IV.

ACTIVITIES OF DAILY LIVING

Activities Before Hospitalization During Hospitalization Interpretation Nursing Responsibilities

NUTRITION  The patient usually eats  The patient was advice not NORMAL
vegetables. to eat foods that are dark in
Weight: 67.5
Height: 5’5”  He also eats pork and chicken. color.

BMI: 24.8  The patient drinks plenty

Category: Normal of water. Approximately

1-2 Liters of water.
 3-day diet recall (Before Hospitalization)
Fat Protein Carbs Calories
Breakfast:
1 cup of Coffee with Creamer 1.5g 0 5g 35
1 cup of rice 5g 6g 1g 68
5 pcs. Fried tuyo 1g 1g 3g 27

Lunch: 5g 4g 1g 36
½ cup of Pork Sinigang 5g 6g 1g 68
1 cup of rice 0 0 0 0
1 glass of water

Snacks:
1 cup of sopas 6g 12g 9g 156
1 glass of water 0 0 0 0

Dinner:
Pork Adobo 2g 4g -- 42
1 cup of rice 5g 6g 1g 68
1 glass of water 0 0 0 0

TOTAL KCAL 499

 3-day diet recall (Before Hospitalization)
Fat Protein Carbs Calories
Breakfast:
1 cup of Coffee with Creamer 1.5g 0 5g 35
1 cup of rice 5g 6g 1g 68
1 medium sized fried egg 5g 5g --- 78

Lunch: 0.9g 4.8g 19.4g 90

208g of cooked vegetables 5g 6g 1g 68
1 cup of rice 0 0 0 0
1 glass of water

Snacks:
100g Congee -- -- 30g 129
1 glass of water 0 0 0 0

Dinner:
Fried fish 1g 1g 1g 20
1 cup of rice 5g 6g 1g 68
1 glass of water 0 0 0 0

TOTAL KCAL 556

 3-day diet recall (Before Hospitalization)
Fat Protein Carbs Calories
Breakfast:
1 cup of Coffee with Creamer 1.5g 0 5g 35
1 cup of rice 5g 6g 1g 68
Omelette 12g 30g 10g 276

Lunch:
1 cup of rice 5g 6g 1g 68
1 glass of water 0 0 0 0
1 cup pinakbet -- 5g 21g 110

Snacks:
1 glass of water 0 0 0 0
Ginataang bilo-bilo 9g 2g 29g 204

Dinner:
1 cup of rice 5g 6g 1g 68
1 glass of water 0 0 0 0
Nilagang baboy 3g 3g 24g 140

TOTAL KCAL 969

 Activities Before Hospitalization During Hospitalization Interpretation Nursing Responsibilities
ELIMINATION  The patient usually  The patient urinates 6-8 times NORMAL
urinates 8 times a day. and defecates 1-2 times a day.
 He also defecates 2-4
times a day.
 Before admission, he was
having diarrhea. He
defecated 6 times.
 Shift INPUT OUTPUT Fluid Balance

Oral Parenteral Total Urine Drainage Total

NOVEMBER 22, 2019

6:00-2:00 ---- ---- ---- ---- ---- ----

2:00-10:00 600 1695 2295 1100 ---- 1100

10:00-6:00 800 1700 2500 900 ---- 900

TOTAL
4795 2000 +2795
INPUT/OUTPUT

NOVEMBER 27, 2019

6:00-2:00 600 600 1200 900 ---- 900

2:00-10:00 800 600 1400 1000 ---- 1000

10:00-6:00 500 600 1100 1300 ---- 1300

TOTAL
3700 3200 +500
INPUT/OUTPUT
EXERCISE  He considers playing basketball  The patient is not able to Leptospirosis  Encourage active ROM
and walking as his exercise. perform exercise. He doesn’t ↓ exercises. Encourage
 He also does house chores. have normal activity because Hospitalization the patient to participate
he only stays in bed. ↓ in planning activities
 He can stand and walk when Pain that gradually build
going to the comfort room. ↓ endurance.
Prolonged bed rest  Encourage physical
↓ activity consistent with
ACTIVITY the patient’s energy
INTOLORANCE levels.
 Have the patient
perform the activity
more slowly, in a longer
time with more rest or
pauses, or with
assistance if necessary.
 Encourage verbalization
of feelings regarding
limitations.
HYGIENE  The patient usually takes a bath  The patient is able to take a NORMAL
2-3 times a day. bath alone.
 He washes his face after waking  He brushes his teeth 1-2 times
up. a day.
 The patient brushes her teeth 2-  He changes his clothes when
3 times a day. he feels hot.
SLEEP AND  He sleeps 10-12 hours a day.  The patient has difficulty in Leptospirosis  Assess patient’s sleep
REST  During his rest, he is using his sleeping because he is not ↓ disturbances that are
cellphone. comfortable in the Hospitalization associated with the
 He also takes a nap 1-2 hours environment. ↓ environment.
daily. Difficulty sleeping  Help patient understand
↓ the main cause of
Uncomfortable environment sleeping difficulties.
↓  Render bedtime nursing
DISTRUBED SLEEPING care such as back rub
PATTERN and other relaxation
techniques.
SEXUAL  The patient has a live-in partner,  The patient doesn’t have Leptospirosis  Assess patient’s sexual
ACTIVITY and they are engaged in sexual sexual activity because his ↓ interest, desire, effect of
activity. partner is pregnant. Hospitalization health status on
↓ sexuality, and factors
Lack of privacy
  He is also staying in the ↓ affecting sexual
hospital for treatment of SEXUAL DYSFUNCTION function.
condition.  Involvement of partners
during the process of
coping with and treating
the dysfunction.
SUBSTANCE  The patient drinks alcoholic  The patient received Nausea and vomiting
USE beverages. He also smokes. medications such as ↓
Omeprazole, Potassium OMEPRAZOLE
Chloride, Paracetamol,
Penicillin, Magnesium Hypokalemia
Sulfate, Calcium Gluconate, ↓
Tramadol, Doxycycline. KCL
 IV Fluids: PNSS1L
Fever
↓
PARACETAMOL

Infection
↓
PENICILLIN
/DOXYCYCLINE
 Decreased magnesium
↓
MAGNESIUM SULFATE

Pain
↓
TRAMADOL