Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Heriette Tolentino
Janvincent Tolentino
JONATHAN TORIBIO
Lovely Tuliao
Specific Objectives:
1. Establish rapport and interact with the patient at the patient’s own level of
understanding and taking into consideration to his present condition.
2. Perform a thorough assessment in his present condition, and discuss the
physical and social changes.
3. Identify the signs and symptoms presented by the patient in relation to the
injury process.
4. Implement a comprehensive plan of care for the patient with spinal cord
injury.
5. Evaluate the interventions provided in the given span of time for efficiency
and effectiveness.
6. Develop skills such as, interpersonal, technical and communication.
INTRODUCTION
Spinal cord injury: Spinal cord injury is damage to the spinal cord as a result of a
direct trauma to the spinal cord itself or as a result of indirect damage to the bones
and soft tissues and vessels surrounding the spinal cord. SCI results in a decreased
or absence of movement, sensation, and body organ function below the level of the
injury. The most common sites of injury are the cervical and thoracic areas. SCI is a
common cause of permanent disability and death in children and adults.
• 7 cervical (neck)
• 12 thoracic (upper back)
• 5 lumbar (lower back)
• 5 sacral (sacrum – located within the pelvis)
• 4 coccygeal (coccyx – located within the pelvis)
Injury to the vertebrae does not always mean the spinal cord has been damaged.
Likewise, damage to the spinal cord itself can occur without fractures or dislocations
of the vertebrae.
Types of SCI
• Complete injury
-Complete injury means that there is no function below the level of the injury
— either sensation and movement — and both sides of the body are equally
affected. Complete injuries can occur at any level of the spinal cord.
• Incomplete injury
-Incomplete injury means that there is some function below the level of the
injury — movement in one limb more than the other, feeling in parts of the
body, or more function on one side of the body than the other. Incomplete
injuries can occur at any level of the spinal cord.
Causes
Symptoms
Symptoms vary depending on the severity and location of the SCI. At first, the
patient may experience spinal shock, which causes loss of feeling, muscle
movement, and reflexes below the level of injury. Spinal shock usually lasts from
several hours to several weeks. As the period of shock subsides, other symptoms
appear, depending on the location of the injury.
Generally, the higher up the level of the injury to the spinal cord, the more severe
the symptoms
SCI is classified according to the person’s type of loss of motor and sensory function.
The following are the main types of classifications:
The following are the most common symptoms of acute spinal cord injuries.
However, each individual may experience symptoms differently. Symptoms may
include:
Diagnosis
The full extent of the SCI may not be completely understood immediately after the
injury, but may be revealed with a comprehensive medical evaluation and diagnostic
testing. The diagnosis of SCI is made with a physical examination and diagnostic
tests. During the examination, the physician obtains a complete medical history and
inquires as to how the injury occurred. Trauma to the spinal cord can cause
neurological problems and requires further medical follow-up.
Treatment
Specific treatment for an acute spinal cord injury will be determined by your
physician based on:
SCI requires emergency medical attention on the scene of the accident or injury.
This is accomplished by immobilizing the head and neck areas to prevent the patient
from moving. This may be very difficult since the victim and/or bystanders may be
very frightened after the traumatic incident.
Surgery is sometimes necessary to, stabilize fractured back bones, decompress (or
release) the pressure from the injured area, and to manage any other injuries that
may have been a result of the accident. Treatment is individualized, depending on
the extent of the condition and the presence of other injuries.
• Heart function
• Blood pressure
• Body temperature
• Nutritional status
• Bladder and bowel function and
• Spasticity (attempt to control involuntary muscle shaking)
A traumatic event that results in a SCI is devastating to the person and the family.
The healthcare team educates the family after hospitalization and rehabilitation on
how to best care for the person at home and outlines specific clinical problems that
require immediate medical attention by the patient’s physician.
The disabled person requires a focus on maximizing his/her capabilities at home and
in the community. Positive reinforcement will encourage him/her to strengthen
his/her self-esteem and promote independence.
A person with a SCI requires frequent medical evaluations and diagnostic testing
following hospitalization and rehabilitation to monitor his/her progress.
Prognosis
Prognosis for patients with spinal cord injuries varies and depends largely on the
degree of damage. The first year following injury is critical, as more patients die of
the injuries within that time period than any other.
Complications
• Bladder control. Your bladder will continue to store urine from your kidneys.
However, your brain may no longer be able to control bladder emptying, as
the message carrier (the spinal cord) has been injured. The loss of bladder
control increases your risk of urinary tract infections. It may also cause
kidney infection and kidney or bladder stones. Drinking plenty of clear fluids
may help. And during rehabilitation, you'll learn new techniques to empty
your bladder.
• Bowel control. Although your stomach and intestines work much like they
did before your injury, your brain may no longer be able to control the
muscles that open and close your anus. This may cause fecal incontinence. A
high-fiber diet may help regulate your bowels, and you'll learn techniques to
better control your bowels during rehabilitation.
• Impaired skin sensation. Below the neurological level of your injury, you
may have lost part or all skin sensations. Therefore, your skin can't send a
message to your brain when it's injured by things such as prolonged pressure,
heat or cold. This can make you more susceptible to pressure sores, but
changing positions frequently — with help, if needed — can help prevent
these sores. And, you'll learn proper skin care during rehabilitation, which can
help you avoid these problems.
• Circulatory control. A spinal cord injury may cause circulatory problems
ranging from spinal shock immediately following your spinal cord injury to low
blood pressure when you rise (orthostatic hypotension) to swelling of your
extremities throughout your lifetime. These circulation changes may increase
your risk of developing blood clots, such as deep vein thrombosis or a
pulmonary embolus. Another problem with circulatory control is a potentially
life-threatening rise in blood pressure (autonomic hyperreflexia). Your
rehabilitation team will teach you how to prevent autonomic hyperreflexia.
• Respiratory system. Your injury may make it more difficult to breathe and
cough if your abdominal and chest muscles are affected. These include the
diaphragm and the muscles in your chest wall and abdomen. Your
neurological level of injury will determine what kind of breathing problems
you may have. If you have cervical and thoracic spinal cord injury you may
have an increased risk of pneumonia or other lung problems. Medications and
therapy can treat these problems.
• Muscle tone. Some people with spinal cord injuries may experience one of
two types of muscle tone problems: spastic muscles or flaccid muscles.
Spasticity can cause uncontrolled tightening or motion in the muscles. Flaccid
muscles are soft and limp, lacking muscle tone.
• Fitness and wellness. Weight loss and muscle atrophy are common soon
after a spinal cord injury. However, limited mobility after spinal cord injury
may lead to a more sedentary lifestyle, placing you at risk of obesity,
cardiovascular disease and diabetes.
• Sexual health. Sexuality, fertility and sexual function may be affected by
spinal cord injury. Men may notice changes in erection and ejaculation;
women may notice changes in lubrication. Doctors, urologists and fertility
specialists who specialize in spinal cord injury can offer options for sexual
functioning and fertility.
• Pain. Some people may experience pain, such as muscle or joint pain from
overuse of particular muscle groups. Nerve pain, also known as neuropathic
or central pain, can occur after a spinal cord injury, especially in someone
with an incomplete injury.
Prevention
Following this advice may reduce your risk of a spinal cord injury:
• Drive safely. Car crashes are one of the most common causes of spinal cord
injuries. Wear a seat belt every time you drive or ride in a car. Make sure that
your children wear a seat belt or use an age- and weight-appropriate child
safety seat. To protect them from air bag injuries, children under age 12
should always ride in the back seat. Don't drive while intoxicated or under the
influence of drugs.
• Be safe with firearms. Lock up firearms and ammunition in a safe place to
prevent accidental discharge of weapons. Store guns and ammunition
separately.
• Prevent falls. Use a stool or stepladder to reach objects in high places. Add
handrails along stairways. Put nonslip mats on tile floors and in the tub or
shower. For young children, use safety gates to block stairs and consider
installing window guards.
• Take precautions when playing sports. Always wear recommended safety
gear. Check water depth before diving to make sure you don't dive into
shallow water. Avoid leading with your head in sports. For example, don't
slide headfirst in baseball, and don't tackle using the top of your helmet in
football. Use a spotter for new moves in gymnastics.
STATISTICS
CVMC (2009)
Current estimates are 250,000 - 400,000 individuals living with Spinal Cord Injury or
Spinal Dysfunction.
Before Hospitalization:
Patient Y stated that health for him is very important to support his
family financially. He defined a healthy person as free or absence of
disease and can do anything he wants without limitations. He also
stated that he didn’t have any allergy to food, drugs and animals.
According to patient Y, he uses herbal plants such as oregano for
cough and guava leaves if he has wounds. He also uses over the
counter drugs such as Paracetamol for fever and Neozep for colds.
He also takes Biogesic for headache if it can’t be manage by bed
rest. He manages his muscle pain through rest. He seldom goes to
the hospital for check up. He’s not taking any supplemental vitamins.
Patient Y believes in quack doctor.
During Hospitalization:
According to patient Y, it is his second hospitalization; his first
hospitalization was during his elementary age due to malaria. Patient
Y perceives that his health became poorer compare before
hospitalization because he can’t accomplish most of his ADL’s
required without assistance. Patient Y stated that he is complying
well with all therapeutic regimen and management for his condition
for faster recovery. He still does not take any supplemental vitamins.
Before Hospitalization:
Patient Y stated that he eats three times a day with a good appetite.
His breakfast was sometimes composed of coffee with bread or plain
rice or plain rice and egg. He can consume 2 to 3 cups of rice each
meal. He was fond to eat any kinds of vegetable and salty foods such
as dried fish and bagoong. He seldom eats meat and fish because
they lack of money. Sometimes he takes his snack in the afternoon
with a cup of coffee and bread, but he never takes his snack in the
morning. He had never uses any food supplements and had no
allergy to foods. He drinks 8 to 10 glasses of water a day. He
sometimes drinks soft drinks and drinks liquor once a week and he
doesn’t smoke cigarette. He can chew and swallow foods without any
difficulty. The patient weighs 58 kg. And 5’7” (174cm) in height. His
BMI is 19.33
During Hospitalization:
According to patient Y his appetite has change. He can’t even
consume 1 cup of rice each meal and he is just eating 1 pack of
biscuit (sky flakes) and just sips of water or juice. His snack contains
1 biscuit or fruits with a cup of coffee or water because he is worried
about his condition regarding his elimination pattern. He drinks 2 to
3 glasses of water a day and is not taking any food supplements. His
IVF was D5LRS regulated at 30gtts/min.
Before Hospitalization:
According to patient Y, he had no difficulty in urinating and
defecating. He described his urine as yellow in color. He voids 4 to 6
times a day, with an estimated amount of 1 glass per voiding which
is equivalent to 240 cc. He defecates once a day or once in two days
with formed stool but according to him, it sometimes depends on the
foods he had eaten.
During Hospitalization:
Patient Y has IFC inserted because he can’t void but he has no urge
to urinate. His urine output was 150 cc per shift with yellow amber in
color. On his ten days of staying at the hospital, patient Y didn’t
defecate, even though he is taking dulcolax. This is due to his
present condition in which his bowel reflex is paralyzed. After 17
days of not defecating, he had defecated last Christmas Break, Dec.
23 and Dec. 29, 2009 with formed stool.
Before Hospitalization:
Patient Y can perform his ADL’s without assistance. He woke up as
early as 5:00 am to prepare their breakfast and after cooking and
eating he would proceed to his working place by walking. He
considered walking and plowing the field as a form of his exercise.
He spent his leisure time listening to radio. Aside from being a
farmer he is also a tricycle driver.
During Hospitalization:
Patient Y tried to be independent as much as possible. His wife and
daughter are assisting him in doing his ADL’s. Patient can eat, drink
alone and even combs his hair but he can’t able to move his two feet
alone. He spends his day in the hospital resting, talking to his wife,
daughter and his visitors. Passive range of motion is his form of
exercise. He is placed on complete bed rest and should be
repositioned every 2 hours. On our second week of duty, patient Y
can move his legs, turn side to side alone without assistance, but he
can’t sit.
Before Hospitalization:
According to patient Y, he was circumcised at the age of 9. He
experienced his first sexual intercourse when he was 16 y/o. He has
an active sexual relationship but as he grows older it gradually
decreases. His last sexual intercourse with his wife was on Dec. 5,
2009. Patient Y had never experienced any problem in sexuality and
he doesn’t have any sexually transmitted disease. They didn’t use
any contraceptive. He experienced erection every morning especially
when he feels the urge to urinate.
During Hospitalization:
Patient Y stated that sex is no longer important because his condition
is his priority. Besides he is in IFC and stated that he doesn’t
experienced a penile erection.
Before Hospitalization:
Patient Y stated that he had 6 to 8 hours of uninterrupted sleep at
night. He sleeps around 9 pm and wake up at between 4-5 am. He
takes 15 minutes nap during daytime every after eating his lunch.
His not using any sleeping aids. He is easily awakened by loud noise
and when he feels the urge to urinate.
During Hospitalization:
According to patient Y he has difficulty in sleeping because of the
new environment and due to worries about his condition. He has
interrupted sleep at night due to treatment regimen. He sleeps
around 9 PM and wakes up before 12 midnight and sleep again
around 1AM and wakes up between 5-6 AM. He stated that
sometimes the cause of the interruption of his sleep at night is
because the room is crowded and have insufficient ventilation. On
our second week of duty, according to patient Y he can’t fall asleep
easily because he worries about his operation, hospital bills and hot
environment. He goes to sleep around 4 AM and wakes up at 6 AM
because of routinely activities of the staff and to eat breakfast. After
breakfast he goes to sleep again at 9 AM and wakes up when its time
to eat lunch. He sleeps again after lunch until late afternoon.
Before Hospitalization:
Patient Y was able to see object; hear sounds, taste food, smell and
sensitive to heat and cold. He doesn’t use any prosthesis such as eye
glasses or hearing aid. He can speak and understand ilocano and
tagalog. Patient Y has no difficulty with his vision, hearing, and he
has the ability to feel, taste and smell. According to him, the best
way for him to learn something new is through everyday experience.
During Hospitalization:
Patient Y can still able to see object; hear sound, taste food, smell
and sensitive to heat and cold. He doesn’t use any prosthesis such as
eye glasses or hearing aid. He can still speak and understand Ilocano
and Tagalog. Patient Y has no difficulty with his vision, hearing, and
the ability to feel, taste and smell. Patient Y is oriented to place, time
and person. He can answer and respond to question appropriately.
Before Hospitalization
Patient Y described himself as a real man though he is not handsome
because he can provide and give the needs of his family such as
food, shelter, clothing and sending his children to school but his
children was the one who refuses to go to school. They just chose to
get married. He considered his family as a source of his strength and
his weakness was to loose one member of his family.
During Hospitalization:
Patient Y described himself as worthless and useless because when
he was hospitalized, he know that he can’t walk and use his legs,
meaning he can’t provide the needs of his family. He doesn’t
consider now himself as a real man because for him, he can’t do his
ADL’s alone without assistance. He considered God and his family as
source of his strength and his weakness was to be paralyzed all
throughout his life.
Before Hospitalization
Patient Y was the bread winner and head of the family. He described
his family as lovable, supportive and happy to be with, though they
are not rich, they show their concern to each other. Patient Y and his
wife are helping in term of making decision. He considered his wife
as the most important person in his life because according to him,
his wife can’t leave him but his children has the possibility to leave
him any time. He also had a good relationship with his neighbors.
During Hospitalization:
Patient Y stated that his family was more supportive to him and to
his condition. They show their concern to patient Y by accompanying
him to the hospital and according to patient Y; he sees it on their
faces. Patient Y and his wife were helping in making decision
regarding the treatment for his condition. He considered God as the
most important in his life because according to him, it is in God’s
plan what will going to happen in his life. He is thinking if he can still
do what he does before he was hospitalize.
Before hospitalization:
During hospitalization:
According to the patient the most stressful time in his life is his
present condition thinking that there is a possibility that he can’t use
his legs to walk and it is considered stressful to him. The only way
for him to divert his attention is by sleeping and by talking to his
wife, daughters and visitors. He doesn’t cry for his problem regarding
his present condition but instead he is praying to God for his faster
recovery.
Before Hospitalization:
Patient Y was baptized as Roman Catholic. He seldom goes to mass
because according to him it was not part of his routine, but he
believes that God is our savior and creator. Patient Y says that even
though he was not going to mass there is a certain time that he
prays to God and asks for his guidance and protection. Patient Y also
believed in quack doctor.
During Hospitalization:
Patient Y stated that his relationship to God got strengthened says
that his illness is a test for his faith, because whenever he has no
problem he is not praying to God.
Spinal cord is a bundle of nerves that carries messages between the brain and the
rest of the body.
The spinal cord functions in the transmission of ascending impulses to the
brain and of descending impulses from the brain to the cord.
Spinal Column
Common name applied to the structure of bone or cartilage surrounding and
protecting the spinal cord.
Humans are born with 33 separate vertebrae. By adulthood, most have only
24, due to the fusion of the vertebrae in certain parts of the spine during
normal development.
The spine consists of 33 vertebrae, including the following:
• 7 cervical (neck)
• 12 thoracic (upper back)
• 5 lumbar (lower back)
• 5 sacral* (sacrum – located within the pelvis)
• 4 coccygeal* (coccyx – located within the pelvis)
By adulthood, the five sacral vertebrae fuse to form one bone, and the four
coccygeal vertebrae fuse to form one bone.)
L4 supplies many muscles, either directly or through nerves originating from L4.
They are not innervated with L4 as single origin, but partly by L4 and partly by other
spinal nerves. The muscles are:
Quadratus lumborum
Is a common source of lower back pain. Because the QL
connects the pelvis to the spine and is therefore capable of
extending the lower back when contracting bilaterally, the two
QLs pick up the slack, as it were, when the lower fibers of the
erector spinae are weak or inhibited (as they often are in the
case of habitual seated computer use and/or the use of a lower
back support in a chair).
Gluteus medius
One of the three gluteal muscles, is a broad, thick, radiating
muscle, situated on the outer surface of the pelvis.
With the leg in neutral (straightened), the gluteus medius and
gluteus minimus function together to pull the thigh away from
midline, or "abduct" the thigh
Gluteus minimus
The gluteus medius and gluteus minimus abduct the thigh,
when the limb is extended, and are principally called into action in
supporting the body on one limb, in conjunction with the Tensor
fasciæ latæ
Quadratus femoris
Quadratus femoris is, as its name implies, a flat, quadrilateral
skeletal muscle. Located on the posterior side of the hip joint, it is a
strong lateral rotator and adductor of the thigh, but also acts to
stabilize the femoral head in the Acetabulum.
PATHOPHYSIOLOGY
BOOK BASED AND PATIENT CENTERED
Age (16-35 y/o) > vehicular accidents > lifestyle (fond of driving)
Gender (male) > falls, sport activities > work (driver)
> Disease
(bone cancer, osteoporosis, arthritis)
Increase blood flow of injured tissue lead to loss of protein rich fluid in
at injured site extravascular tissue
Fluid shift
Edema
Vital Signs: BP: 110/80 Temp: 36.8 C PR: 82 bpm RR: 20 cpm
Date Assessed:
- Evenly distributed
covers the whole scalp - Evenly distributed NORMAL
with no evidences of covers the whole scalp
alopecia with no evidences of
alopecia
- Thick or thin, coarse
or smooth - thick and smooth
NORMAL
NAILS Inspection -Inspect nail plate -Normal convex NORMAL
shape; convex curvature
curvature; angle
between nail bed
about 160
-Inspect nail bed color -Pink and dirty ABNORMAL Due to poor Hygiene
and appearance
- Evenly distributed
- Evenly distributed NORMAL
EYELIDS Inspection - Upper eyelids cover - Upper eyelids cover NORMAL
the small portion of the small portion of the
the iris, cornea and iris, cornea and sclera
sclera when eyes are when eyes are open.
open
- Moist
- No ulcers - Moist NORMAL
- No foreign objects - No ulcers NORMAL
- No foreign objects NORMAL
Sclera is white in color
MOUTH
Lips Inspection - With visible margin - With visible margin NORMAL
- Symmetrical in - Symmetrical in NORMAL
appearance and appearance and
movement movement
- Pinkish in color - Pinkish in color NORMAL
- No edema - No edema NORMAL
Observation -No difficulty on -Limited ROM, weak -ABNORMAL -Due to L4- L5 spinal
Motor Function Movement, full extremities as evidence cord injury.
ROM,and strong lower by need of assistance
extremities while moving
RESULT:
Left wrist – 5 Left knee- 3
Right wrist- 5 Right knee- 2
Left elbow- 5 Left ankle- 3
Right elbow- 5 Right ankle- 2
URINALYSIS
Multiple Axial Tomographic sections of the lumbar spine (L1-S1) with sagittal
& 3D reconstruction were obtained. No IVF or intrathecal contrast was given.
The upper half of the L4 vertebral body is fragmented with signs of ventral &
dorsal displacement. A ledge shaped fragment is displaced 1.96 cm ventrally at the
level of the L3-L4 intervertebral space with slight torsion of the fracture towards the
left. There is displacement of the posterior aspect in to the spinal canal with
demonstration & intracanalicular fragments. The bilateral intervertebral facets are
distracted. The transverse & spinous process & lamina are intact.
These are linear fractures of the L1-L2 right transverse processes & L3
bilateral transverse processes.
The broad contours of the L4-L5 disc extend beyond the rim of the vertebral
bodies.
There is evidence of gas at level of L4-L5 intervertebral disease. (-) for
calcification.
The superior & inferior articulation facets & lateral recesses are unremarkable.
The ligamentum flavum is not thickened.
Impression:
Fracture- disclocation, level of L4
Liner fracture, L1 & L2 right & L3
Bilateral transverse processes.
Disc herniation with vacuum phenomena, level of L4-L5
Degenerative osteophytes, lumbar vertebral bodies.
RATIONALE OF CT SCAN
To determine what specific part of spinal cord is damaged or affected.
Both lungs field are clear and with normal vascular pattern. Heart and great
vessels are normal in size and configuration. Other chest structures are
unremarkable
Impression:
no radiographic abnormality within the chest
RATIONALE OF CXR:
To check the readiness of heart and lungs and note if there any contraindication
before performing any procedure
COURSE IN THE WARD
Shows in Instructed
detail a patient to lie still
specific plane during the
of involved procedure and
bone/injuries. tell patient that
this will last up
to 1 hour and
remove all
metals in the
body.
12-09-09 For ct scan of To determine Informed the
10:30 am lumbar vertebra the extent of patient and SO
( L1 – S1 ) with injury and about the
plate 3D determine diagnostic exam
reconstruction what specific needed to be
part is done Check for
affected any allergy in
iodine or
shellfish
Shows in Instructed
detail a patient to lie still
specific plane during the
of involved procedure and
bone/injuries tell patient that
this will last up
to 1 hour and
remove all
metals in the
body.
12-09-09 Refer to Dr. To inform the Referred to Dr.
5:00 pm Lacambra for co physician Lacambra
management about the
condition of
6:00 pm the patient. Turning schedule
Bed sore done and post at
precaution: To promote the bedside, turn
Turn patient side blood patient using log
to side every 2 circulation roll technique
hours and prevent
bed sore and
pneumonia Emphasized the
Secure egg importance of
crate mattress egg crate
for the use of mattress and
the patient. To prevent encourage the
bed sores. patients S.O to
provide egg
crate mattress.
Celecoxib Thought to inhibit For Acute pain and Contraindicated in CNS: dizziness, Drug may be
prostaglandin primary patients headache, insomnia. hepatotoxic; watch for
synthesis, impeding dysmenorrhea hypersensitive to CV: peripheral signs and symptoms
cyclooxygenase-2 drug, sulfonamides, edema. of liver toxicity.
(COX-2), to produce aspirin, or other EENT: pharyngitis, Drug can be given
anti-inflammatory, NSAIDs. rhinitis, sinusitis. without regard to
analgesic, and Contraindicated in GI: abdominal meals, but food may
antipyretic effects. those with severe pain, diarrhea, decrease GI upset.
hepatic impairment. dyspepsia, flatulence, Tell patient to report
nausea. history of allergic
Metabolic: reactions to
hyperchloremia. sulfonamides, aspirin,
Musculoskeletal: or other NSAIDs
back pain. before starting
Respiratory: upper therapy.
respiratory tract Advise patient to
infection. immediately report
Skin: rash. rash, unexplained
Other: accidental weight gain, or
injury. swelling.
DRUG NAME ACTION INDICATION CONTRAINDICATION ADVERSE REACTION NURSING CONSIDERATION
Diclofenac potassium Unknown. May For Acute pain and Contraindicated in CNS: anxiety, depression, Because of their
Cataflam inhibit primary patients hypersensitive dizziness, drowsiness, insomnia, antipyretic and anti-
prostaglandin dysmenorrhea to drug and in those irritability, headache, aseptic inflammatory actions,
Diclofenac sodium synthesis, to with hepatic porphyria meningitis. NSAIDs may mask the
Fenac‡, Voltaren, Voltaren- produce anti- or history of asthma, CV: heart failure, hypertension, signs and symptoms
XR, Voltaren Rapide†, inflammatory, urticaria, or other edema, fluid retention. of infection.
Voltaren SR† analgesic, and allergic reactions after EENT: tinnitus, laryngeal edema, Tell patient to take
antipyretic effects. taking aspirin or other swelling of the lips and tongue, drug with milk, meals,
NSAIDs. blurred vision, eye pain, night or antacids to
blindness, epistaxis, reversible minimize GI distress.
Use cautiously in hearing loss. Instruct patient not to
patients with history of GI: abdominal pain or cramps, crush, break, or chew
peptic ulcer disease, constipation, diarrhea, enteric-coated tablets.
hepatic dysfunction, indigestion, nausea, abdominal Advise patient to
cardiac disease, distention, flatulence, taste avoid consuming
hypertension, fluid disorder, peptic ulceration, alcohol or aspirin
retention, or impaired bleeding, melena, bloody during drug therapy.
renal function. diarrhea, appetite change, Tell patient to wear
colitis. sunscreen or
GU: proteinuria, acute renal protective clothing
failure, oliguria, interstitial because drug may
nephritis, papillary necrosis, cause sensitivity to
nephrotic syndrome, fluid sunlight.
retention.
Hepatic: jaundice, hepatitis,
hepatotoxicity.
Metabolic: hypoglycemia,
hyperglycemia.
Musculoskeletal: back, leg, or
joint pain.
Respiratory: asthma.
Skin: rash, pruritus, urticaria,
eczema, dermatitis, alopecia,
photosensitivity reactions,
bullous eruption
DRUG NAME ACTION INDICATION CONTRAINDICATION ADVERSE REACTION NURSING
CONSIDERATION
Ketorolac Unknown. May For acute pain Contraindicated in CNS: drowsiness, Correct hypovolemia
exhibit patients sedation, dizziness, before giving
Non steroidal anti- prostaglandin hypersensitive to drug headache ketorolac
inflammatory drugs synthesis, to and in those with CV: edema, When appropriate,
produce anti- active peptic ulcer hypertension, give by deep IM
inflammatory, disease, recent GI palpitations, arythmias injection. Patient
analgesics and bleeding or perforation GI: nausea, dyspepsia, may feel pain at
antipyretic Contraindicated in GI pain, diarrhea, injection site. Put
children younger than vomiting, constipation pressure on site for
age 2 and in patients Hematologic: decrease 15-30 seconds after
with history of peptic platelet adhesion, injection to minimize
ulcer disease or GI prolonged bleeding time local effects.
bleeding Skin: pruritus, rash, NSAID’S may mask
Use cautiously in diaphoresis signs and symptoms
patients who are Other: pain at injection of infection because
elderly or have site of their antipyretic
hepatic or renal and anti-
impairment or cardiac inflammatory actions
decomsation
DRUG NAME ACTION INDICATION CONTRAINDICATION ADVERSE REACTION NURSING CONSIDERATION
Dulcolax (Bisacodyl) Unknown. To prevent Contraindicated in CNS: muscle weakness Give drug at times that
Stimulant constipation. patients with excessive use, don’t interfere with
laxative that hypersensitive to dizziness, faintness scheduled activities or sleep
increases drug or its GI: nausea, vomiting, Before giving for
peristalsis, components and in abdominal cramps, constipation, determine
probably by those with rectal diarrhea with high doses, whether patient has
direct effect on bleeding, burning sensation in adequate fluid intake,
smooth muscle gastroenteritis, rectum with exercise and diet
of the intestine, intestinal suppositories, laxative Tell patient to take drug
by irritating the obstruction, dependence with long with a full glass of water or
muscle or abdominal pain, term or excessive use, juice.
stimulating the nausea, vomiting or protein-losing Teach patient about dietary
colonic other symptoms of enteropathy with sources of bulk, including
intramural appendicitis or acute excessive use bran and other cereals,
plexus. Drug also surgical abdomen Metabolic: alkalosis, fresh fruit and vegetables.
promotes fluid hypokalemia, fluid and Advise patient to report
accumulation in electrolyte imbalance adverse affects to
colon and small Musculoskeletal: tetany prescriber.
intestine
NURSING CARE PLAN
Subjective: Impaired bowel Within the duration Assisted with To asses Goal partially met,
“madi nak maka- elimination r/t loss of duty, the patient physical causative/ the patient
takki” as verbalized of nerve will verbalize examination contributing verbalized
by the patient conduction above understanding of (palpation the factors understanding of
the level of reflex condition, achieve abdomen) condition,
Objective: arc normal elimination participated on
Hyperactive bowel pattern or Determined To help measures to
sounds participate in client’s usual determine level of correct the defects,
measures to daily fluid intake, hydration and defecated last
= 30 bourborygmi correct for defects noted condition of December 23 and
sound upon skin and mucous 29, 2009.
auscultation membrane
Ascertained
clients previous For comparison
pattern of with current
elimination situation
Ascertained
clients S.O’s To assess the
perception of degree of
problem/ degree interference/
of disability disability
Encouraged
fluid intake up to
3000 or more For hydration
m/L per day
Encouraged
client to verbalize
fears/concern
about his Open
condition expression allows
client to deal with
feelings and begin
Administered problem solving
medication as
ordered To help his
bowel elimination
Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective: Activity Within the Evaluated clients To provide Goal partially met.
Verbal report of intolerance r/t duration of duty, actual and perceive comparative Within the duration
fatigue and neuromuscular the patient will limitations/ degree of baseline and provide of duty, the patient
weakness. impairment demonstrate a deficit in light of usual information about demonstrated a
“ Agkakapsot ti decrease in status needed education/ decrease in
bagik” physiologic sign intervention physiologic sign of
of intolerance regarding quality of intolerance as
Objective: life evidenced by
Needs participation of
assistance in Noted client’s report Symptoms may activities of daily
repositioning of weakness, fatigue, results of/or living such as
Inability to do pain and difficulty contribute to grooming, hygiene
his ADL’s accomplishing his intolerance of and turning
task. activity independently
Ascertained ability to
move about and To determined
degree of assistance current status and
necessary use of needs associated
equipment with participation in
needed desired
Encouraged activities.
expression of feelings To assist the client
contributing to his to deal with
condition contributing factors
and manage
activities within
individual limits
Assist with activities
and provide/ monitor To protect from
clients use of assistive injury
devices
Promote comfort
measures and provide
relief of pain To enhanced the
ability to participate
Repositioning every 2 in activities
hours
To prevent bedsore
and to maintain
body alignment all
Made repositioning the time.
schedule and post at To prevent bedsore
bedside and educated and to promote
the patient’s S.O in circulation.
proper turning the
patient
Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective: Impaired urinary Within the Palpated for Bladder Goal partially met.
“Hindi ako makaihi elimination r/t loss duration of duty, bladder distention dysfunction is Within the duration of
as verbalized by of nerve the patient will and observed for variable but may duty, the patient
the patient” conduction above achieve normal over flow include loss of achieved normal
the level of the elimination bladder elimination pattern or
Lack of reflex arc pattern or Encouraged to contraction participate in
awareness of participate in increase his oral To maintain renal measures to correct
bladder fullness measures to fluid intake up to function and to or compensate for
Absence of correct or 3,000 or more mL prevent infection defects as evidenced
urge to void compensate for per day and formation of by urine output of
Objective: defects urinary stones 280 ml per shift but
Uninhibited Kept bladder still unaware of
bladder deflated by use of To empty the bladder fullness.
contraction an IFC bladder
Urine output of Emphasized
150 ml per shift importance of To reduce risk of
keeping area clean infection
and dry
Demonstrated
proper positioning To facilitate
of catheter drainage and to
drainage tubing prevent reflux
and bag
Assessment Diagnosis Planning Intervention Rationale Evaluation
SUBJECTIVE: Impaired physical Within the duration Continually asses Evaluates status of Goal met. Within the
mobility related to of duty, the motor function by individual situation duration of duty, the
“Hindi ako neuromascular patient will requesting patient (motor-sensory patient maintained
makagalaw” as impairment. maintain position to perform certain impairment may be position of function
verbalized by the of function and actions. mixed and/ or not and skin integrity as
patient. skin integrity as clear) for a specific evidenced by absence
evidenced by level of injury, of foot drops,
OBJECTIVE: absence of foot affecting type and contractures and
drops, choice of decubitus ulcer.
Decreased muscle contractures and intervention.
control/strength decubitus ulcer Patient manifested
Limited ROM Enables patient to signs of increased
Inability to Provide means to have sense of muscle strength
purposefully more summon help. control, and
within the physical reduces fear of
environment. being left alone.
M - Instructed patient Y to take his medication on time with right dose and
to complete the duration of his medicine.