PBL PRESENTATION

GROUP 1
(WEEK 1)

GROUP 1
Muhamad Shukur bin Amir
DNM/1399/11
Nik Nurul Athirah binti Nik Mod Kamal DNM/1441/11
Nur Izzatul Asna binti Ismail
DNM/1444/11
Mysara Izzati binti Ishak
DNM/1409/11
Nur Athirah binti Aziz
DNM/1482/11
Nur Ain bt.Dzulkiply
DNM/1512/11
Norhazliana bt. Che Harun
DNM/1430/11

Scenario 1: Nursing
Management for Fever
Mariam age 16, was brought to clinic
by her parent because shes having
epigastric pain. Dr. Kamariah has done
an assessment on her and decided that
she needs to be admitted at 7Utara for
further management.

Scenario 1
Health History

Name : Mariam
Age : 16 years old
Gender : Female

OBJECTIVES

Define epigastric,pain and epigastric

pain.
Identify anatomy and physiology of
epigastric.

Describe the nursing implication for

pharmacologic agents used to
reduce the symptom.
Apply the nursing process for
management

EPIGASTRIC PAIN AND

MANAGEMENT OF FEVER

DEFINITION
Epigastric
The middle of upper abdomen.

Pain
The International Association for the Study
of Pain (IASP) define, pain is an unpleasant
sensory and emotional experience
associated with actual or potential tissue
damage or it is described in terms of such
damage. Pain can be a major factor
inhibiting the ability and willingness to
recover from illness.

Cont.
Epigastric pain
Epigastric pain is pain that is localized to the
region of the upper abdomen immediately
below the ribs. Often, those who experience
this type of pain feel it during or right after
eating or if they lie down too soon after eating.
It is a common symptom of gastroesophageal
reflux disease (GERD) or heartburn. It may be
associated with the gastric contents moving
upward into the back of the throat, causing
inflammation and a burning pain.

SIGN and SYMPTOM

severe burning feeling in the abdomen,

chest and neck that prevents sleep.
constipation, diarrhea, and vomiting,
depending on the underlying cause.
Epigastric pain may accompany other
symptoms, which vary depending on
the underlying disease, disorder or
condition.

ANATOMY AND PHYSIOLOGY

REGION OF ABDOMEN
Epigastric
area

ETHIOLOGY OF EPIGASTRIC
PAIN

Epigastric pain is the result of overeating,

drinking alcohol while eating, or
consuming greasy or spicy foods.
caused by digestive conditions such as
acid reflux or lactose intolerance.
Gastroesophageal reflux disease (GERD) is
another possible cause of epigastric pain.
Inflammatory diseases or cancers affecting
the gallbladder, pancreas or stomach may
result in epigastric pain.

Common Causes of
Epigastric Pain
Dyspepsia (indigestion)
Gastritis (inflammation of the stomach lining)
Gastroesophageal reflux disease (GERD), a
condition in which acidic stomach contents flow
back into the esophagus
Heartburn
Lactose intolerance
Pregnancy
Side effects to medications, such as aspirin and
nonsteroidal anti-inflammatory drugs (NSAIDs)

Other Causes of Epigastric

Pain
Barretts esophagus (cellular changes in the
esophagus that may lead to esophageal cancer)
Esophagitis (inflammation of the esophagus)
Gallstones or gallbladder disease
Hiatal hernia (protrusion of the stomach into the
chest through a hole in the diaphragm)
Pancreatic cancer
Pancreatitis (inflammation of the pancreas)
Peptic ulcer or perforated peptic ulcer, resulting in
stomach bleeding or an intestinal ulcer
Stomach or esophageal cancer

Serious or Life-threatening
causes of Epigastric Pain
In some cases, epigastric pain may be
a symptom of a serious or lifethreatening condition that should be
immediately evaluated in an
emergency setting. These include:
Angina (chest pain due to the heart not
getting enough oxygen)
Heart attack (myocardial infarction)

What are the potential

complications of epigastric pain?
Cancer of the esophagus, stomach, or other
organs
Esophageal scarring and narrowing
Myocardial infarction (heart attack), if the
pain is due to angina
Poor nutrition due to a decreased desire to
eat
Poor quality of life
Spread of cancer
Spread of infection

TYPE OF PAIN

ACUTE PAIN
usually of recent onset and is most commonly
associated with a specific injury. It is time
limited and generally has a defined cause and
purpose. It may be mild, moderate or severe in
nature and is usually sudden in onset.

CHRONIC PAIN
is a complex physiological and psychological
phenomenon that causes varying degrees of
disability in a large portion of the population.
Chronic pain is constant or intermittent in
nature that persist over a period of time and it
is often defined as pain that lasts for six
months or more. Chronic pain also classified as
a malignant or non-malignant.

Ethiology and
Pathophysiology
Examples of disease:DISEASE
Gastritis

Peptic Ulcer Disease

Gastritis
Ethiology
short-term inflammatory
process that can be
initiated by numerous
factors
such as excess
alcohol
ingestion, drug
affect aspirin,
etc.

Physiology
Gastritis occur, result of breakdown in normal gastric mucosal
(protect stomach tissue from auto digestion by acid and
enzyme pepsia)
Barrier broken
Acid diffuse into mucosa
Allow HCl to enter
HCl acis stimulates the conversion of pepsinogen to pepsin
Also stimulate the release of histamine from mast cell
Tissue edema (disruption of capillary walls with loss of plasma
into gastric lumen) occurs
hermorrhage

Peptic Ulcer Disease (PUD)

Ethiology
infection by the organism
Helicobacter pylori (H.pylori)
which produces a chronic
gastritis.
decreasing or increasing of
gastrical secretions lead to
peptic ulcer included in the
difference between gastric
and
duodenal ulcer.

Pathophysiology
Stomach is protected from autodigestion by gastric mucosal barrier.
Mucosal barrier can be impaired and back-diffusion of acid can occur (under
specific circumstances)
Barrier is broken
HCl acid freely enters mucosa
Injury tissue and cellular destruction and inflammation
Histamine release from damage mucosa
Vasolidation and increased caillary permeability
Stimulate further secretion of acid and pepsin
H.Pylori (agent to destroy mucosal barrier) may create chromic inflammation
Drugs inhibit synthesis of mucus e.g .aspirin cause abnormal permeability
Mucosal barrier disrupted, compensatory increase in blood flow

PHYSICAL EXAMINATION
Inspection
note made of the shape of the
abdomen, skin abnormalities,
abdominal masses, and the movement
of the abdominal wall with respiration.
Auscultation
for detection of altered bowel sounds,
rubs, or vascular bruits.

Percussion
useful and kind test for abdominal
tenderness or peritonism.

Palpation
the examination of the abdomen for
crepitus of the abdominal wall, for any
abdominal tenderness, or for
abdominal masses.

Definition ,sign and

symptom of fever

An elevation at temperature above

normal range of 36.5 C due to an
increase in body temperature regulator
y set point
The increase in set point trigger
increase muscle tone and shivering

Chill and rigor

Chill is a sensationof cold, usually with

shivering.
Rigor is a shaking occurring during a high
fever. occurs because cytokines and
prostaglandins are released as part of an
immune response and increase the set
point for body temperature in the
hypothalamus
It is sometimes considered a symptom for
"chills

Vomiting(kemuntahan)

Ejection part or all of the contents of

the stomach through the mouth,
usually in a series of involuntary
spasmic movements

Clinical Manifestation for

Fever

Pain
Nausea
Weakness, or fatigue
Chill and rigor

Medicine or drug

DEFINITION
A drug or medicine given to reduce
pain without resulting in loss of
consciousness.

FEVER
Paracetamol, panadol
Generic
Name
Brand
Name
Group

acetaminophen

Purpose

relief of fever , relieves pain in mild

arthritis,

Side Effect

liver damage due to large doses, Doses of

acetaminophen greater than the
recommended doses are toxic to the liver
and may result in severe liver damage.

Tylenol and others

analgesics (pain relievers) and antipyretics
(fever reducers)

VOMITING
Benadryl
Generic
Name
Brand
Name
Group
Purpose

Diphenhydramine

Side Effect

Sleepiness, fatigue, or dizziness, headache,

dry mouth; or difficulty urinating or an
enlarged prostate.

Aler-Tab, Allergy, Allermax, Altaryl,

Benadryl, Children's Allergy
Antihistamine
Symptoms of allergies and the common
cold.

NURSING DIAGNOSIS

Diagnosis
Objektif
kejururawata
n

Intervensi

Sakit b/d
epigastrik pain
d/d aduan
pesakit

-Taksir keadaan dan -Untuk memudahkan

tahap kesakitan
tindakan kejururawatan
pesakit.
seterusnya

Kesakitan
pesakit
akan
dapat
dikurangk
an.

-rehatkan dan
posisikan pesakit
pada posisi yang
selesa

Rasional

-untuk keselesaan
pesakit

-rancang prosedur
-untuk mengurangkan
yang akan dilakukan pergerakan pesakit
pada pesakit
-kawal kemasukan
pelawat di luar
waktu waktu
melawat

-supaya pesakit dapat

berehat

-beri analgesik
seperti yang
dipreskripsikan oleh
doktor

-untuk mengurangkan
kesakitan pesakit

Diagnosis
kejururawatan

Objektif

Intervensi

Demam b/d infeksi d/d

bacaan suhu badan
pesakit tinggi(37.5-40
darjah Celcius)

Demam
pesakit akan
berkurangan
dengan
bacaan suhu
badan
normal(36.537.4 darjah
Celcius) dalam
masa sehari

-Taksir tahap
keadaan
pesakit.

Rasional

-supaya tindakan
kejururawatan
dapat diambil
-Untuk mengesan
sebarang
-pantau tanda- keabnormalan
tanda vital
pesakit setiap
4jam sekali.
-untuk
menggalakan
pengaliran haba
-lakukan
daripada badan
mandi
pesakit ke
berjelum
persekitaran
secara konduksi

-pastikan
ventilasi yang
mencukupi
seperti pasang
kipas atau

-menggalakkan
pembebasan
haba daripada
badan pesakit ke
persekitaran

Diagnosis
kejururawatan

Objektif

Intervensi

Rasional

Risiko dehidrasi b/d

kemuntahan d/d kulit
pesakit kering

Tahap hidrasi
pesakit akan
terkawal dan
kulit pesakit
lembab

-tafsir
keadaan dan
tahap hidrasi
pesakit

-untuk
mengesan
tahap hidrasi
dan tandatanda
dehidrasi
pesakit

-catat setiap
pengambilan
dan
pengeluaran
cecair pesakit
dalam carta
pengambilan
dan
pengeluaran.
-monitor
keadaan urin
(amaun,warna
dan bau)

-pesakit akan
mengalami
dehidrasi
sekiranya
tahap
pengeluaran
cecair adalah
lebih banyak
daripada
pengambilan
-mengesan
tanda-tanda

Diagnosis
kejururawat
an

Objektif

Intervensi

Rasional

-monitor
keputusan
BUSE:kreatinin

-untuk mengesan
ketidakseimbangan
elektrolite dalam
badan

-tafsir semula
keadaan dan
tahap hidrasi
pesakit

-untuk
memudahkan
tindakan
kejururawatan
diambil

Diagnosis
Objektif
kejururawata
n

Intervensi

Rasional

Bimbang b/d
proses
penyakit d/d
pesakit
kelihatan
bimbang dan
gelisah

-tafsir tahap
kebimbangan
pesakit

-memudahkan
tindakan
kejururawatan
seterusnya
dilakukan

Kebimbangan
pesakit akan
dapat
dikurangkan

-galakkan pesakit
memberitahu
perasaannya
tentang penyakit
dan kebimbangan
dan masalah yang
menyebabkannya
tertekan
-libatkan sistem
sokongan seperti
keluarga dan
individu yang rapat
dengan pesakit
untuk memberi
sokongan emosi

-luahan secara
verbal dapat
mengurangkan
tekanan dan
kebimbangan

-sokongan
daripada individu
seperti ini mudah
diterima oleh
pesakit

Diagnosis
kejururawat
an

Objektif

Intervensi

Rasional

-terangkan
setiap tatacara
yang akan
dilakukan kepada
pesakit dan beri
sokongan untuk
mengurangkan
ketakutan dan
kebimbangan

-Kebimbangan
akan
menyebabkan
peningkatan
keperluan oksigen
dan menambah
burukkan keadaan
pernafasan pesakit

-tafsir semula
tahap
kebimbangan
pesakit

-supaya intervensi
seterusnya dapat
dijalankan

REFERENCES

Indigestion. National Digestive Diseases

Information Clearinghouse (NDDIC).
http://digestive.niddk.nih.gov/ddiseases/pubs/indig
estion/
. Accessed May 8, 2011.
Epigastric pain, gastroesophageal reflux (GER),
and gastroesophageal reflux disease (GERD).
National Digestive Diseases Information
Clearinghouse (NDDIC).
http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/
. Accessed May 6, 2011.
Priscilla Lemone (2009). Medical Surgical
Nursing,.Critical Thinking in Client Care,4th Edition.

THANK YOU