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Samen Samen Document Transcript

  • Bataan Peninsula State University Balanga, Campus Balanga, Campus Diabetes Neprophaty Prepared by: Nuguid, Camille F. Paragiison, Ralp Roentgen Cunanan, Mark Joseph Salvador, Marry Joyce Bartolome, Dazel Gamiao, Joebert Mallari, Apple Lisay, Cristine Abalos, Leslie Pingul, Philip Roman, Lea
  • INTRODUCTION
  • PATIENT’S PROFILE Client’s name: Mr. C Age: 47 Birthday: September 15, 1962 Address: Tapulao, Orani, Bataan Gender: Male Nationality: Filipino Religion: Roman Catholic Civil Status: Single Occupation: Beautician Clinical impression: To consider viral hepatitis rule out cholecystitis vs cholelithiasis Attending Physician: Dr. June G. Reyes FAMILY HEALTH HISTORY According to Mr. C regarding their herido-familial history, his father had a hypertension and his mother had hypotension. His parents were both deceased. PAST HEALTH HISTORY The patient was born on September 15, 1962. He was a permanent resident of Tapulao, Orani Bataan. The patient stated that he was the youngest among his siblings. He lives together with the family of his brother under one roof with four different partitions. He said that he was a smoker; he takes 1-2 packs of cigarette per day. He was also an
  • alcohol drinker; he can take 6 to 8 bottles of beer and 1 bottle hard in a day. He also said that he always lacks of sleep because he enjoys night life. He enjoyed eating salty and fatty foods and also fond of buying street foods. Being a beautician, he was good in doing ear piercing, so after doing the piercing in his client, he used the needle to pierce himself. He also admitted that he was sexually active with multiple male partners. Last 2003 he was confined at Bataan General Hospital with the diagnosis of cholelithiasis. He wasn’t able to have the operation because his income as a beautician is not much. PRESENT ILLNESS: A case OF Mr. C, 47 years old, male, confined at Orani District Hospital with a clinical impression of viral hepatitis rule out cholecystitis vs cholelithiasis. SOCIAL HISTORY Mr. C is a gay beautician with on and off income. He was the one who sustains for the education of his niece and nephews. Sometimes his income is not sufficient because of his underlying disease. ACTIVITIES OF DAILY LIVING Activities Before During hospitalization hospitalization Cigarette >Takes 1 to 2 packs > Restriction of smoking of cigarette per day cigarette smoking Alcohol drinking >Drinks 6 to 8 > Restriction of bottles of beer and alcohols 1 to 2 bottles of
  • hard drinks Nutrition >Likes to eat foods > Increase nutritious rich in cholesterol foods such as chicharon > Low fat diet >He wasn’t able to eat on time >Always eats street foods such as “isaw and barbecue Exercise >Doesn’t have time > Range of motion to exercise or do physical activities Sexual activity >He used to go out > Abstinence together with his gay friends to hunt boys and play with them Rest and sleep >He doesn’t have > Have adequate rest adequate rest and and sleep. sleep because he always goes out during the night together with his gay friends. Livelihood >He is a beautician > He can’t perform with an on and off his job due to income hospitalization. > He doesn’t have enough money for his hospitalization
  • PHYSICAL ASSESSMENT February 11, 2010 Part to be Technique Result Interpretation examine used Skin Inspection >skin color: >increase with jaundice bilirubin level noted >normal Palpation >clean skin >normal >warm to Head Inspection touch >normal Palpation >normal >round
  • >no Scalp Inspection tenderness >normal noted Hair Inspection >normal >oily >normal >due to the >black production of >thick sebum >oily >normal Eyebrows Inspection >properly >normal distributed Eyes Inspection >symmetrical >normal and in line >normal with each >due to other increase Ears Inspection bilirubin level >symmetrical Palpation >black iris >normal Nose Inspection >yellow sclera >due to lifestyle >normal Palpation >bean-shaped >normal >with piercing Lips Inspection noted >normal >firm cartilage >normal >located at Mouth Inspection the midline >due to
  • >patent nares frequent >firm cartilage smoking Teeth Inspection >dry and dark >normal Tongue Inspection >normal Chest Inspection >symmetrical >due to >kept moist acquired by saliva nicotine >normal >yellowish to white >normal Palpation Auscultation >kept moist >normal by saliva Abdomen Inspection >sternum is at >normal the midline >normal >moves >normal Auscultation symmetrically when >normal Percussion breathing Palpation >RR: 20bpm >due to >no increase Upper Inspection tenderness intake of extremities >HR:72 bpm alcohol >normal >skin color is bowel sound Inspection uniform >normal
  • Lower >distended >normal extremities >borborygmi >normal noted >normal Inspection >normal >tympany Nails Palpation noted >normal >no masses >normal noted >due to Inspection previous burns >symmetrical General >proportional >normal appearance >no lesions >due to poor noted hygiene >normal >symmetrical >proportional >normal >with lesion on the right >due to lower leg restlessness >160˚ angle >dirty >capillary refill: after 1 second >conscious and coherent
  • >sleepy appearance February 12, 2010 Part to be Technique Result Interpretation examine used Skin Inspection >skin color: >increase with jaundice bilirubin level noted >normal Palpation >clean skin >normal >warm to Head Inspection touch >normal Palpation >normal >round >no Scalp Inspection tenderness >normal noted Hair Inspection >normal >oily >normal >due to the >black production of >thick sebum >oily >normal Eyebrows Inspection >properly >normal
  • distributed Eyes Inspection >symmetrical >normal and in line >normal with each >due to other increase Ears Inspection bilirubin level >symmetrical Palpation >black iris >normal Nose Inspection >yellow sclera >due to lifestyle >normal Palpation >bean-shaped >normal >with piercing Lips Inspection noted >normal >firm cartilage >normal >located at Mouth Inspection the midline >due to >patent nares frequent >firm cartilage smoking Teeth Inspection >dry and dark >normal Tongue Inspection >normal Chest Inspection >symmetrical >due to >kept moist acquired by saliva nicotine >normal >yellowish to
  • white >normal Palpation Auscultation >kept moist >normal by saliva Abdomen Inspection >sternum is at >normal the midline >normal >moves >normal symmetrically Auscultation when >normal breathing Percussion >RR: 18bpm >due to Palpation >no increase tenderness intake of >HR:82 bpm alcohol Upper Inspection >due to pain extremities >skin color is >normal uniform bowel sound >distended >normal Inspection >with >presence of Lower guarding stones in the extremities behavior gallbladder noted >borborygmi >normal Inspection noted >normal >normal Nails Palpation >tympany noted >normal >with masses >normal
  • Inspection noted >due to previous burns General appearance >symmetrical >normal >proportional >due to poor >no lesions hygiene noted >normal >symmetrical >normal >proportional >due to pain >with lesion >due to pain on the right lower leg >due to >160˚ angle restlessness >dirty >capillary refill: after 1 second >conscious and coherent >weak in appearance >with guarding behavior in the abdomen >sleepy
  • appearance February 13, 2010 Part to be Technique Result Interpretation examine used Skin Inspection >skin color: >increase with slight bilirubin level jaundice Palpation noted >normal >clean skin >normal >warm to Head Inspection touch >normal Palpation >normal >round >no Scalp Inspection tenderness >normal noted Hair Inspection >normal >oily >normal >due to the >black production of >thick sebum >oily >normal Eyebrows Inspection >properly >normal distributed Eyes Inspection >symmetrical >normal and in line >normal with each >due to
  • other increase Ears Inspection bilirubin level >symmetrical >black iris >normal Nose Palpation >slight >due to Inspection yellowish lifestyle sclera >normal Palpation >bean-shaped >normal >with piercing Lips Inspection noted >normal >normal >firm cartilage Mouth Inspection >located at >due to the midline frequent >patent nares smoking Teeth Inspection >firm cartilage >normal Tongue Inspection >dry and dark >normal Chest Inspection >due to >symmetrical acquired >kept moist nicotine by saliva >normal >yellowish to >normal Palpation white Auscultation >normal >kept moist
  • Abdomen Inspection by saliva >normal >sternum is at >normal the midline >normal Auscultation >moves symmetrically >normal Percussion when Palpation breathing >due to >RR: 17bpm increase Inspection >no intake of Upper tenderness alcohol extremities >HR:75 bpm >normal bowel sound Inspection >skin color is >normal uniform >normal Lower >distended extremities >normal >borborygmi >normal Inspection noted >normal Palpation >tympany >normal Nails noted >normal >no masses >due to Inspection noted previous burns General >symmetrical >normal appearance >proportional >due to poor >no lesions hygiene noted >normal
  • >symmetrical >normal >proportional >with lesion on the right lower leg >160˚ angle >dirty >capillary refill: after 1 second >conscious and coherent ANATOMY AND PHYSIOLOGY
  • A. Structures 1. Liver
  • a. The liver is the largest organ in the body , weighing 3 pounds. It is encase in a fibrous capsule and lies in the upper right quadrant of the abdomen. b. The liver is composed of four lobes containing lobules that are the functioning units of the liver. The four lobes are: the right, left, caudate and quadrate. c. Each lobule is composed of hepatocytes (liver cells) and its own blood supply called sinusoids. The phagocytic Kupffer cels are located within the sinusoids. d. The main blood supply to the liver is transported via the hepatic artery and the portal vein emptying into the inferiof vena cava via the hepatic veins. e. The hepatic artery receives blood directly from the aorta and the portal vein drains the blood from the spleen and intestines. f. Fibers from the vagus (parasympathetic) and celiac plexus (sympathetic) comprise the liver’s nerve supply. 2. Biliary system a. Hepatic lobules are the functional unit of the liver. The lobules consist of a network of small ducts called canaliculi. b. The hepatic duct receives bile via the canaliculi that join to create larger bile ducts. c. The common bile duct is formed by the joining of the hepatic and cystic ducts located in the liver and gallbladder respectively. The liquid contents
  • of these ducts drain into the duodenum via the sphincter of the Oddi. d. Relaxing of the Sphincter of Oddi permits the passage of bile into the duodenum e. The gallbladder is a pear-shaped hollow organ, 3 to 4 inches long, located on the undersurface of the right lobe of the liver. f. Normal bile capacity is approximately 50 to 75ml. 3. Pancreas a. The pancreas is a long, slender organ, approximately 6 to 9 inches in length, which is situated behind the stomach and consist of three segments: head, body and tail. b. The organ is composed of lobules that form lobes. c. The lobules have enzyme-producing acini that release their secretions into the duct of Wirsung or pancreatic duct. d. The pancreas produces exocrine and endocrine secretion. The exocrine secretions are via the acini cells of digestive purposes. The endocrine secretions are associated with the islets of Langerhans whose cells are involved in the regulation of carbohydrate metabolism. A. Functions 1. Liver
  • a. The liver is the first organ to receive blood carrying the final products of digestion and decomposition products. b. From this blood the liver begins its enormous role in maintain normal body functions. 2. Major liver function a. Maintains normal serum glucose levels by means of glycogenesis, glycogenelysis, and glucogenesis. b. Deaminizes amino acids, forming ammonia that is then converted into urea. Synthesizes nonessential amino acids, plasma proteins (albumin0, vitamin a, and coagulation factors (fibrinogen, prothrombin), and is the source of heparin, an anticoagulant. c. Breaks down triglycerides and fatty acids and stores and synthesizes excess fats. Also synthesizes cholesterol, lipoprotein, phospholipid and excess fat. d. Serves as a storage place for the fat-soluble vitamins A, D, E, K and B12, iron, and trace elements. e. Detoxifies potentially harmful substances, eg., alcohol, poisons, and various toxic substances produced by the body. Metabolizes drugs and excretes their breakdown products. f. Continuously secretes and excretes bile. 3. Bile components: a. Bile is composed of bilirubin, cholesterol, mucin, electrolytes, bile salts, fatty acids, lecithin, water and various inorganic and organic substances.
  • b. Biliverdin: oxidation of bilirubin forming the greenish color in the bile. c. Bilirubin: pigment from phagocytosed haemoglobin removed from the blood and chemically modified by conjugation to glucoronic acid and formed by the hepatocytes into the bile. d. Bile salts: synthesized from cholesterol, conjugated with amino acid for fat emulsification; recycling is achieved by reabsorption through the ileal mucosa and into the portal circulation for transport to the liver. 4. Biliary system a. Bile from the hepatocytes is transported to the gallbladder via an intricate drainage system. b. Cholecystokinin, a duodenal hormone, stimulates the gallbladder to contract, thereby relaxing the sphincter Oddi and releasing bile for digestion. 5. The pancreas is composed of two basic cell types, endocrine and exocrine. Functions of the pancreatic exocrine cells (acini) include: a. Production of a watery pancreatic juice rich in enzymes for digestion and bicarbonate to neutralize the acidic chime. b. Production of enzymes for digestion, consisting of amylase (hydrolyzes starch), trypsin (proteolytic enzyme that catalizes the hydrolysis of the petite bonds), and lipase (breaks triglycerides into fatty acids and glycerol).
  • PATHOPHYSIOLOGY OF HEPATITIS B Non- modifiable factor Modifiable factors >Age >sexually active with multiple partners >Gender >cigarette smoking >alcoh olic
  • >ear piercing > Unhealthy diet Exposure to Hepa B virus HBV enters the liver through the blood Invasion of HBV in the liver Inflammatory & immune response initiated Deterioration & necrosis Enlargement of the of the hepatocytes Kuffer cells Enlargement of the liver Pain at the causing stomach Formation of the fibrous scar tissue in the liver RUQ of the compression abdomen Obstruction of the vascular & Nausea and vomiting biliary networks Impedes excretion Reduction of the Impaired amount of bile entering of bilirubin Carbohydrate, lipids & the intestine protein metabolism Jaundice, stool becomes light in color, urine becomes darker Indigestion, anorexia Fatigue, Malaise LABORATORY EXAMINATIONS HEPATITIS B Laboratory Tests: Hematology Name: Mr. C Age: 47 y/o Date examined: February 10, 2010
  • Test Result Normal Interpretation CBC Values Hemoglobin 162.5 gm/l 140-170g normal m/l Hematocrit 0.49 0.37-0.47 High hematocrit level can be seen in people living at high altitudes and chronic smokers. It causes lung disease tumors, and disorder of the bone marrow. WBC Count 7.9x10⁹/l 5-10x10⁹/l normal Segmenters 0.48 0.55-0.65 normal Lymphocytes 0.52 0.25-0.35 Indicates a viral infection Blood type: O Rh: (+) Urinalysis Date examined: February 10, 2010 Result Color yellow Glucose negative pH 5.0 Specific gravity 1.015 Protein negative RBC 0-2 WBC 1-3 Calcium oxalate few
  • DRUG STUDY Generic Classification Action Dosage/Route Indication Ingredients Nursing Consideration Name Sylmarine Herbal anti- Protects the 1cap PO TID Nutritionally Each capsule >Administer to right person, oxidant liver by support healthy contains 125mg of time, route and dosage strengthening liver function pure Milk Thistle the outer extract, Lecithin, membranes of Bees wax, Capsule- the liver cells, Gelatin. thereby preventing the toxins from entering the cells.
  • NURSING CARE PLANS Assessment Diagnosis Planning Interventions Rationale Evaluation S:” Masakit tagiliran Pain related to After series of >Assess patient for signs >Assessment allows for The patient will ng tiyan ko” as distended abdomen nursing and symptoms of pain. care plan modification as decrease pain verbalized. secondary to hepatic interventions, the needed. from a pain scale >pain scale of 6 disease as evidenced patient will decrease >Encourage >To assist client in dealing of 6 to2 (where (where 0 is the by a pain scale of 6 pain from a pain verbalization of pain with pain 0 is the lowest lowest and 10 is the (where 0 is the scale of 6 to2 (where >Include client and >To limit focusing on pain and 10 is the highest) lowest and 10 is the 0 is the lowest and significant others in highest) highest) 10 is the highest) establishing pattern of O: discussing pain >conscious >Provide comfort >To provide non >coherent measures such as pharmacologic pain >distended abdomen repositioning and deep management. >facial grimace breathing exercise. >weak and pale in >Encourage diversional >To divert client’s appearance activities such as reading attention to pain. >guarding behavior magazines or texting >Encourage adequate >To prevent fatigue. rest periods.
  • Assessment Diagnosis Planning Interventions Rationale Evaluation S:” Nanlalambot ang Limited body After series of >Discuss with patient >Which will improve The patient will aking katawan” as movements related nursing interventions the need for activity. physical and psychosocial perform self verbalized. to body weakness as the patient will well-being. care activities to evidence by verbal perform self care >Identify activities that >To enhance their positive tolerance level. O: report of fatigue or activities to tolerance patient considers impact. >weak in appearance weakness. level. desirable and >irritable at times meaningful. >limited body >Encourage patient to >Participation in planning movements help plan activity helps ensure patient progression, being sure compliance. to include activities he considers essential. >Encourage to increase >Carbohydrate is energy- foods rich in giving. carbohydrates. >Instruct and help to >To reduce body’s oxygen alternate periods of rest demand and prevent and activity. fatigue. >Teach the patient >which will improve exercises for increasing breathing and gradually strength and endurance. increase activity. >Perform active or >This exercise foster passive ROM exercise to muscle strength and tone, all extremities every 2 to maintain joint mobility and 4 hours. prevent contractures.
  • Assessment Diagnosis Planning Interventions Rationale Evaluation S:” Parang wala na Situational low self- >After series of >Encourage patient to >Self exploration >The patient will akong silbi dahil sa esteem related to nursing interventions express feelings about encourages patient to voice feelings dumapong sakit sa unexpected change the patient will self (past and present). consider future change. related to akin” as verbalized. in health status. verbalize feelings >Assess patient’s mental >If anxiety resulting from current situation related to current status through interview self rejection becomes and its effect on O: situation and its and observation at least severe, patient may self-esteem. >weak in appearance effect on self- once per day. experience disorientation >irritable at times esteem. and psychotic symptoms. >poor concentration >Involve patient in >To combat ambivalence >difficulty making decision making. and procrastination decisions associated with low self >agitated esteem. >Provide patient with >This gives patient feelings positive feedback for of significance, approval verbal reports or and competence, which behavior that indicate a can help him core return to positive self effectively with stressful appraisal. situations.
  • Bataan Peninsula State University Dinalupihan Campus Dinalupihan, Bataan A case Study of Hepatitis B Presentedby: BSN Group J Marie John Cabrera Dhonalyn May Campo Romina Joyce Canlas Elaine Casupanan Jim Francis Cayanan Mark Joseph Cunanan Katrina de Jesus Philip Pingul ~February 2010~