATIENT

1. Loss of reflexes in arms and legs

2. Low blood pressure

3. Uncoordinated movement

4. Facial weakness

5. Clumsiness and falling

6. Severe pain in the lower back

7. Sensation changes

8. Tenderness or muscle pain

9. Blurred vision

10. Respiratory problems

DIAGNOSTIC FINDINGS

• Cerebrospinal fluid investigation: It will elevated at some stage of the illness but
remains normal during the first 10 days. There may be lymphocytosis (> 50000000
cells/L).
• Electrophysiological studies: it includes nerve conduction studies and
electromyography. They are normal in the early stages but show typical changes after
a week or so with conduction block and multifocal motor slowing, sometimes most
evident proximally as delayed F-waves.
The only way to classify a patient as having the axonal or non-axonal type is electro
diagnostically.
• Further investigative procedures can be undertaken to identify an underlying cause
For example:
• Chest X-ray , stool culture and appropriate immunological tests to rule out the
presence of cytomegalovirus or mycoplasma
• Antibodies to the ganglioside GQ1b for Miller Fisher Variant.
• MRI
• Lumbar Puncture: Most, but not all, patients with GBS have an elevated CSF protein
level (>400 mg/L), with normal CSF cell counts. Elevated or rising protein levels on
serial lumbar punctures and 10 or fewer mononuclear cells/mm3 strongly support the
diagnosis.
MANAGEMENT
There is no known cure for Guillain-Barré syndrome. However, there are therapies that
lessen the severity of the illness and accelerate the recovery in most patients. There are
also a number of ways to treat the complications of the disease.

MEDICAL MANAGEMENT

The mainstay of medical management of patients with GBS is

Plasmapheresis

• In plasmapheresis, blood is removed from the body, the red and white blood cells
are separated from the plasma and only the blood cells are returned to the patient.
It is thought that removing the plasma eliminates some of the immune factors that
are responsible for the disease progression.

• Plasmapheresis helps in following ways:

• Reducing the length of the illness

• Shortened time on mechanical ventilation
• Early ambulation

Intravenous immunoglobulins ( I.V.I.G)

• Immunoglobulins are given intravenously which shows a positive impact on the

speed of recovery. But it has been shown to be less effective than plasmapheresis.

Further Medical Management Can Be Done According to the Symptoms and the
Complications

• Supportive Care
• ICU monitoring
• Basic medical management often determines mortality and morbidity.

• Ventilatory Support
• Atelectasis leads to hypoxia.
• Hypercarbia later finding; arterial blood gases may be misleading.
 • Vidal capacity, tidal volume and negative inspiratory force are best indicators of
diaphragmatic function.
• Progressive decline of these functions indicates an impending need or ventilatory
assistance. Mechanical ventilation usually required if VC drops below about 14
ml/kg; ultimate risk depending on age, the presence of accompanying lung
disease, aspiration risk, and assessment of respiratory muscle fatigue.
• Atelectasis treated initially by incentive spirometry, frequent suctioning, and
chest physiotherapy to mobilize secretions.
• Intubation may be necessary for patients with substantial oro-pharyngeal
dysfunction to prevent aspiration.
• Tracheostomy may be needed in patients intubated for 2 weeks who do not show
improvement.

• Autonomic Dysfunction
• Autonomic dysfunction may be self-limited; do not over-treat.
• Sustained hypertension managed by angiotensin-converting enzyme inhibitor or
beta-blocking agent. Use short-acting intravenous medication for labile
hypertension requiring immediate therapy.
• Postural hypotension treated with fluid bolus or positioning.
• Urinary difficulties may require intermittent catheterization.

• Nosocomial Infections Usually Involve Pulmonary and Urinary Tracts.

• Occasionally central venous catheters become infected.
• Antibiotic therapy should be reserved for those patients showing clinical
infection rather than colonization of fluid or sputum specimens.

• Venous Thrombosis Due to Immobilization Poses a Great Risk of Thromboembolism

• Prophylactic use of subcutaneous heparin and compression stockings.

Physiotherapy Management

Aims of physiotherapy management are:

1. Regain the patient's independence with everyday tasks.

2. Retrain the normal movement patterns.
3. Improve patients posture.
4. Improve the balance and coordination
5. Maintain clear airways
6. Prevent lung infection
7. Support joint in functional position to minimize damage or deformity
8. Prevention of pressure sores
9. Maintain peripheral circulation
10. Provide psychological support for the patient and relatives.
Respiratory Care

The common respiratory complications in the rehabilitation setting include incomplete

respiratory recovery including chronic obstructive pulmonary disease, restrictive
respiratory disease (pulmonary scarring, pneumonia), and tracheitis from chronic
intubation and respiratory muscle insufficiency. Sleep hypercapnia and hypoxia, which
worsens during sleep can be the result of a restrictive pulmonary function.[18][19]

Treatment methods are:

• Night time saturation records with pulse oximeter and bilevel positive airway
pressure (BiPAP) may be indicated for the patients.
• Physical therapy measures (chest percussion, breathing exercises, resistive
inspiratory training) may be required to clear respiratory secretions to reduce the
work of breathing.
• Special weaning protocol to prevent over fatigue of respiratory muscles can be
recommended for more severe patients with tracheostomy. Patients with cranial
nerve involvement need extra monitoring as they are more prone to respiratory
dysfunction.
• Patients should be encouraged to cease smoking.
• Posturally drain areas of lung tissues, 2-hourly turning into supine or side lying
positions.
• 2-4 litre anesthetic bag can be used to enhance chest expansion. Therefore, 2 people
are necessary for this technique, one to squeeze the bag and another to apply chest
manipulation.
• Rib springing to stimulate cough.
• After the removal of a ventilator and adequate expansion, effective coughing must be
taught to the patient.

Maintain Normal Range of Movement

Gentle passive movements through full ROM at least three times a day especially at hip,
shoulder, wrist, ankle, feet.

Orthoses

Use of light splints (eg. using PLASTAZOTE) may be required for the following
purpose listed below:

• Support the peripheral joints in comfortable and functional position during flaccid
paralysis.
• To prevent abnormal movements.
• To stabilize patients using sandbags, pillows.
Prevention of Pressure Sores

2- hourly change in patients position from supine to side-lying. If the sores have
developed then UVR or ice cube massage to enhance healing.

Maintenance of Circulation

• Passive movements
• Effleurage massage to lower limbs.

Relief of Pain

• Transcutaneous electrical nerve stimulation

• Massage with passive ROM
• The patient can demonstrate increased sensitivity to light touch, a cradle can be used
to keep the bedsheet away from the skin. Low-pressure wrapping or snug-fitting
garments can provide a way to avoid light touch.
• Reassurance and explanation of what to expect can help in the alleviation of anxiety
that could compound the pain.

Strength and Endurance training

Strengthening exercises can involve isometric, isotonic or isokinetic exercises, while

endurance training involves progressively increasing the intensity and duration of
functional activities such as walking or stair-climbing[20].

Functional training

Retraining of dressing, washing, bed mobility, transfers, and ambulation activities

comprise a big part of the rehabilitation process. Balance and proprioception retraining
in all these functional activities should also be included, while motor control can be
achieved by doing Proprioceptive Neuromuscular Facilitation (PNF) techniques [20].
NURSING DIAGNOSIS

1. Difficulty in breathing related to hypoxemia as evidance by checking Vital

signs
2. Alterd body tempture related to infection process as evidance by checking
Vital signs.
3. Fluid electrolytes imbalance realted to Diarrhoea as evidence by pintch test
4. Alterd Sensorium related to disease progress as evidance by GCS score 10
5. Alterd Nutrition lessthan body requirement related to impared swallowing and
Diarrhoea as evidance by intake output chart.
6. Self care deficiet realted to limb weakness as evidenced by reflex
examination.
7. Risk for infection related to decrease immunity
Assessment Nursing Goal Planning Imlementation Evaluation
diagnosis

Subjective data: Difficulty in To improve To assess General condition General condition

breathing related breathing capacity of patient assessd
Patient said that to hypoxemia as and elivate Hb level
evidance by to reduce hypoxemia To provide comfortable Semifowler position
I feel safocated checking Vital position given
signs
Objective data: To assess vital signs Vitals assessed

Increse breath rate To assess breathing pattern Breathing pattern

assessed
To provide oxygenation
therapy Oxygen cannula
provided
To provide supplementory
medication to improve Hb
Assessment Nursing Goal Planning Implementation Evaluation
diagnosis
Subjective data: Alterd body To reduce body To assess body tempture of Body Temperature After Implementation
tempture related tempture patients assessed 100^F patients condition is
Patient said that i feel to infection improved body tempture
warm process as To provide comfortable Semifowler position reudced 98^F
evidance by position given
Objective data: checking Vital
signs. To provide well ventilated Well ventilated room
Increse tempture 100^ F enviroment provided

To provide tapid sponge Tapid spone procedure

done

To provide anipyretic drug

Anti pyretic drug given
Assessment Nursing Goal Planning Implementation Evaluation
diagnosis

Subjective data: Fluid To improve fluid To assess the patient's General condition After implimentation
electrolytes level General condition assessd patient's condition is
Patient said that i feel imbalance improved
thirsty all time realted to To assess intake output Intake output chart
Diarrhoea as chart assessed
Objective data: evidence by skin To provide comfortable Semifowler position
pintch test position given
Skin pinch test revert back
time more than 2 sec To nasogastric tube feeding Nasogastric tube inserted
and fluid provided

NS and RL fluid infusion

To provide IV fluid infusion provided
To maintain Assessment of
intake output chart
Intake output chart
assessment maintained
DRUG DOSE ACTION INDICATION CONTRA SIDE EFFECTS [Link]
INDICATION

Inj. IV: 3-4 - Piperacillin: • Appendicitis • Allergy to CNS: SEIZURES - Examination and Evaluation
Piperacillin/Taz g/dose Binds to • peritonitis. penicillins, (HIGHER DOSES), Watch for seizures; notify physician
obactam q4-6hr; bacterial cell • Skin and skin cephalosporins, confusion, dizziness, immediately if patient develops or
not to wall structure imipenem headache increases seizure activity.
exceed membrane, infections. GI: - Monitor signs of pseudomembranous
24 g/24hr causing cell • Gynecologic PSEUDOMEMBRAN- colitis, including diarrhea, abdominal
death. infections. OUS COLITIS, pain, fever, pus or mucus in stools, and
Spectrum is • Community- diarrhea, other severe or prolonged GI problems
IM: 2-3 extended acquired GU: interstitial (nausea, vomiting, heartburn). Notify
g/dose compared nephritis. Derm: rashes physician or nursing staff immediately
• nosocomial
q6-12hr; with other (↑ in cystic fibrosis of these signs.
• pneumonia
not to penicillins. patients), urticaria. - Always wash hands thoroughly and
caused by
exceed • Tazobactam: piperacillin-
Hemat: bleeding, disinfect equipment (whirlpools,
24 g/24 Inhibits leukopenia, neutropenia, electrotherapeutic devices, treatment
resistant,
hr betalactamase thrombocytopenia. tables, and so forth) to help prevent the
• beta-lactamase–
, an enzyme Local: pain, phlebitis at spread of infection. eck 6 rights
producing
that can IV site. - Use aseptic technique while given
bacteria.
destroy injection to the patient
penicillins. - Observe for any side effect
NAME OF DOSE & ACTION INDICATIONS CONTRA– ADVERSE NURSING RESPONSI
DRUG ROUTE INDICATIONS REACTION

Inj Disrupts DNA infections: Intra- Treatment of CNS: SEIZURES, - BILITISExamination and Evaluation
metronidazole and protein abdominal giardiasis. dizziness, headache. - Watch for seizures; notify physician
synthesis in infections (may be Treatment of anti- EENT: tearing (topical immediately if patient develops or
susceptible used with a infective– only). increases seizure activity.
organisms. cephalosporin), associated - Monitor signs of peripheral neuropathy
GI: abdominal pain,
Gynecologic pseudomembrano (numbness,
anorexia, nausea,
infections, Skin and us colitis. - Always wash hands thoroughly and
diarrhea, dry mouth,
skin structure disinfect equipment (whirlpools,
furry tongue, glossitis,
infections, electrotherapeutic devices, treatment
unpleasant taste,
tables, and so forth) to help prevent the
- Lower respiratory vomiting.
spread of infection. tingling). Perform
tract
Derm: rashes, objective tests (nerve conduction,
- infections, Bone
urticaria: topical only— monofilaments) to document any
and joint
burning, mild dryness, neuropathic changes
infections,
skin irritation
- CNS infections,
- Septicemia,
Endocarditis
Dietary management:-

Early morning:

Provide high fluid diet

Breakfast:

The breakfast should consist of fruit juice, milk

Lunch:

The patient have lunch with mud dal water or any other seed water, coconut wateretc

Evening tea:

It can be with fruit juice or with tea or coffee

Dinner:

Dinner containing

Milk, split grain water, rice water

Keep patient in semifowler position after nasogastric feeding to avoid aspiration.

PROGRESS CHART:-

Day:1

Patient value Normal value

Vital signs

Temperature 100.4 F 96.8- 97.2 F

Pulse 88 beats / min 80-86 beats/ min

Respiration 20 breath/ min 20 breaths/ min

Blood pressure 120/80 mm of Hg 120/ 80 mm of Hg

During time of admission his vital sign was :

Day 2:

Vital signs were recorded is.

Vital signs Patient value Normal value

Temperature 99.8 F 96.8- 97.2 F

Pulse 80 beats / min 80-86 beats/ min

Respiration 20 breath/ min 20 breaths/ min

Blood pressure 110/ 70 mm of Hg 120/ 80 mm of Hg

• Same medicine was continued on the second day.

Day 3:

Vital signs Patient value Normal value

Temperature 99.2 F 96.8- 97.2 F

Pulse 82 beats / min 80-86 beats/ min

Respiration 18breath/ min 20 breaths/ min

Blood pressure 110/ 70 mm of Hg 120/ 80 mm of Hg

Day 4:

Vital signs Patient value Normal value

Temperature 99.6F 96.8- 97.2 F

Pulse 78 beats / min 80-86 beats/ min

Respiration 20 breath/ min 20 breaths/ min

Blood pressure 118/ 70 mm of Hg 120/ 80 mm of Hg

• Same medications were continued.

• Appetite was much better. General condition was also improved.

• Health education was given on notorious diet, breast care.

Day 5

On the day 5, he was looking very fresh and active.

• Helped her to meet the personal hygiene.

• Vital signs were recorded.

Patient value Normal value

Vital signs

Temperature 98.8 F 98.6- 97.2 F

Pulse 78 beats / min 80-86 beats/ min

Respiration 16 breath/ min 20 breaths/ min

Blood pressure 120/ 76 mm of Hg 120/ 80 mm of Hg

• I advised her to continue the medication and follow up as per doctor’s order.

• Advised to eat food containing more iron like drum stick, jiggery and green leafy

vegetable.
HEALTH TEACHING:

Discharge Plan:

Medication

- Take all the medicine on the time

- Take medicine with small amount of water

Exercise

- Avoid heavy exercise

- Perform range of motion exercise

- Change position every 2 hourly while lying on bed

Health Teaching

- Meet physician if any complication related NG tube occurs like excessive coughing

Breathing difficulty etc.

- Take medication on time

- Follow up after 15 days

 Conclusion:

- Riya Shah is 14 year female was admitted in ICU,Ahmedabad

,Trauma center, civil hospital hospital on 19th Nov 2021 with chief complains Fever,
Weakness, Suffocation, Diarrhea – since 2-3 days, Rashes and itching,Retained
secretion poor gag reflex, Lower limb weakness since 2-3 days
I have maintained good interpersonal relation with family member and patient and
provided adequate care as result patient condition was improved but not cure
completely and patient was discharege because of high risk of infection.
 BIBLIOGRAPHY:-

1. BT Basavanthappa, “MEDICAL SURGICAL NURSING”, 2nd edition (2007) Jaypee

brother medical publishers.

2. Brunner and Suddarth’s, “MEDICAL SURGICAL NURSING”, 13th edition,

Wolter Kluwer Publisher

3. Cotran, Kumar and Robbins, “PATHOLOGIC BASIS OF DISEASE,”

5TH edition, W.B. Saunders company.

4. Suzanne C. Smeltzer and Brenda [Link] , “MEDICAL SURGICAL NURSING,” 8th

edition, Lippincott publishers.