Chronic inflammatory

demyelinating polyneuropathy
(CIDP) is an acquired autoimmune
disorder affecting peripheral nerves
caused by a demyelinating process,
producing sensory loss and positive
sensory symptoms as well as motor
weakness.
 CIDP is closely related to
GuillainBarr syndrome and it is
considered the chronic counterpart
of that acute disease. Its symptoms
are also similar to progressive
inflammatory neuropathy.
 Its prevalence may be as high
as 9 per 100,000 population. It is
more common in men than in
women with a ratio of 2:1. The
diagnosis is the same with GBS.
 CIDP could be diagnose
with the history. The signs and
symptoms experienced must
exceed up to 8 weeks for it to
be diagnosed CIDP.
 The disorder is sometimes
called chronic relapsing
polyneuropathy (CRP) or chronic
inflammatory demyelinating
polyradiculoneuropathy (because
it involves the nerve roots).
 Choosing the case is indeed a challenge
for the group. Aside from its complexity, it
is our first time to encounter such case.
However, with the available time that we
have given for this study, we know that we
have learned much more we have than we
have expected.
PATIENTS PROFILE
Name of Patient: SUPERMAN
Age: 24 years old
Sex: Male
Occupation: Finance Consultant at
DSWD-Kalahi Office
Civil Status: Single
Religion: Roman Catholic
Address: Brgy. Camp Sawi,
Pinag-iwanan City
Nationality: Filipino
Date of Admission: March 19,
2017
Admitting Physician: Dr. Eder
Admitting Diagnosis: Ventilator
Assisted Pneumonia to be
considered Guillain Barre
Syndrome
PRESENT HEALTH HISTORY
One month prior to admission at
Divine Word Hospital, patient
experienced fever, cough and colds.
According to her mother, her son
took over-the-counter drug bioflu
every 4 hours.
 Two weeks PTA, patient experienced
numbness, tingling sensation, weakness
in both feet and inability to move the feet
that subsequently ascends up to the
knee.
On his second day of hospitalization,
he had Acute Respiratory Failure that
prompted the medical team
to insert tracheostomy tube
attached to a mechanical
ventilator.
His paralysis made him
immobile for two weeks that
prompted them to seek medical
assistance.
 On his third hospitalization, he has
been prescribed to undergo
hemodialysis due to renal insufficiency
due from a possible renal vein
thrombosis. His mother added that he
had undergone hemodialysis 3 times in
Divine Word Hospital.
 On March 19, 2017, his family decided
to transfer him to Eastern Visayas
Regional Medical Center due to financial
constraints. According to his uncle
nabayad gud hira hin 80 thousand kada
adlaw amo nga ginbalhin hiya ngadi kay
barato man la. Patient was seen and
examined by Dr. Eder, hence admission.
 On his third hospitalization, he
was referred for rehab for physical
therapy. Last April 25, 2017 patient
was slowly weaned from
Synchronized Intermittent Mandatory
Ventilation to continuous positive
airway pressure with FIO2 at 30% on
both modes.
 Patient complains difficulty of
breathing that prompted reuse of
SIMV then CPAP intervally.
On April 26, 2017 he was referred
to Psychiatric Department for
Psychiatry consultation yet no
consultation was done as of April 26,
2017 at 3:00PM.
PAST HEALTH HISTORY
According to her mother, patient was
hospitalized at the age of three due to
dehydration secondary to diarrhea. He
had no other hospitalization other than
this. Patient had complete vaccination
during his childhood. No known allergy to
any food and drug. Non smoker and
alcoholic consumption.
FAMILY HEALTH HISTORY
According to his mother, they had
no hereditary neurological disease.
On his maternal side, they have a
familial disease of hypertension and
colon cancer on his paternal side.
 GORDONS
FUNCTIONAL
HEALTH PATTERN
NUTRITIONAL METABOLIC PATTERN
Before admission patient eats 1-2 cups
of rice and an ample of viand. His
estimated weight is 67 kg.
During admission, patient has
Nasogastric Tube for blenderized feeding .
His usual intake is 2000mL. His estimated
weight is 40 kg according to the patient.
ELIMINATION PATTERN
Before admission, patient
eliminates once a day usually in the
morning and voids about 4 to 5
times a day with yellow colored
urine. Patient claimed that he has no
difficulty and pain when voiding.
 During admission, patient has
Foley bag catheter attached to
urobag draining to yellow colored
urine with usual output of 1200 mL
per day. His mother added that they
have been changing the patients
diaper usually 3-5 times day.
SLEEP-REST PATTERN
Before and during
admission, patient sleeps
atleast 8-10 hours a day.
Patient does not use sleeping
pills that can aid in his sleep.
ACTIVITY- EXERCISE PATTERN
Before admission, the
patient can perform his
activities of daily living such
as bathing and toileting.
 He also plays basketball in his leisure
time during weekends with no limitations.
Patient works as a finance consultant at
DSWD-Kalahi Office.
During Admission, patient is unable to
perform his ADL and need assistance.
Patient has hypoflexia on both
extremities.
COGNITIVE-PERCEPTUAL PATTERN

Patient speaks waray-waray. He is

an accountancy graduate and works
as a finance consultant at DSWD-
Kalahi office. Patient does not use
eyeglasses and hearing aid.
Role Relationship Pattern
During Admission, patient is
attended by his mother, cousin,
brother and uncle.
SUMMARY OF SIGNIFICANT FINDINGS
crackles upon auscultation
hyporeflexia on both extremities
muscle strength of 2/5
Glasgow Coma Scale of E4, V5, M6
Sacral area ulcer Stage III with
measurement of 6cm length, 5cm
width, and .5 cm depth
LABORATORY
EXAMS
DOPPLER ULTRASOUND
February 13, 2017

Impression:
Dilated Right Ventricle
Dilated Right Atrium
Severe Pulmonary Hypertension
CHEST X-RAY
February 13, 2017

Impression:
Haziness at right basal lung field
Pneumonia right base
Enlarged heart shadow
Immunology Report
February 14, 2017

Area Result Normal Values

Troponin I .01ug/ml <_ .01

Urine Analysis
February 14, 2017

Area Patient Result

Color Dark Yellow
Proteins ++
Blood +++
WBC +
RBC 651/ hpf
 Blood Chemistry
February 17, 2017
Area Result Normal Values

Creatinine 631 71 115

Sodium 133.6 136 145
Potassium 5.4 3.5 5.1
Immunology Report
February 17, 2017

Area Result Normal

Values
Hepa nonreactive nonreactive
BsAG
RBC 4.69 4.5 6.7
 Blood Chemistry
February 23, 2017
Area Result Normal Values

WBC 36.64 4.0 10.0

Neutrophils .86 .55 - .65

RBC 3.89 4.5 6.7

Hgb 108 30 - 180

Hct .32 .4 - .5
 Culture and Sensitivity of
Tracheostomy Tube secretions
February 13, 2017
Impression:
Klebsiella pneumoniae
Blood Chemistry
April 20, 2017

Area Result Normal

Values
WBC 10.7 4.0 10.0
RBC 4.69 4.5 6.7
 OMEPRAZOLE
Frequency: Once a Day
Time: 6 AM
Route: IVTT
Pharmacologic Class: Proton Pump
Inhibitor
Therapeutic Class: Anti-ulcer
NURSING RESPONSIBILITIES:
Before:
Check the doctors order and observe the
rights of medication administration
Administer meds one hour before meal/pre-
meal
Check vital signs and blood test for baseline
data.
Explain the side effects of the drug.
During:
Instruct patient to avoid hazardous activities and
alcohol consumption.
Advise patient to report onset of abdominal pain
and headache.
After:
Reassess patient for possible onset of adverse
effects.
Monitor vital signs and blood test continuously.
 MUPIROCIN
Frequency: Once a Day
Time: 8 AM
Route: Topical Ointment
Pharmacologic Class: Antibiotic
Therapeutic Class: Antibacterial
NURSING RESPONSIBILITIES:
Before:
Checked the doctors order and observe the rights of
medication administration
Explained the side effects of the drug.
During:
Instructed patient to avoid hazardous activities.
After:
Warned patient about local adverse reactions related to
drug use.
Caution patient not to use cosmetics or other skin
products on treated area.
Applied sterile dressing to the area.
 CALCIUM CARBONATE + VITAMIN D

Frequency: Once a Day

Time: 8 AM
Route: Per Orem
Pharmacologic Class: Calcium
Salt
NURSING RESPONSIBILITIES:
Before:
Checked the doctors order and observe
the rights of medication administration
Explained the side effects of the drug.
Advised patient to take calcium
carbonate indiscriminately or to switch
antacids without prescribers
prescription.
After:
Watch for signs and symptoms
of hypercalcemia
Nausea and vomiting
Headache
Confusion
Anorexia
 PREDNISONE
Frequency: Once a Day
Time: 8 AM
Route: Per Orem
Pharmacologic Class: Adrenocorticoid
Therapeutic Class: Corticosteroid
NURSING RESPONSIBILITIES:
Before:
Determined whether patient is sensitive to
other corticosteroid.
Educated possible signs and symptoms of
side effects.
Instructed patient to take drug with food and
milk.
During:
Instructed patient to avoid exposure to
infection.
Warned patient to avoid hazardous
activities.
After:
Monitored for side effects.
Monitored blood pressure and potassium
level.
 CEFIXIME
Frequency: Once a Day
Time: 8 AM
Route: Per Orem
Pharmacologic Class: Second Generation
Cephalosporin
Therapeutic Class: Antibiotic
NURSING RESPONSIBILITIES:
Before:
Administer skin test to detect any allergic reaction to
drug.
Educated for signs and symptoms of side effects.
Instructed patient to take drug as prescribed even after he
feels better.
After:
Evaluated for signs and symptoms of side effects.
Assessed for pain at IV site.
 CARVEDILOL
Frequency: Once a Day
Time: 8 AM
Route: Per Orem
Pharmacologic Class: Alpha non- selective beta
blocker
Therapeutic Class: Antihypertensive
NURSING RESPONSIBILITIES:
Before:
Instructed patient to interrupt or stop drug without
medical approval.
Informed patient that improvement of heart failure
symptoms might take several weeks of drug therapy.
Educated possible signs and symptoms of side
effects.
Informed patient that he may experience low blood
pressure when standing.
During:
Caution patient against performing hazardous
tasks during therapy.
After:
Evaluated for signs and symptoms of side effects.
Checked vital signs.
Advised patient to report immediately any
unusualities.
Assessed patients vision.
 NURSING PROBLEMS
1. Impaired tissue integrity related to
immobility as evidence by stage 3
pressure ulcer
2. Impaired physical mobility related
to neuromuscular impairment as
evidenced by weakness
3. Risk for aspiration related to presence
of nasogastric tubing
4. Ineffective airway clearance related
to increase mucous production
5. Imbalanced nutrition less than body
requirements related to inability to
swallow as evidenced by presence of NGT
Cues for Impaired tissue integrity related to immobility as
evidence by stage 3 pressure ulcer

SUBJECTIVE:
Ma ol.ol it iya lobot dapit, tungod sa iyang samad as verbalized
by the SO.

OBJECTIVES:
Bed pressure ulcer in sacral area with 6cm x 5cm x.5cm size.
 Nursing interventions
Inspected skin/wound in
daily basis
Assisted on wound
dressing
Initiated changed of
position Q2H
Assisted in used of padding
Rationale
Promotes timely
intervention and revision
of plan of care.
To prevent spread of
infectious agents.
To promote circulation &
decreased pressure in
affected area.
To relieve pressure in
Cues for Impaired physical mobility related to
neuromuscular impairment as evidenced by
weakness
Subjective:
Nakukurian man hiya pag lihok it iya tiil as
verbalized by the SO.

Objectives:
Muscle strength of 1 over 5 (movement only)
Limited range of motion noted
Areflexia elicited
 Nursing interventions RATIONALE

Initiated range of motion To stimulate muscle

exercises contractions and prevent
further muscle atrophy
Changed position Q2H To prevent further
damaged to the sacral
ulcer
Supported affected body To prevent pressure ulcer
part with soft linen.
 Instructed in use of side To promote safety
rails. while changing position

Scheduled activities with To prevent fatigue

adequate rest periods

Encouraged adequate To promote faster

intake of fluids and recovery
nutritious blenderized foods
Consulted physical therapist. To develop individual exercise
and mobility program
Cues for Risk for aspiration related to
presence of nasogastric tubing

Objectives:
Presence of nasogastric tubing
Presence of tracheostomy tube
Presence of neuromuscular
disorder (CIDP)
 Nursing interventions RATIONALE

Checked for the patency To ensure NGT does not

and intactness of NGT prior
to feeding.
Placed patient in MHBR To prevent aspiration
upon feeding
Maintained operational To suction aspirates the
suction equipment on ease
bedside.
Cues for Ineffective airway clearance related
to increase mucous production

Subjective:
Nagkukuri hiya pagginhawa tungod han kadamo
na it secretions as verbalized by the SO

Objective:
Presence of tracheostomy tube
Diagnosis of inflammatory demyelinating
 Nursing interventions RATIONALE

Suctioned only as To prevent further

needed damage to cilia and
other tracheal
structure.
Auscultated lung field Ascertain status
Monitored breath Indicates mucous
sounds. blocking the airway
Placed patient on MHBR To facilitate lung
expansion

Changed position Q2H. To enhance drainage of

secretions
Happy birthday
Alura !!!
Suctioned To clear secretions
tracheostomy tube as
needed.

Asked clients about To reduce risk of

feeling of fullness. aspiration

Provided oral meds in To reduce risk of

crushed form. aspiration
Cues for Imbalanced nutrition less than body
requirements related to inability to swallow as
evidenced by presence of NGT
Subjective:
Han una an akon timbang 67 kilo, Yana pag estimate ko bagat
40 nala ako as verbalized by the patient.

OBJECTIVES:
Patients looks too skinny.
Patients weight is 40 kg.
Imbalanced electrolytes.
 Rationale
Nursing interventions

Assisted in NGT feeding To facilitate

Checked the patency and To ensure NGT is in place

intactness of NGT prior to and prevent aspiration
feeding
Placed on Moderate High To prevent aspiration
Back Rest upon feeding
 Promoted adequate To reduce possibility
and timely fluid of early satiety.
intake
Emphasised the Provide information
importance of well regarding individual
balanced nutrition, nutritional needs and
nutritious intake. ways to meet this
needs within financial
constraints.