Case Study Final. Pott's Disease

A Case Study on Aspiration Pneumonia, Sepsis, Cerebral Palsy, Pott’s Disease
1I. INTRODUCTION
2
3 This is a case of an 8 year-old male patient who is diagnosed of Aspiration
4Pneumonia, Sepsis, Cerebral Palsy, and Pott’s disease and was admitted to Capitol
5University Medical City (CUMC) ICU last November 23, 2010. During the assessment,
6findings revealed that there was a normal blood pressure of 100/70, pulse rate was
798bpm, respiration rate of 25cpm and temperature of 37.3 degree Celsius and had chief
8complaints of difficulty in breathing with coffee-ground vomitus. His weight revealed 42
9lbs (20.1 kg).
10 Aspiration pneumonia is an inflammation of the lungs and bronchial tubes caused
11by inhaling foreign material, usually food, drink, vomit, or secretions from the mouth into
12the lungs. This may progress to form a collection of pus in the lungs (lung abscess).
13Aspiration pneumonia is a form of pneumonia that can develop when foreign material,
14such as food, liquid, vomit, or mucus, is accidentally inhaled into the lungs. This can
15happen when a person is unconscious or has a seizure or when a stroke has affected
16the person's ability to swallow. Childhood pneumonia is the leading single cause of
17mortality in children aged less than 5 years. The incidence in this age group is
18estimated to be 0.29 episodes per child-year in developing and 0.05 episodes per child-
19year in developed countries. This translates into about 156 million new episodes each
20year worldwide, of which 151 million episodes are in the developing world. Most cases
21occur in India (43 million), China (21 million) and Pakistan (10 million), with additional
22high numbers in Bangladesh, Indonesia and Nigeria (6 million each). Of all community
23cases, 7–13% are severe enough to be life-threatening and require hospitalization.
24Substantial evidence revealed that the leading risk factors contributing to pneumonia
25incidence are lack of exclusive breastfeeding, undernutrition, indoor air pollution, low
26birth weight, crowding and lack of measles immunization. Pneumonia is responsible for
27about 19% of all deaths in children aged less than 5 years, of which more than 70%
28take place in sub-Saharan Africa and south-east Asia. Although based on limited
29available evidence, recent studies have identified Streptococcus pneumoniae,
30Haemophilus influenzae and respiratory syncytial virus as the main pathogens
31associated with childhood pneumonia. (Bulletin of the World Health Organization
322008;86:408–416.)
33 On the other hand, sepsis is a serious infection usually caused by bacteria —
34which can originate in many body parts, such as the lungs, intestines, urinary tract, or
35skin — that make toxins that cause the immune system to attack the body's own organs
36and tissues. Sepsis can be frightening because it can lead to serious complications that
37affect the kidneys, lungs, brain, and hearing, and can even cause death. As mentioned,
42
1conditions originating in the perinatal period is among the leading cause of mortality; the
2top cause of death being pneumonia, followed by bacterial sepsis.
3 Meanwhile, Cerebral Palsy (CP) is a disorder that affects muscle tone,
4movement, and motor skills (the ability to move in a coordinated and purposeful way).
5Cerebral palsy can also lead to other health issues, including vision, hearing, and
6speech problems, and learning disabilities. CP is usually caused by brain damage that
7occurs before or during a child's birth, or during the first 3 to 5 years of a child's life.
8There is no cure for CP, but treatment, therapy, special equipment, and, in some cases,
9surgery can help a child who is living with the condition. Statistics that were calculated
10extrapolations of various prevalence or incidence rates against the populations of a
11particular country or region which shows the prevalence/incidence of Cerebral Palsy are
12typically based on US, UK, Canadian or Australian statistics. This extrapolation
13calculation is automated and does not take into account any genetic, cultural,
14environmental, social, and racial or other differences across the various countries and
15regions for which the extrapolated Cerebral Palsy statistics below refer to. As such,
16these extrapolations may be highly inaccurate (especially for developing or third-world
17countries) and only give a general indication (or even a meaningless indication) as to
18the actual prevalence or incidence of Cerebral Palsy in that region. Specifically, in the
19aforementioned statistics, Philippines has 172,483 cases for the population of
2086,241,6972
21 Finally, Pott’s disease is a presentation of extrapulmonary tuberculosis that
22affects the spine, a kind of tuberculous arthritis of the intervertebral joints. Scientifically,
23it is called tuberculous spondylitis. Pott’s disease is the most common site of bone
24infection in TB; hips and knees are also often affected. The lower thoracic and upper
25lumbar vertebrae are the areas of the spine most often affected. Pott's disease, which is
26also known as Pott’s caries, David's disease, and Pott's curvature, is a medical
27condition of the spine. Individuals suffering from Pott's disease typically experience back
28pain, night sweats, fever, weight loss, and anorexia. They may also develop a spinal
29mass, which results in tingling, numbness, or a general feeling of weakness in the leg
30muscles. Often, the pain associated with Pott's disease causes the sufferer to walk in an
31upright and stiff position. Pott’s disease is caused when the vertebrae become soft and
32collapse as the result of caries or osteitis. Typically, this is caused by Mycobacterium
33tuberculosis. As a result, a person with Pott's disease often develops kyphosis, which
34results in a hunchback. This is often referred to as Pott’s curvature. In some cases, a
35person with Pott's disease may also develop paralysis, referred to as Pott’s paraplegia,
36when the spinal nerves become affected by the curvature. The incidence and
37prevalence of pediatric tuberculosis (TB) worldwide varies significantly according to the
38burden of the disease in different countries. It has been estimated that 3.1 million
42
1children under 15 years of age are infected with TB worldwide. According to the World
2Health Organization (WHO), children with TB represent 10 % to 20 % of all TB cases.
3The majority of these cases occur in low-income countries where the prevalence of
4Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) is
5high. TB occurs frequently among disadvantaged populations, such as malnourished
6individuals, and those living in crowded areas. According to WHO reports, India, China,
7Pakistan, the Philippines, Thailand, Indonesia, Bangladesh, and the Democratic
8Republic of the Congo account for nearly 75 % of all cases of pediatric TB (World
9Health Organization 2006, Dye 1990). Furthermore, it has also been reported that TB is
10responsible in Sub-Saharan countries for between 7 % and 16 % of all episodes of
11acute pneumonia in HIV-infected children, and for approximately one fifth of all deaths
12in children presenting with acute pneumonia (Chintu 2002, Jeena 2002).
13 This kind of case, requires continuous care and necessitates proper health
14education to the patient and to significant others to provide safety, proper nourishment.
15It is but a collaborative effort of health care providers and the patient in line to
16preventing reoccurrence, and further complication. In light to this, through this case
17presentation the group will be able to come up with versatile ideas relevant to the care
18of patient not only for the betterment of his condition but also to address the needs of
19patient holistically. This paper contains all the relevant care rendered to the patient
20through our duties and all other forms of intervention given by the health team in
21response to the patient’s condition including the medications, laboratory results and
22other doctors’ orders which are related to the patient’s condition.
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1II. GOALS AND OBJECTIVES
2
3General Objectives:
4 This case presentation seeks to enhance the students’ knowledge with regards
5to the patient’s general health and disease condition, its pathophysiology, possible
6complications, treatment plan and medical regimen. It also seeks to assimilate the
7student’s skills through application of several nursing interventions and medical
8management. Furthermore, this case presentation intends to improve the students’
9attitude by conveying open-mindedness and utilizing therapeutic communication all
10throughout the activity.
11
12Specific Objectives:
13 Within one week of thorough study of this specific case, the student nurses aim
14to achieve the following objectives in this case presentation:
15
16  Accurately present a thorough general health assessment of the client which
17 includes physical assessment and family history taking.
18  Effectively discuss and elaborate actual signs and symptoms of the specific
19 diagnoses exhibited by the client.
20  Thoroughly discuss, explain, and elaborate the nature of the disease process.
21  Efficiently provide appropriate and proper nursing diagnosis in line with the
22 client’s medical condition.
23  Skillfully formulate nursing care plans for the different problems identified.
24  Appropriately provide nursing interventions according to the standards of nursing
25 practice.
26  Effectively apply the learned concepts and theories of the disease and the
27 management.
28  Efficiently Appraise the effectiveness and efficacy of nursing interventions
29 rendered to the client.
30  Impart the outcome of the rendered nursing interventions.
31  Convey the significance of client’s response to the rendered nursing interventions
32  Accurately provide concise and concrete information to the audience with
33 regards to Aspiration Pneumonia, Sepsis, Cerebral Palsy, and Pott’s disease.
34  Appropriately provide an environment for learning for the audience.
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1III. CLIENT’S PROFILE
2 A. Socio-demographic Date
3 Patient X is an eight year old male who lives with his family at Damilag,
4 Manolo Fortich, Bukidnon. He is the second and youngest son of his Roman
5 Catholic parents.
6
7 B. Vital Signs
8 The patient vital signs are one of the most important data that should be
9 given a direct attention because it will serve as basis in determining any risk
10 factors towards the patient. The increase and decreased of the vital sign of the
11 patient must be monitored in order to determined whether the patient is at risk or
12 not.
13 Upon assessment, the patient’s vital signs were: BP: 100/70 mmHg,
14 Temperature: 37.3 degree Celsius (but during the shift he reached the
15 temperature of 37.7C) , PR: 98 beats per minute, and RR: 25 cycles per minute.
16 The patient weighs 20.1n kilograms and is 4 feet and 2 inches tall.
17
18 C. Health Pattern Assessment
19  Past Medical History
20 According to the mother, about 10 days after the patient has given
21 birth, he experienced having high intermittent fever, the mother ignored it
22 at once but when the patient exhibits seizure activities, the mother then
23 immediately brought him to the hospital specifically Northern Mindanao
24 Medical Center (NMMC) and was advised for ICU admission. The doctor’s
25 diagnosis then was meningitis. In addition to that, as a complication, the
26 patient develops hydrocephalus and was managed through brain
27 shunting. The patient went on being comatose for about a week, and was
28 later diagnosed with Pott’s disease. He was given high doses of antibiotic
29 then. From then, the patient is no longer able to move by himself, and
30 went on entirely dependent all his life.
31 Patient X was 6 years old then when he was readmitted to the ICU
32 but now in Capitol University Medical City (CUMC) with the same
33 manifestations. After about 5 days of admission, he was later diagnosed
34 with Cerebral Palsy.
35
36
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42
1  History of Present Illness

2 Three days prior to admission, the patient had cough and colds, the
3 phlegm is very copious but the mother opted to nebulizer him, considering
4 the he has always been coughing and had persistent respiratory infection
5 until last November 23, 2010 he began vomiting blood-like, coffee ground
6 vomitus. This alarmed the mom and immediately sought medical attention.
7
8  Physical Assessment
9 Patient X has nasogastric tube in place. He also has a mouth guard
10 secured in place and has an endotracheal tube, at the same time,
11 connected to a mechanical ventilator with set-up as follows: TV=20, FiO2=
12 40%, BUR= 25, PEEP 3. He is hooked with D5NM 1L@15 drops per
13 minute infusing at his left foot. He has heplock on his right arm. He is
14 hooked to a cardiac monitor and a pulse oximeter. He has a condom
15 cathether attached to urobag.
16
17HEENT:
Head, hair and scalp Head appears bigger with fine hair and clean
scalp.
Eyes: sclera, pupils Sclerae are anicteric and pupils are covered with
cataracts and are equal in size. The mother also
reported the patient has been blind since birth.
Ears and tympanic membrane The right ear is bigger than the left with no
discharges and has equal auditory function.
Nose No nasal flaring noted. Septum is medial.
Mouth, lips, tongue, teeth and Lips and oral mucosa are pale. No lesions noted
oral mucosa in the mouth. Tongue is midline. Teeth are
complete with plaques noted.
Throat and neck Neck has limited range of motion. Thyroids are
non palpable.
Facial movements Symmetrical but decreased or limited mobility.
18
19
20  Cognitive/ Neurological Assessment
Level of consciousness Conscious, often drowsy and less responsive (by
means of motor)
Orientation N/A
Emotional state Calm at times and gets restless when coughing
Primary language Communicates thru moaning and crying. The
mother also reported, the patient has been mute
from birth.
42
Educational attainment Haven’t gone to school.

1
2  Nutritional and Metabolic Pattern
3 At home, Patient X is fed with blenderized food ever since, which
4 includes rice, milk and a little of soft viands. He is fed about once or twice
5 a day per demand or if he can tolerate. According to the mom, he often
6 gets choked when fed. He has no vitamins or mineral supplement. Upon
7 hospital stay, Patient X is fed thru NGT with 2500 kcal a day equally
8 divided in four feedings. He seems poorly nourished with a BMI below
9 normal range.
10
11  Elimination Pattern
12 Patient X usually does not follow a pattern in defecating. He used to
13 defecate once in three days or more, but when he does, his stool appears
14 soft in consistency, yellow to brown in color and in minimal amount.
15 He urinates at about 4 times a day with amber to yellow colored
16 urine. He is not used to wearing diaper even at home because he seems
17 to have allergic reactions when he wears it.
Abdominal configuration Symmetrical, no superficial veins, with no lesions
and scars
Bowel sounds Hypoactive (3clicks) upon auscultation
Percussion Tympanic and dullness noted on right upper

quadrant
18
19  Activity-Exercise Pattern
20 At home, the patient has no exercise at all. He lies flat on bed most
21 of the time and gets to sit when fed. He doesn’t have any leisure activities.
22 He is fully dependent with all the activities of daily living (ADL) as well as
23 with his mobility. Most of his joints have decreased mobility, in its range of
24 motion exercises. In terms of his muscular tone and strength, his muscles,
25 in both limbs, are very weak; tend to become spastic and immobile at
26 some time. The patient’s gait might not be uncoordinated nor shuffling
27 neither staggering but definitely not coordinated because he has never
28 learned to walk at all. Patient has kyphosis brought about the complication
29 of Pott’s disease.
30
31CARDIOVASCULAR STATUS
Chest pain, radiation No pain noted and assessed
Point of maximal impulse, 3rd intercostals space, midclavicular line
42
Precordial area bulging

Heart sounds Distinct and regular, no murmurs noted
Peripheral pulses Regular, symmetrical and faint
Capillary refill time 2 seconds, no clubbing noted
1
2
3RESPIRATORY STATUS
Breathing pattern regular, use of accessory muscles noted
Lung expansion Decreased at left side
Vocal/tactile fremitus Not assessed
Percussion Tympany
Breath sounds Crackles noted
Cough nonproductive sputum
4
5  Sleep and Rest Pattern
6 Patient X used to sleep most of the time, if not, lies on bed and
7 listens to stories being shared by his mother in a resting position. His
8 sleep accounts almost 18 hours each day.
9
10  Role and Relationship Pattern
11 Patient X is a son to a 39-year-old mother and overseas worker
12 father. He used to be the youngest and gets almost all attention from his
13 mom. His dad works overseas and seldom talks with him via phone call.
14 His dad, according to his mom, cannot come home and take care of their
15 son because he signed a contract and he needs to strive harder to sustain
16 Patient X’s needs. However, the mother provides ample time and devotes
17 most of her attention for her “special” son. On the other hand, the mother
18 reported their family doesn’t have any history of diabetes, hypertension
19 nor cancer.
20
21
22  Value and Belief Pattern
23 The family is affiliated to the Roman Catholic Church and believes
24 that God can heal their patient. The mother silently prays and moans all
25 her desires and wishes of healing to God.
26
27
28 D. Physical Assessment
29 1. Neurologic Assessment
Level of consciousness Conscious but drowsy and less responsive
42
Orientation N/A
Emotional state Restless when coughing
3 2. Head
Head Slightly bigger ( heading to macrocephalic)
Facial movement Symmetrical but limited
Fontanels Closed
Hair Fine
Scalp Clean
6 3. Eyes
Lids Symmetrical
Periorbital region Non edematous
Conjunctiva pink
Cornea & lens cataracts
Sclera Anicteric
Pupils Equal in size
Visual acuity Loss of sight
Peripheral vision absent
9 4. Ears
External pinnae Right ear is slightly bigger
External canal No discharge
42
Tympanic membrane Intact
Gross hearing normal
2 5. Nose
Mucosa Pinkish
Patency Both patent
Gross smell N/A
Sinuses No tenderness presence
5 6. Mouth
Lips Pallor
Mucosa Pallor
Tongue Midline
Teeth Missing Teeth
Gums pinkish
8 7. Pharynx
Uvula Midline
Tonsils Not inflamed
Posterior pharynx No inflammation is present
10
11 8. Neck
42
Trachea Midline
Thyroids non-palpable
3 9. Skin
General color Pallor
Texture Rough
Turgor Firm
Tempareture warm
6 10. Abdomen
General Normal
Configuration Symmetrical
Bowel sound Hypoactive (3 clicks)
Percussion Tympanitic
9 11. Cardiovascular Status
Precordial area bulging
Point of maximal impulse(PMI) 3rd intercostal space
Apical & rhythm Regular
Heart sound Regular
Peripheral pulse Symmetrical & regular
Capillary refill 2 seconds
10
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1 12. Respiratory Status
Breathing pattern Regular
Shape of chest AP1:L2
Lung expansion Decreased at the left side
Percussion Resonant
Breath sound Crackles noted
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1IV. ANATOMY AND PHYSIOLOGY
Associated Signs and

Brain Structure Function
Symptoms
The outermost layer of the
1. Cerebral Cortex cerebral hemisphere which
is composed of gray matter.
Cortices are asymmetrical.
Both hemispheres are able
to analyze sensory data,
perform memory functions,
learn new information, form
Ventral View ( From bottom) thoughts and make
decisions.
2. Left Hemisphere Sequential Analysis:
systematic, logical
interpretation of information.
Interpretation and
production of symbolic
information:language,
mathematics, abstraction
and reasoning. Memory
stored in a language format.
3. Right Hemisphere Holistic Functioning:
processing multi-sensory
input simultaneously to
provide "holistic" picture of
one's environment. Visual
spatial skills. Holistic
functions such as dancing
and gymnastics are
coordinated by the right
hemisphere. Memory is
stored in auditory, visual
and spatial modalities.
4. Corpus Callosum Connects right and left Damage to the Corpus
hemisphere to allow for Callosum may result in "Split
communication between the Brain" syndrome.
hemispheres. Forms roof of

the lateral and third
ventricles.
Cognition and memory. Impairment of recent

Prefrontal area: The ability memory, inattentiveness,
to concentrate and attend, inability to concentrate,
elaboration of thought. The behavior disorders, difficulty
"Gatekeeper"; (judgment, in learning new information.
inhibition). Personality and Lack of inhibition
emotional traits. (inappropriate social and/or
sexual behavior). Emotional
Movement: lability. "Flat" affect.
5. Frontal Lobe
Motor Cortex (Brodman's): Contralateral plegia, paresis.
voluntary motor activity. Expressive/motor aphasia.
Premotor Cortex: storage

of motor patterns and
voluntary activities.
Ventral View (From Bottom) Language: motor speech.

Premotor – selects
movements, selection and
direction of motor
sequences, choose
Side View
behavior in response to
clues, frontal eye fields.
Prefrontal (PFC) – controls

the cognitive processes so
that appropriate movements
are selected at the correct
time and place
6. Parietal Lobe Processing of sensory input, Inability to discriminate

sensory discrimination. between sensory stimuli.
Inability to locate and
Body orientation. recognize parts of the body

(Neglect).
Primary/ secondary somatic Severe Injury: Inability to
area. recognize self.
Disorientation of environment
space.
Inability to write.
Primary visual reception Primary Visual Cortex: loss
7. Occipital Lobe
area. of vision opposite field.
Visual Association Cortex:
Primary visual association loss of ability to recognize
area: Allows for visual object seen in opposite field
interpretation. of vision, "flash of light",
"stars".
Auditory receptive area and Hearing deficits.
8. Temporal Lobe
association areas. Agitation, irritability, childish
Expressed behavior. behavior.
Language: Receptive Receptive/ sensory aphasia.
speech.
Memory: Information
retrieval.

Olfactory pathways:
Amygdala and their different Agitation, loss of control of
pathways. emotion. Loss of recent
9. Limbic System
Hippocampi and their memory.
different pathways. Loss of sense of smell.
Limbic lobes: Sex, rage,

fear; emotions. Integration
of recent memory, biological
rhythms.
Hypothalamus.
10. Basal Ganglia Subcortical gray matter Movement disorders: chorea,
nuclei. Processing link tremors at rest and with
between thalamus and initiation of movement,
motor cortex. Initiation and abnormal increase in muscle
direction of voluntary tone, difficulty initiating
movement. Balance movement.
(inhibitory), Postural Parkinson's.

reflexes.
Part of extrapyramidal
system: regulation of
automatic movement.
11. Thalamus Processing center of the Altered level of
cerebral cortex. Coordinates consciousness.
and regulates all functional Loss of perception.
activity of the cortex via the Thalamic syndrome -
integration of the afferent spontaneous pain opposite
input to the cortex (except side of body.
olfaction).
Contributes to affectual
expression.
12. Hypothalamus Integration center of Hormonal imbalances.
Autonomic Nervous Malignant hypothermia.
System (ANS): Regulation Inability to control
of body temperature and temperature.
endocrine function. Diabetes Insipidus (DI).
Anterior Hypothalamus: Inappropriate ADH (SIADH).
parasympathetic activity Diencephalic dysfunction:
(maintenance function). "neurogenic storms".
Posterior Hypothalamus:
sympathetic activity ("Fight"
or "Flight", stress response.
Behavioral patterns:
Physical expression of
behavior.
Appestat: Feeding center.
Pleasure center.
13. Internal Capsule Motor tracts. Contralateral plegia
(Paralysis of the opposite
side of the body).
14. Reticular Activating Responsible for arousal Altered level of

System (RAS) from sleep, wakefulness, consciousness.
attention.
1
2Spinal cord
3 The spinal cord is about 18 inches long and is
4the thickness of your thumb. It runs within the
5protective spinal canal from the brainstem to the 1st
6lumbar vertebra. At the end of the spinal cord, the
7cord fibers separate into the cauda equina and
8continue down through the spinal canal to your
9tailbone before branching off to your legs and feet.
10The spinal cord serves as an information super-
11highway, relaying messages between the brain and
12the body. The brain sends motor messages to the
13limbs and body through the spinal cord allowing for
14movement. The limbs and body send sensory
15messages to the brain through the spinal cord about
16what we feel and touch. Sometimes the spinal cord
17can react without sending information to the brain.
18These special pathways, called spinal reflexes, are
19designed to immediately protect our body from harm.
20 The nerve cells that make up your spinal cord
21itself are called upper motor neurons. The nerves that branch off your spinal cord down
22your back and neck are called lower motor neurons. These nerves exit between each of
23your vertebrae and go to all parts of your body.
24Any damage to the spinal cord can result in a loss of sensory and motor function below
25the level of injury. For example, an injury to the
26thoracic or lumbar area may cause motor and
27sensory loss of the legs and trunk (called
28paraplegia). An injury to the cervical (neck) area
29may cause sensory and motor loss of the arms
30and legs (called tetraplegia, formerly known as
31quadriplegia).
32
33Vertebral arch & spinal canal
34 On the back of each vertebra body are
35bony projections that form the vertebral arch. The
36arch is made of two supporting pedicles and two
37arched laminae (Fig. 5). The hollow spinal canal
1contains the spinal cord, fat, connective tissue, and blood supply of the cord. Under
2each pedicle, a pair of spinal nerves exits the spinal cord and passes through the
3intervertebral foramen to branch out to your body.
4 Surgeons often remove the lamina of the vertebral arch (laminectomy) to access
5and decompress the spinal cord and nerves to treat spinal stenosis, tumors, or
6herniated discs.
7 Seven processes arise from the vertebral arch: the central spinous process, two
8transverse processes, two superior facets, and two inferior facets.
9
10The Anatomy of the Lung
11 Each lung is divided into
12 lobes. The right lung, which
13 has three lobes, is slightly
14 larger than the left, which has
15 two. The lungs are housed in
16 the chest cavity, or thoracic
17 cavity, and covered by a
18 protective membrane called
19 the pleura. The diaphragm,
20 the primary muscle involved
21 in respiration, separates the
22 lungs from the abdominal
23 cavity. The pulmonary
24 arteries carry de-oxygenated
25blood from the right ventricle of the heart to the lungs. The pulmonary veins, on the
26other hand, carry oxygenated blood from the lungs to the heart, so it can be pumped to
27the rest of the body.
28
29
30 V. PATHOPHYSIOLOGY 36
31 37 Exposure to the specific

Predisposing Factors: microorganism via droplet
38 Precipitating Factors:
32  Gender (male)
 Age ( 10 days old)  No full immunity against
33 39
 Environmental factors (living infection
Ingestion of bacteria via nasal cavity
near the mountains) 40
34
35 41
Proliferates to the meninges through the
bloodstream reaching the subarachnoid space
1 25
Progressive bone
Intermittent fever
2 26 destruction
3 Descending proliferation 27
of infection occurs Head intends to
Spinal canal get
canbigger
be
4 28 narrowed by abscesses,
granulation tissue of
5
29 direct dural invasion
Extended
6 infections which
30
LEGEND: kyphosis causes Cranial
7 Increased cell division causing further mutations
compression
Predisposing
31 Factors Collapse in the anterior spine
8 Precipitating Factors
32
9 Disease Process Decrease mobility of
33 Activation of compression
Spinal cord facial movements
the k-ras oncogene
Management and neurologic deficits
10
34 Examination
Diagnostic
11
Signs and
35 symptoms P53 mutations which prevent apoptosis
Stimulates the release of cytokines
12 Presence
Abnormal
NPO state of
36 decrease
surgicalin
13 lymphocytes
wound.
Prolong lifespan of affected cells
37 7.1 and 7.9
Increases blood- brainof
Possible
Vasculity
14
barrier permeabilityincrease
cerebral vessels
38 in acid
15 Continuous replication of affected cells
productio
Infection spreads within the CSF 39 n within
16 Fluid leakages from
Decrease
the GI
40
vessels and extends
Increases number blood
ofventricles
malignant flow
liningcells
17 to the Ketoster
Interstitial edema going to the
Susceptibl
Activation of astrocyte and microlgia il 1cap.
Activation
41 CNS
e to
ofPO
1.omeprazole
painBID
18 infection
20mg PO
42 Reached to the mediators
Increase ICP every 6 hours
centrecephalic system
Comatose (about
19 43 2.aranitidine
week)
1. celecoxib 1.5gm
500mgIVTT IVTT
20 44 every 6 hoursevery 8 hrs.
Brain Neuronal excitation from
Infectious Agent spread from the anterior shunting 2. paracetamol 60mg IVTT
21 45 the epileptic focus spreads
aspect of vertebral body adjacent to the every 6 hours
to the brainstem
subchondral plate 46
22 3. ketorolac
Increase WBC in30mg
CSF IVTT
Uncoordinated
every 8 hours
Blindness and
47 movements were
23 development of
X-ray revealed severe Infection spread to the 4. tramadolobserved
500mg IVTT
cataracts in both
skeletal adjacent intervertebral48disk every of
Inflammation 6 hours
the meninges
24 deformities are eyes
noted preextending proper
chest structures 49
Alters the
Affects GI activity Ascending
functioning of the
infection occurs
brainstem
1 16
2 17
3 Decrease 18
Excessive Decrease functioning of
peristaltic
production of Alters the the epiglottis to close in
4 movement 19
HCl neuromuscu the entry of food.
1. ET suctioning
lar activity
5 20
2. Given Combivent I
1. hypoactive bowel nebule via inhalation
Blood-like
6 coffe- Entry of food/fluid within
movement (3 clicks) 21
ground vomitus at HS
the respiratory premises
NGT insertion
7
2. constipation 22
1. Abnormal increase
8
23
of WBCLodge in the
of 31, 000
lungs
1. Crackles heard upon
9
1. famotidine 10mg IVTT BID 24
auscultation
2. sucralfate
10 250mg IVTT at HS
Inflammatory
25 response of the body
2. Nonproductive cough
11 2. Fever of 37.7 C
26
Language deficit, Uncoordinated gait, Jerky
12 Continuous proliferation of
movements present, and Abnormal posture 27
infection
13
28
14
29 Release of damaging toxins
15 Impairs the ciliary Production of
functioning copious secretion
30VI. LABORATORY RESULTS
1. amikacin 100 mg IVTT very 8 hours
2. clindamycin 1mg IVTT every 6 hours

31
32 The laboratory test 3.and
cefepime I mgprocedures
diagnostic IVTT everyindicates
6 hours a very significant finding
33necessary for the care and prevention of particular disease which may occur in the
34clinical settings, here are the data as followed with interpretation.
35
36 Hematology Report
37 (24/11/10)
TEST RESULTS REFERENCE VALUES
Hgb 12.0 13.7-16.7 g/dL Decreas

existenc
Hct 36.0 40.5-49.7 gm% Within th

WBC 22, 800 5,000-10,000 cell/mm3 It is beyo

may indi
DIFFERENTIAL
COUNT:
Segmenters 83.0 45-70% High num

of infecti
Lymphocytes 14.0 18-45% Low lym

to infecti
Monocytes 3.0 4-8% Decreas

the susc
infection
Platelet count 329, 000 144,000-372,000 cell/mm3 Within th

factor is
RBC 4.05 4.7-6.1 10^6/uL Within th
MCV 77.8 80.0-96.0 fL Low MC
MCH 25.3 27.0-31.0 pg Indicate
MCHC 32.6 32.0-36.0% Within th
1
2
3
4
5
6
7
8
9 Hematology Report
10 (23/11/10)
Hgb 13.3 13.7-16.7 g/dL Decreas

existenc
Hct 40.0 40.5-49.7 gm% Slightly d

may indi
DIFFERENTIAL
COUNT:
Segmenters 81.0 45-70% High num

of infecti

to infecti
Monocytes 5.0 4-8% Within th
Platelet count 376, 000 144,000-372,000 cell/mm3 Within th

good.
RBC 4.85 4.7-6.1 10^6/uL normal
MCV 78.0 80.0-96.0 fL Low MC
MCH 25.5 27.0-31.0 pg Indicate
MCHC 36.0 32.0-36.0% normal
2 PHILLIPS MEMORIAL HOSPITAL
3 Hematology Report
4 (23/11/10)
Hgb 15.6 13.7-16.7 g/dL Within th
Hct 47.0 40.5-49.7 gm% Within th

may indi
DIFFERENTIAL
COUNT:
Segmenters 86.0 45-70% Indicates

to infecti
Platelet count 260, 000 144,000-372,000 cell/mm3 normal
6 Culture Report (11/23/10) 9  Preliminary Report:

10  Date: 11/27/10
7  Specimen: Tracheal
8 aspirate
1  Findings: 25
2 organisms isolated,
26X-ray report: 11/23/10
3 Yeast cells Germ
4 Tube negative 27  Severe skeletal deformities are
5  Specimen: blood 28 noted preextending proper
6  Date: 11/25/10 29 evaluation of chest structures.
7  Findings: no growth after
8 2 days of incubation
10AFB Stain Report
11  Date: 11/23/10
12  Result: negative
13  Grade: O
14  Specimen: tracheal aspiration
15
16Reference:
RESULT GRADING
More than 10 AFB Positive 3+

per oil immersion
field
1-10 AFB per oil Positive 2+

immersion fields
10-99 AFB in 100 Positive 1+

oil immersion
fields
17
1811/23/10
19  Specimen: tracheal aspirate
20  Result: Gram (-) bacilli: few
21  Polymorphonuclear cells:
22 moderate
23  Yeast cells: moderate
24  Hyphal elements seen.
1
1VII. DRUG STUDY
DRUG ORDER
(Generic name, brand
MECHANISM OF CONTRAINDICATIONS ADVERSE EFFECTS NURSING
name, classification, INDICATIONS
ACTION OF THE DRUG RESPONSIBILITIES/
dosage, route,
PRECAUTIONS
frequency)
Generic Name: Inhibits production of Treatment of Hypersensitivity to > CNS: ataxia, vertigo 1. Advise patient’s SO
amikacin bacterial protein, serious gram- aminoglycosides. > EENT: ototoxicity about the importance of
Brand Name: causing bacterial cell negative bacillary > GU: nephrotoxicity drinking plenty of fluids.
Amikin death. infections and > MS: muscle paralysis Maintain adequate
infections caused > Neuro: inc. hydration.
Classification:
by staphylococci Neuromuscular blockade 2. Patient’s SO should be
Anti-infectives
when penicillins or > Resp: apnea counseled that antibacterial
Dosage: 100 mg other less toxic > Misc: hypersensitivity drugs including Amikacin
drugs are reactions. should only be used to treat
Route: IVTT
contrsindicated. bacterial infections.
Frequency: every 8 3. Patient’s SO should be
hours told that the medication
should be taken exactly as
Timing: 8am-1pm-6pm
directed.
DRUG ORDER
dosage, route,
PRECAUTIONS
frequency)
Generic Name: Inhibits protein Treatment of: Skin Hypersensitivity; > CNS: dizziness, 1. Instruct patient to notify
clindamycin synthesis in susceptible and skin structure Prevoius headache, vertigo health care professional
Brand Name: bacteria at the level of infections, pseudomembraneous immediately if diarrhea,
> CV: arrythmias,
Cleocin the 50S ribosome. Respiratory tract colitis; Severe liver abdominal cramping, fever,
hypotension
infections, impairment; Diarrhea; or bloody stools occur and
Classification:
Septicemia, Intra- Known alcohol > GI: not to treat with
Anti-infectives
abdominal intolerance. pseudomembraneous antidiarrheals without
Dosage: 2 mg infections, colitis, diarrhea, bitter consulting health care
Osteomyelitis, taste, nausea, vomiting professionals.
Route: IVTT
Gynecologic 2. Inform patient that bitter
> Derm: rashes
Frequency: every 6 infections, taste occuring with IV
hours Endocarditis > Local: phlebitis at IV administration is not
prophylaxis. site. clinically significant.
Timing: 12mn-6am-
3. Notify health professional
12nn-6pm
if no improvement within few
days.
DRUG ORDER
dosage, route,
PRECAUTIONS
frequency)
Generic Name: Binds to the bacterial Treatment of bone Patient w/ hypersensitive > CNS: fever, headaches 1. Before giving drug ask
cefepime cell wall membrane, and joint infections. to drugs, cephalosporin, > CV: phlebitis patients if he/she is allergic
Brand Name: causing cell death. beta-lactam antibiotics, to penicillin or
> GI: colitis, diarrhea,
Maxipime or penicillin cephalosporin.
nausea, vomiting, ural
Classification: 2. Obtain culture and
candidiasis
sensitivity test.
Anti-infectives
> SKIN: rash, pruritus 3. Adjust dosage in pt. w/
Dosage: 1 mg uticaria renal function.
4. Monitor patients for super
Route: IVTT > OTHER: pain
infection.
inflammation, hypersensitivity
Frequency:every 6
reactions anaphylaxis
hours
Timing: 12mn-6am-
12nn-6pm
DRUG ORDER
dosage, route,
PRECAUTIONS
frequency)
Generic Name: Competitively inhibits Short-term Contraindicated in > CNS: headache, 1. Assess patient for
famotidine action of histamine on treatment for patients hypertensive to dizziness, fever, abdominal pain. Look for
Brand Name: the H2 at receptor sites duodenal ulcer. drug. malaise, paresthesia, blood in emesis, stool or
Pepcid of parietal cells, vertigo. gastric aspirate.
decreasing gastric acid > CV: flushing, 2. Oral suspension
Classification:
secretion. palpitations. must be reconstituted and
H2 receptor antagonist
> EENT: orbital edema, shaken before use.
Dosage: 10 mg tinnitus. 3. Store reconstituted
> G.I.: anorexia, oral suspension
Route: IVTT
constipation, diarrhea, below 86°F
Frequency: BID dry mouth, taste (30°C). Discard after
perversion. 30 days
Timing:
> Musculoskeletal:
bone & muscle pain.
> Skin: acne, dry skin.
DRUG ORDER
dosage, route,
PRECAUTIONS
frequency)
1. Advise patient
Generic Name: Binds to the bacterial > Short- There are no known > CNS: dizziness,
that increase fluid
sucralfate cell wall membrane, term contraindications to the drowsiness
intake, dietary
Brand Name: causing cell death. treatment use of sucralfate.
> GI: constipation, bulk, and exercise
Carafate (up to 8
diarrhea, dry mouth, may prevent drug-
weeks) of
Classification: gastic discomfort, induced
active
Antiulcer agents indigestion, nausea constipation.
duodenal
2. Emphasize the
Dosage: 250 mg ulcer. While > Derm: pruritus,
routine
healing with rashes
Route: IVTT examinations to
sucralfate
monitor progress.
Frequency: at HS may occur
3. If antacids are
during the
Timing: 8pm also required for
first week or
pain, administer 30
two,
min before or after
treatment
sucralfate dosage.
should be
continued
for 4 to 8
weeks
unless
healing has
been
demonstrat
ed by x-ray
or
endoscopic
examination
.
DRUG ORDER
dosage, route,
PRECAUTIONS
frequency)
Generic Name: Combivent Indicated for use in Patients with cardiac > CNS: nervousness, 1. Monitor
ipratropium bromide Inhalation patients tachyarrhythmias, restlessness, tremor, respiratory status;
and albuterol sulfate Solution is a with chronic hypertrophic obstructive headache, insomnia auscultate lungs
combination of obstructive cardiomyopathy and before and after
Brand Name: > CV: chest pain,
the pulmonary patients with a history of inhalation
Combivent palpitations,
anticholinergic disease (COPD) on hypersensitivity to any of 2. Consult a doctor
hypertension
Classification: bronchodilator, a regular aerosol its components or to immediately in the
bronchodilators bronchodilator who atropine or its > GI: nausea, vomiting event of acute,
ipratropium
continue to have derivatives. rapidly worsening
Dosage: 1 nebule bromide, and > Endo: hyperglycemia
evidence of dyspnea. In
the beta2-
Route: inhalation bronchospasm and > F and E: hypokalemia addition, the
adrenergic
who require a patient should be
Frequency: at HS bronchodilator, > Neuro: tremor
second warned to seek
salbutamol
Timing: 8pm bronchodilator. medical advice
sulfate.
should a reduced
Ipratropium
response become
bromide is a
apparent.
quaternary 3. Rinse mouth

ammonium after medication
derivative of puffs to reduce
atropine and is bitter taste.
an 4. Do not allow the
anticholinergic solution/ mist to
drug which has enter the eyes.
bronchodilator
properties.
Salbutamol
produces
bronchodilation
through
stimulation of
beta2-
adrenergic
receptors in
bronchial
smooth
muscle, thereby
causing
relaxation of
muscle fibres.
This action is
manifested by
an increase in
pulmonary
function as
demonstrated
by spirometric
measurements.
3VIII. NURSING CARE PLAN
ASESSMENT DATA NURSING DIAGNOSIS GOAL AND OBJECTIVES NURSING INTERVENTIONS AND EVALUATION
(Subjective and Objective) (Problem and Etiology) RATIONALE
Subjective: Ineffective Airway Short-Term Goals: INDEPENDENT: Short- Term Goals:

Intubated clearance related to Within 3-5 minutes of 1. Monitor respiration rate and Goals met. After 5 minutes of
retained secretions in thorough nursing breath sounds. nursing intervention the patient
Objective: the upper airway intervention the patient will R – To come up with a baseline was able to improve airway
 Crackles heard upon be able to: data. clearance as evidenced by the

secondary to upper
auscultation  improve airway absence and/or diminished
respiratory tract
 Inability to cough-out clearance as 2. Assist client in positioning the adventitious sounds.
infection and food
secretions evidenced by the head appropriate for age/condition
aspiration
 With Endotracheal absence and/or R - To open or maintain open Long-Term Goals:
tube attached to diminished airway. Goals met. After 8 hours of
Mechanical ventilator adventitious sounds thorough nursing interventions
with the following set- 3. Elevate head of bed/ change the client was able to maintain
up: Long-Term Goals: position every two hours and as the patency of the airways as
- TV= 200 After 8 hours of the course needed. manifested by normal
- FiO2= 40% of duty, the client will be R - To take advantage of gravity respirations and effective
- BUR= 25 able to: decreasing pressure on excretion of copious
- PEEP= 3 cmH20  Maintain the diaphragm and enhancing secretions.

patency of the mobilization of secretions for
 restless
airways as easy expectoration in order to
manifested by promote ventilation to different
normal respirations lung segments.
and effective
excretion of copious 4. Suction tracheal and oral
secretions. secretions.
R - To provide patent airway.
5. Increase fluid intake of the client

appropriate to his age and disease
condition.
R – It aids in the mobilization of
secretion for easy expectoration.
DEPENDENT:
1. Administer combivent 1 neb at
HS, as ordered.
R - To loosen viscous secretions.
1
Short- Term Goals:

Subjective: Delayed Growth and Short- Term Goals: INDEPENDENT:
 “Luoy kayo akong Development related to 1. Determine existing condition(s) Goals Met. At the end of 2
At the end of 2 hours duty,
anak kay dili jud effects of contributing to growth hours duty, my patient’s
my patient’s mother will be
siya kadagan-dagan physical/mental developmental deviation, such as mother was able to verbalize
able to:
parehas sa uban disability as evidenced limited intellectual capacity, physical understanding of
bata” as verbalized by altered physical a. Verbalize disabilities, chronic illness, genetic growth/developmental delay
by the mother understanding of anomalies or substance abuse. or deviation her son and
growth appropriate for
growth/developmenta R – Basis for implementing plans. demonstrated modification of
age
l delay or deviation various activities appropriate
Objective:
her son 2. Determine nature of for age.
 Altered physical growth b. Demonstrate parenting/caretaking activities (e.g.,
Long- Term Goals:
 Flat affect modification of inadequate, inconsistent,
Goals Met. At the end of 8
 Listlessness various activities unrealistic/insufficient expectations;
hours duty, my patient’s
 Decreased Responses appropriate for age lack of stimulation, limit setting,
mother was be able to initiate
(i.e instead of responsiveness)
interventions/lifestyle changes
running, patient can R – To anticipate a more
promoting appropriate
be assisted with promotive intervention to client in
development and maintained
passive ROM) accordance to his age.
modified activities which help
in promoting gradual growth
Long- Term Goals: 3. Assist/ demonstrate modified
and development appropriate
At the end of 8 hours duty, activities suited for the client’s age
for the client.
my patient’s mother will be and disease condition.
able to: R – To encourage and enhance
development of the client.
a. Initiate
interventions/lifestyle
4. Assist client’s SO to accept and
changes promoting
adjust to irreversible developmental
appropriate
deviatios.
development
b. Maintain modified R – To avoid giving of false

activities which help assurance to family and most
in promoting gradual especially to the client.
growth and
development
COLLABORATIVE:
appropriate for the
client. 1. Refer for consultation of
appropriate professional resources
specific to the client.
R – To address specific individual
needs.
Subjective: Hyperthermia related to Short-Term Goals: INDEPENDENT: Short-Term Goals:

altered body After 4 hours of nursing 1. Provide tepid sponge Goals. Met. After 4 hours of
Intubated thermoregulation interventions, the client will bath(if not nursing interventions, the
secondary to disease be able to: contraindicated) client was able to have a
Objective: condition a. have a decreased R – It provides coolness to body’s decreased axillary temperature
 skin warm to touch axillary temperature surface. from 37.7°C to 37.5°C and
 temperature of 37.7C from 37.7°C to improved the skin’s condition
 flushed skin 37.5°C 2. Promote ventilation of from warm to cool.

b. Improve the skin’s skin by means of undressing
condition from warm R - Heat loss by radiation and Long-Term Goals:
to cool. conduction Goals Mt. After 8 hours of
nursing interventions, the
Long-Term Goals: 3. Promote client safety. client was able to maintain
After 8 hours of nursing R – To avoid interference in body temperature at a normal
interventions, the client will improving of the nursing care to range and free from
be able to: the client and it prevents further complications.
complication.
a. maintain body DEPENDENT:
temperature at a 1. Administer antipyretics
normal range. w/ correct pediatric
b. Free from dose (as ordered).
complications R – Inhibits the inflammatory
response which causes the
abnormal increase in body’s
temperature.
2. administer antibiotics
w/ correct pediatric dose
R - to treat underlying
cause(as ordered)
COLLABORATIVE:
1. Instruct the mother to
increase adequate fluid
intake (if not
contraindicated).
R – To prevent dehydration
causing further complications
unto the client.
RATIONALE
(Subjective and Objective) (Problem and Etiology)
Subjective: Impaired Gas Short- Term Goals: INDEPENDENT: Short- Term Goals:
Intubated exchange related to Within 1-2 minutes of 1. Monitor respiration rate and breath Goals Met. Within 1-2 minutes
obstruction of mucous nursing intervention the sounds. of nursing intervention the
Objective: secretions secondary patient will be able to: R - For baseline data. patients was able to improve
 Crackles heard upon to respiratory tract a. Improve the the patency of airways,
auscultation infection and patency of airways 2. Position head appropriate for gradually excreted of
 Inability to cough-out aspiration b. Gradual excretion of age/condition secretions and displayed and
secretions secretions R - To open or maintain open maintained normal O2
 O2 sat= 72-75% c. Display and airway. saturation from 95-100%.

 restlessness maintain normal O2
 With Endotracheal tube saturation from 95- 3. Suction tracheal and oral Long-Term Goals:
attached to Mechanical 100% secretions to provide patent airway, Goals Met. After 8 hours of
ventilator with the R - To promote proper gas thorough nursing intervention
following set-up: Long-Term Goals: exchange, and to normalize the the client was able to maintain
- TV= 200 After 8 hours of thorough O2sat. the patency of airways as
- FiO2= 40% nursing intervention the manifested by respirations

client will be able: 4. Keep suction materials like suction within the normal range as well
- BUR= 25
a. Maintain the catheters, gloves, and other as the oxygen saturation and
- PEEP= 3 cmH20
patency of airways equipment patent and accessible. the absence of retained
 Restless
as manifested by R - For emergency situation or secretions.
respirations within during desaturation.
the normal range as
well as the oxygen DEPENDENT:
saturation and the 1. Administer combivent 1 neb at HS
absence of retained R - to loosen viscous secretions.
secretions.
Subjective: Impaired physical At the end of 8 hours of INDEPENDENT: Goals Met. At the end of 8
Intubated mobility related to thorough nursing 1. Assist client reposition self on a hours of thorough nursing
Objective: neuromuscular intervention, the client will regular schedule as directed by intervention, the client was
impairment secondary be able to: individual situation. able to demonstrate
 Limited Range of
to cerebral palsy. R – To promote blood circulation. techniques that enable gradual
Motion a. Demonstrate
2. Support affected body parts and resumption of activities and
 Slowed movement techniques that
keep the bed mattress free from increased strength gradually
 Postural instability; gait enable gradual
wrinkles. and function of affected or
changes resumption of
R – To reduce risk of premature compensatory body part.
activities
ulcers.
b. Increase strength
3. Provide skin care to include
gradually and
pressure care management.
function of affected
R – To prevent further
or compensatory
complication brought about the
body part.
immobility.
4. Schedule activities with adequate
rest periods during the day.
R – To reduce fatigue.
5. Encourage adequate intake of
fluids (as indicated) and nutritious
foods (OF).
R- To maximized energy
production.
COLLABORATIVE:
1. Refer with physical therapist, as
indicated.
R – To develop mobility program.
Goals Partially Met. At the end

Subjective: Constipation related to At the end of 8 hours of INDEPENDENT:
of 8 hours of thorough nursing
“Gikan pa sa Martes insufficient physical thorough nursing 1. Determine fluid intake.
intervention, the client was
hangtud karon sa Sabado activity intervention, the client will R – To evaluate client’s hydration
able to regain normal pattern
wala pa jud sya kalibang” be able to: status.
of bowel movement from 3
as verbalized by the mother. a. Regain normal 2. Encourage gradual activity within
clicks to 5 clicks and
Objcetive: pattern of bowel limits of individual.
demonstrated behaviors or
movement from 3 R – to stimulate contraction of
 Distended abdomen lifestyle changes to prevent
clicks to 5 clicks. intestines (peristalsis)
 Hypoactive bowel recurrence of problem but
b. Demonstrate 3. Provide privacy and routinely
movement (3 clicks) failed to identify and maintain
behaviors or lifestyle scheduled time for defecation.
bowel habit within his
 Restless
changes to prevent R - For the client response to preference.

recurrence of urge.
problem.
c. Identify and DEPENDENT:
maintain bowel habit 1. Administer laxatives, if indicated.
within the client’s R – To soften stool for easy
preference. defecation.
Risk Factors: Risk for falls At the end of 45 minutes of INDEPENDENT:

Goals met. At the end of 45
thorough nursing 1. Provide health teaching to the
 Visual problems (blind) minutes of thorough nursing
intervention, the client’s Client’s SO about the risk opf the
 Uncoordinated intervention, the client’s
mother will be able to: client in falls and developing injury.
movement mother was able to
a. Demonstrate R – To provide essential
demonstrate measures to
 Gait problems measures to reduce information about the client’s
reduce risk factors and protect
risk factors and situation.
client from injury, modify
protect client from
environment as indicated to
injury 2. Raising side rails.
enhance safety and promote
b. Modify environment R – To ensure safety
an injury-free environment.
as indicated to
enhance safety 3. Placing pillows on both sides of

c. Promote an injury- the patient
free environment. R – To prevent from falls
4. Instruct client’s SO never leave

the child alone without companion.
R – Because of the uncoordinated
movements of the child, it may
precipitate incidents of falls.
COLLABORATIVE:
1. Assist In treatment and provide
necessary information regarding
client’s disease/ conditions
R – That may result in increased
risk in falls.
1IX. DISCHARGE PLANNING
2
3MEDICATION:
4 Encourage significant others to continue medications as prescribe by the physician.
5With a strict emphasis on explaining the mechanisms of action of the drugs, the
6prescribed dosage, side effects, proper timing of intake of drugs and importance of
7continuing the medications.
8
9
10EXERCISE:
11 Encourage significant others to have an gradual passive ROM to the patient
12because it will promote blood circulation and to improve muscle strength in order to
13promote total range of motion.
14
15
16TREATMENT:
17 Instruct the significant others to consult first the physician in anything that will help
18the patient in his conditions like physical activities that she must follow & most
19especially his diet.
20 Encourage the significant others to compliance on further treatment for the proper
21maintenance and gain of optimal health.
22
23
24HEALTH TEACHINGS:
25 Importance to maintain proper personal hygiene.
26Strict adherence to medications to promote wellness.
27 Increase fluid intake to help liquefy secretions
28Importance of proper nutritious food to maintain healthy body.
29Immediate report to the physician for any abnormalities to note any complications.
30
31
32OUT-PATIENT:
33 Compliance to medical check-up and therapeutic regimen to reduce or prevent risk
34of recurrence of the disease condition. Instruct patient to continue medications as
35prescribed.
36
37
1DIET:
2 Suggest the the significant others to let the patient eat healthy foods because it
3helps the patient feel better and have more energy. Tell the significant others the
4importance of following diet and food restrictions. The patient may also consult to a
5dietary physician to know what are the correct dietary intake he must maintain.
6
7
8SPIRITUAL:
9 Advise patient to never forget to always pray to god. Always have faith and never
10lose hope because God is always with us no matter what.
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
1X. RELATED LEARNING EXPERIENCE
2 In our duty experiences in Capitol University Medical City we’ve

3encountered so many things, though it was not out first time to affiliate in the institution,
4it was still a nerve-wracking experience for each and every one of us. It was really
5unexpected and was full of lessons that must be inculcated in our hearts and minds.
6First day of duty, it’s a mixture of feelings. We were both excited and normal as we are;
7we were a little bit anxious. Though we have an idea what it feels like to be on duty at
8the ICU, it is still different in the actual setting. We learned so many things like
9procedures that we haven’t done in the previous rotations.
10 We were glad that finally had a chance to perform procedures like
11suctioning, tracheostomy care, ECG tracing and a lot of special procedures that we
12don’t usually performed. In addition to that, we also got the basic knowledge on how to
13operate high technology devices commonly found and used in an ICU setting in
14preparation for the brighter future. We also have learning from our patients and their
15significant others. The Nurse-Client relationship had helped us a lot.
16 Predominantly, we experienced so much fun with the fact that the
17environment is so conducive for both learning the much-a-nurse responsibilities of a
18nurse----- specifically ICU nurse. Our PCI’s had helped us so much by guiding us and
19assisting us whatever procedures we are doing. Our CI is calm and cool! He somehow
20trusted us on our performance though we think on ourselves we can’t do all of those
21things as perfectly as it is. And we would like to thank them for doing so.
22 Mistakes are inevitable in life which is also true during the ICU rotation. Yes, we
23made different kinds of errors and we are all guilty for that but for those errors we’ve
24learned a lot and gradually we are learning to improve our work in order to follow the
25mission of the nursing profession, which is to give care to the patient. We’ve learn that
26not at all the times we will be perfect on what we will be doing, we’ve learn that the
27patients admitted in the ICU are mostly confined due to vehicular accident and therefore
28strict monitoring is observed, thus, they need more attention and we need to be more
29careful in the provision of the care they needed.
30 Being there was an easier rotation because you don’t worry much of the I&O
31thing because they’re using infusion pumps and usually doesn’t require us to get the
32vital signs manually because of the cardiac monitor attached to most of the patients.
33 In making this case study, it strengthens us and really proves that in everything
34that we do, learning is always there for us, waiting to be grasped and to be well-
35digested. I know for the fact that this study requires a lot of sacrifices and fortunately we
36did survive all the things we have done. My greatest felicitation and commemoration to
37our beloved Clinical Instructor, Mr. Camilo Rey “Kit” Pabito, RN, MN who gave us the
1motivation to be serious in the clinical area in order to promote the proper and
2appropriate care towards our patient. It was truly enjoyable because we have a clinical
3instructor who is very much approachable and mindful. Though we have “life
4threatening patient”, he’s still there to make some inspiring words and cheers for us (he
5usually does it *LOL*). He makes us calm when we get nervous and treated us like his
6children (I think much more of colleague ‘coz he doesn’t want to be the oldest in the
7group >oops<).
8 We would like to extend our thanks to our PCI, Ms. Georgia Dawn Gacus and Mr.
9Dan Michael Canios who taught and gave us the inspiration to do things well. They did
10not just do things to comply with the requirements but have done it with passion and
11whole heartedly. We also appreciate the nursing staffs for attending to our inquiries
12properly whenever we have some clarifications.
13 And last, we have learned the real value of being a student nurse that we should
14control our temper, our emotions while we are on our patient’s side, we have to adjust to
15the environment where we belong. It is because we didn’t know the feelings of the
16watchers and more importantly our patient. Patient must not be only a patient but
17he/she should be “my/our” patient. Thank you…………
18
19
20
21
22
23
24
25
26
27
28
29
30
1XI. REFERENCE
2  BOOKS:
3  Doenges, M.E., Moorhouse, M.F., & Geissler, A.C, (2002). Nursing Care
4 Plans Guidelines for Individualizing Patient Care, (6th ed.). Thailand
5  Doenges, M.E., Moorhouse, M.F., & Geissler, A.C (2006). Nurse’s pocket
6 Guide; Diagnoses, Prioritized Interventions, and Rationales. (10thed.).
7 Philadelphia, Pennsylvania
8  Smeltzer, Suzanne C., RN, Edd, FAAN, & Bare, Brenda G., RN, MSN,(2004).
9 Textbook of Medical-Surgical Nursing, (10th ed.), Philadelphia
10  Karch, Amy M. ; 2006 Lippicott’s Nursing Drug Guide, 8th edition. Lippincott
11 Williams & Wilkins.
12  Nurses’ Pocket Guide, 10th edition F.A. Davis.
13  Nursing Care Plans, 7th edition F.A. Davis Doeuger, Moorhouse, Murr.
14  Patient’s Chart
15  Black, Joyce M. et. al, Medical-Surgican Nursing: Clinical Management for
16 Positive outcome. 7th edition. Philadelphia, W.B. Saunders. 2005
17  Malseed, Roger T. ; Springhouse Nurses’ Drug Guide 2004, 5th edition.
18  Davis drug handbook, 10th edition
19  Drug handbook by Saunders
20  Medical-Surgical Nursing (Clinical Management for Positive Outcomes) 8 th
21 edition By: Joyce Black and Jane Hokanson Hawks
22  Nursing Care of Infants and Children by Wong
23
24  INTERNET:
25  http://cpmcnet.columbia.edu/dept/gi/.html
26  http://digestive.niddk.nih.gov/ddiseases/pubs/_ez/
27  http://www.angelfire.com/scifi2/lnuphysiology/Blood_Physiology_1.pdf
28  http://www.drstandley.com/labvalues
29  http://www.google.com.ph/search
30  http://www.google.com.ph/search?anatomy&meta=
31  http://www.merck.com/ l
32  rehydrate.org/diarrhoea/pdf/diarrhoea-abstracts.pdf
33  http://www.wpro.who.int/countries/2009/phl/health_situation.htm
34  www.cureresearch.com/c/cerebral_palsy/stats-country.htm?ktrack=kcplink
35  http://www.tuberculosistextbook.com/tb/tbchild.htm

Case Study Final. Pott's Disease

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A Case Study on Aspiration Pneumonia, Sepsis, Cerebral Palsy, Pott’s Disease

1II. GOALS AND OBJECTIVES

1III. CLIENT’S PROFILE

1  History of Present Illness

Educational attainment Haven’t gone to school.

Percussion Tympanic and dullness noted on right upper

Precordial area bulging

Level of consciousness Conscious but drowsy and less responsive

Emotional state Restless when coughing

Head Slightly bigger ( heading to macrocephalic)

Facial movement Symmetrical but limited

Periorbital region Non edematous

Cornea & lens cataracts

Pupils Equal in size

Visual acuity Loss of sight

Peripheral vision absent

External pinnae Right ear is slightly bigger

External canal No discharge

Tympanic membrane Intact

Gross hearing normal

Patency Both patent

Gross smell N/A

Sinuses No tenderness presence

Teeth Missing Teeth

Tonsils Not inflamed

Posterior pharynx No inflammation is present

General color Pallor

Bowel sound Hypoactive (3 clicks)

9 11. Cardiovascular Status

Precordial area bulging

Point of maximal impulse(PMI) 3rd intercostal space

Apical & rhythm Regular

Heart sound Regular

Peripheral pulse Symmetrical & regular

Capillary refill 2 seconds

1 12. Respiratory Status

Breathing pattern Regular

Shape of chest AP1:L2

Lung expansion Decreased at the left side

Breath sound Crackles noted

1IV. ANATOMY AND PHYSIOLOGY

Associated Signs and

hemispheres. Forms roof of

Cognition and memory. Impairment of recent

Premotor Cortex: storage

Ventral View (From Bottom) Language: motor speech.

Prefrontal (PFC) – controls

6. Parietal Lobe Processing of sensory input, Inability to discriminate

Body orientation. recognize parts of the body

Limbic lobes: Sex, rage,

(inhibitory), Postural Parkinson's.

14. Reticular Activating Responsible for arousal Altered level of

31 37 Exposure to the specific

2. clindamycin 1mg IVTT every 6 hours

TEST RESULTS REFERENCE VALUES

Hgb 12.0 13.7-16.7 g/dL Decreas

Hct 36.0 40.5-49.7 gm% Within th

WBC 22, 800 5,000-10,000 cell/mm3 It is beyo

Segmenters 83.0 45-70% High num

Lymphocytes 14.0 18-45% Low lym

Monocytes 3.0 4-8% Decreas

Platelet count 329, 000 144,000-372,000 cell/mm3 Within th