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1. I. Introduction
A. Overview of the disease
A gallstone is a crystalline concretion formed within the gallbladder by accretion
of bile components. These calculi are formed in the gallbladder, but may pass distally into other
parts of the biliary tract such as the cystic duct, common bile duct, pancreatic duct, or
theampulla of Vater.
Presence of gallstones in the gallbladder may lead to acute cholecystitis,
an inflammatory condition characterized by retention of bile in the gallbladder and often
secondary infection by intestinal microorganisms, predominantly Escherichia
coli and Bacteroides species. Presence of gallstones in other parts of the biliary tract can cause
obstruction of the bile ducts, which can lead to serious conditions such asascending
cholangitis or pancreatitis. Either of these two conditions can be life-threatening, and are
therefore considered to be medical emergencies.
As a final point, I aspire to discuss the condition of my client and talk about how I apply
the nursing process and utilize the concepts of medical and surgical nursing, specifically in
managing T/C Obstructed CBD stones vs. Hepatoma.
B. OBJECTIVE AND PURPOSE OF THE STUDY
This study is designed to identify health problems encountered by our client and further
understand the extent of the case. As student nurse, this would serve as a tool for my ground
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2. training from what I have learned in classroom discussions and be able to apply these in a real
hospital setting such as this case.
This case study focuses to accomplish the following objectives:
a. To establish rapport with the client.
b. To ascertain the content on the nursing assessment, diagnosis, planning,
implementation, and evaluation for this specific disease condition;
c. To comprehend on the underlying causes and health history on the client’s medical
diagnosis;
d. To compare & contrast the ideal and actual nursing care management for this specific
disease condition: and
e. To evaluate the effectiveness of the interventions and detect any progress or regression
of the client’s condition.
The purpose of the study is to understand thoroughly the client’s disease condition and
the factors involving the processes of the disease condition, which is T/C Obstructed CBD
stones vs. Hepatoma.
In general, this study aims to develop the skills and learning of the student, wherein I am
exposed and able to learn the genuine hospital setting in every case that they encounter.
Enhancing one’s understanding and competence is important to impart the best possible care to
client
B. Scope of the StudyB. Scope of the Study
 The study focuses on Station 1, room 22, medical patient, admitted at Bukidnon
Provincial Medical Hospital at Malaybalay City, Bukidnon.
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3.  Nature, causes, signs & symptoms, pathophysiology, medical management, and nursing
management.
 Involves the ideal and actual nursing intervention appropriate to address the needs of
Mrs. Macadag-um, the drug study of the medications given to her, the health teachings
as well as referrals for Mrs. Macadag-um.
 Assessment of Mrs. Macadag-um’s personal health history, and history of present
illness.
C. Limitation of studyC. Limitation of study
 Limited only to the history of the patient which is comprised of the patient’s profile, family
and personal health history, chief complaint and history of present illness.
 Information being collected from the patient during the patient assessment and 2 days of
duty, each in 12 hours.
 Limited only to admitting diagnosis and no final diagnosis because the patient haven’t
been discharged yet.
II- Health History
A. Patient Profile
Name: Mrs. Macadag-um
Birth date: November 4, 1956
Age: 54 yrs. old
Sex: Female
Religion: Roman Catholic
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4. Civil Status: Married
Address: Mabuhay, Valencia City
Nationality: Filipino
Date Admitted: January 20, 2011
Time Admitted: 5:10pm
Temperature: 36.8ºC
Pulse rate: 82bpm
Resp. Rate: 20cpm
BP: 130/80 mmHg
Height: 5’2”
Weight: 40kg
Chief Complaint: Abdominal Pain
Admitting Diagnosis: T/C Obstructed CBD stones vs. Hepatoma
B. Family and Personal History
Mrs. Macadag-um, Female, Filipino, 54 years old, is a resident of Mabuhay Valencia
City. She has received all vaccinations during his childhood years. She had a family history of
hypertension on both mother and father side. She also has no known drug and food allergies.
She graduated at the Mabuhay National High school. Unfortunately Mrs. Macadag-um did not
proceed to college due to financial constraint.
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5. At present, Mrs. Macadag-um is a farmer and is independent from his children. She is a
wife of Mr. J, and they had three (3) children. Her eldest, Maris, is helping them in their farm.
And the family has an income of 5000 per month.
Mrs. Macadag-um gave birth to her 3 children through normal spontaneous delivery. She
was admitted last Decembe 2010 due to having jaundice in the hospital of Valencia City.
C. History of Present Illness:
1 month prior to admission, Ms C experienced abdominal pain at the upper quadrant and
was having jaundice and ignored it because of the lack of knowledge about health and
diseases. 1 day prior to admission she experience on and off severe abdominal pain which she
then decided to have a check up.
On the day which she was admitted, she experienced severe abdominal pain which she
can’t bear; she said that it feels like she is dying every time her stomach was touch. According
to the patient, last year she was having a symptom of jaundice but ignored it for a month. Due to
her unbearable pain Mrs. Macadag-um decided to be admitted through the assessment of Dr.
Exile.
III. Developmental Data
A. Erick Erickson (Psychosocial Theory)
Mrs. MAcadag-um age belongs to the adulthood stage of Erik Eriksson’s theory of
stages of development. The central task that she ought to resolve at this stage is to resolve
generativity versus stagnation. With Mrs. Macadag-um’s case, she verbalized that drinking and
smoking is bad in our health. With this, she was able to accept one’s own life’s uniqueness and
5

6. worth. The patient shows signs of positive resolution because whenever she was asked to do
something she is very eager to cooperate and respond to the questions given to her.
Furthermore, she also said that she was happy to raise her children and watch them grow with
them. She also verbalized that she is not afraid to die at this point in his life because according
to her, the task of being a mother to her children and a wife to her husband has been done.
B. Jean Piaget (Cognitive Developmental Theory)
It refers to the manner in which people learn to think, and use language. It involves a
person’s intelligence, perceptual ability, and ability to process information. Cognitive
development represents a progression of mental abilities from illogical to logical thinking,
from simple to complex problems solving, and from understanding concrete ideas to
understanding abstract concepts.
As I have observed, Mrs. Macadag-um could talk and communicate well, able to
answers our questions correctly, she was still able to think logically and she lives with her
good moral standards.
C.Robert Havighurst (Developmental Task)
According to Robert Havighurst’s Developmental Theory, the client belongs to the late
maturity stage wherein in there is adjustment to decreasing physical strength and health.
There’s an adjustment to retirement and reduced income. Establishing an explicit affiliation
with one’s age group is one of the major highlights of this stage. Adapting social roles in a
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7. flexible way. Establishing satisfactory physical living arrangements which are all held true to
the client. Since she is a farmer, she was able to adjust to the life she is having now
especially with the physical works, and is even open to the possibilities that might happen,
like things beyond our control.
D. Sigmund Freud (Psychosexual Theory)
According to Freud’s psychosocial theory, he belongs to the Genital Stage. During this final
stage of psychosexual development, the individual develops a strong sexual interest in the
opposite sex. Where in earlier stages the focus was solely on individual needs and, interest
in the welfare of others grows during this stage. If the other stages have been completed
successfully, the individual should now be well-balanced, warm, and caring. And this is true
to the client. The client was very warm and caring, as verbalized by her husband. Although
she lost already that sexual urge towards the opposite sex, she was able to fulfill those
things during the earlier stage of her married life.
7

8. IV. Medical Management
a. Medical Orders and Rationale
8

9. 9
Date/ Time Order Rationale
January
20,2011
5:10pm
Jan. 21,2011
Jan.27,2011
Jan.27,2011
Jan.27,2011
• Pls. admit
• Secure consent to care
• Monitor V/S every 4hrs then
record
• NPO
• LABS : CBC,UA,total
bilirubin,HBS,Aq,
SGPT,SGOT,whole abdomen
USD.
• Venodusis with D5LR 1liter at
30gtts/min.
• MEDS.
Ketorolac 30mg. amp 1 amp
every 8hrs. IVTT
• Monitor I and O every shift
• Will inform Dr. Generalao
done
• Refer for unusualities
• Refer to Internal medicine for
evaluation
• Refer accordingly
• IVF to follow : D5LR 1L at
30gtts/min.
• Ff/up labs
• Continue meds
• IVF to ff: D5LR at SR
• To secure 3 units of FWB of
patients blood type, properly
crossmatched still for UTZ -
UA
• Pls ff-up procurement of
blood
• Continue meds
• IVF TF: D5LR1Lat 30gtts/min
• Follow-up UTZ result
• TRAMADOL 1 amp IVTT now
then every 8hrs.
• For proper management
and by request of the
patient since the doctor
is specialized in the field
• For legal purposes
• For monitoring patient’s
health status
• For lab accurate result
• Basis in planning for
treatment
• A vehicle for
transportation of IVTT
meds
• To relieve pain stimulus
and decreases
ontraocular inflammation
• To monitor pt. health
status
• To Keep pt. safe
• To be evaluated and be
assessed for treatment
• A vehicle for
transportation of IVTT
meds
• To know results
• For treatment
• To compensate for low
RBC, hemoglobin, and
hematocrit count of the
patient’s CBC exam
result
• For treatment
• Alter perception of and
emotional response to
pain

10. Laboratory Results with Implications
B.Drug Study
10
Diagnostic Exam Results Normal values Significance of the result
CBC
6/29/10
White blood cells
Hemoglobin
Hematocrit
Platelet
HBsAg
CLINICAL
CHEMISTRY
ALKALINE
PHOSPHATE
SGOT
SGPT
RADIOLOGIC
OPINION
REPORT
14,700
8.4
25.0
Adequate
Non-
reactive
110.6
49.1
Extrahepatic
Biliary
obstruction
secondary
to a
Gallbladder
and CBD
new growth
Consider
carcinoma.
Suggest
abdominal
CT
5,000-10,000/mm
13.7-16.7 g/dl
40.5-49.7vols%
144,000-372,000
0-3 IU/L
0-3 IU/L
Indication of infection
Indication of anemia
Indication of severe anemia
Normal range
Normal range
Increased
Increased
Generic Name Ketorolac
Brand Name Toradol
Date Ordered January 20,2011
Classification Nonesteroidal anti-inflammatory, Analgesic
Dose/ Frequency/
Route
30mg. 1amp every 8hrs.IVTT
Mechanism of
Action
An NSAID that inhibit prostaglandin synthesis and reduces
prostaglandin levels in the aqueous humor
Specific Indication Relieves pain and stimulus and reduces intraocular
inflammation
Contraindication • Active peptic ulcer diseas,chronic inflammation of
GI tract, hypersensitivity to NSAIDS.
Side Effects • Headache
• Nausea
• Abdominal cramps
• Dyspepsia
Nursing
Precaution
• If GI upset occur take with food or milk.
• Avoid aspirin or alcohol during therapy.
• Asses onset, type, location duration of pain

11. Generic Name of
the Ordered Drug
Tramadol
Brand Name Ultram
Date Ordered January 28,2011
Classification Analgesic
Dose/ Frequency/
Route
30mg. 1amp every 8hrs.IVTT
Mechanism of
Action
An analgesic that binds to mu-opioid receptors and inhibit
re-uptake of norepeniphrine and serotonin.Reduces the
11

12. intensity of pain stimuli reaching sensory nerve endings.
Specific Indication Management of moderate to moderately severe pain.
Contraindication • Hypersensitivity to opioids. Concurrent use of
centrally acting analgesics,acute alcohol
intoxication
Side Effects Dizziness, vertigo, nausea, constipation, headache
Nursing Precaution • Monitor pulse and BP
• Sips of tepid water may relieve dry mouth
• Monitor daily pattern of bowel activity.
V. Pathophysiology with Anatomy and Physiology
12

13. Bile is a greenish substance
produced by the cells of the liver (hepatocytes) which aids in the digestion of fats. It
emulsifies fats, causing the fats to accumulate into droplets which can be easily
absorbed in the small intestine. It also aids in the absorption of so call Òfat soluble
vitamins, vitamins A, D, E and K. Bile is also the way the body disposes of hemoglobin
from old red blood cells which are no longer functional. This is what makes bile green
and stool brown. Once hepatocytes have made bile it is transported to the duodenum,
the segment of small intestine right after the stomach, where it is secreted through a
small hole known as the Ampulla of Vater. It can then form droplets with fat exiting the
stomach. The bile also goes to the gallbladder where it can be stored.
The network of ducts which transport the bile is known as the biliary system. This
system can be broken down into several sections. The first section is comprised of the
ducts which are inside of the liver, also known as the intrahepatic ducts. Small bile
ductules in the liver combine with each other to form larger ducts known as intrahepatic
bile ducts. The liver can be grossly divided into two lobes, the left and the right. As the
intrahepatic ducts combine with each other they form two large ducts known as the right
and left hepatic ducts. The left and right hepatic ducts come together to form the
common hepatic duct.
The segment of ducts immediately outside of the liver is known as the perihilar ducts.
The gallbladder sits on the underside of the liver and the cystic duct delivers bile into
and out of the gallbladder. As the common hepatic duct exits the liver it connects with
13

14. the cystic duct to form the common bile duct. The common bile duct enters the
pancreas and combines with the pancreatic duct and secretions from both the pancreas
and the common bile duct exit into the duodenum through the ampulla of Vater. These
areas of ductal system are known as the distal biliary tree.
The Liver and Gallbladder
The digestive function of the liver
is to produce bile, which is then
delivered to the duodenum to emulsify
fats. Emulsification is the breaking up of
fat globules into smaller fat droplets,
increasing the surface area upon which
fat-digesting enzymes (lipases) can
operate. Because bile does not
chemically change anything, it is not an enzyme. Bile is also alkaline, serving to
help neutralize the HCl in the chyme.
Bile consists of bile salts, bile pigments, phospholipids (including lecithin),
cholesterol, and various ions. The primary bile pigment, bilirubin, is an end product
of the breakdown of hemoglobin from expended red blood cells. Although some of
the bile is lost in the feces (bilirubin gives feces their brown color), much of the bile
is reabsorbed by the small intestine and returned to the liver via the hepatic portal
vein.
The liver performs numerous metabolic functions. Some of the most important
follow:
• Bile is produced.
14

15. • Blood glucose is regulated. When blood glucose is high, the liver converts
glucose to glycogen (glycogenesis) and stores the glycogen. When blood
glucose is low, glycogen is broken down (glycogenolysis), and glucose is
released into the blood.
• Proteins (including plasma proteins) and certain amino acids are synthesized.
• Ammonia (which is toxic) is converted to urea (less toxic) for elimination by
the kidneys.
• Bacteria and expended red and white blood cells are broken down. From the
red blood cells, Fe and globin are recycled, and bilirubin is secreted in the bile.
• Vitamins (A, D, and B12) and minerals (including Fe from expended red blood
cells) are stored.
• Toxic substances (drugs, poisons) and hormones are broken down.
The liver is composed of numerous functions units called lobules. Within each
lobule, epithelial cells called hepatocytes are arranged in layers that radiate out
from a central vein. Hepatic sinusoids are spaces that lie between groups of layers,
while smaller channels called bile canaliculi separate other layers. Each of (usually)
six corners of the lobule are occupied by three vessels: one bile duct and two blood
vessels (a portal triad). The blood vessels are branches from the hepatic artery
(carrying oxygenated blood) and from the hepatic portal vein (carrying
deoxygenated but nutrient-rich blood from the small intestine).
Blood enters the liver through the hepatic artery and hepatic portal vein and is
distributed to lobules. Blood flows into each lobule by passing through the hepatic
sinusoid and collecting in the central vein. The central veins of all the lobules merge
and exit the liver through the hepatic vein (not the hepatic portal vein).
Within the sinusoids, phagocytes called Kupffer cells (stellate reticuloendothelial
cells) destroy bacteria and break down expended red and white blood cells and
other debris. Hepatocytes that border the sinusoids also screen the incoming blood.
They remove various substances from the blood, including oxygen, nutrients, toxins,
15

16. and waste materials. From these substances, they produce bile, which they secrete
into the bile canaliculi, which empty into bile ducts. Bile ducts from the various
lobules merge and exit the liver as a single common hepatic duct. The common
hepatic duct merges with the cystic duct from the gallbladder to form the common
bile duct, which, in turn, merges with the pancreatic duct to form the
hepatopancreatic ampulla. This last duct delivers the bile to the duodenum.
The gallbladder stores excess bile. When food is in the duodenum, bile flows
readily from the liver and gallbladder into the duodenum. When the duodenum is
empty, a sphincter muscle (sphincter of Oddi) closes the hepatopancreatic ampulla,
and bile backs up and fills the gallbladder.
PATHOPHYSIOLOGY
16
PRECIPITATING FACTOR:
Viral Hepatitis
Contaminated foods
Lifestyle
PREDISPOSING FACTOR:
Age: 54yrs. Old
Sex: female

17. Legend:
VI. Nursing Assessment
Nursing System Review Chart
Name: Mrs. Macadag-um Date: January 26-27-28 2011;
Vital Signs:
Pulse: 82 bpm BP: 130/80 mmHg Temp: 36.8˚C RR: 20 cpm Height: 5’2” Weight: 40 kls.
17
: Hepatocyte Damage
Liver Inflammation
Alteration in blood and
Lymph flow
Liver Necrosis
Decreased bilirubin
Metabolism
And/or biliary tree obstruction
(extrahepatic biliary obstruction )
(Gallbladder and CBD new growth)
Conjugated
hyperbilirubinemia
JAUNDICE
Hepatomegal
y
Increased
WBC : 14,700
Fatigue
Nausea and
Vomiting
Pain
Anorexia/wg
t Loss:40kg.
Pathophsiology
Signs and
Symptoms

18. EENT:
□ impaired vision þ blind blind; Right eye
□ pain □ reddened □ drainage Jaundice on both eyes___
□ gums □ hard of hearing □ deaf
□ burning □ edema □ lesion □ teeth
Assess þ eyes, ears, nose
throat for abnormality □ no problem __IVF D5LR at 30 gtts/min._
RESP: _ IVF D5LR at 30gtts/min.
□ asymmetric □ tachypnea IVF D5LR at 30 gtts/min._
□ apnea □ rales □ cough □ barrel chest __________________
□ bradypnea □ shallow □ rhonchi IVF PNSS 1L @ KVO rate
□ sputum □ diminished □ dyspnea _____________________
□ orthopnea □ labored □ wheezing
□ pain □ cyanotic ______________________
Asses resp, rate, rhythm, depth, pattern, ______________________
breath sounds, comfort þ no problem ______________________
CARDIO VASCULAR ______________________
□ arrhythmia □ tachycardia □ numbness ______________________
□ diminished pulses □ edema □ fatigue ______________________
□ irregular □ bradycardia □ murmur ______________________
□ tingling □ absent pulses □ pain ______________________
Asses heart sounds, rate rhythm, pulse, blood _____________________
pressure, clrc., fluid retention, comfort _____________________
þ no problem ______________________
GASTRO INTESTINAL TRACT ______________________
□ obese □ distention □ mass ______________________
□dysphagia □ rigidlyþ pain ______________________
Assess abdomen, □ bowel habits, swallowing, Dry and Yellow color skin_
bowel sounds, comfort □no problem Wt = 40kgs._____________
GENITO-URINARY and GYNE Pain noted Scale 7
□ pain □ urine color □ vaginal bleeding
□ hermaturia □ discharge □ noctoria body weakness(01-26-10)
Assess urine freq., color, control, odor, comfort/ __BP = 100/80__110/70___
Gyn-bleeding, discharge þ no problem __T=36.8______36.3_____
NEURO __PR=82_______83______
□ paralysis □ stuporous □ unsteady □ seizures __RR=20_______25______
□ lethartic □ comatose □ vertigo □ tremors
□ confused □ vision □ grip ______________________
Assess motor function, sensation, LOC, strength, ______________________
Grip, gait, coordination, orientation, speech, ______________________
þ no problem ______________________
MUSCULOSKELETAL and SKIN _Vomitted________
□ appliance □ stiffness □ itching □ petechiae _Gums bleeding
□ hot □ drainage □ prosthesis □ swelling _no pain noted_________
□ lesion □ poor turgor □ cool □ deformity ______________________
□ wound □ rash þ skin color □ flushed Dry and Yellow skin;
□ atrophy □ pain □ ecchymosis ______________________
□ diaphoretic □ moist ______________________
Asses mobility, motion. Galt, alignment, joint function ______________________
skin color, texture, turgor, integrity □ no problem
NURSING ASSESSMENT II
18

19. 19
SUBJECTIVE OBJECTIVE
COMMUNICATION :
□ hearing Loss
□ visual Changes
□denied
Comments:
“Wala ko problema sa
pangdungog.” as
verbalized by the patient.
□ glasses □ languages
□ contact lens □ hearing aide
□ speech difficulties
Pupil Size: R=0; L=3mm
Reaction: briskly reactive
Pupils Equally Round and Reactive to Light and
Accomodation and Coordianted
OXYGENATION :
□ dyspnea
þ smoking history
occassional smoker
□ cough
□ sputum
□ denied
Comments:
“ok raman akong
paginhawa.ga
panigarilyo ko sauna
pag maginum ra” as
verbalized by the
patient.
Resp. □ regular □ irregular
Describe: breathing normaly and no abnormal
sounds upon inhaling and exhaling; equal lung
expansion
Right lung symmetrical to the left lung.
Left lung symmetrical to the left lung.
CIRCULATION :
□ Chest pain
□ Leg pain
□ Numbness of
extremities
□ Denied
Comments:
“Wala man na siya
problema sa high
blood. Pero iyang
mama ug papa naa .”
as verbalized by the
husband.
Heart Rhythm þ regular □ irregular
Ankle Edema: no ankle edema present.
Pulse Car. Rad. DP Fem
R + 82bpm + not obtained
L + 82bpm + not obtained
Comments: pulses are palpable
NUTRITION :
Diet: Diabetic Diet
□ N □ V
Character
þ Recent change in
weight, appetite
□ Swallowing
difficulty
□ denied
Comments:
“dili nako ganahan
mo kaun sugod
atong sige sakit
akong tiyan.” as
verbalized by the
patient.
□ Dentures þ None
FULL PARTIAL
Upper: □ □
Lower: □ □
ELIMINATION :
Usual bowel pattern
once a day
□ constipation remedy
no constipation
□ Date of last BM
Janaury 26, 2010
□ Diarrhea character:
not applicable
urinary frequency
four times a day
□ urgency
□ dysuria
□ hematuria
□ incontinence
□ polyuria
□ foley in place
□ denied
Comments:
No problem in bowel
and urination.
Bowel Sounds:
Patient has Normal
bowel sounds upon
ausculation
Abdominal DIstention
Present:
yes □ no þ
Not applicable, no foley
bag in place.
MGT. OF HEALTH ILLNESS
þ Alcohol □ denied
“Gainum ko sauna ug tanduay pero talagsa ra.” as
verbalized by the pt.
SBE: Last Pap Smear: not remembered
LMP: not remembered
Briefly describe the patient’s ability to follow
treatments for chronic health problems.
The patient was able to have bedrest and follow
doctors order. she was able to comply
medication regimen.
Subjective Objective
SKIN INTEGRITY:
þ Dry
□ Itching
□ Other
□ Denied
Comments:
“medyo uga lagi akong
pamanit ug ga yellow
ang color.” as
verbalized by the
patient.
þDry
□ Flushed
□ Moist
□ cold
□ warm
□ cyanotic
□ pale
* rashes, ulcers, decubitus (describe size,
location, drainage)
no skin abnormailities present
ACTIVITY/SAFETY:
□ Convulsion
þ dizziness
□ limited motion of
joints
Comments:
“luya jud kayo akong
paminaw,gakalipong
þ LOC and Orientation: Patient is oriented to
time, place and person.

20. 20

21. VII. Nursing Management
a. Ideal Nursing Care Plan
NURSING DIAGNOSIS
Altered Nutrition: Less
than Body Requirements
r/t decreased Intake and
loss of appetite
INTERVENTION
Independent:
1. Obtain a thorough
nutritional
assessment.
2. Provide a pleasant
atmosphere at
mealtime; remove
noxious stimuli.
3. Provide oral hygiene
before meals.
4. Provide the feedings
in the prescribed
amount and on
time.
5. Ambulate and
increase activity as
tolerated
RATIONALE
- Identifies
deficiencies/ needs to
aid in choice in
intervention.
- Useful in promoting
appetite.
- A clean mouth
enhances appetite.
-May reduce fatigue
and thus enhance
intake while
preventing gastric
distention.
- Helpful in expulsion
of flatus. Reduction of
abdominal distension
contributes to overall
recovery and sense
of well- being and
decreases possibility
of secondary
problems.
EVALUATION
After the Nursing
Interventions, the goals
were partially met.
2days after the day of
assessment, the patient
was discharged; the
group was not able to
evaluate the long term
goal.
However, before he was
discharged, he has
shown slight increase in
energy level.
21

22. NURSING DIAGNOSIS
Knowledge deficit
treatment related to
unfamiliarity of treatment
and lack of resources
INTERVENTION
Independent
1.Provide information
relevant to the
situation.
2.Identify information
that needs to be
remembered.
3.Begin with
information the
client already
knows and move to
what the client does
not know,
progressing from
simple to complex.
Dependent
1. Identify available
community resources
and support groups
(e.g. health center).
RATIONALE
1. Provides relevant
knowledge.
2. Establishes the
content to be
included.
3. Facilitates
learning.
1. For continuity of
care and to
promote wellness.
EVALUATION
After the Nursing
interventions, the goals
were partially met. The
patient and his SO were
able to verbalize
understanding of
condition and treatment.
He also
able to initiate lifestyle
changes and participate
in treatment regimen
22

23. B. Actual Nursing Management
23
S No subjective cues
O
· High WBC
· Weak
· Hepatomegaly (+)
A Infection related to inadequate secondary defenses (decrease Hgb and
Increased WBC)
P At the end of 12 hours, the patient will be able to identify interventions to
reduce infection and to understand the risk factors.
I
Independent:
•Placed in a semiprivate room. Limit visitors as indicated.
To protect patient from potential sources of pathogens/infection.
•Instructed proper hand washing
To prevents cross contamination and reduces infection
•Proper hygiene
To protect patient from potential sources of pathogens/infection.
•Encouraged deep breathing exercises
•Monitored skin color, notify pallor
Proliferation of WBC can reduce oxygen carrying capacity of the
blood.
E At the end of 12hours, patient was able to identify interventions to reduce
infection and understand the risk factors.

24. 24

25. 25
S “Sakit kayo akong tiyan”
O O= with facial grimace, with guarding behaviors, pain scale of 7/10, at
abdominal area, with quality of dull
A
Acute Pain related to inflammation of the liver
P
Long term: After 3 days of nursing intervention, pt will demonstrate
technique to alleviate pain
Short term: After 2 hr of nursing intervention the pt will verbalize relieve of
pain from 7/10 to 4/10
I
• Established rapport
• To gain pt’s therapeutic relationship
• Monitored v/s
• To obtain baseline data
• Assessed pt’s general condition
• To note for the etiology or precipitating factors that can lead to
fever.
• Encouraged rest opportunities
• To overcome pain at rest
• Encouraged diversional activities such as talking to S.O.
• to divert the pt’s attention
• Encouraged deep breathing exercises
• Helps to lessen the feeling of pain.
• Provided comfort measures and safety
• To let pt feel safe and comfortable
• Provided Health information regarding the occurring problem
• To lessen the pt’s feeling of anxiety
E . At the end of 8 hours, the patient pain scale was lowered to 4 out of
10.and had understanding on how to alleviate pain.

26. 26

27. VIII. Refferals and Follow-up
 Determined recommended dietary plans and provided dietary education as
appropriate.
 Reinforced to patient the importance of keeping follow-up appointments with the
health care provider.
 Explained to the patient the rationale for, side effects of, importance of taking
medications as prescribed.
 Informed patient's parents/family/caretaker of pertinent food and drug
interactions.
 Implemented measures to the patient's family to improve compliance: included
significant others in all discharge teaching sessions.
 Encouraged questions and allowed more time for reinforcement and clarifications
of information provided.
 Provided written instructions regarding scheduled appointments with health care
provider, medications prescribed, and signs and symptoms to report.
 Referred to the nearest health center for check-up and monitoring of condition.
But for emergency cases the patient was advised to go to the nearest hospital for
monitoring of condition.
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28. IX. Health Teachings
28
Medication: The patient was instructed that compliance of taking the
medications would improve his condition and treat it in
the long run. He was instructed to continue taking pain
reliever with the right dose, and at the right route. He was
instructed to comply in all the medications being allotted
for her or to maintain taking the drugs that are for
maintenance.
Exercise: During her stay in the hospital, the client was assisted in
doing ROM exercises to promote circulation; He was also
assisted in walking, when he would go to the bathroom.
Avoid strenuous activities to avoid over consumption of
oxygen. she can also perform activities of daily living with
minimal effort.
Treatment The patient was instructed to cooperate in planned
interventions for his condition. Cooperate with doctor’s
treatment plan such as routine and scheduled blood
transfusion, weekly check-up and monthly CBC exam.
she was also encouraged to ask question about her
condition and the treatment she was undergoing
Out Patient(Check-up) If discharge, the client was instructed to have a follow-up
check up 1 week after discharge for evaluation of her
condition and her compliance to the home medications
given. she can have routine check-up to the hospital or to
the nearest health care center for his condition to be
monitored and evaluated. she was advised to repeat
CBC after 1 month.
Diet
Diet as tolerated was advised by the doctor. Patient was
encouraged to take nutritious food rich in protein,Vit.A,
Iron and minerals. For health maintenance and recovery

29. X. Prognosis
Severity
she now has decreased physical, physiological and emotional coping
mechanism. She is more prone to infection and complication because of his increasing
29

30. age. For this reason his body is not at its optimum functioning which explains the poor
prognosis.
Age
she is now at the peak age of his life. At this age, his organ and body function is
not the same before. At this age deteriorating organs are present. Some of it has
decreased its function level. With this info, you could say that his body won’t cope up
easily with the treatment and recovery; especially she has a rare disease condition at
this age.
Medication and Compliance
Compliance to medication is vital for the prompt improvement of our patient’s
condition. Her medications were being administered per IVTT. The client received a
good prognosis for he showed willingness to follow or comply with her medication
treatment. But medication alone is not enough for the recovery and treatment. The body
should accept the treatment and should improve her condition.
Family Support
The patient’s family showed full emotional, physical, and financial support
towards the patient, thus, she is given a good rating in this criterion. The group
observed how well the client’s daughter personally took good care of her and attended
to all of her needs during her entire stay in the hospital. They also provided the patient
with all her needs in the ward such as medications, and other supplies as well.
XI. Evaluation
Prompt medical treatment coupled with quality nursing care; will improved prognosis of
the client diagnosed with hepatoma
30

31. Thorough and accurate physical assessment enabled the students to identify priority
actual and potential problems and provide nursing interventions appropriate for the
client’s specific medical condition.
Furthermore, this study provided the students a venue to practice learned skills and
impart valuable health teachings to enhance client’s knowledge regarding her health
condition in order to prevent complications and hasten recovery.
XII. Bibliography
Besa, E.(Mar 16, 2010) Chronic Myelogenous Leukemia from
http://emedicine.medscape.com/article/199425-overview
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32. Chronic myelogenous leukemia and related disorders: An overview. In: Lichtman MA, et
al. Williams Hematology. 7th ed. New York, N.Y.: McGraw-Hill;
2006.http://www.accessmedicine.com/content.aspx?aID=2148618. Accessed Sept. 11,
2008.
Cliffs Notes(n.d) The Fastest way to learn. Lymphatic System Components from
http://www.cliffsnotes.com/study_guide/Lymphatic-System-Components.topicArticleId-
22032,articleId-21980.html#ixzz0tZxAy0PI
Doenges, M., Moorhouse M.F., Murr, A.(2008), Nurse’s Pocket
Guide:Diagnoses,Prioritized
Interventions, and Rationales. Philadelphia, Pennsylvania:F.A Davis Company
Integrative medicine and complementary and alternative therapies as part of blood
cancer care. The Leukemia & Lymphoma Society. http://www.leukemia-
lymphoma.org/attachments/National/br_1150734030.pdf. Accessed Sept. 17, 2008.
Medline Plus(2010) Chronic myelogenous leukemia from
http://www.nlm.nih.gov/medlineplus/ency/article/000570.htm
Nowell PC (2007). "Discovery of the Philadelphia chromosome: a personal
perspective". Journal of Clinical Investigation : 2033–2035.
Schull, P.,(2009), Nursing Spectrum Drug Handbook.USA. McGraw-Hill
Smeltzer, S., Bare, B.,(2004), textbook of Medical-Surgical Nursing. Philadelphia.
Lippincott Williams & Wilkins
Math homework help
https://www.homeworkping.com/
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