Professional Documents
Culture Documents
Of
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PRESENTORS:
• ALBERCA, Michelle J.
• BAROTAC, Razil L.
• EUSALA, Keene E.
• LLAMERA, Joackimm A.
• MINARDO, Sheny G.
Table of Contents
I. Dedication i
II. Acknowledgement ii
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III. Introduction 1
IV. Review of Related Literature 2
V. Anatomy and Physiology 13
VI. Patient’s Health History 24
A. Biographic Data 25
B. History of Present Illness 26
C. Past Health History 27
a. Childhood Illness 27
b. Immunization 27
c. History of Hospitalization 27
d. Surgical History 27
e. Accidents and Injuries 27
f. Allergic and Type of Reaction 27
g. Family Health History 27
h. Personal Health History 28
1. Lifestyle 28
1.1 Personal habits 28
1.2 Diet 28
1.3 Sleep and rest-pattern 29
1.4 Elimination Pattern 29
1.5 Activities of Daily Living (ADL) 29
1.6 Recreation and Hobbies 30
i. Social Data 30
1. Occupational Data 30
j. Environmental Data 30
k. Psychological Data 30
l. Patterns of Health Care 30
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VIII. Physical Assessments 33
a. General Survey 33
b. Vital signs 33
c. Integumentary System 33
d. Hair 33
e. Nails 33
f. Head 34
g. Eyes and vision 34
h. Ears and hearing 34
i. Nose and sinusitis 34
j. Oropharynx (mouth and throat) 34
k. Neck 35
l. Thorax and lungs 35
m. Breast and Axillae 35
n. Abdomen 35
o. Musculoskeletal system 35
p. Cardiovascular system 36
q. Urinary system 36
r. Gastrointestinal system 36
s. Neurologic system 36
a. Cranial nerves I- XII 37
b. Glass Coma Scale 39
c. Muscle Strength 41
Introduction
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We have nerves that live outside the central nervous system (the brain and
spinal cord), and deal with our body's senses and movements. These are called our
peripheral nerves.
Most people will make a full recovery within a few weeks or months, with no
further trouble. Some cases take longer to recover from and there is a possibility of
permanent nerve damage.
We chose patient R’s case for our case study because we think it is interesting
though it’s rarely seen .It is a culprit condition that can cause temporary paralysis and
can affect our activities of daily living since in GBS we can feel weakness and
numbness in our body that’s why patient couldn’t walk and have limited range of motion.
It’s not so depressing though there is a glint hope with the proper medical attention, the
syndrome may be reversed. We are hoping that through this case study we can impart
knowledge and better understanding of GBS to the community for them to be aware of
the said syndrome.
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What is Guillain Barre’ Syndrome?
Guillain-Barre syndrome may occur along with viral infections such as:
• AIDS
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• Herpes simplex
• Mononucleosis
It may also occur with other medical conditions such as systemic lupus
erythematosus or Hodgkin's disease.Some people may get Guillain-Barre syndrome
after a bacterial infection or certain vaccinations (such as rabies and swine flu). A
similar syndrome may occur after surgery, or when critically ill.
Guillain-Barre syndrome can affect all age groups, but you're at greater risk if:
Symptoms of Guillain-Barre can get worse very quickly. It may take only a few
hours to reach the most severe symptoms, but weakness increasing over several days
is also common.
Muscle weakness or the loss of muscle function (paralysis) affects both sides of
the body. In most cases, the muscle weakness starts in the legs and then spreads to
the arms. This is called ascending paralysis.
Patients may notice tingling, foot or hand pain, and clumsiness. If the
inflammation affects the nerves to the diaphragm, and there is weakness in those
muscles, the person may need breathing assistance.
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• Muscle weakness or loss of muscle function (paralysis)
o In mild cases, there may be no weakness or paralysis
o May begin in the arms and legs at the same time
o May get worse over 24 to 72 hours
o May occur in the nerves of the head only
o May start in the arms and move downward
o May start in the feet and legs and move up to the arms and head
• Numbness, decreased sensation
• Sensation changes
• Tenderness or muscle pain (may be a cramp-like pain)
• Uncoordinated movement
• Blurred vision
• Clumsiness and falling
• Difficulty moving face muscles
• Muscle contractions
• Palpitations (sensation of feeling heartbeat)
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How to cope with Guillain Barre Syndrome?
Talking with a mental health provider can play a critically important role in helping
you cope with the mental and emotional strain of this illness. In some cases, your
therapist may recommend family counseling to help you and your loved ones adjust to
the changes caused by Guillain-Barre syndrome.
You may also benefit from talking with others who have experienced this illness.
Ask your doctor or mental health provider to recommend a support group for people and
families coping with Guillain-Barre syndrome.
Seek immediate medical help if you have any of the following symptoms:
• Tingling that started in your feet or toes and is now ascending upward through
your body
• Tingling or weakness that's spreading rapidly
• Tingling that involves both your hands and feet
• Difficulty catching your breath
• Choking on saliva
Alternative Names
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What is the prevention?
Because so little is known about what causes GBS to develop, there are no known
methods of prevention.
What is a 'syndrome'?
A syndrome is a medical condition, characterized by a collection of symptoms
(that the patient feels) and signs (that a doctor can observe or measure), rather than by
a specific organism that causes the disease.
No one knows what causes GBS. Symptoms and signs can vary a great deal in
GBS patients, sometimes making it difficult to diagnose, especially in the early stages.
Diagnosis
The first step in diagnosing Guillain-Barre syndrome is for your doctor to take a
careful medical history to fully understand the cluster of signs and symptoms you're
experiencing.
A spinal tap (lumbar puncture) and nerve function tests are commonly used to
help confirm a diagnosis of Guillain-Barre syndrome.
• Nerve conduction studies assess how your nerves and muscles respond to
small electrical stimuli.
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Nile virus infection, and metabolic neuropathies, but these disorders can usually be
distinguished as follows:
Prognosis
Although some people can take months and even years to recover, most cases of
Guillain-Barre syndrome follow this general timeline:
• Following the first symptoms, the condition tends to progressively worsen for
about two weeks.
• Symptoms reach a plateau and remain steady for two to four weeks.
• Recovery begins, usually lasting six to 12 months.
This syndrome is fatal in < 2%. Most patients improve considerably over a period of
months, but about 30% of adults and even more children have some residual weakness
at 3 yr. Patients with residual defects may require retraining, orthopedic appliances, or
surgery.
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After initial improvement, 3 to 10% of patients develop chronic inflammatory
demyelinating polyneuropathy (CIDP—see below).
Recovery can take weeks or years. Most people survive and recover completely.
According to the National Institute of Neurological Disorders and Stroke, about 30% of
patients still have some weakness after 3 years. Mild weakness may persist for some
people.
A patient's outcome is most likely to be very good when the symptoms go away
within 3 weeks after they first started.
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Treatment
There's no cure for Guillain-Barre syndrome. But two types of treatments speed
recovery and reduce the severity of Guillain-Barre syndrome: When symptoms are
severe, the patient will need to go to the hospital for breathing help, treatment, and
physical therapy.
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• Plasmapheresis or IV immune globulin
.
Often before recovery begins, caregivers may need to manually move your arms
and legs to help keep your muscles flexible and strong. After recovery has begun, you'll
likely need physical therapy to help regain strength and proper movement so that you'll
be able to function on your own. You may need training with adaptive devices, such as
a wheelchair or braces, to give you mobility and self-care skills.
Lifestyle Measures
Instructions
Step 1
Find a good physical therapy program from which you can learn specific
isometric, isotonic and resistance exercises to rebuild weakened muscles. You
may do these exercises on an outpatient basis and continue them at home.
Remember to pace yourself and get adequate rest, as fatigue is to be expected
with Guillain-Barre Syndrome.
Step 2
Step 3
Manage residual pain in the back, legs and feet with medication as needed.
Gabapentin and carbamazepine are often prescribed to relieve Guillain-Barre
Syndrome related pain. Both of these medications are anticonvulsants and may
cause fatigue and dizziness in some people.
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Step 4
Wear comfortable shoes and socks to help soothe pain and burning from
neuropathy in the feet. Inspect your feet often to be sure there are no cuts or
blisters that you may not have noticed.
Step 5
Follow a healthy eating plan with fresh, seasonal fruits and vegetables , lean
meat and fish, whole grains and plenty of colorful salads. Eating well may help
you to sustain your energy and can boost your mood.
Step 6
Seek emotional support to cope with feelings of depression and anxiety that are
part of living with Guillain-Barre Syndrome. Discuss antidepressant medication
with your doctor if you are having trouble with activities necessary for daily living.
Step 7
Connect with others who are learning to live with Guillain-Barre Syndrome in
forums online. See the Resources section below for links.
Instructions
Step 1
Watch for early symptoms like tingling or rubbery sensations in your feet and
legs. In many cases, Guillain-Barre Syndrome comes on rapidly, beginning in the
lower part of the body and climbing to the arms and upper torso within hours.
Tingling around the mouth is common as the symptoms ascend.
Step 2
Note any difficulty with facial muscles or movement, such as trouble moving your
eyes, slow speech and problems chewing or swallowing.
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Step 3
Assess both sides of your body. Guillain-Barre Syndrome affects both sides,
unlike a stroke. Strokes generally paralyze only one side.
Step 4
Test your reflexes. Guillain-Barre Syndrome diminishes the reflex response in the
legs first. Some people also lose feeling in their extremities.
Step 5
Check your heart rate and blood pressure . Both may drop with Guillain-Barre
Syndrome.
Step 6
Step 7
Monitor your breathing, and get help at once if breathing seems shallow. Guillain-
Barre Syndrome can worsen very rapidly and spread to the muscles that control
your breathing. Many people with the syndrome are temporarily placed on
ventilators in order to breathe.
Step 8
Step 9
Pay attention to unusual or severe lower back pain, which can signal Guillain-
Barre Syndrome.
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ANATOMY AND PHYSIOLOGY
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The PNS consists of
• sensory neurons running from stimulus receptors that inform the CNS of the
stimuli
• motor neurons running from the CNS to the muscles and glands - called
effectors - that take action.
In the peripheral nervous system, neurons can be functionally divided in three ways:
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The peripheral nervous system is subdivided into the
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*Note: These do contain a few sensory neurons that bring back signals from the muscle
spindles in the muscles they control.
All our conscious awareness of the external environment and all our motor
activity to cope with it operate through the sensory-somatic division of the PNS.
The autonomic nervous system consists of sensory neurons and motor neurons that
run between the central nervous system (especially the hypothalamus and medulla
oblongata) and various internal organs such as the:
• heart
• lungs
• viscera
• glands (both exocrine and endocrine)
The actions of the autonomic nervous system are largely involuntary (in contrast to
those of the sensory-somatic system). It also differs from the sensory-somatic system is
using two groups of motor neurons to stimulate the effectors instead of one.
• The first, the preganglionic neurons, arise in the CNS and run to a ganglion in the
body. Here they synapse with
• postganglionic neurons, which run to the effector organ (cardiac muscle, smooth
muscle, or a gland).
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The preganglionic neuron may do one of three things in the sympathetic
ganglion:
• synapse with postganglionic neurons which then reenter the spinal nerve
and ultimately pass out to the sweat glands and the walls of blood vessels
near the surface of the body.
• pass up or down the sympathetic chain and finally synapse with
postganglionic neurons in a higher or lower ganglion
• leave the ganglion by way of a cord leading to special ganglia (e.g. the solar
plexus) in the viscera. Here it may synapse with postganglionic sympathetic
neurons running to the smooth muscular walls of the viscera. However,
some of these preganglionic neurons pass right on through this second
ganglion and into the adrenal medulla. Here they synapse with the highly-
modified postganglionic cells that make up the secretory portion of the
adrenal medulla.
• stimulates heartbeat
• raises blood pressure
• dilates the pupils
• dilates the trachea and bronchi
• stimulates the conversion of liver glycogen into glucose
• shunts blood away from the skin and viscera to the skeletal muscles,
brain, and heart
• inhibits peristalsis in the gastrointestinal (GI) tract
• inhibits contraction of the bladder and rectum
• and, at least in rats and mice, increases the number of AMPA
receptors in the hippocampus and thus increases long-term
potentiation (LTP).
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In short, stimulation of the sympathetic branch of the autonomic nervous
system prepares the body for emergencies: for "fight or flight" (and, perhaps,
enhances the memory of the event that triggered the response).
The main nerves of the parasympathetic system are the tenth cranial nerves, the
vagus nerves. They originate in the medulla oblongata. Other preganglionic
parasympathetic neurons also extend from the brain as well as from the lower tip of the
spinal cord.
In short, the parasympathetic system returns the body functions to normal after
they have been altered by sympathetic stimulation. In times of danger, the sympathetic
system prepares the body for violent activity. The parasympathetic system reverses
these changes when the danger is over.
The vagus nerves also help keep inflammation under control. Inflammation
stimulates nearby sensory neurons of the vagus. When these nerve impulses reach the
medulla oblongata, they are relayed back along motor fibers to the inflamed area. The
acetylcholine from the motor neurons suppresses the release of inflammatory cytokines,
e.g., tumor necrosis factor (TNF), from macrophages in the inflamed tissue.
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Although the autonomic nervous system is considered to be involuntary, this is
not entirely true. A certain amount of conscious control can be exerted over it as has
long been demonstrated by practitioners of Yoga and Zen Buddhism. During their
periods of meditation, these people are clearly able to alter a number of autonomic
functions including heart rate and the rate of oxygen consumption. These changes are
not simply a reflection of decreased physical activity because they exceed the amount
of change occurring during sleep or hypnosis.
IMMUNE SYSTEM
Bone Marrow -- All the cells of the immune system are initially derived from the bone
marrow. They form through a process called hematopoiesis. During hematopoiesis,
bone marrow-derived stem cells differentiate into either mature cells of the immune
system or into precursors of cells that migrate out of the bone marrow to continue their
maturation elsewhere. The bone marrow produces B cells, natural killer cells,
granulocytes and immature thymocytes, in addition to red blood cells and platelets.
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Lymph Nodes -- The lymph nodes function as an immunologic filter for the bodily fluid
known as lymph. Lymph nodes are found throughout the body. Composed mostly of T
cells, B cells, dendritic cells and macrophages, the nodes drain fluid from most of our
tissues. Antigens are filtered out of the lymph in the lymph node before returning the
lymph to the circulation. In a similar fashion as the spleen, the macrophages and
dendritic cells that capture antigens present these foreign materials to T and B cells,
consequently initiating an immune response.
T-Cells -- T lymphocytes are usually divided into two major subsets that are functionally
and phenotypically (identifiably) different. The T helper subset, also called the CD4+ T
cell, is a pertinent coordinator of immune regulation. The main function of the T helper
cell is to augment or potentiate immune responses by the secretion of specialized
factors that activate other white blood cells to fight off infection.
Another important type of T cell is called the T killer/suppressor subset or CD8+ T cell.
These cells are important in directly killing certain tumor cells, viral-infected cells and
sometimes parasites. The CD8+ T cells are also important in down-regulation of
immune responses. Both types of T cells can be found throughout the body. They often
depend on the secondary lymphoid organs (the lymph nodes and spleen) as sites
where activation occurs, but they are also found in other tissues of the body, most
conspicuously the liver, lung, blood, and intestinal and reproductive tracts.
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Natural Killer Cells -- Natural killer cells, often referred to as NK cells, are similar to the
killer T cell subset (CD8+ T cells). They function as effector cells that directly kill certain
tumors such as melanomas, lymphomas and viral-infected cells, most notably herpes
and cytomegalovirus-infected cells. NK cells, unlike the CD8+ (killer) T cells, kill their
targets without a prior "conference" in the lymphoid organs. However, NK cells that
have been activated by secretions from CD4+ T cells will kill their tumor or viral-infected
targets more effectively.
Dendritic Cells -- Another cell type, addressed only recently, is the dendritic cell.
Dendritic cells, which also originate in the bone marrow, function as antigen presenting
cells (APC). In fact, the dendritic cells are more efficient apcs than macrophages. These
cells are usually found in the structural compartment of the lymphoid organs such as the
thymus, lymph nodes and spleen. However, they are also found in the bloodstream and
other tissues of the body. It is believed that they capture antigen or bring it to the
lymphoid organs where an immune response is initiated. Unfortunately, one reason we
know so little about dendritic cells is that they are extremely hard to isolate, which is
often a prerequisite for the study of the functional qualities of specific cell types. Of
particular issue here is the recent finding that dendritic cells bind high amount of HIV,
and may be a reservoir of virus that is transmitted to CD4+ T cells during an activation
event.
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An animal’s immune system protects its body from intruders: bacteria, viruses,
parasites, cancer cells, etc. An immune system is present in several animal groups,
especially within the vertebrates. Animals have both non-specific and specific defense
mechanisms to fight invaders. We will be focusing on the human immune system.
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The cell-mediated immune system consists of T-cells which originate in the bone
marrow, but go to the Thymus to finish their development.
T-cells are highly-specialized cells in the blood and lymph to fight bacteria, viruses, fungi,
protozoans, cancer, etc. within host cells and react against foreign matter such as organ
transplants.
There are three kinds of T-cells. Cytotoxic T-cells directly kill invaders. Helper T-cells
aid B and other T-cells to do their jobs, and HIV lives in and kills them. Suppressor T-
cells suppress the activities of B- and other T-cells so they don’t overreact. Allergy
injections are supposed to increase the number of supressor T-cells to make the person
less sensitive to allergens.
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Patient Health History
Occupation: NONE
Health Care Financing and Usual Source of medical Care: Family income
Chief Complain: Present condition noted as sudden onset of weakness of left lower
extremities for almost 3 weeks, then after right lower extremities a week after
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Attending Physician: Dr. Asodisen (from September 25-30)
Dr. Moleta ( from October 1-6)
129 - 128 lbs patient is only 103.61 lbs, therefore patient is underweight
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A. History of Present Illness
On the 2nd week of August 2009, patient stated that he experienced abdominal
cramps and diarrhea with watery stool characterized with yellow-green in color which
lasted for 2 days after he had eaten kinilaw.
On the 2nd week, patient experienced weakness, especially on his left leg that
made him not able to walked and had limited range of motion. On the following days, his
condition worsens. He felt weakness accompanied with tingling sensation which often
attack early in the morning and late afternoon and a couple of time during hour sleep as
claimed by the patient. The day after, numbness on lower extremities with uncontrolled
movements/tremors occurs which last about ten minutes. At that time, he couldn’t sit on
his own and when he did sit up with assistance as well as in his elimination purposes.
He felt like an egg as stated by the patient.
Patient’s family sought advice from the local “manghihilot” who massaged the
affected area with his own-made mixture of herbs. The latter believed that patient
condition is caused by “buyag sa engkanto”. They also asked help from a
“mantayhopay” who gave the same impression. His mother followed the instructions of
the said persons such as soaking his feet with “nilagang sambong” every morning and
at night before sleeping. Hospitalization was not possible during the said span of time
because of financial constraints.
One day prior to hospitalization, our patient was seen by his mother crying on the
floor of their sala. Patient stated that “ gusto na nako magpahospital, nahadlok na ako
basin dili na ako makalakaw pagbalik. That incident prompted his mother to bring him to
Loreto District Hospital that day but was referred directly to Caraga Regional Hospital
for further assessment and management.
Patient was admitted to Caraga Regional Hospital last September 25, 2009 at
exactly 10:25 am for chief complaints: noted as sudden onset of weakness of left lower
extremities for almost 3 weeks, then after right lower extremities a week after
Laboratory tests were also ordered by the attending physician such as:
• Hematology
• Electrolytes
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• Urinalysis
Childhood Illness
Patient’s mother claimed that his son don't have any childhood illnesses
like mumps, chickenpox, rubella and pertussis, etc. He experienced diarrhea last
January 2009 which lasted for almost 2 and a half days characterized with watery stool
yellowish-green in color. After that incidence he suffered diarrhea again last May 2009
with the same duration and feature but he was not able to hospitalized. Patient
experienced 1 week fever accompanied with productive cough with thick yellow sputum
on the last week of July 2009.
Immunization
Patient's mother claimed that only BCG had been immunized to her son
since health center is far away from their house.
History of Hospitalization
Patient has no history of hospitalization; in fact this is his first time of
being admitted in the hospital.
Surgical History
Patient claimed that he did not undergo any surgical procedure.
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swelling on his lower extremities and a week after the upper extremities and developed
into entire body. He was not hospitalized and was not diagnosed, in fact according to
their belief and rumors his grandfather was "na barang". After one month of suffering
from generalized swelling ha was died lying on the bed unnoticely. After 7 years, that is
2005 his grandmother died as claimed by the patient's mother, she died with the same
case to her husband because of generalized swelling but patient's mother claimed that
she can't recall if what happened to her mother-in-law since they were apart from here
when that time happened, all she knows is that after one month also of suffering from
swelling she died.
Lifestyle
1. Personal Habit
Before Hospitalization
Patient is a non-smoker and non-drinker and don't even used harmful
drugs. Before he was confined at hospital, he already felt weakness on his legs that
made him just stay on their house. He just watched wowowee and listening music and
when he got bored he just sit nearby the window and just looked around to his friends
outside since he can't walk and join with them. He just study his lesson by himself since
he stop going to school for almost 3 weeks because of his condition.
During Hospitalization
Since patient was weak and can't moved his legs , he just lied on the
bed and sometimes sit but still his legs were in straight and flat position. Patient has
limited movement that made him uncomfortable. He just sleep and sometimes awake if
tingling sensation occur. He also used to have little conversation to his family. He just
keep on smiling whenever there were people looked at him.
2. Diet
Before Hospitalization
Patient typical food is fish since they lived nearby the sea and his father
occupation is fishing and also vegetables. Patient eats his meals 3x a day but
sometimes he doesn’t want to eat in the breakfast. Patient drinks 8-10 glasses of water
a day he don't have any special diet or any food restriction. Patient was fond of eating
“kinilaw” with vinegar than cooked. He eats 3 large meals a day and drinks 5-6 glasses
of water. Patient is fond of eating raw egg with salt. He eats junk foods as his snacks.
He drinks coffee and Milo sometimes if it is available on their kitchen.
During Hospitalization
Patient eat the food that is being serve in the hospital but sometimes his
mother buy food outside like tinolang baka and any food that has soup. He also eats
fruits like orange, banana and mango. And early in the morning his mother will make
milk/milo for him. Sometimes he refuses to eat because he felt fullness, he drink 3-4
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glasses of water a day. He doesn’t have any order of food restriction or any special diet
from the dietician but the doctor ordered 1 banana last September 26, 2009.
During Hospitalization
Patient has difficulty of sleeping and wakes up a number of times during
hour sleep. He claimed that his not comfortable to sleep in the hospital as well as his
position in sleeping, he felt he's like a dead person lying in a straight and flat position.
And sometimes he's mother awaken him when uncontrolled movements of muscle
occur since patient couldn’t felt any sense.
4. Elimination Pattern
Before Hospitalization
Patient urinate 3x a day characterized by large amount with yellow in
color and defecate once a day characterized by scanty amount with yellowish/brownish
in color with no history of difficulty or pain in urinating and defecating. Patient did not
experience constipation. Before the present illness , he eliminate with himself but
because of his condition he really needs assistance for elimination purposes, usually his
father carried him in going to comfort room.
During Hospitalization
Patient urinate 4-5x a day, when he void he just sit on the bed and his
mother will offer plastic container of the IVF since he can't go by himself to the comfort
room. Sometimes it takes 3-4 days before he can defecate and his father carried him
going to the comfort room. His last void is scanty and yellow in color and his fecal is
hard stool, yellowish in color.
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condition. He just has some conversation with his mother and after that he fined himself
sleeping and awakens for a few hours.
7. Social Data
The patient usually turns to his parents for support during time of stress
and school problem especially about what he felt on his first trimester of illness. He
reported to his parents for every detailed event that happened to his condition. Patient
does not believe in superstitious belief or quack doctors even though his parent do
so. Patient is currently studying first year high school but eventually stopped because of
his condition.
8. Occupational Activity
Not applicable. Patient is still studying.
9. Environmental Data
Patient lived at Esperanza, Loreto, Dinagat Island, SDN. Their house is
located nearby the sea approximately 10-12 meters away from their house. Their house
is made of wood and nipa hut. They have one sala, room, and kitchen and comfort
room. Their house is surrounded with plants and they have garden wherein they plant
vegetables for their food consumption. And also a little chicken poultry for their
consumption of eggs. They have a clean environment where in he can breathe fresh air
with no pollution.
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REVIEW OF SYSTEM
Integumentary system
Patient has no any allergic reaction to certain foods or medication, he don’t have
any history of itchiness. He has lesions, abrasions and scars in his lower extremities. No
hair dyes, curling or strengthening preparation.
Neck
Patient claimed that he doesn’t have any neck lumps and was not diagnose
with any thyroid problem.
Cardiovascular System
Patient doesn’t have any history of cardiovascular disease.
Gastrointestinal System
Patient experienced abdominal cramps and hyperactive bowel movement with
watery stool characterized with yellow-green in color which lasted for two days. Patient
experienced abdominal pain in the lower portion of the abdominal cavity; it just lasted
for few minutes and diminished. He used to drink hot water to relieve the pain, he also
experienced flatulence for 5x a day, for that day only. He don’t any have difficulty in
swallowing.
Musculoskeletal System
Patient claimed that he experienced like an electric current sensation on his
both legs. It is gradual characterized first by the weakness of his legs followed by the
tingling sensation and numbness on his legs especially in the left leg. Because of this,
he had limited range of motion and he can’t move his both legs. Tingling sensation often
attack early in the morning and late afternoon and a couple of time during hour sleep as
claimed by the patient. He also had loss of function without pain in her legs.
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Neurologic System
Patient experienced tingling sensation, numbness and uncontrolled
movements accompanied with tremors on his lower extremities. Patient can’t feel light
pressure only deep pressure and pain through pointing point object.
Urinary System
Patient urinates 2-3x a day, he have difficulty in urination because he need
assistance tot go to comfort room. But he doesn’t have any painful urination.
Hematologic
Patient claims that he doesn’t have any history of anemia.
Endocrine System
Patient verbalizes upon assessment that he cannot tolerate warm
environment since in their place they have fresh air. He doesn’t have any thyroid
problems.
Psychiatric
Patient can manage the stress that his having now. In fact, he is a happy
person. He has a good memory and but he also tend to get nervous easily when
strange people like us talk to him and he tend to perspire more.
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PHYSICAL ASSESSMENT
General Survey:
Patient is awake appeared pale and his legs were numb and weak, patient lies
on bed in a supine position. He appeared untidy with oily face, hair which is not properly
combed and tangled. Patient is coherent and responsive during our interview; he keeps
in smiling and felt shy to answer our questions. Ongoing IVF solution of D5IMB with the
drop rate of 15gtts/min, patently hooked at the right dorsal metacarpal vein.
Integumentary System:
Skin:
Hair:
Nails:
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Head, Eyes, Ears, Nose, Throat (HEENT)
• Auricles same color as facial skin, symmetrical and are aligned with outer
canthus of eye
• Able to hear spoken words clearly
• Able to hear watch ticking in both ears
• Pinna is mobile, firm and not tender
• Pinna recoils after it is folded
• Presence of cerumen noted
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• Plaques on teeth noted
• No tonsillitis noted
• Gag Reflex noted
Neck:
• No difficulty of breathing
• No abnormalities noted
Posterior Thorax
• Normal curvature
• No tenderness upon palpation
• Symmetric
Anterior Thorax
• Chest is symmetric
• Normal breath sounds noted
• No evidenced of any secretions
• No discharges noted
• Skin uniform in color, areola darken in color
• No evidence of enlargement of liver and spleen
• Audible bowel sounds
Musculoskeletal System
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• limited ability to perform gross/fine motor skills,
• difficulty turning his body
• slowed movement and uncoordinated movement
• postural instability,
• inability to maintain activity.
Cardiovascular System
• No abnormalities noted
• Lub-dub sounds noted upon auscultation
• No edema
Urinary System
Gastrointestinal System
• No vomiting
• No diarrhea
• No difficulty in swallowing
• Hard stool noted
Neurologic System
Mental Status:
Language
• Patient does not have any speech problems. He can understand and converse
well using Bisaya dialect. He used non-verbal communication such as eye
movements, gestures and interaction with the support person. He had a
congruence of non-verbal and verbal expression.
Orientation
• Patient is oriented to place, time and is able to answer our questions correctly
during interview.
Memory
• He has good memory and can recall what happened in the past.
40
Attention Span
41
CRANIAL NERVE NAME RESULT
I Olfactory Patient is able to smell
and he can identify if
what he smells.
II Optic He was able to read our
nameplates about 14
inches. He has bright
eyes and can see clearly.
III Occulomotor Patient’s pupil reacted to
light. Pupils constrict
when looking at near
object and dilate when
looking far object. It also
converges when penlight
was moved towards his
nose.
IV Trochlear When penlight was
moved at six cardinal
fields of gaze using the
six ocular movements
namely: superior rectus,
lateral rectus, inferior
rectus, superior oblique,
medial rectus and inferior
oblique patients both
eyes were coordinated
and moved in unisonwith
parallel alignment.
V Trigeminal Positive blink reflex with5
blinks/minute and can
determine blunt and
sharp ends.
VI Abducens Using the six ocular
movements, he was able
to move eyeballs laterally
of both eyes with unison
and in parallel alignment.
VII Facial Patient flashed his smile
when asked of something
private and personal. And
close his together and
able to raise eyebrows.
_________________________________________________________________________________________________
44
MUSCLE STRENGTH SCALE
MUSCLE STRENGTH
Plantar flexion 0 0
Dorsiflexion 0 0
Knee Flexors 0 0
Knee Extensors 0 0
Hip Flexors 0 0
Hip Extensors 0 0
45
Reflex: The patient’s Biceps, Triceps, Brachioradialis, Patellar and Achilles have
the following grade of responses: +2, +2, +1, 0, 0, 0 respectively.
“Patient R”
RIGHT LEFT
BRACHIORADIALIS BRACHIORADIALIS
+1 +1
BICEPS BICEPS
46
+2 +2
TRICEPS TRICEPS
+2 +2
47
DOCTOR’S ORDER
09/25/09
10:25 am
Pls. admit pt. to pedia misc.
TPR every 4 hour
Labs: CBC, Na, Creatinine, u/a
Urinalysis
AFB AST
Start D5IMB to few at 15
Monitor v/s every 4 hours
Dr. Patiño
11:45 am
refer result when in noted
ascending paralysis
09/26/09
T= 37.2˚C
Vit. B complex
Eat 1 banana
Follow up IVF
Dr. Patiño
10:50 pm
Hydrocortisone 100mg IVTT every 8˚
09/27/09
T= 37.1˚C
Continue medication
09/28/09
09:15am
Continue medication
10:24 pm
IVF to follow D5IMB 500ml
Dr. Mantilla
Dr.Mantilla
48
09/30/09
continue medication
Bisacodyl pediatric rectal suppository
Hydrocortisone 250mg every 8 hours
10/01/09
afebrile
continue medication
follow IVF with D5LR IL 15gtts/min.
10/02/09
continue medication
Follow IVF with D5LR IL 15gtts/min.
10/03/09
continue medication
Follow IVF with D5LR IL 15gtts/min.
Decrease Hydrocortisone to 250g and IVTT every 12 hours
10/05/09
continue medication
Follow IVF with D5LR IL 15gtts/min.
10/06/09
May go home
Home medication
Follow up check up at OPD after 2 weeks
49
LABORATORY TESTS
ELECTROLYTE
September 26,2009
HEMATOLOGY
September 26,2009
Urinalysis
October 03, 2009
50
Pathologist
Drug Study
Bisacodyl
Indication:
• temporary relief of acute constipation and
• for evacuation of colon before surgery, prostoscopic, sigmoidoscopic,
• radiologic examinations.
• Also used to cleanse colon before delivery and to relieve constipation in
patients with spinal cord damage.
• Chronic constipation; preparation for childbirth, surgery, or rectal or bowel
examination
•
Dosage, Route of administration: IVTT every 8 hours , rectal suppository
Contraindication:
Adverse Reaction:
• Mild cramping
• nausea,
• diarrhea
• fluid and electrolytes disturbances (especially potassium and calcium).
GI: nausea, vomiting. Abdominal cramps, diarrhea, burning sensation in
rectum, protein-losing enteropathy, laxative dependence
Metabolic: alkalosis, hypokalemia
Musculoskeletal: muscle weakness, tetany
51
Nursing Implication:
• Add high-fiber foods slowly to regular diet to avoid gas and diarrhea.
Adequate fluid intake includes at least 6-8glasses/d.
• Do not breastfeed while taking this drug without consulting physician.
• Give drug at times that don’t interfere with scheduled activities or
sleep. Soft, formed stools are usually produced 15 to 60 minutes after
rectal use.
• Before giving for constipation, determine whether pt. has adequate
fluid intake, exercise, intake and diet.
• Tablets and suppositories are used together to clean the colon before
and after surgery and before and after surgery and before barium
enema.
• Insert suppositoryas high as possible into the rectum , and try to
position suppository against the rectal wall. Avoid embedding within
fecal material because doing so may delay onset of action.
Bisco-Lax may contain tartrazine
52
Generic name: Ascorbic Acid (Vitamin C)
Classification: Vitamin
Action:
Water-soluble vitamin essential for synthesis and maintenance of collagen and
intercellular ground substance of the body tissues cell, blood vessels, cartilages, bones,
teeth, skin, and tendons.
Indication:
Prophylaxis and treatment of scurvy and as a dietary supplement.
To prevent vit. C deficiency in pt. w/ poor nutritional habits or increased requirements.
• RDA
• Frank and subclinical scurvy
• Extensive burns, delayed fracture or wound healing, postoperative wound healing,
severe febrile or chronic dse. State.
Dosage, Route of administration: 1 tab OD, PO
Contraindication:
Use of sodium ascorbate in patients on sodium restriction; use in calcium
ascorbate in patients receiving digitalis.
Adverse Reaction:
Nausea, vomiting, heartburn, diarrhea, or abdominal cramps, acute hemolytic
anemia, sickle cell crisis, headache or insomnia, urethritis, dysuria, crystauria,
hyperlaxalunia, hyperuricemia, mildness soreness at injection site, dizziness, temporary
faintness with rapid IV administration
Nursing implication:
• High doses of vitamin C are not recommended during pregnancy.
• Take large doses of vitamin C in divided amounts because the body uses
only what is needed at a particular time and excretes the rest in urine.
• Megadoses can interfere with the absorption of vitamin B12.
• Note: vitamin C increases the absorption of iron when taken at the same
time as iron rich-foods.
• Do not breastfeed while taking this drug without consulting physician.
• Stress proper nutritional habits to prevent recurrence of deficiency.
• Advise smokers to increase intake of vitamin C.
• When giving for urine acidification, check urine pH to ensure efficacy.
• For pt. receiving vit. C I.M., explain that M.I, route may promote better
utilization.
53
Generic name: Hydrocortisone
54
GENERIC NAME: VITAMIN B COMPLEX - ORAL
USES: Vitamins are the building blocks of the body. They are used to prevent or treat a
vitamin deficiency due to poor nutrition, certain illnesses or during pregnancy.
HOW TO USE: Take as directed. Food may affect the absorption of certain vitamin
products. Consult your pharmacist. Chewable tablets must be chewed thoroughly
before swallowing followed with a glass of water. Timed-release capsules or tablets
must be swallowed whole.
SIDE EFFECTS: This medication may cause mild nausea or unpleasant taste. Consult
your doctor if any of these effects persist or become severe. If you notice other effects
not listed above, contact your doctor or pharmacist.
PRECAUTIONS: Before using this medication, tell your doctor or pharmacist your
medical history, especially of: diabetes, blood disorders such as vitamin B12 deficiency
(pernicious anemia). Tell your doctor if you are pregnant before using this medication.
No problems have been reported in pregnant or nursing women when this medication
was used in normal doses.
DRUG INTERACTIONS: Tell your doctor if you take any other medication, including
nonprescription. This medication may affect certain urine lab tests, including some urine
glucose tests. Do not start or stop any medicine without doctor or pharmacist approval.
55
56
Predisposing factor: PATHOPHYSIOLOGY Precipitating factor:
(Diagram)
DUAL RECOGNITION
Cell-mediated Humoral
immunity immunity
57
Mistaken immune Activates specific T
lymphocytes or T-cells Secrete
attack may arise antibodies
Increased level of
Penetration of macrophage and antibodies into lymphocytes level Antibodies will
basement membrane around nerve fibers fight foreign
microorganisms
T-cells released
Inflammation of the nerve cells lymphokines
Sensory
Tingling sensation Impaired Immobility of the
and
transmission of LE
motor
nerve conduction
loss
Numbness
Inability to
perform ADL
Weakness of the
LE
Constipation
Subjective cues:
“Pasmo ra man daw ni sa kusog kay manhimasa man ko human baktas” as
verbalized by the patient.
Objective cues:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg
• Apathy noted
• Misinterpretation of information
Diagnosis:
Planning:
Intervention: Rationale
1. Determined information the To facilitate learning and determine the
client already knows and move client and SO’s cognitive limitation
to what the client does not know,
progressing from simple to
complex
2. Explained the cause of the
symptoms and disease To provide knowledge
Evaluation:
Goal met. After 4 hours of rendering of nursing intervention the patient was able
to participate in learning process and was able to verbalize understanding of condition
of treatment.
59
NURSING CARE PLAN #2
September 28, 2009
Subjective Cue:
“Dili ko kalakaw ma’am kay wala gajud kusog ako tiil”. As verbalized by the patient
Objective cues:
Limited range of motion, limited ability to perform gross/fine motor skills, difficulty
turning, slowed movement uncoordinated movement, movement induced, postural
instability, inability to maintain activity.
Nursing Diagnosis:
Impaired physical mobility related to inability to maintain activity as evidenced by
limited range of motion.
Planning:
Within 8 hours of giving appropriate nursing intervention, patient will be able to
participate in Activities of Daily Living and desired activities.
Interventions:
Evaluation:
Goal was not met. Patient was not able to participate in Activities of Daily livings
and desired activities.
51
60
NURSING CARE PLAN #3
September 28, 2009
Subjective cue:
“Waya pa ako kaligo pila na kaadlaw” as verbalized by the patient.
Objective cues:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg
Diagnosis:
Self-care deficit related to impaired physical mobility
Planning:
After 2 hours of rendering nursing intervention patient will be able to perform self-
care activities within physical limitations.
Intervention: Rationale
1. Determined individual strengths To know the strengths and weaknesses
and skills /of the client of the client as basis in giving
appropriate interventions
2. Provide for communication To gain trust and cooperation from the
among those who are involved client and SO
in caring
3. Provide health teaching to To promote good hygiene to the patient
patient about the importance of
good hygiene
4. Develop plan of care appropriate To encourage performance of ADL
to individual situation, within physical limitation
scheduling activities to conform
to clients normal schedule
5. Plan time for listening to the To discover barriers to participation in
client and SO regimen
6. Demonstrated to the client and To provide awareness that self care
SO the basic ways in self care activities are still possible even with
such as hand washing, combing physical limitations
the hair, trimming nails, tooth
brushing and bathing
61
7. Encouraged patient and SO to To promote self care
use products to enhance self
image such as deodorant
Evaluation:
Goal met. After 4 hours of rendering nursing intervention patient was able to
perform self-care activities such as combing, tooth brushing and trimming of nails.
62
NURSING CARE PLAN #4
September 28, 2009
Subjective cues:
“ Nanhina man ako maam, murag nawal an ko ug kusog” , as verbalized by the
patient.
Objective Cues:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg
• Decreased physical strength
• Decreased mobility
• Weakness
Nursing Diagnosis:
Powerlessness related to decreased physical strength.
Planning:
After 8 hours of rendering nursing care the patient will be able to express sense
of control over the present situation and hopefulness about future outcomes.
Interventions:
1. Encourage client to be active in own health care management
and to take responsibility for choosing own actions and reactions.
63
NURSING CARE PLAN #5
September 28, 2009
Subjective cue:
“Nabiro ko nga di na ko makalakaw” as verbalized by the patient
Objective cue:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg
Analysis:
Anxiety related to threat on role function secondary to physical illness
Planning:
After 8 hours of duty patient will be able to identify healthy ways to deal with and
relieve anxiety
Intervention Rationale
1. Provided opportunities for question Enhance sense of trust and nurse client
and answer session relationship
Evaluation:
Goal partially met. After 8 hours of intervening, the patient was able to enumerate
ways to relieve anxiety but verbally said, “ Bisan nakasabot na ko..Dili gajud naku
malikayan na mag-isip ng ako kahimtang karon.”
64
NURSING CARE PLAN #6
September 28, 2009
Subjective cues:
‘ Mahadlok lage ako motindog kay basin matumba ako” as verbalized by the patient.
Objective cues:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg
• Diminished productivity
• Avoidance behavior
• Increased perspiration
• Pallor
Diagnosis:
Fear related to loss of physical support as evidenced by diminished productivity.
Planning:
After two days of rendering appropriate nursing care patient will display
appropriate range of feelings lessened fear.
Interventions:
65
Goal is met. After 2 days of rendering appropriate nursing care, patient is able to
display appropriate range of feelings and lessened fear.
Subjective cue:
“Ma’am dili naman ko kalibang tapos tag dugay” as verbalized by he patient.
Objective cue:
irritable, restlessness, weakness, unable to move, hard stool.
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg
Nursing Diagnosis:
Altered Bowel Movement: Constipation related to Insufficient Physical Activity.
Planning:
After 8 hours of duty, patient will be able to verbalize understanding of the
importance of mobility and diet to normal bowel movement
Interventions:
INTERVENTIONS RATIONALE
Independent:
1. Advised patient to drink adequate -to promote moist and soft stool
fluid and include foods that are high in
fiber like papaya, oatmeal and
pineapple
2. Encouraged activity/exercises within -to stimulate abdominal muscle
personal limitation. contraction.
3.Provided with privacy and routinely -to promote defecation
scheduled time defecation
4.Educated patient about the -to provide information
importance of mobility and diet to
normal bowel movement
5.Note energy. Activity level and - sedimentary lifestyle may affect
exercise pattern. elimination patterns
6. Auscultate abdomen for the - reflecting bowel activity
characteristics of bowel sounds
Dependent:
1.Administered Bisacodyl (pedia) To increase peristalsis promoting easy
suppository as prescribed defecation
Evaluation:
66
Goal met. After 8 hours of duty, patient able to defecate and verbalized “
nakalibang na gajud ko maam,importante diay gajud ang exercise ug diet labaw na
adtong tambal na tagsuksuk sa ako lubot.”
Subjective:
“Dili ko karajaw makatulog” as verbalized by the patient.
Objectives:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg
• Eyebags noted
• Frequent yawning noted
• Restlessness noted
• Sunken eyes noted
• Fatigue
• Anxiety
• Decreased ability to function
Nursing Diagnosis:
Sleep Pattern Disturbance related to environmental factors such as external
noise and lack of sleep privacy.
Planning:
After 8 hours of duty, patient will be able to report improvement in sleep pattern.
INTERVENTIONS RATIONALE
Independent
1. Provided with quiet and calm To promote rest and sleep
environment during bedtime
2. Advised to limit fluid intake in -to reduce need for nighttime
evening micturation
3. Encouraged participation in regular -to aid stress control/release of energy
exercise program during day
4. Identified the factors that affect the -to reduce sleep disturbance
sleeping pattern
5..Recommended to limit intake of Such beverages are stimulants that
chocolates and caffeinated beverages inhibits sleep
Dependent
1. Administered sedative / other sleep -to enhance clients ability to fall asleep
medication when indicated
67
Evaluation:
Goal met. After 8 hours of duty, patient able to sleep comfortably and report
improvement of sleep pattern.
Objective cue:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg
Planning:
After 8 hours giving appropriate nursing intervention, patient will acknowledge
self as an individual who has responsibility for self.
Intervention Rationale
1.Encouraged family member to treat To avoid feeling of isolation or rejection
client normally and not as invalid.
2.Encouraged expression of feeling To provide appropriate emotional support
regarding his condition.
3.Encouraged client to look and touch To begin to incorporate changes into body
affected body parts. image
4.Discussed meaning of loss change to A change of function such as immobility
client. may be more different for some to deal
with than a change in appearance
5.Visited client frequently and Provides opportunities for listening of
acknowledged the individual as someone patient’s concerns and questions.
who is worthwhile
Evaluation:
Goal met. After 8 hours giving appropriate nursing intervention, patient
verbalized feeling of acceptance and responsibility of his affected body parts as
evidenced by frequent checking and touching of his lower extremities.
68
NURSING CARE PLAN #10
September 29, 2009
Subjective cue:
“Taglaay na man ko diri sa hospital”, as verbalized by the client.
Objective cues:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg
• Restlessness noted
• Frequent yawning noted
• Verbal expression of boredom
• Keep on lying in bed
Nursing Diagnosis:
Deficient diversional activity related to physical limitations and lack of
sources.
Planning:
After 8 hours of giving appropriate nursing intervention, patient will be able to
engage in satisfying activities within personal limitations.
Intervention: Rationale
1.Acknowledged reality of situation and To establish therapeutic relationship
feelings of the client.
2.Provided with diversional activities To refocus the attention of the client .
such as reading materials and talking To relieve boredom.
to the client.
3.Provided change of scenery . To direct attention.
Evaluation:
69
Goal met. After 8 hours of giving appropriate nursing intervention, patient
verbalized feelings of satisfaction in activities engaged with in personal limitations.
“Kadaghan sad diri tawo, gusto na ako ra isa,” as verbalized by the patient.
Objective Cues:
• Fatigue
• Observed discomfort
• Observed use of unsuccessful social in reactions behavior
• Insecurity in public
• Dysfunctional interaction with others
Diagnosis:
Impaired social interactions related to limited physical mobility.
Planning:
After 8 hours of giving appropriate nursing intervention patient will express
desire/be involved in achieving positive changes in social behaviors and interpersonal
relationships.
Interventions:
Evaluation:
70
Goal met. After 8 hours of giving appropriate nursing intervention, patient
express desire/be involved in achieving positive changes in social behaviors and
interpersonal relationships.
Subjective cue:
Objective cues:
Nursing Diagnosis:
Planning:
INTERVENTIONS RATIONALE
1. Changed patient position every 2 -to promote circulation and prevent bed
hours. sore and constipation
2. Removed wet/wrinkled linens -moisture potentiates skin breakdown
promptly.
3. Developed repositioning schedule -to enhance understanding and
for client, involving client in reasons for cooperation.
and decisions about times and
positions in conjunction w/ other
activities.
4. Provided w/ well ventilated -To promote comfort
environment.
5. Elevated both legs with a pillow To promote blood venous return
6. Encouraged patient to touch his -To remind the patient that his lower
lower extremities every now and extremities are present and still needs
then care
71
7. Increased fluid and high fiber in diet. -to prevent constipation.
Evaluation:
Subjective cue:
Objective cues:
• Physical immobility
• Motor dysfunction
• Weakness and numbness (lower extremities)
Nursing Diagnosis:
Risk for Injury related to Physical Immobility.
Planning:
Patient will be able to understand of individual factors that contribute to possibility
of injury.
Nursing Intervention:
72
• That can contribute to occurrence of injury.
Evaluation:
DISCHARGE PLAN
Name: Patient R
Medications:
Environmental Concerns:
Treatments:
73
Health Teachings:
Diet
• Encouraged patient to eat nutritious food like vegetables.
• Encourage patient to eat fruits rich in vitamin C for strong immunity.
• Advised patient to take low-sodium diet.
• Instructed patient to avoid junk foods.
• Follow a healthy eating plan with fresh, seasonal fruits and vegetables, lean
meat and fish, whole grains and plenty of colorful salads. Eating well may help
you to sustain your energy and can boost your mood.
Spiritual
• Encouraged patient to attend mass as frequent as he can, or even once a week
together with his family.
• Encouraged patient to always pray to God to help him to recover immediately.
• Encouraged patient thank God for the gift of life.
• Encouraged SO to pray for the health of the patient.
Emotional
74
Seek emotional support to cope with feelings of depression and anxiety that are part of
living with Guillain-Barre Syndrome. Discuss antidepressant medication with your doctor
if you are having trouble with activities necessary for daily living.
75
SUMMARY OF INTRAVENOUS FLUIDS
76
B. GENOGRAM
Mother died at the age of 71 year 1998 died at the age of 68 year 2005
Father
Grandmother
Siblings
Patient
GBS
Cough
Arthritis
Generalized Swelling
Deceased
77
Definition of Terms
Autoimmune disease: An illness that occurs when the body tissues are attacked by its
own immune system . The immune system is a complex organization within the body
that is designed normally to "seek and destroy" invaders of the body, including
infectious agents. Patients with autoimmune diseases frequently have unusual
antibodies circulating in their blood that target their own body tissues.
Axon: A long fiber of a nerve cell (a neuron) that acts somewhat like a fiber-optic cable
carrying outgoing (efferent) messages.
Bacteria: Single-celled microorganisms which can exist either as independent (free-
living) organisms or as parasites (dependent upon another organism for life).
Blood pressure: The blood pressure is the pressure of the blood within the arteries. It
is produced primarily by the contraction of the heart muscle. It's measurement is
recorded by two numbers. The first (systolic pressure) is measured after the heart
contracts and is highest. The second (diastolic pressure) is measured before the heart
contracts and lowest. A blood pressure cuff is used to measure the pressure. Elevation
of blood pressure is called "hypertension".
Brain: That part of the central nervous system that is located within the cranium
( skull ). The brain functions as the primary receiver, organizer and distributor of
information for the body. It has two (right and left) halves called "hemispheres."
Breathing: The process of respiration, during which air is inhaled into the lungs through
the mouth or nose due to muscle contraction, and then exhaled due to muscle
relaxation.
Cerebrospinal fluid: A watery fluid, continuously produced and absorbed, which flows
in the ventricles (cavities) within the brain and around the surface of the brain and spinal
cord.
78
Clinical trials: Trials to evaluate the effectiveness and safety of medications or medical
devices by monitoring their effects on large groups of people.
Cure: 1. To heal, to make well, to restore to good health. Cures are easy to claim and,
all too often, difficult to confirm.
2. A time without recurrence of a disease so that the risk of recurrence is small, as in
the 5-year cure rate for malignant melanoma .
3. Particularly in the past, a course of treatment. For example, take a cure at a spa.
Gastrointestinal: Adjective referring collectively to the stomach and small and large
intestines.
Heart: The muscle that pumps blood received from veins into arteries throughout the
body. It is positioned in the chest behind the sternum (breastbone; in front of the
trachea, esophagus, and aorta; and above the diaphragm muscle that separates the
chest and abdominal cavities. The normal heart is about the size of a closed fist, and
weighs about 10.5 ounces. It is cone-shaped, with the point of the cone pointing down
to the left. Two-thirds of the heart lies in the left side of the chest with the balance in the
right chest.
See the entire definition of Heart
Heart rate: The number of heart beats per unit time, usually per minute. The heart rate
is based on the number of contractions of the ventricles (the lower chambers of the
heart). The heart rate may be too fast ( tachycardia ) or too slow ( bradycardia ). The
pulse is bulge of an artery from the wave of blood coursing through the blood vessel as
a result of the heart beat. The pulse is often taken at the wrist to estimate the heart rate.
Immune: Protected against infection. The Latin immunis means free, exempt.
Infection: The growth of a parasitic organism within the body. (A parasitic organism is
one that lives on or in another organism and draws its nourishment therefrom.) A person
with an infection has another organism (a "germ") growing within him, drawing its
nourishment from the person.
79
Knee: The knee is a joint which has three parts. The thigh bone (the femur) meets the
large shin bone (the tibia) to form the main knee joint. This joint has an inner (medial)
and an outer (lateral) compartment. The kneecap (the patella) joins the femur to form a
third joint, called the patellofemoral joint. The patella protects the front of the knee joint.
Low blood pressure : Any blood pressure that is below the normal expected for an
individual in a given environment. Low blood pressure is also referred to as
hypotension.
Muscle: Muscle is the tissue of the body which primarily functions as a source of power.
There are three types of muscle in the body. Muscle which is responsible for moving
extremities and external areas of the body is called "skeletal muscle." Heart muscle is
called "cardiac muscle." Muscle that is in the walls of arteries and bowel is called
"smooth muscle."
Myelin: The fatty substance that covers and protects nerves. Myelin is a layered tissue
that sheathes the axons (nerve fibers). This sheath around the axon acts like a conduit
in an electrical system, ensuring that messages sent by axons are not lost en route. It
allows efficient conduction of action potentials down the axon. Myelin consists of 70%
lipids (cholesterol and phospholipid) and 30% proteins. It is produced by
oligodendrocytes in the central nervous system.
Nerve: A bundle of fibers that uses chemical and electrical signals to transmit sensory
and motor information from one body part to another..
Onset: In medicine, the first appearance of the signs or symptoms of an illness as, for
example, the onset of rheumatoid arthritis . There is always an onset to a disease but
never to the return to good health. The default setting is good health.
Pain: An unpleasant sensation that can range from mild, localized discomfort to agony.
Pain has both physical and emotional components. The physical part of pain results
from nerve stimulation. Pain may be contained to a discrete area, as in an injury, or it
can be more diffuse, as in disorders like fibromyalgia . Pain is mediated by specific
nerve fibers that carry the pain impulses to the brain where their conscious appreciation
may be modified by many factors.
Paralysis: Loss of voluntary movement (motor function). Paralysis that affects only one
muscle or limb is partial paralysis, also known as palsy; paralysis of all muscles is total
paralysis, as may occur in cases of botulism.
80
Paresthesia: An abnormal sensation of the skin, such as numbness, tingling, pricking,
burning, or creeping on the skin that has no objective cause. Paresthesia is the usual
American spelling and paraesthesia the preferred English spelling.
Peripheral nervous system (PNS): That portion of the nervous system that is outside
the brain and spinal cord.
Plasma: The liquid part of the blood and lymphatic fluid, which makes up about half of
its volume. Plasma is devoid of cells and, unlike serum, has not clotted. Blood plasma
contains antibodies and other proteins. It is taken from donors and made into
medications for a variety of blood-related conditions. Some blood plasma is also used in
non-medical products.
Plasmapheresis: A procedure designed to deplete the body of blood plasma (the liquid
part of the blood) without depleting the body of its blood cells. Whole blood is removed
from the body, the plasma is separated from the cells, the cells are suspended in saline,
a plasma substitute or donor plasma), and the reconstituted solution may be returned to
the patient. The procedure is used to remove excess antibodies from the blood in lupus,
multiple sclerosis, multiple myeloma, etc. Plasmapheresis carries with it the same risks
as any intravenous procedure. The risk of infection increases with the use of donor
plasma, which may carry viral particles despite screening procedures. The procedure is
done in a clinic or hospital.
Protein: A large molecule composed of one or more chains of amino acids in a specific
order determined by the base sequence of nucleotides in the DNA coding for the
protein.
Relapse: The return of signs and symptoms of a disease after a patient has enjoyed a
remission . For example, after treatment a patient with cancer of the colon went into
remission with no sign or symptom of the tumor, remained in remission for 4 years, but
then suffered a relapse and had to be treated once again for colon cancer.
Residual: Something left behind. With residual disease, the disease has not been
eradicated.
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Respiratory: Having to do with respiration, the exchange of oxygen and carbon dioxide.
From the Latin re- (again) + spirare (to breathe) = to breathe again.
Sensory: Relating to sensation , to the perception of a stimulus and the voyage made
by incoming ( afferent ) nerve impulses from the sense organs to the nerve centers.
Spinal cord: The major column of nerve tissue that is connected to the brain and lies
within the vertebral canal and from which the spinal nerves emerge. Thirty-one pairs of
spinal nerves originate in the spinal cord: 8 cervical , 12 thoracic , 5 lumbar, 5 sacral,
and 1 coccygeal. The spinal cord and the brain constitute the central nervous system
( CNS ). The spinal cord consists of nerve fibers that transmit impulses to and from the
brain. Like the brain, the spinal cord is covered by three connective-tissue envelopes
called the meninges . The space between the outer and middle envelopes is filled with
cerebrospinal fluid ( CSF ), a clear colorless fluid that cushions the spinal cord against
jarring shock. Also known simply as the cord.
Spinal tap: Also known as a lumbar puncture or "LP", a spinal tap is a procedure
whereby spinal fluid is removed from the spinal canal for the purpose of diagnostic
testing. It is particularly helpful in the diagnosis of inflammatory diseases of the central
nervous system, especially infections, such as meningitis. It can also provide clues to
the diagnosis of stroke , spinal cord tumor and cancer in the central nervous system.
Stage: As regards cancer , the extent of a cancer, especially whether the disease has
spread from the original site to other parts of the body..
Steroid: A general class of chemical substances that are structurally related to one
another and share the same chemical skeleton (a tetracyclic cyclopenta[a]phenanthrene
skeleton).
Stroke : The sudden death of some brain cells due to a lack of oxygen when the blood
flow to the brain is impaired by blockage or rupture of an artery to the brain. A stroke is
also called a cerebrovascular accident or, for short, a CVA.
Surgery: The word "surgery" has multiple meanings. It is the branch of medicine
concerned with diseases and conditions which require or are amenable to operative
procedures. Surgery is the work done by a surgeon. By analogy, the work of an editor
wielding his pen as a scalpel is s form of surgery. A surgery in England (and some other
countries) is a physician's or dentist's office.
Syndrome: A set of signs and symptoms that tend to occur together and which reflect
the presence of a particular disease or an increased chance of developing a particular
disease.
Trigger: Something that either sets off a disease in people who are genetically
predisposed to developing the disease, or that causes a certain symptom to occur in a
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person who has a disease. For example, sunlight can trigger rashes in people with
lupus.
Viral: Of or pertaining to a virus. For example, "My daughter has a viral rash ."
Viral infection: Infection caused by the presence of a virus in the body. Depending on
the virus and the person's state of health, various viruses can infect almost any type of
body tissue, from the brain to the skin. Viral infections cannot be treated with antibiotics;
in fact, in some cases the use of antibiotics makes the infection worse. The vast
majority of human viral infections can be effectively fought by the body's own immune
system , with a little help in the form of proper diet, hydration, and rest. As for the rest,
treatment depends on the type and location of the virus, and may include anti-viral or
other drugs.
Virus: A microorganism smaller than a bacteria, which cannot grow or reproduce apart
from a living cell. A virus invades living cells and uses their chemical machinery to keep
itself alive and to replicate itself. It may reproduce with fidelity or with errors (mutations)-
this ability to mutate is responsible for the ability of some viruses to change slightly in
each infected person, making treatment more difficult.
Viruses: Small living particles that can infect cells and change how the cells function.
Infection with a virus can cause a person to develop symptoms. The disease and
symptoms that are caused depend on the type of virus and the type of cells that are
infected.
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REFERENCES
http://en.wikipedia.org/wiki/Campylobacter_jejuni
http://www.about-guillain-barre.com/
http://www.cehs.siu.edu/fix/medmicro/cmir.htm
http://www.about-campylobacter.com/campylobacter_symptoms_risks
http://www.medicinenet.com/guillain-barre_syndrome/article.htm
http://www.direct-ms.org/pdf/MolecularMimicryOther/GillianBarrMolMimicry.pdf
http://www.microbiologybytes.com/blog/2008/01/30/how-campylobacter-jejuni-survives-
within-cells/
http://www.microbiologybytes.com/blog/2008/01/30/how-campylobacter-jejuni-survives-
within-cells/
http://en.wikipedia.org/wiki/Myelin_sheath
http://www.drkaslow.com/html/blood_cell_counts.html
http://www.scribd.com
http://www.nursingcrib.com
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