I.

INTRODUCTION
Gastroenteritis or infectious diarrhea is a medical condition characterized
by inflammation ("-itis") of the gastrointestinal tract that involves both
the stomach ("gastro"-) and the small intestine ("entero"-), resulting in some
combination of diarrhea, vomiting, and abdominal pain and cramping. Dehydration may
occur as a result. Gastroenteritis has been referred to as gastro, stomach bug,
and stomach virus. Although unrelated to influenza, it has also been called stomach
flu and gastric flu.
Signs and symptoms
Gastroenteritis typically involves both diarrhea and vomiting, or less commonly,
presents with only one or the other. Abdominal cramping may also be present. Signs
and symptoms usually begin 1272 hours after contracting the infectious agent. If due
to a viral agent, the condition usually resolves within one week. Some viral causes may
also be associated with fever, fatigue, headache, and muscle pain. If the stool is bloody,
the cause is less likely to be viral and more likely to be bacterial. Some bacterial
infections may be associated with severe abdominal pain and may persist for several
weeks.
Children infected with rotavirus usually make a full recovery within three to eight
days. However, in poor countries treatment for severe infections is often out of reach
and persistent diarrhea is common. Dehydration is a common complication
of diarrhea, and a child with a significant degree of dehydration may have a
prolonged capillary refill, poor skin turgor, and abnormal breathing. Repeat infections
are typically seen in areas with poor sanitation, and malnutrition, stunted growth, and
long-term cognitive delays can result.
Cause
Viral
Rotavirus, norovirus, adenovirus, and astrovirus are known to cause viral
gastroenteritis. Rotavirus is the most common cause of gastroenteritis in children, and
produces similar incidence rates in both the developed anddeveloping world. Viruses
cause about 70% of episodes of infectious diarrhea in the pediatric age
group. Rotavirus is a less common cause in adults due to acquired immunity.
Norovirus is the leading cause of gastroenteritis among adults in America, causing
greater than 90% of outbreaks. These localized epidemics typically occur when groups
of people spend time in close physical proximity to each other, such as on cruise
ships, in hospitals, or in restaurants. People may remain infectious even after their
diarrhea has ended. Norovirus is the cause of about 10% of cases in children.
Bacterial
In the developed world Campylobacter jejuni is the primary cause of bacterial
gastroenteritis, with half of these cases associated with exposure to poultry. In children,
bacteria are the cause in about 15% of cases, with the most common types
being Escherichia coli, Salmonella, Shigella, and Campylobacterspecies. If food
becomes contaminated with bacteria and remains at room temperature for a period of
several hours, the bacteria multiply and increase the risk of infection in those who
consume the food. Some foods commonly associated with illness include raw or
undercooked meat, poultry, seafood, and eggs; raw sprouts; unpasteurized milk and
soft cheeses; and fruit and vegetable juices. In the developing world, especially sub-
Saharan Africa and Asia,cholera is a common cause of gastroenteritis. This infection is
usually transmitted by contaminated water or food.
Toxigenic Clostridium difficile is an important cause of diarrhea that occurs more often
in the elderly. Infants can carry these bacteria without developing symptoms. It is a
common cause of diarrhea in those who are hospitalized and is frequently associated
with antibiotic use. Staphylococcus aureusinfectious diarrhea may also occur in those
who have used antibiotics. "Traveler's diarrhea" is usually a type of bacterial
gastroenteritis. Acid-suppressing medication appears to increase the risk of significant
infection after exposure to a number of organisms, including Clostridium
difficile, Salmonella, and Campylobacter species. The risk is greater in those
taking proton pump inhibitors than with H2 antagonists.
Parasitic
A number of protozoans can cause gastroenteritis most commonly Giardia lamblia
but Entamoeba histolytica andCryptosporidium species have also been implicated. As a
group, these agents comprise about 10% of cases in children. Giardia occurs more
commonly in the developing world, but this etiologic agent causes this type of illness to
some degree nearly everywhere. It occurs more commonly in persons who have
traveled to areas with high prevalence, children who attend day care, men who have
sex with men, and following disasters.
Transmission
Transmission may occur via consumption of contaminated water, or when people share
personal objects. In places with wet and dry seasons, water quality typically worsens
during the wet season, and this correlates with the time of outbreaks. In areas of the
world with four seasons, infections are more common in the winter. Bottle-feeding of
babies with improperly sanitized bottles is a significant cause on a global
scale. Transmission rates are also related to poor hygiene, especially among
children, in crowded households, and in those with pre-existing poor nutritional
status. After developing tolerance, adults may carry certain organisms without exhibiting
signs or symptoms, and thus act as natural reservoirs of contagion. While some agents
(such as Shigella) only occur in primates, others may occur in a wide variety of animals
(such as Giardia).
Pathophysiology
Gastroenteritis is defined as vomiting or diarrhea due to infection of the small or large
bowel. The changes in the small bowel are typically noninflammatory, while the ones in
the large bowel are inflammatory. The number of pathogens required to cause an
infection varies from as few as one (for Cryptosporidium) to as many as 10
8
(for Vibrio
cholerae).

Diagnosis
Gastroenteritis is typically diagnosed clinically, based on a person's signs and
symptoms. Determining the exact cause is usually not needed as it does not alter
management of the condition. However, stool cultures should be performed in those
with blood in the stool, those who might have been exposed to food poisoning, and
those who have recently traveled to the developing world. Diagnostic testing may also
be done for surveillance. As hypoglycemia occurs in approximately 10% of infants and
young children, measuring serum glucose in this population is recommended.
Electrolytes and kidney function should also be checked when there is a concern about
severe dehydration.
Dehydration
A determination of whether or not the person has dehydration is an important part of the
assessment, with dehydration typically divided into mild (35%), moderate (69%), and
severe (10%) cases. In children, the most accurate signs of moderate or severe
dehydration are a prolonged capillary refill, poor skin turgor, and abnormal
breathing. Other useful findings (when used in combination) include sunken eyes,
decreased activity, a lack of tears, and a dry mouth. A normal urinary output and oral
fluid intake is reassuring. Laboratory testing is of little clinical benefit in determining the
degree of dehydration.

Prevention
Lifestyle
A supply of easily accessible uncontaminated water and good sanitation practices are
important for reducing rates of infection and clinically significant
gastroenteritis. Personal measures (such as hand washing) have been found to
decrease incidence and prevalence rates of gastroenteritis in both the developing and
developed world by as much as 30%. Alcohol-based gels may also be
effective. Breastfeeding is important, especially in places with poor hygiene, as is
improvement of hygiene generally. Breast milk reduces both the frequency of infections
and their duration. Avoiding contaminated food or drink should also be effective.
[28]

Management
The key treatment is enough fluids. For mild or moderate cases, this can typically be
achieved via oral rehydration solution (a combination of water, salts, and sugar). In
those who are breast fed, continued breast feeding is recommended. For more severe
cases, intravenous fluids from a healthcare centre may be needed. Antibiotics are
generally not recommended. Gastroenteritis primarily affects children and those in the
developing world. It results in about three to five billion cases and causes 1.4 million
deaths a year.
Gastroenteritis is usually an acute and self-limiting disease that does not require
medication. The preferred treatment in those with mild to moderate dehydration is oral
rehydration therapy (ORT). Metoclopramide and/or ondansetron, however, may be
helpful in some children, and butylscopolamine is useful in treating abdominal pain.
Rehydration
The primary treatment of gastroenteritis in both children and adults is rehydration. This
is preferably achieved by oral rehydration therapy, although intravenous delivery may
be required if there is a decreased level of consciousness or if dehydration is
severe. Oral replacement therapy products made with complex carbohydrates (i.e.
those made from wheat or rice) may be superior to those based on simple
sugars. Drinks especially high in simple sugars, such as soft drinks and fruit juices, are
not recommended in children under 5 years of age as they may increase diarrhea. Plain
water may be used if more specific and effective ORT preparations are unavailable or
are not palatable. Anasogastric tube can be used in young children to administer fluids if
warranted.
Dietary
It is recommended that breast-fed infants continue to be nursed in the usual fashion,
and that formula-fed infants continue their formula immediately after rehydration with
ORT. Lactose-free or lactose-reduced formulas usually are not necessary.
[42]
Children
should continue their usual diet during episodes of diarrhea with the exception that
foods high in simple sugars should be avoided. The BRAT diet (bananas, rice,
applesauce, toast and tea) is no longer recommended, as it contains insufficient
nutrients and has no benefit over normal feeding. Some probiotics have been shown to
be beneficial in reducing both the duration of illness and the frequency of stools. They
may also be useful in preventing and treating antibiotic associated diarrhea. Fermented
milk products (such as yogurt) are similarly beneficial. Zinc supplementation appears to
be effective in both treating and preventing diarrhea among children in the developing
world.
Antibiotics
Antibiotics are not usually used for gastroenteritis, although they are sometimes
recommended if symptoms are particularly severe or if a susceptible bacterial cause is
isolated or suspected. If antibiotics are to be employed, amacrolide (such
as azithromycin) is preferred over a fluoroquinolone due to higher rates of resistance to
the latter. Pseudomembranous colitis, usually caused by antibiotic use, is managed by
discontinuing the causative agent and treating it with
either metronidazole or vancomycin Bacteria and protozoans that are amenable to
treatment includeShigella Salmonella typhi and Giardia species. In those
with Giardia species or Entamoeba histolytica,tinidazole treatment is recommended and
superior to metronidazole. The World Health Organization (WHO) recommends the use
of antibiotics in young children who have both bloody diarrhea and fever.

BACKGROUND OF THE STUDY
1. Incidence, Race, gender, age, ratio and proportion
Globally, most cases in children are caused by rotavirus.

In
adults,norovirus and Campylobacter are more common. Less common
causes include other bacteria (or their toxins) and parasites. Transmission
may occur due to consumption of improperly prepared foods or
contaminated water or via close contact with individuals who are
infectious. Prevention includes the use of fresh water, regular hand
washing, and breast feeding especially in areas where sanitation is less
good. The rotavirus vaccine is recommended for all children.
It is estimated that three to five billion cases of gastroenteritis resulting in
1.4 million deaths occur globally on an annual basis, with children and
those in the developing world being primarily affected. As of 2011, in
those less than five, there were about 1.7 billion cases resulting in
0.7 million deaths with most of these occurring in the world's poorest
nations. More than 450,000 of these fatalities are due to rotavirus in
children under 5 years of age Cholera causes about three to five million
cases of disease and kills approximately 100,000 people yearly.

In the
developing world children less than two years of age frequently get six or
more infections a year that result in clinically significant gastroenteritis.
Gastroenteritis is associated with many colloquial names, including
"Montezuma's revenge", "Delhi belly", "la turista", and "back door sprint",
among others. It has played a role in many military campaigns and is
believed to be the origin of the term "no guts no glory".
Locally, In July 22, 2004, the Department of Health (DOH), Philippines
declared an epidemic (outbreak) of a water/food-borne disease called
acute gastroenteritis in 45 towns in Central Pangasinan. Acute
gastroenteritis is a human enteric (intestinal) disease primarily caused by
ingestion of spoiled or bacterial contaminated water or food.
2. OBJECTIVES
General:
To improve the knowledge and skills that the nursing students have
learned on their Related Learning Experience in approaching to the
clients condition, also to apply the attitude that they should have in
rendering care to the patient To gather important and pertinent
information regarding the clients data
Specific:
a) To understand the disease process, the nature, the signs
and symptoms, and the treatment for the respiratory
problem of the patient.
b) To determine pharmacologic interventions including their
therapeutic effect and the adverse effects.
c) To enhance skills in doing independent and defective
nursing interventions to the clients
3. Rationale for Choosing the case
The group decided to make this case as their chosen one, for this case is
one of the unique cases that they have encountered in our duty within the
hospital not just because of the predisposing factors but also by its
precipitating factors affecting it. Also, since the client is a pre-school, his
mother can give relevant information which may support the study.
4. Significance of the studies
The importance of the study is that, it will enhance the skills of the student
nurses in assessing the patient and also it will be added to their
knowledge according to the case of the chosen case of the client. The
study will also teach the students to learn how to interconnect with other
health care providers and to be more familiar with those documents that
the hospital has with their clients
5. Scope of limitation of the study
The study will only focus about the case of the client which is t/c bacterial
meningitis AGE with moderate sings of dehydration R/O electrolyte
imbalance which is the condition of the chosen client and to the other
relevant information about the case of the client.
Conceptual and Nursing Theory
DOROTHEA ELIZABETH OREM
(SELF-CARE DEFICIT NURSING THEORY)

Since that Orems theory, defines self-care as the practice of activities that individuals
initiate and perform independently on their behalf in maintaining life, health, and well-
being. (Udan, 2011)
According to Orem, you can say that a person is having a self-deficit when he is unable
to carry out his own self-care. (Udan, 2011)
In our case, the patient lacks care to himself. Even though he is a child the patient
should be able to do basic self care like going to the bathroom and taking a bath and
eating by himself , he is very active and was always on the move the mother doesnt
seem to have any control of her child when it comes to eating , thats why its maybe he
reason o his hospitalization
For our client, Orem stated 5 methods of helping him to conquer self-care deficit. First,
is acting for and doing for others, as his student nurse, we should help him in things she
cant do while hes confined. Doing dependent activities wherein we can help him. Also
by providing an environment to promote patients ability and teaching him the proper
things to do for her situation.
II. CLINICAL SUMMARY
A. General Data Profile
NAME: Mr. Jhon Cris Magdalena
ADDRESS: Brgy Anoling Gen. Nakar Quezon
AGE: 4y/o
BIRTHDAY: 01/21/2010
BIRTHPLACE: Quezon
NATIONALITY: Filipino
RELIGION: Catholic
OCCUPATION: Child
DATE OF ADMISSION: 4/19/2014
ADMITTING DIAGNOSIS: Bacterial Meningitis
ADMITTING PHYSICIAN: Dr Arlan Lopez
B. REASON FOR CONFINEMENT
Seizure

C. NURSING HISTORY
HISTORY OF PRESENT ILLNESS
1 week prior to consult, pt was bitten by a dog at both feet, wounds were thoroughly
cleansed with soap and water, patient also had two episode of loose watery stool, (+)
decrease activity (+) appetite. Consult was done at a local hospital and was admitted; he was
diagnosed with AGE, fluid electrolyte imbalance, pneumonia to consider rabies. Given the
following meds ampicillin, leptosidine, diazepam, gentamycin. Third hospitalization
pneumonia.

CHIEF COMPLAINT
Seizure
a. CHILDHOOD ILLNESSES
-Flu, Fall Injury
b. IMMUNIZATION
-Complete childhood immunization of BCG, DPT, OPV, HEPA B, Measles
c. ALLERGY
-None
d. ACCIDENTS
- Fall Injuries
e. HOSPITALIZATION
-The patient was confined on april 17 in the hospital in gen. Nakar because he was bitten by a
dog after that he was brought to san lazaro for further medical management.
f. DOMESTIC TRAVEL
-Laguna and manila area

D. FAMILY HISTORY
LEGEND

MALE DEAD MALE

FEMALE DEAD FEMALE









In the patients family history, the deceased grandparents are the grandmother on his father side and
the grandfather on his mother side. His uncle is also deceased on his father side.
E. EVIRONMENTAL/LIVING CONDITION

The client lives in a bungalow house type with 3 rooms with one room being the
restroom and the 2 rooms, 1 being the clients room and the other for the parents, they
lived near a poultry farm.





III. Function Health Pattern
Function Health Pattern Before Hospitalization During Hospitalization Interpretation
Health Management
Pattern
Was brought first
to the health
center due to dog
bite
First time to be
hospitalize
He seeks
medical
attention when
he has been
bite by the dog.
Nutritional/Metabolic

a. number of meals per day
b. appetite

c. glass of water per day

d. body built



3 times a day
with very good
appetite
3-4 glasses of
water
with normal body
built



3 times a day
with good appetite

maximum of 5
glasses of water
slightly smaller
than before

Due to the
disease process
the body wasnt
able to resist
the bacteria
that make his
body smaller
before
hospitalization
Elimination
a. frequency of urination
b. amount of urine per day
c. frequency of bowel
movement
d. consistency of the feces
e. amount defecated per
day

3-5 times per day
moderate
1-2 times per day

formed
moderate

4-8 times per day
scanty
1-2 times per day

watery stool
scanty

The frequency
is higher due to
higher
consumption of
water also.
The frequency
of her bowel
elimination was
not regular per
day. The
consistency of
her feces was
watery and
scanty in
amount.
Activity and Exercise
a. exercise
b. fatigability
c. ADL

playing
not easily get tired
independent

none
easily get tired
dependent
Body weakness
that made her
dependent in
doing her ADL.
Cognitive/Perceptual
a. Orientation


b. responsiveness

oriented to time,
place and person

responds
appropriately to
verbal and physical
stimuli

slightly oriented to
time, place and
person
slightly responds
appropriately to
verbal and
physical stimuli
The cognitive
and perceptual
status is still
normal and
intact. The
disease slightly
affects her
recognition and
response.
Roles/Relationship
a. as a son


b. as a brother




with good
relationship to his
parents
with good
relationship to his
sister and brother


with good
relationship to his
parents
with good
relationship to his
sister and brother

He still has
good
relationship
with her family
and relatives.
Self-Perception/ Self-
Concept
Not aware of self-
perception
Not aware of self-
perception
He is not aware
of self-
perception
because hes
still a kid and
doesnt have a
sufficient
knowledge on
that.
Coping/Stress None None He doesnt
know what
stress is and
doesnt know
how to cope
about it.

Values/Beliefs His parents taught
him about God.
He still believes in
God as what his
parents taught
him.
As a child hes
not aware of it
only he believe
on Him.





















IV. PHYSICAL ASSESSMENT
Date of assessment: May 19, 2014
General appearance:
The patient is weak and pale in appearance. He wears tidy clothes exactly for his ectomorphic
body. Upon assessment, the client is lying on bed, with a blood pressure of 90/60mmHg, pulse
rate of 92 beats per minute, respiration rate of 43 breaths per minute, and temperature of 36.7C.
BODY PART NORMAL
FINDINGS
ACTUAL FINDINGS INTERPRETATION/
ANALYSIS
A. HEAD
1.Skull









2. Scalp






3. Hair







4. Face











B. EYES
1. Eyebrows




Proportional to the
body, with
prominences in the
frontal area
anteriorly and the
occipital area
posteriorly
symmetrical in all
planes.

White, clean, free
from masses, lumps,
scars, nits, dandruff,
and lesion.



Black or whitish,
evenly distributed
and covers the whole
scalp, thick, shiny,
free from split ends.



Oblong/oval/square
Or heart-shaped,
symmetrical, facial
expressions that is
dependent on the
mood or true
feelings, smooth and
free from wrinkles,
no involuntary
muscle movements.



Black, symmetrical,
thick can raise and
lower eyebrows
symmetrically and

Proportional to the size
of the body,
asymmetrical by larger
on the right side.






With lumps, scars,
dandruff, and lesion.





Black, evenly
distributed, thin, bristle
like and coarse.





Oval shape.
Symmetrical , free
from wrinkles and
scars. No involuntary
muscle movements.








Black, thin,
symmetrical; can raise
and lower eyebrows.


As the mother say it
may be due to injury
that happened to the
client.






It is a symptom of
meningitis the
generalized rash.




Normal







Normal.












Normal.








2. Eyelids













3. Lid margins





4. Conjunctiva









5. Sclera

6. Iris




7. Pupil







8. Cornea

9. Eye
movement



without difficulty,
evenly distributed
and parallel with
each other.

Upper lids cover a
small portion of the
iris, cornea, and the
sclera when the eyes
are open. When the
eyes are closed, the
lids meet
completely.
Symmetrical color is
the same as the
surrounding skin.



Clear without
scaling or secretions,
lacrimal duct
openings are evident
at the nasal ends.

Pink, without
lesions.








White and clear.

Proportional to the
size of the eye,
round black/ brown,
and symmetrical.

From pinpoint to
almost the size of
the iris, round,
symmetrical,
constrict with
increasing light and
accommodation.

Clear

Able to move eyes
in full range of
motion or able to
move in all
directions.





Upper lids cover a
small portion of the
iris, cornea, and the
sclera when the eyes
are open. When the
eyes are closed, the
lids meet completely.
Symmetrical color is
the same as the
surrounding skin.




Clear, without scaling
or secretions, pale.




Pale, without lesions.









White and clear.

It is symmetrical,
round and proportional
to size.


Symmetrical,
constricted to light and
accommodated from
light.




Clear

Able to move eyes in
full range of motion








Normal.













Normal.





Pallor due to less
oxygen being
available to the
surface tissues
caused by decreased
hemoglobin level
(Medical Surgical
Nursing by Digiulio
p. 177)

Normal.

Normal.




Normal.







Normal.

Normal





C. EARS



1. Hearing Acuity



2. Ear Canal




D. NOSE



1. Internal Nares


2. Septum

E. MOUTH




1. Lips











2. Teeth





3. Tounge





4. Cheeks
(Buccal Mucosa)
5. Palate
Soft Palate


Pinkish, clean, with
scant amount of
cerumen and a few
cilia
Able to hear whisper
spoken words 2 feet
away.

No erythema, no
scaling, no swelling,
absence of foreign
body and odor.

Midline,
symmetrical, and
patent

Clean, pinkish, with
few cilia.

Straight.

Pinkish, symmetrical
lip margin, well-
defined, smooth, and
moist.

Pinkish, smooth,
moist, no swelling,
no retraction, no
discharges.








28-32 permanent
teeth, well-aligned
free from caries or
filling, no Halitosis.


Large, medium, red
or pink, the lateral
margins, moist,
shiny, and freely
Movable.

Pinkish, moist.

Pinkish, moist, and
smooth.
Slightly pinkish.

Cerumen and a few
cilia.


Able to hear whisper
spoken words 2 feet
away.

No erythema, no
scaling, no swelling,
absence of foreign
body and odor.

Midline, symmetrical,
and patent


Clean, pinkish, with
few cilia.

Straight.

Pinkish, symmetrical
lip margin, well-
defined, smooth, and
moist.

Pale and dry lips; no
swelling.










Complete for his age.





Medium, red, the
lateral margins, moist,
shiny, and freely
movable.


Pinkish, moist.

Moist, and smooth.
Slightly pinkish.


Normal.



Normal.



Normal.




Normal.



Normal.


Normal.

Normal.




Pallor due to less
oxygen being
available to the
surface tissues
caused by decreased
hemoglobin level
(Medical Surgical
Nursing by Digiulio
p.177)



Normal.





Normal





Normal

Normal
Normal

Hard Palate

6. Uvula



7. Tonsils



8. Voice






F. Neck




G. Range of
Motion




H. Muscular
Strength




I. Heart



J. Abdomen
I nspection
1. Abdomen skin





2. Contour and
Symmetry
3. Movements
associated w/

At the center,
symmetrical, and
freely movable.

Pinkish, non-
inflamed, no
exudates.

No hoarseness and
well-modulated.





Proportional to the
size of the body and
head, symmetrical
and straight.

Freely movable with
relative ease.




Symmetrical
movements and able
to resist force
applied by the nurse.


Regular beats (80-
140 beats per
minute)




Unblemished skin;
uniform color.




Flat, rounded;
symmetric contour.
Symmetric
movements caused

At the center,
symmetrical, and
freely movable.

Pinkish, non-inflamed,
no exudates.


Unable to verbalize
words.





Proportional to the size
of the body and head,
symmetrical and
straight.

Limited movements





Cannot bear to resist
the pressure that was
applied.



Regular beats (104
beats per minute)





With rashes.








Rounded, symmetric
contour.

Rise and fall caused by
respiration.



Normal


Normal


Due to body
weakness that the
client is experiencing
as a symptom of the
disease



Normal




Due to body
weakness that the
client is experiencing
as a symptom of the
disease

Due to body
weakness that the
client is experiencing
as a symptom of the
disease

Normal









In assessment of
meningitis there is
petechial, purpuric,
or ecchymotic rash
on lower part of the
body. (medical-
surgical nursing,
pg.568)

Normal


Normal



respiration


Auscultation



Palpation


K. Chest
(Thorax)
I nspection





Palpation


Percussion

Auscultation


L. Upper
Extremities
1. ARMS
I nspection



Palpation
by respiration.
Audible bowel
sounds (5-30/min);
absence of arterial
bruits and friction
rubs.


No tenderness;
relaxed abdomen
with smooth,
consistent tension.





Chest symmetrical,
skin intact, no
tenderness, no
masses.






Full and symmetric
chest expansion.
Symmetric vocal
fremitus.

Resonance except on
the scapula.


Vesicular or
bronchovesicular
breath sounds.




Skin varies (pinkish,
tan, dark brown),
skin is smooth, fine
hair evenly
distributed, muscles
symmetrical, length
symmetrical.



Warm, dry and
elastic, no areas of
tenderness. Muscle

Audible bowel sounds
(36/min).


No area of tenderness;
no presence of lumps
and absence of lesion.





Not proportion, with
rashes noted.
Respiration of 43
breaths per minute.






Symmetric and
expands.



Resonant sound heard.



Normal breath sounds






Brown skin, fine
muscle, length
symmetrical, fine hair
evenly distributed.






Rigid left arm




On assessment of
gastroenteritis there
is hyperactive bowel
sounds. (Medical-
surgical nursing,
pg.319)

Normal








Normal










Normal



Normal



Normal






Normal









As an assessment to
meningitis there is
muscle rigidity.



M. Nails









N. Shoulders,
Arms, Elbows,
Hands, and
wrists,
Abduction, and
Adduction.
O. Lower
Extremities
1. Legs
I nspection






Palpation

2. TOES
I nspection



appears equal with
good muscle tone.


Nails are
transparent, smooth,
& convex with pink
nail beds & white
translucent tips.

Five fingers in each
hand. As pressure is
applied to the nail
bed, it appears white
or blanched & pink
color returns
immediately as
pressure is released.



Performs with
relative ease.







Skin varies (pinkish,
tan, dark brown),
skin is smooth, fine
hair evenly
distributed, absence
of varicose veins,
muscles
symmetrical, length
symmetrical.



Muscles appear
equal, warm & with
good muscle tone.


Five toes in each
foot: sole and dorsal
surface is smooth:
With pink nail beds
& translucent tips.


As pressure is
applied, the nail




Complete fingers, 5
each hand.
Nails are thick,
transparent, & convex
with pale nail beds &
white translucent tips.
As pressure is applied
to the nail bed, it
appears white and
color returns after 5
seconds.




Performs with relative
ease.







Left leg is edematous
and stiff.











Left leg is rigid




The toes are in plantar
flexion





As pressure is applied,
the nail beds appear




With deviation from
normal
Patients with anemia
may exhibit delayed
capillary refill
diminished blood
flow to the periphery
and compensatory
vasoconstriction.
(Medical Surgical Nursing
by Black 5
th
edition p.1571)





Normal









Due to excess fluid
volume the patient
may experience
edema (Medical-Surgical
Nursing by Digiulio p.177)
Pallor due to less
oxygen being
available to the
surface tissues
caused by decrease
haemoglobin level
(Medical-Surgical Nursing
by Digiulio p.177)
As an assessment to
meningitis there is
muscle rigidity.



As an assessment to
meningitis there is
muscle rigidity.




Patients with anemia
may exhibit delayed
Palpation




P. Legs, Knees,
Ankles, Toes
Adduction and
Abduction.
beds appear white or
blanched; pink color
returns when
pressure is released
(2 seconds).



Performs with
relative ease.

white or blanched;
pink color returns
when pressure is
released (5 seconds).




Performs with relative
ease.



capillary refill
diminished blood
flow to the periphery
and compensatory
vasoconstriction.
(Medical Surgical Nursing
by Black 5
th
edition p.1571)

Normal




V. Course in the ward
Date Doctors order Interpretation
April 20, 2014
9:30pm
Please admit to PAV
Secure consent for
admission and
management
Monitor V/S every 4hrs
Monitor intake and
output every shift
NPO temporary


PNSS 1LX 65 cc/hr X 8hrs
then reassess
Diazepam 5mg IV now
then every 4hrs
Phenobarbital 100mg
TIVP to be given over
15mins as loading dose
then every 12hrs after
then may give 25mg TIV
over 5mins every 12hrs
as loading dose
Paracetamol
250mg/5ml/2ml every
4hrs for temp > 38.5
Diagnostic CBC, UA ,NA ,
K,Cl,Cal, RBS, possible
lumbar tap ( pls. secure
consent)
For pedia neuro referral

Hook to O
2
via nasal
canula at 2-3 LPM
Watch out for
recurrence of seizure,
cyanosis
Inform ROD of this
admission
Refer
Addendum :

>for continue management
>For approval of admission and
further management

>to have baseline date
>to monitor status of fluid and
electrolyte balance
>patient experienced seizure,
placed temporarily npo to
prevent aspiration
>it has little to no effect to tissue
and for rehydration
>to treat muscle spasms

>to treat or prevent seizures






>antipyretic


>to know the serum
determination and specimen
needed by the physician

>the present disease is related to
the CNS
>difficulty of breathing episode

>prevention of further
complication then response with
proper management
>for follow up orders and
management



PCEC 0.1ml x 2 sites
ATS 1.500 IV #2 given
outside
TT 0.5ml given outside
>anti-rabies vaccine
>anti tetanus serum

>anti-tetanus

Date Doctors order Interpretation
April 20, 2014
11:55pm
















April 21, 2014
6:50am












April 22,2014






12:00nn











Hold Phenobarbital

May give diazepam only
if with active seizures at
2.5mg TIV
Start ceftriaxone 90mg
TIV now then once a day
ANST ()
Please carry out other
orders
Addendum:
STAT serum Na , k , cl , Ca
determination for fecalysis
, monitor Hgt every 8hrs
Ranitidine 9mg TIV every
8hrs
Refer

Turn fast drip with PNSS
90ml now then regulate
to 60 ml/hr
IVF To follow : D
5
IMB
500ml at 40ml/hr
Monitor intake output
every 4hrs and record
pls.
Still on NPO
Continue IV antibiotics
continue management
For refer to pedia neuro
(4-22-14) Dx.
R/
O
bacterial
meningitis
Continue IVF of the same
regulation
Still on NPO pls. facilitate
give of cetriaxone
Continue present
management

May have soft diet of Strict
Aspiration precaution

Discontinue hgt monitoring

Discontinue ranitidine

Discontinue O
2
support

For fecalysis

For possible lumbar
>the patient dont have seizure
episode
>give only during muscle spasm
occur if necessary

>antibiotic drug


>to note and to know if the NOD
done the specific orders

>for serum determinations and
specimen collection

>to reduce acidity



>because the client is
dehydrated

>to rehydration

>the effectivity of the
rehydration was by monitoring
intake and output
>
>for continues medical and
management
>because he has a problem on
CNS functioning



>Antibiotic




>it is given because easily
chewed and to prevent
aspiration

>the patient condition was
progressing

>to prevent dependency to the
oxygen
>to analyze condition of
digestive tract
>to help diagnosed serious













April 23,2014























April 24, 2014








April 25, 2014








puncture please secure
consent for the procedure



For chest X-ray ADL today

For gastric aspirate AFB X3

For PPD



Educate patients relative
regarding proper hygiene

Please secure official chest
x-ray result and other lab
test done since admission

Start O
2
weaning

Discontinue ranitidine once
feeding is tolerated

Increase oral fluid intake
with ore sol start
multivitamins of zinc 5ml
once a day PO

WOF: body weakness ,
paralysis , DOB, seizure

Refer




Hold refer to pedia now
follow-up Chest X-ray
result, continue meds off
O
2
support
Refer



Insert glycerin


May discontinue O2
support if tolerated

Hook back to
O2 if with episodes of
DOB/ dyspnea O2 decrease
<90 percent and record
please.
Continue ceftriaxone IV
infection such as meningitis, for
approval from the patient and
relatives before proceeding to
the procedure.

>way to diagnose disease.

>to detect bacteria called acid
fast bacilli in fluid or tissue
samples



>performed to check if you have
any tuberculosis infection

>the doctor wanted to see all lab
results that he/she has ordered

>the oxygen saturation of the
patient has normalize

>the patient was able to tolerate
soft foods thats why this drug
was ordered to be discontinue
> because the patient has
diarrhea to prevent dehydration



>because this are the
manifestation of meningitis






>the patients lab results not yet
completed





>the patient experienced
constipation


> the oxygen saturation of the
patient has normalize







Continue present
management




April 26, 2014







Continue IVF D5IMB to run
for 40cc/hr
DAT
Discontinue O2 support
Start FESO4 syrup 5ml OD
Continue present medical
management
Monitoring V/S , I and O
record every shift
O2 sat every 4hrs






>the patients hemoglobin and
hematocrit is low



>there is an occurrence with
difficulty of breathing
April 27,2014

























April 28, 2014














Still to submit specimen
for stool exam





Request CBC with APL




Still to submit specimen for
UA

Discontinue paracetamol


Bacillus clausii 1 tube OD



Zinc sulfate syrup 5ml OD
Refer


Please educate relative
regarding proper hygiene


Please follow up stool exam
results
Continue present
management
Refer accordingly
Mebendazole 50mg/ml
10ml PO as single dose at
Bedtime

May discontinue
ceftriaxone
>this order was produced
because the client was need for
fecalysisi and the client cannot
be treted accordingly unless
there is aneatment exact
organism for

This request was ordered
because the doctor wanted to
know if there is an
autonoimmunity

This is a request to please
submit the result for further
management
This durg was stopped because
the patient has not ncountered
any fever and
This is given tot the patient
because the doctor wanted to
be able to normalize the flora
of the intestines
This drug was goven because it
is to stop the diarrhea


The doctor want to educate the
mother because of the poor
hygiene of the mother when it
comes in taking care of the
This result is needed submitted
so the doctor has ordered this t



This drug was given because
the doctor has found
roundworm in the result

This drug was discontinued
because the WBC of the client




April 30, 2014














May 1,2014









May 2,2014
























May 3,2014







Please refer to clarify for
Nutritional build up


Multivitamins +iron syrup
5ml OD
Ascorbic acid syrup 5ml OD


To follow D5IMB 500ml at
40ml/hour




Continue IVF of the same
rate
Inject glycerin support
rectal now
Continue present
management
Refer accordingly



For Na, k , Ca, CBC , Platelet
count



Schedule of anti rabies
ERIG 1.8ml TIM , PCEC
0.1ml TID X 2 sites
Day 0- May 2
Day 3- May 5
Day 7- May 9
Day 30- May 30
please give a schedule for
anti rabies to relatives


For blood culture and
sensitivity with ARD

Maintain on high back rest
Please refer to ROD once
official result of
electrolytes are available
WOF: progression of
weakness, cyanosis,
paralysis
Refer to pedia neuro with
electrolyte results

was at the normal range




>to provide additional energy
with protein,vitamins and
minerals
>this is given because the
doctor wanted to have
supplementary nutrition to the
child

















>the doctor requested to
repeat the laboratory exam so
that he will have a comparison
of the clients condition with the
baseline data
>since the client was bitten by a
dog, the doctor ordered to
have the client anti rabies
vaccine to prevent further
complications.


>the doctor has ordered to give
a schedule to the parents so
that they would have a file on
the schedule of vaccination
>to check for bacteria or other
microorganisms in a blood
sample.
>for management for DOB
> for management of
electrolyte imbalance if any




>For further management




















May 4,2014
























May 5,2014






May 6,2014







IVF: PNSS 1L to run at 40
cc/hr DFA


Follow up lab results

Resume ceftriaxone 90mg
TIV OD via soluset to run for
30mins.
For request CBC with APL
May give diazepam 3mg TIV
every 12hrs for sputum
GS/CS for PPD
Sched for tetanus toxoid
Tetanus 1- april 20
Tetanus 2- may20
Will refer patient for pedia
neuro
WOF recurrence of seizure
Start metronidazole 90mg TIV
every 6hrs ANST()
Continue meds.
For fecalysis










Increase diazepam IV every
8hrs
Request serum Na, k
,cl,Ca
Continue present management
Refer to Dr. Adajar
Continue meds.

Continue meds
Advised
Refer accordingly



Please facilitate serum
electrolyte
For refer
Continue present management
Discontinue diazepam
Shift metronidazole
IV and preparation 250 mg/5ml
(2.5 ml every 8hrs


For cranial CT SCAN with
>this isotonic solution is to
correct the hyponatremia that
the client has experienced

>it is used to diagnose and
monitor treatment
>for use as an antibiotic



>for muscle spasm and seizures


>for anti tetanus


>for refereal and further
management
>seizure precation
>anti protozoan


For collection of another
specimen to see if the organ
ism is stil present in the stool








>Fro management of seizure



















>the client seixzure has ceased
so the doctor has ordered to
stop the medication



May 7,2014






May 8, 2014





May 9,2014


May 10,2014




May 11,2014








May 12, 2014







May 13,2014








May 14,2014




May 15,2014




contrast

Work out toward TB meningitis
Proceed with ct scan


Still cranial ct scan
Maintain IVF same rate
Continue present management
For BUN, UREA


For cranial ct scan with contrast
today

Ct scan not done

Continue present management



Still for CT SCAN

Continue present management




Still cranial ct scan as order
Will update Dr. Adajar once ct
scan done
Follow up PPD
For gastric aspirate AFB x 3




Discontinue ceftriaxone
Start oxacillin IV 225mg every
6hrs ANST()
Continue present medical
management
Still for ct scan



Still ct scan
Continue meds


For follow up official ct scan
result c/o relative
Refer to ROD once with
result
Still for gastric aspiration x3
if PPD not yet done
Continue present
management

To see if there is a
inflammation of the brain
as well as hemorrhage
This is a hypotheses of the
doctor





>to see if the urinary system is
still functioning


























>the doctor has ordered this
drug because this is indicate for
systemic infection























May 16,2014








May 17,2014








May 18,2014






May 19,2014






Still awaits ct scan result
Awaits result AFB smear gastric
aspiration
Shift oxacillin 250/5ml every
6hrs x 7days
Possible discharge



Facilitate cranial ct scan result
Continue other medication
Possible discharge once with
cranial ct scan result
Insert bisacodyl suppository
rectum now then at bedtime



Please follow up ct scan c/o
relatives
Continue present
management



For possible MGH once
official result of ct scan are
seen
Continue present
management
Continue meds.




















>for treatment for constipation
























VI. LABORATORY RESULTS:
Date: May 02, 2014

Date: April 27, 2014

CBC
Exam Name Result Reference Range Interpretation
WBC 8.10 4.8-10.8 Normal
RBC 4.61 4.5-5.9 Normal
Hemoglobin 109.4 140-175 Low
Hematocrit 0.338 0.415-0.504 Low
MCV 73.00 82-98 Low
MCH 23.72 28-33 Low
MCHC 32.34 33-36 Low
Platelet Count 571 150-400 High
RDW 19.20 11.4-14.0 High
Neutrophil 57.10 40-70 Normal
Lymphocyte 28.20 19.0-48.0 Normal
Eosinophil 6.40 2.0-8.0 Normal
Monocyte 7.60 0.00-15.0 Normal
Basophils 0.70 0.00-5.0 Normal






CBC
Exam Name Result Reference Range Interpretation
WBC 6.70 4.8-10.8 Normal
RBC 4.90 4.5-5.9 Normal
Hemoglobin 113.6 140-175 Low
Hematocrit 0.352 0.415-0.504 Low
MCV 72.00 82-98 Low
MCH 23.21 28-33 Low
MCHC 32.28 33-36 Low
Platelet Count 496 150-400 High
RDW 21.70 11.4-14.0 High
Neutrophil 71.70 40-70 High
Lymphocyte 15.90 19.0-48.0 Low
Eosinophil 3.80 2.0-8.0 Normal
Monocyte 7.80 0.00-15.0 Normal
Basophils 0.80 0.00-5.0 Normal

Date: April 21, 2014

CBC
Exam Name Result Reference Range Interpretation
WBC 10.50 4.8-10.8 Normal
RBC 4.93 4.5-5.9 Normal
Hemoglobin 116 140-175 Low
Hematocrit 0.361 0.415-0.504 Low
MCV 73.00 82-98 Low
MCH 23.52 28-33 Low
MCHC 32.18 33-36 Low
Platelet Count 309 150-400 Normal
RDW 19.10 11.4-14.0 High
Neutrophil 65.50 40-70 Normal
Lymphocyte 19.30 19.0-48.0 Normal
Eosinophil 9.50 2.0-8.0 High
Monocyte 5.20 0.00-15.0 Normal
Basophils 0.50 0.00-5.0 Normal

CLINICAL CHEMISTRY
Date: April 04, 2014
Test Name
SI Unit Conventional Unit
Result
Reference
Range
Result Reference
Range
Potassium
3.77 mmol/L 3.50-5.50
mmol/L
3.77 meq/L 3.50-5.50 meq/L
Chloride
100.60mmol/L 98-108 mmol/L 100.60 meq/L 98-108 meq/L
Sodium
132.80mmol/L 135-145
mmol/L
132.80 meq/L 135-145meq/L
Ionized
Calcium
1.24mmol/L 1.10-1.40
mmol/L
1.24 meq/L 1.10-1.40 meq/L
Total Calcium
2.42mmol/L 2.20-2.90
mmol/L
2.42 meq/L 2.20-2.90 meq/L


Date: May 08, 2014
Test Name SI Unit Conventional Unit
Blood Urea
Nitrogen
Result Reference
Range
Result Reference
Range
1.36 mm/oL 2.50-7.20
mmol/L
3.81 mg/dL 7.00-20.16 mg/dL
Creatinine
27.90 umol/L 71-115 umol/L 0.32 mg/dL 0.79-1.29 md/dL
- The physician ordered to take this test to check the water and
electrolyte balance of the client body and to check the progress
of diseases of the kidneys or adrenal glands. These tests will
measure the concentration of electrolytes that are needed for
both the diagnosis and management of renal, endocrine, acid-
base, water balance, and many other conditions. Their importance
lies in part with the serious consequences that follow from the
relatively small changes that diseases or abnormal conditions may
cause. This result finds that the client sodium is high which
indicate Hypernatremia and the rest electrolytes are normal.
- The BUN test is stands for blood urea nitrogen. The blood urea
nitrogen test is primarily used, along with the creatinine test, to
evaluate kidney function of the client in a wide range of
circumstances, to help diagnose kidney disease, and to monitor
people with acute or chronic kidney dysfunction or failure. It also
may be used to evaluate a client general health status when
ordered as part of a basic metabolic panel or comprehensive
metabolic panel. The test result evaluates that the client BUN
and creatinine is low maybe due to over hydrated and
malnutrition.

FECALYSIS:
Date: April 27, 2014
A. Physical
ROUTINE

Test Result Reference
Amount Given

Odor

Color Yellow-Brown Yellow-Brown
Consistency Formed Formed

B. Microscopic
Test Result Reference
Fat Globules

Few present
Leukocytes 2-4/ HPF Few present
Red Blood Cells 4-8/HPF Few present
Muscle Fibers Few present
Food Particles Varies w/ diet
Yeast Cell MANY

Others



MISCELLANEOUS
C. Biochemical

Test Result Reference
pH

6.9-7.2
Occult Blood

Negative
Urobilinogen

40-280 gm/day
Calcium

0.4-0.8 gm/day
Fats

2-4 gm/day
Others


D. Remarks
- Trichuris trichura ova
- 1-3/LPF
INTERPRETATION:
The physician ordered to take Complete Blood Count test to evaluate the client overall
health and detect a wide range of disorders, including anemia, infection and leukemia.
A complete blood count test measures several components and features of the client
blood including:
Red blood cells
White blood cells
Hemoglobin
Hematocrit
Platelets
Abnormal increases or decreases in cell counts as revealed in a complete blood count
may indicate that the client have an underlying medical condition that calls for further
evaluation. And based on the result of CBC exam last April 21, 2014, which the RBC
and WBC is Normal. Hemoglobin and Hematocrit is Low., thats why the result of MCV,
MCH and MCHC is also low because the three tests are calculated using the amount of
hemoglobin and hematocrit to determine whether the red blood cells are in normal size
and if they contain the appropriate amount of hemoglobin. The RDW is high, which
indicates that the red blood cells vary a lot in size. The RDW level can be high because
of iron deficiency, because iron is needed to make hemoglobin. The Eosinophil is also
high, maybe because due to allergic diseases and infections from parasites.

April 27, 4014
- The physician ordered to repeat the CBC test because of the abnormal findings
on the previous exam. To see if theres something changes on the client blood
exam, if it is within in normal range. The result of repeat CBC exam is nothings
different from the previous result, the changes that only happen is the Platelet
count is become high while on the previous result it is Normal. Maybe because
the bone marrow produces too many platelets. The eosinophil is become Normal.

May 02, 2014
- The physician ordered to repeat CBC because theres nothing a change on the
previous result, to see if there are any changes. But based on the result, it
become worst. The RBC and WBC is still normal, hemoglobin and hematocrit is
still low thats why the MCH, MCV,and MCHC is still low. The platelet count, rdw
and neutrophil are high, lymphocyte is low and the rest is normal. Neutrophil can
be high because theres presence of bacterial infection in the client body. Low
lymphocytes indicate that the client body is low on infection resistance that the
body is susceptible to infections.
Fecalysis
- The physician ordered a fecalysis test to help diagnose certain conditions
affecting the digestive tract. These conditions can include infection such as from
parasites, viruses, or bacteria and poor nutrient absorption. A fecalysis is also
performed to check for the presence of any reducing substances such as white
blood cells, sugars, or bile and signs of poor absorption on the client stool. Based
on the client result of fecalysis, theres a presence of Trichuris trichiura it is a
roundworm, known as the Human Whipworm that indicates the client had
infection.
VII. Drug study
Name of Drug
Mechanism of
Action
Indication Contraindication Analysis
Ascorbic Acid Stimulates
collagen
formation and
tissue repair;
involved in
oxidation-
reduction
reactions
Vitamin C
deficiency with
poor nutritional
habits
Hypersensitivity to
tartrazine or sulphites
To increase
patient
immunity and
to stimulates
collagen
formation and
tissue repair

Generic Name:
Bacillus Clausii

Brand Name:
Erceflora
Contributes to
the recovery of
the intestinal
microbial flora
altered during the
course of
microbial
disorders of
diverse origin. It
produces various
vitamins,
particularly
group B vitamins
thus contributing
to correction of
vitamin disorders
caused by
antibiotics &
chemotherapeutic
agents. Promotes
normalization of
intestinal flora.
Acute and
chronic
diarrhea
Immunocompromised
patient
The patient
experiencing
loose watery
stool which is a
manifestation
of the present
disease, the
physician
ordered this
drug to promote
normalize the
intestinal flora.

Generic Name:
Bisacodyl

Brand Name:
Bisacolax


Stimulant
laxative that
increases
peristalsis,
probably by
direct effect on
smooth muscle
of the intestine.
Chronic
constipation
Hypersensitivity to
drug. Patient with
appendicitis or acute
surgical abdomen
The physician
ordered this
drug to promote
the peristalsis
of the patient to
promote
defacation

Generic Name:
Ceftriaxone

Brand Name:
Rocephin
A third
generation
cephalosporin
that inhibits cell-
wall synthesis,
promoting
osmotic
instability;
usually
bactericidal
Most infections
caused by
susceptible
organism;
bacteremia
Patients with
hypersensitivity to
drug and other
cephalosphorins
The attending
physician
ordered this
drug due to his
diagnosis which
is a bacterial
infection. The
drug inhibits
cell-wall
synthesis and
promotes
osmotic
instability.

Generic Name:
Cloxacillin

Brand Name:
Cloxapen
A penicillinase-
resistant
penicillin that
inhibits cell-wall
synthesis during
microorganism
multiplication.
Bacteria resist
penicillins by
producing
penicillinases
Systemic
infections
Hypersensitivity to
the drug
The physician
ordered this
drug to inhibit
cell synthesis
that result to
multiplication
of the
microorganism
which is the
action of the
drug.

Generic Name:
Diazepam

Brand Name:
Valium
Depresses the
CNS at the
limbic and
subcortical levels
of the brain and
suppresses the
spread of seizure
activity produced
by epileptogenic
foci in the cortex,
thalamus, and
limbic structure
Muscles spasm,
severe recurrent
seizure
Hypersensitivity to
the drug. Patient
experienced shock
and coma.
Seizure episode
is the chief
complaint of
the patient, the
physician
ordered this
drug to lessen
the seizure
episode by
depressing the
CNS at the
limbic and
subcortical
levels of brain.
Ferrous Sulfate Provides
elemental iron,
an essential
component in the
formation of
hemoglobin
Iron deficiency Patients with
hemosiderosis,
primary
hemochromatosis,
haemolytic anemia,
peptic ulceration,
ulcerative colitis,
regional enteritis and
in those receiving
repeated blood
transfusions
The physician
ordered this
drug to increase
the red blood
cell and
hemoglobin
count of the
patient which in
the laboratory
result appeared
low

Generic Name:
Glycerin

Brand Name:
Sani-Supp

Hyperosmolar
laxative that
draws water from
the tissues into
the feces, thus
stimulating
evacuation
Constipation Hypersensitivity to
drug and in those
with intestinal
obstruction or signs
and symptoms of
appendicitis, fecal
impaction, or acute
surgical abdomen
The physician
ordered this
drug to promote
defecation of
the patient by
stimulating of
the
hyperosmolar
laxative from
the tissue into
feces.

Generic Name:
Mebendazole

Brand Name:
Vermox

Selectively and
irreversibly
inhibits uptake of
glucose and other
nutrients in
susceptible
helminths
Trichinosis Patient with
hypersensitivity to
the drug
Based on the
result of the
laboratory
exam, the
patient has a
microorganism
which is an
agent of the
present disease.
Therefore, the
physician
ordered this
drug to inhibits
uptake of
glucose and
other nutrients
in susceptible
helminths

Generic Name:
Metronidazole

Brand Name:
Flagyl
A direct-acting
trichomonacide
and amebicide
that works at
both intestinal
and
extraintestinal
sites. Its thought
to enter the cells
of
microorganisms
that contain
nitroreductase.
Unstable
compounds are
then formed that
bind to DNA and
inhibit synthesis,
causing cell
death
Bacterial
infections
Hypersensitivity to
the drug or other
nitroimidazole
derivatives
The present
disease caused
by bacterial
infection
resulting to
gastrointestinal
problems such
as diarrhea and
constipation.
Hence, the
physician
ordered this
drug to inhibit
synthesis of
microorganisms
that causes cell
death.

Generic Name:
Oxacillin
A penicillinase
resistant
penicillin that
inhibits cell-wall
synthesis during
microorganism
multiplication;
bacteria resists
penicillins by
producing
penicilllinase
enzymes that
convert
penicillins to
inactivate
penecillic acids.
Oxacillin resists
these enzymes.
Systemic
infections
caused by
penicillinase-
producing
staphylococci
Hypersensitivity to
the drug
The physician
ordered another
antibiotic which
inhibits cell-
wall synthesis
to prevent
multiplication
of
microorganism.

Generic Name:
Paracetamol

Brand Name:
Acetaminophen
Thought to
relieve fever by
central action in
the hypothalamic
heat regulating
center
Mild pain or
fever
Hypersensitivity The patient
experienced
increased body
temperature
which is the
manifestation
of an infection;
therefore this
drug is given to
the patient to
decreased body
temperature.

Generic Name:
Ranitidine

Brand Name:
Zantac

Competitively
inhibits action of
histamine on the
H2 at receptor
sites of parietal
cells, decreasing
gastric acid
secretion
Duodenal and
gastric ulcer
Hypersensitive to
drug and those with
acute porphyria
The patient is
experiencing
vomiting, to
prevent this
episodes the
physician
ordered this
drug to
decrease gastric
acid secretions
Zinc Sulfate Participate in
synthesis and
stabilization of
proteins and
nucleic acids in
subcellular and
membrane
transport system
To prevent
individual trace
element
deficiencies in
patients
receiving long-
term total
parenteral
nutrition
Hypersensitivity

Children need
vitamins such
as zinc because
zinc is one of
important
vitamins for
growth and for
the
development
and health of
body tissue
-



















VIII. ANATOMY AND PHYSIOLOGY
Meningitis, in general, is the inflammation of the protective membranes surrounding the
brain and spinal cord. In the case of bacterial meningitis, this inflammation is caused by
bacterial infection. In order to inflame these protective membranes, the bacteria must somehow
enter the bloodstream and bypass the blood-brain barrier.
Blood-Brain Barrier
Since the brain is such a delicate organ, nature has taken extra measures to protect the
brain by creating the blood-brain barrier to limit the diffusion of substances from the bloodstream
into brain tissue selectively.
The blood-brain barrier mainly consists of tight junctions, which seals the endothelial
cells that line the brain capillaries. Astrocytes, a type of neuroglia from the brain, closely
attached to the endothelial cells and release chemicals to regulate the permeabilities of the tight
junctions. The major sites of the blood brain barrier are the arachnoid membrane, choroid plexus
epithelium, and the cerebral microvascular endothelium.
Only a few kinds water-soluble substance can move across the blood-brain barrier,
such as glucose by active transport, urea, creatinine, and ions move across by slow diffusion.
On the other hand, lipid-soluble substances can easily cross the blood-brain barrier, such as
oxygen, carbon dioxide, alcohol, and most anesthetic agents.
When bacteria break through the blood-brain barrier, an infection occurs in the
cerebrospinal fluid.

Cerebrospinal Fluid
Cerebrospinal fluid (CSF) is a colorless, transparent liquid that continuously circulates through
the cavities of the brain and spinal cord, and as such, it acts as an internal circulation system to
transport nutrients and wastes between the bloodstream and the brain and spinal cord. This
reducdant circulation protects the brain and spinal cord from chemical injuries similar to the
function of the blood-brain barrier. The CSF also protects the brain and spinal cord from
physical injuries by acting as a shock absorber between the brain and spinal cord from the
skeletal structures (cranium and vertebrae).
CSF is produced in the choroid plexuses, which are networks of capillaries in the
ventricles. The choroid plexuses filter out blood plasma from the bloodstream, which is the main
component of CSF. The choroid plexuses are covered by ependymal cells that are sealed
together with tight junctions. These tight junctions forces the blood plasma to pass through these
ependymal cells, which further filter out the blood plasma, producing CSF.
From the choroid plexuses of each lateral ventricle, CSF flows into the third ventricle
through the interventricular foramina, which are two narrow oval openings. The choroid
plexuses in the third ventricle adds more CSF. Then, CSF flows into the fourth ventricle
throught the cerebral aqueduct. Again, the choroid plexuses in the fourth ventricle adds more
CSF. The fluid then enters the subarachnoid spacethrough the three openings in the roof of the
fourth ventricle. These three openings are a median aperture and a pair of lateral apertures.
Then, CSF circultates in the central canal of the spinal cord and in the subarachnoid space around
the surface of the brain and spinal cord.

Meninges
The meninges are three connective tissue coverings that encircle the spinal cord and
brain. The spinal meninges surround the spinal cord and are continuous with the cranial
meninges, which encircle the brain.
The meninges lined the cranial and vertebral cavities to protect the brain and the spinal
cord, and they are also attached to the cranial bones' inner surfaces, which facilitate the crainal
bones to stabilize the positions of the brain, blood vessels, lymphatic vessels, and nerves.
These three connective tissue coverings are dura mater, which is composed of dense,
irregular connective tissue), arachnoid mater, which is composed of delicate collagen fibers and
some elastic fibers in a spiders web arrangement, and pia mater, which is a thin transparent
connective tissue layer consists of squamous to cuboidal cells within interlacing bundles of
collagen fibers and some fine elastic fibers.
The most superficial of the three spinal meninges, the dura mater, forms a sac from the
level of the foramen magnum in the occipital bone, where it is continuous with the dura mater of
the brain, to the second sacral vertebra. The spinal cord is also protected by a cushion of fat
and connective tissue located in the epidural space, a space between the dura mater and the wall
of the vertebral canal.
The middle meninx is an avascular covering called the arachnoid mater. It is deep to the
dura mater and is continuous with the arachnoid mater of the brain. Between the dura mater and
the arachnoid mater is a thin subdural space, which contains interstitial fluid.
The innermost meninx is the pia mater, which adheres to the surface of the spinal cord
and brain. Within the pia mater are many blood vessels that supply oxygen and nutrients to the
spinal cord. Between the arachnoid mater and the pia mater is the subarachnoid space,
which contains cerebrospinal fluid that serves as a shock absorber and suspension system for the
spinal cord and brain .
All three spinal meninges cover the spinal nerve roots, structures that connect spinal
nerves to the spinal cord, up to the point where they exit the spinal column through the
intervertebral foramina. Triangular-shaped membranous extensions of the pia mater suspend the
spinal cord in the middle of its dural sheath. These extensions, called denticulate ligaments, are
thickenings of the pia mater. They project laterally and fuse with the arachnoid mater and inner
surface of the dura mater between the anterior and posterior nerve roots of spinal nerves on either
side. Extending all along the length of the spinal cord, the denticulate ligaments protect the spinal
cord against sudden displacement that could result in shock.



Digestive System

The primary function of the digestive system is to break down the food we eat into smaller parts
so the body can use them to build and nourish cells and provide energy. There occurs propulsion which
is the movement of food along the digestive tract. The major means of propulsion is peristalsis, a series
of alternating contractions and relaxations of smooth muscle that lines the walls of the digestive organs
and that forces food to move forward. It secretes digestive enzymes and other substances liquefies,
adjusts the pH of, and chemically breaks down the food. Mechanical digestion is the process of physically
breaking down food into smaller pieces. This process begins with the chewing of food and continues
with the muscular churning of the stomach. Additional churning occurs in the small intestine through
muscular constriction of the intestinal wall. This process, called segmentation, is similar to peristalsis,
except that the rhythmic timing of the muscle constrictions forces the food backward and forward rather
than forward only. Chemical digestion which is the process of chemically breaking down food into
simpler molecules. The process is carried out by enzymes in the stomach and small intestines. Then
absorption or the movement of molecules (by passive diffusion or active transport) from the digestive
tract to adjacent blood and lymphatic vessels. Absorption is the entrance of the digested food into the
body. And lastly, defecation which is the process of eliminating undigested material through the anus.

But because of acute gastroenteritis the normal functions were altered. The infectious agents
that cause acute gastroenteritis causes diarrhea by adherence, mucosal invasion, enterotoxin
production, and/or cytotoxin production. These mechanisms result in increased fluid secretion and/or
decreased absorption leading to diarrhea. This produces an increased luminal fluid content that cannot
be adequately reabsorbed, leading to dehydration and the loss of electrolytes and nutrients.

ANATOMY AND PHYSIOLOGY






















The human digestive system is a complex series of organs and glands that processes food. In
order to use the food we eat, our body has to break the food down into smaller molecules that it can
process; it also has to excrete waste.
Most of the digestive organs (like the stomach and intestines) are tube-like and contain the food
as it makes its way through the body. The digestive system is essentially a long, twisting tube that runs
from the mouth to the anus, plus a few other organs (like the liver and pancreas) that produce or store
digestive chemicals.
The Digestive Process:
The start of the process - the mouth: The digestive process begins in the mouth. Food is partly
broken down by the process of chewing and by the chemical action of salivary enzymes (these enzymes
are produced by the salivary glands and break down starches into smaller molecules).
On the way to the stomach: the esophagus - After being chewed and swallowed, the food enters
the esophagus. The esophagus is a long tube that runs from the mouth to the stomach. It uses rhythmic,
wave-like muscle movements (called peristalsis) to force food from the throat into the stomach. This
muscle movement gives us the ability to eat or drink even when we're upside-down.
In the stomach - The stomach is a large, sack-like organ that churns the food and bathes it in a
very strong acid (gastric acid). Food in the stomach that is partly digested and mixed with stomach acids
is called chyme.
In the small intestine - After being in the stomach, food enters the duodenum, the first part of
the small intestine. It then enters the jejunum and then the ileum (the final part of the small intestine).
In the small intestine, bile (produced in the liver and stored in the gall bladder), pancreatic enzymes, and
other digestive enzymes produced by the inner wall of the small intestine help in the breakdown of food.
In the large intestine - After passing through the small intestine, food passes into the large
intestine. In the large intestine, some of the water and electrolytes (chemicals like sodium) are removed
from the food. Many microbes (bacteria like Bacteroides, Lactobacillus acidophilus, Escherichia coli, and
Klebsiella) in the large intestine help in the digestion process. The first part of the large intestine is called
the cecum (the appendix is connected to the cecum). Food then travels upward in the ascending colon.
The food travels across the abdomen in the transverse colon, goes back down the other side of the body
in the descending colon, and then through the sigmoid colon. The end of the process - Solid waste is
then stored in the rectum until it is excreted via the anus.
Digestive System Glossary:
anus - the opening at the end of the digestive system from which feces (waste) exits the body. appendix
- a small sac located on the cecum.
ascending colon - the part of the large intestine that run upwards; it is located after the cecum.
bile - a digestive chemical that is produced in the liver, stored in the gall bladder, and secreted into the
small intestine. cecum - the first part of the large intestine; the appendix is connected to the cecum.
chyme - food in the stomach that is partly digested and mixed with stomach acids. Chyme goes on to the
small intestine for further digestion. descending colon - the part of the large intestine that run
downwards after the transverse colon and before the sigmoid colon.
duodenum - the first part of the small intestine; it is C-shaped and runs from the stomach to the
jejunum.
epiglottis - the flap at the back of the tongue that keeps chewed food from going down the windpipe to
the lungs. When you swallow, the epiglottis automatically closes. When you breathe, the epiglottis
opens so that air can go in and out of the windpipe.
esophagus - the long tube between the mouth and the stomach. It uses rhythmic muscle movements
(called peristalsis) to force food from the throat into the stomach.
gall bladder - a small, sac-like organ located by the duodenum. It stores and releases bile (a digestive
chemical which is produced in the liver) into the small intestine.
ileum - the last part of the small intestine before the large intestine begins.
jejunum - the long, coiled mid-section of the small intestine; it is between the duodenum and the ileum.
liver - a large organ located above and in front of the stomach. It filters toxins from the blood, and makes
bile (which breaks down fats) and some blood proteins.
mouth - the first part of the digestive system, where food enters the body. Chewing and salivary
enzymes in the mouth are the beginning of the digestive process (breaking down the food).
pancreas - an enzyme-producing gland located below the stomach and above the intestines. Enzymes
from the pancreas help in the
digestion of carbohydrates, fats and proteins in the small intestine.
peristalsis - rhythmic muscle movements that force food in the esophagus from the throat into the
stomach. Peristalsis is involuntary - you cannot control it. It is also what allows you to eat and drink while
upside-down.
rectum - the lower part of the large intestine, where feces are stored before they are excreted.
salivary glands - glands located in the mouth that produce saliva. Saliva contains enzymes that break
down carbohydrates (starch) into smaller molecules.
sigmoid colon - the part of the large intestine between the descending colon and the rectum.
stomach - a sack-like, muscular organ that is attached to the esophagus. Both chemical and mechanical
digestion takes place in the stomach. When food enters the stomach, it is churned in a bath of acids and
enzymes.
transverse colon - the part of the large intestine that runs horizontal


IX. PATHOPHYSIOLOGY

































Ingestion of fecally
contaminated food & water
Mild Diarrhea
(2-3 Stools)
Secretion of F&E in the
intestinal lumen
Excessive gas formation
Direct invasion of the bowel
wall
GI Distention
Nausea & Vomiting
Stimulation and destruction
of mucosal lining of the bowel
wall
Endotoxins are released
Digestive & absorptive
malfunction
Increase peristaltic
movement
Ruled out Fluids &
Electrolytes Imbalance
Predisposing Factors
Age
Malnutrition
Precipitating Factors
Contaminated food
and water
ACUTE GASTROENTERITIS
Increase peristaltic
movement
Disease Process - PINK
Disease - VIOLET
Complication BLACK
Signs and symptoms-BLUE


Increased protein in the
lumen
unable to reabsorb the lost
fluid
Intense Diarrhea (>10x)
(Watery Stool)
Serious Fluid Volume Deficit
Hypovolemic Shock
Death
Hyponatremia




































Ingestion of fecally
contaminated food & water
Mild Diarrhea
(2-3 Stools)
Secretion of F&E in the
intestinal lumen
Excessive gas formation
Direct invasion of the bowel
wall
GI Distention
Nausea & Vomiting
Stimulation and destruction
of mucosal lining of the bowel
wall
Endotoxins are released
Digestive & absorptive
malfunction
Increase peristaltic
movement
Ruled out Fluids &
Electrolytes Imbalance
Predisposing Factors
Age
Malnutrition
Precipitating Factors
Contaminated food
and water
Hyponatremia
ACUTE GASTROENTERITIS
Increase peristaltic
movement
Fecalysis
(Presence of Trichuris
trichiura ova)
Disease Process - PINK
Disease - VIOLET
Complication - BLACK
Signs Symptoms - BLUE
Laboratory results RED
NCP - GREEN


Fluid volume deficient related to
excessive loose watery stool.




































Predisposing Factors
- Any age are at risk

Steptococcus
pneumoniae
Nasopharyngeal
Precipitating Factors
- Environment
- Poor Hygiene
- Malnutrition
- Poor immune system
Implantation
Enters the blood From wounds
Invades the CNS
Inflammation of meninges
Brain Parynchema
Pia Mater
Arachnoid & Subarachnoid space
Increased ICP
- Bulging
Anterior
Fontanels
- Vomiting
- Altered Level
of
Consciousnes
s
Diagnostic Tests:
-Lumbar Puncture
Gram Stain &
Culture Sensitivity
MRI
CT Scan
Infection
- Nuchal rigidity
- Photophobia
- Alteration in
sensorium
- nausea
- vomiting
- headache
- rash
- Abnormal skin
color
- Stomach
cramps
- Ice-cold hands
and feet
- Muscle ache
or joint pain
- Rapid
breathing
- Chills

Increase in one component of the brain
Disease Process - PINK
Disease - VIOLET
Complication BLACK
Signs and symptoms-BLUE


Meningitis




































If Treated:
- Early Diagnosis &
Prompt Treatment
- Antibiotics
- Antipyretics
- Analgesics
- Corticosteroids / Anti-
inflammatory agents
- Anti-emetics
- Avoid cooling too
much
- Place in a quiet &
dark environment
If Not Treated
Thrombophlebitis
of veins and
venous sinuses
Good Prognosis
Congestion and
infarction of
surrounding tissue
Adhesion Formation
Cranial nerve palsies
Visual or auditory
impairement
Coma
Death
Sepsis
Early Treatment
Delayed Treatment
Memory
impairement
Profound learning
disabilities
Poor Prognosis
Bacterial Meningitis
Seizures
Desired Treatment- ORANGE
Disease Process - PINK
Disease - VIOLET
Complication BLACK



PATHOPHYSIOLOGY

































Predisposing Factors
- Any age are at risk

Steptococcus
pneumoniae
Nasopharyngeal
Precipitating Factors
- Environment
- Poor Hygiene
- Malnutrition
- Poor immune system
Implantation
Enters the blood From wounds
Invades the CNS
Inflammation of meninges
Brain Parynchema
Pia Mater
Arachnoid & Subarachnoid space
Diagnostic Tests:
-Lumbar Puncture

Infection
- Nuchal rigidity
- Photophobia
- Alteration in
sensorium
- nausea
- vomiting
- headache
- rash
- Abnormal skin
color
- Stomach cramps

Disease Process - PINK
Disease - VIOLET
Complication BLACK
Signs and symptoms-BLUE
NCP - GREEN



Meningitis
Impaired skin integrity
related to presence of
skin lesions.
Impaired physical mobility
related to neuromuscular
impairment.


X. Nursing Care Plan Prioritization:
Nursing Diagnosis Ranking Rationale
Fluid volume deficient related to
excessive loose watery stool.
1st
It should be the first to be prioritized
because according to Callista Roys
adaptation model, fluid and electrolytes is
the 3
rd
physiologic needs of man.
Source:(Kozier, Erb, Berman, and Burke,
2000).
Impaired skin integrity related to
presence of skin lesions.
2nd
It should be the second to be prioritized
because according to Callista Roys
adaptation model, the senses including the
senses of the skin which is the 7
th

physiologic needs of man.
Source:(Kozier, Erb, Berman, and Burke,
2000).
Impaired physical mobility related to
neuromuscular impairment.
3rd
It should be the last to be prioritized
because according to Callista Roys
adaptation model, the role function/motor
function is the 10
th
physiologic needs of
man.
Source:(Kozier, Erb, Berman, and Burke,
2000).


















XI. NURSING CARE PLAN
Assessment Nursing
Diagnosis
Planning Interventions Rationale Evaluation
Objectives:
-decreased urine
output
-sudden weight loss
Weight: 9kg.
-increased body
temperature with
temperature of
39 C.
-decreased skin
turgor
-increased capillary
refill: 5sec.
-dry skin/mucous
membranes
-vomiting
-loose watery stool
-Bowel movement
of 4 a day.
Fluid volume
deficient related
to excessive
loose watery
stool.
After nursing
interventions the
client will maintain
fluid volume at a
functional level as
evidenced by
adequate urinary
output, stable vital
signs, good skin
turgor and moist
mucous membranes.
-Assess vital signs; note strength of
peripheral pulses.
-Administer IV fluids as indicated.


-Monitor vital signs.


-Change position frequently.
-Provide frequent oral care as well as eye
care.
-Administer medications(e.g., antiemetic or
antidiarrheals)(antipyretics)

-To evaluate degree of fluid
deficit.

-To correct losses to
reverse pathophysiologic
mechanisms.
-To determine current
health status.
-To promote comfort and
safety.

-To prevent injury form
dryness.


-To limit gastric/intestinal
losses.
-To reduce fever.
After nursing
interventions the
client maintained
fluid volume at a
functional level as
evidenced by
adequate urinary
output, stable vital
signs, decreased
capillary refill: 2sec.,
good skin turgor and
moist mucous
membranes.



Assessment Nursing Diagnosis Planning Interventions Rationale Evaluation
Objectives:
-Disruption of skin
surface (epidermis)
-Destruction of skin
layers(dermis)
-invasion of body
structures
-damaged tissue e.g.,
integumentary



Impaired skin
integrity related to
presence of skin
lesions.
After nursing interventions
the client will demonstrate
behaviors/ lifestyle changes
to promote healing and
prevent
complications/recurrence.
-Note laboratory
results pertinent to
causative factors (e.g.,
studies such as
Hb/Hct).

-Obtain a history of
condition, including
age at onset, date of
first episode, how
long it lasted, original
site, characteristics of
lesions, and any
changes that have
occurred.
- Inspect skin on a
daily basis, describing
lesions and changes
observed.
-Periodically
remeasure wound and
observe for
complications (e.g.,
infection, dehiscence).
-Keep the affected
area clean/dry,
prevent infection, and
stimulate circulation
to surrounding areas.
-To assess causative/
contributing factors for
having skin lesions.



-To assess extent of
involvement/ injury of the
affected area.


To assist client with
correcting/minimizing
condition and promote
optimal healing.

-To monitor progress of
wound healing.





-To assist bodys natural
process of repair.
After nursing interventions
the client demonstrated
behaviors/ lifestyle changes
to promote healing and
prevent
complications/recurrence.





Assessment Nursing Diagnosis Planning Interventions Rationale Evaluation
Objectives:
-limited range of
motion

-difficulty turning

-slowed movement

-functional level: 3
which indicate
require help from
another person.

-inability to walk

Impaired physical
mobility related to
neuromuscular
impairment.
After nursing
interventions the
client will increase
strength and function
of affected and/or
compensatory body
part.










-Assess nutritional status
and energy level.
-Determine degree of
immobility in relation to
previously suggested scale.
-Observe movement when
client is unaware of
observation.
-Instruct in use of side rails
for position
changes/transfers.
-Support affected body
parts/joints using pillows,
foot support and so forth.
-To identify causative/contributing
factors.
-To assess functional ability.





-To note any incongruencies with
reports of abilities.



-To promote optimal level of
function and prevent
complications.



- To maintain position of function
and reduce risk of pressure ulcers.
After nursing
interventions the
client increased
strength and function
of affected and/or
compensatory body
part.