Case Study - Brain Tumor FINAL
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Transcript of Case Study - Brain Tumor FINAL
Guagua National CollegesSta. Filomena, Guagua, Pampanga
College of Nursing
Case Study of Brain Tumor
Prepared By: 2nd Year
Miranda, Justin Kier D.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.
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 members2. Share our knowledge and skills to each other3. Work together with the health care team4. Provide significant health teaching that would promote our patient
health and wellness5. Formulate effectiveness nursing care plan6. 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 manifest8. Research the drug study of the given medication to our patient9. List all the references used in the study
C. Current Trends
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.
From Reuters Health Information
Birth Defects Tied to Pediatric Brain Tumors
By Amy Norton
NEW YORK (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 findings, 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.
Overall, 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 for 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.
Symptoms 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
II. Demographic DataA. 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 HistoryNo history of diseases.Past HistoryAccording to her mother, Ms. H.A didn’t have any past illness or disease.
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 oC
RR: 25-50 bpm
CR: 80-150 bpm
Vital signs:
T:40.0 oC
RR: 30 bpm
CR: 160 bpm
Organ/Body Parts Normal Findings Significant FindingsSkin Fair in complexion
With good skin turgorOily SkinCold clammy skin
Nails No evidence of clubbing of fingernailsCapillary refill: within 2-3 seconds
Head Skull: Hair texture: black and oily
curly hair strandsScalp: 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(-) lesionsAppeared convex
White and buff
(-)
Ears Auricles Fair in complexion,
symmetrical elastic, and mobile when pinch, and aligned with the outer cantus of the eyes
(+) wet cerumenNose
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
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
MusculoskeletalUpper extremities
Pulses Radial and brachial pulse isnormal and palpable
Lower extremities Legs Long and thin legs
IV. Laboratory and Diagnostic Result
Lab Test Patients Results Normal Value InterpretationComplete
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
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
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.
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.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
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)
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
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
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
Nerves Type Function
IOlfactory
sensory olfaction (smell)
IIOptic
sensoryvision
(Contain 38% of all the axons connecting to the brain.)
IIIOculomotor
motor* eyelid and eyeball muscles
IVTrochlear
motor* eyeball muscles
VTrigeminal
mixedSensory: facial and mouth sensation
Motor: chewing
VIAbducens
motor* eyeball movement
VIIFacial
mixedSensory: taste
Motor: facial muscles and salivary glands
VIIIAuditory
sensory hearing and balance
IXGlossopharyngeal
mixedSensory: taste
Motor: swallowing
XVagu s
mixedmain nerve of the
parasympathetic nervous system (PNS)
XIAccessory
motor swallowing; moving head and shoulder
XIIHypoglossal
motor* tongue muscles
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 Doctor’s Order
January 01, 20128:20 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 evaluationJanuary 02, 20129:20 AM
Paracetamol 0.8mLTID – nowPrn for T = 38.8 oC
To decrease hyperthermia
January 02, 20129:50 AM
T = 40 oC 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
January 02, 20124:45 PM Seizure
Dyphenhydramine 12.5mg IV now To sedate patient from seizure
January 03, 20127:05 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
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
HYPERTHEMIA
fluid intake of the patient
Remove excess clothing and covers
prevent elevated temperature associated with dehydration
These decrease warmth and increase evaporative cooling
ASSESSMENT NURSING DIAGNOSIS
SPECIFIC EXPLANATION
PLANING NURSING INTERVENTION
RATIONALE EVALUATION
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.
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.
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
Keep the patient’s room
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
to promote
Short Term:
The patient’s seizures shall be lessen
Long Term:
The patient’s seizures shall be removed
free from clutter
individual safety
IX. Drug Study
Drug Name Classification Indications Mechanism of
Action
Adverse Effect Nursing Considerations
Rationale
Generic Name:Diphenhydramine
Brand Name:Oral: Allerdyl (CAN), AllerMax Caplets, Banophen, Banophen allergy, Benaryl allergy, Diphen AF, Diphenhist Captabs, Genahist, Siladryl
Antihistamine, Anti-motion-sickness drug,Antiparkinsonian,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
Competitively 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, diplopiaCV: Hypotension, palpitations, bradycardia, tachycardia, extrasystolesstomatitisG.I: Epigastric distress, anorexia, increased appétit and weight gain, nausea, vomiting, diarrhea r constipationG.U: Urinary frequency, dysuria, urinary retention, early menses, decreased libido, impotenceHematologic: 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 hypotension
-> To identify paradoxical reaction.
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.
Drug Name Classification Indications Mechanism 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 catarrhalisNEW INDICATIONAcute 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
Inhibits synthesis of bacterial cell wal, causing cell death
CNS: Headache, dizziness, lethargy, paresthesiasGI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, pseudomembranous colitis, heaptotoxicityGU: NephrotoxicityHematologic: Bone marrow depressionHypersensitivity: 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 hypoprothrombinemia occurs.
-> To prevent drug tolerance.
gonorrhea (urethral and endocervical)-> skin and skin structure infections, including impetigo caused by streptococcus aureus, S. pyogenes-> Treatment of early lyme diseaseParental(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 infections due to S. aureus-> Perioperative prophylaxis-> Treatment of acute bacterial maxillary sinusitis in patient 3 mo-12 yr
Drug Name Classifications
Indications Mechanism of
Action
Adverse Effects Nursing Considerations
Rationale
Generic Name:Acetaminophen
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.
Antipyretics: Reducing fever by acting directly on the hypothalamic heat-regulating center to cause vasodilation and sweating, which heals to lessen heat.
CNS: HeadacheCV: 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, jaundiceGU: Acute renal failure, renal tubular necrosis.Hematologic: methamoglobinemia--cyanosis; hemolytic anemia; anuria; neutropenia; leukopenia; pancytopenia; thrombopenia; hypoglycemiaHypersensitivity: 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.
Drug Study Classification
Indications Mechanism of
Action
Adverse Effects Nursing Considerations
Rationale
Generic Name:Dexamthasone
Brand Name/s:Dexasone, Dexone, Hexadrol
CorticosteroidGlucocorticoidHormone
->Management of cerebral edema->Diagnostic agent in adrenal disorders->Relieves inflammation
Dexamethasone suppresses inflammation and the normal immune response. It prevents the release of substances in the body that causes inflammation.
Systemic AdministrationCNS: Seizures, vertigo, headaches, pseudotumor cerebri, euphoria, insomnia, mood swings, depression, psychosis, intracerebral hemorrhage, reversible cerebral atrophy in infants, caratacts, IOP, glaucomaCV: Hypertension, Heart failure, necrotizing angritisEndocrine: Growth retardation, decreased carbohydrates tolerance, DM, cushingoid state,
->Give drug with food.
->
-> To minimize GI irritation.
->
secondary adrenocortical and pituitary unresponsivenessGI: Peptic or esophageal ulcer, pancreatitis, abdominal distentionGU: Amenorrhea, irregular mensesHematologic: Fluid and electrolytes disturbance, negative nitrogen balance, increased blood sugar, glycosuria, increased serum cholesterol, decreased serum T3 and T4 levelsHypersensitivity: Anaphylactoid or hypersensitivity reactionsMusculoskeletal: Muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, spontaneous fracturesOther/s: Impaired wound healing; petechiae;
ecchymoses; increased sweating; thin and fragile skin, acne; immunosuppression; and masking of signs of infection; activation of latent infections, including TB, fungal , and viral eye infections; pneumonia; abscess; septic infection; GI and GU infections
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.
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
XI. Bibliography
Book(s):
Joyce M. Black and Jane Hokanson Hawks, Medical Durgical Nursing (7th Edition) 2004, EL SEVIER (Singapore) PTE LTD.
Marilynn E. Doenges, Mary Frances Moorhouse, and Alice C. Murr, Nurse’s Pocket Guide (12th 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.