University of the East

Ramon Magsaysay Memorial Medical Center

College of Nursing
Aurora Blvd. Quezon City

CASE PRESENTATION:
NON-SMALL CELL LUNG CARCINOMA
STAGE IV WITH BRAIN METASTASIS

Submitted by:
Fourth Year - Group H29

Magpali, Iris
Mancao, Grace
Mangulabnan, Nicole
Marcelino, Charina
Melgar, Monique
Menrige, RB
Mendoza, Ericson
Navarro, Isaac
Nery, Keren
Noveda, Sibyl

August 28, 2009

I. Client’s Profile

Name: F. M.
Age: 52 yrs. old
Sex: Female
Date of Birth: July 19, 1957
Place of Birth: Isabela
Language: Tagalog, Ilocano
Address: Sampaloc, Manila
Religion: Roman Catholic
Educational Attainment: Elementary graduate
Occupation: Tobacco farmer
Date and Time Admitted: Aug. 17, 2009 9:28 p.m.
Chief Complaint: DOB x 1 day
Final Diagnosis: Non-small cell carcinoma Stage 4 with brain metastasis
Attending Physician: Dr. Dela Rosa

II. Health History

a. Present Health History

3 months prior to admission, the patient experienced difficulty of breathing and pain at
her right anterior and posterior mid-clavicular area. She stated that pain was continuous,
“kumikirot” and can range from 6-10/10 on the pain scale. She would cry because of the pain,
and needs to always have pillows on her back to decrease difficulty of breathing, which was
chracterized as “parang may nakadagan”. She drank Mefenamic acid and tried to relax and
breathe in deeply to relieve pain. She was rushed to the hospital in Isabela. She was diagnosed of
pleural fluid effusion. Xray was done and it shows minimal and unrecalled fluid amount. She
was prescribed with TB drugs: Rifampicin, Isoniazid and Ethambutol taken OD for 2 months.
The patient can’t remember the dosages of the drug taken.
2 months prior to admission, the patient experienced seizure at around 11 am during her
visit to her cousin at Tugegarao. The seizure was 5 minutes in duration. patient said that her
seizure was characterized as “nakalabas ang dila ko, naglalaway , tumitirik and mata at
tnangingisay ang katawan ko.” The patient thought it was due to her high BP so she was not
brought to the hospital. They decided that they will seek consult tomorrow morning.
Furthermore, the patient still experienced difficulty of breathing and pain on her back despite
being compliant with the medications. On the next day, the patient went to the hospital in
Tugegarao for a check-up. Xray and CT Scan were done and revealed abnormalities in her brain
and fluid in the lungs with unrecalled amounts. Hence, the patient stopped taking the TB drugs
after knowing that she didn't have any TB. She was advised to have her symptoms and her CT
scan plates to be checked by her doctor in Isabela. After she was checked, she was referred to
Jose Reyes Hospital in Quezon City.
1 month prior to admission, the patient went to Jose Reyes Hospital under referral of her
doctor in Isabela. CT Scan with biopsy was done and revealed Non-small Cell Carcinoma Stage
IV with brain metastasis. She sought a second opinion at UERM hospital and was advised to
treat her brain metastasis first with radiation therapy because according to the patient, the doctor
said it could be fatal if she had another episode of seizure again.
3 weeks prior to admission, the patient was started on brain radiation therapy at Jose
Reyes Hospital for 15 sessions. After her brain radiation therapy, she was then admitted to
UERM Hospital at the Medicine Ward and started her first cycle of chemotherapy for one day
(Paclitaxel Carboplatin). She was scheduled for a follow-up and a second cycle of chemotherapy
18 days after her first cycle. The next day after her chemotherapy, the patient experienced
syncope and seizures (unrecalled duration). She was then rushed to the E.R. at UERM hospital.
She was given Oxcarbazepine 300mg and was admitted to the Pay ward (3N2). After 24 hours,
the patient was discharged because of improved condition.
4 days prior to admission, the patient experienced another seizure episode and was
brought again to the E.R. She was given Oxcarbazepine 300mg again and was admitted to the
Medicine Ward. She was observed and was discharged 3 days after because she regained her
strength and her condition improved.
On the day of admission, the patient received a call from a doctor in UERM informing
her that she should come earlier than her scheduled follow up day because it was a holiday on
her scheduled follow-up. Xray and biopsy of the pleural fluid was done which revealed
worsening of the pleural effusion. Hence, she was advised to be admitted and have a chest tube
insertion.

b. Past Medical History

The patient had two surgeries before and was confined to a hospital. She had a
cholelithotomy last 1997 and had a Caesarean birth last 1999. The patient is a known
hypertensive but is controlled with Norvasc 5mg taken twice per day. The patient can’t recall if
she was fully immunized when she was young. But she already had chicken pox, mumps and
measles. She has no known allergies to food or any medications.

c. Social History

The patient used to work as a tobacco farmer in a plantation in Isabela for 15 years before
she was diagnosed with cancer. according to patient, when the tobacco plants are already dry, she
gathers them into bundles. during this time, the plants have a strong and heavy smell. Sometimes
they burn the extra tobacco plants together with other wastes, which takes around thirty minutes.
She doesn't wear a mask when working. The patient doesn’t drink any alcohol and doesn’t
smoke. She used to drink 1 cup of coffee every morning but stopped when she was diagnosed
with hypertension in 1997. She lives in a two-storey house in Isabela with her husband and two
children. The house is made up of mixed materials: concrete and wood. She was used to doing
the household chores then but now her son hired a house-help that cleans their house every
morning. According to her, the environment there is safe and peaceful. There were no reported
crimes in the recent years and there’s a barngay tanod that’s roaming and guarding their
barangay. She also verbalized that she’s in a good relationship with their neighbors and she
frequently attends programs and barangay meetings held in their town center. Her income
nowadays comes from her husband’s and children’s jobs. The patient had no any recent travels,
local or foreign, in the past 3 years.
d. Family History

H ?

AR H

H,
CA

Legend:
□ - MALE
○ - FEMALE
H– hypertension
AR- arthritis
C- cancer
? – unknown cause

e. Developmental History

According to Erik Erikson’s Theory, the patient, who is 52 years old, is currently in the
stage of Middle Adulthood wherein the ego development outcome is Generativity vs. Stagnation.
Here, the basic strengths are production and care. It is a stage where work is most crucial since
this is where the patient tends to be occupied with creative and meaningful work and with issues
surrounding family. This is where she can be “in charge”. It is an important task for the patient to
be able to teach values to her family and work to establish a stable environment. Strength comes
from the care she receives and production of something for the betterment of society.
Upon observation, patient’s view about her life now is leading more towards stagnation.
Patient is depressed and verbalized feelings of helplessness about her health. She believes she
cannot be productive in her current situation. Fortunately, she has a husband and family who are
willing to support her. She needs to find significant relationship among her workplace,
community and family to help her lead a life that is geared towards generativity.

Diagnostic Tests

Chest X-ray (Aug. 17, 2009)

Impression:
Slight decrease in the amount of right sided pleural effusion. Presently moderate to
massive in amount.
The visualized aerated lung fields are clear.
True cardiac size not ascertain.
Atherosclerotic aorta.
No evident pneumothorax seen.
Other chest structures not remarkable.

Ultrasound report (Aug. 18, 2009)

The sonogram of the right lower hemothorax shows accumulation of free fluid at the
dependent portion of the thoracic cavity, with approximate volume of 697 ml. Skin marker was
placed at the posterior right lower lateral hemithorax. Depth of needle from skin to pleura and
skin to central portion of fluid collection is 2.5 cm and 5.0 cm, respectively.

Thoracentesis was performed under local anaesthesia. Approximately 700 ml of reddish

fluid was aspirated. Post aspiration sonogram demonstrates approximately 100 ml retained fluid.

Microbiology (Aug. 25, 2009)

No organism seen on the pleural fluid.

Pleural fluid analysis (August 25, 2009)

Panels Result Reference

Color Light red Clear
Turbidity Turbid
Clot Positive Negative
Specific gravity 1.345 7.37–7.43 (usually 7.40)
Albumin 31.0 g/L 30.0 g/dL
LDH 469 iu/L 71 – 207 IU/L
Glucose 3.7 mmol/L Parallels serum levels
WBC 17,424,000/mm3 0–1000/mm3, consisting mainly of lymphocytes
Lymphocytes 59%
Neutrophils 41%
RBC 62,208,000/mm3 0–1000/mm3

Pleural fluid analysis is indicated to the patient to differentiate pleural transudates from
exudates. According to the table above, it is a pleural exudates as it is light red in color, positive
to clot, decreased pH, increased albumin, increased lactic dehydrogenase, increased WBC, and
increased RBC.

Complete blood count with other serum tests

Panels Reference Result

August 17, 2009
Hemoglobin 120-140 g/L 118 g/L
MCH 27.5 – 33.2 ug 27.3 ug
HCT 37 % – 47 % 35 %
MCV 80 – 94 fL 81 fL
MCHC 32 – 37 % 33 %
RBC 4.0 – 4.5 4.3 x 1012/L
WBC 5 – 10 x 109/L 6.2 x 109/L
Neutrophils 40 – 75 % 73 %
August 18, 2009
Prothrombin time 10 – 13 sec. 9.9 sec.
Partial thromboplastin time 29 – 34 sec. 25.1 sec.
August 25,2009
Albumin mass 38 – 50 g/L 30 g/L
LDH – L 109 – 193 iu/L 205 iu/L
Glucose substance 3.8 – 5.8 mmol/L 5.8 mmol/L

Complete blood count is indicated to the patient to rule out suspected hematologic
disorder, neoplasm, or immunologic abnormality and to monitor effects of physical or emotional
stress.
Haemoglobin 118 g/L (120-140 g/L) is the main intracellular protein of the RBC. Its
primary function is to transport oxygen to the cells and to remove carbon dioxide from them for
excretion by the lungs. Decreased haemoglobin count indicates decreased oxygen transportation
to cells and removal of cardon dioxide for excretion to the lungs.
The Hct or packed RBC volume measures the proportion of RBCs in a volume of whole
blood. Normally, Hgb and Hct levels parallel each other and are commonly used together to
express the degree of anemia. Decreased hematocrit count indicates decreased RBC volume in
proportion to other cellular components of the blood.
Mean corpuscular haemoglobin reflects the weight of haemoglobin in each RBC.
Decreased MCH count indicates disproportionate haemoglobin in each RBC.
 Non modifiable Etiology Modifiable

Stress Stress
Age
Smoking/ 2nd hand Lifestyle / food Alcohol
Cellular transformation/ Derangement
APG Carcinogenic Agents

Fight and flight response Benzene, nitrosamines, vinyl Ingested into

Imbalance Adrenaline Epinephrine and nicotine, arsenic, and mouth, pharynx
along the nor epinephrine hydrocarbons, acetaldehyde esophagus,
cell cycle Oxidative stress
stomach, colon,
Alter immune system function Increased o2 metabolism Inhaled , enters, nose,
mouth, pharynx, larynx, Carcinogenic agents
Cell mutation Immune response failure Reactive oxygen trachea, bronchus, lungs
Acetaldehyde, carbon radicals

Susceptible to bacterial Free radicals hydroxyl radical from

hydrocarbons, Alter immune system function
and viral attacks
Damage cells acetaldehyde,etc
Immune response failure
1st Environmental Insult DNA damage
Initiation
DNA repair

Genetic alteration 2nd Environmental insult DNA damage Promotion/ antipromotion

Failure of Dna repair

Failure of Dna repair
Reduced tumor Heredity
Multiple cell division Progression
suppressor genes

Multiple cell division Progression

Cancer
 Cancer

Occult (hidden) stage require a blood supply and energy

Psychological Cancer cells are found in sputum No tumor can be found in the lung Angiogenesis
emotions
Stage 0 Diversion of blood and nutrients

Altered appetite and eating abnormal cells in the innermost lining of the lung. Weight loss Fatigue

Decreased CHON, CHO, lipids etc Stage I Decreased CHON metabolism

Stage IA Stage IB
Weight loss Decreased albumin
Cancer has spread to the innermost layer of the 30g/l
membrane that covers the lungs.
The tumor is in the lung only and is 3 centimeters or
The tumor partly blocks the bronchus or
bronchioles, compression of normal cells
Stage II
Stage IIA Stage IIB Compression of nerves Back pain

Cancer has spread to nearby lymph nodes The tumor partly blocks the bronchus or bronchioles

Stage III Coughing reflex Cough

Stage IIIA Stage IIIB
Decreased
Cancer has spread to the main bronchus of the lungs Spread to lymph nodes above the collar bone HCT 35%

cancer cells block lymphatic ducts Stage IV Radiation therapy Reduce fast dividing cells,
including blood, hair etc
Decreased lymphatic drainaige Spread to the brain
Destroy RBC Decreased rbc 4.3 x
Increase fluid in the peritoneal cavity
1012/L
Low Hgb 118 g/L Reduce 02 perfusion
Pleural effusion
 Pleural effusion Alcohol intake

Compression of lungs Acetaldehyde

Sonogram
Dyspnea, shortness of breath Inhibit protein export to the liver
697 ml free fluid at
dependent portion of Difficulty of breathing Disrupted amino acid production
the thoracic cavity
thoracentesis Decreased CHON metabolism

700ml fluid was aspirated Decreased albumin

30g/l
II. GORDON’S FUNCTIONAL HEALTH PATTERNS

A. Health Perception – Health Management’

Subjective:
“Nasa hospital ako ngayon dahil may cancer ako at na sinabi na stage IV cancer. Pagkatapos ng
xray, nalaman na maraming tubig sa baga ko kaya kailangan daw tanggalin bago ako i-chemo ulit kasi di
daw yun effective kung may tubig pa din ako sa baga. Hindi naman ako sakitin dati pero na-confine na
ako noong 1997 kasi tinanggal yung bato ko sa apdo saka noong 1999 kasi nanganak ako ng CS sa bunso
ko. Mahilig ako kumain ng prinitong pagkain tulad ng isda dati. Hindi ko hilig magpa-check-up pero
kapag hindi ko na kaya, nagpapatingin ako. Kung hindi gumana yung gamot na nireseta ng doctor,
bumibista din ako sa albularyo. Norvasc ang gamot ko para sa high blood, pinakamataas na BP na nakuha
sa ‘kin 140/100 mmHg. Nasusunod ko naman yung schedule ng pag inom ng gamot ko. May malapit na
hospital sa bahay namin kaya madali makakuha ng tulong kung sakali. Hindi ko maalala kung pina-
bakuna ako noong bata. Wala naman akong allergies sa pagkain o gamot. Nagseself-medicate lang ako
kapag may ubo or sipon, iinom ako ng Biogesic o vitamin C. Gumagamit din ako ng alternatibong paraan
katulad ng pag-inom ng calamansi juice kapag may sipon o ubo ako. Sa ngayon, wala naman akong
iniinom na gamot na hindi niriseta ng doctor kasi sumusunod ako kung ano lang pinapainom sa akin.”

Objective:
She is dressed appropriately to the situation, with no foul body odor or bad breath. Her hair is
short (almost bald) and evenly distributed. Upon assessment, patient was oriented to time, place and
person. Patient manifested willingness to participate during the interview and was able to maintain eye
contact. Hair is color black. Good skin turgor and no edema. Capillary refill goes back 2 seconds after
pinching. Nails were kept short and clean. Patient's hearing sensation was not impaired and was able to
pass the whisper and tick test. She was able to determine and differentiate blunt, sharp, deep and light
sensation. No numbness or tingling sensation was felt. Illuminated pupils were able to constrict. The
pupils constricted from 5 mm to 3mm. He was able to differentiate sweet, sour and salty taste testers. No
numbness or tingling sensation was felt. Cranial nerves III, IV and VI were intact upon assessment of eye
movements. Other cranial nerves were intact upon assessment (smell and taste testing, corneal reflex,
face, tongue movement, etc.) Has facial symmetry. Cervical lymph nodes are enlarged. Patient is able to
walk with assistance but hesitates to do so because it might augment her pain. She showed facial grimaces
when trying turn from side to side. The patient’s vital signs are as follows: BP=120/90 mmHg, PR=114,
RR=22 Temp=36.8 C. (8:00 PM). Hemoglobin level: 118 g/L (Reference: 120-140 g/L), Hematocrit: 35%
(Reference: 37-47%). Height = 5’4”, Weight = 127.8 lbs/58kg; BMI = 21.9. The patient’s current
medications are the following: Oxcarbazepine (300 mg), Amlodipine (5mg OD), Dolcet (1 tablet, Q6),
Celecoxib (200 mg, 1 cap, BID), Nalbuphine (PRN medication). Fiinal diagnosis: Non small cell lung
cancer Stage IV with brain metastasis.

Analysis:
Ineffective therapeutic regimen management related to lack of ability to make deliberate and
thoughtful judgements.

B. Nutritional – Metabolic Pattern

Subjective:
“Karaniwan akong kumakain ng 3-5 beses sa isang araw, tapos may merienda rin. Madalas tubig
lang iniinom ako, hindi naman ako mahilig sa softdrinks. Nakaka-anim na baso ako na tubig sa isang
araw.Mas gusto ko ang gulay at isda kaysa sa karne. Madalas ang kinakain ko sa umaga ay isa o dalawang
pandesal tapos may palaman na itlog o cheese spread. Sa tanghalian, isang cup ng kanin at isang platito
ng ulam ang dami Yung ulam ko nun kadalasan gulay o karne.. Sa gabi naman, isang cup din ng kanin at
pritong isda o gulay. Mahilig ako sa mga prinitong pagkain. Dati, yung merienda ko madalas prutas kasi
maraming tanim dun sa probinsya namin sa Isabela ng mangga, guava o suha. Ngayon sa ospital, kinakain
ko kung anong bigay sa akin na rasyon at pina-soft diet ako. Kaninang agahan, naka-dalawang tinapay
ako. Kaninang tanghalian, sinigang na isda at kanin pero hindi ko naubos. Kagabi kumain ako ng isang
mangkok ng sopas. Sa nakalipas na buwan, nangayayat ako pagkatapos nung radiation therapy, nung mga
July 31 yun. Minsan nawawalan ako ng gana kumain kasi masakit ang ulo ko. Wala akong problema sa
pag-nguya at paglunok. Hindi rin sumasakit yung lalamunan ko. Wala naman akong allergies sa pagkain
at walang ipinagbabawal na pagkain ang aking relihiyon maliban na lang kung mahal na araw kasi bawala
ang karne kapag ganun.”

Objective:
Weight loss of 7kg (July 31, 2009) from 65 kg to 58 kg (current weight). Height = 5’4”, Weight =
127.8 lbs/58kg; BMI = 21.9 kg/m2. Patient is dark skinned, uniform in color, smooth and no rashes were
seen. Patient’s hair is thin and black (almost bald). There are no deviations in the shape and symmetry of
the head. The scalp is clean, has no bruises. Patient’s nails are pinkish, convex in shape, smooth, not
brittle and has good capillary refill (less than 2 seconds). Her nails are well trimmed and do not show
signs of clubbing. Her tongue is light pink, rough in texture, freely movable, and has no lesions. The
patient has dentures (upper and lower). Has no signs of tartar and gums are pink and moist. The uvula is
in the midline. The patient has a flat abdomen. Bowel sounds on left upper and lower quadrant is 3/min;
hypoactive. Right upper and lower quadrant: 1/min. Skin shows no lesions, rashes, has good skin turgor.
Has a scar below the umbilicus, midline, 5 inches and a scar on the right upper quadrant of the abdomen
measuring 4 inches. Patient has decreased appetite. There are no signs of lesions on the mouth. No edema
seen on extremities and other parts of body. Gag reflex is present. Patient is on soft diet. She is hooked to
PNSS 1L x 8hrs, regulated at 31 drops/min, infusing well.

Analysis:
Risk for Imbalanced Nutrition: Less than body requirements related to increased metabolic
demand.

C. Elimination Pattern

Subjective:
“3 hanggang 7 beses akong dumudumi dati sa loob ng isang lingo. Naka-diaper ako ngayon,
nagpapalit ako dalawa o tatlong beses sa isang araw. Hindi pa ako nadudumi magmula nung lagyan ako
ng tubo sa may kanang baga. Bale dalawang araw na ngayon na di ako nakakadumi pagkatapos ng CTT.
Ayoko din masyadong uminom ng tubig kasi baka makaapekto naman yun sa tubig sa baga.Yung dumi ko
dati madalas brown, parang oblong na maliit at hindi matigas. Dati mga lima hangang siyam na beses ako
umiihi sa isang araw, mga isang baso kada-ihi at kulay dilaw. Ngayon ganun din naman pero di ko
matantsa kung gano kadami kasi naka-diaper ako. Pag-nagpapalit ako ng diaper, puno naman palagi ng
ihi.1-3 beses ako nagpapalit ng diaper sa isang araw. Wala naman masakit kapag umiihi ako o dumudumi
at hindi ko pa naman nae-experience na may dugo na sa ihi or dumi ko."

Objective:
Upon conducting the abdominal assessment, abdominal contour is flat, uniform in color, has a
scar below the umbilicus, midline, 5 inches and a scar on the right upper quadrant of the abdomen
measuring 4 inches. Upon palpation, suprapubic area was not distended. Patient's intake for the shift was
650cc from oral intake and output 0f 630cc (urine). Patient’s bowel sounds are audible. Bowel sounds on
left upper and lower quadrant is 3/min. Right upper and lower quadrant: 1/min. Upon percussion,
tympany was heard over stomach; dullness over liver and spleen. No tenderness or unusual mass felt upon
palpation. Patient is wearing diaper.
Analysis:
Alteration in bowel elimination: Constipation related to insufficient fluid intake.

D. Activity-Exercise Pattern

Subjective:
The patient verbalized, “’Yung mga gawain sa bukid pati mga gawaing bahay ang exercise ko.
Gumigising ako ng 5 ng umaga para mag almusal kasama ng asawa ko.Tapos pupunta na siya sa bukid.
Ako naman maiiwan kasi gagawa ako sa bahay saka aasikasuhin yung bunso ko kasi pumapasok yun sa
eskwelahan eh. Pagkatapos nun, nagpupunta na ko sa bukid at doon na inaabot ng hapon. Magmula nung
nagkasakit ako, sa bahay na lang ako. Gumagawa pa rin ako ng gawaing bahay pero di na kagaya ng dati
na naglalaba at pati ibang mabibigat na gawaing bahay. Ngayon dito sa ospital, natatakot akong tumagilid
kasi baka matanggal yung tubo ko sa may kanang baga ko. Sinubukan kong umupo, pero masakit pa din.
8/10 yung sakit. Dito lang banda (CTT insertion site), parang kumikirot yung pakiramdam. Sumasakit
lang naman kapag gumagalaw ako eh, yung tipong uupo o tatagilid. Nawawala lang kapag di na ko
gumalaw saka pinainom ako ng gamut.

Objective:
Patient can perform full range PROM and almost all AROM exercises. Patient is ambulatory with
a muscle strength on RUE=4/5; LUE=4/5; RLE=4/5; and LLE=4/5. Patient is weak and has fatigue.
Patient has normal capillary refill (less than 2 seconds). The pulses have a clear quality. There are no
murmurs heard. During inspiration, the lungs expand, costal angle increases, diaphragm descends.
Vibrations are symmetric and most intense in the thoracic area and least at the base. Use of accessory
muscles during inspiration The patient is not cyanotic. The patient’s muscles are of equal size on both
sides of the body. Pulses are readily palpable. Normo-active reflexes on the triceps, biceps and patellar.
The patient’s vital signs are as follows: BP=120/90 mmHg, PR=114, RR=22 Temp=36.8 C. (8:00 PM).
Hemoglobin level: 118 g/L (Reference: 120-140 g/L), Hematocrit: 35% (Reference: 37-47%). Height =
5’4”, Weight = 127.8 lbs/58kg; BMI = 21.9. (+)cough (+) crackles (+)dyspnea

Analysis:
Activity intolerance related to decreased oxygen supply secondary to non small cell lung
carcinoma.

E. Sleep-Rest Pattern
Subjective:
“Dati mga 10:00pm na ko matulog pagkatapos ng “Tayong Dalawa” at 5:00 am ako nagigising.
Maaga kasi dapat nasa bukid na ako, dun yun sa Isabela. Nakataas ang ulo ko kapag natutulog at
gumagamit ako ng 2-3 na unan. Nakatagilid lang ako karaniwan pag-natulog. Ako sa kanan ng kama
tapos and asawa ko sa kaliwa. Naka-electric fan lang kami pag natutulog. Wala naman akong ibang ritwal
bago ako matulog, basta makaligo at mag-toothbrush lang. Sa ngayon, parehas lang din yung pattern ng
pag-tulog ko. Buti nalang ngayon may gamot na ko para sa sakit kaya mas mahimbing ako nakakatulog at
hindi ko masyado nararamdaman yung sakit.”

Objective:
There is no presence of darkening around the periorbital area. The client appears to be well rested
from sleep the night before. Client responds immediately when asked. Px was oriented with time, place
and person. the client was able to discuss logical sequence of ideas during the interview. Patient is
observed to be alert and able to concentrate and maintain eye contact during interview and assessment.

Analysis:
 Readiness for enhanced sleeping pattern

F. COGNITIVE-PERCEPTUAL PATTERN

Subjective:
“Ako ay 52 years old na at nakatira ako sa Isabela. Hapon na ngayon at nandito ako sa ospital sa
Medicine Ward. Si Macapagal ang presidente ngayon.Wala naman nag-iba sakin pagdating sa pang-amoy,
pang- lasa, pagdinig. Malabo ang aking paningin kaya minsan nahihirapan makita yung mga nakasulat sa
mga magazines kaya nagsasalamin ako. Ngayon ang nararamdaman ko ay sakit sa may pinagpasukan ng
tubo ko. Minsan umaabot siya ng 9/10 kapag gumagalaw. Parang pinipiga ‘yung paligid nung nilagyan ng
tubo. Hindi naman kumakalat ‘yung sakit nasa kanang bahagi lang siya ng tagiliran ko”. Patient was
asked questions about her current location, time and weather. “Ako ay nasa UERM hospital, 8:30 na ng
umaga, medyo maaraw sa labas.”

Objective:
The patient was oriented to person, time and place. She was able to answer the questions given to
her. Her thought is coherent.
The sclera of the eye is white. The pupils are round, clear, equal and react to light and accommodation.
The patient has reading glasses. The pinna is perpendicular to the eye. The external canal is pink in color.
The nose is symmetric and straight. There’s no presence of discharge and the patient was able to
distinguish 2 out of the 2 smell testers. Patient was able to distinguish sharp from blunt objects and heat
from cold sensation.
No numbness or tingling sensation noted
The cranial nerves are intact
Patient shows a guarded behavior on the right side of the chest, and irritability when discussing about
pain in abdomen. Manifested facial grimace and self focusing.
Cranial nerves:
I. The patient was able to smell stimulants.
II. 20/100
III, IV, VI. There’s parallel cardinal gaze.
V. Tongue movement is normal and there’s positive sensation in the face and scalp.
VII. Taste senses are normal.
VIII. Patient was able to maintain her balance and is able to hear in both ears.
IX. Gag reflex are active.
X. Swallowing reflex is present.
XI. Sternomastoids and trapezii are strong.

Analysis:
Acute pain related to irritation of nerve endings secondary to CTT insertion.

G. SELF-PERCEPTION AND SELF-CONCEPT PATTERN

Subjective:
The patient verbalized, “Ako yung tipo ng tao na hindi nahihiya sabihin yung opinion ko.
Strength ko yung madali ako makihalubilo sa mga tao. Madali at magaan ako kasama. And weakness ko
ay minsan may nakakabangga ako kapag sinasabi ko opinion ko. At kapag may gusto ako usually
gagawin ko ang lahat para makuha yun. itong sakit ko lang sa ngayon ang iniisip ko. Sana nga lang
gumaling ako para marami na ako magawa. Kasama ko naman dito asawa ko e. Nagdadasal na lang ako
lalo na kapag may nararamdaman akong sakit. Medyo naiilang lang ako sa itsura ko kasi wala na akong
buhok. Sabi ng doktor noon magpaiksi na ako ng buhok kasi pwede daw malagas ang buhok ko dahil sa
radiation. Pero nagulat ako, talagang makakalbo pala ako. Pero wala naman problema ‘yun handa naman
ako kasi kasama ito para gumaling ako. Sa ngayon, pakiramdam ko mamamatay na ako. Sobrang lala na
ng sakit ko. Bakit pa sa lahat ng tao ako pa ang dinapuan ng ganitong sakit. Gusto ko pa makasama ng
matagal ang pamilya ko.”

Objective:
The patient manifested teary eyes, facial tension and quivering of voice upon description of
health status. Speech pattern is normal and thoughts are organized. She answered all the questions
correctly and attentively depending on the situation. She is calm and maintains good eye contact. She is
cooperative.

Analysis:
Anxiety r/t threat in health status (terminal illness)

H. ROLE-RELATIONSHIP PATTERN

Subjective:
The patient verbalized, “Apat kaming tao na nakatira sa bahay. Maganda ang pakikisama ko sa
asawa ko. Sinosuportahan talaga naming ang isa’t-isa. Tignan mo siya ang nagaalaga sakin dito sa ospital.
Minsan nag-aaway kami pero hindi naman ‘yung sobrang away, natural lang naman kasi sa mag-asawa
ang ganoon. Ok rin naman din ang pakikitungo ko sa mga anak ko pero may mga times talaga na
nagkakainisan kami, lalo na kung sinusuway nila ako. Dati sa bahay ako yung taga-bili ng pagkain sa
palengke, tumutulong ako sa pagbayad ng gastusin, nangangaral sa mga anak ko at gumagawa ng
gawaing bahay . Nung nagkasakit ako, di ko n lahat ito nagagampanan.”

Objective:
The client has clear speech pattern and well-organized thoughts. She was able to relate one story
or event to the other without difficulty recalling information. Px uses Tagalog and Ilocano language in
communicating. No speech problems were noted upon assessment. She has an open communication with
her family especially with her husband. She manifests satisfaction with her husband and brother
accompanying her. Inadequate opportunities to perform role enactment. Presence of anxiety.

Analysis:
Ineffective role performance r/t present health status

J. SEXUALITY-REPRODUCTIVE PATTERN

Subjective:
The patient verbalized, “Bilang isang babae, sa tingin ko nagampanan ko naman ang tungkulin
ko bilang asawa at ina.Hindi ako marunong ng breast exam. Una akong nagkaroon noong 14 pa ako.
Regular naman yung mens ko noon, nakaka 4 na napkin ako sa isang araw.. Nagmenopause ako 2 years
ago. Tanggap ko na naman na hindi na kami nagtatalik ng asawa ko kasi matanda na kami. Mas problema
ko ang sakit ko ngayon.”

Objective:
The client’s breasts are bilaterally symmetrical, has no presence of lesions, lacerations. No
palpated mass on both breasts. Refused to assess genital area.

Analysis:
 Readiness for enhanced sexuality-reproductive pattern

K. COPING-STRESS TOLERANCE PATTERN

Subjective:
The patient verbalized, “Itong sakit ko ang pinakaproblema ko ngayon. Minsan kapag may
pagtatalo sa aming mag-asawa, naayos din naming ito kaagad kasi nag-uusap naman kami. Nagdadasal
din ako at pinapasa Diyos ko na lang ang sakit ko. Tapos ‘yung bunso nakakatanggal ng init ng ulo pati
mga apo ko kasi malalambing sila. Sabik na nga ako makita sila ulit eh. Suportado naman ako ng pamilya
ko kaya yun ang isa sa nagpapalakas ng loob ko. Minsan sobrang nalulungkot ako at naiiyak na lang ko
ngayon kasi pakiramdam ko mamatay na ako. Hindi ko na alam gagawin ko, hindi ko na alam ang dapat
kong maramdaman dahil sa saki kong ito.”

Objective:
The client was able to discuss logical sequence of ideas during the interview. She is alert and
immediately respond to the questions asked. The patient communicates calmly. Maintains good eye
contact. Presence of anxiety. Quivering of voice, teary eyes and facial tension. Inability to meet role
expectation.

Analysis:
Ineffective coping r/t situational crisis

K. VALUE-BELIEF PATTERN

Subjective:
“Katoliko ako. Lumaki ako at nasanay na nagsisimba tuwing lingo at nagdadasal lalo na kapag
mahal na araw. Pinalaki ako g magulang ko na may takot sa Diyos at may respeto sa ibang tao lalo na sa
nakatatanda. Sa ngayon, dasal talaga ang isa sa mga nagpapalakas ng loob ko.”

Objective:
the client was able to discuss logical sequence of ideas during the interview. She is alert and
immediately responds to the questions asked. The patient has religious articles and materials found on
her bed. She answered all the questions consciously and coherently.

Analysis:
Readiness for spiritual well being
Name of Dosage, Indication Action Contra- Laborator Adverse Interactions Nursing Responsibilities
Drug; Class; Frequency indication y Effects Reaction
and Route and
Precaution
Celecoxib 200mg; Acute pain Thought to It is not May CNS: Headache, Drug- Assess patient for CV risk
BID; P.O. inhibit contraindic increase dizziness Lifestyle: factors before therapy.
Pharmacologic prostaglandin ated to the ALT, AST, Long-term
Class: synthesis, client. BUN, and CV:Hypertension alcohol use, Drug can cause fluid
cyclooxygenas impeding chloride smoking: retention; monitor patient
e-2 (COX-2) cyclooxygena Use levels. May Respiratory: May cause with hypertension, edema,
inhibitor se-2 (COX- cautiously decrease upper respiratory GI irritation or heart failure.
2), to in elderly phosphate tract infection. or bleeding.
Therapeutic produce anti- patient. level. Check for Drug may be hepatotoxic;
Class: NSAID inflammatory signs and watch for signs and
, analgesic, symptoms of symptoms of liver toxicity.
Brand Name: and bleeding.
Celebrex antipyretic Drug can be given without
effects. regard to meals, but food
may decrease GI upset.

NSAIDs may increase the

risk of serious thrombotic
events, MI, or stroke. The
risk may be greater with
longer use or in patients
with CV disease or risk
factors for CV disease.

Instruct patient to promptly

report signs of GI bleeding
such as blood in vomit,
urine, or stool; or black,
tarry stools.

Advise patient to
 immediately report rash,
unexplained weight gain,
or swelling.

Instruct patient to take drug

with food if stomach upset
occurs.

Inform patient that it may

take several days before he
feels consistent pain relief.

Name of Dosage, Indication Action Contra- Laborator Adverse Interactions Nursing Responsibilities
Drug; Class; Frequency indication y Effects Reaction
and Route and
Precaution
Amlodopine 3mg/tab; Hypertensi Inhibits It is not There were CNS: Headache, There were Monitor blood pressure
besylate O.D; P.O. on calcium ion contraindic no reported fatigue, dizziness no reported frequently during initiation
influx across ated to the effects on drug-drug, of therapy. Because drug-
Pharmacologic cardiac and client. laboratory CV:Hypertension drug-herb; induced vasodilation has a
Class: calcium smooth- values drug-food; gradual onset, acute
channel muscle cells, Respiratory: drug- hypotension is rare.
blocker dilates dyspnea. lifestyle;
coronary interactions.. Assess patient for CV
Therapeutic arteries and system before therapy.
Class: arterioles,
antianginal, and decreases Notify prescriber if signs
antihypertensi blood of heart failure occur, such
ve pressure and as swelling of hands and
myocardial feet or shortness of breath.
Brand Name: oxygen
Norvasc demand. Caution patient to continue
taking drug, even when
feeling better.
Name of Dosage, Indication Action Contra- Laborator Adverse Interactions Nursing Responsibilities
Drug; Class; Frequency indication y Effects Reaction
and Route and
Precaution
Oxcarbazepine 300mg; Episodes Thought to It is not May CNS: Headache, There were Watch for signs and
BID; P.O. of seizure prevent contraindic decrease fatigue, fever, no reported symptoms of
Pharmacologic activity seizure ated to the sodium and dizziness, any drug- hyponatremia, including
Class: spread in the client. thyroxine abnormal gait, drug; drug- nausea, malaise, headache,
carboxamide brain by levels. anxiety, lifestyle; lethargy, confusion, and
derivative blocking Use drug-herb; decreased sensation.
impaired
Therapeutic voltage- cautiously drug-food
Class: sensitive in elderly
concentration interaction Monitor sodium level in
anticonvulsant sodium patient. patients receiving
CV: chest pain
channels, and oxcarbazepine for
Brand Name: to produce maintenance treatment,
GI: dry mouth,
Trileptal anticonvulsan especially patients
thirst
t effects by receiving other therapies
increasing that may decrease sodium
Respiratory:
potassium levels.
upper respiratory
conduction
tract infection,
and Oxcarbazepine use has
coughing,
modulating been linked to several
high-voltage nervous system-related
activated adverse reactions,
calcium including psychomotor
channels. slowing, difficulty with
concentration, speech or
language problems,
somnolence, fatigue, and
coordination abnormalities,
such as ataxia and gait
disturbances.

Drug may be taken with or

without food.
 Advise patient to report
signs and symptoms of low
sodium in the blood, such
as nausea, malaise,
headache, lethargy, and
confusion.

Tell patient to report fever

and swollen lymph nodes
to his prescriber.

Monitor vital signs before

giving medication

Name of Drug; Dosage, Indication Action Contra- Laboratory Adverse Interactions Nursing
Class Frequency indication Effects Reaction Responsibility
and Route and
Precaution
Tramadol 1 tab; Q6 Moderate to Thought to It is not May CNS: There were Reassess level of
hydrocchloride; moderately bind to opiod contraindicat decrease Dizziness, no reported pain at least 30
severe pain receptors and ed to the hemoglobin Headache, drug-drug; minutes after
Pharmacologic inhibit patient. drug- administration
class Narcotic and reuptake of EENT: visual lifestyle;
opioid analgesic norepinephrin Caution pt disturbances drug-food; Monitor CV and
e aand when rising drug-herb respiratory status
Brand Name serotonin and walking. interaction.
Dolcet Monitor bowel and
Use bladder function
cautiously in
pt at risk for For better effect,
seizures, in give it before onset
increase of pain
intracranial
pressure. Monitor for any
adverse reactions
 Monitor for drug
dependence and
withdrawal
syndrome if
stopped.

Instruct patient to
be careful when
rising or moving.

Instruct patient not

to stop drug
abruptly

Tell pt to take drug

as prescribed and
not to increase
dose or dosage
interval unless
ordered by the
prescriber

Name of Drug; Dosage, Indication Action Contra- Laboratory Adverse Nursing Responsibility
Class Frequency indication Effects Reaction
and Route and
Precaution
paclitaxel 135 mg/m2 Initial Prevents Drug not -May GI: nausea, Monitor blood counts often
Pharmacologic through IV treatment of depoly- contra- increase vomiting during therapy. Bone marrow
class : over 24 hours advanced merization of indicated to alkaline Musculo- toxicity is most common and
miscellaneous non-small cell cellular patient. phosphatase, skeletal: dose-limiting toxicity. Packed
antineoplastics lung cancer microtubules, AST, and myalgia RBC or platelet transfusions
thus inhibiting triglyceride Skin: alopecia may be needed in severe cases.
Brand name normal levels Institute bleeding precautions as
Taxol reorganiza- -May appropriate.
tion of decrease
microtubule hemoglobin Don't confuse paclitaxel with
network and paroxetine.
needed for neutrophil,
mitosis and WBC and Advise patient to report any pain
other vital platelet or burning at site of injection
cellular counts. during or after administration.
functions.
Tell patient to watch for
symptoms of infection (sore
throat, fever, fatigue) and
bleeding (easy bruising,
nosebleeds, bleeding gums, tarry
stool).

Teach patient symptoms of

peripheral neuropathy, such as
tingling r burning sensation or
numbness in limbs, and advise
to report symptoms
immediately.

Warn patient that reversible hair

loss is common (up to 82% of
patients)
 Nursing Care Plans
I. Ineffective airway clearance related to increased bronchial secretions and presence of tumor on the lungs secondary to non-
small cell lung carcinoma
Assesment Diagnosis Rationale Planning Implementation Rationale Evaluation

S> The patient Ineffective airway Tumor of the Goal : After 5days Independent After 5days of
verbalized, “inuubo clearance related to epithelial covering of nursing nursing intervention,
parin ako hanggang increased bronchial of lung airways intervention, the Assess status of Tachypnea, shallow the patient had a
ngayon simula pa secretions and grows invasively patient will have a respiratory system respirations, and patent airway as
nung bago ako presence of tumor through surrounding patent airway as asymmetric chest evidenced by clear
maospital…kulay on the lungs tissue. Local evidenced by clear movement are lung sounds,
puti yung plema secondary to non- invasion is likely to lung sounds, present because of eupnea, and ability
ko…sumasakit din small cell lung obstruct airways eupnea, and ability discomfort of to effectively cough
yung dibdib ko carcinoma causing loss of to effectively cough moving chest wall up secretions
kapag umuubo ako ventilation, decrease up secretions and/or fluid in lung.
pero ngayon halos in air volume, and After 8 hours of
wala na...” subsequent infection Objective: Demonstrated and Deep breathing nursing intervention,
behind the After 8 hours of practiced deep facilitates maximum the patient had:
O> Received pt. obstruction. Lung nursing breathing and expansion of the
conscious, coherent, cancers of all intervention, the coughing exercises. lungs/smaller a. Expectorated
afebrile, and lying various cell types patient will be able airways. Coughing secretions more
on bed at semi- have been observed to is a natural self- readily.
fowler position with similarly. cleaning
attached O2 via a. Expectorate mechanism,
nasal cannula at Source: human secretions more assisting the cilia to
2LPM administering physiology by readily. maintain patent
well and with CTT Bernardo Alberto airways
insertion on right 6th houssay
ICS anterior axillary Provided chest To prevent stasis
line. Patient has physiotherapy. and loosen
slow capillary refill, secretions.
(-) for clubbing, (-)
cyanosis, (+) Teach patient about Crackles are heard
wheezes and (+) ; environmental on expiration in
crackles on both factors that can response to fluid
upper and lower precipitate accumulation, thick
lobe of lungs, (+) respiratory secretions, and
Dyspnea, (+) problems. airway
productive cough spasm/obstruction.
with whitish
sputum. Monitored CTT and To facilitate
Vital signs: BP= regulated O2 drainage of excess
120/90; RR= 22; administration via pleural fluid and to
PR= 114;T=36.8; I= nasal cannula. supply oxygen
650cc/ 8hrs; O= demands.
630cc/ 8hrs.
Watched out for To prevent
significant bleeding excessive fluid loss.
greater than 100 ml
per hour.

Dependent

For hourly chest To obtain pleural

draining of 100 cc fluid to diagnostic
than clamp tests

Collaborative

Refer to pulmonary For co-management.

clinical nurse
specialist, home
health nurse, or
respiratory therapist
as indicated

II. Alteration in Comfort: Acute Pain r/t irritation of nerve endings on the right 6th ICS anterior axillary line secondary to CTT
insertion.
Assessment Diagnosis Rationale Goal/ objectives Intervention Rationale Evaluation
Subjective: The Alteration in Neuropathic pain is Goal: After 8 hourss Independent: Goal: After 2 days
patient verbalized Comfort: Acute Pain non-nociceptive of nursing Assessed pt’s To serve as a of nursing
“Ngayon ang r/t irritation of nerve pain and may arise intervention, the pt general status. baseline data intervention, the pt
nararamdaman ko endings on the right from disturbances or will be able to will be able to report
ay sakit sa may 6th ICS anterior function or report a decreased in Maintained pt. on To prevent pt. from a decreased in pain
pinagpasukan ng axillary line pathological change pain scale from 9/10 semi-fowler position any complication of scale from 9/10 to
tubo ko. Minsan secondary to CTT in peripheral and/ or to 2/10 the vertebral disk. 2/10
umaabot siya ng insertion. central nervous
9/10 kapag system Neuropathic Objectives: Provided periods of To reduce any Objectives:
gumagalaw. Parang pain is therefore not After 8 hours of bed rest occurrence of pain After 8 hours of
pinipiga ‘yung a discrete entity. It nursing intervention nursing intervention
paligid nung may comprise the patient will: Demonstrated and Serve as a form of the patient:
nilagyan ng tubo. peripheral nerve practiced with comfort measure
Hindi naman injury, central a. Verbalize feelings patient deep a. Verbalized
kumakalat ‘yung nervous injury and a and concerns breathing exercise feelings and
sakit nasa kanang mixed type. Major regarding pain. concerns regarding
bahagi lang siya ng causes of Instructed to Divert the pain pain.
tagiliran ko”. neuropathic pain in b. Demonstrate use perform guided thoughts into a
patients with cancer of relaxation imagery as pain happy thought b. Demonstrated use
are compression or techniques and occurs of relaxation
Objective: Received infiltration of nerves diversional activities techniques and
patient conscious, by tumor. Cranial as indicated for Instructed to To facilitate diversional activities
coherent, afebrile, nerve involvement individual situation. practice pain divertion of as indicated for
and lying on bed in due to base of skull diversionary attention to other individual situation
semi-fowler’s metastasis mainly activities such as things instead of
position with from breast or listening to music pain
attached O2 via lungs…
nasal cannula at Source: Cancer Assisted on To prevent any
2LPM administering nursing: care in changing position further injury
well and with CTT context by Jessica
insertion on right Corner, Christopher Encouraged To determine the
6th ICS anterior Bailey verbalization of level of pain and
axillary line. The pt. feelings any concern of the
has (+) facial pt
grimace, (+)
guarding behavior Provided morning To provide as one of
on the affected side. care and changed in means of comfort
The pt. has limited bed linens measures
range of motion and
difficulty of turning Advised the relative To maximize the
and changing to maintain the pt on energy capacity and
position complete bed rest to prevent any
independently. Vital further complication
signs: BP= 120/90; upon movement
RR= 22;PR= vigorously
114;T=36.8; I=
650cc/ 8hrs; O= Provided safe To prevent any falls
630cc/ 8hrs. environment by and injury to the
raising the side rails patient
 Encouraged to To prevent
increase fluid intake dehydration

Monitored vital To provide baseline

signs data

Monitored I and O Serve as a baseline

data
Dependent:

Administered pain To reduce the level

medications of pain
• Dolcet
• Celecoxib

Collaborative:

Instructed relative to To reduce

assist patient in occurrence of pain
doing ADLs. due to movement.

III. Activity intolerance r/t to decreased oxygen supply secondary to non-small cell lung carcinoma.
Assessment Diagnosis Rationale Goal/ objectives Intervention Rationale Evaluation
Subjective: The Activity intolerance Insufficient Goal: After 2 days Independent: After 2 days of
patient verbalized “ r/t to decreased physiological or of nursing nursing intervention,
nanghihina at oxygen supply psychological en- intervention, the pt Determine patient's These may be the pt was able to
nahihilo ako tuwing secondary to non- ergy to endure or will be able to perception of causes temporary or demonstrate gradual
sinusubukan kong small cell lung complete required demonstrate gradual of fatigue or activity permanent, physical increase in activity
gumagalaw…” carcinoma. or desired daily increase in activity intolerance or psychological. tolerance.
activities tolerance. Assessment guides
Objective: Received treatment. Objectives:
pt. conscious, Most activity intol- Objectives: After 8 hours of
coherent, afebrile, erance is related to After 8 hours of Assess patient's This aids in defining nursing intervention
and lying on bed at generalized weak- nursing intervention level of mobility what patient is the patient had:
semi-fowler position ness and debilitation the patient will: capable of, which is
with attached O2 via secondary to acute necessary before a. Identified factors
nasal cannula at or chronic illness a. Identify factors setting realistic affecting activity
2LPM administering and disease. This is affecting activity goals. tolerance and
well and with CTT tolerance and eliminated or
insertion on right especially apparent eliminate or reduce Assess nutritional Adequate energy reduced their effects
6th ICS anterior in elderly patients their effects when status. reserves are required when possible.
axillary line. The pt. with a history of or- possible. for activity.
has functional level thopedic, cardiopul- b. Used identified
of , with (+) facial monary, diabetic, or b. Use identified Assess potential for Injury may be techniques to
grimace, (+) pulmonary- related techniques to physical injury with related to falls or enhance activity
guarding behavior, problems. The aging enhance activity activity. overexertion. tolerance such as use
with (+) wheezes process itself causes tolerance such as of assistive devices
and (+) crackles on reduction in muscle use of assistive Assess need for
both upper and devices ambulation aids: Some aids may c. Demonstrated a
strength and func- require more energy
lower lobe of lungs, tion, which can im- bracing, cane, decrease in
(+) Dyspnea, and c. Demonstrate a walker, equipment expenditure for physiological signs
pair the ability to patients who have
slow capillary refill. maintain activity. decrease in modification for of intolerance.
Muscle strength on physiological signs activities of daily reduced upper arm
Activity intolerance strength (e.g.,
upper and lower may also be related of intolerance. living (ADLs).
extremities is 5/5, walking with
to factors such as crutches). Adequate
has limited range of obesity, malnourish-
motion and assessment of
ment, side effects of energy requirements
difficulty of turning medications (e.g.,
and changing is indicated.
-blockers), or emo-
position tional states such as Monitor patient's
independently. Vital sleep pattern and Difficulties sleeping
depression or lack
signs: BP= 120/90; amount of sleep need to be addressed
of confidence to ex-
RR= 22; PR= achieved over past before activity
ert one's self. Nurs-
114;T=36.8; I= few days. progression can be
ing goals are to re-
650cc/ 8hrs; O= achieved.
duce the effects of
630cc/ 8hrs. inactivity, promote Observe and
Decreased optimal physical document response Certain changes in
hemoglobin= activity, and assist to activity. vital signs may need
118g/L the patient to main- to be reported.
tain a satisfactory Assess emotional
lifestyle. response to change Depression over
in physical status. inability to perform
required activities
can further
aggravate the
Source: Nursing
activity intolerance.
Care Plans, Dia- Encourage adequate
gnosis and Interven- rest periods, Rest between
 especially before activities provides
tion by Gulanick, meals, other ADLs, time for energy
Myers, Klopp, exercise sessions, conservation and
Galanes, Gradishar, and ambulation. recovery. Heart rate
Puzas recovery following
activity is greatest at
Dependent: the beginning of a
rest period.
Administer oxygen
@ 2 LPM via nasal To supply oxygen
cannula. demands.

Collaborative:

Teach caregivers to
recognize signs of
physical This promotes
overactivity. awareness of when
to reduce activity.
Involve patient and
caregivers in goal
setting and care Setting small,
planning attainable goals can
increase self-
Encouraged relative confidence and self-
to assist patient in esteem.
doing ADLs To prevent
overexertion in
doing activities.