I. Introduction a.

Overview of the Study Acute diarrhea or gastroenteritis is the passage of loose stools morefrequently than what is normal for that individual. This increased frequency is oftenassociated with stools that are watery or semisolid, abdominal cramps and bloating.Acute watery diarrhea is an extremely common problem, and can be fatal due tosevere dehydration, in both adults and children, especially in the very young and theold or in those who have poor immunity such as individuals with HIV infection or patients who are using certain medications that suppress the immune system.Gastroenteritis means inflammation of the stomach and small and largeintestines. Viral gastroenteritis is an infection caused by a variety of viruses thatresult in vomiting or diarrheaor both. It is often called the "stomach flu," although it isnot caused by theinfluenzaviruses.P e r s o n s c a n r e d u c e t h e i r c h a n c e o f g e t t i n g i n f e c t e d b y f r e q u e n t handwashing, prompt disinfection of contaminated surfaces with household chlorinebleach-based cleaners, and prompt washing of soiled articles of clothing. If food or water is thought to be contaminated, it should be avoided.Since most cases of acute watery diarrhea are infectious, especially indeveloping countries, the majority of such illnesses can be prevented by drinkingwater or eating foods that are not contaminated with infectious agents. Washingh a n d s f r e q u e n t l y w i t h n o n - c o n t a m i n a t e d w a t e r, w h e n c a r i n g f o r a p a t i e n t w i t h diarrhea as also always before eating is important. Proper storage of food and water is also important to prevent harmful bacteria from contaminating them. Other symptoms include nausea, vomiting, loss of appetite, belching, andbloa ting. Occasionally, acute abdominal pain can be a presenting symptom. This ist h e c a s e i n p h l e g m n o u s g a s t r i t i s ( g a n g r e n e o f t h e s t o m a c h ) w h e r e s e v e r e abdominal pain accompanied by nausea and vomiting of potentially purulent gastriccontents can be the presenting symptoms. Fever, chills, and hiccups also may bepresent.The diagnosis of acute gastritis may be suspected from the patient's historyand can be confirmed histologically by biopsy specimens taken at endoscopy. b.Objective of the Study This study aims to: Conduct and evaluate an assessment for the client Determine the causes, predisposing and precipitating factors that constitutethe onset of the disease process. Render series of nursing interventions for the clients care

Provide and disseminate important information as teachings to the client andthe significant others to boost the knowing and understanding of the nature of the said health condition. Improve skills and knowledge as health care providers in the clinical area

I I . P a t i e n t s P r o f i l e Clients Name: Matias, Jhunienne Age: 6 months old Birthday: September 17, 2008 Address: Mambuaya, Cagayan de Oro City Civil Status: Single Sex: Male Nationality: Filipino Religion: Roman Catholic Weight: 6.5 Kg. Informant: Inalen Matias (Mother) Date of admission: Febuary 15, 2009 Time of admission: 4:00 PM Chief complaint:

LBM Admitting diagnosis: AGE with mild dehydration Attending physician: Dr. Baca I I I . D e v e l o p m e n t a l D a t a Developmental Task Theory of Robert Havighurst A developmental task is a task which arises at or about a certain period in thelife of an individual. Havighurst has identified six major age periods: infancy andearly childhood (0-5 years) , middle childhood (6-12 years), adolescence (13-18years), early adulthood (19-29 years), middle adulthood (30-60 years), and later maturity (61+).Basing on Havighursts Theory, my patient belongs in the infancy and earlyc h i l d h o o d s t a g e w h e r e i n h e i s l e a r n i n g t o d i s t i n g u i s h r i g h t f r o m w r o n g a n d developing a conscience. Psychosexual Theory of Sigmund Freud The psychosexual stages of Sigmund Freud are five different developmentalperiods during which the individual seeks pleasure from different areas of the bodya s s o c i a t e d w i t h s e x u a l f e e l i n g s . T h e s e s t a g e s a r e a s f o l l o w s : O r a l B i r t h t o t o 1 y e a r A n a l 2 t o 3 y e a r s P h a l l i c 4 t o 5 y e a r s L a t e n c y 6 t o 1 2 y e a r s G e n i t a l 1 3 a n d U p Basing on this theory, Jhunienne Matias belongs to the oral stage wherein aninfants pleasure centers are in the mouth. This is also the infant's first relationshipwith its mother; it is a nutritive one. Psychosocial Theory of Erik Erickson Erik Erickson envisioned life as a sequence of levels of achievement. Eachstage signals a task that must be achieved. He believed that the greater that taskachievement, the healthier the personality of the person. Failure to achieve a taskinfluences the persons ability to achieve the next task. Stages of EriksonsPsychosocial Theory are as follows: I n f a n c y B i r t h 1 8 m o n t h s T r u s t v s . M i s t r u s t E a r l y C h i l d h o o d 1 8 m o n t h s 3 y e a r s A u t o n o m y v s .

S h a m e L a t e C h i l d h o o d 3 5 y e a r s I n i t i a t i v e v s . G u i l t S c h o o l A g e 6 1 2 y e a r s I n d u s t r y v s . I n f e r i o r i t y A d o l e s c e n c e 1 2 2 0 y e a r s Identity vs. Role Confusion Y o u n g A d u l t h o o d 1 8 2 5 y e a r s I n t i m a c y v s . I s o l a t i o n A d u l t h o o d 2 5 6 5 y e a r s Generativity vs. Stagnation M a t u r i t y 6 5 y e a r s t o d e a t h I n t e g r i t y v s . D e s p a i r Basing on this theory, he is still belongs to Infancy based on Eriksons theorythe child developmental task is the TRUST vs. MISTRUSTBecause an infant isutterly dependent; the development of trust is based on the dependability and qualityof the childs caregivers. If a child successfully develops trust, he or she will feel safeand secure in the world. Caregivers who are inconsistent, emotionally unavailable,or rejecting contribute to feelings of mistrust in the children they care for. Failure tod e v e l o p t r u s t w i l l r e s u l t i n f e a r a n d a b e l i e f t h a t t h e w o r l d i s i n c o n s i s t e n t a n d unpredictable.A s o b s e r v e d t h e c h i l d h a d a l r e a d y b u i l t t r u s t t o h i s m o t h e r a n d h i s grandmother wherein he only allows his mother and grandmother to cuddled andfeed him V . H E A L T H H I S T O R Y a.Family Health History According to the father regarding the herido-familial history both her mother and father side has a history of hypertension. On the father sidethey had a history of cancer since the fathers aunt died last 2001 due tocervical cancer. b.Past Health History The father claimed that his child past illnesses were a typical cough,c o l d s a n d f e v e r t h a t u s u a l l y l a s t e d f o r t h r e e d a y s . O v e r t h e c o u n t e r medicines such as Paracetamol (Calpol) was used to treat for fever andDimetapp for colds. The father claimed that his child has not completedt h e v a c c i n a t i o n r e q u i r e d a n d n e v e r e x p e r i e n c i n g m a j o r i l l n e s s t h a t required hospitalization until this Febuary 15, 2008 wherein the patient hasbeen admitted at JRB Hospital having an acute diarrhea but the father denied that his child does not have known allergies to drugs and foods nor his child received a blood transfusion.The patient was born in JRB Hospital through a normal spontaneousvaginal delivery. c.History of Present Illness A case of Matias, Jhunienne, 6months old Male, Filipino, a resident of M a m b u a y a C a g a y a n d e O r o C i t y, a d m i t t e d f o r t h e f i r s t t i m e a t P G H

hospital with a chief complaint of LBM. Two days prior to admission hehad persistent LBM, vomiting, cough and fever.

V. N u r s i n g A s s e s s m e n t ( S y s t e m R e v i e w & N u r s i n g Assessment II) Name : Jhunienne Matias Date : 02-15-09 T emp : 38.6C HR: 137bpm BP : N/A Height_____Weight :6.5 kgs RR : 50cpm INSTRUCTIONS: Place an [X] in the area of abnormality. Comment at the spaceprovided. Indicate the location of the problem in the figure using [X]. EENT : [ ] impaired vision [ ] blind[ ] p a i n r e d d e n e d [ ] d r a i n a g e S u n k e n e y e s [ ] g u m s [ ] h a r d o f h e a r i n g [ ] d e a f P o o r a p p e t i t e [ ] b u r n i n g [ ] e d e m a [ ] l e s i o n t e e t h C o l d s Ass ess eyes, ears, nose throat CoughF o r a b n o r m a l i t y [ ] n o p r o b l e m P o o r s k i n t u r g o r RESPIRATION: [ ] a s y m m e t r i c [ ] t a c h y p n e a [ ] b a r r e l c h e s t H y p e r a c t i v e [ ] a p n e a [ ] r a l e s [ x ] c o u g h b o w e l s o u n d s [ ] bradypnea [ ] shallow [ ] rhonchi[ ] sputum [ ] diminished [ ] dyspnea[ ] orthopnea [ ] labored [ ] wheezing[ ] pain [ ] cyanoticAssess resp. rate, rhythm, pulse bloodbreath sounds, comfort [ ] no problem

GASTROINTESTINAL TRACT: [ ] obese [ ] distention [ ] mass[ ] dysphagia [ ] rigidity [ ] painAssess abdomen, bowel habits, swallowingbowel sounds, comfort [x] no problem GENITO-URINARY AND GYNE: [ ] pain [ ] urine color [ ] vaginal bleeding[ ] h e m a t u r i a [ ] d i s c h a r g e [ ] n o c t u r i a H y p e r t h e r m i a assess urine frequency , c on tr ol , c ol or, od o r, c om f or t = 38 .6 C NEURO: [] p a r a l y s i s [ ] s t u p o r o u s [ ] u n s t e a d y [ ] s e i z u r e s h o o k e d w i t h [ ] l e t h a r g i c [ ] c o m a t o s e [ ] v e r t i g o [ ] t r e m o r s I V F o f D 5 0 . 3 N a c l [ ] c o n f u s e d [ ] v i s i o n [ ] g r i p 5 0 0 c c assess motor, function, sensation, LOC, strengthgrip, gait, coordination, speech [x] no problem MUSCULOSKELETAL AND SKIN: Watery Stools [ ] appliance [ ] stiffness [ ] itching [ ] petechiae[ ] hot [ ] drainage [ ] prosthesis [ ] swelling[ ] lesio n [x] poor turgor [ ] cool [ ] flushed[ ] atrophy [ ] pain [ ] ecchymosis [ ] diaphoretic/moistassess mobility, motion, gait, alignment, joint functionskin color, texture, turgor, integrity [ ] no problem I . A N A T O M Y A N D P H Y S I O L O G Y : DIGESTIVE SYSTEM The digestive system consists of two linked parts: the alimentary canal and theaccessory digestive organs. The alimentary canal is essentially a tube, some 9meters (30 feet) long, that extends from the mouth to anus, with its longest section-the intestines- packed into the abdominal cavity. The lining of the alimentary canal isc o n t i n u o u s w i t h t h e s k i n , s o t e c h n i c a l l y i t s c a v i t y l i e s o u t s i d e t h e b o d y. T h e alimentary tube consist of linked organs that each play their own part in digestion:mouth, pharynx, esophagus, stomach, small intestine, and large inte stine. Theaccessory digestive organs consist of the teeth and tongue in the mouth; and the

alivary glands, liver, gallbladder, and pancreas, which are all linked by ducts to thealimentary canal. STOMACH It is a J- shaped enlargement of the GI tract directly under the diaphragm inthe epigastric, umbilical and left hypochondriac regions of the abdomen. Whenempty, it is about the size of a large sausage; the mucosa lies in large folds, calledRUGAE. Approximately 10 inches long but the diameter depends on how much foodi t c o n t a i n s . W h e n f u l l , i t c a n h o l d a b o u t 4 L ( 1 g a l l o o n ) o f f o o d . P a r t s o f t h e stomach includes cardiac region w h i c h i s d e f i n e d a s a p o s i t i o n n e a r t h e h e a r t surrounds the cardioesophageal sphincter through which food enters the stomachfrom the esophagus; fundus which is the expanded part of the stomach lateral to thecardia region; body is the mid portion; and the pylorus a funnel shaped which is theterminal part of the stomach. The pylorus is continuous with the small intestinethrough the pyloric sphincter, or valve.With the gastric glands lined with several secreting cells the zymogenic(peptic) cells secrete the principal gastric enzyme precursor, pepsinogen. Thep a r i e t a l ( o x y n t i c ) c e l l s p r o d u c e h y d r o c h l o r i c acid, involved in conversion of pepsinogen to the active enzyme pep s i n , a n d i n t r i n s i c f a c t o r, i n v o l v e d i n t h e absorption of Vitamin B12 for the red blood cell production. Mucous cells secretemucus. Secretions of the zymogenic, parietal and mucus cells are collectively calledthe gastric juice. Enteroendocrine cells secrete stomach gastrin, a hormone thats t i m u l a t e s s e c r e t i o n o f h y d r o c h l o r i c a c i d a n d p e p s i n o g e n , c o n t r a c t s t h e l o w e r esophageal sphincter, mildly increases motility of the GI tract, and relaxes thepyloricsphincter. Most digestive activity occurs in the pyloric region of the stomach.After food has been processed in the stomach, it resembles heavy cream and iscalled CHYME. The chyme enters the small intestine through the pyloric sphincter

Fecalysis Character: soft WBC/hpf: 4-6Color: yellow RBC/hpf: 6-8Parasite ascarasis: none seen cysts: positiveTrichuris: none seen trophosites: none seenHook worm: none see

c.Drug study DRUG NAME

Paracetamol DOSE/FREQUENCY/ROUTE 500 mg 1 tab q4h PRN for fever CLASSIFICATION Analgesic; antipyretic MECHANISM OF ACTION May produce analgesic effect by blocking pain impulses, byinhibiting prostaglandin or pain receptor sensitizers. May relieve fever by actingonhypothalamic heat-regulating center. Relieves fever. SPECIFIC INDICATION For fever. CONTRAINDICATION Contraindicated in patients hypersensitive to drug or itscomponents. SIDE EFFECTS Anemia, jaundice, rash, urticaria. NURSING PRECAUTION Do not administer for fever thats above 39.5 C, lasts longer than 3days or recurs. DRUG NAME AMBROXOL DOSE/FREQUENCY/ROUTE 0.75mlTIDP .O CLASSIFICATION Cough and Cold Preparation MECHANISM OF ACTION Ambroxol is a mucolytic agent. It acts by increasing the respiratorytract secretion of lower viscosity mucus and exerting a positive influence on thealveolar surfactant system which leads to improved mucus flow and transport.Expectoration of mucus is thus facilitated. SPECIFIC INDICATION Cough CONTRAINDICATION Hypersensitivity to ambroxol or any ingredient of Ambrolex. SIDE EFFECTS Mild GI side effects. NURSING PRECAUTION Should be taken with food. DRUG NAME GENTAMYCIN DOSE/FREQUENCY/ROUTE IVT q 8 ANST CLASSIFICATION Amino glycoside

MECHANISM OF ACTION Broad-spectrum aminoglycoside antibiotic derived from Micromonospora purpurea. Action is usually bacteriocidal. SPECIFIC INDICATION Parenteral use restricted to treatment of serious infections of GI CONTRAINDICATION History of hypersensitivity to or toxic reaction with anyaminoglycoside antibiotic. Safe use during pregnancy (category C) or lactation isnot established SIDE EFFECTS a.an allergic reaction (shortness of breath; closing of the throat; hives;swelling of the lips, face, or tongue; rash; or fainting);b . l i t t l e o r n o u r i n e ; c.decreased hearing or ringing in the ears;d.dizziness, clumsiness, or unsteadiness;e.numbness, skin tingling, muscle twitching, or seizures; or f.severe watery diarrhea and abdominal cramps. NURSING PRECAUTION Draw blood specimens for peak serum gentamicin concentration30 min1h after IM administration, and 30 min after completion of a 3060 min IVinfusion. Draw blood specimens for trough levels just before the next IM or IV dose.Use nonheparinized tubes to collect blood. 21

N U R S I N G M A N A G E M E N T Ideal Nursing Manangement Risk for fluid volume deficit related to excessivelosses through normal routes (frequent diarrhea, vomiting) I N T E R V E N T I O N S R A T I O N A L E INDEPENDENT Monitor Intake and Output. Note number,character, and amount of stools; estimateinsensible fluid losses, e.g., diaphoresis. Measureurine specific gravity; observe for oliguria. Assess vital signs (BP, pulse, temperature). Observe for excessively dry skin and mucousmembranes, decreased skin turgor, slowedcapillary refill. Weigh daily Maintain oral restrictions, bed rest. Observe for overt bleeding and test stool daily for occult blood.

Note generalized muscle weakness or cardiacdysrhytmias.COLLABORATIVE Administer parenteral fluids, blood transfusions asindicated. Monitor laboratory studies, e.g., electrolytes(especially potassium, magnesium) and ABGs(acid-base balance). Administer medications as indicated: Antidiarrheal e.g., dipphenoxylate (Lomotil),loperamide (Imodium), anodyne suppositories. Antiemetics, e.g., trimethobenzamide (Tigan),hydroxyzine (Vistaril), prochlorperazine(Comparazine); Antipyretics, e.g., acetaminophen (Tylenol); Electrolytes, e.g., potassium supplement (KCl-IV;K-Lyte, Slow-K); Vitamin K (Mephyton) Provides information about overall fluid balance,renal function, and bowel disease control, as well asguidelines for fluid replacement. Hypotension (including postural), tachycardia, fever can indicate response to and/or effect of fluid loss. Indicates excessive fluid loss/resultant dehydration. Indicator of overall fluid and nutritional status. Colon is placed at rest for healing and to decreasedintestinal fluid losses. Inadequate diet and decreased absorption may leadto vitamin K deficiency and defects in coagulation,potentiating risk for hemorrhage. Excessive intestinal loss may lead to electrolyteimbalance, e.g., potassium, which is necessary for proper skeletal and cardiac muscle function. Minor alterations in serum levels can result in profoundand/or life-threatening symptoms. Maintenance of bowel rest requires alternative fluidreplacement to correct losses/anemia. Note: fluidscontaining sodium may be restricted in presence of regional enteritis. Determines replacement needs and effectiveness of therapy.

Reduces fluid losses from intestines. Used to control nausea and vomiting in acuteexacerbations. Controls fever, reducing insensible losses. Electrolytes are lost in large amounts, especially inbowel with denuded, ulcerated areas, and diarrheacan also lead to metabolic acidosis through loss of bicarbonate (HCO3). Stimulates hepatic formation of prothrombin,stabilizing coagulation and reducing risk of hemorrhage. 22

Knowledge deficient regarding condition, prognosis, treatment, self-care, anddischarge needs as related to unfamiliarity with resources and informationmisinterpretation.Desire outcomes/evaluation criteria- the significant others will:Verbalize understanding of disease processes, possible complications.I N T E R V E N T I O N R A T I O N A L E INDEPENDENT Determine the mothers perceptionof disease process. Review disease process,cause/effect relationship of factorsthat precipitate symptoms, andidentify ways to reduce contributingfactors. Encourage questions. Review medications, purpose,frequency, dosage, and possibleside effects. Stress importance of good skin care,e.g., proper handwashingtechniques and perineal skin care. Emphasize need for long-termfollow-up and periodic reevaluation. Establishes knowledge base andprovides some insight into individuallearning needs. Precipitating/aggravating factors areindividual; therefore, the mother needs to be aware of what foods,fluids, and lifestyle factors canprecipitate symptoms. Accurateknowledge base provides opportunityfor the mother to make informeddecisions/choices about future andcontrol of chronic disease. Althoughmost others know about their owndisease process, they may haveoutdated information or misconceptions. Promotes understanding and mayenhance cooperation with regimen. Reduces spread of bacteria and riskof skin irritation/breakdown, infection.

Patients with IBD are at risk for colon/rectal cancer, and regular diagnostic evaluations may berequired.. IDEAL NURSING MANAGEMENT 23 Hyperthermia related to dehydration as evidenced by increase in bod y temperature higher than normal range.Desired outcomes/evaluation criteria- patient will:Demonstrate temperature within normal range, be free of chills. I N T E R V E N T I O N R A T I O N A L E Independent m o n i t o r p a t i e n t t e m p e r a t u r e ( d e g r e e a n d p a t t e r n ) ; n o t e s h a k i n g chills/profuse diaphoresis. M o n i t o r e n v i r o n m e n t a l temperature; limit/add be d linens as indicated. P r o v i d e t e p i d s p o n g e b a t h s ; avoid use of alcohol.Collaborative Administer antipyretics, e.g.,a c e t y l s a l i c y l i c a c i d ( A S A ) ( a s p i r i n ) , a c e t a m i n o p h e n (Tylenol). Provide cooling blanket. Temperature of 102F-106F (38.9C- 41.1C)suggests acute infectious disease process.F e v e r p a t t e r n m a y a i d i n d i a g n o s i s ; e . g . , sustained or continuous fever curves lastingmore than 24 hour suggest pneumococcalpneumonia, scarlet or typhoid fever; remittentfever (varying only a few degrees in either d i r e c t i o n ) r e f l e c t s p u l m o n a r y i n f e c t i o n s ; i n t e r m i t t e n t c u r v e s or fever that returns ton o r m a l o n c e i n 2 4 - h o u r p e r i o d suggestss e p t i c e p i s o d e , s e p t i c e n d o c a r d i t i s , o r tuberculos i s ( T B ) . C h i l l s o f t e n p r e c e d e temperature spikes.Note: Use of antipyretics alters fever patternsand may be restricted until diagnosis is made or if fever remains higher that 102F (38.9C). Room temperature/number of blanketss h o u l d b e a l t e r e d t o m a i n t a i n n e a r normal body temperature. May help reduce fever. Note: use of icewater/alcohol may cause chills, actuallye l e v a t i n g t e m p e r a t u r e . I n a d d i t i o n , alcohol is very drying to skin. Used to reduce fever by its centrala c t i o n o n t h e h y p o t h a l a m u s ; f e v e r should be controlled in patients who areneutropenic or asplenic. However, fever m a y

be benefial in limiting growth of o r g a n i s m s a n d e n h a n c i n g autodestruction of infected cells. U s e d t o r e d u c e f e v e r, u s u a l l y h i g h e r t h a n 1 0 4 F - 1 0 5 F ( 3 9 . 5 C - 4 0 C ) , w h e n brain damage/seizures can occur. 24

b.Actual Nursing Management Priority number 1 S Sa wala pa na admit akong anak, ge ubo na siya as verbalized by thepatients mother O Productive cough Inability to expectorate secretions Restlessness A Ineffective Airway Clearance related to productive cough P Short Term: At the end of 8 hours, the patient will be able to maintain airwaypatency. I 1. Elevated head of the bed by putting pillow under the head/changedposition frequently. To enhance drainage and ventilation to different lungsegments 2. Monitored infant for feeding intolerance, abdominal distention andemotional stress. May compromise airway.3.Encouraged mother to hydrate infant frequently. To loosen the secretions4.Positioned appropriately and discouraged use of oilbased productsaround the nose. To prevent vomiting with aspiration to lungsDependent:5 . A d m i n i s t e r e d A m b r o x o l as prescribed. To loosen the secretions E The goal has been met; the patient was able to maintain airway patency. Priority number 2 25

S Nangluspad naman gud akong anak tungod kai daghan na siya nasuka uggekalibang as verbalized by the patients mother O Cool extremities Sunken eyes Dry skin Watery stool Persistent vomiting Weight (Before = 7 kgs; Now = 6.5 kgs) A Fluid volume deficit related to excessive losses through GI tract secondary todiarrhea P Short term: At the end of 8 hours, the patient will be able to restore fluid andelectrolyte imbalances I Encouraged the mother to give oral fluid intake. To increase fluid intake2 . M o n i t o r e d i n t a k e a n d o u t p u t b a l a n c e . To ensure accurate picture of fluid status3.Observed for excessively dry skin and mucous membranes, decreasedskin turgor, slowed capillary refill. Indicates excessive fluid loss/resultant dehydration 4. Weighed daily Indicator of overall fluid and nutritional status 5. Monitored vital signs To note the changes in heart rate and respirationDependent:6.Provided supplement fluids as indicated D5LR 500cc @ 28cc/hr Fluids may be given in this manner if patient is unable to takeoral fluid E Goal has been met; at the end of 8 hours, the patient was able to restore fluidand electrolyte imbalances Priority number 3

26 S Sakit kayo ang tiyan sa bata sig era siya hilak sa kasakit. Basa pa gyudiya tae ug sige na siya kalibang as verbalized by the patients mother O Hyperactive bowel sounds 3-5 loose liquid stools per day A Diarrhea related to irritation of the GI tract P Short Term: at the end of 8 hours, the patient will reestablish andmaintain normal pattern of bowel functioning. I 1. Weighed infants diaper. To determine the amount of output and fluid replacementneeds2.Encouraged oral fluid intake containing electrolytes. To maintain fluid and electrolyte balance3.Provided prompt diaper changes and gentle cleansing B e c a u s e , s k i n b r e a k d o w n c a n o c c u r q u i c k l y w h e n diarrhea is present 4. Did auscultation of abdomen. To check for presence, location, and characteristics of bowel sounds.Dependent:5.Administered antidiarrheal medications as prescribed. To treat infectious process and decrease motility andminimize fluid losses E Goals were not metAt the end of 8 hours, the patient was unable to manifest signs of decrease fluid volume. IX.Referrals and Follow-up 27 Our further Inpatient care includes monitoring of changes in vital signs,assessment of effective n e s s o f t r e a t m e n t r e g i m e n , r e i n f o r c e m e n t o f d i e t a r y advice(At par with age regular diet), and the advice regarding the importance of adequate bed rest.Our further Outpatient care includes instructions of Mr.& Mrs.Inalen Matiasdietary modification of their son, compliance with treatment regimen, and parentsparticipation through reporting of

adverse effects of medications to his physician.The parent was also instructed to have a regular check-up at PGH Hospital with their son in order to monitor the current condition. X.Evaluation and Implications Within the span of 2 day of rendering care to Jhunienne Matias. I was able toidentify potential problems and specific nursing interventions were provided. With thehelp of health teachings and other interventions, Parents of Jhunienne Matias wereable to learn how to recognize signs and symptoms and other risk factors of thecondition of their son. The Parents of Jhunienne Matias was able to verbalized thei m p o r t a n c e o f g i v i n g m e d i c a t i o n s t o t h e i r s o n . T h e y h a d a l s o r e c o g n i z e d t h e importance of compliance to treatment regimen in order to manage the condition of their son, Jhunienne Matias