SHRI. K.L.

SHASTRI SMARAK NURSING COLLEGE,

LUCKNOW

NURSING CARE PLAN

ON
BRAIN TUMOR
SUBJECT: PAEDIATRIC

SUBMITTED TO: SUBMITTED BY:

Pushpanki Varun

HOD, Dept. Of child health nursing M.Sc. Nursing (1st year)

SUBMITTED ON:
 HISTORY TAKING
IDENTIFICATION DATA:

NAME : Master Chotu Singh

AGE : 2 years
SEX : Male
WARD : PICU
MRN NO : 2427412245
CONSULTANT : Dr. Anand
DATE OF ADMISSION :
PARIENT’S EDUCATION : High school pass ( Mother & father )
RELIGION : Hindu
ADDRESS : Village
DIAGNOSIS
PROVISIONAL DIAGNOSIS : Fever , vomiting , bilging of posterior fossa
FINAL DIAGNOSIS : Brain tumor
DATE OF OPERATION :
OPERATION : Frontal burrholes with duraplasty

HISTORY OF PATIENT
 PRESENT COMPLAINTS: My patient MR. Chotu Singh has following
present complaint :
 Vomiting since 1weeks
 Bulging since 5 days
 Anorexia since 4 days
 Weakness since 3 days
  ILLNESS HISTORY :
 Present medical history : My patient is complaining about vomiting &
bulging of posterior fossa.
 Past medical history : Nothing significant
 Present surgical history: Frontal burrholes with duraplasty
 Past surgical history : Nothing significant
 SOCIOM-ECONOMIC STATUS : My patient lived in Village Achalpur.
They have own house that contains two rooms , one kitchen , one toilet. His father
have own business with monthly income 12000 and they belong to middle class
family.
 FAMILY HISTORY : My patient belong to joint family.

Sr Name of the Age/sex Relationship Occupation Education Medical

No. family with patient history
members
1 Mr. Ram singh 25yrs/M Father Business 10th pass Good

2 Mrs leela devi 23yrs/F Mother Housewife 10th pass Good

3 Master Chotu 2yrs/M Patient -- -- Unhealthy

Singh
FAMILY TREE :

Mr. Ram singh Mrs. Leela devi (23yrs)

(25 yrs) KEY

Male

Mr. Ravishankar female

(2 yrs)
Patient
 PERSONAL HISTORY:
  Personal history : Patient mother maintained his personal hygiene.
 Dietrary : Dr prescribed him fluid diet.
 Sleep /rest : Patient sleeping pattern is interrupted due to disease condition. He is
taken 20 hours sleep daily.
 Elimination : Patient have normal urine & stool frequency
 Activity & exercise : My patient activity is dull.
 Habits : My patient is not having any bad habits.
 Allergy : Patient is having allergy in cold things.

 NATAL HISTORY :
 Prenatal history : FHS was normal.
 Intranatal history: Mother has under gone normal Delivery.
 Postnatal history: No congenital anomalies , reflexes were normal.

 IMMUNIZATION SCHEDULE:

SR.NO. VACCINE GIVEN NOT GIVEN

1 BCG 
2 OPV 
3 DPT 
4 Hepatitis 
5 Measles 
6 MMR 
  GROWTH & DEVELOPMENT

MILESTONE BABY PICTURE BOOK PICTURE

 Social smile 3 months 6 weeks
 Sitting without 6 months 8 months
support
 Transfers object 8 months 7 months
from one hand to
another hand
 Standing without 11months 9 months
support
 Say simple 18 month 2 years
sentances

PHYSICAL EXAMINATION:
 GENERAL APPEARANCE :
Body built : Thin
Nourishment : Underweight
Look : sad
Mental status : good
Posture : normal
Skin & colour : skin is brown in colour
Birth marks : No birth marks

 VITALS :

SR. NO. VITAL SIGN PATIENT VALUAE NORMAL VALUE

1 Temperature 101`F 98.6`f
2 Pulse 128beats/min 120-140beats/min
3 Respiration 45breaths/min 40-60/breaths min
4 Blood pressure 50/60 mm of hg 60/40 mm of hg
  ANTHROPOMETRIC MEASUREMENT
Height : 3’’1’
Weight :11Kg
HC : 50cm
CH :53cm
Mid arm circumference : 18cm

 HEAD

Scalp- Scalp is clean & sebum production is normal. Size of skull is relatively
largely

Hairs – Hairs are black in colour & quantity of hairs is good, No infection

 EYES
Eyebrows-Eyebrows are present.
Eyelids- Eyelids are normal.
Discharges- No discharge
Vision- vision is normal
Lens – lens is normal

 EARS
Discharge- no any kinds of discharges present
Hearing ability- hearing ability is normal.

 NOSE
Nasal septum- nasal septum is normal
Discharge- watery discharges
Nostril- Nostril are normal in shape but rashes are seen.

 ORAL CAVITY
Lips – lips are pink in colour.
 Tongue- tongue is pink.
Teeth – teeth are examined carefully for their time of eruption.

 NECK
Alignment – neck alignment is normal.
Movement – movement of neck is good.
Glands & lymph nodes – No enlarge glands & lymph nodes.

 CHEST
Inspection- no any lesions or scars
Palpation- no any hard mass
Purcustion- no sign of pleural effusion
Auscultation- normal heart sound
Breath sound- wheezing sound

 ABDOMEN
Inspection- no skin rashes
Palpation- no organomegally
Purcustion- no fluid accumulation
Auscultation- bowel sound is heard

 MUSCULOSKELETON SYSTEM:
Body alignment- Body alignment is good.
Movement – movements are normal
Joint – joints are not having pain.

 NERVOUS SYSTEM: Eye , Motor & verbal response are normal. Patient give
responses to stimuli.

 BACK : No abnormalities
 GENITALIA : No discharge
INVESTIGATION:

INVESTIGATION PATIENTS VALUE NORMAL VALUE REMARKS

Haematology

Haemoglobin 7.2 gm/dl M-13-16 , F-12-15 Normal

Packed cell volume 21.9 % M-40-54 , F-36-97 Decreased

T.L.C. 13,300/cm 4000-11000 Increased

D.L.C.

Neutrophils 38% 40-70 Decreased

Lymphocytes 54% 20-45 Increased

Eosinophil 02% 1-6 Normal

Monocyte 00% 2-10 Decreased

Basophil 00% <1-2 Normal

Blood serum

Serum Ca 8.63 mg/dl 3.4- 10.4 Normal

Serum Na+ 139mmol/l 135-145 Decreased

Serum potassium 4.30mmol /l 3.5-5.5 Normal

MEDICATION CHART :

SR. NAME DOSE ROUTE TIME ACTION SIDE- NURSING

NO. OF EFFECT RESPONSIBILITY
DRUG
1 Deulin 1 ml Inhalation TDS Bronchodilators headache, Nurses should
dizziness, check the
hypersensitivity to
drugs.

2 Inj. 0.5 ml I/V BD H2 receptor skin Nurses should

Rantac antagonist rashes, avoid this drug in
headache, the presence of
dizziness, gastric
mental malignenecy.
confusion

3 Inj. 0.8 I/V TDS Antiemetic headache, Nurses should

Emset ML dizziness, check the
vertigo hypersensitivity to
drugs.

4 Inj. 0.5 ml I/V TDS Non- opoid epigastric The nurses should
Dynapar analgesic pain , take special
vomiting precautions for the
patient with GI
ulceration
 NURSING DIAGNOSIS-

 Acute pain related to tumor compression.

 Fluid volume deficit related to fever $ poor feeding.
 Fatigue related to increased work of breathing
 Knowledge deficit related to care of child
 Anxiety related to respiratory distress & hospitalization
 Vomiting related to disease condition
 Imbalanced nutrition less then body requirement related to decreased nutritional

ASSESSMENT NURSING GOALS INTERVENTION IMPLEMENTATION RATIONAL EV

DIAGNOSIS

SUBJECTIVE Acute pain To reduce Assess the pain Patient condition was It will help to Ex
DATA: related to tumor pain rating scale. assessed. know the base pa
Patient’s compression (intensity , line data of the ev
parents duration , quality ) patient. wa
complaining
about pain on Give comfortable comfortable position was It will help to
posterior fossa. position to the given to to the patient. provide relax to
patient. ( semifowlers) the patient.
OBJECTIVE
DATA: Give non Exercise , mobility , was It will help to
After observation pharmacological provided. reduce the pain.
it was found that treatment to the
because of patient.
tumour
compression pain
occur. Provide medication. Medication was given . It will help to
(Inj.Dynapar), reduce the pain

intake.
 Altered body temperature related to pyrexia ( 101`f )
 ASSESSMENT NURSING GOALS INTERVENTION IMPLEMENTATION
DIAGNOSIS RATIO
SUBJECTIVE Vomiting To reduce Assess the Patient condition was It will
DATA: related to vomiting condition of the assessed. know th
Patient’s headache or patient related to line data
parents tumor vomiting. patient.
complaining
about repeated Provide Comfortable position It will
episodes of comfortable was provided to the give re
vomiting position to the patient. (semifowlers) the patie
patient. .
OBJECTIVE
DATA: Provide low & Dalia , soup was It will
After frequent fluid diet. provided. easy di
observation it of food.
was found that
vomiting due to
headache.. Provide Medication was given . It will
medication. ( Antiemitics ) reduce
vomitin

SMENT NURSING OBJECTIVE INTERVENTION IMPLEMENTATION RATIONAL EVALUAT

DIAGNOSIS
ECTIVE Imbalanced To improve Assess the Patient condition was It will help to Expected
: nutritional less the nutritional condition of the assessed. know the base outcome p
’s than body status of the patient related to line data of the met as ev
parents requirement patient nutritional status . patient. by nutr
aining related to tumor status
less ,decreased maintained
ted in nutritional Before meals oral Oral hygiene was It will help to improved.
or intake hygiene is provided. provided. improve
ia. intake.
Provide fluid diet
CTIVE according to taste of Dalia , soup was
: the patient. provided. It will help to
observation easy digestion
found that Check the daily of food.
e of weight of the Weight was checked.
ng patient patient. It will help to
ss know the
ted in weight of the
patient.

THEORY APPLICATION
J.W. Kenney’s theory
The present theory in based on J.W. Kenney which was based in systems theory
of Luduing van Bertanlaffy (1968). According to J.W. Kenney there is continuous
exchange of matter energy and information.
Input:
According to J.W. Kenney input can be mater energy and information from the
environment.
Throughput
According to J.W. Kenney, the matter, energy and information are continuously
processed through the systems.
Out put
Output is the result of the input and output.
Feedback
 Feedback is the ultimate outcome of the process. If output is not proper then the
whole process occurs again.
 Input Throughput Output

 Comfortable position  Proper position  Breathing pattern

 (Prose or supine)  Suctioning improved
 Place infant on incubator,
 Warmer, Humidifier  Nutritional statues is
radiant warmer
 Aseptic techniques  Vital signs improved
 O2 administration  Give O2 administration  Fluid and electrolyte
 Give par entered fluids
 Mechanical ventilator balance maintained
 Maintain aseptic
support technique  Maintained skin integrity
 IV fluids  Administer medications  Risk for infection is
 Maintain skin integrity
 Medication reduced
 Encourage parents to in
 Neat and Clean valve in aspects of infant  Stable body
environment care temperature maintained.
 Radiant warmer  Emphasize posture
aspects of child care
 Suction apparatus.

FEED BACK
 HEALTH EDUCATION

1. Personal hygiene

 Educate the family member to maintain personal hygiene of the client such as mouth care, back care, sponge bath and provide
clean clothes for patient

2. Diet

 Taught the family member to give fluid diet for patient

 Instructed to family member to give nutritional diet rich in protein, iron & CHO
3. Exercise

 Explained the relatives to make the client perform coughing and breathing exercise
 Explained the limit exercise to be performed by the client
 Explained the relatives to help the patient in moving
4. Medication:

 Taught the relatives about medication and give medicine on correct time.
 To monitor side effect of drugs. if present inform to doctor
5. Follow up

 Explained to relatives about the possible complication that may occur and to contact with physicians
 Give medicine on time
  Taught about importance of follow up regularly.

SUMMARY

Master. Chotu singh admitted in …………………………………………………….. hospital with complaint of vomiting, bulging and anorexia..

It was diagnosed as Brain tumor and was treated surgically. I selected this case for my nursing care plan. I provided care for this patient for 3

days. The patient condition is improved within my care period.

CONCLUSION

I have taken nursing care plan on Master chotu singh admitted with as brain tumor. It was surgically treated. It was nice experience for
me to study the case.