FAR EASTERN UNIVERSITY INSTITUTE OF NURSING

A CASE STUDY ON
ACUTE GASTROENTERITIS (AGE)

SUBMITTED BY: Noriel i. fabros Franchesca michaella s. llagas FE MARIE LIANA GONZALES

I. INTRODUCTION
Gastroenteritis is the infection or irritation of the digestive tract, particularly thestomach and the intestines. It is also known as gastric flu/ stomach flu, although it is notrelated to influenza. It is usually consist of mild to severe diarrhea that may beaccompanied by loss of appetite, nausea, vomiting, cramps and discomfort in theabdomen. Although Gastroenteritis usually is not serious for healthy adults, it can causelife-threatening dehydration and electrolyte imbalance in very ill, the very young and thevery old. (Merck Manual) Gastroenteritis is a very common disease; most people are at some risk toencounter the widespread causes (mainly viral and bacterial). This risk is due to poor hygiene of a few people with the disease that may be encountered frequently in dailyliving (for example, infants, children, or some food handlers). Some people have higher risk for infection; for example, individuals on cruise ships or those that live or work incrowded conditions like child care centers, dorms, or barracks, because of the higher chance that an infected person will come in contact with many other people, and rapidlyspread the causative agent. ( www.medicinenet.com )

II. NURSING HISTORY A. BIOGRAPHIC DATA

NAME: Christian Paul Manic ADDRESS: 5C Santos Balong-Bato, San Juan AGE: 6 years old GENDER: Male DATE OF BIRTH: April 14, 2005 PLACE OF BIRTH: San Juan Medical Center NATIONALITY: Filipino ETHNIC GROUP: none PRIMARY LANGUAGE: Tagalog, Ilokano MARITAL STATUS: n/a EDUCATIONAL: Grade 1 OCCUPATION: Student RELIGIOUS ORIENTATION: Catholic HEALTH CARE FINANCING: From their monthly income INCOME: work- 9,000; no work- from grandmother (father side)

III. Nursing History B. PAST HEALTH HISTORY

The childs immunization is complete. Last year, he has been hospitalized once because of Asthma. He was prescribed to take Salbutamol for his medication. Mrs. Manic explains that whenever she gives Salbutamol to her child, his condition aggravates. She stops giving Salbutamol and decided to go to Health Center. She asked the Barangay Health worker to nebulize her child every time his Asthma aggravates. The child is allergic to chicken, egg, dust, pollens, molds, and latex. They always ask the doctors prescription for any other medications. No foreign travel.

C. HISTORY OF PRESENT ILLNESS

History revealed that two days before the interview, the child had acute gastroenteritis and experienced diarrhea. The childs stool was soft and experienced abdominal cramps

D. FAMILY HISTORY OF ILLNESS

They have history of Asthma on the mother side.

IV. FUNCTIONAL HEALTH PATTERNS E. HEALTH PERCEPTION AND HEALTH MANAGEMENT PATTERN
The mother considers the patients health so important. She assures that her child receives enough nutrition and is alert to any abnormal condition his son is experiencing. Whenever her son has cough, she gives him home remedies in which if does not alleviate makes her decide to bring him on health center. She ensures that she is focused on her childs health.

Analysis: Health is the general condition of a person in all aspects. It is also a level of functional and/or metabolic efficiency of an organism, often implicitly human. WHO (1986) Concepts of Health Behavior Research, Reg. Health Paper No.13, SEARO, New Delhi. Interpretation: Since the client is in good condition, the client is within normal. E. NUTRITIONAL AND METABOLIC PATTERN
The child used to eat foods with soup like sinigang na baboy, tinolang manok. He is not fund of eating vegetables and often eat junk foods and noodles like pancit canton and lucky me. He drinks bear brand Choc, sometimes coffee; every morning. At home, he eats with his family and at school, with his classmates. The child dont feel any discomforts when eating and lost weight because of AGE. In terms of dental condition, he has complete teeth and has eight dental carries. His mother that his child seldom brushes his teeth, usually once a day or sometimes he doesnt brush at all.

Analysis: Nutrition describes the processes by which all of the food a person eats are taken in and the nutrients that the body needs are absorbed. Good nutrition can help prevent disease and promote health. Adults who are physically active and who strength train or pursue athletic activities will have different nutrition needs than typical adults of the same age. Dietary Guidelines for Americans 2005.Washington, D.C.: U.S. Department of Health and Human Services, U.S. Department of Agriculture, 2005. Interpretation: the client food intake is not balance, which makes his nutrition not normal. F. ELIMINATION PATTERN
The child eliminates normally, usually 2-3 times a day. The consistency is good and the color is brown. No feeling of discomforts and pain. The mother verbalized that her child had diarrhea last week, which causes changes on the bowel elimination pattern. The child eliminates very often, the stool is yellowish, soft, watery and bubbly. There is inconsistency upon defecation, very much discomfort and pain. In terms urination, he usually urinates four times a day, yellowish in color, aromatic, and no feeling of discomfort and pain. The child used to play basketball that causes excessive perspiration and odor problems.

Analysis: Urinary elimination and elimination of the waste products of digestion from the body is essentials to health, voiding can be postponed for only so long before the urge normally becomes to great to control. The normal color of urine is straw, amber or transparent. The volume ranges from 250-450 ml. ( Fundamental of Nursing Vol. 2 by Kozier and Erbs 2008, page 1285, 1293)
Defecation is the expulsion of feces from the anus and rectum. The frequency of defecation is highly individual, varying from several times per day 2 3times per week. The color of thestool in adult is brown, The consistency is either formed, soft, moist and semisolid. It is cylindrical in shape. The amount varies in the clients diet and aromatic in odor.( Fundamentals of Nursing Vol 2 by Kozier and erbs 2008 page 1325) Interpretation: the clients elimination pattern is normal

G. ACTIVITY AND EXERCISE PATTERN

Every morning, usually when schooldays, they walk their way to school. He usually plays outside their house after classes, usually 4-5 hours. He plays basketball very often, usually after classes and weekends. Analysis: Exercise is essential for maintaining mental and physical health( Fundamentals of nursing by Kozier and Erbs vol 2 page 1113)

Interpretation: The client has good activity and exercise pattern. H. SLEEP AND REST PATTERN
The client usually sleeps from 8:00 pm to 7:00 am, when he doesnt have classes, and he sleeps from 8:00 pm up to 5:30 am when he have classes. The client verbalized that he feels refreshed when he wake up and doesnt have any problem with the environment. He seldom takes a nap and when he does, its usually in the afternoon. ANALYSIS: The school age child (5 to 12 years) needs 10-11 hours of sleep, but most receive less because of increasing demands( e.g. homework, sports, social activities). They may al o s spending more time at the computer and watching TV. Some may drinking caffeinated beverages. All of these activities can lead to difficulty of falling asleep and fewer hours of sleep. ( Fundamentals of Nursing Vol 2 Kozier and erbs page 1167-68) Interpretation: the client has normal sleeping pattern.

I. COGNITIVE-PERCEPTUAL PATTERN
The client can read and write, he doesnt have difficulty in auditory and vision. The client is not wearing eyeglasses. For him, the easiest way to learn things is to read, write and listen. He doesnt have any problems with speaking but he has difficulty in reading English words. There are no changes in olfactory and taste. Analysis: The ages 7-11 mark the phase of concrete operations. During this stage the child changes from egocentric operations to cooperative interactions to cooperative interactions. (Fundamentals Of Nursing 7th edition vol. 1 by Kozier page382)

Interpretation: the client is in normal condition.

J. ROLE AND RELATIONSHIP PATTERN

According to the mother, he is a very active child and does not cry easily. He recognizes the people around him and play with them. He has a younger brother and they kept on playing with each other when he was around. He can cope easily with other person.

Analysis: The effectiveness of family communication determines the familysability to function as a cooperative, growth-producing unit. The information transmitted influences how members work together, fulfil their assigned roles in the family, incorporate family values, and develop skills to function in society. (Kozier, B. Fundamentals of nursing. 8th edition, Vol.I, p.429,534) Interpretation: The client has a good social interaction. K. SEXUALITY AND REPRODUCTIVE PATTERN
Prior to his age, the patient is not yet oriented with any sexual matters. According to his mother, he has not yet circumcised.

L. COPING AND STRESS TOLERANCE PATTERN

The child is not easily irritated and he is a jolly kid. He is fond of playing with people around him. He said that one of the stressful events for him was to play outside the house. He reduces his stress by entertaining himself with the different things around him. Analysis: Stress can have physical, emotional, intellectual, social, and spiritual consequences. Physically, stress can threaten a persons physiologic homeostasis. Emotionally, stress can produce negative or nonconstructive feelings about the self. Intellectually, stress can influence a persons perceptual and problem-solving abilities. Socially, stress can alter a persons relationship with others. Spiritually, stress can challenge ones beliefs and values. When a person faces stressors, responses are referred to as coping strategies, r esponses or mechanisms. Coping is the cognitive and behavioral effort to manage specific external and/or internal demands that are appraised as taxing or exceeding the resource of the person. (Kozier, B. Fundamentals of nursing. 8th edition, Vol.II, p.1061)

Interpretation: the client has normal coping pattern M. SELF-PERCEPTION AND SELF-CONCEPT PATTERN
According to the mother hes a good son though sometimes he tends to disobey his parents. Her mother said this is normal for his age.

Analysis:Self-concept is ones mental image of oneself. A positive self-concept is essential to a persons mental and physical health. Individuals with a positive selfconcept are better able to develop and maintain interpersonal relationships and resist psychologic and physical illness. An individual possessing a strong self-concept should be better able to accept or adapt to changes that may occur over the life-span (Kozier, B. Fundamentals of nursing. 8 th edition, Vol.II, p.1003) Interpretation: the clients condition does not affect his self concept.

N. VALUE AND BELIEF PATTERN

He is a Roman Catholic. They attend mass regularly. He afraid to do bad because he believes that God will punish him. something

Analysis: According to Fowler, the school age child is at stage 2 in spiritual development, the mythical literal stage. Children learn to distinguish fantasy from fact. Spiritual facts are those beliefs that are accepted by a religious group, whereas fantasy is thoughts and images formed in childs mind. Interpretation: the child has good spiritual development, he thinks god as an old man who punishes when behavior does not meet his standards.

V. PHYSICAL ASSESSMENT

FINDINGS

NORMS

ANALYSIS AND INTERPRETATION

Height Weight BMI Temperature Pulse rate Respiratory rate B. P.

112.5 cm 18 kg 14.32 36.9 degrees C 98bpm 21cpm Not assessed 37-37.6 degrees C 75-120bpm 25-30cpm Normal Normal Normal

GENERAL SURVEY Body Parts Assessed Body built height and weight in relation to the client s age, health and lifestyle. Client s posture and gait, standing, sitting, and walking Client s overall hygiene and grooming Norms & Standards Proportionate, varies with lifestyle Proportionate Actual Finding Analysis Normal

Spinal Curvature posture coordinated movement Clean, neat

Spinal Curvature posture coordinated movement unclean, he s wearing t shirt and short, hands are visibly dirty.

Normal

Hygiene is a highly personal matter determined by individual values and practices. It involves care of the skin, hair, nails, ears, eyes, nose and teeth.

Body breath and odor

No body odor or minor body odor relative to work or exercise; No breath odor

No body odor relative to immobilization; presence of breath odor. No distress noted

Normal

Signs of distress, in posture of facial expression Signs of health or illness Client s attitude Client s affect mood; Appropriateness of client s response Quantity and quality of speech Relevance and organization of thought

No distress noted

Normal

Healthy appearance Cooperative Appropriate to situation

Healthy appearance He s cooperative. His mood and responses is appropriate to the situation. He has a moderate tone of voice. Organization of thought has sense.

Normal Normal

Normal

Understandable, moderate pace; exhibits thought association Logical sequence; makes sense; has sense or reality

Normal

Normal

HEAD Body Parts Assessed Skull size, shape or symmetry Actual Finding SKULL Rounded (normocephalic Rounded ( normocephalic and symmetrical, with and symmetrical, with frontal, parietal, occipital frontal, parietal, occipital prominences; smooth skull prominences and has contour smooth skull contour Smooth, uniform consistency; Uniform consistency, Absence of nodules or absence of nodule and masses masses SCALP Hair is evenly distributed; Evenly distributed no lighter than the skin color; dandruff. no dandruff. No tenderness No tenderness HAIR Evenly distributed hair; Evenly distributed hair; black in color, thick hair no thick hair, black in color, lice and nits. no lice and nits. silky, resilient hair Silky hair FACE Symmetrical or slightly Symmetrical or slightly asymmetrical facial features; asymmetrical facial palpebral fissures equal in features; palpebral fissures Norms & Standards Analysis

Normal

Nodules, masses and depressions

Normal

Color and appearance

Normal

Areas of tenderness Evenness of growth, thickness or thinness texture and oiliness over the scalp Facial features, symmetry of facial movements

Normal Normal

Normal

Normal

size; symmetric nasolabial folds; symmetric facial movements

equal in size; symmetric nasolabial folds; symmetric facial movements

Body Parts Assessed Hair distribution, alignment, skin and quality movement Hair distribution and direction of curl Surface characteristics, position in relation to the cornea, ability to blink and frequency of blinking

Color, texture, and presence f lesions in bulbar conjunctiva Color, texture, and presence of lesions in palpebral conjunctiva Color and clarity

EYES Norms & Standards Actual Finding EYEBROWS Hair evenly distributed; skin Hair evenly distributed, intact; symmetrically symmetrically aligned, aligned; equal movement equal movement EYELASHES Equally distributed; curled Equally distributed curled slightly outward slightly outward EYELIDS Skin intact; no discharge; no Skin intact with no discoloration; lids close discharge , no symmetrically; discoloration, lids close Approximately 15-20 blinks symmetrically; per minute; bilateral 18 blinks per minute; blinking; when lids are bilateral blinking; when open, no visible sclera above lids are open, no visible corneas, and upper and sclera above corneas, and lower borders of corneas upper and lower borders of areas are slightly covered corneas areas are slightly covered CONJUNCTIVA Transparent; capillaries Transparent, sclera appears sometimes evident, sclera white appears white (yellowish in dark skinned clients) Shiny, smooth, and pink or Shiny, smooth, and pink in red color SCLERA Sclera appears white.

Analysis

Normal

Normal

Normal

Normal

Normal

White

Normal

Clarity and texture

Shape and color

Color, shape and symmetry of size

Light reaction and accommodation

CORNEA Transparent, shiny and smooth; details of the iris Visible clear covering; are visible. In older people, details of the iris are a thin, grayish white ring slightly visible. around the margin, called senilis, may be evident IRIS Round and flat Round and flat, brown iris, there is a clear covering PUPILS Black in color; equal in size; Black in color, normally 3-7 mm in approximately 5mm in diameter; round smooth diameter and equal in size border Illuminated pupil constricts Illuminated pupil (direct response); Nonconstricts (direct illuminated pupil constricts response); Non-illuminated (consensual response) ; pupil constricts Pupil constricts when (consensual response) ; looking at near object; Pupil constricts when

Normal

Normal

Normal

Normal

Near vision Distance vision

looking at near object; pupils dilate when looking at far object; pupil is converge when near object is moved toward nose VISUAL ACUITY Able to read newsprint held Able to read newsprint at distance of 36 cm (14 in) held at distance of 36 cm. 20/20 vision on snellen chart Not assessed

pupils dilate when looking at far object; pupil is converge when near object is moved toward nose

Normal -----

LACRIMAL GLAND, LACRIMAL SAC and NASOLACRIMAL DUCT Inspect and palpate No edema or tearing; No edema or tearing; No tenderness; no masses No tenderness; no masses

Normal

Alignment and coordination of both eyes Peripheral fields

EXTRAOCULAR MUSCLES Both eyes coordinated move Both eyes coordinated in unison, with parallel move in unison, with alignment parallel alignment VISUAL FILEDS Client can see the object to Client can see the object to the periphery the periphery

Normal

Normal

Body Parts Assessed Color, symmetry and position

Texture, elasticity and areas for tenderness

EARS Norms & Standards Actual Finding AURICLES Color same as facial skin; Color same as facial skin; symmetrical; Auricle symmetrical; Auricle aligned other cantus of the aligned other cantus of the eye, about 10 from vertical eye Mobile, firm and not tender; Mobile, firm and not pinna recoils after it is tender; pinna recoils after folded it is folded

Analysis

Normal

Normal

Presence of cerumen, skin lesions, pus and blood

Response to normal voice tones Watch tick test Webers test

Rinne Test

EXTERNAL EAR CANAL Distal third contains hair There is a presence of dry follicles and glands; dry cerumen. Color yellow cerumen, grayish-tan in color, or sticky, wet cerumen on various shades of brown HEARING ACUITY TEST Audible to normal voice Audible to normal voice tones tones Able to hear the ticking both Able to hear the ticking ears both ears Sound is heard in both ears Sound is heard in both ears or localized at the center of or localized at the center of the head (Weber negative) the head (Weber negative) Air conducted (AC) hearing Air conducted (AC) is greater than bonehearing is greater than conducted (BC) hearing, bone-conducted (BC) (Rinne Positive) hearing, (Rinne Positive)

Normal

Normal Normal

Normal

Normal

NOSE

Body Parts Assessed Deviations in shape, size, or color, and flaring or discharge from snares

Norms & Standards Symmetric and straight; no discharge or flaring; uniform color

Presence of redness, swelling, growths and discharge in the nasal cavities Nasal septum between nasal chambers Patency of both nasal cavities Tenderness, masses displacements of bone and cartilage Locate/plapate/identify the sinuses and note for tenderness

Mucosa is pink; Clear watery discharge; No lesion Nasal septum is intact and in midline Air moves freely as the client breathes through the nares No tenderness; No lesion

Actual Finding Symmetric in shape, straight;has uniformity in color; any discharge has not been assessed because of discomfort it may give to the patient. There is clear watery discharge with no lesion

Analysis Normal

Normal

Nasal septum is intact and in midline Air moves freely as the client breathes through the nares There is no tenderness and lesion. There is no tenderness in the sinuses.

Normal Normal

Normal

No tenderness in frontal and maxillary sinuses

Normal

Body Parts Assessed Symmetry of contour, color and texture

MOUTH Norms & Standards Actual Finding LIPS Uniform pink color; soft; Uniform pink color; soft; moisturized; able to purse moist. lips

Analysis Normal

Color, moisture, texture and presence of lesions

MUCOSA Uniform pink color ( Uniform pink in color, freckled brown moist, smooth, soft and pigmentation in darkelastic texture. skinned clients); moist, smooth, soft, glistening and elastic texture (drier buccal mucosa on elderly is due to decreased salivation)

Normal

TEETH The brownish discoloration in the teeth is due to lack of oral hygiene.

Color, number and condition; presence of dentures Color and condition

24 teeth; smooth, white, 24 teeth ; brown shiny tooth enamel; smooth discoloration of the and intact dentures enamel; 8 dental carries. GUMS Pink gums (bluish or dark Pink gums, no presence of patches in dark skinned retraction. clients) ; No retraction of gums (pulling away from the teeth)

Normal

Color and texture of the mouth floor and frenulum Position, color, texture, movement and base of the tongue

FRENULUM and UVULA Smooth tongue base with Smooth tongue base with prominent veins prominent veins

Normal

Nodules, lumps or any excoriated areas Color, shape, texture and the presence of bony prominences Position of the uvula and mobility while examining the palate Color and texture

Central position; pink in color (some brown pigmentation on tongue borders in dark skinned clients); moist; slightly rough, thin whitish coating; smooth. lateral margins; no lesions; raised papillae; moves freely; no tenderness Smooth with no palpable nodules Light pink smooth soft palate; lighter pink hard palate; more regular texture Positioned in the midline of the soft palate

Central position; pink in color, thin whitish coating; smooth. lateral margins; no lesions; raised papillae; moves freely; no tenderness.

Normal

Not assessed Not assessed

-----

----Positioned in the midline of the soft palate

Normal

Size of the tonsil, color and discharge

TONSIL Pink in color and smooth posterior wall Pink in color and smooth posterior wall Pink and smooth; No discharge; No deviation Pink and smooth; No from normal size discharge; No deviation from normal size

Normal

Normal

INTEGUMENTARY Body Parts Assessed Norms & Standards SKIN Skin Color; uniformity of color Varies to light to deep brown; from ruddy pink to light pink; from yellow over tones to olive. Generally uniform except in areas exposed to the sun; areas of lighter pigmentations(palms, lips, nail beds) in dark skinned people Presence of edema Lesions according to location, distribution, color, configuration, size, shape, type or No edema Freckles, some birthmarks, some flat and raised nevi; no abrasions or other No edema Actual Finding Analysis

Deep Brown skin color Normal

Normal

There is presence of nevi and lesions.

Skin lesions are due to trauma and infection

structure

lesions

due to initial response to some changes in the external and internal environment. (Kozier and Erbs. Fundamentals of Nursing pg 566)

Skin moisture

Moisture is skin folds and the axillae

Excessive dryness

In AGE the hallmark symptoms are nausea, vomiting, and diarrhea which leads to dehydration. (www.WD.com) Normal

Skin temperature

Uniform, within normal range When pinched, skin springs back to previous state

Uniform, within normal range Skin moves back slowly

Skin turgor

NAILS Fingernail plate shape to determine its curvature and angle Convex curvature; angle of nail plate about 160 Concave curvature and angle of nail plate is about 160. Normal

Fingernail and toenail bed color

Highly vascular and pink in light skinned clients; dark skinned client may have brown or black pigmentation in longitudinal streaks Smooth texture

Jaundiced color of the fingernails Normal

Fingernail and toenail texture Tissues surrounding nails Blanch test of capillary refill

Smooth texture

Normal

Intact epidermis Prompt return of pink or usual color (generally less than 4 seconds)

Intact epidermis Prompt return of pink or usual color (generally less than 4 seconds)

Normal Normal

Body Parts Assessed Locate/palpate/identify lymph nodes and note for tenderness Placement

NECK and LYMPH NODES Norms & Standards Actual Finding LYMPH NODES Not palpable Not palpable TRACHEA Central placement in midline of the neck; spaces are equal on both

Analysis

Normal Not assessed ----

Symmetry and visible masses

Smoothness and areas of enlargement, masses or nodules

spaces THYROID GLAND Not visible on inspection; Not assessed Thyroid ascends upon swallowing Lobes may not be palpated; If palpated, Not assessed lobes are small, smooth, centrally located, painless and rise freely with swallowing THORAX Norms & Standards Actual Finding POSTERIOR THORAX Anteroposterior to Not assessed transverse diameter in ratio of 1:2; Symmetric chest Spine vertically aligned Uniform skin temperature; skin intact; No tenderness; No masses full and symmetric chest expansion Bilateral symmetry of vocal fremitus; Fremitus is heard most clearly in the apex of the lungs Percussion notes resonate except over the scapula; Lowest point of resonance is at the diaphragm Vesicular and bronchovesicular breath sounds Not assessed Not assessed

----

----

Body Parts Assessed Size, shape, symmetry, and compare the diameter of the anteroposterior thorax to transverse diameter; skin color Spinal alignment Temperature, tenderness and masses

Analysis ----

-------

Respiratory excursion Vocal fremitus

Percuss the posterior thorax

full and symmetric chest expansion Bilateral symmetry of vocal fremitus; Fremitus is heard most clearly in the apex of the lungs Not assessed

Normal ----

----

Auscultate the posterior thorax

Presence of adventitious breath sounds( wheezes).

Asthma involves a process that produce mucosal edema, mucus secretion and airway inflammation, when people with asthma are exposed to extrinsic allergens and irritants, their airways become inflamed which causes wheezing initial clinical manifestation. ( Medical Surgical Nursing Vol. 2 8 th Edition

Breathing Pattern

ANTERIOR THORAX quiet, rhythmic and quiet, rhythmic and effortless respirations effortless respirations uniform skin temperature; skin intact No tenderness; no masses full and symmetric chest expansion uniform skin temperature, skin intact No tenderness and masses full and symmetric chest expansion

Normal Normal

Temperature, tenderness, and masses

Respiratory excursion

Normal

Vocal fremitus

Percuss the anterior thorax

Auscultate the trachea Auscultate the anterior thorax

Bilateral symmetry of vocal fremitus; Fremitus is heard most clearly in the apex of the lungs Percussion notes resonate down to the sixth rib at the level of the diaphragm but are flat over areas of heavy muscle and bone, dull on areas over heart and the liver, and tympanic over the underlying stomach Bronchial breath sounds Bronchovesicular and vesicular breath sounds

Not assessed

-----

Not assessed

-----

Not assessed Presence of adventitious breath sounds ( wheezes).

----Asthma involves a process that produce mucosal edema, mucus secretion and airway inflammation, when people with asthma are exposed to extrinsic allergens and irritants, their airways become inflamed which causes wheezing initial clinical manifestation. ( Medical Surgical Nursing Vol. 2, 8 th Edition)

Body Parts Assessed Aortic and pulmonic areas Tricuspud area Apical area

CARDIOVASCULAR Norms & Standards Actual Finding No pulsations No pulsations No pulsations Pulsation visible to 50% of adults and palpable in most PMI in 5th LICS at or medial to MCL Diameter of 1-2 cm; No lift or heave S1: usually heard at all sight, usually louder at the apical area S2: usually heard at all sites, usually louder at the base of the heart Systole: silent interval; slightly shorter duration than the diastole at no deviation from normal heart rate (6090 bpm) Diastole: silent interval; slightly longer interval than systole at no deviation from normal heart rate S3: in children and young No pulsations Not assessed

Analysis Normal Normal

-----

Auscultate the aortic, pulmonic, tricuspid and apical valves

Not assessed

-----

Palpate carotid artery with extreme caution

Auscultate the carotid arteries Jugular veins

adults S4: in many other adults CAROTID ARTERIES Symmetric pulse volumes; Not assessed Full pulsations, thrusting quality; quality remains same when client breathes, turns head, and changes from sitting to supine position; elastic arterial wall no sound heard on Not assessed auscultation JUGULAR VEINS Veins not visible (indicating Veins not visible right side of the heart is functioning normally)

----

-----

Normal

Body Parts Assessed Size, symmetry, contour or shape

Skin of breast for localized discoloration or hyperpigmentation, retraction, dimpling, localized hypervascular areas, swelling or edema

Areola area for size, shape, symmetry, color, surface, characteristics and any mass or lesions

Nipples for size, shape, position, color, discharge, and lesions

BREAST and AXILLAE Norms & Standards Actual Finding Females: rounded in Breast even in chest wall shape; slightly unequal in size; generally symmetric Males: breasts even in chest wall; if obese, maybe similar in shape to female breasts Uniform skin color (same Uniform skin color ,skin appearance as skin of is smooth, intact abdomen and back); skin smooth, intact; diffuse symmetric horizontal or vertical vascular pattern in light skinned people; striae (stretch marks); moles and nevi Round or oval and Round and bilaterally the bilaterally the same; colors same; color is light varies widely from light brown irregular pink to dark brown; placements of sebaceous irregular placements of glands on the surface of sebaceous glands on the the areola surface of the areola (Montgomerys (Montgomerys tubercles) tubercles) Round, everted, and equal Round, everted, and in size; similar in color; equal in size, similar in sof and smooth; both color soft and smooth, nipples point same both nipples point same direction direction

Analysis

Normal

Normal

Normal

Normal

Body Parts Assessed Skin integrity

Abdominal contour

ABDOMEN Norms & Standards Actual Finding Unblemished skin; uniform Uniform skin color skin color; silver-white striae or surgical scars Flat, rounded (convex), or Distended scaphoid

Analysis Normal

It is one of the symptoms in

Enlarge liver or spleen

Symmetry of contour Auscultate abdomen for bowel sounds, vascular sounds and peritoneal friction rubs

No evidence of enlargement of liver and spleen Symmetric contour Audible bowel sounds; absence of arterial bruits, absence of friction rubs

Not assessed

AGE. (www. WD.com) Normal

Symmetric contour There is a borborygmy sound.

Normal It is one of the clinical manifestation in AGE, it may occur from gas released from undigested food, irritation of bowel mucosa and distension of the intestines ( Medical and Surgical Nursing,Black pg810)

Percuss several areas in each of four quadrants

Light palpation followed by deep palpation of all four quadrant

Tympanic over the stomach and gas-filled bowels; dullness, especially over the liver and spleen or a full bladder No tenderness; relaxed abdomen with smooth, consistent tension; tenderness maybe present near xiphoid process; over cecum and other sigmoid colon

Not assessed -----

There is epigastric tenderness.

It is one of the clinical manifestation in AGE, it may occur from gas released from undigested food, irritation of bowel mucosa and distension of the intestines ( Medical and Surgical Nursing,Black pg810)

VI. Ecologic Model

Man

Disease Agent (Bacteria)

Environment (water)

Analysis
 The agent-host-environment model is primarily use in predicting illness rather than promoting wellness, identification of risk factors that result from the interactions of agent, host, and environment are helpful in promoting and maintaining health because each of the agent-host-environment factors constantly interacts with others. Health is an ever changing state. Health is seen when all three elements are in balance while illness is seen when one, two, or all three elements are not in balance
y

Agent- a factor (biologic, chemical, physical, mechanical, psychosocial) that must be present or absent for an illness to occur. In our patients case his exposure to bacteria was considered as the agent of his disease. Host - living beings (e.g., human or animal) capable of being infected or affected by the agent. Christian Manic 6 years old was the host because he was the one who was infected with the disease that was possibly caused by the agent. Environment everything external to the host that makes illness more or less likely. The patient was exposed to different bacteria when their community was being flooded. As been said by his mother all of the other children have been affected by AGE after the flood has subsided.

VII. ANAT

AND PHYSIOLOGY

THE DIGESTIVE SYSTE

Every morsel of food we eat has to be broken down into nutrients that can be absorbed by the body, which is why it takes hours to fully di est food. In humans, protein must be broken down into amino acids, starches into simple sugars, and fats into fatty acids and glycerol. The water in our food and drink is also absorbed into the bloodstream to provide the body with the fluid it needs. The digestive system is made up of the ali ary canal and the other abdominal organs that play a part in digestion, such as the liver and pancreas. The alimentary canal (also i tract) is the long tube of organs including the esophagus, the stomach, called the i and the intestines that runs from the mouth to the anus. An adult's digestive tract is about 30 feet long. Digestion begins in the mouth, well before food reaches the stomach. When we see, smell, taste, or even imagine a tasty snack, our sali ary glands, which are located under the tongue and near the lower jaw, begin producing saliva. This flow of saliva is set in motion by a brain reflex that's triggered when we sense food or even think about eating. In response to this sensory stimulation, the brain sends impulses through the nerves that control the salivary glands, telling them to prepare for a meal.

As the teeth tear and chop the food, saliva moistens it for easy swallowing. A digestive enzyme called amylase, which is found in saliva, starts to break down some of the carbohydrates (starches and sugars) in the food even before it leaves the mouth. Swallowing, which is accomplished by muscle movements in the tongue and mouth, moves the food into the throat, or pharynx. The pharynx (pronounced: fair-inks), a passageway for food and air, is about 5 inches long. A flexible flap of tissue called the epiglottis reflexively closes over the windpipe when we swallow to prevent choking. From the throat, food travels down a muscular tube in the chest called the esophagus. Waves of muscle contractions called peristalsis force food down through the esophagus to the stomach. A person normally isn t aware of the movements of the esophagus, stomach, and intestine that take place as food passes through the digestive tract. At the end of the esophagus, a muscular ring called a sphincter allows food to enter the stomach and then squeezes shut to keep food or fluid from flowing back up into the esophagus. The stomach muscles churn and mix the food with acids and enzymes, breaking it into much smaller, more digestible pieces. An acidic environment is needed for the digestion that takes place in the stomach. Glands in the stomach lining produce about 3 quarts of these digestive juices each day. Most substances in the food we eat need further digestion and must travel into the intestine before being absorbed. When it s empty, an adult s stomach has a volume of one fifth of a cup, but it can expand to hold more than 8 cups of food after a large meal. By the time food is ready to leave the stomach, it has been processed into a thick liquid called chyme. A walnut-sized muscular tube at the outlet of the stomach called the pylorus keeps chyme in the stomach until it reaches the right consistency to pass into the small intestine. Chyme is then squirted down into the small intestine, where digestion of food continues so the body can absorb the nutrients into the bloodstream. The small intestine is made up of three parts: 1. the duodenum, the C-shaped first part 2. the jejunum, the coiled midsection 3. the ileum, the final section that leads into the large intestine The inner wall of the small intestine is covered with millions of microscopic, finger-like projections called villi. The villi are the vehicles through which nutrients can be absorbed into the body. The liver (located under the ribcage in the right upper part of the abdomen), the gallbladder (hidden just below the liver), and the pancreas (beneath the stomach) are not part of the alimentary canal, but these organs are still important for healthy digestion. The pancreas produces enzymes that help digest proteins, fats, and carbohydrates. It also makes a substance that neutralizes stomach acid. The liver produces bile, which helps the body absorb fat. Bile is stored in the gallbladder until it is needed. These enzymes and bile travel through special channels (called ducts) directly into the small intestine, where they help to break down food. The liver also plays a major role in the handling and processing of nutrients. These nutrients are carried to the liver in the blood from the small intestine.

From the small intestine, food that has not been digested (and some water) travels to the large intestine through a valve that prevents food from returning to the small intestine. By the time food reaches the large intestine, the work of absorbing nutrients is nearly finished. The large intestine s main function is to remove water from the undigested matter and form solid waste that can be excreted. The large intestine is made up of three parts: 1. The cecum is a pouch at the beginning of the large intestine that joins the small intestine to the large intestine. This transition area allows food to travel from the small intestine to the large intestine. The appendix, a small, hollow, finger-like pouch, hangs off the cecum. Doctors believe the appendix is left over from a previous time in human evolution. It no longer appears to be useful to the digestive process. 2. The colon extends from the cecum up the right side of the abdomen, across the upper abdomen, and then down the left side of the abdomen, finally connecting to the rectum. The colon has three parts: the ascending colon and transverse colon, which absorb water and salts, and the descending colon, which holds the resulting waste. Bacteria in the colon help to digest the remaining food products. 3. The rectum is where feces are stored until they leave the digestive system through the anus as a bowel movement.