St. Paul University Manila

(St. Paul University System)

680 Pedro Gil St., Malate, 1004 Manila, Philippines

COLLEGE OF NURSING AND ALLIED HEALTH SCIENCES

NURSING CARE STUDY

(Application of Nursing Process)

I. Patient’s Information

This is the case of a patient with initials of W.B. He is a 38 year old male. He had a chief complaint of gradual

progression of headache. His MRI showed a 2.5x2.5 cm suprasellar mass with obstructive HCP and was advised to undergo a surgery

at Philippine General Hospital.

The patient has no known allergies to any food or drugs and with medications of Dexamethasone 5mg IV q8,

Ranitidine 50mg IV q8, Cloxacillin 1g IV ANST(-) 1 hour prior to OR, Gentamycin 80mg IV 1 hour prior to OR, Tramadol 50 mg IV

q8, Mannitol 100cc IV q6. The client’s final diagnosis is craniopharygioma.

II. Physical Assessment

Client’s Initial: W.B.

Client’s Admitting Diagnosis: Craniopharyngioma

AREAS TO BE ASSESSED METHODS OF ASSESSMENT

NORMAL FINDINGS

ACTUAL FINDINGS INTERPRETATION

HEAD

Skull

Inspection(Size, shape,

symmetry and deformities)

Rounded (normocephalic and

symmetric, with frontal, parietal, and

occipital prominences); smooth skull contour; no deformities

Rounded and smooth skull contour. No

deformities.Normal skull on

inspection

Scalp & Hair

Inspection(Color, lesions, hair

distribution and consistency)

White scalp, no lice, no dandruff, no lesions, hair

evenly distributed, thick, shiny, free from split ends

White scalp, no lice, no dandruff, no

lesions, hair evenly distributed, thick,

shiny, free from split ends

Normal Findings

Face

Inspection(Shape, texture,

symmetry of movements, facial expressions, edema

and hollowness)

Oval, square or round in shape,

symmetrical facial movements,

smooth, free from wrinkles, no involuntary

movements, and facial expression

depends on mood. Symmetric

nasolobial folds. No signs of edema and

hollowness.

Round in shape, symmetrical facial movements, free from wrinkles on

forehead and outer canthus of the eyes,

no involuntary movements, and facial expression depends on mood

and situation. Symmetric

nasolobial folds. No signs of edema and

hollowness.

Normal findings.

Eyebrows Inspection Hair evenly Evenly distributed Normal eyebrows.

(hair distribution, alignment, and skin

quality and movement)

distributed; skin intact. Eyebrows symmetrically aligned; equal

movement.

hair; skin is intact without lesions.

Eyebrows symmetrically aligned; moves

equally

Eyelashes

Inspection(Evenness of

distribution and direction of curl)

Equally distributed; curled slightly

outward.

Eyelashes are equally distributed

and are curled slightly outward.

Normal eyelashes.

EYES AND VISION Eyelids

Inspection(Surface

characteristics, position in relation to

the cornea, ability, frequency of blinking, edema, discharge and

scaling.)

Skin intact; no discharge; no

discoloration. Lids close

symmetrically, bilaterally blinking.

No edema and scaling.

Eyelids have intact skin; No

discoloration and discharge was noted.

Lids close symmetrically and bilaterally blinking. Absence of edema

and scaling.

Normal findings on eyelids.

EARS AND HEARING Auricles

Inspection(Color, symmetry of size, and position)

Color same as facial skin.

Symmetrical. Auricle aligned

with outer canthus of eye, about 10 O

from vertical.

Uniform in color. Symmetrical. Auricle 1cm higher than the outer canthus of eye.

Normal findings on auricles

NOSE AND SINUSES

Nose Inspection(Shape, size, or color

and flaring or discharge from the

nose)

Symmetric and straight.

Proportional to face. No discharge or flaring. Uniform

in color.

Symmetric and straight. It is

positioned at the lateral center of the

face. Nose is proportionate to the face and uniform in

Client’s nose is normal.

color.

MOUTH AND ORO-PHARYNX

Lips and Buccal Mucosa

Inspection(Symmetry of contour,

color, and texture)

Uniform pink in color. Soft, moist, smooth texture. Symmetry of

contour. Ability to purse lips.

The lips are symmetrical, dark

brown in color, moist, smooth in

texture.

Abnormal findings of dark colored lips.

NECK Neck MusclesInspection

(Abnormal swellings or masses)

Muscles equal in size; head centered.

No swelling and masses.

Neck muscles are equal in size. Head is located in the center, and no swelling or

masses noted.

Normal findings.

UPPER EXTRE-MITIES

Muscle

Inspection(Size and symmetry,

contractures and tremors)

Equal size on both sides of body. No contractures and

tremors.

Client’s muscles on both upper

extremities equal and appropriate on his

body built. No contractures and tremors noted.

Normal upper extremities.

Bones Inspection No deformities. No deformities No deformities,

tenderness or swelling noted on palpation.

Brachial and radial arteries

Palpation

Pulse rate palpated over the brachial and radial pulse.

Normal radial pulse count is 60-100

beats per minute for adult people.

Pulse rate palpated over the brachial and radial pulse. Clients pulse has a normal

rate.PR= 82bpm

Pulse rate palpated over the brachial and radial pulse. Client has a normal rate.

THORAX AnteriorThorax

Inspection(Breathing pattern)

Quiet, rhythm, and effortless

respirations.

Quiet, rhythm, and effortless

respirations.

Normal findings on anterior thorax

ABDOMENFour

quadrants of Abdomen

Inspection(skin integrity, contour, and symmetry)

Unblemished skin, uniform in color, silver-white striae (stretch mark) or

surgical scars. Flat, rounded (convex),

or scaphoid (concave).

Unblemished skin, uniform in color, and

presence of dark striae. Abdomen appears rounded

(convex).

Normal findings

LOWER EXTRE-MITIES

Muscle

Inspection(Size and symmetry,

contractures and tremors)

Equal size on both sides of body. No contractures and

tremors.

Equal size on both sides of the body. No

contractures and tremors noted.

Normal findings.

Bones Inspection No deformities. No deformities Normal findings.

REVIEW OF RECORDS1. Medical plan of care

To ensure and confirm diagnosis, series of diagnostic tests and laboratory exams should be done to the patient that will verify the diagnosis:

A. Clients health history – health history of the client may reveal past or recent illness

B. Physical examination – to assess present health condition of the client as well as the signs and symptoms present to him

C. Blood Chemistry- to measure different chemicals in the blood

D. Urinalysis- to assess the effects of CVD on renal function and the existence of concurrent renal or systemic diseases

E. Tumor Markers- making a diagnosis of cancer or of a specific type of cancer

F. ECG- graphical recording of the electrical activities of the heart

To ensure condition, progress and response to treatment, continuous monitoring of the patient is required: Monitor vital signs and record every four hours. This is done to be able to evaluate

the body’s response to treatment. Monitoring fluid intake and urinary output every shift and record to be able to

evaluate kidney function based on the amount of his daily intake of fluids, through oral means and intravenous fluid administration and urinary output.

To maintain adequate nutrition and hydration: IVF of PNSS 1L x 30 gtts/min- to replace fluid and electrolyte loss Side drip of PNSS 1L x KVO and D5W 500 cc + 4 ampules of dopamine– to replace

fluid and electrolyte loss Diet as tolerated

Pharmacologic treatment: Dexamethasone 5mg IV q8 Ranitidine 50mg IV q8 Cloxacillin 1g IV ANST(-) 1 hour prior to OR Gentamycin 80mg IV 1 hour prior to OR Tramadol 50 mg IV q8 Mannitol 100cc IV q6

To prevent spread of infection and further complications: Wash hands before and after assessing the patient and after each procedure Wear mask and gloves in every procedure that is needed to be done Practice aseptic technique in every procedure to prevent infection Encourage hygiene to prevent growth of microorganisms

To prevent recurrence of the disease: Compliance of medications as prescribed by the physician Always keep the client’s back dry

To prevent further injury: Observe safety precaution by raising side rails Assist in activities of daily living

LABORATORY RESULTS

A. Blood Chemistry

Examination Normal Value

Unit Result Significance Nursing ResponsibilitiesOctober 4, 2010WBC 5-

10x109L 19.76 It serves as a usual guide to the severity of the disease. Thus

identifies a certain person with increase susceptibility to infection.

The client or the client’s significant other should be informed of the reasons the specimen was ordered, how it is to be collected, the equipment needed, and the stinging sensation that may be felt. There are no fluid restrictions before collection of the specimen.

Label the obtained specimen and secure it properly

Apply pressure or a pressure dressing to the venipuncture site to prevent further bleeding. Observe the site for bleeding.

Provide safety to the client

Monocyte 0.020-0.090

% 0.109 Monocytes have several roles in the immune system and this includes: replenish resident macrophages and dendritic cells under normal states, and in response to inflammation signals, monocytes can move quickly (approx. 8-12 hours) to sites of infection in the tissues and divide/differentiate into macrophages and dendritic cells to elicit an immune response..

B. Metabolic profileDate

Performed

Examination

Normal Value Unit Result Significance

Nursing Responsibilitie

s

October 4, 2010

BUN 2.60-6.4

mmol/L

6.22 N

It is measuring the nitrogen portion of the urea, is used as glomerular function and production and

excretion of the urea. The rate at which BUN rises is influenced by degree of tissue necrosis, protein

catabolism and the rate at which the kidneys excrete urea nitrogen.

Explain the need for this procedure to client.tell the client that no fasting is needed.

Apply pressure or a pressure dressing to the site to prevent further bleeding.

Observe the site for bleeding.

Createnine 53-115 umol/L 102 N

It signifies Impaired renal function. Creatinine is the by-product in the breakdown of muscle creatinine phosphate resulting from energy metabolism. It is produced at a constant rate depending on muscle

mass of the person and is removed from the body by the kidneys. A disorder in kidney function reduces excretion of creatinine, resulting in increased levels

of blood creatinine. It is a more specific and sensitive indicator of kidney disease than the BUN

Sodium 136-145

mmol/L 140 N

Sodium maintains the osmotic pressure and acid-base balance and to transmit nerve impulses. Sodium

concentration is under control of the kidneys and the central nervous system acting through the endocrine

system.

Potassium 3.50-5.10

mmol/L 3.5 N

Potassium level evaluates changes in body potassium and is helpful in diagnosing disorders of acid-base and water balance in the body. It is not an absolute value and varies with the circulatory volume and

other factors such as taking diuretics.In hypertension, the aldosterone level increases thus resulting to water and sodium retention wherein the potassium in our body is secreted that may result to

hypokalemia.

C. Urinalysis

Date Performe

d

Examination

Normal Value Result Interpretatio

n Significance Nursing Responsibilities

August 17, 2010

Color Pale Yellow

to Amber

Pale Yello

w

Normal Result The color of the urine ranges from pale yellow to amber because of the pigment chrome. It indicates the concentration of the specific gravity of urine. The color of the urine is primarily due to the urochrome( pigments that are present in the diet or formed form the metabolism of the bile). Due to the present of the abnormal pigments the color of urine changes in many disease sates

The client should be told the type of specimen needed and the best time of day to collect it.

Explain the purpose and specific method of urine collection to the client. Give the client the proper specimen jars and cleansing agents, if necessary. The perianal area should be washed if it soiled with feces.A small amount of fresh urine is required, enough to moisten a small strip of pH paper.A freshly avoided specimen of at least 30ml is needed for most urinometers. Food and fluid restrictions are not necessarily before collection of the specimen.

Appearance Clear Clear Normal Result The normal urine should be clear. However, normal urine may also be cloudy which provides a warning abnormality such as pus, RBC, or bacteria. However, excretion of cloudy urine may not be abnormal since the change in pH may cause precipitation within the bladder of normal urinary constituents. Alkaline urine may appear cloudy because of phosphates, acid urine may appear cloudy because of urates.

Ph 4 – 6.8 6 Normal Result This is an indication of the renal tubule’s ability to maintain normal

hydrogen ion concentration in the plasma and extracellular fluid.

Specific Gravity

1.005 – 1.030

1.020 Normal Result Specific gravity is a measurement of the concentration of urine. It is a means by which the kidney’s ability to concentrate urine is measured. The range of urine specific gravity depends on the state of hydration varies with urine volume and the loads of solid excreted.

NURSING CARE PLAN

NURSING CARE PLAN(includes independent and dependent Nursing functions)

Assessment Nursing Diagnosis Goal/Objectives Nursing Intervention Rationale Evaluation

With foley-catheter

With IV Will be

undergoing an invasive procedure (craniotomy)

Risk for infection related to surgical incision

After 8 hours of nursing interventions the patient will be able to:a. Have normal

vital signs and laboratory values

b. Have the incision site remain free from signs and symptoms of infection

c. Avoid

Independent:Document and report results of perioperative nursing assessment identify risk factors

A complete nursing assessment allows development of individualized care plan

Goals are met: The vital signs

of the patient remained on normal baseline

The incision remain free from signs and symptoms from infection

Dehiscence is prevented

Make sure all surgical team members wear appropriate operating room attireInspect operating room for cleanliness before opening supplies and instruments

The human body is a major source of microbial contaminationTo provide safe environment

Perform a surgical hand scrub. Put on drapes on patient, furniture and equipment.

Surgical hand scrub minimizes number of microorganisms on skin. Sterile gown and gloves protect against

dehiscence from occurring

contamination sterile drapes create sterile field

Check package integrity, chemical indicator and if appropriate expiration date on all sterile items before dispensing them onto sterile field

All items used within field must be sterile or field will become contaminated.

Use proper techniques when opening items onto sterile field

To avoid contamination

Keep operating room doors closed at all times and minimize traffic in and out

Air turbulence caused by movement and mixing of corridor air with room air can sharply increase bacterial counts in operating room

Maintain room temperature and relative humidity, unless contraindicated

Cooler air and lower humidity inhibit microbial growth

Wash hands following contact with patient or any object contaminated with blood or body fluids

Hand washing is the most effective means for preventing microbial transmission

Disinfect and sterilize all instruments and equipments before and immediately after surgical procedure

All instruments and equipments used during surgery must be free from microorganisms sterilizing instruments and equipment after use

prevents growth and spread of microorganisms during storage

Promptly clean areas outside sterile field that become contaminated by blood, tissues or body fluids with an approved disinfectants

To prevent distribution of microbes into environment

Dependent

Perform preoperative skin preparation of surgical site (done by the surgeon)

Skin preparation reduces resident microbial count to subpathogenic amounts and inhibits rapid rebound growth of microbes

Classify surgical wound according to degree of contamination of wound and surrounding tissue

Classification helps to assess risk of wound infection from an endogenous source and determine need for antibiotic therapy

Administer antibiotic as ordered

Intraoperative administrations of antibiotic can decrease incidence of wound infection and lessen its severity

Apply sterile dressing to surgical wound before remaining drapes

To avoid wound contamination and subsequent infection

NURSING CARE PLAN(includes independent and dependent Nursing functions)

Cues Nursing Diagnosis Goal/Objectives Nursing Intervention Rationale Evaluation with copious

amount of whitish secretions

sedated ineffective

cough difficulty

vocalizing nasal flaring prolonged

expiration phase

pursed lip breathing

shortness of breath

Ineffective airway clearance related to presence of tracheobronchial secretion

After 4 hours of nursing interventions the patient will be able to:a. cough

effectivelyb. expectorate

sputum c. absent

adventitious breath sounds

d. produce normal sputum

e. have patent airway

f. have ABG levels remain at baseline

g. understand the need for adequate hydration, sputum monitor and taking medications as ordered

h. demonstrate controlled coughing technique

DependentAssess respiratory status at least every 4 hours

To detect early signs of compromise

Goals are met if the patient will: cough

effectively expectorate

sputum no

adventitious breath sounds

have patent airway

have normal ABG

understand health teaching

demonstrate controlled coughing technique

Place the patient in semi fowler’s position and support upper extremities

To aid breathing and chest expansion and to ventilate basilar lung fields

Help patient turn, cough and deep breathe

To help prevent pooling of secretions and to maintain airway patency

Mobilize patient to full capabilities

To facilitate chest expansion and ventilation

Provide tissues and paper bags for hygienic sputum disposal

To prevent spreading infection

Teach patient about: Maintaining adequate

hydration Daily monitoring of

sputum Controlled coughing

and postural drainage The need to remain

active

These steps involve patient in own health care

Dependent

Suction as needed and ordered To stimulate cough and clear airways

Perform postural drainage percussion and vibration every 4 hours as ordered

To enhance mobilization of secretions that interfere with oxygenation

NURSING CARE PLAN(includes independent and dependent Nursing functions)

Cues Nursing Diagnosis Goal/Objectives Nursing Intervention Rationale Evaluation with copious

amount of whitish secretions

sedated ineffective

cough difficulty

vocalizing nasal flaring prolonged

expiration phase

pursed lip breathing

shortness of breath

Ineffective breathing pattern related to decreased energy

After 4 hours of nursing interventions the patient will be able to:

a. normal RRb. normal ABG

levelsc. report feeling

comfortable when breathing

d. report feeling rested

e. demonstrate diaphragmatic pursed-lip breathing

f. achieve maximum lung expansion with adequate ventilation

DependentAssess respiratory status at least every 4 hours

To detect early signs of compromise

Goals are met if the patient will: normal RR normal ABG report

feeling comfortable when breathing

reportfeeling rested

demonstrated diaphragmatic pursed-lip breathing

achieved maximum lung expansion with adequate ventilation

Assess ABG levels according to facility policy

To monitor oxygenation and ventilation status

Auscultate breath sounds at least every 4 hours

To detect decreased or adventitious breath sounds

Assist patient to comfortable position

To promote comfort, chest expansion and ventilation of basilar lung fields

Teach patient about: Pursed-lip breathing Abdominal breathing Performing

relaxation techniques

These measures allow patient to participate in maintaining health status and improve ventilation

DATA FROM TEXTBOOK

What is it?

Craniopharyngioma is a tumour that develops in the area of the brain called the hypothalamus, which is close to the pituitary gland. It is usually found in children or young adults and accounts for around 10% of all brain tumours in young people. It can however be diagnosed at any age.

How does it develop?

The pituitary gland starts growing early in a developing fetus from a small amount of tissue called Rathke's pouch, that starts off in the throat area and moves upwards to the brain. Craniopharyngiomas develop from the remains of Rathke's pouch. This explains their name (cranio=skull, pharynx=throat, oma=tumor).

Is it dangerous?

Craniopharyngiomas are nearly always benign but can cause symptoms once they press upon other parts of the brain around them. Therefore they are often quite large when they are detected and may range in size from one, to more than four inches in diameter.

What are the common symptoms?

The symptoms produced by a craniopharyngioma are variable depending upon where the tumour is and which area of the brain that it presses on.

1. Compression of the pituitary stalk or the pituitary gland itself can interrupt the manufacture of part or all of the pituitary hormones. This may cause one or more of the following symptoms

Loss of growth in children Irregular periods Delayed puberty Reduction or loss of sexual drive Fatigue Low blood pressure Dry skin Increased sensitivity to cold and heat Constipation Unexplained weight gain An increase in Prolactin levels, which can cause a milky discharge from the nipples (in

both men and women).

2. Pressure on the nerves that control vision can cause loss of peripheral (side) vision, which may be noticed especially when driving

3. Involvement of the hypothalamus, an area at the base of the brain, may result in weight gain, drowsiness, problems with temperature regulation, mood changes and depression or passing large quantities of urine leading to problems with water balance (a condition called Diabetes Insipidus).

4. Other symptoms can develop for a variety of reasons and may include personality changes, headache, confusion, nausea and vomiting.

What happens if a craniopharyngioma is suspected?

Several specialists may need to be involved in planning investigations and supervising treatment.

1. An Endocrinologist usually assesses the patient first and arranges tests to help make the diagnosis.

2. Most people will need an operation. This is done by a Neurosurgeon and can be performed at Ninewells Hospital.

3. Radiation is also sometimes used as treatment, usually in combination with surgery. Radiation treatment is supervised by a specialist called an Oncologist.

What tests will the Endocrinologist do?

1. Blood tests can detect whether the pituitary gland is manufacturing enough hormones. If any hormones are lacking, it is best to start treatment with hormone tablets as soon as possible.

2. Complete Pituitary Function tests to assess all the major pituitary hormones.3. Water deprivation test may be required if you are passing much urine and are thirsty.4. An eye test (Visual field test) is used to determine whether there is any pressure on the

nerves controlling vision. This can usually be done on the same day as the Endocrine Clinic appointment.

5. MRI scans are used to obtain a picture of the tumour and can tell the extent of the tumour and whether it is invading or pressing on the surrounding brain. Most craniopharyngiomas contain fluid and many also contain some calcium (like bones). This means that they have a unique appearance on a scan that helps to distinguish them from other pituitary tumours. There is often a waiting list for an MRI scan.

What type of operation is needed?

The surgeon will attempt to remove most or all of the tumour and preserve as much of the normal tissue in the pituitary and surrounding brain. The type of operation that is needed will depend on the exact location of the tumour.

If the tumour is mainly confined to the area of the pituitary gland, a trans-sphenoidal operation (through the nose and sinuses) is often used.

If the tumor is not in this region, the surgeon may need to make an opening in the skull (called a craniotomy) to allow access to the tumour.

Following surgery, tests are needed to determine if the pituitary gland is functioning normally. If it is not, then hormones that are lacking need to be replaced in tablet form.

Why is radiation treatment necessary?

Sometimes it is not possible to completely remove the tumour. If this happens, radiation treatment may be recommended. The aim of radiation treatment is similar to surgery i.e. to destroy the tumour and preserve or improve pituitary function and vision. Radiation is also given to prevent a tumour regrowing.

Hormone deficiencies can develop many years after radiation treatment has finished. For this reason, all people who have undergone radiation treatment should be reassessed by an Endocrinologist. Initially this will happen every few months but later once or twice a year can suffice.

PATHOPHYSIOLOGY

Craniopharyngiomas are dysontogenic tumors with benign histology and malignant behavior, as they have a tendency to invade surrounding structures and recur after what was thought to be total resection. Craniopharyngioma usually presents as a single large cyst or multiple cysts filled with a turbid, proteinaceous material of brownish-yellow color that glitters and sparkles because of a high content of floating cholesterol crystals. Because of its appearance, it has been compared to machinery oil. It most frequently arises in the pituitary stalk and projects into the hypothalamus. It extends horizontally along the path of least resistance in various directions—anteriorly into the prechiasmatic cistern and subfrontal spaces; posteriorly into the prepontine and interpeduncular cisterns, cerebellopontine angle, third ventricle, posterior fossa, and foramen magnum; and laterally toward the subtemporal spaces. It can even reach the sylvian fissure.

Vascular supply is dependent on different sources, usually all from the anterior circulation. The anterior portion of the tumor is supplied by small perforators coming off A1 (ie, anterior cerebral artery); lateral portions receive perforators from the proximal portion of the posterior communicating artery; and the intrasellar part is supplied by branches of the intracavernous meningohypophyseal arteries. Craniopharyngioma rarely is supplied with blood coming from the posterior circulation, unless the anterior blood supply for the anterior hypothalamus and floor of the third ventricle is lacking.

Tumor adhesion to surrounding vascular structures represents the most common cause of incomplete tumor removal. Fusiform dilatations of large surrounding vessels have been reported after attempts at radical dissection of the tumor capsule; they injure vasa vasorum, thereby weakening the adventitia. Tumor adhesion is the result of local inflammation. Several inflammatory cytokines have been shown to be elevated in the craniopharyngioma cyst fluid when compared with CSF. IL-1alpha and TNF-alpha were significantly elevated but lower than 10-fold. IL-6 was greater than 50,000 times more concentrated in the cystic fluid than CSF.1 This supports the hypothesis that biomodulation of the cytokine profile could lead to long periods of stability and even tumor regression. IFN-alpha exerts diverse influences mainly on cytokine antagonists and soluble adhesion molecules and has been shown to play a role in the treatment of craniopharyngioma in some limited trials, both after systemic use and local, direct intracystic use.

DRUGS STUDYDrugs Dose, Route

and Frequency

Classification Action/Indication

Side Effects NursingResponsibilities

Tramadol D:50mg R: IVF: q8

Analgesic Tramadol is used similarly to codeine, to treat moderate to moderately severe pain and most

types of neuralgia, including trigeminal neuralgia.

Nausea and vomiting

Diarrhea

1. Document indication for therapy, characteristics and signs and symptoms

Mannitol D: 100 cccR: IVF: q6

Diuretic Mannitol is used clinically to reduce acutely raised intracranial pressure until more

definitive treatment can be applied, e.g., after head trauma. 

Bradycardia Hypotensio

n Cold

extremities Flushing

1. Document indications for therapy, characteristic of symptoms and outcome

2. Note ECG, VS and cardiopulmonary assessment

3. Monitor intake and output

4. Keep log of BP and pulse for provider review

Cloxacillin D: 1 g R: IV

F: 1 hour prior to OR

Antibacterial Cloxacillin is used against staphylococci that produce beta-lactamase, due to its large R

chain, which does not allow the beta-lactamases to bind.

Nausea and vomiting

Abdominal pain

1. Document indication for therapy, characteristics and signs and symptoms

Gentamycin D: 80 mgR: IV

Antibacterial Gentamycin is an aminoglycoside antibiotic, used to treat many types

Nausea and vomiting

1. Document indication for

F: 1 hour prior to OR

of bacterial infections, particularly those caused by Gram-negative bacteria.

Constipation

therapy, characteristics and signs and symptoms

Dexamethasone D: 5mgR: IVF: q8

Glucocorticoid Dexamethasone is a potent synthetic member of the glucocorticoid class of steroid drugs. It

acts as an anti-inflammatory andimmunosuppressant. 

Stomach upset

Allergic reactions

1. Document indication for therapy, characteristics and signs and symptoms

Ranitidine D: 50 mgR: IVF: q8

Anti-histamine Ranitidine is a histamine H2-receptor antagonist that inhibitsstomach

acid production.

1. Document indication for therapy, characteristics and signs and symptoms

ST. PAUL UNIVERSITY MANILAST.PAUL UNIVERSITY SYSTEM

COLLEGE OF NURSING AND ALLIED HEALTH SCIENCES

NURSING CARE STUDY(Application of Nursing Process)

CRANIOPHARYNGIOMA

Submitted by:Ma, Christina B. Talosig

BSN 4DGroup 9

Submitted to:Mr. Nick I. AlfaroClinical Instructor

Research Paper helphttps://www.homeworkping.com/