Guagua National Colleges Sta.

Filomena, Guagua, Pampanga College of Nursing

Case Study of Brain Tumor

Prepared By: 2nd Year Miranda, Justin Kier D. Cruz, Anzelyn B. David, Stephanie G. Miranda, Jazmin Gail D. Prepared To: Mrs. Ma. Jaemee Anne B. Lopez

I.

Introduction

Human existence is always associated with complexities. Man itself is a structured compound. It is with system and subsystems that connect its function to enable to breath, to move and to think. Tolstoy

The main switch in mans anatomical and physiological function is his brain. The brain consists of a huge network of neurons that control the bodys vital functions. So far, this system is vulnerable, and its optimal function depends on several key factors. Therefore any alteration to this system and function greatly affects the body as a whole.

The Brain Tumor is a mass of cells that have grown and multiplied uncontrollably. There are two types of brain tumor the benign tumor and malignant brain tumor A benign tumor does not contain cancer cells and usually, once removed, does not recur. Most benign brain tumors have clear borders, meaning they do not invade surrounding tissue. These tumors can, cause symptoms similar to cancerous tumors because of their size and location in the brain. Malignant brain tumors contain cancer cells. Malignant brain tumors are usually fast growing and invade surrounding tissue. Malignant brain tumors very rarely spread to other areas of the body, but may recur after treatment. Sometimes, brain tumors that are not cancer are called malignant because of their size and location, and the damage they can do to vital functions of the brain. Brain tumors can occur at any age. Brain tumors that occur in infants and children are very different from adult brain tumors, both in terms of the type of cells and the responsiveness to treatment. This case study which primarily talks about brain tumor is directed towards presenting the disease, the management and intervention and the other vital facts that remain in oblivion to the great number of population of this country. Considering that the brain tumor truly and evidently has a devastating impact of our nations health our Group BSN-II of GNC has regarded this study significant to the fields of nursing education practice and research because the completion of this study does not only meet the terms for dissemination information purposes, but for sensible learning as well. OBJECTIVES:

A. General objective:

To be able to choose a case study that will contribute and expand our knowledge and improve our skills on specific procedures this is BRAIN TUMOR. Our group has formulated the following specific objectives to guide us toward the completion of this case study. That we may be able to:

B. Specific Objective(s): 1. Established good intrapersonal and professional relationship with our patient and her accompanying family members 2. Share our knowledge and skills to each other 3. Work together with the health care team 4. Provide significant health teaching that would promote our patient health and wellness 5. Formulate effectiveness nursing care plan 6. Formulate specific, measurable, attainable, realistic and time bounded objectives that will serve a guide for the accomplishment of the study (SMART) 7. List the actual and possible symptoms that our patient may manifest 8. Research the drug study of the given medication to our patient 9. List all the references used in the study

C. Current Trends

This article is about children born with birth defects or to mothers together with a history of multiple stillbirths that may have a higher-than-normal risk of brain cancer. Since these sometimes involve some type of genetic abnormalities, they can increase the risk of having a brain tumor. Some preliminary evidence, Dr. Partap said, suggests that defects of the heart and brain may be particularly linked to childhood cancer. Symptoms of brain tumors are also not clear to Pediatricians. So, researchers are doing their best to find the solution to their problems.

We think that having some type of genetic abnormalities can increase the case of having a brain tumor, because we know it is connected to the brain. Having brain tumor can be frustrating to both the patient with brain tumor and his/her family, which is why we concur about people needing to know the symptoms of brain tumor. So, as early as possible, we can detect if there is brain tumor or not and we can treat it right away.

From Reuters Health Information

Birth Defects Tied to Pediatric Brain Tumors

By Amy Norton NEW YORK (Reuters Health) Aug 10 - Children born with birth defects or to mothers with a history of multiple stillbirths may have a higher-than-normal risk of brain cancer, a new study suggests. The risks are still small, researchers say, as children only rarely develop brain cancer. Each year, about 4,000 U.S. children and teenagers are diagnosed with a tumor of the central nervous system (brain or spinal cord), according to the American Cancer Society. Small portions are caused by specific, inherited genetic syndromes, but otherwise little is known about why children develop brain and spinal cancers. The new findings, published online August 8th in Pediatrics, highlight the potential importance of genetic factors, the researchers say. Using a California database on cancer cases in the state, the researchers found 3,733 cases of brain or spinal tumors diagnosed among children younger than 15 between 1988 and 2006. Overall, 1.2% of those children had been born with a birth defect -- vs. 0.6% of 15,000 cancer-free California children studied for comparison. And children with a birth defect had increased risks of certain tumors.

They were nearly four times as likely as children without birth defects to develop a primitive neuroectodermal tumor. Similarly, their risk of germ cell tumors was elevated more than six-fold. Children with birth defects were not, however, at higher risk for the most common type of brain cancer in the study group -- gliomas, which accounted for 57% of cases. The study also found heightened tumor risks among children whose mothers had had at least two late pregnancy losses in the past -- meaning the fetus died after the 20th week of pregnancy. These children were about three times as likely as other kids to develop some type of brain or spinal tumor. Since both birth defects and pregnancy losses often involve some type of genetic abnormality, it's possible that explains the higher cancer risks, according to the researchers. "Genetics may play a larger role in central nervous system cancer than previously believed," said lead researcher Dr. Sonia Partap, of Stanford University and Lucile Packard Children's Hospital in Palo Alto, California. Early miscarriages were not linked to cancer risks in a woman's other children. So it's possible that the genetic abnormalities that cause early pregnancy loss are not connected to cancer, while gene defects that are "compatible with life to some degree" do contribute to cancer risk, Dr. Partap told Reuters Health in an email. As for birth defects, past studies have connected them to higher risks of childhood cancers in general. But researchers are still trying to figure out whether it's only certain birth defects that come with a higher risk. Some preliminary evidence, Dr. Partap said, suggests that defects of the heart and brain may be particularly linked to childhood cancer. But Dr. Partap also stressed that even with a relatively increased risk of brain or spinal cancer, the absolute risk to any one child is small. "Parents should know that there is still a very low risk of central nervous system cancer," she said. At the same time, she added, pediatricians should be aware that there is a slightly higher chance of the tumors in certain children. Symptoms of brain tumors may be vague and vary from child to child. But some possible signs include morning headaches; mental changes like memory and concentration problems; unusual sleepiness; changes in vision, hearing or speech; and balance or coordination problems. SOURCE: http://bit.ly/oWBZpY

II.

Demographic Data A. Personal information: Ms. H.A is 2 year old patient, confined at DPMMH, residence of Del Carmen, Lubao Pampanga. Her birthday is on March 26, 2009. She has a twin sister. She is the youngest among the 3 siblings. Her religion is Roman Catholic. According to her mother, H.A loves to sing and dance. B. History: Ms. H.A was admitted to the hospital last January 01, 2012 with a chief complaint of headache, vomiting, high fever and seizures.

Present history: Last November 27, 2011 the pt. complains of headache, so the S.O brought her to the clinic for check-up. The doctor prescribes medications for the headaches but it did not worked. So the pt .was brought to PMSH (Pampanga Medical Specialist Hospital) because of the headache and seizures and the doctor ordered for EEG, but the result is normal. The pt. was admitted again to MMH (Macabali Memorial Hospital) but has been transferred to Mother Theresa of Calcuta for a CT scan and been diagnosis of BRAIN TUMOR. Because of financial support,they transferred her to DPMMH (Diosdado P. Macapagal Memorial Hospital) Family History No history of diseases. Past History According to her mother, Ms. H.A didnt have any past illness or disease.

III.

Physical Assessment:

General Appearance: Received a patient who is a 2 year old girl, lying on bed unconsciously with an IVF of D5 0.3 NaCl 500cc @ 350cc level, regulated @ 4-5mgtts/min infusing well on her L hand and also hooked with an O of 3L/min via nasal cannula.

Normal Vital Signs: T: 36-37.5 oC RR: 25-50 bpm CR: 80-150 bpm

Vital signs: T:40.0 oC RR: 30 bpm CR: 160 bpm

Organ/Body Parts Skin

Normal Findings Fair in complexion With good skin turgor

Significant Findings Oily Skin Cold clammy skin

Nails

No evidence of clubbing of fingernails Capillary refill: within 2-3 seconds Skull: Hair texture: black and oily curly hair strands Scalp: fair in complexion (-) lesions Asymmetrical frontal lobe Hair partially distributed

Head

Eyes Peri-orbital area

Thin eyebrows, black in color Equally distributed, curled slightly outward

Eyelashes

Eyelids Skin intact, (-) discharge Conjunctiva Shiny and smooth Pink palpebral conjunctiva

Pupils

Cornea

PERLA (Pupils Equal and Reactive to Light and Accommodation) Clear (-) lesions Appeared convex

Sclera

White and buff (-)

Ears Auricles

Fair in complexion, symmetrical elastic, and mobile when pinch, and aligned with the outer cantus of the eyes (+) wet cerumen

Nose External nose Nasal septum Nasal cavity

Symmetrical and not tender Intact and in midline Pink colored mucosa, (+) black and white cilia

Mouth Teeth

White in color

Tongue Lips

Pinkish in color Pink in color (+) cheilosis

Neck Thyroid gland Lymph nodes

(-) Bulging mass Normal (-) Bruits are palpated (-) Swelling (-) Enlargement (-) Tenderness Normally fast Normal Breathing Pattern normal: no murmur (-) chest pain (-) palpitation

Chest Respiratory rate Breathing pattern Heart sounds

Abdomen Color Contour Palpation

Fair in complexion Normal bowel sounds Palpation: soft, non-tender

Musculoskeletal Upper extremities Pulses

Radial and brachial pulse is normal and palpable

Lower extremities Legs

Long and thin legs

IV.

Laboratory and Diagnostic Result Patients Results Hemoglobin: 136 Erythrocytes: Hematocrit: Leucocytes: Lymphocytes: Platelet Count: 4.78 0.41 8.9 0.60 492 Normal Value 120 170 g/L 4.0 5.0 x 10 0.36 0.46 4.5 11 0.20 0.40 150 450 Interpretation
Normal Normal Normal Normal
There is abnormal cell mutation

Lab Test Complete Blood Count (CBC)

There is abnormal cell mutation

Blood Chemistry

RBS:

150

80 115

It

Cranial CT-Scan There is a 3.3 x 6.1 x 4.9 cm (LxWxAP) lobulated, heterogeneous mass with cystic and homogeneously enhancing solid components, involving the right thalamus, right side of the pons, medical aspect of the right temporal lobe and inferoposterior aspect of the frontal lobe. Associated perifocal edema, contralateralshift if the midline structures, lateral displacement of the dorsal horn of the right lateral ventricle and compression of the third and right lateral ventricles. Resultant moderate dilatation of the lateral ventricles with subependymal seepage is seen.

The posterior fossas are unremarkable. There is no intracranial hemorrhage. The rest of the cisterns and sulci are not widened. The visualized paranasal sinuses and mastoids are well aerated. The cranium is intact.

Impression: Complex mass with cystic and solid components as described involving the right thalamus, right side of the pons, medical aspect of the right temporal lobe and inferoposterior aspect of the frontal lobe with associated perifocal edems, mild mass effect and secondary obstructive hydrocephalus. Primary consideration is a neoplastic process such as glioblastoma multiforme.

V.

Review of system

CENTRAL NERVOUS SYSTEM

Nervous System

The nervous system is broken down into two major parts: the central nervous system, which includes the brain and spinal cord, and the peripheral nervous system, which includes all nerves, which carry impulses to and from the brain and spinal cord. These include our sense organs, the eyes, the ears, our sense of taste, smell and touch, as well as our ability to feel pain.

Spinal Cord The spinal cord is a long bundle of neural tissue continuous with the brain that occupies the interior canal of the spinal column and functions as the primary communication link between the brain and the rest of the body. The spinal cord receives signals from the peripheral senses and relays them to the brain.

Brain The brain is the largest and most complex part of the nervous system. It is compose of more than 100 billion neurons and associated fibers. The brain tissues have a gelatin like consistency. The semi-solid organ weighs about 1400g (approximately 3 pounds) in the adult human.

1. The frontal lobes (motor complex) controls voluntary motor activity. 2. The parietal areas these same areas are thought to contribute to reasoning, problem solving activities and emotional stability. 3. The occipital lobe contains a primary visual receptive (interpretation) area and visual association areas. 4. The temporal lobe is located under (inferior to) the lateral sulcus. It contains primary auditory receptive area and secondary auditory association areas.

Brain Stem The brain stem is the part of the brain that connects the cerebrum and diencephalons with the spinal cord. Medulla Oblongata The medulla oblongata is located just above the spinal cord. This part of the brain is responsible for several vital autonomic centers including The respiratory center, which regulates breathing. The cardiac center that regulates the rate and force of the heartbeat. The vasomotor center, which regulates the contraction of smooth muscle in the blood vessel, thus controlling blood pressure.

The medulla also controls other reflex actions including vomiting, sneezing, coughing and swallowing.

Pons Continuing up the brain stem, it reaches the Pons. The pons lay just above the medulla and acts as a link between various parts of the brain. The pons connects the two halves of the cerebellum with the brainstem, as well as the cerebrum with the spinal cord. The pons, like the medulla oblongata, contains certain reflex actions, such as some of the respiratory responses.

Midbrain The midbrain extends from the pons to the diencephalon. The midbrain acts as a relay center for certain head and eye reflexes in response to visual stimuli. The midbrain is also a major relay center for auditory information.

Diencephalon The diencephalons are located between the cerebrum and the mid brain. The diencephalons houses important structures including the thalamus, the hypothalamus and the pineal gland.

Thalamus The thalamus is responsible for "sorting out" sensory impulses and directing them to a particular area of the brain. Nearly all sensory impulses travel through the thalamus.

Hypothalamus The hypothalamus is the great controller of body regulation and plays an important role in the connection between mind and body, where it serves as the primary link between the nervous and endocrine systems. The hypothalamus produces hormones that regulate the secretion of specific hormones from the pituitary. The hypothalamus also maintains water balance, appetite, sexual behavior, and some emotions, including fear, pleasure and pain.

Limbic System The limbic system, often referred to as the "emotional brain", is found buried within the cerebrum. Like the cerebellum, evolutionarily the structure is rather old.

Cerebellum (little brain) The functions of the cerebellum include the coordination of voluntary muscles, the maintenance of balance when standing, walking and sitting, and the maintenance of muscle tone ensuring that the body can adapt to changes in position quickly.

Cerebrum The largest and most prominent part of the brain, the cerebrum governs higher mental processes including intellect, reason, memory and language skills. The cerebrum can be divided into 3 major functions: Sensory Functions - the cerebrum receives information from a sense organ; i.e., eyes, ears, taste, smell, feelings, and translates this information into a form that can be understood. Motor Functions - all voluntary movement and some involuntary movement. Intellectual Functions - responsible for learning, memory and recall.

Meninges The meninges are made up of three layers of connective tissue that surround and protect both the brain and spinal cord. The layers include the Dura mater, the arachnoid and the pia matter. Pia mater is a vascular layer of connective tissue that is so closely connected to the brain and spinal cord that is follows every sulcus and fissures. Dura mater is a tough non-stretchable vascular membrane with 2 layers the outer and inner layer.

Reflex Mechanism Our conscious autonomic responses to internal and external stimuli known as reflex responses provide many homeostatic functions. Although the spinal cord is often thought of as the reflex center, it is not the only site for regulation .Many of the complex reflexes controlling the heart rate, breathing, blood pressure, swallowing, coughing, and vomiting are found in the brain stem.

Cerebrospinal Fluid The cerebrospinal fluid is a clear liquid that circulates in and around the brain and spinal cord. Its function is to cushion the brain and spinal cord, carry nutrients to the cells and remove waste products from these tissues.

Neurons: A neuronal cell body (soma) is like other cell in that it contains most of the organelles seen in other cells. There are several types of neurons - anaxonic neurons: small neurons where the dendrites and axons are indistinguishable. Bipolar neurons: small neurons with two distinct processes; a dendritic process and an axon extending from the cell body. Unipolar neurons: large neurons with the cell body lying to one side of the continuous dendritic process and axon. Multipolar neurons: large neurons with several dendrites and a single axon extending from the cell body. Bipolar neurons: Bipolar neurons are CNS neurons specific for transmitting information from specialized sensory systems: sight, smell and hearing. Grey and white matter: Grey matter consisting of unmyelinated neurons is the processing area of the CNS. White matter located in the inner cortex and surrounding grey matter in the spinal cord - provide pathways of communication between grey matters.

Glial Cells CNS Glial Cell Types: There are 4 types of glial cells: 1. astrocytes - Regulates the chemical microenvironment surrounding neurons. 2. Oligodendrocytes - Myelinate central nervous system axons. 3. Microglia - Migrating phagocytic cells resembling immune cells that remove waste, debris, and pathogens. 4. Ependymal cells - Columnar cells that line the ventricles of the brain and the spinal canal in the spinal cord.

Peripheral Nervous System The PNS includes all neurons other than those in the brain and spinal cord. It consists of pathways of nerve fibers between the CNS and all outlying structures in the body. Included in the PNS are 12 pairs of cranial nerves and 31 pairs of spinal nerves.

Nerves Nerves are made up of specialized cells, which act as little wires, transmitting information to and from the central nervous system and brain. Nerves form the network of connections that receive signals (known as sensory input) from the environment and within the body, and transmit the body's responses, or instructions for action, to the muscles, organs, and glands. Nerve cells are located outside the central nervous system or spinal cord.

Cranial Nerve 12 pairs of cranial nerves arise from the brain. Most of the cranial nerves are composed of both motor and sensory neurons although a few cranial nerves carry only sensory impulses. Except for the olfactory and optic nerves, whose nuclei lie just below the cerebrum, all other cranial nerve nuclei lie within the brain stem

The Cranial Nerves Nerves I Olfactory II Optic III Oculomotor IV Trochlear V Trigeminal VI Abducens VII Facial VIII Auditory Type sensory sensory motor* motor* mixed motor* mixed sensory Function olfaction (smell) vision (Contain 38% of all the axons connecting to the brain.) eyelid and eyeball muscles eyeball muscles Sensory: facial and mouth sensation Motor: chewing eyeball movement Sensory: taste Motor: facial muscles and salivary glands hearing and balance Sensory: taste Motor: swallowing main nerve of the parasympathetic nervous system (PNS) swallowing; moving head and shoulder tongue muscles

IX mixed Glossopharyngeal X Vagus XI Accessory XII Hypoglossal mixed motor motor*

VI.

Pathophysiology

Risk Factors + normal cells Initiation Promotion Malignant conversion Progression Tumor occupy normal tissue spaces Destroy major function of the Thalamus Sorting out sensory impulses No senses Cerebral edema Brain tumor Death

VII.

Course in the Ward Doctors Order

January 01, 2012 8:20 PM Please admit the pt. to ROC Secure consent TPR q shift and recorded NPO temporarily Lab result CBC typing IVF of D5 0.3 NaCl 500cc KVO Cefuroxime vial 400mg slow IV push q6 NST O2 inhalation 3L Continue high back rest

For continued therapy For legal purposes To obtain baseline data for comparison To prevent aspiration To identify infection For route of medication To treat bacterial infections To help the patient to support decreased perfusion To help improve venous drainage, reduce arterial pressure, and may improve cerebral perfusion For neuro evaluation

Refer to Dra. Balagtas January 02, 2012 9:20 AM Paracetamol 0.8mL TID now Prn for T = 38.8 oC January 02, 2012 9:50 AM T = 40 oC Continue medications DAT w/ aspiration precaution TSB Carry out orders of Dra. Balagtas January 02, 2012 CTScan

To decrease hyperthermia

To continue the therapeutic regimen To prevent aspiration To evaporate heat in the body For evaluation and management To identify tumor, cerebral edema or hydrocephalus To sedate the patient from having seizures For further evaluation and management To decrease cerebral inflammation and edema To hydrate the patient

Give Dyphenhydramine TIV at 0.1mg/kg/dose now Refer to Dr. Give Dexamethasone at 0.1 mg/kg TIV now often q 12 hours Kindly IVF rate as replacement

 May also be dehydrated January 02, 2012 4:45 PM Seizure Dyphenhydramine 12.5mg IV now January 03, 2012 7:05 AM Continue medications Carry out referal to Dr. Rivera and Dr. Beltran TF D5 0.3 NaCl 500cc x SR

To sedate patient from seizure

To continue therapeutic regimen For further evaluation and management To help in hemorrhagic shock

VIII.

Nursing Care Process

NURSING DIAGNOSIS SPECIFIC EXPLANATION PLANING NURSING INTERVENTION RATIONALE EVALUATION

ASSESSMENT

S:

O: >Febrile, T=40C in both axilla; warm to touch with flushing

Hyperthermia r/t increase Intracranial pressure

ENTRY OF PATHOGEN IN THE SYSTEMIC CIRCULATION

Short Term: After 2-3 hours of nursing intervention the patient will be able to decrease body temperature from 40C to 37C. Do/perform tepid sponge bath To help decrease body temperature

Short Term: The patient shall Demonstrated temperature within normal range, from 40 C to 37.5C

REGULATION OF TOXIN IN THE BODY

RELEASE OF PYROGEN

Assess body temperature from time to time

To know what is the response of client to TSB

STIMULATION OF THE HYPOTHALAMUS

Long Term: After 2 days of nursing intervention the patient will be to maintain normal body temperature Do not apply alcohol for TSB Alcohol increases peripheral vascular constriction &CNS depression Long Term: The patient shall have demonstrated behaviors to monitor and promote normothemia

INCREASE OR ALTERRATION OF THERMOREGULATION

INCREASE BODY TEMPERATURE

Advise the so to increase oral

Additional fluids help

HYPERTHEMIA

fluid intake of the patient

prevent elevated temperature associated with dehydration

Remove excess clothing and covers

These decrease warmth and increase evaporative cooling

ASSESSMENT

NURSING DIAGNOSIS

SPECIFIC EXPLANATION

PLANING

NURSING INTERVENTION

RATIONALE

EVALUATION

Independent: S: O: >Unconscious >febrile Ineffective cerebral perfusion related to interruption of blood flow Intracranial pressure Short Term: After 2-3 hours of nursing intervention the SO will verbalized understanding of condition, therapy regimen and when to contact health provider Long Term: After 2 days of nursing intervention the patient will demonstrate behaviors and life style changes to improve circulation such as relaxation techniques. Assess patient condition To be able to identify present physiologic disturbances

Pressure exerted in the cranium by its content

Brain, blood and cerebrospinal fluid

.Position head slightly elevated and in neutral position

Reduces arterial pressure by promoting venous drainage and may improve cerebral perfusion.

Short Term: The So shall have verbalized understanding of condition, therapy regimen and when to contact health care provider

Associated with vasospasm or obstruction in the arteries supplying the brain with blood

Take patients temperature at least 4 hours

Hyperthermia causes increased ICP hypothermia causes decrease cerebral perfusion pressure

Increase vascular resistance can result due to increase ICP

Keep patients in neutral alignment

To keep the carotid flow unobstructed thereby promoting perfusion

Long Term: The patient shall have Demonstrated behaviors and life style changes to improve circulation such as relaxation techniques.

Leading to decrease and or absence of blood flow to the brain cells

Provide quite, restful

Continual stimulation can increase ICP.

environment. Because of this there will be decrease or absence of oxygen supply to the brain cells
Note history of brief/intermitte nt periods or black out Monitor patients behavior and mental status for onset of restlessness, agitation confusion Because this suggest transient ischemic attacks

So there is ineffective cerebral perfusion

Changes in behavior and mental status are sign of altered cerebral perfusion

Dependent: Administer supplemental oxygen. Reduces hypoxemia, which can cause cerebral vasodilatation and increase pressure/ edema formation.

ASSESSMENT

NURSING DIAGNOSIS

Scientific EXPLANATION

PLANING

NURSING INTERVENTION

RATIONALE

EVALUATION

S:

O: > Unconscious >seizures

Risk for injury related to disruption in the normal flow of electricity in the brain

Altered neuronal cells

Short Term: After 2-3 hours of nursing intervention the patients seizures will be lessen Assess patient condition To be able to identify present physiologic disturbances Minimizes injury should seizure occur while patient is in bed

Short Term: The patients seizures shall be lessen

Increased frequency and amptitude

Neuronal firing spreads Long Term: Seizures After 2 days of nursing intervention the patients seizures will be remove

Keep padded side rails up with bed in the lowest position

Long Term: The patients seizures shall be removed

Unpredictable movement or behavior

Provide information regarding the condition that may result in risk for injury. Assess muscle strength gross and fine motor coordination

to promote awareness

Risk for Injury

to determine the severity of body weakness and to be able to perform appropriate intervention

Keep the patients room free from clutter

to promote individual safety

IX. Drug Study Drug Name Classification Indications Mechanis m of Action Competitiv ely blocks the effect of histamine at H1receptor sites, has antropinelike, antipruritic, and sedative effects. Adverse Effect Nursing Considerations -> Administer with food. Rationale

Generic Name: Diphenhydra mine

Antihistamine, Anti-motionsickness drug, Antiparkinsoni an, Brand Name: Cough Oral: Allerdyl Suppressant, (CAN), SedativeAllerMax hypnotic Caplets, Banophen, Banophen allergy, Benaryl allergy, Diphen AF, Diphenhist Captabs, Genahist, Siladryl

-> Relief of symptoms associated with perennial and seasonal allergic rhinitis; vasomotor rhinitis; allergic conjunctivitis, mild, uncomplicated urticaria and angioedema; amelioration of allergic reactions to blood or plasma; dermatographism; adjunctive theraphy in anaphylactic reactions. -> Active and prophylactic treatment of motion sickness. ->Nighttime sleep aid ->Parkinsonism (including drug induced parkinsonism and extrapyramidal reactions), in the elderly intolerant of more potent drugs, for milder forms of disorder in the other age groups, and in combination with centrally acting

CNS: Drowsiness, sedation, dizziness, disturbed coordination, fatigue, confusion, restlessness, excitation, nervousness, tremor, headache, blurred vision, diplopia CV: Hypotension, palpitations, bradycardia, tachycardia, extrasystoles stomatitis G.I: Epigastric distress, anorexia, increased apptit and weight gain, nausea, vomiting, diarrhea r constipation G.U: Urinary frequency, dysuria, urinary retention, early menses, decreased libido, impotence Hematologic: Hemolytic anemia, hypoplastic anemia,

-> To prevent GI upset. -> To avoid accident that may cause by the side effects. ->To prevent aspiration.

->Avoid driving and using Dangerous machine.

-> Administer syrup form for patient who cant take tablets.

->Advice patient to rise ->To slowly from lying or prevent sitting position. orthostatic hypotensio n ->Monitor children closely. -> To identify paradoxica l reaction.

anticholinergic antiparkinsonian drugs. ->Syrup formulation: Suppression of cough due to colds or allergy.

thrombocytopenia, leucopenia, agranulocytosis, pancytopenia. Respiratory: Thickening of bronchial secretions, chest tightness, wheezing, nasal stiffness, dry mouth, dry nose, dry throat, sore throat.

Drug Name

Classification

Indications

Generic Name: Cefuroxime Brand Name: Ceftin Zinacef

Antibiotics; Cephalosporin

Oral(cefuroxime axetil) -> Pharingitis, tonsillitis caused by streptococcus pyogenes ->otitis media caused by streptococcus pneumonia, S. pyogenes, Haemophilus influenza, Moraxella catarrhalis NEW INDICATION Acute bacterial maxillary sinusitis caused by S. pneumonia, H. influenza -> lower respiratory infections caused by S. pneumonia, Haemaphilus parainfluenzae, H. influenza -> UTI caused by E.Coli, klebsiella pneumonia -> Uncomplicated gonorrhea (urethral and endocervical)

Mechanis m of Action Inhibits synthesis of bacterial cell wal, causing cell death

Adverse Effect

Nursing Considerations -> Avoid crushing tablets.

Rationale

CNS: Headache, dizziness, lethargy, paresthesias GI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, pseudomembranous colitis, heaptotoxicity GU: Nephrotoxicity Hematologic: Bone marrow depression Hypersensitivity: Ranging from rash to fever to anphylasis; serum sickness reaction

->To prevent tasting the bitter taste of the drug. -> To decrease GI upset and enhance absorption. -> In case of hypoprothr ombinemia occurs. -> To prevent drug tolerance.

-> Give PO drug with meal.

-> Have vitamin K available.

-> Take full course therapy even if you are feeling better.

-> skin and skin structure infections, including impetigo caused by streptococcus aureus, S. pyogenes -> Treatment of early lyme disease Parental(cefuroxime sodium) -> lower respiratory infections caused by S. pneumonia, S. aureus, E. coli, Klebsiella pneumonia, H. Influenza, S. pyogenes -> Dematologic infections caused by S. aureus, S. pyogenes, E. coli, K. pneumonia, Enterobacter -> UTIs caused by E. coli, K. pneumonia -> Uncomplicated and disseminated gonorrhea caused by N. gonorrhhoeae -> Septicimia caused by S. pneumonia, H. influenzae, S. aureus, N. mengingitidis. -> Bone and joint

infections due to S. aureus -> Perioperative prophylaxis -> Treatment of acute bacterial maxillary sinusitis in patient 3 mo-12 yr

Drug Name

Classification s Analgesic; Antipyretic

Indications

Generic Name: Acetaminoph en Brand Name: Tempra; Tylenol

-> Temporary reduction of fever; temporary relief of minor aches and pains caused by common cold and influenza, headache, sore throat, toothache, menstrual cramps, backache, minor arthritis pain, and muscles pains. -> Unlabeled use: Propylaxis in children and patient at risk for seizures who are receiving DTP vaccination to reduce incidence of fever and pain.

Mechanis m of Action Antipyretic s: Reducing fever by acting directly on the hypothalam ic heatregulating center to cause vasodilatio n and sweating, which heals to lessen heat.

Adverse Effects

Nursing Considerations -> Give pedia patient on liquid form of medication.

Rationale

CNS: Headache CV: Chest pain; dyspnea; myocardial damage when dose of 5-8g/day are ingested daily for several weeks or when dosages of 4g/day are ingested for 1year. GI: Hepatic toxicity and failure, jaundice GU: Acute renal failure, renal tubular necrosis. Hematologic: methamoglobinemia-cyanosis; hemolytic anemia; anuria; neutropenia; leukopenia; pancytopenia; thrombopenia; hypoglycemia Hypersensitivity: Rash, Fever

-> To avoid splitting up and easy to swallow. -> To evaporate heat of the patient. -> To complete therapeutic regiments. -> To prevent GI upset.

-> TSB.

-> Take medicine q4.

-> Give drug with food.

Drug Study

Generic Name: Dexamthason e Brand Name/s: Dexasone, Dexone, Hexadrol

Mechanis m of Action Corticostero ->Management of Dexameth id cerebral edema asone Glucocortic ->Diagnostic agent suppresse oid in adrenal disorders s Hormone ->Relieves inflammati inflammation on and the normal immune response. It prevents the release of substances in the body that causes inflammati on.

Classificati on

Indications

Adverse Effects

Nursing Considerations

Rationale

Systemic ->Give drug with Administration food. CNS: Seizures, vertigo, headaches, pseudotumor cerebri, euphoria, insomnia, -> mood swings, depression, psychosis, intracerebral hemorrhage, reversible cerebral atrophy in infants, caratacts, IOP, glaucoma CV: Hypertension, Heart failure, necrotizing angritis Endocrine: Growth retardation, decreased carbohydrates tolerance, DM, cushingoid state, secondary adrenocortical and pituitary unresponsiveness GI: Peptic or esophageal ulcer, pancreatitis, abdominal distention

-> To minimize GI irritation. ->

GU: Amenorrhea, irregular menses Hematologic: Fluid and electrolytes disturbance, negative nitrogen balance, increased blood sugar, glycosuria, increased serum cholesterol, decreased serum T3 and T4 levels Hypersensitivity: Anaphylactoid or hypersensitivity reactions Musculoskeletal: Muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, spontaneous fractures Other/s: Impaired wound healing; petechiae; ecchymoses; increased sweating; thin and fragile skin, acne; immunosuppression; and masking of signs of infection; activation of latent infections,

including TB, fungal , and viral eye infections; pneumonia; abscess; septic infection; GI and GU infections

X.

Discharge Planning

M- Medicine

-Instructed patient to take the medications.

E-Exercise

-Instructed patient to do the ADL.

T-Treatment -Continue medications and promote supportive treatment as PRN, such as TSB and Paracetamol.

H-Health Teaching

-Instruct SO to give nutritional foods like green leafy vegetables example (malungay, ampalaya and bitter melon). -Instruct SO to give food rich in fiber. -Instruct SO to avoid food rich in saturated fats and hydrogenated oils. -Instruct SO to give foods rich in vitamin C.

O-Out patient

-instructed patient to return after one week @ OPD @ 8AM for follow-up checkup D-Diet

-instructed patient to avoid or limit foods rich in saturated fats and hydrogenated oils -DAT with aspiration diet

XI.

Bibliography

Book(s):

Joyce M. Black and Jane Hokanson Hawks, Medical Durgical Nursing (7th Edition) 2004, EL SEVIER (Singapore) PTE LTD. Marilynn E. Doenges, Mary Frances Moorhouse, and Alice C. Murr, Nurses Pocket Guide (12 th Edition) 2008, Nursing: Joanne Patzek DaCunha, RN, MSN. Amy M. Karch, 2011 LIPPINCOTTS: Nursing Drug Guide, 2011, Chris Burghargt.

Website(s):

http://www.medscape.com/viewarticle/747859, 2012. http://www.emedicinehealth.com/anatomy_of_the_central_nervous_system/article_em.htm http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/C/CNS.html, November 18, 2011. http://serendip.brynmawr.edu/bb/kinser/Structure1.html, 10:45:07 EDT, June 3, 2005. http://www.chw.org/display/router.asp?DocID=22484, 2012.