Michelle P.

Arevalo NR-23

Mr. Tiamson

CASE STUDY

An 8 year old boy was seen in the Ma. F.Guerrero school complaining abdominal pain accompanied by shortness of breath (SOB). Vital Signs was taken and recorded as follow: Pulse Rate: 136 bpm Respiratory Rate: 35 cpm Temperature: 35.8 degrees Celsius The patient appears weak, pale, and under nourish. He was also manifested slight Tremor and Diaphoresis. A complete assessment and management where rendered, the boy was kept rested and comfortable. The school clinic physician ordered Paracetamol acetaminophen to be given orally at a round a clock basis.

QUESTIONS:

1. Make an assessment pattern concerning the boy pain experience. 2. Make an outline of the entire nursing health problem manifested by the boy in a prioritize approach. 3. List down all appropriate nursing diagnosis based on prioritized nursing health problem. 4. Make at least two pediatric care plan for the priority health problems for the boy. 5. Make a comprehensive drug study concerning with the clients condition.

1. ASSESSEMENT PATTERN ABDOMINAL PAIN PLACE the pain felt by the student is in the abdomen. EFFECTS the student felt shortness of breath and he appears weak and pale. INTENSIFIERS the pain become worse because the student felt shortening of breath and slight tremor and diaphoresis. NULLIFIERS paracetamol may lessen the pain and it may decrease the body temperature of the student.

2. OUTLINE OF NURSING HEALTH PROBLEM I. Abdominal pain accompanied by shortness of breath II. The student appears weak, pale, and under nourish. III. The student was also manifested slight tremor is an intentional rhythmic and muscle movement and diaphoresis an excessive sweating.

3. NURSING DIAGNOSIS PAIN MANAGEMENT Perform a comprehensive assessment of pain to include location and characteristics of pain in order to plan effective treatment. Reduce or eliminate factors that precipitate or increase the students experience abdominal pain. Provide the students optimal pain relief with prescribed by the school nurse. Evaluate the effectiveness of the pain control measures used through ongoing assessment of the students pain experience.

4. PEDIATRIC CARE PLAN 1. ASSESSEMENT SUBJECTIVE DATA The student verbalized masakit po tiyan ko!

OBJECTIVE DATA: Pulse Rate: 136 bpm Respiratory Rate: 35 cpm Temperature: 35.8 degrees Celsius

DIAGNOSIS acute pain related to under nourishment. PLANNING- reduce or eliminate factors that precipitate or increase the students experience abdominal pain. INTERVENTION- provides the students paracetamol to lessen the students body temperature and reduce abdominal pain. EVALUATION after 4 hours of nursing intervention the student abdominal pain decreases and the body temperature lowered from 38.5 degree Celsius to 38 degree Celsius.

2. ASESSMENT the student felt shortness of breath and he appears weak, pale, and under nourish. DIAGNOSIS acute pain related to abdominal pain as manifested by slight tremors and diaphoresis. PLANNING assist the student in comfortable position to lessen the abdominal pain. INTERVENTION accepts students description of pain. RATIONALE: pain is subjective experience and cannot be felt by others. EVALUATION after 4 hours of nursing intervention the student will feel more comfortable.

5. COMPREHENSIVE DRUG STUDY

GENERIC NAME: Acetaminophen BRAND NAME: Tylenol

DOSAGE: The oral dose for a child is based on the child's age, and the range is 40-650 mg every 4 hours. >1 month to 12 years: 10 to 15 mg/kg/dose every 4 to 6 hours as needed (Maximum: 5 doses in 24 hours)

MECHANISM OF ACTION: Acetaminophen belongs to a class of drugs called analgesics (pain relievers) and antipyretics (fever reducers). The exact mechanism of action of acetaminophen is not known. Acetaminophen relieves pain by elevating the pain threshold, that is, by requiring a greater amount of pain to develop before a person feels it. It reduces fever through its action on the heat-regulating center of the brain. Specifically, it tells the center to lower the body's temperature when the temperature is elevated. ADVERSE REACTION: When used appropriately, side effects with acetaminophen are rare. The most serious side effect is liver damage due to large doses, chronic use or concomitant use with alcohol or other drugs that also damage the liver. Chronic alcohol use may also increase the risk of stomach bleeding. Early signs of toxicity: Anorexia, nausea, diaphoresis (excessive sweating), generalized weakness within the first 12-24 hours. Late signs of toxicity: Vomiting, right upper quadrant tenderness elevated liver function tests within 48-72 hours after ingestion. Antidote: Acetylcysteine. FREQUENCY: Repeat every 4-6 hours as needed. Don't give more than 5 times a day. CONTRA INDICATION: Acetaminophen is metabolized (eliminated by conversion to other chemicals) by the liver. Therefore drugs that increase the action of liver enzymes that metabolize reduce the levels of acetaminophen and may decrease the action of acetaminophen. Doses of acetaminophen greater than the recommended doses are toxic to the liver and may result in severe liver damage. The potential for acetaminophen to harm the liver is increased when it is combined with alcohol or drugs that also harm the liver.

NURSING RESPONSIBILITIES: 1. Right Patient Medication is given to the intended client. 2. Right Medication The medication given was the medication ordered. 3. Right Dosage The dose ordered is appropriate for the client. 4. Right Route Give the medication by the ordered route.

5. Right Time Give the medication at the right frequency and at the time ordered according to agency policy. 6. Right Documentation Record the drug administered 7. Right Client Education Explain information about the medication to the client. 8. Right to Refuse Clients have the right to refuse in medication.

9. Right Assessment Some medication requires specific assessment prior to administration. 10. Right Evaluation Conduct appropriate follow-up.