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I. INTRODUCTION
Gastroenteritis or infectious diarrhea is a medical condition characterizedbyinflammation ("-itis") of thegastrointestinal tract that involves both
thestomach ("gastro"-) and thesmall intestine ("entero"-), resulting in some
combination ofdiarrhea,vomiting,andabdominal pain and cramping. Dehydration may
occur as a result. Gastroenteritis has been referred to as gastro, stomach bug,
and stomach virus. Although unrelated toinfluenza,it has also been called stomach
flu and gastric flu.
Signs and symptoms
Gastroenteritis typically involves bothdiarrhea andvomiting,or less commonly,
presents with only one or the other. Abdominal cramping may also be present. Signs
and symptoms usually begin 1272 hours after contracting the infectious agent. If due
to a viral agent, the condition usually resolves within one week. Some viral causes may
also be associated withfever,fatigue, headache, andmuscle pain.If thestool is bloody,
the cause is less likely to be viral and more likely to be bacterial. Some bacterial
infections may be associated with severe abdominal pain and may persist for several
weeks.
Children infected with rotavirus usually make a full recovery within three to eight
d H i i f i f i i f f h
http://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Gastrointestinal_tracthttp://en.wikipedia.org/wiki/Stomachhttp://en.wikipedia.org/wiki/Small_intestinehttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Abdomenhttp://en.wikipedia.org/wiki/Influenzahttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Myalgiahttp://en.wikipedia.org/wiki/Dysenteryhttp://en.wikipedia.org/wiki/Dysenteryhttp://en.wikipedia.org/wiki/Myalgiahttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Influenzahttp://en.wikipedia.org/wiki/Abdomenhttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Small_intestinehttp://en.wikipedia.org/wiki/Stomachhttp://en.wikipedia.org/wiki/Gastrointestinal_tracthttp://en.wikipedia.org/wiki/Inflammation -
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consume the food. Some foods commonly associated with illness include raw or
undercooked meat,poultry,seafood, and eggs; raw sprouts; unpasteurized milk and
soft cheeses; and fruit and vegetable juices. In the developing world, especially sub-
Saharan Africa and Asia,cholera is a common cause of gastroenteritis. This infection is
usually transmitted by contaminated water or food.
ToxigenicClostridium difficileis an important cause of diarrhea that occurs more often
in the elderly. Infants can carry these bacteria without developing symptoms. It is a
common cause of diarrhea in those who are hospitalized and is frequently associated
with antibiotic use.Staphylococcus aureusinfectious diarrhea may also occur in thosewho have used antibiotics. "Traveler's diarrhea"is usually a type of bacterial
gastroenteritis. Acid-suppressing medication appears to increase the risk of significant
infection after exposure to a number of organisms, including Clostridium
difficile, Salmonella, and Campylobacter species. The risk is greater in those
takingproton pump inhibitorsthan withH2 antagonists.
Parasitic
A number ofprotozoanscan cause gastroenteritismost commonlyGiardia lamblia
butEntamoeba histolyticaandCryptosporidiumspecies have also been implicated. As a
group, these agents comprise about 10% of cases in children. Giardia occurs more
commonly in the developing world, but this etiologic agent causes this type of illness to
http://en.wikipedia.org/wiki/Poultryhttp://en.wikipedia.org/wiki/Cholerahttp://en.wikipedia.org/wiki/Clostridium_difficilehttp://en.wikipedia.org/wiki/Clostridium_difficilehttp://en.wikipedia.org/wiki/Clostridium_difficilehttp://en.wikipedia.org/wiki/Staphylococcus_aureushttp://en.wikipedia.org/wiki/Staphylococcus_aureushttp://en.wikipedia.org/wiki/Staphylococcus_aureushttp://en.wikipedia.org/wiki/Traveler%27s_diarrheahttp://en.wikipedia.org/wiki/Traveler%27s_diarrheahttp://en.wikipedia.org/wiki/Traveler%27s_diarrheahttp://en.wikipedia.org/wiki/Proton_pump_inhibitorshttp://en.wikipedia.org/wiki/Proton_pump_inhibitorshttp://en.wikipedia.org/wiki/Proton_pump_inhibitorshttp://en.wikipedia.org/wiki/H2_antagonisthttp://en.wikipedia.org/wiki/H2_antagonisthttp://en.wikipedia.org/wiki/H2_antagonisthttp://en.wikipedia.org/wiki/Protozoahttp://en.wikipedia.org/wiki/Protozoahttp://en.wikipedia.org/wiki/Protozoahttp://en.wikipedia.org/wiki/Giardia_lambliahttp://en.wikipedia.org/wiki/Giardia_lambliahttp://en.wikipedia.org/wiki/Giardia_lambliahttp://en.wikipedia.org/wiki/Entamoeba_histolyticahttp://en.wikipedia.org/wiki/Entamoeba_histolyticahttp://en.wikipedia.org/wiki/Entamoeba_histolyticahttp://en.wikipedia.org/wiki/Cryptosporidiumhttp://en.wikipedia.org/wiki/Cryptosporidiumhttp://en.wikipedia.org/wiki/Cryptosporidiumhttp://en.wikipedia.org/wiki/Entamoeba_histolyticahttp://en.wikipedia.org/wiki/Giardia_lambliahttp://en.wikipedia.org/wiki/Protozoahttp://en.wikipedia.org/wiki/H2_antagonisthttp://en.wikipedia.org/wiki/Proton_pump_inhibitorshttp://en.wikipedia.org/wiki/Traveler%27s_diarrheahttp://en.wikipedia.org/wiki/Staphylococcus_aureushttp://en.wikipedia.org/wiki/Clostridium_difficilehttp://en.wikipedia.org/wiki/Cholerahttp://en.wikipedia.org/wiki/Poultry -
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with blood in the stool, those who might have been exposed to food poisoning,and
those who have recently traveled to the developing world. Diagnostic testing may also
be done for surveillance. Ashypoglycemiaoccurs in approximately 10% of infants and
young children, measuring serumglucosein this population is recommended.
Electrolytesandkidney functionshould also be checked when there is a concern about
severe dehydration.
Dehydration
A determination of whether or not the person hasdehydrationis an important part of theassessment, with dehydration typically divided into mild (35%), moderate (69%), and
severe (10%) cases.In children, the most accurate signs of moderate or severe
dehydration are a prolongedcapillary refill,poorskin turgor,and abnormal
breathing. Other useful findings (when used in combination) include sunken eyes,
decreased activity, a lack of tears, and a dry mouth. A normal urinary output and oral
fluid intake is reassuring. Laboratory testing is of little clinical benefit in determining the
degree of dehydration.
Prevention
Lifestyle
http://en.wikipedia.org/wiki/Food_poisoninghttp://en.wikipedia.org/wiki/Food_poisoninghttp://en.wikipedia.org/wiki/Food_poisoninghttp://en.wikipedia.org/wiki/Hypoglycemiahttp://en.wikipedia.org/wiki/Hypoglycemiahttp://en.wikipedia.org/wiki/Hypoglycemiahttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Electrolyteshttp://en.wikipedia.org/wiki/Electrolyteshttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Dehydrationhttp://en.wikipedia.org/wiki/Dehydrationhttp://en.wikipedia.org/wiki/Dehydrationhttp://en.wikipedia.org/wiki/Capillary_refillhttp://en.wikipedia.org/wiki/Capillary_refillhttp://en.wikipedia.org/wiki/Capillary_refillhttp://en.wikipedia.org/wiki/Skin_turgorhttp://en.wikipedia.org/wiki/Skin_turgorhttp://en.wikipedia.org/wiki/Skin_turgorhttp://en.wikipedia.org/wiki/Skin_turgorhttp://en.wikipedia.org/wiki/Capillary_refillhttp://en.wikipedia.org/wiki/Dehydrationhttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Electrolyteshttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Hypoglycemiahttp://en.wikipedia.org/wiki/Food_poisoning -
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those made from wheat or rice) may be superior to those based on simple
sugars. Drinks especially high in simple sugars, such assoft drinksand fruit juices, are
not recommended in children under 5 years of age as they may increase diarrhea. Plainwater may be used if more specific and effective ORT preparations are unavailable or
are not palatable. Anasogastric tubecan be used in young children to administer fluids if
warranted.
Dietary
It is recommended that breast-fed infants continue to be nursed in the usual fashion,and that formula-fed infants continue their formula immediately after rehydration with
ORT. Lactose-free or lactose-reduced formulas usually are not necessary.[42]Children
should continue their usual diet during episodes of diarrhea with the exception that
foods high insimple sugarsshould be avoided. TheBRAT diet(bananas, rice,
applesauce, toast and tea) is no longer recommended, as it contains insufficient
nutrients and has no benefit over normal feeding. Someprobioticshave been shown to
be beneficial in reducing both the duration of illness and the frequency of stools. Theymay also be useful in preventing and treatingantibiotic associated diarrhea.Fermented
milk products (such asyogurt)are similarly beneficial.Zincsupplementation appears to
be effective in both treating and preventing diarrhea among children in the developing
world.
http://en.wikipedia.org/wiki/Soft_drinkshttp://en.wikipedia.org/wiki/Soft_drinkshttp://en.wikipedia.org/wiki/Soft_drinkshttp://en.wikipedia.org/wiki/Nasogastric_tubehttp://en.wikipedia.org/wiki/Nasogastric_tubehttp://en.wikipedia.org/wiki/Gastroenteritis#cite_note-MMWR2003-42http://en.wikipedia.org/wiki/Gastroenteritis#cite_note-MMWR2003-42http://en.wikipedia.org/wiki/Gastroenteritis#cite_note-MMWR2003-42http://en.wikipedia.org/wiki/Simple_sugarhttp://en.wikipedia.org/wiki/Simple_sugarhttp://en.wikipedia.org/wiki/Simple_sugarhttp://en.wikipedia.org/wiki/BRAT_diethttp://en.wikipedia.org/wiki/BRAT_diethttp://en.wikipedia.org/wiki/BRAT_diethttp://en.wikipedia.org/wiki/Probioticshttp://en.wikipedia.org/wiki/Probioticshttp://en.wikipedia.org/wiki/Probioticshttp://en.wikipedia.org/wiki/Antibiotic_associated_diarrheahttp://en.wikipedia.org/wiki/Antibiotic_associated_diarrheahttp://en.wikipedia.org/wiki/Antibiotic_associated_diarrheahttp://en.wikipedia.org/wiki/Yogurthttp://en.wikipedia.org/wiki/Yogurthttp://en.wikipedia.org/wiki/Yogurthttp://en.wikipedia.org/wiki/Zinchttp://en.wikipedia.org/wiki/Zinchttp://en.wikipedia.org/wiki/Zinchttp://en.wikipedia.org/wiki/Zinchttp://en.wikipedia.org/wiki/Yogurthttp://en.wikipedia.org/wiki/Antibiotic_associated_diarrheahttp://en.wikipedia.org/wiki/Probioticshttp://en.wikipedia.org/wiki/BRAT_diethttp://en.wikipedia.org/wiki/Simple_sugarhttp://en.wikipedia.org/wiki/Gastroenteritis#cite_note-MMWR2003-42http://en.wikipedia.org/wiki/Nasogastric_tubehttp://en.wikipedia.org/wiki/Soft_drinks -
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those in thedeveloping world being primarily affected. As of 2011, in
those less than five, there were about 1.7 billion cases resulting in
0.7 million deaths with most of these occurring in the world's poorestnations. More than 450,000 of these fatalities are due to rotavirus in
children under 5 years of ageCholera causes about three to five million
cases of disease and kills approximately 100,000 people yearly.In the
developing world children less than two years of age frequently get six or
more infections a year that result in clinically significant gastroenteritis.
Gastroenteritis is associated with many colloquial names, including"Montezuma's revenge", "Delhi belly", "la turista", and "back door sprint",
among others. It has played a role in many military campaigns and is
believed to be the origin of the term "no guts no glory".
Locally, In July 22, 2004, the Department of Health (DOH), Philippines
declared an epidemic (outbreak) of a water/food-borne disease called
acute gastroenteritis in 45 towns in Central Pangasinan. Acutegastroenteritis is a human enteric (intestinal) disease primarily caused by
ingestion of spoiled or bacterial contaminated water or food.
2. OBJECTIVES
http://en.wikipedia.org/wiki/Developing_worldhttp://en.wikipedia.org/wiki/Cholerahttp://en.wikipedia.org/wiki/Montezuma%27s_revengehttp://en.wikipedia.org/wiki/Montezuma%27s_revengehttp://en.wikipedia.org/wiki/Cholerahttp://en.wikipedia.org/wiki/Developing_world -
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knowledge according to the case of the chosen case of the client. The
study will also teach the students to learn how to interconnect with other
health care providers and to be more familiar with those documents thatthe hospital has with their clients
5. Scope of limitation of the study
The study will only focus about the case of the client which is t/c bacterial
meningitis AGE with moderate sings of dehydration R/O electrolyte
imbalance which is the condition of the chosen client and to the otherrelevant information about the case of the client.
Conceptual and Nursing Theory
DOROTHEA ELIZABETH OREM
(SELF-CARE DEFICIT NURSING THEORY)
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II. CLINICAL SUMMARY
A. General Data Profile
NAME: Mr. Jhon Cris Magdalena
ADDRESS: Brgy Anoling Gen. Nakar Quezon
AGE: 4y/o
BIRTHDAY: 01/21/2010
BIRTHPLACE: Quezon
NATIONALITY: Filipino
RELIGION: Catholic
OCCUPATION: Child
DATE OF ADMISSION: 4/19/2014
ADMITTING DIAGNOSIS: Bacterial Meningitis
ADMITTING PHYSICIAN: Dr Arlan Lopez
B. REASON FOR CONFINEMENT
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e. HOSPITALIZATION
-The patient was confined on april 17 in the hospital in gen. Nakar because he was bitten by adog after that he was brought to san lazaro for further medical management.
f. DOMESTIC TRAVEL
-Laguna and manila area
D. FAMILY HISTORY
LEGEND
MALE DEAD MALE
FEMALE DEAD FEMALE
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III. Function Health Pattern
Function Health Pattern Before Hospitalization During Hospitalization Interpretation
Health Management
Pattern
Was brought first
to the health
center due to dog
bite
First time to be
hospitalize
He seeks
medical
attention whe
he has been
bite by the do
Nutritional/Metabolic
a. number of meals per day
b. appetite
c. glass of water per day
d. body built
3 times a day
with very good
appetite
3-4 glasses of
water
with normal body
built
3 times a day
with good appetite
maximum of 5
glasses of water
slightly smaller
than before
Due to the
disease proce
the body wasn
able to resist
the bacteria
that make his
body smaller
before
hospitalizatio
Elimination
a. frequency of urination
b. amount of urine per day
c. frequency of bowel
movement
d consistency of the feces
3-5 times per day
moderate
1-2 times per day
f d
4-8 times per day
scanty
1-2 times per day
t t l
The frequency
is higher due t
higher
consumption
water also
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Self-Perception/ Self-
Concept
Not aware of self-
perception
Not aware of self-
perception
He is not awa
of self-
perceptionbecause hes
still a kid and
doesnt have a
sufficient
knowledge on
that.
Coping/Stress None None He doesnt
know whatstress is and
doesnt know
how to cope
about it.
Values/Beliefs His parents taught
him about God.
He still believes in
God as what his
parents taughthim.
As a child hes
not aware of i
only he believon Him.
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IV. PHYSICAL ASSESSMENT
Date of assessment: May 19, 2014
General appearance:
The patient is weak and pale in appearance. He wears tidy clothes exactly for his ectomorphic
body. Upon assessment, the client is lying on bed, with a blood pressure of 90/60mmHg, pulse
rate of 92 beats per minute, respiration rate of 43 breaths per minute, and temperature of 36.7C.
BODY PART NORMALFINDINGS
ACTUAL FINDINGS INTERPRETATION/ANALYSIS
A. HEAD1.Skull Proportional to the
body, with
prominences in the
frontal areaanteriorly and the
occipital area
posteriorlysymmetrical in all
planes.
Proportional to the size
of the body,
asymmetrical by larger
on the right side.
As the mother say it
may be due to injury
that happened to the
client.
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2. Eyelids
3. Lid margins
without difficulty,
evenly distributed
and parallel witheach other.
Upper lids cover a
small portion of the
iris, cornea, and thesclera when the eyes
are open. When the
eyes are closed, thelids meetcompletely.
Symmetrical color is
the same as the
surrounding skin.
Clear without
scaling or secretions,
lacrimal ductopenings are evident
at the nasal ends.
Upper lids cover a
small portion of the
iris, cornea, and thesclera when the eyes
are open. When the
eyes are closed, thelids meet completely.Symmetrical color is
the same as the
surrounding skin.
Clear, without scaling
or secretions, pale.
Normal.
Normal.
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C. EARS
1. Hearing Acuity
2. Ear Canal
D. NOSE
1. Internal Nares
2. Septum
E. MOUTH
Pinkish, clean, with
scant amount ofcerumen and a few
ciliaAble to hear whisper
spoken words 2 feet
away.
No erythema, no
scaling, no swelling,absence of foreignbody and odor.
Midline,
symmetrical, andpatent
Clean, pinkish, withfew cilia.
Straight.
Pinkish, symmetrical
Cerumen and a few
cilia.
Able to hear whisper
spoken words 2 feet
away.
No erythema, no
scaling, no swelling,absence of foreignbody and odor.
Midline, symmetrical,
and patent
Clean, pinkish, withfew cilia.
Straight.
Pinkish, symmetrical
Normal.
Normal.
Normal.
Normal.
Normal.
Normal.
Normal.
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Hard Palate
6. Uvula
7. Tonsils
8. Voice
F. Neck
G. Range ofMotion
At the center,
symmetrical, andfreely movable.
Pinkish, non-
inflamed, no
exudates.
No hoarseness and
well-modulated.
Proportional to the
size of the body and
head, symmetricaland straight.
Freely movable withrelative ease.
At the center,
symmetrical, andfreely movable.
Pinkish, non-inflamed,
no exudates.
Unable to verbalize
words.
Proportional to the size
of the body and head,
symmetrical andstraight.
Limited movements
Normal
Normal
Due to body
weakness that the
client is experiencingas a symptom of the
disease
Normal
Due to bodyweakness that the
client is experiencing
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respiration
Auscultation
Palpation
K. Chest
(Thorax)
I nspection
by respiration.
Audible bowelsounds (5-30/min);absence of arterial
bruits and friction
rubs.
No tenderness;
relaxed abdomenwith smooth,
consistent tension.
Chest symmetrical,skin intact, no
tenderness, nomasses.
Audible bowel sounds
(36/min).
No area of tenderness;
no presence of lumpsand absence of lesion.
Not proportion, withrashes noted.
Respiration of 43
breaths per minute.
On assessment ofgastroenteritis there
is hyperactive bowelsounds. (Medical-
surgical nursing,
pg.319)
Normal
Normal
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M.Nails
N. Shoulders,Arms, Elbows,
H d d
appears equal with
good muscle tone.
Nails aretransparent, smooth,
& convex with pink
nail beds & whitetranslucent tips.
Five fingers in eachhand. As pressure isapplied to the nail
bed, it appears white
or blanched & pink
color returnsimmediately as
pressure is released.
Performs with
relative ease.
Complete fingers, 5each hand.
Nails are thick,
transparent, & convexwith pale nail beds &
white translucent tips.
As pressure is applied
to the nail bed, it
appears white and
color returns after 5seconds.
Performs with relative
ease.
With deviation fromnormal
Patients with anemia
may exhibit delayed
capillary refilldiminished blood
flow to the peripheryand compensatoryvasoconstriction.
(Medical Surgical Nursingby Black 5thedition p.1571)
Normal
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Palpation
P. Legs, Knees,Ankles, Toes
Adduction and
Abduction.
beds appear white or
blanched; pink color
returns whenpressure is released
(2 seconds).
Performs with
relative ease.
white or blanched;
pink color returns
when pressure isreleased (5 seconds).
Performs with relative
ease.
capillary refill
diminished blood
flow to the peripheryand compensatory
vasoconstriction.(Medical Surgical Nursingby Black 5thedition p.1571)
Normal
V. Course in the ward
Date Doctors order Interpretation
April 20, 2014
9:30pm
Please admit to PAV
Secure consent for
admission and
management
Monitor V/S every 4hrs
Monitor intake and
>for continue management
>For approval of admission and
further management
>to have baseline date
>to monitor status of fluid and
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PCEC 0.1ml x 2 sites
ATS 1.500 IV #2 given
outside
TT 0.5ml given outside
>anti-rabies vaccine
>anti tetanus serum
>anti-tetanus
Date Doctors order Interpretation
April 20, 2014
11:55pm
Hold Phenobarbital
May give diazepam only
if with active seizures at
2.5mg TIV
Start ceftriaxone 90mg
TIV now then once a day
ANST ()
Please carry out other
orders
Addendum:
STAT serum Na , k , cl , Ca
determination for fecalysis
, monitor Hgt every 8hrs
Ranitidine 9mg TIV every
8hrs
Refer
>the patient dont have seizure
episode
>give only during muscle spasm
occur if necessary
>antibiotic drug
>to note and to know if the NOD
done the specific orders
>for serum determinations and
specimen collection
>to reduce acidity
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April 23,2014
puncture please secure
consent for the procedure
For chest X-ray ADL today
For gastric aspirate AFB X3
For PPD
Educate patients relative
regarding proper hygiene
Please secure official chest
x-ray result and other lab
test done since admission
Start O2 weaning
Discontinue ranitidine once
feeding is tolerated
infection such as meningitis, for
approval from the patient and
relatives before proceeding to
the procedure.
>way to diagnose disease.
>to detect bacteria called acid
fast bacilli in fluid or tissue
samples
>performed to check if you have
any tuberculosis infection
>the doctor wanted to see all lab
results that he/she has ordered
>the oxygen saturation of the
patient has normalize
>the patient was able to tolerate
soft foods thats why this drug
was ordered to be discontinue
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Continue present
management
April 26, 2014 Continue IVF D5IMB to run
for 40cc/hr
DAT
Discontinue O2 support
Start FESO4 syrup 5ml OD
Continue present medical
management
Monitoring V/S , I and O
record every shift
O2 sat every 4hrs
>the patients hemoglobin and
hematocrit is low
>there is an occurrence with
difficulty of breathing
April 27,2014 Still to submit specimen
for stool exam
Request CBC with APL
>this order was produced
because the client was need for
fecalysisi and the client cannot
be treted accordingly unless
there is aneatment exact
organism for
This request was ordered
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April 30, 2014
May 1,2014
Please refer to clarify for
Nutritional build up
Multivitamins +iron syrup
5ml OD
Ascorbic acid syrup 5ml OD
To follow D5IMB 500ml at
40ml/hour
Continue IVF of the same
rate
Inject glycerin support
rectal now
Continue present
management
was at the normal range
>to provide additional energy
with protein,vitamins and
minerals
>this is given because the
doctor wanted to have
supplementary nutrition to the
child
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May 4,2014
IVF: PNSS 1L to run at 40
cc/hr DFA
Follow up lab results
Resume ceftriaxone 90mg
TIV OD via soluset to run for
30mins.
For request CBC with APL
May give diazepam 3mg TIV
every 12hrs for sputum
GS/CS for PPD
Sched for tetanus toxoid
Tetanus 1- april 20
Tetanus 2- may20
Will refer patient for pedia
neuro
WOF recurrence of seizure
Start metronidazole 90mg TIV
every 6hrs ANST()
Continue meds.
For fecalysis
>this isotonic solution is to
correct the hyponatremia that
the client has experienced
>it is used to diagnose and
monitor treatment
>for use as an antibiotic
>for muscle spasm and seizures
>for anti tetanus
>for refereal and further
management
>seizure precation
>anti protozoan
For collection of another
specimen to see if the organ
ism is stil present in the stool
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May 7,2014
May 8, 2014
May 9,2014
May 10,2014
May 11,2014
contrast
Work out toward TB meningitis
Proceed with ct scan
Still cranial ct scan
Maintain IVF same rate
Continue present management
For BUN, UREA
For cranial ct scan with contrast
today
Ct scan not done
Continue present management
Still for CT SCAN
Continue present management
To see if there is a
inflammation of the brain
as well as hemorrhage
This is a hypotheses of the
doctor
>to see if the urinary system is
still functioning
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May 16,2014
May 17,2014
Still awaits ct scan result
Awaits result AFB smear gastric
aspiration
Shift oxacillin 250/5ml every
6hrs x 7days
Possible discharge
Facilitate cranial ct scan result
Continue other medication
Possible discharge once with
cranial ct scan result
Insert bisacodyl suppository
rectum now then at bedtime
Please follow up ct scan c/o
relatives
Continue present
>for treatment for constipation
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VI. LABORATORY RESULTS:
Date: May 02, 2014
CBCExam Name Result Reference Range Interpretation
WBC 6.70 4.8-10.8 Normal
RBC 4.90 4.5-5.9 Normal
Hemoglobin 113.6 140-175 Low
Hematocrit 0.352 0.415-0.504 Low
MCV 72.00 82-98 Low
MCH 23.21 28-33 Low
MCHC 32.28 33-36 Low
Platelet Count 496 150-400 High
RDW 21.70 11.4-14.0 High
Neutrophil 71.70 40-70 HighLymphocyte 15.90 19.0-48.0 Low
Eosinophil 3.80 2.0-8.0 Normal
Monocyte 7.80 0.00-15.0 Normal
Basophils 0.80 0.00-5.0 Normal
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Date: April 21, 2014
CBCExam Name Result Reference Range Interpretation
WBC 10.50 4.8-10.8 Normal
RBC 4.93 4.5-5.9 Normal
Hemoglobin 116 140-175 LowHematocrit 0.361 0.415-0.504 Low
MCV 73.00 82-98 Low
MCH 23.52 28-33 Low
MCHC 32.18 33-36 Low
Platelet Count 309 150-400 Normal
RDW 19.10 11.4-14.0 High
Neutrophil65.50 40-70 Normal
Lymphocyte 19.30 19.0-48.0 Normal
Eosinophil 9.50 2.0-8.0 High
Monocyte 5.20 0.00-15.0 Normal
Basophils 0.50 0.00-5.0 Normal
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- The physician ordered to take this test to check the water and
electrolyte balance of the client body and to check the progress
of diseases of the kidneys or adrenal glands. These tests will
measure the concentration of electrolytes that are needed for
both the diagnosis and management of renal, endocrine, acid-
base, water balance, and many other conditions. Their importance
lies in part with the serious consequences that follow from therelatively small changes that diseases or abnormal conditions may
cause. This result finds that the client sodium is high which
indicate Hypernatremia and the rest electrolytes are normal.
- The BUN test is stands for blood urea nitrogen. The blood urea
nitrogen test is primarily used, along with thecreatinine test,to
evaluate kidney function of the client in a wide range of
circumstances, to help diagnosekidney disease,and to monitor
http://labtestsonline.org/understanding/analytes/creatininehttp://labtestsonline.org/understanding/conditions/kidneyhttp://labtestsonline.org/glossary/chronichttp://labtestsonline.org/glossary/acutehttp://labtestsonline.org/understanding/conditions/kidneyhttp://labtestsonline.org/understanding/analytes/creatinine -
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B.Microscopic
Test Result ReferenceFat Globules Few present
Leukocytes 2-4/ HPF Few present
Red Blood Cells 4-8/HPF Few present
Muscle Fibers Few present
Food Particles Varies w/ diet
Yeast Cell MANYOthers
MISCELLANEOUS
C.Biochemical
Test Result Reference
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Platelets
Abnormal increases or decreases in cell counts as revealed in a complete blood count
may indicate that the client have an underlying medical condition that calls for further
evaluation. And based on the result of CBC exam last April 21, 2014, which the RBC
and WBC is Normal. Hemoglobin and Hematocrit is Low., thats why the result of MCV,
MCH and MCHC is also low because the three tests are calculated using the amount of
hemoglobin and hematocrit to determine whether the red blood cells are in normal sizeand if they contain the appropriate amount of hemoglobin. The RDW is high, which
indicates that the red blood cells vary a lot in size. The RDW level can be high because
of iron deficiency, because iron is needed to make hemoglobin. The Eosinophil is also
high, maybe because due to allergic diseases and infections from parasites.
April 27, 4014
The physician ordered to repeat the CBC test because of the abnormal findings
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parasites, viruses, or bacteria and poor nutrient absorption.A fecalysis is also
performed to check for the presence of any reducing substances such as white
blood cells, sugars, or bile and signs of poor absorption on the client stool. Based
on the client result of fecalysis, theres a presence ofTrichuris trichiura it is a
roundworm, known as the Human Whipworm that indicates the client had
infection.
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VII. Drug study
Name of DrugMechanism of
Action
Indication Contraindication Analysis
Ascorbic Acid Stimulates
collagen
formation and
tissue repair;involved in
oxidation-
reduction
reactions
Vitamin C
deficiency with
poor nutritional
habits
Hypersensitivity to
tartrazine or sulphites
To increase
patient
immunity and
to stimulatescollagen
formation and
tissue repair
Generic Name:
Bacillus Clausii
Brand Name:
Erceflora
Contributes to
the recovery of
the intestinal
microbial floraaltered during the
course of
microbial
disorders ofdiverse origin. It
produces various
vitamins,particularly
B it i
Acute and
chronic
diarrhea
Immunocompromised
patient
The patient
experiencing
loose watery
stool which is amanifestation
of the present
disease, the
physicianordered this
drug to promote
normalize theintestinal flora.
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Generic Name:
Cloxacillin
Brand Name:Cloxapen
A penicillinase-resistant
penicillin that
inhibits cell-wall
synthesis duringmicroorganism
multiplication.
Bacteria resistpenicillins by
producing
penicillinases
Systemicinfections
Hypersensitivity tothe drug
The physicianordered this
drug to inhibit
cell synthesis
that result tomultiplication
of the
microorganismwhich is the
action of the
drug.
Generic Name:Diazepam
Brand Name:
Valium
Depresses theCNS at thelimbic and
subcortical levels
of the brain and
suppresses thespread of seizure
activity produced
by epileptogenicfoci in the cortex,thalamus, and
limbic structure
Muscles spasm,severe recurrentseizure
Hypersensitivity tothe drug. Patientexperienced shock
and coma.
Seizure episodeis the chiefcomplaint of
the patient, the
physician
ordered thisdrug to lessen
the seizure
episode bydepressing theCNS at the
limbic and
subcorticallevels of brain
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ordered thisdrug to inhibits
uptake of
glucose and
other nutrientsin susceptible
helminths
Generic Name:
Metronidazole
Brand Name:Flagyl
A direct-acting
trichomonacide
and amebicidethat works at
both intestinalandextraintestinal
sites. Its thought
to enter the cells
ofmicroorganisms
that contain
nitroreductase.Unstablecompounds are
then formed that
bind to DNA andinhibit synthesis
Bacterial
infections
Hypersensitivity to
the drug or other
nitroimidazolederivatives
The present
disease caused
by bacterialinfection
resulting togastrointestinalproblems such
as diarrhea and
constipation.
Hence, thephysician
ordered this
drug to inhibitsynthesis ofmicroorganisms
that causes cell
death.
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Generic Name:
Ranitidine
Brand Name:Zantac
Competitivelyinhibits action of
histamine on the
H2 at receptor
sites of parietalcells, decreasing
gastric acid
secretion
Duodenal andgastric ulcer
Hypersensitive todrug and those with
acute porphyria
The patient isexperiencing
vomiting, to
prevent this
episodes thephysician
ordered this
drug todecrease gastric
acid secretions
Zinc Sulfate Participate in
synthesis andstabilization ofproteins and
nucleic acids in
subcellular and
membranetransport system
To prevent
individual traceelementdeficiencies in
patients
receiving long-
term totalparenteral
nutrition
Hypersensitivity Children need
vitamins suchas zinc becausezinc is one of
important
vitamins for
growth and forthe
development
and health ofbody tissue
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VIII. ANATOMY AND PHYSIOLOGYMeningitis, in general, is the inflammation of the protective membranes surrounding the
brain and spinal cord. In the case of bacterial meningitis, this inflammation is caused by
bacterial infection. In order to inflame these protective membranes, the bacteria must somehow
enter the bloodstream and bypass the blood-brain barrier.
Blood-Brain Barrier
Since the brain is such a delicate organ, nature has taken extra measures to protect the
brain by creating the blood-brain barrier to limit the diffusion of substances from the bloodstreaminto brain tissue selectively.
The blood-brain barrier mainly consists of tight junctions, which seals the endothelial
cells that line the brain capillaries. Astrocytes, a type of neuroglia from the brain, closely
attached to the endothelial cells and release chemicals to regulate the permeabilities of the tight
junctions. The major sites of the blood brain barrier are the arachnoid membrane, choroid plexus
epithelium, and the cerebral microvascular endothelium.
Only a few kinds water-soluble substance can move across the blood-brain barrier,such as glucose by active transport, urea, creatinine, and ions move across by slow diffusion.
On the other hand, lipid-soluble substances can easily cross the blood-brain barrier, such as
oxygen, carbon dioxide, alcohol, and most anesthetic agents.
When bacteria break through the blood-brain barrier, an infection occurs in the
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From the choroid plexuses of each lateral ventricle, CSF flows into the third ventricle
through the interventricular foramina, which are two narrow oval openings. The choroid
plexuses in the third ventricle adds more CSF. Then, CSF flows into the fourth ventricle
throught the cerebral aqueduct. Again, the choroid plexuses in the fourth ventricle adds moreCSF. The fluid then enters the subarachnoid spacethrough the three openings in the roof of the
fourth ventricle. These three openings are a median aperture and a pair of lateral apertures.
Then, CSF circultates in the central canal of the spinal cord and in the subarachnoid space around
the surface of the brain and spinal cord.
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and connective tissue located in the epidural space, a space between the dura mater and the wall
of the vertebral canal.
The middle meninx is an avascular covering called the arachnoid mater. It is deep to the
dura mater and is continuous with the arachnoid mater of the brain. Between the dura mater andthe arachnoid mater is a thin subdural space, which contains interstitial fluid.
The innermost meninx is the pia mater, which adheres to the surface of the spinal cord
and brain. Within the pia mater are many blood vessels that supply oxygen and nutrients to the
spinal cord. Between the arachnoid mater and the pia mater is the subarachnoid space,
which contains cerebrospinal fluid that serves as a shock absorber and suspension system for the
spinal cord and brain .
All three spinal meninges cover the spinal nerve roots, structures that connect spinalnerves to the spinal cord, up to the point where they exit the spinal column through the
intervertebral foramina. Triangular-shaped membranous extensions of the pia mater suspend the
spinal cord in the middle of its dural sheath. These extensions, called denticulate ligaments, are
thickenings of the pia mater. They project laterally and fuse with the arachnoid mater and inner
surface of the dura mater between the anterior and posterior nerve roots of spinal nerves on either
side. Extending all along the length of the spinal cord, the denticulate ligaments protect the spinal
cord against sudden displacement that could result in shock.
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Digestive System
The primary function of the digestive system is to break down the food we eat into smaller partsso the body can use them to build and nourish cells and provide energy. There occurs propulsion which
is the movement of food along the digestive tract. The major means of propulsion is peristalsis, a series
of alternating contractions and relaxations of smooth muscle that lines the walls of the digestive organs
and that forces food to move forward. It secretes digestive enzymes and other substances liquefies,
adjusts the pH of, and chemically breaks down the food. Mechanical digestion is the process of physically
breaking down food into smaller pieces. This process begins with the chewing of food and continues
with the muscular churning of the stomach. Additional churning occurs in the small intestine throughmuscular constriction of the intestinal wall. This process, called segmentation, is similar to peristalsis,
except that the rhythmic timing of the muscle constrictions forces the food backward and forward rather
than forward only. Chemical digestion which is the process of chemically breaking down food into
simpler molecules. The process is carried out by enzymes in the stomach and small intestines. Then
absorption or the movement of molecules (by passive diffusion or active transport) from the digestive
tract to adjacent blood and lymphatic vessels. Absorption is the entrance of the digested food into the
body. And lastly, defecation which is the process of eliminating undigested material through the anus.
But because of acute gastroenteritis the normal functions were altered. The infectious agents
that cause acute gastroenteritis causes diarrhea by adherence mucosal invasion enterotoxin
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The human digestive system is a complex series of organs and glands that processes food. In
order to use the food we eat, our body has to break the food down into smaller molecules that it can
process; it also has to excrete waste.
Most of the digestive organs (like the stomach and intestines) are tube-like and contain the food
as it makes its way through the body. The digestive system is essentially a long, twisting tube that runs
from the mouth to the anus, plus a few other organs (like the liver and pancreas) that produce or store
digestive chemicals.
The Digestive Process:
The start of the process - the mouth: The digestive process begins in the mouth. Food is partly
broken down by the process of chewing and by the chemical action of salivary enzymes (these enzymes
are produced by the salivary glands and break down starches into smaller molecules).
On the way to the stomach: the esophagus - After being chewed and swallowed, the food enters
the esophagus. The esophagus is a long tube that runs from the mouth to the stomach. It uses rhythmic,
wave-like muscle movements (called peristalsis) to force food from the throat into the stomach. This
muscle movement gives us the ability to eat or drink even when we're upside-down.
In the stomach - The stomach is a large, sack-like organ that churns the food and bathes it in a
very strong acid (gastric acid). Food in the stomach that is partly digested and mixed with stomach acids
is called chyme.
I th ll i t ti Aft b i i th t h f d t th d d th fi t t f
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epiglottis - the flap at the back of the tongue that keeps chewed food from going down the windpipe to
the lungs. When you swallow, the epiglottis automatically closes. When you breathe, the epiglottis
opens so that air can go in and out of the windpipe.
esophagus - the long tube between the mouth and the stomach. It uses rhythmic muscle movements
(called peristalsis) to force food from the throat into the stomach.
gall bladder - a small, sac-like organ located by the duodenum. It stores and releases bile (a digestive
chemical which is produced in the liver) into the small intestine.
ileum - the last part of the small intestine before the large intestine begins.
jejunum - the long, coiled mid-section of the small intestine; it is between the duodenum and the ileum.
liver - a large organ located above and in front of the stomach. It filters toxins from the blood, and makes
bile (which breaks down fats) and some blood proteins.
mouth - the first part of the digestive system, where food enters the body. Chewing and salivary
enzymes in the mouth are the beginning of the digestive process (breaking down the food).
pancreas - an enzyme-producing gland located below the stomach and above the intestines. Enzymes
from the pancreas help in the
digestion of carbohydrates, fats and proteins in the small intestine.
i t l i h th i l t th t f f d i th h f th th t i t th
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IX. PATHOPHYSIOLOGY
Ingestion of fecally
contaminated food & water
Secretion of F&E in the
intestinal lumen
Excessive gas formation
Direct invasion of the bowel
wall
Stimulation and destruction
of mucosal lining of the bowel
wall
Endotoxins are released
Digestive & absorptive
malfunction
Increase peristaltic
movement
Predisposing Factors
Age
Malnutrition
Precipitating Factors
Contaminated food
and water
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Ingestion of fecallycontaminated food & water
Secretion of F&E in the
intestinal lumen
Excessive gas formation
Direct invasion of the bowel
wall
Stimulation and destruction
of mucosal lining of the bowelwall
Endotoxins are released
Digestive & absorptive
malfunction
Increase peristaltic
movement
Predisposing Factors
Age
Malnutrition
Precipitating Factors
Contaminated food
and water
Fecalysis
(Presence ofTrichuris
trichiuraova)
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Predisposing Factors
- Any age are at risk
Steptococcus
pneumoniae
Naso har n eal
Precipitating Factors- Environment-Poor Hygiene
- Malnutrition-Poor immune system
Im lantation
Enters the blood From wounds
Invades the CNS
Disease Process - PINK
Di VIOLET
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If Treated:- Early Diagnosis &Prompt Treatment
- Antibiotics- Antipyretics- Analgesics- Corticosteroids / Anti-
inflammatory agents- Anti-emetics- Avoid cooling too
much- Place in a quiet &
dark environment
If Not Treated
Thrombophlebitisof veins and
venous sinuses
Good Prognosis
Congestion andinfarction of
surrounding tissue
Adhesion Formation
Cranial nerve alsies
Visual or auditory
Early Treatment Delayed Treatment
Memoryim airement
Profound learningdisabilities
Bacterial Menin itis
Seizures
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PATHOPHYSIOLOGY
Predisposing Factors- Any age are at risk
Steptococcus
pneumoniae
Naso har n eal
Precipitating Factors- Environment-Poor Hygiene
- Malnutrition-Poor immune system
Im lantation
Enters the blood From wounds
Invades the CNS
Disease Process - PINK
Disease - VIOLET
I i d h i l bilit
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X. Nursing Care Plan Prioritization:
Nursing Diagnosis Ranking RationaleFluid volume deficient related to
excessive loose watery stool.1st It should be the first to be prioritized
because according to Callista Roys
adaptation model, fluid and electrolytes is
the 3rd
physiologic needs of man.
Source:(Kozier, Erb, Berman, and Burke,
2000).
Impaired skin integrity related to
presence of skin lesions.2nd It should be the second to be prioritized
because according to Callista Roys
adaptation model, the senses including the
senses of the skin which is the 7th
physiologic needs of man.
Source:(Kozier, Erb, Berman, and Burke,
2000).
Impaired physical mobility related to 3rd It should be the last to be prioritized
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XI. NURSING CARE PLAN
Assessment Nursing
Diagnosis
Planning Interventions Rationale Evaluation
Objectives:
-decreased urine
output
-sudden weight loss
Weight: 9kg.
-increased body
temperature with
temperature of
39 C.
-decreased skin
turgor
-increased capillary
refill: 5sec.
-dry skin/mucous
membranes
-vomiting
-loose watery stool
-Bowel movement
of 4 a day.
Fluid volume
deficient related
to excessive
loose watery
stool.
After nursing
interventions the
client will maintain
fluid volume at a
functional level as
evidenced by
adequate urinary
output, stable vital
signs, good skin
turgor and moist
mucous membranes.
-Assess vital signs; note strength of
peripheral pulses.
-Administer IV fluids as indicated.
-Monitor vital signs.
-Change position frequently.
-Provide frequent oral care as well as eye
care.
-Administer medications(e.g., antiemetic or
antidiarrheals)(antipyretics)
-To evaluate degree of fluid
deficit.
-To correct losses to
reverse pathophysiologic
mechanisms.
-To determine current
health status.
-To promote comfort and
safety.
-To prevent injury formdryness.
-To limit gastric/intestinallosses.
-To reduce fever.
After nursing
interventions the
client maintained
fluid volume at a
functional level as
evidenced by
adequate urinary
output, stable vital
signs, decreased
capillary refill: 2sec.,
good skin turgor and
moist mucous
membranes.
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Assessment Nursing Diagnosis Planning Interventions Rationale Evaluation
Objectives:
-Disruption of skin
surface (epidermis)
-Destruction of skin
layers(dermis)
-invasion of body
structures
-damaged tissue e.g.,
integumentary
Impaired skin
integrity related to
presence of skin
lesions.
After nursing interventions
the client will demonstratebehaviors/ lifestyle changes
to promote healing and
preventcomplications/recurrence.
-Note laboratory
results pertinent tocausative factors (e.g.,
studies such as
Hb/Hct).
-Obtain a history ofcondition, includingage at onset, date of
first episode, howlong it lasted, original
site, characteristics of
lesions, and anychanges that have
occurred.- Inspect skin on a
daily basis, describinglesions and changes
observed.-Periodically
remeasure wound andobserve for
complications (e.g.,infection, dehiscence).
-Keep the affectedarea clean/dry,
prevent infection, andstimulate circulation
to surrounding areas.
-To assess causative/
contributing factors forhaving skin lesions.
-To assess extent ofinvolvement/ injury of theaffected area.
To assist client with
correcting/minimizingcondition and promote
optimal healing.
-To monitor progress ofwound healing.
-To assist bodys natural
process of repair.
After nursing interventions
the client demonstratedbehaviors/ lifestyle changes
to promote healing and
preventcomplications/recurrence.
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Assessment Nursing Diagnosis Planning Interventions Rationale Evaluation
Objectives:
-limited range of
motion
-difficulty turning
-slowed movement
-functional level: 3
which indicate
require help from
another person.
-inability to walk
Impaired physical
mobility related to
neuromuscular
impairment.
After nursing
interventions the
client will increase
strength and function
of affected and/or
compensatory body
part.
-Assess nutritional status
and energy level.
-Determine degree of
immobility in relation to
previously suggested scale.
-Observe movement when
client is unaware of
observation.
-Instruct in use of side rails
for position
changes/transfers.
-Support affected body
parts/joints using pillows,
foot support and so forth.
-To identify causative/contributing
factors.
-To assess functional ability.
-To note any incongruencies with
reports of abilities.
-To promote optimal level of
function and preventcomplications.
- To maintain position of functionand reduce risk of pressure ulcers.
After nursing
interventions the
client increased
strength and function
of affected and/or
compensatory body
part.