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Unciano Colleges Antipolo Inc.

Circumferencial road, Antipolo City

A case study of

In partial fulfillment of requirements in

NCM 101

Submitted by:

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I. TABLE OF CONTENTS

I. Table of contents 2

II. Acknowledgement 3

III. Introduction 4

IV. Background of the study 5

V. Objectives 6

VI. Patients Profile 7

VII. Nursing History 8-10

VIII. Pediatric Assessment 11-18

IX. Anatomy and Physiology 19-21

X. Pathophysiology 22-23

XI. Laboratory Results 24-26

XII. Drug Study 27-29

XIII. Nursing Care Plan 30-34

XIV. Evaluation 35-36

XV. Bibliography 37

XVI. Consent Form 38

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II. ACKNOWLEDGEMENT

We, the 3rd year Nursing students of, Section D Group 3 of Unciano Colleges

Antipolo, Inc. - Antipolo City would like to thank our clinical instructor , Mrs. Nhina

Sandeep S. De Rosas, RN, for the knowledge that she imparted to us during our duty in

Carlos Medical and Maternity Clinic. Her active supervision has been a guiding light

during the making of our case study.

We would also like to extend our gratitude to the management and staff ofCarlos

Medical and Maternity Clinic who accepted us wholeheartedly.

We wish to express our heartfelt gratitude to our client and his family for their

cooperation as we make our assessment and also for giving us information about his

health condition.

Much credit is also given to our dear parents and family for supporting us

emotionally and financially as we conduct this case study.

We also like to thank each other. This case study is a synergetic effort and would

not have been made possible without the cooperation and hard work of every member of

the group.

And above all, we would like to give thanks to ourGodAlmighty for giving us

the wisdom, strength and endurance in making our case study worthy and for giving us

the opportunity to realize the essence of nursing as a profession and as a vocation.

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III. INTRODUCTION

Nursing is a learned practice discipline with the ultimate goal of contributing as

individuals, collaborative with others and to the promotion of the clients optimum level

of functioning through health teachings and maximum delivery of case.

Mastering the skills and procedures of nursing practice is essential and is a must.

To survive in nursing practice, one must be able to utilize both hands as well as the head

to be well prepared in dealing with existing and potential problems of the client.

During our exposure in different hospitals we are able to render the proper

attitude towards our client, enhance the knowledge and practice the skills that we have

learned from Unciano Colleges Antipolo.

Our client B.A. is the subject in our case study. We have chosen him to be our

case presentation because our patient is cooperative and easy to talk to. The case

improved our attitudes, skills, and knowledge towards our patient and further gave us

insights on our chosen path. We chose this case to widen our knowledge in Anatomy and

Physiology of the Digestive System and the mechanism and action of Typhoid Fever,

and, to give our best to our clients.

This case study enhanced our knowledge and developed our skills in nursing

process, like assessing the client to come up with the Nursing Diagnosis, formulating

goals and performing interventions with regards to meet our goals.

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IV. BACGROUND OF THE STUDY

Typhoid fever, also known as enteric fever, Salmonella typhi or commonly justtyphoid, is an illness caused by the bacterium Salmonella enterica serovar typhi.Common worldwide, it is transmitted by the ingestion of food or water contaminated with

feces from an infected person. The bacteria then perforate through the intestinal wall and

are phagocytosed by macrophages. Salmonella typhi then alters its structure to resistdestruction and allow them to exist within the macrophage. This renders them resistant to

damage by PMN's, complement and the immune response. The organism is then spread

via the lymphatics while inside the macrophages. This gives them access to thereticuloendothelial system and then to the different organs throughout the body. The

organism is a Gram-negative short bacillus that is motile due to its peritrichous flagella.

The bacteria grows best at 37 C/99 F human body temperature.

S. typhi bacteria are passed into the stool and urine of infected patients. They maycontinue to be present in the stool of asymptomatic carriers, who are persons who have

recovered from the symptoms of the disease but continue to carry the bacteria. This

carrier state occurs in about 3% of all individuals recovered from typhoid fever.

Typhoid fever is passed from person to person through poor hygiene, such as incompleteor no hand washing after using the toilet. Persons who are carriers of the disease and who

handle food can be the source of epidemic spread of typhoid. One such individual gave

her name to the expression "Typhoid Mary," a name given to someone whom othersavoid.

EPIDEMIOLOGY:

With an estimated 16-33 million cases of annually resulting in 500,000 to 600,000deaths in endemic areas, the World Health Organization identifies typhoid as a serious

public health problem. Its incidence is highest in children and young adults between 5

and 19 years old.

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http://en.wikipedia.org/wiki/Bacteriumhttp://en.wikipedia.org/wiki/Salmonella_typhihttp://en.wikipedia.org/wiki/Salmonella_typhihttp://en.wikipedia.org/wiki/Salmonella_typhihttp://en.wikipedia.org/wiki/Feceshttp://en.wikipedia.org/wiki/Phagocytosishttp://en.wikipedia.org/wiki/Macrophageshttp://en.wikipedia.org/wiki/Granulocytehttp://en.wikipedia.org/wiki/Reticuloendothelial_systemhttp://en.wikipedia.org/wiki/Gram-negative_bacteriahttp://en.wikipedia.org/wiki/Flagellumhttp://en.wikipedia.org/wiki/Celsiushttp://en.wikipedia.org/wiki/Fahrenheithttp://www.healthline.com/adamcontent/typhoid-feverhttp://en.wikipedia.org/wiki/Bacteriumhttp://en.wikipedia.org/wiki/Salmonella_typhihttp://en.wikipedia.org/wiki/Feceshttp://en.wikipedia.org/wiki/Phagocytosishttp://en.wikipedia.org/wiki/Macrophageshttp://en.wikipedia.org/wiki/Granulocytehttp://en.wikipedia.org/wiki/Reticuloendothelial_systemhttp://en.wikipedia.org/wiki/Gram-negative_bacteriahttp://en.wikipedia.org/wiki/Flagellumhttp://en.wikipedia.org/wiki/Celsiushttp://en.wikipedia.org/wiki/Fahrenheithttp://www.healthline.com/adamcontent/typhoid-fever


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V. OBJECTIVES

A. General Objectives

Within 32 hours of exposure Carlos Medical and Maternity Clinic, we, the 3rd

year Nursing students, section D group 3 of Unciano Colleges Antipolo, aim to convey

our empathy to our patients in the ward and learn and have knowledge trough our skills

that we do all throughout our rotation in providing holistic care to all our patients in the

ward.

B. Specific Objectives

To be able to establish nurse patient relationship that would build rapport for the

effective and informative interactions with the patient and the significant others.

To be able to assess health problem and condition using the Pediatric Assessment.

To be review the Anatomy and Physiology of the Digestive System and the

pathophysiology of Typhoid Fever.

To be able to gather necessary data and identify needs in order to formulate

specific nursing care plans.

To be able to formulate the care for the nursing care plan.

To be able to impart health teachings relevant to his condition.

To be able to evaluate the effectiveness of our nursing interventions.

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VI. PATIENTS PROFILE

Case Number : 29614

Patients Name : S.G

Address : Antipolo City

Date of Birth : June 28, 2006

Age : 3years old

Sex : Female

Status : Single

Religion : Roman Catholic

Chief Complaint : LBM

Final Diagnosis : AGE

Time and Date of Admission : April 25, 2010 / 3:00 pm

Admitted by : Dr. Fabros

Ward : Private Room 315

Date of Assessment : April 26, 2010

Time of Assessment : 5:00 pm

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VII. NURSING HISTORY

Chief Complaint: Nagtatae ang anak ko, as verbalized by the mother of the patient.

History of Present Illness

According to her mother, 2 days prior to admission, April 24, 2010, she noticed

that her daughter S.G defecated more often. From her usual 2 times a day, S.G defecated

about 4-5 times. But she just ignored it and has not taken any actions

April 25, 2010 at around 1:00pm her mother noticed that S.G is warm to touch.

She then gave her Tempra 125mg. 5ml for one time. But the fever did not cease. She then

decided to bring her to the nearest hospital, Unciano Medical Hospital

On arriving at the hospital she was taken to the emergency room. Her vital

signs were taken and recorded at;

Pulse rate - 97 bpm

Respiratory Rate - 23 cpm

Temperature - 38.1oC

She was given Paracetamol 125mg 5ml STAT for her fever. The doctor on duty

examined her and ordered for admission. She was given Intravenous fluid of D50.3NaCl

L X 75cc/hr at 470cc level inserted at her right metacarpal vein. The doctor ordered the

following medications; Diazepam 5 mg 0.5 ml TIV PRN for active seizures,

Met6ronidazole125/9mL q 80, and Tempra 2.5 ml PO q 4o. The attending physician, Dr.

Fabros made request for Hematology, fecalysis and urinalysis.

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At about 3:00 pm she was brought to Private room 315 with the diagnosis of

Acute Gastroenteritis.

History of Past Illness

According to her mother, our client has not been hospitalized 5 years ago. But

only experienced common cough and colds and took OTC medicines such as

Carbocisteine and Paracetamol to relief illness.

Heredo familial History

According to her mother she cannot recall that there is notable disease in the

family.

Socio Economic Status

Her mother is as Pharmacist at mercury Drug Corporation for 7 years in Antipolo.

She will take charge for her daughters hospital bills and other expenses. She did not

mention the occupation of her husband and their salary as well.

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Immunization:

Vaccine No. of Shots 1st/2nd/3rd Dose

BCG 1 1st Month

DPT 3 2nd/3rd/4th Month

OPV 3 2nd/3rd/4th Month

Hepatitis B 3 2nd/3rd/4th Month

Measles 1 9th Month

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VIII. PEDIATRIC ASSESSMENT

A. Physical Growth and Development

Weight: 13 kg

Normal Value: 13-18 kg

Remarks: within appropriate range

Height: 97 cm

Normal Value: 87-104 cm

Remarks: within appropriate range

Our client, S.G looks kempt. She has round face and body build. Her body is

symmetrical. Her look is appropriate to her age.

During our assessment S.G is smiling to us and does the activities I asked her to

do but she does not respond to all our questions because of being shy.

B. Motor Development

i. Gross Motor Adaptive

According to her mother SG can go upstairs on her own. She loves to play Barbie

dolls with her cousin. We asked SG to perform activities to test her gross motor skills. I

asked her to sit and walk on will. While lying she turns from side to side. She can stand

erect. She was able to walk, sit and stand when we asked her to.

During our assessment SG is sometimes moving bed from one place to the other

to get her toys. We also saw her playing with her mother her favorite Barbie doll.

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ii. Fine Motor Adoptive

According to her mother SG can eat on her own. Her mother also observed that

SG loves to draw. Her mother said that SG always looks for pen and paper where she can

write and draw. She can also wear her clothes by herself.

C. Language and Learning

During our assessment, we observed that SG can already express her feelings and

demands. She responds to our questions when she feels like to answer. Like when she

first answered our question that what is her favorite food, she quickly responded by

saying adobo at sinigang. She can speak and understand using tagalong words. She is

able to communicate her wants and rejections by saying gusto ko ng at ayaw.

According to the studies she should have been speaking at most 2000 words. Her words

are not clearly stated but we are still able to understand what she is trying to say.

We asked her to answer 1+1 she just smiled to us and didnt answer.

D. Playing

SG loves to play at home together with her friends and her cousin. She loves to

play like Barbie Doll. She also loves to play bahay-bahayan. She also loves to show her

friends her favorite Doll. At her stage she is currently on the bridge of the parallel play of

toddlerhood and the competitive play of the pre-schooler. Her plays are more of

competitive as she loves to play with others wanting to be the center of the play.

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E. Nutritional Assessment

We asked her mother about SGs appetite. According to her mother SG eats a lot

before hospitalization. She really likes to eat adobo and sinigang. She especially likes

sabaw for her food. She also loves to eat fruit but not very likely to vegetables.

According to her mother she likes to samalamig from the store beside their

house. She also likes to eat junkfoods, stick-O and candies. She also likes to eat fish-ball

that passess trough their house during the afternoon. According to her mother she uses

the fish-ball as reward to encourage SG to sleep.

During our assessment when she ate her merienda, she ate on her own using

spoon but we havent seen that her hands were washed.

On observing, the color of her buccal mucosa is pinkish. Her tongue and gums is

also pink. She doesnt want us to observe her teeth but we have seen it and observed that

it is color white and has no tooth decay observed. Her lips are observably dry.

During her infancy, according to her mother, SG is bottle fed starting from birth

up to 2 years old. Her mother uses 1:1 formula a scoop of milk to 1 ounce of water.

She has IVF of D50.3NaCl L X 75cc/hr at 470cc level inserted at her right

metacarpal vein.

_______________________________________________________________________

_

F. Stages of Growth and Development

i. Developmental (Robert Havighurst)

According to this developmental theory, learning is basic to life and that people

continue to learn throughout life. A certain task arises at a certain time of life of an

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individual, successes achievement of which leads to happiness and to success with later

tasks, while failure leads to unhappiness in the individual and difficulty with later task.

These are the tasks that CR was able to perform with regards to Havighursts Age

period and Developmental Task

Learned to walk

Learned to take solid foods

Learned to talk

Learned to control the elimination of body wastes but he is not yet fully toilet

trained.

Learned to distinguish right and wrong

ii. Psychosexual (Sigmund Freud)

According to this theory, the personality develops in five overlapping stages from

birth to adulthood. If the individual does not achieve a satisfactory progression at each

stage, the personality becomes fixated at that stage.

According to Sigmund Freuds CR is on Anal stage where his center of pleasure

is his anus and bladder. He is already trained of toileting. He informs his mother when

he feels like voiding or defecating.

iii. Psychosocial (Erik Erikson)

This theory envisions life as a sequence of levels of achievements. Each stage

signals a task that must be achieved. The resolution of the task can be complete, partial or

unsuccessful. The greater the task achievement, the healthier the personality of the

person; failure to achieve a task influences the persons ability to achieve the next task.

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According to Erik Eriksons Stages of Development CR is under Early Childhood

stage and his central task is Autonomy vs. Shame and Doubt. He shows indicators

positive resolution as he is able to cooperate and to express himself. He has control over

himself of what he wants and what he does not want.

He also is showing partial resolution on late childhood stage where his central

task is Initiative versus Guilt. According to his mother, he loves to do things on his own.

iv. Cognitive (Jean Piaget)

This theory refers to the manner in which people learn to think, reason, and use of

language. It involves a persons intelligence, perceptual ability, and ability to process

information. According to this theory, cognitive development is an orderly, sequential

process in which a variety of new experiences must exist before intellectual abilities can

develop.

According to Piagets Phase of Cognitive Development, he is under

Preconceptual Phase. He tells us story of how he plays with his friends and how are they

amazed of his robot toy. He often expresses his wants. He also likes to tell story that he is

a superhero and he will fly and defeat bad guys.

v. Moral (Lawrence Kohlberg)

According to this theory, moral development progresses through three levels and

six stages. Levels and stages are not always linked to a certain development stages,

because some people progresses to a higher level of moral development than others.

According to Kohlbergs Stages of Moral Development CR is under Punishment

and Obedient Orientation Stage. According to his mother he obeys commands when he is

told to be punished of disobedience.

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G. Vital Signs

i. Body Temperature

During our assessment his temperature is 36.1oC using a digital thermometer on

his right axilla for 1 minute.

ii. Respiratory Status

His respiratory rate is 26 cpm. We observed that his respiration is rapid and deep.

We auscultated his chest using a stethoscope and asked him to inhale and exhale deeply

and softly. Soft intensity, low pitch and gentle sound were heard.

iii. Circulatory Status

The radial pulse rate of CR is 116 bpm. Each beat is strong and can be felt easily.

We got his apical pulse and recorded 120 bpm. His pulse deficit is 4bpm.

We used the blanch test to test his Capillary Refill Time. We applied pressure on

the patients right finger of his right hand and released it. His fingertips returned to its

usual color after 2 seconds, the result was normal. We also did the same to his left arm

finger and his lower extremities and obtained the same result.

H. Elimination Pattern

i. Bowel

Before hospitalization, according to his mother CR usually defecates 2 times a

day. With the stool usually soft, brown and foul odor.

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Three days before hospitalization, CR defecated 4-5 times a day. According to his

mother the stool is yellowish in color, watery and foul in odor.

We have auscultated a hyperactive bowel sound. The sound is loud and frequent

at about every 3 seconds. There are 20 sounds per minute in each of the four quadrants.

ii. Bladder

Before hospitalization he voids about 6-7 times a day. His mother told us that it is

approximately 90-100ml per voiding. 7 X 100 = 700 ml/day.

During hospitalization, according to his mother, CR urinates about 7-9 times.

Each urination is 70 ml. X 9 = 630 ml/day.

According to his mother, CR has urinated 3 times until our assessment at 11:00

am. Each urination is about 70 ml.

Approximation is used using the empty vessels of IV fluids.

I. Reproductive Assessment

According to his mother, CR is not yet circumcised. We are not able to assess his

penis because CR is shy and does not allow us to. But we saw him void and his penile

length is approximately 2 inches long.

According to his mother, his penis is smooth and proportioned, and his testes are

normal.

J. State of Skin and Appendages

i. Skin: His skin is brown and intact. There is not presence of lesions observed.

His skin is dry, and he has fair skin turgor.

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ii. Hair: His hair is black, soft and well-trimmed. The strands of his hair is thin/

He has intact scalp. There are no signs of infections or infestations seen. He has evenly

distributed hair.

iii. Nails: CRs nails have a convex curvature. His nails are noticeably long and

there is presence of dirt on finger and toe nails. The epidermis around the nails is intact.

K. State of Rest and Comfort

According to his mother, CR usually sleeps at about 1:00 3:00 pm during

daytime and 8:00pm 6:00am during the night.

During hospitalization, according to his mother, CR sleeps at about 8:00pm. His

sleep is usually disturbed because of his medications but he manages to sleep again with

ease.

He is usually, reporting to his mother pain in the abdomen. We asked him where

he usually feels the pain he pointed on the right upper quadrant of his abdomen.

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IX. ANATOMY AND PHYSIOLOGY

The Digestive System

1. Ingestion is the process of taking food into the mouth.

2. Secretion is the liberation of water, acid buffers and enzymes into the lumen of

GI tract. Within the walls of GI tract are cells that secrete a total of about 9 liters

per day of these substances in the lumen of GI tract.

3. Mixing and Propulsion is the churning and passage of food through the GI tract.

It is usually brought about by the alternate contraction and relaxation of smoothmuscle in the walls of GI tract.

4. Digestion is the mechanical and chemical breakdown of food.

5. Absorption is the passage of food from the GI tract into the blood and lymph.

6. Defecation is the elimination of indigestible substances from the GI tract to the

anus.

Important Facts of Small Intestine

1. This is where the major events of digestion and absorption occur.

2. It begins at the pyloric sphincter of the stomach, coils through the central andinferior parts of the abdominal cavity and eventually opens into the large

intestine.

3. It averages 21/2cm in diameter and the length is about 3meters or 10 feet in a

living person and about 6 meters or 21 ft in a cadaver due to loss of smooth

muscle tone after death.

4. It is divided into three segments: the duodenum, jejunum and ileum.

5. The ileocical sphincter connects the ileum to the large intestine.

6. There are many projections called circular folds or plicae circulars that

enhance absorption by increasing surface area and causing the chyme to spiralas it passes through the small intestine

7. The wall of the small intestine is composed of the same four coats that makeup the GI tract

8. The mucosa forms a series of fingerlike villi that give the intestinal mucosa a

velvetly appearance.

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The Important Facts About Large Intestine

1. Its overall functions are completion of absorption, manufacture of certainvitamins, formation of feces and expulsion of feces from the body

2. It is about 1 m long and 6 cm in diameter that extends from the ileum

to the anus, and is attached to the posterior abdominal wall by itsmesocolon.

3. Structurally the large intgestine is divided into four principal regions, the

cecum, colon, rectum and the anal canal.

4. The wall of the large intestine differs from that of the small intestine sincethere are no villi or permanent circular folds are found in the mucosa

5. The mucosa is consist of simple columnar epithelium, lamina propria andmuscularis mucosae

6. The submucosa is similar to that found in the rest of the GI tract

7. The muscularis is consist of an external layer of longitudinal muscles and

an internal layer of circular muscles

8. There are epicloic appendages, which are small pouches of visceral

peritoneum filled with fats.

PHYSIOLOGY OF DIGESTION IN THE SMALL INTESTINES

1. The first step occurs trough segmentation where major movement of the smallintestine occurs.

(1) It begins with the circular muscle fibers in the small intestines contract, anaction that constricts the intestines into segments.

(2)Next, the muscle fibers that encircle the middle of each segment contract

that further divides the segments into smaller segments.

(3) Finally, the muscle fibers that contract first will relax and each smaller

segment unite to form a large segment.

These segment occur 12-16 times a minute, pushing the chime back and forth.

2) The second process is called Peristalsis that propels the chyme onward trough the

intestinal tract to be absorbed.

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ABSORPTION AND FECES FORMATION IN THE LARGE INTESTINE

1. By the time the chyme has remained in the large intestine 3-10 hours and then

become solid or semisolid as a result of water absorption and feces will beformed.

2. Feces are consisting of water, inorganic salts, and sloughed-off epithelial cellsfrom the mucosa of GI tract, bacteria and undigested parts of food.

Peyers Patches is an oval masses of lymphoid tissue on the mucous membrane

lining the small intestine.

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X. PATHOPHYSIOLOGY OF TYPHOID FEVER

The pathophysiology of typhoid fever is a complex process which proceeds

through several stages. The disease begins with an asymptomatic incubation period of 7-

14 days, during which bacteria invade macrophages and spread throughout the

reticuloendothelial system. The first week of symptomatic disease is characterized by

progressive elevation of the temperature followed by bacteremia. The second week

begins with the development of rose spots, abdominal pain and splenomegaly. The third

week is marked by a more intense intestinal inflammatory response particularly in the

Peyers patches with associated necrosis which can result in perforation and hemorrhage.

These clinical stages are associated with complex cellular events just now being

understood.

Invading organisms pass through the intestinal epithelial cells and come into

contact with phagocytic cells in the Peyers patches of the intestinal wall. However the

macrophages do not kill the bacteria. Thence, bacterial replication is primarily

intracellular. Salmonella avoids encapsulation in lysosomes by diverting normal cellular

mechanisms. Bacteria inject effector proteins into the cells of the innate immune system

(macrophages and natural killer cells) though a type III protein secretion system (TTSS)

which stimulate both pro and anti-inflammatory responses.

Over the asymptomatic incubation period of 7-14 days the bacteria proliferate and spread

through the blood stream to other cells in the reticuloendothelial system in the liver,

spleen, bone marrow and gall bladder. As replication inside phagocytic cells continues,

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bacteria are shed into the blood stream in sustained but low concentrations and the

clinical syndrome of fever, headache and abdominal pain begins. The gallbladder is felt

to be a significant site for ongoing exposure of intestinal epithelial cells to the pathogen.

The inflammatory response to this process of repeated exposure is felt to give rise to the

necrosis which is a prominent feature of the disease. This occurs in areas of greatest

macrophage concentration such as the Peyers patches and explains why intestinal

bleeding and perforation are the most frequent complications. Elsewhere typhoid nodules,

foci of macrophages and lymphocytes proliferate. As the infection progresses the typical

changes of sepsis accumulate in the heart, brain and kidneys. If not interrupted this

process may lead to circulatory failure and death from overwhelming sepsis.

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XII. Laboratory Results

Hematology Date: September 1, 2009

Parameters Result Reference Significance

WBC 7.0X109 5.0-10.0 X 106 u/l Primarily protects the body

against infection and tissueintegrity.

Neutrophils 0.72 0.45-0.73 Phagocytosis (ingestion anddigestion of bacteria and

particles)

Lymphocytes 0.27 0.2-0.4 Integral component of immune

system

Monocytes 0.01 0.02-0.08 Enters tissue as macrophage;

highly phagocytic, especiallyagainst fungus; immune

surveillance

RBC 4.55X1012 4.0-6.0X1012 Carries Hemoglobin to provide

oxygen to tissues; average life

span

Hemoglobin 130gm/dL 13-18gm/dL Iron-containing protein of

RBCs; delivers oxygen totissues

Hematocrit 0.39 0.42-0.52 Percentage of total bloodvolume consisting of RBCs

Acela G. Tantiongco, MD

Pathologist

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Fecalysis Date: July 10, 2009

Parameters Result Reference Significance

Apearance Brown Brown Normal

Consistency Soft formed Soft Normal

PUS Negative Negative Normal

No ova and/or parasite seen

Serology

Ig M Positive

Ig G Positive


Pathologist

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URINALYSIS July 7, 2009

TEST RESULT NORMAL VALUES SIGNIFICANCE

Color Yellow Yellow Normal

Transparency Clear Clear NormalPH (reaction) Neutral Acidic A pH below 7 indicates acidity

and a pH in excess of 7

indicates alkalinity

Specific Gravity 1.020 1.015-1.025 Normal

Glucose (-1) Negative Normal

Protein (albumin) (-1) Negative Nrmal


Pathologist

XIII. DRUG STUDY

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DRUGNAME

CLASSIFICATION &

INDICATION

ACTION ADVERSEREACTION

NURSING RESPONSIBILITY

DIAZEPAM

5 mg 0.5 mlTIV PRNFor active

siezure

C:

benzodiazepine

I: Statusepelepticus,severe recurrentseizures

A benzodiazepine

that probablypotentiates theeffects of GABA,depresses the CNSand suppresses thespread of seizureactivity

No adverse reaction

seen on the patient.

Possible adversereaction:

Drowsiness,dysarthria, slurredspeech, fatigue,headache andinsomnia.

>Warn the patients SO to

avoid activities that requirealertness and goodcoordination until effects ofdrugs are known.>Warn patient not toabruptly stop drug becausewithdrawal symptoms mayoccur.

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DRUGNAME

CLASSIFICATION &

INDICATION



Ceftriaxone

Sodium1 gm, TIV od

(-) ANST

C: Third generationcephalosporin

I: Acute Bacterialinfection

Inhibits cell wallsynthesis, promoting

osmotic instability; usually

bactericidal

No adverse reactionnoted in the patient

Possible adversereactions:

Fever, headache,dizziness, chills.

If large doses are given. Therapyis prolonged, or patient is at highrisk, monitor patient for signs f super

infection

Tell patients SO to reportadverse reaction promptly.

Tell patients SO to notifyprescriber about loose stool or

diarrhea.

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DRUGNAME

CLASSIFICATION &

INDICATION



Tempra

2.5 ml, 125 mg

q 4o PO

C:

Paraaminophenol

I: Mild pain or fever

Thought toproduce analgesia by

blocking pain impulses

by inhibiting synthesisof prostaglandin in theCNS or of other

substances that

synthesizes painreceptors to stimulation.

The drug may relievefever trough central

action in the

hypothalamic heat-regulating center.

Adverse reaction:

No adverse reaction

noted in the patient

Possible adverse

reaction:

Hemolytic anemia,

jaundice, hypoglycemia,rash

May decrease glucose andhemoglobin levels and hematocrit.

Warn patients SO that highdoses or unsupervised long termuse can cause liver damage.

Contraindicated with patientshypersensitive to drug.

XIII. NURSING CARE PLAN

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CUES / DATA NURSING

DIAGNOSIS

GOALS OF

CARE

NURSING INTERVENTIONS EVALUATION

Subjective:

masakit ang tiyan nganak ko as verbalized

by the mother of the

patient

Objective:

Expressive

behavior such asmoaning, crying

and irritability

Distraction behavior such as

pacing and

repetitiveactivities

Facial grimace

Facial pain scale

of

Acute pain

related to biological injuring

agents specifically

infections as

evidenced byexpressive anddestruction

behavior and facial

grimace and facialpain scale of

Within 1

hour of nursinginterventions the

client will

demonstrate

behavior that showsalleviation pain.

Independent

Provided Comfort measuressuch as back rubbing and

change in position

> To provide non-

pharmacologic painmanagement.

Encouraged divisional

activities such as toys, plays

and others.> To divert attention from

pain.

Re-check for the vital signs.

> Usually altered in acute

pain

Dependent

Administered analgesics as

indicated to maximal dosage

as needed (Tempra)> to maintain acceptable level of

pain.

After 1 hour of

nursing interventionsthe client has

demonstrated behavior

that shows alleviation

pain.

Goal met.

CUES / DATA NURSING

DIAGNOSIS

GOALS OF

CARE

NURSING INTERVENTIONS EVALUATION

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Subjective:

madaming beses nasiyang dumudumi as

verbalized by the mother

of the patient

Objective:

Decrease urineoutput

Dry lips

Dry skin

Weakness

Isotonic fluid

volume deficitrelated to active

fluid volume lost

specificallydiarrhea.

Within 30

minutes of nursingintervention the

clients mother will

verbalizeunderstanding of

causative factorsand purpose of

individual

therapeuticinterventions and

medications.

Independent

Kept fluids within clientreached and encouraged the

SO to increase the fluid intakeof the client.

Discussed the effects of

humidity and ambient airtemperature.

Reduced beddings clothes,

provide TSB> Reduced metabolic rate

Encouraged to change position frequently.

>To promote comfort and

safety

Encouraged the mother to

provide frequent oral care

>to prevent injury fromdryness

Discussed factors related tooccurrence of dehydration

After 30


clients mother has

verbalizedunderstanding of

causative factors and purpose of individual

therapeutic

interventions andmedications.

Goal met.

CUES / DATA NURSING GOALS OF NURSING INTERVENTIONS EVALUATION

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DIAGNOSIS CARE

Subjective:

Binibigyan ko siya ng

fishball para makatulogsiya sa hapon as

verbalized by the mother

of the patient

Objective:

Verbalization of

wrong actions.

Inadequateperformance

Deficientknowledge

regarding lifestylerelated to

unfamiliarity with

information.

Within 30minutes of nursing

intervention theclients SO will

verbalize

understanding of

conditions andindividual riskfactors.

Independent

Provided information relevant

to situation

Provided positive

reinforcements. Avoid

negative reinforcements.

Provided information for

clients SO

>Reinforces learning

process

Begin with information the

client already knows and

move to what the client doesnot know, progressing from

simple to complex.

>Limits sense of

overwhelmed.

Provided information about

additional learning resources.>May assist in further

learning/promote learning

at own pace.

After 30minutes of nursing

intervention theclients SO has

verbalized

understanding of

conditions andindividual risk factors.

Goal met.

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CUES / DATA NURSING

DIAGNOSIS

GOALS OF CARE NURSING INTERVENTIONS EVALUATION

Subjective:

Paano kaya nakukuhang anak ko ang sakit

niya? as verbalized by

the mother of the patient

Readiness for

enhanceknowledge on

health.

Within 30


clients SO will

verbalize

understanding ofinformation gain.

Independent

Verified clients SO level ofknowledge about specific

topic.>Provides opportunity to

assure accuracy andcompleteness of knowledge

base for future learning.

Determinedmotivation/expectations for

learning.

>Provides insight useful in

developing goals and

identifying information

needs.

Assisted clients SO to

identify learning goals.>Helps to frame or focus

content to be learned and

provides measure to

evaluate learning process.

Identified/provided

information in valid formats

appropriate to clients

After 30


clients SO has

verbalized

understanding ofinformation gain.

Goal met.

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learning style.

CUES / DATA NURSING

DIAGNOSIS

GOALS OF CARE NURSING INTERVENTIONS EVALUATION

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Objective:

Salmonella

Typhi infection

Risk for infection

related toinsufficient

knowledge to

avoid exposure topathogens.

Within 30


clients SO will


individualcausative/risk

factors.

Independent

Note risk factors for occurrence of infection.

Health Teachings:

Ensuring proper

environmental sanitation Hygienic sewage

disposal systems in a

community as well as

proper personal hygieneare the most important

factors in preventingtyphoid fever.

Proper handling and

cooking of foodsspecially on meats

Avoid the foods that arenot properly cooked

Safe source of water

After 30


clients SO has


individualcausative/risk factors.

Goal met.

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XIV. EVALUATION

A. General Objectives

After 32 hours of exposure Carlos Medical and Maternity Clinic, we, the 3rd year

Nursing students, section D group 3 of Unciano Colleges Antipolo, was able to convey

our empathy to our patients in the ward and learned and had knowledge trough our skills

that we do all throughout our rotation in providing holistic care to all our patients in the

ward.

B. Specific Objectives

We were able to establish nurse patient relationship that would build rapport for

the effective and informative interactions with the patient and the significant

others.

We were able to assess health problem and condition using the Pediatric

Assessment.

We were able to review the Anatomy and Physiology of the Digestive System and

the pathophysiology of Typhoid Fever.

We were able to gather necessary data and identify needs in order to formulate

specific nursing care plans.

We were able to formulate the care for the nursing care plan.

We were to impart health teachings relevant to his condition.

We were able to evaluate the effectiveness of our nursing interventions.

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Health Teaching

Ensuring proper environmental sanitation

Hygienic sewage disposal systems in a community as well as proper personal

hygiene are the most important factors in preventing typhoid fever.

Proper handling and cooking of foods specially on meats

Avoid the foods that are not properly cooked

Safe source of water

Discharge Plan

Advised patient to follow medication regimen properly.

Advised the patient to take adequate rest

Prognosis

Our patient chance is recovery is high. During our rotation in Carlos Medical and

Maternity Clinic, our client CR was able to recover and got home on September 4, 2009.

He is expected to resume his ADLs as soon as he had enough of rest. The mother is

advised to watch out for possible re-infection of salmonella typhi virus and to be carefull

of possible seizures.

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XV. BIBLIOGRAPHY

1. Marieb, Elaine RN; Essentials of Human Anatomy and Physiology 6th Edition

2005

2. Kozier, Barbara RN et al;Fundamentals of Nursing7th Edition2004

3. Smeltzer Suzanne EdD, RN, FAAN et al; Textbook of Medical-Surgical Nursing

11th Edition 2008

4. Doenges, Marilyn RN, BSN, MA;Nurses Pocket Guide 9th Edition 2004

5. Palma, Gregory Navarro; G&A Notes 2nd

Edition2009

6. Divinagracia, Carmelita;PDDs Nursing Drug Guide 2nd Edition 2008

7. Wiley, John; The Bantam Medical Dictionary 5th Edition 2004

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