Final Output Ward 1

VELEZ COLLEGE COLLEGE OF NURSING
F. RAMOS STREET, CEBU CITY
A Case Study on patient A.B.M, 9 years old, female, diagnosed with Pediatric Community Acquired Pneumonia, Right Post Traumatic Brain
Injury Syndrome and Left Sided Hemiparesis
Submitted by:
BSN3-A BSN3-B
Amazona, Jian Lyndon C. Duhaylungsod, Lance Christian S Tamboboy, Honey Ediah P.
Barja, Kate E. Medalla, Patricia Andrea M. Tejada, Heartie Joy P.
Sato, Marlyn B. Monte, Ken Levy Yap, Tonelly Amor S.
Tan, Gemvirle A. Quinto, Giselle Mariz P.
Ugmarez, Mary Frances Claire L. Sipalay, Lustre Claire G.
Submitted to:
Mrs. Jessica L. Dicdican, RN, MN
July 2016
INTRODUCTION
POST TRAUMATIC BRAIN INJURY SYNDROME
What is a Traumatic Brain Injury (TBI)?

A TBI occurs when physical, external forces impact the brain either from a penetrating object or a bump, blow, or jolt to the head. Not all blows or jolts to the head result in
a TBI. For the ones that do, TBIs can range from mild (a brief change in mental status or consciousness) to severe (an extended period of unconsciousness or amnesia
after the injury). There are two broad types of head injuries: penetrating and non-penetrating.
Penetrating TBI (also known as open TBI) occurs when the skull is pierced by an object (for example, a bullet, shrapnel, bone fragment, or by a weapon such as hammer,
knife, or baseball bat). With this injury, the object enters the brain tissue.
Non-penetrating TBI (also known as closed head injury or blunt TBI) is caused by an external force that produces movement of the brain within the skull. Causes include
falls, motor vehicle crashes, sports injuries, or being struck by an object. Blast injury due to explosions is a focus of intense study but how it causes brain injury is not fully
known.
Some accidents such as explosions, natural disasters, or other extreme events can cause both penetrating and non- penetrating TBI in the same person.
Statistics
Traumatic brain injury (TBI) is the leading cause of death and disability in children and young adults in the United States. TBI is also a major concern for elderly
individuals, with a high rate of death and hospitalization due to falls among people age 75 and older. Depending on the severity of injury, TBI can have a lasting impact on
quality of life for survivors of all ages impairing thinking, decision making and reasoning, concentration, memory, movement, and/or sensation (e.g., vision or hearing),
and causing emotional problems (personality changes, impulsivity, anxiety, and depression) and epilepsy.
Annually, TBI injuries cost an estimated $76 billion in direct and indirect medical expenses. The U.S. Centers for Disease Control and Prevention (CDC) statistics for 2010
alone (when the survey was last taken) state:
TBIs were a factor in the deaths of more than 50,000 people in the United States.
More than 280,000 people with TBI were hospitalized.
2.2 million people with TBI visited an emergency department.
Symptoms:
Traumatic brain injury can have wide-ranging physical and psychological effects. Some signs or symptoms may appear immediately after the traumatic event, while others
may appear days or weeks later.
Mild traumatic brain injury
The signs and symptoms of mild traumatic brain injury may include:
Loss of consciousness for a few seconds to a few minutes
No loss of consciousness, but a state of being dazed, confused or disoriented
Headache
Nausea or vomiting
Fatigue or drowsiness
Difficulty sleeping
Sleeping more than usual
Dizziness or loss of balance
Sensory symptoms
Sensory problems, such as blurred vision, ringing in the ears, a bad taste in the mouth or changes in the ability to smell
Sensitivity to light or sound
Cognitive or mental symptoms
Memory or concentration problems
Mood changes or mood swings
Feeling depressed or anxious
Moderate to severe traumatic brain injuries

Moderate to severe traumatic brain injuries can include any of the signs and symptoms of mild injury, as well as the following symptoms that may appear within the
first hours to days after a head injury:
Loss of consciousness from several minutes to hours
Persistent headache or headache that worsens
Repeated vomiting or nausea
Convulsions or seizures
Dilation of one or both pupils of the eyes
Clear fluids draining from the nose or ears
Inability to awaken from sleep
Weakness or numbness in fingers and toes
Loss of coordination
Cognitive or mental symptoms
Profound confusion
Agitation, combativeness or other unusual behavior
Slurred speech
Coma and other disorders of consciousness
Children's symptoms:
Infants and young children with brain injuries may lack the communication skills to report headaches, sensory problems, confusion and similar symptoms. In a child with
traumatic brain injury, you may observe:
Change in eating or nursing habits
Persistent crying and inability to be consoled
Unusual or easy irritability
Change in ability to pay attention
Change in sleep habits
Sad or depressed mood
Loss of interest in favorite toys or activities
The terms "mild," "moderate" and "severe" are used to describe the effect of the injury on brain function. A mild injury to the brain is still a serious injury that requires
prompt attention and an accurate diagnosis.
Causes
Traumatic brain injury is caused by a blow or other traumatic injury to the head or body. The degree of damage can depend on several factors, including the nature of the
event and the force of impact.
Injury may include one or more of the following factors:
Damage to brain cells may be limited to the area directly below the point of impact on the skull.
A severe blow or jolt can cause multiple points of damage because the brain may move back and forth in the skull.
A severe rotational or spinning jolt can cause the tearing of cellular structures.
A blast, as from an explosive device, can cause widespread damage.
An object penetrating the skull can cause severe, irreparable damage to brain cells, blood vessels and protective tissues around the brain.
Bleeding in or around the brain, swelling, and blood clots can disrupt the oxygen supply to the brain and cause wider damage.
Common events causing traumatic brain injury include the following:

Falls
Falling out of bed, slipping in the bath, falling down steps, falling from ladders and related falls are the most common cause of traumatic brain injury overall, particularly in
older adults and young children.
Vehicle-related collisions
Collisions involving cars, motorcycles or bicycles and pedestrians involved in such accidents are a common cause of traumatic brain injury.
Violence
About 20 percent of traumatic brain injuries are caused by violence, such as gunshot wounds, domestic violence or child abuse. Shaken baby syndrome is traumatic brain
injury caused by the violent shaking of an infant that damages brain cells.
Sports injuries
Traumatic brain injuries may be caused by injuries from a number of sports, including soccer, boxing, football, baseball, lacrosse, skateboarding, hockey, and other high-
impact or extreme sports, particularly in youth.
Explosive blasts and other combat injuries
Explosive blasts are a common cause of traumatic brain injury in active-duty military personnel. Although the mechanism of damage isn't yet well-understood, many
researchers believe that the pressure wave passing through the brain significantly disrupts brain function.
Traumatic brain injury also results from penetrating wounds, severe blows to the head with shrapnel or debris, and falls or bodily collisions with objects following a
blast.
Complications
Several complications can occur immediately or soon after a traumatic brain injury. Severe injuries increase the risk of a greater number of complications and more-severe
complications.
Altered consciousness
Moderate to severe traumatic brain injury can result in prolonged or permanent changes in a person's state of consciousness, awareness or responsiveness. Different
states of consciousness include:
Coma
A person in a coma is unconscious, unaware of anything and unable to respond to any stimulus. This results from widespread damage to all parts of the brain. After a few
days to a few weeks, a person may emerge from a coma or enter a vegetative state.
Vegetative state
Widespread damage to the brain can result in a vegetative state. Although the person is unaware of his or her surroundings, he or she may open his or her eyes, make
sounds, respond to reflexes, or move.
It's possible that a vegetative state can become permanent, but often individuals progress to a minimally conscious state.
Minimally conscious state
A minimally conscious state is a condition of severely altered consciousness but with some evidence of self-awareness or awareness of one's environment. It is often a
transitional state from a coma or vegetative condition to greater recovery.
Locked-in syndrome
A person in a locked-in state is aware of his or her surroundings and awake, but he or she isn't able to speak or move. The person may be able to communicate with eye
movement or blinking.This state results from damage limited to the lower brain and brainstem. This rarely occurs after trauma and is more commonly due to a stroke in
that area of the brain.
Brain death
When there is no measurable activity in the brain and the brainstem, this is called brain death. In a person who has been declared brain dead, removal of breathing
devices will result in cessation of breathing and eventual heart failure. Brain death is considered irreversible.
Seizures
Some people with traumatic brain injury will have seizures within the first week. Some serious injuries may result in recurring seizures, called post-traumatic epilepsy.
Fluid buildup
Cerebrospinal fluid may build up in the spaces in the brain (cerebral ventricles) of some people who have had traumatic brain injuries, causing increased pressure and
swelling in the brain.
Infections
Skull fractures or penetrating wounds can tear the layers of protective tissues (meninges) that surround the brain. This can enable bacteria to enter the brain and cause
infections. An infection of the meninges (meningitis) could spread to the rest of the nervous system if not treated.
Blood vessel damage
Several small or large blood vessels in the brain may be damaged in a traumatic brain injury. This damage could lead to a stroke, blood clots or other problems.
Nerve damage
Injuries to the base of the skull can damage nerves that emerge directly from the brain (cranial nerves). Cranial nerve damage may result in:
Paralysis of facial muscles
Damage to the nerves responsible for eye movements, which can cause double vision
Damage to the nerves that provide sense of smell
Loss of vision
Loss of facial sensation
Swallowing problems
Intellectual problems
Many people who have had a significant brain injury will experience changes in their thinking (cognitive) skills. Traumatic brain injury can result in problems with many
skills, including:
Cognitive problems:
Memory
Learning
Reasoning
Speed of mental processing
Judgment
Attention or concentration
Executive functioning problems
Problem-solving
Multitasking
Organization
Decision-making
Beginning or completing tasks
Communication problems
Language and communications problems are common following traumatic brain injuries. These problems can cause frustration, conflict and misunderstanding for people
with a traumatic brain injury, as well as family members, friends and care providers.
Communication problems may include:

Cognitive problems
Difficulty understanding speech or writing
Difficulty speaking or writing
Inability to organize thoughts and ideas
Trouble following conversations
Social problems
Trouble with turn taking or topic selection
Problems with changes in tone, pitch or emphasis to express emotions, attitudes or subtle differences in meaning
Difficulty deciphering nonverbal signals
Trouble reading cues from listeners
Trouble starting or stopping conversations
Inability to use the muscles needed to form words (dysarthria)
Behavioral changes
People who've experienced brain injury often experience changes in behaviors. These may include:
Difficulty with self-control
Lack of awareness of abilities
Risky behavior
Inaccurate self-image
Difficulty in social situations
Verbal or physical outbursts
Emotional changes
Emotional changes may include:
Depression
Anxiety
Mood swings
Irritability
Lack of empathy for others
Anger
Insomnia
Changes in self-esteem
Sensory problems
Problems involving senses may include:

Persistent ringing in the ears
Difficulty recognizing objects
Impaired hand-eye coordination
Blind spots or double vision
A bitter taste, a bad smell or difficulty smelling
Skin tingling, pain or itching
Trouble with balance or dizziness
Degenerative brain diseases
A traumatic brain injury may increase the risk of diseases that result in the gradual degeneration of brain cells and gradual loss of brain functions, though this risk cannot
yet be determined with any certainty for an individual. These include:
Alzheimer's disease, which primarily causes the progressive loss of memory and other thinking skills
Parkinson's disease, a progressive condition that causes movement problems, such as tremors, rigidity and slow movements
Dementia pugilistica most often associated with repetitive blows to the head in career boxing which causes symptoms of dementia and movement problems
Tests and diagnosis

Because traumatic brain injuries are usually emergencies and because consequences can worsen swiftly without treatment, doctors usually need to assess the situation
rapidly.
Glasgow Coma Scale
This 15-point test helps a doctor or other emergency medical personnel assess the initial severity of a brain injury by checking a person's ability to follow directions and
move their eyes and limbs. The coherence of speech also provides important clues.
Abilities are scored numerically in the Glasgow Coma Scale. Higher scores mean less severe injuries.
Imaging tests
Computerized tomography (CT) scan
A CT scan uses a series of X-rays to create a detailed view of the brain. A CT scan can quickly visualize fractures and uncover evidence of bleeding in the brain
(hemorrhage), blood clots (hematomas), bruised brain tissue (contusions) and brain tissue swelling.
Magnetic resonance imaging (MRI)
An MRI uses powerful radio waves and magnets to create a detailed view of the brain. This test may be used after the person's condition has been stabilized.
Intracranial pressure monitor
Tissue swelling from a traumatic brain injury can increase pressure inside the skull and cause additional damage to the brain. Doctors may insert a probe through the skull
to monitor this pressure.
Medications
Medications to limit secondary damage to the brain immediately after an injury may include:
Diuretics
These drugs reduce the amount of fluid in tissues and increase urine output. Diuretics, given intravenously to people with traumatic brain injury, help reduce pressure
inside the brain.
Anti-seizure drugs
People who've had a moderate to severe traumatic brain injury are at risk of having seizures during the first week after their injury.
An anti-seizure drug may be given during the first week to avoid any additional brain damage that might be caused by a seizure. Additional anti-seizure treatments are
used only if seizures occur.
Coma-inducing drugs
Doctors sometimes use drugs to put people into temporary comas because a comatose brain needs less oxygen to function. This is especially helpful if blood vessels,
compressed by increased pressure in the brain, are unable to deliver the usual amount of nutrients and oxygen to brain cells.
Surgery
Emergency surgery may be needed to minimize additional damage to brain tissues.
Craniotomy
Surgical procedure that involves opening the skull surgically to gain access to intracranial structures. This procedure is performed to remove a tumor, relieve elevated ICP,
evacuate a blood clot, or control hemorrhage.
Craniectomy
Surgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain
injury and stroke.
Surgery may be used to address the following problems:

Removing clotted blood (hematomas)
Bleeding outside or within the brain can result in a collection of clotted blood (hematoma) that puts pressure on the brain and damages brain tissue.
Repairing skull fractures
Surgery may be needed to repair severe skull fractures or to remove pieces of skull in the brain.
Opening a window in the skull
Surgery may be used to relieve pressure inside the skull by draining accumulated cerebral spinal fluid or creating a window in the skull that provides more room for
swollen tissues.
Rehabilitation
Most people who have had a significant brain injury will require rehabilitation. They may need to relearn basic skills, such as walking or talking. The goal is to improve their
abilities to perform daily activities.
Therapy usually begins in the hospital and continues at an inpatient rehabilitation unit, a residential treatment facility or through outpatient services. The type and duration
of rehabilitation varies by individual, depending on the severity of the brain injury and what part of the brain was injured.
HEMIPARESIS
What is hemiparesis?
Hemiparesis is weakness on one side of the body. You can still move the affected side of your body, but with reduced muscular strength. Health care professionals such
as physical therapists and occupational therapists play a large role in assisting you in your recovery from hemiparesis. Treatment is focused on improving feeling and
motor skills, allowing you to better manage your daily living.
Statistics
Hemiparesis or one-sided (hemi) weakness (paresis) affects about 8 out of 10 stroke survivors, causing weakness or the inability to move one side of the body. One-
sided weakness can affect your arms, hands, legs and facial muscles. If you have one-sided weakness you may have trouble performing everyday activities such as
eating, dressing, and using the bathroom. Rehabilitation treatments, exercises at home, and assistive devices can help with your mobility and recovery.
Causes
Brain damage caused by head injuries, cancerous growths in a person's brain, or disease may also lead to the development of muscle weakness. Muscle weakness
appears in the side of the person's body that corresponds to the area of the brain that has been injured. Damage to the person's spinal cord may include damage caused
by trauma, such as injuries received through a fall, a car accident, or a wound received in a fight or combat. Conditions including multiple sclerosis, as well as some forms
of cancer, may also cause lesions on a person's spinal cord that interfere with the functioning of their nerves.
The muscle weakness that is characteristic of hemiparesis may be caused by lesions in a person's spinal cord which damages their nerves and innervates their muscles,
leading to weakness. Damage to the person's brain can lead to muscle weakness as well. Stroke; however, is the most common reason, people develop hemiparesis. At
times, muscle weakness is one of the key symptoms of stroke, bringing people to the hospital in the first place.
Diagnosis
When a patient presents with hemiparesis, the first step is to determine the origins of the muscle weakness. Medical imaging studies can be used to isolate the location of
the damage, and the patient will also typically be interviewed to collect a medical history for the purpose of identifying obvious risk factors. If a patient says that he or she
has multiple sclerosis, for example, the doctor will likely attribute the hemiparesis to this condition and may conduct tests to confirm.
Forms of Hemiparesis
People who experience hemiparesis can have difficulty moving their legs and arms, walking, and might also have a loss of balance. Due to this, performing everyday
activities such as dressing, eating, grabbing objects, or using the bathroom can be more difficult. Loss of abilities related to a stroke or hemiparesis depend upon the area
of the person's brain that has been damaged.
Right-sided Hemiparesis
Involves injury to the left side of the person's brain.The left side of a person's brain controls speaking and language. People who have this type of hemiparesis can
also experience difficulty with talking and understanding what others say, as well as determining left from right.
Left-sided Hemiparesis
Involves injury to the right side of the person's brain, which controls learning processes, certain types of behavior, and non-verbal communication. Injury to this
area of a person's brain may also cause people to talk excessively, have short attention spans, as well as memory problems.
Ataxia
Injury to the lower portion of a person's brain may affect their body's ability to coordinate movement. The result is referred to as, 'ataxia,' and might lead to
difficulties with walking, balance, and posture.
Pure Motor Hemiparesis
Pure motor hemiparesis is the most common type of hemiparesis. People who experience this type of hemiparesis have weakness in their leg, arm, and face. The
condition may affect the person's body parts equally, or it may affect one body part more than others.
Ataxic Hemiparesis Syndrome
Ataxic hemiparesis syndrome involves weakness or clumsiness on one side of a person's body. The person's leg is often more affected than their arm. The
symptoms happen over a period of hours to days.
Treatments & Rehabilitation

Rehabilitation can help people with hemiparesis to learn new ways of moving and using their legs and arms. There is potential, with immediate therapy, for people who
experience hemiparesis to eventually regain movement. There are a number of professionals involved in rehabilitation for hemiparesis.
Physiatrists
Physiatrists are doctors who specialize in rehabilitation. As with any other diagnosis, people who have experienced a stroke require the care of a health care
provider who is familiar with not only established practices, but new treatments. A physiatrist is a person who can help to manage the rehabilitative process of
someone who has experienced a stroke.
Physical Therapists
Physical therapists specialize in treating disabilities related to large movement and can help with endurance, strength, and range of motion problems. A physical
therapist may also assist with getting a person who has had a stroke the use of their legs and arms back via balance and coordination skills exercises.
Occupational Therapists
Occupational therapists can help people who have experienced a stroke to perform activities of daily living and fine motor skills. They may also assist people to
learn how to change their environment with the intention of meeting the person's new needs.
Medical science has created, or is looking into, some promising new treatments for people with hemiparesis that can also help people who have experienced a stroke to
improve movement in their legs and arms after the initial stroke.
Electrical Stimulation
Electrical stimulation is something that has been used in the treatment of hemiparesis to strengthen the person's arm while improving their range of motion. The
procedure involves placement of small electrical pads on the muscles of the person's weakened arm and applying a small electrical charge to help their muscles
contract as the person works to make it move. A number of these electrical stimulation devices are now covered through insurance and may be used in a person's
own home.
Cortical Stimulation
Researchers are examining cortical stimulation, something that involves electrical stimulation to the area of the person's brain called the, 'cortex,' to find out if it
can improve the person's arm and hand movement. The procedure is performed by placing a tiny electrode on the membrane covering the person's brain. The
electrode sens a tiny electrical current to the person's brain while the person performs rehabilitation exercises. At this time, the therapy is only targeted toward
people who have some level of movement in their wrist and fingers.
Botox/Baclofen
A number of studies have demonstrated that certain treatments may be helpful in relaxing the muscles in people who have tone, or spasticity. The condition
involves a certain body part on the affected side that is difficult to move, where the person feels as if they are tightened up. Treatment with injection of Botox, and
the use of Baclofen, may improve the condition.
Motor Imagery (MI)
When a person imagines themselves using a specific part of their body, areas of their brain and muscles can be activated as if the person is really doing the
activity they are imagining. Mental practice, at times referred to as, 'Motor Imagery,' or MI, helps people to visualize or imagine their limbs moving. The practice can
improve the arm movement of people with hemiparesis, and it has been suggested that MI can be used to help people to walk.
Modified Constraint-induced Therapy (mCIT)
mCIT is a form of treatment involving people with hemiparetic arms who visit a therapist three times per week for a half hour throughout a ten-week period of time.
Through that time, as well as at home for a number of hours each day, the person practices focused exercises using their weak arm. Research studies have
demonstrated that modified CIT increased both the movement and use of the person's arm. Modified CIT; however, only works for people who have some level of
movement remaining in their wrists and fingers.
Treatment of hemiparesis may include treatment of the person's underlying condition with the goal of resolving the hemiparesis, or ending its progress entirely. Physical
therapy is an important part of the person's treatment. Therapy assists people to regain control of their muscles while developing muscle strength. Physical therapists
might also give a person adaptive tricks and tips that can help them to navigate a world that has been created for people who have full muscle strength in both sides of
their body. Assistive devices to include walkers, braces, and wheelchairs may also be helpful to people who have difficulties with walking as a result of hemiparesis..
PNEUMONIA
What Is Pneumonia?
Pneumonia is an infection in one or both lung. It can be caused by fungi, bacteria, or viruses. Pneumonia causes inflammation in the lungs air sacs, or alveoli. The alveoli
fill with fluid or pus, making it difficult to breathe.
Statistics:
The United Nations Children's Fund (UNICEF) estimates that pediatric pneumonia kills 3 million children worldwide each year. These deaths occur almost exclusively in
children with underlying conditions, such as chronic lung disease of prematurity, congenital heart disease, and immunosuppression. Although most fatalities occur in
developing countries, pneumonia (see the image below) remains a significant cause of morbidity in industrialized nations.
Pneumonia can occur at any age, although it is more common in younger children. Pneumonia accounts for 13% of all infectious illnesses in infants younger than 2 years.
Newborns with pneumonia commonly present with poor feeding and irritability, as well as tachypnea, retractions, grunting, and hypoxemia. Infections with group B
Streptococcus, Listeria monocytogenes, or gram-negative rods (e.g. Escherichia coli, Klebsiella pneumoniae) are common causes of bacterial pneumonia. Group B
streptococci infections are most often transmitted to the fetus in utero. The most commonly isolated virus is respiratory syncytial virus (RSV).
Cough is the most common symptom of pneumonia in infants, along with tachypnea, retractions, and hypoxemia. These may be accompanied by congestion, fever,
irritability, and decreased feeding. Streptococcus pneumoniae is by far the most common bacterial pathogen in infants aged 1-3 months.
Adolescents experience similar symptoms to younger children. They may have other constitutional symptoms, such as headache, pleuritic chest pain, and vague
abdominal pain. Vomiting, diarrhea, pharyngitis, and otalgia/otitis are also common in this age group. Mycoplasma pneumoniae is the most frequent cause of pneumonia
among older children and adolescents.
Signs and Symptoms:

Pneumonia symptoms can vary from mild to severe, depending on the type of pneumonia you have, your age and health.
The most common symptoms of pneumonia are:
Cough (with some pneumonias you may cough up greenish or yellow mucus, or even bloody mucus)
Fever, which may be mild or high
Shaking chills
Shortness of breath, which may only occur when you climb stairs
Additional symptoms include:
Sharp or stabbing chest pain that gets worse when you breathe deeply or cough
Headache
Excessive sweating and clammy skin
Loss of appetite, low energy, and fatigue
Confusion, especially in older people
Types and Causes of Pneumonia

There are five major types of pneumonia. They are:
Bacterial Pneumonia
Bacterial pneumonia can affect anyone at any age. It can develop on its own or after a serious cold or flu. The most common cause of bacterial pneumonia is
Streptococcus pneumoniae. Bacterial pneumonia can also be caused by Chlamydophilapneumonia or Legionella pneumophila. Pneumocystis
jiroveci pneumonia is sometimes seen in those who have weak immune systems due to illnesses like AIDS or cancer.
Viral Pneumonia
In most cases, respiratory viruses can cause pneumonia, especially in young children and the elderly. Pneumonia is usually not serious and lasts a short time.
However, the flu virus can cause viral pneumonia to be severe or fatal. Its especially harmful to pregnant women or individuals with heart or lung issues. Invading
bacteria can cause complications with viral pneumonia.
Mycoplasma Pneumonia
Mycoplasma organisms are not viruses or bacteria, but they have traits common to both. They are the smallest agents of disease that affect humans.
Mycoplasmas generally cause mild cases of pneumonia, most often in older children and young adults.
Other Types of Pneumonia
Many additional types of pneumonia affect immune-compromised individuals. Tuberculosis and Pneumocystis carinii pneumonia (PCP) generally affect people with
suppressed immune systems, such as those who have AIDS. In fact, PCP can be one of the first signs of illness in people with AIDS.
Less common types of pneumonia can also be serious. Pneumonia can be caused by inhaling food, dust, liquid, or gas, as well as by various fungi.
CLASSIFICATION:
COMMUNITY ACQUIRED PNEUMONIA (CAP)
Occurs either in the community setting or within 48 hours upon hospitalization
HOSPITAL ACQUIRED OR NOSOCOMIAL PNEUMONIA (HAP)
Onset of pneumonia symptoms appear more than 48 hours after admission to the hospital
VENTILATOR ASSOCIATED PNEUMONIA
Can be a subtype of HAP
Patient has been endotracheally intubated and has received mechanical ventilator support for at least 48 hours
Most common infection seen in intensive care units
PNEUMONIA IN THE IMMUNOCOMPROMISED HOST (PCP)
Immunocompromised hosts are those using corticosteroids or other immunosuppressive agents, chemotherapy, nutritional depletion, use of broad spectrum
antimicrobial agents, AIDS, genetic immune disorders, and long term advanced life support technology (mechanical ventilation)
Compromised immune systems commonly acquire pneumonia from organisms of low virulence
Common cause: Pneumocystis jiroveci
ASPIRATION PNEUMONIA
Pulmonary consequences resulting from the entry of endogenous or exogenous substances into the lower airway
May occur in the community or hospital setting
STAGES
HYPEREMIA OR CONGESTION
Increased blood flow and capillary permeability due to inflammatory reaction. Infection spreads to neighboring tissue.
RED HEPATIZATION
Massive dilation of capillaries and alveoli are filled with organisms, neutrophils, RBCs, and fibrin.
GREY HEPATIZATION
WBCs colonize the infected part of the lung. Fibrin deposits accumulate throughout the area of injury and phagocytosis of cell debris occurs.
RESOLUTION
Cell debris, fibrin, and bacteria are digested; macrophages that clean up cells of the inflammatory reaction dominate
DIAGNOSIS
Pneumonia can be easily overlooked as the cause of an illness because it often resembles a cold or the flu. However, it usually lasts longer and symptoms seem more
severe than these other conditions.
Detailed Patient History
To determine whether or not you have pneumonia, your doctors will usually inquire about your signs and symptoms.
TREATMENT
The type of treatment prescribed for pneumonia mostly depends on what type of pneumonia is present, as well as how severe it is. In many cases, pneumonia can be
treated at home.
General Treatment
The typical treatment plan for pneumonia includes taking all prescribed medications and participating in follow-up care. A chest X-ray may be ordered to make sure
pneumonia has been successfully treated.
Treating Bacterial Pneumonia
Antibiotics are used to treat this type of pneumonia. Antibiotics should be taken as directed. If you stop taking the antibiotics before treatment is complete,
the pneumonia may return. Most people will improve after one to three days of treatment.
Treating Viral Pneumonia
Antibiotics are useless if a virus is the cause of pneumonia. However, certain antiviral drugs can help treat the condition. Symptoms usually clear within one to
three weeks.
Can Pneumonia Be Prevented?

Anyone with diabetes, asthma, and other severe or chronic health problems is at risk for pneumonia. However, in many cases, it can be prevented with vaccines against
bacterial pneumonia and flu. Quitting smoking will definitely lower your risk of pneumonia.
What Are Risk Factors?

Anyone can get pneumonia, but some people are at a higher risk than others.
Risk factors (that increase your chances of getting pneumonia) include:
Cigarette smoking
Recent viral respiratory infectiona cold, laryngitis, influenza, etc.
Difficulty swallowing (due to stroke, dementia, Parkinson's disease, or other neurological conditions)
Chronic lung disease such as COPD, bronchiectasis, or cystic fibrosis
Cerebral palsy
Other serious illnesses, such as heart disease, liver cirrhosis, or diabetes
Living in a nursing facility
Impaired consciousness (loss of brain function due to dementia, stroke, or other neurologic conditions)
Recent surgery or trauma
Having a weakened immune system due to illness, certain medications, and autoimmune disorders
Anatomy and Physiology 1. Support, protect & nourish neurons
2. Divide by mitosis
The nervous System 3. Do not transmit impulses
The master control & communicating system of the body; mostly made up Neuroglia of the CNS
of nervous tissue. a. ASTROCYTES
Star shaped cells
Functions of the Nervous System Most abundant glial cells of the CNS
1. Sensory Function Function:
2. Integration >Hold neurons in place
3. Motor Function >regulate exchange of substances to & from CNS neurons
Form the blood-brain barrier to protect neurons from harmful chemicals
Divisions of the Nervous System
1. Anatomical/Structural Division B. Microglia
a. CENTRAL NERVOUS SYSTEM (CNS) >spider like cells
Includes the brain & spinal cord, which occupies the cranial & vertebral >phagocytes of CNS
cavities respectively. Function:
b. PERIPHERAL NERVOUS SYSTEM (PNS) >protect against microorganisms
Comprise the sensory & all nerves outside the CNS >clear away debris of dead cells
Relays information to & from the CNS
2. Functional Divisions of the PNS C.Ependymal cells
a. Sensory or afferent division >facilitate movement of CSF
>conveys impulses to the CNS from sensory receptor located to
various part of the body. D. OLIGODENDROCYTES
b. Motor or EFFERENT division >cells whose branches wrap around axons of CNS neurons
> carries impulses from CNS to effector organs Function:
Produce and maintain fatty insulating coverings called myelin sheath
NERVOUS TISSUE
Types of Cells in Nervous Tissue Neuroglia of the PNS
1. Neurons a. SCHWAAN CELLS
2. Neuroglia Surround all axons in the PNS
NEUROGLIA Function:
Or glia or glial cells >make myelin sheath of PNS neurons
Collective term for supporting the nervous system b. SATELLITE CELLS
Outnumber the neurons >surround the cell body of PNS neurons
Function:
Found in both CNS & PNS
>Provide support and nutrition
Character of Neuroglia
5. SEROTONIN
THE NEURONS Genrally inhibitory involved in control of mood & onset of sllep
Or nerve cell; functional unit of the nervous system 6. SUBSTANCE P
Involved in pain perception
Functional Classification of Neurons 7. ENDORPHINES
1. SENSORY Generally inhibitory-reduce pain by inhibiting substance P release
Or efferent neurons 8. NITRIC OXIDE
2. Motor Inhibitory in PNS-promotes Vasodilation
Or efferent
Found in the PNS Central Nervous System
Carry impulses from CNS to effector cells
Can be SOMATIC or AUTONOMIC Spinal Cord
a mass of nerve tissue located in the vertebral tissue located in the
Collection of Nervous tissue vertebral cavity from which 31 pairs of spinal nerves
1. Nuclei transmit impulses to 7 from the brain
2. Ganglia integrating center for spinal reflexes
3. Tracts
4. Nerves
5. White matter THE BRAIN
6. Gray matter Part of the CNS enclosed in the cranial cavity
7. Nerve Composed of 100 billion neurons & 10 to 15 trillion neuroglia
Nerve Physiology: Average weight: 1.5 Kg
1. Resting membrane potential Receives 15% to 20% of blood pumped by the heart.
2. Stimulus initiates deporalization Highly metabolic organ
3. Deporalization& Generation of action potential
Consumes 80% of glucose % 15% of Oxygen that body uses
4. 4. Propagation of action potential
5. Repolarization
Major Neurotransmitter & their action Major Parts of the Brain:
1. ACETYCHOLINE 1. Brain stem
STIMULATES SKELETAL CONTRACTION Is continuous with the spinal cord & consist of medulla oblongata, pons,
2. GAMMA AMINOBYTERIC ACID (GABA) &
Generally inhibitory 2. Diencephalos
Located above of the brain stem & consist mostly of the thalamus &
3. NOREPINEPRINE
Inhibitory or excitatory at ANS synapses hypothalamus
3. Cerebrum
4. DOPAMINE
Forms the bulk of the brain, supported on the diencephalos& brain stem
Acting during emotional responses
4. Cerebellum Carries needed chemicals from the blood to neurons& neuroglia
Located posterior to the brain stem Removes wastes produced by brain & spinal cord cells
Protects the spinal cord & brain from chemical and physical injury
>circulates through the subarachnoid space around the brain & spinal cord,
through cavities in the brain known as ventricles & through the canal of spinal
cord.
Structure related to CSF Production & Absorption
Subrachnoid
-space between pia mater & arachnoid mater
-surrounds brain & spinal cord
> Ventricles
- CSF filled chambers in the brain
> Choroid Plexus
- are specialized networks of capillaries in the walls of the ventricles lined
with ependymal cells
> Arachnoid Villi
- fingerlike extensions of arachnoid mater
> Cranial Venous Sinuses
-large veins within dura mater here CSF drains & becomes blood plasma
again.
A. BRAIN STEM
Protective Structure of the Brain Is the part of the brain between the spinal cord & diencephalon
1. Skull/Cranium Major Regions of the Brainstem:

>Bony structure protecting the brain 1. Medulla oblongata or medulla
2. Meninges A continuation of the spinal cord
> consist with the spinal meninges Forms the inferior part of the brain stem
> consist of 3 layers: outermost Dura mater , middle arachnoid &innermost pia
2. Pons
mater
Located superior to the medulla & anterior to the cerebellum
3. CSF Cerebrospinal Fluid
Bulges anteriorly
> a clear, colorless liquid which contains small amount of glucose, proteins, lactic
acid, urea, cations (Na+, K+, Ca++, Mg++), & small anions (Cl-, HCO3+) 7 Its other nuclei are respiratory centers that control breathing,
SOME WBC 3. Midbrain
Average volume: 80 to 50 ml Connects the pons to the diencephalon
Functions: Its other nuclei are respiratory center that control breathing
4. Midbrain Egg-shaped structure which forms bulk of diencephalon
Contains the pons to the diencephalon The relay station for all sensations except smell
Also contains nuclei for pairs of cranial nerves III & IV which coordinate Groups sensory impulses & transmit them to the cerebrum for localization
eye movements & processing
5. Reticular Formation 2. HYPOTHALAMUS
Group of nuclei scattered throughout brain stem Small part of diencephalon located inferior to the thalamus
Major component of the reticular activating system (RAS) which maintains Has numerous functions & is the major regulator of homeostasis
arousal & regulates sleep wake cycle Functions:
Damage causes coma. -controls ANS
-produces Hormones ( ADH, oxytocin & releasing hormones)
-regulates emotional & behavioural patterns
-regulates eating & drinking (feeding, satiety & rhythms)
-controls bodt temperature (thermoregulatingcenter)
-acts as Biological clock that regulates circadian rhythms
C. CEREBELLUM
Located posterior to the Medulla & Pons and below the cerebrum
Consist of 2 cerebellar hemisphere
Function:
-coordinates movement of the skeletal muscles
> regulates posture & balance
D. CEREBRUM
Largest part of the brain
Seat of intelligence
Divided into left & right hemisphere
Structures / Regions related to the Cerebrum

1. CEREBRAL CORTEX
A region of gray matter that forms the outer rim of the cerebrum
The home of the conscious mind
B. DIENCEPHALON 2. GYRI
-is the part of the brain superior to the midbrain Singular: gyrus
3. Sulci
MAJOR REGIONS OF THE DIENCEPHALONS Singular: sulcus
1. THALAMUS -the shallow grooves between the gyri
4. FISSURE Numbered I-XII from superior to inferior
-the deep grooves Innervate specific areas of the body & function could be sensory, motor or
5. LONGITUDINAL FISSURE both
-separates the cerebrum into right and left halves called cerebral 1. OLFACTORY
hemisphers Sensory function: smell
6. CORPUS CALLOSUM 2. OPTIC
7. FRONTAL, PARIETAL, TEMPORAL, OCCIPAL Sensory function: sight
8. CENTRAL SULCUS 3. OCCULOMOTOR NERVES
9. PREENTAL GYRUS Motor function: moves eyelids & eyeball
10. POST CENTRAL GYRUS Constricts pupil
11. CEREBRAL WHITE MATTER
4. TROCHLEAR NERVE
12. BASAL NUCLEUS
Motor function: Moves the eyeball
13. LIMBIC SYSTEM
5. TRIGEMINAL NERVE
Sensory function: corneal reflex, facial sensation
FUNCTIONAL SYSTEM OF CEREBRAL CORTEX 6. ABDUCENS NERVE
1. Sensory Areas Motor function: moves eyeball
Received sensory information from the various receptors & 7. FACIAL NERVE
sensory/ascending tracts Sensory function: Taste (anterior 2/3 of the tongue)
Involved in the conscious awareness of a sensation called perception Motor function: facial expression
2. Motor Area 8. VESTIBULOCOCHLEAR NERVE
Control the execution of voluntary movements Sensory function: Hearing, balance equilibrium
a. PRIMARY MOTOR AREA 9. GLOSSOPHARYNEAL NERVE
b. BROCAs MOTOR AREA Sensory function( 1/3 of the tongue)
c. ASSOCIATION AREAS 10. VAGUS NERVE
c.1 SOMATOSENSORY ASSOCIATION Sensory function: detects changes in BP & PH blood
c.2 VISUAL ASSOCIATION AREA Motor function: swallowing, speaking
c.3 AUDITORY ASSOCIATION AREA 11. ACESSORY NERVE
c.4.WERNICKs AREA Motor function: moves the head & shoulders
c.5 FACIAL RECOGNITION AREA 12. HYPOGLOSSAL NERVE
c.6 PREMOTOR AREA Motor function: moves tongue
c.7. PREFRONTAL AREA
Astrocytes are the most common support cells in the brain and spinal
CRANIAL NERVES cord. Their gray cytoplasmic process extend in all directions
Part of the PNS
12 pairs of nerves whose cell bodies originate from the brain
The Respiratory System
The respiratory system (called also respiratory apparatus, ventilatory

system) is a biological system consisting of specific organs and structures used
for the process of respiration in an organism. The respiratory system is involved
in the intake and exchange of oxygen and carbon dioxide between an organism
and the environment.
Parts Of the respiratory system:

Upper Respiratory Tract
Nose& Nasal Cavity-The nasal cavity is a hollow space within the nose and
skull that is lined with hairs and mucus membrane. The function of the nasal
cavity is to warm, moisturize, and filter air entering the body before it reaches the
lungs.
Mouth- also known as the oral cavity and is the secondary external opening for epithelium that allows air entering the alveoli to exchange its gases with the
the respiratory tract. Most normal breathing takes place through the nasal cavity, blood passing through the capillaries.
but the oral cavity can be used to supplement or replace the nasal cavitys Physiology Of Breathing
functions when needed.
Pulmonary Ventilation/Breathing is the flow of air between the atmosphere &
Pharynx-also known as the throat, is a muscular funnel that extends from the the alveolis of the lungs and there are 2 phases. Inhalation/Inspiration is the
posterior end of the nasal cavity to the superior end of the esophagus and larynx. movement of air into the lungs, and exhalation/expiration is the movement of air
Nasopharynx out of the lungs. So the flow of air will occur due to differences in air pressure, its
because air flows from the area of high pressure to the area of low pressure, and
Oropharynx
also as a person inhales it means the pressure inside the lungs is less than the
Laryngopharynx atmospheric air pressure. A person exhales out when the pressure inside the
Lower Respiratory Tract lungs is greater than the atmospheric air pressure, and so changes in the
pressure within the lungs results from changes in the volume of the thoracic
Larynx-also known as the voice box, is a short section of the airway that cavity. The different muscles of respiration will also cause the volume of the
connects the laryngopharynx and the trachea. thoracic cavity to increase/derease.
Thyroid Cartilage-also known as the Adams Apple Control
Cricoid Cartilage-where tracheostomy is usually done in this area
Ventilation occurs via the respiratory center in the medulla oblongata and the
Epiglottis pons of the brainstem.
Trachea- or windpipe, itconnects the larynx to the bronchi and allows air to pass
Inhalation
through the neck and into the thorax.
Bronchi & Bronchioles-is to carry air from the trachea into the lungs. Smooth Inhalation is initiated by the diaphragm and supported by the external intercostal
muscle tissue in their walls helps to regulate airflow into the lungs. When greater muscles. Normal resting respirations are 10 to 18 breaths per minute, with a time
volumes of air are required by the body, such as during exercise, the smooth period of 2 seconds. During vigorous inhalation (at rates exceeding 35 breaths
muscle relaxes to dilate the bronchi and bronchioles. The dilated airway provides per minute), or in approaching respiratory failure, accessory muscles of
less resistance to airflow and allows more air to pass into and out of the lungs. respiration are recruited for support. These consist of sternocleidomastoid,
The smooth muscle fibers are able to contract during rest to prevent platysma, and the scalene muscles of the neck. Pectoral muscles and latissimus
hyperventilation. The bronchi and bronchioles also use the mucus and cilia of dorsi are also accessory muscles.
their epithelial lining to trap and move dust and other contaminants away from
the lungs. Under normal conditions, the diaphragm is the primary driver of inhalation. When
the diaphragm contracts, the ribcage expands and the contents of the abdomen
Lungs-are a pair of large, spongy organs found in the thorax lateral to the heart
are moved downward. This results in a larger thoracic volume and negative
and superior to the diaphragm. Each lung is surrounded by a pleural membrane
pressure (with respect to atmospheric pressure) inside the thorax. As the
that provides the lung with space to expand as well as a negative pressure space
pressure in the chest falls, air moves into the conducting zone. Here, the air is
relative to the bodys exterior.
filtered, warmed, and humidified as it flows to the lungs.
Alveoli-are cup-shaped structures found at the end of the terminal bronchioles
and surrounded by capillaries. The alveoli are lined with thin simple squamous
During forced inhalation, as when taking a deep breath, the external intercostal Upon inhalation, gas exchange occurs at the alveoli, the tiny sacs which are the
muscles and accessory muscles aid in further expanding the thoracic cavity. basic functional component of the lungs. The alveolar walls are extremely thin
During inhalation the diaphragm contracts. (approx. 0.2 micrometres). These walls are composed of a single layer of
epithelial cells (type I and type II epithelial cells) close to the pulmonary
Exhalation capillaries which are composed of a single layer of endothelial cells. The close
proximity of these two cell types allows permeability to gases and, hence, gas
Exhalation is generally a passive process; however, active or forced exhalation is exchange. This whole mechanism of gas exchange is carried by the simple
achieved by the abdominal and the internal intercostal muscles. During this phenomenon of pressure difference. When the air pressure is high inside the
process air is forced or exhaled out. lungs, the air from lungs flow out. When the air pressure is low inside, then air
The lungs have a natural elasticity: as they recoil from the stretch of inhalation, flows into the lungs.
air flows back out until the pressures in the chest and the atmosphere reach
equilibrium.[12]
Coughing and sneezing
During forced exhalation, as when blowing out a candle, expiratory muscles
including the abdominal muscles and internal intercostal muscles, generate Irritation of nerves within the nasal passages or airways, can induce a cough
abdominal and thoracic pressure, which forces air out of the lungs. reflex and sneezing. These responses cause air to be expelled forcefully from the
trachea or nose, respectively. In this manner, irritants caught in the mucus which
Gas exchange lines the respiratory tract are expelled or moved to the mouth where they can be
The major function of the respiratory system is gas exchange between the swallowed. During coughing, contraction of the smooth muscle narrows the
external environment and an organism's circulatory system. In humans and other trachea by pulling the ends of the cartilage plates together and by pushing soft
mammals, this exchange facilitates oxygenation of the blood with a concomitant tissue out into the lumen. This increases the expired airflow rate to dislodge and
removal of carbon dioxide and other gaseous metabolic wastes from the remove any irritant particle or mucus.
circulation. As gas exchange occurs, the acid-base balance of the body is
maintained as part of homeostasis. If proper ventilation is not maintained, two
opposing conditions could occur: respiratory acidosis, a life-threatening condition,
and respiratory alkalosis.
CLIENT IN CONTEXT PRESENT STATE INTERVENTION EVALUATION
Identifying Information (Informant: Mother
and patient) PHYSICAL EXAMINATION
Patient A.V.M., 9 years old, female, single, Day 1: June 30, 2016
Filipino, Roman Catholic born on October Time: 10:30 AM
09, 2006 with the highest educational General Appearance: Seen patient lying on bed,
attainment of Grade 4 residing in Sunrise awake, alert with body weakness, conscious,
Village, Pardo, Cebu City was admitted for responsive, with IV on left hand, with the following
the second time in CVGH on June 27, 2016 vital signs:
at 10:40 PM via taxi per fathers arms PR: 75 bpm RR: 21 cpm T: 37.1 C
accompanied by her mother and uncle for
complaints of headache and muscle Height: 47 ft (139.7 cm) Weight: 23 kg (50.7
weakness felt on the left trunk and lbs) IBW: 154 lbs. BMI: 23.121 (Normal)
extremities. Patient is under the care of Dr.
Doris Gigataras in the Pediatrics
Department with the case number 036152 BMI Categories IBW Categories
and hospital ID 16-86339. Information <18.5 Underweight >200 % : Morbid
regarding the patient was obtained from her 18.5 - 24.9 Normal obesity
mother. 25 - 29.9 Overweight 140 - 200% :
CHIEF COMPLAINT 30 - 34.9 Obese class Moderate obesity
Patient was admitted for the complaints of 1 110 - 140% : Mild
sudden onset of severe headache and 35 - 39.9 Obese class obesity
muscle weakness on the left trunk which 2 90 - 110 % : Ideal
spread through the left upper and lower > 40 : Obese class 3 80 - 90% : Mild
extremities characterized by reduced power malnutrition
to sit, stand and walk on her own. 70 - 80% : Moderate
Malnutrition
HISTORY OF PRESENT ILLNESS <70% : Severe
6 years PTA, mother of the patient Malnutrition
verbalized, Natumbahan man ni siya sa
tanke sa gasoline katong gadagandagan SKIN: Evenly colored skin without unusual
siya sulod sa balay, iyang ulo ang naigo ug discolorations, slightly moist, warm to touch, good
gadugo maayo. This prompted the mother skin turgor, smooth in texture, no masses noted,
to seek medical help and had the injury thin without calluses noted on plantar surfaces of
sutured. After it healed, the patient was able both feet, no edema noted.
to go back again to her normal activities of
daily living. No other unusalities or SCALP and HAIR: Hair is short and black in color,
complaints were further noted. not evenly distributed, scalp is dry and clean, hair
2 years PTA, patient complained about smooth and firm without lesions
severe headache and balance problems.
Patient was unable to stand or walk on her NAILS: Transparent both upper and lower
APPENDIX B
FAMILY
ATTACHMENTS:
Strongly attached
Moderately attached
Slightly attached
Very slightly attached CLIENT

Negatively attached ----- TEACHERS FRIENDS
-
NEIGHBORS CHURCH
Name of Family Member Relationship with Family Member Describe said family member, his/her role in
the family and your relationship with him/her
V.M. Mother Has strong faith in God, hard-working, caring, provider
of the family
A.M. Father Hard-working, provider of the family, understanding,
LABORATORY TESTS
COMPLETE BLOOD COUNT
Purpose: The complete blood count (CBC) is a screening test, used to diagnose and manage numerous diseases. It can reflect problems with fluid volume (such as
dehydration) or loss of blood. It can show abnormalities in the production, life span, and destruction of blood cells. It can reflect acute or chronic infection, allergies, and
problems with clotting.
Date: June 26, 2016 22:56
COMPONENT NORMAL VALUES

WBC 24.4K/uL 4.50-13.0 k/uL
NEU 21.588.1% 1.80-8.0 25%-70%
LYM 1.82 7.46% 1.20-5.80 20%-65%
MONO .987 4.04% 0-0.80%-9%
EOS .005 0.020% 0-0.5 0%-8%
BASO .083 .340% 0-0.2 0%-3%
RBC 4.79 k/uL 4.10-5.30 k /uL
HGB 12.7 g/dL 12-16 g/dL
HCT 37.8 % 36%-49%
MCV 79.0 fL 78-102 fL
MCH 26.5 pg 25-35 ph
MCHC 33.6 g/dL 31-36 g/dL
RDW 10.5% 11.6%-18%
PLT 223 140-440
MPV 8.73 fL 0.00- 99.9 fL
IMPLICATION:
High WBC
Indicates the presence of infection and inflammation in the body such as in Pneumonia. Pneumonia is an inflammation of the lower air passages and air sacks of the
lungs resulting from infection of the parenchyma of the lungs.
High Neutrophils
Neutrophils are the body's primary defense against bacterial infection and physiologic stress. An increased need for neutrophils, as with an acute bacterial infection such
as in pneumonia, will cause an increase in both the total number of mature neutrophils and the less mature bands or stabs to respond to the infection.
Low Lymphocytes
This is due to the presence of antibodies to lymphocytes which results in the destruction of the antibody-coated lymphocytes.
Low RBC Distribution Width (RDW)
Low value indicates uniformity in size of RBCs. It is often associated with Macrocytic anemia (not enough red blood cells are produced)
High Monocytes
This is usually due to several reasons such as stress, inflammation, a fever from a virus, severe infection
premature cell death in living tissue, diseases that result from abnormal activity of the immune system, and regeneration of red blood cells.
June 29, 2016 9:48

WBC 10.2 K/uL 4.50-13.0 k/uL
NEU 7.10 69.9% 1.80-8.0 25%-70%
LYM 2.12 20.8% 1.20-5.80 20%-65%
MONO .845 8.32% 0-0.8 0%-9%
EOS .010 0.100% 0-0.5 0%-8%
BASO .087 .855% 0-0.2 0%-3%
RBC 4.66 k/uL 4.10-5.30 k /uL
HGB 12.3 g/dL 12-16 g/dL
HCT 36.4 % 36%-49%
MCV 78.3 fL 78-102 fL
MCH 26.3 pg 25-35 ph
RDW 10.2% 11.6%-18%
PLT 188 140-440
MPV 7.38 fL 0.00- 99.9 fL
IMPLICATION:

July 05, 2016 16:27

WBC 12.8 K/uL 4.50-13.0 k/uL
NEU 10.682.9% 1.80-8.0 25%-70%
LYM 1.7914.0% 1.20-5.80 20%-65%
MONO .358 2.78% 0-0.80%-9%
EOS 0.00 0.00% 0-0.5 0%-8%
BASO .034 .268% 0-0.2 0%-3%
RBC 4.60 k/uL 4.10-5.30 k /uL
HGB 11.5g/dL 12-16 g/dL
HCT 35.8% 36%-49%
MCV 77.6fL 78-102fL
MCH 25.6pg 25-35ph
RDW 9.78% 11.6%-18%
PLT 272 140-440
MPV 7.23fL 0.00-99.9 fL
IMPLICATION:
High Neutrophils
Low Hemoglobin, Hematocrit

Low levels of hemoglobin in the blood is usually associated with low levels of red cells which is a result from the effect of antibodies attacking the red cells and causing
their destruction, a process called hemolytic anemia. A low hemoglobin count can be associated with a disease or condition that causes your body to have too few red
blood cells. This can occur if the body produces fewer red blood cells than usual, the body destroys red blood cells faster than they can be produced or is if there is blood
loss.
Low Mean Corpuscular Volume
MCV reflects the size of red blood cells. This RBC measures isused to diagnose types of anemia. Anemias are defined based on cell size (MCV) and amount of Hgb
(MCH). MCV less than lower limit of normal: microcytic anemia.
July 07, 2016 18:05

WBC 17.4 K/uL 4.10-10.9 k/uL
NEU 15.991.6% 2.5-7.5 47%-80%
LYM .8324.79% 1.0-4.0 13%-40%
MONO .602 3.46% 0.1-1.2 2%-11%
EOS .002 0.010% 0-0.05 0%-5%
BASO .028 .163% 0-0.1 0%-2%
RBC 4.36 k/uL 4.0-5.2 k /uL
HGB 11.4g/dL 12-16 g/dL
HCT 34.0% 36%-46%
MCV 78.0 fL 80-100 fL
MCH 26.2 pg 26-34 ph
RDW 10.0% 11.6%-18%
PLT 228 140-440
MPV 7.30 fL 0.99-9 fL
IMPLICATION:
Low WBC
A low white blood cell count usually is caused by viral infections that temporarily disrupt the work of bone marrow, autoimmune disorders that destroy white blood cells or
bone marrow cells, severe infections that use up white blood cells faster than they can be produced, medications such as antibiotics that destroy white blood cells.
High Neutrophils
Low Lymphocytes
This is due to the presence of antibodies to lymphocytes which results in the destruction of the antibody-coated lymphocytes.
Low Hemoglobin, Hematocrit

Low levels of hemoglobin in the blood is usually associated with low levels of red cells which is a result from the effect of antibodies attacking the red cells and causing
their destruction, a process called hemolytic anemia. A low hemoglobin count can be associated with a disease or condition that causes your body to have too few red
blood cells. This can occur if the body produces fewer red blood cells than usual, the body destroys red blood cells faster than they can be produced or is if there is blood
loss.

CLINICAL CHEMISTRY
Purpose:
Potassium
Potassium Test measures the amount of potassium in the fluid portion (serum) of the blood. Potassium (K+) helps nerves and muscles communicate. It also helps move
nutrients into cells and wastes products out of the cells. Potassium levels in the body are mainly controlled by the hormone aldosterone.
Sodium
A sodium test checks how much sodium is in the blood. Sodium is both an electrolyte and mineral. It helps keep the water (the amount of fluid inside and outside the
bodys cells) and electrolyte balance of the body. Sodium is also important in how nerves and muscles work.
June 27,2016 8:43AM
Conventional Units
Analyte Result Normal Range Result

Normal Range
Clinical Chemistry
Sodium 1.136 mmol/mL [136-142] 1. 136
[136-142]
Potassium 4.4 mmol/mL [4.0-5.6] 4.4
[4.0-5.6]
IMPLICATION:
Result is within normal range
July 7, 2016 2:54-59PM
Conventional Units
Analyte Result Normal Range Result

Normal Range
Clinical Chemistry
Sodium 1.133 mmol/mL [136-142] 1. 133
[136-142]
Potassium 5.0 mmol/mL [4.0-5.6] 5.0
[4.0-5.6]
IMPLICATION:
CREATININE BLOOD TEST

Purpose:
It measures the level of creatinine in the blood. This test is done to see how well your kidneys work. Also, creatinine clearance measures of the amount of
creatinine the kidneys able to clear in a 24 hour period. It is also a good measure of the glomurelar filtration (GFR) , the amount of plasma filtered through glomureli per
unit of time. Creatinine can also be measured with a urine test.
June 29, 2016 02:04
Test Result Unit Flag Reference Range

BLOOD
CHEMISTRY
CREATININE 0.6 mg/dL L 0.6 - 1.5
IMPLICATION:
Result is within normal range. This shows that the kidneys are still functioning well
LIPID PANEL TEST & BLOOD GLUCOSE TEST

Purpose:
Lipid Panel Test

It measures lipids fats and fatty substances used as a source of energy by your body. Lipids include cholesterol, triglycerides, high density lipoprotein (HDL),
and low density lipoprotein (LDL) and other measurements such as very low density lipoprotein (VLDL).
Blood Glucose test

Used to diagnose diabetes, help to determine if it is well controlled.
July 06, 2016 07:34
Test Result Unit Flag Reference Range
GLUCOSE 107.34 mg/dl 75.00 - 115.00

TOTAL 144.6 mg/dl 131.0 - 200.0
CHOLESTEROL 66.6 mg/dl 0.0 - 200.0
TRIGLYCERIDES 43.3 mg/dl 35.0 - 72.0
HDL 88 mg/dl 118- 187
CHOLESTEROL 13 mg/dl 0 - 40
LDL
VLDL
IMPLICATION:
Having a low level of density (LDL) cholesterol or a low total cholesterol level could increase risk of some health problems like cancer, depression and anxiety. A low LDL
cholesterol level is considered good for the heart health.
Analyte Result Unit Flag
Normal Range IMMUNOLOGY REPORT
Immunology
HSCRP 0.6 mgl PURPOSE:
(0.1-2.8)
This test determines whether your immune system is healthy
enough to properly fight off such diseases.
July 05, 2016 11:05 am
IMPLICATION:
X-RAY
Purpose:
Chest X-rays may provide important information regarding the size, shape, contour and anatomic location of the heart, lungs, bronchi, great vessels (aorta, aortic
arch, pulmonary arteries), mediastinum (an are of the middle of the chest separating the lungs), and the bones (cervical and thoracic spine, clavicles, shoulder girdle, and
ribs) Changes in the normal structure of the heart, lungs, and /or lung vessels may indicate disease or other conditions.
Date: June 26, 2016
Radiologic Findings:
Examination reveals the lung fields are clear with normal vascular markings.
The cardiomediastinal outline is normal. The included bones are remarkable.
Conclusion: Normal Chest
Date: July 5, 2016
Examination reveals the lung fields are clear. The cardiac silhouette is not enlarged. The thoracic aorta and pulmonary vessels are unremarkable. The diaphragm is sharp
and distinct. The trachea is in the midline. There are no bony abnormalities.
Conclusion: Essentially normal chest
CT-SCAN RESULT
Purpose:
Non-invasive diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices)
of the body.
July 04, 2016
BRAIN PLAIN AND CONTRAST
History:
Non-contrast and intravenous contrast-enhance axial C.T images head reveals the following findings:
A fluid and air filled cavity is noted in the right frontal region measuring 5.2 x 2.8 cm with very minimal rim enhancement (SP evacuation of right frontal hematoma) Minimal
pnuemoncephalus are also seen in the right frontal convexity.
Minimal structures are displaced to the left by about 0.5 cm.
Minimal right frontotemporopariteal subdural hematoma is also seen measuring 0.3 cm in maximal thickness.A craniectomy defect is noted in the right frontoparietal bones
with metallic sutures and drainage tube in the right frontoparietal scalp.
The rest of the parenchymal density is normal with no focal lesions evident. The gray white matter interface is maintained.
The rest of the ventricles are normal in size and configuration.
The basal cisterns are intact.
The sellaturcica and pineal gland are not unusual.
The included paranasal sinuses, petromastoids , orbits and bony calvaria are unremarkable.
Impression:
FLUID AND AIR FILLED CAVITY IN THE RIGHT FRONTAL REGION WITH VERY MINIMAL RIMENHANCEMENT LIKELY GLIOSIS WITH RESIDUAL EDEMA AND
MASS EFFECT (SP EVACUATION OF RIGHT FRONTAL HEMATOMA MINIMAL PNEUMOCEPHALUS SP CRANIECTOMY WITH METALLIC SUTURES AND
DRAINAGE TUBE IN PLACE
URINALYSIS
Purpose:
It evaluates a sample of urine. It involves examining the appearance, concentration and content of urine. It is used to assess bladder or kidney infections, dehydration
and diabetes.
July 07, 2016
MACROSCOPIC
Color LIGHT YELLOW
Appearance CLOUDY
pH 7.0
Specific Gravity NEGATIVE
Glucose NEGATIVE
ketone NEGATIVE
Blood NEGATIVE
Protein NEGATIVE
Bilirubin NEGATIVE
Urobilinogen NORMAL
Nitrite NEGATIVE
Ascorbic Acid NEGATIVE
MICROSCOPIC
RBC / HPF 0-1 HPF
WBC / HPF 0-1 HPF
Epithelial cells/ HPF 3-6 HPF
Amorphous materials MODERATE (URATES)
Bacteria RARE
TEST: Others Reference Value RESULT
Prothrombin time Control (100% Activity) 11.6 Patient: 12.7 sec
seconds % Activity 100%
IMPLICATION: Results are within normal range or is normal.
INR: 1.00 PROTHROMBIN TIME
Activated Partial N.V : 1-44.8 seconds 28.9 sec
Thromboplastin Time Purpose:
Bleeding Time N.V : 1-3 minutes ***
Clotting Time N.V : 2-6 minutes *** Prothrombin time (PT) is a blood test that measures how long it takes
Erythrocyte Sedimentation N.V : Male: 0-15 mm/hr *** blood to clot. A prothrombin time test can be used to check for bleeding
Rate: Female: 0-20 mm/hr problems. It is also used to check whether medicine to prevent blood
clots is working.
Child: 0-10 mm/hr
Reticulocyte Count: N.V : Adult: 0.5-1.5% *** June 29, 2016
Newborn: (0-7 days)
2.6-6.5%
2 yrs& above: 0-2%
Hemoglobin
Platelet Count (Manual): N.V : 140,000-440,000 ***
cu.mm
Fibrinogen Assay: ***
Remarks: Test not requested***
IMPLICATION:
The average time range for blood to clot is about 10 to 14 seconds but the reference value for this test is 11.6 seconds. A number higher than that range means it takes
blood longer than usual to clot.
BLOOD TYPING
PATIENTS Remarks
Blood Group: Group O Rh POS
COMPATIBILITY TEST
Date Donor No. Donors Blood Group Saline Hi-Protein Coombs

Taken by:
06/30/16 D16-0770 Group O Rh POS Compatible with patients serum
6;15 PM
D16-0771 Group O Rh POS Compatible with patients serum
IMPLICATION:
The patients blood type is type O Rh plus. A and B antibodies are present in her blood. Type O blood does not produce ABO antigens. Therefore, their blood
normally will not be rejected when it is given to others with different ABO types. With this, type O people are universal donors for transfusions, but they can receive only
type O blood.
OLD LABORATORY RESULTS( SIGNIFICANT FINDINGS)
SURGICAL PATHOLOGY
August 27, 2014
GROSS:
The specimen, labeled Right Frontal Lobe, Hematoma RO Cavernoma consists of 2 irregular pieces of clotted blood, each measuring 18 x 14 x 7 mm and 15 x 15 x 7
mm. Both pieces on section reveal an entirely hemorrhagic cut-surface A section from each piece is processed.
MICROSCOPIC:
Microscopic examination of two (2) tissue step-sections in a single slide shows mostly sheets of erythrocytes interspersed by irregular clumps of fibrin. Entrapped within
then are few scattered leukocytes and scanty glial tissue.
DIAGNOSIS:
TISSUE FROM RIGHT FRONTAL LOBE: HEMORRHAGE OF UNDETERMINED ETIOLOGY
MAGNETIC RESONANCE IMAGING
Purpose:
Magnetic resonance imaging (MRI) is a test that uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body. It gives
different information about structures in the body.
Reports: (August 25, 2014)
T1,T2, T2 FLAIR, DWI,SWI and T2* GRE sequences of the whole brain were done without intravenous contrast, including MR angiography of the anterior and posterior
macrocirculation of the brain.
The acute hemorrhage in the mesial right frontal lobe is again noted showing bright signal intensity on T1 and low signal intensity on T2-weighted images. There are
magnetic susceptibility artifacts noted on the SWI. There are also magnetic susceptibility artifacts noted in the trigone of both lateral ventricles, in the left cerebellum and
left side of the fourth ventricle . There is perifocal edema noted in the right frontal lobe causing subfalcine herniation of the right lateral ventricle to the left, bowing of the
falxcerebri to the left and or narrowing of the adjacent cortical sulci slyvian and interhemispheric fissure.
There is no area of infarction seen on the present study.
The brainstem and right cerebellum show normal signal characteristics. There is no mass lesion within blth cerebellopontine angle cisterns.
The internal auditory canals are not enlarged. The mastoid air cells are developed and clear. The cochlea and semicircular canals are symmetrical and normal in
appearance.
The ocular globes are normal in shape with smooth contours and homogenous internal contents. The extraocular muscles are symmetrical in size. The superior
ophthalmic veins are not dilated. The optic nerves display normal course and caliber. The optic chiasm is not displaced nor deformed.
The sellaturcica is not enlarged. The pituitary gland is normal in size. The pituitary stalk is centered in the midline.
The visualized paranasal sinuses are developed and pneumatized. The mucosa sinuses are thick.
The calvarium is normal in shape. There is no evidence of lytic bone destruction.
The MRA sequence show there is good flow in both internal carotid arteries. The middle cerebral
arteries arises from normally from both internal carotids forming normal insular loops.
The anterior cerebral arteries are situated slightly to the left of the midline due to the mass effect caused by the hemorrhage in the right frontal lobe. The anterior
communicating artery is not demonstrated.
The basilar artery receives its dominant supply from the left vertebral artery giving off normal-sized posterior cerebral and superior cerebellar arteries. The posterior
communicating arteries on both sides are patent.
There is no focal dilatation or narrowing seen.No signs of AV malformation is demonstrated.
The MRV sequence show no evidence of venous sinus thrombosis.
IMPRESSION: ACUTE HEMORRHAGE IN THE MESIAL RIGHT FRONTAL LOBE, AS PREVIOUSLY REPORTED ON THE NONCONTRAST BRAIN CT SCAN ON
AUGUST 24, 2014. THIS REMAINS UNCHANGED. THERE IS PERIFOCOAL EDEMA AND MASS EFFECT, AS PREVIOUSLY REPORTED.
OLD HEMORRHAGES IN THE LEFT CEREBELLUM WITHIN THE FOURTH VENTRICLE ON THE LEFT SIDE AND TRIGONE OF BOTH LATERAL VENTRICLES.
BILATERAL SPHENOID SINUSITIS.

X-RAY
Purpose:
Chest X-rays may provide important information regarding the size, shape, contour and anatomic location of the heart, lungs, bronchi, great vessels (aorta, aortic
arch, pulmonary arteries), mediastinum (an are of the middle of the chest separating the lungs), and the bones (cervical and thoracic spine, clavicles, shoulder girdle, and
ribs) Changes in the normal structure of the heart, lungs, and /or lung vessels may indicate disease or other conditions.
August 27,2014
Examination reveals there are patchy densities noted in the left lower lung field.
There is an E.T in good position. The cardiac silhouette is not enlarged.
Conclusion:
1.) Pneumonia LEFT lower lung
2.) E.T in good position
August 29,2014
Examination reveals there are patchy densities noted in the left lower lung field.
The cardiac silhouette is not enlarged. There are no bony abnormalities.
Conclusion:
1.) Pneumonia LEFT lower lung
2.) E.T in good position
MEDICATIONS
Acetylcysteine
C Mucolytic agent
A Exerts mucolytic action through its sulfhydryl group which opens up the disulphide bonds in the mucoproteins thus lowering mucous viscosity.
I The patient was given this medication because of her complaints of cough. This medication treats respiratory affections characterized by thick and viscous
hypersecretions.
C MAO inhibitor therapy within 14 days initiating therapy; severe hypertension; severe coronary artery disease, hypersensitivity to pseudoedephrine, acrivastine or any
component; renal impairment.
A Hypersensitivity reactions: bronchospasm, angioedema, rashes and pruritus. Nausea and vomiting, fever syncope, sweatin, arthralgia, blurred vision, disturbances of
liver function.
N Monitor the effectiveness of the treatment, monitor color of secretions, monitor signs of hypersensitivity reactions., monitor for S&S of aspiration of excess secretions,
and for bronchospasm (unpredictable); withhold drug and notify physician immediately if either occurs, nausea and vomiting may occur, particularly when face mask is
used, due to unpleasant odor of drug and excess volume of liquefied bronchial secretions.
Levetiracetam
C Anticonvulsant, Antiepileptic
A Modulation of synaptic neurotransmitter release through binding to the synaptic vesicle protein SV2A in the brain.
I The patient was given this medication due to her seizure precaution. This treats partial-onset, myoclonic, or generalized tonic-clonic seizures in patients with epilepsy.
C - Hypersensitivity to the medication
A Headache, drowsiness, fatigue, weakness, cough
N Monitor patient for seizure activity, ensure patients safety by raising siderails, monitor & notify physician of difficulty with gait or coordination, Monitor for behavioral
abnormalities, psychiatric symptoms, somnolence, and fatigue.
Azithromycin
C Macrolide Antibiotic
A Inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit of the bacterial 70S ribosome.
I The patient was given this medication due to her pneumonia. This medication is known to treat mild to moderate infections caused by certain bacteria.
C - Hypersensitivity to the medication
A Hypersensitivity reactions, CNS: dizziness, headache, vertigo, somnolence, fatigue; GI: diarrhea, abdominal pain, nausea and vomiting, dyspepsia, flatulence,
melena, pseudomembranous colitis.
N Monitor for hypersensitivity reactions, report severe or watery diarrhea, severe nausea or vomiting, rash or itching, mouth sores, vaginal sores, take the full course
prescribed. Do not take with antacids. Take with food if GI upset occurs.
Ranitidine
C Antacids, Antireflux Agents & Antiulcerants
A Blocks histamine H2-receptors in the stomach and prevents histamine-mediated gastric acid secretion.
I Short-term treatment of active duodenal ulcer, maintenance for duodenal ulcer at reduced dosage, treatment of erosive esophagitis. This was given to the patient to
prevent the increase of intracranial pressure.
C Porphyria, hypersensitivity
A Headache, dizziness, rarely hepatitis, thrombocytopenia, leucopenia, hypersensitivity, confusion, gynecomastia, impotence, somnolence, vertigo, hallucinations.
N Instruct patient to report any unusualities and hypersensitivity reactions, Report sore throat, fever, unusual bruising or bleeding, tarry stools, confusion, hallucinations,
dizziness, severe headache, muscle or joint pain.
Omeprazole
C Antacids, Antireflux Agents & Antiulcerants
A Supress gastric acid by specific inhibition of the H+/K+ ATPase enzyme system at the secretory surface of the gastric parietal cell.
I Treatment of duodenal ulcers, benign gastric ulcers, gastroesophageal reflux disease (GERD), heartburn and other symptoms associated with GERD, erosive
esopahagitis, and long term treatment of pathological hypersecretory conditions. This medication was given to prevent the increase of intracranial pressure of the patient.
C Hypersencitivity to omeprazole or its components.
A Diarrhea, nausea, vomiting, constipation, flatulence, acid regurgitation,dizziness,abdominal pain.
N Monitor for adverse effects and hypersensitivity reactions
Mannitol
C - Diuretics
A Increases urinary output by inhibiting tubular reabsorption of water and electrolytes. It raises the osmotic pressure of the plasma allowing water to be drawn out of
body tissues.
I The patient was given this medication because this medication is known to reduce intracranial pressure.
C Pulmonary congestion or pulmonary edema, intracranial bleeding, heart failure, renal failure & treat cerebral edema.
A Fluid & Electrolyte Imbalance
N Monitor input and output of the patient, monitor patient's urine color and odor
Lactulose
C - Laxative
A Promotes peristalsis by producing an osmotic effect in the colon with resultant distention
I The patient was given this medication because of her constipation.
C Low galactose diet & intestinal obstruction
A Abdominal discomfort associated with flatulence or cramps. Prolonged use or large doses may result in diarrhea with excessive loss of water & electrolytes.
N Monitor F & E imbalances in the patient by monitoring the input and output pf the patient.
PRN Medications
Diazepam
C Anti-epileptic
A It increases neuronal membrane permeability to chloride ions by binding to stereospecific benzodiazepine receptors on the post synaptic GABA neuron within the CNS
and enhancing the GABA inhibitory effects resulting in hyperpolarization and stabilization.
I Management of seizures
C Hypersensitivity, respiratory depression
A CNS: sedation, depression, lethargy, apathy, fatigue, disorientation, restlessness, confusion; CV: bradycardia, tachycardia, CV collapse, hypertension, hypotension
and edema; GI: constipation, diarrhea, dry mouth, salivation,nausea and vomiting
N Monitor patient for hypersensitivity reactions, instruct patient to report any unusualities that is cause by the drug
Paracetamol
C - Analgesics
A Decreases fever by inhibiting effects of pyrogens on the hypothalamus heat regulating centers & by a hypothamic action leading to sweating and vasodilation.
Relieves pain by prostaglandin synthesis at the CNS but does not have anti-inflammatory action because of its minimal effect on peripheral prostaglandin synthesis.
I Relief of mild-to-moderate pain; treatment of fever
C Hypersensitivity, intolerance to tartarzine, alcohol, table sugar, saccharin, allergy to acetaminophen
A stimulation, nausea and vomiting, abdominal pain, hypersensitivity
N instruct patient to recognize signs of chronic overdose: bleeding, bruising, malaise, fever, sore throat.
Nalbuphine
C Analgesics (opioid)
A Inhibits ascending pain pathways, alters the perception of and response to pain by binding to opiate receptors in the CNS. It also produces generalized CNS
depression.
I Relief of moderate to severe pain including that associated with MI. As adjunct to anesthesia.
C Acute respiratory depression & obstructive airway disease; acute alcoholism, convulsive disorders, head injuries and conditions with increased intracranial pressure;
comatose patients. Concomitant MAOI therapy or with in 14 days of discontinuing such treatment.
A Headache; nausea and vomiting
N Monitor patient's pain scale, instruct patient to report any unusualities such as headache, nausea and vomiting.
Bisacodyl
C Laxatives
A acts upon contact with the colonic mucosa where it stimulates the sensory nerve endings that results to increased peristaltic contractions of the large intestine to
produce soft well-formed stools.
I - Constipation
C Ileus, intestinal obstruction, acute surgical abdominal conditions; severe dehydration. Appendicitis and acute bowel diseases
A Rarely abdominal discomfort and diarrhea
N Monitor patients input and output as well as patients stool form and color.
DISCHARGE PLAN
MEDICATIONS
Instructed SO to let patient take full course of medications prescribed by the physician at the right time, route and dosage and not to abruptly stop taking the
medication to avoid tolerance of the medication.
Instructed SO to make sure patient does not skip doses, and to take the medication with good compliance to meet the therapeutic action.
Instructed SO to let patient avoid taking OTC drugs without consulting physician so that it cant make the underlying cause of the side effects.
ENVIRONMENT
Instructed SO to avoid having patient go to crowdy places for the mean time.
Instructed to take patient away from those who have colds, cough, or other infectious diseases.
Encouraged to maintain a pleasant and therapeutic environment such as cleaning the surroundings especially those places where food is kept, arranging things in
such a way where sharp objects and other injury causing materials are kept in their proper places, and keeping an environment conducive for rest and sleep.
Reinforced importance of safety wherever patient goes.
TREATMENT
Instructed SO to seek medical attention immediately if any unusuality or problem occurs such as headache, muscle weakness, bleeding and balance problems.
Advised to have follow-up check-ups as instructed by the physician.
Encouraged to comply and adhere to doctors instructions or orders.
Instructed to report any unexpected unusualities or abnormalities.
Encouraged to contact health care provider for any questions regarding condition or care.
HEALTH TEACHINGS
Advised to have adequate rest and sleep.

Instructed patient not to engage in any strenuous activities.
Encouraged patient and SO in doing diversional activities such as watching TV, listening to music, and reading books to relieve stress.
Instructed to maintain patients hygiene practices.
Encouraged patient and family to perform frequent handwashing.
Advised to have a diet rich in vitamins and minerals to help boost immune system.
OBSERVABLE SIGNS AND SYMPTOMS
Instructed SO to report immediately to the nearest healthcare facility for any unusual symptoms.
Encouraged to consult physician if any adverse effects occurs to the patient.
DIET
Instructed SO to observe cleanliness in preparing food.

Advised to have a healthy well-balanced diet that is rich in vegetables and fruits.
Encouraged to avoid eating junk food and canned goods.
Instructed to limit intake of foods high in fats and sodium content.
Encouraged to follow prescribed diet.
Encouraged to drink at least 8 glasses of water a day.
SPIRITUALITY
Encouraged to pray to God for healing.
Encouraged to always stay faithful to God.
Advised patient and family to always trust in God and believe that He always has wonderful plans purpose for each one of us.
Advised to always be strong and optimistic in facing changes that they may encounter in life.
Encouraged the significant others to be patient and supportive towards the patient
Encouraged SO and patient to never lose hope.
Key Issues Desired Outcome Interventions Actual Outcome
Date: June 30,2016 After 8 hours of student After 8 hours of student nurse-
nurse-client intervention, the client intervention,
Impaired Physical patient will have a 1. Monitored signs of muscle weakness such fatigue, tremors and uncontrollable
mobility related to significant improved movements Day 1
decreased muscle wellness of muscle strength R: Determining the cause of a disease can help direct appropriate interventions. Patient still was manifesting
strength and generalized such a full muscle strength signs of impaired physical
weakness and improved grading scale 2. Encouraged patient to perform self-care activities such as changing clothes mobilitysuch as having
of ADL's. and self-perineal care, tremors of arms when asked
SB: Alteration in mobility R: This may exercise her muscles and may patient may gain the feeling of being to raisen it up and straighten.
may be a temporary or independent on his own She still needs assistance in
more severe problem. performing basic activities
Most disease and acute 3. Kept necessary utensils within reach of patient such as doing self-care
and chronic states R: This can greatly reduce the risk of accident to the patient and reduce the risk activities
involve some degree of fatigue
slight immobility (e.g., as Day 2
seen in hyperthermia, 4. Provided assistance for range of motion exercise. Patient was still manifesting
dizziness, infection) R: Improves and maintains the functions of joints alignment of extremities and the same signs of Impaired
Source: reduces venous stasis Physical mobility.
https://www.coursehero.c
om/file/7308659/NCP-
CVA-Impaired-Physical-
Mobility/
KEY ISSUES OBJECTIVES INTERVENTIONS DESIRED OUTCOME
Date Identified: June 30, Within two days of student nurse- 1. Determined outside stressors: family, work, future healthcare After 8 hours of student
2016 patient interaction, the patient needs nurse-patient interaction, the
would be able to: R: Helps identify specific needs, provides opportunity to offer information and patient:
Ineffective coping related Verbalize acceptance of begin problem-solving. Consideration of social factors, in addition to functional
to stress and physical status, is important in determining appropriate discharge destination. June 30, 2016
self in situation.
disability as expressed by SO expressed
the SO Haaaay, Unsaon Talk/communicate with 2. Assessed extent of altered perception and related degree of positive outlook.
nalang ni siya ing.dako SO about situation and disability. Determine Functional Independence Measure score.
niya, magkalisod jud ni changes that have R: Determination of individual factors aids in developing plan of care/choice of
siya. interventions and discharge expectations.
occurred.
Scientific Basis: Verbalize awareness of 3. Identified the meaning of the dysfunction and change to
Inability to form avalid own coping abilities. patient. Note ability to understand events, provide realistic
appraisal ofthe Meet psychological appraisal of the situation.
stressors,inadequate R: Some patients accept and manage altered function effectively with little
needs as evidenced by
choicesof adjustment, whereas others may have considerable difficulty recognizing and
practicedresponses,and/or appropriate expression adjust to deficits. In order to provide meaningful support and appropriate
inabilityto use of feelings, identification problem-solving, healthcare providers need to understand the meaning of the
availableresources. of options, and use of stroke/limitations to patient.
Reference:
resources.
Doenges, 4. Provided psychological support and set realistic short-term
Moorhouse&MurrsNurses goals. Involve the patients SO in plan of care when possible
Pocket and explain his deficits and strengths.
Guide edition 12 p257 R: To increase the patients sense of confidence and can help in compliance
to therapeutic regimen.
5. Encouraged patient to express feelings, including hostility or

anger, denial, depression, sense of disconnectedness.
R: Demonstrates acceptance of patient in recognizing and beginning to deal
with these feelings.
6. Noted whether patient refers to affected side as it or denies
affected side and says it is dead.
R: Suggests rejection of body part and negative feelings about body image
and abilities, indicating need for intervention and emotional support.
7. Acknowledged statement of feelings about betrayal of body;

remain matter-of-fact about reality that patient can still use
unaffected side and learn to control affected side. Use words
(weak, affected, right-left) that incorporate that side as part of
the whole body.
R: Helps patient see that the nurse accepts both sides as part of the whole
individual. Allows patient to feel hopeful and begin to accept current situation.
8. Identified previous methods of dealing with life problems.

Determine presence of support systems.
R: Provides opportunity to use behaviors previously effective, build on past
successes, and mobilize resources.
9. Emphasized small gains either in recovery of function or

independence.
R: Consolidates gains, helps reduce feelings of anger and helplessness, and
conveys sense of progress.
10. Supported behaviors and efforts such as increased

interest/participation in rehabilitation activities.
R: Suggest possible adaptation to changes and understanding about own role
in future lifestyle.
11. Monitored for sleep disturbance, increased difficulty

concentrating, statements of inability to cope, lethargy,
withdrawal.
R: May indicate onset of depression (common after effect of stroke), which
may require further evaluation and intervention.
Key Issues Objectives Interventions Outcome

Date Identified: June 30, 2016 After 8 hours of patient- Environmental management: After 8 hours of patient student
student nurse nurse interaction the patient was
interaction the patient Provided an environment adequate for rest and sleep able to:
Altered Comfort related to body will be able to: Physical
weakness as verbalized by the Rest and sleep
patient, di ko komportable sa Rest and relax Ascertain what has been tried or is required for comfort or rest Do collaborative comfort
akong sitwasyon karon kay perme Verbalize sense Provided age-appropriate comfort measures measures
ko ga luya. of comfort and Psychospiritual Verbalized sense of
contentment comfort and contentment
Participate in Determined how psychological and spiritual indicators overlap for of her situation
SB: Perceived lack of ease, relief, desirable and client
and transcendence in physical, realistic health- Encouraged verbalization of feelings and made time for
psychological, spiritual, seeking listening/interacting
environmental and social behaviors
dimensions.
KEY ISSUES DESIRED OUTCOME INTERVENTIONS ACTUAL OUTCOME
Date Identified: June 30,
2016
Within 2 days of 8 hours 1. Determined cause of activity intolerance related to fatigue and determine After 8 hours nurse-patient
Activity Intolerance nurse-patient care patient will : whether cause is physical, psychological, or motivational. care:
related to generalized R/: Determining the cause of a disease can help direct appropriate interventions.
weakness and debilitation -Patient is able to provide Day 1
secondary to acute or positive verbal feedback in 2. Assessed client daily for appropriateness of activity and bed rest orders. Patient still was manifesting
chronic illness and disease. response to activity level R/ : Inappropriate prolonged bed rest orders may contribute to activity intolerance. signs of activity intolerance
-Patient is able to display and such as decreased in
SB: Factors that can lead to use effective energy 3. Performed range-of-motion exercises if client is unable to tolerate activity. performance during sitting
activity intolerance may management/conservation R/ : Inactivity rapidly contributes to muscle shortening and changes in periarticular posting. She still needs
include side effects of techniques and cartilaginous joint structure. These factors contribute to contracture and assistance to her activities
medication, extended bed -Patient is able to perform limitation of motion such as standing up and
rest, living a sedentary basic activities without turning to sides due to her left
lifestyle, regular restrictions excessive exhaustion or loss 4. Allowed for periods of rest before and after planned exertion periods such as sided weakness.
to healthy activity levels, of energy meals, baths, treatments, and physical activity.
improper oxygen supply / -Patient is able to display R/ : Rest periods decrease oxygen consumption Day 2
demand balance, pain, physiological improvements Patient was still manifesting the
deprived or low-quality over time 5. Provided emotional support and encouragement to client to gradually increase same signs of activity
sleep, depression, lack of activity. intolerance.
motivation and severe R/ : Fear of breathlessness, pain, or falling may decrease willingness to increase
stress. activity.
Source: http://www.nanda-
books.com/2015/01/activity 6. Obtained any necessary assistive devices or equipment needed before
-intolerance-related-to- ambulating client (e.g., walkers, canes, crutches, portable oxygen).
fatigue.html R/ : Assistive devices can increase mobility by helping the client overcome
limitations.
KEY ISSUES OBJECTIVES INTERVENTIONS OUTCOME
Date Identified: June 30,
2016
Constipation related to Within two days of student 1. Assessed bowel sounds. After two days of student
decreased physical nurse-patient interaction, the R: Presence of bowel sounds indicates active intestinal motility. nurse-patient interaction, the
mobility as verbalized by patient would be able to: patient:
the S.O. Wala pa Pass out stools at 2. Encouraged to increase fluid intake as tolerated.
siyakalibangpero before frequency perceived as normal R: Not drinking enough fluids reduces the speed at which stool moves through the June 30, 2016
siyana admit diri kay to the patient colon. Abdominal clicks: 4
kaduhaman siyasa is aka Patient and S.O. will be clicks/min on all quadrants.
kasemanamakalibang, able to perform and apply 3. Evaluate patients drug regimen.
secondary to activity health teachings given. R: There are certain drugs that cause/exacerbate constipation. Did not pass out stools.
intolerance.
4. Assessed physical mobility.
Scientific Basis: R: Lack of physical mobility is often a factor that affects contractions of intestines. July 1, 2016
A period of immobility Did not pass out stool
results in a weakening of 5. Encouraged to eat foods rich in fiber such as corn, wheat and green leafy
the abdominal wall vegetables.
muscles, leading to R: To enhance ea3sy defecation.
difficulty in raising the
intra-abdominal pressure 6. Encouraged a regular time for defecation.
sufficiently for R: Defecation after a routine daily allows the body to form a habit and encourages the
defecation.Constipation body to pass stools daily
means different things to
different people. For many
people, it simply means
infrequent stools. For
others, however,
constipation means hard
stools, difficulty passing
stools (straining), or a
sense of incomplete
emptying after a bowel
movement. The causes of
each of these symptoms
of constipation vary, so
the approach to each
should be tailored to each
specific person.
Source:
Kyle, G. (2007). A guide to
managing constipation:
part two. Nursing Times.
103(19), 42. Retrieved
from
http://www.nursingtimes.n
et/http://www.medicinenet.
com/constipation
KEY ISSUES OBJECTIVES INTERVENTIONS OUTCOMES
Date Identified: July 30,

2016
Within two days of student Independent Nursing Interventions: After two days of student nurse-
1. Hyperthermia related nurse-patient interaction, the 1. Assessed and monitored patients core temperature q2h. patient interaction, the patient:
to hemorrhage in the patient would be able to: R: Temperature of 38.9-41.1C suggest deterioration in infectious disease process
mesial right frontal lobe
associated associated by Demonstrate a
temperature within the June 30, 2016
increased metabolic 2. Promoted bed rest, diversional activities and encouraged relaxation skills
normal range-- from
expenditure as R: To reduce metabolic demands and oxygen consumption. Temperature was
37.9C to 36.5C to
manifested by a 37.5C/axilla already in normal range
temperature of 37.9 Demonstrate behaviors T= 37.4C/axilla after
Celcius/axilla and skin is to monitor and promote TSB was done
3. Provided TSB as needed. Slept for 2 hours straight
warm to touch, hyperthermia R: Heat is lost by evaporation and conduction.
secondary to patients Identify underlying and increased her fluid
causes/contributing intake after eating
post-traumatic mild brain
factors and importance breakfast
injury
of treatment, as well as 4. Promoted surface colling, loosened clothing and cool environment.
s/s requiring further R: Heat is lost by convection
July 1, 2016
interventions
Scientific Basis: Temperature was still in
5. Discussed the importance of adequate fluid intake and protein diet.
R: To prevent dehydration and aid in the repair of body tissues normal range
Hyperthermia, frequently
T=37.2C/axilla
seen in patients following Wore loose clothing &
a post-traumatic brain did not manifest
Collaborative Interventions:
injury (PTBI), may be sweating
KEY ISSUES OBJECTIVES INTERVENTIONS OUTCOMES
due to posttraumatic Skin is not as warm and

cerebral inflammation, 1. Administered medications as indicated to treat underlying cause such as: flushing was not noted.
intracranial hemorrhage, Demonstrated behaviors
Paracetamol 1 tab PRN to monitor and promote
or secondary infection
R: Paracetamol can relieve pain and reduce hyperthermia normothermia.
resulting in fever.
Regardless of the Took a nap and was
2. Administered replacement of fluids and electrolyres to support circulating read a storybook as
underlying cause, volume and tissue perfusion. form of diversional
hyperthermia increases D5LR 1L @20cc/hr activity
metabolic expenditure, R: To prevent dehyration and maintain normal fluid and electrolyte volume
Verbalized
glutamate release, and understanding on the
neutrophil activity to causes and underlying
levels higher than those factors of the disease
occurring in the and is ready to practice
normothermic brain- specific interventions to
prevent hyperthermia.
injured patient.
Source:
http://www.ncbi.nlm.nih.g
ov/pubmed/12742737
KEY ISSUES DESIRED OUTCOME INTERVENTIONS ACTUAL OUTCOME
Date Identified: June 30, 2016
Fatigue related to reports Within 2 days of 8 hours 1. Obtained clients descriptions of fatigue After 8 hours of student-nurse
inability to maintain usual student-nurse patient R: To assist in evaluating impact on clients life patient care:
routines or usual level of care patient will: 2. Assisted patient in a comfortable position.
physical activity secondary to left - Report improved R: To provide comfort. June 30, 2016 (Thursday)
sided hemiparesis as manifested sense of energy 3. Noted age, gender and developmental stage. Patient still was manifesting
by muscle weakness on the left - Perform activities of R: Some studies, show a prevalence of fatigue more often in females than signs of fatigue such as
side, lack of energy, somnolent daily living and males decreased performance and
in level of consciousness and participate in desired 4. Monitored vital signs. feeling sleepy after having an
impaired memory or activities at level of R: To evaluate fluid status and cardiopulmonary response to activity. adequate sleep. She still needs
concentration. ability 5. Schedule activities for periods when client has the most energy. assistance to her activities
- Increase performance R: For energy conservation and to maximize participation. especially when she wants to
SB: Fatigue is physical and 6. Instructed patient about the methods to conserve energy such as saying no or change position such as sitting
/or mental exhaustion that can b later for an answer due to her left sided weakness.
e triggered by stress, R: To have adequare rest Patient is always asleep and at
medication, overwork, or mental 7. Noted daily living patterns. rest. There is still lack of energy
andphysical illness or disease. R: Helpful in determining pattern/timing of activity and difficulty remembering any
Physically, fatigue is characteriz 8. Provided environment conducive to rest. events during the day.
ed by a profound lack of energy, R: To help promote increase energy level.
feelings of muscle weakness, an
d slowed movementsor central n July 1, 2016 (Friday)
ervous system reactions. Fatigu Patient is seen awake and has
e can also trigger serious mental minimal increase in energy
exhaustion. Persistent fatigue ca because she is attentive when
n cause alack of mental clarity (o having a conversation. She still
r feeling of mental "fuzziness"), d looks tired even after sleeping.
ifficulty concentrating, and in so There is a need of constant
me cases, memory loss. stimulation in waking up of the
Source: Fatigue. (n.d.). patient. Left sided weakness is
Retrieved July 10, 2016, from still present but can raise
http://medical- partially the left arm and legs
dictionary.thefreedictionary.com/f when told to rise. Patient still
atigue sleeps when doing nothing.
KEY ISSUE DESIRED OUTCOME INTERVENTIONS ACTUAL OUTCOME
Date Identified: July 7, 2016
Altered Body Defenses related After 8 hours of student The student nurse: After 8 hours of student nurse-
to surgical incision on the head nurse-client 1. Monitored for signs of infection such as redness, swelling, purulent client intervention, the patient
as manifested by elevated White intervention, the patient discharges and elevated body temperature did not manifest any
Blood Cell Count will have no R: With the onset of an infection, the immune system fights it off and signs signs/symptoms of infection
signs/symptoms of of infection appear such as redness, swelling and
WBC Results as of July 7,2016: infection such as 2. Advised SO to monitor closely patients body temperature purulent discharges.
R: Body temperature provides cues to an infection, inflammation and
absence of purulent
indicates efficacy of treatment
WBC = 17.4 K/Ul drainage wound and
3. Educated client and SO on thorough handwashing before and after coming
(Normal value = 4.10- elevated body
in-contact with the bandage/wound area
10.9 k/uL) temperature. R: Handwashing is the most important means of preventing the spread of
microorganisms
SB: 4. Advised SO of letting patient eat adequate protein and caloric intake for
An open wound carries healing.
significant risk for wound R: Tissure repair requires increased protein and carbohydrates. Deficiency
contamination and subsequent in protein contributes to poor healing rates, because withought getting
infection. Contamination of a enough protein, the body finds it difficult to form collagen (substance that
wound surface by a holds the whole body together which also forms a scaffold to provide
microorganism can interfere with strength and structure). Energy aids in healing and carbohydrates is the
a healthy surface condition that key source of this energy.
leads to infection. 5. Encouraged adequate rest to bolster the immune system
R: Chronic disease, physical, and emotional stress increases the clients
Infection occurs when an need for rest
6. Encouraged to increase intake of fluids
organism is able to colonize and
R: Fluid intake helps hin secretions and replaces fluid lost especially during
multiply within a host. An
fever
infection causing microorganism 7. Advised SO to assess incision site for color, moisture and temperature and
must have virulence, be report to physician in unusualties are noted
transmitted from its reservoir R: Skin assessment facilitates in the prevention of skin breakdown. Intact
and gain entry into the skin is natures first line of defense against microorganism entering the
susceptible host. When an body
immune system is alerted that 8. Followed strict aseptic measures like handwashing before touching the
an invader has entered the body, patient
cytokines send a message to R: This prevents the spread of microorganisms which may worsen
phagocytes to attack the condition
9. Observed if there is pain accompanying the surgical procedure
infection. Lymphocytes and
R: Pain is a subjective experience and must be described by the client to
other white blood cells also
plan effective treatment regimen
begin to attack the
microorganism.The result of this
activity often results in a fever
and causes the blood vessels to
enlarge in order to increase the
amount of blood containing
phagocytes and lymphocytes to
the site of infection. (Lemone
2011 pp 270-273, 292)
KEY ISSUE OBJECTIVES NURSING INTERVENTIONS Desired Outcome
Date Identified: June 30, 2016
Caregiver role strain related to Within 2 days of student 1.Assessed, evaluate, decide what kind of support you need and dont need to the Date: June 30, 2016 July 1,
post surgery and hemiparesis nurse and caregiver family or caregiver. 2016)
secondary to brain tumor. interaction the caregiver R-As primary caregiver for the patient, your family and friends may have
Strain scale 1-10 strain will be lessen to expectations for how you should care for the patient. After 2 days of student nurse
scale of 0 and caregiver interaction, the
SB: 2.Encouraged caregivers to express frustration as well as guilt when trying to care caregiver strain lessened to the
The diagnosis of a brain tumor for the patient and handle all of the responsibilities of a household and other family scale of 2.
can have a major and long- members.iii
lasting impact on the entire R-opportunity to experience greater closeness.
family. Relationships can be both
strengthened and strained. 3. Explained to the child the disease in an age appropriate manner.
Families may band together at R-can help facilitate healthy coping and adjusting. of various ages .
the beginning of the disease but
fall apart as the disease 4. Identified tasks that are routine and tasks that involve hands-on patient care
progresses or the opposite can R- Talk to your loved one about the tasks that need to be accomplished, and
occur. Regardless of the familys involve him or her in doing tasks.
reaction, studies have shown
that brain tumor patients and
their relatives often need more
support than do patients
diagnosed with other types of
cancer.i
Every family reacts to a brain
tumor diagnosis in its own way.
Your own reaction, and the
reaction of your relatives, will
depend on your own
backgrounds how you have
dealt with difficulties in the past,
your knowledge of cancer and
hospital care, and the support
you find in your community.
Caregivers Project /
OsherCenter for Integrative
Medicince University of
California, San Francisco
KEY ISSUES DESIRED OUTOME INTERVENTIONS ACTUAL OUTCOME

Date Identified: June 30,2016 After the 2 days of 8 hours of nursing 1 Assessed clients muscle strength, June 30, 2016
interventions, the patient will be able to gross and fine motor coordination (Day 1)
Self Care Deficit related to left sided perform the following: R: To identify probable
management of care
weakness as manifested by patient After 8 hours of nursing intervention, the
needed assistance when positioning, Do atleast minimal improvement of 2 Determined individual strengths patient was seen lying down, and still
changing of clothes and feeding. The SO movement from her affected body and skills of the client needed assistance in doing her ADLs
also verbalized, Kinahanglannaajud nay part R: To identify plan of care and to such as feeding, toileting, changing of
mu tabangniya. know clients needs for assistance. clothes. She was free from foul odor after
Will show improvement upon she was changed with her clothing.
cooperating with caregiver in doing
SB: Alteration in physical ability may 3 Do hand washing before and after July 1, 2016
her ADLs.
interfere with the individuals performance handling the patient
(Day 2)
R: To prevent the spread of
of activities of daily living. Patients who Will manage to turn to side while microorganisms
are unable to participate on their own are lying on bed by grasping to side After 8 hours of nursing intervention, the
dependent upon others to meet basic rails as a support upon moving. 4 Assisted in changing wet and dirty patient still needed support in positioning
needs and are at risk for problems such as clothes with clean one on her bed. The patient was still
poor hygiene. Self-care refers to those R: Clean clothing will make the dependent on her mother in doing ADLs.
activities of an individual performs patient feel comfortable
independently throughout the life to
5 Provided for communication among
maintain personal well-being. those who are involved in caring for
or assisting the patient
Source: Kozier, 2007; Gulanick, 2007; R: Enhances coordination and
continuity of care
Neal, 2004
6 Assisted and support family with

alternative placements as
necessary
R: To enhance likelihood of finding
individually appropriate situation to
meet clients need.
APPENDIX A
LEGEND
Male
Female
Deceased Male
Deceased Female
Patient X
X
Alive Alive &

with Well
Alive &
HPT
Well
Alive
&Well Alive Alive & Alive Dad Mom Alive & Alive Alive
Dad
&Well Well &Well &Well
Well &Well
HOST:
-A.V.M (9 YEARS OLD)
-HAD PREVIOUS PNEUMONIA
LAST 2014
INFECTIOUS AGENT MEDULLA OBLONGTA

PENETRATES AIRWAY STIMULATED & PRODUCES
MUCOSA & MULTIPLY IN COUGH
ALVEOLAR SPACES.
WBCS MIGRATE TO INFECTION NONPRODUCTIVE COUGH

CAUSING CAPILLARY
LOWERED HOST
LEAK,EDEMA & EXUDATE
DEFENSE
WBC- 24.4K/ul (6/26/16) HYPERTHERMIA
NEU- 21.588 (6/26/17)
(37.9 C
ALVEOLAR COLLAPES
A
FLUID COLLECTION IN &

AROUND ALVEOLI & THE CRACKLES NOTED ON LEFT
WALLS THICKEN LOWER LUNG DURING DAY
REDUCING GAS 1 OF PE
EXCHANGE
HYPOXEMIA TACHYPNEA
CAPILLARY LEAKS TACHYCARDIA
SPREAD INFXN TO OTHER
AREAS IN THE LUNGS
FIBRIN & EDEMA OF
INFLAMMATION
STIFFEN LUNGS
ALVEOLAR DECREASE VITAL

COLLAPSE CAPACITY

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VELEZ COLLEGE COLLEGE OF NURSING

F. RAMOS STREET, CEBU CITY

Amazona, Jian Lyndon C. Duhaylungsod, Lance Christian S Tamboboy, Honey Ediah P.

Barja, Kate E. Medalla, Patricia Andrea M. Tejada, Heartie Joy P.

Sato, Marlyn B. Monte, Ken Levy Yap, Tonelly Amor S.

Tan, Gemvirle A. Quinto, Giselle Mariz P.

Ugmarez, Mary Frances Claire L. Sipalay, Lustre Claire G.

Mrs. Jessica L. Dicdican, RN, MN

POST TRAUMATIC BRAIN INJURY SYNDROME

What is a Traumatic Brain Injury (TBI)?

Moderate to severe traumatic brain injuries

Common events causing traumatic brain injury include the following:

Communication problems may include:

Problems involving senses may include:

Tests and diagnosis

Surgery may be used to address the following problems:

Treatments & Rehabilitation

Signs and Symptoms:

Types and Causes of Pneumonia

Can Pneumonia Be Prevented?

What Are Risk Factors?

1. Skull/Cranium Major Regions of the Brainstem:

Structures / Regions related to the Cerebrum

The respiratory system (called also respiratory apparatus, ventilatory

Parts Of the respiratory system:

Very slightly attached CLIENT

COMPLETE BLOOD COUNT

Date: June 26, 2016 22:56

COMPONENT NORMAL VALUES

June 29, 2016 9:48

COMPONENT NORMAL VALUES

Low RBC Distribution Width (RDW)

COMPONENT NORMAL VALUES

Low Hemoglobin, Hematocrit

July 07, 2016 18:05

COMPONENT NORMAL VALUES

Low Hemoglobin, Hematocrit

Low RBC Distribution Width (RDW)

June 27,2016 8:43AM

Analyte Result Normal Range Result

Result is within normal range

July 7, 2016 2:54-59PM

Analyte Result Normal Range Result

Result is within normal range

CREATININE BLOOD TEST

June 29, 2016 02:04

Test Result Unit Flag Reference Range

LIPID PANEL TEST & BLOOD GLUCOSE TEST

Lipid Panel Test

Blood Glucose test

July 06, 2016 07:34

Test Result Unit Flag Reference Range

GLUCOSE 107.34 mg/dl 75.00 - 115.00

July 05, 2016 11:05 am

Result is within normal range

Date: June 26, 2016

Date: July 5, 2016

Conclusion: Essentially normal chest

July 04, 2016

BRAIN PLAIN AND CONTRAST

Minimal structures are displaced to the left by about 0.5 cm.

The basal cisterns are intact.

The sellaturcica and pineal gland are not unusual.

July 07, 2016