OBJECTIVES:

To be able to know about the patients profile To be able to identify the anatomy and physiology To be able to know the discharge planning of the patient To be able to know the pathophysiology

PATIENTS PROFILE:
Name Address Age Sex Status Religion : : : : : : AIZA ELEZON Alipangpang, Pozorrobio, Pangasinan 19 years old Female Single Roman Catholic

Date of Admission : August 19, 2007 at 6:20 PM A.P. Diagnosis : : Dr. Mayreen Fernandez Cerebral Concussion

PATIENTS HISTORY
General Data: Aiza Elezon, 19 years old, female, single, Roman Catholic from Alipangpang Pozorrobio Pangasinan was admitted on 8-19-07 for the first time at this institution

Patient History: Unremarkable Family History: Unremarkable

LABORATORY RESULT

HEMATOLOGY RESULT

LNC : 25. 4 X 109 /L HGB: 117 g/L HCT: 0.34 MEHC: 345 g/L BLOOD TYPE: 0+

DIFFERENT COUNT SEGMENTERS: 0.80 LYMPOCYTES: 0.14 MIXED CELLS: 0.06 PLATELET COUNT: 274 X109/L

ANATOMY AND PHYSIOLOGY

The Skeletal System serves many important functions; it provides the shape and form for our bodies in addition to supporting, protecting, allowing bodily movement, producing blood for the body, and storing minerals. Functions Its 206 bones form a rigid framework to which the softer tissues and organs of the body are attached. Vital organs are protected by the skeletal system. The brain is protected by the surrounding skull as the heart and lungs are encased by the sternum and rib cage. Bodily movement is carried out by the interaction of the muscular and skeletal systems. For this reason, they are often grouped together as the musculo-skeletal system.

Muscles are connected to bones by tendons. Bones are connected to each other by ligaments. Where bones meet one another is typically called a joint. Muscles which cause movement of a joint are connected to two different bones and contract to pull them together. An example would be the contraction of the biceps and a relaxation of the triceps. This produces a bend at the elbow. The contraction of the triceps and relaxation of the biceps produces the effect of straightening the arm. Blood cells are produced by the marrow located in some bones. An average of 2.6 million red blood cells are produced each second by the bone marrow to replace those worn out and destroyed by the liver. Bones serve as a storage area for minerals such as calcium and phosphorus. When an excess is present in the blood, buildup will occur within the bones. When the supply of these minerals within the blood is low, it will be withdrawn from the bones to replenish the supply. Types of Bone The bones of the body fall into four general categories: long bones, short bones, flat bones, and irregular bones. Long bones are longer than they are wide and work as levers. The bones of the upper and lower extremities (ex. humerus, tibia, femur, ulna, metacarpals, etc.) are of this type. Short bones are short, cube-shaped, and found in the wrists and ankles. Flat bones have broad surfaces for protection of organs and attachment of muscles (ex. ribs, cranial bones, bones of shoulder girdle). Irregular bones are all others that do not fall into the previous categories. They have varied shapes, sizes, and surfaces features and include the bones of the vertebrae and a few in the skull.

Bone Composition Bones are composed of tissue that may take one of two forms. Compact, or dense bone, and spongy, or cancellous, bone. Most bones contain both types. Compact bone is dense, hard, and forms the protective exterior portion of all bones. Spongy bone is inside the compact bone and is very porous (full of tiny holes). Spongy bone occurs in most bones. The bone tissue is composed of several types of bone cells embedded in a web of inorganic salts (mostly calcium and phosphorus) to give the bone strength, and collagenous fibers and ground substance to give the bone flexibility

PATHOPHYSIOLOGY

DISCHARGE PLANNING

MEDICATION : Clindamycin, Erythomycin Chlorampenicol

Environment a. Advice patient to wash hands frequently, especially after going to bathroom to avoid further infection b. Advice patient to clean and disinfect all kitchen surfaces. c. Proper hygiene d. Provide cleanliness and sanitation.

Patients should be instructed to complete the full course of antibiotic therapy.

Patients should be instructed to follow up when indicated or if symptoms worsen.

MEDICAL TREATMENT AND MANAGEMENT Medical Treatment Instruct the patients caregiver to take the medication prescribe by the physician instruct the patients caregiver regarding the medication, dosage, time of administration and side effects Teach the client to: a. Show patient or caregivers how to give drug to avoid reinfection

b. Warn patient not to touch ear with dropperc. Boil water before drinking, boil for at least 30 mins onwards d. Warn client not to eat food containing raw eggs and refrain from buying cans, boxes or jars that are damaged. e. Advised clients to avoid the use of antibiotics over a long time. f. Avoid drinking tap water, ice cube, milk products, raw meat and foods that cannot be cooked or peeled.

UNIVERSITY OF LUZON College of Nursing Dagupan City

Name of Patient: Aiza Eleson Chief Complaint/s: ______ Age: 19 Sex: Female Ward / Area: Diagnosis / Impression: Cerebral Concussion___ Hospital: R1MC Date of Admission: August 19, 2007___

NURSING CARE PLAN

ASSESSMENT Cues/ Clues (Subjective/ Objective Data) Subjective Data: Masakit yung sa may panga ko. As verbalized by the patient. Objective Data: -grimacing -irritability -weak looking NURSING DIAGNOSIS (Nursing Problem) Pain r/t injury AEB by weak looking and grimacing PLANNING (Nursing Objective/ Goal/ Outcome Criteria) Patient will carry out appropriate interventions for pain relief. NURSING INTERVENTION RATIONALE PATIENT TEACHING

1) Monitor vital signs 2) Provide comfort measures (e.g. back rub, change of position and use of heat and cold) 3) Encourage adequate rest periods 4) Instructed patients to practice personal hygiene 5) Encourage diversional activities like reading newspapers or listening to radio 6) Administer pain relievers as ordered

- usually altered in pain - To provide nonpharmacologic pain management - To prevent fatigue - To prevent infection - To divert attention

Show patient or caregiver how to give drug, to avoid reinfection, warm patient not to touch ear with dropper.

- to minimize pain felt by the patient

UNIVERSITY OF LUZON College of Nursing Dagupan City

DRUG STUDY
Name of Patient: Aiza Eleson Chief Complaint/s: ______ Age: 19 Sex: Female Ward / Area: Diagnosis / Impression: Cerebral Concussion___ Hospital: R1MC Date of Admission: August 19, 2007___

DRUG STUDY
DRUG NAME
Clindamycin Hydrochloride

ACTION
Inhibits bacterial protein synthesis by binding 15 the 50s subunit of the ribosome.

DOSAGE
30 mg + tab BID

INDICATION

CONTRAINDICATION
Contraindicated in patients hypersensitive to drugs Use cautiously in patients with renal or hepatic disease, asthma history of GI disease or significant allergies

SIDE/ADVERSE EFFECTS
CV: Thrombophlebitia GI nausea, vomiting, abdominal pain, diarrhea, pseudomembranous colitis Hematoligic :transient leucopenia, eosinophilia, thrombocytopenia Hepatic jaundice Skin: maculopapolar rash, urticaria Other anaphylaxis

DRUG INTERACTION Drug-Drug! Erythomycin, may block access of clindamycin to its site of action. Avoid using together. Koalin: May decrease absorption of oral clindamycin separate dosage times.

NURSING CONSIDERATION

Infections caused by sensitive staphylococci, streptococci, pneumococci, bacteroides, fusobacterium, clostridium, perfringens, and other sensitive aerobic and anaerobic organisms.

Obtain specimen for culture and sensitivity tests before giving first dose. Therapy may begin pending results. For IM administration, inject deep into muscle. Rotate sites IM injection may raise CK level in response to muscle irritation Dont refrigerate reconstituted oral solution because it will thicken. Drug is stable for 2 weeks at room temperature monitor renal, hepatic and hematopoietic functions during prolonged therapy. Observe patients for signs and symptoms of superinfection

UNIVERSITY OF LUZON College of Nursing Dagupan City

DRUG STUDY
Name of Patient: Aiza Eleson Chief Complaint/s: ______ Age: 19 Sex: Female Ward / Area: Diagnosis / Impression: Cerebral Concussion___ Hospital: R1MC Date of Admission: August 19, 2007___

DRUG STUDY
DRUG NAME
Erythromycin

ACTION
Inhibits bacterial protein synthesis usually bacteriostatic but maybe bactericidal in high concentrations or against highly susceptible organisms

DOSAGE

INDICATION

CONTRAINDICATION
Contraindicated in patients hypersensitive to drugs use cautiously in breastfeeding women

SIDE/ADVE RSE EFFECTS

EENT slowed comeal wound healing, blurred vision, itching and burning eyes

DRUG INTERACTION

NURSING IMPLICATION

PATIENT TEACHING

TID on the affected eye

Acute and Chronic conjunctivitis other eye infections

None significant

To patient opthalmia neonaturum, apply ointment no later than 1 hour after birth. Drug is used in neonates born either vaginally or by cesarean section. Gently massage eyelids for 1 minute 5 spread ointment.

Tell patient to clean eye area of excessive discharge before application. Teach patient how to apply drug. Advise him to wash hands before and after applying ointment and warm him not to touch tip of applicator to eye or surrounding tissue. Tell patient that vision may be blured for a few minutes after applying ointment.

UNIVERSITY OF LUZON College of Nursing Dagupan City

DRUG STUDY
Name of Patient: Aiza Eleson Chief Complaint/s: ______ Age: 19 Sex: Female Ward / Area: Diagnosis / Impression: Cerebral Concussion___ Hospital: R1MC Date of Admission: August 19, 2007___

DRUG STUDY
DRUG NAME ACTION DOSAGE INDICATION CONTRAINDICATION SIDE/ADVERSE EFFECTS DRUG INTERACTION NURSING IMPLICATION PATIENT TEACHING

Chloramphenicol

Inhibits or destroys bacteria in the ear canal

500 mg IV q 80

External ear canal infection

Contraindicate d in patients hypersensitive to drugs or its components and in those with perforated eardrum

EENT ear itching or burning GV: hemogloniburia Hematolic: bone marrow depression, bone marroe hypoplasia aplastic anemia Metabolic: lactic acidosis Skin pruritus, urticartia Other: overgrowth of nonsusceptible organisms

Non significant

Obtain history of drug use and reaction Monitor patients for signs and symptoms of superinfection Avoid prolonged use Monitor patients for sore throat Alert Dont confuse chloromycetin with chorambucil

Advise patient to take capsule form with full glass of water to prevent esophageal irritation Warm patient that IM inection may be painful Tell patient to report discomfort at I. V insertion site. Instruct patient to notify prescriber of adverse reactions (esp. diarrhea) warm him not to treat such diarrhea himself because clindamycin therapy may cause severe even life threatening colitis