Case Study - Brain Tumor FINAL

Guagua National CollegesSta. Filomena, Guagua, Pampanga

College of Nursing

Case Study of Brain Tumor

Prepared By: 2nd Year

Miranda, Justin Kier D.Cruz, Anzelyn B.David, Stephanie G.Miranda, Jazmin Gail D.

Prepared To:Mrs. Ma. Jaemee Anne B. Lopez

I. Introduction

“Human existence is always associated with complexities. Man itself is a structured compound. It is with system and subsystems that connect its function to enable to breath, to move and to think.”

- Tolstoy

The main switch in man’s anatomical and physiological function is his brain. The brain consists of a huge network of neurons that control the body’s vital functions. So far, this

system is vulnerable, and its optimal function depends on several key factors. Therefore any alteration to this system and function greatly affects the body as a whole.

The Brain Tumor is a mass of cells that have grown and multiplied uncontrollably. There are two types of brain tumor the benign tumor and malignant brain tumor

A benign tumor does not contain cancer cells and usually, once removed, does not recur. Most benign brain tumors have clear borders, meaning they do not invade surrounding tissue. These tumors can, cause symptoms similar to cancerous tumors because of their size and location in the brain. 

Malignant brain tumors contain cancer cells. Malignant brain tumors are usually fast growing and invade surrounding tissue. Malignant brain tumors very rarely spread to other areas of the body, but may recur after treatment. Sometimes, brain tumors that are not cancer are called malignant because of their size and location, and the damage they can do to vital functions of the brain. 

Brain tumors can occur at any age. Brain tumors that occur in infants and children are very different from adult brain tumors, both in terms of the type of cells and the responsiveness to treatment.

This case study which primarily talks about brain tumor is directed towards presenting the disease, the management and intervention and the other vital facts that remain in oblivion to the great number of population of this country.

Considering that the brain tumor truly and evidently has a devastating impact of our nation’s health our Group BSN-II of GNC has regarded this study significant to the fields of nursing education practice and research because the completion of this study does not only meet the terms for dissemination information purposes, but for sensible learning as well.

OBJECTIVES:

A. General objective:

To be able to choose a case study that will contribute and expand our knowledge and improve our skills on specific procedures this is BRAIN TUMOR.

Our group has formulated the following specific objectives to guide us toward the completion of this case study. That we may be able to:

B. Specific Objective(s):1. Established good intrapersonal and professional relationship with our

patient and her accompanying family members2. Share our knowledge and skills to each other3. Work together with the health care team4. Provide significant health teaching that would promote our patient

health and wellness5. Formulate effectiveness nursing care plan6. Formulate specific, measurable, attainable, realistic and time bounded

objectives that will serve a guide for the accomplishment of the study (SMART)

7. List the actual and possible symptoms that our patient may manifest8. Research the drug study of the given medication to our patient9. List all the references used in the study

C. Current Trends

This article is about children born with birth defects or to mothers together with a history of multiple stillbirths that may have a higher-than-normal risk of brain cancer. Since these sometimes involve some type of genetic abnormalities, they can increase the risk of having a brain tumor. Some preliminary evidence, Dr. Partap said, suggests that “defects of the heart and brain may be particularly linked to childhood cancer.” Symptoms of brain tumors are also not clear to Pediatricians. So, researchers are doing their best to find the solution to their problems.

We think that having some type of genetic abnormalities can increase the case of having a brain tumor, because we know it is connected to the brain. Having brain tumor can be frustrating to both the patient with brain tumor and his/her family, which is why we concur about people needing to know the symptoms of brain tumor. So, as early as possible, we can detect if there is brain tumor or not and we can treat it right away.

From Reuters Health Information

Birth Defects Tied to Pediatric Brain Tumors

By Amy Norton

NEW YORK (Reuters Health) Aug 10 - Children born with birth defects or to mothers with a history of multiple stillbirths may have a higher-than-normal risk of brain cancer, a new study suggests.

The risks are still small, researchers say, as children only rarely develop brain cancer. Each year, about 4,000 U.S. children and teenagers are diagnosed with a tumor of the central nervous system (brain or spinal cord), according to the American Cancer Society.

Small portions are caused by specific, inherited genetic syndromes, but otherwise little is known about why children develop brain and spinal cancers.

The new findings, published online August 8th in Pediatrics, highlight the potential importance of genetic factors, the researchers say.

Using a California database on cancer cases in the state, the researchers found 3,733 cases of brain or spinal tumors diagnosed among children younger than 15 between 1988 and 2006.

Overall, 1.2% of those children had been born with a birth defect -- vs. 0.6% of 15,000 cancer-free California children studied for comparison.

And children with a birth defect had increased risks of certain tumors.

They were nearly four times as likely as children without birth defects to develop a primitive neuroectodermal tumor.

Similarly, their risk of germ cell tumors was elevated more than six-fold.

Children with birth defects were not, however, at higher risk for the most common type of brain cancer in the study group -- gliomas, which accounted for 57% of cases.

The study also found heightened tumor risks among children whose mothers had had at least two late pregnancy losses in the past -- meaning the fetus died after the 20th week of pregnancy.

These children were about three times as likely as other kids to develop some type of brain or spinal tumor.

Since both birth defects and pregnancy losses often involve some type of genetic abnormality, it's possible that explains the higher cancer risks, according to the researchers.

"Genetics may play a larger role in central nervous system cancer than previously believed," said lead researcher Dr. Sonia Partap, of Stanford University and Lucile Packard Children's Hospital in Palo Alto, California.

Early miscarriages were not linked to cancer risks in a woman's other children. So it's possible that the genetic abnormalities that cause early pregnancy loss are not connected to cancer, while gene defects that are "compatible with life to some degree" do contribute to cancer risk, Dr. Partap told Reuters Health in an email.

As for birth defects, past studies have connected them to higher risks of childhood cancers in general.

But researchers are still trying to figure out whether it's only certain birth defects that come with a higher risk. Some preliminary evidence, Dr. Partap said, suggests that defects of the heart and brain may be particularly linked to childhood cancer.

But Dr. Partap also stressed that even with a relatively increased risk of brain or spinal cancer, the absolute risk to any one child is small.

"Parents should know that there is still a very low risk of central nervous system cancer," she said.

At the same time, she added, pediatricians should be aware that there is a slightly higher chance of the tumors in certain children.

Symptoms of brain tumors may be vague and vary from child to child. But some possible signs include morning headaches; mental changes like memory and concentration problems; unusual sleepiness; changes in vision, hearing or speech; and balance or coordination problems.

SOURCE: http://bit.ly/oWBZpY

II. Demographic DataA. Personal information:

Ms. H.A is 2 year old patient, confined at DPMMH, residence of Del Carmen, Lubao Pampanga. Her birthday is on March 26, 2009. She has a twin sister. She is the youngest among the 3 siblings. Her religion is Roman Catholic. According to her mother, H.A loves to sing and dance.

B. History:

Ms. H.A was admitted to the hospital last January 01, 2012 with a chief complaint of headache, vomiting, high fever and seizures.

Present history:

Last November 27, 2011 the pt. complains of headache, so the S.O brought her to the clinic for check-up. The doctor prescribes medications for the headaches but it did not worked. So the pt .was brought to PMSH (Pampanga Medical Specialist Hospital) because of the headache and seizures and the doctor ordered for EEG, but the result is normal. The pt. was admitted again to MMH (Macabali Memorial Hospital) but has been transferred to Mother Theresa of Calcuta for a CT scan and been diagnosis of BRAIN TUMOR. Because of financial support,they transferred her to DPMMH (Diosdado P. Macapagal Memorial Hospital)

Family HistoryNo history of diseases.Past HistoryAccording to her mother, Ms. H.A didn’t have any past illness or disease.

III. Physical Assessment:

General Appearance:

Received a patient who is a 2 year old girl, lying on bed unconsciously with an IVF of D5 0.3 NaCl 500cc @ 350cc level, regulated @ 4-5mgtts/min infusing well on her L hand and also hooked with an O² of 3L/min via nasal cannula.

Normal Vital Signs:

T: 36-37.5 oC

RR: 25-50 bpm

CR: 80-150 bpm

Vital signs:

T:40.0 oC

RR: 30 bpm

CR: 160 bpm

Organ/Body Parts Normal Findings Significant FindingsSkin Fair in complexion

With good skin turgorOily SkinCold clammy skin

Nails No evidence of clubbing of fingernailsCapillary refill: within 2-3 seconds

Head Skull: Hair texture: black and oily

curly hair strandsScalp: fair in complexion (-) lesions

Asymmetrical frontal lobe

Hair partially distributed

Eyes Peri-orbital area

Eyelashes

Eyelids

Conjunctiva

Pupils

Cornea

Sclera

Thin eyebrows, black in color

Equally distributed, curled slightly outward

Skin intact, (-) discharge

Shiny and smooth Pink palpebral conjunctiva

PERLA(Pupils Equal and Reactive to Light and Accommodation)

Clear(-) lesionsAppeared convex

White and buff

(-)

Ears Auricles Fair in complexion,

symmetrical elastic, and mobile when pinch, and aligned with the outer cantus of the eyes

(+) wet cerumenNose

External nose

Nasal septum

Nasal cavity

Symmetrical and not tender

Intact and in midline

Pink colored mucosa, (+) black and white cilia

Mouth Teeth

Tongue

Lips

White in color

Pinkish in color

Pink in color (+) cheilosis

Neck Thyroid gland

Lymph nodes

(-) Bulging mass

Normal(-) Bruits are palpated(-) Swelling(-) Enlargement(-) Tenderness

Chest Respiratory rate

Breathing pattern

Heart sounds

Normally fast

Normal Breathing Pattern

normal: no murmur(-) chest pain(-) palpitation

Abdomen Color

Contour

Palpation

Fair in complexion Normal bowel sounds

Palpation: soft, non-tender

MusculoskeletalUpper extremities

Pulses Radial and brachial pulse isnormal and palpable

Lower extremities Legs Long and thin legs

IV. Laboratory and Diagnostic Result

Lab Test Patients Results Normal Value InterpretationComplete

Blood Count (CBC)

Hemoglobin: 136

Erythrocytes: 4.78

Hematocrit: 0.41

Leucocytes: 8.9

Lymphocytes: 0.60

Platelet Count: 492

120 – 170 g/L

4.0 – 5.0 x 10

0.36 – 0.46

4.5 – 11

0.20 – 0.40

150 – 450

Normal

Normal

Normal

Normal

There is abnormal cell mutation

There is abnormal cell mutation

Blood Chemistry

RBS: 150 80 – 115 It

Cranial CT-Scan

There is a 3.3 x 6.1 x 4.9 cm (LxWxAP) lobulated, heterogeneous mass with cystic and homogeneously enhancing solid components, involving the right thalamus, right side of the pons, medical aspect of the right temporal lobe and inferoposterior aspect of the frontal lobe. Associated perifocal edema, contralateralshift if the midline structures, lateral displacement of the dorsal horn of the right lateral ventricle and compression of the third and right lateral ventricles. Resultant moderate dilatation of the lateral ventricles with subependymal seepage is seen.

The posterior fossas are unremarkable.

There is no intracranial hemorrhage.

The rest of the cisterns and sulci are not widened.

The visualized paranasal sinuses and mastoids are well aerated. The cranium is intact.

Impression:

Complex mass with cystic and solid components as described involving the right thalamus, right side of the pons, medical aspect of the right temporal lobe and inferoposterior aspect of the frontal lobe with associated perifocal edems, mild mass effect and secondary obstructive hydrocephalus. Primary consideration is a neoplastic process such as glioblastoma multiforme.

V. Review of system

CENTRAL NERVOUS SYSTEM

Nervous System

The nervous system is broken down into two major parts: the central nervous system, which includes the brain and spinal cord, and the peripheral nervous system, which includes all nerves, which carry impulses to and from the brain and spinal cord. These include our sense organs, the eyes, the ears, our sense of taste, smell and touch, as well as our ability to feel pain.

Spinal Cord

The spinal cord is a long bundle of neural tissue continuous with the brain that occupies the interior canal of the spinal column and functions as the primary communication link between the brain and the rest of the body. The spinal cord receives signals from the peripheral senses and relays them to the brain.

Brain

The brain is the largest and most complex part of the nervous system. It is compose of more than 100 billion neurons and associated fibers. The brain tissues have a gelatin like consistency. The semi-solid organ weighs about 1400g (approximately 3 pounds) in the adult human.

1. The frontal lobes (motor complex) controls voluntary motor activity.2. The parietal areas these same areas are thought to contribute to reasoning,

problem solving activities and emotional stability.3. The occipital lobe contains a primary visual receptive (interpretation) area and

visual association areas.4. The temporal lobe is located under (inferior to) the lateral sulcus. It contains

primary auditory receptive area and secondary auditory association areas.

Brain Stem

The brain stem is the part of the brain that connects the cerebrum and diencephalons with the spinal cord.

Medulla Oblongata

The medulla oblongata is located just above the spinal cord. This part of the brain is responsible for several vital autonomic centers including

The respiratory center, which regulates breathing. The cardiac center that regulates the rate and force of the heartbeat. The vasomotor center, which regulates the contraction of smooth muscle in the

blood vessel, thus controlling blood pressure.

The medulla also controls other reflex actions including vomiting, sneezing, coughing and swallowing.

Pons

Continuing up the brain stem, it reaches the Pons. The pons lay just above the medulla and acts as a link between various parts of the brain. The pons connects the two halves of the cerebellum with the brainstem, as well as the cerebrum with the spinal cord. The pons, like the medulla oblongata, contains certain reflex actions, such as some of the respiratory responses.

Midbrain

The midbrain extends from the pons to the diencephalon. The midbrain acts as a relay center for certain head and eye reflexes in response to visual stimuli. The midbrain is also a major relay center for auditory information.

Diencephalon

The diencephalons are located between the cerebrum and the mid brain. The diencephalons houses important structures including the thalamus, the hypothalamus and the pineal gland.

Thalamus

The thalamus is responsible for "sorting out" sensory impulses and directing them to a particular area of the brain. Nearly all sensory impulses travel through the thalamus.

Hypothalamus

The hypothalamus is the great controller of body regulation and plays an important role in the connection between mind and body, where it serves as the primary link between the nervous and endocrine systems. The hypothalamus produces hormones that regulate the secretion of specific hormones from the pituitary. The hypothalamus also maintains water balance, appetite, sexual behavior, and some emotions, including fear, pleasure and pain.

Limbic System

The limbic system, often referred to as the "emotional brain", is found buried within the cerebrum. Like the cerebellum, evolutionarily the structure is rather old.

Cerebellum (little brain)

The functions of the cerebellum include the coordination of voluntary muscles, the maintenance of balance when standing, walking and sitting, and the maintenance of muscle tone ensuring that the body can adapt to changes in position quickly.

Cerebrum

The largest and most prominent part of the brain, the cerebrum governs higher mental processes including intellect, reason, memory and language skills. The cerebrum can be divided into 3 major functions:

Sensory Functions - the cerebrum receives information from a sense organ; i.e., eyes, ears, taste, smell, feelings, and translates this information into a form that can be understood.

Motor Functions - all voluntary movement and some involuntary movement. Intellectual Functions - responsible for learning, memory and recall.

Meninges

The meninges are made up of three layers of connective tissue that surround and protect both the brain and spinal cord. The layers include the Dura mater, the arachnoid and the pia matter.

Pia mater is a vascular layer of connective tissue that is so closely connected to the brain and spinal cord that is follows every sulcus and fissures.

Dura mater is a tough non-stretchable vascular membrane with 2 layers the outer and inner layer.

Reflex Mechanism

Our conscious autonomic responses to internal and external stimuli known as reflex responses provide many homeostatic functions. Although the spinal cord is often thought of as the reflex center, it is not the only site for regulation .Many of the complex reflexes controlling the heart rate, breathing, blood pressure, swallowing, coughing, and vomiting are found in the brain stem.

Cerebrospinal Fluid

The cerebrospinal fluid is a clear liquid that circulates in and around the brain and spinal cord. Its function is to cushion the brain and spinal cord, carry nutrients to the cells and remove waste products from these tissues.

Neurons:

A neuronal cell body (soma) is like other cell in that it contains most of the organelles seen in other cells.

There are several types of neurons - anaxonic neurons: small neurons where the dendrites and axons are indistinguishable.

Bipolar neurons: small neurons with two distinct processes; a dendritic process and an axon extending from the cell body.

Unipolar neurons: large neurons with the cell body lying to one side of the continuous dendritic process and axon.

Multipolar neurons: large neurons with several dendrites and a single axon extending from the cell body.

Bipolar neurons: Bipolar neurons are CNS neurons specific for transmitting information from specialized sensory systems: sight, smell and hearing.

Grey and white matter: Grey matter consisting of unmyelinated neurons is the processing area of the CNS. White matter – located in the inner cortex and surrounding grey matter in the spinal cord - provide pathways of communication between grey matters.

Glial Cells

CNS Glial Cell Types: There are 4 types of glial cells:

1. astrocytes - Regulates the chemical microenvironment surrounding neurons.2. Oligodendrocytes - Myelinate central nervous system axons.3. Microglia - Migrating phagocytic cells resembling immune cells that remove

waste, debris, and pathogens.4. Ependymal cells - Columnar cells that line the ventricles of the brain and the

spinal canal in the spinal cord.

Peripheral Nervous System

The PNS includes all neurons other than those in the brain and spinal cord. It consists of pathways of nerve fibers between the CNS and all outlying structures in the body. Included in the PNS are 12 pairs of cranial nerves and 31 pairs of spinal nerves.

Nerves

Nerves are made up of specialized cells, which act as little wires, transmitting information to and from the central nervous system and brain. Nerves form the network of connections that receive signals (known as sensory input) from the environment and within the body, and transmit the body's responses, or instructions for action, to the muscles, organs, and glands. Nerve cells are located outside the central nervous system or spinal cord.

Cranial Nerve

12 pairs of cranial nerves arise from the brain. Most of the cranial nerves are composed of both motor and sensory neurons although a few cranial nerves carry only sensory impulses. Except for the olfactory and optic nerves, whose nuclei lie just below the cerebrum, all other cranial nerve nuclei lie within the brain stem

The Cranial Nerves

Nerves Type Function

IOlfactory

sensory olfaction (smell)

IIOptic

sensoryvision

(Contain 38% of all the axons connecting to the brain.)

IIIOculomotor

motor* eyelid and eyeball muscles

IVTrochlear

motor* eyeball muscles

VTrigeminal

mixedSensory: facial and mouth sensation 

Motor: chewing

VIAbducens

motor* eyeball movement

VIIFacial

mixedSensory: taste

Motor: facial muscles and salivary glands

VIIIAuditory

sensory hearing and balance

IXGlossopharyngeal

mixedSensory: taste

Motor: swallowing

XVagu s

mixedmain nerve of the 

parasympathetic nervous system   (PNS)

XIAccessory

motor swallowing; moving head and shoulder

XIIHypoglossal

motor* tongue muscles

VI. Pathophysiology

Risk Factors + normal cells

↓

Initiation

↓

Promotion

↓

Malignant conversion

↓

Progression

↓

Tumor occupy normal tissue spaces

↓

Destroy major function of the Thalamus

Sorting out sensory impulses

↓

No senses

↓

Cerebral edema

↓

Brain tumor

↓

Death

VII. Course in the Ward Doctor’s Order

January 01, 20128:20 PM

Please admit the pt. to ROC For continued therapy Secure consent For legal purposes TPR q shift and recorded To obtain baseline data for

comparison NPO temporarily To prevent aspiration Lab result CBC typing To identify infection IVF of D5 0.3 NaCl 500cc

KVO For route of medication

Cefuroxime vial 400mg slow IV push q6 NST

To treat bacterial infections

O2 inhalation 3L To help the patient to support decreased perfusion

Continue high back rest To help improve venous drainage, reduce arterial pressure, and may improve cerebral perfusion

Refer to Dra. Balagtas For neuro evaluationJanuary 02, 20129:20 AM

Paracetamol 0.8mLTID – nowPrn for T = 38.8 oC

To decrease hyperthermia

January 02, 20129:50 AM

T = 40 oC Continue medications To continue the therapeutic regimen DAT w/ aspiration precaution To prevent aspiration TSB To evaporate heat in the body Carry out orders of Dra. Balagtas For evaluation and management

January 02, 2012 CTScan To identify tumor, cerebral edema

or hydrocephalus

Give Dyphenhydramine TIV at 0.1mg/kg/dose now

To sedate the patient from having seizures

Refer to Dr. For further evaluation and management

Give Dexamethasone at 0.1 mg/kg TIV now often q 12 hours

To decrease cerebral inflammation and edema

Kindly IVF rate as replacement May also be dehydrated

To hydrate the patient

January 02, 20124:45 PM Seizure

Dyphenhydramine 12.5mg IV now To sedate patient from seizure

January 03, 20127:05 AM

Continue medications To continue therapeutic regimen Carry out referal to Dr. Rivera and

Dr. Beltran For further evaluation and

management TF D5 0.3 NaCl 500cc x SR To help in hemorrhagic shock

VIII. Nursing Care Process

ASSESSMENT NURSING DIAGNOSIS

SPECIFIC EXPLANATION

PLANING NURSING INTERVENTION

RATIONALE EVALUATION

S:

O:

>Febrile, T=40°C in both axilla; warm to touch with flushing

Hyperthermia r/t increase Intracranial pressure

ENTRY OF PATHOGEN IN THE SYSTEMIC CIRCULATION

REGULATION OF TOXIN IN THE BODY

RELEASE OF PYROGEN

STIMULATION OF THE HYPOTHALAMUS

INCREASE OR ALTERRATION OF THERMOREGULATION

INCREASE BODY TEMPERATURE

Short Term:

After 2-3 hours of nursing intervention the patient will be able to decrease body temperature from 40°C to 37°C.

Long Term:

After 2 days of nursing intervention the patient will be to maintain normal body temperature

Do/perform tepid sponge bath

Assess body temperature from time to time

Do not apply alcohol for TSB

Advise the so to increase oral

To help decrease body temperature

To know what is the response of client to TSB

Alcohol increases peripheral vascular constriction &CNS depression

Additional fluids help

Short Term:

The patient shall Demonstrated temperature within normal range, from 40 °C to 37.5°C

Long Term:

The patient shall have demonstrated behaviors to monitor and promote normothemia

HYPERTHEMIA

fluid intake of the patient

Remove excess clothing and covers

prevent elevated temperature associated with dehydration

These decrease warmth and increase evaporative cooling

ASSESSMENT NURSING DIAGNOSIS

SPECIFIC EXPLANATION

PLANING NURSING INTERVENTION

RATIONALE EVALUATION

S:

O:>Unconscious>febrile

Ineffective cerebral perfusion related to interruption of blood flow

Intracranial pressure

Pressure exerted in the cranium by

its content

Brain, blood and cerebrospinal fluid

Associated with vasospasm or

obstruction in the arteries supplying

the brain with blood

Increase vascular resistance can result due to increase ICP

Leading to decrease and or absence of blood flow to the brain

cells

Short Term:After 2-3 hours of nursing intervention the SO will verbalized understanding of condition, therapy regimen and when to contact health provider

Long Term:After 2 days of nursing intervention the patient will demonstrate behaviors and life style changes to improve circulation such as relaxation techniques.

Independent:

Assess patient condition

.Position head slightly elevated and in neutral position

Take patients temperature at least 4 hours

Keep patients in neutral alignment

Provide quite, restful

To be able to identify present physiologic disturbances

Reduces arterial pressure by promoting venous drainage and may improve cerebral perfusion.

Hyperthermia causes increased ICP hypothermia causes decrease cerebral perfusion pressure

To keep the carotid flow unobstructed thereby promoting perfusion

Continual stimulation can increase ICP.

Short Term:The So shall have verbalized understanding of condition, therapy regimen and when to contact health care provider

Long Term: The patient shall have Demonstrated behaviors and life style changes to improve circulation such as relaxation techniques.

Because of this there will be decrease or

absence of oxygen supply to the brain

cells

So there is ineffective cerebral

perfusion

environment.

Note history of brief/intermitte

nt periods or black out

Monitor patients

behavior and mental status for onset of restlessness,

agitation confusion

Dependent:

Administer supplemental

oxygen.

Because this suggest transient ischemic attacks

Changes in behavior and mental status are sign of altered cerebral perfusion

Reduces hypoxemia, which can cause cerebral vasodilatation and increase pressure/ edema formation.

ASSESSMENT NURSING DIAGNOSIS

Scientific EXPLANATION

PLANING NURSING INTERVENTION

RATIONALE EVALUATION

S:

O:

> Unconscious

>seizures

Risk for injury related to disruption in the normal flow of electricity in the brain

Altered neuronal cells

Increased frequency and amptitude

Neuronal firing spreads

Seizures

Unpredictable movement or

behavior

Risk for Injury

Short Term:

After 2-3 hours of nursing intervention the patient’s seizures will be lessen

Long Term:

After 2 days of nursing intervention the patients seizures will be remove

Assess patient condition

Keep padded side rails up with bed in the lowest position

Provide information regarding the condition that may result in risk for injury.

Assess muscle strength gross and fine motor coordination

Keep the patient’s room

To be able to identify present physiologic disturbances

Minimizes injury should seizure occur while patient is in bed

to promote awareness

to determine the severity of body weakness and to be able to perform appropriate intervention

to promote

Short Term:

The patient’s seizures shall be lessen

Long Term:

The patient’s seizures shall be removed

free from clutter

individual safety

IX. Drug Study

Drug Name Classification Indications Mechanism of

Action

Adverse Effect Nursing Considerations

Rationale

Generic Name:Diphenhydramine

Brand Name:Oral: Allerdyl (CAN), AllerMax Caplets, Banophen, Banophen allergy, Benaryl allergy, Diphen AF, Diphenhist Captabs, Genahist, Siladryl

Antihistamine, Anti-motion-sickness drug,Antiparkinsonian,Cough Suppressant,Sedative-hypnotic

-> Relief of symptoms associated with perennial and seasonal allergic rhinitis; vasomotor rhinitis; allergic conjunctivitis, mild, uncomplicated urticaria and angioedema; amelioration of allergic reactions to blood or plasma; dermatographism; adjunctive theraphy in anaphylactic reactions.-> Active and prophylactic treatment of motion sickness.->Nighttime sleep aid->Parkinsonism (including drug induced parkinsonism and extrapyramidal reactions), in the elderly intolerant of more potent drugs, for milder forms of disorder in the other age groups, and in combination with centrally acting

Competitively blocks the effect of histamine at H1-receptor sites, has antropine-like, antipruritic, and sedative effects.

CNS: Drowsiness, sedation, dizziness, disturbed coordination, fatigue, confusion, restlessness, excitation, nervousness, tremor, headache, blurred vision, diplopiaCV: Hypotension, palpitations, bradycardia, tachycardia, extrasystolesstomatitisG.I: Epigastric distress, anorexia, increased appétit and weight gain, nausea, vomiting, diarrhea r constipationG.U: Urinary frequency, dysuria, urinary retention, early menses, decreased libido, impotenceHematologic: Hemolytic anemia, hypoplastic anemia,

-> Administer with food.

->Avoid driving and using Dangerous machine.

-> Administer syrup form for patient who can’t take tablets.

->Advice patient to rise slowly from lying or sitting position.

->Monitor children closely.

-> To prevent GI upset.

-> To avoid accident that may cause by the side effects.

->To prevent aspiration.

->To prevent orthostatic hypotension

-> To identify paradoxical reaction.

anticholinergic antiparkinsonian drugs.->Syrup formulation: Suppression of cough due to colds or allergy.

thrombocytopenia, leucopenia, agranulocytosis, pancytopenia.Respiratory: Thickening of bronchial secretions, chest tightness, wheezing, nasal stiffness, dry mouth, dry nose, dry throat, sore throat.

Drug Name Classification Indications Mechanism of

Action

Adverse Effect Nursing Considerations

Rationale

Generic Name:Cefuroxime

Brand Name:

Ceftin

Zinacef

Antibiotics;Cephalosporin

Oral(cefuroxime axetil)-> Pharingitis, tonsillitis caused by streptococcus pyogenes->otitis media caused by streptococcus pneumonia, S. pyogenes, Haemophilus influenza, Moraxella catarrhalisNEW INDICATIONAcute bacterial maxillary sinusitis caused by S. pneumonia, H. influenza-> lower respiratory infections caused by S. pneumonia, Haemaphilus parainfluenzae, H. influenza-> UTI caused by E.Coli, klebsiella pneumonia-> Uncomplicated

Inhibits synthesis of bacterial cell wal, causing cell death

CNS: Headache, dizziness, lethargy, paresthesiasGI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, pseudomembranous colitis, heaptotoxicityGU: NephrotoxicityHematologic: Bone marrow depressionHypersensitivity: Ranging from rash to fever to anphylasis; serum sickness reaction

-> Avoid crushing tablets.

-> Give PO drug with meal.

-> Have vitamin K available.

-> Take full course therapy even if you are feeling better.

->To prevent tasting the bitter taste of the drug.

-> To decrease GI upset and enhance absorption.

-> In case of hypoprothrombinemia occurs.

-> To prevent drug tolerance.

gonorrhea (urethral and endocervical)-> skin and skin structure infections, including impetigo caused by streptococcus aureus, S. pyogenes-> Treatment of early lyme diseaseParental(cefuroxime sodium)-> lower respiratory infections caused by S. pneumonia, S. aureus, E. coli, Klebsiella pneumonia, H. Influenza, S. pyogenes-> Dematologic infections caused by S. aureus, S. pyogenes, E. coli, K. pneumonia, Enterobacter-> UTIs caused by E. coli, K. pneumonia-> Uncomplicated and disseminated gonorrhea caused by N. gonorrhhoeae-> Septicimia caused by S. pneumonia, H. influenzae, S. aureus,

N. mengingitidis.-> Bone and joint infections due to S. aureus-> Perioperative prophylaxis-> Treatment of acute bacterial maxillary sinusitis in patient 3 mo-12 yr

Drug Name Classifications

Indications Mechanism of

Action

Adverse Effects Nursing Considerations

Rationale

Generic Name:Acetaminophen

Brand Name:

Tempra;

Tylenol

Analgesic;Antipyretic

-> Temporary reduction of fever; temporary relief of minor aches and pains caused by common cold and influenza, headache, sore throat, toothache, menstrual cramps, backache, minor arthritis pain, and muscles pains.-> Unlabeled use: Propylaxis in children and patient at risk for seizures who are receiving DTP vaccination to reduce incidence of fever and pain.

Antipyretics: Reducing fever by acting directly on the hypothalamic heat-regulating center to cause vasodilation and sweating, which heals to lessen heat.

CNS: HeadacheCV: Chest pain; dyspnea; myocardial damage when dose of 5-8g/day are ingested daily for several weeks or when dosages of 4g/day are ingested for 1year.GI: Hepatic toxicity and failure, jaundiceGU: Acute renal failure, renal tubular necrosis.Hematologic: methamoglobinemia--cyanosis; hemolytic anemia; anuria; neutropenia; leukopenia; pancytopenia; thrombopenia; hypoglycemiaHypersensitivity: Rash, Fever

-> Give pedia patient on liquid form of medication.

-> TSB.

-> Take medicine q4.

-> Give drug with food.

-> To avoid splitting up and easy to swallow.

-> To evaporate heat of the patient.

-> To complete therapeutic regiments.

-> To prevent GI upset.

Drug Study Classification

Indications Mechanism of

Action

Adverse Effects Nursing Considerations

Rationale

Generic Name:Dexamthasone

Brand Name/s:Dexasone, Dexone, Hexadrol

CorticosteroidGlucocorticoidHormone

->Management of cerebral edema->Diagnostic agent in adrenal disorders->Relieves inflammation

Dexamethasone suppresses inflammation and the normal immune response. It prevents the release of substances in the body that causes inflammation.

Systemic AdministrationCNS: Seizures, vertigo, headaches, pseudotumor cerebri, euphoria, insomnia, mood swings, depression, psychosis, intracerebral hemorrhage, reversible cerebral atrophy in infants, caratacts, IOP, glaucomaCV: Hypertension, Heart failure, necrotizing angritisEndocrine: Growth retardation, decreased carbohydrates tolerance, DM, cushingoid state,

->Give drug with food.

->

-> To minimize GI irritation.

->

secondary adrenocortical and pituitary unresponsivenessGI: Peptic or esophageal ulcer, pancreatitis, abdominal distentionGU: Amenorrhea, irregular mensesHematologic: Fluid and electrolytes disturbance, negative nitrogen balance, increased blood sugar, glycosuria, increased serum cholesterol, decreased serum T3 and T4 levelsHypersensitivity: Anaphylactoid or hypersensitivity reactionsMusculoskeletal: Muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, spontaneous fracturesOther/s: Impaired wound healing; petechiae;

ecchymoses; increased sweating; thin and fragile skin, acne; immunosuppression; and masking of signs of infection; activation of latent infections, including TB, fungal , and viral eye infections; pneumonia; abscess; septic infection; GI and GU infections

X. Discharge Planning

M- Medicine

-Instructed patient to take the medications.

E-Exercise

-Instructed patient to do the ADL.

T-Treatment

-Continue medications and promote supportive treatment as PRN, such as TSB and Paracetamol.

H-Health Teaching

-Instruct SO to give nutritional foods like green leafy vegetables example (malungay, ampalaya and bitter melon).

-Instruct SO to give food rich in fiber.

-Instruct SO to avoid food rich in saturated fats and hydrogenated oils.

-Instruct SO to give foods rich in vitamin C.

O-Out patient

-instructed patient to return after one week @ OPD @ 8AM for follow-up checkup

D-Diet

-instructed patient to avoid or limit foods rich in saturated fats and hydrogenated oils

-DAT with aspiration diet

XI. Bibliography

Book(s):

Joyce M. Black and Jane Hokanson Hawks, Medical Durgical Nursing (7th Edition) 2004, EL SEVIER (Singapore) PTE LTD.

Marilynn E. Doenges, Mary Frances Moorhouse, and Alice C. Murr, Nurse’s Pocket Guide (12th Edition) 2008, Nursing: Joanne Patzek DaCunha, RN, MSN.

Amy M. Karch, 2011 LIPPINCOTT’S: Nursing Drug Guide, 2011, Chris Burghargt.

Website(s):

http://www.medscape.com/viewarticle/747859, 2012.

http://www.emedicinehealth.com/anatomy_of_the_central_nervous_system/article_em.htm

http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/C/CNS.html, November 18, 2011.

http://serendip.brynmawr.edu/bb/kinser/Structure1.html, 10:45:07 EDT, June 3, 2005.

http://www.chw.org/display/router.asp?DocID=22484, 2012.