104676280 case-study-brain-tumor-final

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Guagua National Colleges
Sta. Filomena, Guagua, Pampanga
College of Nursing

Case Study of Brain
Tumor


Prepared By: 2
nd
Year
Miranda, Justin Kier D.

2. Cruz, Anzelyn B.
David, Stephanie G.
Miranda, Jazmin Gail D.

Prepared To:
Mrs. Ma. Jaemee Anne B. Lopez


I. Introduction
“Human existence is always associated with complexities. Man itself is a structured
compound. It is with system and subsystems that connect its function to enable to
breath, to move and to think.”
- Tolstoy

The main switch in man’s anatomical and physiological function is his brain. The brain
consists of a huge network of neurons that control the body’s vital functions. So far, this
system is vulnerable, and its optimal function depends on several key factors. Therefore
any alteration to this system and function greatly affects the body as a whole.

The Brain Tumor is a mass of cells that have grown and multiplied uncontrollably. There
are two types of brain tumor the benign tumor and malignant brain tumor

A benign tumor does not contain cancer cells and usually, once removed, does not
recur. Most benign brain tumors have clear borders, meaning they do not invade
surrounding tissue. These tumors can, cause symptoms similar to cancerous tumors
because of their size and location in the brain.

Malignant brain tumors contain cancer cells. Malignant brain tumors are usually fast
growing and invade surrounding tissue. Malignant brain tumors very rarely spread to
other areas of the body, but may recur after treatment. Sometimes, brain tumors that
are not cancer are called malignant because of their size and location, and the damage
they can do to vital functions of the brain.

Brain tumors can occur at any age. Brain tumors that occur in infants and children are
very different from adult brain tumors, both in terms of the type of cells and the
responsiveness to treatment.

3. This case study which primarily talks about brain tumor is directed towards presenting
the disease, the management and intervention and the other vital facts that remain in
oblivion to the great number of population of this country.

Considering that the brain tumor truly and evidently has a devastating impact of our
nation’s health our Group BSN-II of GNC has regarded this study significant to the fields
of nursing education practice and research because the completion of this study does
not only meet the terms for dissemination information purposes, but for sensible
learning as well.

OBJECTIVES:


A. General objective:

To be able to choose a case study that will contribute and expand our
knowledge and improve our skills on specific procedures this is BRAIN
TUMOR.
Our group has formulated the following specific objectives to guide us
toward the completion of this case study. That we may be able to:


B. Specific Objective(s):
1. Established good intrapersonal and professional relationship with our
patient and her accompanying family members
2. Share our knowledge and skills to each other
3. Work together with the health care team
4. Provide significant health teaching that would promote our patient
health and wellness
5. Formulate effectiveness nursing care plan
6. Formulate specific, measurable, attainable, realistic and time bounded
objectives that will serve a guide for the accomplishment of the study
(SMART)
7. List the actual and possible symptoms that our patient may manifest
8. Research the drug study of the given medication to our patient
9. List all the references used in the study


C. Current Trends

4. This article is about children born with birth defects or to mothers together with a
history of multiple stillbirths that may have a higher-than-normal risk of brain cancer.
Since these sometimes involve some type of genetic abnormalities, they can increase
the risk of having a brain tumor. Some preliminary evidence, Dr. Partap said, suggests
that “defects of the heart and brain may be particularly linked to childhood cancer.”
Symptoms of brain tumors are also not clear to Pediatricians. So, researchers are
doing their best to find the solution to their problems.

We think that having some type of genetic abnormalities can increase the case of
having a brain tumor, because we know it is connected to the brain. Having brain tumor
can be frustrating to both the patient with brain tumor and his/her family, which is why
we concur about people needing to know the symptoms of brain tumor. So, as early as
possible, we can detect if there is brain tumor or not and we can treat it right away.

5. From Reuters Health Information
Birth Defects Tied to Pediatric Brain Tumors

By Amy Norton
NEW Y ORK (Reuters Health) Aug 10 - Children born with birth defects or to mothers with a history of multiple stillbirths may have a higher-than-normal risk of
brain cancer, a new study suggests.
The risks are still small, researchers say, as children only rarely develop brain cancer. Each year, about 4,000 U.S. children and teenagers are diagnosed with a
tumor of the central nervous system (brain or spinal cord), according to the American Cancer Society.
Small portions are caused by specific, inherited genetic syndromes, but otherwise little is known about why children develop brain and spinal cancers.
The new f indings, published online August 8th in Pediatrics, highlight the potential importance of genetic factors, the researchers say.
Using a California database on cancer cases in the state, the researchers found 3,733 cases of brain or spinal tumors diagnosed among children younger than 15
between 1988 and 2006.
Ov erall, 1.2% of those children had been born with a birth defect -- vs. 0.6% of 15,000 cancer-free California children studied for comparison.
And children with a birth defect had increased risks of certain tumors.
They were nearly four times as likely as children without birth defects to develop a primitive neuroectodermal tumor.
Similarly , their risk of germ cell tumors was elevated more than six-fold.
Children with birth defects were not, however, at higher risk for the most common type of brain cancer in the study group -- gliomas, which accounted for 57% of
cases.
The study also found heightened tumor risks among children whose mothers had had at least two late pregnancy losses in the past -- meaning the fetus died after
the 20th week of pregnancy.
These children were about three times as likely as other kids to develop some type of brain or spinal tumor.
Since both birth defects and pregnancy losses often involve some type of genetic abnormality, it's possible that explains the higher cancer risks, according to the
researchers.
"Genetics may play a larger role in central nervous system cancer than previously believed," said lead researcher Dr. Sonia Partap, of Stanford University and
Lucile Packard Children's Hospital in Palo Alto, California.
Early miscarriages were not linked to cancer risks in a woman's other children. So it's possible that the genetic abnormalities that cause early pregnancy loss are
not connected to cancer, while gene defects that are "compatible with life to some degree" do contribute to cancer risk, Dr. Partap told Reuters Health in an email.
As f or birth defects, past studies have connected them to higher risks of childhood cancers in general.
But researchers are still trying to figure out whether it's only certain birth defects that come with a higher risk. Some preliminary evidence, Dr. Partap said,
suggests that defects of the heart and brain may be particularly linked to childhood cancer.
But Dr. Partap also stressed that even with a relatively increased risk of brain or spinal cancer, the absolute risk to any one child is small.
"Parents should know that there is still a very low risk of central nervous system cancer," she said.
At the same time, she added, pediatricians should be aware that there is a slightly higher chance of the tumors in certain children.
Sy mptoms of brain tumors may be vague and vary from child to child. But some possible signs include morning headaches; mental changes like memory and
concentration problems; unusual sleepiness; changes in vision, hearing or speech; and balance or coordination problems.
SOURCE: http://bit.ly/oWBZpY

6. II. Demographic Data
A. Personal information:
Ms. H.A is 2 year old patient, confined at DPMMH, residence of Del
Carmen, Lubao Pampanga. Her birthday is on March 26, 2009. She has a
twin sister. She is the youngest among the 3 siblings. Her religion is Roman
Catholic. According to her mother, H.A loves to sing and dance.

B. History:

Ms. H.A was admitted to the hospital last January 01, 2012 with a chief
complaint of headache, vomiting, high fever and seizures.

Present history:
Last November 27, 2011 the pt. complains of headache, so the S.O brought her
to the clinic for check-up. The doctor prescribes medications for the headaches
but it did not worked. So the pt .was brought to PMSH (Pampanga Medical
Specialist Hospital) because of the headache and seizures and the doctor
ordered for EEG, but the result is normal. The pt. was admitted again to MMH
(Macabali Memorial Hospital) but has been transferred to Mother Theresa of
Calcuta for a CT scan and been diagnosis of BRAIN TUMOR. Because of
financial support,they transferred her to DPMMH (Diosdado P. Macapagal
Memorial Hospital)
Family History
No history of diseases.
Past History
According to her mother, Ms. H.A didn’t have any past illness or disease.

7. III. Physical Assessment:

General Appearance:
Received a patient who is a 2 year old girl, lying on bed unconsciously with an
IVF of D5 0.3 NaCl 500cc @ 350cc level, regulated @ 4-5mgtts/min infusing well on her
L hand and also hooked with an O² of 3L/min via nasal cannula.

Normal Vital Signs:
T: 36-37.5
o
C
RR: 25-50 bpm
CR: 80-150 bpm

Vital signs:
T:40.0
o
C
RR: 30 bpm

8. CR: 160 bpm

Organ/Body Parts Normal Findings Significant Findings
Skin



Fair in complexion
With good skin turgor
Oily Skin
Cold clammy skin

Nails No evidence of clubbing of
fingernails
Capillary refill: within 2-3
seconds


Head Skull:
Hair texture: black and oily
curly hair strands
Scalp: fair in complexion
(-) lesions

Asymmetrical frontal lobe

Hair partially distributed
Eyes
 Peri-orbital area


 Eyelashes


 Eyelids

 Conjunctiva



 Pupils



 Cornea



 Sclera

Thin eyebrows, black in
color

Equally distributed, curled
slightly outward


Skin intact, (-) discharge

Shiny and smooth
Pink palpebral conjunctiva


PERLA
(Pupils Equal and Reactive
to Light and
Accommodation)

Clear
(-) lesions
Appeared convex


White and buff

9. (-)


Ears
 Auricles

Fair in complexion,
symmetrical elastic, and
mobile when pinch, and
aligned with the outer cantus
of the eyes

(+) wet cerumen

Nose
 External nose

 Nasal septum

 Nasal cavity

Symmetrical and not tender

Intact and in midline

Pink colored mucosa,
(+) black and white cilia










Mouth
 Teeth


 Tongue

 Lips

White in color


Pinkish in color

Pink in color








(+) cheilosis
Neck
 Thyroid gland

 Lymph nodes

(-) Bulging mass

Normal
(-) Bruits are palpated
(-) Swelling
(-) Enlargement
(-) Tenderness

10. Chest
 Respiratory rate

 Breathing pattern

 Heart sounds


Normally fast

Normal Breathing Pattern

normal: no murmur
(-) chest pain
(-) palpitation




Abdomen
 Color

 Contour

 Palpation

Fair in complexion

Normal bowel sounds

Palpation: soft, non-tender


Musculoskeletal
Upper extremities
 Pulses



Radial and brachial pulse is
normal and palpable



Lower extremities
 Legs

Long and thin legs


IV. Laboratory and Diagnostic Result

Lab Test Patients Results Normal Value Interpretation
Complete
Blood Count
(CBC)








Hemoglobin: 136
Erythrocytes: 4.78
Hematocrit: 0.41
Leucocytes: 8.9
Lymphocytes: 0.60
Platelet Count: 492

120 – 170 g/L
4.0 – 5.0 x 10
0.36 – 0.46
4.5 – 11
0.20 – 0.40
150 – 450

Normal
Normal
Normal
Normal
There is abnormal cell mutation
There is abnormal cell mutation

Blood
Chemistry
RBS: 150

80 – 115

It

11. Cranial CT-Scan
There is a 3.3 x 6.1 x 4.9 cm (LxWxAP) lobulated, heterogeneous mass with cystic and
homogeneously enhancing solid components, involving the right thalamus, right side of
the pons, medical aspect of the right temporal lobe and inferoposterior aspect of the
frontal lobe. Associated perifocal edema, contralateralshift if the midline structures,
lateral displacement of the dorsal horn of the right lateral ventricle and compression of
the third and right lateral ventricles. Resultant moderate dilatation of the lateral
ventricles with subependymal seepage is seen.

The posterior fossas are unremarkable.
There is no intracranial hemorrhage.
The rest of the cisterns and sulci are not widened.
The visualized paranasal sinuses and mastoids are well aerated. The cranium is intact.

Impression:
Complex mass with cystic and solid components as described involving the right
thalamus, right side of the pons, medical aspect of the right temporal lobe and
inferoposterior aspect of the frontal lobe with associated perifocal edems, mild mass
effect and secondary obstructive hydrocephalus. Primary consideration is a neoplastic
process such as glioblastoma multiforme.
V. Review of system

CENTRAL NERVOUS SYSTEM

Nervous System

12. The nervous system is broken down into two major parts: the central nervous system,
which includes the brain and spinal cord, and the peripheral nervous system, which
includes all nerves, which carry impulses to and from the brain and spinal cord. These
include our sense organs, the eyes, the ears, our sense of taste, smell and touch, as
well as our ability to feel pain.


Spinal Cord
The spinal cord is a long bundle of neural tissue continuous with the brain that occupies
the interior canal of the spinal column and functions as the primary communication link
between the brain and the rest of the body. The spinal cord receives signals from the
peripheral senses and relays them to the brain.

13. Brain
The brain is the largest and most complex part of the nervous system. It is compose of
more than 100 billion neurons and associated fibers. The brain tissues have a gelatin
like consistency. The semi-solid organ weighs about 1400g (approximately 3 pounds) in
the adult human.

1. The frontal lobes (motor complex) controls voluntary motor activity.
2. The parietal areas these same areas are thought to contribute to reasoning,
problem solving activities and emotional stability.

14. 3. The occipital lobe contains a primary visual receptive (interpretation) area and
visual association areas.
4. The temporal lobe is located under (inferior to) the lateral sulcus. It contains
primary auditory receptive area and secondary auditory association areas.

Brain Stem
The brain stem is the part of the brain that connects the cerebrum and diencephalons
with the spinal cord.
Medulla Oblongata
The medulla oblongata is located just above the spinal cord. This part of the brain is
responsible for several vital autonomic centers including
 The respiratory center, which regulates breathing.
 The cardiac center that regulates the rate and force of the heartbeat.
 The vasomotor center, which regulates the contraction of smooth muscle in the
blood vessel, thus controlling blood pressure.
The medulla also controls other reflex actions including vomiting, sneezing, coughing
and swallowing.

Pons
Continuing up the brain stem, it reaches the Pons. The pons lay just above the medulla
and acts as a link between various parts of the brain. The pons connects the two halves
of the cerebellum with the brainstem, as well as the cerebrum with the spinal cord. The
pons, like the medulla oblongata, contains certain reflex actions, such as some of the
respiratory responses.




Midbrain

15. The midbrain extends from the pons to the diencephalon. The midbrain acts as a relay
center for certain head and eye reflexes in response to visual stimuli. The midbrain is
also a major relay center for auditory information.

Diencephalon
The diencephalons are located between the cerebrum and the mid brain. The
diencephalons houses important structures including the thalamus, the hypothalamus
and the pineal gland.

Thalamus
The thalamus is responsible for "sorting out" sensory impulses and directing them to a
particular area of the brain. Nearly all sensory impulses travel through the thalamus.

Hypothalamus
The hypothalamus is the great controller of body regulation and plays an important role
in the connection between mind and body, where it serves as the primary link between
the nervous and endocrine systems. The hypothalamus produces hormones that
regulate the secretion of specific hormones from the pituitary. The hypothalamus also
maintains water balance, appetite, sexual behavior, and some emotions, including fear,
pleasure and pain.

Limbic System
The limbic system, often referred to as the "emotional brain", is found buried within the
cerebrum. Like the cerebellum, evolutionarily the structure is rather old.




Cerebellum (little brain)

16. The functions of the cerebellum include the coordination of voluntary muscles, the
maintenance of balance when standing, walking and sitting, and the maintenance of
muscle tone ensuring that the body can adapt to changes in position quickly.

Cerebrum
The largest and most prominent part of the brain, the cerebrum governs higher mental
processes including intellect, reason, memory and language skills. The cerebrum can
be divided into 3 major functions:
 Sensory Functions - the cerebrum receives information from a sense organ; i.e.,
eyes, ears, taste, smell, feelings, and translates this information into a form that
can be understood.
 Motor Functions - all voluntary movement and some involuntary movement.
 Intellectual Functions - responsible for learning, memory and recall.

Meninges
The meninges are made up of three layers of connective tissue that surround and
protect both the brain and spinal cord. The layers include the Dura mater, the arachnoid
and the pia matter.
 Pia mater is a vascular layer of connective tissue that is so closely connected to
the brain and spinal cord that is follows every sulcus and fissures.
 Dura mater is a tough non-stretchable vascular membrane with 2 layers the
outer and inner layer.

Reflex Mechanism
Our conscious autonomic responses to internal and external stimuli known as reflex
responses provide many homeostatic functions. Although the spinal cord is often
thought of as the reflex center, it is not the only site for regulation .Many of the complex
reflexes controlling the heart rate, breathing, blood pressure, swallowing, coughing, and
vomiting are found in the brain stem.

Cerebrospinal Fluid

17. The cerebrospinal fluid is a clear liquid that circulates in and around the brain and spinal
cord. Its function is to cushion the brain and spinal cord, carry nutrients to the cells and
remove waste products from these tissues.

Neurons:
A neuronal cell body (soma) is like other cell in that it contains most of the organelles
seen in other cells.
There are several types of neurons - anaxonic neurons: small neurons where the
dendrites and axons are indistinguishable.
 Bipolar neurons: small neurons with two distinct processes; a dendritic process
and an axon extending from the cell body.
 Unipolar neurons: large neurons with the cell body lying to one side of the
continuous dendritic process and axon.
 Multipolar neurons: large neurons with several dendrites and a single axon
extending from the cell body.
Bipolar neurons: Bipolar neurons are CNS neurons specific for transmitting
information from specialized sensory systems: sight, smell and hearing.
Grey and white matter: Grey matter consisting of unmyelinated neurons is the
processing area of the CNS. White matter – located in the inner cortex and surrounding
grey matter in the spinal cord - provide pathways of communication between grey
matters.

Glial Cells
CNS Glial Cell Types: There are 4 types of glial cells:
1. astrocytes - Regulates the chemical microenvironment surrounding neurons.
2. Oligodendrocytes - Myelinate central nervous system axons.
3. Microglia - Migrating phagocytic cells resembling immune cells that remove
waste, debris, and pathogens.
4. Ependymal cells - Columnar cells that line the ventricles of the brain and the
spinal canal in the spinal cord.

Peripheral Nervous System

18. The PNS includes all neurons other than those in the brain and spinal cord. It consists
of pathways of nerve fibers between the CNS and all outlying structures in the body.
Included in the PNS are 12 pairs of cranial nerves and 31 pairs of spinal nerves.

Nerves
Nerves are made up of specialized cells, which act as little wires, transmitting
information to and from the central nervous system and brain. Nerves form the network
of connections that receive signals (known as sensory input) from the environment and
within the body, and transmit the body's responses, or instructions for action, to the
muscles, organs, and glands. Nerve cells are located outside the central nervous
system or spinal cord.

Cranial Nerve
12 pairs of cranial nerves arise from the brain. Most of the cranial nerves are composed
of both motor and sensory neurons although a few cranial nerves carry only sensory
impulses. Except for the olfactory and optic nerves, whose nuclei lie just below the
cerebrum, all other cranial nerve nuclei lie within the brain stem











The Cranial Nerves

19. Nerves Type Function
I
Olfactory
sensory olfaction (smell)
II
Optic
sensory
vision
(Contain 38% of all the axons connecting to the brain.)
III
Oculomotor
motor* eyelid and eyeball muscles
IV
Trochlear
motor* eyeball muscles
V
Trigeminal
mixed
Sensory: facial and mouth sensation
Motor: chewing
VI
Abducens
motor* eyeball movement
VII
Facial
mixed
Sensory: taste
Motor: facial muscles and
salivary glands
VIII
Auditory
sensory hearing and balance
IX
Glossopharyngeal
mixed
Sensory: taste
Motor: swallowing
X
Vagus
mixed
main nerve of the
parasympathetic nervous system (PNS)
XI
Accessory
motor swallowing; moving head and shoulder
XII
Hypoglossal
motor* tongue muscles

20. VI. Pathophysiology

Risk Factors + normal cells
↓
Initiation
↓
Promotion
↓
Malignant conversion
↓
Progression
↓
Tumor occupy normal tissue spaces
↓
Destroy major function of the Thalamus
Sorting out sensory impulses
↓
No senses
↓
Cerebral edema
↓
Brain tumor
↓
Death
VII. Course in the Ward

21. Doctor’s Order
January 01, 2012
8:20 PM

 Please admit the pt. to ROC  For continued therapy
 Secure consent  For legal purposes
 TPR q shift and recorded  To obtain baseline data for
comparison
 NPO temporarily  To prevent aspiration
 Lab result CBC typing  To identify infection
 IVF of D5 0.3 NaCl 500cc
KVO
 For route of medication
 Cefuroxime vial 400mg slow IV
push q6 NST
 To treat bacterial infections
 O2 inhalation 3L  To help the patient to support
decreased perfusion
 Continue high back rest  To help improve venous drainage,
reduce arterial pressure, and may
improve cerebral perfusion
 Refer to Dra. Balagtas  For neuro evaluation
January 02, 2012
9:20 AM

 Paracetamol 0.8mL
TID – now
Prn for T = 38.8
o
C
 To decrease hyperthermia
January 02, 2012
9:50 AM
T = 40
o
C


 Continue medications  To continue the therapeutic regimen
 DAT w/ aspiration precaution  To prevent aspiration
 TSB  To evaporate heat in the body
 Carry out orders of Dra. Balagtas  For evaluation and management
January 02, 2012
 CTScan  To identify tumor, cerebral edema
or hydrocephalus

 Give Dyphenhydramine TIV at
0.1mg/kg/dose now
 To sedate the patient from having
seizures
 Refer to Dr.  For further evaluation and
management
 Give Dexamethasone at 0.1 mg/kg
TIV now often q 12 hours
 To decrease cerebral inflammation
and edema
 Kindly IVF rate as replacement
 May also be dehydrated
 To hydrate the patient

22. January 02, 2012
4:45 PM Seizure

 Dyphenhydramine 12.5mg IV now  To sedate patient from seizure
January 03, 2012
7:05 AM

 Continue medications  To continue therapeutic regimen
 Carry out referal to Dr. Rivera and
Dr. Beltran
 For further evaluation and
management
 TF D5 0.3 NaCl 500cc x SR  To help in hemorrhagic shock

23. VIII. Nursing Care Process
ASSESSMENT NURSING
DIAGNOSIS
SPECIFIC
EXPLANATION
PLANING NURSING
INTERVENTION
RATIONALE EVALUATION

S:

O:
>Febrile, T=40°C
in both axilla;
warm to touch
with flushing


Hyperthermia r/t
increase
Intracranial
pressure

ENTRY OF PATHOGEN
IN THE SYSTEMIC
CIRCULATION

REGULATION OF
TOXIN IN THE BODY

RELEASE OF PYROGEN

STIMULATION OF THE
HYPOTHALAMUS

INCREASE OR
ALTERRATION OF
THERMOREGULATION

INCREASE BODY
TEMPERATURE


Short Term:
After 2-3 hours of
nursing intervention
the patient will be
able to decrease
body temperature
from 40°C to 37°C.



Long Term:
After 2 days of
nursing intervention
the patient will be to
maintain normal
body temperature





 Do/perform
tepid sponge
bath


 Assess body
temperature
from time to
time

 Do not apply
alcohol for TSB




 Advise the so to
increase oral


 To help
decrease body
temperature


 To know what
is the
response of
client to TSB

 Alcohol
increases
peripheral
vascular
constriction
&CNS
depression

 Additional
fluids help

Short Term:
The patient
shall
Demonstrated
temperature
within normal
range, from 40
°C to 37.5°C



Long Term:
The patient
shall have
demonstrated
behaviors to
monitor and
promote
normothemia

24. HYPERTHEMIA fluid intake of
the patient



 Remove excess
clothing and
covers
prevent
elevated
temperature
associated
with
dehydration

 These
decrease
warmth and
increase
evaporative
cooling

25. ASSESSMENT NURSING
DIAGNOSIS
SPECIFIC
EXPLANATION
PLANING NURSING
INTERVENTION
RATIONALE EVALUATION

26. S:

O:
>Unconscious
>febrile


Ineffective
cerebral
perfusion
related to
interruption of
blood flow

Intracranial
pressure


Pressure exerted
in the cranium by
its content


Brain, blood and
cerebrospinal fluid


Associated with
vasospasm or
obstruction in the
arteries supplying
the brain with
blood


Increase vascular
resistance can
result due to
increase ICP


Leading to
decrease and or
absence of blood
flow to the brain
cells


Short Term:
After 2-3 hours of
nursing
intervention the
SO will verbalized
understanding of
condition, therapy
regimen and
when to contact
health provider

Long Term:
After 2 days of
nursing
intervention the
patient will
demonstrate
behaviors and life
style changes to
improve
circulation such as
relaxation
techniques.
Independent:

 Assess patient
condition




 .Position head
slightly
elevated and
in neutral
position


 Take patients
temperature
at least 4
hours



 Keep patients
in neutral
alignment







 Provide quite,
restful


 To be able to
identify present
physiologic
disturbances


 Reduces arterial
pressure by
promoting venous
drainage and may
improve cerebral
perfusion.


 Hyperthermia
causes increased
ICP hypothermia
causes decrease
cerebral perfusion
pressure


 To keep the
carotid flow
unobstructed
thereby
promoting
perfusion




 Continual
stimulation can
increase ICP.

Short Term:
The So shall
have
verbalized
understanding
of condition,
therapy
regimen and
when to
contact health
care provider



Long Term:
The patient
shall have
Demonstrated
behaviors and
life style
changes to
improve
circulation
such as
relaxation
techniques.

27. Because of this
there will be
decrease or
absence of oxygen
supply to the brain
cells


So there is
ineffective
cerebral perfusion


environment.


 Note history of
brief/intermitte
nt periods or
black out

 Monitor
patients
behavior and
mental status
for onset of
restlessness,
agitation
confusion



Dependent:

 Administer
supplemental
oxygen.










 Because this
suggest transient
ischemic attacks


 Changes in
behavior and
mental status are
sign of altered
cerebral perfusion








 Reduces
hypoxemia, which
can cause
cerebral
vasodilatation
and increase
pressure/ edema
formation.

28. ASSESSMENT NURSING
DIAGNOSIS
Scientific
EXPLANATION
PLANING NURSING
INTERVENTION
RATIONALE EVALUATION

S:

O:
> Unconscious
>seizures

Risk for injury
related to
disruption in the
normal flow of
electricity in the
brain

Altered neuronal cells

Increased frequency
and amptitude

Neuronal firing
spreads

Seizures

Unpredictable
movement or
behavior

Risk for Injury

Short Term:
After 2-3 hours of
nursing intervention
the patient’s
seizures will be
lessen


Long Term:
After 2 days of
nursing intervention
the patients seizures
will be remove


 Assess patient
condition


 Keep padded
side rails up
with bed in the
lowest position

 Provide
information
regarding the
condition that
may result in
risk for injury.
 Assess muscle
strength gross
and fine motor
coordination




 To be able to
identify
present
physiologic
disturbances
 Minimizes
injury should
seizure occur
while patient
is in bed

 to promote
awareness



 to determine
the severity of
body
weakness and
to be able to
perform
appropriate
intervention

Short Term:
The patient’s
seizures shall
be lessen



Long Term:
The patient’s
seizures shall
be removed

29.  Keep the
patient’s room
free from
clutter



 to promote
individual
safety

30. IX. Drug Study
Drug Name Classification Indications Mechanis
m of
Action
Adverse Effect Nursing
Considerations
Rationale
Generic
Name:
Diphenhydra
mine

Brand Name:
Oral: Allerdyl
(CAN),
AllerMax
Caplets,
Banophen,
Banophen
allergy,
Benaryl
allergy,
Diphen AF,
Diphenhist
Captabs,
Genahist,
Siladryl
Antihistamine,
Anti-motion-
sickness drug,
Antiparkinsoni
an,
Cough
Suppressant,
Sedative-
hypnotic



-> Relief of symptoms
associated with
perennial and seasonal
allergic rhinitis;
vasomotor rhinitis;
allergic conjunctivitis,
mild, uncomplicated
urticaria and
angioedema;
amelioration of allergic
reactions to blood or
plasma;
dermatographism;
adjunctive theraphy in
anaphylactic reactions.
-> Active and
prophylactic treatment
of motion sickness.
->Nighttime sleep aid
->Parkinsonism
(including drug induced
parkinsonism and
extrapyramidal
reactions), in the
elderly intolerant of
more potent drugs, for
milder forms of disorder
in the other age groups,
and in combination with
centrally acting
Competitiv
ely blocks
the effect of
histamine
at H1-
receptor
sites, has
antropine-
like,
antipruritic,
and
sedative
effects.
CNS: Drowsiness,
sedation, dizziness,
disturbed
coordination, fatigue,
confusion,
restlessness,
excitation,
nervousness, tremor,
headache, blurred
vision, diplopia
CV: Hypotension,
palpitations,
bradycardia,
tachycardia,
extrasystoles
stomatitis
G.I: Epigastric
distress, anorexia,
increased appétit and
weight gain, nausea,
vomiting, diarrhea r
constipation
G.U: Urinary
frequency, dysuria,
urinary retention, early
menses, decreased
libido, impotence
Hematologic:
Hemolytic anemia,
hypoplastic anemia,
-> Administer with
food.


->Avoid driving and
using Dangerous
machine.




-> Administer syrup
form for patient who
can’t take tablets.

->Advice patient to rise
slowly from lying or
sitting position.



->Monitor children
closely.
-> To
prevent GI
upset.

-> To avoid
accident
that may
cause by
the side
effects.

->To
prevent
aspiration.

->To
prevent
orthostatic
hypotensio
n

-> To
identify
paradoxica
l reaction.

31. anticholinergic
antiparkinsonian drugs.
->Syrup formulation:
Suppression of cough
due to colds or allergy.
thrombocytopenia,
leucopenia,
agranulocytosis,
pancytopenia.
Respiratory:
Thickening of
bronchial secretions,
chest tightness,
wheezing, nasal
stiffness, dry mouth,
dry nose, dry throat,
sore throat.

32. Drug Name


Classification Indications Mechanis
m of
Action
Adverse Effect Nursing
Considerations
Rationale
Generic
Name:
Cefuroxime

Brand Name:
Ceftin
Zinacef
Antibiotics;
Cephalosporin

Oral(cefuroxime axetil)
-> Pharingitis, tonsillitis
caused by
streptococcus
pyogenes
->otitis media caused
by streptococcus
pneumonia, S.
pyogenes,
Haemophilus influenza,
Moraxella catarrhalis
NEW INDICATION
Acute bacterial
maxillary sinusitis
caused by S.
pneumonia, H.
influenza
-> lower respiratory
infections caused by S.
pneumonia,
Haemaphilus
parainfluenzae, H.
influenza
-> UTI caused by
E.Coli, klebsiella
pneumonia
-> Uncomplicated
gonorrhea (urethral and
endocervical)
Inhibits
synthesis
of bacterial
cell wal,
causing cell
death
CNS: Headache,
dizziness, lethargy,
paresthesias
GI: Nausea, vomiting,
diarrhea, anorexia,
abdominal pain,
flatulence,
pseudomembranous
colitis, heaptotoxicity
GU: Nephrotoxicity
Hematologic: Bone
marrow depression
Hypersensitivity:
Ranging from rash to
fever to anphylasis;
serum sickness
reaction












-> Avoid crushing
tablets.




-> Give PO drug with
meal.





-> Have vitamin K
available.




-> Take full course
therapy even if you are
feeling better.

->To
prevent
tasting the
bitter taste
of the drug.

-> To
decrease
GI upset
and
enhance
absorption.

-> In case
of
hypoprothr
ombinemia
occurs.

-> To
prevent
drug
tolerance.

33. -> skin and skin
structure infections,
including impetigo
caused by
streptococcus aureus,
S. pyogenes
-> Treatment of early
lyme disease
Parental(cefuroxime
sodium)
-> lower respiratory
infections caused by S.
pneumonia, S. aureus,
E. coli, Klebsiella
pneumonia, H.
Influenza, S. pyogenes
-> Dematologic
infections caused by S.
aureus, S. pyogenes,
E. coli, K. pneumonia,
Enterobacter
-> UTIs caused by E.
coli, K. pneumonia
-> Uncomplicated and
disseminated
gonorrhea caused by
N. gonorrhhoeae
-> Septicimia caused
by S. pneumonia, H.
influenzae, S. aureus,
N. mengingitidis.
-> Bone and joint

34. infections due to S.
aureus
-> Perioperative
prophylaxis
-> Treatment of acute
bacterial maxillary
sinusitis in patient 3
mo-12 yr

35. Drug Name

Classification
s
Indications Mechanis
m of
Action
Adverse Effects Nursing
Considerations
Rationale
Generic
Name:
Acetaminoph
en

Brand Name:
Tempra;
Tylenol

Analgesic;
Antipyretic
-> Temporary reduction
of fever; temporary
relief of minor aches
and pains caused by
common cold and
influenza, headache,
sore throat, toothache,
menstrual cramps,
backache, minor
arthritis pain, and
muscles pains.
-> Unlabeled use:
Propylaxis in children
and patient at risk for
seizures who are
receiving DTP
vaccination to reduce
incidence of fever and
pain.
Antipyretic
s:
Reducing
fever by
acting
directly on
the
hypothalam
ic heat-
regulating
center to
cause
vasodilatio
n and
sweating,
which heals
to lessen
heat.
CNS: Headache
CV: Chest pain;
dyspnea; myocardial
damage when dose of
5-8g/day are ingested
daily for several
weeks or when
dosages of 4g/day are
ingested for 1year.
GI: Hepatic toxicity
and failure, jaundice
GU: Acute renal
failure, renal tubular
necrosis.
Hematologic:
methamoglobinemia-
-cyanosis; hemolytic
anemia; anuria;
neutropenia;
leukopenia;
pancytopenia;
thrombopenia;
hypoglycemia
Hypersensitivity:
Rash, Fever




-> Give pedia patient
on liquid form of
medication.


-> TSB.




-> Take medicine q4.




-> Give drug with food.
-> To avoid
splitting up
and easy
to swallow.

-> To
evaporate
heat of the
patient.

-> To
complete
therapeutic
regiments.

-> To
prevent GI
upset.

37. Drug Study Classificati
on

Indications Mechanis
m of
Action
Adverse Effects Nursing
Considerations
Rationale
Generic
Name:
Dexamthason
e

Brand
Name/s:
Dexasone,
Dexone,
Hexadrol

Corticostero
id
Glucocortic
oid
Hormone
->Management of
cerebral edema
->Diagnostic agent
in adrenal disorders
->Relieves
inflammation
Dexameth
asone
suppresse
s
inflammati
on and the
normal
immune
response.
It prevents
the release
of
substances
in the body
that
causes
inflammati
on.
Systemic
Administration
CNS: Seizures,
vertigo, headaches,
pseudotumor cerebri,
euphoria, insomnia,
mood swings,
depression, psychosis,
intracerebral
hemorrhage, reversible
cerebral atrophy in
infants, caratacts, IOP,
glaucoma
CV: Hypertension,
Heart failure,
necrotizing angritis
Endocrine: Growth
retardation, decreased
carbohydrates
tolerance, DM,
cushingoid state,
secondary
adrenocortical and
pituitary
unresponsiveness
GI: Peptic or
esophageal ulcer,
pancreatitis, abdominal
distention
->Give drug with
food.



->







-> To
minimize
GI
irritation.

->

38. GU: Amenorrhea,
irregular menses
Hematologic: Fluid
and electrolytes
disturbance, negative
nitrogen balance,
increased blood sugar,
glycosuria, increased
serum cholesterol,
decreased serum T3
and T4 levels
Hypersensitivity:
Anaphylactoid or
hypersensitivity
reactions
Musculoskeletal:
Muscle weakness,
steroid myopathy, loss
of muscle mass,
osteoporosis,
spontaneous fractures
Other/s: Impaired
wound healing;
petechiae;
ecchymoses;
increased sweating;
thin and fragile skin,
acne;
immunosuppression;
and masking of signs
of infection; activation
of latent infections,

39. including TB, fungal ,
and viral eye
infections; pneumonia;
abscess; septic
infection; GI and GU
infections

40. X. Discharge Planning

M- Medicine

-Instructed patient to take the medications.

E-Exercise

-Instructed patient to do the ADL.

T-Treatment
-Continue medications and promote supportive treatment as PRN, such as TSB and Paracetamol.

H-Health Teaching

-Instruct SO to give nutritional foods like green leafy vegetables example (malungay, ampalaya and bitter melon).
-Instruct SO to give food rich in fiber.
-Instruct SO to avoid food rich in saturated fats and hydrogenated oils.
-Instruct SO to give foods rich in vitamin C.

41. O-Out patient

-instructed patient to return after one week @ OPD @ 8AM for follow-up checkup

D-Diet

-instructed patient to avoid or limit foods rich in saturated fats and hydrogenated oils
-DAT with aspiration diet

42. XI. Bibliography

Book(s):

Joyce M. Black and Jane Hokanson Hawks, Medical Durgical Nursing (7
th
Edition) 2004, EL SEVIER (Singapore) PTE
LTD.
Marilynn E. Doenges, Mary Frances Moorhouse, and Alice C. Murr, Nurse’s Pocket Guide (12
th
Edition) 2008, Nursing:
Joanne Patzek DaCunha, RN, MSN.
Amy M. Karch, 2011 LIPPINCOTT’S: Nursing Drug Guide, 2011, Chris Burghargt.

Website(s):

http://www.medscape.com/viewarticle/747859, 2012.
http://www.emedicinehealth.com/anatomy_of_the_central_nervous_system/article_em.htm
http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/C/CNS.html, November 18, 2011.
http://serendip.brynmawr.edu/bb/kinser/Structure1.html, 10:45:07 EDT, June 3, 2005.
http://www.chw.org/display/router.asp?DocID=22484, 2012.
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