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Foundation University
COLLEGE OF NURSING
Dumaguete City
CASE STUDY ON CNS INFECTION WITH SEIZURE
ARI WITH SEVERE DISEASE

2. In partial fulfilment of the requirements
In
Nursing Care Management (NCM) 101
Submitted to:
Mrs. Ivy Monteclaro - Cornelia, R.N.
Clinical Instructor
Submitted by:
Catacutan, Rudyard
Go, Teyfel Joline A.
Palubon, Bjon Troy O.
BSN III – B5
Date Submitted:
October 04, 2008
TABLE OF CONTENTS
I. Introduction
II. Central Objectives
III. Specific Objectives
IV. Demographic Profile/ Biographical Information
V. Erik Erikson’s Theory on Psychosocial Development
VI. Nursing History

3. a. Chief Complaints
b. Admitting Impression/ Diagnosis
c. HPI
d. Past Health History
e. Family History with Genogram
f. Psychosocial History
g. Environmental History
h. Spiritual History
VII. Physical Assessment Findings
VIII. Anatomy and Physiology of Systems/ involved in the disease condition
IX. Review of Related Literature
X. Pathophysiology
XI. Medical Interventions
a. treatment
b. laboratory exams and Correlation
c. Drug Study
XII. Nursing Theory applicable to care of patient
XIII. Gordon’s Functional Health Pattern
XIV. List of Nursing Care Plan
XV. Annotated Readings
XVI. Conclusion
XVII. Bibliography
INTRODUCTION
The central nervous system, or CNS, comprises the brain, the spinal cord, and associated membranes. Under some circumstances, bacteria
may enter areas of the CNS. If this occurs, abscesses or empyemas may be established.

4. The CNS is well defended against infection. The spine and brain are sheathed in tough, protective membranes. The outermost membrane, the
dura mater, and the next layer, the arachnoid, entirely encase the brain and spinal cord. However, these defenses are not absolute. In rare cases,
bacteria gain access to areas within the CNS.
Bacterial infection of the CNS can result in abscesses and empyemas (accumulations of pus). Abscesses have fixed boundaries, but
empyemas lack definable shape and size. CNS infections are classified according to the location where they occur. For example, a spinal epidural
abscess is located above the dura mater, and a cranial subdural empyema occurs between the dura mater and the arachnoid.
As pus and other material from an infection accumulate, pressure is exerted on the brain or spinal cord. This pressure can damage the
nervous system tissue, possibly permanently. Without treatment, a CNS infection is fatal.
A seizure complication of infection can consist of a single seizure or can go on to become a chronic epilepsy. Seizures can arise as an acute,
subacute, or long- term consequence of an infectious state. The type of epileptic complication and when it arises from an infection depend on the
nature of the infectious illness, its duration, and the type and extent of damage to the CNS.
Quantitative data on seizure risk from infection would be extremely useful but there are few detailed studies. One reason is that retrospective
analysis of seizure risk factors is complicated by the interdependence of the many multisystemic and iatrogenic events typically impacting patients
during the course of their illness.
A retrospective study of survivors of encephalitis or meningitis between 1935 and 1981 was conducted to assess the risk of unprovoked
seizures after CNS infection. The 20-year risk of developing unprovoked seizures was 6.8%, and the ratio of observed to expected cases of
unprovoked seizures was 6.9%. The increased incidence of unprovoked seizures was highest during the first 5 years after CNS infection but
remained elevated over the next 15 years of follow-up.
OBJECTIVES OF THE STUDY
I. Central Objective:

5. At the end of two hours case presentation, the learners shall acquire deeper knowledge, develop beginning skills and manifested desirable
attitudes / values towards the management of client with CNS Infection with Seizure and ARI with Severe Disease.
II. Specific Objectives:
Given the time and resources, the learners shall:
• Obtain information regarding the demographic profile and the history of the client completely.
• Review the anatomy and physiology of the organs involved and affected in CNS Infection with Seizure.
• Name the medical intervention or treatment given for the disease involved accurately.
• Formulate an effective Nursing Care Plan relative and applicable to the client based on the conditions the client is subjective to.
• Evaluate the data in Gordon’s Functional Health Pattern intensively.
• Develop priorities for the initial management of client with CNS Infection with Seizure.
• Demonstrate reassessment after each therapeutic intervention.
• Able to trace the pathophysiology of CNS Infection with Seizure.
• Objectively evaluate the case study presentation through a socialized discussion.
• Demonstrate an understanding of the pharmacologic action, dose, indication, and toxicity of the following drugs: Paracetamol,
Diazepam, Ceftriaxone, Dexamethasone, and Cimetidine.

6. • Assist client’s condition prior to beginning any treatment.
DEMOGRAPHIC PROFILE
Date of assessment: September 11, 2008
Name: Juniel Medina Lijarso Room and Bed Number: ICU AND Bed # 07
Age: 3 months old
Sex: Male Attending Physician: Dr. Bollos
Religion: Roman Catholic
Birth date: May 31, 2008
Address: Bio – os, Amlan, Oriental Negros
Parents – Father: Jose Lijarso Occupation: Farmer
Mother: Mary Ann M. Lijarso Occupation: House wife
Date and Time of Admission: Admitted on September 09, 2008 at 7:43 pm at pediatric ward
Chief Complaints:
• Non – productive cough, high grade fever, on and off with convulsive episodes was noted four days PTA.
History of Present Illness:
• Patient’s condition started four days PTA. Patient had four days on and off fever, three days cough, 2 days PTA had sought and consult
and was given paracetamol, klancid, and ambroxol. Several hours PTA had rolling of eyeballs and stiffness of extremities for a few
minutes, then this was followed by another at 5:00pm at the time of admission.

7. Admitting Impression:
• R/O, CNS Infection
• ARI with several diseases
General Impression:
• Received sleeping on bed with D5 0.3% NaCl at right metacarpal vein, no inflammation, redness and swelling noted at IV site, with
continuous O2 administration at 1 – 2 L/min. NPO with breastfed with strict aspiration precaution.
NURSING HISTORY

8. A. Chief Complaints:
 Non – productive cough, high grade fever, on and off with convulsive episodes was noted four days PTA.
B. Admitting Impression/Diagnosis:
 R/O, CNS Infection
 ARI with severe disease
C. History of Present Illness:
 Patient’s condition started four days PTA. Patient had four days on and off fever, three days cough, 2 days PTA had sought and consult
and was given paracetamol, klaricid, and ambroxol. Several hours PTA had rolling of eyeballs and stiffness of extremities for a few
minutes, and then this was followed by another at 5:00pm at the time of admission.
D. Past Health History:
 Mother delivered the baby by NSVD. General health in the past has been good despite minor illnesses such as coughs and colds. Breast
fed since birth up to present. And has no allergies. Had not yet given any immunizations. It is his first time to be admitted in the hospital
and also he is the first child of his parents.
E. Psychosocial History:

9.  He is taking cared by his parents. At the age of 3 months, he doesn’t want other people to carry him, except his mother.
F. Environmental History:
 He lives with his mother and father @ Bio-os, Amlan, Negros Oriental, where they live in a small house made of bamboo. Their place is peaceful and
they can breathe fresh air.
G. Spiritual History:
 The family is pure Roman Catholic and they go to church every Sunday. They also go to church on Wednesday and pray the Rosary with the
neighbourhood every Friday.
H. Family History with Genogram:

10. *Father Side * * Mother Side*
Conclusion:
Berto Lijarso
(Grandfather)
 

Emetria
Lijarso
(Grandmother)
Housewife

Jose
Lijarso
30 y.o
Father
Farmer
Rosie
Lijarso
Eldest
Sister

Lodrigo
Medina
(Grandfather)
Farmer

Norma Buenaflor
Medina
(Grandmother)
Housewife

Mary Ann
M. Lijarso
29 y.o
Mother
Housewife
Juniel
M.
Lijarso
3 months
 
Gorio
Lijarso
Eldest
Son
Mario
Lijarso
Third
Child
Christophe
r
Lijarso
Younges
t Son
Miko
Medina
35 y.o
Eldest
Son

Junito
Medin
a
22 y.o
Third
Child
Jovanni
Medina
20 y.o
Younges
t Son

11. The father side family of our client had two genetic diseases these are cancer and anemia. His grandfather died due to cancer and his
grandmother is anemic. They are five in the family and only Ms. Rosie Lijarso got the hereditary disease which is anemia, for the boys they don’t
know if they got any of it.
The mother side family of our client had hypertension. Both of his grandfather and grandmother have hypertension. They are four in the family
and she is the only girl in the family. His elder brother has hypertension while the rest they don’t know if they got that disease.
Cues / Evidences Nursing Diagnosis Objectives Interventions Rationale Evaluation
Subjective Cue: Within our care the Independent: The objective of care
LEGEND:
 - decease
 - died because of cancer
 - Anemic
 - Hypertension
 - Client
 - With CNS infection

12. “ Gi hilantan akong
anak upat na ka adlaw
mu balik daun mawala
iyang hilanat ug taas
pud ” as verbalized by
the mother.
Objective Cues:
Vital Signs:
 T = 38.2 C̊
 P = 142 bpm,
weak and
irregular
 R = 38 cpm,
unlabored
- Seizure and
convulsion
present
- Skin warm to
touch
- Adventitious
breath sound
present : rales
- O2 therapy 1 –
2 L/ Min. (nasal
Hyperthermia related
to excessive fluid loss
as evidenced by
increase in body
temperature higher
than normal range.
client will show
maintain core
temperature within
normal range as
evidenced by:
+ Demonstrate
behaviours to monitor
and promote
normothermia.
+ Be free of seizure
activity.
+ Monitor heart rate
and rhythm.
+ Auscultate breath
sounds noting
adventitious sounds
such as rales.
+ Monitor input and
output.
+ Administer
medications as
ordered.
+ Provide
Supplemental oxygen.
+ Review signs and
+ Monitor client
temperature note shaking,
chills/profuse diaphoresis.
+ Monitor environmental
temperature, limit or add
bed linens.
+ Provide tepid sponge
bath, avoid using alcohol.
+ Maintain bed rest.
Collaborative:
+ Administer Paracetamol
125 mg supp. ½ stick Q 4 ̊
PRN for T = 38 C and up̊
+ Administer Diazepam 1.2
mg IVTT Q 4 PRN for̊
+ To be able to administer
medication in case of fever.
+ Room temperature or
number of blankets should
be altered to maintain near
normal body temperature.
+ May help reduce fever.
+ To reduce metabolic
demands or oxygen
consumption.
+ Decreases fever by
inhibiting the effects of
pyrogens on the
hypothalamic heat
regulating centers and by a
hypothalamic action
leading to sweating and
vasodilation. Relieves pain
by inhibiting prostaglandin
synthesis at the CNS but
does not have anti –
inflammatory action
because of its minimal
effect on peripheral
prostaglandin synthesis.
+ Facilitates/potentiates the
as partially met as
evidenced by:
+ Vital signs stabilized.
+ Freed from seizure
acitivity.
+ Absence of
adventitious sounds :
rales
+ Monitored input and
output.
+ Administered
medications as
ordered.
+Reviewed signs and
symptoms of
hyperthermia.
+ Maintained bed rest.

13. cannula) symptoms of
hyperthermia.
+ Maintain Bed rest.
seizure
+ Administer Ceftriaxone
300 mg IVTT Q 12 ̊
+ Administer
Dexamethasone 0.5 mg
IVTT Q 6 ̊
+ Administer Cimetidine 30
mg IVTT Q 6 ̊
inhibitory activity of GABA
at the limbic system and
reticular formation to
reduce anxiety, promote
calmness and sleep. This
inhibition also suppresses
the spread of seizure
activity produce by
epileptogenic foci in the
cortex, thalamus and limbic
system. Enhancement of
GABA – mediated
presympathetic inhibition at
the spinal level and brain
stem reticular formation
results to skeletal muscle
relaxation.
+ Inhibits bacterial cell wall
synthesis, rendering cell
wall osmotically unstable,
leading to cell death.
+ Synthetic glucocorticoid
with marked anti –
inflammatory effect
because of its ability to
inhibit prostaglandin
synthesis, inhibit migration
of macrophages,
leukocytes and fibroblasts
at sites of inflammation,
phagocytosis and
lysosomal enzyme release.
It can also cause the
reversal of increased
capillary permeability.
+ Competitively inhibits

14. + Provide cooling blanket
+ IVF: D5 0.3% NaCl at 20
mgtts/min. To run for 24H
histamine at H2 - receptor
site of gastric parietal cells ,
resulting to decreased
gastric acid secretion by
about 50 – 80 %.
+ Used to reduce fever.
+ To support circulating
volume and tissue
perfusion.
Medical Interventions

15. A.Treatments:
Treatments Rationale
 September 09, 2008 (7:45 pm)
- Please admit to Pedia – ICU
- TPR
- NPO
- CBC, U/A, Stool Exam start venoclysis 8:05 pm D50.3 NaCl 500
mL to run at 30 mgtts/min.
- Ceftriaxone 600 mg IVTT now then 300 mg every 12 hours IVTT
- Dexamethasone 0.5 mg IVTT every 6 hours
- Cimetidine 30 mg IVTT every 6 hours
- Diazepam 1.2 mg IVTT every 4 hours prn, for seizure
- O2 inhalation 1 – 2 L/min.
- Suction Secretions prn
- Padded tongue Depressor for access
- For close watch
 (10:00 pm)
- Blood typing stat
- Request FWB of patients type 250 mL and transfuse 75 cc as
packed RBC
 September 10, 2008 (12:20am)
+ In order to monitor his vital signs.
+ Indicates more thorough assessment and replace fluid loss and
electrolytes imbalance.
+ Inhibits cell-wall synthesis, promoting osmotic instability; usually
bactericidal.
+ Decreases inflammation, mainly by stabilizing leukocyte lysosomal
membranes; suppresses immune response; stimulates bone marrow; and
influences protein, fat, and carbohydrate metabolism.
+ Competitively inhibits action of histamine on the H2 receptor sites of
parietal cells, decreasing gastric acid secretion.
+ A benzodiazepine that probably potentiates the effects of GABA,
depresses the CNS, and suppresses the spread of seizure activity.
+ indicates more thorough assessment

16. - Paracetamol 125 mg supp ½ stick for rectum then every 4 hours
PRN for T=38 and above
 (8:00 am)
- May breastfeed with strict aspiration precaution
- D5 0.3% NaCl 500 mL at SR
 (6:20 pm)
- IVF to ff D5 0.3% NaCl at SR
 September 11, 2008
- Follow up blood and transfuse when available
- D5 0.3 % NaCl 500 mL for 24 hours
 September 12, 2008
- D5 IMB 500 mL at SR
- Repeat CBC in ARI
 September 13, 2008
- D5 IMB 500 mL at SR
- Consume Cimetidine
- Transfer to respi.
 September 14, 2008
- D/C Dexamethasone
- D5 IMB 500 mL at SR
 September 15, 2008
- D5 IMB at SR
 September 16, 2008
+ Thought to produce analgesia by blocking pain impulses by inhibiting
synthesis of prostaglandin in the CNS or of other substances that
sensitize pain receptors to stimulation. May relieve fever through central
action in the hypothalamic heat-regulating center.
+ To support circulating volume and tissue perfusion.
+ To support circulating volume and tissue perfusion.
+ To support circulating volume and tissue perfusion.
+ To support circulating volume and tissue perfusion.
+ To support circulating volume and tissue perfusion.
+ To support circulating volume and tissue perfusion.
+ To support circulating volume and tissue perfusion.

17. - Consume IVTT meds and IVF
- MGH
- Immunize drops 0.3 mL OD
B. Laboratory Exams and correlation:

18. Laboratory Exams Result Normal Values Correlation
+ Urinalysis:
- Color
- Transparency
- Specific Gravity
- Glucose
- Protein
- pH
U1 + Microscopic Examination:
- Pus cells
- RBC
- Epith. Cells
- Amorph. Urates
- Bacteria
+ Fecalysis:
- Color
- Consistency
F1 + Microscopic Examination:
- Ascaris
- Ring worm
- Hook worm
- Trienuns
- Troph
- Cyst
+ Cross – Matching:
Yellow
Hazy
1.015
Negative
Trace
6.0
0 -2/hpf
None
None
Moderate
Few
Yellow
Soft
No ova
None
Parasites
Seen
None
Seen
Straw to dark yellow
Clear
1.005 – 1.035
Negative
Negative
4.5 - 8
0-2/hpf
0 – 5/hpf
Few
negative
Negative
Within normal range
Within normal range
Within normal range
Glucosuria
Protinuria
Within normal range
Within normal range
Within normal range
Within normal range
Within normal range
Within normal range
Within normal range
Within normal range

19. - No. of Units
- Blood Type
- Serial No.
- Blood Component
- Extraction
- Expiration
+ Complete Blood Count:
- Hemoglobin
- Hematocrit
- Platelet Count
- WBC
+ Differential Count:
- Neutrophil
- Lymphocyte
- Monocyte
- Eosinophil
- Basophil
1
O+
755441
PRBC
8.22
9.26
11.5
33.5
280,00
26,900
51
37
7
4
1
13 – 18 g/dL
40 - 50 L%
150-400T/cumm
4 – 11 k/uL
40 – 75
20 – 45
0 – 20
0 – 6
0 - 1
Malignancy of organs; chronic
renal failure
Within normal range
Acute infection; tissue necrosis;
parasitic disease
Within normal range
Within normal range
Within normal range
Within normal range
Within normal range
C. Drug Study:

20. 1. Diazepam 1.2 mg IVTT every 4 hours PRN for Seizure
 Generic Name: Diazepam
 Brand Name: Diazepam Intensol
 Classification: Anticonvulasants
 Mechanism of Action: A benzodiazepine that probably potentiates the effects of GABA, depresses the CNS, and suppresses the spread
of seizure activity.
 Adverse Reactions:
• CNS: drowsiness, dysarthria, slurred speech, tremor, headache, transient amnesia, fatigue, ataxia, insomnia, paradoxical, anxiety,
hallucinations, minor changes in EEG patterns.
• CV: CV collapse, bradycardia, hypotension
• EENT: diplopia, blured vision, nystagmus
• GI: nausea, constipation, diarrhea with rectal form.
• GU: incontinence, urine retention.
• Hematologic: neutropenia
• Respiratory: respiratory depression, apne
• SKIN: rash
 Nursing Consideration:
• Use Diastat rectal gel to treat no more than five episodes per month and no more than one episode every 5 days because tolerance may
develop.
• When using oral solution, dilute dose just before giving.
• Monitor periodic hepatic, renal, and hematopoietic function studies in patients receiving repeated or prolonged therapy.
2. Ceftriaxone 600 mg IVTT now then 300 mg every 12 hours IVTT

21.  Generic name: Ceftriaxone Sodium
 Brand Name: Rocephin
 Classification: Anti – infectives
 Mechanism of Action: Inhibits cell-wall synthesis, promoting osmotic instability; usually bactericidal.
 Adverse Reaction:
• CNS: fever, headache, dizziness
• CV: phlebitis
• GI: diarrhea
• GU: genital pruritis, candidiasis
• HEMATOLOGIC: leukopenia
• SKIN: pain, induration, tenderness at injection site, rash, pruritis
 Nursing Considerations:
• Before giving drugs, ask patient if he is allergic to penicillins
• Obtain specimen for culture and sensitivity tests before giving first dose.

22. 3. Dexamethasone 0.5 mg IVTT every 6 hours
 Generic Name: Dexamethasone
 Brand Name: Cortastat
 Classification: Corticosteroids
 Mechanism of Action: Decreases inflammation, mainly by stabilizing leukocyte lysosomal membranes; suppresses immune response;
stimulates bone marrow; and influences protein, fat, and carbohydrate metabolism.
 Adverse Effects:
• CNS: Insomnia, psychotic behaviour, vertigo, headache, seizures, depression
• CV: heart failure, hypertension, edema, thrombophlebitis
• EENT: cataracts, glaucoma
• GI: peptic ulceration, GI irritation, increase appetite, nausea, vomiting
• GU: menstrual irregularities, increased urine glucose and calcium levels
 Nursing Diagnosis:
• Determine whether patient is sensitive to other corticosteroids.
• Most adverse reactions to corticosteroids are dose – or duration – dependent.
• Give oral dose with food when possible.
• Always adjust to lowest effective dose.

23. 4. Cimetidine 30 mg IVTT every 6 hours
 Generic Name: Cimetidine
 Barnd Name: Tagamet
 Classification: Anti – ulcer
 Mechanism of Action: Competitively inhibits action of histamine on the H2 receptor sites of parietal cells, decreasing gastric acid secretion
 Adverse Reactions:
• CNS: confusion. Dizziness, hallucinations, headache
• GI: mild and transient diarrhea
• GU: impotence
• MUSCULOSKELETAL: arthralgia, muscle pain
 Nursing Considerations:
• Assess patient for abdominal pain.
• Schedule dose at the end of hemodialysis treatment
• IM injection may be given undiluted.

24. 5. Paracetamol 125 mg ½ stick every 4 hours PRN for T= 38 and above
 Generic Name: Parctamol
 Brand Name: Tempra
 Classification: antipyretics
 Mechanism of action: Thought to produce analgesia by blocking pain impulses by inhibiting synthesis of prostaglandin in the CNS or of
other substances that sensitize pain receptors to stimulation. May relieve fever through central action in the hypothalamic heat-regulating
center.
 Adverse Reaction:
• Hematologic: haemolytic anemia, leukopenia, neutropenia, pancytopenia
• Hepatic: jaundice
• Metabolic: hypoglycemia
• Skin: rash, trauma
 Nursing Considerations:
• Many OTC and prescription products contain acetaminophen; be aware of this when calculating total daily dose.
• Use liquid form for children who have difficulty swallowing.
• In children, don’t exceed five doses in 24 hours.

25. Erik Erikson’s Theory
on
Psychosocial Development

26. Functional Health Pattern
And
Nursing Care Plan

27. Review of Related
Literature

28. ANATOMY AND PHYSIOLOGY
OF THE
INVOLVED SYSTEMS

29. PHYSICAL ASSESSMENT
FINDINGS

30. Nursing Theory
applicable to
care of patient

31. ANNOTATED READINGS

32. CONCLUSIONS

33. BIBLIOGRAPHY

34.  WWW.WIKIPEDIA.ORG
 Smeltzer, Suzanne C. Et. Al. Medical – surgical Nursing . Volume 2. 11th
edition.
 http://cks.library.nhs.uk/search?&page=1&9=CNS.Infection%20&site=2
 Margolis, S. Et. Al. (2003). John Hopkins Symptoms Remedies.
 Black, Joyce M. Et. Al. (2005). Medical-surgical nursing (clinical management for positive outcome). Volume 1.7th
edition.
 Mosby’s pocket dictionary of medicine, nursing and health profession. 5t edition.(2006)
 Freshwater, Dawn. Et. Al. (2005). Blackswell’s Nursing dictionary.
 Malan Press. PPD’s Nursing Drug Guide.2007 edition.
 Lippincott, Williams & Wilkins. Et. al. (2008). Nursing drug handbook. 28th
edition.
 www.mimsonline.com

35. “Physical Assessment “
I. Comprehensive Health History:
A. Patient’s History:
Name: Juniel Medina Lijarso Room and Bed Number: ICU AND Bed # 07
Age: 3 months old
Sex: Male Attending Physician: Dr. Bollos
Religion: Roman Catholic
Birth date: May 31, 2008
Address: Bio – os, Amlan, Oriental Negros
Parents – Father: Jose Lijarso Occupation: Farmer

36. Mother: Mary Ann M. Lijarso Occupation: House wife
Date and Time of Admission: Admitted on September 09, 2008 at 7:43 pm at pediatric ward
B. Chief Complaints:
• Non – productive cough, high grade fever, on and off with convulsive episodes was noted four days PTA.
C. History of Present Illness:
• Admitted on September 09, 2008 at 7:43 pm at pediatric ward with the chief complaints of Non – productive cough, high grade fever, on
and off with convulsive episodes was noted four days PTA.
• Medications:
+ Paracetamol 125 mg supp. ½ stick Q 4 PRN for T = 38̊ ̊ C and up
+ Diazepam 1.2 mg IVTT q 4 PRN for seizure̊
+ Ceftriaxone 300 mg IVTT Q 12 ̊
+ Dexamethasone 0.5 IVTT Q 6 ̊
+ Cimetidine 30 mg IVTT Q 6 ̊
D. Past Health History:
• Mother delivered the baby by NSVD. General health in the past has been good despite minor illnesses such as coughs and colds. Breast
fed since birth up to present. And has no allergies. Had not yet given any immunizations. It is his first time to be admitted in the hospital
and also he is the first child of his parents.
E. Family History:
 Father Side:

37. + The father side family of our client had two genetic diseases these are cancer and anemia. His grandfather died due to cancer and his
grandmother is anemic. They are five in the family and only Ms. Rosie Lijarso got the hereditary disease which is anemia, for the boys they
don’t know if they got any of it.
 Mother Side:
+ The mother side family of our client had hypertension. Both of his grandfather and grandmother have hypertension. They are four in the
family and she is the only girl in the family. His elder brother has hypertension while the rest they don’t know if they got that disease.
II. General Survey:
 Received sleeping on bed with D5 0.3% NaCl at right metacarpal vein, no inflammation, redness and swelling noted at IV site, with continuous
O2 administration at 1 – 2 L/min. NPO with breastfed with strict aspiration precaution. With the final vital signs T = 38..2 C, P = 142 bpm,̊
weak and irregular, and R = 38 cpm, unlabored.
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