A Case Study On Meningioma

A Case Study on Meningioma
In Partial Fulfilment of the Requirements In

NCM 103 Medical Surgical Nursing
(Related Learning Experience)
A Requirement Presented to the

Faculty of the Nursing Department of
Polytechnic College of Davao del Sur, Inc.
Submitted by:
BSN- III
Jhensczy Hazel Maye Alba
Pryll John Colita
Aileen Claire Dagpin
JANUARY 2017
ACKNOWLEDGEMENT
The researchers of this case study would like to extend their warmest gratitude to all the
people who made the success of this undertaking a reality. First and foremost, to the Almighty
Father, for His unceasing love and blessings; for giving us enough power and fortitude to face all
the hardships in making this work. To Him be all the Glory and Praise!
To the institution of Polytechnic College of Davao del Sur, Inc. and the Dean of Nursing,
Madam Jennifer P. Ybaez, RN , MAN; Clinical Coordinator Madam Marina Liu Ledesma, RN ,
MAN and Clinical Instructor, Madam Lourders P. Abecia,RN for invaluable time, knowledge
and effort rendered. To the staff and personel of Southern Philippines Medical Center, especially
in the Neuro Ward foe giving us the oppurtunity to complete this endeavour.
To our classmates, friends and mentors, for giving the inspiration to finish this seemingly
impossible task.
And lastly, to the client and her family who willingly cooperated and gave their time in
answering the questions and sharing some secluded information.
ACKNOWLEDGEMENT
The researchers of this case study would like to extend their warmest gratitude to all the people
who made the success of this undertaking a reality. First and foremost, to the Almighty Father,
for His unceasing love and blessings; for giving us enough power and fortitude to face all the
hardships in making this work. To Him be all the Glory and Praise!
To the institution of Polytechnic College of Davao del Sur, Inc. and the Dean of Nursing,
Madam Jennifer P. Ybaez, RN , MAN; Clinical Coordinator Madam Marina Liu Ledesma, RN ,
MAN and Clinical Instructor, Madam Lourders P. Abecia,RN for invaluable time, knowledge
and effort rendered. To the staff and personel of Southern Philippines Medical Center, especially
in the Neuro Ward foe giving us the oppurtunity to complete this endeavour.
To our classmates, friends and mentors, for giving the inspiration to finish this seemingly
impossible task.
And lastly, to the client and her family who willingly cooperated and gave their time in
answering the questions and sharing some secluded information.
TABLE OF CONTENTS
Chapter I Introduction
Chapter II Identification of the Case
Personal Information
Family Health History/Genogram
Background/History
Medical History
History of present illness
Socio-economic background
Chapter III Anatomy and Physiology
Chapter IV Symptomatology
Chapter V Physiology
Chapter VI Medical Management
Ideal
Actual/ Doctors order
Chapter VII Laboratory Findings
Chapter VIII Nursing Theory
Chapter IX Nursing Assessment
Chapter X Nursing Management
NCP
Drug Study
Chapter XI Health Teachings
Chapter XII Discharge Plan
Chapter XIII Prognosis
Chapter XIV Evaluation
Chapter XV Implication of the Study
References
Chapter I
INTRODUCTION
The main switch in mans anatomical and physiological function is his brain. The brain consists
of a huge network of neurons that control the bodys 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.
A meningioma is a tumor that arises from the meninges the membranes that surround your
brain and spinal cord. Most meningiomas are noncancerous (benign), though rarely a
meningioma may be cancerous (malignant). Some meningiomas are classified as atypical,
meaning they're neither benign nor malignant but, rather, something in between. (Ellison D., et
al).
Meningiomas occur most commonly in older women around 30-60 years old. But a meningioma
can occur in males and at any age, including childhood.A meningioma doesn't always require
immediate treatment.
A meningioma that causes no significant signs and symptoms may be monitored over time.
The incidence of meningioma appears to have increased in the past few decades. An estimated
18,000 new cases of malignant meningiomas occur per year: 14.2 per 100,000 men and 13.9 per
100,000 women (ABTA, 2014). Meningiomas ultimately cause death by impairing vital function,
such as respiration or through increased ICP.
Despite effort in researching data in Philippines concerning cases of meningioma, however

futile. It could either be that data has been held confidential and have not been published or it is
likely that meningioma case is not considered relevant for studies yet.
This case study which primarily talks about meningiomas 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 nations
health our group 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.
Chapter II
IDENTIFICATION OF THE CASE
A. Personal Information
Patients Name: Leila

Age: 39 yrs. old
Birthday: December 6, 1977
Gender: Female
Nationality: Filipino
Religion: Roman Catholic
Civil Status: Married
Address: Prk. 2 Salakot, Talomo Dist., Davao City
Occupation: Housewife
Educational Background: Undergraduate (3rd year high school)
Mothers Name: Leni

Occupation: (Deceased)
Spouses Name: Dayan
Occupation: Carpenter/Driver
Case No.: 2016063184

Date Admitted: November 12, 2016
Time Admitted: 2:10 PM
Chief complaint: Severe Headache
Admitting diagnosis: Meningioma Left Fronto Parietal Area
Final diagnosis: Meningioma Fronto Occipital Area
Procedure: Craniectomy excision of brain tumor
Attending physician: Dr. Chua
B. Family Health History (GENOGRAM)
Paternal Side Maternal Side
103 79
59 90 88
79 80
55 52 49 47 45 43 41 39
36
Legend:
HP
Male Female Alive & Alcohol Smoke Cance Strok Diabeti Brain N Murdere
Patient Well ic r e c Tumor d
Deceas Unknow
ed n
Patient Leilas paternal side are unknown since she claimed that she doesnt know much of them
because her parents broke up when she was 3 years old. Her familys maternal side has
hereditary diseases such as hypertension, diabetes mellitus, CVA and cancer, although the patient
is the only one who have a brain tumor. Her grandmother died because of breast cancer and her
mother died due to tongue cancer. The eldest brother of their mother died because he was killed
by their neighbor for no reason and one of her uncles died because of CVA. The patients eldest
sister died due to DM.
C. Background/History
Patient Leila was born in Gingoog City in Misamis Oriental, she is the 8th child among her
siblings, but when her parents separate when she was 3 years old, her mother decided to go back
to her hometown in Davao City.
The patient was not able to finish her secondary level due to financial issues. She is only up to
third year highschool at Davao City National High School. When she was 16, she started
working in palengke or market as a saleslady, selling vegetables. And soon got married at the
age of 27. Now, they were blessed with 5 children.
According to patient Leila she is having occasional mild to moderate headaches and blurry
visions since 2014 which she only disregard as she thought that it was due to stressed.
On April 2016, patient observed that she started having severe headaches a couple of days after
she got birth with her youngest child and sometimes with occasional grand mal convulsion which
she didnt pay attention as she thought that it was due to not taking medications due to fever.
D. Medical History
According to the patient, she never had any serious illnesses in the past that requires admission
to the hospital but at the age of eight, she had chickenpox. Whenever she became ill, she only
uses alternative ways in treating herself such as herbal medicines. She also stated that she had
complete vaccinations since childhood from their local barangay health center.
The patient gave birth to her first three children only at their home. However, on her 4th child, she
gave birth at SPMC via caesarian section.
D. History of present illness
A day prior to admission the patient experienced seizure that last from a few seconds to more
than five minutes, and that was the time her husband decided to take her to the hospital on
November 12, 2016.
E.Socio-Economic Background
Currently, the patient is a housewife. Her husband works as a carpenter in daytime and earns 300
pesos a day. After working as a carpenter, in the evening, her husband drives their tricycle to earn
extra income of 250 per night. According to her husband, he earns about 15,000-16,000 a month
excluding their daily needs. Their hospital bill was covered by the Lingap Para sa Mahirap.
Chapter III
ANATOMY AND PHYSIOLOGY OF THE BRAIN & MENINGES

The brain, when fully developed, is a large organ which fills the cranial cavity. Early in its
development the brain becomes divided into three parts known as the forebrain, the midbrain and
the hindbrain.
The forebrain is the largest part and is called the cerebrum; it is divided into the right and left
hemispheres by a deep longitudinal fissure. The separation is complete t the front and back but in
the center, the hemispheres are joined by a broad band of nerve fibers called the corpus callosum.
The outer layer of the cerebrum is called the cerebral cortex and is composed of grey matter (cell
bodies) thrown into numerous folds or convolutions called gyri, separated by fissures called
sulci. This enables the surface area of the brain, and therefore the number of cell bodies, to be
increased greatly. The general pattern of the gyri and sulci is the same in all humans; three main
sulci divide each hemisphere into four lobes, each named after the skull bone under which it lies.
The central sulcus runs downwards and forwards from the top of the hemisphere to a point just
above the lateral sulcus; the lateral sulcus runs backwards from the lower part of the front of the
brain and the parieto-occipital sulcus runs downwards and forwards for a short way from the
upper posterior part of the hemisphere. The lobes of the hemispheres are the frontal lobe, lying in
front of the central sulcus and above the lateral sulcus; the parietal lobe lying between the central
sulcus and the parieto-occipital sulcus and above the line of the lateral sulcus; the occipital lobe,
which forms the back of the hemisphere and the temporal lobe lying below the lateral sulcus and
extending back to the occipital lobe.
The area lying immediately in front of the central sulcus between is known as the pre-central
gyrus and is the motor area from which arise many of the motor fibres of the central nervous
system. Immediately behind the central sulcus lies the sensory area, called the post-central
gyrus, in the cells of which several kinds of sensation are interpreted.
Longitudinal section of a hemisphere shows grey matter (cell bodies) on the outside and white
matter (nerve fibres) forming the interior. The nerve fibres connect one part of the brain with the
other parts and with the spinal cord, but within the white matter groups of nerve cells can be seen
forming areas of grey matter. These areas of grey matter are called cerebral nuclei. The main
function of these areas is coordination of movement and posture of the body: disorders affecting
these areas cause jerky movements and unsteadiness.
The cavities within the brain are called ventricles. There are two lateral ventricles, a central third
ventricle and a fourth ventricle between the cerebellum and the pons. All are filled with
cerebrospinal fluid.
The midbrain lies between the forebrain and the hindbrain. It is about 2 cm in length and
consists of two stalk-like bands of white matter called the cerebral peduncles, which convey
impulses passing to and from the brain and spinal cord, and four small prominences called the
quadrigeminal bodies, which are concerned with sight and hearing reflexes. The pineal body lies
between the two upper quadrigeminal bodies.
The hindbrain has three parts:

1. The pons, which lies between the midbrain above and the medulla oblongata below. It
contains fibres which carry impulses upwards and downwards and some which
communicate with the cerebellum.
2. The medulla oblongata lies between the pons above and the spinal cord below. It
contains the cardiac and respiratory centres which are also known as the vital centres
and which control the heart and respiration.
3. The cerebellum projects backwards beneath the occipital lobes of the cerebrum. It is
connected to the midbrain, the pons and the medulla oblongata by three bands of
fibres called the superior, middle and inferior cerebellar peduncles respectively. The
cerebellum is responsible for the coordination of muscular activity, control of muscle
tone and maintenance of posture. It is continuously receiving sensory impulses
concerning the degree of stretch in muscles, the position of joints and information
from the cerebral cortex. It sends information to the thalamus and the cerebral cortex.
The midbrain, the pons and the medulla have many functions in common and together re often
known as the brain stem. This area also contains the nuclei from which originate the cranial
nerves.
Meninges
The meninges (they are serous membranes) are three layers of protective tissue called the dura
mater, arachnoid mater, and pia mater meninges of the brain and spinal cord are continuous,
being linked through the magnum foramen.
Dura Mater
Most superior of the layers it is tough and inflexible and forms several structures that separate
the cranial cavity into compartments and protect the brain from displacement.
Arachnoid Mater
Middle layer of the meninges makes arachnoid villi, small protrusions through the dura mater
into the venous sinuses of the brain, which allow CSF to exit the sub-arachnoid space and enter
the blood stream. Cerebrospinal fluid (CSF) flows under the arachnoid in the subarachnoid
space.
Pia Mater, or Pia

The delicate innermost layer of the meninges a thin fibrous tissue that is impermeable to fluid
which allows it to enclose CSF (cerebrospinal fluid). By containing CSF, pia works with the
other meningeal layers to protect and cushion the brain. Allows blood vessels to pass through and
nourish the brain. The perivascular space created between blood vessels and pia mater functions
as a lymphatic system for the brain. Lines the brain down into its sulci (folds).
The Spaces Between the Layers:
Epidural Space
Between the dura mater and the skull. Common location for hemorrhaging in the brain.
Subdural Space
Between the dura mater and the middle layer of the meninges, the arachnoid mater. When
bleeding occurs, blood may collect here and push down on the lower layers of the meninges,
possible causing brain damage.
Subarachanoid Space
From the fourth ventricle, the cerebrospinal fluid passes into the subarachnoid space where it
circulates around the outside of the brain and spinal cord and eventually makes its way to the
superior sagittal sinus via the arachnoid granulations also called arachnoid villi. In the superior
sagittal sinus, the cerebrospinal fluid is reabsorbed into the blood stream.
Cerebrospinal fluid (CSF) clear, saline bodily fluid that occupies the subarachnoid space and
the ventricular system around and inside the brain. It is produced continuously at a steady rate
and is essential for the normal functioning of the CNS. It acts as a cushion for the neuraxis, also
bringing nutrients to the brain and spinal cord and removing waste from the system.
Chapter IV
ETIOLOGY AND SYMPTOMATOLOGY
ETIOLOGY
PREDISPOSING FACTORS
PRESENT ABSENT JUSTIFICATION

1. Gender Females are more likely to have
meningioma. A progesterone-induced
mechanism has also been reported to be
responsible for enlargement of meningiomas
in pregnancy, it is believed that female
hormones may play a role.
Source: http://www.mayoclinic.org/diseases-
conditions/meningioma/basics/risk-
factors/con-20026098
2. Age Meningiom are more common in female
ages 30-60 years old , although people of
any age can develop a tumor. Which is
present to our patient since she is now 39
years old.
Source:
M. Ponz De Leon, Familial and Hereditary
Tumors. Recent Results in Cancer 1136,
DOI 10.1007/978-3-642-85076-9_8
3. Heredity Patient Leilas mother has tongue cancer.
Grandmother also has a breast cancer. A
mutant gene in the long arm of chromosome
could be involved in the development of
meningioma
Source:
M. Ponz De Leon, Familial and Hereditary
Tumors. Recent Results in Cancer 1136,
DOI 10.1007/978-3-642-85076-9_8
4. Environment Exposure to a lot of toxins and radiation can
increase the risk in developing a tumor.
study that tested the possibility of links
between cancer and chronic exposure to the
type of radiation emitted from cell phones
and wireless devices
Source:
https://www.scientificamerican.com/article/
major-cell-phone-radiation-study-reignites-
cancer-questions/
PRECIPITATING FACTORS
PRESENT ABSENT JUSTIFICATION

1. Exposure Studies have shown that there are certain types
to viral of viruses that can cause brain tumors and there
infections are some infections with certain viruses,
bacteria, and parasites have been recognized as
risk factors for several types of cancer in
humans, such as Herpes simplex virus type 1
encephalitis
Sources: https://www.cancer.org/cancer/cancer-
causes/infectious-agents/infections-that-can-
lead-to-cancer/intro.html
http://www.elsevier.es/en-revista-neurologia-
english-edition--495-articulo-herpes-simplex-
virus-type-1-S217358081500098X
2. Pregnancy Meningiomas are linked to female hormones.
Since during pregnancy there is a surge of these
hormones, it is linked to having a meningioma.
Source:
http://www.eatingwell.com/nutrition_health/nutr
ition_news_information/does_grilling_cause_ca
ncer
3. Diet The client admitted that she frequently eats
grilled meat. Any grilled meat when eaten
frequently can cause possible tumors. It is not
the meat that cause possible tumors, rather
cooking meat at the high temperatures you use
to grillas well as broil and frycreates
heterocyclic amines (HCAs) and polycyclic
aromatic hydrocarbons
(PAHs), compounds linked with some cancers.
Source:
http://www.eatingwell.com/nutrition_health/nutr
ition_news_information/does_grilling_cause_ca
ncer
SYMPTOMATOLOGY
SYMPTOMS PRESENT ABSENT JUSTIFICATION

Patient claimed that she is having blurry
1. Changes in
visions for 2 years but now the patient is
blind on both eyes but can see only
vision, such
shadows.
as seeing
These symptoms occur when the
double or
meningioma directly affects a part of the
blurriness
brain that controls vision. Moreover, for
the patients case the affected part was the
occipital area, which is responsible for our
visions.
Source:
https://www.uptodate.com/contents/
meningioma-beyond-the-basics#H1
The patient started to suffer moderate to
2. Headaches
severe headaches last 2014 until now, this
that worsen
is because of the increasing size of the
with time
tumor. As meningioma grows, it increases
the pressure inside the skull, which causes
the pain.
Source:
Meningiomas can cause hearing loss if the
3. Hearing loss
tumor affects the inner ear or the nerve that
controls the hearing but in our patients
case it is absent because she has good
hearing acuity.
Source:
Patient claimed that shes having a hard
4. Memory loss
time remembering events that happened in
her life since after she delivered her
youngest child.
These symptoms occur when the
meningioma directly affects a part of the
brain that controls the memory. Moreover,
for the patients case, the affected part was
the occipital area but it also affects the
medial temporal lobe because of its
increasing size, which is responsible for
our memory.
Source:
Meningiomas can cause loss of smell if the
5. Loss of smell
tumor affects the nerve that controls the
sense of smell but in our patients case it is
absent because she can smell properly.
Source:
In 2014, patient Leila suffered her first
6. Seizures
seizure attack.
This symptom is caused by the
meningioma that overlie the cerebrum
which is in our patients case is present.
Source:
https://en.m.wikipedia.org
/wiki/meningioma
The patient cant tolerate well on her
7. Weakness in
activities of daily living. She is dependent
the arms or
and needs assistance from the nurse or her
legs
husband. She claims that she started
feeling this weakness a week prior to
admission.
Weakness in legs and arms may be caused
by tumors that overlie the parasagittal
frontoparietal region, which is present to
our patient because of the increasing size
of the tumor.
Source:
https://en.m.wikipedia.org/wiki/
meningioma
Chapter V
PATHOPHYSIOLOGY
PREDISPOSING FACTORS PRECIPITATING FACTORS
Gender Exposure to viral infections

Age Pregnancy
Heredity Diet
Environment
Glial cells in the brain
Cellular Damage
Persistence of Multi-
bit factors
STAGES:
Point mutation
Chromosomal translocation
Chromosomal amplification
Chromosomal change
Gene silencing
Cellular Aberration
Signs and Symptoms:

Invasion to nearby
cells Headaches, which can be
most severe in the morning
Seizures or convulsions
Anorexia
Tumor growth Weight loss
(obstruction) Dizziness
Changes in emotional state
and behavior
Tinnitus and vertigo
Increased tumor size
Consumption of nutrients by tumor
Tumor growth to different areas of

the brain
Increased ICP
Compression of parts
If treated: If not treated:
Medical-Surgical
Surgery-
craniectomy/craniotomy
Radiotherapy
Chemotherapy
(patient is in this level only)
If without If with
complications complications
Good Poor
prognosis prognosis
Cerebral ischemia Primary malignant

neoplasm
Cerebral hypoxia
Angiogenesis
Inflammation Invasion to lymphatic

and blood vessels
Cerebral edema
No room for Arrest in capillary bed
expansion organs
Transport interaction
Cardiac/respiratory
arrest with other blood
elements
DEATH
Adherence of tumor
cells
Metastasis
DEATH
Chapter VI
Medical Management
A. Ideal
Meningiomas are seldom detected before they commence to cause indications. A doctor performs
a neurological assessment and may request for a brain scan: an MRI and/or a CT scan that will
allow to locate the meningioma and determine the sign should clinical signs suggest the
possibility of a tumor.
Sometimes a biopsy may be performed, where a surgeon will remove part of all of the tumor to
determine whether it is benign or malignant. Observation will then be recommended if the tumor
is not causing any symptoms. To determine if the tumor is growing, regular brain scans will be
performed.
A surgery may be required if the tumor's growth threatens to create complications or if
symptoms begin to grow. Should it be, a craniotomy will usually be performed, in which a piece
of bone from the skull will be remove. The procedure will give the surgeon access to the affected
portion of the brain and will remove the tumor or as much of it as possible and the bone that
was taken out at the start of the procedure will then be replaced.
The location of the meningioma will determine how accessible it is to the surgeon. If it can't be
accessed via surgery, radiation therapy is likely applied as radiation can shrink the tumor or can
avoid the tumor from growing any larger. In addition, radiation is also a toll that can kill cancer
cells if the tumor is malignant and can also be used on the parts of a tumor the surgeon was
unable to remove.
B. Actual/Doctors Order
November 12, 2016 Justification/Rationale

@ 2:10 pm
Dr. Paglomutan
Please admit under neuro ward Pt. requires pre-op nursing care routine for
further investigation in preparation for surgery.
secure consent Pt. must give permission before receiving any
type of medical treatment or surgery.
DAT To determine whether pt. food intake will not
lead to any complications and if the pt. needs
further monitoring for further lab tests
IVF PLR To hydrate the pt. appropriately.
To shift fluids
Labs attach to chart + clearance To make sure that pt. is cleared and ready for
the procedure
secure 3 U PRBC + 1 U ff. up stand by To prevent blood loss during the procedure
on OR
Secure mech vent neuro for Helps pt. to breathe after the surgery.
reservation for possible post OR
admission
Inform neuro of this admission Neuro will check the clinical history and health
standing of the patient based on available
documentation ensuring that pt is eligible for
the procedure

@ 9:11 AM
Dr. Malasig
NVS q4 To obtain baseline data for comparison
Still for OR scheduling Pt is being prepared for the procedure
Refer for unusualities Further evaluation and management

@ 7:00 AM
Dr. Malasig
Secure referral from IM neuro for Pt should be fit for the operating procedure to
evaluation and management prevent intra and post-op complications
Still for OR schedule Pt is being prepared for the procedure
Refer unusualities For further evaluation and management.
November 15,2016 Justification/Rationale

@ 5:45 AM
Dr. Malasig
Follow up referral to IM neuro Ensuring that evaluation and management are
in order
For OR scheduling As per elective procedure standard
Refer For further evaluation and management

@ 3:40 PM
Dr. Dillera
Thank you very much for referral Pt has been evaluated and examined.
Patient seen and examined documentation is done and plans has been
History recorded established.
Noted surgical plans
Start dexamethasone 4mg IVTT q6h To control edema

@ 2:07 AM
Dr. Paglomutan
For OR scheduling For elective procedure
DAT In preparation for the elective procedure, pt. is
required to DAT
PLR 1 L @100cc/hour To hydrate the patient appropriately
Labs CBC, Na, K, Ca, Pt lab result must be monitored ensuring that
pt. is eligible for the procedure

@ 7:00 AM
Dr. Paglomutan
For OR scheduling To update the OR schedule
DAT Pt is allowed to DAT in preparation for the
procedure, once procedure is done pt. food
intake will be as per medical advised
Continue meds To continue therapeutic regimen
Refer unusualities For further evaluation and management

@ 2:30 PM
Dr. Dillera
Continue meds To continue therapeutic regimen
Secure OR scheduling To confirm the elective procedure as scheduled
Refer back as necessary For any unusualities referral is advised
Diazepam PRN for seizure To treat seizure

Secure CBC, PC, Na, K, Ca, Crea, Mg As per standard of operating procedure, pt. lab
results must be checked and documented to
make sure that there will be no intra and post-
op complications

@ 7:00 AM
Dr. Paglomutan
For scheduling To schedule the procedure as per OR
availability
Refer for unusualities For further evaluation and management

@ 10:00 AM
Dr. Paglomutan
Still for OR scheduling No available slot for the procedure
Continue meds For therapeutic regimen

November 19,2016
@ 9:00 PM
Dr. Paglomutan
clonidine 150 mcg IVTT now To address the issue of hypertension

@ 9:00 PM
Dr. Paglomutan
For OR scheduling Due to unavailability of OR slot

@ 7:00 AM
Dr. Malasig
Still for OR scheduling No slot available for OR procedure
Continue meds. For therapeutic regimen
Refer Should requires, to address clinical issues early

@ 7:00 AM
Dr. Paglomutan
Schedule patient for craniotomy Schedule for elective procedure has finally
Excision of tumor tomorrow 11/23/16 confirmed
Secure consent Pt. must give permission before receiving any
type of medical treatment or surgery.
Inform OR/AROD To prepare OR bed, prepare the surgical
equipment, ensuring that standby response
team is available
NPO post-midnight As required to prevent aspiration intra-op
Meds: ceftriaxone 1g IVTT q8h Ceftriaxone is given before surgery to prevent
ranitidine 50 mg IVTT q8h or 6 infections that may develop after the operation.
on NPO
Ranitidine to prevent ulcer while patient is on
NPO diet.
ff. up procurement of PRBC & FFP To make sure that it is available as per needed
Anesthesia Pre-Op Orders

@ 5:15 PM
Dr. Toledo
Thank you for this referral
Pt. seen and examined As per standard operating procedure
History and physical examination To determine the appropriate type of anesthesia

reviewed to be given to the pt.
Meds: 1 omeprazole 40 mg 1 tab @ 12 For prophylaxis of acid aspiration prior to
mn surgery
IVF: D5LR 1L @100cc/hr To hydrate the patient appropriately
PNSS 1L @ KVO (bloodset) To supply glucose to the brain since the pt is
on NPO
ensured patency of IVF PTOR To prevent any complications.
VS en route to OR To be monitored strictly as per clinical and
operating standard
NPO post-midnight To prevent aspiration inra-operatively
refer Pt needs to be assess by other specialty to
double check pts eligibility to the procedure
Anesthesia Post-Op Orders

@ 12:45 PM
Dr. Toledo
To PACU then neuro ICU To recover pt. from anesthesia
NPO When the body awakens after anesthesia, the

digestive system also needs some time to
adjust. Filling the belly with solid foods
shortly after surgery may cause to feel
nauseous and might lead to vomiting.
IVF: PNSS 1L @ KVO To hydrate the pt. appropriately
Sterofundin @ 140 cc/hr For fluid replacement
Meds: 1) paracetamol 1g IVTT x 6 Paracetamol for mild to moderate pain and

days @ PACU fever
2) nalbuphine 5 mg IV q6h PRN
for severe pain Nalbuphine for moderate to severe pain.
3) omeprazole 40 mg IV OD
Omeprazole to help decrease the chance of
developing an ulcer while the pt is on NPO
diet.
Mod to HBR This position helps maximize lung expansion
to secure 2 U FFP + 3 U PRBC For possible blood loss after the procedure
Labs: CBC & PG Pt lab result must be monitored to check for
S , NA, K, Crea any complication
Transfuse blood once available The soonest possible per patient necessity
Hook to mech vent To help the patient breathe

IV: 350
RR: 18
I:R: 1:25
F102: 100%
Keep pt. warm & thermoregulated General anesthesia can cause pt.s core body
temperature to drop several degrees, retaining
body heat will prevent hypothermia.
Suction secretions PRN To prevent aspiration
WOF unusualities
November 23,2016
@ 3:30 PM
Dr. Toledo
epinephrine infusion to 15 cc/hr For bradycardia
Relief of respiratory distress
300 cc voluven now For treatment and prophylaxis of hypovolemia
November 23,2016
@ 4:30 PM
Dr. Toledo
ABE
Uncompensated Metabolic Acidosis
Give NaHCO3 50 meQs IV bolus now To treat metabolic acidosis
incorporate 50 meQs NaHCO3 on 1L

sterofundin - HOLD

@ 10:00 PM
Dr. Toledo
Drips Levophed to restore blood pressure control in
Levophed drip (2mg/kg) @ 10 cc/hr certain acute hypotensive states
Dobutamine drip (18mg/kg) @10 cc/hr
Epinephrine drip (25mg + 18 cc PNSS) @ Dobutamine to treat heart failure caused by
9 cc/hr surgery
Epinephrine to relieve respiratory distress

Dr. Guiani
P0515 PRBC
& FFP
Shift sterofundin to voluven 500 cc to For fluid replacement
run @ 160 cc/hr
to secure 3 units of PRBC & transfuse For possible blood loss after the surgery
w/in 2 hrs each
for repeat CBC, Plt, creatinine, Na, K, To monitor any changes of the laboratory
Ca + Mg now results
Vit. K 1 amp now then q8hr x 3 doses To help heal excision after surgery
continue levophed as ordered To restore blood pressure control in certain

acute hypotensive states
D/C epinephrine & dobutamine Patient is not in respiratory distress
Start dopamine drip @ 5 mcg/kg Dopamine is indicated for the correction of
hemodynamic imbalances
Revision of mech vent set OP
F102: 100 I:E: 1:3
IV: 375 AC MDOE
RR: 16
For repeat ABG 1 hour after post To check how well the lungs are able to move
revision oxygen into the blood and removes carbon
dioxide from the blood.
thanks

@ 5:00 AM
Dr. Toledo
Transfer available PRBC & FFP To replace blood loss
Request CBC & PLT for transfusion Lab results must be checked to make sure that
there will be no complications while doing the
BT
Refer to IM neuro For evaluation
Cont. meds For fast recovery
refer For further evaluation and management

November 24,2016
@ 6:20 AM
Dr. Toledo
to secure another 5 U PRBC of pts To replace blood loss
blood type and transfuse to run 4 hrs
each after proper crossmatching
Transfuse 1 U FFP for every 2 U FFP is Indicated to replace labile plasma
PRBC coagulation factors
Furosemide 20 mg IV post BT 2 U Furosemide is a loop diuretic. It works by
with BP precautions helping the kidneys to remove fluid from the
body.
Mod to HBR This position promotes lung expansion
Maintain on mech vent To help the patient breathe
Suggest NGT insertion To drain gastric contents, decompress the
stomach, obtain a specimen of the gastric
contents, or introduce food into the GI tract.
WOF unusalities
refer For further evaluation and management
November 24,2016
@ 7:15 AM
Dr. Clarion
Please insert NGT & start OTF To introduce food in the GI tract since the
1,800 kcal/day x 6 divided feedings patient is still unconscious
November 24,2016
@ 3:20 PM
Dr. Clarion
ceftriaxone 2q IVTT q12/hr Ceftriaxone is given to prevent infections that
may develop after the operation.
November 24,2016
@ 7:30 PM
Dr. Clarion
Pt self extubated Pt doesnt need to be intubated
cont. meds For fast recovery
possible soft diet tomorrow soft diet until the gastrointestinal tract can
tolerate/digest solid food.
November 25,2016
@ 7:00 AM
Dr. Paglomutan
trans out to ward Patient is now recovering from the procedure
and now she is going to trans out to neuro for
further management and evaluation
repeat CBC with blood 1 U PRBC To replace blood loss
transfuse
moderate high back rest To promote lung expansion
soft diet & DAT Client can now tolerate any food she desires
that is nutritious as orderes
daily dressing To prevent infection
D/C voluven Patient recovered from hypovolemia
Cont. meds For faster recovery
Cont. IVF To hydrate the patient appropriately
November 25,2016
@ 7:35 AM
Dr. Toledo
Pls ff. up blood availability & transfuse To replace blood loss
in 4 hrs
Mod to HBR This position facilitate lung expansion
Deep breathing exercises This exercises helps the patient to breathe
Refer For further management and evaluation
November 25,2016
@ 6:45 PM
Dr. Malasig
trans out neuro ward Patient at this time is stable
Chapter VII
LABORATORY FINDINGS
Date: November 16, 2016 @ 10:15 PM
TEST RESULT REFERENCE INTERPRETATION

RANGE
HEMATOLOGY
CBC + PLT
Hemoglobin 134.0 115-155 Within normal range
Hematocrit 0.39 0.36-0.48 Within normal range
RBC Count 4.48 4.20-6.10 Within normal range
WBC Count 12.12 5.0-10.0 High There is an increase in
WBC to fight the
inflammation
Differential Count
Neutrophils 91 55-75 High During tumor
development, neutrophils
appear to be one of the
first inflammatory cell
types on the scene
Lymphocytes 9.0 20-35 Low Low lymphocytes
indicates that the body is
low on infection
resistance
Monocytes 0 2-10 Low Low monocytes indicates
an increased risk for
infections
Eosinophils 0 1-8 Low Low eosinophils
low on infection
resistance
Basophils 0 0-1 Within normal range
Platelet Count 393 150-400 Within normal range
MCH 29.9 25.60-32.20 Within normal range
(mean corpuscular
hemoglobin)
MCHC 34.5 32.20-35.50 Within normal range
(mean corpuscular
hemoglobin
concentration)
MCV 86.6 79.40-94.80 Within normal range
(mean corpuscular
volume)

RANGE
HEMATOLOGY
CBC + PLT
Hemoglobin 127.0 115-155 Within normal range
Hematocrit 0.37 0.36-0.48 Within normal range
RBC Count 4.20 4.20-6.10 Within normal range
WBC Count 16.59 5.0-10.0 High There is an increase in
WBC to fight the
inflammation
Differential Count
Neutrophils 91 55-75 High During tumor
development, neutrophils
appear to be one of the
first inflammatory cell
types on the scene
low on infection
resistance
Monocytes 1.0 2-10 Low Low monocytes indicates
an increased risk for
infections
low on infection
resistance
(mean corpuscular
hemoglobin)
(mean corpuscular
hemoglobin
concentration)
(mean corpuscular
volume)

RANGE
HEMATOLOGY
CBC + PLT
Hemoglobin 32.0 115-155 Low Low hemoglobin results

indicates postoperative
anemia
Hematocrit 0.1 0.36-0.48 Low Low hematocrit results
anemia
RBC Count 1.07 4.20-6.10 Low Low RBC count results
anemia
WBC Count 25.54 5.0-10.0 High It is common for WBC
counts to be high after
surgery, because this cell
initiates healing after the
tissue damaged.
Differential Count
Neutrophils 91 55-75 High It is common for
neutrophils to be high
after surgery because this
cells help mop up regular
body cells that were
damaged during surgery.
low on infection
resistance
Monocytes 5 2-10 Within normal range
low on infection
resistance
(mean corpuscular
hemoglobin)
(mean corpuscular
hemoglobin
concentration)
(mean corpuscular
volume)

RANGE
HEMATOLOGY
CBC + PLT
Hemoglobin 87.0 115-155 Low Low hemoglobin results

anemia
Hematocrit 0.25 0.36-0.48 Low Low hematocrit results
anemia
RBC Count 2.94 4.20-6.10 Low Low RBC count results
anemia
WBC Count 19.35 5.0-10.0 High It is common for WBC
counts to be high after
surgery, because this cell
initiates healing after the
tissue damaged.
Differential Count
Neutrophils 96 55-75 High It is common for
neutrophils to be high
after surgery because this
cells help mop up regular
body cells that were
damaged during surgery.
low on infection
resistance
Monocytes 5 2-10 Within normal range
low on infection
resistance
(mean corpuscular
hemoglobin)
(mean corpuscular
hemoglobin
concentration)
MCV 84 79.40-94.80 Within normal range
(mean corpuscular
volume)

TEST RESULT REFERENCE CLINICAL
RANGE SIGNIFICANCE
CLINICAL
CHEMISTRY
Creatinine 58.09 mmol/L 39.00-113.00 Within normal range

Potassium 3.56 mmol/L 3.6-5.1 Within normal range
Sodium 140 mmol/L 136.00-144.00 Within normal range
Date:
November 17, 2016 @ 11:10 PM
TEST RESULT REFERENCE CLINICAL
RANGE SIGNIFICANCE
CLINICAL
CHEMISTRY
Calcium 2.37 mmol/L 1.75-2.39 Within normal range

Creatinine 58.51 mmol/L 39.00-113.00 Within normal range
Potassium 3.87 mmol/L 3.6-5.1 Within normal range
Serum Magnesium 0.94 mmol/L 0.74-1.03 Within normal range
Sodium 139.60 mmol/L 136.00-144.00 Within normal range
Arterial Blood Gas Test
Measured test Result Units Reference Analyzer

range
pH@37 7.282 PCO (-) pHox
PCO2@37 29.0 mmHg (-) pHox
PO2@37 489.9 mmHg (-) pHox
Temp 37.0 deg (-)
Calculated Test -13.1 mmol/L
BE-ecf -10.8 mmol/L
BE-b 16.1 mmol/L
HCO3 13.8 mmol/L
TCO2 14.7 mmol/L
SO2b 100.0 mmol/L
A 113.9 mmHg
a/A 4.3 mmHg
PO2/F102 2344.2 mmHg
Measured test Result Units Reference Analyzer

range
pH@37 7.410 PCO (-) pHox
PCO2@37 26.3 mmHg (-) pHox
PO2@37 385.5 mmHg (-) pHox
Temp 36.9 deg (-)
Calculated Test 8.0 mmol/L
BE-ecf -5.5 mmol/L
BE-b 20.0 mmol/L
HCO3 16.8 mmol/L
TCO2 17.6 mmol/L
SO2b 100.0 mmol/L
A 117.5 mmHg
a/A 3.3 mmHg
PO2/F102 1844.5 mmHg
Cranial CT Scan with Contrast
FINDINGS:
Multiple and IV-contrast enchanced axial CT images of the head were obtained. No adverse
reactions are observed. A well-defined enhancing mass with slightly increased attenuation to the
brain parenchyma is noted in the left fronto parietal convexity measuring 4.5 x 5.4 x 5.0 cm
(CCAPW) with perilesional low density edema. The left lateral ventricle is compressed. No
abnormal distinct changes appreciated in the brain and brainstem parenchyma. No abnormally
enhancing areas.
Midline structures are displaced to the right by about 0.7 cm.
Sella, orbits, paranasal sinuses and petromastoids are unremarkable.
Calvarium and visualized facial bones are intact with no evidence of fracture.
Extracalvarial soft tissues are unremarkable.
No other significant findings.
IMPRESSIONS:
Consider meningioma, left frontoparietal convexities with mass effect.
Chapter VII
NURSING THEORY
Environmental Theory
By: Florence Nightingale
The Environmental Theory by Florence Nightingale defined Nursing as the act of utilizing the
environment of the patient to assist him in his recovery. It involves the nurses initiative to
configure environmental settings appropriate for the gradual restoration of the patients health,
and that external factors associated with the patients surroundings affect life or biologic and
physiologic processes, and his development.
This particularly correlates with the patients case since one of the most important factors that
aids not only in the healing process but also the preventive aspect is the environment. By
manipulating the environment of the patient such as ventilation, light and warmth, the body can
repair itself quickly compared to a poor environment.
Self-care Deficit Theory

By: Dorothea Orem
Orems theory defined nursing as The act of assisting others in the provision and management
of self-care to maintain or improve human functioning at home level of effectiveness. It focuses
on each individuals ability to perform self-care, defined as the practice of activities that
individuals initiate and perform on their own behalf in maintaining life, health, and well-being.
Self-care deficit delineates when nursing is needed. Nursing is required when an adult (or in the
case of a dependent, the parent or guardian) is incapable of or limited in the provision of
continuous effective self-care.
As in the case of the patient, she is unable to take care of herself such as doing his activities of
daily living like taking a bath, urinating, defecating and ambulating due to her inability to see
clearly. Thus comes the role of the nurse to fill in the gap and assist the patient in doing such
activities as much as possible.
Nursing Need Theory
By: Virginia Henderson
The Nursing Need Theory was developed by Virginia A. Henderson to define the unique focus of
nursing practice. The theory focuses on the importance of increasing the patients independence
to hasten their progress in the hospital. Hendersons theory emphasizes on the basic human needs
and how nurses can assist in meeting those needs.
The nurses task in every patient is to assist them in achieving optimal health. However, nurses
are not always beside their patients and cant assist or help them round the clock. Thus, it is one
of the nurses responsibilities for the patient to not only achieve optimal health but also in
gradually attaining independence during the healing process. With the patients case, the nurse
slowly allows him to do minor tasks such as eating all by herself as long as she can tolerate or do
so. The nurse also gave instructions to the patient and her husband on what must be done after
they are discharged from the hospital. This allows the continuation of care through independence
attained by the patient and his significant others.
CHAPTER IX
NURSING ASSESSMENT
Date of assessment: November 18, 2016

Time: 9:05 am
REVIEW OF SYSTEMS:
NEUROLOGICAL
Patient Leila appears conscious and responsive. She is oriented to time, place and person.
The patient though suffered seizures.
EYE/VISION
The patients pupils are equal and reactive to light and accommodation. She cannot see
properly on both eyes though. Patient Leila stated that she only sees shadows.
EARS/HEARING
Both ears appear normal without the presence of discharges, impacted cerumen and
foreign objects upon thorough inspection using a pen light. The patient can hear normally
without any difficulty.
NOSE
Nose is patent with no lesions and abrasions. Nasal mucosa is pink, moist and intact.
Nostrils are patent with no signs of nasal flaring. No discharges and foreign objects observed.
MOUTH/TONGUE/TEETH/SPEECH
The buccal mucosa is pink and has no evident signs of infection. No lesions present on
tongue and buccal mucosa. Teeth are complete with no dentition although there are small signs
of tooth decay. The patient has also no difficulty in speaking and pronounces words correctly.
THROAT/NECK
The throat is pink with normal tonsils and adenoids. Patient can swallow without any
problems and has no signs of infection. The neck appears normal but has some enlarged lymph
nodes upon palpation.
RESPIRATORY SYSTEM
The patient had respiratory distress. Upon auscultation, crackles were heard. Clear
secretions were noted.
MUSCULOSKELETAL SYSTEM
The extremities have decreased range of motion. The patient still needs some assistance
in doing activities of daily living such as going to the comfort room. No tremors or spasms
observed on the muscles.
INTEGUMENTARY SYSTEM
No abrasions were noted on the skin. Other parts of the skin are intact and no evident
signs of dehydration was noted. Hair is well kempt and has dandruff.
CIRCULATORY SYSTEM
The patient has no signs of cyanosis as evidenced by pinkish conjunctiva and mucosa.
Upon pressing the nails, redness goes back within 3 seconds which indicates that capillary refill
is good. The patient has also no signs of cardiovascular diseases with a pulse rate within normal
range of 80 beats per minute.
GASTROINTESTINAL
Bowel sounds were heard indicative of normal peristalsis. The patient has not
experienced any loose bowel movement and has no signs of indigestion. Upon palpation, no pain
was noted. Percussion of the abdomen yielded a resonant sound.
GENITOURINARY
The patient has a normal urinary frequency of about 3 every 8 hours. She also has no
difficulty in urinating.
PRESENT BEHAVIOR
The patient is alert and responsive. She answers the groups questions immediately and
appropriately. She is also cooperative and open minded to several nursing interventions that the
group advised and done.
SOCIO-ECONOMIC STATUS
Currently, the patient is a housewife. Her husband works as a carpenter and earns 300 pesos a
day. After working as a carpenter, in the evening her husband drives their tricycle to earn extra
income of 250 per night. According to them, their financial income is enough to sustain their
daily needs.
FAMILY CONCERN
The family is concerned on patient Leilas condition since it requires an invasive
procedure and there are chances of poor prognosis.
LATEST VITAL SIGNS:

BP-130/80 mmHg
PR-80 bpm
RR-18 cpm
Temp-37.2 oC
GCS:
Best eye response: 4
Best verbal response: 4
Best motor response: 6
Total: 14
Chapter X
NURSING MANAGEMENT
A. Nursing Care Plan
DATE/ CUES NEEDS NURSING SCIENTIFIC GOALS NURSING RATIONALE EVALUATION

TIME DIAGNOSIS BASIS OBJECTIVES INTERVENTIONS
CRITERIA
Nov. 18, Subj: A Ineffective Normally the Within 8 hours of 1. Obtained and 1. To obtain GOAL MET
2016 @ Pag muubo C airway lungs are free nursing monitor vital baseline data
8:00 am ko naay plema T clearance r/t from interventions, the signs 2. To gain Within 8 hours of
I
maapil V increased secretions. patient will be 2. Established cooperation nursing
I mucous Pneumonia able to show rapport 3. To ease interventions, the
Obj. T production bacteria are signs of effective 3. Elevated head of respiratory patient was able to
-productive Y secondary to invading the airway clearance bed discomfort show signs of
cough noted bacterial lung as evidenced by: 4. To loosen effective airway
E parenchyma 4. Encouraged to secretions
-whitish infection clearance as
X increase OFI 5. To loosen
secretions E thus -decreased cough evidenced by:
noted ,producing frequency 5. Provided back secretions
R
-nasal flaring C inflammatory -decreased tapping 6. To increase -decreased
-orthopnea I process. And sputum 6. Encouraged to exertional frequency of
noted S these -absent nasal perform deep effort cough
E responses flaring breathing and 7. To promote -decreased sputum
leading to -absent orthopnea coughing healing production
P exercises
A filling of the -absent nasal
alveolar sacs 7. Encouraged to
T flaring
T with exudates have adequate
-absent postural
E leading to bed rest
discomfort
R consolidation
N
Kozier and
Erbs
Fundamental
s on Nursing
DATE/ CUES NEEDS NURSING SCIENTIFIC GOALS NURSING RATIONALE EVALUATION
TIME DIAGNOSIS BASIS OBJECTIVES INTERVENTIONS
CRITERIA
Nov. 18, Subjective: C Acute pain Inflammation Within 4 hours of 1. Establish rapport 1. To gain GOAL MET
2016 @ sakit kaayo O related to especially nursing 2. Monitor and cooperation Within 4 hours of
9 AM akong ulo, G increase inside the interventions the record Vital 2. To obtain nursing
as verbalized N intracranial meninges patient will be Signs baseline data interventions the
by the patient I pressure triggers the able to report 3. Position the for patient reported
T vascular pain is relieved client: head of comparison pain is relieved by:
I system to as evidenced by: bed elevated with 3. To decrease
V body in central ICP
Objective: release Verbalization of:
E position 4. To help pt.
-Pain scale of prostaglandin Verbalization of 3/10 nalang ang
- 4. Encourage divert his
7/10 P s which are decrease pain kasakiton nurse
-Facial neurotrans- from 7/10 to 4/10 diversional attention to
E
grimace mitters of activities: other matters Demonstrated
R
noted C pain Demonstrates listening to than pain felt ways to relieve the
-Guarded E use of relaxation music, 5. To reduce
pain: deep
behavior P Kozier & skills: deep 5. Encourage use of tension
breathing
noted T erbs breathing relaxation 6. To decrease
-Restlessness U fundamental techniques: deep ICP
7. To promote Appeared relax
noted A of nursing Appears relax breathing,
wellness and and able to rest
-Irritability L and able to imaging.
prevent appropriately.
noted sleep/rest 6. instruct client to
- VS of: P appropriately avoid going to fatigue
T: 38.5 A the bathroom
PR: 115 T 7. Encourage to
T have adequate
RR: 28
E rest periods
BP: 130/70
R
N
DATE/ CUES NEED NURSING SCIENTIFIC GOALS NURSING RATIONALE EVALUATION
TIME S DIAGNOSIS BASIS OBJECTIVES INTERVENTIONS
CRITERIA
Nov. 19, Sub. N Hyperthermi Pyrogens Within 4 hours of 1. Establish rapport 1. Promotes GOAL MET
2016 @ init kaayo U a related to cause a rise nursing with the client. cooperation in
10:00 AM akong pamati T secondary in body interventions, 2. Monitor vital the nursing Within 4 hours of
nurse. as R infection temperature, client will be able signs care. nursing
I 3. Provide TSB 2. Helps to
verbalized by it also acts as to report and interventions,
T 4. Encourage to
the pt. antigen show identify the client was able to
I
triggering manifestations increase OFI development report and show
O
Obj. immune that fever is 5. Promote bed rest of the clients manifestations that
N
Temp: 39.1c system relieved as 6. Maintain IVF as VS fever was relieved
A
RR:32 cpm L responses. evidenced by: indicated by 3. To reduce as evidenced by:
PR: 127 bpm - The physician body
BP: 130/80 M hypothalamu Verbalization of 7. Administer temperature Verbalization of
mmHg E s reacts to feeling well medications as through the the client:
-pallor T raise the set order by process of dili na init akong
-flushed skin A
point and the VS within normal physician such as conduction pamati ate nurse.
B paracetamol or 4. Water
-dry mucous body respond range
O any antipyretic
membranes by producing regulates body VS of:
L drugs
-chills heat. Absence of temp. Temp= 36.7c
I 8. Monitor I & O
-malaise C muscular 5. To promote RR= 25 cpm
Fundamental rigidity/chills relaxation PR= 92
P s of Nursing 6. To replenish
A -Harry & Absence of fluid losses Absence of
T Perry flushing during muscular
T shivering rigidity/chills
E chills
R 7. To treat Normal
N underlying complexion of
causes skin
8. To know the
fluid balance
of the body.
DATE/TIME CUES NEEDS NURSING SCIENTIFIC GOALS NURSING RATIONALE EVALUATION
DIAGNOSIS BASIS OBJECTIVES INTERVENTIONS
CRITERIA
Nov.24,2016 Subjective: A Activity Most activity Within the 8 1.Establish 1.To gain GOAL MET
@ 8:30am Dili gyud C Intolerance intolerance is hours of nursing rapport cooperation Within the 8 hours of
nako kaya T r/t to body related to interventions, the 2. Monitor and 2. As baseline nursing interventions,
mubangon o I weakness as generalized patient will : record Vital data the patient enhanced
maglihok- V evidenced by weakness and Signs 3. To maintain her physical activity as
lihok maam I insufficient debilitation Show 3. Increase oral hydration evidenced by:
kay luya pa T to endure a secondary to eagerness fluid intake. 4. To provide
kayo ko, as Y desired post-operative and 4. Determine any special a. Patient showed
verbalized by - activity such procedure. participation side effects of precaution for eagerness and
the patient. E as in enhancing any drug given to the drugs side participation in
X ambulation. Fundamentals physical patient before effect enhancing physical
Objective: E of Nursing activity proceeding with 5. To promote activity independently
-Limited R -Harry & Perry Demonstrate doing the activity such as:
range of C activities planned enhancing *turning to side lying
motion noted I necessary in activities. situation position every2 hours
-Limited S enhancing 5.Plan for a. Exercise as tolerated
ability to E present progressive maintain muscle b. Demonstrated
perform condition. increase of the strength and activities suitable for
gross or P Verbalize activity joint ROM. enhancing her
motor skills A understandin level/participatio b. To prevent condition such as deep
noted T g of the n in exercise pressure ulcer breathing exercises.
-Difficulty T management training as 6. To promote c. The patient was able
turning side E regimen, and tolerated by the patients to verbalize, dapat
to side R safety client such as: tolerance in jud diay maningkamot
-Slowed N procedures a. Performing executing kog lihok-lihok bisag
movement given. ROM exercise desired or ingun ani akong
noted Maintain daily. required kahimtang aron di
- position of b. Turning to activities. musamot ang kakapoy
Uncoordinate function and side lying 7. To reduce ug kaluya sa akong
d and tremors skin integrity position. fatigue lawas
noted as evidence 6. Discuss 8.
by absence ways/activities Acknowledgem
of that could ent that living
contactures, enhance activity with activity
footdrop, tolerance, such intolerance is
decubitus as walking both physically
and so forth. moderately. and emotionally
7. Plan care to difficult coping
fully balance rest 9. To promote
periods with patients
activities such as confidence in
an hour at least doing the
of planned activities.
activities as 10. Helps avoid
tolerated. accidental
8. Encourage injuries or falls
verbalization of 11. Assistance
feelings provides the
regarding patient safety
limitations. 12. To help
9. Give positive promoting
reinforcement patients
during activity. independency
10. Give safety and boost her
needs such as self esteem.
raising the side 13. Enhance
rails. sense of well
11. Assist the being.
patient in
standing or
walking.
12. Permit
patient to
execute task at
his or her own
pace as tolerated.
13. Encourage
patient to
maintain positive
attitude, suggest
use of relaxation
techniques such
as breathing
exercise.
DATE/TIME CUES NEEDS NURSING SCIENTIFIC BASIS GOALS NURSING RATIONALE EVALUATION
DIAGNOSIS OBJECTIVES INTERVENTION
CRITERIA S
Nov.24,2016 Subjective: H Risk for An individual with Within the 8 1.Establish 1.To gain GOAL MET
Sigehan E Infection r/t an incision that will hours of rapport cooperation Within the 8 hours of
@ 10:30am niyag gunit A surgical serves as portal of nursing 2. Monitor and 2. Fever may nursing interventions, the
iyang samad L incision entry is at risk to be interventions, record Vital indicate patient will be able to
sa ulo T invaded by an the patient Signs infection reduce the risk of infection
maam, as H opportunistic or will be able 3. Assess 3. To check as evidence by:
verbalized by pathogenic agent to reduce the affected area for for skin
the patients P such as virus, risk of redness, integrity, -VS within normal limits
significant E fungus, bacteria, infection as swelling, or monitor BP , temp , RR , PR
others. R protozoa, or other evidence by: soaked dressing progress of -remains free from the
C parasite from 4. Assist healing and symptoms of infection
E endogenous or -VS within physician on identify need -identifies the symptoms
Objective: P exogenous sources. normal limits regular for further of infections such as
-Penrose T -remains free provision on management purulent dressing and
drain I from the wound dressing 4. To fever
-Surical site O symptoms of 5. Maintain promote fast -Patient is able to clean the
with dressing N infection aseptic healing wound properly and apply
- -identifies the technique when 5.To prevent dressing
H symptoms of changing contaminatio -demonstrate appropriate
E infections dressing/ caring n hygienic measures such as
A such as wound 6.Reduce hand washing, bathing,
L purulent 6.Encourage to likelihood of hair and nail care.
T dressing and wear clean loose worsening Changing the bed linens.
H fever clothing/coverin skin
-Patient is g breakdown
M able to clean 7.Observe for 7. To monitor
A the wound reddened areas improvement
N properly and or any purulent of wound
A apply drainage and condition.
G dressing institute 8.To improve
E -demonstrate treatment per circulation.
M appropriate doctors order 9. To prevent
E hygienic 8. Encourage bacterial
N measures patient to infections
T such as hand engage in 10. To allow
washing, ambulation continuous
P bathing, hair within room monitoring.
A and nail care. perimeter as 11. To
T Changing the tolerated. prevent
T bed linens. 9. Administer further injury
E -swelling antibiotic as and trauma.
R decrease in ordered. 12. For
N size 10. Encourage hydration and
to verbalized faster wound
any untoward healing.
feelings such as 13. To
discomfort or prevent
pain, changes growth of
noted on the microorganis
affected area. m.
11. Provide 14. To
safety maintain
precautions such cleanliness.
as raising the 15. Physical
bed rails. and
12.Encourage to emotional
increase OFI stress
13. Keep linens increase the
clean and dry clients need
and wrinkle- for rest.
free.
14. Encourage
to maintain
proper hygiene.
15. Encourage
adequate rest to
boost immune
system
B. Drug Study
DATE/ BRAND ACTION INDICATION ROUTE/ DRUG ADVERSE PRECAUTION NURSING

TIME NAME DOSAGE/ INTERACTION EFFECT CONTRAINDICAT RESPONSIBILITES
ORDERED TIME IONS
INTERVAL
Nov. 15, Sodium Decreases Cerebral IVTT, 4 -Increased risk of CNS: euphoria, Hypersensitivity Determine whether
2016 @ phosphate inflammation, edema mg q6 hrs hypokalaemia when insomnia, vertigo, to drug; active patient is sensitive to
3:40 PM mainly by associated with used concurrently headache, untreated other corticosteroids
stabilizing brain tumor, with potassium- depression. infections; Monitor intake and
leukocyte craniotomy or depleting drugs ophthalmic use output of patient
lysosomal head injury such as CV: hypertension, in viral, fungal Assess then for level of
membranes; amphotericin B and edema, arrythmias, disease of the consciousness changes
suppresses loop diuretics. thromboembolism. eye.
GENERIC HALF and headache during the
immune Reduces efficacy of therapy.
NAME response; LIFE isoniazid, EENT: cataracts,
glaucoma. Observe the patient for
stimulates bone salicylates,
Dexamethason 190 mins. peripheral edema,
marrow; and vaccines and
e GI: peptic ulceration, steady weight gain, rales
influences toxoids.
GI irritation, or crackles or dyspnea.
protein, fat and -Increased activity
increased appetite, Notify the physician
carbohydrate of dexamethasone
pancreatitis, nausea, immediately if these
metabolism and cyclosporin
vomiting. clinical manifestations
when used together.
are noted.
Concurrent use
GU: increase urine Administer with meals
with aspirin or
ethanol may lead to glucose, and calcium to minimize GI
increased GI side levels irritation.
effects. Teach patient signs and
Metabolic: symptoms of adrenal
hypokalemia, insufficiency; fatigue,
hyperglycemia muscle weakness, join
CLASSIFI- ABSORP EXCRETION pain, fever, anorexia.
CATION TION Musculoskeletal:
Urine muscle weakness
Anti- Well-
inflammatory absorbed Skin: Delayed
glucocorticoid wound healing

TIME NAME DOSAGE/ INTERACTION EFFECT CONTRAINDICATIO RESPONSIBILITES
ORDERED TIME NS
INTERVAL
Nov. 15, Valium It increases Treatment of IVTT, 10 mg -May significantly CNS: Contraindicated to Monitor BP, PR,RR
2016 @ neuronal status PRN enhance CNS Dizziness, patient w/ acute frequently during IV
3:40 PM membrane epilepticus/ depressant effect w/ drowsiness, angle closure therapy.
permeability to uncontrolled antivirals, narcotic lethargy, glaucoma, pre- Assess IV site
Cl ions by seizures analgesics, hangover, existing CNS frequently during
binding to antihistamines, headache, depression, coma, administration,
stereospecific antihypertensives, depression severe or acute resp diazepam may cause
benzodiazepine muscle relaxants insufficiency, sleep phlebitis and venous
GENERIC receptors on HALF LIFE -May decrease EENT: blurred apnoea syndrome, thrombosis.
NAME the clearance w/ vision myasthenia gravis, Prolonged high-dose
postsynaptic Rapid (initial), antibacterials severe hepatic
diazepam 1 or 2 days RESP: therapy may lead to
GABA neuron -May increase serum impairment. psychological or
w/in the CNS (terminal) level w/ disulfiram. respiratory
depression physical
and enhancing -May reduce dependence.
the GABA therapeutic effect w/
CV: Observe depressed
inhibitory theophylline.
hypotension patients closely for
effects -Reversible
suicidal tendencies
resulting in deterioration of
GI: Observe and record
hyperpolarisati parkinsonism w/
Constipation, intensity, duration
on and levodopa.
CLASSIFI- stabilisation. ABSORPTIO EXCRETION diarrhea, and location of
CATION N nausea, seizure activity.
Urine vomiting The initial dose of
Benzodiazepin Well-absorbed diazepam offers
e, DERM: Rashes seizure control for
Anxiolytic 15-20 min after
Antiepileptic, Other: Phlebitis administration
Skeletal and thrombosis
muscle at IV injection
relaxant sites, hiccups,
(centrally fever,
acting) diaphoresis,
paresthesias,
muscular
disturbances

TIME NAME DOSAGE/ INTERACTION EFFECT CONTRAINDICATI RESPONSIBILITES
ORDERED TIME ONS
INTERVAL
Nov. 19, Catapres Clonidine treatment of IVTT, 150 -Increased CNS: Drowsiness, sedation, Contraindicated Assess blood pressure
2016 @ stimulates hypertension, mcg now hypotensive dizziness, headache, fatigue, with and apical pulse before
9:00 PM 2- either alone or effect w/ other insomnia, hallucinations, hypersensitivity to initial dose.
adrenocepto with diuretic or antihypertensive delirium, nervousness, clonidine or any
rs in the other s restlessness, anxiety, adhesive layer If systolic blood pressure
brain stem antihypertensive -Reduced depression, components of the is <90mmhg or pulse
which agents. antihypertensive transdermal is<60 bpm, withhold
results in effect and CV: system. drug and notify
GENERIC reduced HALF induced CHF, orthostatic physician.
NAME sympathetic LIFE orthostatic hypotension, palpitations, Use cautiously
outflow hypotension w/ tachycardia, bradycardia, with severe Check for edema in feet,
clonidine from the 6-24 hr TCAs or coronary legs daily
CNS, and a neuroleptics w/ Derma: insufficiency,
decrease in -receptor Ras, hives, urticaria, hair recent MI, Monitor input-output
peripheral blocking thinning and alopecia, cerebrovascular ratio: check for
resistance, properties. pruritus, dryness, burning of disease; chronic decreasing output.
heart rate, -Reduced the eyes, pallor renal failure;
BP and renal therapeutic pregnancy, Note allergic reactions:
vascular effect w/ GI: lactation.
resistance NSAIDs. Dry mouth, constipation, fever, rash, pruritus,
anorexia, malaise, nausea, urticaria, and edema.
vomiting,
GU: Impotence, urinary

retention
CLASSIFI- ABSORP EXCRETION
CATION TION Other:
Urine Weight gain, transient
Antihypertensi Well- elevation of blood glucose
ve absorbed or serum creatine
phosphokinase, weakness,
muscle or joint pain, cramps
of the lower limbs, dryness
of the nasal mucosa, fever

ORDERED TIME NS
INTERVAL
Nov. 22, Pantrixon Ceftriaxone Surgical IVTT, 1 g -May increase CNS: Headache, Contraindicated BEFORE:
2016 @ binds to 1 or infection q8 hrs nephrotoxicity of dizziness, with allergy to Do Skin Testing in to the
7:00 AM more of the prophylaxis aminoglycosides. lethargy cephalosporins or intradermal area
penicillin- -May diminish penicillins. Protect Drug from light
binding therapeutic effect GI: Do not mix ceftriaxone
proteins (PBPs) of BCG, typhoid Nausea, vomiting, Use cautiously with with other antimicrobial
which inhibit vaccine, Na diarrhea, renal failure drug
the final picosulfate. anorexia,
GENERIC transpeptidatio HALF -May increase pseudomembrano
NAME LIFE DURING:
n step of anticoagulant uscolitis
Use a separate syringe
peptidoglycan effect of vit K
ceftriaxone 6-9 hrs when giving this drug
synthesis in antagonists. Hematologic:
bacterial cell -May increase bone marrow Have Vitamin K available
wall, thus serum level w/ depression, in case of
inhibiting probenecid. decrease WBC, hypoprothrombinemia
CLASSIFI- biosynthesis ABSORP EXCRETION platelets, Hct occurs
CATION and arresting TION
cell wall Urine Local: pain, AFTER:
Antibiotic assembly Well- inflammation of Discontinue if
cephalosporin resulting in absorbed IV Site hypersensitivity occurs
bacterial cell Monitor Blood levels in
death. patients taking this drug

TIME NAME DOSAGE/ INTERACTION EFFECT CONTRAINDICATI RESPONSIBILITES
ORDERED TIME ONS
INTERVAL
Nov. 22, Zantac Ranitidine Treatment and IVTT, 30 Antacids: may CNS: Contraindicated Instruct patient not to take
2016 @ blocks prevention of mg q8 hrs interfere with vertigo, malaise, to patients new medication w/o
7:00 AM histamine H2- indigestion, absorption headache hypersensitive to consulting physician
receptors in the and sour drug and those Instruct patient to take as
stomach and stomach. EENT: with acute directed and do not
prevents blurred vision porphyria increase dose
histamine- Prophylaxis of Allow 1 hour between any
mediated GI hemorrhage Hepatic: Use cautiously in other antacid and
GENERIC gastric acid from stress HALF jaundice patients with
NAME LIFE ranitidine
secretion. It ulceration hepatic
Avoid excessive alcohol
does not affect Other: burning dysfunction
ranitidine pepsin 2.5-3 hrs and itching at Assess patient for
secretion, epigastric or abdominal pain
and frank or occult blood in
CLASSIFI- pentagastrin- ABSORP EXCRETION injection site the stool, emesis, or gastric
CATION stimulated TION aspirate
factor secretion Unchanged, renal Nurse should know that it
H2 antagonist or serum Raidly- may cause false-positive
gastrin. absorbed results for urine protein;
test with sulfosalicylic
acid
Inform patient that it may
cause drowsiness or
dizziness
Inform patient that
increased fluid and fiber
intake may minimize
constipation
Advise patient to report
onset of black, tarry
stools; fever, sore throat;
diarrhea; dizziness; rash;
confusion; or
hallucinations to health
care professional
promptly
Inform patient that
medication may
temporarily cause stools
and tongue to appear gray
black
Instruct patients to
monitor for and report
occurrence of drug-
induced adverse reaction
TIME NAME DOSAGE/ INTERACTION EFFECT CONTRAINDICA RESPONSIBILITES
ORDERED TIME INTERVAL TIONS
Nov. 22, Prilosec Inhibits proton Indicated to PO 40mg OD May interact with CNS: Contraindicated Monitor magnesium
2016 pump activity control gastric ampicillin, calcium dizziness, to patients levels before starting
@ by binding to acid secretion salts, benzo- headache hypersensitive to treatment
7am hydrogen- diazepines, the drug Monitor patient for
potassium methotrexate and GI: signs and symptoms
adenosine salicylates abdominal Use cautiously of low magnesium
triphosphate to pain, in patients with level
suppress constipation, hypokalemia and Watch out for
GENERIC gastric acid HALF LIFE diarrhea, respiratory abnormal heart
NAME secretion 30-60 min nausea and alkalosis rhythm and
Omeprazole vomiting palpitation
Monitor for muscle
Musculoskele
spasms and tremors
tal:
CLASSIFI- ABSORPTION EXCRETION Back pain Do not let patient
CATION Rapidly absorbed Unchanged, renal take any calcium
Proton pump after IV Respiratory: containing foods or
inhibitor administration cough, URTI drinks such as milk
Skin: rash Tell patient to
swallow tablets
whole and not to
open, crush or chew
them
Instruct patient to
take the drug at least
1 hour before meal
Caution patient to
avoid hazardous
activities if he gets
dizzy

ORDERED TIME INTERVAL NS
Nov. 23, B braun Ions of sodium For use as an IV, 500 ml @ Corticosteroids & nausea, Contraindicated to With careful use of
2016 @ and chlorine electrolyte 150 cc/hr carbenoxolone; vomiting, patient with large amounts of
12:45 PM are the major replenisher and suxamethonium, diarrhea, hypervolemia, Sterofundin Isotonic
inorganic in the K-sparing stomach severe CHF, renal (Sodium Chloride)
components of treatment of diuretics; cramps, thirst, failure w/ oliguria or in patients with
the hypokalemia. tacrolimus, lacrimation, anuria, severe impaired renal
extracellular cyclosporine; sweating, fever, general edema, excretory function
GENERIC fluid, HALF LIFE digitalis tachycardia, hyperkalemia, and hypokalemia.
NAME maintaining an glycosides, hypertension, hypercalcemia, The injection of
appropriate 3-6 hrs carbonate-, renal metabolic alkalosis. large amounts of
Sterofundin osmotic phosphate-, dysfunction, solution can lead to
pressure of sulphate- or edema, chloride acidosis,
blood plasma tartrate-containing shortness of hyperhydration,
and medications. breath, increased excretion
CLASSIFI- extracellular ABSORPTION EXCRETION headache, of potassium from
CATION fluid. Isotonic dizziness, the body.
solution of Well-absorbed Urine anxiety, Hypertonic solution
Isotonic Sterofundin weakness, of Sterofundin
electrolyte Isotonic twitching and Isotonic (Sodium
soluion (Sodium muscle Chloride) do not
Chloride) fills hypertonicity. applied SC and IM.
a deficit of With prolonged use
body fluids it is necessary to
during monitor the
dehydration. concentration of
electrolytes in the
plasma and the daily
urine output.
The temperature of
infusion solution
should be 38 C.

ORDERED TIME NS
INTERVAL
Nov. 23, Para-IV Reduces fever Mild to IVTT, 1g x -May reduce serum NS: Contraindicated Report cyanosis,
2016 @ by directly moderate pain 6 doses levels w/ Headache with allergy to shortness of breath
12:45 PM acting on the and fever anticonvulsants acetaminophen, and abdominal pain
hypothalamic CV: antibacterial as these are signs of
heat-regulating -Accelerated Chest pain, sulfonamides or toxicity.
center to cause absorption w/ dyspnea, thiazides; chronic Monitor blood
vasodilation metoclopramide and noncongestive studies, especially
and sweating domperidone. GI: angle-closure CBC and pro-time if
GENERIC which helps HALF Hepatic toxicity glaucoma patient is onlong-
NAME dissipate heat. LIFE -May increase serum and failure, termtherapy.
levels w/ probenecid. Jaundice Use cautiously with Check I & O ratio;
Paracetamol 1-3 hours fluid or electrolyte decreasing output
-May increase serum GU: imbalance may indicate renal
levels of Acute kidney (specifically failure.
chloramphenicol. failure, renal decreased Na+,
Report paleness,
tubular necrosis decreased K+,
weakness and heart
-May reduce hyperchloremic
beat skips
absorption w/ Hematologic: acidosis), renal
colestyramine w/in 1 hr hematuria, disease, hepatic Assess
of admin. anuria; disease hepatotoxicity: dark
neutropenia, urine, clay-colored
-May cause severe leucopenia, stool
hypothermia w/ pancytopenia, Assess allergic
phenothiazine. thrombocytopeni reactions: rash,
CLASSIFI- ABSORP EXCRETION a, hypoglycemia urticaria
CATION TION
urine Hypersensitivity:
Analgesic/ Well- Rash, fever,
Antipyretic absorbed

ORDERED TIME NS
INTERVAL
Nov. 23, Nubaine Nalbuphine Treat and IVTT, 5 mg Avoid CNS: Contraindications: Assess respiratory
2016 @ acts as an prevent every 6 hrs nalbuphine sweating headache, hypersensitivity to rate before drug
12:45 PM agonist at moderate to coadministrati nervousness, nalbuphine, sulfites; administration.
specific opioid severe pain on with other restlessness,depression, lactation. Withhold drug and
receptors in the CNS crying, confusion, notify physician if
CNS to Preoperative depressants, as faintness, , Use cautiously with respiratory rate falls
produceanalges analgesia, as a coadministrati hallucinations,euphoria, emotionally unstable below 12.
ia, sedation but supplement to on dysphoria, dizziness, clients or those with Watch for allergic
GENERIC also acts to surgical HALF significantly vertigo, floating feeling, a history of narcotic
NAME LIFE response in persons
cause anesthesia increases the feeling of abuse; pregnancy with sulfite
hallucinations risk for heaviness,numbness, prior to labor, labor sensitivity.
Nalbuphine and is an 5 hours respiratory tingling, flushing, or delivery,
Administer with
antagonist at depression, warmth, blurred vision. bronchial asthma,
caution to patients
receptors low blood COPD, respiratory
with hepatic or renal
pressure, and CV: depression, anoxia,
impairment.
death Hypotension, increased
Hypertension, intracranial Avoid abrupt
CLASSIFI- ABSORPTI EXCRETIO
CATION ON N bradycardia, tachycardia pressure, acute MI termination of
when nausea and nalbuphine
Narcotic Well- urine DERMATOLOGIC: vomiting are following prolonged
agonist- absorbed Itching, burning, present, biliary tract use, which may
antagonist urticaria surgery. result in symptoms
analgesic GI: similar to narcotic
Nausea, vomiting, withdrawal: nausea,
cramps, dyspepsia, bitter vomiting, abdominal
taste, dry mouth cramps, lacrimation,
nasal congestion,
GU: piloerection, fever,
Urinary urgency restlessness, anxiety.
RESPIRATORY:
Respiratory depression,
dyspnea, asthma
ORDERED TIME TIONS
INTERVAL
Nov. 23, Primatene mist Relaxes Treatment and Epinephrine Halogenated CNS: Contraindicated Monitor BP, pulse,
2016 @ bronchial prophylaxis of infusion to inhalation drowsiness, to patient with respirations, and
3:30 PM smooth muscle cardiac arrest 15 cc/hr anaesthetics; - or headache, angle closure urinary output and
by stimulating and and attacks -blocking agents; nervousness, tremor, glaucoma, observe patient closely
beta2 receptors methyldopa, cerebral hemorrhage, shock, organic following IV
and alpha and guanethidine; drugs stroke, vertigo, pain, brain damage, administration.
beta-receptors with disorientation, cardiac dilation, Epinephrine may
in the vasoconstrictor and agitation, fear, arrhythmias, widen pulse pressure.
GENERIC sympathetic HALF pressor effects; dizziness, weakness coronary If disturbances in
NAME nervous LIFE antihypertensives; insufficiency, or cardiac rhythm occur,
system. adrenergic neuron CV: cerebral with hold epinephrine
Epinephrine 5-10 mins blockers; palpitations, arteriosclerosis. and notify physician
(adrenaline) potassium- ventricular Patients immediately.
depleting drugs; fibrillation, shock, receiving Keep physician
cardiac glycosides; widened pulse general informed of any
ephedra, yohimbe. pressure, anesthesia with changes in intake-
TCAs may induce hypertension, halogenated output ratio.
hypertension and tachycardia, angina hydrocarbons or
Use cardiac monitor
arrhythmia. pain, altered ECG cyclopropane
with patients receiving
CLASSIFI- ABSORPTI EXCRETION (including adecreased Patients with
epinephrine IV.
CATION ON T-wave amplitude) sulfite allergies
Have full crash cart
Urine
Autonomic Well- GI: immediately available.
nervous absorbed nausea, vomiting Check BP repeatedly
system agent; Respiratory: when epinephrine is
alpha and beta Dyspnea administered IV
adrenergic during first 5 min,
agonist; Skin: then q3-5min until
bronchodilator urticaria, hemorrhage stabilized.
at injection site, Monitor blood glucose
pallor & HbA1c for loss of
glycemic control if
Other: diabetic.
tissue necrosis
Nov. 23, Voluven Voluven Therapy & IV infusion @ There were no Pruritus, blood Contraindicated to Do not use
2016 @ contains prophylaxis of 300 cc drug interactions component patients with Fluid hydroxyethyl starch
3:30 PM hydroxyethyl hypovolemia found dilution eg overload (HES) products in
starch in a coagulation (hyperhydration) patients with severe
colloidal factors & other including liver disease.
solution which plasma pulmonary edema;
expands proteins, renal failure w/ Do not use HES
plasma volume decrease oliguria or anuria; products, including
GENERIC when HALF LIFE hematocrit, patients receiving in patients with
NAME administered blood dialysis treatment; known
intravenously. unknown coagulation intracranial hypersensitivity to
Hydroxyethyl disturbance. bleeding; severe hydroxyethyl starch
starch 130/4 hypernatremia or Do not use HES
severe products in clinical
CLASSIFI- ABSORPTION EXCRETION hyperchloremia.
CATION conditions with
Well-absorbed Urine volume overload.
blood Do not use HES
substitutes and products in patients
plasma protein with pre-existing
fractions coagulation or
bleeding disorders
Do not use HES
products in patients
with renal failure
with oliguria or
anuria not related to
hypovolemia.
Do not use HES
products in patients
with severe
hypernatremia or
severe
hyperchloremia.
DATE/ BRAND ACTION INDICATION ROUTE/ DRUG ADVERSE PRECAUTION NURSING RESPONSIBILITES
TIME NAME DOSAGE/ INTERACTION EFFECT CONTRAINDICA
ORDERED TIME TIONS
INTERVAL
Nov. 23, Solunate Increases Treatment of IV bolus, 50 Increases toxicity Edema, Contraindicated Assess the clients fluid
2016 @ plasma metabolic meqs of amphetamines, Flatulence, to patients with balance throughout the
4:30 PM bicarbonate, acidosis, ephedrine, Gastric distention, hypoventilation, therapy. This assessment
neutralizes promotion of pseudoephedrine, Metabolic alkalosis, hypocalcemia, includes intake and
gastric acid gastric, flecainide, Hypernatremia, increase serum output, daily weight,
which forms systemic and quinidine and Hypocalcemia, osmolarity, edema and lung sounds.
water, sodium urine quinine. Hypokalemia, further in all Symptoms of fluid
chloride, alkalinization Decreases effects Sodium and water situations where overload should be
GENERIC carbon in the case of HALF LIFE of lithium, retention, sodium intake reported such as
NAME dioxide, and intoxication chlorpropamide Irritation at IV site must be hypertension, edema,
raises blood with weak unknown and salicylates Tetany restricted like difficulty breathing or
Sodium Ph. organic acids due to increased cardiac dyspnea, rales or
bicarbonate clearance. May insufficiency, crackles and frothy
affect the edema sputum.
absorption of hypertension, Signs of acidosis should
certain drugs due eclampsia, be assessed such as
to raised intra- severe kidney disorientation,
gastric pH. insufficiency headache, weakness,
CLASSIFI- ABSORPTIO EXCRETION dyspnea and
CATION N hyperventilation.
urine Assess for alkalosis by
Fluids, Rapidly
monitoring the client for
Electrolyte, absorbed
confusion, irritability,
Blood products,
paresthesia, tetany and
and
altered breathing
Hematological
pattern.
drugs
Hypernatremia clinical
manifestations should
be assessed and
monitored
Hypokalemia should
also be assessed by
monitoring signs and
symptoms.
IV sites should be
observed closely.
Extravasation should be
avoided as tissue
irritation or cellulitis
may occur when taking
sodium bicarbonate.
DATE/ BRAND ACTION INDICATI ROUTE/ DRUG ADVERSE PRECAUTIO NURSING
TIME NAME ON DOSAGE/ INTERACTION EFFECT N RESPONSIBILITES
ORDERE TIME CONTRAIND
D INTERVAL ICATIONS
11/23/16 Levophed Produces Indicated to 2mcg/kg @ May interact with -Anxiety Vascular, -Monitor constantly while
@ vasoconstricti modulate 10cc/hr MAO inhibitors, -Dizziness mesenteric or patient is receiving
10pm on and seizure alpha adrenergic -Headache peripheral norepinephrine.
myocardial activity blockers, and beta -Insomnia thrombosis, Take baseline BP and
stimulation, blockers -Restlessness Hypoxia, pulse before start of
which may be -Tremor Hypercabia, therapy, then q2min from
required after -weakness Hypotension initiation of drug until
adequate -Dyspnea secondary to stabilization occurs at
GENERIC fluid HALF LIFE -Arrhythmias hypovolemia desired level, then every 5
NAME replacement 2-2.5 min -Bradycardia (without min during drug
Norepinephrine in the -chest pain appropriate administration.
treatment of -hypertension volume
severe -Decreased replacement), -Adjust flow rate to
hypotension urine output Hypersensitivity maintain BP at low
CLASSIFI- and shock. ABSORPTION EXCRETION -renal failure to bisulfites. normal (usually 80100
CATION Rapidly Unchanged, renal - mm Hg systolic) in
Vasopressor absorbed after Hyperglycem normotensive patients. In
IV ia previously hypertensive
-Metabolic patients, systolic is
administration
acidosis generally maintained no
-Phlebitis at higher than 40 mm Hg
IV site below preexisting systolic
-Fever level.
-Observe carefully and

record mental status
(index of cerebral
circulation), skin
temperature of
extremities, and color
(especially of earlobes,
lips, nail beds) in addition
to vital signs.
-Monitor I&O. Urinary

retention and kidney
shutdown are possibilities,
especially in hypovolemic
patients. Urinary output is
a sensitive indicator of the
degree of renal perfusion.
Report decrease in urinary
output or change in I&O
ratio.
-Be alert to patients

complaints of headache,
vomiting, palpitation,
DATE/ BRAND ACTION INDICATION ROUTE/ DRUG ADVERSE PRECAUTION NURSING RESPONSIBILITES
TIME NAME DOSAGE/ INTERACTION EFFECT CONTRAINDICATION
ORDERED TIME S
INTERVAL
Nov. 23, Dobutrex Dobutamine Dobutamine is IV, 18 Risk of Increased heart Contraindicated to Correct hypovolemia by
2016 @ exerts prescribed to mg/kg @ hypotension and rate, ectopic patients with administration of
4:30 PM positive help increase 10 cc/hr tachycardia w/ - heartbeats, Idiopathic appropriate volume
inotropic cardiac output blockers angina, chest hypertrophic expanders prior to
effect on the in a failing pain, palpitation, subaortic stenosis, initiation of therapy.
myocardium heart due to May produce elevations in BP, phaeochromocytoma. Monitor therapeutic
by heart disease or ventricular skin rash, fever, effectiveness. At any
stimulating cardiac arrhythmias w/ eosinophilia, Special precautions given dosage level, drug
GENERIC 1-adrenergic surgery. HALF cyclopropane, bronchospasm, to patient w/ takes 1020 min to
NAME receptors, LIFE halothane and paraesthesia, hyperthyroidism, produce peak effects.
thereby other halogenated nausea, vomiting, active myocardial Monitor ECG and BP
dobutamine increasing Approx. 2 anaesth. tingling sensation, ischaemia or recent continuously during
myocardial min. dyspnoea, fever, MI, cardiogenic administration.
contractility, Increased risk of headache, mild shock complicated by
Note: Marked increases
stroke vol and arrhythmias w/ leg cramps; severe hypotension,
in blood pressure and
cardiac quinidine and pruritus of the DM, closed angle
heart rate, or the
output. cardiac scalp; phlebitis at glaucoma.
appearance of
glycosides. the inj site.
arrhythmias or other
Rarely,
adverse cardiac effects
Risk of HTN and ventricular
are usually reversed
arrhythmias w/ tachycardia,
promptly by reduction
TCAs. hypokalaemia.
in dosage.
May increase BP Observe patients with
w/ preexisting hypertension
antihypertensives. closely for exaggerated
CLASSIFI- ABSORP EXCRETION pressor response.
CATION TION Note: Tolerance has
urine been observed with
autonomic Rapidly continuous or prolonged
nervous system absorbed infusions; adverse
agent; beta- reactions are no
adrenergic different than those seen
agonist; with shorter infusions.
catecholamine Monitor I&O ratio and
pattern. Urine output
and sodium excretion
generally increase
because of improved
cardiac output and renal
perfusion.
ORDERED TIME INTERVAL TIONS
Nov. 23, Hema-K Phytomenadi Low levels of 1 amp q8 x 3 Decreased Anaphylaxis, Contraindicated Protect infusion solution
2016 @ one promotes blood clotting doses effect of oral dyspnoea, to patient with from light by wrapping
10:00 PM hepatic factors anticoagulants. cyanosis, pain, hypersensitivity container with aluminum
synthesis of swelling, to foil or other opaque
clotting phloebitis at the phytomenadione material.
factors. It is a Inj site, Discard unused solution
naturally diaphoresis, and contents in open
occurring dizziness, ampule.
GENERIC compound HALF LIFE hypotension Monitor patient constantly.
NAME that is used to (rare), allergic
1.5 to 3 hrs Severe reactions, including
prevent and reactions after fatalities, have occurred
Vit. K treat SC and IM inj. during and immediately
haemorrhages after IV injection.
related to
CLASSIFI- ABSORPTION EXCRETION Lab tests: Baseline and
vitamin K
CATION frequent PT/INR.
deficiency.
well absorbed urine Frequency, dose, and
anticoagulant therapy duration are guided
by PT/INR clinical
response.
Monitor therapeutic
effectiveness which is
indicated by shortened PT,
INR, bleeding, and clotting
times, as well as decreased
hemorrhagic tendencies.
Be aware that patients on
large doses may develop
temporary resistance to
coumarin-type
anticoagulants. If oral
anticoagulant is reinstituted,
larger than former doses
may be needed. Some
patients may require change
to heparin.
Nov. 23, Dopamax Dopamine Dopamine is IV, @ 5 mcg/kg -adrenergic Ectopic Contraindicated to Monitor blood
2016 @ stimulates indicated for blocking agents heartbeats, patient with pressure, pulse,
10:00 PM dopaminergic the correction may antagonise the angina, phaeochromocytom peripheral pulses,
receptors at of vasoconstricting tachycardia, a, uncorrected atrial and urinary output at
lower doses hemodynamic effect of high dose palpitation, or ventricular intervals prescribed
producing imbalances dopamine. hypotension, tachyarrhthmias or by physician.
renal and vasoconstriction ventricular
mesenteric Used in Prolonged and , dyspnoea, fibrillation. Precise
GENERIC vasodilation; treatment for HALF LIFE enhanced effect w/ nausea, measurements are
NAME at higher heart failure MAOIs. vomiting, Special Precautions essential for accurate
doses Approx. 2 min. headache, to patient w/ CV titration of dosage.
Dopamine stimulates Risk of cardiac disease, cardiac
both hypotension and conduction arrhythmias and/or Report the following
dopaminergic bradycardia w/ abnormalities, occlusive vascular indicators promptly
and 1- phenytoin.. HTN, azotemia, disease, active to physician for use
adrenergic anxiety, myocardial in decreasing or
receptors Risk of excessive widened QRS ischaemia or recent temporarily
producing vasoconstriction w/ complex, MI. suspending dose:
cardiac ergot alkaloids. bradycardia, Reduced urine flow
CLASSIFI- stimulation ABSORPTION EXCRETION piloerection, rate in absence of
CATION and renal peripheral hypotension;
vasodilation; Rapidly urine cyanosis. ascending
large doses absorbed tachycardia;
stimulates - dysrhythmias;
adrenergic disproportionate rise
receptors. in diastolic pressure,
signs of peripheral
ischemia
Monitor therapeutic
effectiveness.
TIME NAME DOSAGE/ INTERACTION EFFECT CONTRAINDICAT RESPONSIBILITES
ORDERED TIME IONS
INTERVAL
Nov. 24, Lasix Inhibit reabsorption Edema due to 20 mg IV May interact with low blood Anuria; hepatic Assess patients
2016 @ of sodium and cardiac, hepatic aspirin, metoprolol pressure, coma & underlying condition
6:20 am water in the & renal disease, and albuterol dehydration precoma; severe before starting therapy.
ascending limb of burns; mild to and hypokalemia Monitor VS especially
the loop of Henle moderate HTN, electrolyte &/or
BP
by interfering with hypertensive depletion (for hyponatremia;
the chloride binding crisis, acute example, hypovolemia w/ Monitor for renal
site of the 1Na+, heart failure, sodium, or w/o cardiac,neurologic, GI
GENERIC 1K+, 2Cl- reduced urinary HALF potassium), hypotension. manifestations of
NAME cotransport system. output due to LIFE jaundice, Hypersensitivity hypokalemia.
Furosemid Loop diuretics gestoses, 2 hours ringing in the to sulfonamides. Monitor for CNS, GI,
e increase the rate of chronic renal ears cardiovascular,
delivery of tubular failure, (tinnitus), integumentary and
fluid and nephrotic sensitivity to neurologic
CLASSIFI- electrolytes to the syndrome. ABSORPTI EXCRETION light manifestations of
CATION distal sites of ON Unchanged, renal (photophobia) hypocalcemia,
Diuretic hydrogen and Rapidly , rash, Monitor for CNS,
potassium ion absorbed pancreatitis, hyperactive reflexes,
secretion, after IV nausea, depressed cardiac
while plasma diarrhea, output, nausea,
administrati
volume contraction abdominal vomiting, tachycardia
increases on pain, and Assess fluid volume
aldosterone dizziness. status (urine,color,
production. The Increased quality and specific
increased delivery blood sugar gravity)
and high and uric acid
Assess patient tinnitus,
aldosterone levels levels
promote sodium or pain
reabsorption at the
distal tubules, thus
increasing the loss
of potassium and
hydrogen ions.
Chapter XI
HEALTH TEACHINGS
Primary:
Encourage the patient to have a sufficient rest.

Encourage patient not to do strenuous activities.
Encourage patient to perform active range of motion intermittently and activities of daily
living.
Encourage patient to eat nutritious foods rich in protein, iron, vitamin C such as lean
meat, green leafy vegetables, as ordered.
Secondary:
Orient the patients family about the patients condition and necessary
information/treatment and recovery process.
Instruct the family to remain at patients side to give physical support and
encouragement.
Teach significant others to assist the patient always in a comfortable position.
Instruct significant others to wash hands before and after contact with patient.
Instruct the family to maintain the environment of the patient safe and clean at all times.
Tertiary:
Instruct the patient to take the medications prescribed by the physician.

Instruct the patient to report for any abnormalities immediately to the physician or nurse.
Chapter XII
DISCHARGE PLAN
Medications:
Discuss all take home medications to the patient and significant others.
Encourage to take drugs with food if not contraindicated.
Inform patient that the drugs may exhibit undesirable side effects.
Inform patient about the possible adverse effects that the drugs can cause.
Encourage to report to the physician if she suffers any unusualities.
Exercises:
Encourage patient to have adequate rest and sleep.

Encourage patient not to do too much activities and chores.
Encourage patient not to stress herself too much
Treatment:
Orient the patients family about the patients condition and necessary information,
treatment and recovery process.
Encourage to comply with treatment regimen.
Provide comfort measures and encourage use of relaxation techniques such as focus
breathing and imaging to distract attention and reduce tension.
Special care is taken in the positioning of the head of the patient to avoid flexion of the
neck which might impair circulation of the brain.
Hygiene:
Emphasize constant and proper hygiene.

Educate client and significant others in infection control procedure like washing hands,
wearing gloves in dressing the wound.
Clean the surgical wound regularly and keep it dry and intact.
Outpatient Orders:
Instruct the family members to have a check-up or to consult the physician once
complications like unusual discharges on the wounds are notice.
Instruct the patient to follow and comply the medications ordered by the physician.
Diet:
Eat more nutritious foods such as green leafy vegetables and foods rich in CHON and
Vitamin C to promote faster wound healing.
Drink at least 8-10 glasses of water every day.
Diet as tolerated is advice by the attending physician to sustain the patients nutritional needs.
Significant Others:
Encourage patient and significant others to maintain clean and safe environment at all
times.
Chapter XIII
PROGNOSIS
Good Fair Poor Justification

Duration After two years of some
episodes of mild to severe
headache the patient experienced
generalized seizure. And
because of that she was rush
immediately to the hospital for
medical help and was diagnosed
with meningioma
Onset of Illness Two years prior to admission the
patient already experienced
different signs and symptoms of
meningioma like headache, and
blurring of vision.
Compliance of The patient and the family is
the medication trying to be compliant with the
medication regimen as
prescribed by the physician but
there are some instances that
they are not able to buy all the
prescribed medications due to
financial issues
Family Support The patients husband is always
there for her all throughout the
patients entire admission.
Environment According to the patient they
lived in the squatters area.
There are high chances of
pollution and noise which may
affect the patients healing
process and recovery.
Age Meningioma is common to
adults in 30-60 years of age.
(Medical- Surgical Nursing)
Precipitating The patient said that she will try
Factor to follow all the doctors order
but since the patient is living in
the squatters area she is exposed
to different stressors that might
trigger the patients condition.
Summary
GOOD:1/7x100 = 14.28%
FAIR:5/7x100 = 71.42%
POOR:1/7x100 = 14.28%
The patient has a fair prognosis of 71.42%. She did not sought medical attention
immediately after the onset of signs and symptoms. The patient may have difficulty or slow
recovery from the condition since the patient is living in the squatters area and exposed to
stressors.
Chapter XIV
EVALUATION
Upon finishing the case study, the researchers had not only gained knowledge from the
study but learned as well as the surprisingly diverse ecosystem in the hospital. When the patient
was under the care of the researchers, they have observed several things to the various persons in
the hospital ecosystem and thus encourage recommendation to the following;
To the Client:
Patient Leila was a great client to have, not only that she highly complies with the
treatment, she also has a great perspective towards her own health and aims for progression to
optimum state. It is assuring to know that the patient wants to have faster recovery thus, she
promised to follow the entire physicians order.
To the Family:
The family of Patient Leila is just an outstanding as the patient herself; they share the
same view on health and its importance to each person. The researchers would encourage the
family to continue on supporting not only patient Leilas health status but every family member
and to keep valuing greatly a persons health.
To the Staff Nurses:
I believe that the nurses on the Neuro Ward of SPMC had put as much love as they do for
their own family. The setting in the ward itself may not be most ideal, the nurses there have
shown a lot of hard work and compassion on their job despite the minor bumps in the harmony
of the workplace.
Chapter XV
IMPLICATION OF THE STUDY
A meningioma is a tumor that grows inside the meninges of the central nervous system. It can be
either benign or malignant however most cases are benign. Women in older ages are more
susceptible in developing such disease. The cause of meningiomas is unknown but there are
several risk factors which includes exposure to ionizing radiation, heredity, diet and the
environment. In patient Petra's case, her meningioma was diagnosed as benign which means it is
not cancerous. However, the cause of her disease might be linked to her heredity.
The patient has understood her condition and is aware of the treatment and procedure that
she will undergo. Patient Petra now knows not to increase her activity levels and not to stress
herself too much which could possibly trigger a seizure. Not only did the patient benefit from the
study but also the members of the group. With the case of Patient Petra, the group has applied the
knowledge and skills acquired from lectures and lessons. Through interviewing, the group has
applied therapeutic communication which allowed them to established rapport with the patient
and the patients significant others. Through the study, the group has enhanced and furthered
their knowledge on effective patient care specifically in the surgical ward area of the hospital.

A Case Study On Meningioma

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A Case Study on Meningioma

In Partial Fulfilment of the Requirements In

A Requirement Presented to the

Despite effort in researching data in Philippines concerning cases of meningioma, however

Patients Name: Leila

Mothers Name: Leni

Case No.: 2016063184

ANATOMY AND PHYSIOLOGY OF THE BRAIN & MENINGES

The hindbrain has three parts:

Pia Mater, or Pia

PRESENT ABSENT JUSTIFICATION

PRESENT ABSENT JUSTIFICATION

SYMPTOMS PRESENT ABSENT JUSTIFICATION

PREDISPOSING FACTORS PRECIPITATING FACTORS

Gender Exposure to viral infections

Signs and Symptoms:

Consumption of nutrients by tumor

Tumor growth to different areas of

Cerebral ischemia Primary malignant

Inflammation Invasion to lymphatic

November 12, 2016 Justification/Rationale

November 13, 2016 Justification/Rationale

November 14, 2016 Justification/Rationale

November 15,2016 Justification/Rationale

NVS q4 To obtain baseline data for comparison

Refer For further evaluation and management

November 15,2016 Justification/Rationale

Start dexamethasone 4mg IVTT q6h To control edema

November 16,2016 Justification/Rationale

November 17,2016 Justification/Rationale

Refer unusualities For further evaluation and management

November 17,2016 Justification/Rationale

Refer back as necessary For any unusualities referral is advised

Diazepam PRN for seizure To treat seizure

November 18,2016 Justification/Rationale

Refer for unusualities For further evaluation and management

November 19,2016 Justification/Rationale

NVS q4 To obtain baseline data for comparison

Refer For further evaluation and management

November 20, 2016 Justification/Rationale

November 21,2016 Justification/Rationale

Refer Should requires, to address clinical issues early

Anesthesia Pre-Op Orders

November 22,2016 Justification/Rationale

History and physical examination To determine the appropriate type of anesthesia

Anesthesia Post-Op Orders

November 23,2016 Justification/Rationale

NPO When the body awakens after anesthesia, the

Meds: 1) paracetamol 1g IVTT x 6 Paracetamol for mild to moderate pain and

Hook to mech vent To help the patient breathe

Refer For further evaluation and management

incorporate 50 meQs NaHCO3 on 1L

November 23,2016 Justification/Rationale

Epinephrine to relieve respiratory distress

Refer For further evaluation and management

November 23,2016 Justification/Rationale

continue levophed as ordered To restore blood pressure control in certain

November 24,2016 Justification/Rationale

refer For further evaluation and management

Date: November 16, 2016 @ 10:15 PM

TEST RESULT REFERENCE INTERPRETATION

TEST RESULT REFERENCE INTERPRETATION

Date: November 23, 2016 @ 9:29 PM