Case Study

Benign Paroxysmal
Positional Vertigo
(BPPV)
Presented by:
Jacinto, Arvie D.
Mariano, Lalaine B.
BSN122
Group87
January 18, 2010

Presented to:
Mr. Oliver Sanidad R.N. MA
 Biographic Data
Name: Mr. M.M.
Address: Fortune Village 5, Valenzuela City
Age: 56 yrs. old Gender: Male
Religious Affiliation: Catholic
Marital Status: Married Occupation: Laborer
Room and Bed #: 208
Chief Complaint: Dizziness
Provisional Diagnosis: BPPV (Benign Paroxysmal
Positional Vertigo)
Attending Physician: Dra. T. Dela Cruz, Dr.
Olonan, and Dr. Santos
 Past Health History
According to the patient, he can’t
remember all his childhood illnesses. But
he can recall he had chickenpox when he
was 10 years old. He certainly verbalized
that he has complete immunization. The
patient doesn’t have any allergies to foods
and drugs. There’s no previous or any
accident encountered by the patient. His
past and first hospitalization was because
of hypertension for 3 days at Grace
Hospital, Bulacan.
Treatments were unrecalled during the
said hospitalization. The patient is
currently taking Adalat 30 mg once a day
as his hypertension maintenance as
prescribed by his physician after he was
hospitalized.
In 1986, the patient worked at Kuwait as
a mechanical maintenance for 10 years
with occasional vacation.
 History of Present
Illness
According to the patient, a night prior to
confinement he experienced sudden
dizziness when he woke up 1 a.m. to void.
He went back to bed still feeling dizzy
believing his dizziness to diminish. The next
day, he was advised by his wife to admit
himself to the hospital since he has health
insurance so might as well he can use it.
 Family Health History
According to the patient, his parents were still
alive and well. He also added that they don’t
have any diseases except his father sometimes
experience increase in blood pressure. Known
hereditary diseases in their family were
Hypertension and Diabetes although his parents
didn’t acquire any. However, the patient has
hypertension and type II diabetes mellitus which
according to him he might acquire it from his
father’s siblings who are also hypertensive and
diabetic. Luckily, his wife and family have no
significant diseases in the present.
Patterns of
Functioning
 Psychological Health
Coping Patterns
When asked about his condition, the
patient verbalized that, “Medyo ok na
naman ako, pwede na rin daw akong
umuwi.” He added that he is now
happy because he can go home. He
also mentioned that in terms of his
problems regarding his hospitalization,
he can able to manage all of these
because his wife is always there to
care for him.
He said that even though there are times
that he and his wife have some
misunderstandings, they easily solve
these problems by confronting each
other. He verbalized that, “Mabigat kasi
sa pakiramdam pag pinapatagal pa, yung
hindi pagpapansinan.” If there are
problems with the family especially with
their two daughters, they discuss it with
the whole family.
Interaction Pattern
According to the patient, he has many
friends in his work and in their place at
Valuenzuela. He said that socialization
with other people is not a problem with
him because he can easily mingle to
them and adjust to their culture. He also
mentioned that during his stay in Kuwait,
he met different people but he adjusted
easily to it.
 When it comes to his interaction
with his family, he verbalized that,
“Parang magkakapatid lang ang
turingan naming lahat sa bahay.”
He added that if their 2 daughters
have some problems, he will just
give them advices. He also doesn’t
have any problems with their
neighbors and mentioned that they
have good interaction.
Self-concept
Mr. M.M. thinks that he is now healthy. He
verbalized that, “Maayos na naman yung
pakiramdam ko pero medyo nahihilo pa rin
ako.” He said that he feels that way
because compare to what he experienced
before he was hospitalized, it is much
better now. During his hospitalization, he
said that whenever he is in a good mood,
he usually talks and chat with his wife. He
keeps on talking and telling those pieces
of advice that he has.
When it comes to physical aspect, he said that
sometimes he is sad because he cannot do his
work as a laborer. He cannot earn money that
he will need for the expenses in their family. He
is also bored during his hospitalization because
all he was doing was sleeping, eating, and
watching the television. Mr. M.M also
mentioned that he has so many goals that he
wanted to achieve in his life. He said that he
was only an elementary graduate but he didn’t
mind what others will say about him. According
to him, as of now, he was so grateful that his
two daughters both finished their studies and
also have their own jobs.
Emotional Patterns
Mr. M.M. said that whenever he
has problems especially in his work,
he usually tells it to his wife. He
believes that if a couple has the
communication especially when
there are problems, they will have a
good relationship. He verbalized
that, “Sinasabi ko naman agad
sakanya yung mga problema ko.
Minsan nagaaway rin kami pero
naguusap rin naman kami agad.”
 He added that if ever there are
problems between them, they don’t
want their children see that they are
quarrelling. They solve problems by
confronting each other.
In terms of the whole family, each
one of them has the freedom to say
his/her own feelings regarding family
problems. Mr. M.M. said that their
family has a harmonious relationship
with each other.
Sexuality
Mr. M.M. verbalized that, “Dapat kasi
tatlo yang mga anak ko. Kaso nga lang
yung panganay ay namatay nung
pinapanganak, premature kasi siya.” He
added that they didn’t use any family
planning method and verbalized that,
“Hindi naman talaga naming plano ang
maraming anak.” He also mentioned
that after her last daughter, her wife
undergone tubal ligation.
 Socio-cultural Patterns
Recreation Pattern
According to Mr. M.M., his usual
recreational activity is playing tennis.
He said that he usually plays for 4
hours together with his friends. Aside
from playing tennis he sometimes
chats with their neighbors and if he is
in their house, he watches the
television.
Mr. M.M. together with his wife and two
daughters are currently living at Fortune
Village 5, Valenzuela City. According to
him, in their village, it is peaceful and
clean. He verbalized that, “Kahit naman
minsan may mga nagaaway hindi naman
rin sila nagkakasakitan.” He also said that
he has many friends and he has a good
relationship with their neighbors.
Economic Pattern
According to Mr. M.M., he went to Kuwait
because during that time he needed money
for him to send her two daughters in school.
As of now, he is a laborer and he earns
money that is sometimes not enough for his
family. When asked about what are the
expenses that they focused on, he
mentioned that they a lot more money on
their food. Second to it was for the health of
the family especially for the medications.
Lastly was for other expenses like electric
and water bills.
Activities of
Daily Living
 Nutrition
According to the client, before his hospitalization,
he and his family often eats rice, vegetable, fish
and chicken. The patient drinks at least 8-10
glasses a day. They seldom eat pork, at least 1-2
times a week. He usually eats 3 times a day
together with his family. He also includes variety
of fruits in his diet. He added that he has a good
appetit During his hospitalization, he still eats 3
times a day but the hospital foods were often
meat and so sometimes he eats less than the
usual. But his wife also cook foods in their house
and brought to him in the hospital.
Analysis and Interpretation:
There are no significant differences in his
nutrition before and during hospitalization.
Patients who are hospitalized may have an
inadequate dietary intake because of the
illness or disorder that necessitated the
hospital stay or because the hospital’s food
is unfamiliar or unappealing. But the patient
however still eats 3 times a day.
Reference:
Bruneer and Suddhart’s Medical-Surgical
Nursing, 11th edition, volume 1, pg. 83
 Elimination
The client usually urinates 7 times a day almost
the same amount of what he drinks. Light yellow in
color and faint aromatic in odor. He said that she
doesn’t feel any discomfort in urinating. The
patient defecates 2 times a day – one in the
morning and one in the afternoon. Semi-solid and
aromatic in odor, brown in color and formed.
During hospitalization, patient’s urination pattern is
the same from his usual habit. The patient only
defecates once since his hospital stay, hard in
consistency.
Analysis and Interpretation:
Urination pattern did not change. However,
defecation pattern significantly deviated from
usual. Hospitalized clients may suppress the
urge to defecate because of embarrassment
may be because of lack of privacy or because
defecation is too uncomfortable.
Reference:
Kozier and Erb’s Fundamentals of Nursing, 8th
edition, volume 2, page 1327
 Exercise
According to the client, before his
hospitalization, he plays tennis everyday. This
is his sort of excercision. He spends almost
half of the day playing tennis with his
playmates. “Athletic ako”, as verbalized by
the client.
During his hospitalization, he’s just lying or
sitting down since he was confined on bed.
He would only stand and walk when he has to
use the toilet to void or defecate. He usually
calls his wife to help him in going to the
bathroom.
Analysis and Interpretations:
The client has limited movement as
indicated by his condition. Bed rest to
promote healing may limit activity and
movement therefore inability to perform
basic ADLs can occur.
Reference:
Kozier and Erb’s Fundamentals of
Nursing, 8th edition, volume 2,
page1117
 Hygiene
In terms of hygienic practices before hospitalization,
the client takes a bath once a day provided that he
will bathe with warm water. “Minsan lang ako maligo
lalo pag hindi mainit yung tubig.” He also added,
“Pag malamig ang tubig ayokong ng maligo.”
Brushes his teeth only once a day and doesn’t use
deodorant. Trim his nails everytime it becomes long.
During hospitalization, the patient didn’t take a bath
yet because according to him, there’s no warm
water to use. He still brushes his teeth once a day.
Analysis and Interpretation:
The patient obviously neglected to take a
bath during hospitalization. Ill people may
not have the motivation or energy to attend
to hygiene.
Reference
Kozier and Erb’s Fundamentals of Nursing,
8th edition, volume 1, page 742
 Substance Abuse
According to the client, he smokes and consumes
1 pack of filter cigarette everyday. He also drinks
occasionally with maximum of 4 bottles of beer
during special events only. He is also taking Adalat
30mg once a day as his anti-hypertensive
maintenance.
While hospitalized, there’s no way he can do his
vices. He has plans to stop smoking and alcohol
drinking, since he can also perceive the effects of
long term cigarette smoking.
Analysis and Interpretation:
The patient has no choice but to
abstain from smoking. Primarily,
because hospitals don’t allow
cigarette smoking.
 Sleep and Rest
For the client’s sleep and rest pattern, he said
that his usual sleep is at 8pm and usually wakes
up 2am but continues his sleep until 6am He is
satisfied and comfortable with the amount and
quality of sleep he’s getting. He also stated,
“gising matanda na ang gising ko”.
During hospitalization, the patient’s sleeping
pattern is the same with his’ normal. He is
satisfied and comfortable also. But he got some
time to rest during the day.
Analysis and Interpretation:
There’s no change with his
sleeping pattern during
hospitalization except that more
resting time he’s getting during
the day.
 Sexual Activity
For the patient’s sexual activity with his
wife before hospitalization, they are less
often than not engaged in sexual
intercourse. “Tumatanda na kami, hindi
na namin yun masyado ginagawa” as
verbalized by the patient. According to
the patient, his wife had menopause
already.
During hospitalization, no sexual
engagement occurred.
 Physical
Assessment
 Body part Normal Findings Actual Findings Analysis and Interpretation
1.General Survey
-Body built -Proportionate -Proportionate -Normal findings
-Height -No data available
-Weight -No data available
-Posture and gait -Relaxed, erect and react -Relaxed and erect -Normal findings
with coordinated posture while sitting
-Over all hygiene and movement and standing -Normal findings
grooming -Clean and neat -Clean and neat
-Body and breath odor -Deviation from normal
-No body or minor odor -Presence of breath Halitosis, or most commonly
and breath odor odor and body odor bad breath are terms used to
describe noticeably unpleasant
odors exhaled in breathing. Bad
breath may be due to poor
hygiene and usage of tobacco
products. (Halitosis. January 11,
2010. Retrieved last January
-Signs of distress 16, 2009 from
-Signs of health or -No distress noted -No distress noted http://en.wikipedia.org/wiki/Hali
illness -Healthy appearance -He appears healthy. tosis)
-Attitude -Cooperative and able to -Can response to -Normal findings
follow instructions questions and followed -Normal findings
-Affect and mood instructions correctly
-The affect and mood -He feels happy and -Normal findings
-Quantity and quality should be appropriate to comfortable
of speech the situation -Soft voice tones; -Normal findings
-The quality and quantity understandable and in -Normal findings
-Relevance and of speech is moderate pace
organization of understandable, in -Her thoughts has a -Normal Findings
thoughts moderate pace sense of reality and
-Logical sequence; makes related to the
sense; has sense of reality questions asked to her
Integumentary
2. Skin
-Skin color and -Varies from light to -Light brown skin -Normal findings
uniformity deep brown; from color
ruddy pink to light
pink; from yellow
-Presence of overtones to olive -Normal findings
Edema -Generally uniform -Uniform in color;
skin color except in there is presence of
areas exposed to the hyperpigmentation
sun; areas of lighter and -Normal findings
-Presence of skin -No presence of hypopigmentation
lesions edema -No presence of -Normal findings
-Skin moisture edema
-Freckles; some
birthmarks, some flat -No presence of -Normal findings
raised nevi; no birthmarks, abrasions
abrasions or other and lesions on the
lesions body
-Moisture in skin folds -Small amount of -Normal findings
-Skin temperature and axillae moisture is present in
the axillae,
-Uniform skin antecubital area and -Normal findings
-Skin turgor temperature; within popliteal
the normal range -Temperature is
-When pinched, the uniform all
skin springs back to throughout the body
its previous state and is warm to touch
-Has good skin
3. Nails
-Fingernail plate -Convex curvature; -Convex nails with -Normal findings
shape angle of plate about an angle of 160°
-Finger nail and 160° -White in color -Deviation from Normal
toenail bed color -Highly vascular and Pallor may reflect poor
pink in light-skinned arterial circulation.
clients; dark-skinned (Kozier, et al.
clients may have 2007.Fundamentals of
brown or black Nursing 8th Edition.
pigmentation in Phillipines:Pearson
longtitudinal streaks Education, Inc.p.584)
-Nail texture -Smooth texture and -Normal findings
there is no visible
-Tissues -Smooth texture cracks -Normal findings
surrounding the -Tissues that
nails -Intact epidermis surrounds that the
-Blanch test of nails are intact -Deviation from Normal
capillary refill Delayed return to usual
- Prompt return of -The color of the color of the nails may
pink or usual color; nails, when pressed indicate circulatory
generally less than 4 were still the same impairment. (Kozier, et
second color (white) al. 2007.Fundamentals of
Nursing 8th Edition.
Phillipines:Pearson
Education, Inc.p.584)
Head
4. Skull
-Size and shape -Rounded and -Slightly round and -Normal findings
smooth skull contour has smooth skull
-Symmetry -Symmetrical contour -Normal findings
-Presences of -No presence of -Symmetrical -Normal findings
nodules, masses masses or nodules -No visible masses
and depressions and depression or nodules and
areas of depression
5. Scalp
-Color -Lighter to the color -Grayish in color, -Normal findings
of the facial skin lighter than the
color of the facial
-Areas of -No areas of skin -Normal findings
tenderness tenderness -No areas of
tenderness
6. Hair
-Evenness of -Evenly distributed -Hair is evenly -Normal findings
growth and and thick distributed all
thickness throughout the
scalp an is thick
-Presence of -No presence of -Negative flakes, no -Normal findings
infections infections infections or insects
in the hair
7. Facial
Features -Symmetrical facial -Symmetrical facial -Normal findings
-Symmetry of movements movements when
facial movements elevating the eyebrows,
smiling, closing the eyes
tightly, pouting, puffing
the cheeks, and frowning

EYES
8. Visual Acuity
-Near Vision -Able to read the -He was able to read all -Normal findings
newsprint the letters and words
given to him in a piece
of paper with the
distance of 1 foot away
-Distant Vision -Has a 20/20 vision from him
for both right and -No data available
left eyes on the
Snellen-type chart
9.Eyebrows
-Distribution of -Evenly distributed -Hair in the eyebrows are-Normal findings
hair hair and equally distributed
-Symmetry -Symmetrically -Symmetrically aligned -Normal findings
aligned on both sides
-Movement -Coordinated -Normal findings
-Equal movement movements
10. Lacrimal -No presence of -Upon palpation, there -Normal findings
gland, lacrimal tenderness, edema and is no areas of
sac and tearing tenderness, edema or
nasolacrimal duct swelling and tearing

11. Eyelids
-Surface -Evenly distributed hair -Hair on the eyelashes -Normal findings
characteristics on the eyelashes; skin are evenly distributed,
is intact; no discharges; skin is intact with no
no discoloration discoloration and
-Ability to blink -Lids closes discharges -Normal findings
symmetrically -The eyelids closes and
-Frequency of opens symmetrically -Normal findings
blinking -Approximately 15 to -Approximately 17
20 involuntary blinks blinks per minute with
per minute; bilateral symmetrical blinking
blinking

12. Bulbar
Conjunctiva -Transparent; -Transparent in color -Normal findings
-Color capillaries are and some capillaries
sometimes evident are visible -Normal findings
-Texture -Smooth texture -Appears to be smooth
in texture -Normal findings
-Presence of lesions -No presence of lesions -No lesions observed
on the surface -Normal findings
-Palpebral -Pink or red -Pinkish in color
Conjucntiva -Normal findings
-Color and Texture -Smooth and shiny -Smooth and shiny in
texture -Normal findings
13. Sclera
-Color and clarity -White in color -Appears to be white in color-Normal findings
and with smooth texture

14. Cornea
-Clarity and texture -Transparent, shiny and -Transparent, shiny and -Normal findings
smooth smooth
15. Iris
-Shape and color -Varies with client's -Iris appears to be flat, -Normal findings
race; flat and round round and brown in color
16. Pupils
-Color -Black in color -Appears to be white in color-Normal findings
-Shape -Round and has smooth -Round and has smooth -Normal findings
border border
-Symmetry and size -Equal in size; normally -Normal findings
3mm to 7mm in -Equal in size and
-Light Reaction diameter symmetrical on both sides -Normal findings
-Illuminated pupil -Constricts at approximately
constricts (direct 4mm as light directed to the
response); non- eyes and dilates at
-Accommodation illuminated pupil dilates approximately 6mm when -Normal findings
(consensual response light is removed.
-Pupils constrict when -When the client was asked
looking at near objects; to look at near object, the
pupils dilate when pupils constrict; on the
looking at far object; other hand, when he was
pupils converge when asked to look on far object,
near object is moved the pupils dilates
toward the nose
17. Extra
Ocular Muscles -Both eyes -Both eyes followed -Normal findings
-Alignment and coordinated; move the penlight in
coordination in unison with different direction
parallel alignment with parallel
alignment and
move in unison

18. Visual -When looking -He can able to see -Normal findings
Fields straight ahead, my fingers at
client can see different angles
objects in the
periphery
EARS
19. Auricles
-Color -Color same as -Light brown, same -Normal findings
facial skin as the facial skin
-Symmetry -Symmetrical -Symmetrical -Normal findings
-Position -Aligned with the -Vertically aligned -Normal findings
outer canthus of the at the outer canthus
eyes at about 10º of the eye at about
vertical 10º vertical
-Texture, -Soft but firm -Normal findings
elasticity and -Mobile, firm and texture; no lesions
areas of not tender; the present and no
tenderness pinna recoils after it tenderness felt by
is folded the client upon
20. External Ear
Canal
-Dry cerumen, grayish- -Dry cerumen is visible -Normal findings
-Presence of tan color; or sticky wet
cerumen, skin cerumen in various
lesions, pus and shades of brown
blood -No presence of skin -No lesion, pus and -Normal findings
lesions, pus and blood blood is present

21. Hearing
Acuity test -Normal voice tones -The client can hear -Normal findings
-Normal voice tones audible the normal voice tone
and can repeat what
was told to him
-Able to hear ticking in -The client stated that -Normal findings
-Watch tick test both ears he heard “tick-tack”
sound when watch
was placed in his ear.
-Sound is heard in both -The client said that he -Normal findings
-Weber’s Test ears or is localized at felt the vibration and
the center of the head both ears equally
(Negative Weber) heard the sound
-Air-conducted hearing -Normal findings
-Rinne Test is greater than bone- -The air-conducted
conducted hearing hearing lasted for 10
(Positive Rinne) seconds and the bone-
conducted hearing
lasted for 7 seconds
NOSE
-Shape and size -Symmetric and -Symmetric and -Normal findings
-Color straight straight -Normal findings
-Flaring or -Uniform color -Uniform color -Normal findings
discharge from -No flaring or -No flaring or
nares discharge discharge -Normal findings
-Nasal cavities
(redness, -Mucosa pink; has a -Mucosa appears to be
swelling, growthsclear, watery pink in color; has a
and discharge discharge; there are no clear, watery
lesions discharge and there -Normal findings
-Nasal septum are no lesions,
(position) swelling, redness and
-It is intact and in growth -Normal findings
-Patency of both middle line -Nasal septum is
nasal cavities located at the middle
-Air moves freely when line and is intact
the client breathes -The air coming from -Normal findings
-Tenderness, through the nares the nares can be felt
masses and it moves freely
displacements of -No areas of when the client
bone and tenderness, masses, breathes.
cartilage and displacement of -No areas of
bone and cartilage tenderness, masses,
and displacement of
bone and cartilage
SINUSES
-Any presence of -No presence of -No presence of -Normal findings
tenderness tenderness tenderness
MOUTH
22. Lips
-Symmetry of -Symmetric - Symmetric -Normal findings
contour appearance appearance -Normal findings
-Color -Normal findings
-Texture -Uniform pink color -Slightly bluish in color
-Soft, moist, smooth - Soft, moist and has
texture smooth texture

23. Buccal
Mucosa -Uniform pink color -Pink in color; smooth, -Normal findings
-Color, moisture, -Has a moist, smooth, soft and glistening -Normal findings
and texture soft, glistening, and and has elastic
elastic texture texture
-No lesions
-Presence of lesions -No presence of
lesions
24. Teeth
-Number of -32 adult teeth -22 adult teeth -Absence of 10 teeth. The
condition normal number of adult
teeth is 32.
(Kozier, et al.
2007.Fundamentals of
Nursing 8th Edition.
Phillipines:Pearson
-Color -Smooth, white, shiny -Rough in texture, Education, Inc.p.584)
tooth enamel discoloration of the -Black discoloration of the
enamel (black in enamel may indicate
color) staining or presence of
caries. (Kozier, et al.
2007.Fundamentals of
25. Gums
-Color and condition -Pink gums, moist, firm -Pink gums, moist, firm -Normal findings
texture texture
-No retraction of gums -Normal findings
-No presence of -No retraction of gums -Normal findings
tenderness -No presence of tenderness

26. Tongue/Floor
of the Mouth
-Color and texture -Pink color; moist; -Appears to be pink in color; -Normal findings
slightly rough; thin smooth whitish coating;
whitish coating; bilateral margins; raised
smooth, lateral papillae; and there is no
-Position and margins; no lesions; presence of lesions -Normal findings
movement raised papillae -Central position; moves
-Presence of -Central position; freely -Normal findings
nodules, lumps or moves freely
excoriated areas -No tenderness, -No areas of tenderness,
-Floor of the mouth nodules, lumps or masses or nodules, lumps or -Normal findings
and frenulum excoriated areas excoriated areas
-Smooth tongue base with
-Smooth tongue base prominent veins can be
with prominent veins observed
27. Palates and
Uvula -Light pink, smooth, -Soft palate appears to be -Normal findings
-Color and texture soft palate pink in color, smooth and
-Lighter pink hard soft; hard palate is lighter
palate than soft palate
-Normal findings
-Position of the
28. Oropharynx
and Tonsils -Pink and smooth -Pinkish in color and -Normal findings
-Color, texture and posterior wall; of has smooth posterior
size normal size or not wall; of normal size
-Presence of visible (Grade 1) -Normal findings
discharge -No discharge -No discharge
observed
Neck and Lymph
Nodes
29. Lymph Nodes
-Enlargement of the -Not palpable -Lymph nodes are not -Normal findings
lymph nodes palpable and this
indicates no
enlargement
30. Trachea
-Placement -Central placement in -The placement of the -Normal findings
midline of neck; trachea determined
spaces are equal on upon palpation and is
both sides located at the midline
of the neck and both
sides have equal
spaces

31. Thyroid Gland

-Symmetry and -Not visible in -Symmetry is not -Normal findings
smoothness inspection; gland visible in inspection
ascends during and the elevation of
swallowing but it is not the gland can be
visible observed right after
-Presence of the patient swallowed -Normal findings
Thorax
32. Posterior
Thorax -Anteroposterior to - Anteroposterior to -Normal findings
-Size, shape and transverse diameter intransverse diameter in
symmetry ration of 1:2 ration of 1:2
-Spine vertically -Spine vertically -Normal findings
-Spinal alignment aligned; spinal columnaligned; spinal column
is straight, right andis straight, right and
left shoulders are at left shoulders are at
the same height the same height -Normal findings
-Temperature, -Chest wall intact; no-Chest wall intact; no
tenderness and tenderness; no tenderness; no
masses masses; uniform masses; uniform -Normal findings
-Respiratory temperature temperature
excursion -Full symmetric -Full symmetric -Normal findings
-Vocal/Tactile expansion expansion
Fremitus -Normal findings
-Percussion sounds -Bilateral symmetry of -Bilateral symmetry of
heard vocal fremitus vocal fremitus
-Percussion notes -Percussion notes
resonance, except overresonance, except
scapula; lowest point over scapula; lowest
of resonance is at the point of resonance is -Normal findings
-Auscultation diaphragm; a rib at the diaphragm; a rib
sounds heard normally elicits normally elicits
dullness dullness
-Vesicular and -Vesicular and
bronchovesicular bronchovesicular
breath sounds breath sounds
33. Anterior Thorax
-Breathing patterns -Quite, rhythmic and effortless -Quite, rhythmic and effortless -Normal findings
respirations respirations
-Temperature, - No tenderness; no masses; - No tenderness; no masses; -Normal findings
tenderness and masses uniform temperature uniform temperature
-Respiratory excursion -Full symmetric expansion -Full symmetric expansion -Normal findings
-Vocal/Tactile Fremitus -Bilateral symmetry of vocal -Bilateral symmetry of vocal -Normal findings
fremitus fremitus
-Percussion sounds -Percussion notes resonance -Normal findings
heard down to the sixth rib at the -Percussion notes resonance
level of the diaphragm; flat down to the sixth rib at the level
over areas of heavy muscle of the diaphragm; flat over areas
and bone; dull on areas over of heavy muscle and bone; dull
the heart and the liver, and on areas over the heart and the
tympanic over the underlying liver, and tympanic over the
-Auscultation sounds stomach underlying stomach -Normal findings
heard (trachea) -Bronchial or tubular sound
-Auscultation sounds -Bronchial or tubular sound -Normal findings
heard (anterior thorax) -Bronchovesicular and
vesicular sound -Bronchovesicular and vesicular
sound

Cardiovascular
34. Heart
-Presence of abnormal -No pulsations on the aortic -No pulsations on the aortic and -Normal findings
pulsations, lifts or and pulmonic areas; no lifts or pulmonic areas; no lifts or
heaves heaves on the tricuspid area; heaves on the tricuspid area; no
no lifts or heaves on the lifts or heaves on the mitral area
mitral area but with visible but with visible pulsations
pulsations -S1: usually heard at all sites; -Normal findings
-Auscultation sound -S1: usually heard at all sites; usually louder at apical area; S2:
heard usually louder at apical area; usually heard at all sites; usually
S2: usually heard at all sites; louder at the base of the heart;
usually louder at the base of Systole: silent interval; slightly
the heart; Systole: silent shorter duration than diastole at
interval; slightly shorter normal heart rates; Diastole:
duration than diastole at silent interval; slightly longer
35. Carotid
Artery -Symmetric pulse -Symmetric pulse -Normal findings
-Quality of volumes; full can be felt, full
pulsations pulsations; has a pulsations and has a
thrusting quality thrusting quality
-No sounds can be -Normal findings
-Auscultation -No sound heard heard
sound heard
36. Jugular
veins -Veins not visible -Veins are not -Normal findings
-Presence of visible when on the
distention lateral side of the
neck when the
client is in Semi-
fowler’s position
Breast and
Axillae
35. Breast
-Size, symmetry, -Females: Rounded -Even with the size -Normal findings
and contour or shape; slightly of the chest wall
shape unequal in size;
Males: even with the
size of the chest
-Skin color wall -Uniform in color -Normal findings
-Presence of -Uniform in color -No presence of -Normal findings
swelling or -No swelling or swelling or edema.
edema, and edema and
36. Areola
-Shape -Round or oval -Round in shape -Normal findings
-Symmetry -Bilaterally -Bilaterally -Normal findings
-Color symmetric symmetric -Normal findings
-Varies from light -Light to dark brown
-Presence of mass pink to dark brown in color -Deviation from normal
or lesions -No skin lesions or -Presence of pimple-
masses like behind his right
nipple, located
around the areola

37. Nipples
-Size -Equal in size on -Both nipples are -Normal findings
both nipples equal in size
-Shape -Round and everted -Round and everted -Normal findings
-Position -Centrally located on -Centrally located -Normal findings
each breast on each breast
-Color -Uniform in color -Uniform in color -Normal findings
-Direction -Both nipples point -Both nipples point -Normal findings
in the same in the same
-Presence of direction direction -Normal findings
discharge an -No discharges and -No discharges and
lesions lesions lesions

38. Axillae
-Presence of -No tenderness, -Upon palpation, -Normal findings
tenderness, masses or nodules there is no presence
Abdomen
-Skin integrity -Unblemished skin; uniform -Uniform in color. No presence -Normal findings
color; visible silver white of surgical scars.
striae or surgical scars
-Abdominal contour -Flat, rounded or scaphoid -Round in shape -Normal findings
appearance
-Enlargement of the -No evidence of enlargement -No evidence of enlargement of -Normal findings
liver or spleen of liver or spleen liver or spleen
-Symmetry of -Symmetric contour -Symmetric contour -Normal findings
Contour -Symmetric movements -Symmetric movements caused -Normal findings
-Abdominal caused by respirations by respirations is visible
Movements -Visible peristalsis in very
(respirations, lean people
peristalsis, or aortic -Aortic pulsations in thin
pulsations) person at epigastric area
-No visible vascular patterns -Vascular patterns is not visible -Normal findings

-Audible bowel sounds -Audible bowel sounds can be -Normal findings

-Presence of -Absence of arterial bruits heard upon auscultation
vascular patterns -Absence of friction rub -There is no presence of arterial -Normal findings
-Auscultation sound bruits
heard (bowel -There is no presence of friction -Normal findings
movements, -Tympany over the stomach rub -Normal findings
vascular sounds and and gas-filled bowels; -Tympany over the stomach
peritoneal friction dullness, especially over the and gas-filled bowels; dullness,
rubs) liver and spleen, or a full especially over the liver and
-Percussion sounds bladder spleen, or a full bladder -Normal findings
heard (Four -No tenderness; relaxed
quadrants) abdomen with smooth, -No tenderness; relaxed -Normal findings
consistent tension abdomen with smooth,
-Tenderness may be present consistent tension
-Light palpation near xiphoid process, over -No presence of tenderness
cecum and over the sigmoid
-Deep palpation colon
39. Liver
-Size -6 to 12 cm in the -6 to 12 cm in the -Normal findings
midclavicular line; 4 to 8 midclavicular line; 4 to 8
cm at the midsternal line cm at the midsternal line
-Areas of tenderness -May not be palpable; -May not be palpable; -Normal findings
and enlargement borders feels smooth; no borders feels smooth; no
enlargement and areas of enlargement and areas of
tenderness tenderness
40. Symphysis
Pubis -Not palpable -Not palpable -Normal findings
-Possible urinary
retention
Musculoskeletal
System
41. Muscles
-Size -Equal size on both sides of -The right arm and left arm -Normal findings
the body is at equal size
-Presence of -No contractures -No contractures noted -Normal findings
contractures
-Presence of -No tremors -No tremors on the arms -Normal findings
fasciculation and and hands of the client
tremor
-Muscle Tonicity -Normally firm -Muscle were observed to -Normal findings
be normally firm
-Muscle Strength -Equal strength on each -Equal strength on each -Normal findings
body side body side was determined
when test for strength in
the neck, upper and lower
extremities were done.
-Is Grade 5 of normal
strength; normal full
42. Bones
-Structure -No deformities -No deformities -Normal findings
-Areas of -No tenderness -No tenderness -Normal findings
tenderness and and swelling and swelling
swelling
43. Joints
-Presence of -No swelling -No swelling or -Normal findings
swelling edema present
-Areas of -No tenderness, -No areas of -Normal findings
tenderness, swelling, tenderness,
swelling, crepitation and swelling, nodules
crepitation and nodules and crepitation
nodules heard
-Smoothness of -Normal findings
movement -Joints move -All joints can
-Range of smoothly move freely and
Motion -Varies to some smoothly
degree in -No data available
accordance with
person's genetic
makeup and
degree of physical
activity
Diagnostics
and
Laboratories
Procedure/It Result Units Reference Interpretation and Analysis
em range
FBS 7.75 mmol/l 2.9 – 5.6 Deviation from Normal
•An elevated blood glucose level is called
hyperglycemia which leads to common
clinical manifestations associated with
diabetes mellitus.
(Black and Hawk’s Medical Surgical Nursing
8th Edition Volume 1, volume 1, pg. 1067)
BUN 10 mg/dl 8 – 23 Normal
Creatinine 0.9 mg/dl 0.6 – 1.1 Normal
Cholesterol 4.80 mmol/l 0.5 – 0.9 Deviation from Normal
•Hypertension and high serum cholesterol
levels are linked factors to the development
of coronary artery disease.
(Black and Hawk’s Medical Surgical Nursing
8th Edition Volume 1, volume 1, pg. 1302)
Triglycerides 1.24 mmol/l 0.46 – 1.88 Normal
HDL 1.19 mmol/l 0.0 – 0.91 Deviation from Normal
•Coronary heart disease risk decreases as
blood levels of HDL-C increase.
(Black and Hawk’s Medical Surgical Nursing
8th Edition, volume 1, pg. 1382)
LDL 3.05 mmol/l 1.56 – 4.55 Normal
Sodium - - -
SGOT - - -
SGPT - - -
Potassium - - -
 Item Result Normal Analysis and Interpretation

Macroscopic
Color Yellow Straw/Amber Normal
Transparency Clear Clear Normal
pH 5.0 4.6-8.0 Normal
Specific Gravity 1.005 1.005-1.030 Normal
Sugar Trace Negative Deviation from Normal
•Glucose in the urine indicates
high blood glucose levels and
maybe indicative of
undiagnosed or uncontrolled
diabetes mellitus.
(Kozier and Erb’s
Fundamentals of Nursing, 8th
edition, volume 2, page 1293)
Protein Negative Negative Normal
Microscopic
Pus cells 0 – 1/HPF -
RBC 0 – 1/HPF <2 per HPF Normal
Epithelial Cells RARE
Bacteria RARE
Mucus Threads RARE
Crystals
Urates RARE
Procedure/Ite Result Reference Interpretation and Analysis
m Range
Hemoglobin 141 120 – 160 g/L Normal
Hematocrit 0.41 0.37 – 0.47 Normal
RBC - 4.0 – 5.4 x -
16^12/L
MCHC - 32 – 36 g/dL -
MCV - 27 – 33 -
MCH - 80 – 97 fl -
WBC 5.5 5.10 x 10^9/L Deviation from Normal
•An increase in white blood cells can often indicate that the body
is reacting to an allergen or to a minor infection. It can also
indicate injury to the tissue, such as that caused by a heart attack,
surgery or burns.
(Wallace, O. 2003. What Does a White Blood Cell Count Indicate?
Retrieved from http://www.wisegeek.com/what-does-a-white-
blood-cell-count-of-too-numerous-to-count-tntc-indicate.htm)
Different
Count
Segmenters 0.48 0.55 – 0.70 Deviation from Normal
Lymphocytes 0.44 0.23 – 0.40 Deviation from Normal
An increased percentage of lymphocytes (lymphocytosis) may
indicate:
•Chronic bacterial infection
•Infectious hepatitis
•Infectious mononucleosis
•Lymphocytic leukemia
•Multiple myeloma
•Viral infection (such as infectious mononucleosis, mumps,
measles)
•Recovery from a bacterial infection
(Brose, M. 2003. Blood Differential. Retrieved from
http://health.allrefer.com/health/blood-differential-results.html)
Eosinophils - 0.01 – 0.06 -
 Procedure/Ite Result Reference Interpretation and
m Range Analysis
Sodium 146.1 135 – 140 Deviation from Normal
mmol/L •An increased in plasma
sodium level greater than
145mEq/L is known as
hypernatremia.
Neurologic changes
manifested as confusion,
seizures, or coma, and in
some cases with
irreversible brain damage.
(Black and Hawk’s Medical
Surgical Nursing 8th
Edition Volume 1, volume
1, pg. 147)

Potassium 4.73 3.5 – 5.3 Normal

mmol/L
 2D Echo
Results Normal Volumes
LV edd 4.5 3.5 – 5.1 LV edv 93
LV esd 2.3 LV esv 18
IVS edd 1.1 0.8 – 1.1 SV 75
IVS esd 1.6 CO 3.5 L/min
LVPW edd 1.1 0.8 – 1.1 EF 81 % 55 – 77 %
LVPW esd 1.6 0.8 – 1.1 FS 49 % 29 – 42 %
LA (APdia) 3.6 3.0 – 2.5 -
Aortic Root 3.5 AV Opening
MPA 2.8 HR
RA 3.3 2.2 – 4.5
RV 3.0 2.3 – 4.0
LVET
EPSS 0.8 < 1.0 mm
MV annulus
TV annulus DT 188 160 – 220 msec

LV OT IVRT 112 60 – 90 msec

Color Flow and Doppler
Study

Value Vmax P.I.G. Onfice Regurgit

(m/sec) (mm Hg) Area ation

Aortic 0.7 2.1

Mitral .7/.9
Tricuspid

Pulmonic 0.8

PAT: TRjet: 36
Interpretation:
Normal left ventricular with adequate wall motion and contractility
Normal right ventricular diameter with adequate wall motion and
contractility
Normal left and right atrial diameters
Thickened mitral valves without restriction of motion
Structurally normal aortic, tricuspid and pulmonic valves
Normal vein pulmonary artery diameter
Nomal aortic aortic root
Color Flow and Doppler:
Mild mitral and tricuspid regurgitation
Reversed mitral inflow pattern
ESPAP of 36 mm Hg by TRjet
 
Conclusion:
Normal left ventricular resting systolic function grade 1 diastolic
dysfunction
Normal right ventricular size and function
No significant valve disease nor dysfunction
Mild pulmonary hypertension
Mild mitral & tricuspid regurgitation
 Chest X-ray
Radiologic Report
Both lung fields are clear
The heart is not enlarged
Aorta is tortous
Diaphragm and sinuses are intact
 
Impression
Atheromatous aorta
 
Interpretation:
Atheromatous aorta are found in chest x-ray results of a lot of
folks in their 40s above. It means that there are fat deposits
in her artery – the result of a lifetime of eating fatty foods.
Drug Study
Generi Dosage/ Classificatio Indication Contraindi Side Nsg.
c/ Frequency n cation Effects Responsibiliti
Trade es
Name
5mg/tab OD Antihypertens Hypertensio Hypersensiti Headache • Monitor Vital
Amlodi ive n alone or in vity to , nausea signs
pine Calcium combination amlodipine and • Monitor
channel with other vomiting cardiac
blocker hypertensiv rhythm
es during
stabilization
of dosage.
• Administer
drug without
regard to
meals.

Adalat 30mg OD Antihypertens Treatment Contraindica Dizziness, •Monitor Vital

ive for ted with light- signs.
Calcium hypertensio allergy to headedne •Do not exceed
channel n adalat ss, 30mg/dose
blocker vertigo, increases.
nausea •Protect drug
and from light and
vomiting moisture.
 Peripheral
Vessel 1 tab BID Anticoagu vascular Contraindic Pain, •Adjust dose
Due 1amp/IV lants insufficiency, ated with burn and according to
OD diabetic allergy to hematomcoagulation test
retinopathy, MI, vessel due a at the results performed
retinal vasal site of just before
thrombosis. injection. injection (30min
before each
intermittent dose
or every 4-6hr
continuous IV
dose).
•Always check
compatibilities
with other IV
solutions.
•Drug must be
given by
parenteral route
(cannot be taken
orally).
Lipway 1 cap HS Antihyperli Adjunct to Contraindica Diarrhea •Administer drug
SR pidemic diet for ted with and loss of with meals.
treatment of allergy to appetite •Monitor patient
adults with lipwar SR carefully.
hypertriglyce •Ensure that clients
ridemia continues strict
dietary restrictions.
•Give frequent skin
care to deal with
rashes and dryness.
•Monitor patient for
muscle weakness,
and aches.

Solosa 2 Antidiabeti Adjunct to Contraindica • Administer drug

met 500mg/t c agent diet and ted with before breakfast
ab OD exercise and allergy to • Monitor urine
lower blood antidiabetic and serum
glucose in drugs, glucose levels.
patients with Insulin- • Arrange for
type 2 (non- dependent transfer to
insulin- (type 1) insulin therapy
dependent) diabetes,. during high
diabetes stress.
mellitus • Provide skin
care to prevent
Omep 40mg/TIV Antisecreto Contraindicat Dizzines • Administer
razole OD ry drug ed with s, before
Proton hypersensitiv headach meals.
pump ity to e, Caution the
inhibitor omeprazole nausea client to
and its and swallow
components. vomiting capsules
, whole--- not
diarrhea to open,
and chew or
cough crush.
• Administer
antacids
with, if
needed.
Anatomy and
Physiology
 Vestibular System
"The first sensory system to fully develop by six months
after conception is the vestibular system, which controls
the sense of movement and balance. This system is
the sensory system considered to have the most
important influence on the other sensory systems
and on the ability to function in everyday life. Directly or
indirectly, the vestibular system influences nearly
everything we do. It is the unifying system in our brain
that modifies and coordinates information received
from other systems. The vestibular system functions like
a traffic cop, telling each sensation where and when it
should go or stop."
 and iii) the otolithic organs
(in the blue/purple
pouches), which transduce
linear accelerations.

The labyrinth of the inner

ear, from the left ear. It
contains i) the cochlea
(yellow), which is the
peripheral organ of our
auditory system; ii) the
 Anatomy
The vestibular system, which is the system of balance,
consists of 5 distinct end organs: 3 semicircular canals
that are sensitive to angular accelerations (head
rotations) and 2 otolith organs that are sensitive to linear
(or straight-line) accelerations.
The semicircular canals are arranged as a set of 3 mutually
orthogonal sensors; that is, each canal is at a right angle
to the other 2. This is similar to the way 3 sides of a box
meet at each corner and are at a right angle to one
another. Furthermore, each canal is maximally sensitive
to rotations that lie in the plane of the canal. The result of
this arrangement is that 3 canals can uniquely specify the
direction and amplitude of any arbitrary head rotation.
The canals are organized into functional pairs wherein
both members of the pair lie in the same plane. Any
rotation in that plane is excitatory to one of the members
of the pair and inhibitory to the other.
The otolith organs include the utricle and the
saccule. The utricle senses motion in the horizontal
plane (eg, forward-backward movement, left-right
movement, combination thereof). The saccule
senses motions in the sagittal plane (eg, up-down
movement).
Membranous Labyrinth
The membranous labyrinth is surrounded by
perilymph and suspended by fine connective tissue
strands from the bony labyrinth. It consists of an
anterior chamber and the cochlear duct, which
subserves hearing and connects by way of the
round saccule with the posterior vestibular
apparatus. The peripheral vestibular apparatus
consists of the saccule, utricle, and semicircular
canals.
Saccule
The saccule is an almost globular-shaped
sac that lies in the spherical recess on the
medial wall of the vestibule. It is
connected anteriorly to the cochlear duct
by the ductus reuniens and posteriorly to
the endolymphatic duct via the
utriculosaccular duct. The saccular macula
is an elliptical thickened area of sensory
epithelium that lies on the anterior vertical
wall of the saccule.
Utricle
The utricle is larger than the saccule and lies
posterosuperiorly to it in the elliptical recess of
the medial wall of the vestibule. It is connected
anteriorly via the utriculosaccular duct to the
endolymphatic duct. The 3 semicircular canals
open into it by means of 5 openings; the
posterior and the superior semicircular canals
share one opening at the crus commune.
The macula of the utricle lies mainly in the
horizontal plane and is located in the utricular
recess, which is the dilated anterior portion of
the utricle.
Semicircular canals
The 3 semicircular canals are small ringlike
structures: lateral or horizontal, superior or
anterior, and posterior or inferior. They are
oriented at right angles to each other and are
situated so that the superior and posterior canals
are at 45° angles to the sagittal plane, and the
horizontal canal is 30° to the axial plane. Each
canal is maximally responsive to angular motion in
the plane in which it is situated and is paired with a
canal on the contralateral sized so that stimuli that
are excitatory to one are inhibitory to the other.
The horizontal canal is paired with the
contralateral horizontal canal; however, the
superior canal is paired with the contralateral
posterior canal and vice versa. Each canal forms
two thirds of a circle with a diameter of about
6.5 mm and a luminal cross-sectional diameter
of 0.4 mm. One end of each canal is dilated to
form the ampulla, which contains a saddle-
shaped ridge termed the crista ampullaris, on
which lies the sensory epithelium. The
nonampulated ends of the superior and
posterior canal form the crus commune or
common crus. All canals merge into the utricle.
Semicircular canals afferents
The ascending branches of the fibers from the superior
and lateral canals terminate in the rostral part of the
superior vestibular nucleus in a distribution of large and
small fibers.
After giving off long collaterals in the nucleus, the
ascending branches continue directly to the cerebellum.
The incoming fibers from the posterior canal crista
bifurcate more medially, and the ascending branches
end in a more central and medial region of the superior
vestibular nucleus and also probably continue to the
cerebellum.
The descending branches of fibers from the 3 cristae
give collaterals mainly to the medial vestibular nucleus
and, to a lesser extent, to the lateral and descending
vestibular nuclei.
PHYSIOLOGY
The functions of the vestibular system are to sense
angular acceleration, linear acceleration and to
coordinate head and eye movements as well as
maintain the antigravity and lower body muscles in
relation to the head.  The semicircular canals provide
sensation for angular acceleration.  The membranous
labyrinth moves with head motion while the
endolymph does not, causing a relative flow of
endolymph and deflection of the cupula.  Each hair
cell has a resting potential and its associated neuron
has a spontaneous discharge.  Movement will cause
an increase in the discharge rate on one side and a
decrease from the paired canal on the opposite side.
 The otolith organs are sensitive
to linear acceleration.  Movement of
the otoconia mass deflects the hair
cells attached to it.  The maculae
have hair cells oriented in many
directions so linear acceleration in
any direction may be sensed.  The
saccule is most sensitive to gravity
since it is in the vertical plane.
The reflexes involving the vestibular system include
the vestibulo-ocular reflex and the vestibulospinal
reflex.  The vestibule-ocular reflex helps maintain
fixation of the eyes on an object with movement of the
head.  Both angular and linear acceleration signals are
use in the vestibule-ocular reflex.  Projections from the
vestibular nuclei to the extraocular muscle nuclei allow
for eye movements that counteract head movements
for gaze stabilization.  The vestibulospinal reflex allows
for input from the vestibular organs to be use for
posture and stability in a gravity environment.  The
projections from the vestibular nuclei travel to
antigravity muscles for coordinated movements to
maintain posture.
What causes BPPV?
BPPV is a disorder involving the vestibular system in the inner
ear. It develops when calcium carbonate crystals, which are
known as otoconia, shift into and become trapped within the
semicircular canals (one of the vestibular organs of the inner ear
—see diagram). The otoconia make up a normal part of the
structure of the utricle, a vestibular organ adjacent to the
semicircular canals. In the utrical, the otoconia may be loosened
as a result of injury, infection, or age and they land in a sac (the
utriculus), where they are naturally dissolved.
However, otoconia in the semicircular canals will not dissolve,
and, as a person’s head position changes with respect to gravity,
the otoconia begins to roll around and push on tiny hairs lining
the semicircular canals. Those hairs act as sensors to give the
brain information about balance. Vertigo develops when the hairs
are stimulated by the rolling otoconia.
Movements that can trigger an episode of BPPV include rolling
over or sitting up in bed, bending the head forward to look down,
or tipping the head backward.
Pathophysiolo
gy
 Assessment Diagnosis Analysis Goals & Nursing Rationale Evaluation
Objective Intervention
Subjective: Activity Most activity Goal: Independent: The goal was
•“Lagi lang naman intolerance intolerance is After an 8 hour Supplemental: met as
akong nakahiga related to bed related to shift, the client 1) Assist client in 1) Assisting the manifested by a
dito” rest generalized will be able to performing range client in report increase
•“Wala ka naman weakness and report an of motions such performing in activity
magawa kaya debilitation increase in as: range of motion tolerance as
higa’t upo nalang secondary to activity • rotating upper will help in the evidenced by
ang gagawin mo.” acute or chronic tolerance as and lower faster recovery. walking in
•“Nakakalakad illness and evidenced by extremities in a regular pace
naman ako. Pero disease. This is walking in circular motion . and on level of
dahil nga nahihilo especially regular pace and • walking for at indefinitely
ako tinutulungan apparent in on level of least 10-15mins. without the help
ako lagi ng asawa elderly patients indefinitely • flexion and of significant
ko.” with a history of without the help extension of the others.
Objective: orthopedic of significant extremities.
•Ambulatory with cardiopulmonary others. 2) Rest before
assistance diabetic or Facilitative: activities
•Limited pulmonary 2) Encourage provides time
movements such related adequate rest for energy
as lying, sitting problems. the periods, conservation
•Signs of mild aging process especially after and recovery.
dizziness by itself causes performing 3) Exercises
holding the reduction in activities. maintain
forehead when muscle strength 3) Encourage muscle strength
going out of bed and function active range of and joint range
•Walking slowly which can impair motion or of motion.
and evidence of the ability to exercise 4) Energy
shortness of maintain everyday. conservation
breath after activity. Activity methods reduce
walking intolerance may 4) Teach methods oxygen
also be related to conserve consumption,
to factors such energy such as allowing more
as side effects of stopping to rest prolonged
medications or for 3 minutes activity.
prolonged bed during a 10-
 Assessment Diagnosis Analysis Goals & Objective Nursing Rationale Evaluation
Intervention
S> The patient Risk for May causes or Goal: Independent: Within the 8 hours
defecates 2 times a constipation r/t factors that may After the 8 hour 1)Determines stool 1)assist in of shift the client
day before irregular affect constipation, shift the client will color, consistency, identifying will verbalize
hospitalization defecation habits among them were maintain usual frequency, and causative/ understanding of
> The patient only insufficient fiber bowel elimination amount contributing risk factors and
defecates once since intake, insufficient pattern as factors and appropriate
his hospital stay, fluid intake, evidenced by appropriate interventions
hard in consistency insufficient activity normal consistency 2)Auscultate bowel interventions related to
or immobility, and frequency of sounds 2)Bowel sounds areconstipation
O> Audible bowel irregular defecation the stool. generally increased
sounds habits, change in in diarrhea and
daily routine, decreased in
chronic use of 3)monitor intake and constipation
laxatives and output (I & O) with 3)May identify
enemas, irritable specific attention to dehydration,
bowel syndrome, food/ fluid intake excessive loss of
pelvic floor fluids or aid in
dysfunction or identifying dietary
muscle damage; 4)Encourage fluid deficiencies
medications such as intake to 2500- 4)Assist in
opiods, iron 3000ml/day within improving stool
supplements, count cardiac consistency if
antihistamines, tolerance. constipated. Helps
antacids and 5)Provide privacy and maintain hydration
antidepressants routinely scheduled status if diarrhea is
time for defecation present
6)Educate client/SO 5)So that the client
about safe and risky can respond to
practices for urge
managing 6)Information can
constipation help the client to
7)Discuss use of stool make beneficial
softeners, mild choices when need
stimulants, bulk arises
forming-laxatives, or 7)Facilitates
enemas as indicated defecation when
8)Encourage client to constipation is
maintain elimination present
 Assessment Diagnosis Analysis Goals & Nursing Rationale Evaluation
Objective Intervention
S> Self-care deficit Motivations for Goal: Independent: The goal was met
•“Minsan lang ako related to personal hygiene After the 8 hour Supplemental: as manifested by
maligo lalo pag personal hygiene practice include shift the client will 1) Discuss 1) This will help verbalizing an
hindi mainit yung practices reduction of verbalize importance of the client understanding
tubig.” personal illness, understanding proper hygiene understand what and willingness
•“Pag malamig ang healing from and willingness by proper hygiene by enumerating
tubig ayokong ng personal illness, enumerating is. proper ways of
maligo.” optimal health proper ways of 2) Encourage the 2) Deodorant maintaining
•“Hindi ako and sense of well maintaining use of deodorant helps in hygiene.
gumagamit ng being, social hygiene. after bathing. minimizing body
deodorant.” acceptance and 3) Encourage to odor.
•“Isang beses lang prevention of wash hands 3) This will help
ako spread of illness thoroughly. prevent the
nagtotoothbrush sa to others. Risk for spread of
isang araw.” infection or 4) Encourage to microorganisms.
O> contamination of take a bath 4) This will also
•Presence of breath the body may be everyday. help prevent the
odor an effect of spread of
•Presence of body improper personal microorganisms.
odor hygienic 5) Encourage to 5) Brushing teeth
•Presence of 22 practices. Body brush the teeth at helps remove
adult teeth hygiene is least twice a day. microorganisms
•Teeth are rough in achieved by using present and
texture and there personal body prevent dental
is discoloration of hygiene products problems
the enamel (black including: soap, 6) Encourage client 6) To reduce the
in color) hair shampoo, to maintain proper risks of having
toothbrushes, hygienic practices infection and
tooth paste, even after diseases.
cotton swabs, hospitalization
antiperspirant,
facial tissue,
mouthwash, nail
files, skin
 Assessment Diagnosis Analysis Goals & Nursing Rationale Evaluation
Objective Intervention
S> Readiness for When systems in Goal: Independent: The goal was met
•“Simula nga sa enhanced the body respond After the 8 hour 1) Identify steps 1) Understanding as manifested by
paglabas ko dito sa therapeutic to treatments and shift the client will necessary to reach the process verbalizing
ospital hindi na ko regimen medications, it verbalize the desired health enhances responsibilities
talaga management results to good responsibilities for goals. commitment and for managing
manigarilyo.” related to health. Thus, our managing likelihood of treatment
•“Dati kasi halos 4 avoidance of body is ready to treatment achieving the regimen and
na bote naiinom. smoking and regain its normal regimen and 2) Acknowledge goals. enumerating
Paglabas ko dito alcohol drinking. functioning. enumerate ways patient’s efforts to 2) Provides ways to achieve
babawasan ko na to achieve these reinforce positive these
at talagang pag responsibilities. movement toward reinforcement responsibilities.
may okasyon attainment of encouraging
nalang.” desired outcomes. continued
O> progress toward
•Noted some 3) Encourage desired goals.
dizziness but can utilization of 3) This will help
move. community more in the
•Can walk slowly programs regarding acquisition of
•Receive in a good anti-smoking and knowledge
mood alcohol drinking. regarding the
•Talking without 4) Encourage the problem.
any signs of cooperation of 4) This will help
distress significant others. the patient
•Happy and understand more
express self freely the situation and
5) Accepts client’s to continue the
evaluation of own effort given.
strengths/limitation 5) Promotes
s. sense of self-
esteem and
6) Encourage client confidence to
to continue continue efforts.
interventions for 6) This will also
easy progress of help in reduction
Discharge
Plan
Medicine:
a.) Encouraged client to take medications as
prescribed by his physician,
• Solosamet 2/500mg
• Lipway 250mg before bedtime
• Vessel due (twice a day)
• Hypromellose eyedrops
• Betahistine 16g (thrice a day)
• Vit B Complex (twice a day)
• Adalat 30mg (once a day)
b.) Teach patient of the different side and
adverse effects of the drugs.
c.) Report any unusualities when taking the
prescribed drug such as nausea and
vomiting or skin allergies.
d.) Instruct him not to take other medications
without consulting with her physician to
prevent any harmful drug-drug interactions.
Exercise
a.) Exercises for vertigo often sound very simple. But
depending on the severity of your vertigo, you may
find them difficult to do. They generally consist of
exercises that practice:
• Maintaining balance while standing still.
• Maintaining balance while swaying.
• Maintaining balance while turning.
• Maintaining balance while walking.
• Head movements. Head movements are one of the
most common triggers of vertigo. Practicing moving
your head may help your body learn how to deal
with the problems that cause your vertigo.
Treatment
a.) Encouraged the patient to comply with the
medication as ordered by her physician.
b.) Explain the importance of adhering to her
treatment regimen.
c.) Teach the Epley Maneuver with the SO

• The procedure is as follows:

• Sit upright.
• Turn your head to the symptomatic side at a 45
degree angle, and lie on your back.
• Remain up to 5 minutes in this position.
• Turn your head 90 degrees to the other side.
• Remain up to 5 minutes in this position.
• Roll your body onto your side in the direction
you are facing; now you are pointing your
head nose down.
• Remain up to 5 minutes in this position.
• Go back to the sitting position and remain up
to 30 seconds in this position.
• *The entire procedure should be repeated
two more times, for a total of three times.
• *During every step of this procedure the
patient may experience some dizziness.
Health Teaching
a.) Instruct the client to:
• Do not walk without help, drive a car, or operate
heavy machinery if you are feeling dizzy.
• Sit or lie down right away when you feel dizzy. Keep
your head as still as possible and do not change
positions quickly.
• Sudden head movements may sometimes cause
dizziness. Move slowly and let yourself get used to
one position before moving to another position. This
is very important, especially when getting up from a
lying down or sitting position.
Out- patient referral:
• a.) Inform the patient to have follow-up check-
up after a week to prevent possible
complications and to update the medical team
concerning the progress of the patient’s
condition and to promote continuity of care
Diet:
• Eat less salty and fatty foods.
• Limit sugar food intake
• *Vertigo has also been associated with high
cholesterol and high blood sugar, so dietary
changes may be necessary to treat and prevent
vertigo
THANK YOU!!!
Presented by:
BSN122
Jacinto, Arvie
Mariano, Lalaine