Table of Contents

I.
A. Introduction
B. Objectives of the study
C. Scope and Limitation.
II. Patients profile
III. Health history
IV. Developmental data
o PSYCHOSOCIAL THEORY OF ERIK ERICKSON
o COGNITIVE THEORY OF JEAN PIAGET
o FREUDS THEORY OF PSYCHOSEXUAL DEVELOPMENT
V. Medical Management
A. Doctors Order with Rationale:
B. Laboratory Result/significance

VI. Pathophysiology with Anatomy and Physiology
A. Anatomy and Physiology
B. Pathophysiology
VII. Nursing Assessment(system review chart)
VIII. Nursing Management
IX. Health teachings
X. Prognosis
XI. Referrals and follow up
XII. Evaluation
XIII. Implication
XIV. Bibliograph
Introduction:

Nursing involves an interrelationship of many people concerned with a
clients responses to potential or actual problems. Health is changing, evolving
concept that is basic to nursing. For centuries, the concept of disease was the
yardstick by which was measured. Now there is an increasing emphasis on
health and wellness. Most people want to be healthy and feel a sense of loss
when they are not.
In the case of our patient who is suffering from acute gastroenteritis (AGE)
the etiology is to determine, it is said that unlike other abdominal disorder, AGE is
the most occurring abdominal dysfunction especially among the children. It is
most often results from any non-inflammatory or inflammatory infection of the
colon or either in the upper part of the small bowel. It can range from mild
dysfunction to severe complication, and the most common is dehydration due to
diarrheal reaction of the body.
. Usually this is caused by an infection,
[2]
but this is not always the case. It
usually is of acute onset, normally lasting less than 10 days and self-limiting.
Sometimes it is referred to simply as 'gastro'. It is often called the stomach flu or
gastric flu even though it is not related to influenza.
Bacterial gastroenteritis is frequently a result of poor sanitation, the lack of
safe drinking water, or contaminated food-conditions common in developing
nations. Natural or man-made disasters can make underlying problems in
sanitation and food safety worse. In developed nations, the modern food
production system potentially exposes millions of people to disease-causing
bacteria through its intensive production and distribution methods. Common
types of bacterial gastroenteritis can be linked
to Salmonella andCampylobacter bacteria; however, Escherichia coli 0157
and Listeria monocytogenes are creating increased concern in developed
nations. Cholera and Shigella remain two diseases of great concern in
developing countries, and research to develop long-term vaccines against them
is underway.
Non-bacterial gastroenteritis is a syndrome that affects a broad
segment of the population throughout the world. Several studies have
proved that causative agents could be established only in about 30%
of cases[3] and it leads to the suggestion that the virus may be the
aetiological agent. Rota virus has been reported as the commonest
cause of acute non-bacterial diarrhoeal illness.[1] Therefore this study
was undertaken to find out the incidence of Rota virus in acute
diarrhoea cases.
As an NCM501202 students, this care study helps us not just to pass this
said requirement but also to evaluate our efficacy upon rendering our services in
the optimum capacity or the ability to care to a patient suffering this kind of
illness. This study also provide information on actual handling, caring and an
overview of the patients nutritional status and dietary management with acute
gastroenteritis
Objectives of the study
: A case study is designed to determine health problems or possible
health threats arising in a specific client. As student nurses, this would serve as a
tool for our training ground from what we had learned in classroom discussions
and be able to apply these in community setting such as this case.
This case study focuses to accomplish the following objectives on
hypertension:
1. To ascertain the content on the nursing assessment, diagnosis, planning,
implementation, and evaluation for these specific disease conditions;
2. To comprehend on the underlying causes and health history on our
clients medical diagnosis upon admission;
3. To compare & contrast the ideal and actual nursing care management for
these specific disease conditions.
4. Identify the development theory of my patient.
5. Identify history of present illness.
6. Discuss pathophysiology of the disease.
7. Enumerate and discuss the nursing management.
8. Discuss the discharge plan which includes health teachings.

Scope and Limitations
The scope of this study covers from the patients health history,
developmental data, and as well as with his medical and nursing management.
Based upon the assessment done, appropriate interventions were implemented
to have a proper care for the clients health.

The study is limited from the information being collected from the patient.
The data gathering through objective and subjective assessment was limited
based upon our interview (From the mother) and nursing assessment. The
patient was being assessed for 2 days from the time we had our ward duty
exposure.


I. Patients Profile:

Name: Eurey Lambaco
Age: 1month old
Sex: Male
Nationality: Filipino
Highest educational attainment: n/a
Occupation: n/a
Monthly income: n/a
Civil Status: Child
Religion: Roman Catholic
Birth Day: December 15,2009
Address: Lapasan, Cagayan de Oro City

Vital Signs:
Temp: 37.7 c Pulse rate: 130 BPM
Resp. rate: 35CPM .

II. Patients Health History:
The Patient X. A 1 month old baby has been experiencing Loose Bowel
Movement (LBM) accompanied with dehydration last January 23, 2010.
Two days prior to admission Patient X encountered onset of loose watery
stools, brownish in color and characterized by non-mucoid and non-blood
streaked for about 4-6 times a day. The client then brought to Sabal hospitals
emergency room. Patients mother claimed that she is not exclusively
breastfeeding her child rather she sometimes bottle feed her child. And she
doesnt always sterilized the childs belongings specifically the utensils which the
child is using when eating.
The client has the chief complaint of loose bowel movement upon his
admission. Patients mother claimed that it was the first admission of the patient.

III. DEVELOPMENTAL DATA

PSYCHOSOCIAL THEORY OF ERIK ERICKSON

Erik Erickson envisioned life as a sequence of levels of achievement. Each stage
signals a task that must be achieved. He believed that the greater that task achievement,
the healthier the personality of the person. Failure to achieve a task influences the
persons ability to achieve the next task.

FREUDS THEORY OF PSYCHOSEXUAL DEVELOPMENT

According to Freuds theory of psychosexual development, the personality develops
in five overlapping stages from birth to adulthood. The libido changes its location of
emphasis within the body from one stage to another. Therefore, a particular body area has
special significance to a client to a particular stage. The first three stages (oral, anal,
phallic) are called pregenital stages. The culminating stage is genital stage.

If the individual does not achieve a satisfactory resolution at each stage, the personality
becomes fixated at that stage. Fixation is immobilization or the inability of the
personality to proceed to the next stage because of anxiety. The patient belongs to early
childhood where the center of pleasure is in the anus.

COGNITIVE THEORY OF JEAN PIAGET

Cognitive development refers to how a person perceives, thinks, and gain
understanding of his or her world through the interaction and influence of genetic and
learning factors. Birth- 2years differentiates self from objects. Recognizes self as agent of
action and begins to act intentionally. Achieves object permanence.

IV. MEDICAL MANAGEMENT:
A. Doctors Order with Rationale:

DATE AND TIME ORDER RATIONALE
January 23, 2010
9:00 am
Pls. Admit to room of
choice.
>To provide care and
proper medical
management.
TPR every 4 hours >To further monitor the
condition of client.
CFACS-V >To check the
characteristics, frequency,
amount, color, stool and
vomitus of the patient.
Diet as tolerated with
aspiration precaution.
>Prescribed food for the
client and prevent aspiration
of foods.
Labs.





Stool Exam





Urinalysis







CBC
>To help physician in
diagnosing his present
health condition and give
specific treatment with
regards to his condition.

>A laboratory test to
determine if a stool sample
contains parasites or eggs
(ova) that are associated
with intestinal infection.

>Used to detect excessive
protein escaping into the
urine to help evaluate and
monitor kidney function,
and to detect kidney
damage affected by his
disease.

>to determine if clients
blood components are
elevated which could
further help he doctor in
prescribing appropriate
medicatios.
PLR 1L 40gtts/hr. >maintain fluid and
electrolytes balance.
Time tape IVF >To monitor the IV fluids
of the patient.
Monitor hydration status
every 4 hours
>To monitor patients
reaction.
Medications:
E-zinc Drops 1ml OD P.O

>Required for normal
development and
maintenance of immune
system.

B. Laboratory Result/significance:
Date/diagnostic
exam done
Lab result Normal
values
Significance

1/24/2010
CBC(HEMATOLOGY)
Hgb:11.3gm%

Hct: 34 vol%
WBC:
7,700/mm3
Lymphocytes:
40

Segmenters:
13-18gm%

42-51 vol%
5,000-
10,000/mm3
25-35 %

55-85%
2-4%
>Decreased in renal
and liver disease,
hypoxia
>Decreased in renal
and liver disease

>no significance
>signifies presence of
parasite and adrenal
44
Monocytes: 4
Eosinophils: 12

Platelet:
498,000
2-3%

150-350/mm3
hypofunction
>Decreased in renal
and liver disease
> no significance
>signifies presence of
parasite and adrenal
hypofunction
>signifies renal
disease,anemia

1/24/2010
Blood chemistry

BUN:28.5
Createnin:
0.88
Potassium:3.5
Sodium:139.20

15.0-
51.0mgs%
0.8-1.4 mgs%
3.4-5.3mEq/L
135-
155mEq/L


>no significance,
normal
>at the borderline, no
significance
>no significance.
Normal
> no significance.
Normal




Date/diagnostic
exam done
Lab result Normal values Significance

1/24/2010
URINALYSIS
(RANDOM
SAMPLING)

Color: yellow
Appearance:
clear
Glucose: neg.
Protein: neg.
Reaction: G.S
Spe. Gravity:0.1-
0.10
Wbc:2-4
Rbc; 0-2
Epi. Cell: 0-2
Mucous cells:
none
Urate none
Bacteria:none







.

1/24/2010
Hgb

Hct


Hgb: 9.8

Hct: 30.0


13-18gm%

42-51 vol%


>Decreased in
renal and liver
disease

>Decreased in
renal and liver
disease




V. PATHOPHYSIOLOGY WITH ANATOMY AND PHYSIOLOGY

A. ANATOMY AND PHYSIOLOGY

The stomach is an expanded section of the digestive tube between the esophagus and
small intestine. Its characteristic shape is shown,
along with terms used to describe the major regions
of the stomach. The right side of the stomach is
called the greater curvature and the left the lesser
curvature. The most distal and narrow section of the
stomach is termed the pylorus - as food is liquefied
in the stomach it passes through the pyloric canal
into the small intestine.
The wall of the stomach is structurally similar to other parts of the digestive tube, with
the exception that the stomach has an extra oblique layer of smooth muscle inside the
circular layer, which aids in performance of complex grinding motions.
In the empty state, the stomach is contracted and its mucosa and submucosa are thrown
up into distinct folds called rugae; when distended with food, the rugae are "ironed out"
and flat. The image below shows rugae on the surface of a dog's stomach.

Within the stomach there is an abrupt transition from stratified squamous epithelium
extending from the esophagus to a columnar epithelium dedicated to secretion. In most
species, this transition is very close to the esophageal orifice, but in some, particular
horses and rodents, stratified squamous cells line much of the fundus and part of the
body.
The image below is of the mucosal surface of an equine stomach showing esophageal
epithelium (top) and glandular epithelium (bottom). The creatures attached to the surface
are bots, larval forms of Gasterophilus.
If the lining of the stomach is examined with a hand lens, one can see that it is covered
with numerous small holes. These are the openings of gastric pits which extend into the
mucosa as straight and branched tubules, forming gastric glands.

B. PATHOPHYSIOLOGY

ACUTE GASTROENTERITIS
Definition:
Gastroenteritis is the irritation and inflammation of the digestive tract. This
condition may cause abdominal pain, vomiting and diarrhea. Severe cases of
gastroenteritis can result in dehydration. In such cases, fluid replacement is the
primary factor in treatment. All ages and both sexes may be affected yet the most
severe symptoms are experienced by infants and those individuals over sixty
years old. The use of certain drugs such as aspirin, antibiotics or cortisone drugs
may increase risk for this condition.
Food poisoning, stress, excessive alcohol or tobacco use, viral infections, food
allergies, improper diet, certain drugs, food consumed in foreign countries and
intestinal parasites are all possible causes for this condition
Gastroenteritis caused by viral infection or bacteria is easily passed from one
person to another. Care should always be taken to wash the hands often,
especially when preparing food and after bowel movements. Hand washing after
bowel movements is important since the organism that causes this condition lives
in the digestive tract.



Contaminated food and water; unhygienic lifestyle

Food eaten; irritates stomach
Increase peristalsis movement of the intestines (Inflammatory response to mucous
membrane lining is destroyed due to excessive production of intestinal fluids)


S/SX:
Nausea and vomiting
Diarrhea
Loss of appetite
Fever
Abnormal flatulence
Abdominal cramps
Bloody stools
Fainting and Weakness



Predisposing Factor
Age (1month old)
Precipitating Factors:

>Environmental Sanitation
>Personal Hygiene
>Improper handling of
foods
>unsterilized utensils.
Effect to produce hyperemia (vascular dilatation with local increase in blood flow of
the intestinal mucosa)


Hyperistalsis in the intestine


Fluid loss dehydration


Acute Gastroenteritis


.
16
VI. NURSING ASSESSMENT REVIEW CHART

VI. Nursing system review chart
Name: Lambaco, Eurey Date: March 23, 2010
Vital signs:
Pulse:130bpm Temperature:37.7 C Resp:35 cpm

Instructions: Place an [x]in the area of abnormality. Comment at the space provided.
Indicate the location of the problem in the figure.
EENT
[]impaired vision [] blind [] pain reddened [] drainage sunken fontanels
Forehead and neck are Temp: 37.7c
[] gums [] hard of hearing [] deaf [] burning anterior and
p p osterior fontanels
are still open
[] edema [] lesion on teeth RR: 35cpm
[] assess the eyes, ears, nose and throat for abnormality Poor skin turgor
Unable to talk clearly Abdominal pain
[x] no problem Abdominal cramps
Respiration IV site
[] asymmetric [] tachypnea [] barrel chest
[] apnea [] rales [] cough [] bradypnea [] shallow
Tolerates soft diet
[] rhonchi [] sputum [] diminished [] dyspnea
[] orthopnea [] labored [] wheezing
Unable to hear well
[] pain [] cyanotic
[] assess respiratory rate, rhythm, pulse blood
Expectoration of
[] breath sounds and comfort [x] no problem
sputum
Cardiovascular
[] arrhythmia [] tachycardia [] numbness
Mildly elevated
[] diminished pulses [] edema [] fatigue
blood pressure
[] irregular [] bradycardia[] murmur
[] tingling [] absent pulses [] pain
[x] assess heart sounds, rate, rhythm, pulse,
Condom catheter in
blood pressure, circulation, fluid retention and comfort
place
[x] no problem


17

Gastrointestinal tract
Posterior tibial and
[] obese [] distention [] mass [] dysphagia [] rigidity [x] pain
[] assess the abdomen, bowel habits and swallowing
pulses are not
[] bowel sounds and comfort [] no problem weight loss
Genito-urinary and Gyne
[] pain [] urine [] color [] vaginal bleeding
[] hematuria [] discharge [] nocturia body weakness
[] assess urine frequency, control, color, odor and comfort
[] gyne bleeding discharge [x] no problem Diarrhea, watery
stool
Neuro
[] paralysis [] stuporous [] unsteady [] seizures
Skin is hot to touch
[] lethargic [] comatose [] vertigo [] tremors
[] confused [] vision [] grip
[] assess motor function, sensation, LOC and strength,
Non-pitting edema
grip, gait, coordination and speech [x] no problem
Musculo-skeletal and skin
extremities
[] appliance [] stiffness [] itching [] petechiae [ ] hot [] drainage
[] prosthesis [] swelling [] lesion [] poor turgor [] cool [] flushed
Unsteady - patient
[] atrophy [] pain [] ecchymosis [] diaphoretic []moist
needs assistance
[] asses mobility, motion, gait, alignment, joint function
on ambulation
[x] skin color, texture turgor integrity [] no problem




Nursing Assessment II
SUBJECTIVE OBJECTIVE

COMMUNICATION

[] hearing loss Comments wala man pud
problema iyang pandugog, kay pag amu siyang
tawgon mlingi man pud siya.
[ ] visual changes

[ ] glasses [ ] language
[ ] contact lens [ ] hearing aid
[ ] speech difficulties

Pupil size 2mm
Reaction Pupils are equally rounded and reactive to
18
[ x ] denied light and accommodation
OXYGENATION
[ ] dyspnea Comments: wala man pud
Hinuon siya gi ubo.
.
[ ] smoking history
[ ] cough
[ ] sputum
[x] denied

Respiration [x] regular [ ] irregular
Description Regular breathing pattern.


Right: Right lung is symmetrical to left lung.
Left: Left lung is symmetrical to right lung.
CIRCULATION
[ ] chest pain Comments: No subjective cue
gathered since the patient is an infant

[ ] leg pain
[ ] numbness of extremities
[ x] denied
Heart rhythm [x] regular [ ] irregular
Ankle edema None

Pulse Carotid Radial Dorsalis pedis
Femoral + + +

Right + + +
Left
Comments: Heart beat and heart rhythm are normal.


NUTRITION
Diet Diet for Age with aspiration precaution.
[ ] nausea Comments: ginagmay lang jud
iyang ga kan-on
[ ] vomiting
character
[ x ] recent change in
weight / appetit
[ ] swallowing
difficulty
[ ] denied

[ ] dentures [x] none

Full Partial

upper [ ] [x] [ ]

lower [ ] [x] [ ]

ELIMINATION
Usual bowel pattern [ ] urinary frequency
2x a day 3x a day
[ ] constipation remedy [ ] urgency
[ ] dysuria
Date of last BM [ ] hematuria
March 23, 2010 [ ] incontinence
[ x ] diarrhea character [ ] polyuria
Watery stool, yellowish in color
[ ] denied
Comments: loose passive Watery stool, yellowish in
color and in moderate amount.

Bowel sounds: hyperactive (2x/3-5sec.)
Abdominal distention
[ ] yes [x] no

Urine (color, odor,
Consistency) : light colored in moderate amount.
19
MANAGEMENT OF HEALTH AND
ILLNESS
[ ] alcohol (amount and frequency) [x] denied
[ ] SBE Last pap smear not applicable
[ ] Last menstrual period not applicable
Briefly describe the patients ability to follow
treatments (diet. Medications, etc.) for chronic
health problems.
Patients mother is supportive to treatment regimen
and patient is cooperative..




SUBJECTIVE OBJECTIVE
SKIN INTEGRITY
[x] dry
[ ] itching
[x ] other : Poor skin turgor
[ ] denied
[x] dry [ ] cold [ ] pale
[ ] flushed [x] warm
[ ] moist [ ] cyanotic
Rashes, ulcers, decubitus (describe size,
location and drainage) None

ACTIVITY / SAFETY
[ ] convulsion Comments: luya jud
kaayo siya karon, sugod pa atong nag
kalibanga siya.
[ ] dizziness
[ ] limited motion
of joints
Limitation in the
ability to:
[x ] ambulate
[ ] bathe self
[ ] other
[ ] denied
Level of consciousness and orientation
Patient is 11 months old.
Gait [ ] walker [ ] cane [x] others

[ ] steady [x] unsteady
[ ] sensory losses in face or extremities
None

[ ] Range of motion limitation: Patient is
still unable.

COMFORT / SLEEP / AWAKE
[x] pain Comments: sige siya ug
hilak, ga sakit jud siguro iyang tiyan ani.
frequency, remedies)
[ ] nocturia
[ x] sleep difficulties
[ ] denied

[x] facial grimace
[ ] guarding
[ ] other signs of pain: patient is Frequently
crying.

[ ] siderail release form signed (60+ years)
Not applicable.
COPING
Occupation Not applicable since the
patient is infant
Most supportive person: the mother and
father
Observed non-verbal behavior: none
The person and his phone number that can
be reached anytime
09063064576- patients father.
20
VII. Nursing Management
Nursing Diagnosis


Intervention Rationale


Hyperthermia related to dehydration as
evidence by flushed skin and warm to
touch



Independent
promote surface cooling by
means of tepid sponge bath
maintain bed rest
increase fluid intake (PO)
Collaborative
administer antipyretic
(paracetamol) as ordered







To lower down body temperature.

To prevent energy consumption.

To maintain fluid and electrolytes
balance in the body.


To lower down body temperature.
21

Nursing Diagnosis Intervention Rationale

Fluid volume deficient related to
excessive losses through normal
routes
Monitor intake and output, note
number, character and amout of
stools.
Assess vital signs changes.
Observe for excessively dry skin
and mucous membrane, dry skin
turgor.
Weigh daily.
Administer parenteral as
indicated.
Provide information about over
all fluid balance, renal function
and bowel diseases control as
well as guidelines for fluid
replacement.
Hypotension, tachycardia and
fever can indicate response of
fluid loss.
Indicates dehydration.
Indicator of overall fluid and
nutritional status.
Maintenance of bowel rest that
will require alternate fluid
replacement to correct losses.


22

Nursing Diagnosis Interventions Rationale

Nutrition, altered: Less than body
requirements related to altered
absorption of nutrients and hyper
metabolic state.
Weigh daily.
Encourage bed rest or limited
activity during acute phase of
illness.
Record intake changes in
symptomalogy.
Provide oral hygiene.
Keep NPO and administer
medication as indicated.
Provide information about
dietary needs.
Decreasing metabolic rate
needs aid in preventing caloric
depletion and conserves
energy.
Useful in identifying specific
deficiency and determining GI
response to foods.
Clean mouth can enhance the
taste of foods.
Promote tissue
healing/regeneration. Prevent
treat anemia, oral route for iron
supplement is ineffective
because of intestinal alteration
that for absorption of nutrients.

23



Nursing Diagnosis Intervention Rationale

Acute pain related to hyper peristalsis
prolonged diarrhea, skin/tissue
irritation, peri rectal fissures, fistulas

.
Note non verbal cues.
Permit patient to assume
position of comfort.
Cleans rectal area with mild
soap and water wipes after
defecating.
Record abdominal distention
increase temperature and
decrease blood pressure.
Implement prescribe dietary
modifications, administer
medication as indicated.

Non verbal cues may be used in
conjunction with verbal cues to
identify extent of the problem.
Reduce abdominal tension and
sense of control.
Protect skin from undigested
bowel contents preventing
excoriation.
May indicate developing
intestinal obstruction from
inflammation.
Complete bowel rest can reduce
pain and cramping.
24
S N/A
O -sudden loss of weight
-weak
-sunken fontanels
-consumes half of share
A Imbalanced Nutrition less than body requirements as evidenced by sudden change in
weight.
P Long term: At the end of an 16 hours of rendering nursing care the patient will be able
to maintain weight.
Short term: At the end of 8 hours the patient regain appetite.
I 1. Monitored bowel sounds.
2. Promoted pleasant, relaxing environment.
3. Checked stools.
4. Consulted dietitian.
5. Monitored laboratory studies.
E After giving an intervention the patient have a good appetite and regain his weight.


25
S

N/A

O

-Frequently cries
-Restless
- facial grimaced
A

-Acute pain related to physiologic response of the stomach due to over stimulation
of the gastric acid.

P



Long term: At the end of 16 hours rendering nursing care patient will be able to be
relieved from pain as evidence by;
Appears calm and comfortable.
Short term: At the end of 8 hours rendering nursing care the patient will be able to
demonstrate relief from pain.

I

1. Provided with cool and well-ventilated room
2. Monitored vital signs of the patient to check for stability upon pain occur.
3. Given some materials to divert his feeling of pain.
4. Administered with anti-ulcer drugs or anti-pyretic drug as ordered.
E

After 8 hours of intervention that has been given, the patient able to be relived from
pain.



26
S N/A
O -sudden change of weight
-poor skin turgor
-dry mucous membranes
A Risk for fluid volume deficient as evidenced by sudden losses of weight and
loose bowel movement
P Long term: At the end of 8 hours rendering nursing care the patient will
demonstrate a normal pattern of bowel function.
Short term: At the end of 5 hours rendering nursing care the patient will be able
to attain normal bowel pattern.
I 1. Monitor intake and output.
2. Increased fluid intake.
3. Assessed vital signs, skin turgor and mucous membrane.
4. Checked and compare laboratory values.
5. Provide IV Fluids with the doctors prescription.
E After giving nursing intervention patient attain normal pattern of bowel
function.


27

VIII. Health Teaching:
Medication:
Before the patient is discharge, patients mother was instructed to comply all
of his medication regimen as prescribe by the attending physician,(Dr.Bejarasco).
This medication is E-zinc Drops 1ml OD P.O.
Exercise:
Patients mother was instructed to ambulate client ,and deep breathing
excercise and do ADLs as tolerated by patient. Tolerable excercises will promote
blood circulation and, sense of well being, and promote fast healing. Relaxation
exercise may do.
Treatment:
Patients mother instructed to increased fluid intake of client. This is to
promote regain of electrolytes and fluid balance. Treatment regimen such as
some diet restriction, exercise, compliance on medication and to submit self 1
week after being discharge from the hospital. Encouraged to maintain good
hygiene of client.
Out-patient check-up:
Patients mother was instructed to come back 1 week after or if symptoms
persist with Dr. Bejarascos clinic at sabal hospital.This is to check the progress
of the patients treatment and to monitor any signs of further medical assistance.


28
Diet:
Patients mother encouraged to let client eat foods with high protein content such
as the egg whites, and lean meats, and also vegetable and encourage increased
fluid intake.
IX. Prognosis:

PROGNOSTIC INDICATORS POOR GOOD
A. Onset of illness X
B. Duration of Illness X
C. Attitude and willingness
to take medication
X
D. Precipitating Factors X
F. Family Support X


X. REFERRALS AND FOLLOW UP

Before the patient is discharged from the hospital, mother was suggested
to return the patient to his physician Dr. Bejarasco one week after discharge for
follow up check-up, for further evaluation, instructions and care.
The recovery of patients wounds depends on medications and treatment
regimen if it was followed religiously as ordered by his physician.


XI. Evaluation:

At the end of two days of nursing care rendered to patient, the patient showed
some sort of progress as evidence by:
Clients stool is semi-formed.
Has good appetite eating.
29
Active and regained his strength.

XII. Implication
This study will serve as a reference material in rendering and competent
care to our patient especially those with similar conditions. Through this, we will
be able to develop our knowledge as well as our skills and attitudes in applying
the prescribed procedures to improve the health status of the patient.
This study will act as a baseline data as well as guide for coming up with a
good, reliable, accurate and comprehensive research paper dealing with issues
commonly experienced by patients in the hospital setting. This may aid the
researchers to widen the scope of the study in relation to more or less similar
cases.

XIII. Bibliography:

WEBSITE:
1. http://en.wikipedia.org/w/index.php?title=Piaget%27s_cognitive_developm
ent&action=edit
2. http://www.patient.co.uk/showdoc/40000681
3. http://en.wikipedia.org/wiki/Erikson's_stages_of_psychosocial_developme
nt#Middle_Adulthood_.2835-60_Years.29
4. "http://en.wikipedia.org/wiki/Erikson%27s_stages_of_psychosocial_develo
pment"
5. Category: Developmental psychology
6. ^
a

b
Murray PR, Pfaller MA, Rosenthal KS. Medical Microbiology. Mosby,
2005. ISBN 0323033032.
7. ^ Seven Surfing Sicknesses.
8. ^
a

b

c

d

e
The Oxford Textbook of Medicine. Edited by David A. Warrell,
Timothy M. Cox and John D. Firth with Edward J. Benz, Fourth Edition
(2003), Oxford University Press, ISBN 0-19-262922-0
30
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