Brain Tumor
Brain Tumor
Brain Tumor
Subjective: • Acute pain related to After 8 hours of proper 1. Assess the location, and
severe headache and nursing intervention the pt. duration of headache and
“Labad kaayo akong side effects of pain in the incision every 2 Goal partially met
will :
ulo miss as verbalized hours.
treatments secondary to
by the pt. report decreased pain as R- Sudden changes or severe
convexity meningioma pain may indicate increased ICT
evidenced by:
Objective: and should be reported to the
Scientific Bases
• Reported no doctor.
• Pain scale of Because the brain has no 2. Encourage verbalization of
discomfort,
7/10 feelings
pain receptors, brain
• Vital signs within R- Pain is subjective experience
• Moaning tumors themselves do and cannot be felt by others
not cause headache normal limits,
3. Observe non-verbal cues
• Appears pain. Headaches are • Negative symptoms and pain behaviours
agitated actually the result of the R-Observations may not be
growth of meningioma Verbalize non-pharmacologic congruent with verbal reports
• C beaten look 4. Monitor skin colour and
or tumor, its increasing methods that provide relief.
temperature and vital signs
• C facial grimace size can increase
R- this aspects are usually
pressure inside the skull altered in acute pain
• diaphoretic and related fluid build- 5. Provide comfort measures
up on pain-sensitive like touch, repositioning,
blood vessels and nerves use of hot and cold packs,
within the brain. nurse’s presence
R- to promote a non-
Source: pharmacologic pain
management
Hinkle & Cheever: 6. Instruct in and encourage
Brunner&Suddarth’s use of relaxation
techniques like focused
textbook of Medical –
breathing and imaging
Surgical Nursing R- To distract attention and
13thEdition:Vol. 2, reduce tension
pp.2052-2057 7. Identify ways or methods
of avoiding or minimizing
pain
R- to explore methods for
alleviation/control
8. Encourage adequate rest
periods
R- to prevent fatigue
9. Review ways to lessen pain,
including techniques such
as Therapeutic touch (TT),
biofeedback, and
relaxation skills.
R- To promote wellness
Dependent
1. Administer analgesics as
indicated to maximum
dosages as needed
Collaborative
1. Collaborative treatment of
underlying condition or
disease processes causing
pain and proactive
management of pain
R- to assist client to explore
methods for alleviation/control
of pain
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATION
OUTCOME
Subjective: Situational Low Self- After 8 hours of nursing 1. Assess the response, Goal Met
“ naka perwisyo na Esteem related to intervention the patient and the patient's
gyud kos akoang dependency, role will be able to: family's reaction to Demonstrate
pamilya” as changes, changes in self- Demonstrate disease and treatment. behaviours to
verbalized by the image R /: To simplify the
behaviours to restore positive
pt. process approach.
SB: restore positive 2. 2. Assess the self-esteem
Development of a self-esteem relationship between Express positive
Objective: Express positive appraisal
negative perception of patient and close family
Not taking appraisal members. Identify feelings
responsibility self-worth in response
to current situation. Identify feelings R /: Support families and underlying
for self-care, and underlying helps in the healing dynamics for
lack of follow- process
Doenges, Moorhouse, dynamics for negative
through 3. Involve everyone
Murr, Nurse’s Pocketguide: negative perception of self
Change in self- nearby in education
Diagnosis, Prioritized perception of self
perception/oth and home care
er’s perception Interventions, Rationales, planning.
of role 12ed, pp. 723-726 R /: Can ease the
burden on the handling
and adaptation at home
4. Give time / listen to the
things that become
complaints.
R /: continuous support
will facilitate the
adaptation process.
5. Encourage expression
of feelings, anxieties
R/: Facilitates grieving
the loss