Case Study Ovarian Cancer

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COLLEGE OF OUR LADY OF MT. CARMEL
A Case Presentation to the

Faculty of College of Allied Health Professions
College of Our Lady of Mt. Carmel
City of San Fernando, Pampanga
A Case Study of Ovarian Cancer

Stage 5 Secondary to Chronic Kidney Disease (CKD)
In Partial Fulfillment
Of the Requirements for the Degree
Bachelor of Science in Nursing
Submitted By:
Aguarin, Donne Corneille M.
Bognot, FKG L.
Novemver 2019
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A. Table of Contents
Title page ………………………………………………………………………………………………………………1

A. Table of Contents ……………………………………………………………………….……………….2
B. Glossary ……………………………………………………………………………….3
I. Introduction …..……………………………………………………………………………………..10
Statistics ………………………………………………………………………………………13
Current Trends ………………………………………………………………………………………15
Anatomy and Physiology ……………………………………………………………………….17
II. Pathophysiology ……………………………………………………………………………..23
III. Nursing Assessment …………………………………………………………………………26
Pedigree …………………………………………………………………………………….29
Physical Assessment …………………………………………………………………………30
IV. Health History ………….……………………………………………………………………..34
V. Laboratory Procedures …………………………………………………………………35
VI. Diagnostic Procedure ………………………………………………………………………41
VII. Medical Management ………………………………………………………………….43
VIII. Surgical Procedure ………………………………………………………………………..81
IX. Nursing Care Plan ………………………………………………………………………………84
X. References ………………………………………………………………………………………….95
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B. GLOSSARY
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I. INTRODUCTION
Background of the Disease
Ovarian Cancer is a type of cancer that begins in the ovaries. It often goes undetected until it
has spread within the pelvis and abdomen. At this late stage, ovarian cancer is more difficult to treat.
Early stage of ovarian cancer in which the disease is confined to the ovary is more likely to be treated
successfully. Surgery and chemotherapy are generally used to treat ovarian cancer. Malignant ovarian
lesions include primary lesions arising from normal structures within the ovary and secondary lesions
from cancers arising elsewhere in the body. Primary lesions include epithelial ovarian carcinoma (70%
of all ovarian malignancies). Metastases to the ovaries are relatively frequent; common sources are
tumors in the endometrium, breast, colon, stomach, and cervix.
It’s not clear what causes ovarian cancer but in general cancer begins when a cell develops
errors in mutations of DNA. The mutations tell the cell to grow and multiply quickly, creating a mass
or tumor of abnormal cells. The abnormal cells continue living when healthy cells would die. They can
invade nearby tissues and break off from an initial tumor to spread elsewhere in the body. Factors
that can increase the risk of ovarian cancer include older age, inherited gene mutations, family history
of ovarian cancer, estrogen hormone replacement therapy and when menstruation ceased.
Types of ovarian cancer:
Epithelial Tumors
- begin in the thin layers of the tissues that covers the outside of the ovaries
Stromal Tumors
- Begin in the ovarian tissues that contains hormone producing cells
Germ cell Tumors

- Begin in the egg producing cells.
Signs and symptoms

Early ovarian cancer causes minimal, nonspecific, or no symptoms. The patient may feel an abdominal
mass. Most cases are diagnosed in an advanced stage.
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Epithelial ovarian cancer presents with a wide variety of vague and nonspecific symptoms, including
the following:
• Bloating; abdominal distention or discomfort
• Pressure effects on the bladder and rectum
• Constipation
• Vaginal bleeding
• Indigestion and acid reflux
• Shortness of breath
• Tiredness
• Weight loss
• Early satiety
Symptoms independently associated with the presence of ovarian cancer include pelvic and
abdominal pain, increased abdominal size and bloating, and difficulty eating or feeling full.
Symptoms associated with later-stage disease include gastrointestinal symptoms such as nausea and
vomiting, constipation, and diarrhea. [2] Presentation with swelling of a leg due to venous thrombosis
is not uncommon. Paraneoplastic syndromes due to tumor-mediated factors lead to various
presentations.
Diagnosis
Physical findings are uncommon in patients with early disease. Patients with more advanced
disease may present with ovarian or pelvic mass, ascites, pleural effusion, or abdominal mass or
bowel obstruction.
The presence of advanced ovarian cancer is often suspected on clinical grounds, but it can be
confirmed only pathologically by removal of the ovaries or, when the disease is advanced, by
sampling tissue or ascitic fluid.
Screening
Laboratory testing
No tumor marker (eg, CA-125, beta-human chorionic gonadotropin, alpha-fetoprotein, lactate
dehydrogenase) is completely specific; therefore, use diagnostic immunohistochemistry testing in
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conjunction with morphologic and clinical findings. Also, obtain a urinalysis to exclude other possible
causes of abdominal/pelvic pain, such as urinary tract infections or kidney stones.
Imaging studies
Routine imaging is not required in all patients in whom ovarian cancer is highly suggested. In cases in
which the diagnosis is uncertain, consider the following imaging studies:
• Pelvic ultrasonography [6, 7] : Warranted
• Pelvic and abdominal computed tomography (CT) scanning [6, 7] : Warranted
• Pelvic and abdominal magnetic resonance imaging: Increases specificity of imaging when
sonography findings are indeterminate.
• Chest radiography: Routine imaging to exclude lung metastases
• Mammography: Part of preoperative workup for women older than 40 years who have not had
one in the preceding 6-12 months; estrogen-producing tumors may increase the risk of breast
malignancies, and breast cancers can metastasize to the ovaries and are often bilateral
In patients with diffuse carcinomatosis and GI symptoms, a GI tract workup may be indicated,
including one of the following imaging studies:
• Upper and/or lower endoscopy
• Barium enema
• Upper GI series
Procedures
Fine-needle aspiration (FNA) or percutaneous biopsy of an adnexal mass is not routinely
recommended, as it may delay diagnosis and treatment of ovarian cancer. Instead, if a clinical
suggestion of ovarian cancer is present, the patient should undergo laparoscopic evaluation or
laparotomy, based on the presentation, for diagnosis and staging. An FNA or diagnostic paracentesis
should be performed in patients with diffuse carcinomatosis or ascites without an obvious ovarian
mass.
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Chronic kidney disease (CKD) means the kidneys are damaged and can’t filter blood the way it
should. The main risk factors for developing kidney disease are diabetes, high blood pressure, heart
disease, and a family history of kidney failure. CKD or chronic renal failure (CRF), as it was historically
termed as a term that encompasses all degrees of decreased renal function, from damaged at risk
through mild, moderate, and severe chronic kidney failure.
CKD as either kidney damage or a decreased glomerular filtration rate (GFR) of less than 60
mL/min/1.73 m2 for at least 3 months. Whatever the underlying etiology, once the loss of nephrons
and reduction of functional renal mass reaches a certain point, the remaining nephrons begin a
process of irreversible sclerosis that leads to a progressive decline in the GFR. Hyperparathyroidism is
one of the pathologic manifestations of CKD.
Staging
The different stages of CKD form a continuum. The stages of CKD are classified as follows
 Stage 1: Kidney damage with normal or increased GFR (>90 mL/min/1.73 m 2)
 Stage 2: Mild reduction in GFR (60-89 mL/min/1.73 m 2)
 Stage 3a: Moderate reduction in GFR (45-59 mL/min/1.73 m 2)
 Stage 3b: Moderate reduction in GFR (30-44 mL/min/1.73 m 2)
 Stage 4: Severe reduction in GFR (15-29 mL/min/1.73 m 2)
 Stage 5: Kidney failure (GFR < 15 mL/min/1.73 m 2 or dialysis)
By itself, measurement of GFR may not be sufficient for identifying stage 1 and stage 2 CKD, because
in those patients the GFR may in fact be normal or borderline normal. In such cases, the presence of
one or more of the following markers of kidney damage can establish the diagnosis
 Albuminuria (albumin excretion > 30 mg/24 hr or albumin:creatinine ratio > 30 mg/g [> 3
mg/mmol])
 Urine sediment abnormalities
 Electrolyte and other abnormalities due to tubular disorders
 Histologic abnormalities
 Structural abnormalities detected by imaging
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 History of kidney transplantation in such cases
Hypertension is a frequent sign of CKD but should not by itself be considered a marker of it, because
elevated blood pressure is also common among people without CKD. In an update of its CKD
classification system, GFR and albuminuria levels be used together, rather than separately, to improve
prognostic accuracy in the assessment of CKD. More specifically, the guidelines recommended the
inclusion of estimated GFR and albuminuria levels when evaluating risks for overall mortality,
cardiovascular disease, end-stage kidney failure, acute kidney injury, and the progression of CKD.
Referral to a kidney specialist was recommended for patients with a very low GFR (< 15 mL/min/1.73
m²) or very high albuminuria (> 300 mg/24 h). Patients with stages 1-3 CKD are frequently
asymptomatic. Clinical manifestations resulting from low kidney function typically appear in stages 4-
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Signs and symptoms
Patients with CKD stages 1-3 are generally asymptomatic. Typically, it is not until stages 4-5 (GFR
< 30 mL/min/1.73 m²) that endocrine/metabolic derangements or disturbances in water or electrolyte
balance become clinically manifest.
Signs of metabolic acidosis in stage 5 CKD include the following:
 Protein-energy malnutrition
 Loss of lean body mass
 Muscle weakness
Signs of alterations in the way the kidneys are handling salt and water in stage 5 include the
following:
 Peripheral edema
 Pulmonary edema
 Hypertension
Anemia in CKD is associated with the following:
 Fatigue
 Reduced exercise capacity
 Impaired cognitive and immune function
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 Reduced quality of life

 Development of cardiovascular disease
 New onset of heart failure or the development of more severe heart failure
 Increased cardiovascular mortality
Other manifestations of uremia in ESRD, many of which are more likely in patients who are being
inadequately dialyzed, include the following:
 Pericarditis: Can be complicated by cardiac tamponade, possibly resulting in death if
unrecognized
 Encephalopathy: Can progress to coma and death
 Peripheral neuropathy, usually asymptomatic
 Restless leg syndrome
 Gastrointestinal symptoms: Anorexia, nausea, vomiting, diarrhea
 Skin manifestations: Dry skin, pruritus, ecchymosis
 Fatigue, increased somnolence, failure to thrive
 Malnutrition
 Erectile dysfunction, decreased libido, amenorrhea
 Platelet dysfunction with tendency to bleed
Screen adult patients with CKD for depressive symptoms; self-report scales at initiation of dialysis
therapy reveal that 45% of these patients have such symptoms, albeit with a somatic emphasis.
Diagnosis
Screening
American College of Physicians guidelines on screening for CKD include the following
recommendations:
 Do not screen for CKD in asymptomatic adults without risk factors for CKD (grade: weak
recommendation, low-quality evidence).
 Do not test for proteinuria in adults with or without diabetes who are currently taking an
angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin II-receptor blocker (ARB)
(grade: weak recommendation, low-quality evidence).
Laboratory studies
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Laboratory studies used in the diagnosis of CKD can include the following:
 Complete blood count (CBC)
 Basic metabolic panel
 Urinalysis
 Serum albumin levels: Patients may have hypoalbuminemia due to malnutrition, urinary
protein loss, or chronic inflammation
 Lipid profile: Patients with CKD have an increased risk of cardiovascular disease
Evidence of renal bone disease can be derived from the following tests:
 Serum calcium and phosphate
 25-hydroxyvitamin D
 Alkaline phosphatase
 Intact parathyroid hormone (PTH) levels
In certain cases, the following tests may also be ordered as part of the evaluation of patients with
CKD:
 Serum and urine protein electrophoresis and free light chains: Screen for a monoclonal
protein possibly representing multiple myeloma
 Antinuclear antibodies (ANA), double-stranded DNA antibody levels: Screen for systemic lupus
erythematosus
 Serum complement levels: Results may be depressed with some glomerulonephritides
 Cytoplasmic and perinuclear pattern antineutrophil cytoplasmic antibody (C-ANCA and P-
ANCA) levels: Positive findings are helpful in the diagnosis of granulomatosis with polyangiitis
(Wegener granulomatosis); P-ANCA is also helpful in the diagnosis of microscopic polyangiitis
 Anti–glomerular basement membrane (anti-GBM) antibodies: Presence is highly suggestive of
underlying Goodpasture syndrome
 Hepatitis B and C, human immunodeficiency virus (HIV), Venereal Disease Research
Laboratory (VDRL) serology: Conditions associated with some glomerulonephritides
Imaging studies
Imaging studies that can be used in the diagnosis of CKD include the following:
 Renal ultrasonography: Useful to screen for hydronephrosis, which may not be observed in
early obstruction or dehydrated patients; or for involvement of the retroperitoneum with
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fibrosis, tumor, or diffuse adenopathy; small, echogenic kidneys are observed in advanced
renal failure
 Retrograde pyelography: Useful in cases with high suspicion for obstruction despite negative
renal ultrasonograms, as well as for diagnosing renal stones
 Computed tomography (CT) scanning: Useful to better define renal masses and cysts usually
noted on ultrasonograms; also the most sensitive test for identifying renal stones
 Magnetic resonance imaging (MRI): Useful in patients who require a CT scan but who cannot
receive intravenous contrast; reliable in the diagnosis of renal vein thrombosis
 Renal radionuclide scanning: Useful to screen for renal artery stenosis when performed with
captopril administration; also quantitates the renal contribution to the GFR
Biopsy
Percutaneous renal biopsy is generally indicated when renal impairment and/or proteinuria
approaching the nephrotic range are present and the diagnosis is unclear after appropriate workup.
Type 1 Diabetes
Is also called insulin-dependent diabetes. It used to be called juvenile-onset diabetes, because it
often begins in childhood. It is an autoimmune condition. It’s caused by the body attacking its own
pancreas with antibodies. In people with type 1 diabetes the damaged pancreas doesn’t make insulin.
This type of diabetes maybe cause by a genetic predisposition. It could also be the result of faulty beta
cells in the pancreas that normally produce insulin.
Type 2 Diabetes
Used to be called adult – onset diabetes but with the epidemic of obese and overweight kids,
more teenagers are now developing type 2 diabetes. It was also called non – inulin independent
diabetes and it is often a milder form of diabetes than type 1. Nevertheless, type 2 diabetes can still
cause major health complication particularly in the smallest blood vessels in the body that nourish the
kidneys, nerves, and eyes. It also increases the risk of heart disease and stroke. With type 2 diabetes
the pancreas usually produces some insulin but either the amount produce is not enough for the
body’s needs, or the body’s cells are resistant to it. Insulin resistance or lack of sensitivity to insulin
happens primarily in fat, liver, and muscle cells.
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STATISTICS
CKD is more common in people aged 65 years or older (38%) than in people aged 45-64 years
(13%) or 18-44 years (7%). CKD is more common in women (15%) than men (12%). CKD is more
common in non-Hispanic blacks (16%) than in non-Hispanic whites (13%) or non-Hispanic Asians
(12%). About 14% of Hispanics have CKD
WORLD
CKD is a worldwide public health problem. In the United States, there is a rising incidence and
prevalence of kidney failure, with poor outcomes and high cost. CKD is more prevalent in the elderly
population. However, while younger patients with CKD typically experience progressive loss of kidney
function, 30% of patients over 65 years of age with CKD have stable disease. CKD is associated with an
increased risk of cardiovascular disease and end-stage renal disease (ESRD). Kidney disease is the
ninth leading cause of death in the United States.
PHILIPPINES
One Filipino develops chronic renal failure every hour or about 120 Filipinos per million
population per year. More than 5,000 Filipino patients are presently undergoing dialysis.
CURRENT TRENDS
Early diagnosis and treatment of the underlying cause and/or institution of secondary preventive
measures is imperative in patients with CKD. These may slow, or possibly halt, progression of the
disease. The medical care of patients with CKD should focus on the following:
 Delaying or halting the progression of CKD: Treatment of the underlying condition, if possible,
is indicated
 Diagnosing and treating the pathologic manifestations of CKD
 Timely planning for long-term renal replacement therapy
The pathologic manifestations of CKD should be treated as follows:
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 Anemia: When the hemoglobin level is below 10 g/dL, treat with erythropoiesis-stimulating
agents (ESAs), which include epoetin alfa and darbepoetin alfa after iron saturation and
ferritin levels are at acceptable levels
 Hyperphosphatemia: Treat with dietary phosphate binders and dietary phosphate restriction
 Hypocalcemia: Treat with calcium supplements with or without calcitriol
 Hyperparathyroidism: Treat with calcitriol or vitamin D analogues or calcimimetics
 Volume overload: Treat with loop diuretics or ultrafiltration
 Metabolic acidosis: Treat with oral alkali supplementation
 Uremic manifestations: Treat with long-term renal replacement therapy (hemodialysis,
peritoneal dialysis, or renal transplantation)
Indications for renal replacement therapy include the following:
 Severe metabolic acidosis
 Hyperkalemia
 Pericarditis
 Encephalopathy
 Intractable volume overload
 Failure to thrive and malnutrition
 Peripheral neuropathy
 Intractable gastrointestinal symptoms
 In asymptomatic patients, a GFR of 5-9 mL/min/1.73 m², irrespective of the cause of the CKD
or the presence or absence of other comorbidities
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PURPOSE OF THE STUDY
The purpose of this study is to be able to give information regarding the patient’s condition and
to deliver logical presentation about Chronic Kidney Disease Stage 5 Secondary to Diabetes Mellitus.
And to be able to gain knowledge, skills and attitude on how to handle patient and to develop an
awareness of the potential, physical, behavioral and psychosocial effects of Chronic Kidney Disease
Stage 5 Secondary to Diabetes Mellitus
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ANATOMY AND PHYSIOLOGY
PATHOPHYSIOLOGY
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A normal kidney contains approximately 1 million nephrons, each of which contributes to the total
glomerular filtration rate (GFR). In the face of renal injury (regardless of the etiology), the kidney has
an innate ability to maintain GFR, despite progressive destruction of nephrons, as the remaining
healthy nephrons manifest hyper filtration and compensatory hypertrophy. This nephron adaptability
allows for continued normal clearance of plasma solutes. Plasma levels of substances such as urea
and creatinine start to show measurable increases only after total GFR has decreased 50%.
The plasma creatinine value will approximately double with a 50% reduction in GFR. For example, a
rise in plasma creatinine from a baseline value of 0.6 mg/dL to 1.2 mg/dL in a patient, although still
within the adult reference range, actually represents a loss of 50% of functioning nephron mass.
The hyperfiltration and hypertrophy of residual nephrons, although beneficial for the reasons noted,
has been hypothesized to represent a major cause of progressive renal dysfunction. The increased
glomerular capillary pressure may damage the capillaries, leading initially to secondary focal and
segmental glomerulosclerosis (FSGS) and eventually to global glomerulosclerosis. Factors other than
the underlying disease process and glomerular hypertension that may cause progressive renal injury
include the following:
 Systemic hypertension
 Nephrotoxins (eg, nonsteroidal anti-inflammatory drugs [NSAIDs], intravenous contrast media)
 Decreased perfusion (eg, from severe dehydration or episodes of shock)
 Proteinuria (in addition to being a marker of CKD)
 Hyperlipidemia
 Hyperphosphatemia with calcium phosphate deposition
 Smoking
 Uncontrolled diabetes
A strong association between episodes of acute kidney injury (AKI) and cumulative risk for the
development of advanced CKD in patients with diabetes mellitus who experienced AKI in multiple
hospitalizations. Any AKI versus no AKI was a risk factor for stage 4 CKD, and each additional AKI
episode doubled that risk
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I. NURSING ASSESSMENT
A. Personal history (demographics, educational attainment, occupation, religion )
Mr. Polycythemia a 31 year old male stands as father of 2 children the eldest is 8 years
old while the youngest is 2 years old. He is married to Mrs. Polycythemia for 10 years. He lives
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in Sta. Cruz Poblacion San Luis city of San Fernando Pampanga. His nationality is Filipino and
was born in San Luis Pampanga on the 11th of December 1987.
Mr. Polycythemia graduated of Secondary Education in San Luis High School. He was
raised as a Catholic, where he learned about religious values. He believes in super natural
forces and superstitious belief. The client seeks medical help from a physician for a serious
health condition although Mrs. Polycythemia admits to seek help from the “Hoax doctor “or
the local “albularyo “who would prescribed alternative medicine to relieve mild signs and
symptoms and other bodily discomfort.
B. Socio economic
Mr. Polycythemia is presently working as a tricycle driver and works from 7 am to 5

pm. The client source of income is coming from his own daily income as tricycle driver. On a
daily basis Mr. Polycythemia gives Mrs. Polycythemia Php 400. This amount is for the
utilization of their daily needs like foods and allowance of their children stated by Mrs.
Polycythemia. She stated that their monthly electric bill is around Php 1000 and their water
bill is around Php 500 and her mother was the one who’s paying it. The client is the one
responsible for paying other miscellaneous including the expenses of the children in school.
He doesn’t save some money for the education of their children and in case of emergency
he has no money to use.
C. Environment
Mr. Polycythemia resides at Sta. Cruz Poblacion San Luis and occupies the ancestry
house of his wife’s family and still living with parents of her wife. The location of their house
is accessible to hospitals, health centers and other government institutions. The client’s wife
did not report problems regarding his environment that could interfere with the client
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condition but instead states that sometimes he cannot control his emotions like getting mad
at her family and getting tired all the time because of his work as stated by Mrs. Polycythemia
D. Activities of Daily living (diet and nutrition, habits/vices,etc )
Mrs. Polycythemia said that Mr. Polycythemia’s diet is by consuming 3 cups of coffee
a day. He also includes soft drinks in his meal. He eats a lot of fatty and salty foods. She said
also that Mr. Polycythemia doesn’t exercise. The client would usually wake up at 5:00 in the
morning and then he would drink coffee while his wife is the one preparing for their breakfast.
His wife cooks fried rice and meat process food like hot dogs and ham in the morning as their
breakfast but sometimes he will just buy” pandesal” and put spread on it. At 6:00 am he
and his eldest child will prepare for school and at exact 6:30 am they will leave the house and
he will drive his son to school since his child is also studying near where he works. In between
9 am to 10 am he will take his snack and usually eat food on the street. He takes his lunch at
12:00 pm and preferred to eat ready to eat food all the time in Cafeteria. The client will stay
until 5:00 pm in terminal then go back home at 5:30 pm. He will pick up his son with his motor
cycle. When he is at home already he will watch TV while at 6:00 pm his wife will prepare their
dinner at exact 7:00 pm he will take his dinner and his favorite food is vegetable and fish when
it comes to dinner, and at 8:00 pm he will watch television until he fall asleep. The client has
bad habits or vices like smoking 1 pack a day and drinking liquor like 1 bottle of brandy once
a week that can interfered his present condition.
E. Family health history with pedigree
Hereditary disease in the family is hypertension which his mother currently has and the
reason of death of his father, his father sibling had a heart attack due to hypertensive. This shows
that hypertension is evident in their family and is hereditary. On maternal side his grandmother
died with arthritis while his grandfather died of natural death. The client’s mother has currently
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hypertension while his father died of hypertension. Mr. Polycythemia uncle died at the age of 60
and he cannot recall anymore the cause of death while his auntie, his mother’s siblings was died
of heart attack at the age of 58. On paternal side, his grandmother and grandfather died in
natural death and all of his uncle and auntie, siblings of his father were all alive and healthy.
FAMILY HEALTH HISTORY WITH PEDIGREE
MATERNAL SIDE PATERNAL SIDE

Grandmother Grandfather Grandmother Grandfather
age 83 age 82 age 76 age 82
died: arthritis died: naturally died:naturally died: naturally
Grandmother
Grand of
Arthritis
Age:83Died of
Arthritis
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Auntie
age:58 Father
died:Hyperten Age: 67
sive died: Hypertensive Uncle age:
unknown alive
and well
Mr.polycythemia
LEGEND
FEMALE MALE DIED

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Physical Assessment (IPPA-cephalocaudal approach)
The patient was first met lying in bed with ongoing intravenous fluid of PNSS to be
run at 160 cc per hour, wearing a hospital gown and was unconscious. He has an indwelling
catheter. Mechanical ventilation was hooked. With GCS of 7, Vital signs were taken and
recorded as follows:
Vital signs
T- 37.2 celcius degree
RR- 18 cycle per minute
PR- 100 beat per minute
BP-120/80 mmhg
O2SAT- 96
Skin, Hair, and Nails Inspection
Skin
Skin is pale
Skin is diaphoresis
Hair and Scalp
Hair is black, fine, and even in distribution
Scalp is clean and dry
Hair is thick and fine; Black in color
Nails
Nails are smooth, firm and clean.
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Nail’s color does not go back in 3 seconds after capillary test.
Head and Neck Inspection

Head
Head is round, symmetric, erect, proportional
No presence of visible lesions
Head is held still and upright
Face is symmetric with an oval appearance
Neck
Neck is symmetric with head centered and without bulging masses.
Thyroid cartilages move symmetrically as the client swallows.
Neck movement is smooth and controlled
Eyes and Ears Inspection

Eyes
With sclera is seen around the iris
Cornea is transparent with no opacities.
The lower eyelids are upright

No inward or upward turning eyes
No presence of swelling, redness, or lesions of the eye
Upper and lower palpebral conjunctiva are free of swelling or lesions
Eyes are sunken appearance
Iris is round, flat and evenly colored
Ears
Ears are equal in size bilaterally.
Earlobes are attached
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Skin is smooth with no lesions

Canal walls are pink and smooth and without nodules
Mouth, Nose and Sinuses Inspection

Mouth
Lips are pale and dry
Teeth has no yellowish discoloration
No presence of dental caries
Gums are pink in color
With moist pink buccal mucosa
Frenulum is midline
Tonsils and uvula show no presence of swelling
Throat is pink in color
Nose
Color is the same as the rest of the face
Nasal structure is both smooth and symmetric
Nasal mucosa is smooth, moist and free of exudates
Sinuses
Sinuses do not appear enlarged or swollen
Peripheral and Vascular Inspection
Arms are bilaterally symmetric with variation in size and shape
Presence of edema of the hands or prominent venous patterning throughout the
extremities
Veins are flat and barely seen under the surface of the skin
Legs have equal distribution of hair
The skin tone of the head legs is consistent
Legs are free of lesions and ulcerations
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Abdominal Inspection
Color is consistent with the color of the rest of the body
No visible veins of the abdomen are present upon infection
No presence of ulcerations
No presence of rashes
Skin tone of umbilicus is similar with that of abdominal skin tone
Umbilicus is located on midline of the abdomen
No signs of swelling of the umbilicus, no bulges or masses
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II. Health history (Past and Present illness )
Besides being hospitalized for his present condition, Mr. Polycythemia did not have
any previous hospital stays. He had only consulted a doctor when he was 14 years old when
he had an ear infection and took anti biotic to manage which he cannot recall the name of
the drug. He has also episodes of fever, cough and colds and this was managed by taking over
the counter drug like Paracetamol for fever, Solmux for cough and Neozep for colds. He has
also episodes of diarrhea and this was managed by taking over the counter drug like Diatabs.
He was admitted in a private hospital of Mt. Carmel Hospital at 1:00 am on January
26, 2019 with the initial diagnosis of Severe Dehydration to be considered Polycythemia.
Assessment done by the resident duty .Prior to admission after discharged to other institution
patient was then drinking less than 2 glass of water a day in one week. Patient was lethargic
and unresponsive. Vital signs are T- 37.2 Celsius degree RR- 10 cycle per minute PR- 120
beat per minuteBP-120/90 mmhgO2SAT- 86asleep, arousable weak body, dry lips, sunken
eyeball.
In regards to his present illness, Mr. Polycythemia did not notice any sign or symptoms
of his present condition as stated by Mrs. Polycythemia aside of noticing his husband for being
quiet all the time and whenever he sees something on the floor he picked it up and eat it and
then spit it out. She noticed many unusual behaviors like talking to his self which she perceives
not normal for a person to do. She called her relatives to report her husband condition and she
was advised by her relatives to send him in GuaGua Institution. Mr. Polycythemia was admitted
in that institution to treat him in his condition. Until one morning the nurse whose attending him
notice that Mr. Polycythemia was not moving and unconscious, after taking the vital signs and
getting a result which is high than normal range such as Blood Pressure of 160/120 RR of 30 PR
of 120, The institution decided to refer Mr. polycythemia in JBL hospital but unfortunately he
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was not accepted in that Hospital because of no available space or room for him to accommodate
him and that is the time Mr. polycythemia brought to Mt. Carmel Hospital at 1:00 am on January
26, 2019 with the initial diagnosis of Severe Dehydration to be considered Polycythemia.
III. LABORATORY PROCEDURES
DIAGNOSTICS/ DATE PURPOSE(S) RESULTS NORMAL ANALYSIS AND

LABORATORY REQUESTED/ OF THE VALUES INTERPRETATION
PROCEDURES DATE PROCEDURE OF RESULTS
RESULT(S) IN ( Patient
Centered)
CREATININE Doctors They measure 2.6 mg/dL 0.40- 1.40 This test showed
ordered: the level of mg/dL that the result
A creatinine blood creatinine of was in above
test measures the January the patient in normal range. It
level of creatinine in 25,2019 the blood and shows that the
the blood. it is used to kidney of the
Creatinine is a diagnose patient might not
waste product that impaired renal function well and
that forms when function and it may already
creatinine breaks assess damage brought
down. Creatinine is glomerular about the disease
found in the muscle. filtration. or the
Creatinine levels in medications.
the blood can
provide the
physician with
information about
how well the
kidneys are
working. Creatinine
28
is one of the
substances that the
kidneys normally
eliminate from
the body.
BUN January They measure 28.0 mg/dL 7.0-18.0 This test showed
Blood urea 28,2019 the level of mg/dL that the result
nitrogen (BUN) is a urea nitrogen was in above
medical test that of the patient normal range. It
measures the in the blood shows that the
amount of urea and it is used kidney of the
nitrogen found to diagnose patient might not
in blood. The liver impaired functioning well
produces urea in kidney and it may
the urea cycle as a function and already damage
waste product of assess liver brought about
the digestion of function the disease or
protein. the medications.
Ionized calcium February They measure 1.35mmol/l 1.10-1.30 This test showed
Ionized 2,2019 the level of mmol/l that the result
calcium is calcium in calcium of the was in above
your blood that is patient in the normal range. It
29
not attached to blood and it is shows that the

proteins. It is also used to kidney of the
called free calcium. diagnose patient might not
All cells need impaired function well and
calcium in order to kidney it may already
work. Calcium helps damage brought
build strong bones about the disease
and teeth. It is or the
important for heart medications.
function
Uric Acid January They measure 8.2 mg/dL 2.50-7.70 This test showed
Uric acid is a 28,2019 the level of mg/dL that the result
chemical created uric acid of was in above
when the body the patient in normal range. It
breaks down the blood and shows that there
substances called it is used to is kidney stones
purines. Purines are diagnose the and the kidney of
normally produced cause the patient might
in the body and are of kidney not function well
also found in some stones and it may
foods and drinks. already damage
Foods with high brought about
content of purines the disease or
the medications.
SGPT Serum February They measure 97.0 iu/L 9.0-50.0 iu/L This test
glutamic pyruvic 1,2019 the level of showed that the
transaminase, serum glutamic- result was in
SGPT is released pyruvic above normal
into blood when transaminaseof range. It shows
the liver or heart the patient in that the liver of
is damaged. The the blood and it the patient
blood SGPT levels is used to might not
30
are diagnose functioning well

thus elevated with impaired liver and it may
liver damage (for already damage
example, from brought about
viral hepatitis) or the disease or
with an insult to the medications
the heart (for
example, from a
heart attack).
Some medications
can also
raise SGPT levels.
Also called alanine
aminotransferase
(ALT).
31
COMPLETE BLOOD COUNT
DIAGNOSTICS/ DATE INDICATION RESULTS NORMAL ANALYSIS AND

LABORATORY ORDERED OR PURPOSE VALUES INTERPRETATION OF
PROCEDURES DATE RESULTS
RESULTS
White Blood Cell January This test was 28.90/L 5.00- WBC is elevated, This
COUNT 26,2019 indicated for 10.00X10^9/L test showed that the
These are the the patient to result was in
cells of the confirm if she abnormal range and
immune system is already there is the presence
that are involved experiencing of infection.
in protecting the any infection.
body against
both infectious
diseases and
foreign bodies.
SEGMENTERS January This test was 0.90/L 0.50-0.70/L Segmenters are

Neutropenia is a 26,2019 indicated for elevated, This test
blood condition the patient to showed that the
characterized by provide a result was in
low levels of numeric abnormal range and
32
neutrophils, estimate of there is the presence

which are white the client’s of infection.
blood cells that immune
protect your status
body from
infections.
Without enough
neutrophils, your
body can't fight
off bacteria.
MONOCYCTE January This test was 0.07/L 0.01-0.06/L The result showed a
Phagocytic cells 26,2019 indicated for slight elevated
in the blood, the patient to number of
leaves the blood determine the monocytes. These
and becomes a presence of may indicate that the
macrophage Chronic patient is
which inflammatory experiencing slight
phagocytize disease or inflammatory
bacteria, dead viral infection process due to her
cells, cells condition and
fragments and possible injuries.
other debris
within the tissue
HEMOGLOBIN January This test was 200g/L 140-180 g/L The result showed an
A main 26,2019 indicated for elevated number of
component of the patient to hemoglobin. These
RBC which is measure the may indicate that the
conjugated total amount patient is
protein that of hemoglobin experiencing
serves as a in the blood dehydration
33
vehicle for the

transportation of
oxygen to the
tissue and
carbon dioxide
from the tissue.
HEMATOCRIT January This test was 0.60 g/L 0.40-0.54 The result showed an
A hematocrit 26,2019 indicated for slight elevated
test, which the patient to number of
maybe perform check if there hematocrit due to
separately or as is still a hemo concentration
part of complete normal ratio of blood
blood count, between the
measures bloods total
percentage by volume which
volume packed is mainly
red blood cells in compose of
a whole blood plasma and
sample. the amount of
Hematocrit is the red blood
proportion or cells.
ration of the
total blood
volume (Plasma)
and the amount
of red blood
cells.
34
Red Blood Cell January This test was 7.0 iu/L 5.5-6.5 iu/L The result showed an
Count 26,2019 indicated for slight elevated
RBC count also the patient to number of
called an check if there hematocrit due to
erythrocyte is still a hemoconcentration
count, is part of a normal ratio of blood
complete blood between the
count. It’s used bloods total
to detect the volume which
number or red is mainly
blood cells in compose of
microliter, or plasma and
cubic millimeter the amount of
of whole blood. red blood
The RBC blood cells.
itself provides no
qualitative
information
regarding the
size, shape or
concentration of
HGB within the
corpuscles, but it
may be used to
calculate two
erythrocyte
indices; MHC,
MCV.
35
IV. DIAGNOSTIC PROCEDURES
DIAGNOSTICS/ DATE PURPOSE(S) OF RESULTS NORMAL ANALYSIS AND

LABORATORY REQUESTED/ THE VALUES INTERPRETATION
PROCEDURES DATE PROCEDURE OF RESULTS
RESULT(S) IN ( Patient
Centered)
CRANIAL CT SCAN January This procedure Communicating The result showed
WITH CONTRAST 27,2019 was indicated Hydrocephalus that the patient has
AGENT for the patient meningitis Communicating
A cranial CT to diagnose Hydrocephalus
scan uses a series pathologies in meningitis due to
of X-rays to the brain and increase ICP
diagnose skull
pathologies in the
brain and skull. In
this case, a
contrast agent is
injected
intravenously to
36
highlight the area

being examined.
CHEST X-RAY January This procedure Pneumonia The result showed

Chest x-ray uses a 25,2019 was indicated bilateral that the patient has
very small dose of for the patient Pneumonia bilateral
ionizing radiation To evaluate the due chronic smoking
to produce lungs, heart
pictures of the and chest wall
inside of the chest. and may be
It is used to used to help
evaluate the lungs, diagnose
heart shortness of
and chest wall and breath,
may be used to
help diagnose
shortness of
breath, persistent
cough,
fever, chest pain or
injury.
The result showed

February Pneumothorax that the patient has
1,2019 right, PTB left Pneumothorax right,
upper lung zone PTB left upper lung
37
zone due to chronic

smoking
WHOLE ABDOMEN January This procedure Mild hydro The result showed
ULTRASOUND 28,2019 was indicated nephrosis ,right that the patient has
Abdominal for the patient Mild hydro
ultrasound is a to evaluate nephrosis ,right
type of imaging organs in the because of swelling
test. It is used to abdomen, of a kidney due to a
look at organs in including the build-up of urine
the abdomen, liver,
including the liver, gallbladder,
gallbladder, spleen,
spleen, pancreas, pancreas, and
and kidneys. kidneys.
38
V. MEDICAL MANAGEMENT
INTRAVENOUS THERAPY
Treatment or General Action Purpose Date Ordered Response of Nursing

Medication (Patient- the patient Responsibilities
(Generic and Centered)
Brand Name)
Plain Normal Normal Saline is This fluid was January Patient Check the
Saline Solution a sterile, non- given to patient 26,2019 hydration and physician order;
160 cc/hour pyrogenic to replace fluid energy status
solution for loss in the body was Check all parts
fluid and .Maintain maintained. of the order for
electrolyte hydration and accuracy.
replenishment. electrolytes
It contains no within
antimicrobial functional Note for the
agents. It level. It is also patency of IV
contains served as the line and needle.
Sodium route for giving
Chloride with an parenteral
osmolality. medications.
Used because it
has little to no
39
effect on the
tissues and
make the
person feel
hydrated.
MECHANICAL VENTILATION
Treatment or General Action Purpose Date Response of Nursing

Medication (Patient- Ordered the patient Responsibilities
Brand Name)
O2 USE Fraction of This was given January The patient Check the physician
F102 100% inspired to the patient 28,2019 was order; Check all parts
40
oxygen (FiO2) is since he was provided of the order for

the fraction of on intensive oxygen and accuracy.
oxygen in the care units and difficulty of
volume being experiencing breathing Relieve hypoxemia
measured. difficulty was lessen and maintain
Medical patients breathing adequate oxygenation
experiencing of tissues and vital
difficulty organs, as assessed by
breathing are SpO2 /SaO2 monitoring
provided with and clinical signs.
oxygen-enriched
air, which means Give oxygen therapy
a higher-than- in a way which
atmospheric FiO2. prevents excessive
CO2accumulation - i.e.
selection of the
appropriate flow rate
and delivery device.
Reduce the work of
breathing.
NEBULIZER

Medication (Generic (Patient- Ordered the patient Responsibilities
and Brand Name) Centered)
COMBIVENT This drug was January The patient Check the
Generic Name: Inhalation indicated for 28,2019 was provided physician order;
ipratropium bromide Aerosol is the patient inhalation Check all parts
indicated for because he and difficulty of the order for
41
Brand Name: use in patients has difficulty of breathing accuracy.

Combivent neb with chronic of breathing was lessen NOTE: Attach
obstructive the nebulizer to
pulmonary compressed air
disease (COPD) if available
on a regular
aerosol
bronchodilator
who continue
to have
evidence of
bronchospasm
and who
require a
second
bronchodilator.
NASOGASTRIC TUBE

Brand Name)
42
This process is This procedure January The patient Check the

NGT : 1600 kcal known as was indicated 28,2019 was able to physician order;
/6 (267 nasogastric for the patient feed through Check all parts
kcal/feeding (NG) because it can NGT and has of the order for
A nasogastric intubation. be used for given extra accuracy.
tube (NG tube) During NG all feedings or calories
is a intubation, for giving a
special tube that your doctor or person extra Check tube
carries food and nurse will calories. placement
medicine to the insert a thin
stomach plastic tube Clean area
through the through your around the tube
nose. nostril, down every 4 hours
your
esophagus, and Report
into your complaints and
stomach. Once signs of nose or
this tube is in throat irritation
place, they can
use it to give
you food and
medicine.
INDWELLING FOLEY CATHETER

A Foley catheter Your health care This January The patient Check the
is a thin, sterile tube provider may procedure 28,2019 was able to physician order;
inserted recommend that was urinate and
into the bladder you use a catheter indicated for Check all parts of
43
to drain urine. Because if you have: the patient output was the order for
it can Urinary incontinence because he monitor accuracy.
be left in place in the (leaking urine or has urinary
bladder for a period of being unable retention Wash hands for
time, to control and to Measure urine
it is also called when you urinate) monitor output as indicated
an indwelling Urinary retention (being output 1 – 4 hourly and
catheter. unable to empty your assess the color
bladder and concentration
when you need to) of urine output.
Surgery on the prostate
or genitals. The IDC insertion
site and
securement should
be assessed at
least once a shift,
to ensure the IDC
is not pulling on
the genitals and
not twisted.
IDC drainage bags

should be emptied
once a shift at a
minimum.
Position drainage
bag to prevent
backflow of urine
or contact with the
floor.
44
2D ECHO WITH DOPPLER

Medication (Patient- Ordered the patient Responsibilities
Brand Name)
45
2D ECHO WITH Echocardiography This January The patient Check the

DOPPLER uses standard procedure 29,2019 blood physician order.
two-dimensional, was Flow was
When combined three- indicated for measure Check all parts
with dimensional, and the patient through of the order for
the Doppler Doppler for diagnostic various accuracy.
technique, which ultrasound to purposes for chambers of
records changes create images of suspected the heart and Ensure to
in frequency of the heart. heart disease heart valves empty
sound waves, Echocardiography and used to and calculate the bladder
echocardiography has become measure pressure Inform that a
can be used to routinely used in blood difference conductive gel
measure blood the diagnosis, Flow through across valves. is applied to
Flow through management, various the chest area.
various chambers and follow-up of chambers of Position the
of the heart and patients with any the heart and patient on his
heart valves and suspected or heart valves left side
calculate pressure known heart and calculate
difference across diseases. pressure
valves. difference
across valves.
INTUBATION

Brand Name)
46
Intubation is This procedure January The patient Check the

INTUBATION the process of was indicated 29,2019 was able to physician order;
inserting a for the patient breath by the
Tracheal tube, called an to placed on a assistance of Check all parts
Intubation, endotracheal ventilator to the ventilator of the order for
usually simply tube (ET), assist with accuracy.
referred to as through the breathing
intubation, is mouth and Assess the
the placement then into the client’s
of a flexible airway. This is respiratory
plastic tube done so that status at least
into the trachea a patient can be every 2 hours or
(windpipe) to placed on a frequently as
maintain an ventilator to indicated.
open airway or assist with
to serve as a breathing Assess nasal and
conduit during oral mucosa for
through which anesthesia, redness and
to administer sedation, or irritation.
certain drugs. severe illness.
Assess nasal and
oral mucosa for
redness and
irritation.
Place the
patient in a side
lying position or
semi fowler’s if
not
contraindicated
to avoid
aspiration.
Reposition
47
patient every 2
hours.
Provide oral
care at least
every 4 hours
using
antibacterial or
antiseptic
solution.
Use bite block

to avoid patient
from biting
down.
48
VENTRICULOPERITONEAL (VP) SHUNT

49
Ventriculoperitoneal Ventriculoperitoneal This January The patient Check the

(VP) shunts, (VP) shunts, which procedure 29,2019 cerebrospinal physician
which are used are used to was fluid was order.
to treat treat hydrocephalus indicated f able to flow
hydrocephalus, shunt cerebrospinal or the patient and ICP was Check all parts
shunt cerebrospinal fluid (CSF) from the to let the fluid lessen of the order for
fluid (CSF) from the lateral ventricles of flow normally accuracy.
lateral ventricles of the brain into the and ICP will
the brain into the peritoneum. lessen to treat Ensuring
peritoneum. Tapping or hydrocephalus proper function
aspirating the shunt of the shunt
is performed for device,
both diagnostic
reasons (eg, Monitoring the
evaluate for shunt patient's
infection and neurologic
blockage) and status.
therapeutic reasons
(eg, allows fluids to Assessing for
be drawn off to complications,
alleviate symptoms and caring for
from a blocked the surgical
shunt). sites.
Assess both
proximal (head)
and distal
(abdominal)
shunt catheter
site incisions
for bleeding,
drainage, and
50
signs of wound
infection.
CHEST TUBE
51

Brand Name)
A chest tube A chest This February 01, The patient Check the
is a hollow, tube can procedure 2019 was able to physician order;
flexible tube help was drain air, Check all parts
Placed into the drain indicated blood, of the order for
chest. air, blood, for the patient or fluid accuracy.
It acts as or fluid to from the
a drain. from the drain space Instruct the
Chest tubes space air, blood, surrounding patient not to
drain blood, surrounding or fluid the lungs, rest the body on
fluid, or air your lungs, from the called the the tubing.
from around called the space pleural space.
your lungs, pleural space. surrounding Check the
heart, or Chest tube the lungs, patient’s tubing
esophagus. insertion called the for twists and
The tube is also pleural space. kinks in the
around the referred to tubing line.
lung is placed as chest tube
between the thoracostomy. Tape the tubing
ribs and into It's typically connections to
the space an emergency prevent air from
between the procedure. leaking out of
inner lining It may also the tube.
and the outer be done
lining of the after surgery Encourage the
chest on organs or patient to
cavity. tissues in your perform deep-
chest cavity. breathing
exercises or
coughing.
52
MEDICATIONS
Treatment or General Purpose Date Ordered Response of Nursing Responsibilities

Medication Action (Patient- the patient
53

Brand Name)
Generic Name: Reduces The purpose of February 3, Patient did Check doctor’s order for
esomeprazole gastric acid esomeprazole 2019 not manifest the medication, route,
sodium secretion sodium is to any signs or dosage and frequency
Brand Name: and treat the symptoms of of administration
Nexium I.V. decreases condition of allergic -To prevent errors.
gastric the patient reaction to Administer the drug
Dosage: acidity. caused by too the drug. Also exactly as prescribed.
40 mg much acid relieve the -To prevent
OD (6AM) production in acid complication for the
Route: I.V. his stomach. production in patient.
his stomach. Administer the drug at
least 1 hour before a
meal.
-For proper absorption
of the drug.
Advise the SO that
antacids can be used
while taking drug unless
otherwise directed by
prescriber.
-For SO knowledge
about the medication.
Monitor GI symptoms
for improvement or
worsening.
-To know the
effectiveness of the
drug. Because this
medication is to reduce
gastric acid and
54
secretion.
Monitor magnesium
level before treatment
and periodically during
treatment.
-because this
medication it can affect
the magnesium level of
the patient and it may
decrease.
Monitor patient for
signs and symptoms of
low magnesium level,
such as abnormal heart
rate or rhythm,
palpitations, muscle
spasms, tremor,
seizures.
-For patient’s safety and
to prevent any other
complication for the
patient.
Tell the SO to inform
prescriber of worsening
signs and symptoms,
pain, or diarrhea that
doesn’t improve.
-Because it may part of
an allergic reaction. So
that the doctor will have
the patient to stop
taking this drug.
55
Instruct SO to alert
prescriber if rashes or
other signs and
symptoms of allergy
occur.
-To prevent other
patient.
Warn SO to
immediately report
symptoms of low
magnesium level.
-Because this drug can
decrease the
magnesium level of the
patient.

Brand Name)
Generic Name: Not clearly Hydrocortison February 3, Patient did Determine whether
hydrocortisone defined. e is an anti- 2019 not manifest patient is sensitive to
56
Brand Name: Decreases inflammatory any signs or other corticosteroids.

Cortef inflammatio medication. Th symptoms of -To know if the patient
n, mainly by at why the allergic have allergic- type
Dosage: stabilizing purpose of this reaction to reactions to these
100 mg leucocyte medication for the drug. Also agents.
q12 (10AM- lysosomal the patient is it lessen his Give a once- daily dose
10PM) membrane, to relieves edema. in morning.
Route: I.V. suppresses inflammation - For better results and
immune in various parts less toxicity.
response, of the body. Monitor patient’s
stimulates weight, BP, and
bone electrolyte level.
marrow; and -To prevent any type of
influences complication that the
protein, fat, patient may manifest.
and Monitor patient for
carbohydrat cushingiod effects,
e including buffalo hump,
metabolism. moon face, central
obesity, thinning hair,
hypertension, and
increased susceptibility
to infection.
-Because these drug is a
corticosteroid, to
prevent the adverse
effect.
Unless contraindicated,
give a low- sodium diet
that’s high in potassium
and protein.
57
-For patient’s safety.

Watch for depression or
psychotic episodes, - It
may affect the patients
neurologic function
especially during high
dose.
Inspect patient’s skin
for petechiae.
-To know if the patient
has an allergic reaction.
Tell SO not to stop drug
abruptly or without
prescriber’s consent.
-For better absorption
of the drug and to
prevent drug resistance.
Tell the SO to need to
notify the prescriber
about sudden weight
gain or swelling.
-For SO knowledge for
the adverse effect of the
drug and to know when
they will call the doctor.
Warn the SO about easy
bruising.
-For SO knowledge,
because one of the
adverse effect is easy
bruising.
58

Brand Name)
Generic Name: Inhibits Digoxin its February The response Check doctor’s order for
digoxin sodium- purpose to the 3,2019 of the patient the medication, route,
Brand Name: potassium- patient is to the dosage and frequency
Lanoxin activated to help make medication is of administration
adenosine the heart beat slows down -To prevent any errors.
Dosage: triphosphata stronger and the rate of his Monitor potassium
0.25 mg se, with a more heart beats, level carefully. Take
59
BID (8AM- promoting regular and also corrective action before

8PM) movement rhythm. increases the hypokalemia occurs.
Route: Oral of calcium force with -Hyperkalemia may
(tab) from which the result from digoxin
extracellular heart muscle toxicity.
cytoplasm contracts
and with every Withhold the drug and
strengthenin heartbeat. notify prescriber if
g myocardial This makes excessively slow pulse
contraction. each rate occurs.
Also acts on heartbeat -Because (60
CNS to more efficient beats/minute or less)
enhance at pumping may be sign of digitalis
vagal tone, blood around toxicity.
slowing the body. Teach SO about drug
conduction action, dosage regimen,
through the how to take pulse,
SA and AV reportable signs, and
nodes. follow up care.
-For patient’s SO
knowledge.
Tell SO to report pulse
rate less than 60
beats/minute or more
than 110 beats per
minute, or skipped
beats or other rhythm
changes.
-To prevent any serious
patient.
60
Instruct SO to report
adverse reactions
promptly. Nausea,
vomiting, diarrhea,
appetite loss
-It may indicators of
toxicity.
Tell the SO not to

substitute the drug to
one brand for another.
-To prevent drug
resistance.
Advise SO to avoid the

use of herbal drugs or to
consult his prescriber
before taking one.
-To prevent any other
problem or
patient.
Observe the patient for
any reaction to the
drug.
-To know and prevent
any kind of allergic
reaction or adverse
effect for the patient.
Tell patient’s SO to
report if they notice to
the patient that he/she
61
feels shortness of
breath.
-withhold the drug if
there is a sign of
shortness of breath.
Because one of the
adverse effect is the
shortness of breath.
Chart the medication

after
Administering.
-To know what is the
procedure done for the
patient and also for
legality purposes.

Brand Name)
Generic Name: Increases The purpose February The response Check patency at
mannitol osmotic of mannitol is 3,2019 of the patient infusion site before and
Brand Name: pressure of to promote to the during administration
Osmitrol glomerular diuresis for medication it -To prevent any
filtrate, thus acute renal forces his problem especially an
Dosage: inhibiting failure to urine infiltration.
100 cc tubular prevent or production in .
62
q6 (10AM- reabsorption treat the his acute Monitor patient for

4PM) of water and oliguric phase (sudden) signs and symptoms of
Route: I.V. electrolyte. before kidney failure. infiltration,
Drug irreversible It increased -To prevent
elevates damage. urine inflammation, edema,
plasma production and necrosis.
osmolality helps to keep Monitor vital signs,
and the kidneys including central venous
increases from shutting pressure and fluid
urine down, and intake and output
output. also speeds hourly.
up -Because the use of the
elimination of drug is to promote
certain toxic diuresis.
substances in Check weight, renal
his body. function, fluid balance,
and serum and urine
sodium and potassium
levels daily.
-To know if there is a
water retention brought
about by the edema.
In comatose or
incontinent use urinary
catheter.
–Because therapy is
based on strict
evaluation of fluid
intake and output.
Give frequent mouth
care or fluids.
- To relieve thirst.
63
Tell SO that the patient

may feel thirsty or have
a dry mouth, and
emphasize importance
of drinking only the
amount of fluids
ordered.
-For patient’s SO
knowledge.
Instruct SO to promptly
report adverse effect or
reactions and
discomfort at I.V. site.
-For immediately
resolution and to
prevent other serious
patient.
any reaction to the
drug.
adverse reaction, and if
any withhold the drug.
after administering.
-For documentation of
all the procedure that
being administer to the
legality purposes.
64
General Purpose Date Ordered Response of Nursing Responsibilities

Treatment or Action (Patient- the patient
Medication Centered)
(Generic and
Brand Name)
Generic Name: Inhibits Losartan is February Patient Check doctor’s order for
losartan vasoconstric used with or 3,2019 polycythemia’ the medication, route,
Brand Name: tive and without other s blood dosage and frequency
Cozaar aldosterone medications to pressure was of administration.
secreting treat high maintained to -To prevent any errors.
Dosage: action of blood pressure 120/80 Check the medication
50 mg angiotensin (hypertension) mmHg. It also properly and read labels
65
OD (4PM) II receptor . Lowering high control his properly.

Route: Oral on the blood pressure hypertension -To prevent errors and
(tab) surface of helps prevent and risk of complication for the
vascular strokes, heart stroke. patient.
smooth attacks, and Know the reason for
muscle and kidney which patient is
other tissue problems. receiving the
cells. medication.
-To know the purpose
why the patient needs
the medication.
Check the label three
times before
administering.
-To prevent errors in
giving the medication.
Assess patient’s history
of allergic reaction to
the drug.
-To prevent any kind of
adverse reaction.
Monitor patient’s BP.
-Because it is a
hypertensive
medication.
Assess patient’s renal
function.
-Because these drug can

affect the renal function
especially for long term
use.
66
Calculate correctly the

dose and check the
required amount to be
given.
-To give the exactly
required amount of
medication the patients
need and to prevent
overdose for the
patient.
Inform SO about the
side effects and adverse
effects of the
medication.
-For patient’s So
knowledge about the
mediation being
administering for the
patient.
any reaction to the
drug.
has any allergic reaction
and to prevent any kind
of adverse reaction.
feels shortness of
breath.
-To prevent it
67
immediately, because
one of the adverse of
the drug is shortness of
breath.
legality purposes.

Brand Name)
Generic Name: Actively To function February It helps the Check doctor’s order for
vitamin B participate and 3,2019 patient’s the medication, route,
complex in the development nutrient need dosage and frequency
Brand Name: metabolism of the brain, for his health of administration.
Nascobal of nerve cells, the and gives him -To prevent any errors.
carbohydrat myelin sheaths an energy to Check the medication
Dosage: es, proteins that protect fight in his properly and read labels
68
and fats. nerves, and disease. properly.

OD (8AM) Thiamine blood -To prevent errors and
Route: hydrochlorid cells. Vitamin complication for the
e acts as a B12 is patient.
co-enzyme sometimes Know the reason for
in the taken to treat which patient is
breakdown memory loss, receiving the
of glucose poor medication.
and concentration, -To know the purpose
glycogen. and why the patient needs
Alzheimer's the medication.
disease and to Check the label three
boost your times before
mood or administering.
energy levels. -To prevent errors in
the drug.
adverse reaction.
Inform SO about the
effects of the
medication.
-For SO knowledge
about the mediation
being administering for
the patient.

69
any reaction to the

drug.
has any allergic reaction
and to prevent any kind
of adverse reaction.
feels shortness of
breath.
-To prevent it
breath.
Determine reticulocyte
count, hct, Vit.B12, iron,
folate levels before
beginning therapy.
-To prevent any
problem when
administering the drug.
Obtain a sensitivity test
history before
administration.
-To prevent any
problem when
administering the
medication.
Avoid I.V.
administration for these
70
drug.
-Because faster
systemic elimination
will reduce
effectiveness of
vitamin.
Don’t give large doses
routinely
- Because drug is lost
through excretion.
Protect Vit.B 12 from
light. Don’t refrigerate
or freeze.
-To prevent the
drug.

(Generic and
Brand Name)
Generic Name: Unknown. It used this January 27 Patient If there is fever, assess
paracetamol Thought medicine to and February polycythemia’ patient’s fever,
to produce help treat pain 3,2019 s fever was intensity, duration,
Brand Name: analgesia and reduce a relief. temperature, and
Biogesic by blocking high diaphoresis.
71
generation temperature -To know if the

Dosage: of pain (fever) of the medication will give.
300 mg impulses, pr patient. Assess allergic
q4 (PRN) obably by reactions: rashes,
Route: I.V. inhibiting urticarial; if these occur
prostaglandi -To know if the drug
n synthesis in may have to be
the CNS or discontinued.
the synthesis Teach SO to recognize
or action of signs of chronic
other substanc overdose: bleeding,
es that bruising, malaise, fever,
sensitize sore throat.
pain -For SO knowledge
receptors to about the drug
mechanical overdose.
or chemical Tell patient’s SO not to
stimulation. use for marked fever
It is thought to (higher than39.5 º C).
relieve fever Fever persisting longer
by central than 3 days, or
action in the recurrent fever unless
hypothalamic directed by prescriber.
heat- -So that the SO know
regulating about the medication.
center. Avoid giving patient
aspirin or aspirin-like
analgesics
-Because it inhibits
platelet aggregation.
72
Teach SO warning signs

that needs immediate
attention of the
physician.
-For SO knowledge, to
know what they will do.
Evaluate therapeutic
effects.
-To know the
drug for the patient.
Inform SO about the
effects of the
medication.
-For SO knowledge
about the medication.
any reaction to the
drug.
-To prevent any king of
adverse reaction for the
patient.
legality purposes.
73

Brand Name)
Generic Name: Inhibits The purpose February 3, It treat the Check doctor’s order for
furosemide sodium and of Lasix for the 2019 fluid the medication, route,
Brand Name: chloride patient is to retention dosage and frequency
Lasix reabsorption allow the salt (edema) of of administration.
at the to instead be the patient -To prevent any errors.
Dosage: proximal and passed in his with his liver Check the medication
20 mg distal urine. disease, or a properly and read labels
q12 (2AM- 2PM) tubules and kidney properly.
Route: I.V. the disorder. -To prevent errors and
ascending complication for the
74
loop of patient.
Henle. Know the reason for
which patient is
receiving the
medication.
the medication.
Administer the drug in
morning.
-To prevent need to
urinate at night. If
patient needs second
dose, tell to the SO to
take it in early
afternoon, 6 to 8 hours
after morning dose.
Inform SO to possible
need for potassium or
magnesium
supplements.
-For better absorption
of the drug and to
prevent any other
complication.
Advice the patient’s SO
to immediately report
presence of sore throat
or fever of the patient.
-Because these
symptoms may indicate
toxicity.
75
Tell SO to consult
prescriber or
pharmacist before
taking OTC drugs.
-To prevent any
problem or
patient.
Teach SO to avoid the
patient in direct sunlight
and use protective
clothing.
-Because of risk of
photo sensitively
reactions.
Monitor fluid intake and
output and electrolyte,
BUN, and carbon
dioxide levels
frequently.
-Because the use of
these drug is to allow
the salt to instead be
passed in his urine. So
that will able to know
the effectiveness of the
drug.
Watch for signs of
hypokalemia, such as
muscle weakness and
cramps.
-Because it may
76
indicative of adverse
effect to the patient.

(Generic and
Brand Name)
Generic Name: A The purpose of February 3, The response Check doctor’s order for
diazepam benzodiazep diazepam to 2019 of the patient the medication, route,
Brand Name: ine that the patient is in diazepam dosage and frequency
Valium probably to relieve medication is of administration.
potentiates muscle treated his -To prevent any errors.
Dosage: the effects of spasms. seizures Check the medication
OD GABA, Because this episode. properly and read labels
Route: depresses medication properly.
the CNS, and works by -To prevent errors and
suppresses calming the complication for the
the spread brain and patient.
of seizure nerves. Know the reason for
77
activity. which patient is

receiving the
medication.
the medication.
times before
administering.
-To prevent errors and
patient.
the drug.
adverse reaction.
Calculate correctly the
dose and check the
required amount to be
given.
-To give the exactly
required amount of
medication the patients
need and to prevent
overdose for the
patient.
Inform SO about the
effects of the
medication.
-For SO knowledge
78
about the mediation

the patient.
any reaction to the
drug.
patient.
feels shortness of
breath.
-To prevent it
breath.
Monitor patient’s BP
-Because these drug
may affect the patient’s
blood pressure.
Monitor periodic
hepatic, renal, and
hematopoietic function
studies in patients
receiving repeated or
prolonged therapy.
-Because these drug
also affect the hepatic,
renal, and
79
hematopoietic function
of the patient especially
for prolonged uses.
Warn the patient’s SO

not to stop abruptly.
-Because withdrawal
symptoms may occur.

Brand Name)
Generic Name: Replaces This February It prevent the Explain use and
magnesium magnesium medication is 3,2019 seizures administration of drug
sulfate Drip and used to treat episode of the to patient and family.
Brand Name: maintains and prevent patient. -For SO knowledge
magnesium low about the drug being
and blood magnesi administer to the
maintains um and patient.
magnesium seizures of the Tell SO to report
level; as an patient. adverse effects.
anticonvulsa -To prevent other
nt, reduces serious complication for
muscle the patient.
80
contractions Keep I.V. calcium

by available.
interfering -To reverse magnesium
with release intoxication.
of Test knee-jerk and
acetylcholin patellar reflexes before
e at each additional dose.
myoneutral - If absent notify
junction. prescriber and give no
more magnesium until
reflexes return.
Check magnesium level
after repeated doses.
-To monitor the levels
hourly in patients with
severe
hypomagnesemia.
Monitor fluid intake and
output.
- Output should be
100Ml or more during 4-
hours period before
dose.
Monitor renal function.

-Because these drug
may affect the renal
function.
Don’t confuse
magnesium sulfate to
manganese sulfate.
-To prevent any errors
81
in giving the
medication.
legality purposes.
82

(Generic and
Brand Name)
Generic Name: Not clearly Verapamil me February 3, It treats the Check doctor’s order for
verapamil defined. A dication is used 2019 patient’s the medication, route,
hydrochloride calcium for the patient, hypertension dosage and frequency
Brand Name: channel in order to (high blood of administration.
Verelan blocker that relax the pressure), -To prevent any errors.
inhibits muscles of his and certain Check the medication
Dosage: calcium ion heart and heart rhythm properly and read labels
5 mg influx across blood vessels. disorders. properly.
OD (11AM) cardiac and -To prevent errors and
Route: I.V. smooth- complication for the
muscle cells, patient.
thus Know the reason for
decreasing which patient is
myocardial receiving the
contractility medication.
and oxygen -To know the purpose
demand; it why the patient needs
also dilates the medication.
83
coronary Patients receiving beta

arteries and blockers should receive
arterioles. lower doses of this drug.
serious complication
and adverse reaction for
the patient.
Monitor these patient
closely.
-To prevent any
problem that the
patient may manifest.
When clinically
advisable, have the
patient perform vagal
maneuver before giving
drug.
-For patient safety.
Frequently monitor PR
interval.
-To prevent other
problem for patient.
Monitor BP at the start
of therapy and during
dosage adjustments.
-Because the action of
these drug is to relax the
muscles of patient’s
heart and blood vessels.
It may affect the
patient’s blood
84
pressure.
If signs and symptoms
of heart failure occur,
such as swelling of
hands and feet and
shortness of breath,
notify prescriber.
serious complication for
the patient.
Monitor renal function
test and LFT result
during prolonged
treatment.
-Because these drug can
affect the renal function
of the patient especially
for long term use.
Don’t confuse Verelan
with Vivarin or Voltaren.
-To prevent errors in
legality purposes.
85

Brand Name)
Generic Name: Inhibits Ciprofloxacin is February Patient did Check doctor’s order for
ciprofloxacin bacterial used to treat or 3,2019 not manifest the medication, route,
Brand Name: DNA prevent certain any signs or dosage and frequency
Cipro synthesis, infections symptoms of of administration.
mainly by caused by allergic -To prevent any errors.
Dosage: blocking bacteria, reaction to Check the medication
400 mg DNA gyrase; because of the the drug. properly and read labels
OD (6AM) bactericidal. patient’s properly.
Route: I.V. pneumonia. -To prevent errors and
patient.
Know the reason for
which patient is
receiving the
medication.
the medication.
times before
administering.
-To prevent errors and
patient.
86
the drug.
adverse reaction.
Inform SO about the
effects of the
medication.
-For SO knowledge
about the mediation
the patient.
any reaction to the
drug.
patient.
Tell SO that it must take
the drug as prescribed,
even after feeling
better.
-To prevent drug
resistance.
If a rash or other
reaction occurs, tell
patient’s SO to stop
drug immediately and
notify prescriber.
-For patient’s SO
Knowledge.
Tell SO that tendon
87
rupture can occur with

drug and notify
prescriber if pain or
inflammation occurs.
-For patient’s SO
Knowledge.
Monitor patient intake
and output,
-To observe patient for
crystalluria.

88
(Generic and
Brand Name)
Generic Name: Inhibits cell- The purpose of January 26, tazobactam i Take note that the drug
piperacillin wall the 2019 njection may cause CDAD
sodium/ synthesis piperacillin/taz treats the ranging in severity from
tazobactam during obactam for pneumonia of mild diarrhea to fatal
sodium bacterial the patient is the patient colitis.
Brand Name: multiplicatio to treat a wide with no signs -To monitor patient for
Zosyn n. variety of and diarrhea and initiate
bacterial symptoms of therapeutic measures
Dosage: infections. adverse as needed. Drug may
100 mg Because it is a effect. need to be stopped.
q8 (8AM- 4PM- penicillin Watch out for bacterial
12MN) antibiotic. It or fungal
Route: I.V. works by superinfection.
stopping the -Because if large doses
growth of are given or therapy is
bacteria. prolonged, the patient
can manifest
superinfection.
Monitor patient sodium
intake and electrolyte
levels.
-Because these
medication work as a
bactericidal.
Monitor hematologic
and coagulation
parameters.
-For patient’s safety.
Patient with cystic
89
fibrosis may have higher

rate of fever and rash.
-To monitor these
patients closely.
report adverse
reactions promptly.

patient.
Watch for patient
discomfort at the I.V.
site.
-Because it can lead to
infiltration and can also
cause an edema on the
part of the I.V site of the
patient.
90
Treatment or
Medication General Purpose Date Ordered Response of Nursing Responsibilities
(Generic and Action (Patient- the patient
Brand Name) Centered)
Generic Name: Bactericidal: used to treat a February 3, treat Tell patient’s SO to

ceftriaxone Inhibits wide variety of 2019 conditions report adverse
sodium synthesis of bacterial such as lower reactions promptly.
91
Brand Name: bacterial cell infections respiratory -To prevent any serious
Rocephin wall causing tract complication for the
cell death. infections patient.
Dosage: Check regularly the I.V.
1 gm site if there is a
TID discomfort the patient.
Route: I.V. -Because it can lead to
infiltration and can also
cause an edema on the
part of the I.V site of the
patient.
Teach family how to
prepare and give drug
for the patient.
-For SO knowledge.
Tell SO to notify
immediately the
prescriber about the
loose stools or diarrhea.
-Because it may
indicative of the
adverse effect of the
medication.
Monitor patient for
signs and symptoms of
superinfection.
-Because if large doses
are given, therapy is
prolonged, the patient
is at high risk of
superinfection.
92
Monitor patient for

superinfection,
diarrhea, and anemia.
-To treat appropriately.

Brand Name)
Generic Name: Act The purpose of February 1, The patient Check doctor’s order for
midazolam selectively this 2019 was get the medication, route,
hydrochloride on medication for drowsy dosage and frequency
polysynaptic the patient is before his of administration.
Brand Name: neuronal as part of the medical -To prevent any errors.
Benzodiazepam pathways anesthesia procedures Check the medication
throughout during surgery and surgery. properly and read labels
Dosage: the CNS. to produce a properly.
1 gm Precise sites loss of -To prevent errors and
Route: I.V. and consciousness. complication for the
mechanism patient.
of action are Know the reason for
not fully which patient is
known. receiving the
However, medication.
benzodiazep -To know the purpose
ines enhance why the patient needs
or facilitate the medication.
the action of Check the label three
GABA, an times before
inhibitory administering.
neurotrans -To prevent errors and
93
mitter in the complication for the

CNS. This patient.
drug appear Assess patient’s history
to act at the of allergic reaction to
limbic, the drug.
thalamic, -To prevent any kind of
and adverse reaction.
hypothalami Calculate correctly the
c level of the dose and check the
CNS to required amount to be
produce given.
anxiolytic, -To give the exactly
sedative, required amount of
hypnotic, medication the patients
skeletal need and to prevent
muscle overdose for the
relaxant, and patient.
anticonvulsa Inform SO about the
nt effects. side effects and adverse
effects of the
medication.
-For patient’s SO
knowledge about the
medication.
any reaction to the
drug.
patient.
94

feels shortness of
breath.
-To prevent it
breath.
Monitor patient’s BP
-Because these drug
may affect the blood
Pressure of the patient.
legality purposes.
95
VI. SURGICAL MANAGEMENT
TRACHEOSTOMY
This procedure was indicated to the patient because he has difficulty of breathing.
A tracheostomy is an opening created at the front of the neck so a tube can be inserted into the
windpipe (trachea) to help you breathe. If necessary, the tube can be connected to an oxygen supply
and a breathing machine called a ventilator.
A tracheostomy is usually done for one of three reasons: to bypass an obstructed upper
airway; to clean and remove secretions from the airway; to more easily and usually more safely,
deliver oxygen to the lungs.
All tracheostomies are performed due to a lack of air getting to the lungs. There are many
reasons why sufficient air cannot get to the lungs.
Airway Problems That May Require a Tracheostomy
 Tumors, such as cystic hygroma

 Laryngectomy
 Infection, such as epiglottitis or croup
 Subglottic Stenosis
 Subglottic Web
 Tracheomalacia
 Vocal cord paralysis (VCP)
 Laryngeal injury or spasms
 Congenital abnormalities of the airway
 Large tongue or small jaw that blocks airway
 Treacher Collins and Pierre Robin Syndromes
 Severe neck or mouth injuries
 Airway burns from inhalation of corrosive material, smoke or steam
 Obstructive sleep apnea
 Foreign body obstruction
96
Lung Problems That May Require a Tracheostomy
 Need for prolonged respiratory support, such as Bronchopulmonary Dysplasia (BPD)

 Chronic pulmonary disease to reduce anatomic dead space
 Chest wall injury
 Diaphragm dysfunction
Other Reasons for a Tracheostomy
 Neuromuscular diseases paralyzing or weakening chest muscles and diaphragm

 Aspiration related to muscle or sensory problems in the throat
 Fracture of cervical vertebrae with spinal cord injury
 Long-term unconsciousness or coma
 Disorders of respiratory control such as congenital central hypoventilation or central apnea
 Facial surgery and facial burns
 Anaphylaxis (severe allergic reaction)
Nursing Responsibilities
Before
 Check diagnostic results.

 Administer pre-operative medicine as prescribed.
 Explain the procedure to the patient.
 Removed all the jewelries.
 Informed consent for the surgery
During
 Positioning of the patient in the operating room.

 Preparing the operating site.
 Draping of operating site.
97
 Ensuring sterile technique inside the operating room.
After
 Keep patient nothing per oral.

 Continue intravenous therapy as ordered.
 Administer medication as ordered.
 Monitor vital signs.
 Assess the operative site.
 Initial dressing changed after 48-72 hours (to inspect for infection of suture line)
 Watch out for complications such as hemorrhage, respiratory distress, hoarseness of voice.
98
LIST OF PRIORITY OF NURSING CARE PLAN:
1. INEFFECTIVE AIRWAY CLEARANCE RELATED TO OBSTRUCTIONS FROM THE

RESPIRATORY TRACT
2. DEFICIENT FLUID VOLUME RELATED TO ACTIVE FLUID LOSS
3. INFECTION RELATED TO PRESENCE OF BACTERIA

99
IX. NURSING CARE PLAN
1. INEFFECTIVE AIRWAY CLEARANCE RELATED TO OBSTRUCTIONS FROM THE RESPIRATORY

TRACT
Scientific Planned/ Evaluation
Assessment Rationale Scientific Expected Nursing Rationale
for Nursing Explanatio Outcomes Interventions
Diagnosis n
SUBJECTIVE: Ineffective Breathing SHORT
Airway comes TERM:
>“nahihirapa Clearance i naturally
n po syang s defined and
huminga” as as the effortlessly After 1 to 2 >Perform >Suctioning is Patient
verbalized inability to to days of nasotracheal needed when shall be
by the clear everyone. interventio suctioning as patients are able to
brother secretions But there n the necessary, unable to Patient will
or are some patient will especially if cough out maintain
obstruction who are be able to cough is secretions clear, open
OBJECTIVE: s from the incapable Patient will ineffective. properly due airways
respiratory of keeping maintain to weakness, manifested
>Patient is tract to their clear, open thick mucus by the
hooked with maintain a airways airways plugs, or patient
mechanical clear clear and manifested excessive or already
ventilation airway. their lungs by the tenacious breaths in a
healthy. patient mucus normal way
Maintainin already production.
g a patent breaths in a
airway has normal way
always >Using well-
100
been vital >Use well- lubricated

to life. lubricated soft catheters
catheters reduces
irritation and
prevents
trauma to
mucous
membranes.
>Chest
>Coordinate physiotherapy
with a includes the
respiratory techniques of
therapist for postural
chest drainage and
physiotherapy chest
and nebulizer percussion to
management as mobilize
indicated. secretions
from smaller
airways that
cannot be
eliminated by
means of
coughing or
suctioning.
101
>Intubation
>If secretions may be
cannot be needed to
cleared, consider facilitate
the need for an removal of
intubation tenacious and
copious
amounts of
secretions and
provide
source for
augmenting
oxygenation.
> Educate >The proper

the patient sitting
in the following: position and
Optimal splinting of
positioning (sitti the abdomen
ng position) promote
Use of pillow or effective
hand splints coughing by
when coughing increasing
Use of abdominal
abdominal pressure and
muscles for upward
more forceful diaphragmatic
cough movement.
Use of quad and Controlled
huff techniques coughing
Use of incentive methods help
spirometry mobilize
secretions
102
Importance of from smaller

ambulation and airways to
frequent larger airways
position changes because the
coughing is
done at
varying times.
Ambulation
promotes lung
expansion,
mobilizes
secretions,
and lessens
atelectasis.
>Position the
patient
upright if
> Position the tolerated.
patient upright if Regularly
tolerated. check the
Regularly check patient’s
the patient’s position to
position to prevent sliding
prevent sliding down in bed.
down in bed.
> Increasing
LONG humidity of
TERM: inspired air
will reduce
103
After 1 to 2 > Maintain thickness of

weeks of humidified secretions and Patient
interventio oxygen as aid their shall be
n the prescribed. removal. able to
patient will demonstrat
be able to > Fluids help e effective
demonstrat minimize gas
e effective mucosal exchange
gas drying and
exchange > Encourage maximize
patient to ciliary action
increase fluid to move
intake to 3 liters secretions.
per day
within the limits
of cardiac
reserve and
renal function. >variety of
medications
are prepared
>Give to manage
medications specific
as prescribed, problems.
such as Most promote
antibiotics, clearance of
mucolytic airway
agents, secretions and
bronchodilators, may reduce
Expectorants, airway
noting resistance.
effectiveness
and side effects.
104
> Oral care

freshens
the mouth aft
> Provide oral er respiratory
care every 4 secretions
hours. have been
expectorated.
105
2. DEFICIENT FLUID VOLUME RELATED TO ACTIVE FLUID LOSS
Scientific Planned/ Evaluation

Assessme Rationale Scientific Expected Nursing Rationale
nt for Nursing Explanation Outcomes Interventions
Diagnosis
SUBJECTI Deficient Deficient SHORT
VE: fluid volume fluid volume TERM:
“halos related to is a state or
umiinom active fluid condition
lang sya loss is where the After 1 to 2 > Insert and IV > Parenteral patient
ng defined as fluid output days of catheter to have fluid shall be
dalawang decreased exceeds the interventio IV access. replacement able to
baso sa intravascular fluid intake. It n the is indicated replace
isang , interstitial, happens patient will to prevent or fluid to
araw” as and/or when water be able to treat prevent
verbalized intracellular and electrolyt replace hypovolemic hypovolemi
by her fluid. This es fluid to complications c
sister refers Are lost as prevent . complicatio
to dehydrati they exist in hypovolemi ns
on, water normal body c
OBJECTIV loss alone fluids. complicatio
E: without Common ns > Fluids are
>Sunken change in sources of > Administer necessary to
eye balls sodium. fluid loss are parenteral fluids maintain
the as prescribed. hydration
>dry lips gastrointestin Consider the status.
al tract, need for an IV Determinatio
polyuria, and fluid challenge n of the type
increased with immediate and amount
perspiration infusion of of fluid to be
fluids for replaced and
patients with infusion rates
106
abnormal vital will vary

signs. depending on
clinical
status.
> Blood
> Administer transfusions
blood products may be
as prescribed. required to
correct fluid
loss
> Maintain IV >Susceptible

flow rate. Stop to fluid
or delay the overload and
infusion if signs require
of fluid overload immediate
transpire, refer attention.
to physician
respectively.
> Provide
measures to
prevent >Antipyretics
excessive can decrease
electrolyte fever and
107
loss such as fluid losses

administering from
antypyretics diaphoresis.
drug as
indicated
>Urge the
LONG patient to drink >Oral fluid
TERM: prescribed replacement
amount of fluid. is indicated
After 1 to 2 for mild fluid
weeks of deficit and is patient
interventio a cost- shall be
n the effective able to
patient will method for drink
be able to replacement prescribed
drink treatment. amount of
prescribed fluid
amount of
fluid.
> Aid the >Dehydrated
patient if he is patients may
unable to eat be weak and
without unable to
assistance, and meet
encourage the prescribed
family or SO to intake
assist with independentl
feedings, as y.
necessary.
108
>Emphasize >Fluid deficit

importance can cause a
of oral hygiene. dry, sticky
mouth.
Attention to
mouth care
promotes
interest in
drinking and
reduces
discomfort of
dry mucous
membranes.
>Drop situati
ons where
>Provide patient can
comfortable experience
environment by overheating
covering patient to prevent
with light further fluid
sheets. loss
> Patient
needs to
>Enumerate understand
interventions to the value of
prevent or drinking extra
minimize future fluid during
episodes of bouts of
dehydration. diarrhea,
109
fever, and
other
conditions
causing fluid
deficits.
3. INFECTION RELATED TO PRESENCE OF BACTERIA
Scientific Planned/ Evaluatio

Assessment Rationale Scientific Expected Nursing Rationale n
for Explanation Outcomes Interventions
Nursing
Diagnosis
SUBJECTIVE: Infection is Infections SHORT
defined as occur when TERM:
>xray result at the natural
PTB increased defense
for being mechanism After 1 to 2 >Place the > Protective patient
OBJECTIVE: invaded by s of an days of patient in isolation is set will be
>difficulty of pathogeni individual interventio protective when WBC able to
breathing c are n the isolation counts indicate free of
>temperatur organisms. inadequate patient will because the neutropenia infection
e to protect be able to patient is at very (less than 500
38.7 c them. free of high risk. mm3).
Organisms infection
110
such as
bacterium, > Antibiotics
virus, work best
fungus, and >administered when a
other antibiotics as constant blood
parasites prescribed level is
invade maintained
susceptible which is done
hosts when
through medications
inevitable are taken as
injuries and prescribed.
exposures.
People >Aseptic
have technique
dedicated > Maintain or decreases the
cells or teach asepsis for changes of
tissues that dressing transmitting or
deal with changes and spreading
the threat wound care, pathogens to
of infection. peripheral IV the patient.
These are and central Interrupting
known as venous the
the management, transmission of
immune and catheter infection along
system. care and the chain of
handling. infection is an
effective way
to prevent
infection.
> Encourage > Helps reduce

coughing and stasis of
111
deep breathing secretions in

exercises; the lungs and
frequent the bronchial
position tree. When
changes. stasis occurs,
pathogens can
cause upper
respiratory
tract infections
>Restricting
visitation
> Limit visitors. reduces the
transmission of
pathogens.
> Provide
surgical mask to
visitors who are > Educating
coughing and visitors on the
provide importance of
an explanation preventing
why. Instruct: droplet
Cover mouth an transmission
d nose during from
coughing or themselves to
sneezing. others can
Use tissues to help reduce
contain the infection.
respiratory
secretions with
an immediate
disposal to a no-
112
touch receptacle
; wash hands
with soap and
water afterward.
> Encourage > Helps

intake of support the
protein-rich and immune
calorie-rich system
foods. responsiveness
.
LONG
TERM:
> Teach the >Patients and
After 1 to 2 patient and/ SO can spread
weeks of or SO to wash infection from patient
interventio hands often, one part of shall be
n the especially after the body to able to
patient will toileting, before another prevent
be able to meals, and handwashing infection
prevent before and after reduces
infection administering these risks.
self-care.
> Other people

> Teach the can spread
patient the infections or
importance of colds to a
avoiding contact susceptible
113
with individuals patient

who have through direct
infections or contact,
colds. contaminated
objects, or
through air
currents.
> Demonstrate > Patient and

and allow return SO need
demonstration opportunities
of all high-risk to master new
procedures that skills to reduce
the patient risk for
and/or SO will infection.
do after
discharge, such
as dressing
changes,
peripheral or
central IV site
care, and so on.
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Case Study Ovarian Cancer

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1

COLLEGE OF OUR LADY OF MT. CARMEL

A Case Presentation to the

A Case Study of Ovarian Cancer

COLLEGE OF OUR LADY OF MT. CARMEL

Title page ………………………………………………………………………………………………………………1

COLLEGE OF OUR LADY OF MT. CARMEL

COLLEGE OF OUR LADY OF MT. CARMEL

Background of the Disease

Germ cell Tumors

Signs and symptoms

COLLEGE OF OUR LADY OF MT. CARMEL

COLLEGE OF OUR LADY OF MT. CARMEL

COLLEGE OF OUR LADY OF MT. CARMEL

COLLEGE OF OUR LADY OF MT. CARMEL

 History of kidney transplantation in such cases

Signs and symptoms

COLLEGE OF OUR LADY OF MT. CARMEL

 Reduced quality of life

COLLEGE OF OUR LADY OF MT. CARMEL

COLLEGE OF OUR LADY OF MT. CARMEL

COLLEGE OF OUR LADY OF MT. CARMEL

COLLEGE OF OUR LADY OF MT. CARMEL

COLLEGE OF OUR LADY OF MT. CARMEL

ANATOMY AND PHYSIOLOGY

COLLEGE OF OUR LADY OF MT. CARMEL

COLLEGE OF OUR LADY OF MT. CARMEL

COLLEGE OF OUR LADY OF MT. CARMEL

A. Personal history (demographics, educational attainment, occupation, religion )

COLLEGE OF OUR LADY OF MT. CARMEL

Mr. Polycythemia is presently working as a tricycle driver and works from 7 am to 5

COLLEGE OF OUR LADY OF MT. CARMEL

E. Family health history with pedigree

COLLEGE OF OUR LADY OF MT. CARMEL

FAMILY HEALTH HISTORY WITH PEDIGREE

MATERNAL SIDE PATERNAL SIDE

COLLEGE OF OUR LADY OF MT. CARMEL

FEMALE MALE DIED

COLLEGE OF OUR LADY OF MT. CARMEL

Physical Assessment (IPPA-cephalocaudal approach)

COLLEGE OF OUR LADY OF MT. CARMEL

Nail’s color does not go back in 3 seconds after capillary test.

Head and Neck Inspection

Eyes and Ears Inspection

The lower eyelids are upright

COLLEGE OF OUR LADY OF MT. CARMEL

Skin is smooth with no lesions

Mouth, Nose and Sinuses Inspection

COLLEGE OF OUR LADY OF MT. CARMEL

COLLEGE OF OUR LADY OF MT. CARMEL

II. Health history (Past and Present illness )

COLLEGE OF OUR LADY OF MT. CARMEL

III. LABORATORY PROCEDURES

DIAGNOSTICS/ DATE PURPOSE(S) RESULTS NORMAL ANALYSIS AND

COLLEGE OF OUR LADY OF MT. CARMEL

COLLEGE OF OUR LADY OF MT. CARMEL

not attached to blood and it is shows that the

COLLEGE OF OUR LADY OF MT. CARMEL

are diagnose functioning well

COLLEGE OF OUR LADY OF MT. CARMEL

COMPLETE BLOOD COUNT

DIAGNOSTICS/ DATE INDICATION RESULTS NORMAL ANALYSIS AND

SEGMENTERS January This test was 0.90/L 0.50-0.70/L Segmenters are