GBS sinco mark

8142019 GBS sinco mark

httpslidepdfcomreaderfullgbs-sinco-mark 168

SURIGAO EDUCATION CENTERKm 2 National Highway

Surigao City

College of Allied Medical Sciences

GUILLAIN BARRESYNDROME

A CASE PRESENTATION

Presented byAlberto Kyra Czarelle OArlan Arwela JaneBansag GirlieBordas Regie RCaerlang Kimberly Y

Dagamihan Edwin JrEspinile KathleenGonzales Gazilyn PGruyal Gienette Claire BJurcales Yvonne VManlimos Dan Warren NPaelmar Cheenee Rose RSegura Jheril ESuazo Marichu L

Presented toMary Claire C Urag RNTeresita P Adobas RNFrederick Jones Perez RNBonifacio Salmayor RNChristine Sykimte RN

Aida Manto RNEdcel Paler RN USRNRhea Mesias RNRocelyn Dawsan RNTracy Paula Catelo RNVivian Ceryn Cabuga RNJeanith Muntildeoz RN

1



TABLE OF CONTENTS

bull Dedication

bull Acknowledgement

bull Introduction

bull Review of Related Literaturebull Patientrsquos History

Biographic data (Patientrsquos Profile)

Admission Data

History of Present Illness

Past Health History

Child illness

Immunizations (records)

History of hospitalizations

Family health history

radicLifestyleradic Personal habits

radic Diet

radic Sleep and Rest Patterns

radic Elimination Pattern

radic Activities of Daily Living (ADL)

Social Data

Environmental Data

Psychologic data

Patterns of Health Care

bull Physical Assessment and Review of Systems

General Survey

Vital Signs

Integumentary System

Hair

Nails

Head

Eyes and Vision

Ears and Hearing

Nose and Sinuses

Oropharynx (mouth and throat)

Neck Breast and Axillae

Abdomen

Extremities

Musculoskeletal System

Respiratory System

Cardiovascular System

Genitourinary System

2



Neurologic System

Mental Status

radic Language

radic Orientationradic Memory

radic Level of Consciousness

Cranial Nerves I ndash XII

bull Laboratory Data

Hematology

Urine Analysis

Electrolytes

bull Anatomy and Physiology

bull Pathology and Physiology of the disease

Detailed discussion of the schematic diagram

Schematic diagram (landscape format)

bull Drug Study

bull Nursing Care Plan (NCP)

bull Discharge Plan (detailed)

Medication

Exercise

Treatment Regimen

Out patient follow up check up

Diet

Spiritual

3



DEDICATION

We heartily dedicate this Case Presentation to the following

To our families and loved ones especially our parents You are our constantsource of strength and inspiration

To our dutiful Clinical Instructors May your passion for teaching never fades

And to the Heavenly Father We offer this product of our hard work to you dear Lord

4



ACKNOWLEDGEMENT

Bringing about a Case Presentation is no easy task Certainly this CasePresentation would not have been possible without the aid of some people We extendour sincerest gratitude to the following

To our families and loved ones for their unconditional love and supportMere words cannot convey our unending gratitude

To our Clinical Instructors for the knowledge skills and attitude that theyhave imparted on us

To all the people who may have knowingly or unknowingly contributed to thefulfillment of this Case Presentation

And most importantly we thank the most Gracious Heavenly Father whomakes all things possible

5



INTRODUCTION

Guillain-Barre Syndrome is a neuromuscular autoimmune disorder wherein thebodyrsquos own immune system attacks the peripheral nerves that convey sensoryinformation (eg pain temperature) from the body to the brain and motor (iemovement) signals from the brain to the body It is a rare condition occurring once inevery 100000 people per year but it is one of the leading causes of non-trauma inducedparalysis in the world Exactly what triggers Guillain-Barre syndrome is unknown and itmay occur at any age but is most common among young adults and the elderly Thecondition is often preceded by either a viral or bacterial infection of the lungs or gastrointestinal tract Signs of the original infection have already disappeared before the

symptoms of Guillain-Barre begin

People with GBS usually have muscle weakness or paralysis that starts in thelegs and feet It progresses up toward the arms and head Sometimes the weaknessstarts in the arms and moves downward Occasionally it starts in the arms and legs atthe same time The spread from feet to head can occur within 24 to 72 hours but cantake longer Mild cases of Guillain-Barre syndrome may present only with ataxia(difficulty in walking and balancing) whereas severe cases may present with difficulty inrespiration due to paralysis of the respiratory muscles and cranial nerves

Treatment for Guillain-Barre Syndrome consists of supportive care ventilatory

management (in about one third of patients) and specific therapy with intravenousimmunoglobulin or plasmapheresis However each case of Guillain-Barre Syndrome isdifferent It is important to realize that the complications and therefore treatments of Guillain-Barre syndrome are not predictable For the most part treatments are highlyindividualized

Our patient is Mr C a seventeen year old first year high school student of LoretoNational High School He was admitted last September 25 2009 at the CaragaRegional Hospital after being referred by the Loreto District Hospital His chief complaintupon admission was sudden onset of weakness on both legs

Guillain-Barre Syndrome is a serious disorder requiring prompt medical attentionwhich can even be a medical emergency However most Filipinos have not even heardof such a condition Yes it is a rare condition but more and more Filipinos are struck byit

Hence our group decided to present this case with the earnest intention toacquire sufficient and accurate information about the disorder for us to be able to playour part on the prevention of the said disorder through information dissemination As

6



future nurses we understand the indispensable role of health promotion in theprevention of diseases

REVIEW OF RELATED LITERATURE

Guillain-Barreacute syndrome (GBS) causes progressive muscle weakness and paralysis(the complete inability to use a particular muscle or muscle group) which develops over days or up to four weeks and lasts several weeks or even months

Description

The classic scenario in GBS involves a patient who has just recovered from a typicalseemingly uncomplicated viral infection Symptoms of muscle weakness appear one to

four weeks later The most common preceding infections are cytomegalovirus herpesEpstein-Barr virus and viral hepatitis A gastrointestinal infection with the bacteriaCampylobacter jejuni is also common and may cause a severe type of GBS from whichit is particularly difficult to recover About 5 of GBS patients have a surgical procedureas a preceding event Patients with lymphoma systemic lupus erythematosus or AIDShave a higher than normal risk of GBS Other GBS patients have recently received animmunization while still others have no known preceding event In 1976ndash77 there wasa vastly increased number of GBS cases among people who had been recentlyvaccinated against the Swine flu The reason for this phenomenon has never beenidentified and no other flu vaccine has caused such an increase in GBS cases

GBS can be divided into types on the basis of the type of destruction caused

If the myelin sheath (described below see figure 1) insulating an axon is damaged or destroyed the nerve signals through the axon are disrupted or slowed down causingsymptoms such as abnormal sensations and weakness This inflammation is thedemyelinising type and the process is called primary demyelination

In the axonal type the nerve axon itself is destroyed in a process called secondarydemyelination This is said to occur in patients who experience a very violentinflammation phase If the axon dies the nerve signal is blocked and cannot betransmitted further This causes weakness and paralysis in the body area controlled by

the nerve

The axonal type occurs most frequently after preceding diarrhoea It may be responsiblefor a less favourable prognosis (outcome) as axons regenerate after a long delaycompared to the myelin sheath which heals faster There are however some kinds of axonal types that have a more favourable prognosis

7



The mixed type destroys both axons and myelin Long-term paralysis in some GBSpatients is thought to be caused by permanent damage to both axons and myelinsheaths

Peripheral nerves and spinal roots are the major sites of demyelination but cranialnerves may also be involved

Destruction of nerve insulation

The immune systems attack on the peripheral nerve cells starts a chain reaction

The immune system is responsible for the production of special proteins the antibodiesor immunoglobulins (Ig) as part of the bodys normal defence mechanism Theseantibodies are produced in reaction to the presence of antigens or introduced particlesin the body such as various bacteria and vira Antibodies match specific antigens andwhen the two come in contact they bind together and a number of destructive reactionsoccur

In GBS patients antibodies are somehow produced against myelin They circulate inthe blood seeking myelin which is found in nerve cells

Nerve cells have long thin extensions called axons that transmit signals between nervecells Some axons are surrounded by a myelin sheath a little like electrical cables aresurrounded by plastic The myelin sheath insulates and protects the nerve cells It alsoincreases both the speed and the distance over which nerve signals can be transmittedFor example signals from the brain to muscles are transmitted at a speed of over 50kmh

Fig1 Longitudinal section of an axon and its myelin sheath The axon is part of nerve cell

1 stretching toward nerve cell 2 The myelin sheath resembles tape wrapped around theaxon in several layers

8



Myelin does not cover the axon in an uninterrupted tube like an electrical cableInstead it resembles long beads on a string with space between the beads (see figureabove) The spaces are known as Ranvier Nodes Axons are uncovered betweenthese nodes of Ranvier and are therefore vulnerable to attack here

The nerve signals transmitted are also delayed a little at the nodes and the more nodesthere are the slower the signal becomes This fact is important when understandingrecovery - increased numbers of Ranvier nodes may be produced during nerverecovery slowing signal transmission

The myelin-attacking antibodies produced in the GBS patient circulate in the blood andeventually find myelin They attack and destroy it with the help of white blood cellsproducing inflammation in the nerves The inflamed cells in turn secrete chemicals thataffect the Schwann cells These cells produce the fatty materials required to produce

myelin Affecting Schwann cells reduces myelin production and some of them mayeven die further reducing myelin production while at the same time the existing myelinis destroyed by the antibodies

As the attack progresses the peripheral nerve network is gradually destroyed Motorsensory or autonomic nerves are attacked signals are slowed down blocked or disrupted and the patients body is affected accordingly

If the signal transmission speed of a motor nerve is reduced the patient experiencesweakness in the body area controlled by the nerve If the signal speed is reducedfurther or blocked the patient can become paralysed Similarly attacks on sensory or

autonomic nerves result in disturbances of the organs hooked up to the nerves

Simultaneously the patients brain receives fewer signals from the body and these maybe disrupted This results in parts of the body feeling numb as well as strangesensations of pain tingling and pins and needles

Signals to and from the arms and legs must travel furthest from the brain and spinalcord and are therefore most susceptible to a barrage of disturbances while en routeThis is why hands and feet are usually the first body areas that display GBS symptoms

Attack on the peripheral nerves

All the nerves in the human body with the exception of the brain and spinal cordbelong to the peripheral group of nerves ie the peripheral nervous system comprisesmost of the cranial nerves and the spinal nerves (sensory motor autonomic andmixed)

9



The peripheral nerves transmit signals from the brain and spinal cord to and from themuscles organs and skin Depending on their function the nerves can be classified asmotor sensory and autonomous (involuntary) peripheral nerves

When the immune system malfunctions temporarily and GBS sets in an attack islaunched on the peripheral nerves damaging them This causes sensory disturbances

progressive weakening andor acute paralysis Metaphorically speaking the nervoussystem short-circuits Exactly how the nerves are damaged is described below

Only the peripheral nervous system is affected which is why GBS is also known asperipheral neuropathy

Causes and symptoms

The cause of the weakness and paralysis of GBS is the loss of myelin which is thematerial that coats nerve cells (the loss of myelin is called demyelination) Myelin is aninsulating substance which is wrapped around nerves in the body serving to speed

conduction of nerve impulses Without myelin nerve conduction slows or stops GBShas a short severe course It causes inflammation and destruction of the myelin sheathand it disturbs multiple nerves Therefore it is considered an acute inflammatorydemyelinating polyneuropathy

The reason for the destruction of myelin in GBS is unknown although it is thought thatthe underlying problem is autoimmune in nature An autoimmune disorder is one inwhich the bodys immune system trained to fight against such foreign invaders asviruses and bacteria somehow becomes improperly programmed The immune systembecomes confused and is not able to distinguish between foreign invaders and thebody itself Elements of the immune system are unleashed against areas of the bodyresulting in damage and destruction For some reason in the case of GBS the myelinsheath appears to become a target for the bodys own immune system

The first symptoms of GBS consist of muscle weakness (legs first then arms thenface) accompanied by prickly tingling sensations (paresthesias) Symptoms affect bothsides of the body simultaneously a characteristic that helps distinguish GBS from other causes of weakness and paresthesias Normal reflexes are first diminished then lostThe weakness eventually affects all the voluntary muscles resulting in paralysis Whenthose muscles necessary for breathing become paralyzed the patient must be placedon a mechanical ventilator which takes over the function of breathing This occurs about30 of the time Very severely ill GBS patients may have complications stemming fromother nervous system abnormalities which can result in problems with fluid balance inthe body severely fluctuating blood pressure and heart rhythm irregularities

Diagnosis

Diagnosis of GBS is made by looking for a particular cluster of symptoms (progressivelyworse muscle weakness and then paralysis) and by examining the fluid that bathes thebrain and spinal canal through cerebrospinal fluid (CSF) analysis This fluid is obtainedby inserting a needle into the lower back (lumbar region) When examined in a

10



laboratory the CSF of a GBS patient will reveal a greater-than-normal quantity of protein with normal numbers of white blood cells and a normal amount of sugarElectrodiagnostic studies may show slowing or block of conduction in nerve endings inparts of the body other than the brain Minor abnormalities will be present in 90 of patients

Diagnostic tests

Lumbar Puncture

A needle is inserted in between the bones of the lower back into the fluid around the

spinal cord A small amount of spinal fluid is taken and the protein level is tested InGBS the protein level is usually increased

Electromyogram (EMG or Electromyography)

A thin-needle electrode is inserted into the muscle to be tested and electrodes are

placed on the skin over peripheral nerves This test helps to determine if the peripheral

nerves are not communicating between the brains and muscles in the body

Nerve Conduction Study (NCS)

Two electrodes are taped to the skin in the affected area of the patients body A smallshock is then passed through to measure the electrical impulses from one electrode tothe other This test records how long it takes for the electrical impulse to travel from oneelectrode to another If the impulse is slow it suggests nerve damage

Treatment

There is no direct treatment for GBS Instead treatments are used that support thepatient with the disabilities caused by the disease The progress of paralysis must becarefully monitored in order to provide mechanical assistance for breathing if it

becomes necessary Careful attention must also be paid to the amount of fluid thepatient is taking in by drinking and eliminating by urinating Blood pressure heart rateand heart rhythm also must be monitored

A procedure called plasmapheresis performed early in the course of GBS has beenshown to shorten the course and severity of GBS Plasmapheresis consists of withdrawing the patients blood passing it through an instrument that separates thedifferent types of blood cells and returning all the cellular components (red and whiteblood cells and platelets) along with either donor plasma or a manufactured

11



replacement solution This is thought to rid the blood of the substances that areattacking the patients myelin

It has also been shown that the use of high doses of immunoglobulin givenintravenously (by drip through a needle in a vein) may be just as helpful as plasma-pheresis Immunoglobulin is a substance naturally manufactured by the bodys immune

system in response to various threats It is interesting to note that corticosteroidmedications (such as prednisone) often the mainstay of anti-autoimmune diseasetreatment are not only unhelpful but may in fact be harmful to patients with GBS

Prognosis

About 85 of GBS patients make reasonably good recoveries However 30 of adultpatients and a greater percentage of children never fully regain their previous level of muscle strength Some of these patients suffer from residual weakness others frompermanent paralysis About 10 of GBS patients begin to improve then suffer a

relapse These patients suffer chronic GBS symptoms About 5 of all GBS patientsdie most from cardiac rhythm disturbancesPatients with certain characteristics tend to have a worse outcome These includepeople of older age those who required breathing support with a mechanical ventilatorand those who had their worst symptoms within the first seven days

Prevention

Because so little is known about what causes GBS to develop there are no knownmethods of prevention

12



ASSESSMENT

Nursing Health History

Hospital Caraga Regional HospitalWard service Pedia Ward - MiscName of Patient Mr CAge 17 years oldSex MaleBirth date October 21 1993Nationality FilipinoAddress Esperanza Loreto Province of Dinagat IslandReligion IFIHeight 5rsquo2rdquo feetWeight 47 kgs (10361 lbs)Admitting date and time September 25 2009 (1025 am)Attending Physician Dr AsodisenChief complaint Sudden onset of weakness on both legsAdmission diagnosis Guillain barre syndromePrincipal diagnosis Guillain barre syndrome

Vital Signs upon Admission

T = 363degCP = 89 bpmR = 19 cpmBP = 11070 mmHg

Date of Assessment September 29 2009Vital Signs during Assessment

T = 367degCP = 88 bpmR = 20 cpmBP= 11070 mmHg

IBW = 118 118

13



-10 +10

129 - 128 lbs patient is only 10361 lbs therefore patient is underweight

BMI = weight (in kgs) height (in m)2

= 47 kg (1585 m)

2

= 47 251

= 1872 patientrsquos BMI is normal

NURSING HEALTH HISTORY

Date of AssessmentSeptember 29- October 1 2009 (date of duty)

Source of informationPatient and his mother

HISTORY OF PRESENT ILLNESS

One (1) month prior to hospitalization Mr C stated that he experiencedabdominal cramps and diarrhea for 2 days A week after he suffered on and off lower back pain which he described as ldquomorag gitusokrdquo (sharp pain) than lasted for about aweek

When the pain abated it was replaced by a sudden tingling ldquopins and needlerdquosensation on both feet which he noticed to worsen during rest periods Thinking that itwas only an effect of a frequent 4-km walk to and from school Mr C just massaged thearea with herbal oils

Two days passed the tingling sensation disappeared but was replaced with

numbness weakness and eventually loss of sensation not only on his feet but also onboth of his lower legs It ascended to his pelvic area in two days time Mr C can neither stand nor walk due to such condition

As people who believe in folk practitionersrsquo healing powers Mr Crsquos family soughtadvice from the local ldquomanghihilotrdquo who massaged the affected area with his own-mademixture of herbs The latter believed that Mr Crsquos condition is caused by ldquobuyag saengkantordquo They also asked help from a ldquomantayhopayrdquo who gave the same impressionMr C and his mother followed the instructions of the said persons such as soaking hisfeet withldquonilagang sambongrdquo every morning and at night before sleeping for about nine(9) days 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 onhis bedroom His mother stated ldquomorag nag-wild ang akong anakhellipnagsinggit singgit ug hilak kay gusto na magpahospital kay nahadlok na siya nga dili makalakaw pagbalikhelliprdquo

14



That incident prompted the family to bring their son to Loreto District Hospital that daybut was referred directly to Caraga Regional Hospital for further assessment andmanagement

Mr C was admitted to Caraga Regional Hospital last September 25 2009 atexactly 1025 am for complaints of weakness on both legs and pelvic area

Upon confinement the doctor prescribed the following

bull IVF D5IMB100 25 gttsmin

bull Vitamin B complex 1 cap OD

bull Hydrocortisone 100mg IVTT q80

Laboratory tests were also ordered by the attending physician such as

bull Hematology

bull Electrolytes

bull Urinalysisbull Lumbar puncture

PAST HEALTH HISTORY

History of Hospitalization

Mr C claimed that he has not been admitted to any hospital before for whatever illness or disease

Childhood Illnesses

Mr C experienced having measles when he was three years old and chicken poxwhen he was on his 4th grade He did not have any history of poliomyelitis and rubella

Immunizations

Her mother said that his son (Mr C) donrsquot have childhood immunization such asDPT OPV Hepatitis A Hepatitis B Influenza and MMR except for BCG

Allergy

He claimed to have no allergy on certain foods drugs animals and other environmental agents

15



Family Health History

According to the patient they donrsquot have any history of this kind of healthcondition Mr Crsquos maternal grandfather has arthritis and his grandmother has cataract

on the right eye On his paternal side both his deceased grandparents died of kidneyproblem with generalized edema

His 56 year old father complains of episodes of joint pains while his mother whois 43 years old claimed to have no health problems except for occasional cough coldsand fever which can be relieved by over the counter drugs such as biogesic neozepcarbocisteine and paracetamol Among the four siblings he is the only one diagnosedwith Guillain Barre Syndrome

SURGICAL HISTORY

As claimed by his mother the patient has not yet undergone any invasivesurgical procedure

PERSONAL AND SOCIAL HISTORY

LIFESTYLE

Personal Habits

Mr C used to enjoy strolling together with his other gay friends every night Hisearly morning task was to feed their native chicken in their backyard He also stated thathe loves to cook clean their house and read novels

He claimed that he doesnrsquot drink hard liquors smoke or use recreational drugs

Diet

Before hospitalization our patientrsquos regular diet was 2 cups of rice fish andvegetables His mother told us that the patient was fond of eating ldquokinilawrdquo whenever they can buy fish He preferred eating raw fish ldquokinilawrdquo with vinegar than cooked Heeats 3 large meals a day and drinks 5-6 glasses of water Her mother also stated thathis son is fond of eating raw egg with salt every morning

During hospitalization the patient claimed that his appetite is as good as before

16



Sleep and Rest Pattern

Our patient usually sleeps at around 900pm and wakes up at 500 in themorning to prepare for school

During hospitalization he spends most of the time sleeping during the daybecause of weakness and boredom However at night time he reported that he hastrouble sleeping because of the noise of other patientrsquos watchers and bright light

Elimination Pattern

Before hospitalization our patient defecates everyday and urinates three to four times a day During the appearance of the symptoms he only defecated once a week

During hospitalization he never defecated until he was inserted rectally with a

suppository (bisacodyl pedia) He has hard and well formed yellow-colored fecesDuring defecation he is usually carried and assisted by his father to the comfort roomHis mother reported that Mr C experienced urinary incontinence Subsequently wehave observed his pants to be wet with urine during assessment

Activities of Daily Living

Before hospitalization the patient did not experience any difficulties in the basicactivities of eating grooming dressing elimination and locomotion

During hospitalization he always needs help from his mother and father ineating dressing grooming elimination and locomotion

SOCIAL DATA

The patient and his family are followers of IFI (Iglesia Filipina Independiente)

Our patient is known to be a gay He is friendly and very close to his brother andsisters Usually they would wake up early morning and would wait for their hens to layeggs They would eat those eggs raw with salt

Mr C believed of ldquoengkantordquo The ldquoquack doctorsrdquo they consulted had the belief on how the patient got the disease All said that the disease was given by theldquoengkantordquo or ldquogibuyaganrdquo

The patient and his family also believed that a person with fever or other illnesses should not take a bath because it will aggravate the disease

Our patient is a first year high school student of Loreto National High SchoolDuring this hospitalization he has not gone to school due to his illness

17



ENVIRONMENTAL DATA

The patientrsquos house is situated just beside the street in Esperanza Loreto DinagatIsland Their house is made of wood and nipa with fruit trees shading the house Their

house has only one (1) bedroom and their CR is situated outside their house It is wellventilated clean and spacious Their source of drinking water is from a commongovernment faucet shared by the whole sitio They have ornamental and herbal plantsin front of their house They also have poultry in their backyard The patient and hisfamily usually used herbal plants as alternative medicine such as guava for diarrheahelbas for abdominal pain lemon grass and carabo for cough However they are alsofond of buying over the counter drugs such as Biogesic Neozep Kremil-s andParacetamol as the need arises

PSYCHOLOGIC DATA

The patientrsquos major stressor was his disease and sometimes if he is scolded byhis mother In addition it makes him feel rejected when teased by his peers as ldquobayotrdquothat exacerbated when his feminine gait became more pronounced as one of the earlysigns and symptoms of Guillain Barre Syndrome began to manifest (gait changes)

PATTERNS OF HEALTH CARE

Their family is not Philhealth members Whenever a member got ill they usuallysought help from ldquotambayonrdquordquomantayhopayrdquo and ldquomanghihilotrdquo They only seek medicalattention whenever the condition cannot be treated by the said folk healers

DEVELOPMENTAL TASK

According to Erick Erickson a 17 year old personrsquos developmental task is identityversus role confusion During this stage a person attempts to find hisher own identitystruggle with social interactions and grapple with moral issues The task is to discover hisher true identity as individual separate from family of origin and as member of awider society

In our case our patient is unsuccessful in navigating this stage because he wasbeing interrupted by his disease His world focused mainly on his disease and familymembers He is constantly confused as to why it suddenly happened to him Beingdependent to his parents aloof to her peers and without own identity will be the mostprobable outcome He will most probably experience role confusion and upheaval

In Freudrsquos psychosexual development our patient will likely be fixated in thegenital phase As a 17 year-old boy he is concerned about body image ldquocrushesrdquo ndashromantic idealization and develops a strong interest in the same sex since he claimed tobe homosexual However he finds it difficult to express such interest because of his

18



health condition especially that the disease had caused him to compulsory stay in thehouse

During this stage also there is an increase comparison of oneself to the peer group that further resulted in negative self-appraisals that cause lower self-esteem andpoor self-worth Unpleasant comments from peers as to why he got the disease also

contributed to the possible genital phase fixation

PHYSICAL ASSESSMENT

Vital Signs during Assessment

September 29 2009 September 30 2009 October 1 2009

T = 367degC T = 368degC T = 368degC

P = 88 bpm P = 90 bpm P = 90 bpmR = 20 cpm R = 19 cpm R = 20 cpm

BP= 11070 mmHg BP= 11070 mmHg BP= 11070 mmHg

GENERAL SURVEY

bull Patient lies quietly on bed in a left lateral position with head elevated with 1pillow awake conscious and coherent

bull Ongoing IVF solution of D5IMB300 running at 25gttsmin hooked at right dorsalmetacarpal vein infused well

bull Patient appeared weak and palebull Poor hygiene and grooming noted

bull Patient wears loose clothing

bull Patient cannot move his lower extremities

bull Patient is cooperative

SKIN

bull Generalized pallor skin noted

bull Scars from chicken pox noted on the abdomen part

bull Skin is dry

bull Diaphoresis noted

bull Crusted lesions noted at the left dorsalis pedis right knee and at the right big toe

bull Good skin turgor

HAIR

bull Hair color is brown

19



bull Thin and dry hair

bull Not properly combed

bull No lice infestation noted

NAILS

bull Nails are convex with an angle at about 160 degrees

bull Untrimmed dirty nails

bull With intact epidermis surrounding the nail

bull Prompt return of pink or usual color (blanch capillary refill of 2 seconds)

bull Nail texture is smooth

SKULL AND FACE

bull Normocephallic and symmetrical with frontal parietal and occipital prominencesbull Symmetric facial features

bull Symmetric facial movements

bull Dandruff noted

bull Smooth skull contour

bull Absence of nodules or masses upon palpation

EYES AND VISION

bullHair in eyebrows are evenly distributed

bull Eyebrows are symmetrically aligned and move equally

bull Eyelashes equally distributed and slightly curled outward

bull Pupil equally round and reactive to light and accommodation

bull Normal bilateral involuntary blinking

bull Non-icteric sclerae

bull Shiny and pink palpebral conjunctiva noted upon inspection

bull No edema noted around the eyes

bull Patient blinks when cornea is touched indicating trigeminal nerve is intact

bull Pupils constrict when looking at near object pupils dilate when looking at far object pupils converge when near object is moved toward nose

bull Both eyes coordinated move in unison with parallel alignment

bull Able to read printed materials

EARS AND HEARING

bull Auricles same color as facial skin symmetrical and are aligned with outer canthus of eye

20



bull Dry cerumen

bull Able to hear spoken words clearly

bull Able to hear watch ticking in both ears

bull Pinna is mobile firm and not tender

bull Pinna recoils after it is folded

NOSE

bull Nose has the same color as facial skin

bull No discharge or flaring

bull Air moves freely as the client breathes through the nares

bull Not tender No lesion noted

MOUTH AND THROAT

bull Lips are dry and pale

bull Lips are symmetrical

bull Plaques on teeth noted

bull Tongue moves freely and no tenderness noted

bull Tongue in central position

bull Halitosis noted

bull Gag reflex is intact and present

bull Pink and smooth tonsils of normal size

NECK

bull Neck muscles equal in size head centeredbull Head movement is coordinated and with no discomfort

bull Head can hyperextend flexes and rotates normally

bull Neck muscles has equal strength

bull No palpable lymph nodes

THORAX amp LUNGS

bull Chest is symmetric

bull Spine vertically aligned

bull Spinal column is straight shoulders and hips are at the same height

bull Chest wall intact

bull With full and symmetric chest expansion

bull No tenderness and masses noted

ABDOMEN

bull Skin in the abdomen is uniformly pale in color

21



bull Flat abdominal contour observed

bull hypoactive bowel sounds heard during auscultation

UPPER EXTREMITIES

Inspectionbull Able to flex and extend arms

bull Normal Biceps reflex (++)

bull Normal Triceps reflex (++)Palpation

bull Immediate return of color upon Capillary refill test

LOWER EXTREMITIES

Inspection

bull Unable to flex and extend legsbull Positive westphalrsquos sign noted

bull Positive babinski reflex

Palpation

bull Non-pitting bipedal edema noted

bull Pedal pulse is present upon palpation


NEUROLOGIC TEST

bull Oriented to date time and place

bull Displays normal non-verbal and verbal communication

bull Able to recall word being said a while ago to him

bull Bicep and tricep reflexes are hypoactive

bull Positive westphalrsquos sign noted

bull Level of Consciousness Glasgow Coma Scale

Faculty Measured Response Score

Eye opening

Spontaneous 4

To verbal command 3

To pain 2

No Response 1

Motor Response To verbal command 6

To localized pain 5

Flexes and withdraw 4

Flexes abnormally 3

22



Extends abnormally 2

No response 1

Verbal response

Oriented converses 5

Disoriented converses 4

Uses inappropriate words 3

Make incomprehensible sounds 2

No response 1

bull Total score of 14 out of 15 possible highest score

Cranial Nerves Assessment

Cranialnerves

Types Function Result

IOlfactory Sensory Smell

Able to identifydifferent aromas being

introduced to him(colognesoaporange)

II Optic SensoryVision and visual

acuityAble to read title of

our assessment book

III Oculomotor Motor

Extraocular eyemovement

Movement of sphincter of

pupil

Pupil is constrictedupon focused to light

the six ocular movements are

present and intact inthe patient

IV Trochlear Motor

EOM specificallymoves eyeballdownward and

laterally

Patient is able tomove his eyeballdownward andlaterally without

difficulty

VTrigeminalOphthalmic

Branch

SensoryMotor

Sensation of cornea skin of face amp nasal

mucosa

Patient sensation of

skin in face is presenthe can differentiate

what is blunt dull andsharp patient blinkswhen the sclera is

touch

Maxillary Branch Sensory Sensation of skinof pace andanterior oral

Able to feel thesensation being

introduced to him

23



cavity

Mandibular Branch

Motor ampSensory

Muscles of mastication

sensation of skinof face

Patient is able toclench his teeth

VI Abducens Motor EOM moveseyeball laterally

Able to move his

eyeball laterally aswhere the direction of gaze

VII FacialMotor ampSensory

Facialexpression taste

The patient canwrinkle his foreheadraise and lower hiseyebrows smile to

show his teeth patientcan identify taste of

salt sugar andvinegar

VIII AuditoryVestibular Branch

Sensory Equilibrium The patient cannotstand due to legmuscle weakness

Cochlear Branch Sensory HearingThe patient can hear whispered words and

ticking of a wrist watch

IX GlossopharyngealMotor ampSensory

Swallowingability tongue

movement taste(posterior tongue)

Able to swallowproperly amp move histongue side to side

X VagusMotor ampSensory

Sensation of pharynx amp

larynxswallowingvocal cordmovement

Patient voice is clear and speaks properly

XI Accessory Motor Head movement

shrugging of shoulders

Able to move headand can shrug his

shoulders

XII Hypoglossal Motor

Protrusion of tongue moves

tongue up ampdown side to

side

The patient canprotrude tongue and

can move it side toside

24



REVIEW OF SYSTEMS

INTEGUMENTARY SYSTEMbull With complaints of infected wounds

bull With complaints of itching

bull With complaints of diaphoresis

bull With complaints of non-pitting edema

bull With complaints of dry skin and dandruff

RESPIRATORY SYSTEM

bull No history of difficulty of breathing

bull No history of asthma

bull No history of hemoptysis

CARDIOVASCULAR SYSTEM

bull No history of chest pain

bull No history of hypertension

GENITOURINARY SYSTEM

bull With complaints of less urine excretion (oliguria)

GASTROINTESTINAL SYSTEM

bull No history of nausea and vomiting

bull With history of abdominal pain

bull With complaints of constipation

MUSCULOSKELETAL SYSTEM

bull With complaints of lower extremities weakness

bull With complaints of paresthesia

bull No history of fracture

bull With history of prickling ldquopins and needlesrdquo sensation at lower extremities

bull With history of back pain

bull With complaints of leg muscle spasm

25



ENDOCRINE SYSTEM

bull No history of hyperthyroidism

bull No history of hyperglycemia

bull No history of cold intolerance

NEUROLOGIC SYSTEMbull With history of headache

bull No history of seizure


bull Positive Westphalrsquos sign

bull No history of memory loss

LABORATORY TESTS

ELECTROLYTESeptember 262009

ELECTROLYTES RESULTS NORMAL VALUES SIGNIFICANCE

SODIUM 143mmolL 135-155mmolL NORMAL

POTASSIUM 54 mmolL 35-55mmolL NORMAL

HEMATOLOGYSeptember 262009

Criteria Result Normal Values Significance

Hematocrit 35 M40-52F36-48

Reduced number of RBC in theblood (anemia)

Platelet ADEQUATE 150 ndash 400 Normal

WBC 84 x 10 9L 40 ndash 11 Normal

Neutrophils 69 25-75 Normal

Lymphocytes 35 15-35 Normal

PONCIANO LIMCANGCO MD FPSPPathologist

Note

Other test ordered by the attending physician such as lumbar puncture were not donebecause the patient refused to have the test for reasons of financial constraint

26



ANATOMY AND PHYSIOLOGY

THE NERVOUS SYSTEM

Typical Structure of a Nerve Cell

27



The nervous system is divided into the

28

A nerve cell (neuron) consists of a large cell bodyand nerve fibersmdashone elongated extension (axon)for sending impulses and usually many branches(dendrites) for receiving impulses Each large axonis surrounded by oligodendrocytes in the brain and

spinal cord and by Schwann cells in the peripheralnervous system The membranes of these cellsconsist of a fat (lipoprotein) called myelin Themembranes are wrapped tightly around the axonforming a multilayered sheath This myelin sheathresembles insulation such as that around anelectrical wire Nerve impulses travel much faster innerves with a myelin sheath than in those without

one If the myelin sheath of a nerve is damaged nerve transmission slows or stops



bull peripheral nervous system (PNS)bull central nervous system (CNS)

The PNS consists of

29



bull sensory neurons running from stimulus receptors that inform the CNS of thestimuli

bull motor neurons running from the CNS to the muscles and glands - calledeffectors - that take action

The CNS consists of the

bull spinal cord and thebull brain

THE PERIPHERAL NERVOUS SYSTEM IN FOCUS

In the peripheral nervous system neurons can be functionally divided in three ways

1 Sensory (afferent) - carry information INTO the central nervous system

from sense organs or motor (efferent) - carry information away from the

central nervous system (for muscle control)

2 Cranial - connects the brain with the periphery or spinal - connects thespinal cord with the periphery

3 Somatic - connects the skin or muscle with the central nervous system or

visceral - connects the internal organs with the central nervous system

The peripheral nervous system is subdivided into the

bull sensory-somatic nervous system and thebull autonomic nervous system

The Sensory-Somatic Nervous System

The sensory-somatic system consists of

bull 12 pairs of cranial nerves andbull 31 pairs of spinal nerves

The Cranial Nerves

Nerves Type Function

IOlfactory

sensory olfaction (smell)

IIOptic sensory vision(Contain 38 of all the axons connecting to the brain)

IIIOculomotor

motor eyelid and eyeball muscles

IVTrochlear

motoreyeball muscles

VTrigeminal

mixedSensory facial and mouth sensationMotor chewing

30



VIAbducens

motor eyeball movement

VIIFacial

mixedSensory tasteMotor facial muscles andsalivary glands

VIIIAuditory sensory hearing and balance

IXGlossopharyngeal

mixedSensory tasteMotor swallowing

XVagus

mixedmain nerve of theparasympathetic nervous system (PNS)

XIAccessory

motor swallowing moving head and shoulder

XIIHypoglossal

motor tongue muscles

Note These do contain a few sensory neurons that bring back signals from the muscle spindles in themuscles they control

The Spinal Nerves

All of the spinal nerves are mixed that is they contain both sensory andmotor neurons

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

The autonomic nervous system consists of sensory neurons and motor neurons thatrun between the central nervous system (especially the hypothalamus and medullaoblongata) and various internal organs such as the

bull heartbull lungsbull viscerabull glands (both exocrine and endocrine)

It is responsible for monitoring conditions in the internal environment and bringingabout appropriate changes in them The contraction of both smooth muscle and cardiacmuscle is controlled by motor neurons of the autonomic system

The actions of the autonomic nervous system are largely involuntary (in contrast tothose of the sensory-somatic system) It also differs from the sensory-somatic system isusing two groups of motor neurons to stimulate the effectors instead of one

31



bull The first the preganglionic neurons arise in the CNS and run to a ganglion in thebody Here they synapse with

bull postganglionic neurons which run to the effector organ (cardiac muscle smoothmuscle or a gland)

The autonomic nervous system has two subdivisions the

bull sympathetic nervous system and thebull parasympathetic nervous system

The Sympathetic Nervous System

The preganglionic motor neurons of the sympathetic system arise in thespinal cord They pass into sympathetic ganglia which are organized into two chainsthat run parallel to and on either side of the spinal cord

The preganglionic neuron may do one of three things in the sympatheticganglion

bull synapse with postganglionic neurons which then reenter the spinal nerveand ultimately pass out to the sweat glands and the walls of blood vesselsnear the surface of the body

bull pass up or down the sympathetic chain and finally synapse withpostganglionic neurons in a higher or lower ganglion

bull leave the ganglion by way of a cord leading to special ganglia (eg the solar plexus) in the viscera Here it may synapse with postganglionic sympatheticneurons running to the smooth muscular walls of the viscera However

some of these preganglionic neurons pass right on through this secondganglion and into the adrenal medulla Here they synapse with the highly-modified postganglionic cells that make up the secretory portion of theadrenal medulla

The neurotransmitter of the preganglionic sympathetic neurons isacetylcholine (ACh) It stimulates action potentials in the postganglionic neurons

The neurotransmitter released by the postganglionic neurons isnoradrenaline (also called norepinephrine)

The action of noradrenaline on a particular gland or muscle is excitatory issome cases inhibitory in others (At excitatory terminals ATP may be releasedalong with noradrenaline)

The release of noradrenaline

bull stimulates heartbeat bull raises blood pressure

32



bull dilates the pupilsbull dilates the trachea and bronchi bull stimulates the conversion of liver glycogen into glucosebull shunts blood away from the skin and viscera to the skeletal muscles

brain and heartbull inhibits peristalsis in the gastrointestinal (GI) tractbull

inhibits contraction of the bladder and rectumbull and at least in rats and mice increases the number of AMPA receptors in the hippocampus and thus increases long-term potentiation (LTP)

In short stimulation of the sympathetic branch of the autonomic nervoussystem prepares the body for emergencies for fight or flight (and perhapsenhances the memory of the event that triggered the response)

Activation of the sympathetic system is quite general because

bulla single preganglionic neuron usually synapses with manypostganglionic neurons

bull the release of adrenaline from the adrenal medulla into the bloodensures that all the cells of the body will be exposed to sympatheticstimulation even if no postganglionic neurons reach them directly

The Parasympathetic Nervous System

The main nerves of the parasympathetic system are the tenth cranial nerves thevagus nerves They originate in the medulla oblongata Other preganglionicparasympathetic neurons also extend from the brain as well as from the lower tip of the

spinal cord

Each preganglionic parasympathetic neuron synapses with just a fewpostganglionic neurons which are located near - or in - the effector organ a muscle or gland Acetylcholine (ACh) is the neurotransmitter at all the pre- and many of thepostganglionic neurons of the parasympathetic system However some of thepostganglionic neurons release nitric oxide (NO) as their neurotransmitter

Parasympathetic stimulation causes

bull slowing down of the heartbeatbull

lowering of blood pressurebull constriction of the pupilsbull increased blood flow to the skin and viscerabull peristalsis of the GI tract

In short the parasympathetic system returns the body functions to normal after they have been altered by sympathetic stimulation In times of danger the sympatheticsystem prepares the body for violent activity The parasympathetic system reversesthese changes when the danger is over

33



The vagus nerves also help keep inflammation under control Inflammationstimulates nearby sensory neurons of the vagus When these nerve impulses reach themedulla oblongata they are relayed back along motor fibers to the inflamed area Theacetylcholine from the motor neurons suppresses the release of inflammatory cytokineseg tumor necrosis factor (TNF) from macrophages in the inflamed tissue

Although the autonomic nervous system is considered to be involuntary this isnot entirely true A certain amount of conscious control can be exerted over it as haslong been demonstrated by practitioners of Yoga and Zen Buddhism During their periods of meditation these people are clearly able to alter a number of autonomicfunctions including heart rate and the rate of oxygen consumption These changes arenot simply a reflection of decreased physical activity because they exceed the amountof change occurring during sleep or hypnosis

IMMUNE SYSTEM

The immune system is composed of many interdependent cell types thatcollectively protect the body from bacterial parasitic fungal viral infections and from thegrowth of tumor cells Many of these cell types have specialized functions The cells of the immune system can engulf bacteria kill parasites or tumor cells or kill viral-infectedcells Often these cells depend on the T helper subset for activation signals in the formof secretions formally known as cytokines lymphokines or more specificallyinterleukins

The Organs of the Immune System

Bone Marrow -- All the cells of the immune system are initially derived from the bonemarrow They form through a process called hematopoiesis During hematopoiesisbone marrow-derived stem cells differentiate into either mature cells of the immunesystem 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 cellsgranulocytes and immature thymocytes in addition to red blood cells and platelets

Thymus -- The function of the thymus is to produce mature T cells Immaturethymocytes also known as prothymocytes leave the bone marrow and migrate into the

thymus Through a remarkable maturation process sometimes referred to as thymiceducation T cells that are beneficial to the immune system are spared while those Tcells that might evoke a detrimental autoimmune response are eliminated The mature Tcells are then released into the bloodstream

Spleen -- The spleen is an immunologic filter of the blood It is made up of B cells Tcells macrophages dendritic cells natural killer cells and red blood cells In addition tocapturing foreign materials (antigens) from the blood that passes through the spleenmigratory macrophages and dendritic cells bring antigens to the spleen via the

34



bloodstream An immune response is initiated when the macrophage or dendritic cellspresent the antigen to the appropriate B or T cells This organ can be thought of as animmunological conference center In the spleen B cells become activated and producelarge amounts of antibody Also old red blood cells are destroyed in the spleen

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 Tcells 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 thelymph to the circulation In a similar fashion as the spleen the macrophages anddendritic cells that capture antigens present these foreign materials to T and B cellsconsequently initiating an immune response

The Cells of the Immune System

T-Cells -- T lymphocytes are usually divided into two major subsets that are functionallyand phenotypically (identifiably) different The T helper subset also called the CD4+ Tcell 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 killersuppressor subset or CD8+ T cellThese cells are important in directly killing certain tumor cells viral-infected cells andsometimes 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 oftendepend on the secondary lymphoid organs (the lymph nodes and spleen) as siteswhere activation occurs but they are also found in other tissues of the body mostconspicuously the liver lung blood and intestinal and reproductive tracts

35



Natural Killer Cells -- Natural killer cells often referred to as NK cells are similar to thekiller T cell subset (CD8+ T cells) They function as effector cells that directly kill certaintumors such as melanomas lymphomas and viral-infected cells most notably herpesand 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 thathave been activated by secretions from CD4+ T cells will kill their tumor or viral-infected

targets more effectively

B Cells -- The major function of B lymphocytes is the production of antibodies inresponse to foreign proteins of bacteria viruses and tumor cells Antibodies arespecialized proteins that specifically recognize and bind to one particular protein thatspecifically recognize and bind to one particular protein Antibody production andbinding to a foreign substance or antigen often is critical as a means of signaling other cells to engulf kill or remove that substance from the body

Granulocytes or Polymorphonuclear (PMN) Leukocytes -- Another group of whiteblood cells is collectively referred to as granulocytes or polymorphonuclear leukocytes

(PMNs) Granulocytes are composed of three cell types identified as neutrophilseosinophils and basophils based on their staining characteristics with certain dyesThese cells are predominantly important in the removal of bacteria and parasites fromthe body They engulf these foreign bodies and degrade them using their powerfulenzymes

Macrophages -- Macrophages are important in the regulation of immune responsesThey are often referred to as scavengers or antigen-presenting cells (APC) becausethey pick up and ingest foreign materials and present these antigens to other cells of theimmune system such as T cells and B cells This is one of the important first steps in theinitiation of an immune response Stimulated macrophages exhibit increased levels of

phagocytosis and are also secretory

Dendritic Cells -- Another cell type addressed only recently is the dendritic cellDendritic cells which also originate in the bone marrow function as antigen presentingcells (APC) In fact the dendritic cells are more efficient apcs than macrophages Thesecells are usually found in the structural compartment of the lymphoid organs such as thethymus lymph nodes and spleen However they are also found in the bloodstream andother tissues of the body It is believed that they capture antigen or bring it to thelymphoid organs where an immune response is initiated Unfortunately one reason weknow so little about dendritic cells is that they are extremely hard to isolate which isoften 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 HIVand may be a reservoir of virus that is transmitted to CD4+ T cells during an activationevent

36



An animalrsquos immune system protects its body from intruders bacteria virusesparasites cancer cells etc An immune system is present in several animal groupsespecially within the vertebrates Animals have both non-specific and specific defensemechanisms to fight invaders We will be focusing on the human immune system

Non-specific defense mechanisms work against a wide variety of invadersThese defense mechanisms include the barrier formed by our skin chemicals in

perspiration skin oil saliva tears etc the hairs in our nostrils the ciliary escalator (the cilia and mucus that clean out dust and debris from our lungs and trachea) in our respiratory tracts the inflammatory response which is the dilation of blood vesselsand accumulation of WBCs at the site of an injury (the signs of which are that the areais red hot and swollen) and fever a raised body temperature to inhibit the growth of pathogens Note that a fever is caused by your body to inhibit the growth of bacteriaetc not by the ldquogermsrdquo themselves per se

Specific defense mechanisms are effective against specific pathogens Thisinvolves various WBCs called lymphocytes or leukocytes There are several kinds of WBCs involved in the immune system all of which originate in the bone marrow

Leukemia is a cancer of the bone marrow thus it typically is treated by killing all of thepersonrsquos bone marrow Unfortunately this leaves the person with no immune systemso (s)he must be extremely careful during that time to avoid all possible pathogens

There are two main types of specific defense mechanisms involved in theimmune system

The humoral immune system consists of B-cells which originate in the Bone marrow andstay there to develop

The cell-mediated immune system consists of T-cellswhich originate in the bone marrow but go to theThymus to finish their development

B-cells can produce antibodies but needexposure to foreign antigens to do so Theseantigens are cell surface oligosaccharides andproteins which the cell uses as ldquoID tagsrdquo

T-cells are highly-specialized cells in the blood and lymphto fight bacteria viruses fungi protozoans cancer etcwithin host cells and react against foreign matter such asorgan transplants

Antibodies are proteins in blood plasma andlymph to fight bacteria and viruses in body fluidsAll daughter cells of a B-cell will be able toproduce the same antibodies as the mother cellAntibodies bind to certain parts of an antigen tomark it for destruction (by the T-cells)

There are three kinds of T-cells Cytotoxic T-cellsdirectly kill invaders Helper T-cells aid B and other T-cells to do their jobs and HIV lives in and kills themSuppressor T-cells suppress the activities of B- andother T-cells so they donrsquot overreact Allergy injectionsare supposed to increase the number of supressor T-cells to make the person less sensitive to allergens

37



Immunity is the ability to ldquorememberrdquo foreign substance previously encounteredand react again promptly There are two kinds of immunity active immunity when thebody is stimulated to produce its own antibodies and passive immunity where theantibodies come from outside the personrsquos body Active immunity is usually permanentand can be induced due to actual illness or vaccination Passive immunity is notpermanent because the antibodies are introduced from outside the body thus the B-

cells never ldquolearnrdquo how to make them Some examples of passive immunity includeantibodies passed across the placenta and in milk from a mother to her baby sometravelersrsquo shots and the Rhogam shots we we discussed earlier this quarter Becauseantibodies are only protein they donrsquot last very long and must be replaced if theimmunity is to continue

38



DRUG STUDY

Generic NameBrand Name

andClassification

Prescribedand

recommendedDosage

Frequencyand Route of

Administration

Mechanismof

ActionIndication

ContraindicationAdverse

ReactionsNursing Implications

HydrocortisoneCortef

Corticosteroids

100 mg IVTTQ 8 H

Decreasesinflammationmainly bystabilizingleukocyteslysosomalmembranessuppressesimmune

responsestimulates bone marrowand influencesprotein fat andcarbohydratemetabolism

bull Severeinflammationadrenalinsufficiency

bull Shock

bull Adjuncttreatment for

ulcerativecolitis andproctitis

bull Contraindicated in pthypersensitiveto drug or itsingredients inthose wsystemic fungalinfection inthose receivingimmunosuppressive dosestogether w livevirus vaccinesand inpremature

infant(succinate)

bull Use wcautions in ptw recent MI

bull Use cautiouslyin pt w GIulcer renaldse HPT andhypothyroidism

bull CNSeuphoreainsomiaparesthesiaseizurespsuedotumor cerebri

bull CV heart

failureedemaHPNarrhythmiasthrombo-embolisms

bull EENTcataractglaucoma

bull GI pepticulcer GIirrirationincreaseappetiteamppancreatitis

bull Determine whether thept is

Is sensitive toother corticosteroid

bull Give oral dose withfood when possibleptmay need another drug to prevent GIirritation

bull Most adverse reactionto corticosteroids aredose-duration-dependent

bull Monitor pt weight BPand electrolyte level

bull Monitor pt cushingoideffects including moonface buffalo humpcentral obesitythinning hairhypertension andincreasedsusceptibility toinfection

39



DRUG STUDY


andClassification

Prescribed andrecommended

DosageFrequency and

Route of

Administration

Mechanismof

Action Indication ContraindicationAdverseReaction Nursing Implication

Vitamin C(Ascorbic acid)

1 tab OD Stimulatescollagenformation andtissue repairinvolved inoxygenation-reductionreactions

bull RDA

bull Frank andsubclinicalscurvy

bull Extensiveburnsdelayedfracture or woundhealingpostoperative woundhealing

severefebrile or chronic dseState

To prevent vit Cdeficiency in ptw poor nutritional habitsor increasedrequirements

Contraindicatedin patients w anallergy totartrazine or sulfates Largedoses arecontraindicatedduring pregnancy

bull CNSfaintnessdizziness

bull GIdiarrheaheartburnnauseavomiting

bull GU acidurineoxaluriarenalcalculi

bull OTHERdiscomfortatinjectionsite

bull Stress proper nutritional habits toprevent recurrence of deficiency

bull Advise smokers toincrease intake of vitamin C

bull When giving for urineacidification checkurine pH to ensure

efficacy

bull For pt receiving vitC IM explain that

MI route maypromote better utilization

40



DRUG STUDY

41




andClassification


DosageFrequency and

Route of Administration

Mechanismof

ActionIndication Contraindication

AdverseReactions Nursing Implications

Bisacodyl Pedia

Laxative

RectalSuppositoryinsert 1 RS

Stimulantlaxative thatincreasesperistalsisprobably bydirect effect onsmooth muscleof the intestine

by irritating themuscle or stimulating thecolonicintramuralplexus Drugalso promotesfluidaccumulationin colon andsmall intestine

bull Chronicconstipationpreparationfor childbirthsurgery or rectal or bowelexamination

bull Contraindicated in patientshypersensitive to drug or itscomponentsand in thosewith rectal

bleedinggastroenteritis intestinalobstructionabdominalpain nauseavomiting or other symptoms of appendicitisor acutesurgicalabdomen

bull CNSdizzinessfaintnessmuscleweaknesswithexcessiveuse

bull GIabdominalcrampsburningsensationin rectumwithsuppositor iesnauseavomitingdiarrheawith highdoseslaxative

dependence withlong-termor excessiveuseprotein-losingenteropathy withexcessiveuse

bull Metabolicalkalosisfluid andelectrolyte

imbalance

bull Give drug at times thatdonrsquot interfere withscheduled activities or sleep Soft formedstools are usuallyproduced 15 to 60minutes after rectaluse

bull Before giving for constipationdetermine whether pthas adequate fluidintake exerciseintake and diet

bull Tablets andsuppositories are usedtogether to clean thecolon before and after surgery and beforeand after surgery andbefore barium enema

bull Insert suppositoryashigh as possible into

the rectum and try toposition suppositoryagainst the rectal wallAvoid embeddingwithin fecal materialbecause doing so maydelay onset of action

bull Bisco-Lax may containtartrazine

42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex

1 amp IVTT q8h Vitamins B1 B2B3 and biotinparticipate in

different aspectsof energy

productionvitamin B6 isessential for amino acid

metabolism andvitamin B12 and

combat everydaystress boostenergyB1 B2 B3 andbiotin participatein differentaspects of energyproductionvitamin B6 isessential for amino acid

Vitamin B-complex includes several different componentseach of which has the potential to interact with drugs It is

recommended that before taking this vitamins doctor or

pharmacist should discuss the use of vitamin B-complex

and current medication(s)

43



folic acid facilitatesteps required for

cell division

metabolism andvitamin B12 andfolic acid facilitatesteps required for cell divisionimprove overallmicronutrientintake andpreventdeficiencies

44



GENOGRAM

17 years oldPatient with

Guillain barresyndrome

= Patient

= deceased Male female mother father

77 years oldKidney problem


74 years oldWith arthritis

74 years oldWith cataract

56 years oldJoint pains

43 years old

13 years old 10 years old 7 years old

45



Nursing Care Plan 1(September 29 2009)

Subjective cue

ldquoSige naku siya bantayan mam kay basin mahulog sa katre ug masamadhellipdili rabamakabati iyang mga tiilrdquo as verbalized by the mother

Objective cuesbull Loss of sensation

bull Muscles weakness noted

bull Ascending paralysis

Diagnosis

High risk for injury related to loss of sensation

Planning

After 4 hours of duty patient will be free from any risk of injuries

Intervention Rationale

Independent

1 Ascertained knowledge of safetyneed injury prevention

To prevent injury

2 Provided information regardingdisease conditions that may resultin increased risk for injury

To prevent injury

3 Raised side rails To prevent from falling

4 Kept the sharp objects away fromthe patient

To prevent injury or harmful damage

5 Educated the SO about thepossibility of injury and how toprevent

To protect and prevent injury

Evaluation

Goal met After 4 hours of rendering of nursing intervention the patient is free from injury asevidenced by absence of any signs of injury

46




Objective cues

bull paresthesia

bull Acute onset of symmetrical progressive muscle weakness(beginning in the legs that ascends to the trunk)

bull Vital signso Temp = 3670C

o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis

High risk for Ineffective Breathing Pattern related to neuromuscular dysfunctionsecondary to ascending paralysis

Planning

Within 2 hours of rendering nursing interventions patient will maintain a normaleffectivebreathing pattern


1 Auscultated chest notingpresencecharacter of breath soundspresence of secretions

to assess adequacy of air flow and detectspresence of adventitious sounds

2 Noted rate and depth of respirationstype of breathing pattern tachypneacheyne-stokes other irregular patterns

To assess types of breathing pattern so towatch sign of respiratory fatigue

3 Maintained calm environment To promote comfort and relaxation4 Position patient with head of bed

elevatedTo provide maximum chest excursion

5 Monitored for signs of impendingrespiratory failure

Prepare to intubate if patientrsquos heart rate isabove 120 or below 70 bpm and respiratoryrate above 30bpm

6 Prepared emergency equipment inreadily accessible location and includeappropriate ET tubes

To provide emergency intubation if needed

7 Encouraged adequate rest periodsbetween activities

To limit fatigue

8 Assisted client to learn breathing

exercises such as pursed lip breathing

Pursed lip breathing helps get rid of the old

stale air in your lungs that is trapped in theairways and to help patient breath more freshair through nose

EvaluationGoal met After 2 hours of rendering nursing intervention patient maintains a normaleffectivebreathing pattern as evidenced by normal respiration rate (RR=19cpm)

47



NURSING CARE PLAN 3(September 29 2009)

Subjective cue

ldquoDili ko kalihok-lihokrdquo as verbalized by the patient

Objective cues

bull Ascending paralysis noted (from feet to the pelvic part)

bull Limited ROM

bull Slowed body movements noted

bull Weakness

bull Nonpitting bipedal edema

Analysis

High risk for impaired skin integrity related to immobility as evidenced by ascendingparalysis

Planning

After 8 hours of rendering appropriate nursing interventions patient will be free from anyrisk of impaired skin integrity

INTERVENTIONS RATIONALE1 Changed patient position every 2 hours -to promote circulation and prevent bed

sore and constipation2 Removed wetwrinkled linens promptly -moisture potentiates skin breakdown

3 Developed repositioning schedule for client involving client in reasons for anddecisions about times and positions inconjunction w other activities

-to enhance understanding andcooperation

4 Provided w well ventilated environment -To promote comfort

5 Elevated both legs with a pillow To promote blood venous return

6 Encouraged patient to touch his lower extremities every now and then

-To remind the patient that his lower extremities are present and still needs care

7 Increased fluid and high fiber in diet -to prevent constipation

Evaluation

Goal met Patient is free from impaired skin integrity as evidenced by absence of any signs of complication of immobility

48




Subjective cues

ldquoDi ko kalakaw kay dili nako maalsa akong duha ka tiil rdquo as verbalized by the patient

Objective cues


bull Muscle weakness noted

bull Paresthesia noted

bull Loss of sensation

bull Functional level classification 3 (requires help from another person ampequipment device)

Diagnosis Impaired physical mobility related to neuromuscular dysfunction

Planning

After 3 days of duty patient will verbalize understanding of his condition and willdemonstrate willingness to participate in activities with in physical limitations


Independent

1 Determined degree of immobilitybased on functional levelclassification scale

To assess functional level of the patient asbasis in giving appropriate interventions

2 Assisted client in ADLs To promote independence prevent fatigueand to promote blood circulation

3 Provided support to affective bodyparts using pillows and rolls

To maintain body parts function reducerisk of pressure ulcers and to avoidcontractures

4 Encouraged participation in self-care and diversional activity

To enhance self-concept and sense of independence

5 Encouraged adequate intake of fluids and nutritious foods

6 Scheduled activities with adequaterest periods during the day

Promote well being and maximize energyproduction

To reduce fatigue

Evaluation

Goal met After 3 days of duty patient verbalize understanding of his condition and demonstrateparticipation in activities within physical limitations

49



Nursing care plan 5(September 30 2009)

Subjective cues

ldquoWala pa ko kalibang sulod sa upat ka adlawrdquo as verbalized by the patient

Objective cues

bull Hypoactive bowel sounds heard upon auscultation

bull Paralysis noted

Analysis

Constipation related to abdominal muscle weakness and immobility

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 RATIONALEIndependent1 Advised patient to drink adequate fluidand include foods that are high in fiber likepapaya oatmeal and pineapple

-to promote moist and soft stool

2 Encouraged activityexercises withinpersonal limitation

-to stimulate abdominal musclecontraction

3Provided with privacy and routinelyscheduled time defecation

-to promote defecation

4Educated patient about the importance of mobility and diet to normal bowelmovement

-to provide information

Dependent1Administered Bisacodyl (pedia)suppository as prescribed

To increase peristalsis promoting easydefecation

Evaluation

Goal met After 8 hours of duty patient verbalized understanding of the importance of normalbowel movement as evidenced by saying ldquonakalibang ra gjud kohellipimportante gajud diay angexercise ug diet hilabina ang tambal nga gisuksok sa akong lubotrdquo as verbalized by the patient

50



NURSING CARE PLAN 6(October 1 2009)

Subjective

ldquodi ko kabantay na makaihi na diay ko rdquo as verbalized by the patient

Objective

bull Uncontrolled urination

bull ascending paralysis (feet up to pelvic area)

bull Wet pants observed

bull Ammonia odor on the patientrsquos linens

Analysis

Urinary Incontinence related to neuromuscular dysfunction

Planning

After 4 hours of duty patient will be able to verbalize understanding of condition andidentify appropriate interventions to prevent incontinence

INTERVENTIONS RATIONALE

1 encouraged use of diaper -to prevent wet pants

2 scheduled voiding for every 3 hours -to minimize bladder pressure

3 suggested limiting intake of coffee teaand alcohol

Such beverages have diuretic effects

4 maintained positive regard -to reduce embarrassment associated wincontinence

5 provided bedside commode urinal or bedpad as indicated

-to save time and energy

Evaluation

Goal met After 8 hours of duty patient verbalized understanding of his condition andidentified appropriate interventions to prevent incontinence such as scheduling voiding every 3hours

51




Subjective

ldquodi ko karajaw katulogrdquo as verbalized by the patient

Objectives

bull Eyebags noted

bull Frequent yawning noted

bull Restlessness noted

bull Lethargy noted

Analysis

Sleep Pattern Disturbance related to environmental factors such as external noise andlack of sleep privacy

Planning

After 8 hours of duty patient will be able to report improvement in sleep pattern

INTERVENTIONS RATIONALEIndependent1 provided with quiet and calmenvironment during bedtime

To promote rest and sleep

2 Advised to limit fluid intake in evening -to reduce need for nighttime micturation3 Encouraged participation in regular exercise program during day

-to aid stress controlrelease of energy

4 Identified the factors that affect thesleeping pattern

-to reduce sleep disturbance

5Recommended to limit intake of chocolates and caffeinated beverages

Such beverages are stimulants that inhibitssleep

Dependent1 Administered sedative other sleepmedication when indicated

-to enhance clients ability to fall asleep

EvaluationGoal met After 8 hours of duty patient verbalized improvement in sleeping pattern as

evidenced by increase number of sleeping hours

52




Subjective cues

ldquoKamaguyangan raba ni siya unya mga gagmay pa iya mga manghud wala nay

nagbantay nila didto sa amoahellipwala na rabay magpautang nila didto pangkonsumordquo asverbalized by the mother

Objective cues

bull Frequent verbalization of worries regarding family functioning

bull Verbalization of financial problems

Diagnosis

Interrupted family processes related to shift in health status of a family member

Planning

After 3 days of duty family members maintain functional system of mutual support for one another

Intervention RationaleIndependent

1 Dealt with family members in warmcaring and respectful manner

To establish rapport

2 Acknowledged difficulties andrealities of the situation

Reinforces that some degree of conflict isto be expected and can be used topromote learning and acceptance

3 Encouraged expressions of emotions

Encouraging client to share feelings canprovide a safe outlet for fears andfrustrations and can increase self-awareness

4 Emphasized importance of opendialogue between family members

To facilitate ongoing problem solving

5 Encouraged family members toreorganized their schedules tomeet their own physical andpsychological needs

Family members who ignore their ownhealth requirements are prone tobecoming ill which may reduce their effectiveness as support persons Afamily member who falls ill may cause the

53



client to have feelings of guilt

6 Involved family members inphysical care of client and showyour appreciation of the familyinvolvement

7 Addressed the client financialconcerns and responsibilitiesa Promote an environment for

client to verbalize concernsb Initiate a referral to social for

assistance

Allowing involvement of family memberswith care will maintain a supportive familystructure and strengthen the family units

The sudden look of income can beoverwhelming causing excessive mentalanguish and slowing progress with goalsetting

Evaluation

Goal met After 3 days of duty family members verbalize understanding of the importancemutual support for one another as evidenced by saying ldquobisan nagkalisod kami sa kwartanakasabot kami nga kami ra gajud ang magtinabangayrdquo as verbalized by the mother

54




Subjective cue

ldquoWaya pa ako kaligo pila na kaadlawrdquo as verbalized by the patient

Objective cues

bull Dirty nails noted

bull Bad body odor noted

bull Dandruff noted


bull Patient is not properly groomed

bull Dry skin noted

Diagnosis

Self-care deficit related to impaired physical mobility

Planning

After 2 hours of rendering nursing intervention patient will be able to perform self-careactivities within physical limitations


1 Determined individual strengthsand skills of the client

To know the strengths and weaknesses of the client as basis in giving appropriateinterventions

2 Provide for communication among

those who are involved in caring

To gain trust and cooperation from the

client and SO3 Provide health teaching to patientabout the importance of goodhygiene

To promote good hygiene to the patient

4 Develop plan of care appropriate toindividual situation schedulingactivities to conform to clientsnormal schedule

To encourage performance of ADL withinphysical limitation

5 Plan time for listening to the clientand SO

To discover barriers to participation inregimen

6 Demonstrated to the client and SOthe basic ways in self care such as

handwashing combing the hairtrimming nails toothbrushing andbathing

To provide awareness that self careactivities are still possible even with

physical limitations

7 Encouraged patient and SO to useproducts to enhance self imagesuch as deodorant

To promote self care

Evaluation Goal met After 4 hours of rendering nursing intervention patient was able toperform self-care activities such as combing toothbrushing and trimming of nails

55




Subjective cue

ldquoMaulaw nako sa ako kahimtangrdquo as verbalized by the patient

Objective cue

bull Paralysis noted (feet to pelvic area)

bull Loss of body function noted


bull Hiding body parts with blanket (lower extremities)

bull Less eye contact

Analysis

Disturbed body image related to physical illness as evidenced by inability to walk

Planning

After 8 hours of rendering nursing intervention patient will acknowledge self as anindividual who has responsibility for self


Encouraged family member to treat clientnormally and not as invalid

To avoid feeling of isolation or rejection

Encouraged expression of feeling regardinghis condition

To provide appropriate emotional support

Encouraged client to look and touch affectedbody parts

To begin to incorporate changes into bodyimage

Discussed meaning of loss change to client A change of function such as immobility maybe more different for some to deal with than achange in appearance

Visited client frequently and acknowledged theindividual as someone who is worthwhile

Provides opportunities for listening of patientrsquosconcerns and questions

Evaluation Goal met After 8 hours of rendering nursing intervention the patient verbalizedfeeling of acceptance and responsibility of his affected body parts as evidenced by frequentchecking and touching of his lower extremities

56



NURSING CARE PLAN 11

Subjective cue

ldquoNabiro ko nga di na ko makalakawrdquo as verbalized by the patient

Objective cuebull Poor eye contact

bull Tearfulness during conversation

bull Verbalization of concerns (refer to subjective cue)

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


1 Provided opportunities for question andanswer session

Enhance sense of trust and nurse clientrelationship

2 Compared verbal and non-verbal responses

3 Encouraged verbalization of feelings

To note misperception of situations

To provide appropriate emotional supportivecare

4 Discussed the disease of Guillain-BarreSyndrome

5 Enumerated ways the patient may use torelieve anxiety such as accepting the reality of his condition optimistic way of seeing thingsand having faith in Godrsquos love

To provide information that could help patientunderstand conditions

To provide information and to boost patientrsquoshope

Evaluation

Goal partially met After 8 hours of intervening the patient was able to enumerate waysto relieve anxiety but verbally said ldquo Bisan nakasabot na koDili gajud naku malikayan na mag-isip ng ako kahimtang karonrdquo

57




Subjective cues

ldquoPasmo ra man daw ni sa kusog kay manhimasa man ko human baktas morag mao

man to laong ni doctorrdquo as verbalized by the mother

Objective cues

bull Apathy noted

bull Misinterpretation of information

Diagnosis

Knowledge deficit related to cognitive limitation

Planning

After 4 hours of rendering nursing intervention patient will be able to verbalizeunderstanding of condition disease process and treatment


1 Determined information the clientalready knows and move to whatthe client does not knowprogressing from simple to complex

To facilitate learning and determine theclient and SOrsquos cognitive limitation

2 Explained the cause of thesymptoms and disease To provide knowledge

3 Explained the goal of treatment To provide appropriate information

4 Provide an environment that isconducive to learning

To facilitate learning

5 Identify support persons or SOrequiring information

To let the SO aware of the condition of theclient

Evaluation

Goal met After 4 hours of rendering of nursing intervention the patient was able to participate inlearning process and was able to verbalize understanding of condition of treatment

58




Subjective cues

ldquoTaglaay ko diri walay koy lingaw rdquo as verbalized by the client

Objective cuesbull Restlessness noted

bull Lethargy noted


bull Verbal expression of boredom

Diagnosis

Deficient diversional activity related to physical limitations and lack of sources

Planning

After 8 hours of duty patient will engage in satisfying activities within personal limitations


Independent

1 Acknowledged reality of situationand feelings of the client

To establish therapeutic relationship

2 Provided with diversional activitiessuch as reading materials

To relieve boredom

3 Provided change of scenery To direct attention

4 Encouraged expression of feelings To determine concerns that needsintervention

5 Provided requirements for mobilitysuch as wheelchair

For mobility

6 Developed plan of care appropriateto individual situation scheduling

activities to conform to clientsnormal schedule


Evaluation

Goal met After 8 hours of duty the patient verbalizes feelings of satisfaction in activitiesengaged with in personal limitations

59



DISCHARGE PLAN

Upon discharge from the hospital the patient and his significant others will begiven home care instructions containing the following

MEDICATIONS bull Instructed patient to follow medication regimen prescribed bythe physician

Time Dose

Vit B complex After breakfast 1 capsule bymouth

Vit C (AscorbicAcid)

After breakfast 1 tablet by mouth

EnvironmentalConsideration

s

Encouraged patient to stay in a calm and quiet environment

Advised SO to keep away sharp objects to prevent accident

since the patient has sensory problem Encouraged patient to refrain from strenuous activities as much

as possible

Instructed the SO to keep their environment clean

Treatment Discussed the importance of the medications prescribed by thephysician

Instructed patient to understand and follow discharge planinstruction religiously and accurately

HealthTeachings

Encouraged patient to have enough rest and sleep

Instructed SO to place patient in a comfortable patient-preferred position

Encouraged patient to have a healthy lifestyle like havingregular exercise healthy diet and positive outlook in life

Encouraged personal hygiene such as regular bathingtoothbrushing and grooming

Encouraged patient to increase fluid and fiber in diet

Discussed the disease process of Guillain-Barre Syndrome

Encouraged the SO to do passive range of motion exercises tothe patient

Explained function of medical equipment and mobility aids suchas walkers and wheel chairs

Teach patient and SO about proper handwashingo Steps of proper handwashing

1 Turn on the faucet2 Wet hands with water 3 Squeeze a small amount of sanitiser gelsoap on

palms4 Rub palms together 5 Rub the back of both hands6 Interlace fingers and rub hands together

60



7 Interlock fingers and rub the back of fingers of bothhands

8 Rub thumb in a radiating manner followed by thearea between index finger and thumb for bothhands

9 Rub fingers on palm for both hands

10Rub both wrists in a rotating manner11Rinse and dry thoroughly

Out-Patientcheck-up

Instructed patient of follow scheduled check-up

Instructed patient to seek immediate medical attention whencondition worsens

Diet Encouraged patient to have a balanced diet

Encouraged patient to eat nutritious foods such as vegetablesand fruits

Spiritual Encouraged patient to be more faithful and have trust in God

Encouraged SO to pray for patients early recovery

Encouraged patient to visit church and attend holy massregularly

61



Guillain-Barre Syndrome Glossary of Terms

Autoimmune Pertaining to autoimmunity a misdirected immune response that occurs

when the immune system goes awry and attacks the body itselfSee the entire definition of Autoimmune

Autoimmune disease An illness that occurs when the body tissues are attacked by itsown immune system The immune system is a complex organization within the bodythat is designed normally to seek and destroy invaders of the body includinginfectious agents Patients with autoimmune diseases frequently have unusualantibodies circulating in their blood that target their own body tissuesSee the entire definition of Autoimmune disease

Axon A long fiber of a nerve cell (a neuron) that acts somewhat like a fiber-optic cable

carrying outgoing (efferent) messagesSee the entire definition of Axon

Bacteria Single-celled microorganisms which can exist either as independent (free-living) organisms or as parasites (dependent upon another organism for life)See the entire definition of Bacteria

Bacterial Of or pertaining to bacteria For example a bacterial lung infection

Blood pressure The blood pressure is the pressure of the blood within the arteries Itis produced primarily by the contraction of the heart muscle Its 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 heartcontracts and lowest A blood pressure cuff is used to measure the pressure Elevationof 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 hemispheresSee the entire definition of Brain

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 musclerelaxation

Campylobacter jejuni a species of curved rod-shaped non-spore forming Gram-negative microaerophilic bacteria commonly found in animal feces[1] It is one of themost common causes of human gastroenteritis in the world Food poisoning caused byCampylobacter species can be severely debilitating but is rarely life-threatening It hasbeen linked with subsequent development of Guillain-Barreacute syndrome (GBS) whichusually develops two to three weeks after the initial illness

62



Cerebrospinal fluid CSF A watery fluid continuously produced and absorbed whichflows in the ventricles (cavities) within the brain and around the surface of the brain andspinal cordSee the entire definition of Cerebrospinal fluid

Clinical trials Trials to evaluate the effectiveness and safety of medications or medical

devices by monitoring their effects on large groups of peopleSee the entire definition of Clinical trials

Cure 1 To heal to make well to restore to good health Cures are easy to claim andall too often difficult to confirm2 A time without recurrence of a disease so that the risk of recurrence is small as inthe 5-year cure rate for malignant melanoma 3 Particularly in the past a course of treatment For example take a cure at a spaSee the entire definition of Cure

Diagnosis 1 The nature of a disease the identification of an illness 2 A conclusion or

decision reached by diagnosis The diagnosis is rabies 3 The identification of anyproblem The diagnosis was a plugged IVSee the entire definition of Diagnosis

Gastrointestinal Adjective referring collectively to the stomach and small and largeintestines

Hammer The malleus

Heart The muscle that pumps blood received from veins into arteries throughout thebody 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 thechest and abdominal cavities The normal heart is about the size of a closed fist andweighs about 105 ounces It is cone-shaped with the point of the cone pointing downto the left Two-thirds of the heart lies in the left side of the chest with the balance in theright chestSee the entire definition of Heart

Heart rate The number of heart beats per unit time usually per minute The heart rateis based on the number of contractions of the ventricles (the lower chambers of theheart) The heart rate may be too fast ( tachycardia ) or too slow ( bradycardia ) Thepulse is bulge of an artery from the wave of blood coursing through the blood vessel asa result of the heart beat The pulse is often taken at the wrist to estimate the heart rate

See the entire definition of Heart rate

Immune Protected against infection The Latin immunis means free exempt

Immune system A complex system that is responsible for distinguishing us fromeverything foreign to us and for protecting us against infections and foreign substances

63



The immune system works to seek and kill invadersSee the entire definition of Immune system

Infection The growth of a parasitic organism within the body (A parasitic organism isone that lives on or in another organism and draws its nourishment therefrom) A personwith an infection has another organism (a germ) growing within him drawing its

nourishment from the person

Intensive care See critical care

Knee The knee is a joint which has three parts The thigh bone (the femur) meets thelarge 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 athird joint called the patellofemoral joint The patella protects the front of the knee joint

Limb The arm or leg

Low blood pressure Any blood pressure that is below the normal expected for anindividual in a given environment Low blood pressure is also referred to ashypotensionSee the entire definition of Low blood pressure

Muscle Muscle is the tissue of the body which primarily functions as a source of powerThere are three types of muscle in the body Muscle which is responsible for movingextremities and external areas of the body is called skeletal muscle Heart muscle iscalled cardiac muscle Muscle that is in the walls of arteries and bowel is calledsmooth muscle

Myelin The fatty substance that covers and protects nerves Myelin is a layered tissuethat sheathes the axons (nerve fibers) This sheath around the axon acts like a conduitin an electrical system ensuring that messages sent by axons are not lost en route Itallows efficient conduction of action potentials down the axon Myelin consists of 70lipids (cholesterol and phospholipid) and 30 proteins It is produced byoligodendrocytes 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 See Nervous system

Neurological Having to do with the nerves or the nervous system

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 butnever to the return to good health The default setting is good health

Pain An unpleasant sensation that can range from mild localized discomfort to agonyPain has both physical and emotional components The physical part of pain resultsfrom nerve stimulation Pain may be contained to a discrete area as in an injury or itcan be more diffuse as in disorders like fibromyalgia Pain is mediated by specific

64



nerve fibers that carry the pain impulses to the brain where their conscious appreciationmay be modified by many factors

Paralysis Loss of voluntary movement (motor function) Paralysis that affects only onemuscle or limb is partial paralysis also known as palsy paralysis of all muscles is totalparalysis as may occur in cases of botulism

Paresthesia An abnormal sensation of the skin such as numbness tingling prickingburning or creeping on the skin that has no objective cause Paresthesia is the usualAmerican spelling and paraesthesia the preferred English spelling

Peripheral Situated away from the center as opposed to centrally located

Peripheral nervous system (PNS) That portion of the nervous system that is outsidethe brain and spinal cord

Physical therapy A branch of rehabilitative health that uses specially designed

exercises and equipment to help patients regain or improve their physical abilitiesPhysical therapists work with many types of patients from infants born withmusculoskeletal birth defects to adults suffering from sciatica or the after- effects of injury to elderly post-stroke patients

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 plasmacontains antibodies and other proteins It is taken from donors and made intomedications for a variety of blood-related conditions Some blood plasma is also used innon-medical products

Plasmapheresis A procedure designed to deplete the body of blood plasma (the liquidpart of the blood) without depleting the body of its blood cells Whole blood is removedfrom the body the plasma is separated from the cells the cells are suspended in salinea plasma substitute or donor plasma) and the reconstituted solution may be returned tothe patient The procedure is used to remove excess antibodies from the blood in lupusmultiple sclerosis multiple myeloma etc Plasmapheresis carries with it the same risksas any intravenous procedure The risk of infection increases with the use of donor plasma which may carry viral particles despite screening procedures The procedure isdone in a clinic or hospital

Pneumonia Inflammation of one or both lungs with consolidation Pneumonia is

frequently but not always due to infection The infection may be bacterial viral fungal or parasitic Symptoms may include fever chills cough with sputum production chestpain and shortness of breath

Protein A large molecule composed of one or more chains of amino acids in a specificorder determined by the base sequence of nucleotides in the DNA coding for theprotein

65



Proteins Large molecules composed of one or more chains of amino acids in aspecific 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 aremission 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 butthen suffered a relapse and had to be treated once again for colon cancer

Residual Something left behind With residual disease the disease has not beeneradicatedSee the entire definition of Residual

Respiratory Having to do with respiration the exchange of oxygen and carbon dioxideFrom 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 lieswithin 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 sacraland 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 thebrain Like the brain the spinal cord is covered by three connective-tissue envelopescalled the meninges The space between the outer and middle envelopes is filled withcerebrospinal fluid ( CSF ) a clear colorless fluid that cushions the spinal cord against

jarring shock Also known simply as the cord

See the entire definition of Spinal cord

Spinal tap Also known as a lumbar puncture or LP a spinal tap is a procedurewhereby spinal fluid is removed from the spinal canal for the purpose of diagnostictesting It is particularly helpful in the diagnosis of inflammatory diseases of the centralnervous system especially infections such as meningitis It can also provide clues tothe 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 hasspread from the original site to other parts of the body See also Staging

Steroid A general class of chemical substances that are structurally related to oneanother and share the same chemical skeleton (a tetracyclic cyclopenta[a]phenanthreneskeleton)

Stroke The sudden death of some brain cells due to a lack of oxygen when the bloodflow to the brain is impaired by blockage or rupture of an artery to the brain A stroke isalso called a cerebrovascular accident or for short a CVA

66



Surgery The word surgery has multiple meanings It is the branch of medicineconcerned with diseases and conditions which require or are amenable to operativeprocedures 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 physicians or dentists office

Syndrome A set of signs and symptoms that tend to occur together and which reflectthe 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 geneticallypredisposed to developing the disease or that causes a certain symptom to occur in aperson who has a disease For example sunlight can trigger rashes in people withlupus

Ventilator A ventilator is a machine which mechanically assists patients in theexchange of oxygen and carbon dioxide (sometimes referred to as artificial respiration)

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 onthe virus and the persons 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 antibioticsin fact in some cases the use of antibiotics makes the infection worse The vastmajority of human viral infections can be effectively fought by the bodys own immunesystem with a little help in the form of proper diet hydration and rest As for the resttreatment 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 apartfrom a living cell A virus invades living cells and uses their chemical machinery to keepitself 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 ineach infected person making treatment more difficult

Viruses Small living particles that can infect cells and change how the cells functionInfection with a virus can cause a person to develop symptoms The disease andsymptoms that are caused depend on the type of virus and the type of cells that areinfected

67



REFERENCES

Brunner and Suddarthrsquos Medical and Surgical Nursing eleventh edition

Pathophysiology 3rd edition by Thomas J Nowak

Assessment by Lippincott Williams and Wilkins

httpenwikipediaorgwikiCampylobacter_jejuni

httpwwwabout-guillain-barrecom

httpwwwcehssiuedufixmedmicrocmirhtm

httpwwwabout-campylobactercomcampylobacter_symptoms_risks

httpwwwmedicinenetcomguillain-barre_syndromearticlehtm

httpwwwdirect-msorgpdfMolecularMimicryOtherGillianBarrMolMimicrypdf

httpwwwmicrobiologybytescomblog20080130how-campylobacter-jejuni-survives-within-cells


httpenwikipediaorgwikiMyelin_sheath

httpwwwdrkaslowcomhtmlblood_cell_countshtml



TABLE OF CONTENTS

bull Dedication

bull Acknowledgement

bull Introduction

bull Review of Related Literaturebull Patientrsquos History

Biographic data (Patientrsquos Profile)

Admission Data

History of Present Illness

Past Health History

Child illness

Immunizations (records)

History of hospitalizations

Family health history

radicLifestyleradic Personal habits

radic Diet

radic Sleep and Rest Patterns

radic Elimination Pattern

radic Activities of Daily Living (ADL)

Social Data

Environmental Data

Psychologic data

Patterns of Health Care

bull Physical Assessment and Review of Systems

General Survey

Vital Signs

Integumentary System

Hair

Nails

Head

Eyes and Vision

Ears and Hearing

Nose and Sinuses

Oropharynx (mouth and throat)

Neck Breast and Axillae

Abdomen

Extremities

Musculoskeletal System

Respiratory System

Cardiovascular System

Genitourinary System

2



Neurologic System

Mental Status

radic Language





Hematology

Urine Analysis

Electrolytes





bull Drug Study



Medication

Exercise

Treatment Regimen


Diet

Spiritual

3



DEDICATION





4



ACKNOWLEDGEMENT






5



INTRODUCTION









6






Description






the nerve


7












8














9







Causes and symptoms





Diagnosis


10




Diagnostic tests

Lumbar Puncture









Treatment




11






Prognosis



Prevention


12



ASSESSMENT







IBW = 118 118

13



-10 +10



= 47 kg (1585 m)

2

= 47 251












14










bull Hematology

bull Electrolytes


PAST HEALTH HISTORY



Childhood Illnesses


Immunizations


Allergy


15







SURGICAL HISTORY



LIFESTYLE

Personal Habits



Diet



16






Elimination Pattern







SOCIAL DATA






17



ENVIRONMENTAL DATA



PSYCHOLOGIC DATA




DEVELOPMENTAL TASK




18






PHYSICAL ASSESSMENT






GENERAL SURVEY







SKIN



bull Skin is dry




HAIR


19






NAILS






SKULL AND FACE



bull Dandruff noted



EYES AND VISION













EARS AND HEARING


20



bull Dry cerumen





NOSE





MOUTH AND THROAT









NECK





THORAX amp LUNGS







ABDOMEN


21





UPPER EXTREMITIES





LOWER EXTREMITIES

Inspection



Palpation




NEUROLOGIC TEST








Eye opening

Spontaneous 4

To verbal command 3

To pain 2

No Response 1


To localized pain 5


Flexes abnormally 3

22




No response 1

Verbal response





No response 1



Cranialnerves







our assessment book




pupil




IV Trochlear Motor


laterally


difficulty


Branch

SensoryMotor


mucosa




touch



introduced to him

23



cavity

Mandibular Branch

Motor ampSensory





Able to move his






















shoulders




side



24



REVIEW OF SYSTEMS






RESPIRATORY SYSTEM




















25



ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES
















Neurologic System

Mental Status

radic Language





Hematology

Urine Analysis

Electrolytes





bull Drug Study



Medication

Exercise

Treatment Regimen


Diet

Spiritual

3



DEDICATION





4



ACKNOWLEDGEMENT






5



INTRODUCTION









6






Description






the nerve


7












8














9







Causes and symptoms





Diagnosis


10




Diagnostic tests

Lumbar Puncture









Treatment




11






Prognosis



Prevention


12



ASSESSMENT







IBW = 118 118

13



-10 +10



= 47 kg (1585 m)

2

= 47 251












14










bull Hematology

bull Electrolytes


PAST HEALTH HISTORY



Childhood Illnesses


Immunizations


Allergy


15







SURGICAL HISTORY



LIFESTYLE

Personal Habits



Diet



16






Elimination Pattern







SOCIAL DATA






17



ENVIRONMENTAL DATA



PSYCHOLOGIC DATA




DEVELOPMENTAL TASK




18






PHYSICAL ASSESSMENT






GENERAL SURVEY







SKIN



bull Skin is dry




HAIR


19






NAILS






SKULL AND FACE



bull Dandruff noted



EYES AND VISION













EARS AND HEARING


20



bull Dry cerumen





NOSE





MOUTH AND THROAT









NECK





THORAX amp LUNGS







ABDOMEN


21





UPPER EXTREMITIES





LOWER EXTREMITIES

Inspection



Palpation




NEUROLOGIC TEST








Eye opening

Spontaneous 4

To verbal command 3

To pain 2

No Response 1


To localized pain 5


Flexes abnormally 3

22




No response 1

Verbal response





No response 1



Cranialnerves







our assessment book




pupil




IV Trochlear Motor


laterally


difficulty


Branch

SensoryMotor


mucosa




touch



introduced to him

23



cavity

Mandibular Branch

Motor ampSensory





Able to move his






















shoulders




side



24



REVIEW OF SYSTEMS






RESPIRATORY SYSTEM




















25



ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES
















DEDICATION





4



ACKNOWLEDGEMENT






5



INTRODUCTION









6






Description






the nerve


7












8














9







Causes and symptoms





Diagnosis


10




Diagnostic tests

Lumbar Puncture









Treatment




11






Prognosis



Prevention


12



ASSESSMENT







IBW = 118 118

13



-10 +10



= 47 kg (1585 m)

2

= 47 251












14










bull Hematology

bull Electrolytes


PAST HEALTH HISTORY



Childhood Illnesses


Immunizations


Allergy


15







SURGICAL HISTORY



LIFESTYLE

Personal Habits



Diet



16






Elimination Pattern







SOCIAL DATA






17



ENVIRONMENTAL DATA



PSYCHOLOGIC DATA




DEVELOPMENTAL TASK




18






PHYSICAL ASSESSMENT






GENERAL SURVEY







SKIN



bull Skin is dry




HAIR


19






NAILS






SKULL AND FACE



bull Dandruff noted



EYES AND VISION













EARS AND HEARING


20



bull Dry cerumen





NOSE





MOUTH AND THROAT









NECK





THORAX amp LUNGS







ABDOMEN


21





UPPER EXTREMITIES





LOWER EXTREMITIES

Inspection



Palpation




NEUROLOGIC TEST








Eye opening

Spontaneous 4

To verbal command 3

To pain 2

No Response 1


To localized pain 5


Flexes abnormally 3

22




No response 1

Verbal response





No response 1



Cranialnerves







our assessment book




pupil




IV Trochlear Motor


laterally


difficulty


Branch

SensoryMotor


mucosa




touch



introduced to him

23



cavity

Mandibular Branch

Motor ampSensory





Able to move his






















shoulders




side



24



REVIEW OF SYSTEMS






RESPIRATORY SYSTEM




















25



ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES
















ACKNOWLEDGEMENT






5



INTRODUCTION









6






Description






the nerve


7












8














9







Causes and symptoms





Diagnosis


10




Diagnostic tests

Lumbar Puncture









Treatment




11






Prognosis



Prevention


12



ASSESSMENT







IBW = 118 118

13



-10 +10



= 47 kg (1585 m)

2

= 47 251












14










bull Hematology

bull Electrolytes


PAST HEALTH HISTORY



Childhood Illnesses


Immunizations


Allergy


15







SURGICAL HISTORY



LIFESTYLE

Personal Habits



Diet



16






Elimination Pattern







SOCIAL DATA






17



ENVIRONMENTAL DATA



PSYCHOLOGIC DATA




DEVELOPMENTAL TASK




18






PHYSICAL ASSESSMENT






GENERAL SURVEY







SKIN



bull Skin is dry




HAIR


19






NAILS






SKULL AND FACE



bull Dandruff noted



EYES AND VISION













EARS AND HEARING


20



bull Dry cerumen





NOSE





MOUTH AND THROAT









NECK





THORAX amp LUNGS







ABDOMEN


21





UPPER EXTREMITIES





LOWER EXTREMITIES

Inspection



Palpation




NEUROLOGIC TEST








Eye opening

Spontaneous 4

To verbal command 3

To pain 2

No Response 1


To localized pain 5


Flexes abnormally 3

22




No response 1

Verbal response





No response 1



Cranialnerves







our assessment book




pupil




IV Trochlear Motor


laterally


difficulty


Branch

SensoryMotor


mucosa




touch



introduced to him

23



cavity

Mandibular Branch

Motor ampSensory





Able to move his






















shoulders




side



24



REVIEW OF SYSTEMS






RESPIRATORY SYSTEM




















25



ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES
















INTRODUCTION









6






Description






the nerve


7












8














9







Causes and symptoms





Diagnosis


10




Diagnostic tests

Lumbar Puncture









Treatment




11






Prognosis



Prevention


12



ASSESSMENT







IBW = 118 118

13



-10 +10



= 47 kg (1585 m)

2

= 47 251












14










bull Hematology

bull Electrolytes


PAST HEALTH HISTORY



Childhood Illnesses


Immunizations


Allergy


15







SURGICAL HISTORY



LIFESTYLE

Personal Habits



Diet



16






Elimination Pattern







SOCIAL DATA






17



ENVIRONMENTAL DATA



PSYCHOLOGIC DATA




DEVELOPMENTAL TASK




18






PHYSICAL ASSESSMENT






GENERAL SURVEY







SKIN



bull Skin is dry




HAIR


19






NAILS






SKULL AND FACE



bull Dandruff noted



EYES AND VISION













EARS AND HEARING


20



bull Dry cerumen





NOSE





MOUTH AND THROAT









NECK





THORAX amp LUNGS







ABDOMEN


21





UPPER EXTREMITIES





LOWER EXTREMITIES

Inspection



Palpation




NEUROLOGIC TEST








Eye opening

Spontaneous 4

To verbal command 3

To pain 2

No Response 1


To localized pain 5


Flexes abnormally 3

22




No response 1

Verbal response





No response 1



Cranialnerves







our assessment book




pupil




IV Trochlear Motor


laterally


difficulty


Branch

SensoryMotor


mucosa




touch



introduced to him

23



cavity

Mandibular Branch

Motor ampSensory





Able to move his






















shoulders




side



24



REVIEW OF SYSTEMS






RESPIRATORY SYSTEM




















25



ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES



















Description






the nerve


7












8














9







Causes and symptoms





Diagnosis


10




Diagnostic tests

Lumbar Puncture









Treatment




11






Prognosis



Prevention


12



ASSESSMENT







IBW = 118 118

13



-10 +10



= 47 kg (1585 m)

2

= 47 251












14










bull Hematology

bull Electrolytes


PAST HEALTH HISTORY



Childhood Illnesses


Immunizations


Allergy


15







SURGICAL HISTORY



LIFESTYLE

Personal Habits



Diet



16






Elimination Pattern







SOCIAL DATA






17



ENVIRONMENTAL DATA



PSYCHOLOGIC DATA




DEVELOPMENTAL TASK




18






PHYSICAL ASSESSMENT






GENERAL SURVEY







SKIN



bull Skin is dry




HAIR


19






NAILS






SKULL AND FACE



bull Dandruff noted



EYES AND VISION













EARS AND HEARING


20



bull Dry cerumen





NOSE





MOUTH AND THROAT









NECK





THORAX amp LUNGS







ABDOMEN


21





UPPER EXTREMITIES





LOWER EXTREMITIES

Inspection



Palpation




NEUROLOGIC TEST








Eye opening

Spontaneous 4

To verbal command 3

To pain 2

No Response 1


To localized pain 5


Flexes abnormally 3

22




No response 1

Verbal response





No response 1



Cranialnerves







our assessment book




pupil




IV Trochlear Motor


laterally


difficulty


Branch

SensoryMotor


mucosa




touch



introduced to him

23



cavity

Mandibular Branch

Motor ampSensory





Able to move his






















shoulders




side



24



REVIEW OF SYSTEMS






RESPIRATORY SYSTEM




















25



ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES

























8














9







Causes and symptoms





Diagnosis


10




Diagnostic tests

Lumbar Puncture









Treatment




11






Prognosis



Prevention


12



ASSESSMENT







IBW = 118 118

13



-10 +10



= 47 kg (1585 m)

2

= 47 251












14










bull Hematology

bull Electrolytes


PAST HEALTH HISTORY



Childhood Illnesses


Immunizations


Allergy


15







SURGICAL HISTORY



LIFESTYLE

Personal Habits



Diet



16






Elimination Pattern







SOCIAL DATA






17



ENVIRONMENTAL DATA



PSYCHOLOGIC DATA




DEVELOPMENTAL TASK




18






PHYSICAL ASSESSMENT






GENERAL SURVEY







SKIN



bull Skin is dry




HAIR


19






NAILS






SKULL AND FACE



bull Dandruff noted



EYES AND VISION













EARS AND HEARING


20



bull Dry cerumen





NOSE





MOUTH AND THROAT









NECK





THORAX amp LUNGS







ABDOMEN


21





UPPER EXTREMITIES





LOWER EXTREMITIES

Inspection



Palpation




NEUROLOGIC TEST








Eye opening

Spontaneous 4

To verbal command 3

To pain 2

No Response 1


To localized pain 5


Flexes abnormally 3

22




No response 1

Verbal response





No response 1



Cranialnerves







our assessment book




pupil




IV Trochlear Motor


laterally


difficulty


Branch

SensoryMotor


mucosa




touch



introduced to him

23



cavity

Mandibular Branch

Motor ampSensory





Able to move his






















shoulders




side



24



REVIEW OF SYSTEMS






RESPIRATORY SYSTEM




















25



ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES



























9







Causes and symptoms





Diagnosis


10




Diagnostic tests

Lumbar Puncture









Treatment




11






Prognosis



Prevention


12



ASSESSMENT







IBW = 118 118

13



-10 +10



= 47 kg (1585 m)

2

= 47 251












14










bull Hematology

bull Electrolytes


PAST HEALTH HISTORY



Childhood Illnesses


Immunizations


Allergy


15







SURGICAL HISTORY



LIFESTYLE

Personal Habits



Diet



16






Elimination Pattern







SOCIAL DATA






17



ENVIRONMENTAL DATA



PSYCHOLOGIC DATA




DEVELOPMENTAL TASK




18






PHYSICAL ASSESSMENT






GENERAL SURVEY







SKIN



bull Skin is dry




HAIR


19






NAILS






SKULL AND FACE



bull Dandruff noted



EYES AND VISION













EARS AND HEARING


20



bull Dry cerumen





NOSE





MOUTH AND THROAT









NECK





THORAX amp LUNGS







ABDOMEN


21





UPPER EXTREMITIES





LOWER EXTREMITIES

Inspection



Palpation




NEUROLOGIC TEST








Eye opening

Spontaneous 4

To verbal command 3

To pain 2

No Response 1


To localized pain 5


Flexes abnormally 3

22




No response 1

Verbal response





No response 1



Cranialnerves







our assessment book




pupil




IV Trochlear Motor


laterally


difficulty


Branch

SensoryMotor


mucosa




touch



introduced to him

23



cavity

Mandibular Branch

Motor ampSensory





Able to move his






















shoulders




side



24



REVIEW OF SYSTEMS






RESPIRATORY SYSTEM




















25



ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES




















Causes and symptoms





Diagnosis


10




Diagnostic tests

Lumbar Puncture









Treatment




11






Prognosis



Prevention


12



ASSESSMENT







IBW = 118 118

13



-10 +10



= 47 kg (1585 m)

2

= 47 251












14










bull Hematology

bull Electrolytes


PAST HEALTH HISTORY



Childhood Illnesses


Immunizations


Allergy


15







SURGICAL HISTORY



LIFESTYLE

Personal Habits



Diet



16






Elimination Pattern







SOCIAL DATA






17



ENVIRONMENTAL DATA



PSYCHOLOGIC DATA




DEVELOPMENTAL TASK




18






PHYSICAL ASSESSMENT






GENERAL SURVEY







SKIN



bull Skin is dry




HAIR


19






NAILS






SKULL AND FACE



bull Dandruff noted



EYES AND VISION













EARS AND HEARING


20



bull Dry cerumen





NOSE





MOUTH AND THROAT









NECK





THORAX amp LUNGS







ABDOMEN


21





UPPER EXTREMITIES





LOWER EXTREMITIES

Inspection



Palpation




NEUROLOGIC TEST








Eye opening

Spontaneous 4

To verbal command 3

To pain 2

No Response 1


To localized pain 5


Flexes abnormally 3

22




No response 1

Verbal response





No response 1



Cranialnerves







our assessment book




pupil




IV Trochlear Motor


laterally


difficulty


Branch

SensoryMotor


mucosa




touch



introduced to him

23



cavity

Mandibular Branch

Motor ampSensory





Able to move his






















shoulders




side



24



REVIEW OF SYSTEMS






RESPIRATORY SYSTEM




















25



ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES

















Diagnostic tests

Lumbar Puncture









Treatment




11






Prognosis



Prevention


12



ASSESSMENT







IBW = 118 118

13



-10 +10



= 47 kg (1585 m)

2

= 47 251












14










bull Hematology

bull Electrolytes


PAST HEALTH HISTORY



Childhood Illnesses


Immunizations


Allergy


15







SURGICAL HISTORY



LIFESTYLE

Personal Habits



Diet



16






Elimination Pattern







SOCIAL DATA






17



ENVIRONMENTAL DATA



PSYCHOLOGIC DATA




DEVELOPMENTAL TASK




18






PHYSICAL ASSESSMENT






GENERAL SURVEY







SKIN



bull Skin is dry




HAIR


19






NAILS






SKULL AND FACE



bull Dandruff noted



EYES AND VISION













EARS AND HEARING


20



bull Dry cerumen





NOSE





MOUTH AND THROAT









NECK





THORAX amp LUNGS







ABDOMEN


21





UPPER EXTREMITIES





LOWER EXTREMITIES

Inspection



Palpation




NEUROLOGIC TEST








Eye opening

Spontaneous 4

To verbal command 3

To pain 2

No Response 1


To localized pain 5


Flexes abnormally 3

22




No response 1

Verbal response





No response 1



Cranialnerves







our assessment book




pupil




IV Trochlear Motor


laterally


difficulty


Branch

SensoryMotor


mucosa




touch



introduced to him

23



cavity

Mandibular Branch

Motor ampSensory





Able to move his






















shoulders




side



24



REVIEW OF SYSTEMS






RESPIRATORY SYSTEM




















25



ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES



















Prognosis



Prevention


12



ASSESSMENT







IBW = 118 118

13



-10 +10



= 47 kg (1585 m)

2

= 47 251












14










bull Hematology

bull Electrolytes


PAST HEALTH HISTORY



Childhood Illnesses


Immunizations


Allergy


15







SURGICAL HISTORY



LIFESTYLE

Personal Habits



Diet



16






Elimination Pattern







SOCIAL DATA






17



ENVIRONMENTAL DATA



PSYCHOLOGIC DATA




DEVELOPMENTAL TASK




18






PHYSICAL ASSESSMENT






GENERAL SURVEY







SKIN



bull Skin is dry




HAIR


19






NAILS






SKULL AND FACE



bull Dandruff noted



EYES AND VISION













EARS AND HEARING


20



bull Dry cerumen





NOSE





MOUTH AND THROAT









NECK





THORAX amp LUNGS







ABDOMEN


21





UPPER EXTREMITIES





LOWER EXTREMITIES

Inspection



Palpation




NEUROLOGIC TEST








Eye opening

Spontaneous 4

To verbal command 3

To pain 2

No Response 1


To localized pain 5


Flexes abnormally 3

22




No response 1

Verbal response





No response 1



Cranialnerves







our assessment book




pupil




IV Trochlear Motor


laterally


difficulty


Branch

SensoryMotor


mucosa




touch



introduced to him

23



cavity

Mandibular Branch

Motor ampSensory





Able to move his






















shoulders




side



24



REVIEW OF SYSTEMS






RESPIRATORY SYSTEM




















25



ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES
















ASSESSMENT







IBW = 118 118

13



-10 +10



= 47 kg (1585 m)

2

= 47 251












14










bull Hematology

bull Electrolytes


PAST HEALTH HISTORY



Childhood Illnesses


Immunizations


Allergy


15







SURGICAL HISTORY



LIFESTYLE

Personal Habits



Diet



16






Elimination Pattern







SOCIAL DATA






17



ENVIRONMENTAL DATA



PSYCHOLOGIC DATA




DEVELOPMENTAL TASK




18






PHYSICAL ASSESSMENT






GENERAL SURVEY







SKIN



bull Skin is dry




HAIR


19






NAILS






SKULL AND FACE



bull Dandruff noted



EYES AND VISION













EARS AND HEARING


20



bull Dry cerumen





NOSE





MOUTH AND THROAT









NECK





THORAX amp LUNGS







ABDOMEN


21





UPPER EXTREMITIES





LOWER EXTREMITIES

Inspection



Palpation




NEUROLOGIC TEST








Eye opening

Spontaneous 4

To verbal command 3

To pain 2

No Response 1


To localized pain 5


Flexes abnormally 3

22




No response 1

Verbal response





No response 1



Cranialnerves







our assessment book




pupil




IV Trochlear Motor


laterally


difficulty


Branch

SensoryMotor


mucosa




touch



introduced to him

23



cavity

Mandibular Branch

Motor ampSensory





Able to move his






















shoulders




side



24



REVIEW OF SYSTEMS






RESPIRATORY SYSTEM




















25



ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES
















-10 +10



= 47 kg (1585 m)

2

= 47 251












14










bull Hematology

bull Electrolytes


PAST HEALTH HISTORY



Childhood Illnesses


Immunizations


Allergy


15







SURGICAL HISTORY



LIFESTYLE

Personal Habits



Diet



16






Elimination Pattern







SOCIAL DATA






17



ENVIRONMENTAL DATA



PSYCHOLOGIC DATA




DEVELOPMENTAL TASK




18






PHYSICAL ASSESSMENT






GENERAL SURVEY







SKIN



bull Skin is dry




HAIR


19






NAILS






SKULL AND FACE



bull Dandruff noted



EYES AND VISION













EARS AND HEARING


20



bull Dry cerumen





NOSE





MOUTH AND THROAT









NECK





THORAX amp LUNGS







ABDOMEN


21





UPPER EXTREMITIES





LOWER EXTREMITIES

Inspection



Palpation




NEUROLOGIC TEST








Eye opening

Spontaneous 4

To verbal command 3

To pain 2

No Response 1


To localized pain 5


Flexes abnormally 3

22




No response 1

Verbal response





No response 1



Cranialnerves







our assessment book




pupil




IV Trochlear Motor


laterally


difficulty


Branch

SensoryMotor


mucosa




touch



introduced to him

23



cavity

Mandibular Branch

Motor ampSensory





Able to move his






















shoulders




side



24



REVIEW OF SYSTEMS






RESPIRATORY SYSTEM




















25



ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES























bull Hematology

bull Electrolytes


PAST HEALTH HISTORY



Childhood Illnesses


Immunizations


Allergy


15







SURGICAL HISTORY



LIFESTYLE

Personal Habits



Diet



16






Elimination Pattern







SOCIAL DATA






17



ENVIRONMENTAL DATA



PSYCHOLOGIC DATA




DEVELOPMENTAL TASK




18






PHYSICAL ASSESSMENT






GENERAL SURVEY







SKIN



bull Skin is dry




HAIR


19






NAILS






SKULL AND FACE



bull Dandruff noted



EYES AND VISION













EARS AND HEARING


20



bull Dry cerumen





NOSE





MOUTH AND THROAT









NECK





THORAX amp LUNGS







ABDOMEN


21





UPPER EXTREMITIES





LOWER EXTREMITIES

Inspection



Palpation




NEUROLOGIC TEST








Eye opening

Spontaneous 4

To verbal command 3

To pain 2

No Response 1


To localized pain 5


Flexes abnormally 3

22




No response 1

Verbal response





No response 1



Cranialnerves







our assessment book




pupil




IV Trochlear Motor


laterally


difficulty


Branch

SensoryMotor


mucosa




touch



introduced to him

23



cavity

Mandibular Branch

Motor ampSensory





Able to move his






















shoulders




side



24



REVIEW OF SYSTEMS






RESPIRATORY SYSTEM




















25



ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES




















SURGICAL HISTORY



LIFESTYLE

Personal Habits



Diet



16






Elimination Pattern







SOCIAL DATA






17



ENVIRONMENTAL DATA



PSYCHOLOGIC DATA




DEVELOPMENTAL TASK




18






PHYSICAL ASSESSMENT






GENERAL SURVEY







SKIN



bull Skin is dry




HAIR


19






NAILS






SKULL AND FACE



bull Dandruff noted



EYES AND VISION













EARS AND HEARING


20



bull Dry cerumen





NOSE





MOUTH AND THROAT









NECK





THORAX amp LUNGS







ABDOMEN


21





UPPER EXTREMITIES





LOWER EXTREMITIES

Inspection



Palpation




NEUROLOGIC TEST








Eye opening

Spontaneous 4

To verbal command 3

To pain 2

No Response 1


To localized pain 5


Flexes abnormally 3

22




No response 1

Verbal response





No response 1



Cranialnerves







our assessment book




pupil




IV Trochlear Motor


laterally


difficulty


Branch

SensoryMotor


mucosa




touch



introduced to him

23



cavity

Mandibular Branch

Motor ampSensory





Able to move his






















shoulders




side



24



REVIEW OF SYSTEMS






RESPIRATORY SYSTEM




















25



ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES



















Elimination Pattern







SOCIAL DATA






17



ENVIRONMENTAL DATA



PSYCHOLOGIC DATA




DEVELOPMENTAL TASK




18






PHYSICAL ASSESSMENT






GENERAL SURVEY







SKIN



bull Skin is dry




HAIR


19






NAILS






SKULL AND FACE



bull Dandruff noted



EYES AND VISION













EARS AND HEARING


20



bull Dry cerumen





NOSE





MOUTH AND THROAT









NECK





THORAX amp LUNGS







ABDOMEN


21





UPPER EXTREMITIES





LOWER EXTREMITIES

Inspection



Palpation




NEUROLOGIC TEST








Eye opening

Spontaneous 4

To verbal command 3

To pain 2

No Response 1


To localized pain 5


Flexes abnormally 3

22




No response 1

Verbal response





No response 1



Cranialnerves







our assessment book




pupil




IV Trochlear Motor


laterally


difficulty


Branch

SensoryMotor


mucosa




touch



introduced to him

23



cavity

Mandibular Branch

Motor ampSensory





Able to move his






















shoulders




side



24



REVIEW OF SYSTEMS






RESPIRATORY SYSTEM




















25



ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES
















ENVIRONMENTAL DATA



PSYCHOLOGIC DATA




DEVELOPMENTAL TASK




18






PHYSICAL ASSESSMENT






GENERAL SURVEY







SKIN



bull Skin is dry




HAIR


19






NAILS






SKULL AND FACE



bull Dandruff noted



EYES AND VISION













EARS AND HEARING


20



bull Dry cerumen





NOSE





MOUTH AND THROAT









NECK





THORAX amp LUNGS







ABDOMEN


21





UPPER EXTREMITIES





LOWER EXTREMITIES

Inspection



Palpation




NEUROLOGIC TEST








Eye opening

Spontaneous 4

To verbal command 3

To pain 2

No Response 1


To localized pain 5


Flexes abnormally 3

22




No response 1

Verbal response





No response 1



Cranialnerves







our assessment book




pupil




IV Trochlear Motor


laterally


difficulty


Branch

SensoryMotor


mucosa




touch



introduced to him

23



cavity

Mandibular Branch

Motor ampSensory





Able to move his






















shoulders




side



24



REVIEW OF SYSTEMS






RESPIRATORY SYSTEM




















25



ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES



















PHYSICAL ASSESSMENT






GENERAL SURVEY







SKIN



bull Skin is dry




HAIR


19






NAILS






SKULL AND FACE



bull Dandruff noted



EYES AND VISION













EARS AND HEARING


20



bull Dry cerumen





NOSE





MOUTH AND THROAT









NECK





THORAX amp LUNGS







ABDOMEN


21





UPPER EXTREMITIES





LOWER EXTREMITIES

Inspection



Palpation




NEUROLOGIC TEST








Eye opening

Spontaneous 4

To verbal command 3

To pain 2

No Response 1


To localized pain 5


Flexes abnormally 3

22




No response 1

Verbal response





No response 1



Cranialnerves







our assessment book




pupil




IV Trochlear Motor


laterally


difficulty


Branch

SensoryMotor


mucosa




touch



introduced to him

23



cavity

Mandibular Branch

Motor ampSensory





Able to move his






















shoulders




side



24



REVIEW OF SYSTEMS






RESPIRATORY SYSTEM




















25



ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES



















NAILS






SKULL AND FACE



bull Dandruff noted



EYES AND VISION













EARS AND HEARING


20



bull Dry cerumen





NOSE





MOUTH AND THROAT









NECK





THORAX amp LUNGS







ABDOMEN


21





UPPER EXTREMITIES





LOWER EXTREMITIES

Inspection



Palpation




NEUROLOGIC TEST








Eye opening

Spontaneous 4

To verbal command 3

To pain 2

No Response 1


To localized pain 5


Flexes abnormally 3

22




No response 1

Verbal response





No response 1



Cranialnerves







our assessment book




pupil




IV Trochlear Motor


laterally


difficulty


Branch

SensoryMotor


mucosa




touch



introduced to him

23



cavity

Mandibular Branch

Motor ampSensory





Able to move his






















shoulders




side



24



REVIEW OF SYSTEMS






RESPIRATORY SYSTEM




















25



ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES
















bull Dry cerumen





NOSE





MOUTH AND THROAT









NECK





THORAX amp LUNGS







ABDOMEN


21





UPPER EXTREMITIES





LOWER EXTREMITIES

Inspection



Palpation




NEUROLOGIC TEST








Eye opening

Spontaneous 4

To verbal command 3

To pain 2

No Response 1


To localized pain 5


Flexes abnormally 3

22




No response 1

Verbal response





No response 1



Cranialnerves







our assessment book




pupil




IV Trochlear Motor


laterally


difficulty


Branch

SensoryMotor


mucosa




touch



introduced to him

23



cavity

Mandibular Branch

Motor ampSensory





Able to move his






















shoulders




side



24



REVIEW OF SYSTEMS






RESPIRATORY SYSTEM




















25



ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES


















UPPER EXTREMITIES





LOWER EXTREMITIES

Inspection



Palpation




NEUROLOGIC TEST








Eye opening

Spontaneous 4

To verbal command 3

To pain 2

No Response 1


To localized pain 5


Flexes abnormally 3

22




No response 1

Verbal response





No response 1



Cranialnerves







our assessment book




pupil




IV Trochlear Motor


laterally


difficulty


Branch

SensoryMotor


mucosa




touch



introduced to him

23



cavity

Mandibular Branch

Motor ampSensory





Able to move his






















shoulders




side



24



REVIEW OF SYSTEMS






RESPIRATORY SYSTEM




















25



ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES

















No response 1

Verbal response





No response 1



Cranialnerves







our assessment book




pupil




IV Trochlear Motor


laterally


difficulty


Branch

SensoryMotor


mucosa




touch



introduced to him

23



cavity

Mandibular Branch

Motor ampSensory





Able to move his






















shoulders




side



24



REVIEW OF SYSTEMS






RESPIRATORY SYSTEM




















25



ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES
















cavity

Mandibular Branch

Motor ampSensory





Able to move his






















shoulders




side



24



REVIEW OF SYSTEMS






RESPIRATORY SYSTEM




















25



ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES
















REVIEW OF SYSTEMS






RESPIRATORY SYSTEM




















25



ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES
















ENDOCRINE SYSTEM









LABORATORY TESTS














Note


26




THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES

















THE NERVOUS SYSTEM


27




28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES

















28







The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES

















The PNS consists of

29




















The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES

































The Cranial Nerves


IOlfactory



IIIOculomotor


IVTrochlear


VTrigeminal


30



VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES
















VIAbducens


VIIFacial



IXGlossopharyngeal


XVagus


XIAccessory


XIIHypoglossal



The Spinal Nerves








31



















32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES
































32












spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES

























spinal cord






33





IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES


















IMMUNE SYSTEM







34










35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES























35











36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES
























36















37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES




























37





38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES


















38



DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES
















DRUG STUDY


andClassification

Prescribedand

recommendedDosage


Administration

Mechanismof

ActionIndication




Corticosteroids

100 mg IVTTQ 8 H




bull Shock




infant(succinate)




bull CV heart










39



DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES
















DRUG STUDY


andClassification


DosageFrequency and

Route of

Administration

Mechanismof




bull RDA













efficacy



40



DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES
















DRUG STUDY

41




andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES

















andClassification


DosageFrequency and


Mechanismof



Bisacodyl Pedia

Laxative











imbalance







42



DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES
















DRUG STUDY


andClassification


DosageFrequency and


Mechanismof


AdverseReactions

NursingImplications

vitamin B-complex










43




cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES

















cell division


44



GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES
















GENOGRAM



= Patient







43 years old


45




Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES

















Subjective cue





Diagnosis


Planning



Independent


To prevent injury


To prevent injury






Evaluation


46




Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES

















Objective cues

bull paresthesia



o RR = 20 cpm

o P = 88 bpm

o BP = 11070 mmHg

Diagnosis


Planning














To limit fatigue






47




Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES

















Subjective cue


Objective cues


bull Limited ROM


bull Weakness


Analysis


Planning











Evaluation


48




Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES

















Subjective cues


Objective cues







Planning



Independent











To reduce fatigue

Evaluation


49




Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES

















Subjective cues


Objective cues



Analysis


Planning












Evaluation


50




Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES

















Subjective


Objective





Analysis


Planning










Evaluation


51




Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES

















Subjective


Objectives

bull Eyebags noted



bull Lethargy noted

Analysis


Planning














52




Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES

















Subjective cues



Objective cues



Diagnosis


Planning













53







assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES




















assistance



Evaluation


54




Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES

















Subjective cue


Objective cues



bull Dandruff noted



bull Dry skin noted

Diagnosis


Planning





















55




Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES

















Subjective cue


Objective cue






Analysis


Planning













56




Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES

















Subjective cue





Analysis


Planning


anxiety












Evaluation


57




Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES

















Subjective cues



Objective cues

bull Apathy noted


Diagnosis


Planning











Evaluation


58




Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES

















Subjective cues



bull Lethargy noted



Diagnosis


Planning



Independent




To relieve boredom




For mobility




Evaluation


59



DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES
















DISCHARGE PLAN



Time Dose





s




as possible




HealthTeachings












60







Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES




















Out-Patientcheck-up








61

















62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES






























62










Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES























Hammer The malleus







63








Limb The arm or leg








64















65

















66











67



REFERENCES





















Limb The arm or leg








64















65

















66











67



REFERENCES




























65

















66











67



REFERENCES






























66











67



REFERENCES
























67



REFERENCES
















REFERENCES














Documents

GBS sinco mark