Ward 1 Final Compilation 2003

7/29/2019 Ward 1 Final Compilation 2003

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Velez College College of NursingF. Ramos Street, Cebu City, 6000

A Case Study on Patient Z.C.P , 1 year old, Female Diagnosed With Complex Febrile Seizure Secondary to Pneumonia.

Submitted to:

Ms. Urlyn Doydora, RN, MNWard 1 Clinical Instructor

Submitted by:Cabaluna, Mary Angeli A.Calva, Quennie Ann N.

Navarro, Jassel S.BSN 4D

Balingit, Regina nagela N.Lastimoso, Salve Reggina N.

Bahena, Angelique M.Rosas, Fleur Abigail G.

BSN 2C

February 14, 2012


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INTRODUCTION

COMPLEX FEBRILE SEIZURES

A febrile seizure, also known as a fever it or febrile convulsion, is a convulsion associated wi th a significant rise in body temperature. Full body convulsions that occur durin

and children in the age group of 6 months to 6 years old i s febrile seizures. These seizures last for a few minutes with a fever temperature above 102 F (38.9 C). These febrile seizureas common in boys as compared to girls. A febrile seizure is diagnosed when all underlying causes are eliminated, such as meningitis, encephalitis, or any other intracranial disease.

There are two types of febrile seizures:

Simple febrile seizuresconvulsions last between a few seconds to 15 minutes and are followed by a period of confusion and sleepiness which slowly resolves

Complex febrile seizures last longer than 15 minutes, occur more than once within 24 hours, or produce convulsions which affect only part the body.

Causes

Elevated body temperature

normally precipitated by a recent upper respiratory infection

or gastroenteritis

Risk Factors

Age

Family Hx

Symptoms

Signs of a febrile seizure include:

A fever, usually above 102F

Convulsion (jerking or stiffening muscles)

Abnormal eye movements

Coarse breathing sounds during the convulsion

Loss of consciousness

Loss of bladder or bowel control

Vomiting Brief period of drowsiness or confusion following a seizure

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DiagnosisIn the case of simple febrile seizures, the diagnosis revolves around determining the source of the fever. This may require blood or urine tests. If the doctor suspects meningitis

a lumbar puncture may be needed to analyze the spinal fluid.

In the case of complex febrile seizures, the source of the fever is important. Additional neurologic evaluation may be needed, including:

CT scan a type of x-ray that uses a computer to make pictures of structures inside the head

MRI scan a test that uses magnetic waves to make pictures of structures inside the head

Electroencephalogram (EEG)a test used to evaluate brain function or disorders

MRI Scan

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Febrile Seizures and Epilepsy

There are different types of seizures and epilepsy which makes people more susceptible to seizures. However, febrile seizures and epilepsy are two different conditions that cFebrile seizure causes includes a feverish il lness. Epilepsy on the other hand is due to brain abnormalities. Also, an epileptic seizure can occur even if an individual is not suffering from parents think that fever, febrile seizures and epilepsy are interconnected or a child with febrile fever will develop epilepsy in future. The chances of a child developing epilepsy later in cof febrile seizure are about 2 in 100 children. This shows that if a child develops febrile seizures, it does not always lead to epilepsy in the future.

Treatment

Control the temperature with acetaminophen (Paracetamol).

Make sure your child is placed in a safe bed and does not fall down and hit something hard.

The child must be gently rolled over to his side to avoid choking.

Remain near your child and stay alert for any signs of breathing problems or change in color of the face.

Never try to put anything in the child's mouth during a seizure and do not try and restrain the child .

Anticonvulsants can be prescribed. Sodium valproate or clonazepam

are active against febrile seizures, with sodium valproate showing superiority over clonazepam

Prevention

About 30% of children will suffer another febrile seizure when they have a fever. This tendency is outgrown, and very few will develop epilepsy. Giving your child acetaminopa fever may help prevent recurrent febrile seizures. Unfortunately, a fever can happen suddenly, with the seizure being the first sign. Do not give oral medications during a seizure. Dailmedications, such as phenobarbital and valproic acid , can be used to prevent seizures. These medications do have side effects, though. Simple febrile seizures, while alarming, do not the side effects, medications are not routinely recommended. In children with recurrent febrile seizures, your doctor may prescribe rectal valium to stop the seizure if it lasts more thanAspirin is not recommended for children or teens w ith a current or recent viral infection. This is because of the risk of Reye's syndrome. Ask your doctor which other medicines are safe

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PNEUMONIA

Pneumoniais a general term that refers to an infection of the lungs, which can be caused by a variety of microorganisms including viruses, bacteria, fungi, and parasites. It is character

inflammation of the alveoli in the lungs or by alveoli that are filled with fluid (alveoli are microscopic sacs in the lungs that absorb oxygen). At times a very serious condition, pneumoniavery sick or even cause death. Although the disease can occur in young and healthy people, it is most dangerous for older adults, babies, and people with other diseases or impaired im

Most cases of pneumonia are caused by viruses, including adenoviruses, rhinovirus, influenza virus (flu), respiratory syncytial virus (RSV), and parainfluenza virus (which caupneumonia begins after an upper respiratory tract infection (an infection of the nose and throat), with symptoms of pneumonia beginning after 2 or 3 days of a cold or sore throat.

Causes

Bacteria and viruses are the primary causes of pneumonia. When a person breathes pneumonia-causing germs into his lungs and his body's immune system cannot otherworganisms settle in small air sacs called alveoli and continue multiplying. As the body sends white blood cells to attack the infection, the sacs become filled with fluid and pus - causingpneumonia. Pneumonia has bacterial, viral, fungal, and other primary causes.

BacterialStreptococcus pneumoniae

Klebsiella pneumoniae and Hemophilus influenzae.

Mycoplasma pneumonia

Legionella pneumoniae

Chlamydia pneumoniae.

Pneumocystis carinii

ViralAdenoviruses,

Rhinovirus,

Influenza virus (flu),

Respiratory syncytial virus (RSV), and

Parainfluenza virus

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FungalHistoplasmosis,

Ccoccidiomycosis,

Bastomycosis,

Aspergillosis, and

Cryptococcosis

Nosocomial and othersNosocomial organisms

MRSA, or methicillin-resistant Staph aureus

Anthrax,

Plague, and

Tularemia

Symptoms

Symptoms vary depending on the age of the child and the cause of the pneumonia, but common ones include:

fever

chills

cough

nasal congestion unusually rapid breathing (in some cases, this is the only symptom)

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breathing with grunting or wheezing sounds

labored breathing that makes the rib muscles retract (when muscles under the ribcage or between ribs draw inward with each breath) and causes nasal flaring

vomiting

chest pain

abdominal pain

decreased activity

loss of appetite (in older kids) or poor feeding (in infants), which may lead to dehydration

in extreme cases, bluish or gray color of the lips and fingernails

Incubation

4 to 6 days;

for influenza, 18 to 72 hours.

Duration

Ttt: 1-2 weeks for bacterial pneumonia

Viral may last longer

4 to 6 weeks for Mycoplasmal pneumonia

Contagiousness

The viruses and bacteria that cause pneumonia are contagious and usually found in fluid from the mouth or nose of someone who's infected.

Illness can spread when an infected person coughs or sneezes on others, by sharing drinking glasses and eating utensils, and when someone touches the used tissues or handkperson.

Diagnosis

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physical exam symptoms and medical history hear coarse breathing, wheezing, crackling sounds, or

rumblings when listening to the chest through a stethoscope. Chest x-rays blood tests bronchoscopy

Treatment

Pneumonia treatments depend on the type of pneumonia and the severity of symptoms:

Bacterial pneumonias are usually treated with antibiotics,

viral pneumonias are treated with rest and plenty of fluids

Fungal pneumonias are usually treated with antifungal medications.

Over-the-counter medications are also commonly prescribed to better manage pneumonia symptoms.

Addition, it is important to get plenty of rest and sleep and drink lots of fluids.

Prevention

Vaccines

Prophylactic (disease-preventing) antibiotics

Antiviral medication

Regular tuberculosis screening

Keep his or her drinking glasses and eating utensils separate from those of other family members

Wash your hands frequently

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ANATOMIC AND PHYSIOLOGIC OVERVIEW OF THE RESPIRATORY SYSTEM

RESPIRATOTY SYSTEM

The respiratory system is the bodys means of acquiring the oxygen necessary for cell and tissue maintenance and disposing of unwanted carbon dioxide, and for the energy needed

Classification according to structure:

Upper Respiratory TractComprises the nose, mouth, and pharynx

Lower Respiratory TractComprises the larynx, trachea, bronchi, & lungs.

Classification according to function:

Conducting Zone-consists of a series of interconnecting cavities & tubes: nose, pharynx, larynx, trachea, bronchi, bronchioles, and terminal bronchioles

Respiratory zone- consists of tissues within lungs where gas exchange occurs: alveolar ducts, alveolar sacs, and alveoli.

NOSE

The nose, the only external visible part of the respiratory system, provides a passageway for air. During breathing, air enters the nose by passing through the nostrils (external nasal cavity. Particles that go with the inhaled air are trapped by tiny hairs (vibrissae) that line the nostrils. Inhaled air is then filtered, warmed, and moistened. In the nasal cavity, a larcreated by the curved structure of the superior, middle, and inferior nasal conchae. The blood vessels supplying this large surface area provide the capacity for warming of inhaled air, wlining of the conchae picks up any remaining inhaled particles. Olfactory receptors for the sense of smell are located in the mucosa in the slit li ke superior part of the nasal cavity, just bbone. The tiny hairs (cilia) lining the respiratory mucosa are responsible for this task, while tiny glands in the mucosa produce a watery secretion that serves to protect the walls of the

nasal cavity, and evaporates to humidify the inspired air.The nasal cavity is surrounded by a ring of paranasal sinuses located in the frontal, sphenoid, ethmoid, and maxillary bones. Ththe skull and they act as resonance chambers for speech; produce mucus, which drains into the nasal cavities. The internal nose is connected to the pharynx through two openings, inte

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PHARYNX

The pharynx or throat, 13cm long, is a funnel-shaped tube that starts at the internal nares and extends partway down the neck. It lies posterior to the nasal and oral caviticervical vertebrae. It is composed of skeletal muscles lined with mucous membrane. It serves as a passageway for air and food, provides a resonating chamber for speech sounds, awhich participate in the immunological defenses of the body.

Consists of three parts:

Nasopharynx- The nasopharynx is the upper part of the pharynx which connects from the two internal nares. It serves as a passageway for air only. It also has two openings that lead to the to exchange small amounts of air to

equalize air pressure between pharynx and middle ear. The posterior wall houses the pharyngeal tonsil (adenoid). It is lined with pseudostratified ciliated columnar epithmucus-dust packages downward to the mouth.

Oropharynx- The oropharynx is the middle part of the pharynx that opens into the mouth and nasopharynx. It serves as a passageway for air, water, and food. Two pairs of tonsils are locaPalatine tonsils and Lingual tonsils.

Laryngopharynx- The laryngopharynx is the lowest part of the pharynx that connects with both the esophagus and larynx. It serves as a passageway for air, water, and food.

LARYNX

The larynx or voice box is a short tube of cartilage lined by mucous membrane that connects the pharynx with trachea. Part of its mucous membrane is a two paired foldTruethat allows a person to speak. It lies anterior to the fourth, fifth, and sixth cervical vertebrae (C4 to C6). Its anterior wall is formed with the thyroid cartilage, Adams Apple.The epAirway is a large leaf-shape piece of elastic cartilage. During swallowing, the pharynx and larynx rise. The elevation of pharynx causes its widening to receive the food or drink whillarynx causes the epiglottis to move down and form a lid over the larynx, closing it off. This closing routes liquids and foods into the esophagus instead of the airway.The cricoid cartilacartilage that forms the interior wall of the pharynx. Above the cricoid cartilage is the arytenoid cartilage that attaches to the true vocal cords and pharyngeal muscles for voice produc

TRACHEA

The trachea, or windpipe, is a tubular passageway for air, anterior to the esophagus. The short tube measures about 3 1/5 5 inches long that ends at the Carina and 3/5 in16 to 20 C-shaped rings. The open part of the C-shaped cartilage faces the esophagus so as to allow esophageal expansion. It extends from T5 then divides into right and left primary bmucous membrane, ciliated columnar cells, goblet cells, and basal cells and supported by cartilage. The cilia move mucous upward to the mouth.

LUNGS

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Two, spongy, cone-shaped lungs are located in the thoracic cavity. They are separated from each other by the heart and other structures in the mediastinum. It is protecdouble-layered serous membrane, the pleural membrane.

Pleural Membrane

Parietal Pleura- The Parietal Pleura is the outer layer attached to the wall of the thoracic cavity and diaphragm.

Visceral Pleura-The Visceral Pleura is the inner layer directly attached to the lungs. Between the visceral and parietal pleura is the Pleural Cavity that contains the Pleural Fluid, a lubricating flprevent friction among neighboring organs, allowing the organs to slide easily against each other during breathing. The lungs extend from the diaphragm to slightly aboveagainst the ribs. Its broad portion is the base while the narrow portion is the apex. The left lung has an indentation, the cardiac notch, in which the heart lies. Thus, the left lunthe right lung. Deep grooves called fissures separate each lobes in the lungs.

Oblique Fissure- divides the left lung into superior and inferior lobes.

Oblique & Horizontal Fissures- divide the right lung into 3 lobes: superior, middle, & inferior lobes

BRONCHIAL TREE

Primary Bronchi- The trachea divides into the right and left pulmonary bronchi and enter the lungs at the hilum, located on the mediastinal surface of the lungs. The major blood vessels servinand leave at this location These primary

bronchi contain incomplete rings of cartilage and are lined with pseudostratified ciliated columnar epithelium. Pulmonary blood vessels, lymphatic vessels, and nerves enteprimary bronchi.

Secondary Bronchi- Each primary bronchus divides to form secondary bronchi, one for each lobe of the lung wherein the right lung has three lobes while the left has two lobes separated by fissure

Tertiary Bronchi- Each secondary bronchus continues to branch out into tertiary bronchi which also divides into smaller bronchioles.

Bronchioles- Each bronchiole divides into smaller tubes, terminal bronchioles that are microscopically visible. Bronchioles are composed of less cartilage and more of smooth muscles, alnervous system to act upon it.

Lung lobes are divided into lobules containing lymphatic vessels, an arteriole, a venule, and a branch from a terminal bronchiole wrapped in elastic connective tissue.

TERMINAL BRONCHIOLES

The terminal bronchioles subdivide into Respiratory Bronchioles.

RESPIRATORY BRONCHIOLES

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Respiratory Bronchioles are lined by nonciliated simple cuboidal epithelium. Respiratory Bronchioles subdivide into Alveolar Ducts.

ALVEOLI

a cup-shaped outpouching of an alveolar sac. Its walls consist of alveolar cells, simple squamous epithelial cells that serve as the main site of gas exchange. Scattered among the alveo

SURFACTANT CELLS

Secrete alveolar fluid that keeps the surface between the cells and the air moist. Alveolar fluid contains surfactant, a mixture of phospholipids and lipoproteins that reduces the tcollapse by decreasing the surface tension inside the alveolus.

ALVEOLAR MACROPHAGES (dust cells or Clara cells)

- are wandering phagocytes that remove fine dust particles and other debris in the alveolar spaces

Physiology

The exchange of gases (O2 & CO2) between the alveoli & the blood occurs by simple diffusion: O2 diffusing from the alveoli into the blood & CO2 from the blood into the alveoconcentration gradient. So, the concentration (or pressure) of O2 in the alveoli must be kept at a higher level than in the blood & the concentration (or pressure) of CO2 in the alveoli mlever than in the blood. We do this, of course, by breathing - continuously bringing fresh air (with lots of O2 & little CO2) into the lungs & the alveoli.

There are four distinct events that occur during respiration:

1. PULMONARY VENTILATION. Air must move into and out of the lungs so that the gases in the air sacs (alveoli) of the lungs are continuously changed and refreshed. This process of pucommonly called breathing.

2. EXTERNAL RESPIRATION. Gas exchange (oxygen loading and carbon dioxide unloading) between the pulmonary blood and alveoli must take place. Remember that in external respare being made between the blood and the

body exterior.

3. RESPIRATORY GAS TRANSPORT. Oxygen and carbon dioxide must be transported to and from the lungs and tissue cells of the body via the bloodstream.

4. INTERNAL RESPIRATION. At systemic capillaries, gas exchanges must be made between the blood and tissue cells. In internal respiration, gas exchanges are occurring between thethe body.Breathing is an active process

requiring the contraction of skeletal muscles. The primary muscles of respiration include the external intercostal muscles (located between the ribs)sheet of muscle located between the thoracic &

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abdominal cavities).

Intra-alveolar pressure during inspiration & expiration

As the external intercostals & diaphragm contract, the lungs expand. The expansion of the lungs causes the pressure in the lungs (and alveoli) to become slightly negative rpressure. As a result, air moves from an area of higher pressure (the air) to an area of lower pressure (our lungs & alveoli). During expiration, the respiration muscles relax & lung volcauses pressure in the lungs (and alveoli) to become slight positive relative to atmospheric pressure. As a result, air leaves the lungs.

The walls of alveoli are coated with a thin film of water & this creates a potential problem. Water molecules, including those on the alveolar walls, are more attracted to eachthis attraction creates a force called surface tension. This surface tension increases as water molecules come closer together, which is what happens when we exhale & our alveoli beleaving a balloon). Potentially, surface tension could cause alveoli to collapse and, in addition, would make it more difficult to 're-expand' the alveoli (when you inhaled). Both of thserious problems: if alveoli collapsed they'd contain no air & no oxygen to diffuse into the blood &, if 're-expansion' was more difficult, inhalation would be very, very difficult if not imour alveoli do not collapse & inhalation is relatively easy because the lungs produce a substance called surfactant that reduces surface tension.

Exchange of gases:

External respiration:o exchange of O2 & CO2 between external environment & the cells of the bodyo efficient because alveoli and capillaries have very thin walls & are very abundant (your lungs have about 300 million alveoli with a total surface area of about 75 square

Internal respiration - intracellular use of O2 to make ATP

occurs by simple diffusion along partial pressure gradients

CENTRAL NERVOUS SYSTEM

The Central Nervous System

The nervous system is the master controlling and communicating system of the body. There are two subdivisions, the central nervous sytem and the peripheral nervous systemsystem (CNS) consists of the brain and the spinal cord. They act as the command centers of the sytem. The peripheral nervous system (PNS) is the part of the nervous system outsidemainly of the nerves that extend from the brain and the spinal cord.

Brain. The brain has 4 major regions: the cerebral hemispheres, the cerebral corx, the diencephalon and the cerebellum.

Cerebral Hemispheres

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The paired cerebral hemispheres (left and right) are collectively called the cerebrum. The surface of the cerebral hemispheres has elevated ridges of tissue called gyri, wshallow grooves called sulci. There are deeper grooves called fissures that are less numerous which separate large regions of the brain. Other fissures divide each hemisphere into lobhas 3 basics regions, a superficial cortex of gray matter, internal white matter and basal nuclei which are islands of gray matter situated within the white matter.

The cerebral cortex is the outermost gray matter of the cerebrum. It is responsible for speech, memory, logical and emotional response, consciousness, interpretation of semovement. The primary somatic sensory area is l ocated in the partetal lobe. This allows you to recognize pain, coldness or light touch. The visual area is located in the posterior part ofauditory area is in the temporal l obe bordering the lateral sulcus, while the olfactory area is deep within the temporal lobe. The primary motor area that allows us to consciously movelobe. The deeper white matter is composed of fiber tracts that carry impulses to and from or within the cortex. One large fiber tract is the corpus callosum, which connects the cerecorpus callosum allows the cerebral hemispheres to communicate with each other. The basal ganglia or nuclei are islands of gray matter that are responsible for the control of fine moto

Diencephalon

The diencephalon is also called the interbrain and is enclosed by the cerebral hemispheres. Its major structures include the thalamus, hypothalamus and epithalamus. The thalastation for sensory implses passing upward to the sensory cortex. The hypothalamus is the chief regulating center for the autonomic nervous system and plays a role in the regulation owater balance and metabolism. It also regulates the pituitary gland that hangs from the anterior roof of the hypothalamus. The important parts of the epithalamus are the pineal body, endocrine system, and the choroid plexus.

Brain Stem

The brain stem connects the diencephalon to the spinal cord. Its structures include the midbrain, pons and medulla oblangata. The brain stem has many small gray mattautonomic behaviors necessary for survival.

The midbrain connects the pons and the cerebellum with the cerebral hemispheres. It contains reflex centers that are involved with vision and hearing. The pons is a rounded structthe cerebellum and is a bridge between the two halves of the cerebellum. It contains motor and sensory pathways. Parts of the pons also control the heart, respiration and blood poblangata is the most inferior part of the brain stem. It contains centers that control heart rate, blood pressure, breathing, swallowing and vomiting. Extending from the entire length

mass of gray matter called the reticular formation. A special group of reticular formation neurons, the reticular activating system, plays a role in consciousness and in the awake/sleep c

Cerebellum

The cerebellum is located behind the brain stem and under the cerebrum. It has two hemispheres like the cerebrum. It also has an outer cortex or gray matter and an inner regis separated from the cerebral hemispheres by a fold of dura mater, the tentorium cerebellil. The cerebellum controls our balance and equilibrium and is responsible for unconscious pcontrols fine movement and integration of sensory input.

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THE NERVOUS SYSTEM

The nervous system is the master control system of the body. Every thought, action, and sensation is a reflection of its activity.

Two principal cell populations:

1. Supporting cells or Neuroglia/glial cells

a. Central Nervous System: act as phagocytes and protect and myelinate the delicate neurons; also act as a selective barrier between thecapillary blood supply and the neurons

b. Peripheral Nervous System: Schwann cells, which they insulate nerve fibers

2. neurons

Neuron Anatomy

Neurons

are specialized to transmit messages (nerve impulses) from one part of the body to another

differ functionally:

o sensory, or afferent: neurons carrying impulses from the sensory receptors on the internal organs or in the skill

o motor, or efferent: neurons carrying activating impulses from the CNS to the viscera and/or body muscles and glands

o association neurons, or interneurons: are situated in pathways that connect sensory and motor neurons

differ structurally, but still have common features: a cell body, that makes up the gray matter of the system

o Central Nervous System: in clusters called nuclei

o Peripheral Nervous System: in cluster called ganglia

o Impulses are carried toward the cell body are the dendrites

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o Impulses are carried away from the cell body are the axons

processes or fibers extend, makes up the white matter.

o Central Nervous System : processes running through form tracts

o Peripheral Nervous System: they form the nerves.

o If only 1 process: are unipolar neurons which mainly composes the ones towards the CNS

o If many processes: are multipolar neurons which most neurons in the brain and spinal cord (CNS neurons) and those whose axon carry impulses away from the CNS

2 major physiological properties

1. the ability to respond to stimuli and convert them into nerve impulses

2. the ability to transmit the impulse to other neurons, muscles, or glands.

CENTRAL NERVOUS SYSTEM

The CNS consists of the brain and spinal cord, each interpret incoming sensory information and issue instructions based on past experiences.

1. Brain

- Cerebral Hemisphere - or the cerebrum is the largest part of the brain and covers most of diencephalon and brain stem

- Functional Areas:

a. Primary Motor area

control Skeletal Muscles for voluntary movement

axons of these neurons would descend to the brain stem through the spinal cord and their axons are composed of Corticospinal or Pyramidal Tract (this is the croterminate motor neurons spinal cord of opposite side)

b. Pre-Motor Area

concerned with control of mass movement and postural movement (concerned of the movement of larger muscles)c. Frontal Association Area

concerned with individuals personality and ones personal judgmentd. Brocas Speech Area

concerned with ones ability to express his thoughts in words damage results to expressive/motor Aphasia or Brocas Aphasia (when an individual will not be able to communicate verbally; no paralysis or sensory loss)

e. Primary Somatic/ Sensory Area

concerned with interpretation of Somatic Sensation Touch, Pain, Temperature damage results to loss or demunition of sensation on opposite side of body

f. Gustatory Areag. Wernickes Area

gives meaning to sounds heard and objects seen

damage results to Wernickes Aphasia /sensory aphasia (is the inability to interpret sound or spoken language and read/interpret written symbols given no sensory imh. Auditory Area

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responsible for reception of sounds damage results to partial deafness of both ears

i. Visual Area

reception of visual stimuli damage results to blindness

- The cell bodies of neurons involved in these functions are found only on the outermost gray matter of the cerebrum (cerebral cortex)

- Most of the balance of cerebral tissue, the deeper cerebral white matter, consists of fiber tracts carrying impulses to or from the cortex.

- Reflexes - is an involuntary muscle reaction to a certain type of stimulation. Certain sensations or movements are known to produce specific muscular response; infant refare normal in infants, but abnormal in other age groups. Such reflexes include:

a. Mororeflex(also called startle reflex: pulling arms and legs inward after loud noise)

b. Sucking reflex(sucks when area around mouth stimulated; lasts until 10-12 months)c. Step reflex(stepping motions when sole of foot touches hard surface)d. Glabellar reflex(scrunching of eyebrows toward the center)e. Babinski reflex(fanning out of toes upon inverted J stimulation; lasts until 2 years old)f. Tonic neck reflex (is described as the fencer's position because i t resembles the stance of a fencer)g. Truncal incurvation or Galant reflex(twitching his or her hips toward the side of the stimulus)h. Plantar and palmar grasp reflex(hand/foot will close around the finger ; lasts until 8-10 months)i. Rooting reflex(turn toward the side that was stroked and begin to make sucking motions with its mouth)

j. Parachutereflex(arms extend as if to break a fall)- Examples of reflexes that persist into adulthood are:

a. Blinking reflex-- you blink your eyes when they are touched or when sudden bright light appearsb. Cough reflex-- you cough when your airway is stimulatedc. Gag reflex-- you gag when the throat or back of mouth is stimulated

d. Sneeze reflex-- you sneeze when nasal passages are irritatede. Yawn reflex- you yawn when the body needs additional oxygen

2. Diencephalon

- This area is covered by the cerebrum, the interbrain located between brain stem and cerebral hemisphere and is sometimes consideredportion of the brain stem.

- Components:

a. Epithalamusb. Thalamusc. Hypothalamusd. Subthalamus

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3. Brain stem

- This connects the diencephalon with spinal cord and it also contains the nuclei that give rise to the cranial nerves

- 3 Regions:

a. Midbrain serve as reflex centers involved in vision and hearingb. Pons means bridge, involves nuclei in the respiratory regulationc. Medulla oblongata -contain numerous nuclei that regulate visceral activities like HR, BP, RR

4. Cerebellum

- Concerned with coordination of voluntary skilled/ skeletal movement (movement of the smaller group muscles)

- Maintenance of posture and equilibrium or unconsciousproprioception

- Meninges - composed of CT membrane that serve as covering and protection of CNS

- 3 Layers:

a. Dura Materb. Arachnoid Membranec. Pia Mater

d. SubarachnoidSpace - between Arachnoid Space and Pia Matero contain cerebrospinal fluid

similar to blood plasma from which it is derived contains less proteins, more vitamin C, and have different Ion Composition secreted by the choroid plexus > clusters of capillaries attached to ventricles of brain serve as protective cushion for brain

normal production in adults is 600-700mL/day, or 0.2-0.7 mL/min normal production in children is 300-500 mL/day, or 0.2-0.3 mL/min

o Circulation of CSF

1. Choroid Plexus at lateral Ventricles (through the arachnoid membrane)

2. Foramen of Monroe or Interventricular Foramen

3. 3rd Ventr ic le

4. Cerebral Aqueduct

5. 4th Ventricle

6. Central Canal of Spinal Cord OR Subarachnoid Space

7. Arachnoid Vill i

8. Dura l S inuses

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9. Veins (Venous circulation System)

5. Blood-Brain Barrier

- the barrier that separates nervous tissue from blood and serves to protect nervous tissue f rom substances coming from blood since the capillaries of brain are less permeab

- virtually useless against fats, respiratory gases, fat soluble molecules like alcohol, nicotine, anesthetics

- Chemotaxic Trigger Zone is the area where the BBB doesnt protect the brain that causes nausea and vomiting

PERIPHERAL NERVOUS SYSTEM

This consists of the cranial (12 pairs) and spinal (31 pairs) nerves, ganglia and sensory receptors. These structures serve as communication lines they carry impulses from ththe CNS and from the CNS to the appropriate glands or muscles.Consists of two areas:

Gray Matter

- shaped like a butterfly or H

- surrounds Central Canal

- mainly composed of neurons which are grouped together to form nuclei

- unmyelinated nerve fibers

- two parts of Gray Matter:

a. Dorsal Horn

fibers are central processes of Sensory Neurons (pseudounipolar) in Spinal Ganglia damage to dorsal horn, dorsal root, or dorsal ganglia results to sensory loss

b. Ventral Horn

contains motor neurons that send axons out of the cord to form ventral root

damage to ventral horn results to flaccid paralysis (affects lower motor neuron including cord, nerves; there is atrophy of muscles)White Matter

- composed of myelinated nerve fibers that ascend and descend the cord

- 3 Parts of White Matter:

a. Posterior Column- contain only sensory tracts that ascend to the brainb. Lateral Column- contain ascending and descending fibersc. Anterior Column- same as lateral

1. Spinal Nerves

- 31 pairs of spinal nerves

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- Union of ventral and dorsal roots of the spinal cord

- Ventral root is motor, dorsal root is sensory

- Spinal nerves are named for the region from which they arise

- Anatomy of spinal nerves:

Spinal nerves divide soon after leaving the spinal cord

Dorsal ramus serve the skin & muscles of the posterior trunk

Ventral ramus for the anterior trunk skin and muscles (T1 T2); rest from plexuses

2. Cranial Nerves

- 12 pairs of nerves that mostly serve the head and neck

- Numbered in order, front to back

- Most are mixed nerves but 3 are purely sensory and purely motor

CN I olfactory nerve; sensory for smell CN II optic nerve; sensory for vision CN III oculomotor nerve; motor fibers to eye muscles CN IV trochlear nerve; motor fiber to superior oblique muscle and the rotational movement of eyeball CN V trigeminal sensory for face; motor fibers for chewing muscles CN VI abducens motor fibers to lateral rectus CN VII facial nerve sensory for taste (frontal); motor fibers to facial expression CN VIII vestibulocochlear sensory for balance and hearing CN IX glossopharyngeal nerve sensory for taste (posterior); motor fibers to the pharynx

CN X vagus nerve sensory and motor fibers for pharynx, larynx and viscera; longest cranial nerve CN XI accessory nerve motor fibers to neck and upper back CN XII hypoglossal nerve motor fibers to tongue

AUTONOMIC NERVOUS SYSTEM

Involuntary branch of the nervous systemConsist of only motor nervesBasically a 2 neuron pathway2 divisions:

Sympathetic fight or flight

- Responds to unusual stimulus

- Takes over to increase activities

- Remember as the E division: exercise, excitement, emergency and embarrassment

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Parasympathetic housekeeping activities

- Converse energy

- Maintains daily necessary body functions

- Remember as the D division: digestion, defecation, diuresis

SOMATIC NERVOUS SYTEM

The voluntary branchThe differences between somatic and autonomic:

1. Nerves: Somatic -1 motor neuron;Autonomic pre-ganglionic & post-ganglionic nerves2. Effector glands: Somatic skeletal muscles; Autonomic smooth, cardiac muscles & glands

3. Neurotransmitter: Somatic Ach;Autonomic Ach, epinephrine or norepinephrine

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CLIENT IN CONTEXT PRESENT STATE INTERVENTIONS EVAL(Informant: Mother) PHYSICAL EXAMINATION

Date Assessed: Jan 30 Feb 1 2012

DOCTORS ORDER1/27/12


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Z.C.P., 1 year old, female, Filipino, Roman Catholic,was born on January 12, 2011 at Cebu Doctors UniversityHospital, currently residing at Yati, Liloan, Cebu was admitted forthe first time at Cebu Velez General Hospital (CVGH) last January27, 2012 5:20am accompanied by her mother and her Tita forcomplaints of elevated temperature and episode of seizure for 5minutes noted an hour prior to admission under the services ofDr. Ranulfo Noval of the Department of Pediatrics with a casenumber of 005155 and a hospital number of 12-14628.

HISTORY OF PRESENT ILLNESS

7 days PTA, Px was noted with nonproductive coughassociated with clear nasal discharge. No fever, dyspnea and

irritability. Mother of Px sought consultation and Px wasprescribed with Cefaclor drops 1.8ml PO TID Carboceistine(Solmux) drops 1.2ml TID. Condition was slightly relieved.

2 days PTA, Px received MMR vaccine. Mother claimedthat she forgot to give Tempra after the immunization. As forevery immunization given, she always give Tempra to Pxafterwards.

1 hour PTA, Px woke up her Mother. Mother notedelevated temperature upon touching the Px on her forehead. Asudden onset of generalized tonic-clonic seizure of upperextremities was noted associated with upward rolling of eyeballsand jerking of the body lasting for approximately 5 minutes. Nophysical injury sustained along the incident and Px was awake.

This was associated with fever (temperature was not noted) andvomiting of previously ingested food approximately 50ml, bloodstreaked. Mother administered Ibugesic suppository but only halfwas consumed because Px bear down. After the seizure, they

packed-up clothes and rushed to Cebu Velez General Hospital.Fever was not relieved. They went to the Emergency room. Pxwas then placed on IV and no medications were given. Then,they Px was admitted to Ward 1.

PAST HISTORY

Prenatal HxPatient was born to a 21-year old mother with an

obstetrical score of G1P1001. Mother started prenatal care 4months of gestation. From 4 th-6th month of gestation, she visitsher OB once a month, from the 7 th-9th month of gestation; shevisited her OB twice a month. Prenatal care was done in CDUHospital by her private OB. Mother claimed to have no illnessesduring the entire course of pregnancy. She was compliant to theprescribed iron supplement and folic acid 1cap OD withunrecalled dosage. She also drinks Anmum 1glass per day, dailyduring her pregnancy. She received 2shots of Tetanus vaccineon the unrecalled month of gestation. No history of still birth andabortion.

Labor & Deliver

Date Assessed: Jan 30 Feb 1, 2012

Pace Assessed: Ward 1 -1

ER BLOTTER

ER number: 2012-0606

Case & Hospital Number: 12-14628/5155

January 27, 2012

Time In: 5:20 AM

Time Out: 6 AM

Vital Signs:

Temp: 38.6C/axillaPR: 160 bpm

RR: 34 cpm

Problem: Seizure

Anthropometric Measurements:

Weight: 7 kg

Height: 72 cm

Head Circumference: 43 cm

Chest Circumference: 44.5 cm

Abdominal Girth: 45.75 cm

Mid-arm Circumference: 15 cm

General Appearance:

January 30,2012 ( Monday)

8A> examined px lying on bed in a semi-fowlers position, afebrile, awake, playful &quite irritable with ISA @ L dorsal foot PR: 140bpm (apical) , RR: 30 cpm, Temp:36.2C/axilla.

SKIN: skin is fair with evenly colored skintone, slightly moist and soft. Skin is slightlywarm to touch with good skin turgor.

Hematoma noted on the L & R dorsum of thehand (diagonal) & R antecubital areaapproximately 1 cm in length. Has minimalcalluses on the palmar surface of both handsand plantar surface of both feet. Cafe au laitspot noted over the sacral areaapproximately 1 cm in diameter.

5:50AM pls admit to the Dept of Pediatrics

under the service of Dr. Noval secure consent to care TPR q 4H problem: seizure diet : diet for age labs: CBC, UA (pls attach urobag) start venoclysis with D5 0.3% NaCl 1

pint @ rate of 32cc/hr meds:

o paracetamol drops 0.7 ml q4H PO PRN for fever >38C

o Ventolin 1 neb PRN seizure precaution

o O2 tank @ bedsideo Diazepam 1.5 mg IVTT PRN

for seizureo Suction secretions

I&O q 4H : in absolute figures Monitor v/s q 2H & refer for any

reoccurrence of seizure Please refer accordingly Will inform AP Thank you! Dr Bator

1/27/1211:20 AM

IVF TF c PNSS 1 pint @ 30cc/hr

Repeat CBC @ 12 NN Paracetamol + supp/rectum now Dr.

Gasaygay11:45 AM

Give diazepam 1.5 mg IVTT now x 2doses

O2 inhalation @ 2L/min via nasalcanula

Suction secretions PRN Paracetamol ( naprex ) 100 mg q 4H

IVTT for fever12:30 PM

Start Phenobarbital 140 mgvnow IVTTas loading dose then 15 mg q 12H asmaintenance

Please refer to Dr. Doris Gigatamas

for consult of Phenobarbital Dr.Noval Start loading dose of Phenobarbital @

5 PM Monitor neuro q 2H

2:25 PM


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DISCHARGE PLAN

M EDICATIONS

Encouraged S.O to let patient take full course of the medications.

Encouraged S.O. not to take over the counter medications.

Advised S.O. to seek consult with the physician whenever allergic reactions are noted such as rashes.

Encouraged S.O. to comply with and administer to the patient the medications at the right route, and right frequency.

E - NVIRONEMENT25


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Advised S.O. not to bring patient in a crowded place.

Encouraged S.O. to keep sorroundings clean with minimal dusts.

Encouraged S.O. not to travel using a motorcycle, jeepney or bus to avoid exposure to pollution.

Advised S.O. to keep room well ventilated.

Instructed S.O. to avoid exposure to toxins such as pesticides, and household chemicals.

T- REATMENT

Advised S.O. to comply with medications as directed by the physician.

Advised S.O. to contact physician if medications are not effective or are having side effects.

Instructed S.O. not to quit giving medications to the patient until the physician says so.

Reinforced to S.O. the importance of follow-up check-up.

H- EALTH TEACHINGS

Encouraged S.O. to get patient plenty of sleep and increase number of hours of sleep at night.

Advised S.O. to minimize patients outdoor activities.

Encouraged S.O. to let patient maintain bedrest to reduce metabolic demands and oxygen consumption

Advised S.O. to look after the patient at all times.

O- BSERVABLE SIGNS AND SYMPTOMS

Advised S.O. to seek consult whenever unusualities are noted.

Instructed S.O. to call physician when signs and symptoms of fever and seizure will occur.

Advised S.O. to monitor patients vital signs periodically

D- IET

Encouraged S.O. to let patient eat iron-rich foods such as mashed vegetables and fruits.

Encouraged S.O. to increase oral fluids.

Encouraged S.O. to let patient drink milk several times daily.

Encouraged S.O. to let the patient eat foods rich in Vitamin C such as oranges and other citrus fruits.

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S PIRITUALITY


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S- PIRITUALITY

Encouraged family to go to the church and attend mass every Sunday.

Encouraged family to pray always to the Almighty God.

Encouraged family to always be there whenever the patient needs spiritual support.

DRUG STUDY

1. Phenobarbital 15 mg q12H IVTT in 20-30 minC:

Anti convulsant; barbiturateA:

mimics the effect of GABA by stimulating an influx of chloride ions, thus suppressing theactivity of neurons to fire limi ting seizure activity.

I: Partial seizures Generalised tonic-clonic seizures

Sedation Hypnotic, Emergency management of acute seizures,

Pre-op sedation,

status epilepticusC:

Severe renal and hepatic disorders Severe respiratory depression dyspnea or airway obstruction

Porphyria Pregnancy.

A: sleepiness, fatigue, reduces the breathing and heart rate, and decreases blood pressure

and body temperature depression, hyperactivity (in children), impaired attention (in children and adults),

dizziness, impotence, slurred speech, nausea anemia, folate deficiency, rash, fever, low calcium levels

N: Monitor heart rate, temperature, respiration and blood pressure Taper dose if long term medication Assess the patient's pressure readings, laboratory values, fluid balance, and pulmonary

status to accurately interpret his clinical status. Assure patient safety by raising side rails due to CNS effects.

2. Meropenem 280mg IV drip for 30 mins q8H ANST

C:

antiinfective; carbapenem antibioticA:

binds to penicillin-binding-proteins inhibiting peptidoglycan synthesis wand eventually, cell death

I: treatment of intra-abdominal, skin, urinary tract and gynecologic infect

CAP caused by variety of gram (+), gram (-) and anaerobic organisms

C: hypersensitivity to the drug History of seizure disorders or impaired renal function Pregnant and lactating

A: Diarrhea nausea and vomiting rash

urticaria

superinfection (including candidiasis)

erythema Dermatitis

angioedema

pseudomembranous colitisN:

monitor patient for signs and symptoms of superinfection such as blackvaginal itching and discharges and loose foul smelling stools

Monitor input and output Observe for signs of anaphylaxis such as rash, pruritis, rash, superinfec Assess for presence of blood, mucus or pus in the stool.

3. Zinc Drops (E-Zinc) 250mg/ml 2ml OD POC:

Vitamins and mineralsA:

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a cofactor of the en me s pero ide dism tase hich helps the bod s nat ral defense To b ild tiss e and help stim late appetite L sine
http://en.wikipedia.org/wiki/Urticariahttp://en.wikipedia.org/wiki/Superinfectionhttp://en.wikipedia.org/wiki/Candidiasishttp://en.wikipedia.org/wiki/Erythemahttp://en.wikipedia.org/wiki/Angioedemahttp://en.wikipedia.org/wiki/Pseudomembranous_colitishttp://en.wikipedia.org/wiki/Urticariahttp://en.wikipedia.org/wiki/Superinfectionhttp://en.wikipedia.org/wiki/Candidiasishttp://en.wikipedia.org/wiki/Erythemahttp://en.wikipedia.org/wiki/Angioedemahttp://en.wikipedia.org/wiki/Pseudomembranous_colitis


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a cofactor of the enzyme superoxide dismutase, which helps the bodys natural defenseagainst damaging free radicals (or anti-oxidant effect) that helps boost immune function

affects the ability of the cells to replicate the deoxyribonucleic acid acid (DNA) which isrequired for cells to multiply, thus needed for normal growth

I: adjunct to treatment to acute diarrhea Help boost immune function Support optimum physical growth and development

C: hypersensitivity to the components of the multivitamin

A: nausea

vomiting abdominal cramps diarrhea fever

N: assess for allergies to any component of E-zinc Assess for signs and symptoms of zinc toxicity (N/V, diarrhea, fever, metallic taste,

lethargy) Report for any unusualities Be cautious in consuming any other sources of zinc such as milk, meat, nuts and

legumes to prevent excessive use

4. Multivitamins syrup (Growee) 2.5ml PO after SupperC:

vitamins and mineralsA:

it helps in the production of enzymes which aid in digestion, lysine can also act as anappetite enhancer.

I:

Helps stimulate cell growth and multiplication for optimum development of children

For good eyesight and healthy skin: Vitamins A and E, taurine

For strong bones: Vitamin D3.

To facilitate conversion of food to energy: Vitamins B1, B2 and B12, niacinamide, vitaminB6

To maintain normal growth of cells and keep the blood healthy: Vitamins B6 and B12

To help strengthen resistance against sickness: Vitamins A and E

To build tissue and help stimulate appetite: Lysine

To promote brain development and nervous system function: Taurine, and B12, choline

To help promote growth: Chlorella growth factor.

C:A:

increase in bad cholesterol levels gallstones, stomach cramps and diarrhea.

N:

5. Iron (Ferlin) drops 1.2 OD POC:

vitamins and mineralsA:

necessary for hemoglobin formationI:

For the prevention and treatment of iron deficiency anemia in infants aC:

patients receiving repeated blood transfusions Primary hemochromatosis peptic ulcer ulcerative colitis

A: gastrointestinal irritation and abdominal pain with nausea and vomiting Other effects may include either diarrhea or constipation

It may cause temporary staining of teeth Stools may appear darker in color Prolonged folic acid therapy may cause a decrease in vitamin B12-seru

N: taken with or after meals to prevent gastrointestinal irritation Take with vitamin c for better absorption Administer with meals avoiding eggs, milk, coffee and tea Assess for stool discoloration.

6. Diazepam 1.5mg IVTTC:

Antianxiety agents, anticonvulsants, sedative/hyptonics, skeletal musc(centrally acting)

A: Act in the limbic system and the RAS to make GABA more effective, ca

with neuron firing.28

I: 7 Solmux
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I: Anxiety Preoperative sedation Conscious sedation Provides light anesthesia and anterograde amnesia Treatment of status epilepticus/ uncontrolled seizures Skeletal muscle relaxant

C:

Severe hypoventilation.

Acute narrow-angleglaucoma.

Severe hepatic deficiencies (hepatitisand livercirrhosisdecrease elimination by a factorof 2).

Severe renal deficiencies (for example, patients on dialysis). Liver disorders. Severe respiratory disorders.

Severe sleep apnea. Caution required in elderly or debilitated patients.

Coma or shock. Abrupt discontinuation of therapy.

Hypersensitivity or allergy to any drug in the benzodiazepine class.A:

Central Nervous System: dizziness, drowsiness, lethargy, hangover, headache,depression

EENT: blurred vision

Respiratory System: respiratory depression

Cerebrovascular: hypotension

Gastrointestinal: constipation, diarrhea, nausea, vomiting

Dermatologic: rashes

Local: intramuscular pain, intravenous phlebitis, venous thrombosis

Miscellaneous: physical & psychological dependence toleranceN:

Monitor BP, PR,RR prior to periodically throughout therapy and frequently during IVtherapy.

Assess IV site frequently during administration, diazepam may cause phlebitis andvenous thrombosis.

Observe and record intensity, duration and location of seizure activity. The initial dose ofdiazepam offers seizure control for 15-20 min after administration.

IM injections are painful and erratically absorbed. If IM route is used, inject deeply intodeltoid muscle for maximum absorption.

Effectiveness of therapy can be demonstrated by decrease anxiety level; control ofseizures; decreased tremulousness.

7. SolmuxC:

mucolytic

A: binds to mucoprotein which breaks the mucopolypeptide bonds making

secretions less viscous.

I:

Relief ofcough associated w/ excessive & tenacious sputum or phlegmchronic bronchitis, chronic obstructive pulmonary disease, otitis media& glue ear.

C: Hypersensitivity Peptic ulcer

A: Nausea stomach discomfort diarrhea

skin rashes are the most common undesirable effects.

N: Chest physiotherapy done such as chest tapping, vibration Monitored respiratory rate with regular intervals Encouraged S.O. to increase intake oral fluids as tolerated by the patie

8. CefaclorC:

2nd generation cephalosporin

A: binds to penicillin-binding-proteins inhibiting peptidoglycan synthesis w

and eventually, cell deathI:

treatment of respiratory tract infections: pneumoniaC:

Hypersensitivity to cephalosporins or penicillins Patients with hepatic or renal impairment Pregnancy and lactating

A: Nausea and vomiting, diarrhea, anorexia, abdominal pain and flatulenc

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pseudomembranous colitis bronchodilator
http://en.wikipedia.org/wiki/Hypoventilationhttp://en.wikipedia.org/wiki/Hypoventilationhttp://en.wikipedia.org/wiki/Glaucomahttp://en.wikipedia.org/wiki/Glaucomahttp://en.wikipedia.org/wiki/Hepatichttp://en.wikipedia.org/wiki/Hepatitishttp://en.wikipedia.org/wiki/Hepatitishttp://en.wikipedia.org/wiki/Cirrhosishttp://en.wikipedia.org/wiki/Cirrhosishttp://en.wikipedia.org/wiki/Cirrhosishttp://en.wikipedia.org/wiki/Renalhttp://en.wikipedia.org/wiki/Dialysishttp://en.wikipedia.org/wiki/Sleep_apneahttp://en.wikipedia.org/wiki/Comahttp://en.wikipedia.org/wiki/Hypersensitivityhttp://en.wikipedia.org/wiki/Allergyhttp://en.wikipedia.org/wiki/Benzodiazepinehttp://www.mims.com/Philippines/diagnoses/info/560http://www.mims.com/Philippines/diagnoses/info/2746http://www.mims.com/Philippines/diagnoses/info/484http://www.mims.com/Philippines/diagnoses/info/3081http://www.mims.com/Philippines/diagnoses/info/2899http://en.wikipedia.org/wiki/Hypoventilationhttp://en.wikipedia.org/wiki/Glaucomahttp://en.wikipedia.org/wiki/Hepatichttp://en.wikipedia.org/wiki/Hepatitishttp://en.wikipedia.org/wiki/Cirrhosishttp://en.wikipedia.org/wiki/Renalhttp://en.wikipedia.org/wiki/Dialysishttp://en.wikipedia.org/wiki/Sleep_apneahttp://en.wikipedia.org/wiki/Comahttp://en.wikipedia.org/wiki/Hypersensitivityhttp://en.wikipedia.org/wiki/Allergyhttp://en.wikipedia.org/wiki/Benzodiazepinehttp://www.mims.com/Philippines/diagnoses/info/560http://www.mims.com/Philippines/diagnoses/info/2746http://www.mims.com/Philippines/diagnoses/info/484http://www.mims.com/Philippines/diagnoses/info/3081http://www.mims.com/Philippines/diagnoses/info/2899


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pseudomembranous colitis headache, dizziness, lethargy and parasethesia

N: monitor patient for signs and symptoms of superinfection such as black furry tongue,

vaginal itching and discharges and loose foul smelling stools Monitor input and output Observe for signs of anaphylaxis such as rash, pruritis, rash, superinfection, fever Assess for presence of blood, mucus or pus in the stool.

9. Paracetamol (biogesic)C:

anti-pyretic, NSAID

A: Acetaminophen probably produces antipyresis by acting centrally on the hypothalamic

heat-regulating center to produce peripheral vasodilation resulting in increased bloodflow through the skin, sweating, and heat loss. The central action may involve inhibitionof prostaglandin synthesis in the hypothalamus.

I: Fever Mild pain

C: hypersensitivity

A: Leucopenia anemia weakness dizziness nausea and vomiting abdominal pain

N: Regulated room temperature Encouraged S.O. to increase intake oral fluids as tolerated by the patient Encouraged S.O. to let the patient wear loose clothing Monitored vital signs specially temperature with regular intervals Monitored input and output

10. Ventolin

C:

bronchodilator

A:

acts relatively selectively at beta 2 adrenergic receptors to cause brovasodilation; at higher doses, beta 2 selectivity is lost, and the drug acreceptors to cause typical sympathomimetic cardiac effect.

I:

Relief and prevention of brochospasm in patients with reversible obstru

airwaydisease. Inhalation: treatment of acute attacks of brochospasm.

Prevention of exercise-induced brochospasm.

C:

Contraindicated with hypersensitivity to albuterol; tachyarrhythmias, taby digitalis intoxication.

Use cautiously with diabetes mellitus; hyperthyroidism, history of seizu

A:

fine tremor (particularly of the hands), restlessness, anxiety, and headcommon side effects; less likely are palpitation, dilatation of blood vessextremities, increased heart rate, and muscle cramps.

N:

Do not exceed the recommended dosage. Position patient on high back rest position. Do backtapping after you nebulize the patient.

Do not give a food immediately it can cause vomiting.

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Documents

Ward 1 Final Compilation 2003