I. INTRODUCTI ON Gastroenteritis is a catchall term for infection or irritation of the digestive tract, particularly the stomach and intestine. It is frequently referred to as the stomach or intestinal flu, although the influenza virus is not associated with this illness. Major symptoms include nausea and vomiting, diarrhea, and abdominal cramps. These symptoms are sometimes also accompanied by fever and overall weakness. Gastroenteri tis typically last s about three days. Adu lts usually recover wit hout problem, but children, the elderly, and anyone with an underlying disease are more vulnerable to complications such as dehydration. (www.wikipedia.com ) Bacterial gastroenteritis is frequently a result of poor sanitation, the lack ofsafe drinking water, or contaminated food—conditions common in developing nations. Natural or man-made disasters can make underlying problems in sanitation and food safety worse. In developed nations, the modern food production system potentially exposes millions of people to disease-causing bact er ia through its intensive production and distribution methods. Common types of bacterial gastroenteritis can be linked to Salmonella and Campylobacterbacteria; however, Escherichia coli 0157 and Listeria monocytogenes are creating increased concern in developed nations. Cholera and Shigella remain two diseases of great concern in developing countries, and research to de ve lop long-term vaccines against them is underway. ( www.emedicines.com) Gastroenteritis is an uncomfortable and inconvenient ailment, but it is rarely life-threa ten ing in the Uni ted States and other develo ped nations. How ever , an estimated 220,000 children yo unger th an age five are hospitali ze d with gastroenteritis symptoms in the United States annually. Of these children, 300 die as a result of severe diarrhea and dehydration. In developing nations, diarrheal illnesses are a major source of mortality. In 1990, approximately three million deaths occurred worldwide as a result of diarrheal illness.(www.emedicines.com) Loc all y, In Jul y 22, 200 4, the De par tme nt of Hea lth (DOH), Philip pine s dec lare d an epidemic (outbreak) of a water/food-borne disease called acute gastroenteritis in 45 towns in Centr al Pangasinan. Acute gastr oenterit is is a human enteric (inte stinal) dise ase primarily caused by inge stion of s poiled o r bacte rial conta minate d water or food. According to the DOH Secretary, Dr. Manuel Dayrit, a total of 2,778 cases of the said intestinal infection were recorded in just 45 days (from May 31 to July16, 2004). From the studies on the medical diagnoses of 81 cases, Dayrit concluded that infectious (transmittable) cholera disease was the main cause of the epidemic.( www.doh.gov.ph)
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Gastroenteritis is a catchall term for infection or irritation of the digestive tract,particularly the stomach and intestine. It is frequently referred to as the stomach orintestinal flu, although the influenza virus is not associated with this illness. Majorsymptoms include nausea and vomiting, diarrhea, and abdominal cramps. Thesesymptoms are sometimes also accompanied by fever and overall weakness.Gastroenteritis typically lasts about three days. Adults usually recover withoutproblem, but children, the elderly, and anyone with an underlying disease are morevulnerable to complications such as dehydration. (www.wikipedia.com)
Bacterial gastroenteritis is frequently a result of poor sanitation, the lack of safe drinking water, or contaminated food—conditions common in developing nations.Natural or man-made disasters can make underlying problems in sanitation and foodsafety worse. In developed nations, the modern food production system potentiallyexposes millions of people to disease-causing bacteria through its intensiveproduction and distribution methods. Common types of bacterial gastroenteritis canbe linked to Salmonella and Campylobacter bacteria; however, Escherichia coli 0157and Listeria monocytogenes are creating increased concern in developed nations.Cholera and Shigella remain two diseases of great concern in developing countries,and research to develop long-term vaccines against them is underway.( www.emedicines.com)
Gastroenteritis is an uncomfortable and inconvenient ailment, but it is rarelylife-threatening in the United States and other developed nations. However, anestimated 220,000 children younger than age five are hospitalized withgastroenteritis symptoms in the United States annually. Of these children, 300 die asa result of severe diarrhea and dehydration. In developing nations, diarrheal illnessesare a major source of mortality. In 1990, approximately three million deaths occurredworldwide as a result of diarrheal illness.(www.emedicines.com)
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 inCentral Pangasinan. Acute gastroenteritis is a human enteric (intestinal) disease primarily caused
by ingestion of spoiled or bacterial contaminated water or food.
According to the DOH Secretary, Dr. Manuel Dayrit, a total of 2,778 cases of the saidintestinal infection were recorded in just 45 days (from May 31 to July16, 2004). From the studies
on the medical diagnoses of 81 cases, Dayrit concluded that infectious (transmittable) cholera
disease was the main cause of the epidemic.(www.doh.gov.ph)
Locally, here in Tagum City, at Davao Regional Hospital pediatric department acute
gastroenteritis was considered number 3 among the most common pediatric cases. It is common in
this area because some of the people are not aware regarding the proper handling and preparationof food.
Gastroenteritis is a general term referring to inflammation or infection of thegastrointestinal tract, primarily the stomach and intestines.[1] It can be caused by infection with
bacteria, viruses, or other parasites, or less commonly reactions to new foods or medications. Itoften involves stomach pain (sometimes to the point of crippling), diarrhea and/or vomiting, with
noninflammatory infection of the upper small bowel, or inflammatory infections of the colon. It
usually is of acute onset, normally lasting fewer than 10 days and self-limiting. Sometimes it isreferred to simply as 'gastro'. It is often called the stomach flu or gastric flu even though it is not
related to influenza. If inflammation is limited to the stomach, the term gastritis is used, and if the
small bowel alone is affected it is enteritis. As such, this has a relationship on the concept fluidsand electrolyte. Because dehydration the most common complication of gastroenteritis if not
treated or no immediate intervention done it could lead to shock and eventually can lead to death.
Based on the patient’s chart, it appears that seizure, dyspnea,weakness, poor suckling, LBM with watery stool were the chief complaints experience by Bb. Zoo Sy which eventually made her familysought for admission.
C. HISTORY OF PRESENT ILLNESS
One week prior to admission, patient experienced on and off fever,no consultation and medicines given to the patient at home. Until 3 daysprior to admission patient was positive of several episodes of LBM,yellowish to greenish in color, mucoid, non blood streaked and positivefever again no consultation done. Upon admission, the patientexperienced 2 episodes of upward rolling of eyeballs with cycling motionof extremities at the ER. With admitting vital signs of BP- 70/50 mmHg,CR- 140bpm, RR- 58cpm, Temp- 36.4˚C, with pulse oxymeter reading of 96% O2 saturation.
D. PAST MEDICAL HISTORY
E. PERSONAL, FAMILY AND SOCIO-ECONOMIC
Bb. Zoo Sy was born January 8, 2007. He was the youngest of the4 children in the family. Two weeks prior to admission Bb. Zoo Sytogether with his siblings were left by their mother. While his father wasa hardworking businessman who was then at GenSan. The income of hisfather is just enough to support their basic needs.
Upon admission, patient was placed on NPO with OGT F8and keep distal and open. Admitting weight was 5.2kg. During ourshift patient was on dropper feeding.
Fine and evenly distributed, thin and dry hair was noted. Hisnails were in convex shape, smooth in texture , capillary refill of five seconds an untrimmed finger nails with poor skin turgor. Hisskin was pale, dry, with fine and fare complexion
F. HEENT
The size of head was in proportion with the body. The eyeswere symmetrical with the ears; with sunken fontanels and eyes.When the eyes were tested papillary reaction to light, the pupilconstricted to 2mm. Ear had no discharges noted. Nasal septum
were intact and in the midline. Patient had cleft lip. The throat wasfunctioning well and in normal condition.
G. PULMONARY SYSTEM
Respiratory rate was 58 cpm and dyspnic. Upon
auscultation, crackles were heard and with symmetrical chestexpansion. With history of Pneumonia.
Patient’s CR was 140 bpm which is normal. No murmurheard upon auscultation. There was no history of cardiopulmonarydisease.
I. GASTROINTESTINAL SYSTEM
The abdomen was distended, soft and there was no palpablemass felt upon palpation. Hypoactive bowel sound heard uponauscultation. The patient vomited 3-5 times a day and defecatedmore than 6 times a day with watery stool.
J. MUSCULOSKELETAL SYSTEM
The patient manifested good posture and moved voluntarily;he had symmetrical musculature on both sides of the body.Weakness was noted.
K. GENITO- URINARY SYSTEM
Patient voided 60 – 350 cc per shift as weighed and yellowin color.
The liver is the largest internal organ in the human body, located at the top of
the abdomen on the right side of the body. A dark red organ with a spongy texture,
the liver is divided into right and left lobes by the falciform ligament. The liver
performs more than 500 functions, including the production of a digestive liquid
called bile that plays a role in the breakdown of fats in food. Bile from the liver passes
through the hepatic duct into the gallbladder, where it is stored. During digestion bile
passes from the gallbladder through bile ducts to the small intestine, where it breaks
down fatty food so that it can be absorbed into the body. Nutrient-rich blood passes
from the small intestine to the liver, where nutrients are further processed and
stored. Deoxygenated blood leaves the liver via the hepatic vein to return to the
heart.
Small Intestine
Most digestion, as well as absorption of digested food, occurs in the small
intestine. This narrow, twisting tube, about 2.5 cm (1 in) in diameter, fills most of the
lower abdomen, extending about 6 m (20 ft) in length. Over a period of three to six
hours, peristalsis moves chyme through the duodenum into the next portion of the
small intestine, the jejunum, and finally into the ileum, the last section of the smallintestine. During this time, the liver secretes bile into the small intestine through the
bile duct. Bile breaks large fat globules into small droplets, which enzymes in the
small intestine can act upon. Pancreatic juice, secreted by the pancreas, enters the
small intestine through the pancreatic duct. Pancreatic juice contains enzymes that
break down sugars and starches into simple sugars, fats into fatty acids and glycerol,
and proteins into amino acids. Glands in the intestinal walls secrete additional
enzymes that break down starches and complex sugars into nutrients that the
intestine absorbs. Structures called Brunner’s glands secrete mucus to protect theintestinal walls from the acid effects of digestive juices.
The small intestine’s capacity for absorption is increased by millions of
fingerlike projections called villi, which line the inner walls of the small intestine. Each
villus is about 0.5 to 1.5 mm (0.02 to 0.06 in) long and covered with a single layer of
cells. Even tinier fingerlike projections called microvilli cover the cell surfaces. This
combination of villi and microvilli increases the surface area of the small intestine’s
lining by about 150 times, multiplying its capacity for absorption. Beneath the villi’s
single layer of cells are capillaries (tiny vessels) of the bloodstream and the lymphatic
system. These capillaries allow nutrients produced by digestion to travel to the cells
of the body. Simple sugars and amino acids pass through the capillaries to enter the
bloodstream. Fatty acids and glycerol pass through to the lymphatic system.
Large Intestine
A watery residue of indigestible food and digestive juices remains unabsorbed.
This residue leaves the ileum of the small intestine and moves by peristalsis into thelarge intestine, where it spends 12 to 24 hours. The large intestine forms an inverted
U over the coils of the small intestine. It starts on the lower right-hand side of the
body and ends on the lower left-hand side. The large intestine is 1.5 to 1.8 m (5 to 6
ft) long and about 6 cm (2.5 in) in diameter.
The large intestine serves several important functions. It absorbs water—about
6 liters (1.6 gallons) daily—as well as dissolved salts from the residue passed on by
the small intestine. In addition, bacteria in the large intestine promote the breakdown
of undigested materials and make several vitamins, notably vitamin K, which the
body needs for blood clotting. The large intestine moves its remaining contents
toward the rectum, which makes up the final 15 to 20 cm (6 to 8 in) of the alimentary
canal. The rectum stores the feces—waste material that consists largely of
undigested food, digestive juices, bacteria, and mucus—until elimination. Then,
muscle contractions in the walls of the rectum push the feces toward the anus. When
sphincters between the rectum and anus relax, the feces pass out of the bod
11pm-7am 1:15am>Admitted this 3 months old, male child, lethargic, afebrile, dyspneic in due todifficulty in breathing. Vital signs checked. Seen and examined by Dr. Dagooc with ordersmade. Lab exams requested. IVF of PLR IL @ 156 cc as IV bolus. OGT inserted. O2
inhalation @ 4 Lpm per face mask. Suctioning of secretions done. For CXR-ADL. Ushered toward per wheelchair. Endorsed to NOD.
2:50am>In from ER per wheelchair, stupurous. On NPO with Ogt distal end to bedsidebottle. With an IVF of PLR, with ongoing infusion of 156ccx1hr. with O2 inhalation on @4Lpm via face mask. Ushered to room. Placed on bed comfortably. O2 inhalationcontinued. vs checked and recorded. Lab exams and medicines prescribed followed up.Watched for.
7am-3pm 7:00am>On bed, stupurous. On NPO with OGT open to bedside bottle. With PLR @104cc in2 hrs. with O2 inhalation @ 4Lpm via face mask. With pulse oximeter with O2 saturation @99%. To secure 1 unit Fresh Frozen Plasma for transfusion. Lab exams followed up. vstaken and recorded. Medicated. Seen and examined by Dr.Dagooc with orders made and
carried out. Cared for.
May 3,2007
3-11pm 3:00pm> on bed stupurous and afebrile. On NPO with Ogt open to bedside bottle. With IVF@ right arm D5 o.3 NaCl @ KVO rate, with side drip of dopamine @ 2 cc/hr via infusionpump. With D5 LR @ 32 cc/hr x 8 hrs, on KSS. Still for insertion. On O2 inhalation. Still tosecure FFP for transfusion. Vs checked and recorded. Lab exams followed-up. due medsgiven. Watched for any unusualities.
4:15pm>Seen by Dr.Tiongco, ordered for IV cutdown, refer to surgery by Dr. Gazmen.
May 3,2007
11-7 am 11:00pm> Received asleep on bed, afebrile. On NPO
7-3 pm 7:00am> On bed awake, weak, pallor, coherent and responsive, on MHBR, with 02inhalation @ 5 Lpm via face mask. With ongoing BT #2 FWB 500 cc with serial # 112-07-23172 blood type A+. On left arm is PNSS 1L @ 200 cc/hr. Due meds given. With FBC tourobag. Endorsed to NOD.
3-11pm 3:00pm> Received lying on bed, awake, responsive, and coherent to verbalcommunication. On MHBR position. With droopy eyes noted. With pale lips, dry and warmskin noted, capillary refill less than 2 seconds. Established rapport. On NPO exceptmedications. With 02 inhalaltion @ 5 lpm via nasal cannula. With double line IVF- #7 PNSS1L @ 200 cc/hr infusing well @ L brachial vein, #8 PNSS 1L @ 100 cc/hr infusing well @ Rbasilica vein. With FBC attached to urobag draining amber colored urine. On CBR withoutBRP-reinstructed.
4:00pm> VS, I & O checked and recorded every hour.
4:25pm> Above IVF consumed and followed-up with #9 PNSS 1L @ KVO rate @ R basilicvein.
5:20pm> Temp. 37.8 C, NOD aware. TSB done
6:00pm> Above IVF consumed and followed-up with #9 PNSS 1L @ KVO rate @ R basilicvein.
10:00pm> Still to secure 6 units of platelet and 3 units of fresh whole blood. Advise forbone marrow biopsy, still undecided.
11:00pm> Watched and monitored for any unusualities. Endorsed to NOD.
11.7 11 pm> Received asleep on bed, afebrile, on milk feeding 30cc every 3 hours per OGT, With IVFof D5IMB @ 20 cc/hr with side of 2 cc/hr, with heplock @ left and right foot, with O2 @4 Lpm, tosecure another unit of fresh frozen plasma followed-up, V/S checked, due meds given, cared andwatched for.
May 5, 2007
7.3 7 am> On bed, on milk feeding/OGT 30cc every 1hr, # 4 D5IMB @ 20cc/hr, with side drip to run@ 2cc/hr, O2 @ 4cc/mask. To secure 1 unit Fresh Frozen Blood for transfusion. Watched andcared for.
3.11 3 pm> Received patient on bed awake, febrile. On milk feeding 30cc every 3hr per OGT,checked patency, with Ivf ofD5IMB 500cc @3cc/hr infusing well, withside drip dopamine @ 2cc/hrper infusion pump, with O2 inhalation @ 5Lpm via face mask, still to secre fresh frozen plasmafollowed-up. V/S checked once recorded. Watched and cared for.
11.7 11pm> On bed asleep, on dropperfeeding 50cc every 3hr, with IVF of D5IMB @ 3cc/hr x 24hr,infusing well @ the level of 400cc/hr, with side drip of dopamine @ 2cc/hr infusing via infusion
pump. O2 @5 Lpm via face mask. Still to secure fresh frozen plasma for transfusion. V/S checkedand recorded. Lab exams followed-up,due meds given. Watched for any unusualities.
May 6, 2007
7.3 7am> On bed asleep, on dropper feeding 50cc every 3hr, with IVF D5IMB @ 3cc/hr x 24hr, withattached O2 @ 5Lpm via face mask, to secure kit fresh frozen plasma for transfusion. Lab examsfollowed-up. V/S taken and checked. Endorsed to NOD.
7:45> seen and examined by Dr. Garingalao with orders made and carried out. Transferred toCardio Ward as ordered.
3-11 3pm> On bed, asleep, dropper feeding, with IVF of D5IMB @ 5cc/hr.
Still for blood CS. still to secure urine and stool exam. Followed up availability of fresh frozenplasma. V/S checked. Meds given. Endorsed to NOD.
11.7 11pm. Received on bed asleep, on dropper feeding 50cc every 3hr, with IVF of D5IMB @ 5cc/hron KSS. V/S checked and recorded. Meds followed up. Cared for.
May 7, 2007
7.3 7am> on bed awake, dropper feeding, with IVF regulated infusing well. V/S checked andrecorded. Meds cut off. Watched and cared for.
3-11 3pm> Received on bed awake, on dropper feeding, helock KSS, labs followed up. still to secureblood followed up. V/S checked and recorded, medicated, watched and cared for,
11-7 11pm> received lying on bed, awake, patient not in respiratory distress, minimal wheezes heardupon auscultation, with cleft lip, with good capillary refill, with good skin turgor, warm to touch,with heplock on right metatarsal vein. On dropper feeding, for blood CS, U/A, S/E, ABG.
12am> VS checked and recorded, afebrile. Bedside care done; linens stretched and tucked well.Health teachings rendered to mother such as increasing OFI, encouraged to promote goodhygiene. Instructed to keep child away from allergens such as dust, smoke, ect...instructed torefer any unusualities and to comply medical regimens. Infant was able to defecate 180cc- softin characteristics and yellowish in color.
4am> V/S checked and recorded; afebrile; watched and cared for.
5am> morning care done. Intake and output summed up and recorded.
7am> Left on bed with watcher. Endorsed to NOD.
May 8, 2007
7.3 7:30am> received on bed awake with mother on side, with cleft lip palate, with heplock on rightmetatarsal vein; on on respiratory distress. On syringe feeding, able to consume milk feeding50cc, able to defecate with semisolid character of stool and yellowish in color about 30cc. VSchecked and recorded, afebrile T: 36.4, PR:109, RR:39, BP:90/50. Bedside care done. Instructedmother to increase OFI and to report for vomiting and type of stool and its consistency. V/Srechecked and documented. Give ample time for sleeping.
3pm> Health teaching given regarding proper hygiene, milk preparation, proper feedingtechniques and burping of the baby after each feeding. Observed closely for sign of intolerancelike vomiting and nausea.
3.11 3pm> Received on bed, awake on dropper feeding 70cc every 3hr, with heplock attached; stillpatent. V/S checked and recorded, afebrile; lab exams followed up. due meds given, watchedand cared for.
11-7 11pm> Received on bed asleep ,with watcher on side, not in distress, with cleft lip, with goodskin turgor and warm to touch, with heplock in right metatarsal; V/S checked and recordedafebrile; bedside care done. Linens stretched and properly tucked; left on bed comfortably.Health teachings rendered to watcher such as increasing OFI of patient, promote goodventilation and relaxation, encouraged mother to breastfed.
7.3 7am> Received patient on bed, sleeping with mother on side, with heplock @ right metatarsal
vein, on bottle feeding, able to consumed 90cc. V/S checked and recorded, afebrile, T:36.4,PR:120, RR:28,BP:90/60. instructed mother to feed baby every 3-4 hours and should preparemilk formula using sterile or distilled water and to report any sign of dehydration such as crackedlips and sunken fontanels.
3pm> Endorsed to NOD.
3-11 3pm> received patient on bed awake, on dropper feeding, with heplock attached on; V/S takenand recorded, afebrile. Followed up availability of meds. Watched and cared for.
11-7 11pm> Received asleep on bed, afebrile; on dropper feeding with aspiration precaution, withheplock attached, still for lumbar puncture, with consent, lab exams followed up, meds followedup, V/S checked an recorded. Watched and cared for.
May 10, 2007
7-3 7am> On bed awake, on breast feeding with heplock, patent and intact. V/S checked andrecorded, labs followed up, medicated, watched and cared for.
3-11 3pm> Received on bed, awake, on dropper feeding 70cc every 3hrs; with heplock attached. Stillpatent. V/S checked and recorded, afebrile. Lab exams followed up. Due meds given. Cared for.
11-7 11pm> Received on bed, asleep, on dropper feeding; with heplock attached; V/S checked andrecorded; meds given, cared for.
May 11, 2007
7-3 7am> On bed, awake, on dropper feeding, with attached on. V/S checked and recorded, medsgiven. Cared for.
3-11 3pm> Lying on bed asleep, on NPO temporarily; for lumbar puncture any time today withconsent. Still for cranial CT scan. V/S checked and recorded. Medicines provided, followed up
intervention.
11-7 11pm> Received asleep on bed, afebrile, on dropper feeding, with heplock attached, still for LPwith consent. Lab exams and medicines followed up. V/S checked, cared for.
7-3 7am> On bed awake, NPO for 4 hours reminded, flat on bed x 4 hours, instructed, with heplock,patent and intact, watched and cared for.
3-11 3pm> On bed asleep, on dropper feeding 79cc every 3 hours, with heplock attached on. V/Schecked and recorded. Lab exams followed up. Due meds given; watched for.
11-7 11pm> received asleep on bed, afebrile; on dropper feeding, with strict aspiration precaution,with heplock attached, cranial ultrasound and lab exams followed up, V/S checked, medsfollowed up, cared for.
May 13, 2007
7-3 7am> On bed, awake, with heplock patent and intact, V/S checked and recorded, labs followedup, meds prescribed, watched and cared for.
3-11 3pm> Received on bed, awake; on dropper feeding every 3 hours. With heplock attached, stillpatent. V/S cheched and recorded; afebrile. Lab exams followed up. Due meds given. Cared for.
11-7 11pm> Received asleep on bed; afebrile, on dropper feeding, with heplock attached. Urinalysisand cranial ultrasound followed up, V/S checked, due meds given, cared for.
May 14, 2007
7-3 7am> Received patient cuddled by mother, awake. On breastfeeding, with heplock attached on.V/S taken and recorded. Afebrile. Medicated. Watched and cared for.
3.11 3pm> On bed, afebrile, dropper feeding, with heplock attached; followed up cranial ultrasound;urine CS followed up, fresh frozen plasma was available.
11-7 11pm> Received on bed, asleep, on dropper feeding, with heplock; V/S taken and recorded,meds given; cared for.
7.3 7am> Received lying flat on bed, asleep with watcher at bedside. With heplock attached to rightmetatarsal vein; still patent and intact. With cleft lip and dry skin warm to touched. With normalcapillary refill less than 2 seconds, with good skin turgor. Instructed on dropper feeding every 3-4 hours.
8am> V/S checked and recorded; within normal ranges. Intake and output monitored closely asordered. Instructed watcher to report any signs of dehydration such as dry lips and skin, sunkeneyes and fontanels, vomiting, LBM, and weakness.
9am> Bed linen stretched and tucked well. Arranged things properly. Provided with restfulenvironment conducive for sleep. Changed soiled diaper into clean one, with semi-solid stool,yellow in color weighing 70gs.
10am> Vitamin K given 1mg IM as ordered. Watched out for any signs of adverse reactions, notnoted. Able to consumed 70cc of milk via bottle feeding.
10:40am> Changed soiled diaper into clean one, with semi- solid formed stool, yellow in colorweighing 80gs. Measured head circumference as ordered: 40cm. health teaching imparted on
proper hygiene, importance of proper feeding and burping after each feeding, and to observe forvomiting and LBM. IVTT meds given by NOD; watched out for any signs of adverse reaction, notnoted.
12nn> V/S rechecked and recorded. Intake and output monitored closely as ordered. Watchedout for any unusualities, not noted. Provided with restful environment conducive for sleep. Needsattended to and cared for.
3-11 3pm> On bed asleep. On dropper feeding 70cc every 3 hours, with heplock attached. V/Schecked and recorded. Watched and cared for.
11-7 11pm> Received on bed, asleep. On dropper feeding 70cc every 3 hours. With heplockattached. V/S checked and recorded. Meds given, cared for.
May 16, 2007
7-3 7am> Received carried by watcher per arm, awake andconscious. With no heplockattached. With cleft lip and dry skin warm to touch. With normal capillary refill less than 2seconds, with good skin turgor. Instructed on dropper feeding every 3-4 hours. Still forcranial ultrasound; repeat CBC, platelet; for transfer to miscellaneous room.
8am> V/S checked and recorded; within normal ranges. Intake and output monitoredclosely as ordered. Bed linens stretched and tucked well. Provided with restfulenvironment conducive for sleep. Able to consume 60cc of milk via bottle feeding with
good appetite. Instructed watcher to report any signs of dehydration such as dry lips andskin, sunken fontanels, vomiting and diarrhea.
9am> Asleep; provided with restful and safe environment.
10am> Transferred to miscellaneous room as ordered. Bed linens stretched and tuckedwell. Arranged things in proper place.
11am> IVTT meds given by medicating NOD as ordered. Watched out for any signs of adverse reations, not noted. Instructed watcher to bottle feed within 3-4 hours.
12:30pm> V/S rechecked and recorded. Intake and output monitored closely as ordered.Watched out for any unusualities, not noted. Needs attended and cared for.
- willdefecatesemi-formedstool at lest2 times aday
- there willbe decreaseoccurrenceof vomitingat least 12times a day
- willmanifestmoist lipsand mucousmembranesand capillaryrefill in 2-3seconds
- weight of 5.2 kgs willincrease to5.7 kgs
- fever willsubside withthetemperatureof less than37.5
previous readings
- reduction of circulatingblood volume can occurfrom ↑fluid loss resulting inhypotension andtachycardia
• Observed for fever,
changes in LOC,skin turgor,dryness of skin and mucousmembranes, pain.
- symptoms reflective of DHN/ hemoconcentrationwith consequentvasoocclusive state.
• Monitored v/s closely duringblood transfusions andnoted presence of dyspnea,crackles,ronchi,wheezes,diminished breath soundscough and cyanosis.
- patient’s heart may bealready weakened andprone to failure due tochronic demands,placedon it by the anemic state.Heart may be unable totolerate the added fluidvolume from thetransfusions or rapid IVfluid administered toheart crisis/shock
Clients with Acute Gastroenteritis, watchers are instructedto take the following plan for discharge:
M- Medications should be taken regularly as prescribed , onexact dosage, time, & frequency, making sure that thepurpose of medications is fully disclosed by the health careprovider.
E- Exercise should be promoted in a way by stretching hand andfeet every morning and exercise burping every after bottle
feeding.
T- Treatment after discharge is expected for patients andwatcher with Acute Gastroenteritis to fully participate incontinuous treatment.
H- Hygiene must be maintained for patients with AcuteGastroenteritis. Promotion of personal hygiene should beencouraged such as, daily bathing and changing of diaperswhen soiled.
O- OPD such as regular follow-up check-ups should be greatlyencouraged to clients wather with Acute Gastroenteritis asordered by physician to ensure the continuing managementand treatment.
D- Diet should be promoted, since, during admission, the patientwas on NPO. Proper selection of milk that are suitable forbabies will help enhance immunity.
b. Indication: Treatment for lower respiratory tract infection
c. Mechanism of Action : Inhibits bacterial cell wall synthesis by
binding to one or more o the penicillin binding protein.d. Nursing Responsibilities:
Assess for previous history of reaction to other cephalosphorin orpenicillin. Monitor for allergic reactions.
Assess for bowel function (if severe diarrhea occurs, discontinuedrug).
Monitor urine output (if decreased, notify the physician)
• Ampicillin
a. Doctor’s Order: 260mg IVTT q 6hrs
b. Indication : For susceptible bacterial infections
c. Mechanism of Action: Interferes with bacterial cell wall synthesisduring active multiplication, causing cell wall death and resultant
bactericidal against susceptible bacteria.d. Nursing Responsibilities :
Monitor effectiveness of therapy and active reaction, includingdevelopment of opportunistic infections.
• Phenobarbital
a. Doctor’s Order : 104mg IVTT now as LB/13mg IVTT q 12hrs
b. Indication: For generalized tonic clonic (grand mal) and partial
seizures.
c. Mechanism of Action: Interferes with transmission of impulsesfrom the thalamus to the cortex of the brain, resulting in animbalance and facilitatory mechanism.
Constant observation and frequent monitoring of BP, RR and HR.
Monitor infusion site for irritating extravasations.
• Paracetamol
a. Doctor’s Order: 60mg IVTT q 4hrs (PRN for temp ≥ 37.8 °C)
b. Indication: For mild to moderate pain and fever.
c. Mechanism of Action: Reduces fever by acting on thehypothalamus to cause vasodilation and sweating.
d. Nursing Responsibilities:
Monitor for effectiveness o therapy.
Recheck Temp 15minutes after administration.
• Dopamine
a. Doctor’s Order: 2cc/°.
b. Indication: Treatment of shock which persist after adequate fluidvolume replacement.
c. Mechanism of Action: Stimulates both adrenergic anddopaminergic receptors, lower doses are mainly dopaminergicstimulating and produce renal and mesenteric vasodilation, higherdoses also are both dopaminergic and Beta1 adrenergicstimulating and produce cardiac stimulation and renalvasodilation.
d. Nursing Responsibilities:
Monitor infusion site for extravasation.
Monitor closely for AR and S/S of overdosage.
• Silver Sulfadiazine
a. Doctor’s Order : Apply to affected area TID.
b. Indication : prevention and treatment of infection and burns.
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