dandy walker presentation

8/4/2019 dandy walker presentation

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DANDY WALKER SYNDROME

Presented by:Group 4 BSN S31



I. INTRODUCTION

This case of Patient D who was diagnosed with DandyWalker Syndrome secondary to Hydrocephalus on 2006. Thepatient was initially diagnosed with hydrocephalus but afterperforming several laboratory and diagnostics test, the resultsshows that patient was suffering from dandy walker syndrome.Dandy-Walker Syndrome is a rare malformation of the brain thatis present at birth (congenital). It is characterized by anabnormally enlarged space at the back of the brain (cystic 4thventricle) that interferes with the normal flow of cerebrospinalfluid through the openings between the ventricle and other parts

of the brain (foramina of Magendia and Luschka). Excessiveamounts of fluid accumulate around the brain and causeabnormally high pressure within the skull, swelling of the head(congenital hydrocephalus), and neurological impairment. Motordelays and learning problems may also occur.



II. OBJECTIVES OF THE STUDY

We chose this case for us to extend and improve our

knowledge and understanding with regards to the causes,effects, complications, signs and symptoms and nursingimplications for Dandy Walker Syndrome for us to be able toattain a comprehensive and thorough learning experience withregards to our study that would benefit not only us but also thereaders and for the patients that we will be catering in the futurewith such kind of disease.

This case study is important because it imparts knowledgeregarding the complication in having dandy walker syndrome.We, as students will benefit from this study as we reviewed theanatomy and physiology and studied nursing interventions forthis case.

The scopes of this study are patients who are suffering anddiagnosed from dandy walker syndrome. This case presentationwill attempt to cover and discuss the disease process and presentcondition of the patient. This case presentation will be limitedonly to the patient’s verbalizations, laboratory reports, signs andsymptoms as evidenced by and observed from the patient.



III. BIOGRAPHICAL DATA

Name: Miss D

Age: 7 years old

Date of Birth: March 16, 2004

Place of Birth: Malolos, Bulacan

Gender: Female

Religion: Roman Catholic

Civil Status: Single

Address: Purok 2, Kaybanban, San Jose del Monte, Bulacan

Educational Attainment: Grade 1

Occupation: Student

Ethnic Group: Tagalog

Primary Language Spoken: Tagalog



Theoretical framework



Ida Jean Orlando, a first-generation American of

Italian descent was born in 1926. She received hernursing diploma from New York Medical College, LowerFifth Avenue Hospital, School of Nursing, her BS inpublic health nursing from St. John's University,Brooklyn, NY, and her MA in mental health nursing from

Teachers College, Columbia University, New York.

The focus of Orlando’s paradigm hubs the context of a dynamic nurse-patient phenomenon constructivelyrealized through highlighting the key concepts such as :Patient Behavior, Nurse Reaction , Nurse Action.



The nursing process is set in motion by the PatientBehavior. All patient behavior, verbal ( a patient’s use of language ) or non-verbal ( includes physiological

symptoms, motor activity, and nonverbalcommunication) , no matter how insignificant, must beconsidered an expression of a need for help and needsto be validated .

The Patient behavior stimulates a Nurse Reaction .In this part, the beginning of the nurse-patientrelationship takes place. It is important to correctlyevaluate the behavior of the patient using the nursereactions steps to achieve positive feedback responsefrom the patient.



Critically considering one or two ways in

implementing Nurse Action. When providingcare, nursing action can be done eitherautomatic or deliberative. Automatic reactionsstem from nursing behaviors that are performed

to satisfy a directive other than the patient’sneed for help. Deliberative reaction is a“disciplined professional response” It can be

argued that all nursing actions are meant to helpthe client and should be considered deliberative.



We used Orlando’s Dynamic Nurse-Patient Relationship in ourpatient with Dandy-Walker Syndrome. It is ordered to give PRNParacetamol to the patient if experiencing fever. It was Monday when our

patient had fever. Automatic response of the nurse is to give the client aTepid Sponge Bath and administer Paracetamol as ordered.. Beingdeliberate in your actions include knowing the pharmacokinetics of thedrug in relation to the client’s physiologic standing.

The patient’s motor activity is a non-verbal cues that must be

considered to be an expression of a need for help. Since our patient isunsteady, we used precautionary measures by offering or giving helpwhen the patient wants to stand or walk. Also, side rails are always up toprevent client from fall.

The rapport built between us nurse and our patient also plays an

important role to achieve patient’s cooperation in achieving health. Ourpatient was able to verbalized her needs and what she feels, like forexample is pain. As a nurse, it is important for her case to identify andattend all her needs in order to promote a satisfaction in both parties andprevent the patient from feeling of helplessness.



FUNCTIONAL HEALTH PATTERNS

HEALTH PERCEPTION AND HEALTH MANAGEMENTPATTERN

BEFORE

Before the patient rate herself 6 from 1 to 10 which is fairand she consider herself as near to healthy child and she

usually eat fruits and vegetables to remain healthy as herhealth goal. Before she always washes her hands beforeand after she eats to prevent the microorganism entersher body as her traditional beliefs and practices.

Our patient sees her health care provider five times for this

past year because of her high fever, cough, pains anddrowsiness. Before, it’s not been easy for her to find waysto follow the suggestions of her Nurse and Doctor. Shepractices healthy eating habits as her safety practices.



She thinks healthy lifestyle is the mostimportant to keep health because she thinkthat it can lower the risk of getting an illness.For her personal hygiene she took a bath

regularly, hand washed regularly, trimmedher fingernails regularly, wear slippersregularly and brushed her tooth two times aday. On our patient’s environment they

practice complete sanitation asenvironmental sanitation practice.



DURING

Now that she was confined she rates herself 8 from 1

to 10 which is average. She usually eats fruits andvegetables to remain healthy as her health goal. Untilnow she always washes her hands before and after sheeats to prevent the microorganism that will enters herbody as her traditional beliefs and practices.

Our patient sees her health care provider every other daybecause she was confined for the reason that the V/P shuntwas infected. For her, now it’s been easy to find ways tofollow things nurses or doctors suggestions because thereis some instances that she needs to do what the doctor is

preventing her to do. She still practices healthy eatinghabits as her safety practices.



Until now she thinks that healthy lifestyle is the most important to keephealth still because it can lower the risk of getting an illness. Now that shewas confined, she usually take a bath three times a week, hand washed

regularly, trimmed her fingernails regularly, wear slippers regularly andbrushed her tooth two times a day. Our patient’s environments practicescomplete sanitation as environmental sanitation practice.

Analysis

The parent rate their daughter’s general health 8/10. Before, she can’t easilyfollow the doctor’s suggestion. Now, that she was confined she is willing tofollow the doctor’s suggestion. Before she usually take a bath everyday.Now she only do it three times a week.



E. NUTRITIONAL AND METABOLIC PATTEN

BEFORE Patient D’s typical daily food intake is biscuits and she has her medicines

supplements. She prefers to drink more juice than soft drinks or even water.proper nutritional food suitable for her condition proper nutritional foodsuitable for her condition Proper nutritional food suitable for her conditionproper nutritional food suitable for her condition proper nutritional foodsuitable for her condition



DURING

Patient D’s typical daily food intake is still biscuits and she has her medicinessupplements. She prefers to drink more juice than soft drinks or even water.proper nutritional food suitable for her condition proper nutritional foodsuitable for her condition Proper nutritional food suitable for her conditionproper nutritional food suitable for her condition proper nutritional foodsuitable for her condition nutritional food is suitable for health condition. He

still loves to eat chocolate foods and she hates vegetables even her parentspractice her to eat vegetables. Even now that she was confined, therepreparations of food want to be neat. She eats on her bed with her parents.Her grandmother is still the one who budgeting for her food. She lost herweight for 1kg. Patient D still has her fair appetite and she has discomfortsin eating. She has lots of restriction in food esp. on junk foods and street

foods. She had dryness on her skin and had dental problems. Analysis

There is no changes in her nutritional and metabolic pattern.



F. ELIMINATION PATTERN

BEFORE

She always does bowel elimination once a day andshe only feel pain if she is constipated because of eatingbanana. On urinary elimination she does it always, eighttimes a day and she doesn’t have any problem on

controlling her urine and she doesn’t feel any pain duringurinary elimination. She does it whenever it is necessaryand she do it frequent as needed to achieve normalelimination. She doesn’t have any odor problem on it.



DURING

Even now that she was confined, she always does bowel

elimination every other day and she only feels pain if she isconstipated. On urinary elimination she does it many times. And yet,she doesn’t have any problem on controlling her urine and shedoesn’t feel any pain during urinary elimination. She does itwhenever it is necessary and she do it frequent as needed to achieve

normal elimination. She doesn’t have any odor problem on it.

Analysis

Before, she used to void 8 times a day and now she is voidingapproximately 16 times a day.



G. ACTIVITY-EXERCISE PATTERN

BEFORE

Our patient always wakes up early to go toschool. Sometimes they do some exercises. Afterher school, she plays on their house with the PSP

and watch television. Patient D is satisfied withthe amount of exercise she gets from school andshe really needs to do it every day for her health.She spares her time playing her PSP and eats

outside with her family and was satisfy of it.



DURING

Our patient wakes up early in the hospital because sheneeds to take her medications. Then after that she is playing

with the PSP and talking with her parents. Patient D cannotperform exercises because of her confinement. Shespares her time playing PSP and eating. Her activitieswere limited because of her condition.

AnalysisBefore, she used to exercised at her school. Now that she

was confined she doesn’t have enough chance to haveher regular exercise pattern. Her activities was now

limited because of her situation.



H. SLEEP-REST PATTERN

BEFORE She sleeps mostly 11 hours a day and she is satisfied with that. She

usually sleeps at 9:00 P.M. and she usually wake-up at 8:00 A.Mcontinuously. She feels refreshed when she wake-up. She have pillow on herlap. She doesn’t have any problem in falling sleep and a simple massage can

help her sleep. She takes nap during afternoon. She prefers sleeping as aform of relaxation.



DURING

Since that Patient D is in hospital, she sleeps mostly 12 hours a

day and she is satisfied with that. She usually sleeps at 7:00 P.M andshe usually wake-up at 7:00 A.M not continuously because every nowand then she is taking her medications. She doesn’t feel refresheswhen she wake-up. She have pillow on her lap. Now, she hasproblem in falling sleep but a simple massage and drinking milk canhelp her sleep. She takes nap during afternoon. She prefers sleeping

as a form of relaxation.

Analysis

Before, she slept calmly and feel refreshed when she woke up. Butnow, she need to wake up at around midnight to take her

medication.



COGNITIVE-PERCEPTUAL PATTERN

Before:

The client can’t read, right and she also have difficulty on concentrating on reading and writing.About the client’s sense of hearing and sight, it seems to be good at all. There are no changes at allon her memories and she finds difficulty in learning. The client doesn’t have any problem inspeaking but she has a problem when it comes into reading and writing. The client’s sense of smelland taste seems to be good and she always plays and exercises when she’s at school.

Present:

The client still can’t read, right and still have difficulty on concentrating on her reading andwriting. About the client’s sense of hearing, it doesn’t change at all but when it comes to her senseof sight, there a change like her sight become blur and still she doesn’t use and eye glasses. Abouther memory, there’s no change at all and still she find difficulty in learning. About her speaking,reading and writing, still the same as before. There’s no also a change on her sense of smell and

taste. And right now the client can’t plays and exercises anymore in the school unlike before.

Analysis:

It seems that there’s a changes in the client like her vision became blurred and she does plays orexercise anymore in the school unlike before because on her condition.



SELF-PERCEPTION AND SELF-

CONCEPT PATTERN Before:

Before, most of the time , the client described herself that she feels sogood and said that there’s no changes on her body at all and she doesn’t feel anychanges on her body. The client expresses herself by telling what she feels insideto her parents. The client seems to be a moody type of person and she get angrywhen she don’t get her will, and when she doesn’t get her will, she frown andgrumble.

Present:

The client described herself that she feels so good but she said that herhead started to change after her operation. The client doesn’t feel any changeson her body except on her head. Still the client expresses herself by telling what

she feels inside to her parents. The client still seems to be a moody type of person and she still get angry when she don’t get her will, and when she doesn’tget her will, she frown and grumble.

Analysis:

The client finds that something is changing on her after she goes throughthe operation. She noticed that her head circumference is changing.



ROLE-RELATIONSHIP PATTERN

Before:

The client lives with her parents and her grandparents, and the client seems to be aprincess on her family because she’s the only child of her parents. It’s also seems that the familydoesn’t find any difficult on handling a family problems. When it comes in organizing someactivities, the client’s mother and grandmother we’re the one who organizes their activities. Theclient tells to her parents when she feels something unusual to her. Things are seem good whenshe’s at school and the client feels part of the neighborhood.

Present: The client still lives with her parents and her grandparents, and still the client seems to be a

princess on her family because she’s the only child of her parents. It’s also seems that the stillfamily doesn’t find any difficult on handling a family problems. When it comes in organizing someactivities, the client’s mother and grandmother we’re still the one who organizes their activities.The client tells to her parents when she feels something unusual to her. Things are seem not goodwhen the client stopped going to her school because she seems to be shy with her condition andthe client feels apart of the neighborhood because of her condition.

Analysis: Thing get change after her operation, she stopped on her studies and she feels that she’s

not a part of the neighborhood because she seems to be shy on her condition.



COPING-STRESS TOLERANCE

PATTERN Before:

The client find herself on handling her stress by playing andmost of the time she finds that her mother is the most helpfulwhen it comes in talking things over. And there are no changes atall on her life.

After:

The client still find herself on handling her stress by playingand most of the time she still finds that her mother is the mosthelpful when it comes in talking things over. And now there’s achanges on her life after the operation in her life.

Analysis: After the operation, there’s a change on the client’s life, she

seems to be shy to people because of her condition.



VALUE-BELIEF PATTERN

Before: The clients finds that eating healthy foods such as vegetables can make a

person healthy and when it comes in prioritization, the client prioritize health to be #1. She always prays every time before she goes to sleep. The client seems to get

whatever she wants when her parents can afford the things that she wants. Religion

were seems to be important to the client because it seems that she get her strength

through prayers and the support of her family.

After:

The clients still finds that eating healthy foods such as vegetables can make a personhealthy and when it comes in prioritization and still the client prioritize health to be #

1. She still prays every time before she goes to sleep. The client still seems to get

whatever she wants when her parents can afford the things that she wants because

she’s the only child in their family. Religions were still to be important to the client

because it seems that she get her strength through prayers and the support of her

family.

Analysis:

There’s no change at all when it comes to the client’s values and beliefs.



Area to assess Normal Findings Abnormal Findings

ANTHROPOMETRIC

MEASUREMENT

WEIGHT: 45 LBS.

HEIGHT: 3’11 ft.

The patient’s weight is below the

normal range.

VITAL SIGNS TEMPPERATURE: 37.4 DEGREES

CELSIUS

PULSE RATE: 78 bpm

RESPIRATORY RATE: 23 cpm

BLOOD PRESSURE: 90/60 mmHg

SKIN Skin is smooth Pale in skin color.

When skin is released it rapidly

returns to its original contour.

HAIR Hair varies from dark black to pale

blonde.

The distribution of hair is partially

scalp baldness.

The texture of hair was thin and

easily breaks off.

NAILS Nails are normally having a pink

cast and have a capillary refill

within 2-3 seconds.

The shape and configuration of

nails are smooth and slightlyrounded to flat.

The textures of the nails base are

firm upon palpation.

HEAD The scalp is normally shiny, intact

and without any lesions.

There is an enlargement of the

head without any enlargement of

the facial structures.

Hard masses in the cranial bones

upon palpation.



FACE The facial structure is

partially deformed.

EYES Has normal visual acuity of

20/20.

EYELIDS The eyelids appear

symmetrically.

CORNEA The corneal surface was

moist and shiny withoutdischarges.

IRIS The iris is smooth and

without apparent

vascularity.

PUPIL The pupil is deep black,

round and of equal

diameter ranging from 2-

6mm.

LENS The lenses are transparent.

VOICE WHISPER TEST Hard to correctly repeat the

words when whispered.



EXTERNAL EAR The color is matching the

color of the rest of the

patient’s skin and is

positioned centrally andis proportion to the head.

The patient doesn’t

complain pain or

tenderness during

palpation.

NOSE Located at the midline of

the face and is without

swelling, bleeding, lesions

and masses.

Each nostril is patent.

No evidence of swelling

around the nose and

eyes.LIPS The lips and membranes

are pinkish and have no

lesions or inflammation.

The lips are dry.

TONGUE The tongue is in the

midline of the tongue.

The tongue doesn’t move

freely.

TEETH Th t th t i



TEETH The teeth are not in

proper alignment, has

dental caries.

NECK The muscle is

symmetrical.

Has palpable mass.

VP shunt is seen and

palpable

BREAST The breasts and axillae are

flesh colored, and the

areolar areas and nipples

are darker in

pigmentation.

No tenderness upon

palpation and has no

lesions.ABDOMEN The right lower quadrant

of the abdomen is

protruded because of

thew swelling

abdomen has tenderness

upon palpation

VP shunt is seen and

palpable BOWEL SOUNDS Hypoactive bowel sounds

GENITALIA N/E N/E

KNEES Knees are in alignment

with each other

The skin is fair in color

without any lesions and

scars.

ANKLE AND FOOT The foot is alignment with

the lower leg.



Components Normal Values SI units

WBC count 5.0 Adult: 5-10

Newborn: 9-10

x10^9/L

Hemoglobin 111 Male: 140-170

Female: 120-140 Newborn: 187-201

gm/L

Hematocrit 0.351 Male: 0.40-0.050

Female: 0.38-0.48

Newborn: 0.49-0.55

%

LABORATORY EXAMINATION Ms. D 6y/o/Female Room: OPD

Sample no: 083 HEMATOLOGY



Differential count Normal Values SI units

Neutrophil 0.49 Adult: 0.45-0.65

Newborn: 0.40-0.58

%

Lymphocyte 0.42 Adult: 0.25-0.50

Newborn: 0.31-0.60

%

Monocyte 0.05 0.02-0.06 %

Eosinophils 0.04 0.02-0.04 %

Basophils 0.00-0.01 %

Bands 0.02-0.04 %

Platelet count 331 150-450 x10^9/L

MCV 82.5 80-100 fL

MCH 26.1 27-31 pg

MCHC 316 320-336 g/L

RDW 14.3 11.6-14.6 %

Toxic Granules



Drug study

DRUG ACTION INDICATION SIDE EFFECT NURSING INTERVENTION



Generic Name

Oxacilin sodium

Dosage/ Route/

Frequency 475 mg IV q12

hrs.

Bactericidal: Inhibits

synthesis of bacterial

cell wall, causing cell

death

Infections due to

penicillinase-producing

staphylococci; may be use to

initiate treatment when a

staphylococci infection issuspected.

Lethargy, hallucinations,

seizures, stomatitis, sore

mouth, anemia.

Report difficulty of

breathing, rashes, severe

diarrhea, severe pain at

injection site, mouth sores.

DRUG ACTION INDICATION SIDE EFFECT NURSING INTERVENTION



Generic Name

Paracetamol

Brand Name

Biogesic

Dosage/ Route/

Frequency

250 mg/ oral/

PRN

Antipyretic: Reduces

fever by acting directly

on the hypothalamic

heat-regulating center

causes vasodilation

and sweating, which

helps dissipate heat.

Bacterial or viral infections

with pain and fever.

Headache, chest pain,

dyspnea, hepatic toxicity and

failure.

Advice the patient not to

exceed recommended

dosage and not to take for

longer than 10 days

Take the drug only for

complaints indicated; it is

not an inflammatory agent

Give drug with food if GI

upset occurs



DRUG ACTION INDICATION SIDE EFFECT NURSING

INTERVENTION

Generic Name

Ceftriaxo

ne

Sodium Brand Name

Rocephin

Dosage/

Route/

Frequency

475 mgIV q12

hrs.

Bactericidal:

Inhibits

synthesis of

bacterial cell

wall, causingcell death

> Infections caused

by Staphylococcus

aureus

Headache, nausea,

vomiting,

abdominal pain,

pseudomembranous

colitis,nephtotoxicity

Protect drug from

light

Have Vitamin K

available in case

hypoprothrombinemia occurs

Discontinue if

hypersensitivity

occurs



List of Prioritized Problems

Acute pain

Hyperthermia

Risk for situational low-esteem

ASSESSMENT NURSING PLANNING INTERVENTION EVALUATION



DIAGNOSIS

Subjective

“Mainit ang

pakiramdam

ko”, asverbalized by

the patient

Objective

Flushed skin

Warm to

touch

T= 37.9 0C

Increased body

temperature

related to

infection

After 8 0 of nursing

intervention, the

patient will be able

to maintain normalbody temperature

1. Monitored

temperature.

2. Promoted surface

cooling by means of tepid sponge bath

3. Monitored intake and

output

4. Discussed importance

of adequate fluid

intake to prevent

dehydration

5. Administered

paracetamol as

ordered.

After of nursing

intervention, patient’s

temperature was

reduced 36 0C from 37.90C

ASSESSMENT NURSINGDIAGNOSIS

PLANNING INTERVENTIONS EVALUATION



DIAGNOSIS

Subjective:

“ Masakit yung itto ko

pag hinahawakan” as

verbalized by the

patient.

Pain scale of 7/10according to the

patient.

Objective:

Positioning to avoid

pain

Irritable

Reduced interaction

with people and

environment.

Acute Pain

related to

infective VP

shunt.

After 8hours of nursing

intervention, the patient

will:

Report pain as

tolerated.

Demonstrated use of relaxation skills and

diversional activities.

Verbalized non

pharmacologic

methods that provide

relief.

Monitored pain

Provided comfort

measures (e.g.

repositioning)

Encouraged use of

relaxation techniqueto distract attention

and reduce tension

Encouraged

diversional activities

(playing psp)

After 8 hours of nursing

intervention the patient:

Reported pain as tolerated

Demonstrated use of

relaxation skills and

diversional activities Verbalized non

pharmacologic methods that

provide relief

Pain scale is also reduced

from 7/10 to 4/10

ASSESSMENT NURSING

DIAGNOSISPLANNING INTERVENTIONS EVALUATION



DIAGNOSIS

Subjective:

“nahihiya akomakipaglaro sa

ibang bata eh.” As

verbalized by the

patient.

Objective: Shyness

Self-isolation

Risk for

situationallow self-

esteem

due to

physical

illness

After 5 days of

nursingintervention, the

patient will:

Partially

improve her

self confidence.

Communicate

and interact

well with

other people

Listened to

client’s

comments and

stories

Encouraged

significant

others to treatclient normally

as possible

After 5 days of nursing

intervention thepatient:

Partially improved

her self

confidence.

Interacted wellwith other people



DISCHARGE PLANNING

Medication •Continue taking medicines as prescribed at the right dose, time, frequency, and routeExercise

•Encouraged patient to exercise regularly•Encouraged to get enough rest and sleep•Advised patient to stay in clean, safe and comfortable place

Treatment •Instructed the patient to seek medical aid in the nearest hospital for continuing health care•Encouraged to follow treatment regimen

Health Teaching •The patient is instructed about the importance of an adequate oral intake and of maintaining bowel and urinary tract function•The patient should resume activities gradually

•Encouraged patient to limit doing strenuous activities

Out-patient follow up •The patient is reminded about following appointment after 2 weeks

Diet •Encourage to follow recommended diet

Spiritual Counseling

•Advise the patient to go to the church every weekends to uplift of spiritual health•Encourage patient to participate in desired religious activities

dandy walker presentation

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