Brain Tumor Case Study: Nursing Care and Pathophysiology

Aklan Polytechnic College - College of Nursing
BRAIN TUMOR
A Case Study
Presented
to
The Faculty of the College of Nursing
Aklan Polytechnic College
Kalibo, Aklan
In Partial Fulfilment
Of the Requirements in
Related Learning Experience
Submitted by:
Bolido, Jill Cheastine C.
Castro, Roselyn V.
Dela Torre, Rochelle Andrea P.
Llamer, Clint B.
Pedro, Nori Fe
Relor, Leoni Beth R.
Tumbokon, Rosemary R.
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OBJECTIVES
General Objective:
After the case study, we the nursing students will be able to acquire new knowledge,
enhance basic skills, and develop desirable attitudes towards the care of a patient with
Gestational Diabetes Mellitus through the utilization of the nursing process.
Specifically, we will be able to:
Knowledge
 Define terminologies related to Brain Tumor;
 Discuss and explain the pathophysiology, etiology, clinical signs and symptoms,
incidence rate, diagnostic procedures and management of patient with Brain Tumor;
 Discuss the Anatomy and Physiology of the Brain;
 Identify and explain the drugs used to treat Brain Tumor;
 List nursing responsibilities in caring a patient with Brain Tumor;
Skills
 Assess and classify gathered data relevant to the patient’s condition;
 Formulate nursing diagnosis specific to the identified health problem;
 Plan a care specific to the patient’s identified health problems;
 Implement the plan of care to the patient;
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 Evaluate the effectiveness of nursing care rendered;
 Formulate a Concept Map;
 Identify deviation of laboratory results and its significance;
Attitude
 Acknowledge patient’s expression of feelings and emotion;
 Observe courtesy at all times to the patient and to all the members of the health care team;
 Establish rapport and promote cooperation through nurse – patient interaction;
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DEFINITION OF TERMS
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INTRODUCTION
INCIDENCE RATE:
RISK FACTORS:
CLINICAL MANIFESTATION
COMPLICATIONS
DIAGNOSTIC EVALUATIONS:
MEDICAL MANAGEMENT
SURGICALMANAGEMENT
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ANATOMY AND PHYSIOLOGY
The 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.
Brain
The brain is composed of the cerebrum, cerebellum, and brainstem.
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The brain has three main parts: 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.

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Right brain – left brain
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. If a stroke occurs on the right side of the
brain, your left arm or leg may be weak or paralyzed.
Not all functions of the hemispheres are shared. In general, the left hemisphere controls speech,
comprehension, arithmetic, and writing. The right hemisphere controls creativity, spatial ability,
artistic, and musical skills. The left hemisphere is dominant in hand use and language in about
92% of people.
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Figure 2. The cerebrum is divided into left and right hemispheres. The two sides are connected
by the nerve fibers corpus callosum.
Lobes of the brain
The cerebral hemispheres have distinct fissures, which divide the brain into lobes. Each
hemisphere has 4 lobes: frontal, temporal, parietal, and occipital (Fig. 3). Each lobe may be
divided, once again, into areas that serve very specific functions. It’s important to understand
that each lobe of the brain does not function alone. There are very complex relationships between
the lobes of the brain and between the right and left hemispheres.
Figure 3. The cerebrum is divided into four lobes: frontal, parietal, occipital and temporal.
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Frontal lobe
 Personality, behavior, emotions
 Judgment, planning, problem solving
 Speech: speaking and writing (Broca’s area)
 Body movement (motor strip)
 Intelligence, concentration, self awareness
Parietal lobe
 Interprets language, words
 Sense of touch, pain, temperature (sensory strip)
 Interprets signals from vision, hearing, motor, sensory and memory
 Spatial and visual perception
Occipital lobe
 Interprets vision (color, light, movement)
Temporal lobe
 Understanding language (Wernicke’s area)
 Memory
 Hearing
 Sequencing and organization
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Language
In general, the left hemisphere of the brain is responsible for language and speech and is called
the "dominant" hemisphere. The right hemisphere plays a large part in interpreting visual
information and spatial processing. In about one third of people who are left-handed, speech
function may be located on the right side of the brain. Left-handed people may need special
testing to determine if their speech center is on the left or right side prior to any surgery in that
area.
Aphasia is a disturbance of language affecting speech production, comprehension, reading or
writing, due to brain injury – most commonly from stroke or trauma. The type of aphasia
depends on the brain area damaged.
Broca’s area: lies in the left frontal lobe (Fig 3). If this area is damaged, one may have difficulty
moving the tongue or facial muscles to produce the sounds of speech. The person can still read
and understand spoken language but has difficulty in speaking and writing (i.e. forming letters
and words, doesn't write within lines) – called Broca's aphasia.
Wernicke's area: lies in the left temporal lobe (Fig 3). Damage to this area causes Wernicke's
aphasia. The individual may speak in long sentences that have no meaning, add unnecessary
words, and even create new words. They can make speech sounds, however they have difficulty
understanding speech and are therefore unaware of their mistakes.
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Cortex
The surface of the cerebrum is called the cortex. It has a folded appearance with hills and
valleys. The cortex contains 16 billion neurons (the cerebellum has 70 billion = 86 billion total)
that are arranged in specific layers. The nerve cell bodies color the cortex grey-brown giving it
its name – gray matter (Fig. 4). Beneath the cortex are long nerve fibers (axons) that connect
brain areas to each other — called white matter.
The cortex contains neurons (grey matter), which are interconnected to other brain areas by
axons (white matter). The cortex has a folded appearance. A fold is called a gyrus and the valley
between is a sulcus.
The folding of the cortex increases the brain’s surface area allowing more neurons to fit inside
the skull and enabling higher functions. Each fold is called a gyrus, and each groove between
folds is called a sulcus. There are names for the folds and grooves that help define specific brain
regions.
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Deep structures
Pathways called white matter tracts connect areas of the cortex to each other. Messages can
travel from one gyrus to another, from one lobe to another, from one side of the brain to the
other, and to structures deep in the brain (Fig. 5).
Coronal cross-section showing the basal ganglia.
Hypothalamus: is located in the floor of the third ventricle and is the master control of the
autonomic system. It plays a role in controlling behaviors such as hunger, thirst, sleep, and
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sexual response. It also regulates body temperature, blood pressure, emotions, and secretion of
hormones.
Pituitary gland: lies in a small pocket of bone at the skull base called the sella turcica. The
pituitary gland is connected to the hypothalamus of the brain by the pituitary stalk. Known as the
“master gland,” it controls other endocrine glands in the body. It secretes hormones that control
sexual development, promote bone and muscle growth, and respond to stress.
Pineal gland: is located behind the third ventricle. It helps regulate the body’s internal clock and
circadian rhythms by secreting melatonin. It has some role in sexual development.
Thalamus: serves as a relay station for almost all information that comes and goes to the cortex.
It plays a role in pain sensation, attention, alertness and memory.
Basal ganglia: includes the caudate, putamen and globus pallidus. These nuclei work with the
cerebellum to coordinate fine motions, such as fingertip movements.
Limbic system: is the center of our emotions, learning, and memory. Included in this system are
the cingulate gyri, hypothalamus, amygdala (emotional reactions) and hippocampus (memory).
Memory
Memory is a complex process that includes three phases: encoding (deciding what information
is important), storing, and recalling. Different areas of the brain are involved in different types of
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memory (Fig. 6). Your brain has to pay attention and rehearse in order for an event to move from
short-term to long-term memory – called encoding.
Structures of the limbic system involved in memory formation. The prefrontal cortex holds
recent events briefly in short-term memory. The hippocampus is responsible for encoding long-
term memory.
 Short-term memory, also called working memory, occurs in the prefrontal cortex. It
stores information for about one minute and its capacity is limited to about 7 items. For
example, it enables you to dial a phone number someone just told you. It also intervenes
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during reading, to memorize the sentence you have just read, so that the next one makes
sense.
 Long-term memory is processed in the hippocampus of the temporal lobe and is activated
when you want to memorize something for a longer time. This memory has unlimited
content and duration capacity. It contains personal memories as well as facts and figures.
 Skill memory is processed in the cerebellum, which relays information to the basal
ganglia. It stores automatic learned memories like tying a shoe, playing an instrument, or
riding a bike.
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.
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CSF is produced inside the ventricles deep within the brain. CSF fluid circulates inside the brain
and spinal cord and then outside to the subarachnoid space. Common sites of obstruction: 1)
foramen of Monro, 2) aqueduct of Sylvius, and 3) obex.
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.
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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).
Skull
The purpose of the bony skull is to protect the brain from injury. The skull is formed from 8
bones that fuse together along suture lines. These bones include the frontal, parietal (2), temporal
(2), sphenoid, occipital and ethmoid. The face is formed from 14 paired bones including the
maxilla, zygoma, nasal, palatine, lacrimal, inferior nasal conchae, mandible, and vomer.
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The brain is protected inside the skull. The skull is formed from eight bones.
Inside the skull are three distinct areas: anterior fossa, middle fossa, and posterior fossa (Fig. 9).
Doctors sometimes refer to a tumor’s location by these terms, e.g., middle fossa meningioma.
A view of the cranial nerves at the base of the skull with the brain removed. Cranial nerves
originate from the brainstem, exit the skull through holes called foramina, and travel to the parts
of the body they innervate. The brainstem exits the skull through the foramen magnum. The base
of the skull is divided into 3 regions: anterior, middle and posterior fossae.
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Similar to cables coming out the back of a computer, all the arteries, veins and nerves exit the
base of the skull through holes, called foramina. The big hole in the middle (foramen magnum) is
where the spinal cord exits.
Cranial nerves
The brain communicates with the body through the spinal cord and twelve pairs of cranial nerves
(Fig. 9). 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.
The Roman numeral, name, and main function of the twelve cranial nerves:
Number Name Function
I olfactory Smell
II optic Sight
III oculomotor moves eye, pupil
IV trochlear moves eye
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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
Meninges
The brain and spinal cord are covered and protected by three layers of tissue called meninges.
From the outermost layer inward they are: the dura mater, arachnoid mater, and pia mater.
Dura mater: is a strong, thick membrane that closely lines the inside of the skull; its two layers,
the periosteal and meningeal dura, are fused and separate only to form venous sinuses. The dura
creates little folds or compartments. There are two special dural folds, the falx and the tentorium.
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The falx separates the right and left hemispheres of the brain and the tentorium separates the
cerebrum from the cerebellum.
Arachnoid mater: is a thin, web-like membrane that covers the entire brain. The arachnoid is
made of elastic tissue. The space between the dura and arachnoid membranes is called the
subdural space.
Pia mater: hugs the surface of the brain following its folds and grooves. The pia mater has many
blood vessels that reach deep into the brain. The space between the arachnoid and pia is called
the subarachnoid space. It is here where the cerebrospinal fluid bathes and cushions the brain.
Blood supply
Blood is carried to the brain by two paired arteries, the internal carotid arteries and the vertebral
arteries. The internal carotid arteries supply most of the cerebrum.
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The common carotid artery courses up the neck and divides into the internal and external carotid
arteries. The brain’s anterior circulation is fed by the internal carotid arteries (ICA) and the
posterior circulation is fed by the vertebral arteries (VA). The two systems connect at the Circle
of Willis (green circle).
The vertebral arteries supply the cerebellum, brainstem, and the underside of the cerebrum. After
passing through the skull, the right and left vertebral arteries join together to form the basilar
artery. The basilar artery and the internal carotid arteries “communicate” with each other at the
base of the brain called the Circle of Willis. The communication between the internal carotid and
vertebral-basilar systems is an important safety feature of the brain. If one of the major vessels
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becomes blocked, it is possible for collateral blood flow to come across the Circle of Willis and
prevent brain damage.
Top view of the Circle of Willis. The internal carotid and vertebral-basilar systems are joined
by the anterior communicating (Acom) and posterior communicating (Pcom) arteries.
The venous circulation of the brain is very different from that of the rest of the body. Usually
arteries and veins run together as they supply and drain specific areas of the body. So one would
think there would be a pair of vertebral veins and internal carotid veins. However, this is not the
case in the brain. The major vein collectors are integrated into the dura to form venous sinuses —
not to be confused with the air sinuses in the face and nasal region. The venous sinuses collect
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the blood from the brain and pass it to the internal jugular veins. The superior and inferior
sagittal sinuses drain the cerebrum, the cavernous sinuses drains the anterior skull base. All
sinuses eventually drain to the sigmoid sinuses, which exit the skull and form the jugular veins.
These two jugular veins are essentially the only drainage of the brain.
Cells of the brain
The brain is made up of two types of cells: nerve cells (neurons) and glia cells.
Nerve cells
There are many sizes and shapes of neurons, but all consist of a cell body, dendrites and an axon.
The neuron conveys information through electrical and chemical signals. Try to picture electrical
wiring in your home. An electrical circuit is made up of numerous wires connected in such a way
that when a light switch is turned on, a light bulb will beam. A neuron that is excited will
transmit its energy to neurons within its vicinity.
Neurons transmit their energy, or “talk”, to each other across a tiny gap called a synapse (Fig.
12). A neuron has many arms called dendrites, which act like antennae picking up messages
from other nerve cells. These messages are passed to the cell body, which determines if the
message should be passed along. Important messages are passed to the end of the axon where
sacs containing neurotransmitters open into the synapse. The neurotransmitter molecules cross
the synapse and fit into special receptors on the receiving nerve cell, which stimulates that cell to
pass on the message.
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Nerve cells consist of a cell body, dendrites and axon. Neurons communicate with each other by
exchanging neurotransmitters across a tiny gap called a synapse.
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Glia cells
Glia (Greek word meaning glue) are the cells of the brain that provide neurons with nourishment,
protection, and structural support. There are about 10 to 50 times more glia than nerve cells and
are the most common type of cells involved in brain tumors.
 Astroglia or astrocytes are the caretakers — they regulate the blood brain barrier,
allowing nutrients and molecules to interact with neurons. They control homeostasis,
neuronal defense and repair, scar formation, and also affect electrical impulses.
 Oligodendroglia cells create a fatty substance called myelin that insulates axons –
allowing electrical messages to travel faster.
 Ependymal cells line the ventricles and secrete cerebrospinal fluid (CSF).
 Microglia are the brain’s immune cells, protecting it from invaders and cleaning up
debris. They also prune synapses.
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HEALTH ASSESSMENT
Demographic data
Name: A.Q.S
Age: 49 years old
Birth Date: Oct. 24, 1969
Birt Place: Kalibo, Aklan
Gender: Male
Height:
Weight:
Marital Status: Married
Current Address: Santan Road, Andagao, Kalibo, Aklan
Nationality/Race: Filipino
Religion: Jehovah’s Witness
Educational Attainment: High school Graduate
Occupation: Tricycle Driver
Monthly Family Income: 20,000
Admitting Physician: Dr. MGT S. S
Attending Physician: Dr. MGT S. S
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Date and time of Admission: August 29, 2019 at 11:10 am
Chief Complaint:
Admitting Vital Signs:
Temperature – 36.4 ºC/axilla Pulse Rate- 106bpm
RR – 26 cpm BP- 100/70mm/Hg
O2 Sat-96%
Informant
Primary: None
Secondary: Wife
Other Sources: Client’s Chart
Admitting Diagnosis: Soft tissue mass (L) Fronto Temporal Area, Satge IV
Final Diagnosis:
History of Present Illness
According to the patient’s wife before, he was diagnosed he seldom experiences having
body malaise, dizziness and pain while he drives his tricycle to pick up passengers, his wife, and
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daughter at work, and their children at school however he ignored all those symptoms when he
does he takes rest every after meal and he takes over the counter drugs like paracetamol, alaxan,
mefenamic, planax to relieve the pain.
On April 2019 Mr. A.Q.S complained to his wife of body malaise and felt that the lump
on his left occipital part of his head is getting bigger, so they decided to have a check-up at
MMG and after series of tests the doctor referred to consult either at Ilo-Ilo or Manila for further
evaluation. They decided to go to PGH at Manila, from there another series of tests was done to
him while waiting for the results he stayed at his brother’s home and according to his wife he
urinated blood, after 2 months he decided to go back home.
On July 6, he was admitted at PHC and after the doctor read his results, in there he was
diagnosed with Brain Cancer with right sided paralysis and after 6 days he was discharged with
pain medications to take. On August 29, 2019 while he was at home in Adagao he suffered from
pain, so his wife decided to call MDDRMO to take them to DRSTMH via ambulance. When
they arrived at the Emergency room at around 11:00 a.m. they gave Mr. A.Q.S paracetamol IM
for his pain he underwent thorough examination and was admitted by Dr.S.
Past Health History
Immunization
The patient’s wife does not have any idea if his husband is completely immunized.
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Childhood Illness
Allergies
According to his wife, the patient is allergic to dried fish
Medication
The patients wife claimed that whenever his husband gets common illness like cough,
fever and colds she just take over the counter drugs such as Biogesic 500mg, Mefenamic acid
500mg and Neozep tablet.
Previous Hospitalization
According to his wife when his husband did a check-up at Medway, they found out that
there was a mass on his lung, he was admitted by then, however no biopsy was done and the
doctor only gave medications for 6 months for him to take.
Surgeries
Patient’s wife report no history of surgery.
Serious Injuries or Accidents
Patient reports no history of serious injury and accidents.
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Family Genogram
Mr. M.Q.S
80 yrs. old Mrs. S.P.Q
Alive and Hypertensive
Mr. A.Q.S Mr. L.Q.S Mr. A.Q.S Mr. A.Q.S Ms. A.Q.S Mr. R.Q.S
55yrs.old 53 yrs.old 50yrs.old 49yrs.old 46yrs.old 44yrs.old
ALIVE AND WELL ALIVE AND WELL ALIVE AND WELL PATIENT ALIVE AND WELL ALIVE AND WELL
Mrs. A.P.S
45 yrs. Old
Alive and WELL
Mr. RJ.P.S Mr. R.P.S Ms. A.P.S Ms. A.P.S

26 yrs.old 25 yrs.old 19 yrs.old 8 yrs.old
ALIVE AND WELL ALIVE AND WELL ALIVE AND WELL ALIVE AND WELL
Legend:
Patient’s Parents
Patient’s Siblings
Patient
Patient’s Wife
Patient’s Children
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Mr. A.Q.S’s parents are married with 6 children. His father Mr. M.Q.S 80 years old alive
and well, her mother Mrs. R.P.Q deceased. Our patient Mr. A.Q.S is the 4th child among the
siblings. He has 4 children. His 1st child is Mr. RJ.P.S 26 years old alive and well. His 2nd child,
Mr. R.P.S, 25 years old is alive and well, his 3rd child Ms. A.P.S 19 years old is alive and well,
and youngest Ms. A.Q.S years old is alive and well. His siblings, Mr. A.Q.S 55 years, Mr. L.Q.S
53 years old, Mr. A.Q.S 50 years old, Ms. A.Q.S 46 years old, and Mr. R.Q.S 44 years old are
alive and well.
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PSYCHOSOCIAL HISTORY
Health Beliefs and Practices
The patient’s wife claimed that they don’t believe in traditional healers like “albularyo”
but whenever they get sick they usually seeks medical help to the doctor.
Sleep and Rest Pattern
According to patient’s wife he usually sleeps at around 1 A.M and wakes up at 4 A.M
every morning. He also takes a nap at noon for 2 hours
Elimination Pattern
He defecates every day to a brownish, well-formed stool and voids more than 4-5 times a
day and his urine is yellowish in color.
Activities of Daily Living
Patient’s wife stated before his husband was diagnosed, during weekdays Mr. A.Q.S
usually wakes up at 4am. He takes his breakfast by having coffee and porridge before dropping
off his wife at work via tricycle he will then do his routine route at Kalibo to drive and pick up
some passengers, then at lunch time he will pick up his 2 children at school before going home to
take their lunch. He will then take a few minutes nap when he gets enough rest he will then drop
off his children at school then do his routine route again at Kalibo. he will drop Then at around
8am to 9am, he will start to drive his tricycle to pick up passengers. In the evening, they usually
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eat dinner together and before he sleeps he will read his bible every night. Sometimes when his
eldest child works too late he picks her up from work.
Nutritional Pattern
The patient eats regularly three times a day. According to his wife, his breakfast consists
of coffee and porridge while during lunch and dinner he eats fish and vegetable. He also
consumes fruits like banana, mango, orange or any available fruits in his house. He prefer to
drink soda than water.
Role/Relationship Pattern
Mr.A.Q.S lives with his wife and 4 children. They have a good relationship and
communication with each other. He seeks advice from his wife when it comes to decision
making but he has the final decision
Sexuality Pattern
“ Ko uwa pa imaw sakit hay, mga tatlo beses sa isang dumingo”. Verbalized by his wife.
Values and Belief Pattern
Mr. A.Q.S is a devoted Jehovah’s Witnesses. He is one of shepherd in their church. Every
Saturday he goes to people’s houses with his wife to spread the word of their religion and during
Sunday’s and Thursday he goes to church with his family.
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Social History
He has a good relationship with his neighbors.
REVIEW OF SYSTEM
General Survey
On August 30, 2019, at 8 o’clock in the morning the patient was seen from Room 13. He
was awake lying on bed. He was wearing a black undershirt, diapers, and black socks with
contraption of IVF PNSS @ left Cephalic vein.
Vital signs were as follow:
T: 36.4 ºC/axilla. CR: 106 bpm
RR: 26 cpm BP: 100/70 mmHg
INTEGUMENT
Skin
 Skin is brown in color, smooth and warm to touch.
 Presence of mole in right arm and chest area.
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 He uses soap for his skin care and takes a bath every day before he was diagnosed, he
hasn’t bathed since that day.
Hair
 Hair is black in color and evenly distributed covering the whole scalp
 Hair is curly, dry and presence of dandruff
 Present of mass in the left side of his scalp during inspection and palpation.
Nails
 Fingernails are trimmed upon inspection.
 Nail beds are pale pink in color without clubbing.
 Has a good capillary refill that returns in 2 seconds.
 Cuts nails once a week.
Head
 Oval shape
 Face is not oily
 Present of mustache and beard.
 No present of pimples, wrinkles, scar, lesions,
 Mass felt in left side of his head upon palpation.
 Not able to turn head from left to right with or without resistance.
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Eyes
 Eyes are symmetric, outer canthus of the eye are aligned to the auricles.
 Eyebrows are black in color and fairly distributed.
 Eyelashes appeared to be equally distributed and curled slightly outward.
 Eyelids have no presence of discharges or discoloration and closes symmetrically.
 The sclera is clear, iris is black in color flat and round.
 Pupils are equally round and reactive to light and accommodation.
 Not able to perform 6 cardinal eye movements.
Ears
 Ears are symmetric; auricles are aligned at the outer canthus of the eyes.
 Pinna recoils when folded.
 No mass and tenderness upon palpation.
 Able to hear the clicking sound of a pen 2 feet away from him.
 Cleans his ears once a week.
Nose and sinuses
 Nose is intact, aligned, symmetrical without discharge or redness.
 Both nares are patent.
 No tenderness upon palpation on sinuses.
Mouth and Pharynx
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 Teeth are incomplete; 2 lower right molar and 1 upper left molar extracted.
 Lips, gums and tonsils are moist and pinkish in color.
 Uvula is intact and hangs in the midline.
 Brushes his teeth once a day.
Neck
 Neck is in midline and has the same color with the body.
 Not able to perform full range of motion (ROM).
 No masses, swelling and venous distention observed.
 Trachea is in midline.
Breast and Axilla
 Areola is dark brown in color nipple is everted.
 No palpable lumps and lesions upon palpation and inspection.
 Axilla has present of hair, no lesion, masses, and rashes present.
 Uses deodorant
Lungs
 Respiration is 26 cpm no use of accessory muscle upon breathing.
 No crackles or abnormal sounds heard upon auscultation.
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 Does not smoke or use tobacco.
Heart
 No jugular distention observed.
 No mass and tenderness with palpation on heart landmarks
 Heart beats 106 bpm.
Gastrointestinal
 Abdomen is round in shape.
 Umbilicus is in midline and inverted.
 Patient eliminates every day to a brown well-formed stool.
 Abdominal distention upon inspection ( 36 cm).
Peripheral vascular
 Arms are equal in size, no swelling, and no clubbing of finger nails.
 Capillary refill time less than 2 seconds.
 Legs are warm to touch bilaterally and no ulcers or edema noted.
 No apparent varicosities or superficial thrombophlebitis noted.
 Right upper and lower extremities was paralyzed. Left arm and legs are slightly week.
40
Genitourinary
 No history of reproductive disease or disorders claim by patient wife
 The patient consume 4 diaper a day.
 Present of pubic hair as verbalized by his wife.
Musculoskeletal
 There are no deformities on the bones.
 Symmetrical muscles on the both sides of the body.
 There are no contractures or shortening of the muscles and tendons.
Neurologic
 GCS 13 (E4, V4, M5), Confused with time, place and person.
 He is barely cooperative and attentive all throughout the assessment.
 Not able to answer concretely all questions being asked.
CRANIAL NERVES
CRANIAL NERVES RESULT

Not able to identifies the smell of calamaci
Cranial Nerve – I (Olfactory)
and vinegar.
Patient was not able to read printed writing
Crania Nerve – II (Optic )
held at a distance of 12 inches.
Cranial Nerve – III,IV& VI (Oculomotor, Intact. Pupils equally round and reactive to
41
Trochlear and Abducens) light and accommodation, not able to perform

6 cardinal eye movements.
Able to sense and distinguish the point of
Cranial Nerve – V (Trigeminal Nerve)
pencil only on cheeks, left arm and left leg.
The patient is not able to fallow the
instruction to smile, frown, wrinkle forehead,
Cranial Nerve – VII (Facial)
show teeth, puff out cheeks, purse lips, raise
eyebrows, and close eyes against resistance.
Cranial Nerve – VIII (Acoustic nerve) Able to hear clicking sounds of a pen.
Cranial Nerve IX and X (Glossopharyngeal
Intact. Patient is able to swallow.
&Vagus)
Patient was not able to shrugs shoulders but
Cranial Nerve XI (Accessory Nerve)
able to nod his head to right and left.
The patient is not able to fallow instruction to
move his tongue side to side and protrude.
Cranial Nerve XII (Hypoglossal)
Sensory Function Test
 Mr. A.Q.S was able to feel touch, pain, and temperature only on his head and left
side of his body.
 Patient was not able to identify the direction of movement of his fingers.
 The patient was barely able to identify the shapes and letters drawn in his hand.
Glasgow Coma Scale

Response
I.MOTOR RESPONSE 6- Obeys command fully 5 ( Localizes pain)
42
5- Localizes pain
4- Withdraws from pain
3-Abnormalflexion
(decorticate)
2-Extensor response
(decerebrate)
1- No response
5- Alert and oriented
4- Confused, yet coherent

speech
II. VERBAL RESPONSE
4 (Confused, yet coherent
3- Inappropriate words speech)
2- Incomprehensible sounds
1- No sounds
4- Spontaneous eye opening
II. EYE OPENING 3- Eyes open to speech

4 (Spontaneous eye
opening)
2- Eyes open to pain
1- No eye opening
Score: 13
DIAGNOSTIC/LABORATORY TEST
Laboratory Test#1: Hematology
43
Indication: To evaluate characteristics of blood components.
Date Performed: August 29, 2019
Test Result Normal Values Significance
Hemoglobin 129 g/L 120-160 g/L Normal
Hematocrit 0.38 Vol. fr 0.41-0.47 Vol. fr Slightly decrease,
Red Blood cell 3.80 L 4.60-6.20 x1012/L Decrease, due to
White blood cell 14.0 4.50-11.00 x1012/L Increase, due to

inflammatory
response
Neutrophil 0.81 0.36-0.68 Increase, due to

inflammatory
response
Segmenter 0.81 Normal
Lymphocyte 0.19 0.24-0.44 Decrease,
Laboratory Test#2 Ultrasound
Indication: To evaluate kidneys, liver, gallbladder, pancreas, spleen and abdominal aorta.
Date Performed: July 9,2019
WHOLE ABDOMEN ULTRASOUND
44
The liver is enlarged with craniocaudal span of 16cm, increased parenchymal echogenicity with
heterogenous echopattern. There are multiple hypoechoic and cystic nodules with peripheral
hypodensity in the right and left hepatic lobe. There are also cystic nodules with thin walls
largest in the right measuring 2.6 x 2.4 cm and largest in the left is 2.0x 2.0 cm. There is a solid
nodule with peripheral hypodensity at the left hepatic lobe measuring 1.4 x 1.0 cm. The common
bile duct and intrahepatic ducts are not dilated, the former measuring 0.5 cm. Gallbladder is not
visualized, probably contracted.
The intrahepatic vessels and inferior vena cava are unremarkable.
There is no fluid noted at the Morison’s pouch.
Pancreas and spleen are normal in size and tissue echogenicity. No focal lesion seen.
Both kidneys are normal in sizes with increased parenchymal echogenicity with fairly defined
corticomedullary demarcations. The central echo complexes are intact.
Right kidney measures 9.4 x 4.9 x 5.0 x 1.6 cm (Lx AP x W x Cortical Thickness).
There are multiple cystic foci noted, largest measuring 2.2 x 1.7 cm at the superior pole.
Left kidney measures 10.6 x 6.0 x 5.5 x 1.4cm (L x AP x W x Cortical Thickness)
There are multiple high intensity echoes noted, largest measuring 0.7 cm at the inferior pole.
Ureters are not delineated sonographically.
45
Urinary bladder is well distended with smooth walls. No intraluminal echoes noted.
Prostate gland is normal in size and measures 2.3 x 3.9 cm (L x W x AP) with approximate
weight
Of 18.3 grams. Prostatic capsule is intact. No focal lesions seen.
Negative for ascites.
IMPRESSIONS:
 ENLARGED LIVER WITH DIFUSE PARENCHYMAL DISEASE
 T/C SIMPLE HEPATIC CYST, CYST METASTASES AND SOLID METASTATIC
NODULES
 NON-VISUALIZED GALLBLADDER, PROBABLY CONTRACTED
 DIFUSE RENAL PARENCHYMAL DISEASE, BILATERAL
 SIMPLE RENAL CYSTS, RIGHT
 NON-OBSTRUCTING NEPHROLITHIASIS, LEFT
 SONOGRAPHICALLY NORMAL COMMON BILE DUCT, PANCREAS, SPLEEN,
URINARY BLADDER
AND PROSTATE GLAND
46
Laboratory Test#3: Ultrasound
Indication: To assess tumor masses
Date Performed: MAY 1, 2019
MASS ULTRASOUND
A well-defined hypoechoic complex-predominantly solid soft tissue mass is observed at the left
Parieto-temporal measuring approx. 8.72cm x 2.53cm.
Incidental note of focal destruction (approx. 1.35 cm) of the outer table, Parieto- Temporal bone.
IMPRESSION:
COMPLEX- PREDOMINANTLY SOLID TISSUE MASS, LEFT PARIETO- TEMPORAL
AREA
FOCAL DESTRUCTION, OUTER TABLE, LEFT PARIETO- TEMPORAL BONE.
Laboratory Test#4: Radiology
Indication: To assess Cardiopulmonary disease
ROENTOLOGICAL REPORT
47
There are suspicious densities in the periphery of the right upper lung.
The heart is normal in size.
The aorta is prominent.
Both hemidiaphragms, costophrenic sulci, and visualized bones are intact.
IMPRESSION:
Suspicious densities, periphery of the right upper lung. Spot view of the right upper lung
is suggested for further evaluation.
Prominent aorta.
Laboratory Test#5: MRI of the Brain without Contrast
Indication: To assess the inner structure of brain and tumors.
Date Performed: June 17, 2019
Clinical Information: 5-month history of an enlarging left parietal mass. S/P punch biopsy of a
left nasopharyngeal mass showing non-keratinizing squamous cell CA (05/20/19)
Findings:
Correlation is made with the CT 05/07/19, done at outside institution.
48
There is an expansile causing extensive cortical destruction of the left parietal and occipital
bones, with an enhancing multiseptated, multiloculated soft tissue component, measuring 9.1 x
5.2 x 9.7 cm (AP/T/CC). The intracranial component appears predominantly extradural, although
there are small portions of the dura that are equivocal for dehiscence. There is moderate of
comprehension of the adjacent parietal and posterior temporal lobes and left cerebellar
hemisphere, with no evident edema or abnormal parenchymal enhancement. There is resultant
compression of the left lateral ventricle and left to right midline shift of about 6 mm. There are
punctate signal abnormalities involving the parietal white matter bilaterally, with no associated
mass effect, consistent with chronic small vessel ischemic changes. No other parenchymal
abnormalities are demonstrated in the cerebral hemispheres or posterior fossa structures. There is
no evidence of hydrocephalus.
Partially visualized is an ill-defined, heterogeneously enhancing mass involving the left
nasopharyngeal mucosa and pharyngeal space, involving the left medial and, to lesser extent,
pterygoid muscles, the left longus capitis muscle, and the prevertebral space. It also extends
inferiorly to the left oropharynx and soft palate. It invades the left side of sella and left cavernous
sinus, mildly displacing the left medial temporal lobe, and encroaches on the distal-most portion
of the left orbital apex. It further involves the petrous apex., clivus and left occipital condyle. The
distal cervical, petrous and cavernous portions of the left ICA are encased. This corresponds to
known nasopharyngeal malignancy. There is non-enhancing fluid signal involving the left
mastoid air cells, consistent with obstructive mastoid disease. Abnormal signal and enhancement
is seen involving the left side of the atlas, as well as the odontoid process, which may represent
49
osseous metastasis. There are partially visualized prominent and enhancing left level II cervical
lymph nodes.
IMPRESSION:
1. Expansile lesion causing extensive cortical destruction of the left parietal occipital bones,
with an enhancing multiseptated, multiloculated soft tissue component, with features and
mass effects. Consistent with a malignant neoplasm, probably metastasis from biopsy-
proven malignancy.
2. Mild chronic small vessel ischemic changes involving the parietal white matter bilaterally.
3. No other brain parenchymal abnormalities demonstrated.
4. Partially visualized ill-defined, heterogeneously enhancing left nasopharyngeal mass,
corresponding to the biopsy proven malignancy.
5. Non-enhancing fluid signal involving the left mastoid air cells, consistent with
obstructive Mastoid disease.
6. Abnormal signal and enhancement involving the left side of the atlas, as well as the
odontoid process, which may represent osseous metastasis. Partially visualized prominent
and enhancing left level II cervical lymph nodes.
Laboratory Test#6: X-ray
50
Indication: To assess cardiopulmonary disease
Date Performed: July 6, 2019
X-RAY RESULT:
There is haziness in the right paracardiac area
Heart is not enlarged.
Aorta is prominent.
The pulmonary vascular markings are exaggerated
Trachea is at midline
Hemidiaphragms and costophrenic angles are intact.
Soft tissues and osseous structures are unremarkable.
IMPRESSION:
 PNEUMONIA VS VESSEL CROWDING, RIGHT PARACARDIAC AREA
 PROMINENT AORTA
 PLEASEE CORRELATE CLINICALLY
Laboratory Test#7: Clinical Chemistry
Indication: To evaluate different compounds in blood and urine.
51
EXAMINATION RESULT REFERENCE RANGE
CREATININE 58.2 80.00-115.00 umol/L
UREA NITROGEN 3.22 2.83-7.17 mmol/L
SGPT 35.4 4.00- 36.00 U/L
SODIUM 132.1 135.00- 148.00 mmol/L
POTASSIUM 3.00 3.50-5.30 mmol/ L
Laboratory Test#8: Ultrasound
Indication: To assess the size, location, and shape of the kidneys and related structures such as
ureters and bladder and to detect cysts, tumors, obstructions and infection within the kidneys.
Date Performed: June 28, 2019
URINARY- TRACT SONOGRAPHY: Right kidney is normal in size but with 2.3 X 1.3 – cm
and 2.2 x 1.7-cm cysts at the lower pole and cortex, respectively. Left kidney is normal in size
but hyperechoic. Right and left kidney measure 10.2 x 3.6cm and 10.6 x 4.7-cm respectively.
Calices, pelves and ureters are not dilated. Urinary bladder is physiologically distended with
normal anechoic lumen. Remainder is unremarkable.
IMPRESSION:
Renal cysts, multiple, right.
52
Parenchymal renal disease left.
INCIDENTAL NOTE: Hepatic cysts, left.
Laboratory Test#9: Radiology
Indication: To assess the bones of the skull, facial bones, the nose and sinuses.
Date Performed: May 1, 2019
RADIOLOGY REPORT
Skull APL views reveal no gross evidence of fracture.
Cranial sutures are intact.
Note of a lytic change at the left temporal area.
The visualized facial bones appear unremarkable
IMPRESSION: *AS DESCRIBED
53
DRUG STUDY
Medication No. 1
Generic name: Clonidine
Brand name: Catapres
Drug classification: Antihypertensive
Dosage/Route/Frequency: oral/ now/ 150mg
Mechanism of Action: Stimulate alpha adrenergic receptor in the CNS, which results in
decreased sympathetic outflow inhibiting cardio acceleration and vasoconstriction centers.
Indication: It is indicated in the treatment of hypertension.
54
Side effects:
CNS: dizziness, drowsiness, insomnia
GI: constipation
EENT: dry eyes
Adverse effect:
CV: Hypotension, Bradycardia, Congestive heart failure, edema
Nursing Responsibilities:
1. Assess BP before and after giving medication.
Rationale:
2. Monitor BP carefully when discontinuing clonidine.
Rationale: Hypertension usually returns within 48hrs.
3. Advice the patient to take exactly as prescribed and not to stop abruptly.
Rationale: Withdrawal symptoms and severe hypertension may occur.
4. Advice the pt. to take clonidine at bedtime.
Rationale: To minimize side and adverse effects.
Medication 2
Generic name: Nalbuphine Hydrocloride
55
Brand name: Nubain
Drug classification: Synthetic opoiod agonist-antagonist analgesic
Dosage/Route/Frequency: 5mg/ IVTT/ q8h
Mechanism of Action: Binds to oblate receptors in the CNS, alters the perception of the
reponses to painful stimuli of white producing generalized CNS depression.
Indication: For the relief of moderate to severe pain.
Side effects:
CNS: Restlessness, confusion, faintess, nervousness
Adverse effect:
Cns: hallucination, dysphoria
EENT: Blurred vision
Cardio: Hypertension, hypotension, bradycardia, tachycardia
Respi: Depression, dyspnea, asthma
Others: Speech difficulty
56
1. Assess type, location and intensity of pain before and after 30 min. of IV administration.
Rationale:
2. Assess blood pressure, pulse and respiration before and periodically during
administration.
Rationale:
3. Assess previous analgesic history.
Rationale: Antagonistic properties may induce withdrawal symptoms in pt. physically
dependent on opoiods.
Medication 3
Generic name: Ketorolac
Brand name: Toradol
Drug classification: Non-steroidal anti-inflammatory agents
Dosage/Route/Frequency: 30mg/ IVTT/ q6h
57
Mechanism of Action: Inhibits prostaglandin synthesis, producing peripherally mediated
analgesia. Also has antipyretic and anti-inflammatory properties.
Indication: Short-term management of pain,
Side effects:
CNS: drowsiness, abnormal thinking, dizziness, headache
Respi: dyspnea
GI: Diarrhea, dry mouth, dyspepsia
Derm: Sweating
Adverse effect:
CV: Edema, pallor
GI: GI bleeding
GU: Renal toxicity
Derm: Exfoliative dermatitis
1. Administer the drug on time.
Rationale: To maintain serum levels and control of pain.

58
2. Instruct patient to take medication exactly as ordered.
Rationale: To provide therapeutic effect.
3. Advise the patient to avoid activities requiring alertness until response to the medication
is known.
Rationale: Because this drug may cause drowsiness or dizziness.
Medication No. 4
Generic Name: Parecoxib
Brand Name: DYNASTAT
Drug Class: COX-2 selective inhibitor
Dosage/ Route/ Frequency: 4mg/ IVTT/ single dose
Drug action: Inhibitscyclooxygenase COX enzymes which are involved in the synthesis of
prostaglandins and thereby reduce pain and inflammation.
Drug indication: Management of acute pain and post-operative pain.
59
Side effects:
CNS: dizziness
CV: Bradycardia
GI: vomiting, nausea&constipation
Dermatologic: Rash
Adverse Effects:
CV: hypertension aggravated, hypotension postural
CNS: insomnia, agitation
Dermatologic: rash, pruritus, diaphoresis
GU: oliguria
MS: arthralgia, back pain
Nursing Responsibilities with Rationale:
1. Assess for hypersensitivity.
Rationale: To prevent allergic reaction.
2. Check the patency of the IV line prior to drug administration.
Rationale: To ensure the delivery of the drug.
3. Administer the drug slowly.
Rationale: To prevent irritation of the IV site.
60
4. Advise patient to increase fluid intake.
Rationale: To prevent constipation.
5. Advise patient avoid activities that requires alertness.
Rationale: To promote client’s safety because this drug may cause dizziness
Medication 5
Generic Name: Tramadol Hydrochloride
Brand Name: ULTRAM
Drug Class: Opioid analgesic
Dosage/ Route/ Frequency: IVTT / q6h
Drug action: Binds to the opioid receptor and inhibits the reuptake of serotonin and
norepinephrine the CNS.
Drug indication: Moderate to moderately severe pain
61
Side effects:
CNS: dizziness, headache, somnolence
EENT: Visual disturbances
GI: constipation, nausea, dry mouth, anorexia, flatulence
Adverse Effects:
CNS: anxiety, confusion, seizure, CNS stimulation, euphoria, nervousness
CV: vasodilation
GI: abdominal pain, diarrhea, dyspepsia, flatulence, vomiting
GU: urine retention,
Dermatologic: pruritus, sweating
Nursing Responsibilities with Rationale:
1. Explain to the patient the indication and classification of the drug.
Rationale: To promote awareness and cooperation.
2. Prepare medication exactly as ordered.
Rationale: To achieve the intended effect of the drug
3. Check V/S especially blood pressure.
Rationale: This drug may cause hypotension.
62
4. Monitor client closely after administration of the drug.
Rationale: To provide prompt intervention to untoward adverse reaction of the drug.
5. Advise to increase oral fluid intake.
Rationale: To prevent constipation.
Medication 6
Generic name: Celecoxib
Brand name: celebrex
Drug classification: Nonsteroidal anti-inflammatory
Dosage/Route/Frequency: 40mg/ OD/ oral
Mechanism of Action: Inhibits prostaglandin synthesis by selectively inhibiting enzyme an
enzyme needed for biosynthesis.
63
Indication: For acute pain and foe inhibition of inflammatory response.
Side effects:
CNS: Headache, drowsiness, weakness,dizziness
Respi: Chest pain
GI: Diarrhea,abdominal pain, bloating, constipation
Adverse effect:
Derma: skin rash
CV: Heart problem
GI: Stomach bleeding, liver problem, kidney problem
1. Assess for hypersensitivity in Celecoxib.
Rationale: To prevent allergic reaction.
2. Instruct the patient to take medication with full stomach.
Rationale: For better absorption.
3. Encourage the patient to increase fluid intake.
Rationale: To prevent dehydration.
64
CONCEPT MAP
LEGEND:
 Straight arrow: Denotes direct relationship from medical
diagnosis/chief complaint
 Broken arrow: Denotes Risk Nursing Diagnosis
 Dotted Arrow: Denotes linking relationship between or among
Nursing Diagnosis
65
NURSING CARE PLAN
NURSING CARE PLAN
Nursing Diagnosis No. 1
Nursing Diagnosis: Risk for impaired skin integrity related to altered nutritional state.
Subjective cues: “ indi namon imaw tagilid dahil ga reklamo nga ga sakit” as verbalized by the
wife.
Objective cues:
 Immobile
66
 Paralysis of right upper and lower extremities
General objectives: To prevent skin breakdown
Specific objective: Within 8 hours of nursing intervention, the patient’s folks will be able to:
 Participate in techniques about preventive measures of bed sores
 Utilize complementary alternative medicine to
1. Inspect skin surfaces and pressure points routinely
Rationale: To prevent pressure sores
2. Provide protection by use of pads, pillows, foam mattress and so forth
Rationale: To increase circulation and mimic or eliminate tissue pressure
3. Change continents pad or diapers frequently
Rationale: To minimize contact irritants
4. Emphasize importance of adequate nutritional and fluid intake
Rationale: to maintain general god health and skin turgor
5. Apply lotion in not contraindicated
Rationale: To prevent friction and shear
 Evaluation: Goals met. The folks was able to participate in techniques about preventive
measures of bed sores.
67
Nursing Diagnosis: Impaired physical mobility related to neuromascular impairment
Subjective cues: “ umpisa nga nag uli kami halin sa panay ga hiningga lat a imaw” as verbalized
by his wife
Objective cues:
 Limited range of motion
 Limited movement
 Difficulty turning
General objectives: To
Specific objectives: Within 8 hours of nursing intervention, the folks of the patient will be able
to:
 Verbalize non-pharmacologic methods to avoid muscle atrophy such as use of pillows in
bony prominences
1. Assess mobility level prior to any activity and other interventions.
Rationale: To ensure the patient safety.
68
2. Educate patient and family the importance of changing position every 2hours and assist
her in a comfortable position.
Rationale: To promote circulation to all body tissues and prevent complications of
immobility.
3. Advice folks to provide foam, mattresses and pillows
Rationale: To promote comfort and decrease pressure on skin
4. Administer medications prior to activity as needed for pain relief
Rationale: To permit maximal effort and involvement
5. Place items within easy reach.
Rationale: To promote patient’s independence and convenience.
6. Assist patient in passive range of motion.
Rationale: To prevent falls or injury and promote safe environment.
Evaluation: Goals partially met. The folks was able to verbalize non-pharmacologic methods to
avoid muscle atrophy such as use of pillows in bony prominences
Nursing Diagnosis: Chronic confusion related to disease process
69
Objective cues:
 Inappropriate words
 Disorientated to person
General objectives: remain safe and free from harm
 Verbalize understanding of disease process, prognosis, and clients needs
 Identify and participate in interventions to deal effectively with situation
1. Monitor vital signs especially temperature.
Rationale: To serve as baseline data and to give prompt intervention because elevation
of temperature or pyrexia indicates infection.
2. Assess if there is any redness, swelling, increased pain and purulent discharge from site.
Rationale: To give prompt intervention because these are the classic signs of infection.
3. Teach aseptic technique for dressing changes and wound care.
Rationale: Aseptic technique for cleaning the wound will minimize the risk for
developing infection and further swelling.
4. Emphasize to the patient and significant others the importance of hand washing technique
before and after contact with the incision.
70
Rationale: To reduce the risk of transmitting pathogens that causes infection.
5. Advise patient to avoid rubbing and scratching the operative site.
Rationale: To prevent further injury and delay wound healing.
6. Administer medication regimen, as prescribed.
Rationale: To determine effectiveness of the therapy.
7. Encourage patient to increase oral fluid intake and eat nutritious foods rich in vitamin C,
high protein and caloric diet.
Rationale: To facilitate wound healing and helps boost the immune system.
Evaluation: Goals met. The patient remains free from infection as evidenced by normal vital
signs especially temperature, absence of signs and symptoms of infection and able to enumerate
preventive measures against infection such as maintaining aseptic technique for wound dressing,
and what are those nutritious food rich in protein, calories and vitamin C that will help to boost
immune system to fight against infection.
71
Nursing Diagnosis: #4 Chronic pain related to disease process
Subjective cues: “ga hambae imaw it agay agay ag ga kurisom pag naka batyag imaw it sakit”
as verbalized by his wife.
Objective cues:
 Irritability
 Restlessness
 Atrophy of involved muscle group
General objectives: To promote physical comfort.
 Utilize non-pharmacological methods or relaxation techniques to control pain such as
deep breathing exercise.
6. Assist the patient in comfortable position.
Rationale: To alleviate pain.
7. Provide quiet and well-ventilated environment.
Rationale: Relaxing environment can promote rest and aid in fast recovery.
8. Provide the patient adequate rest periods.
Rationale: To facilitate comfort and relaxation.

72
9. Instruct patient’s folks to use relaxation technique and deep breathing exercise.
Rationale: To distract attention and reduce tension that increases the intensity of pain.
Evaluation: Goals not met.
73

Brain Tumor Case Study: Nursing Care and Pathophysiology

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Aklan Polytechnic College - College of Nursing

The Faculty of the College of Nursing

Aklan Polytechnic College

Related Learning Experience

Bolido, Jill Cheastine C.

Dela Torre, Rochelle Andrea P.

Relor, Leoni Beth R.

Gestational Diabetes Mellitus through the utilization of the nursing process.

Specifically, we will be able to:

 Define terminologies related to Brain Tumor;

 Discuss the Anatomy and Physiology of the Brain;

 Identify and explain the drugs used to treat Brain Tumor;

 List nursing responsibilities in caring a patient with Brain Tumor;

 Assess and classify gathered data relevant to the patient’s condition;

 Formulate nursing diagnosis specific to the identified health problem;

 Plan a care specific to the patient’s identified health problems;

 Implement the plan of care to the patient;

 Evaluate the effectiveness of nursing care rendered;

 Formulate a Concept Map;

 Identify deviation of laboratory results and its significance;

 Acknowledge patient’s expression of feelings and emotion;

 Establish rapport and promote cooperation through nurse – patient interaction;

ANATOMY AND PHYSIOLOGY

nerves that branch from the brain.

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

reasoning, emotions, learning, and fine control of movement.

maintain posture, and balance.

sleep cycles, digestion, sneezing, coughing, vomiting, and swallowing.

Right brain – left brain

brain, your left arm or leg may be weak or paralyzed.

by the nerve fibers corpus callosum.

Lobes of the brain

 Personality, behavior, emotions

 Judgment, planning, problem solving

 Speech: speaking and writing (Broca’s area)

 Body movement (motor strip)

 Intelligence, concentration, self awareness

 Interprets language, words

 Sense of touch, pain, temperature (sensory strip)

 Interprets signals from vision, hearing, motor, sensory and memory

 Spatial and visual perception

 Interprets vision (color, light, movement)

 Understanding language (Wernicke’s area)

 Sequencing and organization

Aphasia is a disturbance of language affecting speech production, comprehension, reading or

depends on the brain area damaged.

and words, doesn't write within lines) – called Broca's aphasia.

understanding speech and are therefore unaware of their mistakes.

brain areas to each other — called white matter.

other, and to structures deep in the brain (Fig. 5).

Coronal cross-section showing the basal ganglia.

circadian rhythms by secreting melatonin. It has some role in sexual development.

It plays a role in pain sensation, attention, alertness and memory.

cerebellum to coordinate fine motions, such as fingertip movements.

short-term to long-term memory – called encoding.

Ventricles and cerebrospinal fluid

fluid is constantly being absorbed and replenished.

foramen of Monro, 2) aqueduct of Sylvius, and 3) obex.

sagittal sinus called arachnoid villi.

where the spinal cord exits.

Number Name Function

III oculomotor moves eye, pupil

IV trochlear moves eye