chang CAse study.docx

8/10/2019 chang CAse study.docx

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I. ACKNOWLEDGEMENT

I would like to extend my profound gratitude to the following people who played a vital role in the success of this study:

First, to our Almighty God for sustaining us with wisdom, knowledge, love and strength that enabled us to understand, recognize, and overcome all

the trials,\ and difficulties.

To our clinical instructor, Mrs. Herlie B. Ontoy , RN, for incessant understanding, patience, guidance and support throughout this rotation.

To the client and his significant others for their willingness to share their personal data for the fulfillment of this study.

To my loved ones, family, and friends, who served as my inspirations to persevere and continue in my endeavor and for not being hesitant to help

me.


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I. INTRODUCTION

Acute Gastroenteritis (AGE)Gastroenteritis is a catchall term for infection or irritation of the digestive tract, particularly thestomach and

intestine. It is frequently referred to as the stomach or intestinal flu, although theinfluenzavirus is not associated with this illness. Major symptoms

includenausea andvomiting,diarrhea, and abdominal cramps. These symptoms are sometimes also accompanied byfever and overall weakness.

Gastroenteritis typically lasts about three days. Adults usuallyrecover without problem, but children, the elderly, and anyone with an underlying

disease aremore vulnerable to complications such asdehydration.Gastroenteritis arises from ingestion of viruses, certain bacteria, or parasites. Food

that hasspoiled may also cause illness. Certain medications and excessive alcohol can irritate thedigestive tract to the point of inducing

gastroenteritis. Regardless of the cause, the symptomsof gastroenteritis include diarrhea, nausea and vomiting, and abdominalpainand

cramps.Sufferers may also experience bloating, low fever, and overall tiredness. Typically, thesymptoms last only two to three days, but some viruses

may last up to a week.A usual bout of gastroenteritis shouldn't require a visit to the doctor. However, medicaltreatment is essential if symptoms

worsen or if there are complications. Infants, youngchildren, the elderly, and persons with underlying disease require special attention in

thisregard.The greatest danger presented by gastroenteritis is dehydration. The loss of f luids throughdiarrhea and vomiting can upset the body's

electrolyte balance, leading to potentially life-threatening problems such as heart beat abnormalities (arrhythmia). The risk of dehydrationincreases

as symptoms are prolonged. Dehydration should be suspected if adry mouth,increased or excessive thirst, or scanty urination is experienced.If

symptoms do not resolve within a week, an infection or disorder more serious thangastroenteritis may be involved. Symptoms of great concern

include a high fever (102 F[38.9 C] or above), blood or mucus in the diarrhea, blood in the vomit, and severe abdominal pain or swelling. These

symptoms require prompt medical attention.Gastroenteritis is a self-limiting illness which will resolve by itself. However, for comfort andconvenience,

a person may use over-the-counter medications such as Pepto Bismol to relievethe symptoms. These medications work by altering the ability of the

intestine to move or secrete spontaneously, absorbing toxins and water, or altering intestinal microflora.

III. SIGNIFICANCE OF THE STUDY

Nursing Education:

The significance of this study to nursing education is to further increase and expound knowledge of the students. It also helps to make a

reliable and holistic care plans to improve the quality of life of the client. The study hastens the opportunity for the students to apply theoretical

knowledge to actual health care settings.

Nursing Practice:

This study is significant to nursing practice to further improve the skills and ability of the nursing students and enhances students capability to

make intelligent actions and decisions in the clinical area. This study also helps us to attain our goal which is to provide quality care to our client to

improve their quality of life.

Nursing Research:

Through having this study, nursing students would be able to apply their skills in research. Be able to apply systematic and scientific way of

solving problems and discover new ideas that would give answers to the patients situation. It also a means of revision the k ind of therapy we have

and a means of discovering a new technique or methods in dealing and caring of client with this kind of condition.
http://medical-dictionary.thefreedictionary.com/Influenzahttp://medical-dictionary.thefreedictionary.com/Nausea+and+Vomitinghttp://medical-dictionary.thefreedictionary.com/Nausea+and+Vomitinghttp://medical-dictionary.thefreedictionary.com/Feverhttp://medical-dictionary.thefreedictionary.com/Dehydrationhttp://medical-dictionary.thefreedictionary.com/Dehydrationhttp://medical-dictionary.thefreedictionary.com/Dehydrationhttp://medical-dictionary.thefreedictionary.com/Painhttp://medical-dictionary.thefreedictionary.com/Painhttp://medical-dictionary.thefreedictionary.com/Dry+Mouthhttp://medical-dictionary.thefreedictionary.com/Dry+Mouthhttp://medical-dictionary.thefreedictionary.com/Dry+Mouthhttp://medical-dictionary.thefreedictionary.com/Painhttp://medical-dictionary.thefreedictionary.com/Dehydrationhttp://medical-dictionary.thefreedictionary.com/Feverhttp://medical-dictionary.thefreedictionary.com/Nausea+and+Vomitinghttp://medical-dictionary.thefreedictionary.com/Nausea+and+Vomitinghttp://medical-dictionary.thefreedictionary.com/Influenza


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IV. Objectives of the Study

A. General Objectives

1..

B. Specific Objectives

1. To determine the previous and present medical history of the patient.

2. To perform physical assessment with special attention on the systems focus.

3. To show the laboratory examination results with the corresponding normal values, actual result from the patient, and its interpretation.

4. To learn the basic principle of medical management of Gastroenteritis

5. To gain information through Nurse-Patient interaction, identify problems from the client and provide the appropriate nursing care plan.

6. To understand the pharmacological management set on the client and provide nursing interventions.

7. To identify the discharge plan for the patientsrehabilitation to conduct an evaluation of the clientscondition from admission to prese

V. PATIENTSPROFILE

Nursing Health History

Biographical Data:

Patient X is 10 years old, Female, from Balingasag Misamis Oriental . She lived with her family. She was baptized as Roman Catholic. She

weighed 30kg and stands 130cm in height. Patient X was admitted to the hospital last September 25 , 2014 , 8 oclock in the evening due to the

complaint of pain in the Abdominal area and associated with undocumented fever and persistent vomiting . Upon assessment, patients vital signs

are BP: 90/50mmHg (lying), HR: 110bpm, RR: 23cpm, and T: 38.9*C

Chief Complaint:

Patient X was brought to the hospital due to abdominal pain and high grade fever associated with persistent vomiting

History of Present Illness:

2 days Prior to Admission patient complaint of abdominal pain and was consulted at the Pedia OPD.

Past Medical History:

Patient was admitted when she was 1 year old because of Dengue.


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Family History of Illness:

No one in the family had any respiratory illness or allergies. On her fathers side,almost all have hypertension.

Nutritional and Metabolic Pattern:

Patient X used to consume full share of three meals every day with 1 cup of rice, with good appetite. Patient has no eating discomforts.

Patient could consume 5-8 glasses of water a day.

Patient A has a special diet of DAT with aspiration precaution. Patient has no eating discomforts. He is well nourished but reports loss

of appetite.

Elimination Pattern

Patient defecates once a day with firm brownish stool, without discomforts. Has no hemorrhoids. He urinates 4-6x a day with yellow

colored urine and weighs around 120-150mL each urination.

Activity-Exercise Pattern

Patient X is a very playful and active girl. She has lots of energy . She smiles and laughs a lot. Her daily living activities were provided by her

parents. There is no musculoskeletal impairment. She usually plays after she wakes up in the morning.

Sleep-Rest Pattern

She sleeps at 8 P.M. in the evening and usually gets up 7 A.M. 8 A.M. in the morning. After playing or eating she takes a nap. She has

straight undisturbed sleep at night.

Cognitive Perceptual Pattern

Patient X has no sensory deficits. She response well to verbal stimulus by looking at you or having facial expressions.

Self-Perception Pattern

Patient X is not afraid of new people around her. She is friendly and is easy to accommodate.

Sexual-Reproduction Pattern

Prior to age, S.Q. is not yet oriented with any sexual matters.

Value-Belief

The family is Roman Catholic. They regularly attend church together with all the members of the family.


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PHYSICAL ASSESSMENT

Head, Eyes, Ears, Nose, and Throat

She had a normocephalic head, symmetrical facial movements, closed fontanels, coarse hair, and no dandruff on his scalp.

She had symmetrical lids, pale conjunctiva, opaque cornea and lens, anicteric sclera, and equal- sized pupils which were brisk in reaction to

light and were uniform in constriction or convergence in reaction to accommodation.

She had normoset and symmetrical external pinnnae, intact tympanic membrane, and normal gross hearing.

She had normal and symmetrical gross smell, patent nose with pale mucosa. Her uvula was in midline and his tonsils were not inflamed.

Mouth

Her lips were pallor while her mucosa and gums also pale. Her tongue was in midline. Her teeth were already missing.

Neck

Her trachea is in midline and her thyroids are non- palpable.

Skin

She had a pale, supple skin with a rough texture. It is cool and moist or clammy.

Cardiovascular Status

She had not reported any occurrence of chest pain. She had an regular apical rhythm at the rate of 110 beats per minute. Her heart sounds

and his symmetrical peripheral pulse were also regular. His capillary refill was less than 2 seconds. Hence, it was normal. She had no pacemaker.

Respiratory Status

She had regular breathing. Her anterior- posterior- lateral ratio is 2:1. She had symmetrical lung expansion and vocal ortactile fremitus upon

percussion. No abnormal sound heard upon ausculatation. She had no oxygen supplement/ventilator assistance attached.

Abdomen

No superficial veins and striae noted on his symmetrical abdomen. Normoactive sound was heard on auscultation while tympanic sound was

heard upon percussion.

Back and Extremities

Her range of motion was full nor symmetrical. Her muscle tone and strength were strong and neither symmetrical in size.

Her spine was midline. She had coordinated gait.

Activities of Daily Living

Feeding 2

Bathing 2

Toileting 2

Bed Mobility 2

Dressing 2


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Grooming 2

Meal Preparation 4

Cleaning 4

Laundry 4

Chair transfer 2

VI. ANATOMY AND PHYSIOLOGY

Digestion is the process by which food is broken down into smaller pieces so that the bodycan use them to build and nourish cells and to provide

energy. Digestion involves themixing of food, its movement through the digestive tract (also known as thealimentarycanal), and the chemical

breakdown of larger molecules into smaller molecules. Every piece of food we eat has to be broken down into smaller nutrients that the bodycanabsorb,which is why it takes hours to fully digest food.The digestive system is made up of the digestive tract. This consists of a long tube

of organs that runs from themouthto theanusand includes the esophagus, stomach, smallintestine,and large intestine, together with theliver ,

gallbladder ,andpancreas,which produce important secretions for digestion thatdraininto the small intestine. The digestivetract in an adult is about

30 feet long.Mouth and Salivary GlandsDigestion - begins in the mouth, where chemical andmechanical digestion occurs. Saliva or spit, produced by

the salivary glands (located under thetongueand near the lowerjaw), is released into the mouth. Saliva Saliva begins to break down the food,

moistening it and making it easier to swallow. A digestiveenzyme(calledamylase)in the saliva begins to break down thecarbohydrates(starches and

sugars). One of the most important functions of the mouth is chewing. Chewing allows food to bemashed into a soft mass that is easier to swallow

and digest later.Esophagus - Once food is swallowed, it enters the esophagus, amusculartube that is about10 inches long. The esophagus is

located between the throat and the stomach. Muscular wavelike contractions known asperistalsispush the food down through the esophagus tothe

stomach. A muscular ring (called thecardiacsphincter) at the end of the esophagusallows food to enter the stomach, and, then, it squeezes shut to

prevent food and fluid fromgoing back up the esophagus.Stomach - a J-shapedorganthat lies between the esophagus and the small intestine in

theupperabdomen.The stomach has 3 main functions: to store the swallowed food and liquid to mix up the food, liquid, and digestive juices

produced by the stomach; and to slowlyempty its contents into the small intestine.Small Intestine - Most digestion andabsorptionof food occurs in the

small intestine. Thesmall intestine is a narrow, twisting tube that occupies most of the lower abdomen betweenthe stomach and the beginning of the

large intestine. It extends about 20 feet in length. Thesmall intestine consists of 3 parts: the duodenum (the C-shaped part), thejejunum(thecoiledmidsection), and theileum
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(the last section). The small intestine has 2 importantfunctions. First, the digestive process is completed here by enzymes and other substancesmade

by intestinal cells, the pancreas, and the liver. Glands in the intestine walls secreteenzymes that breakdown starches and sugars. The pancreas

secretes enzymes into the smallintestine that help breakdown carbohydrates,fats,and proteins. The liver produces bile,which is stored in the

gallbladder.Bile helps to make fat molecules (which otherwise arenot soluble in water) soluble, so they can be absorbed by the body. Second, the

smallintestine absorbs the nutrients from the digestive process. The inner wall of the smallintestine is covered by millions of tiny fingerlike projections

calledvilli.The villi arecovered with even tinier projections called microvilli. The combination of villi andmicrovilli increase the surface area of the

small intestine greatly, allowing absorption of nutrients to occur. Undigested material travels next to the large intestineileum(the last section). The

small intestine has 2 importantfunctions. First, the digestive process is completed here by enzymes and other substancesmade by intestinal cells, the

pancreas, and the liver. Glands in the intestine walls secreteenzymes that breakdown starches and sugars. The pancreas secretes enzymes into the

smallintestine that help breakdown carbohydrates,fats,andproteins.The liver producesbilewhich is stored in thegallbladderBile helps to make fat

molecules (which otherwise arenot soluble in water) soluble, so they can be absorbed by the body. Second, the small. Large intestine - forms an upside

down U over the coiled small intestine. It begins at thelower right-hand side of the body and ends on the lower left-hand side. The large intestineis about 5-6 feet long. It

has 3 parts: thececum,thecolon,and therectum.The cecum is a pouch at the beginning of the large intestine. This area allows food to pass from the

smallintestine to the large intestine. The colon is where f luids and salts are absorbed and extendsfrom the cecum to the rectum. The last part of the

large intestine is the rectum, which iswherefeces(waste material) is stored before leaving the body through the anus. The main job of the large

intestine is to remove water and salts (electrolytes)from the undigestedmaterial and to form solid waste that can be excreted.Bacteriain the large

intestine help to break down the undigested materials. The remaining contents of the large intestine aremoved toward the rectum, where feces are

stored until they leave the body through theanus as abowelmovement.

VII. Pathophysiology

Predisposing:

Age: 10 years old

Precipitating:

Lifestyle

Diet

Hygiene

Etiology : Hystolytica, Salmonella,

Shigella, Campylobacter jejun, E

Coli

Person to person (hands)

Ingestion of Pathogens

Direct invasion of the bowel

wallEndotoxins are relesead

Digestion and absorptive

malfunction

Stimulation and destruction of

mucosal lining of the bowel wall

Contaminated food or Water

Secretion of fluid and

electrolytes in the intestinal

lumen

Excessive Gas Formation Increased Peristaltic

Movement Diarrhea

GI Distention

Nausea and Vomiting

Fluid and Electrolytes

Imbalance

Dehydration

Dry lips,

Dry mouth ,

fatigue,

irritability
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VIII. DIAGNOSTIC TEST

September 25, 2014

TEST RESULTS REFERENCE INTERPRETATION

White BloodCells

8.05 5.0-10.0 10^3/uL Normal

Red Blood Cells 4.58 4.2-5.4 10^6/uL Normal

Hemoglobin 11.9 12.0-16.0 g/dL Infection

Hematocrit 35.4 37.0-47.0% Infection

MCV 84.3 82.0-98.0fL Normal

MCH 29.3 27.0-31.0pg Normal

MCHC 34.7 31.5-35.0g/dL Normal

RDW-VC 12.0-17.0% Normal

PDW 10.1 9.0-16.0fL Normal

MPV 8.5 8.0-12.0fL Normal

DIFFERENTIAL COUNT

Lymphocyte (%) 14.1 17.4-48.2 Normal

Neutrophil(%) 71.9 43.4-76.2 Normal

Monocyte(%) 6.3 4.5-10.5 Normal

Eosinophil(%) 2.3 1.0-3.0 Normal

Basophil(%) 0.0 0.0-2.0 Normal

Bands/Stabs(%)

PLATELET 387 150-400x10^3/uL Normal


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IMMUNOLOGY REPORT

X HbsAg NONREACTIVE

URINALYSIS REPORT

PHYSICAL PROPERTIES

Color Amber

Clarity Clear

Odor

pH 6.0

Specific Gravity 1.030

CHEMICAL PROPERTIES

Proteins Negative

Glucose Negative

SEGMENT/MICROSCOPIC EXAMINATION

Red blood cells 0-2

IX. DRUG STUDY

DRUG ORDER

Generic Name: Omeprazole

Brand Name: Omepron

Classification: Proton Pump Inhibitor

Dosage: 5 mg

Route: IV

Frequency:Once a day


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MECHANISM OF ACTION:

Inhibitsactivity of acid (proton) pumps & binds tohydrogen-

potassiumadenosinetriphosphateat secretorysurfaceof gastric parietal cellsto block formation of gastric acid

INDICATIONS:

Gastrointestinaldisturbaces andirritations

ADVERSE EFFECTS OF THE DRUG:

Headache

Restlessness

dizziness

f atigue

NURSING RESPONSIBILITIES/ PRECAUTIONS:

Take 30 minutes before meal

Report any changes in urinary elimination such as pain or discomfort

associated with urination, or blood urine.

X. NURSING CARE PLAN #1

ASSESSMENT DATA:

SUBJECTIVE:

.

OBJECTIVE:

Flushed skin with body temperature of 38.9 degree Celsius Respiratory rate of 21

Pulse rate of 110 bpm

Muscle rigidity : chills

Profuse diaphoresis

Restless and Irritable noted

NURSING DIAGNOSIS (Problem and Etiology):

Hyperthermia related to increase metabolic rate, illness

GOALS AND OBJECTIVES:

After 2 hours of nursing intervention the patient will be able to demonstrate

temperature within the normal range be free to chills.


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NURSING INTERVENTIONS AND RATIONALE:

EVALUATION:

NURSING CARE PLAN #2

ASSESSMENT DATA:

SUBJECTIVE:

OBJECTIVE:

The patient manifested:

Abdominal Pain

Appears weak

Limited range of motion

Restlessness

Verbalization of pain with a pain scale of 6/10.

The pt. may manifest:

Facial grimaces

Irritability

Impaired thoughtprocess

Reduced interaction with people

sleep disturbances

diaphoresis


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Acute pain related to irritation/inflammation of gastric mucosa, possibly

evidenced by verbal reports, guarding/distraction behaviors and

autonomic response.


Short term Goal

After 3 hours of NI the patient will report a decrease of pain.

Long Term:

After 2 days of nursing interventions the patient will be free from pain

and demonstrate relaxation skills.


1. Establish rapport

2. Monitor and record vital signs.

3. Review factor that aggravate or alleviate pain

4. Instruct the SO to massage the area where pain is elicited if notcontraindicated

5. Encourage pain reduction techniques

6. Provide adequate rest

7. Provide diversional activities like socialization

8. Administer analgesics to maintain acceptable level of pain if not

contraindicated

9. Instruct client to perform: deep breathing exercises (DBE)

10. Monitor effectiveness of pain medications

RATIONALE

1. To gain the trust and cooperation of the patient

2. To provide baseline data and note deviations from normal.

3. Helpful in establishing diagnosis and treatment needs

4. To lessen/alleviate pain caused by various factors (administer meds via

IV push)5. To reduce pain and promote relief/comfort

6. To promote healing

7. For clients comfort and relief from pain

8. To decrease pain.


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9. Deep breathing exercises may reduce pain sensation/ used in pain

management

10. To promote timely intervention/ revision of plan of care

EVALUATION:

Short Term:

After 2-3 hours of nursing interventions, the patient shall haveverbalized understanding of causative factors and rationale fortreatment regimen.

Long Term:

After 1-2 days of nursing interventions, the patient shall have

reestablished and maintained normal pattern of bowel functioning


ASSESSMENT DATA:

SUBJECTIVE:

OBJECTIVE:

The patient manifested:

passage of loose watery stool

vomiting

abdominal cramping

dehydration

nausea

fatigue

weakness


Deficient fluid volume RT excessive losses through normal routesAEB frequent passage of loose watery stool


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Short term: After 4 hours of nursing interventions, the patient will report

understanding of causative factors for fluid volume deficit

Long Term:

After 3 days of Nursing Interventions, the patient will maintain fluid

volume at functional level AEB well hydrated, intake is equal as

output, and normal skin turgor.


1. Establish rapport

2. Monitor and record VS

3.Assess patients condition

4. Monitor Input & Output balance

5. Maintain adequate hydration, increase fluid intake.

6. Provide frequent oral care

7. Administer Intravenous fluids as prescribed

8. Determine effects of age.9. Restrict solid food intake, as indicated

10. Discuss individual risk factors/ potential problems and specific

intervention

1. To gain patients trust

2. To obtain base line data

3. To be aware of the patients condition and feeling

4. to ensure accurate picture of fluid status

5. To prevent dehydration & maintain hydration status.

6. To prevent from dryness

7. To deliver fluids accurately and at desired rates.

8. Very young and extremely elderly individuals are quickly affected by

fluid volume deficit

9. To allow for bowel rest and to reduced intestinal workload.

10. To prevent or limit occurrence of fluid deficit.


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EVALUATION:

Short term:

After 4 hours of nursing interventions, the patient shall have

reported understanding of causative factors for fluid volume deficit

Long term:

After 3 days of Nursing Interventions, the patient shall have

maintained fluid volume at functional level AEB well hydrated, intake

is equal as output, and normal skin turgor.


ASSESSMENT DATA:

SUBJECTIVE:

OBJECTIVE:

Patient may manifest:

Weakness

Restlessness

Physical inactivity

Increase respiratory rate

Fatigue

Low hgb count

Low hct count


Activity intolerance related to generalized weakness AEB limited

physical activity.


Short Term:

After 4 hours of nursing interventions the patient will identifynegative factors affecting activity intolerance and eliminate or reducetheir effects.


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Long Term:

After 1-2 days of nursing interventions, the patient will report activity

tolerance with enhance energy and the patient will participate

willingly in necessary or desired activities.


1. Monitor and record vital signs

2. Provide health teaching on the client regarding the organization and

time management technique to prevent while on activity

3. Provide enough air coming from the electric fan or from the window

4. Develop and adjust simple activity like brushing his teeth

5. Assist client with activity

6. Promote comfort measures on the activity

7. Cluster nursing care

8. Ascertain ability to stand and move about degree of assistance

9. Encourage complete bed rest.

RATIONALE

1. To obtain the baseline data

2. To provide adequate knowledge on the client

3. To enhance patient ability to participate in activity

4. To monitor patients respond to activities

5. To prevent overexertion

6. To protect patient from injury

7. To prevent over-exhaustion8. To determine current status and needs

9. For patient recuperation and recovery

EVALUATION:

Short Term: After 4 hours of nursing interventions the patient shall have identified

negative factors affecting activity intolerance and eliminate or reducetheir effects.

Long Term:


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After 1-2 days of nursing interventions, the patient shall reported

activity tolerance with enhance energy and the patient will participate

willingly in necessary or desired activities

XI. DISCHARGED PLAN/ HEALTH TEACHINGS

Medication:

Instruct client that home medication should be taken regularly on exact

dosage, time, and frequency and to complete the medication regimen

as prescribed by the physician.

Exercise:

Teaching breathing retaining exercise to increase diaphragmatic

excursion and reduce work of breathing.

Teach relaxation techniques to reduce anxiety and pain.

Treatment:

Teach significant others about the importance of making follow-up

appointments.

Explain the importance of medications as prescribed by the physician

making sure that the purpose of medication is fully disclosed to the

client.

Instruct client and significant others to contact or see a physician if

serious side effects are experienced.

Health Teachings:

Keep a list of your medicines: Keep a written list of the medicines you

take, the amounts and when and why you take them. Bring the list of

your medicines or the pill bottles when you see your caregivers. Do not


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take any medicines, over the counter drugs, vitamins, herbs or food

supplements without first talking to caregivers.

Eat foods rich in protein, carbohydrates, vitamin C.

Drink enough liquids and get plenty of rest. Be sure to drink enough

liquids every day. Most people should drink at least 8(oz.) Cups of

water a day. This help to keep your air passages moist and better able

to get rid of germs and other irritants. You may feel like resting more.

Slowly start to do more each day. Rest when you feel it is needed.

Avoid heavy lifting and strenuous activity.

Advice significant others to provide a safe environment and good

sanitation for the client to avoid further complications.

Outpatient:

Encourage patient and significant others to have regular check-ups as

ordered by the physician to ensure the continuing management and

treatment.

Diet:

Instruct patient that a healthy diet which is prescribed should be

followed.

Encourage client to eat healthy and nutritious foods especially fruits

and green leafy vegetables.

Encourage client to drink enough liquids each day and not just during

thirsty.

Spiritual:

Encourage client and significant others to strengthen their relationship

to God, to maintain religious practices and beliefs and to ask God for

continue protection and guidance.


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Advice significant others to provide emotional support to the client and

making sure to have somebody to assist him wherever he will go.

XII. BIBLIOGRAPHY:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2424119/

http://archinte.jamanetwork.com/article.aspx?articleid=1105601

http://lifeinthefastlane.com/2010/04/minor-injuries-002/

https://reader010.{domain}/reader010/html5/0607/5b1902bbeeada/5b1902d281ddf.jpg

http://www.nlm.nih.gov/medlineplus/ency/article/000793.htm

http://www.rnpedia.com/home/notes/pharmacology-drug-study-notes/tramadol-

hydrochloride

http://nurseslabs.com/ampicillin-sodium-principen/

http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=23b6d4a3-b273-4e10-

9da9-1376933fdbdf

http://www.drugstudyultimate.com/2012/07/chloramphenicol-pentamycetin.html

http://medical-dictionary.thefreedictionary.com/Jackson-Pratt+drain

http://www.mayoclinic.com/health/post-concussion-syndrome/DS01020

http://www.merriam-webster.com/dictionary/electroencephalography

http://www.thefreedictionary.com/electroencephalography
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2424119/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2424119/http://archinte.jamanetwork.com/article.aspx?articleid=1105601http://archinte.jamanetwork.com/article.aspx?articleid=1105601http://lifeinthefastlane.com/2010/04/minor-injuries-002/http://lifeinthefastlane.com/2010/04/minor-injuries-002/http://htmlimg1.scribdassets.com/2szjnj096on40ac/images/3-a3751a52e0.jpghttp://htmlimg1.scribdassets.com/2szjnj096on40ac/images/3-a3751a52e0.jpghttp://www.nlm.nih.gov/medlineplus/ency/article/000793.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000793.htmhttp://www.rnpedia.com/home/notes/pharmacology-drug-study-notes/tramadol-hydrochloridehttp://www.rnpedia.com/home/notes/pharmacology-drug-study-notes/tramadol-hydrochloridehttp://www.rnpedia.com/home/notes/pharmacology-drug-study-notes/tramadol-hydrochloridehttp://nurseslabs.com/ampicillin-sodium-principen/http://nurseslabs.com/ampicillin-sodium-principen/http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=23b6d4a3-b273-4e10-9da9-1376933fdbdfhttp://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=23b6d4a3-b273-4e10-9da9-1376933fdbdfhttp://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=23b6d4a3-b273-4e10-9da9-1376933fdbdfhttp://www.drugstudyultimate.com/2012/07/chloramphenicol-pentamycetin.htmlhttp://www.drugstudyultimate.com/2012/07/chloramphenicol-pentamycetin.htmlhttp://medical-dictionary.thefreedictionary.com/Jackson-Pratt+drainhttp://medical-dictionary.thefreedictionary.com/Jackson-Pratt+drainhttp://www.mayoclinic.com/health/post-concussion-syndrome/DS01020http://www.mayoclinic.com/health/post-concussion-syndrome/DS01020http://www.merriam-webster.com/dictionary/electroencephalographyhttp://www.merriam-webster.com/dictionary/electroencephalographyhttp://www.thefreedictionary.com/electroencephalographyhttp://www.thefreedictionary.com/electroencephalographyhttp://www.thefreedictionary.com/electroencephalographyhttp://www.merriam-webster.com/dictionary/electroencephalographyhttp://www.mayoclinic.com/health/post-concussion-syndrome/DS01020http://medical-dictionary.thefreedictionary.com/Jackson-Pratt+drainhttp://www.drugstudyultimate.com/2012/07/chloramphenicol-pentamycetin.htmlhttp://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=23b6d4a3-b273-4e10-9da9-1376933fdbdfhttp://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=23b6d4a3-b273-4e10-9da9-1376933fdbdfhttp://nurseslabs.com/ampicillin-sodium-principen/http://www.rnpedia.com/home/notes/pharmacology-drug-study-notes/tramadol-hydrochloridehttp://www.rnpedia.com/home/notes/pharmacology-drug-study-notes/tramadol-hydrochloridehttp://www.nlm.nih.gov/medlineplus/ency/article/000793.htmhttp://htmlimg1.scribdassets.com/2szjnj096on40ac/images/3-a3751a52e0.jpghttp://lifeinthefastlane.com/2010/04/minor-injuries-002/http://archinte.jamanetwork.com/article.aspx?articleid=1105601http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2424119/


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http://www.merriam-webster.com/dictionary/neuroimaging

Medical-Surgical Nursing pp. 1933-1940
http://www.merriam-webster.com/dictionary/neuroimaginghttp://www.merriam-webster.com/dictionary/neuroimaginghttp://www.merriam-webster.com/dictionary/neuroimaging

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