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Far Eastern University

Institute of Nursing

Hand, foot, mouthdisease

Submitted To:

C. I Susan Romero

Submitted By: BSN 402-rou! "

#$%ayde, Catherine &ane

Busti$$o, 'austine C$aire

Ca(estani, )rin%ess

Chan%o, Car$o *ane

C$ara(a$$, +irstie oraine

Cunanan, +enneth Bernadeth

*imaranan, +ris%he$$e

*omino, ar% C$aren%e

'aro$an, &omar

'ernande/, &ohn i%hae$

1R1I3 ' TH *IS#S



Hand, foot, and mouth disease is a common viral illness that usually affects

infants and children younger than 5 years old. However, it can sometimes occur

in adults. Symptoms of hand, foot, and mouth disease include fever, blister-like

sores in the mouth (herpangina), and a skin rash. t is caused by viruses that

belong to the !nterovirus genus (group). "his group of viruses includes

polioviruses, co#sackieviruses, echoviruses, and enteroviruses.

"he viruses that cause hand, foot, and mouth disease (H$%&) can be found

in an infected person's nose and throat secretions (such as saliva, sputum, or

nasal mucus), blister fluid, and feces (stool). n infected person may spread the

viruses that cause hand, foot, and mouth disease through close personal contact,

the air (through coughing or sneeing), contact with feces, and contaminated

ob*ects and surfaces.

"here is no specific treatment for hand, foot and mouth disease. However,

some things can be done to relieve symptoms, such as taking over-the-counter

medications to relieve pain and fever and using mouthwashes or sprays thatnumb mouth pain

I. BIR#)HIC *#T#

+ame hild ++!/0

ddress "ondo, %anila

ge 1 year old, 2 mos

3ender %ale

4lace of irth "ondo, %anila

&ate of irth 6anuary 17, 8918

+ationality $ilipino

/eligious ffiliation /oman atholic

&ate and time of confinement 6uly 8:, 891: ; 1885pm

/eason for confinement $ever, cough and rashes

dmitting diagnosis hand, $oot and mouth disease

ttending physician &r. %iranda

Source of information 4atient's %other and 4atient's hart

http://www.cdc.gov/non-polio-enterovirus/index.html

http://www.cdc.gov/non-polio-enterovirus/index.html



II. NRSIN HISTR5

#. )ast Hea$th History

ccording to the mother, hild ++!/ was born through normalspontaneous delivery. His mother said that she had no complications and had

taken vitamin supplements and nutritious foods during her pregnancy with

hild ++!/. hild ++!/ has completed his immuniation appropriate for his

age and has no known allergies to foods or medicines. He also hasn't

e#perienced any kind of accidents. ccording to the mother, it is hild

++!/'s first time to be hospitalied and his previous visits to the hospital

were because of the child baby wellness checkups since he was a newborn.

"he patient is not taking any medication before his hospitaliation and before

he was discharged, he has been receiving drugs namely mpicillin, cyclovir,

+ystatin, 4aracetamol, <inc S=7, and 4rote#in. "he patient has no foreign

travels.

B. History of )resent Hea$th I$$ness

t all started with fever and a little cough. hild ++!/ started

e#periencing elevation of temperature last Sunday, 6uly 81, 891: which was

followed by cough. %rs. /eyes said, “Sumunod bigla nung Monday na

nagkaroon sya ng rashes sa bandang ari nya. Akala pa namin diaper rash

lang e kaso dumami na ng sumunod na time.” She said that the rashes

reached hild ++!/'s legs and arms and a little on the client's chest and

back. Nag-alala na kami kaya dinala namin sya dito nung Martes,” said hild++!/'s mother. %rs. /eyes also said that the rashes of hild ++!/ do not

hurt because she tried touching the lesions in her child's legs and inguinal

area before putting some ointment that was prescribed by the doctor but he

is not complaining. "he lesions are reddish during his first confinement and

his temperature was above normal.

C. 'ami$y Ba%6round

hild ++!/ is third among the : children of %r. and %rs. /eyes. "heir

family is from "ondo, %anila. "hey are staying in their own house there whereall 5 of them in the family with %rs. /eyes' mother and her older sister. %r.

and %rs. /eyes are married. ccording to authority, the family is patriarchal

for the father is the one who makes decisions within the house and health

matters.

"he family's source of income is from %r. /eyes' *ob who is a police

officer and %rs. /eyes' little buy and sell business of breads and meat

(tocino, tapa).



>hen it comes to the educational attainment of the family, only %r.

/eyes is a college graduates. He finished S riminology while %rs. /eyes is

a high school graduate. "heir eldest child is currently in : rd grade and their

middle child is in 1st grade.

n terms of family diseases, %rs. /eyes verbalied that the only disease

she knows that her parents and one of her sisters have is asthma while thefamily of her husband, %r. /eyes, have diabetes mellitus and hypertension.

III. )#TTRNS ' 'NCTININ

7. )S5CHIC# H#TH

4atient ++!/ is an active and friendly baby. His mother verbalied,

Takot lang siya sa mga nakaputi eh. Umiiyak pa siya pag may lumapit na

mga nurses saka doctor.” "he patient's mother also added that her son plays

with the health care team as they get along well and as long as the child

doesn't get hurt. She mentioned that as long as the child is with his mother,

he stays calm and comfortable.

#na$ysis:

ccording to !rickson's 4sychosocial "heory, as the child enters the

toddler years, gaining a greater sense of personal control becomes

increasingly important. "asks such as learning how to use the toilet, selecting

foods and choosing toys are ways that children gain a greater sense of

independence. ased on the theory of psychose#ual by $reud, the anal stage

is directly related to a child's awareness of bowel control and gaining

pleasure through the act of eliminating or retaining feces.

Inter!retation:

Since the patient's developmental functioning falls at the right time,

the patient will not have any problems in the future regarding the autonomy,

patient wont doubt and be ashamed on the things she wishes to do. Since the

patient is not yet able to be toilet trained, he *ust wears diaper. However, this

is still unremarkable since toilet training can be developed during toddler and

he is *ust at the start of the said stage. %oreover, the patient displays

mistrust to strangers.

2. SCI-CTR# )#TTRN

"he patient's family's primary spoken language is $ilipino. "he patient

lives with her parents and 8 other siblings. His mother is from atangas while

his father was raised in %anila. /egarding his recreational pattern, his mother

said he spends most of his time watching "? especially cartoons and playing

with his family. His relationship with his family is good. His siblings visit him



every day. /egarding the family's tradition on health, the mother said,

“Minsan, nagpapahilot kami lalo na sa likod.” side from this, they don't

practice any other traditional practices regarding health. n addition, the

patient's environment according to his mother is good. She stated, Maayos

naman at malinis sa bahay namin kasi sakto lang yung laki niya tapos

maayos din yung mga drainage sa kalsada yun nga lang meron pa ring mgabasura sa paligid.”

#na$ysis:

ulture plays a critical role in the socialiation agenda of a person

through particular views of child development. (o!ier pp. "#$%.

!nvironmental factors that support positive change should be used to

reinforce the clients efforts to change lifestyle. ll groups of people face

issues in adapting to their environment@ providing nutrition and shelter,

controlling disease and maintenance of health. &o!ier pp."''% $amily

members support one another and have the ability to listen, empathie, andreach out to one another in times of crisis. >hen the needs of family

members are met, they are able to reach out to meet the needs of others in

society. (Aoier, p.1B:)

Inter!retation:

"he child is able to socialie well with others especially with his family

who is the one supporting and caring for him. "he family members reach out

and help one another in caring for patient +/. "he patient's environment is

good and secured especially with his caring family who is concerned with

him. "he conte#ts of family and environment are where the child develops hisfeelings and e#periences.

8. S)IRIT# H#TH

4atient ++!/ and his family's religion is /oman atholic. ccording to

the patient's mother, they are only able to attend masses twice a month. She

verbalied, Madalang lang kaming magsimba eh. (ala kasing oras.”

However, the patient mother added that they pray every day especially for

their son, patient +/.

#na$ysis:

Spiritual health is the ability to develop one's inner nature to its fullest

potential Spiritual beliefs can affect a person's interpretation of events in his

or her life. (Aoier pp. 8C7)

Inter!retation:



!ven if the family rarely attends to church services, they still value

their spirituality. %oreover, it is an une#ceptional thing that his family shares

common religious beliefs which can influence each member of the family.

*. *e(e$o!menta$ History

)sy%hose9ua$ Theory of *e(e$o!ment by Simund 'reud

Sigmund $reud thinks that from birth, humans have instinctual se#ual

appetites (libido) which unfold in a series of stages. !ach stage is

characteried by the erogenous one that is the source of the libidinal drive

during that stage. "hese stages are, in order oral, anal, phallic, latency, and

genital.

Stae *es%ri!tion Resu$t &ustifi%ation

nal

Stage

"his occurs about age 1 to :

years old. Here, individuals

have their first encounter with

rules and regulations, as they

have to be toilet trained. "his

encounter with rules and

regulations will dictate the

later behavior with rules and

regulations. "he libido is

focused anally, and frustration

may arise from having to

learn a comple# cognitive andmotor response. eing fi#ated

at this stage can result in

stinginess, stubbornness, or

orderliness, as well as

messiness. !ssentially,

behavior related to retention

and e#pulsion may be related

to e#periences at this stage.

+=" D!"

H!?!

&

n this psychose#ual

developmental stage, hild

++!/ is still in the process of

controlling the drives that

come along with it. lthough

he still doesn't show off

startling degree of

independency wherein he can

be left along by his mother to

some strangers without any

complains, it was observed

that hild ++!/ could beobedient to some commands

made by his mother. "he

child is not yet toilet trained

since he is still at the

beginning of this stage.

lthough he is confined and

is having an ? infusion on his

right foot, he can still

manage himself around his

crib with or without his

mother beside him.

I1. #CTI1ITIS ' *#I5 I1IN



#*Before

Hos!ita$i/ation

*urin

Hos!ita$i/ation

Inter!retation and

#na$ysis

Nutrition ccording to the

mother the client

has no problem

regarding food

consumption. She

verbalied,

Mataka) pa nga

yan sa pagdedede

eh.0 She said that

her child seldom

eats solid or soft

foods and seldom

drinks beverages

like orange andapple *uices. hild

++!/'s usual diet

is either breast

milk or formula

milk and E glass

of water.

"he client is on

diet as tolerated.

"he mother uses

breast milk in

feeding hild

++!/. &uring their

:rd day in the

hospital, she fed

her child with rice

and a little

amount of soup in

it and an

estimation of F9mlof orange *uice

and some sips of

water.

&uring nights of

their stay, hild

++!/ is being

breastfed but his

mother.

"he client is not choosy when

it comes to eating foods.

His appetite does not change

even he is in the hospital.

%oreover, it is also good that

the child is still being

breastfed by his mother.

#na$ysis:

n individual's food

preferences and habits are

often a ma*or factor affecting

actual food intake. Habits

about eating are influencedby developmental

considerations , gender ,

ethnicity and culture, beliefs

about food, personal

preferences , religious

practices, lifestyle

economics, medications and

therapy, health , alcohol ,

consumption, advertising and

physiological factors.reast milk is the most

desirable complete food for

the first F months of child's

life.

/ef. (p.18:2 , Aoier and

!rb's $undamentals of

+ursing , Cth !dition , ?olume

)

$imination

"he motherverbalied that

before the child

was hospitalied,

she changes hild

++!/'s diaper : to

5 times a day. She

"he mother saidthat she

freGuently

changes her

child's diaper

about 7 to F times

from morning that

Inter!retation: "he client urinates and

defecates normally even

before and during

hospitaliation.

#na$ysis:



said that

sometimes it has

soft brown stools,

or *ust filled with

light yellow

colored urine.

%rs. /eyes also

said that hild

++!/ usually likes

to drink either

water, breast milk

or formula milk

that makes him

have his diaper

full of urine.

her child wakes up

until the night he

sleeps. &uring his

stay, %rs. /eyes

said that last 6uly

85, the client hasbeen defecating

yellow watery

stool freGuently

which started in

the morning and

lessened during

the night. "he

urine appeared to

be light yellow in

color.

Successful elimination in

human beings depends on

individual having an intact

and fully functional urinary

tract, gastrointestinal tract

and nervous system. "hroughvariation of what is normal

occur in every individual,

there is a pattern in

elimination that every

individual must have.

($undamentals of +ursing 8th

edition pp.852 by 6ose

uiambao - Idan)

Hyiene "he mother

bathes the client

twice daily.

She said that she

trims her kids'

nails every week.

hild ++!/'s

parents usuallycarry him around

the house

because he needs

assistance before

wearing slippers

inside and outside

the house.

"he mother cleans

the patient while

in bed or seated in

her lap.

She is also able to

trim hild ++!/'s

nails during their

stay in the

hospital.

Inter!retation:

+ormal since the mother

gives importance to the

client's hygiene, but the day

he has been confined to the

hospital there is no regular

bath.

#na$ysis:

Hygiene is the science of

health and its maintenance.4ersonal hygiene is the self-

care by which people attend

to such functions as bathing,

toileting, general body

weight and grooming.

Hygiene is highly a personal

matter determined by

individual values and

practices.

($undamentals of nursing 2th

edition p.11F7, by Aoier)S$ee! and

Rest

ccording to his

mother the client

usually sleeps B -

19 hours at night.

ccording to his

mother the client

usually sleeps C-

19 hours at night

but sometimes,

Inter!retation:

"he sleep pattern of the

client is normal since. %ost

infants between reGuire

about 18-17 hours of sleep a



"he client doesn't

have any

difficulties in

sleeping.

his sleeping

pattern is being

disturbed due to

the visits of his

doctors andJor the

nurses on duty.

day.

He gets enough of sleep.

"here is no sleep deprivation.

#na$ysis:Sleep is the basic human

need. t is biological process

common to all people. >e

reGuire sleep to cope with

daily stresses, to prevent

fatigue, to conserve energy,

to restore the mind and body

and to en*oy life more fully.

Sleep enhances daytime

functioning. t is vital for not

optimal psychological

functioning but also

psychological functioning as

rate of healing of damaged

tissue is greatest during

sleep. t is an important

factor in person's Guality of

life.

($undamentals of nursing 2th

edition p.11F7, by Aoier)

1. )H5SIC# #SSSSNT

1I. )#TH)H5SI5

)R*IS)SIN '#CTRS

• ge K19 years old

)RCI)IT#TIN '#CTRS

• ontact with someone

who is affectedCausati(e aent:

!#posure to?irus particles implanted

initially in the buccal and ilealmucosaJ 3 tractSpread into the?iremia

-Lymphocyte 9.F1-increase rate of

infection



1II. )RB I*NTI'IC#TIN

Cues Inferen%e Nursin *ianosis

nvasion of the skin and mucous

Hand 'oot outhCom!$i%ations:- ?iral

edi%ations:- mpicillin 859mg "? G

Chrs

cyclovir 899mg J 5ml G

Fhrs 4=

+ystatin drops 1ml :# a

day 1hr +4= after

intake

4aracetamol drops 1ml

G 7hrs 4/+

<inc s97 drops 1ml =&

Nursin inter(entions:- 4romote hand hygieneespecially after changingdiaper-nstruct to avoid closecontact with children withH$%&-dminister medicationprescribed by the &octor-!ncourage to drink coldbeverages such as milk orice water and avoid citrusfruits and acidic food.-

aboratory:- "hroat swab

-Stool specimen

-4ainful blister like lesion

in the buccal mucosa,tongue, gums, and hard

-$ever-Sorethroat

/ed rashes, soreblister-palm, soles of the



ough ommon cold

nfluena (flu)

nhaling an irritant

4neumonia

sthma

llergies

neffective airway

clearance rJt secretions

secondary to infection

rashes sa bandang ari

nya0 as verbalied by the

mother.

rashes on both legs and

arms and a little on the

client’s chest and back

?iral infection

?iruses

f the child also has a cold,

a cough, or diarrhea

mpaired tissue integrity

rJt inflammatory response

secondary to viral

infection

1III. )RB )RIRITI#TIN

Nursin )rob$ems

Identified

Cues &ustifi%ation

neffective airway

clearance rJt secretions

secondary to infection

ough as$o;<s Hierar%hy

"he problem is on physiologic

needs of the client

*eree of )rob$em

"his the highly prioritied

problem because according to

%aslow's hierarchy of needs

under biological and

physiological needs, it stated

that air together with food,

water, shelter, rest, sleep,

activity and temperature

maintenance are crucial for

survival of an individual.

=#ygen is necessary for proper

functioning of all living cells.

Secretions in the airway could

affect breathing of the client for

it blocks the entrance and e#it

of air in the lungs going to the



different organs. f it is not

treated further complication will

occur and even death.

Inter!retation

"his is highly prioritied

because this is an actual

problem. "he nurse or the

health care provider has the

necessary resources to solve

this problem such as time,

skills, knowledge and money.

!liminating this problem may

help to prevent further

complications and completely

eliminate the actual problem.

*e+erence

o!ier and rb. undamentals

o+ Nursing, /th edition. 0olume

", pp. #1'-#12

o!ier and rb. undamentals

o+ Nursing, /th edition. 0olume

#, p. "'31

mpaired tissue integrityrJt inflammatory

response secondary to

viral infection

Sub*ective

rashes sa bandang ari

nya0 as verbalied by

the mother.

-rashes on both legs

and arms and a little on

the client's chest and

back

as$o;<s Hierar%hy

"he problem is on the

physiologic need of the client

*eree of )rob$em

"he problem is moderately

prioritied because the problem

needs immediate action yet it

isn't life threatening.

Inter!retation

"his is moderately prioritied

because this is an actual



problem. "he nurse or the

health care provider has the

necessary resources to solve

this problem such as time,

skills, knowledge and money.

!liminating this problem mayhelp to prevent further

complications and completely

eliminate the actual problem.

*ISCH#R )#N

edi%ations %ake sure that the client will take all his

medications listed such as

mpicillin 859mg "? G Chrs

cyclovir 899mg J 5ml G Fhrs 4=

+ystatin drops 1ml :# a day 1hr +4=

after intake

4aracetamol drops 1ml G 7hrs 4/+

<inc s97 drops 1ml =&

4rote#in (restore) =&

&escribe the importance of regularly

taking of prescribed medications

including the potential unpleasant

effects of non compliance.

nstruct the mother of the client to

continue with follow up medical care.

dvise the mother of the client not to

miss the intake of medications given by

their physician upon discharge.n(ironment #nd 9er%ise %aintain a Guiet, environment to

promote rela#ation. 4rovide clean and

comfortable environment.

!ncourage client to continue deep

breathing e#ercises, also instruct the

family for the e#ercise needed. "his is to

promote circulation of blood, rela#ation

also.



!#ercise that appropriate for the clients

age . Such as active and passive range

of motion.Treatments ontinue home medications.

$or the follow-up check-up repeat.

!ncourage patient to take multivitamins

for immunity.

$ollow doctors adviseHea$th Tea%hins nstruct the mother of the client that the

client must always wash his hands.

4erform good oral and personal hygiene

4rovide a clean environment

t can reduce the risk of having foot-

mouth disease by always performing

hand washing

*isinfe%t %ommon areas

Tea%h ood hyiene. Show your

children how to practice good hygiene

and how to keep themselves clean.

!#plain to them why itMs best not to put

their fingers, hands or any other ob*ects

in their mouths.

n%ourae the %$ient to In%rease

f$uid inta6e

ut )atient 'o$$o; u! 4atient will be advised to go back in the

hospital in a specific date to have a

follow-up check up after discharge.

onsult doctor for any problems or

complications encountered such as

-?omiting

-$ever of 199.7o$ or higher

-Shaking hills

lso if the physician advise the client to

go back for a follow up check up for

continuity of care

*iet &epends on physician order but



here are some home remedies

Low salt low fat diet

&rink cold beverages, such as milk

or ice water

void acidic foods and beverages,

such as citrus fruits, fruit drinks and soda

void salty or spicy foods

!at soft foods that donMt reGuire

much chewing

/inse your mouth with warm

water after meals

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