3. This is a case study of a 58-year-old female
who was diagnosed to have Brain herniation
admitted at Northern Mindanao Medical
Center.
The study made use of Behavioral System
Model and Dynamic Nurse-Patient
Relationship, anchored to the nursing
theory of Dorothy Johnson and Ida Jean
Orlando. This case study includes the ideal
and actual interventions related to the
disease condition.
The authors were able to identify
various factors that contributed to the
present condition by understanding the
pathophysiology of the disease. From
this, appropriate medical and nursing
interventions were derived.
This study will benefit the nursing
profession both in the clinical area and
the academe. Management of patients
with Brain herniation and similar
conditions can still be improved.
3
5. Brain herniation is when brain tissue, cerebrospinal fluid, and blood
vessels are moved or pressed away from their usual position inside the
skull. It occurs when something inside the skull produces pressure that
moves brain tissues. Typically the result of swelling in the brain. The
swelling puts pressure on brain tissues (referred to as
increased intracranial pressure), causing the tissue to be forced away
from its normal position. This is most often the result from a head
injury, stroke, or brain tumor. It is a medical emergency and requires
immediate medical attention. It’s often fatal if not treated right away.
5
6. There can be early signs of herniation and late signs, too. The early
signs include decreased level of consciousness, confusion, and difficulty
with memory and thinking abilities, restlessness and lethargy. There is
deterioration of motor function, along with papillary dysfunction and
vision changes. There is the presence of a persistent headache. Certain
personality changes could also be seen. Finally, there is
a decreasing Glasgow coma score.
6
7. It is important to know that, according to the Monro-Kellie doctrine, a
theory for understanding intracranial pressure (ICP), states that
because the bony skull cannot expand, when one of the three
components expands, the other two must compensate by decreasing
by decreasing in volume for the total brain volume and pressure to
remain constant.
7
8. In our case, our patient X is a 58 year old female and has no changes in
her sedentary lifestyle which means that she is an alcohol drinker, and
eating unhealthy foods that includes high in fats in oils. She manifested
these changes in her body which is relevant to the symptoms of brain
herniation which are altered level of consciousness, decreased GCS,
restlessness, hemiplegia, papillary dysfunction and visual changes,
persistent headache, and difficulty with memory and thinking abilities,
8
9. There is no precise estimate of the global epidemiological burden of
Brain herniation. (https://www.sciencedirect.com/topics/veterinary-
science-and-veterinary-medicine/brain-herniation) 9edit
9
11. The Behavioral System Model or what is also referred to as Dorothy
Johnson’s Model fits the case of patient X well. Johnson’s Behavioral
System Model is a model of nursing care that advocates the fostering
of efficient and effective behavioral functioning in the patient to
prevent illness. She defined nursing as “an external regulatory force
which acts to preserve the organization and integration of the patients
behaviors at an optimum level under those conditions in which the
behaviors constitutes a threat to the physical or social health, or in
which illness is found”.
11
12. Johnson believes each individual has patterned, purposeful, repetitive
ways of acting that compromise a behavioral system specific to that
individual. An individual’s behavior is influenced by the events in the
environment and “social inclusion intimacy and the formation and
attachment of a strong social bond.”
12
13. This is especially true for Patient X since it was revealed, after the fact,
that Patient X is an excessive alcohol drinker together with her
husband and relatives, amounting from 2 to 4.5 liters per week. It was
verbalized by her daughter and husband that she was always drinking
alcohol since she was 17 years old and she can consumed 2 glass of
coffee every morning and late afternoon. Patient loves to eat food,
especially food that is high in fats and oils. She can consume full of her
share and tends to add more. They also verbalized that the patient is
not following what was the doctor said to her and no compliance to her
medications.
13
14. With the help of this theory, we can identify the behavior of the patient
and encouraged her to prevent or minimized the intake of such
contributing factors. Since the patient cannot talk and respond with
us, we emphasized the health teaching as well as the prevention of
such condition to her husband and daughter where some of their
family members especially the husband are alcoholic drinker. It was
the nurses' responsibility to advocate, and educate the patient or
family member as well as the husband and family members about the
prevention of any illnesses that can affect the daily living of a person.
14
15. Johnson proposed that the client is a behavioral system, organized
into seven subsystems of behavior which are attachment or affiliative
subsystem, dependency subsystem, ingestive subsystem, eliminative,
sexual, and aggressive and achievement. The patient was fall into
category of attachment and ingestive subsystem in where
attachment is when patient X is always with her husband and brothers
to have drink outside of their house. As mentioned in the above that
the patient is always drinking an alcoholic beverages.
15
16. Drinking alcohol plays an important social role in many cultures, where
there is a formation of social inclusion, intimacy, and the formation of
attachment of a strong social bond that is ultimate function is survival.
Patient X falls into category of ingestive subsystem, as mentioned in
the above that the patient loves to eat food that is high in fats and oils
even though she knows that it is not good for her but tends to eat and
add more.
16
17. According to Dorothea Orem’s Self Care Deficit Model wherein she
defined it that it is the key when and how much a nurse is needed in the
care of the patient. Nursing care is needed if there is a problem that
prevents a person from reaching their optimal health. Orem’s theory
has three components to the self-care nursing model, the wholly
compensatory system, the partial compensatory system and
educative- developmental system. The wholly compensatory system is
when the nurse provides total care to the patient. This patient cannot
do anything for himself/herself including activities of daily living and
ambulation.
17
18. This type of patient is totally dependent of the nurse. The second of
Orem’s systems is the partial compensatory. The nurse must assist in
the care of the patient but the patient and family can assist as well.
The patient will be able to resume their own care when they are better
but need the assistance and education a nurse can provide at this
time. The third of Orem’s systems is the educative-developmental
system. The patient has primary control over their health; the nurse
assist with education and promoting safe health practices (Josie
Quiambao-Udan, 2011).
18
19. In relation to our patient, she falls under the wholly compensatory
system in view of the fact that during the course of our assessment,
the patient is in the state of coma with a GCS of 9/15, but during our
assessment, we can say that the GCS of the patient is 4/15 wherein the
patient is in unconscious state, no meaningful response and no
voluntary activities. Patient X has paralysis of her four extremities
(quadriplegia) which also makes her dependent to the nurse as well as
to us student nurses where it provides total care to the patient.
Nursing is needed when the self-care demands are greater than the
self-care abilities.
19
20. Another theory that fits well to our patient is the theory of Faye Glenn
Abdellah’s patient centered approach, she developed the twenty-one
nursing problems. According to Abdellah’s theory, Nursing is a helping
profession. Nursing care is doing something to or for the person or
providing the information to the person with the goals of meeting
needs, increasing or restoring help ability, or alleviating impairment.
Nursing is broadly grouped into 21 nursing problem areas to guide care
and promote use of nursing judgment. She considers nursing to be
comprehensive service that is based on art and science and aims to
help people, ick or well, cope with their health needs.
20
21. Abdellah’s work is a set of problems formulated in terms of nursing-
centered services, which are used to determine the patient’s needs.
The nursing-centered orientation to client care appears to be
contradicting to the client-centered approach that Abdellah professes
to support. This can be observed by her desire to move away from a
disease-centered orientation. In her attempt to bring nursing practice
to its proper relationship with restorative and preventive measures for
meeting total client needs. She proposed the nursing process that
includes nursing assessment, nursing diagnosis, implementation,
evaluation.
21
22. In the case of the patient X, she is a 58 year old that is in need of
high care during the course of her condition. During the first day of our
assessment with the patient X, the theory of Faye Glenn Abdellah was
then developed, with the help of this theory, the twenty-one nursing
problems can be applied to the nursing process, where identifying
patients problem was the first action. When the patient has been
diagnosed, nursing goals have already been established. The goals can
be used as a framework to develop a plan and nursing interventions.
22
23. We asked the husband and the daughter of the Patient X if what was
the doctor and nurses do upon and during the admission of the patient,
they verbalized that they always monitor the patient’s condition if it is
progressing or not. As a student nurses’, we make sure that the plans
and intervention during our duty should be implemented to the
patient. The theory of Faye Glenn Abdellah was very helpful to us as
nursing student and to the patient also. `
23
40. White
Is the color of milk and fresh snow, the
color produced by the combination of all
the colors of the visible spectrum.
You can also split your content
Black
Is the color of coal, ebony, and of outer
space. It is the darkest color, the result of
the absence of or complete absorption of
light.
40
41. In two or three columns
Yellow
Is the color of gold, butter and
ripe lemons. In the spectrum of
visible light, yellow is found
between green and orange.
Blue
Is the colour of the clear sky
and the deep sea. It is located
between violet and green on
the optical spectrum.
Red
Is the color of blood, and
because of this it has
historically been associated
with sacrifice, danger and
courage.
41
42. Let’s review some concepts
Yellow
Is the color of gold, butter and ripe
lemons. In the spectrum of visible
light, yellow is found between green
and orange.
Blue
Is the colour of the clear sky and the
deep sea. It is located between
violet and green on the optical
spectrum.
Red
Is the color of blood, and because of
this it has historically been
associated with sacrifice, danger
and courage.
Yellow
Is the color of gold, butter and ripe
lemons. In the spectrum of visible
light, yellow is found between green
and orange.
Blue
Is the colour of the clear sky and the
deep sea. It is located between
violet and green on the optical
spectrum.
Red
Is the color of blood, and because of
this it has historically been
associated with sacrifice, danger
and courage.
42
43. Place your screenshot here
Desktop project
Show and explain your
web, app or software
projects using these
gadget templates.
43
44. SlidesCarnival icons are editable shapes.
This means that you can:
● Resize them without losing quality.
● Change fill color and opacity.
Isn’t that nice? :)
Examples:
44
45. Now you can use any emoji as an icon!
And of course it resizes without losing quality and you can change the color.
How? Follow Google instructions
https://twitter.com/googledocs/status/730087240156643328
✋👆👉👍👤👦👧👨👩👪💃🏃💑❤😂
😉😋😒😭👶😸🐟🍒🍔💣📌📖🔨🎃🎈
🎨🏈🏰🌏🔌🔑and many more...
😉
45
