I.

INTRODUCTION
A. Overview of the study

Spinal cord injury: Spinal cord injury is damage to the spinal cord as a result
of a direct trauma to the spinal cord itself or as a result of indirect damage to
the bones and soft tissues and vessels surrounding the spinal cord. SCI
results in a decreased or absence of movement, sensation, and body organ
function below the level of the injury. The most common sites of injury are the
cervical and thoracic areas. SCI is a common cause of permanent disability
and death in children and adults.

The spine consists of 33 vertebrae, including the following:

 7 cervical (neck)
 12 thoracic (upper back)
 5 lumbar (lower back)
 5 sacral (sacrum – located within the pelvis)
 4 coccygeal (coccyx – located within the pelvis)

Injury to the vertebrae does not always mean the spinal cord has been
damaged. Likewise, damage to the spinal cord itself can occur without
fractures or dislocations of the vertebrae.

National Spinal Cord Injury Statistical Center (2009)

Current estimates are 250,000 - 400,000 individuals living with Spinal Cord
Injury or Spinal Dysfunction.

 82% male, 18% female

 Highest occurs between ages 16-30
 Average age at injury - 33
 Median age at injury - 26
 Mode (most frequent) age at injury 19

1
 As a requirement of NCM501104, we the students were required to
conduct a Case study. In relation to this, I have chosen the Patient WS for my
case study.

B. Objectives and Purpose of the Study

As a student nurse, it is indeed my vocation to adjoined hands with the
health care team for the promotion of wellness of our clients.
My main goals for this study are the following:
· To establish rapport
· To identify chief complaints of clients to give its specific interventions
· To determine the family and personal history of the client that many affect
client’s present condition
· To identify the cause and effect the main problem through the correct
analysis of the pathophysiology of the case
· To determine the medical management given through identifying doctor’s
order and its rationale
· To make nursing care plans for the different health problems encountered by
the client
· To evaluate the effectiveness of the actual nursing care plan that was
established
C. Scope and Limitation of the Study
Specifically this study is more concerned with the care of one patient in
NMMC Ortho Ward. I performed physical assessment to the patient to
properly identify the nursing problems, which requires necessary and direct
interventions and medical regimen. I had 1 day duty or 8 hours care for the
patient and some limited informants.. Thus this care study focuses on the
particular case of the patient. The study of the medications and doctor’s order
are limited to my chosen patient, a case of Spinal Cord Injury.

2
II. HEALTH HISTORY

A. Patients Profile

Name of Patient: WS
Sex: Male
Age: 33 years old
Birthday: September 21, 1978
Birthplace: Misamis Oriental
Religion: Roman Catholic
Civil Status: Single
Educational Attainment: High School Level
Occupation: ElectricianC
Number of Siblings: 5
Nationality: Filipino
Date Admitted: September 24, 2011
Time Admitted: 8:30 pm
Informant: Father
Blood Pressure: 110/60 mmHg
Temperature: 37.7O C
Pulse Rate: 82 bpm
Respiration: 21 cpm
Allergy: No known allergy
Attending Physician: Dr. C
Admitting Diagnosis: Acute Spinal Cord Injury Cervical Spine C5
(incomplete) (Central Cord Syndrome)

B. Past Health History and Family history

According to pt. WS, he had experienced some common childhood

illnesses such as measles, chicken pox and mumps when he was in
elementary. He had also experienced sore throat, cough, colds, and fever. He
managed it through bed rest and sometimes he takes herbal medicine such

3
as oregano for cough and guava leaves if he has wounds. He also took OTC
drugs such as paracetamol for fever, biogesic for headache and neozep for
colds.. He has no allergy to foods, drugs & animals. And He had never
undergone any major/minor operation and he had no history of fracture.

According to patient WS , they had a history of asthma on maternal

side & hypertension on both sides. They don’t have any history of Diabetes
Mellitus, Cancer & any other diseases which are hereditary.

C. Chief Complains and History of Present Illness

Pt. WS is a 33, y.o male born on September 21, 1978, Currently living
in Magsaysay, admitted for the 1st time at NMMC. His chief complaint is
limitation of movement at extremities. 5 days prior to admission, pt. was
apparently well when he was repairing electrical wiring on the ceiling and
accidentally fell. Pt hit face first on the floor causing loss of level of
consciousness and then he vomits, after that he already experience minimal
movement of extremeties. Pt. tolerated the condition with no consultation
done and no medication taken persistence of the condition.

III. DEVELOPMENT DATA

A. Erik Erikson’s Stages of Psychosocial Development Theory

Erikson describes eight developmental stages through which a

healthily developing human should pass from infancy to late adulthood. In
each stage the person confronts, and hopefully masters, new challenges.
Each stage builds on the successful completion of earlier stages. The
challenges of stages not successfully completed may be expected to
reappear as problems in the future. Each of Erikson's stages of psychosocial
development are marked by a conflict, for which successful resolution will
result in a favourable outcome and by an important event that this conflict
resolves itself around.

B. Sigmund Freud’s Psychosexual Development Theory

4
 According to Freud, people enter the world as unbridled pleasure
seekers. Specifically, people seek pleasure through from a series of
erogenous zones. These erogenous zones are only part of the story, as the
social relations learned when focused on each of the zones are also
important. Freud's theory of development has 2 primary ideas: One,
everything you become is determined by your first few years - indeed, the
adult is exclusively determined by the child's experiences, because whatever
actions occur in adulthood are based on a blueprint laid down in the earliest
years of life (childhood solutions to problems are perpetuated) Two, the story
of development is the story of how to handle anti-social impulses in socially
acceptable ways. My patient belongs to the genital stage which begins at
puberty involves the development of the genitals, and libido begins to be used
in its sexual role. However, those feelings for the opposite sex are a source of
anxiety, because they are reminders of the feelings for the parents and the
trauma that resulted from all that.

C.Robert J. Havighurst’s Developmental Task Theory

Havighurst categorized the tasks, in first category are the tasks, which
has to be completed in certain period, and the second are the tasks that
continue for a long, sometimes for a lifetime.So what happens if the task is not
completed in that stage or completed in a later date? Havighurst reply to that
it is critical that the tasks should be completed during the appropriate stage,
otherwise result will be the failure to achieve success in future tasks.

D. Jean Piaget’s Theory of Development

According to Piaget, development is driven by the process of

equilibration. Equilibration encompasses assimilation (i.e., people transform
incoming information so that it fits within their existing schemes or thought
patterns) and accommodation (i.e., people adapt their schemes to include
incoming information). My patient belongs to the formal operational stage. In
this stage, individuals move beyond concrete experiences and begin to think
abstractly, reason logically and draw conclusions from the information
available, as well as apply all these processes to hypothetical situations. The

5
abstract quality of the adolescent's thought at the formal operational level is
evident in the adolescent's verbal problem solving ability. The logical quality of
the adolescent's thought is when children are more likely to solve problems in
a trial-and-error fashion. Adolescents begin to think more as a scientist thinks,
devising plans to solve problems and systematically testing solutions. They
use hypothetical-deductive reasoning, which means that they develop
hypotheses or best guesses, and systematically deduce, or conclude, which is
the best path to follow in solving the problem.

IV. MEDICAL MANAGEMENT

A. DOCTORS ORDER

DATE ORDER RATIONALE NURSING

RESPONSIBILITY
September  PLEASE  To intervene  Admitted the
24, 2011 ADMIT TO & give the patient at the
Ortho Ward needed ward as
8:30 pm under the health ordered.
service of service
Dr. C  Witnessed
 Secure  As a form for the signing
consent for legal of consent &
admission & purposes. checked if
manageme the consent
nt was signed

 For  Inform the

 DAT with nutritional Patient and
aspiration supplement his SO about
precaution his diet and
its important.
 Dx:
 Informed the
 CBC;  To evaluate patient & his
for possible SO about the
abnormalitie laboratory
s indicating exams
infection or ↓ needs to be
in platelet done.
count or if
 Blood there is any
Typing; deviation.

6
  To know the
ABO blood
type prior to
blood
transfusion.

 CT  To visualize
Mylogram the cervical
of the spine &
cervical determine if
spine there is any
part affected
by the
accident.

 Meds:  Treatment  Observed

 Tramadol for acute the 10 R’s
50 mg IVTT pain before
q8 administerin
 Start g the drug
venolysis
with D5LR
@ 20 gtts/
min

 Bedsore  To inform  Referred to

Precaution the the physician
physician if there is
about the untoward
 Refer condition of signs and
accordingly the patient symptoms

September  Follow up CT
27, 2011 mylogram of
the cervical
spine
 Log roll every
2o

September  Still for CT

28, 2011 mylogram

September  No new orders

7
29, 2011  Still for CT
mylogram
October 1,  Still for CT
2011 mylogram of
the cervical
spine
 Continue Log
roll every 2o

 Still for CT
mylogram

October 3,
2011

B. LABORATORY TEST

Result Normal Values Rationale

Hemoglobin 135 g/dL 135-180 g/dL Normal

Hematocrit 0.42 l/l 0.42-0.52 l/l Normal

RBC count 4.36 x 10¹²/L 4.7-6.1 x 10¹²/L Decrease due to

bleeding
Platelet count 3.21 x 10/L 150-400 x 10/L Normal

WBC count 16.0 x 10/L 5-10 x 10/L

Increase due to
inflammatory
process
Lymphocyte 0.23 .20-.40 Normal

Blood type “ A “

8
V. PATHOPHYSIOLOGY & ANATOMY AND PHYSIOLOGY

A. PATHOPHYSIOLOGY of SPINAL CORD INJURY

BOOK BASED AND PATIENT CENTERED

Predisposing Factor Etiology Precipitating Factor

 Age (16-35 y/o) > accidents

 Gender (male) > falls, sport activities > work (ELECTRICIAN)
> Disease
(bone cancer, osteoporosis, arthritis)

Can result to any of the following:

 Hyperextension
 Hyperflexion
 Rotational movement
 Compression
 Lateral flexion

Fracture and dislocation of vertebral disc

Excessive force is exerted on spinal cord

9
 can lead to:
> Ischemia
 > Hemorrhage
C5 – controls extremities
 Muscle weakness
 Absence of withdrawal reflex
 Absence of Biceps reflex
 Muscle Paralysis
In gray matter in white matter

Increase in size rapidly lead to massive edema

Necrosis frequently spreads to involve

surrounding segment
Scaring

Shrinkage of axonal and

Myelin sheath

Rapid loss of axonal conduction

Result to production of free radicals

- normally found in the body but
quickly controlled by antioxidant
enzyme tissue

When antioxidant is overwhelmed

10
 Free radicals damage tissue

Dilation of arterioles in injured area inflammatory process (lumbar area)

Result capillary bed close Increase capillary permeability

Increase blood flow of injured tissue lead to loss of protein rich fluid in
at injured site extravascular tissue

Bleeding pain hematoma

Decrease extravascular Increase intravascular

osmotic pressure osmotic pressure

Fluid shift

Edema

fever (compensatory mechanism)

11
 B. ANATOMY AND PHYSIOLOGY

Spinal cord is a bundle of nerves that carries messages between the brain
and the rest of the body.
 The spinal cord functions in the transmission of ascending impulses to
the brain and of descending impulses from the brain to the cord.

Spinal Column
 Common name applied to the structure of bone or cartilage
surrounding and protecting the spinal cord.

 Humans are born with 33 separate vertebrae. By adulthood, most have

only 24, due to the fusion of the vertebrae in certain parts of the spine
during normal development.

12
The spine consists of 33 vertebrae, including the following:

 7 cervical (neck)
 12 thoracic (upper back)
 5 lumbar (lower back)
 5 sacral* (sacrum – located within the pelvis)
 4 coccygeal* (coccyx – located within the pelvis)

 By adulthood, the five sacral vertebrae fuse to form one bone, and the
four coccygeal vertebrae fuse to form one bone.)

L4 supplies many muscles, either directly or through nerves originating from

L4. They are not innervated with L4 as single origin, but partly by L4 and
partly by other spinal nerves. The muscles are:

 Quadratus lumborum
 Is a common source of lower back pain. Because the QL
connects the pelvis to the spine and is therefore capable
of extending the lower back when contracting bilaterally,
the two QLs pick up the slack, as it were, when the lower
fibers of the erector spinae are weak or inhibited (as they
often are in the case of habitual seated computer use
and/or the use of a lower back support in a chair).

 Gluteus medius
 One of the three gluteal muscles, is a broad, thick, radiating
muscle, situated on the outer surface of the pelvis.
 With the leg in neutral (straightened), the gluteus medius and
gluteus minimus function together to pull the thigh away from
midline, or "abduct" the thigh

 Gluteus minimus

13
  The gluteus medius and gluteus minimus abduct the thigh,
when the limb is extended, and are principally called into
action in supporting the body on one limb, in conjunction with
the Tensor fasciæ latæ

 Tensor fasciae latae

 is a muscle of the thigh
 is a tensor of the fascia lata; continuing its action, the
oblique direction of its fibers enables it to abduct the thigh
and assists with internal rotation and flexion of the hip
inward (medial rotation).
 Obturator externus muscle

 Obturator externus muscle is a flat, triangular muscle, which

covers the outer surface of the anterior wall of the pelvis.

 Inferior gemellus muscle

 Inferior gemellus muscle is a muscle of the human body. The

Gemelli are two small muscular fasciculi, accessories to the
tendon of the Obturator internus which is received into a groove
between them.

 The Gemellus inferior arises from the upper part of the

tuberosity of the ischium, immediately below the groove for the
Obturator internus tendon. It blends with the lower part of the
tendon of the Obturator internus, and is inserted with it into the
medial surface of the greater trochanter. Rarely absent.

 Quadratus femoris
 Quadratus femoris is, as its name implies, a flat, quadrilateral
skeletal muscle. Located on the posterior side of the hip joint, it

14
 is a strong lateral rotator and adductor of the thigh, but also acts
to stabilize the femoral head in the Acetabulum.

VI. NURSING REVIEW CHART

IV. PHYSICAL ASSESSMENT

NURSING SYSTEM REVIEW CHART

Name: WS
Date:October 2, 2011
Vital Signs:
Pulse: 82 bpm BP: 110/60 Temp: 37.7 Respi: 20 cpm

EENT
[] impaired vision [] blind
[] pain reddened [] drainage
[] gums [] hard of hearing [] deaf
[] burning [] edema [] lesion teeth
[] asses eyes, ears, nose FEVER
[] throat for abnormality [X] no problem
RESPIRATION
[] asymmetric [] tachypnea [] barrel chest
[] apnea [] rales [] cough No biceps reflex
[] bradypnea [] shallow [] rhonchi
[] sputum [] diminished [] dyspnea
[] orthopnea [] labored [] wheezing
[] pain [] cyanotic
[] assess resp rate, rhythm, depth, pattern
[] breath sounds, comfort [X]no problem
GASTRO INTESTINAL TRACT
[] obese [] distention [] mass
[] dysphagia [] rigidly [] pain
[] asses abdomen, bowel habits, swallowing
[] bowel sounds, comfort [X]no problem
GENITO-URINARY and GYNE
[] pain [] urine color [] vaginal bleeding
[] hematuria [] discharge [] nocturia
[] assess urine freq., control, color, odor, comfort
[] grip, gait, coordination, speech, [X]no problem
NEURO Generalized
[] paralysis [] stuporous [] unsteady [] seizure weakness
[] lethargic [] comatose [] vertigo [] tremors
[] confused [] vision [X] grip
[] assess motor function, sensation, LOC, strength
[] grip, gait, coordination, speech, []no problem
2
MUSCULOSKELETAL and SKIN
[] appliance [] stiffness [] itching [] petechiae
[X] hot [] drainage [] prosthesis [] swelling

15
[] lesion [X] poor turgor [] cool [] deformity
[] atrophy [] pain [] ecchymosis [] diaphoretic
[] assess mobility, motion, gait, alignment, joint function
[X] skin color, texture, turgor, integrity [] no problem

16
VII. NURSING MANAGEMENT
A. IDEAL NURSING MANAGEMENT
PATIENT: WS

Assessment Diagnosis Objective Intervention Rationale Evaluation

SUBJECTIVE: Impaired physical Within the duration  Continually asses  Evaluates status of Goal not met the pt.
mobility related to of duty, the motor function by individual situation was not cooperative.
“dili kaayo ko ka neuromascular patient will requesting patient (motor-sensory
lihok lihok” as impairment. maintain position to perform certain impairment may be
verbalized by the of function and actions. mixed and/ or not
patient. skin integrity as clear) for a specific
evidenced by level of injury,
OBJECTIVE: absence of foot affecting type and
drops, choice of
 Decreased muscle contractures and intervention.
control/strength decubitus ulcer
 Limited ROM  Enables patient to
 Inability to  Provide means to have sense of
purposefully more summon help. control, and
within the physical reduces fear of
environment. being left alone.

 Assist in range of  Enhances

motion exercises circulation, restores
on all extremities or maintains
and joints, using muscle tone and
slow, smooth joint mobility, and
movements. prevent disuse
contractures and
 Plan activities to muscle atrophy.

17
 provide
uninterrupted rest  Prevents fatigue,
periods. allowing
Encourage opportunity for
involvement within maximal efforts or
individual participations by
tolerance or patient.
ability.
 Reposition  Reduces pressure
periodically even areas, promotes
when sitting in peripheral
chair. Teach circulation.
patient how to use
weight-shifting  Open expression
techniques. allows client to deal
 Encourage with feelings and
verbalization of begin problem
feelings. solving.

 Inspect the skin  Altered circulation,

daily. Observe for loss of sensation,
pressure areas, and paralysis
and provide potentiate pressure
meticulous skin sore formation.
care.
 Helpful in planning
 Consult with and implementing
physical or individualized
occupational exercise program
therapist. and identifying or
developing
assistive devices to
maintain function
enhance mobility

18
and independence.

19
Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Activity Within the  Evaluated clients  To provide Goal not met. The
“Dali rako intolerance r/t duration of duty, actual and perceive comparative patient didn’t
kapoyon maong neuromuscular the patient will limitations/ degree of baseline and provide cooperate.
matulog nlang ko” impairment demonstrate a deficit in light of usual information about
decrease in status needed education/
Objective: physiologic sign intervention
 Needs of intolerance regarding quality of
assistance in life
repositioning
 Inability to do  Noted client’s report  Symptoms may
his ADL’s of weakness, fatigue, results of/or
pain and difficulty contribute to
accomplishing his intolerance of
task. activity
 Ascertained ability to
move about and  To determined
degree of assistance current status and
necessary use of needs associated
equipment with participation in
needed desired
 Encouraged activities.
expression of feelings  To assist the client
contributing to his to deal with
condition contributing factors
and manage
activities within
individual limits
 Assist with activities
and provide/ monitor  To protect from
clients use of assistive injury
devices
 Promote comfort

20
 measures and provide
relief of pain  To enhanced the
ability to participate
 Repositioning every 2 in activities
hours
 To prevent bedsore
and to maintain
body alignment all
 Made repositioning the time.
schedule and post at  To prevent bedsore
bedside and educated and to promote
the patient’s S.O in circulation.
proper turning the
patient

21
 CUES NURSING DX OBJECTIVES INTERVENTIONS RATIONALE EVALUATION
Subjective Data: That within my 8o - Perform tepid  Vaporization GOAL MET:
Pt. verbalized... Hyperthermia span of care, the sponge bath of water At the end of my
“gitugnaw ko” related to disease patient’s body - Apply cold wet relieves heat 8o span of care:
Objective Data process as temperature will compress if from the - the patient’s
- Temp: 37.7 oC evidenced by lower from 37.7 oC necessary surface of the temperature will
- skin warm to chills noted to 37oC and will - Remove some skin lowers to 37.5oC
touch demonstrate blankets and  To help - The patient will
- body malaise absence of chills clothes which normalize manifest negative
- poor appetite are not body chilling
- chills noted necessary temperature - The patient will
- If patient’s skin  To provide air verbalize comfort
feels cold to movement, to
touch, apply augment heat
friction loss.
- Advise to wear  To stimulate
loose and circulation
comfortable  To be more
clothes Comfortable

22
 B. ACTUAL NURSING MANAGEMENT
PATIENT: RF

S “gitugnaw ko”
as verbalized by the patient

O
- Temp: 37.7 oC
- skin warm to
touch
- body malaise
- poor appetite
- chills noted

A Hyperthermia related to disease

process as evidenced by chills noted

P That within my 8o span of care, the

patient’s body temperature will
lower from 37.7 oC to 37oC and will
Demonstrate absence of chills

I - Perform tepid sponge bath

- Apply cold wet compress if necessary
- Remove somem blankets and clothes
which are not necessary
- If patient’s skin feels cold to touch, apply
friction
- Advise to wear loose and comfortable
clothes

E GOAL MET:
At the end of my 8o span of care:
- the patient’s temperature lowers to 37oC

23
C. DRUG STUDY
DRUG/MEDICATION CLASSIFICATION ACTION INDICATION SIDE EFFECTS NSG.
IMPLICATION
Tramadol Dose: Analgesics- relieve painUnknown. A centrally actingModerate toCNS: -use consciously in pt. risk for

150mg without loss ofsynthetic analgesicsevere pain Dizziness, vertigo,seizures or respiratory depression;
increased intracranial pressure or
Frequency: consciousness compound not chemically headache, and anxiety.
head injury, acute abdominal,
q 8 Anti-depressants- related to opiates. Drug CV:
condition or renalor heptic
route: prevent or relieve thethrough to mind to opiola Vasodilation
impairment; and in physical
P.O. symptoms ofreceptors and inhibit EENT: dependence on opiodes.
depressions reuptate of norepinephrine Visual disturbances -monitor bowel and bladder fxn.
and serotonin. GI TRACT: Anticipate need for laxative.
Nausea, constipation,- for better analgesic effect give drug
vomiting,dyspepsia, drybefore onset of intense pain.
-monitor pt. at risk for seizure. Drug
mouth, and diarrhea.
may reduce threshold.
SKIN:
-monitor pt. for drug dependence.
Pruritus, and rash.
Drug can produce dependence
similar to that of codeine or
dextropropoxyphene and thus has
potential for abuse.

24
DRUGS/MEDICATION CLASSIFICATION ACTION INDICATION SIDE EFFECTS NSG. IMPLICATION

Paracetamol Route: P.O Antipyretic Antipyretic: reduces>common colds ,CNS: headache, >observed the rights of
(biogesic) Dose: 500mg fever by acting directlyother viral andCV: chest pain,giving needs
Frequency: P.R.N forAnalgesic on the hypothalamicbacterial infection withdyspnea >do not exceed the
fever heat-regulating centerpain and fever. GI: hepatic toxicityrecommended dosage.
to cause vasodilation and failure, jaundice. >d/c drug if
and sweating w/c hypersensitivity
helps discipate heat. reaction occurs.
>assess allergy
>advice patient that
paracetamol is only for
short-term use.

25
DRUG/MEDICATION CLASSICATION ACTION INDICATION SIDE EFFECTS NSG.IMPLICATION

Tramal Dose:30 mg Non-steroidal anti- Unknwon. Though Short-term CNS: drowsiness, >use cautiously in
Route: IVTT inflammatory drugs to inhibit management o sedation, dizziness, patients with hepatic
Frequency: q 8 =prevent prostaglandin moderately severe, headache. or renal impairment
inflammation, pain synthesis acute pain single- CV: edema, >carefUlly observed
and fever support Route: IV dose treatment. hypertension, patients with
the blood clotting Onset: immediate palpitations. coagulopathies and
function of platelets, Peak: 1 to 3min. GI: nausea, those taking
and protect the Duration: 6 to 8 hrs. dyspepsia, GI pain, coagulant.
lining of the stomach diarrhea, peptic >don’t give drug
from the damaging ulceration, vomiting, epidurally or
effects of acid constipation, intrathecally because
flatulence, of alcohol content.
stomatitis. >correct hypovolemia
HEMATOLOGIC: before giving.
prolonged bleeding
time
SKIN: rash,
diaphoresis.

26
VIII. REFERRAL AND FOLLOW – UP

HEALTH TEACHINGS => Encourage the patient’s family to wash hands with
an antibacterial soap and maintain good hygiene.
=> Instruct the family to inform the health care
providers if symptoms persist beyond 3 days discharged from the hospital.
ANTICIPATORY S/S => Upon instructing the patient to take his medicines
ordered by his doctor, the patient will be able to lessen the pain at his incision
sites.
=> After recommending the patient with his
diet/nutrition he will be able to gain weight and recover from undesired weight
loss/cachexia
SPIRITUALITY => Encourage the patient’s family members to pray for
the patient’s fast recovery and encourage also the patient to have a
strengthen faith to GOD.
MEDICATION => Instruct the patient’s father to continue medication
as what his doctor has ordered for the patient and not to discontinue even If
the patient feels better.
=> Instruct also the patient’s family member to take
home the medication and follow the frequency ordered by the doctor.
INCISION CARE => Instruct the family members to clean and dressed
with bandage the incision site of the patient.
=> Instruct the Family members to use sterile
materials in assessing/cleaning the incision sites of the patient.
NUTRITION => Recommend patient to increase fluid intake and eat
foods that’s more on fiber.
ENVIRONMENT => Encourage the patient and his family members to
maintain clean surroundings (especially patients room).

IX. EVALUATION AND IMPLICATION

At the end of our hospital duty, I was able to render care to our patient to
help him resolve his health condition. Through observing the patient’s status, I
was able to identify priority problems related to his health. The patient was willing

27
to pursue the medical therapy just to promote health and wellness for the
betterment of his condition. I have also made the patient’s father realize the
importance of completing the course of therapy by taking the medicines
prescribed or ordered for him by his physician. In addition, eating healthy or
nutritious foods that were prescribed to him by the health providers was further
been explained to the benefits he will gain in eating those foods. Moreover, this
several intervention to him as given to the patient made his body conditioning
normal and I can say that our patient has somehow recovered from his illness.

X. BIBLIOGRAPHY

BOOKS
 Suzzanne C. Smeltzer, EdD, RN,FAAN,et.al
Medical Surgical Nursing
11th Edition,
 Lippincott Williams and Wilkins
Manual of Nursing Practice
7th Edition
c 2001 by Lippincott Williams and Wilkins

WEBSITES
www.nursingcrib.com
www.scribd.com
www.wikipedia.com/coloncancer

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