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ntestinalarasitismith Erratic
;igrationPneumonia
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randcasepresentation
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Presented:y-SN 3 A-SN 3 A-SN 3 A
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General Objective:
Within 4 hours of General CasePresentation, we will be able to convey
an accurate picture of a 2 year oldpediatric client diagnosed withIntestinal Parasitism with Erratic
Migration; Pneumonia, and thecorresponding medical-surgicalmanagement and nursing interventions
for identified priority nursing
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Specific Objectives:
1.To provide comprehensive informationregarding the medical diagnosis.
2.To present the nursing history, which is
reflective of the clients background datae.g. baseline, present history of illness,past medical history, lifestyle, nutrition,
and socioeconomic status.3.To justify physical assessment findings asmanifestations of the disease process
4.To correlate laboratory tests or diagnosticstudies done with corresponding medical-
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5.To present administered medications
throughout the course of the therapy andtheir corresponding drug actions.6.To present the pathophysiology of the
disease process through comparison withthe normal anatomy and physiology ofinvolved body systems.
7.To identify priority nursing diagnoses based
on defining cues.8.To identify nursing interventions appropriate
for each respective nursing diagnosis.
9.To evaluate the effectiveness of the nursing
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10. To provide an in depth rationalization of
suggested activities of daily living,nutrition, personal hygiene, medications,special treatments, and follow up visitswith the prepared discharge plan.
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SpotMap
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Legend:
Household
Clients House
Tree
Car
Main Road
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Legend:
Household
Clients House
Tree
Car
Main Road
Jaro Plaza
LHS
Bridge
Ricefield
Jaro Plaza
Land Heights Subd
Track
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Brgy.Balabago,
Jaro,Iloilo City
Jaro Plaza
LHS
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NursingHealth
History
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Biographic Data
Name: A.D.Age: 2 years old
Sex: FemaleAddress: Zone 4 Balabago, Jaro,Iloilo City
Date of Birth: May 7, 2006Nationality: Filipino
Religion: Roman Catholic
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Date of admission: November 5, 2008
Time of Admission: 10:00 pm
Attending physician: Dr. J.B.
Chief complaint: Vomiting and
abdominal painDiagnosis: Intestinal parasitism with
erratic migration; pneumonia
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Prenatal HistoryMrs. R.A.D. had her first menstruation
when she was 12 years old. She has a regularmenstrual cycle with an average of 28 days. Shecan consume 3-4 pads a day but she prefers not
to use a sanitary napkin because she feels morecomfortable when her menstruation drains orflows out directly. On August 31,2005, she
noticed that her menses was delayed. She was23 years old when she got pregnant on her thirdbaby. On her first month of pregnancy, sheexperienced nausea and vomiting upon waking upin the morning. She also had cravings for
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She slept more frequent and longer than the
usual sleeping habit. When R.A.D was pregnant,she would sleep at 8pm and wake up at 7am.What she experienced what not that unusual to
her because it is her third time to be pregnant.
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She had two prenatal check-ups, first whenshe was three months pregnant and the second
was when she was five months pregnant. Bothcheck-ups were done in their health centerfacilitated by the midwife. As relayed to her bythe midwife, the baby was in cephalicpresentation and in good condition. She did nothave a shot of tetanus toxoid during her prenatalvisits. She received tetanus toxoid injection when
she was about to deliver her baby in the hospitalwhich is the same with her past pregnancies. Thedoctor in the health center prescribed ferrous
sulfate 325mg per capsule daily because she was
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She consumed a total of 1 stub containing10 capsules taken irregularly.
She had not experienced any serious illnessor complication on her pregnancy except for
fever which lasted for 1 day when she was 4months pregnant. She said she felt warm andhot. She also had cough and runny nose whenshe was 6 months pregnant and lasted for aweek. She did not take any medicines to remedythe above mentioned rather she drank morewater.
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Natal History
Mrs. R.A.D. delivered her baby atWestern Visayas Medical Center,Mandurriao, Iloilo City facilitated by the
resident doctor on duty (name not recalled)on May 7, 2006 at about 8 am. The babywas delivered in a Normal Spontaneous
Vaginal Delivery (NSVD) in cephalicpresentation after the bag of water hasruptured. She had difficulty in delivering
the baby but there was no complications
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Neonatal HistoryAfter delivery, baby A.D. is
pinkish in color and covered withminimal amount of whitish cheesy
substance (vernix caseosa). She alsonoticed the fine downy hairs sparselydistributed on the neonates body.She weighed 6.2 lbs. while the lengthcould not be recalled by the mother.
The baby cried loudly and
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Postnatal History
Due to exhaustion, she fell asleep aftergiving birth. The baby had good suckingreflex during breastfeeding. The vernix
caseosa gradually diminished as they bathethe baby. They also noticed the bluish spotson her right buttocks and right thigh(mongolian spots). As relayed by the mother,the baby first defecated 12 hours afterdelivery. The stool (meconium) was greenishand minimal in amount. They stayed in thehos ital for one da . Mrs. RAD was ha
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Nutritional History
The mother started to breastfeed her babyright after giving birth until one and a half yearold. She breastfed her baby 8-10 times a day.She has not bottlefed her child with any othermilk products. She started to give su-am orrice am, about 150 ml per feeding, when A.D.was 6 months old. She can consume 5-6 bottles
of it daily. At 5 months, A.D. started to eatsoft foods like lugaw or porridge and mashedbanana. At 1 and a half years old, she noticed
her child eating more frequently. At same age,
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The mother prepares their food butsometimes they would buy cooked food in the
market. A.D. has her own serving of foodeats 3 times a day. Her usual diet includes:rice, powdered milk and adobong kangkong for
breakfast. For lunch, rice, laswa and an 9-ounce softdrink, and for dinner, they wouldeat egg, dried fish and rice. A.D. also likes to
eat cheese curls, lollipop and drink mountaindew. Her food preference is utan and friedchicken. The familys usual food is utan and
rice. She could drink as much as 12 glasses of
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Her mother supplements A.D. with tiki-tiki0.6ml once a dayat 2 months old, but they
stopped giving it when they noticed that A.D.was gaining weight by about 3 months old.
l
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Growth and Development
A.D. has a birth weight of 6.2 lbs andcurrently she weighs 10 lbs and stands 81 cm.In terms of her developmental milestone, duringthe first 2 months, A.D. was exhibiting the
following reflexes like grasp reflex and mororeflex. At 5 months, her first 2 lower incisorserupted and for the following month, her 2 upper
incisors erupted. During her 6th month, shebegan to crawl. At 7th month, she started tospeak her first words like aa and baba. Also,during this month, she was able to sit alonewithout su ort and b 11 months she was able
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With regards to her elimination pattern, shetells her mother that she wanted to urinate or
defecate and this started when she was at her 1year and 3 months of age. However, until now,she is unable to defecate or urinate by herselfand she still asks her mother to accompany her.Due to her separation anxiety, she is scaredwhen left with someone she doesnt know or notacquainted to. Currently, she can utter 4-6
words in a sentence. She loves to playhousekeeping toys plastic cooking utensils. Whenshe is playing, most of the time her mother
caught her eating leaves and places her dirty
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They sourced out their water used fordrinking and cooking from a jetmatic pump situated
almost 2 meters right in front of their house. Itis connected to a deep well 20 meters away fromtheir house. The well is chlorinated but notroutinely examined. They then store the water in
a covered blue container right there in thejetmaticpump. Next to their source of water is amuddy canal filled with black, foul smelling muck.
They do not boil the water they use for drinking.Their food preparation includes washing of cookingutensils, raw vegetables, and meat with tap water.
Their toilet is classified as an antipolo type, with
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They burn their garbage including dry leaves,waste and plastic materials 10 meters away
from their house everyday and sells used bottlesand cans.
R.D. has finished his 2nd year in high
school at Balasan National High School. Heworks as a driver of a track that is used in thedelivery of candies, automobiles fortransportation and earns 3000 php a month
utilized for their daily needs.His income is not enough for their daily
expenses so they would sometimes ask R.D.s
aunt who is a elementary public teacher for
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R.A.D. is an elementary graduate ofBalabago Elementary School at Jaro, Iloilo City
and a housewife. Their eldest child is 6 yearsold and currently in kinder 2. Second child is 5years old, while the third (A.D) and fourth childis 2 and 1 year old respectively. They do not
own the land where they live and rents for it for10php per month. They are in good terms withtheir neighbors who are also their relatives.
A.D. usually sleeps at 8:00 in the evening andwakes up at 6:00 in the morning. A.D.sometimes takes a nap for 3 hours or spends the
whole afternoon playing with her playmates
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A.D. sometimes joins her grandfather indrinking coffee for breakfast. They do not have
electricity at home for almost 1 year alreadybecause they lack money to pay their electricbill instead, they use oil lamp. A.D. would
sometimes watch television in their neighborshouse.
They do not hear Sunday mass regularly
but they would usually attend the weekly serviceat the chapel presided by a Baptist pastorevery Sunday at 2 to 4 oclock in the afternoon.
If they would go to church, they usually go to
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History of Present Illness
On November 3, 2008, Monday, 3 pm, BHWof the health center presented a scored tablet tothe mother as a dewormingmedicine. Specific
name of the drug was not mentioned by the BHWas verbalized by the mother. Knowing that herchild has intestinal parasites, R.A.D. allowed the
BHW to administer the tablet to A.D. At 10 pm,the child woke up and cried complaining itchinesson her throat as if something was moving. Themother soothed her childs throat by rubbing theneck.
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Dewormingtablet
presentedand given bythe BHW tothe mother
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The next day at 1 am, A.D. vomitedapproximately 3 cups of vomitusconsisting of the
her previous meal which includes rice and fish.She vomited twice until 2 am. After which shefell asleep and woke up at 7 am. Several minutesafter eating lugaw for breakfast, she vomitedagain of approximately 3 cups of vomitus. Thevomitus is greenish in color with 5-6 cylindrical,glistening, whitish worms about 5 cm in length.
Her father, R.D. gave lugaw again to A.D. butshe only ate 3 tablespoons of it.
non-specific abdominal pain Pain subsided after
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non-specific abdominal pain. Pain subsided afterseveral minutes. They observed body malaise,pale and dryness of lips. Her mother continued
to give her hydrite solution. By 7 pm, she atelugaw again. By 8:30, A.D. she defecated soft,brownish stool with 5-6 worms.
November 5, 2008 (Wednesday)Mr. R.D. gave again A.D. hydrite solution
(Oresol) but consumed only liter (500 ml). At 8am Mrs. R.A.D. cooked lugaw but A.D. refusedto eat. She has no appetite to eat any food, sothey just continue to give hydrite. By nighttime,
about 8:30 pm, they brought A.D. to her
A.D. rested and slept. She did not take herlunch so her father prepared hydrite solution(Oresol) and let her child drink. R.D. diluted 1tablet of hydrite to a pitcher of water about 1liter. She only consumed pitcher about 500
ml. By 2 pm, A.D. complained of non specificabdominal pain. The pain subsided after severalminutes. They observed body malaise, pale skin
and dryness of lips. Her parents continued togive hydrite solution. By 7 pm, she ate lugaw.By 8:30pm, A.D. defecated soft, brownish
stool, with 5-6 worms.
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On November 5, 2008, Mr. R.D. preparedagain hydrite solution (Oresol) 1 liter but she
only consumed 1 glass of it. At 8 am, Mrs.R.A.D cooked lugaw but A.D. refused to eat.She has no appetite to any food, so they just
continued to give hydrite. By night time about8:30 pm, A.D vomited again about 4 cups andwith a bolus of worms. They were so alarmed sothey brought her immediately to WVMCemergency department. They arrived to thehospital at 9 pm and admitted at 10 pm.
A.D. arrived at the WVMC emergency
department, cuddled by father with a chief
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She was diagnosed with acute gastroenteritiswith severe dehydration and intestinal
parasitism with erratic migration. An IVF of D50.3 NaCl 500cc x 62 cc/hr was inserted atright metacarpal vein.
Dr. B ordered administration of Ampicillin250 mg IVTT q6h ANST and laboratory testssuch as urinalysis, Fecalysis, Chest x-ray,
Hematolgy and Serum Na and K.
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Family Medical History
The heredo-familial diseases on the clients
paternal side are hypertension, diabetes mellitus,and heart disease. Her fathers uncle died dueto diabetes mellitus at the age of 42 years old.
At the age of 75, her grandmother died becauseof hypertension. Mr. R.D.s father died at theage of 54 due to heart disease. No other
immediate family member died of disease or itscomplication.On Mrs. R.A.D.s side, they do not have any
heredo-familial disease.
P t M di l Hi t
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Past Medical History
A.D has completed her immunizations however,
the mother could not recall the specific vaccinesgiven. Her yellow card was lost during the typhoonFrank. She has a scar on her right deltoid showing
the possibility that she had received BCG vaccine.She has experienced usual sickness like fever,cough and colds which usually lasted for not morethan one week. Mrs. R.A.D. would give A.D. over-
the-counter drugs like 1 tablespoon of Calpol every6 hours for fever and perform tepid sponge bath.She has no known allergies such as to food or
animal dander and other environmental agents. A.D.
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She was hospitalized once prior to her presentconfinement last April 2007 due to pneumonia
as relayed by the mother. A.D. experienceditching of her throat, rapid breathing, andvomiting. She vomited almost half the meal
she took with 3-4 whitish, long, cylindricalglistening worms. She was brought to theWestern Visayas Medical Center (WVMC)Mandurriao, Iloilo and was admitted for 2weeks. She received antibiotic therapy andIVF therapy, but Mrs. R.A.D. nor Mr. R.D.could not recall any specific medication given
to their child.
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PhysicalAssessment
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Date Performed:November 6, 2008
Pre- Physical
Assessment
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General survey
Generally weak, lying in crib, Height is 82.5cm, and weighs 10 kilograms, malnourished, bodymass index of 14.69, irritable, coordinatedmovement, animated facial expressions, foul body
odor, no halitosis noted, pale, cooperative, strongvoice when crying, poor appetite. Temperature is37.7 oC per axilla, slightly febrile cardiac rate of
110 beats per minute, respiratory rate of 22breaths per minute, and blood pressure of 90/70mmHg. With IVF of D50.3NaCl 500 cc x 62
mgtts/min at the level of 125 cc inserted at the
Ski
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Skin
Brown in color, generally uniform except for
the palms, soles and lips, which are pale. Bodyhair is thin and evenly distributed. Moisturenoted on the forehead, axilla, and back but
generally dry With profuse sweating noted, noedema noted, rough in texture, has variousinterruptions in skin integrity such as scar,crusts, ulcerations noted, particularly on thelower and upper extremities, presence of whitespots on the forehead, vary in size. Scar notedbelow the left elbow, on the lateral portion and
central portion of the right knee, on the
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Nails
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NailsConvex curvature, pale pink in color, smooth in
texture, pus noted on the nail root of the right
thumb, tissues surrounding other nails are intact,nails untrimmed and dirty, good capillary refill,returns to original color after 2 seconds
HeadNormocephalic and symmetrical with frontal,
parietal, and occipital prominences, smooth skull
contour 37.5 cm in circumference, scalp same coloras the facial skin, no flakes or infestation, hairbrownish in color, short, thin, dry, straight andevenly distributed, facial features symmetrical,
al ebral fissures e ual in size, s mmetrical
Eyes
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Eyes
Eyebrows symmetrically aligned and evenly
distributed, eyelashes slightly curved outward,eyelids intact and close symmetrically, noexcessive blinking, palpebral and bulbar
conjunctiva pale, slightly sunken eyeballs, sclera isanicteric with presence of pinpoint sized macule,dark brown in color at the right sclera. Cornea isshiny and smooth. Pupils black in color, equal insize (approximately 2 mm) and both reactive tolight and accommodation, can see objects at theperiphery, both eyes moves in unison, no
periorbital edema or tenderness over the lacrimal
Ears
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EarsSame color as the facial skin, symmetrical and
aligned with the outer cantus of the eye. Hair
follicles noted in the ear canal, presence of dry andyellowish cerumen in both ears, scant in amount.Auricles recoils immediately after it is folded, notenderness noted. Normal voice tones audible at 5meters, whispered words audible at the range of 6inches.
Nose and sinusesExternal nose straight and symmetrical, presence
of clear watery nasal discharge, scant in amount,uniform in color, non tender and no lesions noted. Both
nares patent, nasal mucosa pinkish in color, nasal
Mouth and Oropharynx
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Mouth and OropharynxLips has symmetrical contour, pale pink in color,
soft, dry, and smooth in texture. Able to purse lips,
facial nerve intact. Inner lips and mucosa uniform pink incolor, moist, smooth, glistening and elastic in texture,with 20 sets of teeth, yellowish in color, 4 upper incisorsnoted with presence of dental carries, gums pinkish, moist
and firm, tongue is in central position, no lesions, moist,appears rough and with thin whitish coating at thesurface. Papillae raised, tongue moves freely base of thetongue smooth. Soft palate is smooth and light pink incolor. Hard palate lighter pink in color and has irregulartexture. Uvula positioned at the midline, oropharynxpinkish and uniform in color. Tonsils pinkish and smooth,
no discharge and of normal size. Gag reflex present,
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Heart
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Heart
Apical pulse present on the 5th intercostals
space midclavicular line. Dullness heard uponpercussion, heart sounds heard on cardiaclandmarks, no thrills and murmurs heard upon
auscultation, Cardiac rate of 110 beats perminute, rhythm is regular.
BackNo redness, no mass and swelling, no bone
deformity, spine and posture is straight,
thoracic expansion is symmetrical, tactile
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The right and left inguinal lymph nodes
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The right and left inguinal lymph nodespalpable approximately 0.6 cm in diameter.Defecates 2 times a day to a yellowish, mucoidstool, with visible ascaris of 4-7 worms. Andvoids approximately 7 times a day with lightyellow urine, approximately 100 cc in amount per
voiding.
Extremities
Upper extremitiesNumerous skin lesions noted on arms,
shoulder, elbow, wrist and fingers, has full range
of motion, with quick capillary refill within 2
Lower extremities
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Lower extremities
Presence of lesions distributed all over the
legs and thigh, varicosities are absent in bothfeet. Knees and ankles have full range of motion.Knees can flex as well as the ankle. Both can
rotate without pain, toes can abduct and hyperextend. Popliteal, Dorsalis pedis, Posterior tibialpulses present.
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-Pathophysiology
Intestinal Parasitism with Erratic
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Intestinal Parasitism with ErraticMigration; Pneumonia
Precipitating Factors
vPoor hygienevImproper food preparations
vEnvironment
Predisposing Factor
vAge
(Children are more prone to acquire
the disease)
Ascarid eggs swallowed from contaminated raw
fruits or vegetables and soiled hands
Eggs pass through the stomach and arrive in the duodenum
Becomes a larvae after 18 days; depending on the
environmental condition
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Invades the blood vessels and
carried in the blood stream
Heart
Liver
Larvae burrow through
intestinal lining and into the
tissue underneath
of the bowel, abdominal discomfort
Hepatic damage (hepatitis)
Lungs
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Larvae matures for 10-14 days
Larvae penetrates alveolar walls
Inflammatory response
Minimal hemorrhage, hemoptysi
Accumulation of fluids in the lungsEdema, crackles
Ascaris
Pneumonia
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MEDICAL MANAGEMENT
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LABORATORIES
Laboratory examinations were ordered todetermine the cause of the disease. This
includes fecalysis, urinalysis, hematology andblood chemistry. The physician ordered forthe request of Serum Sodium and Potassium
to determine if the electrolyte level is belownormal.
FECALYSIS
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Fecalysis is also known as stoolanalysis. It refers to a series of laboratorytests done on fecal samples to analyze thecondition of a person's digestive tract ingeneral. It is also performed to check for
parasites, the presence of any reducingsubstances such as white blood cells (WBCs),sugars, or bile and signs of poor absorption.
This is done on the client to help the doctordetermine the presence of intestinal parasitethrough microscopic examination.
URINALYSIS
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Urinalysis is a diagnostic physical,chemical, and microscopic examination of aurine sample (specimen). It is done on theclient to determine various properties (color,specific gravity, ph, glucose, etc.) and
abnormal constituents as seen under amicroscope.
HEMATOLOGY
Hematology is the study of blood and itsdisorders. Hematologists, board-certifiedinternists, look specifically at blood
components such as blood count, and blood
This tests can help diagnose anemia.
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p gCommon hematological test includes whiteblood cell count, red blood cell count,platelet count, hematocrit red blood cellvolume, and hemoglobin concentration. Ablood test that shows you have an increased
number of a certain type of white blood cell(eosinophils) may indicate the presence of anintestinal parasite.
BLOOD CHEMISTRY
Blood chemistry measures the levels of anumber of chemical substances that are
The amounts of these chemicals in the blood
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may reflect abnormalities in the tissuessecreting them. On the clients case, the serum
sodium and serum potassium is measured todetermine possible dehydration.
Chest X-RayIt is a projection radiograph of the thorax
which is used to diagnose problems with thatarea. A chest x-ray may be ordered when aperson's symptoms include a persistent cough,coughing up blood, chest pain, a chest injury, ordifficulty in breathing. The test is also used when
tuberculosis, lun cancer, or other chest or lun
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INTRAVEOUS FLUID THERAPY
The doctor ordered IV fluids such as D5 0.3NaCl 500cc to run at 62-63 cc/hr or 15-16gtts/min x 6 hours, then the next day it wasD5 0.3 NaCl 500cc + 10 mEqs of KCl at 62-
63 cc/hr x 8 hours. In case of Gastro-intestinal loss, the doctor ordered to replaceit volume/volume of PLNSS to avoid
dehydration.
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This is usually ordered by the physicianto maintain or replace body stores of water,electrolytes, vitamins, protein, calories, andnitrogen in the client who cannot maintainadequate intake by mouth, restore acid base
balance, replenish blood volume and provideavenues for keeping the vein open for easyadministration of drugs whenever the condition
becomes severe or the client cannot able totake medications orally, it is given through IVfor the medications to take effect as rapidly as
possible.
1 D5 0 3 NaCl 500cc x 62 63 cc/hr
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1.D5 0.3 NaCl 500cc x 62-63 cc/hr
D5 0.3% NaCl is typically thechoice for maintenance fluid for pediapatients. Dextrose and sodium chloride
solutions are used as sources ofelectrolytes, calories and water forhydration. Sodium and chloride ions are
responsible for regulating the acid-base balance of the body.
Dextrose is a source of calories. It is
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readily metabolized and helps to
decrease losses of body protein andnitrogen. It also promotes glycogendeposition and decreases or prevents
ketosis.2.D5 0.3 NaCl + 10 mEq KCl x 62-63cc/hr
Potassium chloride is used in thetreatment of hypokalemia and associated
3 D5 IMB (hypertonic solution) 500 cc x 41-
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3.D5 IMB (hypertonic solution) 500 cc x 4142 cc/hr
Hypertonic solution has higher osmoticpressure than that of plasma drawing fluid intothe cell. It is also used in repairing electrolyte
and acid/base imbalances, and also include totaland partial parenteral nutrition solutions.
4. Plain NSS
It is an effective method of supplying fluidsdirectly into the intravenous compartments. It
MEDICATIONS
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For the medications, the doctor ordered for
Ampicillin 250 mg IVTT q6h and a go homemedication which is the Cotrimoxazole 80mg/5ml to prevent infection.
NUTRITIONAL SUPPORT
For the nutrition of the client, the doctor
ordered Diet as Tolerated with Strict AspirationPrecaution to maintain the nourishment of theclient and to prevent aspiration pneumonia.
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Nursing Management
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Nursing Management
vWhen the client was admitted, the nurseadministered D5 0.3 NaCl 500 cc + 10 mEqKCl x 62-63 cc/hr as ordered
vVital signs were checked every 4 hours.
vCareful intake and output monitoring for theclient was done.
vStool and vomiting count was made and a
sheet was placed on the bedside.vOrdered medications were given.
vAfter 3 days, the IVF was changed to D5
IMB re ulated at 41-42 cc/hr as ordered
vHealth Teachings was given to the folks to
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create awareness about the disease and toprevent reinfection. Proper handwashing ofhands before and after eating wasemphasized.
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LaboratoryResults andDiagnostic
Tests
URINALYSIS
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URINALYSIS
Definition: Urinalysis is a diagnostic testused as screening because it can help
detect substances or cellular material inthe urine associated with differentmetabolic and kidney disorders. It is
ordered widely and routinely to detectany abnormalities that should be followedupon.
Preparation: The specimen can be
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Preparation The specimen can becollected anytime of the day. Collect
midstream clean catch urine specimenin a clean, dry, wide mouth plastic cupor container. Collected specimen must
not be less than 30ml. Bring it to thelaboratory immediately aftercollection. Label the specimen cup withthe clients name, and ward/roomnumber.
Result Normal ValuesSignificance
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Physical
PropertiesColor Palestraw
Pale straw Normal
Transparency Slightlyhazy
Clear toslightly hazy
Normal
Reaction Acidic Acidic Normal
SpecificGravity
1.012 1.010-1.025 Normal
Result Normal ValuesSignificance
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Chemical
testSugar Negative Absence ofsugar
Normal
Protein Negative Absence ofprotein
Normal
Result NormalV l
Significance
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ValuesMicroscopic
RBC 0-1 Veryoccasional
Normal
Pus 0-1 None Indicates early
infection in thegenitourinarytract
Cast None None Normal
NormalCrystal
Few None to few Normal
Result NormalV l
Significance
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ValuesMicroscopic
Squamousepithelial cells
Few few Normal
Round
epithelial cells
None None Normal
Bacteria Few None tofew
Normal; presence offew bacteria may be
possible due toimproper handling ofspecimen and dirtycontainer.
Result Normal Significance
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ValuesMicroscopic
Mucousthreads
None None to few Normal
Yeast cells None None Normal
Parasite None None normal
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Interpretation: From the results of the
urinalysis indicated above, AD does notsuffer from any urinary tract or renaldisorder. There is a very slight deviationfrom the normal values as in the presence offew bacteria which is due to improperhandling of specimen.
FECALYSIS (Direct fecal smear)
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( )
Name: A.D Received: 11-6-08
Age: 2 y.o Ward/Room No.: Pedia Apex
Sex: Female Lab No.: 2-7
Requesting Physician: Dr. B.
Definition: Stool analysis is used to determinethe various constituents of the stool for
diagnostic purposes such as diseases of thegastrointestinal tract. It is done to makeadequate, gross and microscopic examination.
Purpose: Its purposes are to detect the
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p p ppresence of parasites and identify certaintypes of bacteria that can cause disease. Itdetermines the cause of symptoms affectingthe digestive tract, including prolongeddiarrhea, bloody diarrhea, an increased
amount of gas, nausea, vomiting, loss ofappetite, bloating, abdominal pain andcramping, and fever.
Preparation: The specimen can be collected
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anytime of the day. Place the fecal matter
in a clean, dry, wide mouth plastic cup orcontainer. The fecal specimen must be atleast the size of the thumb. Bring it to thelaboratory immediately after collection,
preferably one hour after defecating. Labelthe specimen cup with the clients name, andward/room number.
Result Normal ValuesSignificance
Ph l
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PhysicalProperties
Color Brown Brown Normal; due tobacterialdegradation ofbile pigments
to stercobilin.
Consistency Mucoid Soft; Formed Abnormal; dueto increased
gastric motilityand presenceof bacteria
MICROSCOPICEXAM
Result NormalV l
Significance
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EXAM Values
Ascarislumbricoides
More than12ova/slide
none Indicatesintestinalparasitism;ascariasis
Hookworm none none Normal
Trichuristrichiura
0-1ova/slide
noneIntestinalparasitism;trichuriasis
Trichomonashominis
few none Indicates intestinalparasitism
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hominis parasitism
Entamoebacoli
5 ova/slide none Indicates intestinalparasitism;amoebiasis
Entamoebahistolytica
More than 12cyst/slide
none Indicates intestinalparasitism;
amoebiasisRBC 2-4/hpf none Increased; due to
GI tractinflammation
Pus cells 0-1/hpf none Presence indicatesbacterial infection
Ascaris
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Ascarislumbricoides
Trichuris trichura
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Trichuristrichura
Trichomonashominis
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Entamoeba coli
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Entamoebacoli
Entamoebahistolytica
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Interpretation: From the results of stool
analysis indicated above, it showed thatA.D. experiences severe intestinal parasitismwith the presence of the following parasitesand helminthes: ascaris lumbricoides,trichuris trichiura, trichomonas hominis.Results also showed intestinal amoebiasis dueto the presence of Entamoeba hystolytica.
Because of the reaction to bacterialinfection, it ensued to an increased level ofRBC and WBC.
ROENTGENOLOGICAL REPORT
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Case No: 19596-cj Date: 11-5-2008
Name: D. A. Age: 2 y.o.Examination: Chest APL Sex: FemaleDepartment: APEX
Requesting Physician: Dr. B.Findings:
Chest APL shows parachilar and peribronchial
haziness.Heart is not enlarged.Trachea is at midline.
Hemidiaphragm and costrophrenic angles
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BLOOD CHEMISTRY
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Name: A. D. C.S.: SingleWard: Pedia Apex Age: 2Examinationdesired: Na+, K+ Sex: FemalePhysician: Dr. R. B. Date:11-07-08
HospitalNo: 45174 Lab No: 5-27Results Normal Values
Electrolytes
Serum Sodium(Na+)
140.1 135.143 mmol/L
Serum Potassium(K+)
4.19 3.5-6.3 mmol/L
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SIGNIFICANCE:
Results shows that sodium-potassiumlevel is within the normal range, no
indication of electrolyte imbalance.
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Results NormalValues
Significance
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ValuesNeutrophils
Segmenters
0.63
0.63
0.59-0.68
0.32-0.62
Slightly
increased,indicatesinflammatorydisease
Lymphocytes 0.37 0.25 0.33 Increased; inresponse topresence of
microorganisms, possibleinfection
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Significance: Based on thefindings, A.D. manifestsinflammatory disease and infection
as evidenced by slight increase ofantigen presenting cells such assegmenters and lymphocytes.
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DrugStudy
Name of Classification
Indication Action
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Drug
GenericName:Ampicillin
BrandName:
Principen
Antibiotic For GITinfection
Inhibitscell wallsynthesisduringmicroorganism
multiplication.
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Adverse Reactions andSide Effects
Dosage
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Side Effects
SE:Vein irritation, nauseaand vomiting, diarrhea
AR:Thrombophlebitis,thrombocytopenia,
urticaria,hypersensityivityreaction, anaphylaxis
250 mg IVTT q6h ANST
(-)6-12-6-12
Availability:Capsule: 250mg, 500 mgInfusion: 500mg, 1g, 2g
Injection: 25mg, 250mg,500mg, 1g, 2gOral suspension:125mg/5ml,
Nursing ResponsibilitiesObserve 10 Rights in giving medications
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Observe 10 Rights in giving medications.Obtain history of patients infection before
therapy.Ask patient or folks about previous allergicreaction to penicillin
Perform skin test before giving the medication.Be alert for adverse reactions and druginteractions.Monitor hydration status.Give at least 2 hour before bacteriostaticantibiotic.Stop drug immediately if anaphylaxis occurs.
Name ofDrug
Classification
Indica-tion
Action
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GenericName:PotassiumChloride(KCl)
PotassiumSupplement
Forprevention ofhypoka-lemia
Aids intransmittingnerve impulses,contractingcardiac andskeletal muscle,and maintaining
intracellularmetabolism, acidbase balance,
and normal renal
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Adverse Reactions andSide Effects
Dosage
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Side Effects
SE:Paresthesia, listlessness,confusion, n/v,abdominal pain,diarrhea, cold skin,oliguria
AR:Arrhythmias, heartblock, cardiac arrest,
GI ulcerations and
DosageKCl 6 mEq incorporated to300 cc D5 0.3 NaCl x62-63 mgtts/min
Availability:Capsule: 8mEqs, 10mEqs
Injection: 0.5meqs/ml,2meqs/mlOral liquid: 20meqs/15mlPowder: 15meqs/packet,
Nursing ResponsibilitiesObserve 10 Rights in giving medications
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Observe 10 Rights in giving medications.Assess patients condition before start of therapy.Be alert for adverse reactionsMonitor fluid input and output, creatinine and BUNlevels.
Give cautiously because different potassiumsupplements deliver varying amounts of potassium.Drug is commonly given with potassium-wastingdiuretics to maintain pottasium levels.Advise to eat potassium rich foods.Dont give postoperatively until urine flow isestablished.
Name ofD
Classification
Indication Action
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Drug
GenericName:Cotrimoxazole
Antibiotic Forsusceptiblemicroorganisms
Sulfamethoxazole inhibitsformation ofdihydrofolic
acid fromPABA;trimethopriminhibits
dihydrofolatereductase.Both decreasebacterial folicacid synthesis
Special Precautions Contraindications
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Use with caution andreduce dose in clientwith hepatic
impairment, CrCl of15-30 ml/min, severeallergy or asthma,
G6PD deficiency, orblood dyscrasia
Contraindicated in clientswith megaloblastic anemiacaused by folate
deficiency, severe renalimpairment, orhypersensitivity of the
drug
Adverse Reactions andSide Effects
Dosage andAvailability
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Side Effects Availability
SE:Headache, abdominalpain, diarrhea, anorexia,muscle weaknessAR:Thrombocytopenia,leukopenia, anaphylaxis,
hepatic necrosis
Dosage:
80mg/5ml
Nursing ResponsibilitiesObserve 10 Rights in giving medications.
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Observe 0 R ghts n g v ng med cat ons.Assess clients infection before and after
therapy.Before giving first dose, obtain specimen forculture and sensitivity tests. Begin therapy
pending results.If adverse GI reactions occur, monitor hydrationstatus.Monitor MIO. Ensure urine output is at least 1.5L daily. Inadequate urine output leads tocrystalluria.For full absorption, give with a full glass of
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NursingCare Plan
List of Priority Nursing
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y g
Diagnosis
Fluid volume deficitAltered Nutrition, less than
body requirementsHyperthermiaImpaired skin integrity
NURSING DIAGNOSIS
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Fluid volume deficit related to activefluid loss as evidenced by 5 episodes ofvomiting with approximately 100cc of semi-solid vomitus which contains previously taken
foods; defecated 2 times a day with ayellowish, mucoid stool, skin warm to touch,dryness of skin in palms and sole of the feet,
skin turgor of 4 seconds, dryness of lips, palebulbar and palpebral conjunctiva, temp= 37.7degrees celcius, slightly sunken eyeballs and
profuse sweating Mrs RAD verbalized that
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GOAL
Within 4 hours of effectivenursing intervention, client will
display improvement onhydration status to a functional
level such as good skin turgorand stable vital signs.
NURSINGINTERVENTIONS
RATIONALE
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INTERVENTIONS
INDEPENDENT:
1. Monitor vital signs
every 4 hours includingthe intake and outputand note the strengthof peripheral pulses.
-Vital signs serve as
patients baselinedata. Monitoring fluidintake and outputenables us to evaluatethe degree of fluidvolume deficit.
2. Estimate proceduralfl l
-To note the volumef l fl
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fluid losses and
possible route ofinsensible fluid losses.
of insensible fluid
losses for properreplacement.
3. Note clientsf
-This will help inh l
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preferences concerning
foods with high fluidcontent such as papayaand jelly ace.
4. Encourage theparents to increaseclients fluid intake
approximately 2-3liters per day astolerated.
encouraging the client
to increase her fluidintake.
-Increasing fluidintake will replace
fluid losses and helpmaintain fluid volumeat functional level.
5. Instruct theparents to secure
-This is a preparation ifthe client will crave for
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parents to secure
available drinkingwater at the bedside.
6. Give crackers or
ice chips to theclient.
the client will crave for
water. The availabilityof fluids is a good wayto respond immediatelyto the physiologicalneeds of the client.
-This is a non-
pharmacologicmanagement to reducenausea.
Dependent:
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1.Administermedications asorderedAmpicillin 250 mg
IVTT q6h6am-12nn-6pm-12pm
-Ampicillin is a broadspectrum antibiotic thatkills parasites byinterfering their ability
to form cell walls, thusthey will break up anddie.
2.Infuse IV fluids asordered and regulate
-this is given tocounteract hypotonic
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ordered and regulateat prescribed rate:D5 0.3% NaCl 500 ccx 62 63 cc/hr
Collaborative1. Monitor laboratorydata such as
hematocrit,electrolytes andspecific gravity of
urine
counteract hypotonicdehydration and tomaintain the balance influids and electrolytes inthe clients system.
-to note if there areprogress in clients
condition as to her fluidvolume.
E
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EVALUATION Goal met. A.Dwas able toimprove her hydration status to afunctional level after 4 hours of
effective nursing interventions asevidenced by good skin turgor of 2seconds and stable vital signs.
NursingDiagnosis
Altered Nutrition, less than the body requirementsrelated to Inability to Absorb Nutrients due to Biological
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y gFactors (Intestinal Parasites) as evidenced by BMI of
14.69 (malnourished), persistent vomiting approximately5 times prior to admission from November 3 toNovember 5, 2008 approximately 100cc per episode ofvomiting, dryness of lips, pale palpebraland bulbarconjunctiva with slightly sunken eyeballs, hair is brownin color, thin and dry, pallor, protuberant and distendedstomach, weakness, ,presence of intestinal parasites as
laboratory results revealed, presence of Ascarislumbricoides (more than 12 ova per slide), Trichuristrichuria (0-1 ova per slide), Trichomonas hominis (few),Entamoeba coli (5 ova per slide), Entamoeba histolytica
(more than 12 cyst per slide) RBC 2 4hph presence of
Goal
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GoalWithin 14 days of
effective nursing interventions,
client will demonstrateprogressive weight gain from
4-7 kilograms to achievenormal Body Mass Index of20-24.
Nursing InterventionsRationale
Independent:
1. Assess age, body Helps to determine
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1. Assess age, bodybuild, activity and restlevel.
2. Reassess weight.
Assess BMI.3. Establish a minimumweight goal with the
client of approximately4-7 kilograms withintime span.
pnutritional needs.
To establish baseline
parameter.- Provides comparativebaseline data for
effectiveness of therapy.Improved nutritionalstatus enhances activitytolerance and physiologic
4. Review the nutritionalhistory including quality of
- Identify thedeficiencies and
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food taken and meal eaten
per day.
5. Weigh regularly andrecord results.
6. Identify and manageunderlying causative factors
such as food preparations,proper hygiene andenvironmental sanitationincluding the present
suggest proper daily
intake.To monitoreffectiveness of
nursing interventions.
- To determine theamount that should be
added in the diet andmonitor the foodpreferences of the
client
7. Evaluate the totaldaily food intake
Reveal possible causeof malnutrition and
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daily food intake
including caloric intake,patterns and time ofeating.
8. Provide smallfrequent meals andsupplemental snacks
like boiled kamotewhich is readilyavailable in the clients
back ard
of malnutrition and
changes that could bedone to be made inclients intake.
- Gastric dilation canoccur and if refeedingis too rapid and canlead to gastric reflux.
9. Use flavoring agentsminimal in amount such
- To enhance foodsatisfaction and
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minimal in amount such
as salt, pepper andother herbs in food aspreferred.
10. Ensure minimalintake of foods thatcause intolerances suchas foods that are gasforming and avoid toohot/cold or spicyaccording to clients
satisfaction and
stimulate appetite.
Increase gastricmotility leading toreflux and diarrhea
11. Promote adequateand timely fluid intake astolerated by the client
Replace fluid loss dueto diarrhea and
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tolerated by the client
preferably 2-3L. Limitfluids 1 hour as possibleprior to meal.
12. Recommend eatingin upright position.
13. Minimize unpleasantodors or sight includingscent of spoiled and raw
vomiting. Limiting fluid
intake prior to mealprevents early satiety.
May enhance intakeand reduce sensation ofabdominal fullness.
To promote pleasantatmosphere that canincrease and stimulateintake.
14. Schedule activitieswith adequate rest
Conserve energy andreduces caloric needs
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with adequate rest
periods and promoterelaxation technique.
15. Monitor laboratory
results
reduces caloric needs
To monitor the
condition of the clientand any alterationsassociated to clients
status like presence ofintestinal parasites.
Dependent
P id t l
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Administer IVF of D5
0.3% NaCl 500cc x 62-63 cc/hr as ordered.
Interdependent:Refer to dietician forspecific meal plan.
Provide parenteral
nutrition and replace GIloses.
- To meet proper daily
nutritional needs.
2. Refer to physicianf
To eliminate parasites
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prescription of
antihelmenthic drugs.
in the GI tract.Parasites such asentamoeba hystolyticaand ascaris lumbricoides
competes with thenutrition acquired bythe client causing not
enough nutrition beingacquired by the body.
Evaluation
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Goal met. Within 14days of effective nursinginterventions, client was ableto gain weight of 4kg withBMI of 20.56.
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Goal
Within one hour ofnursing effective nursing
interventions, client will beable to maintain coretemperature of 36-37.5 oCof per axilla.
NursingInterventions
Rationale
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Interventions
Independent:
Monitor clients
temperature prior totherapy.
2.Monitor vital signsevery 15 minutes.
- To provide comparative
baseline data.
-To note any alterations
in the current conditionand monitor effectivityof nursing interventions.
3. Perform tepidsponge bath
Promotes heat lossthrough the process of
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sponge bath.
4. Limit bed linens.
5. Instruct folks tolet client wear loose-
through the process of
conduction andevaporation.
- Number of linens
should be minimized tomaintain near bodytemperature by allowing
heat loss.
-Tight clothes trapmoisture coming from
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Goal
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Within 5 days of nursinginterventions, the client will be
able to achieve timely healing oflesions without complications.
Nursing Interventions Rationale
Independent
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p
1.Identify theunderlying conditions,the cause and the
nature of the skinlesions, ulcerations andscars.
2.Instruct mother toclean the lesions withsoap and water.
-Identifying thecondition, cause, andthe nature of the skinlesions will determineappropriate nursinginterventions.
-Washing the lesion sitewith antiseptic soap andwater cleanses it andprevents bacterial
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5. Instruct mother toprovide A.D. withVitamin C rich food
- Protein-rich foodfacilitates skinregeneration thus
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like calamansi and suha.
6. Instruct mother tofeed A.D. protein richfood such as fish and
legume, string beans,mongo and kadyos.
promoting healing.
-vit. C rich food booststhe immune system thus,preventing infections and
eventually maintaining goodskin integrity.
-Protein-rich foodfacilitates skinregeneration thuspromoting healing.
7. Instruct mother toapply herbal medicine
-This herbal medicinesare accessible available
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apply herbal medicine
such as guava leavesand found in theirvicinity.8. Instruct mother tohave her child wearappropriate footwear
like slippers withgarter.
are accessible, available
and DOH-recommendedfor wound healing.
-To protect the soles ofthe feet from injury.
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Evaluation
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EvaluationGoal partially met. Some
lesions were still noted on the
upper and lower extremitiesbut still on the stage ofhealing.
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A.D.
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Skin
Brown, generally uniform in color, body
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hair is thin and evenly distributed, skin is moist,no edema noted, rough in texture, has variousinterruptions in skin integrity such as scars,crusts, ulcerations particularly on the upper and
lower extremities with signs of healing in variousstages. Ulcerations noted on the left tarsal withevidence of healing process. Bluish discoloration
noted at the anterior portion of the buttocksand left gluteus medius (Mongolian spot),presence of pinpoint marks on the soles of the
f t Ski t t if ll th
Nails
Convex curvature, pinkish in color, smooth int xt tiss s ndin th n ils int ct
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texture, tissue surrounding the nails are intact.
Nails are untrimmed and dirty, good capillaryrefill, returns to original color after 2 seconds.
Head
Normocephalic and symmetrical with frontal,parietal, and occipital prominences, smooth skull contour37.5 cm in circumference, scalp same color as the facial
skin, no flakes or infestation, hair brownish in color,short, thin, dry, straight and evenly distributed, facialfeatures symmetrical, palpebral fissures equal in size,symmetrical nasolabial folds, no masses nor nodules
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Mouth and OropharynxLips has symmetrical contour, pink in color, soft,
moist, and smooth in texture. Able to purse lips, facial
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nerve intact. Inner lips and mucosa uniform pink incolor, moist, smooth, glistening and elastic in texture,with 20 sets of teeth, yellowish in color, 4 upperincisors noted with presence of dental carries, gums
pinkish, moist and firm, tongue is in central position, nolesions, moist, appears rough and with thin whitishcoating at the surface. Papillae raised, tongue movesfreely base of the tongue smooth. Soft palate is
smooth and light pink in color. Hard palate lighter pinkin color and has irregular texture. Uvula positioned atthe midline, oropharynx pinkish and uniform in color.
T il i ki h d th di h d f l
Neck
Neck muscles equal in size, head centered,
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m q , ,
head movement coordinated, with no discomfort,head flexes, hyperextends, flexes laterally androtates laterally, lymph nodes not palpable,
trachea placed at the midline of the neck.Thyroid isthmus rises when client swallow,thyroid gland not visible on inspection, smooth,nontender nonenlarge, lobes of thyroid glandcannot be palpated.
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Heart
Apical pulse present on the 5th intercostals
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p p p
space midclavicular line. Dullness uponperscussion. Heart sounds heard on cardiaclandmarks, no thrills and murmurs heard uponauscultation, Cardiac rate of 110 beats perminute, rhythm is regular.
Back
No redness, no mass and swelling, no bonedeformity, spine and posture is straight,thoracic expansion is symmetrical, tactile
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GenitalsNo unusual discharges, Perinuem intact,
wound marks noted absence of redness at the
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wound marks noted, absence of redness at the
anal opening. Presence of sticky clear dischargesnoted at the vaginal opening. Right and leftinguinal lymph nodes slightly palpable. Defecates
two times a day to a yellowish formed stoolwithout the presence of worms(ascaris) and voidsapproximately 7 times a day to a light yellow urineapproximately 100 cc in amount per voiding. The
right and left inguinal lymph nodes slightlypalpable.
Extremities Upper extremities
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Numerous skin lesions noted on arms,shoulder, elbow, wrist and fingers and on variousstages of healing, has full range of motion, with
quick capillary refill within 2 seconds.Lower extremities
Presence of lesions distributed all over the
legs and thigh, varicosities are absent in bothfeet. Knees and ankles have full range ofmotion. Knees can flex as well as the ankle.
B th t t ith t i t bd t
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DischargePlan
I. General Objectives:
To provide continuity of care at home in
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p y f m
the absence of a health care provider.
II. Specific Objectives
1. To discuss to the folks of the client someinformation about the clients illness,including its background, etiology,
epidemiology, and signs and symptoms.2. To help the folks assist the client in
dealing with her personal hygiene so as to
3. To guide the folks of the client byinstructing the ADLs listed and practice it sothat the client can avoid any complications
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y p
again and live normally as a child.4. To provide a list of nutritional foods that is
appropriate to the client and teach folks how to
prepare, store and cook it properly.5. To help the folks interpret and understand
the medications and herbal medicines listed.
6. To inform the folks when will be theappropriate time to return for follow-up checkup and repeat laboratory exams as requested.
III. Health Teachings
A)Knowledge about the Illness
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The intestinal parasitism is an endemicclinical condition that prevails in nations withthe population's severe imbalances social and
economic, where vast sectors they lack thebasic services of education, health, housing,and recreation.
Etiology
Among these parasites, the ascarislumbricoides is a nematode which is one of the
A lumbricoides is the most prevalent andthe largest of the intestinal nematodes thatinfect humans This illness is characterized by
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y
variable symptomatology ; it is generallyasymptomatic in the adult, and it is in childrenwhere we see the most florid clinical
presentation and the complications of thisillness.
As most of the intestinal parasite
infections, the ascariasis prevails and is endemicin areas lacking of sanitary infrastructure, withprecarious housings, poverty and ignorance. This
h l i thi i f ti i i d b th i ti
They ascend for the respiratory tree andthen continuing go up for later to be swallowedand arrive to the small intestine where they
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and arrive to the small intestine where they
become adults.
Epidemiology
The form of more frequent presentation isthe chronic infection, which mostly contributes tothe process that takes to the malnutrition. It can
happen to any age, being more frequent inchildren of school age and persisting in theadulthood. Every year, 60.000 deaths areattributed directly to this infection.
The clinical illness is restricted to subjectwith important load of parasites. This minorityrepresents from 1 2 to 2 million cases with
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represents from 1,2 to 2 million cases with
clinical manifestations in the world, beingconsidered around 50.000 deaths a year forsevere illness caused by ascaris lumbricoides.
Signs and Symptoms
The infested patients could not have anysymptom, or to manifest low of weight, chronicabdominal colic pain, nausea, vomiting and theelimination of parasites by stools. Children couldhave retardation related growth and weight, and
Most of children have the antecedents ofascaris expulsion by rectum, and patients withintestinal obstruction is common to records
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parasites expulsion by mouth, which help as anelement to keep in mind for making a rightdiagnosis. The diagnosis is carried out by means
of the visualization of the eggs in the directexam of fecal matter. The mature females canalso be visualized in feces. In few cases thatthe infection is only for males, there are noteggs in the stools, and an abdomen x-ray allowsvisualizing the parasites in the intestine.
Erratic MigrationOne of the peculiarities that characterize
the massive infestation conditioned by these
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the massive infestation conditioned by theseworms is the enormous capacity that theypossess to invade spaces, organs, conduits andcavities of the human body where it is not
normal to find them, for what this extensivechapter has been denominated in theinternational literature as erratic or ectopic
ascariasis. As consequence of the erraticlocalizations, the presence of parasites has beendescribed in biliar ducts, nasal graves, hearings,
f ll i t b llbl dd th
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1. Sanitary disposal of human feces and goodpersonal hygiene.
2. Washing of hands before and after eating and
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after going to the comfort room, or handlingpets.
3. Keep fingernails short and clean becauseparasites can live for two months under thefingernails.
4. Keep environment neat and clean by doing ageneral cleaning thrice a week together with the
family.5. Do not walk barefoot on warm moist soil, or
while playing in the backyard because parasites
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C.) Activities of Daily Living
1.Eating:
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a)Before and after eating, make sure towash hands properly using a soap andclean water because proper hand
washing may prevent the spread ofmicroorganisms.
b)Encourage to avoid eating foods from
streets like fish balls, fried chicken,ice candy, and other foods which aresold on the nearby streets since we
These foods may not be cleanedproperly, or may be already
contaminated
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contaminated.c) Encourage to boil water at least
5-15 minutes if they use water from
the faucet in order to destroymicroorganisms present in the water.2. Bathing, Grooming, and Clothing:
a) Wearing of shoes or slippersproperly outside and inside of thehouse.
c) Counsel not to allow children to belicked or kissed by pets that are notdewormed regularly.
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g y
d) Discourage nail-biting and scratchingthe anal area.
e) Have children change into a clean
underwear each day to prevent infection.
3) Eliminating/ Toileting
a) It is necessary to wash hands aftertoileting for infection control and towipe perineum from front to back to
b) Encourage not to ignore the urge to void sothat the bacteria from the urinary tractwill be flushed out.
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c) It is also necessary to defecate in a day toremove toxins from the body.
Rationale: To guide the folks of theappropriate ADL that must be performedand practiced by the client daily.
D.) Nutritional Status
1.Wash thoroughly and cook foodparticularly fruits and vegetables.
3. Encourage to drink more clean water byboiling it 15-30 minutes or to boiling point.
4. Eat Vitamin C rich foods and high in protein
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and calories to replace weight loss likeoranges, and other citrus fruits, milk, meat,and fish.
5. Prepare food properly to enhance appetite ofthe child.6. Light soups, rice and eggs are good foods to
eat during recovery.7. Sugar and sweetened foods should be avoided
because parasites thrive on it.8. Take large doses of plant derivatives
Rationale: To take foods appropriately andavoid foods that is restricted.
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E.) Medication, Treatment and SpecialProcedures
1.Instruct the folks of the client tofollow physicians order take homemedications, correct dose, preparations
or for any laboratory exam likefecalysis.2.Let bowel rest by drinking only clear
3. Avoid taking OTC medications or other drugswithout asking a knowledgeable health careprovider regarding it.
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4. Comply with antibiotic medications.Cotrimoxazole 2.5 ml BID,(8am and 6pm) PO,for 7 days. Give with full glass of water, 1 to2 hours after meals.
5. Suggest herbal medicines.Preparation:Boil Star apple leaves for 10 minutes
Strain the extract and get rid of theleaves and residue
Cool the extract for 5 min
Rationale: To subject client for medicationsand special procedures to enhance health.
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F.) Follow-up VisitEncourage the folks of the client to return
for follow-up visit after 1 week after dischargeNovember 16, 2008, WVMC OPD 8:00 am tomonitor condition or health status or if neededor necessary.
Rationale: To inform the folks and the clientwent to go back to monitor the status and
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WardObservation
octor s r er S eetDr. B made the following orders:
please admit patient at pedia apex down
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please admit patient at pedia apex down- this is to monitor patient's condition andprovide necessary care and interventionsrelated to patient's diagnosis. Pedia apex
down is used for the admission of patientswith infectious diseases particularlygastrointestinal diseases
TPR every 4 hours and record- to monitor and note any alterations thatmay need or elicit prompt referral and
d
A w t SA- the patient is two years old and should berequired to be in SAP and because thepatient has experienced vomiting and should
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p p g
be cautioned for aspirationContinue Na K- A laboratory examination performed to
determine and correct fluid electrolyteimbalance caused by previous episodesvomiting and diarrhea
Fecalysis- a routine laboratory examination intendedto identify parasites present in thegastrointestinal tract and the extent of
Urinalysis- to provide information about the basicproperties of a urine sample and aid in diagnosis.Measures the pH and concentration check for
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Measures the pH and concentration, check forglucose, protein, the presence of bloodAPC chest x-ray right and left lung-to identify extent of damage to the lungs due to
erratic migration of the parasites to the organIVF D5 0.3 NaCl 500cc x 6h to run at 62-63cc/hr or 15-16 gtts/min; reassess at 4am
- an isotonic solution that can be used as initialfluid for hydration because it provides morewater than sodium; commonly used asmaintenance fluid
Medication: Ampicillin 250mg IVTT every 6hours ANST
-an antibiotic intended to fight the infection
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caused by the parasite invading the organsMIO every shift and record include stool andvomiting count at bedside
-to monitor GI losses in order to know howmuch is to be replaced based on the outputand to note characteristics of stool to
identify gastrointestinal function-
Replace GI loss volume/volume with PNSS
-to prevent hypovolemia and fluid and
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electrolyte imbalance)-Refer accordingly
- to prevent any complication or untoward
incidents that may need immediate medical orsurgical interventions
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7:30am Lips dry, dirty nails and untrimmed,good capillary refill, poor skin turgor,springs back after 4 seconds, pale
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p g p
bulbar and palpebral conjunctiva, noadventitious breath sounds, abdomendistended 53cm, normoactive bowel
sounds in all 4 quadrants with 7cycles/min., no abdominal pain uponpalpation, has not defecated since
after admission, separation anxietyevident, Mongolian spots on rightbuttocks and thigh about 5cm indiameter. Skin lesions on right knee and
8:00am8:15am
TSB done.Breakfast taken. Consumed 1/2 cupof rice bowl of chicken soup and
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8:30am
of rice, bowl of chicken soup andapproximately 240cc of chocolatedrink well-tolerated.Temperature rechecked. Temp. per
axilla=37.50C. TSB donecontinuously.
9:00am
9:15am
IVF consumed and followed withthe same IVF of D5 0.3 NaCl
500cc and regulated to the desiredrate.Wound dressing done.
9:30am Defecated in CR but the mother failedto get a stool specimen. Stool isformed, yellow in color with 4-6 white,
10:00am