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ACKNOWLEDGEMENT
Teamwork divides the task and multiplies the success teamwork is one thing student
nurses cannot succeed without. In completing this paper, the participation and contribution of
each member has taken its place in the final product. Without which all this would have been
impossible to achieve. That being said we would like to express our gratitude to all those who
have helped make all this, a definite success.
First of all, we would like to thank the Almighty Father, for guiding us throughout our
whole nursing life. For giving us the patience, courage and perseverance to deal with all the
mishaps and problems weve had to fight our way through to complete this paper. We thank
Him endlessly for sharing his wisdom to every single person involved in this work our parents,
clinical instructors, patients and our fellow nurses.
Second, we would like to thank our patient, for welcoming us despite of her fragile
condition. We would like to show our appreciation for the obvious participation of his family
for answering all our questions, and giving us the necessary information about our patient, and
the entire family.
To our kind clinical instructor, Mrs. Rhoda N. Ocampo, R.N., who helped us in reading
the files in the charts and gave us little bits of information about presenting cases. To our parents
and families, we are forever grateful, for allowing us to have sleepless nights to finish our case
presentation. We would like to thank all of them for supporting us in the challenges weve all
had to undergo together. Without their support we would have not had the motivation to do all
this and be happy in our choice of work.
Lastly we would like to thank and congratulate ourselves for working together and
achieving all this. This case presentation would not have been possible if not for the
participation, patience and support from each member of the group. A wise man once said, In
order to succeed, your desire for success should be greater than your fear of failure. For all the
pep talks and memories we have made in the process of making this presentation a big success.
INTRODUCTION
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Health is a dynamic condition that represents a range of physical and emotional states and
our health is our most precious asset given by our creator. It is our major responsibility to protect
our health from becoming ill and preventing it from danger, our knowledge would be the key,
knowledge of how our body works, of what we should not do to keep it in its best possible
functions, and perhaps most important of all, the knowledge that enables us to recognize any
illness or disorder in its earliest stage, when medical treatment stands the greatest chance of
success. In connection, our case study was made to reveal the nature of an illness called Facial
Nerve Paralysis or Bells Palsy providing additional knowledge and eliminating vagueness
regarding this disease, but not in any sense a substitute for the enormous range of service
provided by the medical profession.
Bells palsy or idiopathic facial paralysis is a disease caused by inflammation of
unknown origin affecting the facial nerve resulting in acute paralysis of one side of the face. The
condition may cause considerable emotional distress because of its characteristic appearance
drooping appearance around the eye and mouth thus adversely effecting self-esteem and life
experience.
Bells palsy is seen in approximately 2 to 3 people per 10,000 and may resolve by itself
within a few months with severe cases taking up to one year. Unfortunately, up to 10% of
patients will experience some degree of permanent paralysis.
(http://www.gancao.net/acupuncture/bells-palsy-acupuncture-herbs-228) In 2003, there were
12,682 estimated cases here in the Philippines.
(http://www.cureresearch.com/b/bells_palsy/stats-country.htm)
Our group is scheduled to have our clinical duty at the ENT Ward of Southern
Philippines Medical Center, where we have come across different patients. Among these patients
is the woman who is 23 years old. The subject of our case study has differed among others. She
was diagnosed having facial nerve palsy. We believed that it is something that we students need
to understand fully.
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http://www.gancao.net/acupuncture/bells-palsy-acupuncture-herbs-228http://www.cureresearch.com/b/bells_palsy/stats-country.htmhttp://www.gancao.net/acupuncture/bells-palsy-acupuncture-herbs-228http://www.cureresearch.com/b/bells_palsy/stats-country.htm -
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This case study will help us student nurses in more ways. It will not only re acquaint us
with the concepts we have learned in our Primary Health Care and Nursing Care Management
lectures but it also gives us the chance to master and gather much enough experiences to equip us
for greater challenges ahead. By knowing more, we function more effectively, efficiently and
safely.
Presentation of the case in relation to the concept will serve as the groups final
evaluation. The case study must be able to portray what the group learned. It should also be a
manifestation of the groups hard work throughout the rotation. And, the experience of making
this case study must leave a valuable lesson that the group will never forget.
Moreover, we just have to remember that in learning all these things, we are now guided
and oriented on what else we can do to augment the quality of human life.
OBJECTIVES
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After 1 day of data gathering, research and analysis, our group shall have devised
objectives that will guide us for the proper understanding and fair interpretation of the case of
our chosen patient.
GENERAL OBJECTIVES
Cognitive
Within the 1 day span of duty, the student nurses will be able to:
Gather significant data from the patients chart which includes the doctors order, laboratory
exams and etc. to have complete information about the patients current condition.
Research on the anatomy and physiology of the clients affected system.
Research on the possible causes and also the symptoms the patient experienced that may
suggest the current condition of the patient.
Determine and interpret the medical management employed including laboratory and diagnostic
procedures.
Identify and study the drugs prescribed to the patient which affects the patients current
situation.
Psychomotor
Within the 1 day span of duty, the student nurses will be able to:
Conduct a thorough physical assessment and to interpret the assessment in order to give the
care the patient need.
Formulate nursing care plans and apply them to satisfy the patients needs and give appropriate
nursing interventions.
Make a discharge plan for the patient using M.E.T.H.O.D and validate the patients prognosis
according to categories.
Affective
Within the 1 day span of duty, the student nurses will be able to:
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Establish rapport and therapeutic communication in order to gain information about the patient
which includes the medical and family health history, expectations of her condition to gather
significant data from the patients chart and to his family and etc.; and for the betterment of
nursing care.
Assume the role of being the patients advocate.
PATIENTS DATA
Name : Bea A.
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Age : 27 years old
Sex : Female
Weight : 49kg
Height : 52
Address : Riverside, Davao City
Birthday : May 18, 1987
Birthplace : Bukidnon
Civil Status : Single
Nationality : Filipino
Religion : Roman Catholic
Educational Attainment : High School Graduate
Occupation : none/housewife
MEDICAL DATA
Hospital : SPMC
Ward / Bed Number : ENT ward, Isolation Room
Reason for Admission : Ear discharge
Admitting Date and Time : June 29, 2010 at 10:44 am
Admitting Diagnosis : Facial Nerve Palsy
Admitting Physician : Dr. Mark Wingleaf Yu
Final Diagnosis :
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GENOGRAM
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FAMILY HISTORY
Family Background
Our patient, Bea A., is the third child of Shaina and John Lloyd. She has four siblings,
three boys and one girl. Both of her parents dont have the same illness like the one she has. Her
parents do not have any illness like hypertension, diabetes mellitus, or cancer.
Her mother has six female siblings and is second of seven. Her father has one male
sibling. They are all living with no present illness according to the patient.
Her mother delivered all of them through normal spontaneous vaginal delivery without
any complications during the said delivery.
She was born and grew up in the province of Bukidnon. She was living in a bahay kubo
with no water supply and electricity. At the age of three, she lived in her grandmothers house to
have her education. It is because it is nearer and her grandmother pays for the fees of her
schooling. She only lived in her parents house during her grade 3 4 of schooling. She had her
primary and secondary education in the same province.
She moved here in Davao City in the year 2007 with his boyfriend. It is because she
wants to be with his boyfriend and she could also not pursue college education because of
financial problems. She met her boyfriend, Sam, in Bukidnon. They met because Sam heard of a
job opportunity in Bukidnon which is construction works. She is currently living in Riverside,
Davao City together with his live-in partner while the rest of her family is in Bukidnon. She is
now 23 years old, born on May 18, 1987.
Her husband is a contractual worker and does not have a permanent job. He is only called
whenever there are carpentry job available. In one job, he could have 1,000 pesos as an average
wage. He could have at least one job per month. In times where there are no available resources
left for the two of them, Sam would ask for financial help to his parents or to his brother.
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Diet and Lifestyle
In her younger years, she already lived in her grandmothers house already. She had a
habit that itching or cleaning her ears every now and then. She was playful and loves to play
outside. During her high school years, she was active in sports. She participates in women
softball games. She would still play in the outdoors and still have her habit of itching her ears.
However, after moving here in Davao, she did not have any sports to play anymore and stays a
lot in their house. She does the household chores everyday. Her hygiene was a part of her
everyday activities. She was fond of cleaning her ears with a cotton bud inserting half of it inside
the ear canal. She cleans it vigorously.
Her usual meals consist of vegetables and fish. She also eats meats such as chicken, pork
and beef but only in minimal amount. They would eat cheaper viands because of financial
constraints. Her leisure time is watching TV and talking to her neighbours. She does not have
any vices such as drinking liquors and smoking.
History of Past Illnesses
Bea A. has her complete immunization (BCG, DPT, Oral Polio Vaccine, Hepatitis B
vaccine, measles vaccine) at the Bukidnon Health Center. Aside from common illness such as
fever, cough, and colds, Bea A. did not experience other illnesses. If she has fever, she would
only take over the counter drugs such as Neozep, Paracetamol and Bioflu. She also uses herbal
medicine such as tawa-tawa and kalabog and for her; it has a therapeutic effect on her body.
History of Present Illness
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Because of her habit of cleaning and itching her ear every now and then even without
proper handwashing, there was a complication arise. Six weeks prior admission, Bea A.
experienced pus discharges in her left ear. She then used cotton buds and checked the ear and she
noticed that there were pus and blood discharges. She had the same experience for one week. She
felt that her ear is hot and swelling. After one week observing of the pus ear discharges, she
eventually noticed that her left side of her face is already numb. In addition to that, she could
already felt pain in her ears and still ear pus would come out of her ears. She then decided to
consult to a doctor. She went to the clinic of Dr. Hernandez to have a check-up and she was
prescribed Amoxicillin and Mefenamic Acid for her pain. Since the medications are not
effective, she decided to have her second check-up at the Southern Philippines Medical Center
where she was diagnosed to have Facial Nerve Palsy. She was admitted last June 29, 2010 at
around 10:44 am under ENT service, isolation room.
PHYSICAL ASSESSMENT
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General Survey
Physical assessment was taken on July 2, 2010 at 10am, 71 hours and 16 minutes after
admission. Received sitting on bed, conscious, alert and responsive with an on-going IVF bottle
PNSS 1 liter at 200cc level infusing well 20gtts/min rate to left metacarpal vein.
Upon entering in the room of a 23 year old female whos conversing with her watcher
with a height of 52with a weight of approximately 49 kg and is wearing a oranged colored t-
shirt and blue, flower-patterned pajamas, whos lower half is covered in a blanket. Appears clean
and neat with hair combed. With noted foul body odor. Was relaxed, fully rested with no
hesitancy in changing body position. No noted pallor or other noticeable signs of illness. Is
cooperative and able to follow requests with promptness and is in a sociable mood and willing to
interact. Speech is understandable, moderate pace. Voice is fully audible, speaks at moderate
volume and has clear voice tone. Speaks clearly with coherent organization of thought, speaks in
logical sequence, makes sense and has good sense of reality with minimal vagueness and is able
to further respond to and clarify inquiries.
Vital Signs are:
Blood Pressure: 120/80
Respiratory Rate: 19
Pulse Rate: 68
Temperature: 35.8 C
Neurological System
Has no noted difficulty in speaking: Is fully oriented upon interview and is able to state
the current location, time of the day, day of the week, duration of current hospital stay, duration
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of illness and the names of the family members. With regards to memory client is able to recall
various events of the day including time seen by the physician and is also able to recall and
repeat information given early in the interview. Has good attention span with maintained eye
contact. Good motor function upon verbal request and is able to converse normally with good
grammar, sentence structure and showed ability to speak bilingually.
Skin
Upon inspection, skin color varies from light to deep brown. Skin is generally uniform
except in areas exposed to the sun including face and upper extremities which is of a darker tone.
Areas of lighter pigmentation include the palms, lips and nail beds. No edema noted Noted mole
on lobule of left ear. Has noted puncture mark on right mid forearm, encircled with a dark
colored pen. Upon palpation, skin was moist. Skin felt generally warm on areas under the blanket
but cool on the arms. With a Temperature of 35.8 C. Skin springs back to previous state upon
light pinching of the left forearm indicating good skin turgor.
Head
Upon inspection, the skull is normocephalic and symmetric, with frontal, parietal, and
occipital prominences and has smooth skull contour. Palpation of the skull reveals absence of
nodules and masses has symmetric facial features. Facial movements are assymmetrical and is
particularly evident when showing emotions such as smiling. Head is full of hair, black in color
with some noted brown strands, reaching below shoulder level. Bangs do not reach eyebrows.
Hair is parted through the side and does not cover the face. Has thin hair strands and dry hair. No
presence of infection or infestation was noted. The left mastoid part is bigger than the other side.
There is weakness on left side of face muscle.
Eyes
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Eyebrows were symmetrically aligned with equal movement. Eye lashes was equally
distributed and curled slightly outward. The skin of the eyelids were intact, no discharges and no
discoloration. Noted unable to open eye lids fully. Lids close assymmetrically however with
noted frequent blinking on right eye only with a rate of 36 blinks per minute. Upon inspection,
anicteric sclera. No noted visible sclera above corneas Palpebral conjunctiva appeared smooth
and pink. Lacrimal gland, lacrimal sac and nasal lacrimal duct had no noted edema or tearing.
Has brown colored iris. Pupils are black in color, equal in size of about 3mm. Both pupils
constrict when illuminate. Has noted sensitivity to light; pain observed after penlight test. Has
noted exotropia. Both eyes move in unison but uncoordinated.
Ears
During inspection, the color of auricles is same as the facial skin and is symmetrical.
Auricles are aligned with the outer canthus of the eye. Upon palpation, found to be firm and not
tender; noted pain on left ear. Pinnea recoils after it is folded. External ear has hair follicles and
dry cerumen. Upon inspection with a penlight, noted continuous blood and pus discharges on
left external ear canal. Upon assessment of hearing, normal voice tones are audible, however
more acuity on right ear than left. During the watch tick test, unable to hear the ticking on left
ear.
Nose
Upon inspection, nose is wide, symmetric and straight. Upon palpation, no noted
tenderness or lesions. Able to breath freely through nares. Upon inspection with a penlight,
mucosa is pink; no noted swelling, redness, growth or lesions. No noted purulent discharge or
bleeding. Olfactory sense is functional, able to smell without difficulty. Nasal septum is intact
and in the midline between the nasal chambers.
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Mouth
Upon inspection outer lips are dark pink in color; appeared soft and smooth; with
symmetrical contour and has ability to purse lips. Noted slight dryness and roughness. Inner, lips
are pinkish red and uniform in color soft, moist and smooth. Teeth appear smooth, generally
white with slightly yellow crown; has complete set of 32 adult teeth. Gums are pink, moist and
appear firm. No noted retraction of gums. Tongue is in central position of the mouth, light pink
in color; moist; slightly rough with noted thin whitish coating in some areas. Reported loss of
taste. Papillae are raised. Able to move side to side. Smooth tongue base with prominent veins.
No noted lesions or dryness. Soft palate is pink and smooth. Hard palate is light pink and
irregular in texture. Uvula is positioned in midline of palate.
Neck
During inspection, neck muscles are equal in size and head is centered. Coordinated head
movement with no observable difficulty. Neck has full range of motion. Upon palpation, no
noted enlarged lymph nodes. Trachea is in central placement in the midline of the neck. Thyroid
gland not visible upon inspection.
Chest and lungs
Has symmetrical anterior chest expansion with a respiratory rate of 19 breaths per
minute. Spine is vertically aligned. Noted productive coughing. Sputum appears with noted
whitish color. Upon auscultation, faint crackles are audible. Breathing pattern rhythmic and with
minimal effort during respirations. Right and left shoulders are of the same height. Anterior chest
wall is intact, no noted tenderness or masses. Posterior chest has full and symmetric respiratory
excursion. Upon palpation of the posterior chest there is bilateral symmetry of vocal fremitus
although faint vibrations. Upon percussion of the posterior chest, sounds resonate; no noted
dullness or flatness over lung tissue. Upon auscultation of the upper chest using a stethoscope, no
noted adventitious breath sounds.
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Heart
Upon auscultation, the two heart sounds are audible, the systole and diastole. Noted very
audible, loud apical pulsations. Upon palpation of the carotid artery, pulse volumes are
symmetric, with full pulsations and good thrusting quality. Thrusting quality remains the same
when client breathes, turns head, and changes from sitting to from supine position. Radial pulse
is also symmetric in volume along with full pulsations and good thrusting quality. Noted pulse
rate of 68 beats per minute. Jugular veins not visible upon inspection.
Abdomen
Abdomen round, flabby and is uniform, medium brown in color with unblemished skin.
Abdomen has rounded, symmetrical countour. No noted enlargement of liver or spleen. Has
symmetrical movements upon respiration. Upon auscultation, bowel sounds are audible, with
irregular gurgling noises occurring approximately every 30 seconds. Upon palpation, no noted
tenderness; relaxed abdomen with soft texture.
Genito-Urinary
No noted change in urinary pattern. Urine is amber-colored. No noted pain while
urinating. No observed hematuria.
Back and Extremities
Upon inspection upper extremities and lower extremities are grossly proportional to body
shape. Nails of upper extremities are trimmed and cleaned with capillary refill of less than 2
seconds. Toenails are trimmed and cleaned. No noted deformities or edema. Upon palpation,
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muscles are soft with minimal tone. Able to ambulate normally, unassisted with no noted
difficulty. No observable difficulty changing position in bed. Muscles are at 100% of normal
strength on each side of the body and able to fully move against gravity and resistance. Joints in
upper and lower extremities have good range of motion. Noted deformity on radiocarpal joint in
the form of a dislocation. Noted pain upon movement and palpation. Other than the
aforementioned, joints move smoothly with no noted deformities, swelling, pain, tenderness or
crepitation. Spinal column vertically aligned and is straight with no noted protrusions or
deformities.
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DEVELOPMENTAL DATA
Development is an increase in the complexity of function and skill progression. It is the
capacity and the skill of a person to adapt to the environment and it implies a progressive and
continuous process of change leading to a state of organized and specialized functional capacity.
Development is the behavioral aspect of growth, such as a persons ability to walk, talk, and run.
It proceeds from simple to complex or from single acts to integrated acts. Any interpretation of
this process by a disease or a disorder is called developmental delay. These changes can be
measured quantitatively but more distinctly measured in qualitative changes.
THEORIST STAGE JUSTIFICATION
Cognitive Development by
Jean Piaget is defined as an
orderly and sequential process
in which the variety of new
experiences must occur in
order for intellectual abilities
to develop.
Piaget believed that human
beings are all born with an
innate drive toward knowledge
which is our overall need forsurvival.
Formal-Operational Stage (11
years and above)
-develop hypothetical-deductive
reasoning
-abstraction
-make hypothesis and solve
problems
-LOGICO
-MATHEMATICAL
-INTELLIGENCE
Achieved
Bea A. achieved this stage of
being a person. We can see that
she had developed her intellect
well because she sought for
medical attention when she
noticed unusualities in her body.
It is evidenced that she is using
her knowledge and critical
thinking. When she noticed that
there is something wrong with
her, she pay attention on it instead
of just letting the situation pass.
We can conclude that Bea A.
achieved this cognitive stage.
Developmental Task Theory Early Adulthood (18-30 years old) Partially Achieved
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Robert Havighurst was an
educator who theorized that
learning was a lifelong
process. He believed that a
person moves through 6 life
stages, each associated with a
number of tasks that must be
learned. Havighurst
characterizes developmental
task as follows: A
developmental task is midway
between an individual need
and societal demand. It
assumes an active learner
interacting with an active
social environment. Failure to
master a task leads to
unhappiness of the individual,
difficulty mastering futuretask, and interacting with
others.
Selecting a Mate
Learning to live with a
Marriage Partner
Starting a Family
Rearing Children
Managing a Home
Getting started with an
Occupation
Taking on Civic
Responsibilities
Finding a Congenial SocialGroup
Bea A. lives with her live-in
partner in Maa Davao City. They
dont have a child yet because
they want to have enough
financial support before they will
create a bigger family. Though
Bea A. became a housewife most
of her time and she keeps to a
point that shell be able to relax
and unwind with her partner and
family.
As a wife, Bea A. is well
supported by her partner,
especially with her present
problem about her health
condition, as he stayed with his
wife/partner in the hospital.
Bea A. , on this stage didnt
passed, as her educational
attainment was only up to high
school level, thus, she never
experienced working at an office.
Psychosocial Developmental
TheoryIntimacy vs. Isolation (Young
Adults, 20 to 34 years)
Partially Achieved
Bea A. lives with her live-in
partner in Maa. They are not yet
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Erik Erikson
Focuses and gives emphasis on
the belief that psychological
development depends on the
quality of social relations
people establish at various
points in life. In other words,
the persons ego development.
Intimacy means the process of
achievingrelationships with family
and marital or mating partner(s).
Erikson explained this stage also in
terms of sexualmutuality - the
giving and receiving of physical and
emotional connection, support,
love, comfort, trust, and all the
other elements that we would
typically associate with healthy
adult relationships conducive to
mating and child-rearing. There is a
strong reciprocal feature in the
intimacy experienced during this
stage - giving and receiving -
especially between sexual or marital
partners.
Isolation conversely means beingand feeling excluded from the usual
life experiences of dating and
mating and mutually loving
relationships. This logically is
characterised by feelings of
loneliness, alienation, social
withdrawalor non-participation.
married and has no children yet.
Bea was able to find her mate
which she has commited to. She
was able to give and receive
support, love, comfort and trust to
her partner. She didn't withdrawn
herself to the society or to other
people. Bea A. also sought for
help about her illness, this shows
that she hadnt loss the trust for
the society or other people.
DEFINITION OF COMPLETE DIAGNOSIS
Facial Nerve Paralysis or Bell's Palsy
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Facial Nerve Paralysis/Palsy results from loss of function pf the facial nerve. It is
characterized by paralysis of the muscles of facial expression which may be associated
with loss of other facial nerve functions such as lacrimation, salivation, sound dampening
and loss of taste in the two anterior thirds of the tongue.
(689. Albert L. Baert. Encyclopedia of Diagnostic Imaging
Springer-Verlag Berlin Heidelberg New York, 2008)
Facial Nerve Paralysis is the dysfunction of the facial nerve (7 th cranial nerve), causing
paralysis or weakness of the muscles of the ears, eyelids, lips, and nostrils. Weakness or
paralysis caused by impairment of the facial nerve or the neuromuscular junction
peripherally or the facial nucleus in the brainstem.
(295. Paul W. Brazis, Joseph C. Masdeu, Jos Biller. Localization in clinical neurology 5 th
edition
. Lippincott Williams & Wilkins, 2001 )
Facial nerve paralysis: Loss of voluntary movement of the muscles on one side of the
face due to abnormal function of the facial nerve (also known as the 7th cranial nerve)
which supplies those muscles. Facial nerve paralysis is also called Bell's palsy. s
(http://www.medterms.com/script/main/art.asp?articlekey=6482)
ANATOMY and PHYSIOLOGY
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The facial nerve is the seventh (VII) of twelve paired cranial nerves. It emerges from the
brainstem between thepons and themedulla, and controls the muscles of facial expression, and
functions in the conveyance oftastesensations from the anterior two-thirds of the tongue and
oral cavity. It also supplies preganglionicparasympathetic fibers to several head and neck
ganglia.
Course
The motor part of the facial nerve arises from the facial nerve nucleusin thepons while the
sensory part of the facial nerve arises from thenervus intermedius.
The motor part and sensory part of the facial nerve enters thepetrous temporal boneinto the
internal auditory meatus (intimately close to the inner ear) then runs a tortuous course (including
two tight turns) through the facial canal, emerges from the stylomastoid foramenand passes
through theparotid gland, where it divides into five major branches. Though it passes through
the parotid gland, it does not innervate the gland. This action is the responsibility of cranial nerve
IX, the glossopharyngeal nerve.
The facial nerve forms thegeniculate ganglion prior to entering the facial canal.
Branches
Greater petrosal nerve - provides parasympathetic innervation to lacrimal gland,sphenoid
sinus, frontal sinus,maxillary sinus, ethmoid sinus, nasal cavity, as well as specialsensory taste fibers to the palate via the Vidian nerve.
Nerve to stapedius - provides motor innervation forstapedius muscle in middle ear
Chorda tympani - provides parasympathetic innervation tosubmandibular gland andsublingual gland and special sensory taste fibers for the anterior 2/3 of the tongue.
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http://en.wikipedia.org/wiki/Cranial_nerveshttp://en.wikipedia.org/wiki/Cranial_nerveshttp://en.wikipedia.org/wiki/Ponshttp://en.wikipedia.org/wiki/Medulla_oblongatahttp://en.wikipedia.org/wiki/Medulla_oblongatahttp://en.wikipedia.org/wiki/Medulla_oblongatahttp://en.wikipedia.org/wiki/Tastehttp://en.wikipedia.org/wiki/Tastehttp://en.wikipedia.org/wiki/Tonguehttp://en.wikipedia.org/wiki/Parasympathetichttp://en.wikipedia.org/wiki/Gangliahttp://en.wikipedia.org/wiki/Gangliahttp://en.wikipedia.org/wiki/Facial_nerve_nucleushttp://en.wikipedia.org/wiki/Facial_nerve_nucleushttp://en.wikipedia.org/wiki/Ponshttp://en.wikipedia.org/wiki/Nervus_intermediushttp://en.wikipedia.org/wiki/Nervus_intermediushttp://en.wikipedia.org/wiki/Nervus_intermediushttp://en.wikipedia.org/wiki/Petrous_temporal_bonehttp://en.wikipedia.org/wiki/Petrous_temporal_bonehttp://en.wikipedia.org/wiki/Internal_auditory_meatushttp://en.wikipedia.org/wiki/Inner_earhttp://en.wikipedia.org/wiki/Facial_canalhttp://en.wikipedia.org/wiki/Stylomastoid_foramenhttp://en.wikipedia.org/wiki/Stylomastoid_foramenhttp://en.wikipedia.org/wiki/Parotid_glandhttp://en.wikipedia.org/wiki/Glossopharyngeal_nervehttp://en.wikipedia.org/wiki/Geniculate_ganglionhttp://en.wikipedia.org/wiki/Geniculate_ganglionhttp://en.wikipedia.org/wiki/Greater_petrosal_nervehttp://en.wikipedia.org/wiki/Sphenoid_sinushttp://en.wikipedia.org/wiki/Sphenoid_sinushttp://en.wikipedia.org/wiki/Sphenoid_sinushttp://en.wikipedia.org/wiki/Frontal_sinushttp://en.wikipedia.org/wiki/Frontal_sinushttp://en.wikipedia.org/wiki/Maxillary_sinushttp://en.wikipedia.org/wiki/Ethmoid_sinushttp://en.wikipedia.org/wiki/Nasal_cavityhttp://en.wikipedia.org/wiki/Vidian_nervehttp://en.wikipedia.org/wiki/Vidian_nervehttp://en.wikipedia.org/wiki/Nerve_to_stapediushttp://en.wikipedia.org/wiki/Stapediushttp://en.wikipedia.org/wiki/Chorda_tympanihttp://en.wikipedia.org/wiki/Submandibular_glandhttp://en.wikipedia.org/wiki/Submandibular_glandhttp://en.wikipedia.org/wiki/Sublingual_glandhttp://en.wikipedia.org/wiki/Cranial_nerveshttp://en.wikipedia.org/wiki/Ponshttp://en.wikipedia.org/wiki/Medulla_oblongatahttp://en.wikipedia.org/wiki/Tastehttp://en.wikipedia.org/wiki/Tonguehttp://en.wikipedia.org/wiki/Parasympathetichttp://en.wikipedia.org/wiki/Gangliahttp://en.wikipedia.org/wiki/Facial_nerve_nucleushttp://en.wikipedia.org/wiki/Ponshttp://en.wikipedia.org/wiki/Nervus_intermediushttp://en.wikipedia.org/wiki/Petrous_temporal_bonehttp://en.wikipedia.org/wiki/Internal_auditory_meatushttp://en.wikipedia.org/wiki/Inner_earhttp://en.wikipedia.org/wiki/Facial_canalhttp://en.wikipedia.org/wiki/Stylomastoid_foramenhttp://en.wikipedia.org/wiki/Parotid_glandhttp://en.wikipedia.org/wiki/Glossopharyngeal_nervehttp://en.wikipedia.org/wiki/Geniculate_ganglionhttp://en.wikipedia.org/wiki/Greater_petrosal_nervehttp://en.wikipedia.org/wiki/Sphenoid_sinushttp://en.wikipedia.org/wiki/Sphenoid_sinushttp://en.wikipedia.org/wiki/Frontal_sinushttp://en.wikipedia.org/wiki/Maxillary_sinushttp://en.wikipedia.org/wiki/Ethmoid_sinushttp://en.wikipedia.org/wiki/Nasal_cavityhttp://en.wikipedia.org/wiki/Vidian_nervehttp://en.wikipedia.org/wiki/Nerve_to_stapediushttp://en.wikipedia.org/wiki/Stapediushttp://en.wikipedia.org/wiki/Chorda_tympanihttp://en.wikipedia.org/wiki/Submandibular_glandhttp://en.wikipedia.org/wiki/Sublingual_gland -
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Outside skull
Posterior auricular nerve - controls movements of some of the scalp muscles around theear
Branch to Posterior belly of Digastric and Stylohyoid muscle
Five major facial branches (in parotid gland) - from top to bottom:o Temporal (frontal) branch of the facial nerve
o Zygomatic branch of the facial nerve
o Buccal branch of the facial nerve
o Marginal mandibular branch of the facial nerve
o Cervical branch of the facial nerve
A traditional mnemonic device for the five major branches of the facial nerve is, "The Zebra
Bummed My Cat." Other mnemonics for the divisions of the facial nerve include, "Today Zoe
Bummed My Car", "To Zanzibar By Motor Car", "Tell Ziggy Bob Marley Called", "Ten Zebras
Bit My Cock", "Two Zulus buggered my cat" and "The Zoo Bought Monkey Clothes."
Embryology
The facial nerve is developmentally derived from the hyoid arch (second pharyngealbranchial
arch)
Function
Efferent
Its main function is motor control of most of the muscles of facial expression. It also innervates
the posterior belly of the digastricmuscle, the stylohyoid muscle, and thestapedius muscle of the
middle ear. All of these muscles are striated muscles ofbranchiomeric origin developing from
the 2nd pharyngeal arch.
The facial also suppliesparasympathetic fibers to the submandibular gland and sublingual glands
via chorda tympani. Parasympathetic innervation serves to increase the flow of saliva from these
glands. It also supplies parasympathetic innervation to the nasal mucosa and the lacrimal gland
via thepterygopalatine ganglion.
The facial nerve also functions as the efferent limb of thecorneal reflex and the blink reflex.
Afferent
In addition, it receives tastesensations from the anterior two-thirds of the tongue and sends them
to the gustatory portion of the solitary nucleus. The facial nerve also supplies a small amount of
afferent innervation to the oropharynxbelow thepalatine tonsil. There is also a small amount of
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http://en.wikipedia.org/wiki/Posterior_auricular_nervehttp://en.wikipedia.org/wiki/Temporal_branch_of_the_facial_nervehttp://en.wikipedia.org/wiki/Zygomatic_branch_of_the_facial_nervehttp://en.wikipedia.org/wiki/Buccal_branch_of_the_facial_nervehttp://en.wikipedia.org/wiki/Marginal_mandibular_branch_of_the_facial_nervehttp://en.wikipedia.org/wiki/Cervical_branch_of_the_facial_nervehttp://en.wikipedia.org/wiki/Hyoid_archhttp://en.wikipedia.org/wiki/Branchial_archhttp://en.wikipedia.org/wiki/Branchial_archhttp://en.wikipedia.org/wiki/Branchial_archhttp://en.wikipedia.org/wiki/Facial_muscleshttp://en.wikipedia.org/wiki/Facial_muscleshttp://en.wikipedia.org/wiki/Digastrichttp://en.wikipedia.org/wiki/Digastrichttp://en.wikipedia.org/wiki/Stylohyoidhttp://en.wikipedia.org/wiki/Stapediushttp://en.wikipedia.org/wiki/Stapediushttp://en.wikipedia.org/wiki/Earhttp://en.wikipedia.org/wiki/Special_visceral_efferenthttp://en.wikipedia.org/wiki/Parasympathetic_nervous_systemhttp://en.wikipedia.org/wiki/Submandibular_glandhttp://en.wikipedia.org/wiki/Sublingual_glandhttp://en.wikipedia.org/wiki/Chorda_tympanihttp://en.wikipedia.org/wiki/Lacrimal_glandhttp://en.wikipedia.org/wiki/Pterygopalatine_ganglionhttp://en.wikipedia.org/wiki/Corneal_reflexhttp://en.wikipedia.org/wiki/Corneal_reflexhttp://en.wikipedia.org/wiki/Tastehttp://en.wikipedia.org/wiki/Tastehttp://en.wikipedia.org/wiki/Tonguehttp://en.wikipedia.org/wiki/Solitary_nucleushttp://en.wikipedia.org/wiki/Oropharynxhttp://en.wikipedia.org/wiki/Oropharynxhttp://en.wikipedia.org/wiki/Palatine_tonsilhttp://en.wikipedia.org/wiki/Posterior_auricular_nervehttp://en.wikipedia.org/wiki/Temporal_branch_of_the_facial_nervehttp://en.wikipedia.org/wiki/Zygomatic_branch_of_the_facial_nervehttp://en.wikipedia.org/wiki/Buccal_branch_of_the_facial_nervehttp://en.wikipedia.org/wiki/Marginal_mandibular_branch_of_the_facial_nervehttp://en.wikipedia.org/wiki/Cervical_branch_of_the_facial_nervehttp://en.wikipedia.org/wiki/Hyoid_archhttp://en.wikipedia.org/wiki/Branchial_archhttp://en.wikipedia.org/wiki/Branchial_archhttp://en.wikipedia.org/wiki/Facial_muscleshttp://en.wikipedia.org/wiki/Digastrichttp://en.wikipedia.org/wiki/Stylohyoidhttp://en.wikipedia.org/wiki/Stapediushttp://en.wikipedia.org/wiki/Earhttp://en.wikipedia.org/wiki/Special_visceral_efferenthttp://en.wikipedia.org/wiki/Parasympathetic_nervous_systemhttp://en.wikipedia.org/wiki/Submandibular_glandhttp://en.wikipedia.org/wiki/Sublingual_glandhttp://en.wikipedia.org/wiki/Chorda_tympanihttp://en.wikipedia.org/wiki/Lacrimal_glandhttp://en.wikipedia.org/wiki/Pterygopalatine_ganglionhttp://en.wikipedia.org/wiki/Corneal_reflexhttp://en.wikipedia.org/wiki/Tastehttp://en.wikipedia.org/wiki/Tonguehttp://en.wikipedia.org/wiki/Solitary_nucleushttp://en.wikipedia.org/wiki/Oropharynxhttp://en.wikipedia.org/wiki/Palatine_tonsil -
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intermedius is so called because of its intermediate location between the eighth cranial nerve and
the somatomotor part of the facial nerve just prior to entering the brain). There are two sensory
(special and general) components of facial nerve both of which originate from cell bodies in the
geniculate ganglion. The special sensory component carries information from the taste buds in
the tongue and travel in the chorda tympani. The general sensory component conducts sensation
from skin in the external auditory meatus, a small area behind the ear, and external surface of the
tympanic membrane. These sensory components are connected with cells in the geniculate
ganglion.
Both the general and visceral sensory components travel into the brain with nervus
intermedius part of the facial nerve. The general sensory component enters the brainstem and
eventually synapses in the spinal part of trigeminal nucleus. The special sensory or taste fibers
enter the brainstem and terminate in the gustatory nucleus which is a rostral part of the nucleus
of the solitary tract.
(http://www.meddean.luc.edu/lumen/MedEd/grossanatomy/h_n/cn/cn1/cn7.htm)
FACIAL NERVE
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The motor fibers of the facial nerve arise from a nucleus in the lower part of the pons,
from which they extend by way of several branches to the superficial muscles of the face and
scalp. Efferent autonomic fibers of the facial nerve extend to the submaxillary and sublingual
salivary glands, as well as to the lacrimal glands. Sensory fibers from the taste buds of the
anterior two thirds of the tongue run in the facial nerve to cell bodies in the geniculate ganglion,
a small swelling on the facial nerve, where it passes through a canal in the temporal bone. From
the ganglion, fiber extends to a nucleus in the medulla.
(ANATOMY and PHYSIOLOGY 5th Edition by: Gary A. Thibodeau and Kevin T. Patton)
ETIOLOGY
PREDISPOSING FACTORS
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Etiologic factors Patient
Manifestation
(PRESENT/A
BSENT)
Rationalization Justification
1. Age Present Bell' Palsy can occur at any age.But the most common age that
Bell's Palsy occurs is the age of
before 15 and after 60.
The age of our patientis 23 years old.
2.Hereditary Absent Inheritance of this illness may
be autosomal dominant with
low penetration.
No one of the family
of our patient had a
case of Bell's Palsy.
PRECIPITATING FACTORS
Etiologic factors
Patient
Manifestati
on
(PRESENT
/ABSENT)
Rationalization Justification
1. Diabetes
MellitusAbsent
The diabetic patient is more
prone than the non-diabetic
person to nerve degeneration, and
this tendency to nerve
degeneration is not age-related
(http://diabetes.diabetesjournals.o
rg/content/24/5/449.abstract).
Our patient is not
diabetic.
2. Pregnancy Absent The 7th cranial nerve passes
through the complex tortuous
route in the skull before it gets to
the muscle and other structures.
Some of the openings that the
nerve must pass through are
extremely narrow. One of these
openings in the skull is called
"coincidently", the fallopian
Our patient has never
been pregnant.
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canal is comparatively long
relationship to the nerve it self
and therefore any swelling of the
cranial nerve can result to
compression and impaired
functioning of the nerve itself.
3. Trauma in the
head part.Absent
Head trauma can obstruct any
nerve located in the head, one
will be affected is the facial nerve
Our patient never had
head trauma.
4. Ear Infection Present
Bleeding and pus is
present on our patient
during assessment.
5. compromisedimmune systems
Absent
6. Exposure to
Viral infection
Absent
Bell's palsy is most often
connected with a viral infectionsuch as herpes (the virus that
causes cold sores), Epstein-Barr
(the virus that causes mono), orinfluenza (the flu). It's also
associated with the infectious
agent that causes disease. The
immune system's response to aviral infection leads to
inflammation of nerve. Because
it's swollen, the nerve getscompressed as it passes through a
small hole at the base of the
skull.
SYMPTOMATOLOGY
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Basic signs and symptoms Present/ absent Rationalization
When the facial nerve is
working properly, it carries ahost of messages from the
brain to the face. These
messages may tell an eyelid to
close, one side of the mouth to
smile or frown, or salivary
glands to make spit. Facial
nerves also help our bodies
make tears and taste favorite
foods. But if the nerve swells
and is compressed, as happenswith Bell's palsy, these
messages don't get sent
correctly. The result is
weakness or temporary
paralysis of the muscles on one
side of the face.
1. Weakness and paralysis,
usually on one side of the face
Present
2. Drooping of eyelid Present
3. Tearing in the eye on the
affected side.
Present
4. Drooping of one side of the
mouth.
Present
5. Loss of the sense of taste Present
PATHOPYSIOLOGY
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Ear infection
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Bacteria enters the ear due to habit of inserting unclean
pinky finger inside the ear whenever it is itching and
Bacteria produces
Enterotoxins is a toxic substance that excreted by microorganism
can cause damage to the host by destroying cells or disrupting
Inflammatory reaction around the seventh cranial nerve, usually
at the internal auditory meatus where the nerve leaves bony
Produces a conduction block that inhibits appropriate
stimulation to the muscle by the motor fibers of the
Results to the characteristics of
unilateral or bilateral facial
weakness and paralysis.
Weakness and
paralysis usually on
one side of the face.
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10:10 am under ENT service
isolation ward
related to ears, nose and
throat that need a close
monitoring in the medical
facility are admitted in the
ENT ward.
Isolation ward is intended to
patients who had an
underlying disease that is
communicable.
- Secure consent to
care
A signed consent from an
able client is needed beforeany procedure is done
particularly invasive
procedures, to ensure that
the client approves of the
invasive procedure to be
done.
This also serves as a legalbasis in case of problems in
the future
DONE
- Vital signs every 4
hours
To monitor patients status
and determine changes in
the bodys condition.
DONE
- On DAT Diet as tolerated is only
given when the client cantolerate any food she desires
that is nutritious, if this will
not lead to any
complications and if the
DONE
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client needs further
monitoring for lab test.
Laboratory tests:
- Complete BloodCount, platelet
- CBC and platelet testmonitoring is done in order
to evaluate the level of
RBC, which can give
information about the
oxygen-carrying capacity of
the blood and can be an
important component of
nutrition assessment and
platelet are monitored or
checked to evaluate blood
coagulation.
DONE
- Blood Typing -Blood typing is done for a
variety of reasons including
when a person plans to
donate blood or to be
transfused blood or if
pregnant. and to establish
compatibility between the
donor and the recipient to
avoid transfusion reaction.
DONE
- Serum sodium,
potassium
Serum sodium and
potassium tests are taken to
test if the patients kidney is
functioning well.
DONE
- Chest X-Ray Chest X-ray is intended to DONE
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visualize any abnormalities
of the lungs and heart that
may contraindicate a
surgical operation to be
performed on the patient.
This is needed for a
cardiopulmonary clearance
prior to a surgery.
An X-Ray Procedure is
used to study and diagnose
disease of the skeletal
system as well as for
detecting some disease
processes in soft tissue. X-
rays use invisible
electromagnetic energy
beams to produce images of
internal tissues, bones, and
organs on film. X-rays are
made by using external
radiation to produce images
of the body, its organs and
other internal structures for
diagnostic purposes. X-rays
pass through body tissues
onto specially treated plates(similar to camera film) and
a negative type picture is
made (the more solid a
structure is, the whiter it
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appears on the film).
- Mastoid series Mastoid series is done to
view three or four times of
the mastoid bone all
somewhat are angled. It is
commonly indicated to those
who have trauma,
mastoiditis and tumor
DONE
- Temporal CT-Scan The temporal bone houses
and is surrounded by many
vital structures. The
temporal bone is actually
comprised of 4 bones
consisting of the squamous,
petrous, tympanic, and
mastoid segments, CT scan
is used to define normal and
abnormal structures in the
body and/or assist in
procedures by helping to
accurately guide the
placement of instruments or
treatments.
DONE
- Please start
venoclysis with 1
liter PNSS at20gtts/min
To promote fluid balance in
the body, to maintain
hydration status and for IV
medication administration
purposes.
PNSS is an isotonic
solution, it has the same
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osmolality as the body fluids
Medications:
- Please start Pen G 5
M units IVTT every6 hours ANST via
soluset
- ketorolac 30mg
IVTT every 8 hours
- ranitidine 50mg
IVTT every 8 hours
- Pen G is an antibacterial
type of drug it is given toour client because her
condition might be caused
by bacterial type of
microorganism. given after
negative sensitivity test to
ensure that the client is not
hypersensitive to drug
- ketorolac, A Non-steroidal
Anti-inflammatory drug for
Short term management of
moderately severe acute
pain. It May inhibit
prostaglandin synthesis, to
produce anti-inflammatory,
analgesic, and antipyretic
effects
-Ranitidine It is a histamine
H2 receptor antagonist and
anti-ulcerative for Active
duodenal and gastric ulcer.
It Competitively inhibits
action of histamine on the
H2 at receptor sites of
parietal cells, decreasing
gastric acid secretions.
DONE
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- Vitamin B complex
1cap Bid
-Support and increase the
rate of metabolism,
Maintain healthy skin and
muscle tone, Enhance
immune and nervous system
function, Promote cell
growth and division,
including that of the red
blood cells that help prevent
anemia
- Monitor Intake andOutput every shift
Monitoring the intake andoutput of patients are
necessary to determine the
fluid balance of their body.
A large volume difference
between the patients intake
and output may indicate
excessive fluid excretion
(more output than intake) or
fluid retention in the body
(less output than intake).
Patients are at risk for fluid
imbalances since one of the
major organs affected is the
kidney, which is also
responsible for retaining
fluid in the body.
DONE
- Monitor Vital signs
and record to chart
For close monitoring of the
client and if there is any
DONE
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every 4 hours unusualities.
- May give
dexamethasone 8mg
ODx3 doses ones
with normal chest
X-Ray
If chest X-ray is normal with
no unusualities then may
give dexamethasone, a
glucocorticoid.
DONE
- Refer accordingly Appropriate referral
provides continuous
treatment and proper
interventions
DONE
06/09/10
8:00 am
- give paracetamol
500mg 1 tab every 4
hours PRN if
temperature is
greater than 38c
Paracetamol is given with 4
hours interval if fever still
persists.
DONE
- TSB for fever Tepid sponge bath is done if
there is an elevation in the
clients temperature, it is
done if client is
experiencing slight fever.
DONE
- refer accordingly Appropriate referral
provides continuous
treatment and proper
interventions
DONE
06/30/10 - follow up lab results Laboratory results must be
followed up so that results
will be evaluated and to see
if there is irregularities with
the result and proper
intervention must be made
DONE
- Continue Continue medications as DONE
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8:00am results and chest x-
ray
must be followed up to
evaluate the results and
proper intervention must
made, the physician must
see the results to view what
is the source of the problem
or to see how is it.
- continue meds Continue medications as
prescribed by the physician
to treat the condition of the
client.
DONE
07/02/10
8:45 am
- still for mastoid x-
ray and pure tone
audiometry
Mastoid x-ray and pure tone
audiometry is to be done it
must be followed by the
client so that condition will
be evaluated, maybe the
client does not able to
comply with the first order
of the physician.
- Please send patient
to OPD for
suctioning this 9:00
am today July 02,
2010
Secretions may block the
pathways. Pathways should
be cleared to prevent
complications and to aid the
clients comfort.
DONE
- After OPD let
patient out on pass
for pure tone
audiometry outside
SPMC
Pure tone audiometry is the
key hearing test used to
identify hearing threshold
levels of an individual,
enabling determination of
the degree, type and
DONE
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cavity and mastoid process,
in which the mastoid and
epitympanic spaces are
converted into an easily
accessible common cavity
by removing the posterior
and superior external canal
walls.
- inform OR/ANOD Informing the operating
room that an operation is
scheduled to be performed
allows the operating room
staff to prepare the operating
area and the needed staff
and materials for the
operation.
DONE
- secure consent Consent is needed for legal
purposes and for giving
approval to the medical
team and the institution to
perform the invasive
procedure to the patient.
This also ensures that the
client is aware of the reasons
for the operation and that he
permits the invasive surgery
to be performed
DONE
- refer Referral is needed so that
there is order in any
procedure also so that the
DONE
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physician will know if client
agrees with the procedure to
be done.
It is also needed to notify
the physician.
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DIAGNOSTIC TESTS
Date Reported: June 30, 2010
Blood Chemistry Blood chemistry testing identifies many chemical blood constituents. It is often necessary to measure several
blood chemicals to establish a pattern of abnormalities. A wide range of tests can be grouped under theheadings of enzymes, electrolytes, blood sugar, lipids, hormones, vitamins, minerals and drug investigation.
Other tests have no common denominator. Selected tests serve as screening devices to identify target-organ
damage.
TEST RESULT REFERENCE REMARK RATIONALE INTERPRETATION
sodium 137.10
mmol/L
136.00-155.00 mmol/L Normal Sodium is the major cation
in the extracellular fluid,
and it has a water retaining
effect. When there is a
excess sodium in the ECF,
more water will be
reabsorbed from the
kidneys. Aldosterone,
secreted from the adrenal
cortex, promotes sodium
reabsorption from the distal
The result is within
normal range.
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tubules of the kidneys.
When there is a sodium
deficit, more aldosterone
secreted and more sodium
and water reabsorption
occurs. With an increased
serum sodium level, there is
a decrease in aldosterone
secretion and excess sodium
is excreted through the
kidneys.
Potassium 4.20
mmol/L
3.5-5.5 mmol/L Normal Potassium is the electrolyte
found most abundantly in
the intracellular fluids
(cells), with a cellular
potassium level of 150
mEq/L. Serum potassium
level is the measurable body
potassium, and death could
occur if serum levels less
than 2.5 mEq/L or greater
than 7.0 mEq/L persist
The result is within
normal range.
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Nursing Responsibilities
- Explain to the patient that the test is to measure the sodium (electrolyte) level in the blood.
- Explain the procedure involving use of tourniquet.
- Instruct the patient that he/ she may eat and drink before the test
For Sodium:
- Recognize clinical problems and drugs related to Hypernatremia /Hyponatremia.
- Assess/ observe for signs of Hypernatremia /Hyponatremia.
- For hyponatremia: encourage to avoid drinking only plain water. Suggest fluids with solutes. For hypernatremia:
encourage to drink plenty of water, unless it is contraindicated.
- Monitor the medical regimen in correcting hyponatremia/ hypernatremia.
- Encourage not to eat food high in sodium. For hypernatremia.
- Check for serum sodium and other laboratory results and report serum electrolyte changes.
- Check specific gravity of urine
- Take vital signs to determine cardiac status during hyponatremia/ hypernatremia.
For Potassium:
- Recognize clinical problems and drugs related to Hyperkalemia /Hypokalemia.
- Assess/ observe for signs of Hyperkalemia /Hypokalemia.
- Record intake/ output.
- Report any alterations in the potassium levels.
- Determine the hydration status.
- For hypokalemia: eat high potassium food, for hyperkalemia: eat low potassium foods.
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- Monitor ECG results.
- Monitor the medical regimen in correcting hypokalemia/ hyperkalemia.
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Date Reported: June 30, 2010
COMPLETE
BLOOD COUNTA Complete blood count (CBC), otherwise known as a Full blood count, is a hematological diagnostic test
that is requested by a doctor or other another medical professional for the purpose of evaluating the
composition and concentration of cellular blood components. The CBC is a basic screening test and is one of
the most frequently ordered laboratory procedures. The findings in the CBC give valuable diagnostic
information about the hematologic and other body systems, prognosis, response to treatment, and recovery.
The CBC consists of a series of tests that determine number, variety, percentage, concentrations, and quality
of blood cells. A CBC may be used as a preoperative to ensure adequate carrying capacity of oxygen and
hemostatis and to identify the presence of infection.
TEST RESULT REFERENCE REMARK RATIONALE INTERPRETATION
Hemoglobin 102 g/ L 115-155 g/ L Low Hemoglobin determination is
part of a complete blood count.
It screens for disease associated
with anemia, determines the
severity of anemia, follows the
response to treatment for
anemia and evaluates
Result is below normal
range indicates anemia
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polycythemia.
Hemoglobin, the main
component of erythrocytes,
serves as the vehicle for the
transportation of oxygen and
carbon dioxide. Hemoglobin
also serves as an important
buffer in the extracellular fluid.
In tissue, oxygen concentration
is lower and the carbon dioxide
level and hydrogen ion
concentration are higher.
Unoxygenated hemoglobin
binds to hydrogen ions thus
raising the pH. The efficiency
of this buffer system depends
on the ability of the CO2 or
bicarbonate to be eliminated in
the lungs and kidneys,
respectively.
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Hematocrit 0.37 0.36-0.38 Normal Hematocrit is part of the
complete blood count. This test
determines red blood cell mass.
The results are expressed as the
percentage of packed red cells
in a volume of whole blood. It
is an important measurement in
the determination of anemia or
polycythemia.
Result is within
normal range.
RBC Count 4.58
x10^6/uL
4.20-6.10 x10^6/uL Normal RBCs contain haemoglobin,
which is needed to carry oxygen
to body cells. the values for the
total number of RBCs,haemoglobin and hematocrit
have to be known to calculate
the RBC incides, and to identify
the types of anemias.
Result is within
normal range.
WBC Count 6.27
x10^3/uL
5.0-10.0 x10^3/uL Normal White blood cells,
or leukocytes are cells of
Result is within
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the immune system involved in
defending the body against
both infectious disease and
foreign materials. Fivedifferent
and diverse types of leukocytes
exist, but they are all produced
and derived from
a multipotent cell in thebone
marrow known as
a hematopoietic stem cell.
Leukocytes are found
throughout the body, including
the blood and lymphatic system.
The number of WBCs in the
blood is often an indicator
ofdisease. An increase in the
number of leukocytes over
the upper limits is called
leukocytosis, and a decrease
below the lower limit is
called leukopenia. The physical
properties of leukocytes, such
normal range.
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as volume, conductivity,
and granularity, may change
due to activation, the presence
of immature cells, or the
presence
ofmalignant leukocytes
in leukemia.
DIFFERENTIAL COUNT
Neutrophil 84 % 55-75% High Neutrophils are the most
numerous circulating blood
cells and they respond more
rapidly in large numbers to the
inflammatory and tissue injury
sites than leukocytes. duringacute infection, the bodys first
line of defence is the
neutrophils.
Result is above normal
elevated Neutrophils
indicates the presence
of acute infections,
inflammatory disease,
tissue damage andcancer.
Lymphocyte 14% 20-35% Low They comprise the second
largest group of leukocytes.
Lymphocytes are responsible
Result is below normal
Decreased level may
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forimmune responses. There
are two main types of
lymphocytes: B cells and T
cells. The B cells make
antibodies that attack bacteria
and toxins while the T cells
attack body cells themselves
when they have been taken over
by viruses or have become
cancerous. Lymphocytes secrete
products (lymphokines) that
modulate the functional
activities of many other types of
cells and are often present at
sites ofchronic inflammation
indicate as a result of
cancer and neurologic
disorders.
Monocyte 2% 2-10% Normal Monocytes and macrophages
play important roles in the
immune defence, inflammation
and tissue remodelling and they
do so by phagocytosis, antigen
processing and presentation and
Result is within
normal range.
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cell. Macrocytic RBCs are large
so tend to have a higher MCH,
while microcytic red cells
would have a lower value.
MCHC
(Mean corpuscular
hemoglobin
concentration)
35.3 g/dl 32.20-35.50 g/dl Normal Mean corpuscular hemoglobin
concentration (MCHC) is a
calculation of the average
concentration of hemoglobin
inside a red cell. Decreased
MCHC values (hypochromia)
are seen in conditions where the
hemoglobin is abnormally
diluted inside the red cells, such
as in iron deficiency anemia and
in thalassemia. Increased
MCHC values (hyperchromia)
are seen in conditions where the
hemoglobin is abnormally
concentrated inside the red
cells, such as in burn patients
and hereditary spherocytosis, a
Platelet count is within
normal range.
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relatively rare congenital
disorder.
MCV
(Mean corpuscular
volume)
80 fl 79.40-94.80 fl Normal Mean corpuscular volume
(MCV) is a measurement of the
average size of your RBCs. The
MCV is elevated when your
RBCs are larger than normal
(macrocytic), for example in
anemia caused by vitamin B12
deficiency. When the MCV is
decreased, your RBCs are
smaller than normal
(microcytic) as is seen in iron
deficiency anemia or
thalassemias.
Platelet count is within
normal range.
Nursing Responsibilities
- Explain test procedure. Explain that slight discomfort may be felt when skin is punctured.
- Avoid stress if possible because altered psychological states influence and damage normal CBC values
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- Select hemogram components ordered at regular intervals, should be consistently drawn at the same time of day for
accurate comparison. Natural body rhythms cause fluctuations in lab values at certain times of the day.
- Dehydration or overhydration can dramatically alter values. Both of these states should be communicated to the lab.
- Fasting is not necessary. However, fat-laden meals may alter some test results.
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Date Reported: June 30, 2010
TESTRESULT REFERENCE REMARK RATIONALE INTERPRETATION
Clotting time 3:00 mins 2:00-5:00 mins Normal The tests frequently used to
monitor clotting time are
prothrombin time, partial
thromboplastin time,
activated partial
thromboplastin time, and
coagulation time or Lee-
White clotting time.
The result is within
normal range.
Bleeding time 1:15 mins 1:00-3:00 mins NormalThe tests frequently
performed when there is a
history of bleeding, familial
bleeding or preoperative
screening.
The result is within
normal range.
Nursing Responsibilities
- Explain the purpose of the laboratory and diagnostic test.
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DRUG STUDY
Generic Name: Penicillin G
Brand Name: Pen G
Classification: Antibiotic
Suggested Dose: 5 million units IVTT evey 6 hours
Mode of Action: All penicillin derivatives produce their bacteriocidal effects by inhibition of
bacterial cell wall synthesis. Specifically, the cross linking of peptides on
the mucosaccharide chains is prevented. If cell walls are improperly made
cell walls allow water to flow into the cell causing it to burst.
Indication: is indicated in the therapy of severe infections caused by penicillin
G-susceptible microorganisms when rapid and high penicillin levels
are required in the conditions listed below. Therapy should be
guided by bacteriological studies (including susceptibility tests) and
by clinical response.
Pneumococcal infections.
Staphylococcal infections-penicillin G sensitive.
Other infections
Contraindications: A history of a previous hypersensitivity reaction to any penicillin
Interactions: Concurrent administration ofbacteriostatic antibiotics
(e.g., erythromycin,tetracycline) may diminish the bactericidal effects ofpenicillins by slowing the rate ofbacterial growth. Bactericidal agents work
most effectively against the immature cell wall of rapidly proliferating
microorganisms.
Penicillin blood levels may be prolonged by concurrent administration of
probenecid which blocks the renal tubular secretion of penicillins.
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Displacement of penicillin from plasma protein binding sites will elevate
the level of free penicillin in the serum.
Side Effects: The following hypersensitivity reactions: skin rashes ranging from
maculopapular eruptions to exfoliative dermatitis; urticaria; and
reactions resembling serum sickness, including
chills, fever, edema,arthralgia and prostration.
Severe and occasionally fatal anaphylaxis
Hemolytic anemia, leucopenia, thrombocytopenia, nephropathy,
and neuropathyare rarely observed adverse reactions and are usually
associated with highintravenous dosage.
Adverse Effects: Cardiac arrhythmias and cardiac arrest may also occur. (High
dosage of penicillin G sodium may result in congestive heart
failure due to high sodium intake.)
Patients given continuous intravenous therapy with penicillin
G potassium in high dosage (10 million to 100 million units daily)
may suffer severe or even fatal potassiumpoisoning, particularly
ifrenal insufficiency is present. Hyperreflexia, convulsions,
and coma may be indicative of thissyndrome.
Nursing
Responsibilities:
1. Give the right drug to the right patient at the right time with the
right dose at the right route.2. Inform the patient about the drug she is receiving including the risks
and benefits.
3. Note any allergy to drug and to other drugs related.
4. Inform that the drug should only be used to treatbacterial infections
5. Instruct patient to take as directed
6. Remind that skipping doses or not completing the full course of
therapy may (1) decrease the effectiveness of the immediate
treatment and (2) increase the likelihood thatbacteria will
develop resistance and will not be treatable
7. remind that stopping the medication too early may result in a return
of the infection.
Bibliography: http://www.rxlist.com/pfizerpen-drug.htm
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Generic Name: Ranitidine Hydrochloride
Brand Name: Zantac, Zantac-C, Zantac EFFERdose, Zantac Geldose, Zantac 75
Classification: Pharmacologic class: Histamine H2 receptor antagonist
Therapeutic class: Antiulcerative
Suggested Dose: Adults: 150mg PO bid or 300mg once daily hs. Dosage up to
6g/day may be prescribed in patients with Zollinger-Ellison
syndrome
Parenteral: 50mg IV or IM q6 to q8h. When administering IV push,
dilute to a total volume of 20 ml and inject over a period of 5
minutes. Dilute 50mg ranitidine in 100ml of D5W and infuse over
15 to 20 minutes.
Maintenance therapy of duodenal ulcer: 150mg PO hs.
Mode of Action: Competitively inhibits gastric acid secretion by blocking the effect of
histamine on histamine H2 receptors. Both daytime and nocturnal basal
gastric acid secretion, as well as food and pentagastrin-stimulated gastric
acid are inhibited.
Indication: Active duodenal and gastric ulcer
Maintenance therapy for duodenal or gastric ulcer
Pathologic hypersecretory conditions, such as Zollinger-Ellison
syndrome(ZES)
Gastroesophageal reflux disease
Erosive esophagitis
Heartburn
Contraindications: Contraindicated in patients hypersensitive to drug and those with
acute porphyria.
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Interactions: Antacids: may interfere with ranitidine absorption
Diazepam: may decrease absorption of diazepam
Glipizide: may increase hypoglycemia effect
Procainamide: may decrease a renal clearance procainamdie Warfarin: may interfere with warfarin clearance
Side Effects: CNS: vertigo, malaise, headache
EENT: blurred vision
Hepatic: jaundice
Other: burning and itching at injection site
Adverse Effects: Pancytopenia
Reversible leucopenia
Thrompocytopenia
Anaphylaxis
Angioedema
Nursing
Responsibilities:
1. Give the right drug to the right patient at the right time with the
right dose at the right route.
2. Inform the patient about the drug she is receiving including the risks
and benefits.
3. Note any allergy to drug and to other drugs related.4. Instruct patient to take as directed with or immediately following
meals.
5. Remind patient to take once-daily prescription drug at bedtime for
best results.
6. Advise patient to report abdominal pain, blood in stool or emesis
and other signs and symptoms.
7. Use cautiously in patients with hepatic dysfunction. Adjust dosage
with impaired kidney function
8. Instruct patient to avoid things that may aggravate symptoms (i.e.,
alcohol, aspirin, NSAIDS, caffeine, chocolate, and black pepper)
9. Symptoms of breast tenderness will usually disappear after several
weeks; report if persistent and evaluate need to stop drug.
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Indication: Short term management of pain
Ocular itchingcaused by seasonal allergic rhinitis
Postoperative inflammation following cataract surgery
Pain and burning or stinging following corneal refractive surgeryContraindications: Contraindicated in patients hypersensitive to drug and in those with
active peptic ulcer disease, recent GI bleeding or perforation,
advanced renal impairment, cerebrovascular bleeding, hemorrhagic
diathesis, or incomplete hemostasis, and those at risk for renal
impairment from volume depletion or at risk of bleeding.
Contraindicated in patients with history of peptic ulcer disease or GI
bleeding, past allergic reactions to aspirin or other NSAIDs, and
during labor and delivery or breas-feeding.
Contraindicated as prophylactic analgesic before major surgery or
intraoperatively when hemostasis is critical; and in patients currently
receiving aspirin or probenecid.
Interactions: ACE inhibitors: may cause renal impairment, particularly in volume
depleted patients.
Anticoagulants, salicylates: may increase salicylate or anticoagulant
levels in the blood
Antihypertensives, diuretics: may decrease effectiveness
Lithium: may increase lithium level
Methotrexate: may decrease methotrexate clearance and increased
toxicity
Side Effects: CNS: dizziness, dizziness, headache, sedation
CV: edema, hypertension, palpitations
GI: nausea, dyspepsia, GI pain, diarrhea, peptic ulceration, vomiting,
constipation, flatulence, stomatitis
Hema: decreased platelet adhesion, purpura, prolonged bleeding
time.
Skin: pruritus, rash, diaphoresis
Other: pain at injection site
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Adverse Effects: Arythmias
Perforation
Bronchospasm
AnaphylaxisNursing
Responsibilities:
1. Identify reasons for therapy, onset, location, pain intensity/level,
characteristics of symptoms
2. Correct hypervolemia prior to administering
3. Warn patient receiving drug IM that pain may occur at injection site.
Put pressure on site for 15-30 seconds after injection to minimize
local effects
4. Teach patient signs and symptoms of GI bleeding, including blood in
vomit, urine, or stool; coffee-ground vomit; and black, tarry stool.
Tell him to notify immediately if any of these occurs.
5. Alert the patient using NSAIDS for serious GI toxicity, including
peptic ulcers and bleeding can occur despite lack of symptoms.
6. Instruct to take only as directed; do not exceed prescribed dosage.
May take with food/milk if GI upset occurs.
7. Inform the patient that drug causes drowsiness and dizziness; avoid
activities that require mental alertness8. Instruct to avoid alcohol, aspirin, and all OTC agents without
approval
9. With eye
top related