Case Study-BPPV

Case StudyCase StudyBenign Paroxysmal Benign Paroxysmal Positional Vertigo Positional Vertigo

(BPPV)(BPPV)Presented by:Presented by:

Jacinto, Arvie D.Jacinto, Arvie D.

Mariano, Lalaine B.Mariano, Lalaine B.

BSN122BSN122

Group87Group87

January 18, 2010January 18, 2010

Presented to:Presented to:

Mr. Oliver Sanidad R.N. MAMr. Oliver Sanidad R.N. MA

Biographic DataBiographic DataName: Name: Mr. M.M.Mr. M.M.

Address: Address: Fortune Village 5, Valenzuela CityFortune Village 5, Valenzuela City

Age: Age: 56 yrs. old56 yrs. old Gender: Gender: MaleMale

Religious Affiliation: Religious Affiliation: CatholicCatholic

Marital Status: Marital Status: MarriedMarried Occupation: Occupation: LaborerLaborer

Room and Bed #: Room and Bed #: 208208

Chief Complaint: Chief Complaint: DizzinessDizziness

Provisional Diagnosis: Provisional Diagnosis: BPPV (Benign BPPV (Benign Paroxysmal Positional Vertigo)Paroxysmal Positional Vertigo)

Attending Physician: Attending Physician: Dra. T. Dela Cruz, Dr. Dra. T. Dela Cruz, Dr. Olonan, and Dr. SantosOlonan, and Dr. Santos

Past Health HistoryPast Health HistoryAccording to the patient, he can’t According to the patient, he can’t

remember all his childhood illnesses. But remember all his childhood illnesses. But he can recall he had chickenpox when he he can recall he had chickenpox when he was 10 years old. He certainly verbalized was 10 years old. He certainly verbalized that he has complete immunization. The that he has complete immunization. The patient doesn’t have any allergies to patient doesn’t have any allergies to foods and drugs. There’s no previous or foods and drugs. There’s no previous or any accident encountered by the patient. any accident encountered by the patient. His past and first hospitalization was His past and first hospitalization was because of hypertension for 3 days at because of hypertension for 3 days at Grace Hospital, Bulacan. Grace Hospital, Bulacan.

Treatments were unrecalled Treatments were unrecalled during the said hospitalization. The during the said hospitalization. The patient is currently taking Adalat 30 patient is currently taking Adalat 30 mg once a day as his hypertension mg once a day as his hypertension maintenance as prescribed by his maintenance as prescribed by his physician after he was hospitalized. physician after he was hospitalized.

In 1986, the patient worked at In 1986, the patient worked at Kuwait as a mechanical Kuwait as a mechanical maintenance for 10 years with maintenance for 10 years with occasional vacation.occasional vacation.

History of Present History of Present IllnessIllness

According to the patient, a According to the patient, a night prior to confinement he night prior to confinement he experienced sudden dizziness when experienced sudden dizziness when he woke up 1 a.m. to void. He went he woke up 1 a.m. to void. He went back to bed still feeling dizzy back to bed still feeling dizzy believing his dizziness to diminish. believing his dizziness to diminish. The next day, he was advised by his The next day, he was advised by his wife to admit himself to the hospital wife to admit himself to the hospital since he has health insurance so since he has health insurance so might as well he can use it.might as well he can use it.

Family Health HistoryFamily Health HistoryAccording to the patient, his parents According to the patient, his parents

were still alive and well. He also added that were still alive and well. He also added that they don’t have any diseases except his they don’t have any diseases except his father sometimes experience increase in father sometimes experience increase in blood pressure. Known hereditary diseases in blood pressure. Known hereditary diseases in their family were Hypertension and Diabetes their family were Hypertension and Diabetes although his parents didn’t acquire any. although his parents didn’t acquire any. However, the patient has hypertension and However, the patient has hypertension and type II diabetes mellitus which according to type II diabetes mellitus which according to him he might acquire it from his father’s him he might acquire it from his father’s siblings who are also hypertensive and siblings who are also hypertensive and diabetic. Luckily, his wife and family have no diabetic. Luckily, his wife and family have no significant diseases in the present.significant diseases in the present.

Patterns of Patterns of FunctioningFunctioning

Psychological HealthPsychological HealthCoping PatternsCoping Patterns

When asked about his condition, When asked about his condition, the patient verbalized that, “Medyo ok the patient verbalized that, “Medyo ok na naman ako, pwede na rin daw na naman ako, pwede na rin daw akong umuwi.” He added that he is akong umuwi.” He added that he is now happy because he can go home. now happy because he can go home. He also mentioned that in terms of his He also mentioned that in terms of his problems regarding his problems regarding his hospitalization, he can able to manage hospitalization, he can able to manage all of these because his wife is always all of these because his wife is always there to care for him.there to care for him.

He said that even though there He said that even though there are times that he and his wife have are times that he and his wife have some misunderstandings, they easily some misunderstandings, they easily solve these problems by confronting solve these problems by confronting each other. He verbalized that, each other. He verbalized that, “Mabigat kasi sa pakiramdam pag “Mabigat kasi sa pakiramdam pag pinapatagal pa, yung hindi pinapatagal pa, yung hindi pagpapansinan.” If there are pagpapansinan.” If there are problems with the family especially problems with the family especially with their two daughters, they discuss with their two daughters, they discuss it with the whole family.it with the whole family.

Interaction PatternInteraction Pattern

According to the patient, he According to the patient, he has many friends in his work and in has many friends in his work and in their place at Valuenzuela. He said their place at Valuenzuela. He said that socialization with other people that socialization with other people is not a problem with him because is not a problem with him because he can easily mingle to them and he can easily mingle to them and adjust to their culture. He also adjust to their culture. He also mentioned that during his stay in mentioned that during his stay in Kuwait, he met different people Kuwait, he met different people but he adjusted easily to it.but he adjusted easily to it.

When it comes to his When it comes to his interaction with his family, he interaction with his family, he verbalized that, “Parang verbalized that, “Parang magkakapatid lang ang turingan magkakapatid lang ang turingan naming lahat sa bahay.” He added naming lahat sa bahay.” He added that if their 2 daughters have some that if their 2 daughters have some problems, he will just give them problems, he will just give them advices. He also doesn’t have any advices. He also doesn’t have any problems with their neighbors and problems with their neighbors and mentioned that they have good mentioned that they have good interaction.interaction.

Self-conceptSelf-concept

Mr. M.M. thinks that he is now Mr. M.M. thinks that he is now healthy. He verbalized that, “Maayos healthy. He verbalized that, “Maayos na naman yung pakiramdam ko pero na naman yung pakiramdam ko pero medyo nahihilo pa rin ako.” He said medyo nahihilo pa rin ako.” He said that he feels that way because that he feels that way because compare to what he experienced compare to what he experienced before he was hospitalized, it is much before he was hospitalized, it is much better now. During his hospitalization, better now. During his hospitalization, he said that whenever he is in a good he said that whenever he is in a good mood, he usually talks and chat with mood, he usually talks and chat with his wife. He keeps on talking and telling his wife. He keeps on talking and telling those pieces of advice that he has.those pieces of advice that he has.

When it comes to physical aspect, he When it comes to physical aspect, he said that sometimes he is sad because he said that sometimes he is sad because he cannot do his work as a laborer. He cannot cannot do his work as a laborer. He cannot earn money that he will need for the earn money that he will need for the expenses in their family. He is also bored expenses in their family. He is also bored during his hospitalization because all he was during his hospitalization because all he was doing was sleeping, eating, and watching doing was sleeping, eating, and watching the television. Mr. M.M also mentioned that the television. Mr. M.M also mentioned that he has so many goals that he wanted to he has so many goals that he wanted to achieve in his life. He said that he was only achieve in his life. He said that he was only an elementary graduate but he didn’t mind an elementary graduate but he didn’t mind what others will say about him. According to what others will say about him. According to him, as of now, he was so grateful that his him, as of now, he was so grateful that his two daughters both finished their studies two daughters both finished their studies and also have their own jobs.and also have their own jobs.

Emotional PatternsEmotional Patterns

Mr. M.M. said that whenever he Mr. M.M. said that whenever he has problems especially in his work, has problems especially in his work, he usually tells it to his wife. He he usually tells it to his wife. He believes that if a couple has the believes that if a couple has the communication especially when communication especially when there are problems, they will have a there are problems, they will have a good relationship. He verbalized good relationship. He verbalized that, “Sinasabi ko naman agad that, “Sinasabi ko naman agad sakanya yung mga problema ko. sakanya yung mga problema ko. Minsan nagaaway rin kami pero Minsan nagaaway rin kami pero naguusap rin naman kami agad.”naguusap rin naman kami agad.”

He added that if ever there are He added that if ever there are problems between them, they don’t problems between them, they don’t want their children see that they are want their children see that they are quarrelling. They solve problems by quarrelling. They solve problems by confronting each other.confronting each other.

In terms of the whole family, In terms of the whole family, each one of them has the freedom to each one of them has the freedom to say his/her own feelings regarding say his/her own feelings regarding family problems. Mr. M.M. said that family problems. Mr. M.M. said that their family has a harmonious their family has a harmonious relationship with each other.relationship with each other.

SexualitySexuality

Mr. M.M. verbalized that, “Dapat Mr. M.M. verbalized that, “Dapat kasi tatlo yang mga anak ko. Kaso kasi tatlo yang mga anak ko. Kaso nga lang yung panganay ay namatay nga lang yung panganay ay namatay nung pinapanganak, premature kasi nung pinapanganak, premature kasi siya.” He added that they didn’t use siya.” He added that they didn’t use any family planning method and any family planning method and verbalized that, “Hindi naman talaga verbalized that, “Hindi naman talaga naming plano ang maraming anak.” naming plano ang maraming anak.” He also mentioned that after her last He also mentioned that after her last daughter, her wife undergone tubal daughter, her wife undergone tubal ligation.ligation.

Socio-cultural PatternsSocio-cultural Patterns

Recreation PatternRecreation Pattern

According to Mr. M.M., his According to Mr. M.M., his usual recreational activity is usual recreational activity is playing tennis. He said that he playing tennis. He said that he usually plays for 4 hours together usually plays for 4 hours together with his friends. Aside from playing with his friends. Aside from playing tennis he sometimes chats with tennis he sometimes chats with their neighbors and if he is in their their neighbors and if he is in their house, he watches the television.house, he watches the television.

Mr. M.M. together with his wife Mr. M.M. together with his wife and two daughters are currently and two daughters are currently living at Fortune Village 5, living at Fortune Village 5, Valenzuela City. According to him, in Valenzuela City. According to him, in their village, it is peaceful and clean. their village, it is peaceful and clean. He verbalized that, “Kahit naman He verbalized that, “Kahit naman minsan may mga nagaaway hindi minsan may mga nagaaway hindi naman rin sila nagkakasakitan.” He naman rin sila nagkakasakitan.” He also said that he has many friends also said that he has many friends and he has a good relationship with and he has a good relationship with their neighbors.their neighbors.

Economic PatternEconomic Pattern

According to Mr. M.M., he went to According to Mr. M.M., he went to Kuwait because during that time he needed Kuwait because during that time he needed money for him to send her two daughters money for him to send her two daughters in school. As of now, he is a laborer and he in school. As of now, he is a laborer and he earns money that is sometimes not enough earns money that is sometimes not enough for his family. When asked about what are for his family. When asked about what are the expenses that they focused on, he the expenses that they focused on, he mentioned that they a lot more money on mentioned that they a lot more money on their food. Second to it was for the health their food. Second to it was for the health of the family especially for the of the family especially for the medications. Lastly was for other expenses medications. Lastly was for other expenses like electric and water bills.like electric and water bills.

Activities of Activities of Daily LivingDaily Living

NutritionNutritionAccording to the client, before his According to the client, before his

hospitalization, he and his family often eats hospitalization, he and his family often eats rice, vegetable, fish and chicken. The patient rice, vegetable, fish and chicken. The patient drinks at least 8-10 glasses a day. They drinks at least 8-10 glasses a day. They seldom eat pork, at least 1-2 times a week. seldom eat pork, at least 1-2 times a week. He usually eats 3 times a day together with He usually eats 3 times a day together with his family. He also includes variety of fruits in his family. He also includes variety of fruits in his diet. He added that he has a good appetit his diet. He added that he has a good appetit During his hospitalization, he still eats 3 times During his hospitalization, he still eats 3 times a day but the hospital foods were often meat a day but the hospital foods were often meat and so sometimes he eats less than the usual. and so sometimes he eats less than the usual. But his wife also cook foods in their house and But his wife also cook foods in their house and brought to him in the hospital.brought to him in the hospital.

Analysis and Interpretation:Analysis and Interpretation:

There are no significant differences There are no significant differences in his nutrition before and during in his nutrition before and during hospitalization. Patients who are hospitalization. Patients who are hospitalized may have an inadequate hospitalized may have an inadequate dietary intake because of the illness or dietary intake because of the illness or disorder that necessitated the hospital disorder that necessitated the hospital stay or because the hospital’s food is stay or because the hospital’s food is unfamiliar or unappealing. But the unfamiliar or unappealing. But the patient however still eats 3 times a day.patient however still eats 3 times a day.

Reference:Reference:

Bruneer and Suddhart’s Medical-Surgical Bruneer and Suddhart’s Medical-Surgical Nursing, 11Nursing, 11thth edition, volume 1, pg. 83 edition, volume 1, pg. 83

EliminationEliminationThe client usually urinates 7 times a day The client usually urinates 7 times a day

almost the same amount of what he drinks. almost the same amount of what he drinks. Light yellow in color and faint aromatic in Light yellow in color and faint aromatic in odor. He said that she doesn’t feel any odor. He said that she doesn’t feel any discomfort in urinating. The patient discomfort in urinating. The patient defecates 2 times a day – one in the morning defecates 2 times a day – one in the morning and one in the afternoon. Semi-solid and and one in the afternoon. Semi-solid and aromatic in odor, brown in color and formed. aromatic in odor, brown in color and formed.

During hospitalization, patient’s During hospitalization, patient’s urination pattern is the same from his usual urination pattern is the same from his usual habit. The patient only defecates once since habit. The patient only defecates once since his hospital stay, hard in consistency.his hospital stay, hard in consistency.


Urination pattern did not change. Urination pattern did not change. However, defecation pattern However, defecation pattern significantly deviated from usual. significantly deviated from usual. Hospitalized clients may suppress the Hospitalized clients may suppress the urge to defecate because of urge to defecate because of embarrassment may be because of lack embarrassment may be because of lack of privacy or because defecation is too of privacy or because defecation is too uncomfortable. uncomfortable.

Reference: Reference:

Kozier and Erb’s Fundamentals of Kozier and Erb’s Fundamentals of Nursing, 8th edition, volume 2, page Nursing, 8th edition, volume 2, page 13271327

ExerciseExerciseAccording to the client, before his According to the client, before his

hospitalization, he plays tennis everyday. hospitalization, he plays tennis everyday. This is his sort of excercision. He spends This is his sort of excercision. He spends almost half of the day playing tennis with almost half of the day playing tennis with his playmates. “Athletic ako”, as his playmates. “Athletic ako”, as verbalized by the client.verbalized by the client.

During his hospitalization, he’s just During his hospitalization, he’s just lying or sitting down since he was lying or sitting down since he was confined on bed. He would only stand confined on bed. He would only stand and walk when he has to use the toilet to and walk when he has to use the toilet to void or defecate. He usually calls his wife void or defecate. He usually calls his wife to help him in going to the bathroom.to help him in going to the bathroom.

Analysis and Interpretations:Analysis and Interpretations:

The client has limited The client has limited movement as indicated by his movement as indicated by his condition. Bed rest to promote condition. Bed rest to promote healing may limit activity and healing may limit activity and movement therefore inability to movement therefore inability to perform basic ADLs can occur.perform basic ADLs can occur.

Reference:Reference:

Kozier and Erb’s Fundamentals of Kozier and Erb’s Fundamentals of Nursing, 8th edition, volume 2, Nursing, 8th edition, volume 2, page1117page1117

HygieneHygiene

In terms of hygienic practices before In terms of hygienic practices before hospitalization, the client takes a bath once a hospitalization, the client takes a bath once a day provided that he will bathe with warm day provided that he will bathe with warm water. water. “Minsan lang ako maligo lalo pag hindi “Minsan lang ako maligo lalo pag hindi mainit yung tubig.” He also added, “Pag mainit yung tubig.” He also added, “Pag malamig ang tubig ayokong ng maligo.”malamig ang tubig ayokong ng maligo.”

Brushes his teeth only once a day and doesn’t use Brushes his teeth only once a day and doesn’t use deodorant. Trim his nails everytime it becomes deodorant. Trim his nails everytime it becomes long.long.

During hospitalization, the patient didn’t During hospitalization, the patient didn’t take a bath yet because according to him, take a bath yet because according to him, there’s no warm water to use. He still brushes there’s no warm water to use. He still brushes his teeth once a day.his teeth once a day.


The patient obviously neglected The patient obviously neglected to take a bath during hospitalization. to take a bath during hospitalization. Ill people may not have the Ill people may not have the motivation or energy to attend to motivation or energy to attend to hygiene. hygiene.

ReferenceReference

Kozier and Erb’s Fundamentals of Kozier and Erb’s Fundamentals of Nursing, 8th edition, volume 1, page Nursing, 8th edition, volume 1, page 742742

Substance AbuseSubstance AbuseAccording to the client, he smokes and According to the client, he smokes and

consumes 1 pack of filter cigarette everyday. consumes 1 pack of filter cigarette everyday. He also drinks occasionally with maximum of He also drinks occasionally with maximum of 4 bottles of beer during special events only. 4 bottles of beer during special events only. He is also taking He is also taking AdalatAdalat 30mg once a day as 30mg once a day as his anti-hypertensive maintenance.his anti-hypertensive maintenance.

While hospitalized, there’s no way he While hospitalized, there’s no way he can do his vices. He has plans to stop can do his vices. He has plans to stop smoking and alcohol drinking, since he can smoking and alcohol drinking, since he can also perceive the effects of long term also perceive the effects of long term cigarette smoking. cigarette smoking.


The patient has no choice but The patient has no choice but to abstain from smoking. Primarily, to abstain from smoking. Primarily, because hospitals don’t allow because hospitals don’t allow cigarette smoking. cigarette smoking.

Sleep and RestSleep and RestFor the client’s sleep and rest pattern, For the client’s sleep and rest pattern,

he said that his usual sleep is at 8pm and he said that his usual sleep is at 8pm and usually wakes up 2am but continues his usually wakes up 2am but continues his sleep until 6am He is satisfied and sleep until 6am He is satisfied and comfortable with the amount and quality of comfortable with the amount and quality of sleep he’s getting. He also stated, “gising sleep he’s getting. He also stated, “gising matanda na ang gising ko”. matanda na ang gising ko”.

During hospitalization, the patient’s During hospitalization, the patient’s sleeping pattern is the same with his’ sleeping pattern is the same with his’ normal. He is satisfied and comfortable also. normal. He is satisfied and comfortable also. But he got some time to rest during the day.But he got some time to rest during the day.


There’s no change with his There’s no change with his sleeping pattern during sleeping pattern during hospitalization except that more hospitalization except that more resting time he’s getting during resting time he’s getting during the day.the day.

Sexual ActivitySexual ActivityFor the patient’s sexual activity For the patient’s sexual activity

with his wife before hospitalization, with his wife before hospitalization, they are less often than not engaged they are less often than not engaged in sexual intercourse. “Tumatanda in sexual intercourse. “Tumatanda na kami, hindi na namin yun na kami, hindi na namin yun masyado ginagawa” as verbalized by masyado ginagawa” as verbalized by the patient. According to the patient, the patient. According to the patient, his wife had menopause already.his wife had menopause already.

During hospitalization, no sexual During hospitalization, no sexual engagement occurred.engagement occurred.

Physical Physical AssessmentAssessment

Body part Normal Findings Actual Findings Analysis and Interpretation

1.General Survey-Body built-Height-Weight-Posture and gait

-Over all hygiene and grooming-Body and breath odor

-Signs of distress-Signs of health or illness-Attitude

-Affect and mood

-Quantity and quality of speech

-Relevance and organization of thoughts

-Proportionate

-Relaxed, erect and react with coordinated movement-Clean and neat

-No body or minor odor and breath odor

-No distress noted-Healthy appearance-Cooperative and able to follow instructions

-The affect and mood should be appropriate to the situation-The quality and quantity of speech is understandable, in moderate pace-Logical sequence; makes sense; has sense of reality

-Proportionate-No data available-No data available-Relaxed and erect posture while sitting and standing -Clean and neat

-Presence of breath odor and body odor

-No distress noted-He appears healthy.-Can response to questions and followed instructions correctly-He feels happy and comfortable-Soft voice tones; understandable and in moderate pace-Her thoughts has a sense of reality and related to the questions asked to her

-Normal findings

-Normal findings

-Normal findings

-Deviation from normalHalitosis, or most commonly bad breath are terms used to describe noticeably unpleasant odors exhaled in breathing. Bad breath may be due to poor hygiene and usage of tobacco products. (Halitosis. January 11, 2010. Retrieved last January 16, 2009 from http://en.wikipedia.org/wiki/Halitosis)-Normal findings-Normal findings

-Normal findings

-Normal findings-Normal findings

-Normal Findings

Integumentary2. Skin-Skin color and uniformity

-Presence of Edema

-Presence of skin lesions-Skin moisture

-Skin temperature

-Skin turgor

-Varies from light to deep brown; from ruddy pink to light pink; from yellow overtones to olive-Generally uniform skin color except in areas exposed to the sun; areas of lighter-No presence of edema

-Freckles; some birthmarks, some flat raised nevi; no abrasions or other lesions-Moisture in skin folds and axillae

-Uniform skin temperature; within the normal range-When pinched, the skin springs back to its previous state

-Light brown skin color

-Uniform in color; there is presence of hyperpigmentation and hypopigmentation-No presence of edema

-No presence of birthmarks, abrasions and lesions on the body-Small amount of moisture is present in the axillae, antecubital area and popliteal-Temperature is uniform all throughout the body and is warm to touch-Has good skin turgor, when pinched, it immediately goes back to the previous state

-Normal findings

-Normal findings

-Normal findings

-Normal findings

-Normal findings

-Normal findings

-Normal findings

3. Nails-Fingernail plate shape-Finger nail and toenail bed color

-Nail texture

-Tissues surrounding the nails-Blanch test of capillary refill

-Convex curvature; angle of plate about 160°-Highly vascular and pink in light-skinned clients; dark-skinned clients may have brown or black pigmentation in longtitudinal streaks

-Smooth texture

-Intact epidermis

- Prompt return of pink or usual color; generally less than 4 second

-Convex nails with an angle of 160°-White in color

-Smooth texture and there is no visible cracks-Tissues that surrounds that the nails are intact

-The color of the nails, when pressed were still the same color (white)

-Normal findings

-Deviation from NormalPallor may reflect poor arterial circulation.(Kozier, et al. 2007.Fundamentals of Nursing 8th Edition. Phillipines:Pearson Education, Inc.p.584)-Normal findings

-Normal findings

-Deviation from NormalDelayed return to usual color of the nails may indicate circulatory impairment. (Kozier, et al. 2007.Fundamentals of Nursing 8th Edition. Phillipines:Pearson Education, Inc.p.584)

Head4. Skull-Size and shape

-Symmetry-Presences of nodules, masses and depressions

-Rounded and smooth skull contour-Symmetrical-No presence of masses or nodules and depression

-Slightly round and has smooth skull contour-Symmetrical-No visible masses or nodules and areas of depression

-Normal findings


5. Scalp-Color

-Areas of tenderness

-Lighter to the color of the facial skin

-No areas of tenderness

-Grayish in color, lighter than the color of the facial skin-No areas of tenderness

-Normal findings

-Normal findings

6. Hair-Evenness of growth and thickness

-Presence of infections

-Evenly distributed and thick

-No presence of infections

-Hair is evenly distributed all throughout the scalp an is thick-Negative flakes, no infections or insects in the hair

-Normal findings

-Normal findings

7. Facial Features-Symmetry of facial movements

-Symmetrical facial movements

-Symmetrical facial movements when elevating the eyebrows, smiling, closing the eyes tightly, pouting, puffing the cheeks, and frowning

-Normal findings

EYES8. Visual Acuity-Near Vision

-Distant Vision

-Able to read the newsprint

-Has a 20/20 vision for both right and left eyes on the Snellen-type chart

-He was able to read all the letters and words given to him in a piece of paper with the distance of 1 foot away from him-No data available

-Normal findings

9.Eyebrows-Distribution of hair-Symmetry

-Movement

-Evenly distributed hair and-Symmetrically aligned

-Equal movement

-Hair in the eyebrows are equally distributed-Symmetrically aligned on both sides-Coordinated movements

-Normal findings

-Normal findings

-Normal findings

10. Lacrimal gland, lacrimal sac and nasolacrimal duct

-No presence of tenderness, edema and tearing

-Upon palpation, there is no areas of tenderness, edema or swelling and tearing

-Normal findings

11. Eyelids-Surface characteristics

-Ability to blink

-Frequency of blinking

-Evenly distributed hair on the eyelashes; skin is intact; no discharges; no discoloration -Lids closes symmetrically

-Approximately 15 to 20 involuntary blinks per minute; bilateral blinking

-Hair on the eyelashes are evenly distributed, skin is intact with no discoloration and discharges-The eyelids closes and opens symmetrically-Approximately 17 blinks per minute with symmetrical blinking

-Normal findings

-Normal findings

-Normal findings

12. Bulbar Conjunctiva-Color

-Texture

-Presence of lesions

-Palpebral Conjucntiva-Color and Texture


-Transparent; capillaries are sometimes evident-Smooth texture

-No presence of lesions

-Pink or red

-Smooth and shiny


-Transparent in color and some capillaries are visible-Appears to be smooth in texture-No lesions observed on the surface-Pinkish in color

-Smooth and shiny in texture-No observable lesions

-Normal findings

-Normal findings

-Normal findings

-Normal findings

-Normal findings

-Normal findings

13. Sclera-Color and clarity -White in color -Appears to be white in color and

with smooth texture-Normal findings

14. Cornea-Clarity and texture -Transparent, shiny and

smooth-Transparent, shiny and smooth -Normal findings

15. Iris-Shape and color -Varies with client's race;

flat and round-Iris appears to be flat, round and brown in color

-Normal findings

16. Pupils-Color-Shape

-Symmetry and size

-Light Reaction

-Accommodation

-Black in color-Round and has smooth border-Equal in size; normally 3mm to 7mm in diameter-Illuminated pupil constricts (direct response); non-illuminated pupil dilates (consensual response-Pupils constrict when looking at near objects; pupils dilate when looking at far object; pupils converge when near object is moved toward the nose

-Appears to be white in color-Round and has smooth border

-Equal in size and symmetrical on both sides-Constricts at approximately 4mm as light directed to the eyes and dilates at approximately 6mm when light is removed.-When the client was asked to look at near object, the pupils constrict; on the other hand, when he was asked to look on far object, the pupils dilates


-Normal findings

-Normal findings

-Normal findings

17. Extra Ocular Muscles-Alignment and coordination

-Both eyes coordinated; move in unison with parallel alignment

-Both eyes followed the penlight in different direction with parallel alignment and move in unison

-Normal findings

18. Visual Fields -When looking straight ahead, client can see objects in the periphery

-He can able to see my fingers at different angles

-Normal findings

EARS19. Auricles-Color

-Symmetry-Position

-Texture, elasticity and areas of tenderness

-Color same as facial skin-Symmetrical-Aligned with the outer canthus of the eyes at about 10º vertical

-Mobile, firm and not tender; the pinna recoils after it is folded

-Light brown, same as the facial skin-Symmetrical-Vertically aligned at the outer canthus of the eye at about 10º vertical-Soft but firm texture; no lesions present and no tenderness felt by the client upon palpation; the pinna recoils immediately after folding it

-Normal findings


-Normal findings

20. External Ear Canal

-Presence of cerumen, skin lesions, pus and blood

-Dry cerumen, grayish-tan color; or sticky wet cerumen in various shades of brown-No presence of skin lesions, pus and blood

-Dry cerumen is visible

-No lesion, pus and blood is present

-Normal findings

-Normal findings

21. Hearing Acuity test-Normal voice tones

-Watch tick test

-Weber’s Test

-Rinne Test

-Normal voice tones audible

-Able to hear ticking in both ears

-Sound is heard in both ears or is localized at the center of the head (Negative Weber)-Air-conducted hearing is greater than bone-conducted hearing (Positive Rinne)

-The client can hear the normal voice tone and can repeat what was told to him-The client stated that he heard “tick-tack” sound when watch was placed in his ear. -The client said that he felt the vibration and both ears equally heard the sound

-The air-conducted hearing lasted for 10 seconds and the bone-conducted hearing lasted for 7 seconds

-Normal findings

-Normal findings

-Normal findings

-Normal findings

NOSE-Shape and size-Color-Flaring or discharge from nares-Nasal cavities (redness, swelling, growths and discharge

-Nasal septum (position)

-Patency of both nasal cavities

-Tenderness, masses displacements of bone and cartilage

-Symmetric and straight-Uniform color-No flaring or discharge

-Mucosa pink; has a clear, watery discharge; there are no lesions

-It is intact and in middle line

-Air moves freely when the client breathes through the nares

-No areas of tenderness, masses, and displacement of bone and cartilage

-Symmetric and straight-Uniform color-No flaring or discharge

-Mucosa appears to be pink in color; has a clear, watery discharge and there are no lesions, swelling, redness and growth-Nasal septum is located at the middle line and is intact-The air coming from the nares can be felt and it moves freely when the client breathes.-No areas of tenderness, masses, and displacement of bone and cartilage

-Normal findings-Normal findings-Normal findings

-Normal findings

-Normal findings

-Normal findings

-Normal findings

SINUSES-Any presence of tenderness

-No presence of tenderness -No presence of tenderness

-Normal findings

MOUTH22. Lips-Symmetry of contour-Color -Texture

-Symmetric appearance

-Uniform pink color-Soft, moist, smooth texture

- Symmetric appearance

-Slightly bluish in color- Soft, moist and has smooth texture


23. Buccal Mucosa-Color, moisture, and texture


-Uniform pink color-Has a moist, smooth, soft, glistening, and elastic texture-No lesions

-Pink in color; smooth, soft and glistening and has elastic texture



24. Teeth-Number of condition

-Color

-Presence of dentures

-32 adult teeth

-Smooth, white, shiny tooth enamel

-No dentures present

-22 adult teeth

-Rough in texture, discoloration of the enamel (black in color)

-No dentures present

-Absence of 10 teeth. The normal number of adult teeth is 32. (Kozier, et al. 2007.Fundamentals of Nursing 8th Edition. Phillipines:Pearson Education, Inc.p.584)-Black discoloration of the enamel may indicate staining or presence of caries. (Kozier, et al. 2007.Fundamentals of Nursing 8th Edition. Phillipines:Pearson Education, Inc.p.584)-Normal findings

25. Gums-Color and condition -Pink gums, moist, firm

texture-No retraction of gums-No presence of tenderness

-Pink gums, moist, firm texture

-No retraction of gums-No presence of tenderness

-Normal findings


26. Tongue/Floor of the Mouth-Color and texture

-Position and movement-Presence of nodules, lumps or excoriated areas-Floor of the mouth and frenulum

-Pink color; moist; slightly rough; thin whitish coating; smooth, lateral margins; no lesions; raised papillae-Central position; moves freely-No tenderness, nodules, lumps or excoriated areas

-Smooth tongue base with prominent veins

-Appears to be pink in color; smooth whitish coating; bilateral margins; raised papillae; and there is no presence of lesions-Central position; moves freely

-No areas of tenderness, masses or nodules, lumps or excoriated areas-Smooth tongue base with prominent veins can be observed

-Normal findings

-Normal findings

-Normal findings

-Normal findings

27. Palates and Uvula-Color and texture

-Position of the uvula and mobility

-Light pink, smooth, soft palate-Lighter pink hard palate

-Position in midline of soft palate

-Soft palate appears to be pink in color, smooth and soft; hard palate is lighter than soft palate

-Uvula is located at the midline of the soft palate and can moves freely

-Normal findings

-Normal findings

28. Oropharynx and Tonsils-Color, texture and size-Presence of discharge

-Pink and smooth posterior wall; of normal size or not visible-No discharge

-Pinkish in color and has smooth posterior wall; of normal size (Grade 1)-No discharge observed

-Normal findings

-Normal findings

Neck and Lymph Nodes29. Lymph Nodes-Enlargement of the lymph nodes

-Not palpable -Lymph nodes are not palpable and this indicates no enlargement

-Normal findings

30. Trachea-Placement -Central placement in

midline of neck; spaces are equal on both sides

-The placement of the trachea determined upon palpation and is located at the midline of the neck and both sides have equal spaces

-Normal findings

31. Thyroid Gland-Symmetry and smoothness

-Presence of enlargement, masses or nodules

-Not visible in inspection; gland ascends during swallowing but it is not visible

-No enlargement, masses or nodules

-Symmetry is not visible in inspection and the elevation of the gland can be observed right after the patient swallowed-No presences of enlargement, masses or nodules

-Normal findings

-Normal findings

Thorax32. Posterior Thorax-Size, shape and symmetry

-Spinal alignment

-Temperature, tenderness and masses-Respiratory excursion-Vocal/Tactile Fremitus-Percussion sounds heard

-Auscultation sounds heard

-Anteroposterior to transverse diameter in ration of 1:2 -Spine vertically aligned; spinal column is straight, right and left shoulders are at the same height-Chest wall intact; no tenderness; no masses; uniform temperature-Full symmetric expansion

-Bilateral symmetry of vocal fremitus-Percussion notes resonance, except over scapula; lowest point of resonance is at the diaphragm; a rib normally elicits dullness-Vesicular and bronchovesicular breath sounds

- Anteroposterior to transverse diameter in ration of 1:2-Spine vertically aligned; spinal column is straight, right and left shoulders are at the same height-Chest wall intact; no tenderness; no masses; uniform temperature-Full symmetric expansion

-Bilateral symmetry of vocal fremitus-Percussion notes resonance, except over scapula; lowest point of resonance is at the diaphragm; a rib normally elicits dullness-Vesicular and bronchovesicular breath sounds

-Normal findings

-Normal findings

-Normal findings

-Normal findings

-Normal findings

-Normal findings

-Normal findings

33. Anterior Thorax-Breathing patterns

-Temperature, tenderness and masses-Respiratory excursion-Vocal/Tactile Fremitus

-Percussion sounds heard

-Auscultation sounds heard (trachea)-Auscultation sounds heard (anterior thorax)

-Quite, rhythmic and effortless respirations- No tenderness; no masses; uniform temperature-Full symmetric expansion-Bilateral symmetry of vocal fremitus-Percussion notes resonance down to the sixth rib at the level of the diaphragm; flat over areas of heavy muscle and bone; dull on areas over the heart and the liver, and tympanic over the underlying stomach -Bronchial or tubular sound

-Bronchovesicular and vesicular sound

-Quite, rhythmic and effortless respirations- No tenderness; no masses; uniform temperature-Full symmetric expansion-Bilateral symmetry of vocal fremitus

-Percussion notes resonance down to the sixth rib at the level of the diaphragm; flat over areas of heavy muscle and bone; dull on areas over the heart and the liver, and tympanic over the underlying stomach

-Bronchial or tubular sound

-Bronchovesicular and vesicular sound

-Normal findings

-Normal findings


-Normal findings

-Normal findings

-Normal findings

Cardiovascular34. Heart-Presence of abnormal pulsations, lifts or heaves

-Auscultation sound heard

-No pulsations on the aortic and pulmonic areas; no lifts or heaves on the tricuspid area; no lifts or heaves on the mitral area but with visible pulsations-S1: usually heard at all sites; usually louder at apical area; S2: usually heard at all sites; usually louder at the base of the heart; Systole: silent interval; slightly shorter duration than diastole at normal heart rates; Diastole: silent interval; slightly longer duration than systole at normal heart rates

-No pulsations on the aortic and pulmonic areas; no lifts or heaves on the tricuspid area; no lifts or heaves on the mitral area but with visible pulsations-S1: usually heard at all sites; usually louder at apical area; S2: usually heard at all sites; usually louder at the base of the heart; Systole: silent interval; slightly shorter duration than diastole at normal heart rates; Diastole: silent interval; slightly longer duration than systole at normal heart rates

-Normal findings

-Normal findings

35. Carotid Artery-Quality of pulsations

-Auscultation sound heard

-Symmetric pulse volumes; full pulsations; has a thrusting quality

-No sound heard

-Symmetric pulse can be felt, full pulsations and has a thrusting quality-No sounds can be heard

-Normal findings

-Normal findings

36. Jugular veins-Presence of distention

-Veins not visible -Veins are not visible when on the lateral side of the neck when the client is in Semi-fowler’s position

-Normal findings

Breast and Axillae35. Breast-Size, symmetry, and contour or shape

-Skin color-Presence of swelling or edema, and tenderness

-Females: Rounded shape; slightly unequal in size;Males: even with the size of the chest wall-Uniform in color-No swelling or edema and tenderness

-Even with the size of the chest wall

-Uniform in color-No presence of swelling or edema.

-Normal findings


36. Areola-Shape-Symmetry-Color

-Presence of mass or lesions

-Round or oval-Bilaterally symmetric-Varies from light pink to dark brown-No skin lesions or masses

-Round in shape-Bilaterally symmetric-Light to dark brown in color-Presence of pimple-like behind his right nipple, located around the areola


-Deviation from normal

37. Nipples-Size

-Shape-Position

-Color-Direction

-Presence of discharge an lesions

-Equal in size on both nipples-Round and everted-Centrally located on each breast-Uniform in color-Both nipples point in the same direction-No discharges and lesions

-Both nipples are equal in size-Round and everted-Centrally located on each breast-Uniform in color-Both nipples point in the same direction-No discharges and lesions

-Normal findings



-Normal findings

38. Axillae-Presence of tenderness, masses or nodules

-No tenderness, masses or nodules

-Upon palpation, there is no presence of tenderness, masses or nodules

-Normal findings

Abdomen-Skin integrity

-Abdominal contour

-Enlargement of the liver or spleen-Symmetry of Contour-Abdominal Movements (respirations, peristalsis, or aortic pulsations)

-Presence of vascular patterns-Auscultation sound heard (bowel movements, vascular sounds and peritoneal friction rubs)-Percussion sounds heard (Four quadrants)

-Light palpation

-Deep palpation

-Unblemished skin; uniform color; visible silver white striae or surgical scars-Flat, rounded or scaphoid appearance-No evidence of enlargement of liver or spleen-Symmetric contour-Symmetric movements caused by respirations-Visible peristalsis in very lean people-Aortic pulsations in thin person at epigastric area-No visible vascular patterns

-Audible bowel sounds-Absence of arterial bruits-Absence of friction rub

-Tympany over the stomach and gas-filled bowels; dullness, especially over the liver and spleen, or a full bladder-No tenderness; relaxed abdomen with smooth, consistent tension-Tenderness may be present near xiphoid process, over cecum and over the sigmoid colon

-Uniform in color. No presence of surgical scars.

-Round in shape

-No evidence of enlargement of liver or spleen-Symmetric contour-Symmetric movements caused by respirations is visible

-Vascular patterns is not visible

-Audible bowel sounds can be heard upon auscultation-There is no presence of arterial bruits-There is no presence of friction rub-Tympany over the stomach and gas-filled bowels; dullness, especially over the liver and spleen, or a full bladder

-No tenderness; relaxed abdomen with smooth, consistent tension-No presence of tenderness

-Normal findings

-Normal findings

-Normal findings


-Normal findings

-Normal findings

-Normal findings


-Normal findings

-Normal findings

39. Liver-Size

-Areas of tenderness and enlargement

-6 to 12 cm in the midclavicular line; 4 to 8 cm at the midsternal line-May not be palpable; borders feels smooth; no enlargement and areas of tenderness

-6 to 12 cm in the midclavicular line; 4 to 8 cm at the midsternal line-May not be palpable; borders feels smooth; no enlargement and areas of tenderness

-Normal findings

-Normal findings

40. Symphysis Pubis-Possible urinary retention

-Not palpable -Not palpable -Normal findings

Musculoskeletal System41. Muscles-Size

-Presence of contractures-Presence of fasciculation and tremor-Muscle Tonicity

-Muscle Strength

-Equal size on both sides of the body-No contractures

-No tremors

-Normally firm

-Equal strength on each body side

-The right arm and left arm is at equal size-No contractures noted

-No tremors on the arms and hands of the client

-Muscle were observed to be normally firm-Equal strength on each body side was determined when test for strength in the neck, upper and lower extremities were done.-Is Grade 5 of normal strength; normal full movement against gravity and against full resistance

-Normal findings

-Normal findings

-Normal findings

-Normal findings

-Normal findings

42. Bones-Structure-Areas of tenderness and swelling

-No deformities-No tenderness and swelling

-No deformities-No tenderness and swelling


43. Joints-Presence of swelling-Areas of tenderness, swelling, crepitation and nodules-Smoothness of movement-Range of Motion

-No swelling

-No tenderness, swelling, crepitation and nodules

-Joints move smoothly-Varies to some degree in accordance with person's genetic makeup and degree of physical activity

-No swelling or edema present-No areas of tenderness, swelling, nodules and crepitation heard

-All joints can move freely and smoothly-No data available

-Normal findings

-Normal findings

-Normal findings

Diagnostics Diagnostics and and

LaboratoriesLaboratories

Procedure/Item Result Units Reference range

Interpretation and Analysis

FBS 7.75 mmol/l 2.9 – 5.6 Deviation from NormalAn elevated blood glucose level is called hyperglycemia which leads to common clinical manifestations associated with diabetes mellitus.(Black and Hawk’s Medical Surgical Nursing 8th Edition Volume 1, volume 1, pg. 1067)

BUN 10 mg/dl 8 – 23 NormalCreatinine 0.9 mg/dl 0.6 – 1.1 NormalCholesterol 4.80 mmol/l 0.5 – 0.9 Deviation from Normal

Hypertension and high serum cholesterol levels are linked factors to the development of coronary artery disease.(Black and Hawk’s Medical Surgical Nursing 8th Edition Volume 1, volume 1, pg. 1302)

Triglycerides 1.24 mmol/l 0.46 – 1.88 NormalHDL 1.19 mmol/l 0.0 – 0.91 Deviation from Normal

Coronary heart disease risk decreases as blood levels of HDL-C increase.(Black and Hawk’s Medical Surgical Nursing 8th Edition, volume 1, pg. 1382)

LDL 3.05 mmol/l 1.56 – 4.55 NormalSodium - - -SGOT - - -SGPT - - -Potassium - - -HBA1C - - -

Item Result Normal Analysis and InterpretationMacroscopicColor Yellow Straw/Amber NormalTransparency Clear Clear NormalpH 5.0 4.6-8.0 NormalSpecific Gravity 1.005 1.005-1.030 NormalSugar Trace Negative Deviation from Normal

Glucose in the urine indicates high blood glucose levels and maybe indicative of undiagnosed or uncontrolled diabetes mellitus.(Kozier and Erb’s Fundamentals of Nursing, 8th edition, volume 2, page 1293)

Protein Negative Negative NormalMicroscopicPus cells 0 – 1/HPF -RBC 0 – 1/HPF <2 per HPF NormalEpithelial Cells RAREBacteria RAREMucus Threads RARECrystalsUrates RARE

Procedure/Item Result Reference Range Interpretation and Analysis

Hemoglobin 141 120 – 160 g/L NormalHematocrit 0.41 0.37 – 0.47 NormalRBC - 4.0 – 5.4 x 16^12/L -MCHC - 32 – 36 g/dL -MCV - 27 – 33 -MCH - 80 – 97 fl -WBC 5.5 5.10 x 10^9/L Deviation from Normal

An increase in white blood cells can often indicate that the body is reacting to an allergen or to a minor infection. It can also indicate injury to the tissue, such as that caused by a heart attack, surgery or burns.(Wallace, O. 2003. What Does a White Blood Cell Count Indicate? Retrieved from http://www.wisegeek.com/what-does-a-white-blood-cell-count-of-too-numerous-to-count-tntc-indicate.htm)

Different CountSegmenters 0.48 0.55 – 0.70 Deviation from NormalLymphocytes 0.44 0.23 – 0.40 Deviation from Normal

An increased percentage of lymphocytes (lymphocytosis) may indicate: Chronic bacterial infection Infectious hepatitis Infectious mononucleosis Lymphocytic leukemia Multiple myeloma Viral infection (such as infectious mononucleosis, mumps, measles) Recovery from a bacterial infection(Brose, M. 2003. Blood Differential. Retrieved from http://health.allrefer.com/health/blood-differential-results.html)

Eosinophils - 0.01 – 0.06 -Monocytes 0.08 0.02 – 0.08 NormalBlasts - - -Platelet 200 150 – 450 x 10^9/L Normal

Blood Type - - -

Procedure/Item Result Reference Range

Interpretation and Analysis

Sodium 146.1 135 – 140 mmol/L

Deviation from NormalAn increased in plasma sodium level greater than 145mEq/L is known as hypernatremia. Neurologic changes manifested as confusion, seizures, or coma, and in some cases with irreversible brain damage.(Black and Hawk’s Medical Surgical Nursing 8th Edition Volume 1, volume 1, pg. 147)

Potassium 4.73 3.5 – 5.3 mmol/L

Normal

2D Echo2D EchoResults Normal Volumes

LV edd 4.5 3.5 – 5.1 LV edv 93LV esd 2.3 LV esv 18IVS edd 1.1 0.8 – 1.1 SV 75IVS esd 1.6 CO 3.5 L/minLVPW edd 1.1 0.8 – 1.1 EF 81 % 55 – 77 %LVPW esd 1.6 0.8 – 1.1 FS 49 % 29 – 42 %LA (APdia) 3.6 3.0 – 2.5 -Aortic Root 3.5 AV OpeningMPA 2.8 HRRA 3.3 2.2 – 4.5RV 3.0 2.3 – 4.0LVETEPSS 0.8 < 1.0 mmMV annulusTV annulus DT 188 160 – 220 msecLV OT IVRT 112 60 – 90 msec

Color Flow and Doppler Color Flow and Doppler StudyStudy

Value Vmax (m/sec)

P.I.G. (mm Hg)

Onfice Area

Regurgitation

Aortic 0.7 2.1Mitral .7/.9TricuspidPulmonic 0.8PAT: TRjet: 36

Interpretation: Interpretation:

Normal left ventricular with adequate wall motion and contractilityNormal left ventricular with adequate wall motion and contractility

Normal right ventricular diameter with adequate wall motion and Normal right ventricular diameter with adequate wall motion and contractilitycontractility

Normal left and right atrial diametersNormal left and right atrial diameters

Thickened mitral valves without restriction of motionThickened mitral valves without restriction of motion

Structurally normal aortic, tricuspid and pulmonic valvesStructurally normal aortic, tricuspid and pulmonic valves

Normal vein pulmonary artery diameterNormal vein pulmonary artery diameter

Nomal aortic aortic rootNomal aortic aortic root

Color Flow and Doppler:Color Flow and Doppler:

Mild mitral and tricuspid regurgitationMild mitral and tricuspid regurgitation

Reversed mitral inflow patternReversed mitral inflow pattern

ESPAP of 36 mm Hg by TRjetESPAP of 36 mm Hg by TRjet

Conclusion:Conclusion:

Normal left ventricular resting systolic function grade 1 diastolic Normal left ventricular resting systolic function grade 1 diastolic dysfunctiondysfunction

Normal right ventricular size and functionNormal right ventricular size and function

No significant valve disease nor dysfunctionNo significant valve disease nor dysfunction

Mild pulmonary hypertensionMild pulmonary hypertension

Mild mitral & tricuspid regurgitationMild mitral & tricuspid regurgitation

Chest X-rayChest X-ray

Radiologic ReportRadiologic Report

Both lung fields are clearBoth lung fields are clear

The heart is not enlargedThe heart is not enlarged

Aorta is tortousAorta is tortous

Diaphragm and sinuses are intactDiaphragm and sinuses are intact

ImpressionImpression

Atheromatous aortaAtheromatous aorta

Interpretation:Interpretation:

Atheromatous aorta are found in chest x-ray results of a lot Atheromatous aorta are found in chest x-ray results of a lot of folks in their 40s above. It means that there are fat of folks in their 40s above. It means that there are fat deposits in her artery – the result of a lifetime of eating deposits in her artery – the result of a lifetime of eating fatty foods.fatty foods.

Drug StudyDrug Study

Generic / Trade Name

Dosage/ Frequency

Classification Indication Contraindication

Side Effects Nsg. Responsibilities

Amlodipine

5mg/tab OD Antihypertensive

Calcium channel blocker

Hypertension alone or in

combination with other

hypertensives

Hypersensitivity to

amlodipine

Headache, nausea and

vomiting

Monitor Vital signs

Monitor cardiac rhythm during stabilization of dosage.

Administer drug without regard to meals.

Adalat 30mg OD Antihypertensive

Calcium channel blocker

Treatment for hypertension

Contraindicated with

allergy to adalat

Dizziness, light-

headedness, vertigo,

nausea and vomiting

Monitor Vital signs.Do not exceed 30mg/dose increases.Protect drug from light and moisture.

Vessel Due

1 tab BID1amp/IV

OD

Anticoagulants

Peripheral vascular insufficiency,

diabetic retinopathy, MI, retinal vasal

thrombosis.

Contraindicated with allergy to vessel due

Pain, burn and

hematoma at the site of

injection.

Adjust dose according to coagulation test results performed just before injection (30min before each intermittent dose or every 4-6hr continuous IV dose).Always check compatibilities with other IV solutions.Drug must be given by parenteral route (cannot be taken orally).

Lipway SR

1 cap HS Antihyperlipidemic

Adjunct to diet for treatment of adults with hypertriglyceri

demia

Contraindicated with allergy to lipwar SR

Diarrhea and loss of

appetite

Administer drug with meals.Monitor patient carefully.Ensure that clients continues strict dietary restrictions.Give frequent skin care to deal with rashes and dryness.Monitor patient for muscle weakness, and aches.

Solosamet

2 500mg/ta

b OD

Antidiabetic agent

Adjunct to diet and exercise

and lower blood glucose

in patients with type 2

(non-insulin-dependent)

diabetes mellitus

Contraindicated with allergy to antidiabetic drugs, Insulin-

dependent (type 1)

diabetes,.

Administer drug before breakfast

Monitor urine and serum glucose levels.

Arrange for transfer to insulin therapy during high stress.

Provide skin care to prevent breakdown.

Omeprazole

40mg/TIV OD

Antisecretory drug

Proton pump inhibitor

Contraindicated with

hypersensitivity to

omeprazole and its

components.

Dizziness, headache, nausea

and vomiting, diarrhea

and cough

Administer before meals. Caution the client to swallow capsules whole--- not to open, chew or crush.

Administer antacids with, if needed.

Anatomy and Anatomy and PhysiologyPhysiology

Vestibular SystemVestibular System"The first sensory system to fully develop by "The first sensory system to fully develop by

six months after conception is the vestibular six months after conception is the vestibular system, which system, which controls the sense of controls the sense of movement and balancemovement and balance. This system is the . This system is the sensory system considered to have the most sensory system considered to have the most important influence on the other sensory important influence on the other sensory systemssystems and on the ability to function in and on the ability to function in everyday life. Directly or indirectly, the vestibular everyday life. Directly or indirectly, the vestibular system influences nearly everything we do. It is system influences nearly everything we do. It is the unifying system in our brain that modifies and the unifying system in our brain that modifies and coordinates information received from coordinates information received from other systemsother systems. The vestibular system functions . The vestibular system functions like a traffic cop, telling each sensation where like a traffic cop, telling each sensation where and when it should go or stop."and when it should go or stop."

The labyrinth of the inner ear, from the left ear. It contains i) the cochlea (yellow), which is the peripheral organ of our auditory system; ii) the semicircular canals (brown), which transduce rotational movements;

and iii) the otolithic organs (in the blue/purple pouches), which transduce linear accelerations.

AnatomyAnatomyThe vestibular system, which is the system of balance, The vestibular system, which is the system of balance,

consists of 5 distinct end organs: 3 semicircular canals consists of 5 distinct end organs: 3 semicircular canals that are sensitive to angular accelerations (head that are sensitive to angular accelerations (head rotations) and 2 otolith organs that are sensitive to linear rotations) and 2 otolith organs that are sensitive to linear (or straight-line) accelerations.(or straight-line) accelerations.

The semicircular canals are arranged as a set of 3 mutually The semicircular canals are arranged as a set of 3 mutually orthogonal sensors; that is, each canal is at a right angle orthogonal sensors; that is, each canal is at a right angle to the other 2. This is similar to the way 3 sides of a box to the other 2. This is similar to the way 3 sides of a box meet at each corner and are at a right angle to one meet at each corner and are at a right angle to one another. Furthermore, each canal is maximally sensitive another. Furthermore, each canal is maximally sensitive to rotations that lie in the plane of the canal. The result of to rotations that lie in the plane of the canal. The result of this arrangement is that 3 canals can uniquely specify the this arrangement is that 3 canals can uniquely specify the direction and amplitude of any arbitrary head rotation. direction and amplitude of any arbitrary head rotation. The canals are organized into functional pairs wherein The canals are organized into functional pairs wherein both members of the pair lie in the same plane. Any both members of the pair lie in the same plane. Any rotation in that plane is excitatory to one of the members rotation in that plane is excitatory to one of the members of the pair and inhibitory to the other.of the pair and inhibitory to the other.

The otolith organs include the utricle and the The otolith organs include the utricle and the saccule. The utricle senses motion in the saccule. The utricle senses motion in the horizontal plane (eg, forward-backward horizontal plane (eg, forward-backward movement, left-right movement, combination movement, left-right movement, combination thereof). The saccule senses motions in the thereof). The saccule senses motions in the sagittal plane (eg, up-down movement).sagittal plane (eg, up-down movement).

Membranous LabyrinthMembranous Labyrinth

The membranous labyrinth is surrounded by The membranous labyrinth is surrounded by perilymph and suspended by fine connective perilymph and suspended by fine connective tissue strands from the bony labyrinth. It tissue strands from the bony labyrinth. It consists of an anterior chamber and the cochlear consists of an anterior chamber and the cochlear duct, which subserves hearing and connects by duct, which subserves hearing and connects by way of the round saccule with the posterior way of the round saccule with the posterior vestibular apparatus. The peripheral vestibular vestibular apparatus. The peripheral vestibular apparatus consists of the saccule, utricle, and apparatus consists of the saccule, utricle, and semicircular canals.semicircular canals.

SacculeSaccule

The saccule is an almost The saccule is an almost globular-shaped sac that lies in the globular-shaped sac that lies in the spherical recess on the medial wall spherical recess on the medial wall of the vestibule. It is connected of the vestibule. It is connected anteriorly to the cochlear duct by the anteriorly to the cochlear duct by the ductus reuniens and posteriorly to ductus reuniens and posteriorly to the endolymphatic duct via the the endolymphatic duct via the utriculosaccular duct. The saccular utriculosaccular duct. The saccular macula is an elliptical thickened area macula is an elliptical thickened area of sensory epithelium that lies on the of sensory epithelium that lies on the anterior vertical wall of the saccule.anterior vertical wall of the saccule.

UtricleUtricle

The utricle is larger than the saccule The utricle is larger than the saccule and lies posterosuperiorly to it in the and lies posterosuperiorly to it in the elliptical recess of the medial wall of the elliptical recess of the medial wall of the vestibule. It is connected anteriorly via the vestibule. It is connected anteriorly via the utriculosaccular duct to the endolymphatic utriculosaccular duct to the endolymphatic duct. The 3 semicircular canals open into it duct. The 3 semicircular canals open into it by means of 5 openings; the posterior and by means of 5 openings; the posterior and the superior semicircular canals share one the superior semicircular canals share one opening at the crus commune.opening at the crus commune.

The macula of the utricle lies mainly The macula of the utricle lies mainly in the horizontal plane and is located in in the horizontal plane and is located in the utricular recess, which is the dilated the utricular recess, which is the dilated anterior portion of the utricle.anterior portion of the utricle.

Semicircular canalsSemicircular canals

The 3 semicircular canals are small The 3 semicircular canals are small ringlike structures: lateral or horizontal, ringlike structures: lateral or horizontal, superior or anterior, and posterior or superior or anterior, and posterior or inferior. They are oriented at right angles to inferior. They are oriented at right angles to each other and are situated so that the each other and are situated so that the superior and posterior canals are at 45° superior and posterior canals are at 45° angles to the sagittal plane, and the angles to the sagittal plane, and the horizontal canal is 30° to the axial plane. horizontal canal is 30° to the axial plane. Each canal is maximally responsive to Each canal is maximally responsive to angular motion in the plane in which it is angular motion in the plane in which it is situated and is paired with a canal on the situated and is paired with a canal on the contralateral sized so that stimuli that are contralateral sized so that stimuli that are excitatory to one are inhibitory to the other.excitatory to one are inhibitory to the other.

The horizontal canal is paired with the The horizontal canal is paired with the contralateral horizontal canal; however, contralateral horizontal canal; however, the superior canal is paired with the the superior canal is paired with the contralateral posterior canal and vice contralateral posterior canal and vice versa. Each canal forms two thirds of a versa. Each canal forms two thirds of a circle with a diameter of about 6.5 mm and circle with a diameter of about 6.5 mm and a luminal cross-sectional diameter of 0.4 a luminal cross-sectional diameter of 0.4 mm. One end of each canal is dilated to mm. One end of each canal is dilated to form the ampulla, which contains a saddle-form the ampulla, which contains a saddle-shaped ridge termed the crista ampullaris, shaped ridge termed the crista ampullaris, on which lies the sensory epithelium. The on which lies the sensory epithelium. The nonampulated ends of the superior and nonampulated ends of the superior and posterior canal form the crus commune or posterior canal form the crus commune or common crus. All canals merge into the common crus. All canals merge into the utricle.utricle.

Semicircular canals afferentsSemicircular canals afferents

The ascending branches of the fibers from The ascending branches of the fibers from the superior and lateral canals terminate in the the superior and lateral canals terminate in the rostral part of the superior vestibular nucleus in a rostral part of the superior vestibular nucleus in a distribution of large and small fibers.distribution of large and small fibers.

After giving off long collaterals in the After giving off long collaterals in the nucleus, the ascending branches continue directly nucleus, the ascending branches continue directly to the cerebellum. The incoming fibers from the to the cerebellum. The incoming fibers from the posterior canal crista bifurcate more medially, and posterior canal crista bifurcate more medially, and the ascending branches end in a more central and the ascending branches end in a more central and medial region of the superior vestibular nucleus medial region of the superior vestibular nucleus and also probably continue to the cerebellum.and also probably continue to the cerebellum.

The descending branches of fibers from the The descending branches of fibers from the 3 cristae give collaterals mainly to the medial 3 cristae give collaterals mainly to the medial vestibular nucleus and, to a lesser extent, to the vestibular nucleus and, to a lesser extent, to the lateral and descending vestibular nuclei.lateral and descending vestibular nuclei.

PHYSIOLOGYPHYSIOLOGY

The functions of the vestibular system are The functions of the vestibular system are to sense angular acceleration, linear acceleration to sense angular acceleration, linear acceleration and to coordinate head and eye movements as and to coordinate head and eye movements as well as maintain the antigravity and lower body well as maintain the antigravity and lower body muscles in relation to the head. The semicircular muscles in relation to the head. The semicircular canals provide sensation for angular canals provide sensation for angular acceleration. The membranous labyrinth moves acceleration. The membranous labyrinth moves with head motion while the endolymph does not, with head motion while the endolymph does not, causing a relative flow of endolymph and causing a relative flow of endolymph and deflection of the cupula. Each hair cell has a deflection of the cupula. Each hair cell has a resting potential and its associated neuron has a resting potential and its associated neuron has a spontaneous discharge. Movement will cause an spontaneous discharge. Movement will cause an increase in the discharge rate on one side and a increase in the discharge rate on one side and a decrease from the paired canal on the opposite decrease from the paired canal on the opposite side.side.

The otolith organs are sensitive The otolith organs are sensitive to linear acceleration. Movement of to linear acceleration. Movement of the otoconia mass deflects the hair the otoconia mass deflects the hair cells attached to it. The maculae cells attached to it. The maculae have hair cells oriented in many have hair cells oriented in many directions so linear acceleration in directions so linear acceleration in any direction may be sensed. The any direction may be sensed. The saccule is most sensitive to gravity saccule is most sensitive to gravity since it is in the vertical plane.since it is in the vertical plane.

The reflexes involving the vestibular The reflexes involving the vestibular system include the vestibulo-ocular reflex and system include the vestibulo-ocular reflex and the vestibulospinal reflex. The vestibule-ocular the vestibulospinal reflex. The vestibule-ocular reflex helps maintain fixation of the eyes on an reflex helps maintain fixation of the eyes on an object with movement of the head. Both object with movement of the head. Both angular and linear acceleration signals are use angular and linear acceleration signals are use in the vestibule-ocular reflex. Projections from in the vestibule-ocular reflex. Projections from the vestibular nuclei to the extraocular muscle the vestibular nuclei to the extraocular muscle nuclei allow for eye movements that counteract nuclei allow for eye movements that counteract head movements for gaze stabilization. The head movements for gaze stabilization. The vestibulospinal reflex allows for input from the vestibulospinal reflex allows for input from the vestibular organs to be use for posture and vestibular organs to be use for posture and stability in a gravity environment. The stability in a gravity environment. The projections from the vestibular nuclei travel to projections from the vestibular nuclei travel to antigravity muscles for coordinated movements antigravity muscles for coordinated movements to maintain posture.to maintain posture.

What causes BPPV?What causes BPPV?

BPPV is a disorder involving the vestibular system in BPPV is a disorder involving the vestibular system in the inner ear. It develops when calcium carbonate crystals, the inner ear. It develops when calcium carbonate crystals, which are known as otoconia, shift into and become trapped which are known as otoconia, shift into and become trapped within the semicircular canals (one of the vestibular organs within the semicircular canals (one of the vestibular organs of the inner ear—see diagram). The otoconia make up a of the inner ear—see diagram). The otoconia make up a normal part of the structure of the utricle, a vestibular organ normal part of the structure of the utricle, a vestibular organ adjacent to the semicircular canals. In the utrical, the adjacent to the semicircular canals. In the utrical, the otoconia may be loosened as a result of injury, infection, or otoconia may be loosened as a result of injury, infection, or age and they land in a sac (the utriculus), where they are age and they land in a sac (the utriculus), where they are naturally dissolved. naturally dissolved.

However, otoconia in the semicircular canals will not However, otoconia in the semicircular canals will not dissolve, and, as a person’s head position changes with dissolve, and, as a person’s head position changes with respect to gravity, the otoconia begins to roll around and respect to gravity, the otoconia begins to roll around and push on tiny hairs lining the semicircular canals. Those hairs push on tiny hairs lining the semicircular canals. Those hairs act as sensors to give the brain information about balance. act as sensors to give the brain information about balance. Vertigo develops when the hairs are stimulated by the Vertigo develops when the hairs are stimulated by the rolling otoconia.rolling otoconia.

Movements that can trigger an episode of BPPV Movements that can trigger an episode of BPPV include rolling over or sitting up in bed, bending the head include rolling over or sitting up in bed, bending the head forward to look down, or tipping the head backward.forward to look down, or tipping the head backward.

PathophysioloPathophysiologygy

Assessment Diagnosis Analysis Goals & Objective Nursing Intervention Rationale EvaluationSubjective:“Lagi lang naman akong nakahiga dito”“Wala ka naman magawa kaya higa’t upo nalang ang gagawin mo.”“Nakakalakad naman ako. Pero dahil nga nahihilo ako tinutulungan ako lagi ng asawa ko.”Objective:Ambulatory with assistanceLimited movements such as lying, sittingSigns of mild dizziness by holding the forehead when going out of bedWalking slowly and evidence of shortness of breath after walking

Activity intolerance related to bed rest

Most activity intolerance is related to generalized weakness and debilitation secondary to acute or chronic illness and disease. This is especially apparent in elderly patients with a history of orthopedic cardiopulmonary diabetic or pulmonary related problems. the aging process itself causes reduction in muscle strength and function which can impair the ability to maintain activity. Activity intolerance may also be related to factors such as side effects of medications or prolonged bed rest.

Goal:After an 8 hour shift, the client will be able to report an increase in activity tolerance as evidenced by walking in regular pace and on level of indefinitely without the help of significant others.

Independent:Supplemental: 1) Assist client in performing range of motions such as:• rotating upper and lower extremities in a circular motion .• walking for at least 10-15mins.• flexion and extension of the extremities.

Facilitative:2) Encourage adequate rest periods, especially after performing activities.3) Encourage active range of motion or exercise everyday.

4) Teach methods to conserve energy such as stopping to rest for 3 minutes during a 10-minute walk.

1) Assisting the client in performing range of motion will help in the faster recovery.

2) Rest before activities provides time for energy conservation and recovery. 3) Exercises maintain muscle strength and joint range of motion.4) Energy conservation methods reduce oxygen consumption, allowing more prolonged activity.

The goal was met as manifested by a report increase in activity tolerance as evidenced by walking in regular pace and on level of indefinitely without the help of significant others.

Assessment Diagnosis Analysis Goals & Objective Nursing Intervention Rationale EvaluationS> The patient defecates 2 times a day before hospitalization > The patient only defecates once since his hospital stay, hard in consistency

O> Audible bowel sounds

Risk for constipation r/t irregular defecation habits

May causes or factors that may affect constipation, among them were insufficient fiber intake, insufficient fluid intake, insufficient activity or immobility, irregular defecation habits, change in daily routine, chronic use of laxatives and enemas, irritable bowel syndrome, pelvic floor dysfunction or muscle damage; medications such as opiods, iron supplements, antihistamines, antacids and antidepressants

Goal:After the 8 hour shift the client will maintain usual bowel elimination pattern as evidenced by normal consistency and frequency of the stool.

Independent:1)Determines stool color, consistency, frequency, and amount

2)Auscultate bowel sounds

3)monitor intake and output (I & O) with specific attention to food/ fluid intake

4)Encourage fluid intake to 2500-3000ml/day within count cardiac tolerance.5)Provide privacy and routinely scheduled time for defecation6)Educate client/SO about safe and risky practices for managing constipation7)Discuss use of stool softeners, mild stimulants, bulk forming-laxatives, or enemas as indicated8)Encourage client to maintain elimination diary

1)assist in identifying causative/ contributing factors and appropriate interventions2)Bowel sounds are generally increased in diarrhea and decreased in constipation3)May identify dehydration, excessive loss of fluids or aid in identifying dietary deficiencies4)Assist in improving stool consistency if constipated. Helps maintain hydration status if diarrhea is present5)So that the client can respond to urge6)Information can help the client to make beneficial choices when need arises7)Facilitates defecation when constipation is present8)To help monitor bowel pattern

Within the 8 hours of shift the client will verbalize understanding of risk factors and appropriate interventions related to constipation

Assessment Diagnosis Analysis Goals & Objective Nursing Intervention Rationale Evaluation

S>“Minsan lang ako maligo lalo pag hindi mainit yung tubig.”“Pag malamig ang tubig ayokong ng maligo.”“Hindi ako gumagamit ng deodorant.”“Isang beses lang ako nagtotoothbrush sa isang araw.”O> Presence of breath odorPresence of body odorPresence of 22 adult teethTeeth are rough in texture and there is discoloration of the enamel (black in color)

Self-care deficit related to personal hygiene practices

Motivations for personal hygiene practice include reduction of personal illness, healing from personal illness, optimal health and sense of well being, social acceptance and prevention of spread of illness to others. Risk for infection or contamination of the body may be an effect of improper personal hygienic practices. Body hygiene is achieved by using personal body hygiene products including: soap, hair shampoo, toothbrushes, tooth paste, cotton swabs, antiperspirant, facial tissue, mouthwash, nail files, skin cleansers, toilet paper.

Goal:After the 8 hour shift the client will verbalize understanding and willingness by enumerating proper ways of maintaining hygiene.

Independent:Supplemental:1) Discuss importance of proper hygiene

2) Encourage the use of deodorant after bathing.3) Encourage to wash hands thoroughly.

4) Encourage to take a bath everyday.

5) Encourage to brush the teeth at least twice a day.

6) Encourage client to maintain proper hygienic practices even after hospitalization

1) This will help the client understand what proper hygiene is.2) Deodorant helps in minimizing body odor. 3) This will help prevent the spread of microorganisms.4) This will also help prevent the spread of microorganisms.5) Brushing teeth helps remove microorganisms present and prevent dental problems6) To reduce the risks of having infection and diseases.

The goal was met as manifested by verbalizing an understanding and willingness by enumerating proper ways of maintaining hygiene.

Assessment Diagnosis Analysis Goals & Objective Nursing Intervention Rationale Evaluation

S>“Simula nga sa paglabas ko dito sa ospital hindi na ko talaga manigarilyo.”“Dati kasi halos 4 na bote naiinom. Paglabas ko dito babawasan ko na at talagang pag may okasyon nalang.”O> Noted some dizziness but can move.Can walk slowlyReceive in a good moodTalking without any signs of distressHappy and express self freely

Readiness for enhanced therapeutic regimen management related to avoidance of smoking and alcohol drinking.

When systems in the body respond to treatments and medications, it results to good health. Thus, our body is ready to regain its normal functioning.

Goal:After the 8 hour shift the client will verbalize responsibilities for managing treatment regimen and enumerate ways to achieve these responsibilities.

Independent:1) Identify steps necessary to reach the desired health goals.

2) Acknowledge patient’s efforts to reinforce movement toward attainment of desired outcomes.

3) Encourage utilization of community programs regarding anti-smoking and alcohol drinking.4) Encourage the cooperation of significant others.

5) Accepts client’s evaluation of own strengths/limitations.

6) Encourage client to continue interventions for easy progress of the condition.

1) Understanding the process enhances commitment and likelihood of achieving the goals.2) Provides positive reinforcement encouraging continued progress toward desired goals.3) This will help more in the acquisition of knowledge regarding the problem.4) This will help the patient understand more the situation and to continue the effort given.5) Promotes sense of self-esteem and confidence to continue efforts.6) This will also help in reduction of further complications.

The goal was met as manifested by verbalizing responsibilities for managing treatment regimen and enumerating ways to achieve these responsibilities.

Discharge Discharge PlanPlan

Medicine: Medicine:

a.) Encouraged client to take medications as a.) Encouraged client to take medications as prescribed by his physician,prescribed by his physician,• Solosamet 2/500mgSolosamet 2/500mg• Lipway 250mg before bedtimeLipway 250mg before bedtime• Vessel due (twice a day)Vessel due (twice a day)• Hypromellose eyedropsHypromellose eyedrops• Betahistine 16g (thrice a day)Betahistine 16g (thrice a day)• Vit B Complex (twice a day)Vit B Complex (twice a day)• Adalat 30mg (once a day)Adalat 30mg (once a day)

b.) Teach patient of the different side and b.) Teach patient of the different side and adverse effects of the drugs.adverse effects of the drugs.

c.) Report any unusualities when taking c.) Report any unusualities when taking the prescribed drug such as nausea and the prescribed drug such as nausea and vomiting or skin allergies. vomiting or skin allergies.

d.) Instruct him not to take other d.) Instruct him not to take other medications without consulting with her medications without consulting with her physician to prevent any harmful drug-physician to prevent any harmful drug-drug interactions.drug interactions.

ExerciseExercise

a.) Exercises for vertigo often sound very simple. a.) Exercises for vertigo often sound very simple. But depending on the severity of your vertigo, But depending on the severity of your vertigo, you may find them difficult to do. They you may find them difficult to do. They generally consist of exercises that practice:generally consist of exercises that practice:

• Maintaining balance while standing still.Maintaining balance while standing still.• Maintaining balance while swaying.Maintaining balance while swaying.• Maintaining balance while turning.Maintaining balance while turning.• Maintaining balance while walking.Maintaining balance while walking.• Head movements. Head movements are one of Head movements. Head movements are one of

the most common triggers of vertigo. Practicing the most common triggers of vertigo. Practicing moving your head may help your body learn moving your head may help your body learn how to deal with the problems that cause your how to deal with the problems that cause your vertigo.vertigo.

TreatmentTreatment

a.) Encouraged the patient to comply with a.) Encouraged the patient to comply with the medication as ordered by her the medication as ordered by her physician.physician.

b.) Explain the importance of adhering to her b.) Explain the importance of adhering to her treatment regimen.treatment regimen.

c.) Teach the Epley Maneuver with the SOc.) Teach the Epley Maneuver with the SO

• The procedure is as follows:The procedure is as follows:• Sit upright.Sit upright.• Turn your head to the symptomatic side at Turn your head to the symptomatic side at

a 45 degree angle, and lie on your back.a 45 degree angle, and lie on your back.• Remain up to 5 minutes in this position.Remain up to 5 minutes in this position.

• Turn your head 90 degrees to the other Turn your head 90 degrees to the other side.side.

• Remain up to 5 minutes in this position.Remain up to 5 minutes in this position.• Roll your body onto your side in the Roll your body onto your side in the

direction you are facing; now you are direction you are facing; now you are pointing your head nose down.pointing your head nose down.

• Remain up to 5 minutes in this position.Remain up to 5 minutes in this position.• Go back to the sitting position and remain Go back to the sitting position and remain

up to 30 seconds in this position.up to 30 seconds in this position.• *The entire procedure should be repeated *The entire procedure should be repeated

two more times, for a total of three times.two more times, for a total of three times.• *During every step of this procedure the *During every step of this procedure the

patient may experience some dizziness.patient may experience some dizziness.

Health TeachingHealth Teaching

a.) Instruct the client to:a.) Instruct the client to:• Do Do notnot walk without help, drive a car, or walk without help, drive a car, or

operate heavy machinery if you are feeling operate heavy machinery if you are feeling dizzy.dizzy.

• Sit or lie down right away when you feel dizzy. Sit or lie down right away when you feel dizzy. Keep your head as still as possible and do not Keep your head as still as possible and do not change positions quickly.change positions quickly.

• Sudden head movements may sometimes Sudden head movements may sometimes cause dizziness. Move slowly and let yourself cause dizziness. Move slowly and let yourself get used to one position before moving to get used to one position before moving to another position. This is very important, another position. This is very important, especially when getting up from a lying down especially when getting up from a lying down or sitting position.or sitting position.

Out- patient referral:Out- patient referral:• a.) Inform the patient to have follow-up a.) Inform the patient to have follow-up

check-up check-up after a week after a week to prevent possible to prevent possible complications and to update the medical complications and to update the medical team concerning the progress of the patient’s team concerning the progress of the patient’s condition and to promote continuity of carecondition and to promote continuity of care

Diet:Diet:• Eat less salty and fatty foods.Eat less salty and fatty foods.• Limit sugar food intake Limit sugar food intake • *Vertigo has also been associated with high *Vertigo has also been associated with high

cholesterol and high blood sugar, so dietary cholesterol and high blood sugar, so dietary changes may be necessary to treat and changes may be necessary to treat and prevent vertigoprevent vertigo

Presented by:Presented by:

BSN122BSN122

Jacinto, ArvieJacinto, Arvie

Mariano, LalaineMariano, Lalaine

THANK YOU!!!THANK YOU!!!

Case Study-BPPV

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