COLLEGE OF NURSING

Foundation University
Dr. Miciano Road, Taclobo, Dumaguete City 6200

CASE STUDY
On
LEFT CEREBELLOPONTINE ANGLE TUMOR

In Partial Fulfillment of the Requirements for the

Degree if Bachelor of Science in Nursing
NUR205

Submitted by:
Cotales, Floramae T.

NOVEMBER 30,2023
 TABLE OF CONTENTS

I. Foundation University Mission, Vision, and Life Purpose .......................................................................................................................................................................i

II. Central Objectives and Specific Objectives ........................................................................................................................................................................................... ii
III. Acknowledgement ................................................................................................................................................................................................................................iii
IV. Introduction ........................................................................................................................................................................................................................................... 1
V. Demographic Profile ........................................................................................................................................................................................................................... 2-3
VI. Developmental Tasks ............................................................................................................................................................................................................................4
VII. Anatomy and Physiology ..................................................................................................................................................................................................................5-6
VIII. Review of Related Literature ..............................................................................................................................................................................................................7
IX. Medical Management ............................................................................................................................................................................................................................8
A. Laboratory Exams and Correlation ................................................................................................................................................................................................... 8-11
B. Treatment Modalities ......................................................................................................................................................................................................................12-18
C. Drug Study ...................................................................................................................................................................................................................................... 19-29
D. Concept Map ................................................................................................................................................................................................................................. 30-31
A. Nursing History ...............................................................................................................................................................................................................................32-33
1.Family History with Genogram
2. Psychosocial History
3. Environemental History
4. Spiritual History
B. Physical Assessment .............................................................................................................................................................................................................................34
C. Nursing Theory .....................................................................................................................................................................................................................................35
D. Gordon's Functional Health Pattern ................................................................................................................................................................................................36-43
E. Summary of Nursing Diagnoses ........................................................................................................................................................................................................... 44
F. Nursing Care Plans NCP: 1 ............................................................................................................................................................................................................. 45-50
X. Annotated Readings ............................................................................................................................................................................................................................. 51
XI. Conclusion .......................................................................................................................................................................................................................................... 52
XII. References ......................................................................................................................................................................................................................................... 53
 I. FOUNDATION UNIVERSITY VISION, MISSION, AND LIFE PURPOSE

VISION
Foundation University envision itself as a dynamic, progressive environments that cultivates effective learning, generates creative ideas,
responds to societal need, and offers equal opportunity for all.

MISSION

To enhance and promote a climate of excellence relevant to challenges of the time, where individuals are committed to the pursuit of new
knowledge and life-long learning in service of society.

LIFE PURPOSE

To educate and develop individuals to become productive, creative, useful, and responsible citizens of the society.

CORE VALUES

● Excellence
● Commitment
● Integrity
● Service

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 II. CENTRAL OBJECTIVES AND SPECIFIC OBJECTIVES

Central Objectives
The purpose of this is to present a general picture of left cerebellopontine angle tumor through effective nurse-patient interaction and relevant research
with critical, competent, and collaborative application of the nursing process.

Specific Objectives
To obtain pertinent information about the patient's demographic and socioeconomic profile.

To be well-informed on the patient's history including past and present hospitalization.

To be knowledgeable on the different diagnostic procedures to be ruled-out, focusing on nursing responsibilities and patient teaching.

To be familiar with the structure of the brain and other parts affected and also the function of its parts.

To educate ourselves about the pathophysiology of intracranial mass or brain tumor, its pathogenesis, causes and clinical manifestation.

To identify the medical and surgical management indicated for the patient.

To be acquainted with the medications prescribed for the patient noting their therapeutic effects and adverse reactions.

To establish an appropriate nursing care plan that includes dependent, independent, and collaborative nursing; and lastly.

To formulate necessary discharge planning and health teachings essential for the patient's fast recovery and prevention of possible complications.

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 III.ACKNOWLEDGEMENT

I would like to express our heartfelt gratitude to all who made this case study possible and successful. I am extremely thankful to everyone who offered
their time, effort, insight, and abilities to make this study a reality.

Mr. Jed Keoni Uy Jolo for his uplifting and unending support from the start to the end of this study, this research would not be possible without
sharing his beneficent knowledge. I am thankful that I have been given the opportunity to learn and experience such a case and will be indebted to him
for his expertise.

Mr. Jethri Ken Carlo Catalan, Dean of the College of Nursing for his continuous sincere encouragement and valuable support in this study.

And above all, to the Almighty God, for his blessings that enable the researchers to achieve their goals in life. Hence, without him, this study would
have been in vain.

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 IV. INTRODUCTION

One that would be never understood, a person with a simple symptom of dizziness and hearing loss might lead to a serious complication. Let us
understand the complexities of this study as we delve into the management and treatment strategies employed in a real- life scenario involving a patient
diagnosed with a “left cerebellopontine angle tumor.”Millions of people encounter a left cerebellopontine angle tumor, which is commonly known as a
“brain tumor”. Cerebellopontine angle tumors (CPA), are still a major cause of mortality and morbidity, particularly in vulnerable populations, and they
are a major global public health concern. It can affect all ages and genders in any group. Cerebellopontine angle tumors can be caused by many different
organisms, can present as a primary condition or as a complication of other diseases, and can lead to acute or chronic health problems if not immediately
prompted by the condition. These studies will provide us with more information about this type of disease that will help us to be more aware and
knowledgeable.
According to the Neuroscience Institute, cerebellopontine angle tumors (CPAs) occur between the lower part of the brain and the brain stem.
Most CPAs are benign, but can cause nerve damage or compress the brain stem if not treated.The symptoms of this tumor vary according to the size and
location of the lesion. Some general symptoms include hearing loss, tinnitus, vertigo/ unsteadiness, disequilibrium, headache, facial hypesthesia,
diplopia and vision loss/ blurring vision. Other symptoms include speech impediment, tremors, and loss of muscle control. Larger tumours may cause
ataxia and obstructive hydrocephalus and may rarely be life threatening. Cerebellopontine Angle Tumors accounts for almost 5-10% of the intracranial
tumors and most of them are benign. They are the most common neoplasm in the posterior fossa. The cerebellopontine angle is a space filled with spinal
fluid. Common pathologies in the CPA include vestibular schwannomas, which account for 10% of all primary brain neoplasms, meningiomas and
arachnoid cysts.
Cerebellopontine angle (CPA) is a triangular space in the posterior cranial fossa that is bounded by the tentorium superiorly, brainstem
posteromedially and petrous part of temporal bone posterolaterally. It is an important landmark anatomically and clinically as it is occupied by the CPA
cistern, which houses the cranial nerve V, VI, VII, and VIII along with the anterior inferior cerebellar artery. CPA tumors can be broadly classified into
two types; those arising from structures located in the CPA, and those extending from adjacent regions into the CPA. Treatment for CPA tumors
depends upon the patient’s age, his medical condition, growth rate of tumor, and the pathologic behaviour of the tumor. Some cases may be treated with
diuretic therapy. But the main options for CPA tumor management include surgical resection, radiation therapy and observation with serial imaging
(most commonly is MRI).

In this study patient C.B.P. is one of millions of people who develop this type of disease. Four months prior to his admission, he developed symptoms of
dizziness and sudden loss of hearing in his left ears, and immediately sought consultation.
 V. DEMOGRAPHIC PROFILE
A. IDENTIFICATION DATA
● Patient’s Name: C.B.P
● Date of Birth: Jan. 30, 1979
● Address: Masaplod Norte, Dauin Negros Oriental
● Age: 47 yrs. old
● Sex: Male
● Status: Married
● Religion: Roman Catholic
● Position of the family: Father
● Occupation: None (Previous supervisor in URC 3 years of work)
● Weight: 64 kg
● Height: 165 cm
● Date of admission: 10/15/16
● Diagnosis: Left Cerebellopontine Angle Tumor
● Consultant-in-Charge: Dr.

General Impression:
Received a patient awake, alert and coherent on time, with IV fluid PNSS 1L @ 10gtts/min consumed well @ L metacarpal vein.Well groomed and no
usual body odor, appearance tired and exhausted. Patient is diet as tolerated and has a poor appetite, presence of dryness of skin also shown a presence
of sunken eyes and dryness of mucous membrane. Patient BMI is 23.5 normal. Patient vital sign, Temperature 36.6 ℃, Respiratory 14 cpm, Pulse rate
73 bpm, O2Sat 98% and Blood pressure 130/90 mmHg.
Chief Complaint:
Presence of mass in his head.
Present Health History:
4 months PTA, patient had onset of dizziness and was suddenly deaf on left ear. Sought consultation, prescribed medicine but did not alleviate
symptoms. Sought consultation in this institution and was advised to undergo an MRI which shows the presence of a brain tumor. Advised craniotomy,
thus this admission.
Past Health History:
Patient had no history of heart disease, diabetes mellitus, HIV, tuberculosis, epilepsy, asthma and blood transfusions. Patient previous admission/
surgeries AV shunt on Sept. 3, 2023. Patient is also a nonsmoker and occasional beverage drinker. No known family health history especially brain
tumors.Patient has previous encountered motor vehicular accident last 2013.
 VI. DEVELOPMENTAL TASKS
Erick Erickson’s Psychosocial Theory
(Generativity vs. Stagnation)

According to Erikson(1963), he argued that in order to be generative in adulthood, people must have a fundamental “belief in the species” or
faith that human progress (Water & McAdams, 2004). Adults think about their contributions to society that they seek to make a positive impact, and
find fulfillment through productive work and nurturing relationships. Research has shown that failure of generativity can lead to profound personal
stagnation, masked by a variety of escapism that can occur mid-life crisis as generativity is a developmental challenge for the middle-adult years. If
individuals fail to meet the developmental challenges during their life stages, they experience emotional despair as the outcomes.

In the realm of midlife, there are various misconceptions surrounding its nature and the significant developmental milestones and challenges that
people may encounter. Generativity refers to making a positive impact and contributing to the world and a positive goal of middle adulthood, interpreted
in terms not only of procreation but also of creativity and fulfilling one’s social responsibilities, according to American Psychological Association
(2018). Erik Erikson (1982) posited that generativity plays a key role in well-being from midlife onward. Shin An Cooner (2006) found evidence
supporting the role of generativity in well-being, noting that those middle aged and older adults who were more generative reported greater well-being
compared to those who were less generative. Therefore, understanding what cultivates generative behavior throughout mid and later life is crucial. Grit
contributes to success (Duckworth et al.,2007), so grit may promote generative behavior to allow for the successful resolution of this psychosocial stage.
Additionally, having a strong sense of community cohesion may foster a need to give back (Levy, Itzhaky, Zambar, &Schwartz, 2012) making it
another likely contributor to engaging generatively.

Correlation: In this theory it correlates to the patient's developmental task. During the interview the patient seemed distressed because of his condition,
he said that he is the head of the family but because of his condition he cannot work anymore and all he can do is to rest. He said also that there is
reversibility of the roles, his wife was the one who found a job to provide for their family financially, instead of him. Despite this outburst feeling he
engaged in a one way where it contributed to a self independency as what he showed during his hospitalization. Even though the patient is still stuck in
his room all he can do is to survive in order to get outside the box.
 VII. ANATOMY AND PHYSIOLOGY

Cerebellopontine angle tumor is bound anterolaterally by the posterior aspect of the petrous
temporal bone and posteromedially by the cerebellum and pons. It contains important vascular
structures and cranial nerves and is subject to a certain gamut of lesions, notably tumors with
interesting radiological manifestations.

Brain is an amazing three-pound organ that controls all functions of the body, interprets
information from the outside world, and embodies the essence of the mind and soul. Intelligence,
creativity, emotion, and memory are a few of the many things governed by the brain. Protected
within the skull, the brain is composed of the cerebrum, cerebellum, and brainstem. The brain
receives information through our five senses: sight, smell, touch, taste, and hearing often many at
one time. It assembles the messages in a way that has meaning for us, and can store that
information in our memory. The brain controls our thoughts, memory and speech, movement of the
arms and legs, and the function of many organs within our body.

The central nervous system (CNS) is composed of the brain and spinal cord. The peripheral nervous system (PNS) is composed of spinal nerves that
branch from the spinal cord and cranial nerves that branch from the brain.

The brain is composed of the cerebrum, cerebellum, and brainstem.

● Cerebrum: is the largest part of the brain and is composed of right and left hemispheres. It performs higher
functions like interpreting touch, vision and hearing, as well as speech, reasoning, emotions, learning, and fine
control of movement.
● Cerebellum: is located under the cerebrum. Its function is to coordinate muscle movements, maintain posture,
and balance.
● Brainstem: acts as a relay center connecting the cerebrum and cerebellum to the spinal cord. It performs many
automatic functions such as breathing, heart rate, body temperature, wake and sleep cycles, digestion, sneezing,
coughing, vomiting, and swallowing.
Right and Left hemispheres

The cerebrum is divided into two halves: the right and left hemispheres. They are joined by a bundle of fibers called the
corpus callosum that transmits messages from one side to the other. Each hemisphere controls the opposite side of the body

Ventricles and cerebrospinal fluid

The brain has hollow fluid-filled cavities called ventricles. Inside the ventricles is a ribbon-like
structure called the choroid plexus that makes clear colorless cerebrospinal fluid (CSF). CSF
flows within and around the brain and spinal cord to help cushion it from injury. This
circulating fluid is constantly being absorbed and replenished. There are two ventricles deep
within the cerebral hemispheres called the lateral ventricles. They both connect with the third
ventricle through a separate opening called the foramen of Monro. The third ventricle connects
with the fourth ventricle through a long narrow tube called the aqueduct of Sylvius. From the fourth ventricle, CSF flows
into the subarachnoid space where it bathes and cushions the brain. CSF is recycled (or absorbed) by special structures in the
superior sagittal sinus called arachnoid villi.

A balance is maintained between the amount of CSF that is absorbed and the amount that is produced. A disruption or
blockage in the system can cause a build up of CSF, which can cause enlargement of the ventricles (hydrocephalus) or cause a
collection of fluid in the spinal cord (syringomyelia).

Cranial nerves
The brain communicates with the body through the spinal cord and twelve pairs of cranial nerves. Ten of the twelve pairs of
cranial nerves that control hearing, eye movement, facial sensations, taste, swallowing and movement of the face, neck,
shoulder and tongue muscles originate in the brainstem. The cranial nerves for smell and vision originate in the cerebrum.

● I (olfactory) smell.
● II (optic) sight
● III (oculomotor) moves eye, pupil
● IV ( trochlear) moves eye
● V ( trigeminal) face sensation
● VI (abducens) moves eye
● VII (facial) moves face, salivate
● VIII (vestibulocochlear) hearing, balance
● IX (glossopharyngeal) taste, swallow
● X (vagus) heart rate, digestion
● XI ( accessory) moves head
● XII (hypoglossal) moves tongue
 VIII. Review of Related Literature
Cerebellopontine angle (CPA) tumor is a triangular space located posterior to the pyramid, inferior to the tentorium, lateral to the pons, and
ventral to the cerebellum. It is formed by the superior and inferior limbs of the cerebellopontine fissure. The CPA is occupied by the CPA cistern, which
includes the trigeminal, abducent, facial, and vestibulocochlear nerves, the superior cerebellar and anterior inferior cerebellar arteries, the flocculus of
the cerebellum, and the choroid plexus that protrudes through the foramen of Luschka (Rhoton, 2000).The most common mass encountered in CPA is
vestibular schwannoma (VS). It represents up to 85–90% of tumors in this area followed by meningioma and schwannomas of other cranial nerves (VII
and V), so-called non-acoustic CPATs. (Zurek, Wojciechowski & Niemczyk) The optimal approach for a given patient depends on the tumor’s growth
pattern (e.g., the middle fossa approach is suboptimal for tumors with extensive growth in the CPA), the patient’s hearing status, the surgeon’s expertise
in a given approach, and the goals of the operation. CPA tumors are mostly benign, slow-growing tumors with low potential for malignancy (~1%). The
etiology of vestibular schwannoma remains unknown. However, there are two major types; Sporadic these are unilateral tumors and most commonly
present between the fourth and sixth decade of life. Those associated with neurofibromatosis (NF) type 2 the most common presentation is bilateral
acoustic neuromas in younger patients with a positive family history. NF2 results from a mutation at the chromosome 22q12. This mutation leads to an
increased risk of other intracranial tumors as well.
According to the central nervous system (CNS) tumors classification of the World Health Organization (WHO), a total of more than a hundred
and fifty types of tumors can be investigated that are generally characterized as primary and secondary tumors. The tumors originating from the brain
are regarded as primary tumors and are assigned their names from their source cell type. In the meantime, a secondary brain tumor originates from other
parts of the body. Unique biological, radiographic, and clinical characteristics are found to be associated with each of these tumors. A biopsy is a
commonly accepted standard process for classifying brain tumors, though it generally needs definitive brain surgery to take samples.
According to Biomedcentral Public health it stated that from 2011 to 2020 6,173 Polish adult patients were diagnosed with cerebellopontine
angle and internal acoustic meatus tumors. The average incidence in Poland is 1.99 per 100,000 residents/year. It mostly affects women (61.64%), and
the average age of patients is 53.78 years. The incidence has steadily increased over the past decade. Treatment has changed significantly over the years,
with a definite increase in the number of patients treated with radiotherapy (from 0.54 to 19.34%), and a decrease in surgical therapies (from 41.67 to
6.8%). The most common symptoms were vertigo and/or dizziness (43.48%) and sensorineural hearing loss (39.58%). 4.65% of patients suffered from
sudden deafness, in this group of patients the risk of CPAT detection was the highest (6.25 / 1000 patients).
According to the 2016 report of the World Health Organization (WHO), the global burden of disease for neurological disorders is growing at a
disproportionately increasing rate vis-à-vis the capacity of LMICs to cope. Specifically, the latest data reported an increase in age-standardised
incidence rates of the central nervous system (CNS) cancer globally by 17.3% as well as 227,000 deaths, which accounted for 7.7 million disability-
adjusted life-years (DALYs) between 1990 and 2016. In the Philippines, the burden of disease data in 2016 reported the following: a) incidence of 2,297
cases; b) 1,969 deaths and c) 82,021 DALYs. Based on a 2015 study that looked at the patient profile and outcomes of 262 cases of adult brain tumours
from the Philippine General Hospital (PGH), the biggest tertiary hospital in the Philippines, majority of patients were female with a mean age of 41.7
years and a mean symptom duration of 13.2 months. Meningioma, astrocytoma and glioblastoma (GBM) were the most common types. Treatment-wise,
56.5% had surgery, 13.1% had combination therapy and 17.6% had no intervention due to poor prognosis and no patient consent.
 IX. Medical Management
A. Laboratory Exams and Correlation

Table 1.1: Hematology

Date: 10-09-23

Examination Result Normal value Unit Implication

Hemoglobin 12 (L) (F) 12-14 gm% Low level of Hgb your body isn't getting
(M) 13-16 enough oxygen, making you feel very
tired and weak

Hematocrit 43.0 (F) 37-44 (M) 42-50 % WNL

WBC count 6.2 4.0-10 T WNL

RBC 5.42 (G) 3.5-5.5 /cumm WNL

(M) 4.3-6.0

Platelet count 229,000 150-450 T/cumm WNL

Neutrophil 54 (L) 55-70 % Low levels of neutrophils indicate that

your body can't fight off bacteria. Having
neutropenia increases your risk for many
types of infection.

Lymphocyte 38 (H) 20-35 % High lymphocyte count indicates an

increase in white blood cells.
Lymphocytes help fight off diseases.

Basophil 0 0-1 % WNL

Eosinophil 4 1-4 % WNL

Monocyte 4 1-6 % WNL

MCV 79.4 80-100 fL WNL

MCH 26.7 27-34 pg WNL

MCHC 33.7 32-36 g/dL WNL

Correlation: Cerebellopontine angle tumor (CPA) necessity for hematology laboratory testing can be helpful in ways to provide valuable information.
It shows that hemoglobin is low with a range of 12 gm%, neutrophil is low with a range of 54%. Lymphocytes show a high range of 38%.

Table 1.2: Chemistry

Date: 10-09-23

Examination Result Normal value Unit Implication

Creatinine 0.95 (F) 0.6-1.1 (M) 0.7-1.3 mg/dL WNL

BUN 14.3 7.9-20 mg/dL WNL

Sodium 141.2 135-145 mmol/L WNL

Potassium 4.12 3.5-5.0 mmol/L WNL

HBA1C 4.20 4.0-6.0 % WNL

Date: 10-09-23

Examination Result Normal value Unit Implication

Sodium 138.9 135-145 mmol/L WNL

Potassium 3.81 3.5-5.0 mmol/L WNL

Date: 10-16-23

Examination Result Normal value Unit Implication

Creatinine 0.92 0.64-1.00 mg/dL WNL

Albumin 4.3 (H) 3.5-4.0 g/dL High albumin levels are typically
the result of dehydration or severe
dehydration.

Date: 10-22-23

Examination Result Normal value Unit Implication

Sodium 137.00 135-145 mmol/L WNL

Potassium 4.10 3.5-5.0 mmol/L WNL

Correlation: Cerebellopontine angle tumor (CPA) necessity for chemistry laboratory testing can be helpful in ways to provide valuable information. It
only shows that albumin is a high range of 4.3 g/dL.
BLOOD GAS
10/19/23
Examination Result Normal value Unit Implication
pH 7.35 7.35-7.45 mmHg WNL
PaCO2 26.60 (L) 25-45 mmHg Low indicating a respiratory
alkalosis
PO2 377.00 (H) 75-100 mmHg High PO2 means that it
increased oxygen levels in
the inhaled air
Bicarbonate 14.60 (L) 22-29 mEq/L Low bicarbonate levels in
the blood are a sign of
metabolic acidosis

Correlation: Patient Blood gas shows that PaCO2 is low (26.60), PO2 is high (377) and bicarbonate is low (L).
Date of procedure: 8/23/2023
Report Date: 8/28/2023
Magnetic Resonance Imaging Report

Brain MRI with contrast

History: Loss of balance

Comparison: None
Technique: Multiplanar and multisequential MR scan of the head were obtained without and with contrast.

Findings: There is a complex, extra-axial mass in the left side of the posterior fossa partially extending to the left jugular foramen, measuring 3.9 x 3.9
x 3.5 cm (cc x w x AP). There is associated mass effect, with the tumor compressing the pons, medulla and anterior left cerebellar hemisphere, where
there is a small focus of increased T2/FLAIR signal in keeping with edema. The 4th ventricle is likewise compressed and distorted, with resultant
dilation of the lateral ventricles. The lesions shows heterogeneous enhancement, with high T2 signal foci, likely cystic components and some foci of
increased susceptibility likely representing hemorrhagic foci. The internal auditory canal is not widened.
There are few punctate signal abnormalities involving the frontal lobe white matter bilaterally. There is no evidence of an acute parenchymal infarct or
hemorrhage or mass. The sella and suprasellar regions are normal.
Post-contrast study shows no other abnormal parenchymal or leptomeningeal enhancement identified.

Impression: Complex, heterogeneously enhancing mass in the left posterior fossa region partially extending to the left jugular foramen with mass effect
and resultant obstructive hydrocephalus as detailed above. Consider nerve sheath tumor.
Chronic small vessel ischemic changes.
B. Treatment Modalities

Table 1.3

DATE PHYSICIAN’S ORDER RATIONALE

10/15/23 - Please admit pt. to surgery under the service of - To provide patient care.
Dr. D

- Secure consent to care. - Informed consent is a collaborative process

allowing patients and healthcare providers to make
decisions together when more than one is
reasonable.

- DAT then NPO 8 hrs prior to procedure. - Pt. is diet as tolerated but nothing per orem for 8
hrs before procedure.

- STAT IVF PNSS L @ 10 gtts/min. - It is a crystalloid fluid administered via an

intravenous solution. Its indications include both
adult and pediatric populations as sources of
hydration and electrolyte disturbances.

- Attach labs to chart. - To know the laboratory results of the patient.

Medication:
- Omeprazole 40 mg IVTT OD dose once on - Prevent vomiting to ensure that vit. B12 will not
NPO (for craniotomy on 10/19/23) be passed within the body through vomit.

- Secure consent for procedure - To inform pt. in any invasive or non-invasive

- Inform OR and Anesthesia procedure.

- Monitor V/S and I&O q shift. - To obtain baseline data.

10/16/23 - DAT
Medication:
- Paracetamol 650 mg + Orphenadrine 50 mg - To help relieve headache and pain.
 Labs: - To look for changes in pt. health. It also help
- CBC, Blood typing, protein, Na, K doctors diagnose medical conditions, plan or

evaluate treatments, and monitor diseases

10/17/23 - For the left retrosigmoid cavity, exercise twice - To assess lesions in the posterior fossa of the
on Thursday. brain, including the cerebellopontine angle.

10/18/23 - NPO - To prepare patient before surgery.

- STAT IVF PNSS 1L @ 30gtts/min.

Medication:
- Omeprazole 40 mg IVTT OD - Prevent vomiting to ensure that vit. B12 will not
be passed within the body through vomit.
- Dexamethasone 50 mg IVTT q8 - It reduces swelling and allergic reactions in
various conditions, such as arthritis, cancer, and
rheumatoid arthritis.

4 PM Anesthesia Pre-OP orders: - It is a fasting required before a medical or surgical

- NPO post midnight procedure to lower risk of aspiration pneumonia.
- Plan: GETA w/ planned delayed extubation and
SICU admission.
- Please inform SICU OF post-op admission.

Compression:
- Stockings on route to OR - To improve blood flow in the veins of your legs.
This helps prevent leg swelling and, to a lesser
extent, blood clots.

- Insert bloodline and hook to PNSS 1L @ KVO

Pre-Op Meds.:
- Tranexamic acid 1 gm IV @ 6 am
- Metoclopramide 10 mg IV @ 6 am
- Paracetamol 600 mg IV @ 6 am
- Hydrocortisone 100mg IV @ 6 am
- Slowing the breakdown of blood clots, which
helps to prevent prolonged bleeding.
- Used to treat the symptoms of slow stomach
emptying.
- To relieved pain and headache.
- To treat many different conditions, including
allergic disorders, skin condition.

- Wheel-in to OR @ 7 am

- Full body & oral hygiene prior to transfer to OR. - Help to reduce the risk for infection and any further
complications.

Anesthesia Post-op orders:

- To SICU - To provide close monitoring of the patient.
- O2 inhalation @ 5 pm via ambu bagging than - To provide immediate and controlled positive pressure
hook mech vent. ventilation.

- Monitor V/S q 15 min. X 1 hr then q hourly. - To provide baseline data.

- Mech vent setting: AC mode - To support respiratory function, ensure adequate

TV: 400 FiO2: 100% oxygenation and maintain proper levels of carbon
BUR: 16 PEEP: 5 dioxide in the blood.

- Monitor neuro vital signs q hourly. - To provide early detention or chaanges of patient and
ensuring optimal care.
- Monitor UO q shift. - To assess renal function, fluid balance and overall
status of pt.
- NPO except meds. - To prevent complications related to anesthesia, protect
the airway and support the pt. Overall recovery.

- IVF: L PNSS @ 30gtts/min - To provide electrolyte balance, fluid resuscitation and

- R PNSS @ 10gtts/min. nutrient administration.
Medications:
- Paracetamol 600 mg IV q 4hrs x 2 doses then q
6 hrs
- Tramadol 50mg IV q8h
- Ketorolac 30mg IV q 6h x 3 dose
- Omeprazole 40mg IV OD
- Metoclopramide 10mg IV q8h x 3 dose
- Tranexamic acid 500mg IV x 3 dose
- Levetiracetam 500mg in 90 cc PNSS to run for
15 min. q 12 hrs.
- Ceftriaxone 2gm IV q12h
- Cerebrolysin 1 amp slow IV q8h
- Dexamethasone 5mg IV q8h
- Repeat CT scan, brain, plan in am
- Elevate head of 30 degrees.
- Please inform Dr. A for post-op
- ABG 30 mins post-hooking to mech vent.
- To relieve pain and headache.
- It works in the brain to change how your body
feels and responds to pain.
- Used for the short-term treatment of moderate to
severe pain.
- Prevent vomiting to ensure that vit. B12 will not
be passed within the body through vomit.
- Used to treat the symptoms of slow stomach
emptying.
- Helps to prevent prolonged bleeding.
- To treat certain types of seizures in people with
epilepsy.
- To treat meningitis, typhoid, pneumonia, otitis
media.
- Used for the treatment of cerebral disorders,
cranial injuries.
- It reduces swelling and allergic reactions in
various conditions, such as arthritis, cancer, and
rheumatoid arthritis.
- To know the patient's health outcome.
- To minimize the risk of elevated ICP in the hopes
of decreasing cerebral blood and fluid volume and
increasing cerebral venous outflow with
improvement in jugular venous drainage.
- To provide immediate and controlled positive pressure
ventilation.
 - May remove compression stocking for 1 hr & - To improve blood flow in the veins of your legs.
reapply. This helps prevent leg swelling and, to a lesser
extent, blood clots.

10/19/23 Medication:
2:30 pm - NAC neb q12
- Salbutamol + Ipratropium neb q6 - Relief of severe bronchospasm

- FBS q6 while NPO - To assess the conditions related to hypoglycemia

or hyperglycemia.

- Chest x-ray AP post-op as under by DR. A. - Useful for monitoring your recovery after you've
had surgery

5:45 pm - Shift MV to SIMV mode, decreased EiO2 to - SIMV used has to dropped off precipitously in current
40%. critical care patient.

7:16 pm - ⬇ Salbutamol + Ipratropium neb to q8 - Relief of severe bronchospasm

- Discontinue NAC also

9:40 pm - Sodium Bicarbonate 50 mEq IVTT q6 x 2 -

doses.

10/20/23 For transport to ward

6:30 am - Soft diet - Patients should eat a soft diet first to prevent
complications and promote healing.
- Removed FBC
- Patient is able to urinate without difficulty in urination.

9:12 am - Shift Levetiracetam 500mg 1 tab BID
- D/C tramadol
- Shift Omeprazole to 50 mg OD
- D/C O2 as ordered by Dr. D.
- To treat certain types of seizures in people with
epilepsy.
- Prevent vomiting to ensure that vit. B12 will not
be passed within the body through vomit.

10/21/23 - D/C Salbutamol + Ipratropium neb - Patient shows no difficulty in breathing.

7:30 am
 - ⬇ Dexamethasone to 5mg IV q12 - It reduces swelling and allergic reactions in
2:35 pm
various conditions, such as arthritis, cancer, and
rheumatoid arthritis.

10/22/23 - Ensure gold plus HMB: 4 scoops in 1 glass of - High quality triple protein and Vitamin D3, and is
H20 OD. clinically proven to support strength, energy, and
immunity.
Medication:
- Lactulose (Peptoburg) 30 ml OD q 9pm (Hold - To treat constipation.
for BMI>2 x 1 day)
- Alanerv cap q cap OD - Uses Food supplement w/ antioxidant effect on
free radicals, w/ action on cell tropism & helps
protect the nervous cells.
- If still no BM tomorrow give Dulcolax supp 1 - To treat constipation or to empty the bowels
supp per rectum. before surgery.

- Rpt CBC, Na, K today - To obtain pt. changes in health. It also help doctors
diagnose medical conditions, plan or evaluate

treatments, and monitor diseases

- DAT - Pt. is able to eat any food as long as he can tolerate it.
- Wound care done. - Prevent infection and accelerate the healing
process with less scarring.

10/23/23 Medication: - It reduces swelling and allergic reactions in

- ⬇ Dexamethasone to 5mg IV q OD x 2 days various conditions, such as arthritis, cancer, and
rheumatoid arthritis.
then D/C
- To treat constipation.
- Lactulose 30 ml OD q 9pm (Hold for BMI>2 x
1 day)
- Orathex oral gargle 5 ml for 10-20 sec TID (spit - It is used for antisepsis of clean and surgical hands
it out). to prevent infections.
- To consume due then shit to heplock. - To treat meningitis, typhoid, pneumonia.
- Complete Ceftriaxone 50 x 7 days then shift to
Cefpodoxime (Podoxi) 200 mg tab BID PO.
10/25/23 - Shift to heplock - Patient used for continuous and intermittent short-
- MGH in am term IV therapy.
- Ordered to May go home, because of patient
health improvement but still need to monitor or
out-patient.

Medication:
- Paracetamol 650 g - To relieve pain and headache.
- NeuroAid 2 tabs BID to complete 3 months

10/26/23 - No objection for discharge.

In home med.
- Cefpodoxime (Podoxi) 200 mg tab BID PO x - It is used to treat various bacterial infections.
7 days

- Follow up check up 2 weeks after discharge - To monitor pt. Health and also for any health
Negros Polymedic Hospital. complication.
C. Drug Study

Generic Name: Omeprazole

Brand Name: Prilosec, and Prilosec OTC
Classification: GASTROINTESTINAL AGENT; PROTON PUMP INHIBITOR
Indications: An antisecretory compound that is a gastric acid pump inhibitor.
Contraindications: Long-term use for gastroesophageal reflux disease (GERD), duodenal ulcers; proton pump inhibitors (PPIs), hypersensitivity;
children <2 y; use of OTC formulation in children <18 y or GI bleeding; pregnancy (category C); use of Zegerid in metabolic alkalosis, hypocalcemia,
vomiting, GI bleeding.
Cautious Use: Dysphagia; metabolic or respiratory alkalosis; lactation.
Adverse Effects:
CNS: Headache, dizziness, fatigue. GI: Diarrhea, abdominal pain, nausea, mild transient increases in liver function tests. Urogenital: Hematuria,
proteinuria. Skin: Rash.
Nursing Implications/Responsibilities:
● Lab tests: Monitor urinalysis for hematuria and proteinuria. Periodic liver function tests with prolonged use.
● Report any changes in urinary elimination such as pain or discomfort associated with urination, or blood in urine.
● Report severe diarrhea; drug may need to be discontinued.
● Do not breast feed while taking this drug.

Generic Name: Paracetamol

Brand Name: Dymadon®, Lemsip®, Panadol®, Panamax®, Tylenol®
Classification: Non-opioid analgesic
Indications: Indicated for the relief of mild to moderate pain and fever and pain.
Contraindications: Hypersensitivity; Hepatic or Renal disease
Cautious Use: Children <3 y unless directed by a physician; repeated administration to patients with anemia or hepatic disease; arthritic or rheumatoid
conditions affecting children <12 y; alcoholism; malnutrition; thrombocytopenia. Safety during pregnancy (category B) or lactation is not established.

Adverse Effects:
CNS: agitation, anxiety, headache, fatigue, insomnia Respiratory: atelectasis, dyspnea CV: hypertension, hypotension GI: hepatotoxicity, constipation,
increased liver enzymes, nausea, vomiting F & E: hypokalemia GU: renal failure Hemat: neutropenia, pancytopenia MS: muscle spasms, trismus Derm:
acute generalized exanthematous pustulosis, steven-johnson syndrome, toxic epidermal necrolysis
Nursing Implications/Responsibilities:
● Assess the patient’s pain level before administering the medication.
● Assess overall health status and alcohol usage before administering
● Monitor the patient’s response to the medication.
● Assess the patient’s allergies and previous reactions to medications before administering
● Assess fever; note the presence of associated signs (diaphoresis, tachycardia, and malaise).

Generic Name: Dexamethasone

Brand Name: Decadron, Dexamethasone Intensol, Dexasone, Solurex, and Baycadron
Classification: HORMONES AND SYNTHETIC SUBSTITUTES, ADRENAL CORTICOSTEROID; GLUCOCORTICOID; STEROID
Indications: Long-acting synthetic adrenocorticoid with intense antiinflammatory (glucocorticoid) activity and minimal mineralocorticoid activity.
Contraindications: Systemic fungal infection, acute infections, active or resting tuberculosis, vaccinia, varicella, administration of live virus vaccines
(to patient, family members), latent or active amebiasis.
Cautious Use: Stromal herpes simplex, keratitis, GI ulceration, renal disease, diabetes mellitus, hypothyroidism, myasthenia gravis, CHF, cirrhosis,
psychic disorders, seizures.
Adverse Effects: CNS: Euphoria, insomnia, convulsions, increased ICP, vertigo, headache, psychic disturbances. CV: CHF, hypertension, edema.
Endocrine: Menstrual irregularities, hyperglycemia; cushingoid state; growth suppression in children; hirsutism. Special Senses: Posterior subcapsular
cataract, increased IOP, glaucoma, exophthalmos. GI: Peptic ulcer with possible perforation, abdominal distension, nausea, increased appetite, heartburn,
dyspepsia, pancreatitis, bowel perforation, oral candidiasis. Musculoskeletal: Muscle weakness, loss of muscle mass, vertebral compression fracture,
pathologic fracture of long bones, tendon rupture. Skin: Acne, impaired wound healing, petechiae, ecchymoses, diaphoresis, allergic dermatitis, hypo- or
hyperpigmentation, SC and cutaneous atrophy, burning and tingling in perineal area (following IV injection).
Nursing Implications/Responsibilities:
● Monitor for S&S of a hypersensitivity reaction.
● Report changes in appearance and easy bruising to physicians.
● Add potassium-rich foods to diet; report signs of hypokalemia.
● Discontinue drugs gradually under the guidance of the physician.
● Do not breast feed while taking this drug without consulting a physician.
● Keep appointments for checkups; make sure electrolytes and BP are evaluated during therapy at regular intervals.
● Take drugs exactly as prescribed.
Generic Name: Orphenadrine
Brand Name: Norflex and Norgesic
Classification: SOMATIC NERVOUS SYSTEM AGENT; SKELETAL MUSCLE RELAXANT; CENTRAL-ACTING
Indications: To relieve muscle spasm discomfort associated with acute musculoskeletal conditions.
Contraindications: Narrow-angle glaucoma; pyloric or duodenal obstruction, stenosing peptic ulcers; prostatic hypertrophy or bladder neck obstruction;
myasthenia gravis; cardiospasm (megaloesophagus). Safe use during pregnancy (category C), lactation, or in the pediatric age group is not established.
Cautious Use: History of tachycardia, cardiac decompensation, arrhythmias, coronary insufficiency.
Adverse Effects:
CNS: Drowsiness, weakness, headache, dizziness; mild CNS stimulation (high doses: restlessness, anxiety, tremors, confusion, hallucinations, agitation,
tachycardia, palpitation, syncope). Special Senses: Increased ocular tension, dilated pupils, blurred vision. GI: Dry mouth, nausea, vomiting, abdominal
cramps, constipation. Urogenital: Urinary hesitancy or retention. Body as a Whole: Hypersensitivity [pruritus, urticaria, rash, anaphylactic reaction
(rare)].
Nursing Implications/Responsibilities:
● Report complaints of mouth dryness, urinary hesitancy or retention, headache, tremors, GI problems, palpitation, or rapid pulse to physician.
● Monitor therapeutic drug effects and monitor elimination patterns.
● Do not drive or engage in potentially hazardous activities until response to drugs is known.
● Avoid concomitant use of alcohol and other CNS depressants; these may potentiate depressant effects.
● Do not breast feed while taking this drug without consulting a physician.

Generic name: Tramadol

Brand name: Ultram

Classification: OPIOIDS (NARCOTIC ANALGESIC)

Indication: Tramadol belongs to a class of drugs known as opioid analgesics. It works in the brain to change how your body feels and responds to pain.

Contraindication: History of head injury, epilepsy or other seizure disorder, drug or alcohol addiction, metabolic disorder, using certain medicines to
treat migraine, headaches, muscle spasms, depression, mental illness, nausea and vomiting, severe asthma or breathing problems, blockage in stomach
or intestines, recently used alcohol, sedatives, tranquilizers or narcotic medications.

Cautious use: Seizures have been reported in patients taking tramadol. Your risk of seizures is higher if you are taking higher doses than recommended.
Seizure risk is also higher in those with a seizure disorder or those taking certain antidepressants or opioid medications.
Tramadol should not be used if you are suicidal or prone to addiction.
Adverse effects:

Nausea, Vomiting, Constipation, Dizziness and Headache.

Nursing Implications/Responsibilities:

● Assess patient for any allergies and the medical history of the patient.
● You should not breastfeed while taking tramadol.
● Instruct patient not to drink alcohol, take prescription or nonprescription medications that contain alcohol, or use street drugs during your
treatment.
● Instruct the patient if you are taking the tramadol extended-release tablet or capsule, swallow them whole; do not chew, break, divide, crush, or
dissolve them.
● Educate the patient to take tramadol exactly as directed. Do not take more of it, take it more often, or take it in a different way than directed by
your doctor.

Generic name: Ceftriaxone

Brand name: Rocephin
Classification: THIRD GENERATION CEPHALOSPORIN ANTIBIOTIC.
Indication: Meningitis, typhoid, pneumonia, otitis media, pyelonephritis, pelvic infection, septicaemia and gonococcal infections.
Contraindication: Ceftriaxone is contraindicated inpatients with known allergy to the cephalosporin group of antibiotics.
Cautious use: History of kidney or liver disease.
Drug action: Inhibits bacterial cell-wall synthesis causing cell lysis; bactericidal effect.
Adversed effects: Nausea, dyspepsia, stomatitis, vomiting, diarrhea, abdominal cramps, flatulence, rash, flushing, diaphoresis, fever, pruritus,
headaches, dizziness, edema, injection site reaction, epistaxis, chills,
Nursing Implications/Responsibilities:
● Ask patient for any allergies, particularly cephalosporins, penicillins.
● Monitor patient I & O.
● Be alert for super infection: fever, vomiting, diarrhea, anal/genital pruritus, oral mucosal changes (ulceration, pain erythema).
● Observe patient for any side effects.
● Instruct SO to report any signs of bleeding.
Generic name: Salbutamol
Brand Name: Multivent
Classification: BRONCHODILATORS
Indication: Relief of severe bronchospasm Hyperkalemia
Contraindication: Patients with a history of hypersensitivity to any of its components.
Cautiou use: Caution should be exercised in patients with a history of heart problems, high blood pressure, diabetes, low levels of potassium in the

● Assess patient for any allergies and the medical history of the patient.
● You should not breastfeed while taking tramadol.
● Instruct patient not to drink alcohol, take prescription or nonprescription medications that contain alcohol, or use street drugs during your
treatment.
● Instruct the patient if you are taking the tramadol extended-release tablet or capsule, swallow them whole; do not chew, break, divide, crush, or
dissolve them.
● Educate the patient to take tramadol exactly as directed. Do not take more of it, take it more often, or take it in a different way than directed by
your doctor.

Generic name: Ceftriaxone

Brand name: Rocephin
Classification: THIRD GENERATION CEPHALOSPORIN ANTIBIOTIC.
Indication: Meningitis, typhoid, pneumonia, otitis media, pyelonephritis, pelvic infection, septicaemia and gonococcal infections.
Contraindication: Ceftriaxone is contraindicated inpatients with known allergy to the cephalosporin group of antibiotics.
Cautious use: History of kidney or liver disease.
Drug action: Inhibits bacterial cell-wall synthesis causing cell lysis; bactericidal effect.
Adversed effects: Nausea, dyspepsia, stomatitis, vomiting, diarrhea, abdominal cramps, flatulence, rash, flushing, diaphoresis, fever, pruritus,
headaches, dizziness, edema, injection site reaction, epistaxis, chills,
Nursing Implications/Responsibilities:
● Ask patient for any allergies, particularly cephalosporins, penicillins.
● Monitor patient I & O.
● Be alert for super infection: fever, vomiting, diarrhea, anal/genital pruritus, oral mucosal changes (ulceration, pain erythema).
● Observe patient for any side effects.
● Instruct SO to report any signs of bleeding.
Generic name:Ketorolac
Brand name: Toradol
Classification: NONSTEROIDAL ANTI-INFLAMMATORY DRUGS ( NSAIDs)
Indications: Ketorolac is used for the short-term treatment of moderate to severe pain in adults, It works by blocking your body's production of certain
natural substances that cause inflammation. This effect helps to decrease swelling, pain, or fever.Ketorolac should not be used for mild or long-term
painful conditions
Contraindications: Patients at risk for renal failure due to volume depletion or dehydration.
Cautious use: Peptic ulcers, gastrointestinal bleeding and/or perforation of the stomach or intestines
Adverse Effects: Upset stomach, nausea, vomiting, constipation, diarrhea, and gas.
Nursing Implications/Responsibilities:
● Monitor signs of allergic reactions and anaphylaxis.
● Monitor signs of GI bleeding, including abdominal pain, vomiting blood, blood in stools, or black, tarry stools.
● Report these signs to the physician immediately.
● Assess blood pressure (BP) periodically and compare to normal values

Generic name: Metoclopramide

Brand name: Reglan
Classification: ANTIEMETICS AND PROKINETICS
Indication:Metoclopramide is used to treat the symptoms of slow stomach emptying (gastroparesis) in patients with diabetes. It works by increasing the
movements or contractions of the stomach and intestines.
Contraindication: Known hypersensitivity to metoclopramide
Cautious use: Do not use this medicine if you've ever had muscle movement problems after using metoclopramide or similar medicines.
Adverse Effects: Nausea, vomiting, heartburn, a feeling of fullness after meals, and loss of appetite.
Nursing Implications/Responsibilities:
● Monitor diabetic patients, arrange for alteration in insulin dose or timing if diabetic control is compromised by alterations in timing of food
absorption.
● Monitor BP carefully during IV administration.
Generic name: Cerebrolysin
Brand name: Cerebroprotein Hydrolysate
Classification: NEUROPEPTIDE
Indication: It is used for the treatment of cerebral disorders, cranial injuries, Alzheimer's disease, and various form of dementia. This medicine is not
recommended for use in patients suffering from epilepsy and in patient's suffering from severe renal impairment.
Contraindications: It can be described as a special circumstance or a disease or a condition wherein you are not supposed to use the drug or undergo
particular treatment as it can harm the patient.
Cautious use: There is limited information available on the use of Cerebrolysin Injection in patients with kidney disease. Please consult your doctor.
Adverse effect: Headache, Nausea, Vertigo, Sweating, Agitation, Fever, Anxiety, Hallucination, Confusion and Flu-like symptoms.
Nursing Implication/ Responsibilities:
● Regularly assess patient neurological status, including cognitive function, motor skills and vital signs.
● Monitor for any signs of adverse reactions such as allergic, fever,or changes in mental status.
● Administered medication as prescribed dosage and schedule by physician.
● Educate patient and significant others the purpose of this medication, potential side effects and importance of aghering to the prescribed
treatment plan.

Generic name: Chlorhexidine gluconate

Brand name: Orahex
Classification: CETYLPYRIDINIUM CHORIDE
Indication: It indicates dental problems, gingivitis treatment, periodontitis maintenance, plaque reduction and also oral hygiene in critical care. Also it
is used for antisepsis of clean and surgical hand to prevent infections
Contraindication: Hypersensitivity
Cautious use:Keep away from the reach of children. If the solution comes in contact with your eyes, wash your eyes with water immediately. Keep
away from light and keep at room temperature. Keep away from combustible material and fire
Adverse effect: Skin sensitivity; mucosal irritation; reversible brown staining of the teeth; tongue discoloration and burning sensation; transient taste
disturbance; parotid gland swelling.
Nursing Implication/ Responsibilities:
● Instruct and assist the patient in proper oral hygiene practices.
● Administered orahex according to prescribed dosage and schedule.
● Monitor patient for any adverse effect such as allergic reactions or irritations of the oral mucosa.
 ● Educate patient the importance of maintaining good oral hygiene.

Generic name: Cefpodoxime

Brand name: Vantin
Classification: THIRD GENERATION CEPHALOSPORIN ANTIBIOTIC
Indication: It is used to treat various bacterial infections.
Contraindication: Contraindicated to hypersensitivity and renal impairment.
Adverse effect: Nausea, skin rash, leukopenia, thrombocytopenia, dizziness and renal effects.
Nursing Implication/ Responsibilities:
● Administered cefpodoxime according to prescribed dosage and schedule.
● Monitor patient for any adverse effect such as allergic reactions.
● Educate patient the importance of completing the full course of antibiotics even if the symptoms improve before the medication is finished.
● Encourage patient to adequate fluid intake to support hydration and help with the elimination of the antibiotic from the body.
Generic name: Lactulose
Brand name: Duphalac
Classification: OSMOTIC LAXATIVE
Indication: To treat constipation. Help draw water into the colon, softening stools and promoting bowel movements.
Contraindication: To intestinal obstruction,hypersensitivity, diabetes and unconsciousness.
Cautious use: Diabetes, Hepatic impairment, dehydration
Adverse effect: Severe diarrhea may cause dehydration electrolyte imbalance.
Nursing Implication/ Responsibilities:
● Assess pt. Usual stool pattern, frequently, characteristics.
● Conduct neurological exam in pt. With elevated serum ammonia levels.
● Encourage adequate fluid intake
● Assess bowel sounds for peristalsis.

Generic name: Tranexamic acid

Brand name: Adrenex
Classification: ANTIFIBRINOLYTICS
Indication: Slowing the breakdown of blood clots, which helps to prevent prolonged bleeding.
Contraindication: Hypersensitivity to tranexamic acid, active thromboembolic disease.
Cautious use: Severe allergic reactions reported; anaphylactic shock reported w/ IV product.
Adverse effect: Difficulty in breathing, swelling on the face, lips, tongue or throat, problems with vision and confusion.
Nursing Implication/ Responsibilities:
● Monitor BP, PR and RR status as indicated by bleeding.
● Monitor the site closely and any signs of bleeding.
● Instruct pt. to notify the health care provider if there's a presence of bleeding.
● Instruct pt. To make position changes to avoid orthostatic hypotension.
Generic name: Alpha lipoic acid
Brand name: Alanerv
Classification: NUTRITION SUPPLEMENT
Indication: Uses Food supplement w/ antioxidant effect on free radicals, w/ action on cell tropism & helps protect the nervous cells.
Contraindication: Hypersensitivity
Cautious use: History of renal and hepatic impairment.
Adverse effect: Allergic reaction, GI discomfort, hypersensitivity and dizziness.

Nursing Implication/ Responsibilities:

● Conduct thorough assessment including medical history, allergies and current medications to identify any contraindication or potential
interactions.
● Monitor pt. Any signs of adverse effect such as allergies, GI disturbance and changes in v/s.
● Administered at the prescribed dosage.
● Educate pt. the purpose of alanerv.
Generic name: Bisacodyl
Brand name: Dulcolax
Classification: LAXATIVE
Indication: To treat constipation or to empty the bowels before surgery, colonoscopy, x-rays, or other intestinal medical procedure.
Contraindication:
Cautious use:
Adverse effect: Stomach pain or discomfort; feeling light-headed; or rectal burning.
Nursing Implication/ Responsibilities:
 ● Assess pt. bowel function pattern, frequently, characteristics.
● Educate pt. the proper use of dulcolax
● Monitor pt. Signs of laxative dependence or misuse.
● Encourage pt. to adequate fluid intake while using dulcolax.
● Monitor pt. for abdominal discomfort, cramps, or diarrhea.

Generic name: Levetiracetam

Brand name: Keppra
Classification: ANTICONVULSANTS
Indication: To treat certain types of seizures in people with epilepsy, including partial onset seizures, myoclonic seizures, and tonic-clonic seizures.
Contraindication: Hypersensitivity, Caution if pregnancy, renal impairment or psychiatric disorder
Cautious use: Depression, history of hypertension, or mental illness, history of, as it may make these conditions worse
Adverse effect: Aggressive or angry anxiety change, Bloody nose burning, crawling, itching, numbness, prickling.
Nursing Implication/ Responsibilities:
● Monitor for suicidal thoughts, dizziness, weakness, somnolence, and liver function changes.
● Do not drive or engage in potentially hazardous activities until response to drugs is known.
● Do not abruptly discontinue drugs. Use gradual dose reduction/taper.
● Notify the physician of the intention to become pregnant.
● Do not breast feed while taking this drug without consulting a physician.
Generic name: Hydrocortisone
Brand name: Cortef Classification:
Glucocorticoids
Indication: To treat many different conditions, including allergic disorders, skin condition, ulcerative colitis, arthritis, lupus, lung disorders, and certain
blood cell disorders such as anemia (low red blood cells) or thrombocytopenia (low platelets).
Contraindication: Heart disease, high blood pressure, tuberculosis; kidney disease; cirrhosis;a thyroid disorder; low bone mineral density
(osteoporosis); stomach ulcers, ulcerative colitis, and diabetes.
Cautious use: use hydrocortisone if you are allergic to hydrocortisone, corticosteroids, or if you have a systemic fungal infection.
Adverse effect: blurred vision, eye pain or redness, seeing halos around lights; muscle weakness, loss of muscle mass; new or unusual pain in your
joints, bones, or muscles; severe headaches, ringing in your ears, pain behind your eyes; unusual changes in mood or behavior; a seizure.
Nursing Implication/ Responsibilities:
● Monitor pt. Vital signs.
 ● Assess for any sign of adrenal insufficiency
● Educate pt. About the medication adherance.
● Closely observe for any potential side effects.

Generic name: Sodium Bicarbonate

Brand name: Sodium Bicarbonate
Indication: Management of metabolic acidosis, gastric hyperacidity. Dissociates provide bicarbonate ion.
Contraindication: Hypersensitivity or allergy to sodium bicarbonate or its components, Metabolic or respiratory alkalosis, Hypocalcemia, Excessive
chloride loss from vomiting or GI suctioning and Hypercarbic acidosis.
Cautious use: History of kidney disease.
Side effects: Abdominal distention, flatulence, belching.
Nursing Implication/ Responsibilities:
● Monitor serum, urinary pH, CO2 level, serum electrolytes, plasma bicarbonate levels.
● Monitor for metabolic alkalosis, fluid overload.
● Assess for clinical improvement of metabolic acidosis (relief from hyperventilation, weakness, disorientation).
● Monitor serum phosphate, calcium, uric acid levels. Assess for relief of gastric distress
D. Concept Map
Nursing Management
A. Nursing History
1. Family History with Genogram
Implication: The patient’s or paternal side, his mother has a disease of hypertension, while on the maternal side or his wife side, her mother is paralysed
and his father dies because of tuberculosis.
2. Psychosocial History
- Patient C. B.P. 47 yrs. old, lives in an extended family together with his wife, childrens and sister. The patient's sister is the one who takes care
of him during the admission of the patient. His wife is the one looking for financial obligations because of his health, but previously he worked 3
years at URC as a supervisor. While their childrens are still studying.

3. Environmental History
- The patient lives in Masaplod Norte, Dauin Negros Oriental, but currently lived with his sister at Sibulan Negros Oriental. Patient lived in a safe
environment. He is living in an area where it is not exposed to hazardous or toxic substances.

4. Spiritual History
- Patient is a Roman Catholic. Patient religion is important to him because he has a strong faith and hope. He stated that during difficulties it helps
him and also to his family because he stated that "God, can do anything possible, and I know he has a good plan for me".
B. Physical Assessment
General Survey: Patient awake, alert and coherent on time, with IV fluid PNSS 1L @ 10gtts/min consumed well @ L metacarpal vein.Well groomed
and no usual body odor, appearance tired and exhausted. Patient is diet as tolerated and has a poor appetite, presence of dryness of skin also shown a
presence of sunken eyes and dryness of mucous membrane. Patient vital sign, Temperature 36.6 ℃, Respiratory 14 cpm, Pulse rate 73 bpm, O2Sat 98%
and Blood pressure 130/90 mmHg.

Age: 47 yrs. old

Gender: Male Height:
165 cm
Weight: 64 kg
Neurological:
- Patient is awake, oriented to time and place, able to respond during the assessment. Unaided sight. Pupils are equal, round, reactive to light.
Patient had a hearing loss in his left ear. Patient is able to perform hand grips and foot pushes. Patient cranial nerve affects only the VII with he
had a hearing loss in his left ear and before admission shows a loss of balance. Patient pain using the pain scale he stated 7/10 because his onset
of pain is recurring.
GLASCOW COMA SCALE: After his operation on 10/20/23 his eyes open first is none with a score of 1/4 then in 3 hours his eyes open
spontaneously with a score of 4/4, his verbal response within 7 hours it shows absence with a score of 1/4 but then within 8 hours patient is confused
with a score of 4/5 and for his motor response within 3 hours patient shows withdrawal to pain with a score of 4/6 then for 7 hours of assessment patient
obeye simple command with a score of 6/6.
Musculoskeletal:
- Patient mobility activity daily living is independent, he can able to turn, sit, dangle and stand without the help or assistance, but after his surgery
the patient need some assistance. No muscle treatment like fractures. No presence of nail clubbing. Patient capillary refill is not normal (3 sec.).
- After his surgery patient extremities for his right arms it scored none with a score of 1/4 and then it progressed to 2/4 which marked weakness
and then it progressed to 3/4 of SI weakness. For his left arm it scored 2/4 which marked weakness and then progress to SI weakness score of 3/4
. His R leg score 1/1 which is none then it progresses to 3/4 SI weakness. For his L leg it shows none with a score of 1/4 , then progresses
to 2/4 which marks weakness after that it progresses to 3/4 SI weakness.
Integumentary:
- Patient skin color is brown, there is no presence of bruises in the injected site, skin is normal in color, no lumps and it shows the presence of dry
skin. Patient is hair is black in color, no dandruff, normal. No lesions, no signs of infection, no problem of smelling Patient is warm upon
palpation. Surgery site RLQ for craniotomy.
C. Nursing Theory

Lydia Hall
Lydia Hall theory contains three independent but interconnected circles: “the care” which focuses on performing the task and nurturing patients, which
may include comfort measures, patient instruction, and helping the patient meet his or her needs when help is needed. “The cure” which explains that
the nurse shares the cure circle with other health professionals, such as physicians, these are interventions geared toward treating the patient whatever
illness they are suffering for. “The core” is the patient receiving nursing care, the core has goals set by him or herself.

In conjunction with the patient’s condition, care provided focused on giving comfort measures and collaborative interventions to promote the
patient's well-being. Nurses should use counselling techniques on how to adapt to the present situation and learn how to cope with it.

Erik Erikson
Erikson’s theory described the impact of social experience across the whole lifespan. He was interested in how social interaction and relationships
played a role in the developmental and growth of human beings. Each stage in Erikson’s theory (Trust vs. Mistrust, Autonomy vs. Shame and Doubt,
Initiative vs. Guilt, Industry vs. Inferiority, Identity vs. Role Confusion, Intimacy vs. Isolation, Generativity vs. Stagnation, Ego Integrity vs. Despair)
are concerned with becoming competent in an area of life.

During the course of our care with the patient, we have been tasked to get her vital signs and do an interview with physical assessment. Due to the
current developmental stage that our patient is in, trust is a very important factor to address for us to be able to provide the desired care and
interventions.

Ida Jean Orlando

Deliberative Nursing Process by Ida Orlando allows nurses to formulate an effective nursing care plan that can also be easily adapted when and if
any complexity comes up with the patient. According to the theory, all patient behavior can be a cry for help. Through these, the nurse’s job is to
determine the nature of the patient’s distress and provide the help he or she needs.

Nursing care plan is the most essential tool to identify the specific needs of the patient. We are able to make an effective nursing care plan for our
patient suited specifically for her needs.
D. Gordon's Functional Health Pattern
Usual Functional Pattern Initial Functional Pattern Ongoing Functional Pattern Ongoing Functional Pattern

(10/17/2023) (10/18/2023) (10/25/2023)

1. Health Management- Admitted on October 15, 2023 Admitted on October 15, 2023 Admitted on October 15, 2023
Health Pattern Vital Signs: Vital Signs: Vital Signs:
● Patient stated that this is T=36.6 ℃, RR= 14 cpm, PR= 73 T = 36.6°C T = 36.5°C
the 2nd hospitalization bpm, O2Sat 98% and BP=130/90 P = 73 bpm P = 80 bpm
this year. mmHg R = 14 cpm R = 16 cpm
● Patient stated that he has BP= 130/90 mmHg BP= 120/90 mmHg
a complete meal pattern Chief complaint: “Lipong-lipong, 02 stat= 98% 02 stat= 98%
of 3 meals everyday. kapoy, sakit ulo, maglisod og ● Patient shows a presence
● Patient doesn’t have any lakaw-lakaw. Chief complaint: “Lipong- of tiredness and agitation.
childhood illnesses Presence of mass in his head. lipong, kapoy, sakit ulo, maglisod Chief complaint: Presence of
stated by him and Medical Diagnosis: og lakaw-lakaw. mass in his head.
significant others. Cerebellopontine angle tumor Presence of mass in his head. Medical Diagnosis:
● Patient takes OTC drugs Medications: Medical Diagnosis: Cerebellopontine angle tumor
such as biogesic or ● Omeprazole 40mg IVTT Cerebellopontine angle tumor Medications:
Paracetamol whenever OD once on NPO Medications: ● Paracetamol 650mg +
he is experiencing fever. ● Dexamethasone 5mg IVTT ● Omeprazole 40mg IVTT Orphenadrine 50mg 1tab
● Patient doesn’t smoke q8h OD once on NPO TID PRN for headache.
but drinks alcohol most ● Paracetamol 650mg + ● Dexamethasone 5mg ● NeuroAid 2 tabs BID.
of the time. Orphenadrine 50mg 1tab IVTT q8h
● Patient doesn’t take any TID PRN for headache. ● Paracetamol 650mg +
herbal medicines, has Orphenadrine 50mg 1tab
been in an motor TID PRN for headache.
accident before (2013)
but wasn’t too serious.
2. Nutritional Metabolic- IVF Bottle: PNSS 1L @ IVF Bottle: 1L consume 600cc IVF Bottle: Patient shifts to
Pattern 10gtts/min consumed well @ L for first hour then 400cc/hr for heplock.
metacarpal vein. the next 5 hours then regulate to Diet: DAT
● Patient’s appetite has Diet: DAT 100cc/hr ● Allergies: None
remained consistent and ● Allergies: None ● Diet: DAT ● Fluid Intake: 2-4 glasses
eating their regular ● Fluid Intake: 4-6 glasses ● Allergies: None of water then 1 glass of
meals breakfast, lunch of water. ● Fluid Intake: 4 glasses ensure gold.
and dinner. ● Food Intake: of water as of 2pm. ● Food Intake:
● Patient stated that he Breakfast: Rice, Hotdog, ● Food Intake: Breakfast: Lugaw,Water
eats anything offered at Vegetables, Water Breakfast: Rice, Egg, Lunch: Isda, Rice, Water
his plate. Lunch: Isda, Rice, Water, Vegetables, Water Dinner: Rice, Water, Vegetables
● No discomfort, Vegetables Lunch: Isda, Rice, Water, Weight: 63 kg
swallowing difficulties, Dinner: Pork, Rice, Water, Vegetables Height: 165 cm
and diet restrictions. Vegetables Dinner: Isda, Rice, Water, ● Patient has a presence of
● Patient takes vitamin C’s Weight: 63 kg Vegetables dry skin.
daily. Height: 165 cm Weight: 63 kg ● Patient has a dental
● Usually drink 8 glasses Height: 165 cm problem.
of water per day. ● Patient has a presence of ● Patient has a presence of ● Capillary refill is normal.
● Wounds tend to heal dry skin. dry skin.
well. ● Patient has a dental ● Patient has a dental
● Previous Ht: 165 cm problem. problem.
Wt: 65kg ● Capillary refill is normal. ● Capillary refill is normal.
 3. Elimination Pattern Bowel elimination:
● Patient stated that he ● Patient stated he hasn't
doesn’t have any defecated yet since
problems urinating admission.
before. ● Patient stated that he
Bowel Elimination doesn't have any problems
● Frequency – 7-10x a in defecating.
week ● Frequency: 0
● Character: Brown ● Character: N/A
● Discomfort: None ● Discomfort: N/A
● Problem with control: ● Problem with control: N/A
None ● Colostomy: None
Urinary Elimination Urinary elimination:
● Frequency- 4-5x a day ● Patient stated that he
● Character: Yellowish doesn't have any problems
● Discomfort: None with urinating.
● Problem with control: ● Frequency: 2x
None ● Volume: Medium amount
● Discomfort: None
● Problem with control: None
● Catheter: None
● Patient doesn’t feel pain
when urinating or
defecating.
● Patient also verbalized,
“tig kalibang ko taga
adlaw, kas ah o ikaduha sa
usa ka adlaw.
● No excess perspiration
and body odor.
Bowel Elimination
● Frequency: 1
● Character: Brown
● Discomfort: None
● Problem with control:
None
● Colostomy: None
Urinary Elimination
● Frequency: 2x
● Volume: Medium amount
● Discomfort: None
● Problem with control:
None
● Catheter: None
Bowel elimination:
● Patient stated he already
defected.
● Patient stated that he
doesn't have any problems
in defecating.
● Frequency: 1
● Character: Brown
● Discomfort: None
● Problem with control:
None
● Colostomy: None
Urinary elimination:
● Patient stated that he
doesn't have any problems
with urinating.
● Frequency: 4
● Volume: Medium amount
● Discomfort: None
● Problem with control:
None
● Catheter: None
 4. Activity – exercise
pattern
● Patient stated that he
used to exercise a lot
when he was well with
his friends.
● Perceived ability for:
· Feeding- 0
· General mobility- 0
· Bed mobility- 0
· Grooming- 0
· Toileting- 0
· Dressing- 0
· Bathing-0
· Home maintenance- 0
· Shopping- 0
● Functional Level codes:
0- Full Self Care
1-Use of equipment/device
2- Requires
assistance/supervision
3- Dependent
● Patient is able to move ● Patient verbalized, ● Patient is able to move
independently, but “Patabang rako sakong independently but
sometimes his sister will igsuon og alalay nakog because of his surgery he
help him. tindog kay dili ko ka might need help from his
● Patient also added that he is tarong og lakaw og medjo sister sometimes.
normally tired and just lies lipong-lipong ko ushay” ● Patient also feeling tired
down on bed to rest to ● Patient also added that he and doesn't want to be
avoid stress or making his is normally tired and just disturbed.
headaches worsen. lies down on bed to rest to Perceived ability for:
Perceived ability for: avoid stress or making his · Feeding- 1
· Feeding- 1 headaches worsen. · General mobility- 2
· General mobility- 2 Perceived ability for: · Bed mobility- 2
· Bed mobility- 2 · Feeding- 1 · Grooming- 2
· Grooming- 0 · General mobility- 2 · Toileting- 0
· Toileting- 0 · Bed mobility- 2 · Dressing- 2
· Dressing- 0 · Grooming- 0 · Bathing-2
· Bathing-0 · Toileting- 0 · Home maintenance- 3
· Home maintenance- 3 · Dressing- 0 · Shopping- 3
· Shopping- 3 · Bathing-0 Functional Level codes:
Functional Level codes: · Home maintenance- 3 0- Full Self Care
0- Full Self Care · Shopping- 3 1- Use of equipment/device
1- Use of equipment/device Functional Level codes: 2- Requires assistance/supervision
2- Requires assistance/supervision 0- Full Self Care 3-Dependent
3-Dependent 1- Use of equipment/device
2- Requires assistance/supervision
3-Dependent
5. Sleep- Rest Pattern ● Patient stated his general
rest is not okay because of
● Patient sleeps 8 hours a his condition.
day, sleeps from 9pm to ● Patient verbalized,
11pm and usually wakes “Makatulog raman ko
up at 5am to 7am. dayun basta kapuyon ko,
● Patient stated that he pero og naay mo sulod na
doesn’t have any nurse kay makamata ko”
difficulty in sleeping. ● Patient sometimes has days
● Patient doesn’t have where he has full rest and
assistive devices and some days with
insomnia. disturbances.
● Patient stated his general
rest is not okay because of
his condition.
● Patient verbalized,
“Makatulog raman ko
dayun basta kapuyon ko,
pero og naay mo sulod na
nurse kay makamata ko”
● Patient sometimes has
days where he has full rest
and some days with
disturbances.
● Patient stated his general
rest is not okay because of
his condition.
● Patient verbalized,
“Makatulog pero putol-
putol siya og naay mo
sulod na nurse kay
makamata ko”

6. Cognitive – Perceptual
pattern
● No hearing problems.
● Can clearly see objects
near and afar.
● Can read and answer
questions.
● No changes in memory
and concentration noted.
● Patient is able to respond
appropriately when
asked questions.
● Patient is deaf on the left
ear.
● Patient is both experiencing
farsightedness and
nearsightedness
● Patient is able to read the
material I gave him.
● Patient stated that his
abdomen on the RLQ
where the incision site is
from the
Ventriculoperitoneal (VP)
Shunt procedure that was
done and it hurts when he
touched it and rates it of 7
out of 10.
● Patient is deaf on the left ● Patient stated that he
ear. experienced deaf on his L
● Patient is both ear.
experiencing ● Patient sometimes unable
farsightedness and to respond appropriately
nearsightedness. when I asked questions,
● Patient is able to read the because he is agitated.
material I gave him.
● Patient stated that his
abdomen on the RLQ
where the incision site is
from the
Ventriculoperitoneal (VP)
Shunt procedure that was
done and it hurts when he
touched it and rates it of 6
out of 10.
7. Self-perception–Self-
concept pattern
● Patient feels good about
himself.
● Patient doesn’t have any
● Patient verbalized,
“makalakaw raman ko pero
tungod aning brain tumor
nako og kaning geh
operahan sakong tiyan,
● Patient verbalized,
“makalakaw raman ko
pero tungod aning brain
tumor nako og kaning geh
operahan sakong tiyan,
Objective data
● Patient looks
stressed,tired and agitated
but sometimes responsive.
● Cannot make eye contact

problems in his body. kinahalngan pa ko og kinahalngan pa ko og because he doesn't want to

tabang para mo bangon.”
Objective data
● Patient looks stressed and
tired but is responsive and
active throughout the
interview.
● Can make eye contact.
tabang para mo bangon.” disturbed.
Objective data
● Patient looks stressed and
tired but is responsive and
active throughout the
interview.
● Can make eye contact.

8. Role-relationship
pattern
● Patient lives with his
family that consists of
his wife and 2 sons.
● Has a good relationship
with his family,
relatives, and neighbors.
● Has good relations with
neighbors and people
from different
barangays.
● Family struggles
financially due to taxes
and payment for
children’s education.
● Patient is with his sister
when we visited.
● Patient verbalized,
“Nagbantay akong ate nako
niya sigeh ra siyag atiman
sa akoa, og naa koy
kinahalngan mo tuman
siya.”
● Currently financially
unstable due to hospital
bills and having to pay in
debt children’s tuition fees
for a 3rd – college student
and a grade 12 senior high
student both from
foundation university.
● Patient is with his sister
when we visited.
● Patient verbalized,
“Nagbantay akong ate
nako niya sigeh ra siyag
atiman sa akoa, og naa
koy kinahalngan mo
tuman siya.”
● Currently financially
unstable due to hospital
bills and having to pay in
debt children’s tuition
fees for a 3rd – college
student and a grade 12
senior high student both
from foundation
university.
● Patient is with his sister
when we visited.
● Patient verbalized,
“Nagbantay akong ate
nako niya sigeh ra siyag
atiman sa akoa”
● Currently financially
unstable due to hospital
bills and having to pay in
debt children’s tuition
fees for a 3rd – college
student and a grade 12
senior high student both
from foundation
university.

9. Sexuality –
reproductive pattern
● Patient is active with
sexual activities with his
partner.
● Patient stated that before
they usually do it once a
month.
10.Coping – Stress
tolerance pattern
● Patient stated that he
tends to avoid the
situation that stresses
him out by doing other
things.
● Patient usually drinks
with his friends to
relieve stress
● Patient stated that he
usually goes with family
and friends on outings to
forget about problems
● His support system is
his family.
● Coping strategies
sometimes helps and
sometimes doesn’t.
● Patient stated “wala sa
pagkakaron”
● Is unable to do any sexual
activities at the moment
due to the situation.
● Patient verbalized, “Na
stress og kapoy kos akong
sitwasyon karon, kinsa may
dili ma stress ani”
● His coping mechanisms
managing his thoughts by
himself and talks with
family about situations.
● Patient stated ‘maka stress
ang way kwarta, mga
balayran sa skwelahan para
sakong mga anak.”
● Patient can ease stress
when he gets proper rest
● Patient stated “wala sa
pagkakaron”
● Is unable to do any sexual
activities at the moment
due to the situation.
● Patient verbalized, “Na
stress og kapoy kos akong
sitwasyon karon, kinsa
may dili ma stress ani”
● His coping mechanisms
managing his thoughts by
himself and talks with
family about situations.
● Patient stated ‘maka stress
ang way kwarta, mga
balayran sa skwelahan
para sakong mga anak.”
● Patient can ease stress
when he gets proper rest
● Patient stated “wala sa
pagkakaron”
● Is unable to do any sexual
activities at the moment
due to the situation.
● Patient verbalized, “Na
stress og kapoy kos akong
sitwasyon karon, kinsa
may dili ma stress ani”
● His coping mechanisms
managing his thoughts by
himself and talks with
family about situations.
● Patient stated ‘maka stress
ang way kwarta, mga
balayran sa skwelahan
para sakong mga anak.”
● Patient can ease stress
when he gets proper rest
11.Value- Belief pattern ● Believes in God. ● Believes in God. ● Believes in God.
● Religion: Catholic ● Patient verbalized, “nag ● Patient verbalized, “nag ● Patient verbalized, “nag
● Patient goes to church ampo rajud ko na ma ampo rajud ko na ma ampo rajud ko na ma
on Sundays. successful operation” successful operation” successful operation”
● Patient prays before ● Patient says that his ● Patient says that his ● Patient says that his
sleeping and meals. religion helps solve his religion helps solve his religion helps solve his
● Patient wishes to be problems depending on the problems depending on problems depending on
financially stable. situation. the situation. the situation.
E. Summary of Nursing Diagnoses

Ineffective tissue perfusion related to increased intracranial pressure, secondary to cerebellopontine angle tumor as evidenced by dizziness and hearing
loss on left part

Rationale: Patient shows a presence of higher capillary refill, also he has irritability, skin dryness and sunken eyes. Patient also use accessory
muscles when breathing that is why physicians administered salbutamol and also oxygen therapy. Patient also shows the changes in his blood
pressure.

Acute Pain related to surgical incision site at RLQ due to VP shunt insertion.

Rationale: Patient encounter acute pain because of the procedure done which surgical incision of VP shunt. Patient might experience pain
spontaneously.

Impaired physical mobility related to postoperative surgical incision.

Rationale: Patient undergoes surgery of Left retrosigmoid craniotomy gross total excision of tumor that leads him to limit his range of motion
and decreased muscle strength.
F. Nursing Care Plans
NCP: 1

Assessment Nursing Planning Intervention Rationale Evaluation

Diagnosis

Subjective: Acute Pain related to Within 2 days of Independent: At the end of 2 days
surgical incision site nursing intervention, nursing intervention
“Ayaw rag I palpate due to VP shunt the patient will able ● Monitor vital ● To obtain the patient was able to:
ning akong ulo sir kay insertion. to: signs. baseline data.  Vital signs:
sakit siya” as ● Provide morning ● To provide T = 36.5°C
verbalized by the ● Maintain a care. comfort to the P = 80 bpm
patient. normal vital patient. R = 16 cpm
signs: BP= 120/90 mmHg
Objective: ● Reduced ● Provide ● It is preferable to 02 stat= 98%
pain scale of measures to provide an
7 (0 being relieve pain analgesic as Partially met: Reduced
Vital sign taken: the less pain before it pain to 4/10 (0 being the
physician orders
and 10 being becomes severe. before the onset less pain and 10 being
T: 36.6⁰C the highest the highest pain).
of pain or before
pain). it becomes severe
PR: 73 bpm Partially met: Have a
● Verbalized when a larger
relief of pain. dose may be comfortable position to
RR: 14 cpm
● No facial required. reduce pain. “Okay-
BP: 130/90 mmHg grimace of ● Evaluate pain ● In evaluating pain okay na siya karun mas
pain during characteristics we used pain comfortable ko ug mag
O2sat: 98% palpation. and intensity. scale and facial higda pa right side nga
● Have a grimace. takilid kai naa biya sa
Pain Scale: comfortabl ● Encourage ● To prevent left akong opera, ug
e position patient adequate fatigue that can mutukar ra gihapon
7/10 (0 being the less to reduce rest periods. ang sakit mausahay, di
impair ability to
pain and 10 being the pain. na pareho atung una
manage or cope
worst pain) ● Take nga baling sakita
with pain.
medication ● Educate ● To promote kaayo” as patient
 Facial as patient/SO verbalized.
grimacing ( a independence if a
little twisted prescribed impact of pain patient
shows in his by the on discharges. Met: Take medication
face). physician. lifestyle/indepen as prescribed by the
dence and ways physician.
to maximize
level of
functioning.

Dependent:

Administer medications
as prescribed by the
physician.  To relieve mild to
● Paracetamol 650 moderate pain and
mg +
Orphenadrine 50 fever and pain. For
mg 1 tab TID orphenadrine to
PRN for relieve muscle
headache. spasm discomfort.
 It works in the
 Tramadol 50 brain to change
mg IV q8h how your body
feels and responds
to pain.
 To decrease
 Ketorolac 30 swelling, pain, or
mg IV q6h x 3 fever.
doses
NCP: 2
Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis

Subjective: Impaired comfort Independent:

related to pain Within 2 days of ● Established ● To gain At the end of 2 days
“ Ikapoy ko, unya
secondary to post nursing patient’s patient’s trust. nursing intervention
sakit pa jud akoa
operative of intervention, the the patient was able
ulo, wala ko rapport.
retrosigmoid patient will able to: to:
kasabot sa akoa gi ● Assess pain ● Closely
craniotomy total  Vital signs:
bati” as ● Maintain a level. monitor pain
excission of tumor. T = 36.5°C
verbalized by the normal using pain P = 80 bpm
patient. vital signs: scale. R = 16 cpm
T: 36.5 °C-37.5 °C ● Assess mental ● Observe BP= 120/90 mmHg
Objective: RR: 12-20 cpm outward signs 02 stat= 98%
or emotional
PR: 60-100 bpm feelings of of discomfort
Vital sign taken:
02Sat: 95-100% discomfort. Partially met:
T: 36.6⁰C ● Explain ● To decreased Reduced pain to 4/10
● Appear procedures and (0 being the less pain
any
PR: 73 bpm calm care before and 10 being the
and discomfort highest pain).
implementing.
RR: 14 cpm relaxed. and fear.
● Encourage
● Reduced ● To prevent Partially met: He
patient adequate
BP: 130/90 mmHg pain scale of fatigue that appeared calm but still
rest periods.
7 (0 being can impair shows of irritability.
O2sat: 98% the less pain ability to
● Capillary and 10 being manage or Met: Take medication
refill ＞3 the highest cope with as prescribed by the
seconds pain). pain. physician.
Dependent:
● Skin dryness
and sunken Administer medications
eyes as prescribed by the
● Dizziness and physician.
hearing loss ● Paracetamol 650  To relieve mild
on his left ear. mg + to moderate
● Irritability
 ● Restlessness Orphenadrine 50 pain and fever
mg 1 tab TID and pain. For
Pain Scale: PRN for orphenadrine
headache.
7/10 (0 being the to relieve
less pain and 10 muscle spasm
being the worst discomfort.
pain)  It works in the
●  Tramadol 50 brain to change
mg IV q8h how your body
feels and
responds to
pain.
 To decrease
 Ketorolac 30 swelling, pain,
mg IV q6h x 3 or fever.
doses
NCP:3

Assessment Nursing Planning Intervention Rationale Evaluation

Diagnosis

Subjective: “Maglisod Impaired physical Independent: At the end of my 2

ko ug gimok tungod mobility related to Within 2 days of ● Established ● Nurse-patient days of nursing
aning akong opera kay postoperative nursing intervention, patient’s relationship. intervention, the
if gamay lihok lang surgical incision. the patient will able rapport. client was able to:
magsakit akoa ulo.” to: ● Encourage ● To decrease ● Vital signs
patient to do dependence taken:
Objective: ● Maintain a as much as on others and T = 36.5°C
normal vital they can. increase the P = 80 bpm
Vital sign taken: signs: patient's R = 16 cpm
T: 36.5 °C-37.5 °C capabilities. BP= 120/90 mmHg
T: 36.6⁰C RR: 12-20 cpm ● Provide ● Allows for 02 stat= 98%
PR: 60-100 bpm adaptive maximum Partially met:
PR: 73 bpm 02Sat: 95-100% equipment. movement “Okay- okay na akoa
related to
RR: 14 cpm ● Participate in paminaw karun pero
patient
their daily capabilities.
BP: 130/90 mmHg life. mausahay mukalit ra
● Provide ● If the patient
● Improvement passive ROM is unable to jud ug kalipungon ko
O2sat: 98%
in physical perform
mobility by pero maka lihok-lihok
Limited range of exercises
motion transferring independently naku di pareha atung
Perceived ability for: from bed to , as a student
wheelchair. bag.o pa pag opera”
· Feeding- 1 nurse/ nurse
· General mobility- 2 provide as verbalized by
· Bed mobility- 2 passive ROM patient.
· Grooming- 2 to prevent
· Toileting- 0 contractures Met: Demonstrated a
· Dressing- 2 and muscle clear understanding
· Bathing-2 weakness.
· Home maintenance- 3 ● Position the ● To improve about the safety
· Shopping- 3 patient in his tissue
 comfortable circulation precautions in order to
position
prevent falls and also
Functional Level every 2 hrs
codes: or as importance of his
0-Full Self Care needed.
follow up check-up
1- Use of
equipment/device Dependent: Administer and healthy
2- Requires medications as
precautions.
assistance/supervisi prescribed by the
on physician.
3-Dependent
 X. Annotated Readings

Comparison of the Functional State and Motor Skills of Patients after Cerebral Hemisphere, Ventricular System, and Cerebellopontine Angle
Tumor Surgery

Cerebellar and cerebellopontine angle (CPA) tumors can cause balance and coordination disturbances and ataxia, which result in gait disorders,
adiadochokinesia, and fatigue, and many patients with CPA tumors need rehabilitation for facial nerve palsy. Determining the risks associated with
tumor site and preoperative condition might therefore be helpful for anticipating the need for and type of postoperative rehabilitation in neurosurgical
wards and to identify and preemptively manage at-risk individuals.
We therefore specifically addressed these knowledge gaps in the current study. Our primary aim was to assess the functional status, motor skills,
and gait efficiency of patients undergoing brain tumor surgery. An additional aim was to assess the incidence of complications affecting the
rehabilitation course and time parameters such as the overall LOS, LOS after surgery, LOS in the Intensive Care Unit (ICU), the time needed for
rehabilitation, and the time needed to improve any loss in basic motor skills after surgery.

● Cerebellar and cerebellopontine angle (CPA) tumors can cause balance and coordination disturbances and ataxia, - it can affect hearing loss and
loss of balance, which the cranial nerve of VIII this cranial is one of the most symptoms that CPA shows.
● gait disorders, adiadochokinesia, and fatigue, and many patients with CPA tumors need rehabilitation for facial nerve palsy - some of people
with CPA don't undergo rehabilitation after surgery because of the outcome of surgery or an early detection of tumor.
● to assess the functional status, motor skills, and gait efficiency of patients undergoing brain tumor surgery- this is the most common that we need
to assess after the surgery perform, inorder to known the outcome of the patient. We commonly know this as a GLASCOW COMA SCALE.
 XI. Conclusion

In conclusion, Cerebellopontine (CP) angle tumor undergo the importance of holistic care that addresses mostly of the middle age group, with
the incidence in females slightly more than in males. Most of the patients on admission had a non-serviceable hearing and presence of drowsiness.
Heterogeneous enhancement with cystic components was found in most of the lesions. Gross-total excision was one in the majority of cases and
vestibular schwannoma was the most common histopathological lesion obtained. Facial nerve palsy was the most complicated and as the size of the
lesion increased, the possibility of facial nerve palsy also increased post-operatively if not treated immediately.

Patient age and medical condition, specific tumor growth rate, and pathologic behavior are taken into account when recommending a mode of
therapy, surgical resection is considered for any patient in good medical condition with a benign or malignant lesion in the cerebellopontine angle (CPA)
if the boundaries of the tumor are resectable with minimal risk to the local neurologic structures.

The primary goal of this study was to identify and understand the major causes of this condition, disease process, medical management and
nursing interventions which partially met. I discovered that closely monitoring the patient’s input and output especially the neurologic are critical since
as student nurse we have the capacity to react promptly if the patient health changes. In, addition, complete resection is impossible because of the
intimate involvement of surrounding structures, which may impose unwarranted morbidity if complete excision is attempted, and planned partial
resection is considered.
 XII. References

● Arthurs, B. J., Fairbanks, R. K., Demakas, J. J., Lamoreaux, W. T., Giddings, N. A., Mackay, A. R., Cooke, B. S., Elaimy, A. L., & Lee, C. M.
(2011). A review of treatment modalities for vestibular schwannoma. Neurosurgical Review, 34(3), 265–279. https://doi.org/10.1007/s10143-
011-0307-8
● Cerebellopontine Angle Tumors (CPA) | AdventHealth Neuroscience Institute. (n.d.).
https://www.adventhealthneuroinstitute.com/programs/brain-tumors/cerebellopontine-angle-tumors-cpa
● Gus. (n.d.). Główny Urząd Statystyczny. https://stat.gov.pl/
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