32113884 case study on typhoid fever

8/13/2019 32113884 Case Study on Typhoid Fever

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FATHER SATURNINO URIOS UNIVERSITY

NURSING PROGRAM

Butuan City

An Individual Case Study

On

TYPHOID

FEVER

Bondoc, James Aurelle S.

Student Nurse

Ms. Edgracia Airrane A. Vega, RN

Supervising Clinical Instructor


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IntroductionTyphoid fever , otherwise known as enteric fever, is an acute illness associated with

fever caused by the Salmonella typhibacteria. S. typhosa is a short, plump, gram negative rod

that is flagellated and actively motile. Contaminated food or water is the common medium ofcontagion.

The disease follows four stages. The first stage is known as incubation period, usually 10-

14 days in occurrence. In this stage generalization of the infection occurs. In the second stage,

aggregation of the macrophages and edema in focal areas indicates bacterial localization(embolization) and resultant toxic injury which disappear after few days. The third stage of

disease is dominated by effects of local bacterial injury especially in the intestinal tract,

mesenteric lymph nodes, spleen, and liver. The fourth stage, or the stage of lysis, is the stagewherein the infectious process is gradually overcome. Symptoms slowly disappear and the

temperature gradually returns to normal.

The symptoms of typhoid fever include high fever, chills, cough, muscle pain, weakness,

stomach pain, headache and a rash made up of flat, rose-colored spots. Diarrhea is a lesscommon symptom of a typhoid fever, although it is a gastrointestinal disease. Sometimes there

are mental changes, know as typhoid psychosis. A characteristic feature of typhoid psychosis

is plucking at the bedclothes if patient is confined to bed.

Risk factors for acquiring typhoid fever likely include improper food handling, eating

food from outside sources like carinderia, drinking contaminated water, poor sanitation and evenpoor hygiene practices. War and natural disasters as well as weak, non existent of health care

infrastructure may also contribute. Both genders do have equal chances on acquiring such

disease. Asian, African and Americans are at greatest risks of acquiring the disease sincegeographical locations play a part.

Complications of typhoid fever are secondary conditions, symptoms, or other disorders

that are caused by typhoid fever. Complications include overwhelming infection, pneumonia,intestinal bleeding, and intestinal perforation may eventually lead to death.

Typhoid fever is one of the most protean of all bacterial diseases thus laboratoryprocedures are usually depended on to confirm or disprove suspicion of such disease. The place

of blood culture, serologic studies and bacteriologic examination feces and urine are useful in

establishing the diagnosis. Agglutination (Widal) for typhoid fever is done to determine antibody

response against different antigenic fractions of organisms.

Typhoid fever is treated with antibiotics which kill the Salmonella bacteria. Severalantibiotics are effective for the treatment of typhoid fever. The choice of antibiotics needs to be

guided by identifying the geographic region where the organism was acquired and the results of

cultures once available. Two new vaccines are currently licensed and widely used worldwide, a

subunit (Vi PS) vaccine administered by the intramuscular route and a live attenuated S typhistrain (Ty21a) for oral immunization.

In most cases, typhoid fever is managed at home with antibiotics and bedrest. For

hospitalized patients, effective antibiotics, goodnursing care, adequate nutrition, careful attention

to fluid

and electrolyte balance, and prompt recognition and treatment

of complications arestrategies to avert the possibility of death.

I choose this topic since it catches my interest from the time being I was able to handle

patient having typhoid fever. It gives me the motivation to look for the things that governs suchdisease. Typhoid fever as my case study allows me to find for ways to contribute something for

the alleviation of the condition of its victims may it be in my own little ways perhaps. May this

case study of mine serves as advent to understand more fully the existence of such disease andthe proper interventions needed to be rendered upon to address such condition looking to a new

perspective of life.
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Nursing health history is the first part and one of the most significant aspects in case

studies. It is a systematic collection of subjective and objective data, ordering and step-by-step process inculcating detailed information in determining clients history, health status,

and functional status and coping pattern. These vital informations provide a conceptual

baseline data utilized in developing nursing diagnosis, subsequent plans for individualizedcare and for the nursing process application as a whole. It is needed for solving and

determining a clients problem and for the nurse to know what interventions to be applied

and rendered upon and what may be the cause of the illness. It aims to determine the

biographic data of the client, chief complaint history of present illness, social datapsychological data, lifestyle patterns and se of health care systems among others

It was the 19th

day of April, 2010 when our group was first exposed to the world of

pediatric nursing. Under the supervision of Ms. Edgracia Airrane A. Vega, RN, all of uspracticed our skills by applying the concepts we learned from school. Then we were told by

our C.I to make an individual case study regarding on the cases of the children we were ableto care with. I was able to care patient with typhoid fever last April 20, 2010. So I chose towork on the case of typhoid fever after obtaining the permission of the patient as well to her

significant others

For the purpose of confidentiality and respect to the identity of my patient, I decided to

withhold her real identity and decided to address her as Patient R. We will also address her

mother as Mother A, grandmother as Grandmother B and aunt as Aunt C.

Patient R is a native of Agusan and true Filipino in blood. She first saw the light last

October 11, 1995. She is fourteen years old at present and an Iglesia ni Cristo in faith.

Prenatal History

The pregnancy of Patient R was expected by the couple. Wala man ko nasakit adtong

nagbuntis ko niya as verbalized by Mother A when asked about any history illnesses duringpregnancy. According to her, she took iron supplements such as Ferrous Sulfate during the

course of pregnancy as prescribed to her. She also had her regular check up to the barangay

health center and vaccinated with tetanus toxoids respectively.

Mother A gave birth to 7 lbs baby girl on the 11th

day of October, 1995 through Normal

Spontaneous Vaginal Delivery at Agusan del Norte Provincial Hospital, Libertad, ButuanCity. According to Mother A, the labor took for three days and the length of hospitalization

was also three days. She was then breastfed hours after birth. Breastfeeding continued up to 6

months of life of Patient R.

Kumpleto jud na siya ug bakuna as verbalized by Mother A when asked about

immunization status of the patient.

Developmental Milestones

Between the 1stand 2ndmonths, client M can already flex her elbows.

She was about 3 months old when the first smile was noted by Mother A.

On the 4th

month of life, she can lift upper part of he body while in prone position.

She was about 5 to 6 months old when client M can already rest weight on her forearm

when in prone position. She can also turn from front to back. Sige man to siya ug hilak bastamagligid- ligid siya as verbalized by Mother A. Her first tooth erupted at the age of 6 months.

It was between the 7th

and 8th month when Patient R can already crawl as what being

mentioned by Mother A.


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Between the 9th

to 11th

months, client M can sit momentarily but with support from her

mother. Mohilak gale siya kung kugoson sa uban as verbalized by Mother A. when asked boutthe clients reaction if held by others.

At the age of 1, Patient R can already walk but with support. She was 1 year and 2months old where she can already walk without support. She was then toilet trained at the age of2. She was able to dress herself at the age of seven.

Family History of Illness

Patient R is the 2nd

child among the 5 siblings. Brother D , the eldest, is 17 years of age

and currently working as a miner. Okey ra man to siya, wala man to siyay balatian asverbalized by Mother A. Brother E, the 3

rdsibling, is 13 years of age. According to Mother A, he

is in good health condition. . Sister F, the fourth sibling, is 7 years of age at present. According to

Mother A, she is in good health condition at present and she didnt have any health problems.

Brother G is 4 years old and still in good health condition at present. Kanang hypertension manang problema o sakit sa amo kaliwat as verbalized by Mother A. Wala man koy nahibaw an

nga sakit sa side sa akong bana as verbalized by Mother A when asked about any health

problems from the family.

Social Data

According to Mother A, the family relationships they have are strong and stable. Sheseldom quarrels with her husband. Mother A ensures that all her children are on the right track as

much a possible. Wala jud ko nagkulang ug pahinumdum ug hatag tambag sa akong mga anak

as verbalized by Mother A. Being an Iglesia ni Cristo in faith, the family goes to church everyThursday and Sunday. Patient R graduated at Guiasan Elementary School during her elementary

years at the year 2007. Dili man ko apil sa honor roll sa among klase sa elementary ko maski

karon sa high school as verbalized by Patient R when asked about her academic achievements.She is presently enrolled at Pipisan Maug National High School at Tagum City. Simple ra man

among kinabuhi, kanang okey ra ang kadak on sa sa among panimalay para sa among pamilya

as verbalized by Patient R when asked about their way of living or present economic status.

According to Mother A, her income along with his husbands income is just enough to sustainthe familysbasic needs.

Lifestyle

Hilig ra man na siya ug dula- dula uban iya mga amigodidot sa Davao, as verbalized

by Aunt C when asked about play activities of the patient. Patient R is socially interactive in

nature as observed. Pertaining to diet preference, Patient R is fun of eating fruits, vegetables andloves eating kinilaw. Na hilig jud na siya ug kaon kinilaw,as verbalized by Mother A. When

it comes sleep/rest patterns of the patient, Patient R verbalized that Matulog ko ug 9 sa gabie ug

mumata dayon ko ug 6 sa buntag..Mao na ako naandan. Dili kayo ko tigtulog ug hapon. When itcomes to her recreational activities, she added Laag lag kauban sa akong mga amigo ug apil ug

mga activities sa among lugar.

Past Health History

When talking about childhood illnesses, Patient R only experienced common cough and

colds. She also experienced mumps and chicken pox. Wala man na siya niagi ug grabe ngasakit. Bale first time niya mahospital karon, as verbalized by Grandmother B. When Patient Rwas asked about allergies, she verbalized that, Wala man koy mga allergy, maski unsa gale

akong imnon ug kaonon. There were no also reported accidents and injuries wherein she has

been subjected to. Vitamins ra man iya ginatumar sukad sauna ra, as verbalized by Mo ther Awhen asked about medications taken by Patient R from the past years up to the present.

History of Present Illness

Naghilanat man ko adtong nagbakasyon ko sa Magallanes as verbalized by Patient R.

She experienced fever and chils for about 9 days which started last April 12, 2010. According to


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Aunt C, she observed that Patient R would complain of headache, lethargy, fatigue, body

weakness and pain. Pateint R also experienced diarrhea. Ako nahinumduman , nagkaon man

me adto ug kinilaw kadtong naa pa ko sa Davao mao kadtong pag anhi nako sa Magallanesnagsugod na dayon akong hilanat ug apil takig she verbalized. She was then brought to Agusan

del Norte Provincial Hospital last April 20, 2010. She got admitted that day around 12:40 in the

afternoon under the management of Dr. Bungabong. She was admitted at ARI( AcuteRespiratory Infection) Ward .

It was on the 20th

day of April, 2010, wherein our group had our duty at the Pediatric

Ward of Agusan del Norte Provincial Hospital. On the same day, Patient R was admitted to thesaid hospital. Her admitting impression was to consider typhoid fever basing form the chief

complaint of fever associated with chills. Her temperature upon admission was 38.8 C and

weight of 40.5 kgs.

At 1:00 pm, Dr Bungabong made the following orders:

.> TPR q4h> DAT except dark colored foods

> IVF PNSS 1L @ 30 gtts/min

> IVF TF PLR 1L @ 20 gtts/min

> Paracetamol 500mg 1 tab P.O now, then q4h PRN for fever> Chloramphenicol 500mg 1 tab P.O now q6h

> CBC with platelet count

> UA/ SE> Widal test, BSM

Patient R was received on bed on left side lying position; awake and coherent with IVF# 1 PNSS 1L@ the level of 900 cc, regulated at 30 gtts/min hooked @ right metacarpal vein,

infusing well around 4:10 in the afternoon.

Patient R was observed grimacing, diaphoretic and self-focusing. Initial vital signs were

taken and recorded as follows:

T: 37.5oC RR: 24 bpm PR: 97 bpm BP: 90/70 mmHg

Ngutngot akong kamot ganiha ra ni siya human gisuksukan Mga 5 kung

sukdon.Patient R verbalized when asked about discomfort felt upon admission. With the cues

noted, a nursing care plan was formulated with a nursing diagnosis of Acute Pain related to

presence of traumatized tissue from IV insertion. Independent interventions were rendered toaddress such problem like changing bed positions, positioning patients affected arm,

emphasizing to client not to use affected arm unnecessarily. Around 6:00 pm, widal and CBC

results was brought to the station. I referred the laboratory results to Dr. Bungabong. There wereno doctors orders being carried out.

Around 9:30 in the evening, patient R was observed weak. Upon assessment, her skinwas warm to touch, flushed skin and is not diaphoretic. Mucous membrane was dry and lips were

cracked and dried. Vital signs were taken and recorded as follows:


Init napud balik akong paminaw patient R verbalized. With the cues, another problem

was identified with a diagnosis of hyperthermia related to underlying disease process.

Independent interventions were being rendered like initiating tepid sponge bath, encouraging

adequate fluid intake and promoting surface cooling by means of removing some body coversfrom the patients body.

On the second day of duty, Dr. Amoroso made the following orders around 8:30 in the

morning as follows: Cotrimoxazole 800 mg 1 tab P.O BID Paracetamol 500 mg 1 tab RTC Continue chloramphenicol P.O Ascorbic acid 500 mg 1 tab P.O OD


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Around 4:10 in the afternoon, I received patient R lying on bed on supine position, awake

and coherent with IVF #2 PLR 1 liter at the level of 400 cc; regulated at 20 gtts/min hooked at

the right metacarpal vein; infusing well. Vital signs were taken and recorded as follows:T: 36.5

oC RR: 24 bpm PR: 71 bpm BP: 90/60 mmHg

Wala pa ko kalibang gikan adtong gi-admit koas verbalized by patient R. patient R wasobserved with dry skin, absence of sweating and claimed having positive flatus that day. She alsoneeds assistance upon getting up/out in bed. Patient R refused to get up on bed and slowed

movement noted.

With the cues gathered, a problem was identified with a diagnosis of Risk for

Constipation related to insufficient physical activity. Independent nursing interventions were

rendered to address the said problem like encouraging intake of balanced fiber and bulk in dietsuch as fruits, vegetables and whole grain; emphasizing DAT except for dark colored foods and

encouraging activity/exercise within limits of individual activity.

Due oral medications were given in due timing. Around 9:30 in the evening, above IVF#2 was terminated and followed up with IVF #3 D5NM 1 liter regulated at 20 gtts/min as

ordered. At 10:00 pm, patient R verbalized that init napud balik akong paminaw arang

inita.As observed, patient Rs skin was warm to touch, flushed skin, dry lips, not diaphoretic,

poor skin turgor and slowed movement were observed. Vital signs were taken and recorded asfollows:

T: 38oC RR: 29 bpm PR: 91 bpm BP: 90/70 mmHg

Another problem was identified with a diagnosis of Hyperthermia related to underlying

disease process was formulated. Interventions were rendered to the patient to address the

problem.

On April 22, 2010, around 4:20 in the afternoon, I received patient lying flat on bed with

IVF #3 D5NM 1 liter regulated at 20 gtts/min hooked at the right metacarpal vein at level of 50cc which was temporarily stopped from the time being. Vital signs were taken and recorded as

follows:


Upon interaction, patient R was noted with slowed movement, body weakness and

yawning. Poor skin turgor was observed and dry skin is noted. She needed assistance upon

getting up in bed. When I asked patient to perform range of motion exercises and to walk upon

the hospitals vicinity, she refused to do so while saying kapoy ibakod.

With the gathered cues, a problem was identified with a diagnosis of Impaired Physical

Mobility related to reluctance to initiate movement. Interventions were rendered to address thesaid problem like positioning patient on bed comfortably, explaining importance of ambulation

to avoid possible skin breakdown and encouraging patient to have adequate rest periods every

activity performance.Around 5:30 in the afternoon, Dr. Amoroso made the following order:

D5NM 1 liter at same rate

Around 6:10 in the evening, above IVF #3 was consumed and followed up with IVF #4

D5NM 1 liter regulated at 20 gtts/min. IVF was regulated properly and frequently checked.

At 10:00 pm, patient R experienced flushed skin and drying of lips. Her skin was warm totouch. Poor skin turgor in noted. Dry mucous membrane was observed along with slowedmovement. Nag-init na pud balik akong pamati,as verbalized by patient R. Hyperthermia

related to underlying disease process was identified.

On April 23, 2010, Dr. Amoroso made the following orders at around 8:00 in themorning:

TWC Continue all oral meds For billing DAT


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Around 4:00 in the afternoon, patient R was received lying supine on bed, awake and

coherent; with IVF #4 D5NM 1 liter regulated at 20 gtts/min hooked at right metacarpal vein at

the level of 100 cc; infusing well. Vital signs were taken and recorded as follows:T: 37


Upon interaction with the patient, she verbalized that Gusto nako diretso akong tulog

inig gabie bahala ug igang ug saba.As observed, patient R was frequently yawning. Bodyweakness, slowed movement and reaction were noted.A nursing problem was identified basing from the cues gathered. Nursing care plan was

made with a diagnosis of Readiness for Enhanced Sleep. Interventions and health teachings were

given to address such problem like recommending patient to limit intake of chocolate andcaffeine or alcoholic beverages prior to sleep, instructing significant others to ensure quiet

environment and instructing client to limit/avoid afternoon naps as possible.

Around 6 in the evening, above IVF was consumed and terminated as ordered aseptically.

Due oral medications were given and IVF was regularly checked and regulated.

On April 24, 2010, around 8:00 in the morning, Dr. Bungabong made the followingorders:

Re-insert IVF D5LR 1L at 20 gtts/min Hold chloramphenicol P.O Continue cotrimoxazole DAT

No interaction was made since our group was having activities such as NCP conference,annotated reading reporting and quiz respectively at the conference hall.

On April 25, 2010, around 8 oclock in the morning, Dr. Bungabong made the following

order: D5NM 1 liter at same rate

In our second week of duty, we had our morning shift. Around 8 oclock in the morning,Dr, Bungabong made the following order:

MGH w/ chloramphenicol P.O meds to continue at home

At 8:30 in the morning, Patient R was received lying on bed on supine position, awake andcoherent with IVF #6 D5NM regulated at 20 gtts/min hooked at the left metacarpal vein at the

level of 600 cc; infusing well. Vital signs were taken and recorded as follows:


Patient R was seen calm and interactive upon interaction. No problems were being

identified. As instructed, discharge plan was written and instructed to patient and to the

significant others. Significant other (grandmother) was instructed to process papers.

On April 27, 2010, patient R was received around 8:20 in the morning; sitting on chair

without IVF. Vital signs were taken and recorded as follows:T: 36.8


No doctors orders were made. Patient was seen walking in the vicinity together with hergrandmother. At 2:00 pm, patient R was discharged with home medications. The total length of

stay in the hospital was 7 days.


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PHYSIC L SSESSMENTPhysical examination follows a methodical head to toe format in the cephalocaudal

assessment. This is done systematically using the techniques of inspection, palpation, percussion

and auscultation with the use of materials and investments such as the penlight, thermometer,sphygmomanometer, tape measure and stethoscope and also the senses. During the procedure, I

made every effort to recognize and respect the patients feelings as well as to provide comfort

measures and follow appropriate safety precautions.

Physical assessment is a systematic, comprehensive, continuous collection, validation and

communication of the patients data using a variety of methods. The purposes of the physicalassessment are as follows:

-to collect data and establish a need for continued physical assessment;

-to ascertain patients level of health condition and physiological functioning;-to identify factors facing the patient at risk; and

-to determine the areas of preventive nursing.

The physical assessment of Patient R was done last April 21, 2010 at ARI ( AcuteRespiratory Infection) Ward of Agusan del Norte Provincial Hospital around 6 clock in the

evening. The student nurses used the cepholocaudal approach in assessing the patient. The

student brought with him bp apparatus, temperature, stethoscope, wristwatch, ballpen, andnotebook

General Survey:Patient R was lying on bed; awake and coherent, with D5NM 1L hooked @ right

metacarpal vein, regulated @ 20 gtts/ min @ the level of 400 cc; infusing well. She stands 5 feet

and 2 inches in tall and weighs 40.5 kgs with limited body movements noted.

Vital Signs:TEMPERATURE: 36. 5 C

HEART RATE: 81 beats/ min

RESPIRATORY RATE: 24 breaths/ minBP: 90/60 mmHg

Skin:The skin was brown in color. Muscle tone present. Few abrasions are noted but

nevertheless, the skin was dry.Skin goes back slowly in less than 2 seconds when pinched back.

Head:The head circumference measures 50 cm, round in shape. The scalp is free from

inflammation and is lighter in color of that of the complexion of the skin. Hair is long, thick and

coarse, straight andevenly distributed. Scalp is smooth and white in color, minimal lesionswere noted. Dandruff and lice were not seen.

Ears:Ears were symmetrical, free of abrasions. Color was good, same with the rest of the body

with no pale manifestations. Minimal cerumen notedat both ears. Patient can hear normallywhen spoken softly

Eyes:Eyes are rounded in shape. Inspection of conjunctiva was done by pulling the lower

eyelid slightly down with the finger tip and are pink in color. Eyebrows and eyelashes are evenlydistributed. The scleras of both eyes were clear, equally round and reactive to light

accommodation. The eyes involuntarily blink.

Nose:


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With narrow nose bridge, there were no discharges noted upon inspection. No

swelling of the mucous membrane and presence of nasal hairs were seen. No discharges or

flaring noted.

Lips:

Lips are drybut with no pale manifestations. Cracking of lips noted.

Mouth:She has a complete set of teeth with minimal dental caries noted. Oral mucosa and

gingival are pink in color, moist and there were no lesions nor inflammation noted. Tongueis pinkish and is free of swelling and lesions. Lips are symmetrical, appears pale without bitsnoted upon observation.

NeckLymph nodes noted. Neck has strength that allows movement back and forth, left

and right. Patient is able to freely move her neck.

Chest:Chest circumference measures 43 cm. Color is brown, the same with the rest of the body.

Breasts are symmetrical and rounded in shape. No inflammation or deformities noted.

Lungs and Thoracic RegionNo reports of pain during the inhalation and exhalation. Absence of adventitious

sounds upon auscultation noted . Respiratory rate 24 breathes per minute from the normalrange of 20-40 breaths per minuteHeart

Patient R has an audible heart sound. PMI is heard between 4 th - 5th intercostalsspace upon ausculation. Heart is pumping well with a pulse rate of 81 bpm from the normal

rate of 60-100 beats per minute.

Abdomen:Abdomen is rounded in shape while in sitting position and flat when in supine position.

The rest of the abdomen is of the same color and with no abrasions. Bowel sounds re hears at 15bowel sounds per minute upon auscultation. Upon palpation, no distention noted.

Back:No inflammations and lesions observed. No abrasions are noted.

Upper Extremities:Both hands can be flexed and moved freely. Fingers are symmetrical with no abrasions.

Nails are not trimmed, manifested with dirt.Skin: Brown in color; no presence of marks/scars of wounds in the arms, neck and legs.Skin was dry.Skin goes back slowly in less than 2 seconds when pinched backHands: Medium in size with 5 fingernails in each side. Nails are short, small dustyparticles are present.Arms: Able to move through active ROM. Able to extend arms in front or push them out tothe side

Lower Extremities:Ten fingers are present. Toes are symmetrical, nails are not trimmed. No deformities

and inflammation noted upon inspection. Both feet can be flexed and moved freely. Fingers aresymmetrical with no abrasions.

Bowel and Urine Excretion:

Genitals were not assessed due to patients refusal. Patient is able to urinate twice and not

defecated since day of admission.

Neurologic Status:

Behavior Patient is silent but is conscious and coherent upon interaction. She sits andwalks if she wants to. She has good eye contact upon interaction and is able to follow

simple instructions. She speaks clearly in a soft, moderate voice.


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Motor Functioning Patient R is able to move extremities through active ROM. She isable to extend arms front and resist active as pushed down/up on his hands.

Reflexes - Reflexes were present such as the blinking reflex and deep tendon reflex.Swallowing reflex is evident when patient was asked to drink a glass of water.

Sensory Functioning Patients sensory system is intact, she was able to distinguishtouch, pain, hot and cold. She was able to read letter E when positioned 10 feet away.

natomy and Physiologyastrointestinal system

To aid in understanding the disease process, Anatomy and Physiology provides thenecessary information about the normal function of certain body components, its structure andfunction. Anatomy and physiology are always related. Anatomy is the study of the structure and

shape of the body and body parts and their relationships to one another. Physiology is the study

of how the body pars work or function.

The gastrointestinal tract (GIT) consists of a hollow muscular tube starting from the oralcavity, where food enters the mouth, continuing through the pharynx, oesophagus, stomach andintestines to the rectum and anus, where food is expelled. There are various accessory organs that

assist the tract by secreting enzymes to help break down food into its component nutrients. Thus

the salivary glands, liver, pancreas and gall bladder have important functions in the digestive

system. Food is propelled along the length of the GIT by peristaltic movements of the muscularwalls.

The primary purpose of the gastrointestinal tract is to break down food into nutrients,which can be absorbed into the body to provide energy. First food must be ingested into the

mouth to be mechanically processed and moistened. Secondly, digestion occurs mainly in the

stomach and small intestine where proteins, fats and carbohydrates are chemically broken downinto their basic building blocks. Smaller molecules are then absorbed across the epithelium of the

small intestine and subsequently enter the circulation. The large intestine plays a key role in

reabsorbing excess water. Finally, undigested material and secreted waste products are excretedfrom the body via defecation (passing of faeces). In the case of gastrointestinal disease or

disorders, these functions of the gastrointestinal tract are not achieved successfully. Patients may

develop symptoms of nausea, vomiting, diarrhoea, malabsorption, constipation or obstruction.

Gastrointestinal problems are very common and most people will have experienced some of theabove symptoms several times throughout their lives.
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Basic structure

The gastrointestinal tract is a muscular tube lined by a special layer of cells, called epithelium.

The contents of the tube are considered external to the body and are in continuity with the

outside world at the mouth and the anus. Although each section of the tract has specialisedfunctions, the entire tract has a similar basic structure with regional variations.

The wall is divided into four layers as follows:

Mucosa

The innermost layer of the digestive tract has specialised epithelial cells supported by an

underlying connective tissue layer called the lamina propria. The lamina propria contains blood

vessels, nerves, lymphoid tissue and glands that support the mucosa. Depending on its function,the epithelium may be simple (a single layer) or stratified (multiple layers).

Areas such as the mouth and oesophagus are covered by a stratified squamous (flat) epitheliumso they can survive the wear and tear of passing food. Simple columnar (tall) or glandular

epithelium lines the stomach and intestines to aid secretion and absorption. The inner lining is

constantly shed and replaced, making it one of the most rapidly dividing areas of the body!

Beneath the lamina propria is the muscularis mucosa. This comprises layers of smooth musclewhich can contract to change the shape of the lumen.

Submucosa

The submucosa surrounds the muscularis mucosa and consists of fat, fibrous connective tissue

and larger vessels and nerves. At its outer margin there is a specialized nerve plexus called the

submucosal plexus or Meissner plexus. This supplies the mucosa and submucosa.

Muscularis externa

This smooth muscle layer has inner circular and outer longitudinal layers of muscle fibres

separated by the myenteric plexus or Auerbach plexus. Neural innervations control the


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contraction of these muscles and hence the mechanical breakdown and peristalsis of the food

within the lumen.

Serosa/mesentery

The outer layer of the GIT is formed by fat and another layer of epithelial cells called

mesothelium.

Individual components of the gastrointestinal system

Oral cavity

The oral cavity or mouth is responsible for the intake of food. It is lined by a stratified squamous

oral mucosa with keratin covering those areas subject to significant abrasion, such as the tongue,hard palate and roof of the mouth. Mastication refers to the mechanical breakdown of food by

chewing and chopping actions of the teeth. The tongue, a strong muscular organ, manipulates the

food bolus to come in contact with the teeth. It is also the sensing organ of the mouth for touch,temperature and taste using its specialised sensors known as papillae.

Insalivation refers to the mixing of the oral cavity contents with salivary gland secretions. Themucin (a glycoprotein) in saliva acts as a lubricant. The oral cavity also plays a limited role in

the digestion of carbohydrates. The enzyme serum amylase, a component of saliva, starts the

process of digestion of complex carbohydrates. The final function of the oral cavity is absorptionof small molecules such as glucose and water, across the mucosa. From the mouth, food passes

through the pharynx and oesophagus via the action of swallowing.

Salivary glands

Three pairs of salivary glands communicate with the oral cavity. Each is a complex gland with

numerous acini lined by secretory epithelium. The acini secrete their contents into specialised

ducts. Each gland is divided into smaller segments called lobes. Salivation occurs in response tothe taste, smell or even appearance of food. This occurs due to nerve signals that tell the salivary

glands to secrete saliva to prepare and moisten the mouth. Each pair of salivary glands secretes

saliva with slightly different compositions.

Parotids

The parotid glands are large, irregular shaped glands located under the skin on the side of the

face. They secrete 25% of saliva. They are situated below the zygomatic arch (cheekbone) and

cover part of the mandible (lower jaw bone). An enlarged parotid gland can be easier felt when

one clenches their teeth. The parotids produce a watery secretion which is also rich in proteins.


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Immunoglobins are secreted help to fight microorganisms and a-amylase proteins start to break

down complex carbohydrates.

Submandibular

The submandibular glands secrete 70% of the saliva in the mouth. They are found in the floor of

the mouth, in a groove along the inner surface of the mandible. These glands produce a more

viscid (thick) secretion, rich in mucin and with a smaller amount of protein. Mucin is aglycoprotein that acts as a lubricant.

Sublingual

The sublinguals are the smallest salivary glands, covered by a thin layer of tissue at the floor of

the mouth. They produce approximately 5% of the saliva and their secretions are very sticky due

to the large concentration of mucin. The main functions are to provide buffers and lubrication.

Oesophagus

The oesophagus is a muscular tube of approximately 25cm in length and 2cm in diameter. It

extends from the pharynx to the stomach after passing through an opening in the diaphragm. Thewall of the oesophagus is made up of inner circular and outer longitudinal layers of muscle that

are supplied by the oesophageal nerve plexus. This nerve plexus surrounds the lower portion of

the oesophagus. The oesophagus functions primarily as a transport medium between

compartments.

Stomach

The stomach is a J shaped expanded bag, located just left of the midline between the oesophagusand small intestine. It is divided into four main regions and has two borders called the greater

and lesser curvatures. The first section is the cardia which surrounds the cardial orifice where the

oesophagus enters the stomach. The fundus is the superior, dilated portion of the stomach that

has contact with the left dome of the diaphragm. The body is the largest section between thefundus and the curved portion of the J.

This is where most gastric glands are located and where most mixing of the food occurs. Finallythe pylorus is the curved base of the stomach. Gastric contents are expelled into the proximal

duodenum via the pyloric sphincter. The inner surface of the stomach is contracted into

numerous longitudinal folds called rugae. These allow the stomach to stretch and expand whenfood enters. The stomach can hold up to 1.5 litres of material. The functions of the stomach

include:

1. The short-term storage of ingested food.2. Mechanical breakdown of food by churning and mixing motions.3. Chemical digestion of proteins by acids and enzymes.4. Stomach acid kills bugs and germs.5. Some absorption of substances such as alcohol.

Most of these functions are achieved by the secretion of stomach juices by gastric glands in the

body and fundus. Some cells are responsible for secreting acid and others secrete enzymes to

break down proteins.

Small intestine

The small intestine is composed of the duodenum, jejunum, and ileum. It averages approximately

6m in length, extending from the pyloric sphincter of the stomach to the ileo-caecal valveseparating the ileum from the caecum. The small intestine is compressed into numerous folds

and occupies a large proportion of the abdominal cavity.


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The duodenum is the proximal C-shaped section that curves around the head of the pancreas. The

duodenum serves a mixing function as it combines digestive secretions from the pancreas and

liver with the contents expelled from the stomach. The start of the jejunum is marked by a sharpbend, the duodenojejunal flexure. It is in the jejunum where the majority of digestion and

absorption occurs. The final portion, the ileum, is the longest segment and empties into the

caecum at the ileocaecal junction.

The small intestine performs the majority of digestion and absorption of nutrients. Partly

digested food from the stomach is further broken down by enzymes from the pancreas and bilesalts from the liver and gallbladder. These secretions enter the duodenum at the Ampulla of

Vater. After further digestion, food constituents such as proteins, fats, and carbohydrates are

broken down to small building blocks and absorbed into the body's blood stream.

The lining of the small intestine is made up of numerous permanent folds called plicae circulares.

Each plica has numerous villi (folds of mucosa) and each villus is covered by epithelium withprojecting microvilli (brush border). This increases the surface area for absorption by a factor of

several hundred. The mucosa of the small intestine contains several specialised cells. Some are

responsible for absorption, whilst others secrete digestive enzymes and mucous to protect theintestinal lining from digestive actions.

Large intestine

The large intestine is horse-shoe shaped and extends around the small intestine like a frame. Itconsists of the appendix, caecum, ascending, transverse, descending and sigmoid colon, and the

rectum. It has a length of approximately 1.5m and a width of 7.5cm.

The caecum is the expanded pouch that receives material from the ileum and starts to compress

food products into faecal material. Food then travels along the colon. The wall of the colon is

made up of several pouches (haustra) that are held under tension by three thick bands of muscle(taenia coli).

The rectum is the final 15cm of the large intestine. It expands to hold faecal matter before itpasses through the anorectal canal to the anus. Thick bands of muscle, known as sphincters,

control the passage of faeces.


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The mucosa of the large intestine lacks villi seen in the small intestine. The mucosal surface is

flat with several deep intestinal glands. Numerous goblet cells line the glands that secrete

mucous to lubricate faecal matter as it solidifies. The functions of the large intestine can besummarised as:

1. The accumulation of unabsorbed material to form faeces.2. Some digestion by bacteria. The bacteria are responsible for the formation of intestinalgas.

3. Reabsorption of water, salts, sugar and vitamins.

Liver

The liver is a large, reddish-brown organ situated in the right upper quadrant of the abdomen. It

is surrounded by a strong capsule and divided into four lobes namely the right, left, caudate andquadrate lobes. The liver has several important functions. It acts as a mechanical filter by

filtering blood that travels from the intestinal system. It detoxifies several metabolites includingthe breakdown of bilirubin and oestrogen. In addition, the liver has synthetic functions,

producing albumin and blood clotting factors. However, its main roles in digestion are in theproduction of bile and metabolism of nutrients. All nutrients absorbed by the intestines pass

through the liver and are processed before traveling to the rest of the body. The bile produced by

cells of the liver, enters the intestines at the duodenum. Here, bile salts break down lipids intosmaller particles so there is a greater surface area for digestive enzymes to act.

Gall bladder

The gallbladder is a hollow, pear shaped organ that sits in a depression on the posterior surfaceof the liver's right lobe. It consists of a fundus, body and neck. It empties via the cystic duct into

the biliary duct system. The main functions of the gall bladder are storage and concentration of

bile. Bile is a thick fluid that contains enzymes to help dissolve fat in the intestines. Bile isproduced by the liver but stored in the gallbladder until it is needed. Bile is released from the gall

bladder by contraction of its muscular walls in response to hormone signals from the duodenum

in the presence of food.

Pancreas

Finally, the pancreas is a lobular, pinkish-grey organ that lies behind the stomach. Its head

communicates with the duodenum and its tail extends to the spleen. The organ is approximately15cm in length with a long, slender body connecting the head and tail segments. The pancreas

has both exocrine and endocrine functions. Endocrine refers to production of hormones which

occurs in the Islets of Langerhans. The Islets produce insulin, glucagon and other substances andthese are the areas damaged in diabetes mellitus. The exocrine (secretrory) portion makes up 80-

85% of the pancreas and is the area relevant to the gastrointestinal tract.

It is made up of numerous acini (small glands) that secrete contents into ducts which eventually

lead to the duodenum. The pancreas secretes fluid rich in carbohydrates and inactive enzymes.

Secretion is triggered by the hormones released by the duodenum in the presence of food.

Pancreatic enzymes include carbohydrases, lipases, nucleases and proteolytic enzymes that canbreak down different components of food. These are secreted in an inactive form to prevent

digestion of the pancreas itself. The enzymes become active once they reach the duodenum.

L BOR TORY RESULTS

Name of Test Ordering Physician Date Ordered Date Done

Serology( Widal Test)

Dr. Bungabong April 20, 2010 April 20, 2010


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Complete BloodCount

Dr. Bungabong April 20, 2010 April 20, 2010

Urinalysis Dr. Bungabong April 20, 2010 April 21, 2010

Fecalysis Dr. Bungabong April 20, 2010 April 22, 2010

Serology

Date Ordered: April 20, 2010

O H AH BH

1:20 HT3 HT3 H2 H2

1:40 H2 H2 +1 +1

1:80 +1 +1 Trace Trace

1:160 Trace Trace neg neg

1:320 neg neg neg neg

Hematology Complete Blood CountDate Ordered: April 20, 2010

Test Definition Result Reference

Range

Interpretation Clinical

significanceHemoglobin It is the main

component of red

blood cells. Its

main function is

to carry oxygen

from the lungs tothe body tissues

10.1 (11-16 g/dl) Decreased Decreased level

denotes for

hemorrhage,

anemia or

hemodilution (

overhydartion).


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and to transport

Carbon Dioxide,

the product of

cellular

metabolism, back

to the lungs.

Hematocrit It is themeasurement of

the percentage of

red blood cells in

the total volume

of blood. It is

expressed as the

percentage of red

cells in the total

blood volume.

27% (36-46%) Decreased Decreased levelmay account for

anemia, acute

blood loss or

hemodilution.

Leukocytes

(WBC)

The total white

blood count

(WBC) is the

absolute number

of white blood

cells (leukocytes)

circulating in a

cubic millimeter

of blood.

6900 (3100-10000) Normal .

Platelet Count Also called

thrombocytes, are

large, non-

nucleated cells

derived from the

megakaryotes

produced in the

bone marrow.

They promotecoagulation.

(205) x 10

g/L

150-390 Normal

Differential Count

Test Definition Result Reference

Range


significance

Eosinophil They play a role inallergic reactions,

possibly

inactivating

histamine.

Not indicated (0.00-0.06)

Lymphocyte They play a role in

our immune

response.

32% (25-35%) Normal

Basophil They contain

histamine and

heparin and appear

to be involved in

immediate

hypersensitivityreactions.

Not indicated (0.0-0.1)

Monocyte They are the

second line of

defense against

bacterial infections

and foreign

substance.

Not indicated (4-6%)

Neutrophils Most numerous

circulating WBCs

and they respond

more rapidly to the

inflammatory and

tissue injury sites

than other types of

68% (50-70%) Normal


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WBCs.

URINALYSIS


Property/Constituents Definition Result Reference

Value


significanceColor Yellow Light straw to

dark amber

yellow

Normal

Transparency Clear Clear Normal

PH It is the

hydrogen

concentration of

the urine. It is a

measurement of

the acid or

alkaline status

of he urine.

5.0 4.5-8.0 Normal

.

Specific Gravity it is the

measurement of

the

concentration ofurine

1.030 1.005-1.030 Normal

Protein Protein found in

the urine

albumin, a

serum protein

that normally

does not leak

into the

glomerular

filtrate

Negative Qualitative

Analysis

> negative

Quantitative

Analysis

> 10-100

mg/24 h

Normal

Sodium It is the

principal cation

of theextracelluar

fluids and is the

most important

antelectrolytein the

maintenance of

fluid balance in

the body.

Not

indicated

135-1487

mEq/l

Potassium It is one of the

major

electrolytes in

the body fluid

that isresponsible for

maintaining

life-sustaining

neuromuscular

functioning.

Not

indicated

3.5-5.5 mEq/l

Microscopic Examination of Urinary Sediment

Constituents Definition Result Reference

Value

Interpretation Clinical significance

WBC and WBC

casts

Casts are formed

within the

kidney tubules

from

1-3/1pf > 4 per lower

powerfield

Decresed Accumulation of

white cells casts

occurs in

glumerolonephritis,


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agglutination of

protein cells, of

red and white

cells of

epithelial cells.

pyelonephritis,and

Rickey

inflammation.

RBC and RBC

casts

Casts are formed

within thekidney tubules

from

agglutination of

protein cells, of

red and white

cells of

epithelial cells.

Not indicated >2/11 pf

Epithelial Cells Casts are formed

within the

kidney tubules

from

agglutination of

protein cells, of

red and white

cells of

epithelial cells.

Occasional Occasional Normal

Fecalysis


Property/constituent Result Reference Value Interpretation Clinical

significance

Consistency Formed Formed Normal

Color Brown Brown Normal

Pus cells

RBC

Fat globules

RESULT: No intestinal parasites/ ova seen

DRUG STUDY

Drug Name Date Ordered Ordering Physician

Chloramphenicol April 20, 2010 Dr. Bungabong

Paracetamol April 20, 2010 Dr. Bungabong

Cotrimoxazole April 21, 2010 Dr. Amoroso


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DRUG STUDY NO. 1

Name of Drug:Amikacin

Brand Name: Eticlob

Classification: Anti- Bacterial


Dose and Frequency: 500 mg q6h

Mechanism of Action: Binds to 50s ribosomal subunits which interferes with or inhibits protein

synthesis..

Indications: Infections caused by S. typhi

Contraindications: Hypersensitivity, renal disease, severe heapaic disorders, minor infections

Adverse Reactions: Anemia, thrombocytopenia, optic neuritis, nausea, vomiting, diarrhea,

abdominal pain, itching, rashes, headache and depression

Nursing Considerations:

- Alert SO and patient for signs of infection like inflammation, redness, swelling andpresence of pus.

- Assess patients infection before and regularly throughout therapy.


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- Review patients history of allergies.- Monitor patient for adverse reactions.- Obtain culture and sensitivity of specimen.- Monitor renal function, PT and platelet count.

DRUG STUDY NO. 2

Name of Drug: Acetaminophen

Brand Name:Paracetamol

Classification: Non-opioid analgesic, anti-pyretic


Dose and Frequency: 500 mg every 4 hours or PRN

Mechanism of Action: Blocks pain impulses, probably inhibiting prostaglandin or pain receptorsensitizers. May relieve fever by acting on hypothalamic heat-regulating center.

Indications: Mild pain or fever

Contraindications: Contraindicated to patients hypersensitive to the drugs and use cautiously in

patients with a history of chronic alcohol abuse because hepatotoxicity may occur.

Adverse Reactions:

Hematologic: hemolytic anemia, leukopeniaHepatic: liver damage, jaundice

Metabolic: hypoglycemia

Skin: rash, urticaria


Assess patients pain and temperature before giving any drugs.

Assess patients drug history and calculate daily dosage accofdingly.

Be alert for adverse reactions and drug interactions. Assess patient and familys knowledge of drug use.

Tell patient not to use drug for fever higher than 103 degrees Fahrenheit orlasts longer than 3 days or recurs.

Te patient to keep track of daily acetaminophen intake.

DRUG STUDY NO. 3

Name of Drug:Cotrimoxazole

Brand Name: TimizoleForte

Classification: Antibiotic


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Dosage/ Frequency: 800 mg, BID

Mechanism of Action: Inhibits susceptible bacteria, including S. typhi

Indications: Urinary Tract Infection

Contraindications: Hypersensitivity to trimethoprim or sulfonamides and severe renal

impairment.

Adverse Reactions: Headache, imsonia, agranulocytosis, muscle weakness, oliguria, anuria,

nausea, vomiting and diarrhea


- Alert SO and patient for signs of infection like inflammation, redness, swelling andpresence of pus.

- Assess patients infection before and regularly throughout therapy.- Review patients history of allergies.- Monitor patient for adverse reactions.- Obtain culture and sensitivity of specimen.- Monitor renal function, PT and platelet count.

NURSING CARE PLAN

A nursing care plan outlines the nursing care to be provided to a patient. It is a set of

action the nurse will implement to resolve nursing problems identified by assessment. The

creation of the plan is an intermediate stage of the nursing process. It guides in the ongoing

provision of nursing care and assists in the evaluation of that care.

Problem list is a means of problem prioritization. The methods used in prioritizing the

identified problems are:

the date the problem identified

ABC (Airway, Breathing, Circulation)

Maslows Hierarchy of Needs

Patients Name: Patient R

Age: 14 years old

Chief complaint: on and off fever for 9 days associated chills

Problem No. Nursing Problem Date Identified Date Evaluated

1 Acute Pain r/tpresence of

traumatized tissue

April 20, 2010 April 20, 2010


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resulting frominsertion of IV

2 Hyperthermia r/t

underlying diseaseprocess

April 20, 2010 April 20, 2010

3 Risk for Constipationr/t insufficient

physical activity

April 21, 2010 April 21, 2010

4 Hyperthermia r/t

underlying diseaseprocess

April 21, 2010 April 21, 2010

5Impaired Physical

Mobility r/t reluctance

to initiate movement

April 22, 2010 April 22, 2010

6 Hyperthermia r/t

underlying disease

process

April 22, 2010 April 22, 2010

7 Readiness for

Enhanced Sleep

April 23, 2010 April 23, 2010

Nursing Care Plan No. 1Problem Identified: Acute PainDate Identified: April 20, 2010

Subjective Cues: Ngutngot akong kamot ganina ra ni siya human gisuksukan. Mga 5 kung

sukdon

Objective Cues: Grimacing Diaphoretic Self focused Weak looking Guarding behavior With initial v/s taken as follows:

T: 37.5 C P: 97 bpmR: 24 cpm BP: 90/70 mmHg

Nursing Diagnosis: Acute Pain r/t presence of traumatized tissue resulting from insertion of IV

Planning: Within 6 hours of nursing interventions and giving of health teachings, the patient will

be able to verbalize reduction of felt pain from a scale of 5 to 1.

Interventions:

1. Determine possible pathophysiologic/ psychologic causes of pain.

R: To assess etiology precipitating contributing factors.2. Observe for non verbal cues.

R. Observations may/ may not be congruent with verbal reports.3. Accept clients description of pain.


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R: Pain is subjective experience and cannot be felt by others.

4. Encourage verbalization of feelings about pain.

R: To assist client to explore methods to control/ alleviate pain.5. Encourage us of relaxation techniques such as deep breathing exercises.

R: To assist client to explore methods to control/ alleviate pain

6. Encourage participation in diversional activities like socialization or listening to music.R: To assist client to explore methods to control/ alleviate pain7. Provide patient with a quiet environment and calm activities.

R: To assist client to explore methods to control/ alleviate pain

8. Instruct patient to position affected arm properly.R: To promote comfort.

9. Instruct patient to not use affected arm unnecessarily.

R: To prevent complicationsCollaborative:

10. Administer analgesics as indicated.

R: Inhibits prostaglandin synthesis by decreasing an enzyme needed for biosynthesis.

11. Notify physician for unusualities.R: For prompt management.

Evaluation:

Goal Met. After 3 hours of nursing interventions, the patient was able to verbalizereduction of felt pain from a scale of 5 to 1 as evidenced by the verbalization of Wala nay

sakit akong gitusukan nga kamot.

Date Evaluated: April 2O, 2010

Nursing Care Plan No. 2Problem Identified: HyperthermiaDate Identified: April 20, 2010

Subjective Cues: Init napud balik akong paminaw

Objective Cues:

Skin warm to touch Flushed skin Dry, cracked lips Absence of sweating Slowed movement With initial v/s as follows:

T: 39.2 C P: 99bpm R: 28 cpm BP: 90/70 mmHg

Nursing Diagnosis: Hyperthermia r/t underlying disease process

Planning: Within 2 hours of nursing interventions, the patient will be able manifest reduction of

core temperature from 39.2 to a normal range of 36.5 C- 37.5 C

Interventions:

1. Monitor patients vital signs.

R: Serves as baseline data for future comparison.2. Note chronological and developmental age of client.R: Assess for causative/ contributing factor.

3. Note presence/ absence of sweating.

R: To assess degree of hyperthermia.4. Initiate tepid sponge bath.

R: Facilitates heat through conduction and evaporation.

5. Promotes surface cooling through undressing or removing extra linens.R: Facilitates heat loss by radiation

6. Encourage adequate fluid intake.

R: To promote heat loss and hydration.

7. Encourage adequate bed rest.


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R: To reduce metabolic consumption and oxygen demands.

8. Instruct patient and SO to report signs and symptoms of hyperthermia like flushed

skin, increasing respiratory rate and body temperature.R: To promote wellness

9. Maintain patent airway and pad or raise siderails upon turning and positioning.

R: To promote safety.10. Provide high calorie diet unless contraindicated.R: To meet increased metabolic demands.

11. Instruct patient and SO to record all sources of fluid loss such as urine, vomiting and

diarrhea.R: It potentiates fluid and electrolyte losses.

Collaborative

12. Administer paracetamol 500mg, 1 tablet for fever as ordered.R: Relieves fever by acting in hypothalamic heat regulating center.

13. Administer replacement fluid and electrolytes as needed.

R: To support circulating volume and tissue perfusion.

14. Notify physician for unusualities.R: For prompt management.

Evaluation: Goal Unmet. After 1 hour and 45 minutes of nursing interventions, the patient was

not able to manifest reduction of core temperature from 39.2 to normal range with latest

temperature of 38.5 C.

Date Evaluated: April 20, 2010


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Nursing Care Plan No. 3

Problem Identified: Risk for ConstipationDate Identified: April 21, 2010

Subjective Cues: Wala pa ko kalibang gikan atong gi admit ko

Objective Cues: Dry skin Absence of sweating Needs assistance upon getting up in bed Refused to ambulate or to do ROM exercises Slowed movement (+) flatus Defecates 3-4 times per week

Nursing Diagnosis: Risk for Constipation r/t insufficient physical activity


be able to verbalize understanding of risk factors and appropriate interventions/ solutions toindividual situation.

Interventions:1. Auscultate abdomen for presence, location, and characteristics of bowels sounds.

R: Reflects bowel activity.

2. Ascertain clients belief and practices about bowel elimination.R: To identify individual risk factors/ needs.

3. Ascertain clients usual elimination pattern.

R: To assess clients individual risk factors/ needs.4. Encourage intake of balanced fiber and bulk in diet.

R: To improve consistency of stool and facilitates passage through colon.

5. Promote increase in fluid intake unless contraindicated.

R: to promote moist/ soft stool.6. Encourage participation in activity/ exercise within limits of own ability.R: To stimulate contractions of intestines.

7. Instruct patient to respond to urge to defecate.

R: To promote comfort and prevent complications.8. Instruct client and SO to ascertain frequency, color, consistency of stool once

defecated.

9. Advise patient to have elimination diary if appropriateR: To help monitor bowel pattern.

Collaborative:

10. Notify physician for unusualities.

R: For prompt management


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Evaluation: Goal Met. After 4 hours of nursing interventions, the patient was able to verbalize

understanding of risk factors and appropriate interventions/ solutions to individual situation asevidenced by the verbalization of Mobakod nako diri sa higdaanan ug maglakaw lakaw na

dayon ko human and patient was able to defecate during the shift of duty.


Nursing Care Plan No. 4Problem Identified: Hyperthermia

Date Identified: April 20, 2010

Subjective Cues: Init napud balik akong pamatiarang inita

Objective Cues: Skin warm to touch Flushed skin Dry, cracked lips Absence of sweating Slowed movement With initial v/s as follows:

T: 38 C P: 91bpm R: 29 cpm BP: 90/70 mmHg


Planning: Within 2 hours of nursing interventions, the patient will be able manifest reduction of

core temperature from 38 C to a normal range of 36.5 C- 37.5 C.

Interventions:1. Monitor patients vital signs.

R: Serves as baseline data for future comparison.

2. Note chronological and developmental age of client.

R: Assess for causative/ contributing factor.3. Note presence/ absence of sweating.

R: To assess degree of hyperthermia.

4. Initiate tepid sponge bath.R: Facilitates heat through conduction and evaporation.

5. Promotes surface cooling through undressing or removing extra linens.

R: Facilitates heat loss by radiation6. Encourage adequate fluid intake.


7. Encourage adequate bed rest.R: To reduce metabolic consumption and oxygen demands.

8. Instruct patient and SO to report signs and symptoms of hyperthermia like flushed

skin, increasing respiratory rate and body temperature.

R: To promote wellness9. Maintain patent airway and pad or raise siderails upon turning and positioning.R: To promote safety.

10. Provide high calorie diet unless contraindicated.

R: To meet increased metabolic demands.11. Instruct patient and SO to record all sources of fluid loss such as urine, vomiting and

diarrhea.

R: It potentiates fluid and electrolyte losses.Collaborative

12. Administer paracetamol 500mg, 1 tablet for fever as ordered.

R: Relieves fever by acting in hypothalamic heat regulating center.

13. Administer replacement fluid and electrolytes as needed.


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R: For prompt management.

Evaluation: Goal Met. After 1 hour and 45 minutes of nursing interventions, the patient was ableto manifest reduction of core temperature from 38C to normal range with latest temperature of

37.5 C.



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Nursing Care Plan No. 5Problem Identified: Impaired Physical Mobility


Subjective Cues: Kapoy ibakod sa higdaanan

Objective Cues: Slowed movement Body weakness noted Refused to ambulate or to do ROM exercises Needs assistance upon getting up/ out in bed Prefers to lie down on bed

Nursing Diagnosis: Impaired Physical Mobility r/t to reluctance to initiate movement


be able to verbalize willingness to and demonstrate participation in activities.

Interventions:

1. Determine degree of mobility.

R: To assess functional ability2. Assess nutritional status and energy level.

R: To identify causative/ contributing factors.

3. Ascertain clients perception of activity/ exercise needs.R: To identify causative/ contributing factors.

4. Have client reposition self on regular schedule as indicated.

R: To promote optimal level of functioning.5. Instruct in use of siderails upon positioning.

R: To promote safety.

6. Schedule activities with adequate rest periods during the day.

R: To prevent/ reduce fatigue.7. Encourage client to participate in self care activities.

R: Enhances self- concept and sense of independence.

8. Identify energy- conserving techniques for ADLs.

R: Limits fatigue, maximizing participation.9. Instruct patient to promote / have ambulation as necessary.

R: To prevent skin breakdown and maximizes energy production.

10. Instruct patient to eat nutritious foods and drink adequate fluid intake.R: promotes well being and maximizes energy production.

Evaluation: Goal Met. After 2 hours of nursing interventions, the patient was able verbalize

willingness to and demonstrate participation in activities as evidenced the verbalization of

Mubakod nako ug maglakaw lakaw dayon paghuman aron dlil ko luyahon ug samot.


Nursing Care Plan No.6


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Problem Identified: Hyperthermia


Subjective Cues: Nag-init napudbalik akong pamati

Objective Cues: Skin warm to touch Flushed skin Dry, cracked lips Absence of sweating Slowed movement With initial v/s as follows:

T: 38.8 C P: 91bpm R: 25 cpm BP: 90/70 mmHg


Planning: Within 2 hours of nursing interventions, the patient will be able manifest reduction ofcore temperature from 38.8 to a normal range of 36.5 C- 37.5 C

Interventions:

1. Monitor patients vital signs.R: Serves as baseline data for future comparison.

2. Note chronological and developmental age of client.

R: Assess for causative/ contributing factor.3. Note presence/ absence of sweating.

R: To assess degree of hyperthermia.

4. Initiate tepid sponge bath.R: Facilitates heat through conduction and evaporation.

5. Promotes surface cooling through undressing or removing extra linens.

R: Facilitates heat loss by radiation6. Encourage adequate fluid intake.


7. Encourage adequate bed rest.

R: To reduce metabolic consumption and oxygen demands.8. Instruct patient and SO to report signs and symptoms of hyperthermia like flushed

skin, increasing respiratory rate and body temperature.

R: To promote wellness

9. Maintain patent airway and pad or raise siderails upon turning and positioning.R: To promote safety.

10. Provide high calorie diet unless contraindicated.

R: To meet increased metabolic demands.11. Instruct patient and SO to record all sources of fluid loss such as urine, vomiting and

diarrhea.

R: It potentiates fluid and electrolyte losses.Collaborative

12. Administer paracetamol 500mg, 1 tablet for fever as ordered.

R: Relieves fever by acting in hypothalamic heat regulating center.13. Administer replacement fluid and electrolytes as needed.



R: For prompt management.

Evaluation: Goal Unmet. After 1 hour and 45 minutes of nursing interventions, the patient wasnot able to manifest reduction of core temperature from 38.8 to normal range with latest

temperature of 38.3 C.


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Nursing Care Plan No. 7

Problem Identified: Readiness for Enhanced Sleep


Subjective Cues: Gusto nako diritso akong tulog inig gabie bahala igang ug saba

Objective Cues:

Yawning noted Finds way to promote sleep like turning on the electric fan

Slowed movement


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Doesnt practice afternoon naps Sleeps 6-8 hours a day

Nursing Diagnosis: Readiness for Enhanced Sleep

Planning: Within 4 hours of nursing interventions and giving of health teachings, the patient willbe able to verbalize understanding on ways to promote sleep.

Interventions:

1. Listen to clients reports of sleep quantity and quality.R: Reveals clients expectations and experiences.

2. Obtain feedback from client and SO about usual bedtime, desired rituals and routine.

R: To determine usual sleep pattern and provide comparative baseline data.3. Note clients report of potential for alteration for habitual sleep time.

R: Helps identify circumstances that are known to interrupt sleep patterns.

4. Arrange care as necessary.

R: to provide for uninterrupted periods for rest.5. Explain to patient the necessity of disturbances for hospital procedure like v/s taking.

R: Allows for longer periods of uninterrupted sleep.

6. Provide quiet environment prior to sleep.

R: To promote relaxation and readiness to sleep.7. Instruct patient to practice proper hygiene practices like washing of hands and feet

before sleeping.

R: To promote relaxation and readiness to sleep.8. Instruct patient to limit intake of chocolate and caffeine/ alcoholic beverages prior to

bedtime.

R: Substances are known to impair falling or staying asleep.9. Instruct patient to limit fluid intake in evening.

R: To reduce need for nighttime elimination.

10. Discuss patients usual bedtime rituals, expectations for obtaining good sleep time.R: Provides information on clients management of the situation and identifies areas that

might be modified.

Evaluation: Goal Met. After 2 hours of nursing interventions, the patient was able to verbalizeunderstanding on ways to promote sleep as evidenced by the verbalization of Dili nako

makalimot ug hinlo sa akong lawas adisir ko matulog inig gabie


DISCH RGE PL NNING

MMedication

- Advise patient to take home medication following right drug, frequency, dosage and

timing as prescribed by the physician such as follows:

> Chloramphenicol, 500mg 1 tablet taken every six hours

- Encourage patient to follow drug regimen especially antibiotics.

EEnvironment

- Instruct patient to stay in calm, quiet environment.

- Home environment must be free from slipping or accident hazards.

- Instruct SO to provide patient with well ventilated room so that patient can rest well.

TTreatment

- Inform patient to have a follow-up check up after 1- 2 weeks


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HHealth Teachings

Inform patient to about proper food handling techniques as necessary.

- Stress the importance of proper hygiene like handwashing, toileting, toothbrushing

and bathing.

- Encourage client to engage to range of motion exercises.

- Instruct patient to drink only purified drinking water or have drinking water boiled

as necessary.

- Advise patient to increase adequate fluid intake for hydration purposes.

- Encourage patient not to participate in strenuous activities

- Tell patient not to hesitate to ask for assistance when waking up in bed or when

going to comfort room.

- Promote rest periods among the client but also encourage ambulation.

- Advise patient to avoid eating foods from outside sources like carinderia.

- Encourage deep breathing and coughing exercises among the client.

OObservable Signs and Symptoms

- Instruct patient to report signs and symptoms of typhoid fever like high grade fever,

generalized aches and pain, lethargy, fatigue, headache, diarrhea and rashes for

prompt management and to avoid further complications.

DDiet

- Encourage client to increase intake of fiber to avoid constipation

- Instruct to increase fluid intake

- Instruct to increase intake of nutritious foods rich in Vitamin C such as fruits and

vegetables to boost ones immune system.

S- Spirituality

- Advise patient to keep believing on Gods holy will so that he could be spirituallymotivated.

- Tell patient to constantly participate to religious activities so that his faith couldbe more strengthened.

LE RNING OUTCOMES

Life is indeed full of surprises. Things happen as what expected to them to happen.

No one ever travels the highway of success without ever crossing the road of failures instead.

All we need to is to follow path that leads us to the unknown road. But we should always beglad that as we get stumbled along the road, we learn to stand on our own feet putting our

heads up. From those experiences, we learn to grow as a person accountable for every action

we take. Thats how learning process takes place. It comes naturally as it may seem.

How could I ever forget the experience I have acquired upon exposure to the Pedia Ward

of Agusan del Norte Provincial Hospital. It was the 19

th

day of April, 2010, when I firstentered the innocent world of pediatric nursing. I have to admit on my part that I got anxious


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and nervous as I found out that our group was assigned to the pedia ward knowing children

really are stubborn in nature and truly demand for extra attention. Preparations were being

made. I also reviewed my lecture notes on pediatric nursing within that short span of time, ifthat would be possible.

As day progressed, I have gained new learnings and insights most especially duringexposure to the said area. Its just that in pedia ward , there is no room for mistakes perhaps.A student nurse must practice good therapeutic communication skills in order to gain the

trust of those sick young individuals. It entails cooperation and presence of mind as one

engages to the world of pedia. But patience and dedication area somewhat virtues to keep, soone should keep the fire burning.

When engagimg oneself to duty, one should be fully prepared. One must be assertiveenough to do all things needed to be carried out. One must be fully equipped with the

knowledge, skills and attitude before exposing to the area so that one could be productive and

useful perhaps since we aim for the recovery of those children. One should really pay

attention so that things would run smoothly.

Upon exposure, I was able to appreciate the call of duty since caring for the young ones

are somewhat a challenging task to be tackled upon. It somehow made me appreciate myself

and lot more becoming a part of the health care team. What a big relief on my part seeing mypatient, wearing a happy smile on his/her face after rendering nursing care to such patient.

When you are a nurse, you know that every day you will touch a life or a life will touchyours-a quotation on worth to lived for. As for now, I should live my life doing good things

not just for myself but also for others. I should bear in mind that I should not count the

number of times I felt better just because I made them happy. Two weeks of exposure may beshort enough yet with the experiences and learnings I gained, the hardships were all worth it.

The experience was truly superb and remarkable indeed.

32113884 case study on typhoid fever

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