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Nursing diagnosis

Nursing Diagnosis for Susan Ryan

Cluster of cues/signs & symptoms/assessment data

Nursing Diagnosis Title/

Patient Problem


Middle aged female (34 yrs), had a delivery through caesarian; meningioma: cerebral shunt performed; gastric ulcers; nausea; vomiting; spasticity and weakness of right side: jerking rght arm, right sided hyperreflexia; history of hyperemeses; abdominal-pain; difficulties finding words; bruising easily where blood tests had been taken; menses absent for five months; experiencing pain 1-2 hours after meals; burning gaseous pressure; decreased urine output: dark yellow color, strong odor; feeding problems; pale skin; hair cropped; scalp characterized by scars from surgeries; neck and head movement restricted with dull pain; ataxia: uses 4-point cane to ambulate; immunization up to date; introverted; quiet; harbors fear and guilt; is spiritual and believes in prayers;

Ineffective breastfeeding.

Nutrition, imbalanced: Less than body requires.

Intracranial adaptive capacity, decreased.

Urinary elimination impared.

Vomiting refers to the ejection of gastric content in a forceful manner. It comes after nausea and usually happens when diaphragm descends violently with constriction of abdominal muscle. There are two major central nervous system centers that are involved in vomiting reflexes. Various noxious stimuli trigger the vomiting center and may include; elevated intracranial pressure, metabolic disturbances, gastric irritation, myocardial ischemia, emotional upset and drugs (Goroll &Mulley, 2009 P.479). The vomiting act is a response that is stereotyped and varies little despite its primary cause. Projectile vomiting has a characteristic of forceful emesis which is not necessarily coming after nausea and retching. This vomiting is usually common in cases of intracranial pressure but occasionally in other conditions. A good portion (one third) of patients suffering from intracranial pressure complains of vomiting (Goroll &Mulley, 2009 P.480). Intracranial pressure may result from Meningioma which is a brain tumour and specifically a tumour of the meninges (the protective membranes that surrounds the brain and the spinal cord). In most cases the meningioma tumour is benign and occasionally malignant. The tumour is most likely to be found among middle aged or elderly people just like Susan who is aged 34 years. Recent research shows that meningioma possess a higher level of progesterone receptors as compared to oestrogen receptors. This is an explanation as to why meningioma is more common in women than in men (lee, 2009 p.12). The tumor is slow growing and the symptoms results from increased pressure within the skull-raised intracranial pressure. The elevated pressure could be as a result of swelling around the tumour or blockage in the ventricles leading to a build-up of cerebral spinal fluid (CSF). Raised intracranial pressure may lead to headaches, vomiting and problem with vision although Susan is not experiencing all these problems but most of them. Behavioural change is also common for instance; Susan is finding it hard to get words to express self while communicating. These symptoms are present in our client Susan Ryan since she has been experiencing headaches, nausea and vomiting. Susan has been affected behaviour wise also because she smiles inappropriately revealing the adversity of her condition. She also experiences the emotion of fear and guilt. Meningioma has been linked to breast cancer and runs in family tree. Susan has two maternal aunties who were suffering from breast cancer that we can link to her condition. Treatment of meningioma is planned by a team of specialists who are trained in broad professionals because her condition requires varied attention ranging from drug administration, surgery to counseling. Before treatment starts, the raised pressure in the skull is reduced by prescribing steroid drugs aimed at reducing swelling around the tumour. A tube shunt may be inserted to drain off excess cerebral spinal fluid in case the raised pressure resulted from the buildup of the CSF (Al-Mefty, 1991 p. 234). Susan has been occasionally hospitalized for cerebral shunt revision. Susan is also suffering from amenorrhea. Amenorrhea can result from several factors such as; natural, contraceptives, lifestyle, hormonal imbalances and medication. Natural causes include; breast feeding, pregnancy, and menopause. Certain medications have been reported to interfere with menstrual cycle. Some of these treatments include; cancer chemotherapy, antidepressants, antipsychotics and blood pressure drugs. Lifestyle factors include; stress, reduced body weight and excessive exercise. Susan has not been tested positive for pregnancy and neither is she using any contraceptive drugs. She is also under forty five years hence menopause is unlikely. Chances are that stress resulting from her ailment may have caused amenorrhea. Since the brain is the center of control of all the body activities, we can concur that Susan has amenorrhea and vomiting at the same time because control is originating from the brain. Susan also is diagnosed with hyperemesis which is a condition presented by severe nausea and vomiting. The increased level of human chorionic gonadotrophin (HCG) hormone is the major cause of vomiting and nausea in pregnancy (Goodwin, 1998 p. 598). Other conditions may as well lead to hyperemesis and treatment is required to prevent dehydration and loss of weight. Susan’s vomiting and nausea seems to originate from the cerebral shunts she is receiving. Susan has a serious nausea and vomiting complains which could be a symptom of a serious underlying illness (brain tumuor). Vomiting causes dehydration as well as reduced urine output, increased urine concentration, weakness, and decreased skin turgor.

The underlying effect that vomiting would result into nutrition imbalanced; lower than the body needs. Susan vomits one to two hours after meal, meaning that food absorption is inadequate. This may compound the illness she is already suffering. Further, other complications related to nutrition imbalance may sprout. This is because the body cells and tissues function depend on adequate nutrition (Braun & Anderson, 2007 p. 396). Hence, nutrition imbalance would worsen Susan’s condition further.

Hope means having good future expectations. It helps the terminally ill person to cope with the condition well as well as enhancing the quality of their lives (Herth, 1990 p. 1252). Hope can be present even in cases where there is limited time just like in the case of Susan who is suffering from cancer. Cancer clients are obviously termed as terminally ill even when the diagnosis does not indicate that the tumor is malignant or benign. For instance, Susan who has a meningioma tumour but not told if it is curable or not but the issue of fear of death is still considered. The hope in clients under end-of-life-care ill patients is bolstered through appreciating the patient and strengthening them. For Susan, we find that she has close family members who are there for her when she needs them and who support and ensure her financial support. This is because the husband is working in addition to the pension she is getting. Patients with financial issues lose hope more often than those who are well up. Hence, Susan has some hope because finance is catered for. Furthermore, she gets more hope from her neighbours whom appear to be supportive in addition to the church community. The mother group in her church particularly helps Susan to explore her spiritual issues as well as control her symptoms.

Although there is the doubt in hope, Susan has no fear of dying rather she is scared that she cannot breastfeed her five months child. Further, she cannot take care of the child herself, which is the joy of most mothers. Furthermore, most mothers always fear leaving their children in the care of other people. The fear is causing Susan to harbour guilt, which could deteriorate her condition. This means that there is ineffective breastfeeding. This could lead to minimal bonding between Susan and her child meaning that the child could feel detached from her mother. There is also the issue of love which is contributed by breastfeeding and thus the ineffectiveness would mean that love is absent. Susan could be guilty because she deprives the child the essential immune booster present in breast milk. Furthermore, it is a fact that breast milk is the recommended for babies especially after birth.


Al-Mefty, O 1991, meningiomas, Michigan, Raven Press.

Braun, C., & Anderson, C 2007, pathophysiology: functional alterations in human health, USA, Lippincott Williams & Wilkins

Goodwin, T. M 1998, hyperemesis gravidarum. Clinical Obstetric Gynecology, 41, 597-605.

Goroll, A. & Mulley, A 2009, primary care medicine: office evaluation and management of the

adult patient, USA: Lippincott Williams & Wilkins

Herth, K 1990, fostering hope in terminally-ill people, Journal Advanced Nursing, 15, 1250-

Lee, J. H 2009, meningiomas: diagnosis, treatment, and outcome, Springer.