UNIVERSITY OF THE CORDILLERAS

College of Nursing
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(+6374) 442-3316, 442-2564, 442-8219, 442-8256
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A CASE OF MODERATE SIGNS OF DEHYDRATION SECONDARY TO VOMITING AND

SEVERE CHRONIC MALNUTRITION

A Case Presented to the

College of Nursing

In Partial Fulfillment of the requirements in the Course

Care of Mother, Newborn and Child at Risk or with Problems
NCM 109A

Submitted by:

AMOSLO, Kimberly T.
BANDAO, Marc Joseph T.
CHAN, Olivia B.
DE ASIS, Sheila Mae R.
DULNUAN, Jhane A.
DUMAG, Elaijah B.
GOYALA, Janella Hannes B.
ORPILLA, Allysa Megan D.
SORIANO, Edeniel
WAG-E, Dawnmurph Dharlene P.

Date: 26-04-2022
Noted and Approved for Presentation

Signature of Adviser/s / Date

ABSTRACT

A 1-year-old and 11-month-old girl with previous Complete Intestinal Obstruction Secondary to
Intestinal Malrotation with Volvulus, Adhesive Band Secondary to Meckel’s Diverticulum-Resolved; Acute
Surgical Abdomen Secondary to Multiple Ileal Perforations, Mesenteric Ischemia Secondary to Volvulus-
Resolve, wound dehiscence, Anastomotic Leak with the different procedures. A Jejunoileostomy was
performed, linking the jejunum to the ileum, to treat the intestinal obstruction. Other operations that were
ordered included Emergency exploratory laparotomy; adhesiolysis; double barrel jejunoileostomy; takedown
of jejunoileostomy; emergency wound suturing; Ex-lap segmental jejunoileal resection with double barrel
jejunoileostomy; Ex-lap Ladd's procedure; reduction of intestinal malrotation (counter-clockwise); removal of
adhesive band (ileocecal area); wedge resection of Meckel's diverticulum; appendectomy. 10 months after the
surgeries, the patient was admitted to Baguio General Hospital with an admitting diagnosis of vomiting with
moderate warning signs of dehydration and severe chronic malnutrition. WBC, eosinophils, and platelet counts
were above the normal range. She was ordered D5 LRS, multivitamins, ascorbic acid, vitamin B, probiotics,
zinc sulfate, vitamin D, and ondansetron to overall improve her nutrition. The patient made a rapid recovery
after being admitted to the hospital for 8 days. Her nutritional state improved, her symptoms resolved, and her
serum biochemistry normalized. She remains well at follow-up with normal blood results. This exploratory
case-based session centers on the clinical presentation and initial evaluation of a patient experiencing moderate
warning signs of dehydration and severe chronic malnutrition.

TITLE: A Case of Moderate Signs of Dehydration Secondary to Vomiting and Severe

Chronic Malnutrition

AUTHOR INFORMATION: Kimberly Amoslo, Marc Joseph Bandao, Olivia Chan,

Sheila De Asis, Jhane Dulnuan, Elaijah Dumag, Janella Hannes Goyala, Allysa Megan
Orpilla, Edeniel Soriano,Dawnmurph Dharlene Wag-e

BACKGROUND:
Dehydration is a condition that develops when the body loses too much water and other fluids
required for regular functioning (Shaheen, Alqahtani, Assiri, Alkhodair, & Hussein, 2018). Dehydration is
typically caused by severe diarrhea and vomiting, but it can also be caused by not drinking enough water or
other fluids, excessive perspiration, fever, excessive urination, or the use of certain medications. The process
of food dehydration involves the simultaneous transfer of mass and heat within the food and the medium used
to transfer energy to the food (Jayas, 2016). In food dehydration methods that supply energy to the food using
media other than hot air, air or some other gas may be required to move moisture away from the food.
The signs and symptoms include thirst, dry mouth, headache, weariness, dark-colored urine, peeing
less than usual, sunken eyes or cheeks, dry and chilly skin, dizziness, fainting, muscular cramps, fast pulse, and
quick breathing. It was claimed that dehydration contributes to both short and long-term health problems and
that drinking more water improves the ability to learn as “when we are thirsty, mental performance deteriorates
by 10%” (Benton, 2011).
Dehydration may be fatal, especially in small children and the elderly. Currently, up to 12,500 Filipino
children under the age of five may away from dehydration brought on by diarrhea every year. In the
Philippines, it is the fourth most common cause of newborn mortality and the main source of disease.
Malnutrition is characterized by an imbalance between the nutrients the body needs to operate and the
nutrients it receives. It can refer to either undernutrition or over nutrition. A person may be malnourished due
to a general lack of calories or they may be deficient in protein, vitamins, or minerals.
Stunting is the most common symptom as a proxy for chronic undernutrition; it is quantified as a
height- or length-for-age ratio. Other signs include cognitive dysfunction, impaired motor abilities, weakened
immunological function, and height deficiencies (Reinhardt & Franzo, 2014). Such symptoms can appear
during pregnancy and remain throughout the lifetime. Underlying causes of chronic malnutrition include
household food security, proper care, feeding habits, health care access, and living in a healthy environment.
The immediate causes are the consequences of the fundamental and underlying causes at the personal level,
such as insufficient food intake and sickness.
Globally, 45.4 million children under five were malnourished of which 13.6 million were severely
malnourished (UNICEF, 2023). This translates into a prevalence of 6.7% and 2.0%, respectively. About a third
(or 3.5 million) of Filipino children under five years old are stunted, 2 a marker of chronic malnutrition
(UNICEF, 2021). Although the Philippines is anticipated to become an upper-middle-income nation by 2023,
the prevalence of stunting remains equivalent to that of the world's poorest countries. Philippines ranks 69th
out of the 121 countries with data to calculate 2022 Global Hunger Index scores. With a score of 14.8,
Philippines has a level of hunger that is moderate (Global Hunger Index, 2022). Additionally, according to
DOH, at least 21.6% of infants and toddlers nationwide are stunted, 12.3% of children aged zero to 23 months
are underweight, while 7.2% of them are wasted.

CASE DESCRIPTION:
A 1-year-old female was presented to the emergency room with a history of Complete Intestinal
Obstruction Secondary to Intestinal Malrotation with Volvulus, Adhesive Band Secondary to Meckel’s
Diverticulum – resolved; Acute Surgical Abdomen Secondary to Multiple Ileal Perforations, Wound
Dehiscence; Anastomotic leak with the different procedures. The patient had a regular follow up check-up but
few hours upon consultation, she was rushed to the emergency due to 1 episode of vomiting ¼ cup previously
ingested food with decreased appetite and irritability and having the diagnosis of moderate signs of
dehydration secondary to vomiting and severe chronic malnutrition. Patient was noted to have dry lips, sunken
eyes, 3-4-sec skin turgor, dry skin, heart rate of 160 bpm, 4-sec capillary refill, respiratory rate of 45 cpm,
yellowish urine, poor appetite to ORS and milk, with abdominal pain. Her physical examination revealed a
temperature of 36.6℃, pulse rate of 160 beats/min, respiratory rate of 45 cpm and a weight of 5.2kg and 75 cm
in height. She appears to be weak, malaise, and requires full assistance when performing daily activities. The
baseline work up done had abnormal results; findings include an increase in WBC, eosinophils, and platelet
count levels. Other physical examination findings were unremarkable.
The patient was admitted to the pediatric ward and given intravenous hydration of 5% Dextrose in
Lactated Ringer’s Solution to increase intravascular fluid volume. Additionally, she was treated conservatively
with Ondansetron 0.8 mg intravenously PRN for nausea and vomiting, Probiotics 1 CAP to prevent and treat
antibiotic-associated diarrhea, and Zinc Sulfate 2 mL once a day. She was also given vitamins such as
Ascorbic Acid 2.5 mL, Vitamin B3, and Vitamin D. On the fifth day of admission; she was retained in the
hospital for monitoring and kept on heplock for her IV medications.

CONCLUSION:
The study highlights the progression of health in a patient who had Moderate Signs of Dehydration
Secondary to Vomiting and Severe Chronic Malnutrition. 10 months ago, the patient underwent surgeries such
as Emergency exploratory laparotomy, adhesiolysis, double barrel jejunoileostomy, takedown of
jejunoileostomy, emergency wound suturing, Ex-lap segmental jejunoileal resection with double barrel
jejunoileostomy, Ex-lap Ladd's procedure, reduction of intestinal malrotation (counter-clockwise), removal of
adhesive band (ileocecal area), wedge resection of Meckel's diverticulum, and an appendectomy. The patient
presented to the emergency room with symptoms of vomiting, dry lips, sunken eyes, dry skin, a heart rate of
160 bpm, respiratory rate of 45 cpm, yellowish urine, a poor appetite for ORS and milk, and abdominal pain.
The patient has undergone blood tests that confirmed her dehydration and malnutrition. She continued to
manifest the symptoms, then slightly recovered on the 8th day and remained under observation. The results of
the initial assessments were abnormal; they revealed an increase in the WBC, eosinophils, platelet count,
sodium, and potassium levels. Upon admission, the patient was given intravenous hydration of 5% Dextrose in
Lactated Ringer’s Solution. She was also treated with Ondansetron 0.8 mg intravenously, Probiotics 1 CAP,
and Zinc Sulfate 2 mL once a day. She was also given vitamins such as Ascorbic Acid 2.5 mL, Vitamin B3,
and Vitamin D. On the eight day of admission, she was given permission to be discharged from the hospital as
her blood tests showed improvements on her overall health.
 TABLE OF CONTENTS
I. Introduction ----------------------------------------------------------- 54
II. Statement of Objectives ----------------------------------------------------------- 65
A. General Objectives ----------------------------------------------------------- 65
----------------------------------------------------------- 6
B. Specific Objectives
5
III. Patient’s Profile ----------------------------------------------------------- 6
IV. Chief Complaint ----------------------------------------------------------- 76
V. Present History of Illness ----------------------------------------------------------- 76
VI. Past History of Illness ----------------------------------------------------------- 76
VII. Family Health History ----------------------------------------------------------- 77
VIII. Developmental History ----------------------------------------------------------- 77
IX. Social and Environmental -----------------------------------------------------------
87
History
X. Lifestyle and Health Practices ----------------------------------------------------------- 87
XI. Health Assessment ----------------------------------------------------------- 87
A. General Assessment ----------------------------------------------------------- 87
B. Head to Toe Assessment ----------------------------------------------------------- 98
C. 13 Areas of Assessment ----------------------------------------------------------- 109
XII. Diagnostics ----------------------------------------------------------- 142
XIII. Comprehensive Pathophysiology ----------------------------------------------------------- 186
XIV. Treatment/Management ----------------------------------------------------------- 197
----------------------------------------------------------- 20
A. Drugs
16
B. IV Fluids ----------------------------------------------------------- 24
C. Surgery ----------------------------------------------------------- 25
XV. Nursing Care Plans ----------------------------------------------------------- 26
A. Prioritization of Problems ----------------------------------------------------------- 26
a.1. List of Problems ----------------------------------------------------------- 26
a.2. Basis for Prioritization ----------------------------------------------------------- 26
B. Nursing Care Plans ----------------------------------------------------------- 286
NCP 1 ----------------------------------------------------------- 287
----------------------------------------------------------- 30
NCP 2
29
NCP 3 ----------------------------------------------------------- 321
NCP 4 ----------------------------------------------------------- 343
NCP 5 ----------------------------------------------------------- 354
C. Discharged Plan ----------------------------------------------------------- 386
XVI. Learning Insights ----------------------------------------------------------- 397
XVII. List of References ----------------------------------------------------------- 420

3
I. Introduction
Dehydration is the significant depletion of body water and, to varying degrees, electrolytes. It
can also occur as a result of reduced intake combined with continuing losses. Infants and young
children are more vulnerable to diarrhea and dehydration. Dehydration in children is most usually
caused by diarrhea, although it can also be caused by vomiting, decreased fluid intake due to
decreased appetite, increased insensible water loss due to fever, tachypnea, or poor skin integrity
(Freedman & Thull-Freedman, 2021). This causes approximately 800,000 deaths globally each year in
children below 5 years old. Higher metabolic rates, inability to convey their demands or hydrate
themselves, and greater insensible losses are some of the causes. In addition to total body water loss,
electrolyte imbalances may occur. Infants and children have higher metabolic demands, making them
more prone to dehydration.
The signs and symptoms include thirst, lethargy, dry mucosa, decreased urine output, and, as
the degree of dehydration progresses, tachycardia, hypotension, and shock (Cellucci, 2022). The
warning signs can include dry skin, tongue, and lips, rapid breathing, fewer wet diapers, and tearless
crying (Dehydration and Your Child, n.d.).
Globally, the prevalence of dehydration in children without diarrhea is 3.0% (2019/68 204)
and comprised 15.9% of all dehydration cases. Only 55.8% of affected children received either oral or
intravenous fluid therapy (Omoke, et al., 2021). Where fluid treatment was given, the volumes, type of
fluid, duration of fluid therapy, and route of administration were similar to those used in the treatment
of dehydration secondary to diarrhea. Moreover, eight of every ten Filipino children are suffering
from dehydration, according to a study by the Department of Science and Technology-Food and
Nutrition Research Institute. Eighty-three percent of Filipino kids are not drinking enough water to
keep them hydrated and healthy. Up to 12,500 Filipino children aged under 5 years currently die each
year of dehydration caused by diarrhoea. It is also the leading cause of illness and the fourth leading
cause of death in infants in the Philippines.
Child malnutrition and non-communicable illnesses are the most serious global public health
issues. Severe malnutrition during childhood is associated with an increased risk of NCDs, suggesting
that developmental plasticity extends beyond prenatal life (Grey, et al., 2022). Severe malnutrition in
childhood thus has serious implications not only for acute morbidity and mortality but also for the
survivors’ long-term health. Poor access to proper healthcare, a lack of food security, incorrect feeding
habits, a monotonous diet with low nutrient density, and a lack of water, sanitation, and hygiene
services are the key underlying causes of wasting. Severe wasting episodes compromise a child's
immunity, putting him or her vulnerable to long-term developmental impairments and an increased
chance of mortality.
Usual signs and symptoms of malnutrition in a child include a lack of growth and low body
weight; tiredness and a lack of energy; irritability and anxiety; slow behavioral and intellectual
development, possibly resulting in learning difficulties.
Globally, 45.4 million children under five were malnourished of which 13.6 million were
severely malnourished (UNICEF, 2023). This translates into a prevalence of 6.7% and 2.0%,
respectively. About a third (or 3.5 million) of Filipino children under five years old are stunted, 2 a
marker of chronic malnutrition (UNICEF, 2021). Although the Philippines is anticipated to become an
upper-middle-income nation by 2023, the prevalence of stunting remains equivalent to that of the
world's poorest countries. Philippines ranks 69th out of the 121 countries with data to calculate 2022
Global Hunger Index scores. With a score of 14.8, Philippines has a level of hunger that is moderate
(Global Hunger Index, 2022). Additionally, according to DOH, at least 21.6% of infants and toddlers
nationwide are stunted, 12.3% of children aged zero to 23 months are underweight, while 7.2% of
them are wasted.

II. Statement of Objectives

A. General Objectives

4
 This case analysis aims to increase the understanding and knowledge of student nurses
on how to care for patients with severe malnutrition and vomiting with moderate signs of
dehydration.

B. Specific Objectives
Specifically, this case analysis aims to:
i. define severe malnutrition, vomiting with moderate signs of dehydration, and its effects
to the body as a whole;

ii. illustrate the pathophysiology of severe malnutrition, vomiting with moderate signs of
dehydration, and in relation to the signs and symptoms specifically observed in the
patient;

iii. describe and identify the common signs and symptoms of severe malnutrition and
vomiting with moderate signs of dehydration

iv. discuss the medical and surgical interventions for the management of severe
malnutrition and vomiting with moderate signs;

v. formulate appropriate nursing care plans suited for the patient based on the assessment
findings;

vi. identify care measures to be given to the patient and family to promote
continuity of care and independence after discharge.

III. Patient’s Profile

Name : Patient X

Age/Sex: : 1 year and 11 months/ Female

Religion : Roman Catholic

Ethnic Background : Tagalog

Occupation : N/A

Vomiting with Moderate Warning Signs

Admitting Diagnosis : of Dehydration; Severe Chronic
Malnutrition

Vomiting with Moderate Signs of

Final/Principal Diagnosis : Dehydration; Severe Chronic
Malnutrition

Date and Time Admitted : April 1, 2023 at 9:30 am

Date and time handled : April 6-8, 2023

IV. Chief Complaint

The patient was admitted to the pediatric service. Upon admission, the patient had a chief
complaint of an episode of vomiting ¼ cup, dry lips, sunken eyes, 3–4 sec skin turgor, dry skin, a
heart rate of 160 bpm, a 4 sec capillary refill, a respiratory rate of 45 cpm, yellowish urine, a poor
appetite for ORS and milk, and abdominal pain.
V. History of Present Illness

5
 The patient was admitted to the pediatric ward and was noted to be pallor with poor skin
turgor, sunken eyeballs, dry lips, and oral, and buccal mucosa. The patient underwent surgery for
complete intestinal obstruction secondary to intestinal malrotation with volvulus status post-double
barrel Jejuno-ileostomy. The patient was closely monitored and then transferred to the wards.
On the first day of hospitalization, the patient was seen and examined. The patient now
tolerates feeding with no noted bouts of loose stools or vomiting. Moreover, the patient has an intact
ileo-jejunostomy, soft normoactive bowel sounds, and is non-tender. Other physical examination
findings were unremarkable.
On the third to sixth days of hospitalization, the patient was noted to have no vomiting
episodes and had a fair oral intake, which she was able to tolerate oral fluids such as ORS and milk.
She also has a fair oral intake of RUTF. Medications were continued, and the patient was monitored
closely and referred accordingly.
VI. History of Previous illness
The patient has a known case of severe chronic malnutrition, complete intestinal obstruction
secondary to intestinal malrotation with volvulus status post double barrel Jejuno-ileostomy (June
2022). The patient was admitted to Notre Dame for two weeks. She was transferred to this institution
from Olongapo City after having a case of complete intestinal obstruction secondary to intestinal
malrotation with volvulus, adhesive band secondary to Meckel’s Diverticulum- resolved; Acute
surgical abdomen secondary to multiple ileal perforations, mesenteric ischemia secondary to volvulus-
resolve, wound dehiscence; anastomotic leak with the different procedures such as Emergency
exploratory laparotomy; adhesiolysis ;double barrel jejunoileostomy, take down of jejunoileostomy,
emergency wound suturing, Ex-lap segment jejunoileal resection with double barrel jejunoileastomy,
Ex lap, Ladd’s procedure, reduction of intestinal malrotation (counter-clockwise) removal of adhesive
band (ileocecal area); wedge resection of Meckel’s diverticulum ; appendectomy. Her previous
hospitalization centered on hydration and nutritional buildup via tube feeding, at least 3–4 feedings
per day. Long-term plans for the patient include nutritional buildup via elemental formula feeding and
hydration.
VII. Family History
The patient’s mother claims to have no familial history of gastrointestinal disease or disorders
such as irritable bowel syndrome, hemorrhoids, or colitis. No present illness is currently experienced
by any member of the family.
VIII. Developmental History
The patient is the only daughter. The patient is 1 year and 11 months old. According to Erik
Erikson’s psychological stage, she is in the "Autonomy versus Shame and Doubt" stage, which is the
second stage of Erik Erikson’s stages of psychosocial development. This stage occurs between the
ages of 18 months and around 2 or 3 years. According to Erikson, children at this stage are focused on
developing a greater sense of self-control." According to the mother, the patient was born with
malrotation with volvus. The patient is very close to her mother compared to her father. She needs her
mother by her side to sleep comfortably.

IX. Social and Environmental History

They reside near the road, where various fumes can be frequently inhaled. They are currently
living in a concrete house, which does not affect the condition. Imitates the behavior of others,
especially adults and older children. Increasingly aware of herself as separate from others and
enthusiastic about the company of other children. Safety measures in the patient’s bed are pillows,
which prevent her from falling. The walls have foam to keep her from bumping her head. Sharp and
pointy objects are kept out of her reach. They utilize public transportation vehicles such as jeepneys
and taxis as their primary mode of transportation. The mother also mentioned that their water source
comes from the water district and water refilling station. As for their drinking water, they purchase it
in nearby stores.
X. Lifestyle and Health Practices
The mother verbalizes that she did not frequently breastfeed the patient. Additionally, at the
age of 8 months, she was fully fed with milk formulas like PediaSure and Lactum. Moreover, they do

6
 not have any food restrictions, but the mother did not eat much when she was pregnant with the
patient. Furthermore, with regards to health practices, as the patient underwent jejuno-ileostomy, the
mother was oriented on how to remove, change, or clean the ileostomy bag. The mother usually seeks
medical attention when sickness arises in the patient in hospitals and private clinics.
XI. Health Assessment
A. General Assessment
The patient was received awake, lying on bed, afebrile, and irritable. An intact and patent
heplock was noted on the right hand.
The patient appears weak and needs full assistance in doing activities such as drinking
formula and sitting on the bed. She wears a neat gown; her hygiene is fair; and no various
interruptions in skin integrity were noted. The patient has dry skin, sunken eyes, a skin turgor of 3–4
seconds, and a capillary refill of 4 seconds. Additionally, she is most irritable when the ileostomy bag
is filled with liquid stool. Correspondingly, the mother was oriented on how to properly clean the
colostomy bag, as seen during the shift when she would often change the ileostomy bag. Moreover,
the patient was fed 3–4 times a day. In addition, the patient’s initial vital signs are: PR: 160 bpm;
SPO2: 98%; RR: 45 cpm; Temperature: 36.6°C.

B. Head to Toe Assessment

1. Head Normocephalic, hair is well distributed, no infestations and no hair loss noted. No
areas of pain or tenderness were noted during palpation.
2. Eyes Dry and sunken eyes noted upon assessment. Pupils are equal, round, sensitive to
light, and reactive to accommodation. No corrective lenses noted. The patient was
able to open her eyes independently. Moreover, she is able to follow six fields of
gaze with no pain.
3. Ears No hearing aids were noted. The ear is symmetrical. No tenderness noted upon
palpation of the mastoid process; no discharges or lesions were seen. No signs of ear
infection were noted. Able to follow instructions.
4. Nose and Sinuses The nose is in a symmetrical position. No nasal discharges were seen. No
tenderness, swelling, or deformities noted upon palpation of the nose. No deviation
was seen upon inspection of nasal septum.No episodes of epistaxis and no stuffiness
were noted.
5. Mouth No lumps were seen. No unusual odor was noted. The tongue is in a midline
position. Able to move the tongue in different directions. Presence of good sucking
reflex during bottle feeding.
6. Neck The neck is symmetrical. No scars were seen, no visible pulsations, masses, or
swelling noted upon palpation. Neck stiffness noted.

7
7. Chest Chest wall expansion is symmetrical. No retractions, adynamic precordium, PMI at
ICS LMCL, tachycardia, or irregular rhythm. No murmurs upon auscultation. No
paradoxical movement observed. No masses palpated. Respiratory rate of 45 cpm.
8. Cardiac Heart rate of 160 bpm, indicating tachycardia. SPO2 of 98%. Pulse scale of 3+ and
acyanotic.
Chest wall expansion is symmetrical. No retractions, adynamic precordium, PMI at
9. Breast/Chest ICS LMCL, tachycardia, or irregular rhythm. No murmurs upon auscultation. No
paradoxical movement observed. No masses palpated. Respiratory rate of 45 cpm.
10. Abdomen Normoactive bowel sounds are heard upon auscultation in all quadrants. Right
ileostomy noted. No bumps, no bulges, or no masses palpated.
11. Genitals No lesions were noted. Diaper is being used.

12. Musculoskeletal No signs of redness, swelling, or nodules on both ankles. Slightly able to perform
ROM of the head, wrist, arms, and ankle. Hypotonic muscle tone. No muscle spasm
was noted. No muscle wasting noted.
13. Integumentary The hair is well distributed; there is no excessive hair on the body or face. No
itching or rashes were noted, and no lesions or bruising were observed. Nails are
clean and well-trimmed, there is no edema or cyanosis, and the skin is warm to the
touch. The skin appears to be pale and dry. No pallor on palms or pale nail beds
were noted.

C. 13 Areas of Assessment
1. Psychosocial and Psychological Status
Patient X is a 1-year-old female who is currently residing at 159 Milflores Street,
Amparo Heights, Camp 7, Baguio City. According to Erik Erikson’s psychosocial
development, at this stage, the child is focused on developing a sense of personal control over
physical skills and a sense of independence. The patient’s mother verbalized that they are
practicing Roman Catholic, have a good relationship within the family, and are sometimes
sociable with other people through laughing and playing with them.
2. Mental and Emotional Status
Patient was seen awake and minimally cooperative. She is conscious, active, and
responds to verbal and non-verbal stimuli. Moreover, she is only able to perform slight limited
movements due to the heplock on her right hand. Based on the Wong-Baker Faces Pain Rating
Scale, she was able to show response to painful stimuli with a rating of 4 (Hurts Little More).
3. Environmental Status
The patient and her family live in a house built with mixed materials like concrete
walls and hardwood. The house has two (2) bedrooms, a kitchen, and a separate comfort room
located outside. The house is provided with adequate lighting and ventilation. Daily-used
water is supplied by the city water district, while their source of drinking water is from the
nearby water refilling stations. The house is near the road, which provides them easy access to
transportation and health care. The patient was admitted to Baguio General Hospital's
Pediatric Ward. Her bed was located on the right side of the ward, close to the nurse’s station.
Her bed is far from any windows, with no access to sunlight. The patient was not able to rest
well due to the noise from neighboring patients. The patient was provided with pillows and a
blanket, along with an organized bedside table containing only necessary things such as
medication and monitoring sheets. They were provided with adequate lighting and ventilation.
4. Sensory Status
a) Visual Status

8
 Upon assessment, the patient’s eyes were sunken and teary. She was able to open her
eyes independently. Moreover, she is able to follow the toy that moves and her eyes also
response to light.
b) Auditory
According to the mother, a hearing test was done when the patient was born with
normal results. There are no lesions and discharges noted.
c) Olfactory Status
The patient has no discharge or tenderness upon palpation. Her naris is patent by
occluding her mouth by holding it close and obstructing a naris with the use of thumb and
we were able to feel the air passing out.
d) Gustatory Status
The tongue appears dry. She has no difficulty swallowing, as observed. Her gag
reflex is normal and was tested by touching the back of her tongue with a tongue depressor.
She can also move her tongue and show her teeth.
e) Tactile Status
The patient was able to perceive sensations when touching her face and arms as
evidenced by facial grimace and irritability.

5. Motor Status
The patient has well motor skills as evidenced by her picking up her toy. She also
needs full assistance and support when assuming self-care activities. No tremors or
deformities noted on both upper and lower extremities. Upper extremities are symmetrical as
well as the lower extremities. Peripheral pulses were present such as radial.
6. Thermoregulatory Status
Date Time Temperature Remarks
12 AM 37.9℃ Elevated
April 1, 2023 4 AM 37.6℃ Slightly elevated
8 AM 37.4℃ Normal
12 AM 37.8℃ Elevated
April 2, 2023 4 AM 37.5℃ Normal
8 AM 38.0℃ Elevated
12 AM 37.7℃ Slightly elevated
April 3, 2023 4 AM 37.7℃ Slightly elevated
8 AM 37.2℃ Normal
12 AM 37.9℃ Elevated
April 4, 2023 4 AM 37.6℃ Slightly elevated
8 AM 37.4℃ Normal
12 AM 36.8℃ Normal
April 5, 2023 4 AM 36.6℃ Normal
8 AM 36.8℃ Normal
12 AM 36.5℃ Normal
April 6, 2023 4 AM 36.6℃ Normal
8 AM 36.6℃ Normal
12 AM 36.5℃ Normal
April 7, 2023 4 AM 36.6℃ Normal
8 AM 36.5℃ Normal
12 AM 36.6℃ Normal
April 8, 2023 4 AM 36.5℃ Normal
8 AM 36.6℃ Normal
Analysis: The patient’s temperature during the first till the fourth day of admission was
slightly elevated and elevated. On the other hand, her temperature was within the normal range
during the fifth to eight day of admission.

9
7. Respiratory Status
Date Time RR Remarks SPO2 Remarks
12 AM 48 cpm Above normal 89% Hypoxemia
April 1, 2023 4 AM 29 cpm Normal 95% Normal
8 AM 28 cpm Normal 96% Normal
12 AM 34 cpm Normal 98% Normal
April 2, 2023 4 AM 46 cpm Above normal 92% Low
8 AM 32 cpm Normal 95% Normal
12 AM 32 cpm Normal 97% Normal
April 3, 2023 4 AM 29 cpm Normal 98% Normal
8 AM 30 cpm Normal 97% Normal
12 AM 30 cpm Normal 98% Normal
April 4, 2023 4 AM 29 cpm Normal 98% Normal
8 AM 30 cpm Normal 97% Normal
12 AM 34 cpm Normal 98% Normal
April 5, 2023 4 AM 32 cpm Normal 99% Normal
8 AM 45 cpm Above normal 93% Below normal
12 AM 29 cpm Normal 97% Normal
April 6, 2023 4 AM 45 cpm Above normal 95% Normal
8 AM 28 cpm Normal 96% Normal
12 AM 34 cpm Normal 98% Normal
April 7, 2023 4 AM 32 cpm Normal 99% Normal
8 AM 36 cpm Normal 98% Normal
12 AM 32 cpm Normal 97% Normal
April 8, 2023 4 AM 29 cpm Normal 98% Normal
8 AM 30 cpm Normal 97% Normal

Analysis: The patient’s respiration is within the normal range (22 cpm–37 cpm), but at 12 am
of April 1, 4 am of April 2, 8 am of April 5, and 4 am of April 6 it increased above normal
which indicates having tachypnea. Also, the oxygen saturation obtained on the entire stay
ranges from 89% to 99% but on the first day of admission the patient’s O2 is below normal
which indicates having a hypoxia and there are instances that it becomes below normal.

8. Circulatory Status
Date Time PR Remarks Capillary Remarks
12 AM 120 bpm Normal 4 seconds Slow
April 1, 2023 4 AM 145 bpm Above normal 4 seconds Slow
8 AM 125 bmp Normal 4 seconds Slow
12 AM 125 bpm Normal 4 seconds Slow
April 2, 2023 4 AM 120 bpm Normal 4 seconds Slow
8 AM 145 bpm Above normal 4 seconds Slow
12 AM 143 bpm Above Normal 4 seconds Slow
April 3, 2023 4 AM 142 bpm Above Normal 4 seconds Slow
8 AM 142 bpm Above Normal 4 seconds Slow
12 AM 135 bpm Normal 4 seconds Slow
April 4, 2023 4 AM 128 bpm Normal 4 seconds Sow
8 AM 145 bpm Above Normal 4 seconds Slow
12 AM 120 bpm Normal 4 seconds Slow
April 5, 2023 4 AM 145 bpm Above normal 4 seconds Sow
8 AM 125 bmp Normal 4 seconds Slow
12 AM 120 bpm Normal 4 seconds Slow
April 6, 2023 4 AM 129 bpm Normal 4 seconds Sow
8 AM 125 bmp Normal 4 seconds Slow

10
 12 AM 130 bpm Normal 4 seconds Slow
April 7, 2023 4 AM 128 bpm Normal 4 seconds Sow
8 AM 143 bpm Above normal 4 seconds Slow
12 AM 125 bpm Normal 4 seconds Slow
April 8, 2023 4 AM 120 bpm Normal 4 seconds Sow
8 AM 130 bpm Normal 4 seconds Slow

Analysis: The patient’s pulse rate was above normal from day one to day five and day seven,
which indicates tachycardia, while her pulse rate on the sixth and eighth day was within
normal range (80 bpm–140 bpm). Moreover, her capillary refill day one to eight has been
slow.
9. Nutritional Status
The patient also has a poor appetite; she consumes 40% of the food served in the
hsopital. She was drinking PediaSure milk to boost nutrition and growth. She drinks her milk
from a bottle with an amount of 90 mL per bottle three times a day. She usually eats biscuits
and fruits like oranges and bananas. The patient’s mother verbalized that her daughter is a
picky eater but has no food allergies. The patient is on a Diet As Tolerated (DAT) as ordered
by the physician.
10. Elimination Status
The patient's frequency of urination and defecating is monitored twice times every
shift with a volume of 600 ml. Her ileostomy bag is changed every morning and evening as it
is filled with a liquid brown stool and urine.
11. Sleep, Rest and Comfort Status
The patient sleeps at least eight to ten hours a day. She usually sleeps at 9 pm and
wakes up at 7 am. Additionally, she usually takes naps in the afternoon.
12. Fluids and Electrolytes Status
She is also able to consume 300 ml of milk and water every day. Her skin is fair in
color and dry with pail nail beds. No edema formations noted.
13. Integumentary Status
The patient’s skin appears clean and dry; she has poor skin turgor that returns within
4 seconds. Hair is finely distributed in the scalp, eyelashes, and eyebrows with no parasite
infestation. The patient’s conjunctiva is pink; her skin feels warm, is generally brown with no
discolorations, paleness, jaundice, or cyanosis.

11
 XII. Diagnostics

Significance/ Purpose of the

Diagnostic Procedure Description of the Procedure Date of Procedure Implication of Findings
Procedure
Abdomen X-Ray (Upright-Supine- Abdominal X-rays capture images of It is useful in assessing abdominal April 2, 2023 Upon doing the abdominal x-ray, it is
Lateral) the inside of the abdominal cavity pathologies, including bowel noted that there have no
using an immensely modest dosage of obstructions, calcifications and abnormalities that come up from the
ionizing radiation. It is used to assess neoplastic changes. It is also used as previous operation that was done.
the stomach, liver, intestines, and a scout/baseline image for contrast
spleen and may aid in the diagnosis of studies of the abdomen
unexplained discomfort, nausea, or
vomiting.

Diagnostic Procedure and Significance/ Purpose of The

Description of Procedure Significant Findings Implication of Findings
Date Done Procedure
Complete Blood Count A CBC is done and can be ordered by It used to evaluate and determine the Hemoglobin Within normal range
the doctor to check any related blood overall health and detect a wide range Normal Range: 110 -160g/L
problems that can affect an individual. of disorders, including anemia, Result: 149
These also help doctors to diagnose infection and leukemia.
any blood disease, infection, and
immune disorders or any medical
conditions.
Hematocrit Within normal range
Normal Range: 0.37 – 0.54 L/L
Result: 0.43
WBC High
Normal Range: 5.0 – 10.0 10^9/L
Result: 15.51 10^9/L
Neutrophils Within normal range
Normal Range: 50 – 70%
12
 Result: 56%
Lymphocytes Within normal range
Normal Range: 20 – 40%
Result: 26%
Monocytes Within normal range
Normal Range: 0 – 10%
Result: 9%
Eosinophils High
Normal Range: 0 – 7%
Result: 8%
Basophils Within normal range
Normal Range: 0 – 1%
Result: 1%
RBC Count Within normal range
Normal Range: 4.04 – 5.48 10^12/L
Result: 5.46 10^12/L
Platelet Count High
Normal Range: 150 – 400 10^9/L
Result: 493 10^9/L
MCV Within normal range
Normal Range: 80 – 100 fL
Result: 79.20 fL
MCH Within normal range
Normal Range: 27 – 31 pg
Result: 27.30 pg
MCHC Within normal range
Normal Range: 310 – 360 g/L
Result: 345.00 g/L
RDW-CV Within normal range
Normal Range: 11 – 16%
13
 Result: 14.70%
RDW-SD Within normal range
Normal Range: 35 – 56 fL
Result: 43.00 fL
MPV Within normal range
Normal Range: 6.5 – 12fL
Result: 8.40 fL

Diagnostic Procedure and Date Significance/ Purpose of the

Description of the Procedure Significant Findings Implication of Findings
Done Procedure
Routine Chemistry Routine clinical chemistry for General or routine chemistry is the Sodium Slightly Elevated
blood alongside other body fluids field of scientific research that Normal Range: 135 – 145
is used to assess a patient’s health quantifies commonly ordered mmol/L
status. It is carried out using tests analytes, typically in serum or Result: 134.30
such as Enzymes, Substrates, plasma, and is responsible for
Electrolytes, Proteins, Therapeutic most clinical testing in
drug monitoring, and Drug abuses. laboratories.
14
 Potassium Slightly Elevated
Normal Range: 3.5 – 5.5
mmol/L
Result: 5.97
15
XIII. Pathophysiology

Roth, R.A. & Townsend, C.E. (2005). Nutrition & Diet Therapy 8th Edition. Shenton Way,
Singapore: Delmar Learning. Long, B.C.,

Phipps, W.J., & Cassmeyer, V.L. (1994). Medical-Surgical Nursing: A Nursing Process
REFERENCES: Approach. Malabon, Metro Manila: Guiani Prints House. Saunders, W.B. (1998). Clinical
Medicine Fourth Edition. Oval Road, London: Harcourt Publishers Limited

16
 XIV. Treatment/Management

A. Drugs

a.1.Summary of Drugs

Drug Dose Route Frequency

Ascorbic Acid 2.5ml Oral O.D

Vitamin B 3ml Oral O.D

Probiotics 1 cap Oral O.D

Zinc Sulfate 2 ml Oral O.D

Vitamin D 400 IU Oral O.D

Ondansetron 0.8 mg IV PRN

17
 Drug Name Mechanism of Action Indication/Contraindication Adverse Effect Nursing Responsibilities
Generic name: Serves as a cofactor for many enzymatic Indication: GI: Gastric BEFORE
Zinc Sulfate reactions. Required for normal growth and irritation, nausea, ● Checked for doctor’s order
Replacement and supplementation
tissue repair, wound healing, and senses of vomiting. ● Observe 5R’s
therapy in patients who are at risk
Classification: taste and smell.
for zinc deficiency. DURING
Therapeutic: Mineral
(Davi’s Drug Handbook) ● Administered with food to decrease gastric irritation.
and electrolyte
● Let patient take full course prescribed
replacement
Contraindication: AFTER
Pharmacologic: ● Monitor progression of zinc deficiency symptoms
Contraindicated in hypersensitivity
Trace metals ● Instruct not to take caffeine, dairy products, or bran as it
or allergy to any components in
may impair absorption.
formulation; preparations
Route: ● Instructed patient to report adverse reactions promptly
containing benzyl alcohol should
Oral not be used in neonates.

Dosage:
2ml O.D

Drug Name Mechanism of Action Indication/Contraindication Adverse Effect Nursing Responsibilities

Generic Name: It works by blocking the action of serotonin, a Indication: CNS: Headache, BEFORE
Ondansetron natural substance that may cause nausea and dizziness, ● Checked for doctor’s order
Prevention of nausea and
vomiting. drowsiness, fatigue, ● Verify patient’s identity
vomiting.
Classification: weakness.
DURING
Therapeutic:
Antiemetics GI: Constipation, ● Administered drug intravenously as per doctor’s order.
Ondansetron: MedlinePlus Drug Information. diarrhea, abdominal
(n.d.). https://medlineplus.gov/druginfo/meds/a6 pain, dry mouth,
Route: AFTER
01209.html#:~:text=Ondansetron%20is%20in Contraindication: increase liver
IV Monitor for any extrapyramidal effects periodically.
%20a%20class,may%20cause%20nausea enzymes.
●
Should not be used in patients Instruct patient to notify for any abnormal signs and
%20and%20vomiting. ●
Dosage: with phenylketonuria; congenital symptoms.
0.8mg PRN long QT syndrome; concurrent ● Monitor injection site for pain, swelling, and irritation.
use of apomorphine.
18
 Drug Name Mechanism of Action Indication/Contraindication Adverse Effects Nursing Responsibilities
Generic Name: Requires activation in the liver and kidneys to Indication: CNS: Headache, BEFORE
create the active form of D. Promotes the ● Checked for doctor’s order
Vitamin D intestinal absorption of dietary calcium. Prevention of Vitamin D Irritability, ● Verified patient’s identity
deficiency. somnolence,
(Davi’s Drug Handbook) weakness. DURING
● Administer medication as directed.
Classification: GI: Anorexia,
Contraindication: AFTER
constipation, dry
Therapeutic: ● Monitored for any signs of adverse effects
mouth, increase
Vitamins Contraindicated in ● Instructed patient to take drug as prescribed by the
liver enzymes,
hypersensitivity; hypercalcemia; physician
metallic taste,
vitamin d toxicity; concurrent use ● Instruct patient to notify for any abnormal signs and
nausea, vomiting.
of magnesium-containing symptoms.
Route: Oral
antacids or other vitamin D
supplements; malabsorption
problems.
Dosage: 400 IU O.D.

Drug Name Mechanism of Action Indication/Contraindication Adverse Effect Nursing Responsibilities

19
 Generic: Ascorbic Stimulates collagen formation and tissue repair, Indication: CNS: faintness, Before:
Acid involved in oxidation- reduction reactions. dizziness ● Checked for doctor’s order
Used to treat vitamin C ● Observed for 5 rights
deficiency and is a dietary GI: diarrhea,
During:
supplement. It has also been heartburn, nausea,
Brand Name: (MIMS Philippines) ● Administer the proper dosage of medication
suggested to be an effective vomiting ● Inform the possible adverse effects of the drug
Acecrola C antiviral agent.
After:
● Monitor for S&S of acute hemolytic anemia, sickle cell
Contraindication: crisis
Classification: ● Instruct to notify physician immediately for any adverse
Multivitamins effects
 Hypersensitivity to the drug
 Use of sodium ascorbate in
patients in sodium restriction
 Use of calcium ascorbate in
Dosage: 2.5 mL
patient receiving digitalis
Route: Oral

Drug Name Mechanism of Action Indication/ Contraindication Adverse Effects Nursing Responsibilities
Generic: Vitamin B3/ Inhibits a hormone-sensitive lipase in adipose Indication: DERM: dry skin Before:
Niacin tissue which reduces the breakdown of  Assessed for signs of niacin deficiency
Niacin is indicated to prevent
triglycerides to free fatty acids, and the transport  Checked for doctor’s order
vitamin deficiencies, converts GI: hepatoxicity,
of free fatty acids to the liver.  Verified the dosage of the drug and prepared drug on
nutrients into energy, to make GI upset, diarrhea, time
Brand: Niacor fats and cholesterol and to form dry mouth, During:
and repair our genetic material flatulence,
 Verify patient’s identity
https://tmedweb.tulane.edu/pharmwiki/ (DNA). heartburn, hunger
 Inform the client for the purpose of the drug
Class: Antilipemic doku.php/ pains, nausea,  Check for patient’s status
nicotinic_acid_niacin#:~:text=Mechanism peptic ulceration
Contraindication: After:
%20of%20Action%3A,fatty%20acids
 Instruct client to report for any adverse effects
%20to%20the%20liver.  Hypersensitivity to the drug  Monitor accordingly
 Patients with active peptic
20
 Route: 3mL ulcer disease  Ensure patient’s safety
 Patients who have active
Dosage: Oral liver disease or present with
unexplained and persistent
elevations in hepatic
transaminases.

Drug Name Mechanism of Action Indication/ Contraindication Adverse Effects Nursing Responsibilities
Generic: Probiotics Probiotics fight infectious diarrhea Indication: GI: temporary Before:
include exclusion of pathogens by means of increase in gas,  Checked for doctor’s order
Helps the body absorb nutrients.
Brand: Bio-Kult competition for binding sites and available bloating,  Observed 5 rights
substrates, lowering of luminal pH and constipation, thirst  Verified dosage of medication
Classification: N/A production of bacteriocins, and promotion of the During:
production of mucus. Contraindication:  Verify patient’s identity
Dosage: 1 CAP N/A  Informed the purpose of the drug
After:
Route: Oral  Instructed to notify physician for any unusual S&S
Isolauri, E. (2003). Probiotics for infectious
diarrhoea. Gut, 52(3), 436–437.
https://doi.org/10.1136/gut.52.3.436

B. IV Fluids

Name Classification Component/s Use & Effects Nursing Responsibilities

5% Hypertonic Electrolytes 1000ml Hypertonic solutions are those Before:

Dextrose that have an effective osmolarity ● Check doctor’s order for correct fluid to be given.
in Lactated Sodium 130 mmol greater than the body fluids. ● Check integrity of IV solution.
Ringer’s This pulls the fluid into the ● Document baseline data. Before infusion, assess the patient’s vital signs, edema
Calcium 1.4 mmol
Solution vascular by osmosis resulting in status, lung sounds, and heart sounds.
Chloride 109 mmol an increase vascular volume. It ● Caution must be exercised in the administration of parenteral fluids, especially those
(D5 LRS) containing sodium ions to patients receiving corticosteroids or corticotrophin
raises intravascular osmotic
Lactate 28 mmol pressure and provides fluid, During:
21
 electrolytes and calories for ● Properly label the IV fluid during preparation.
energy. ● Observe aseptic technique during preparation.
Osmolality 406 mOsm ● In very low birth weight infants, excessive or rapid administration of dextrose
injection may result in increased serum osmolality and possible intracerebral
Potassium 4 mmol hemorrhage
● Solution containing acetate should be used with caution as excess administration
may result in metabolic alkalosis.
● Monitor if swelling is present around injection site.
● Regulate to ordered drop rate
After:
● Assess the injection site to make sure all parts of the cannula are withdrawn
● Discard unused portion

C. Surgery

Procedure Description & Indication Nursing Care/ Responsibilities

Jejunoileostomy A procedure in which the jejunum is linked to the ileum  Suggest patient with ileostomy to limit prunes, dates,
(small intestine) while either the jejunum’s end or the stewed apricots, strawberries, grapes, bananas,
June 2022 ileum’s tip has been removed or needs to be bypassed and cabbage, beans, and avoid foods high in cellulose.
usually utilized to treat gastrointestinal diseases. It had  Monitor vital signs, evaluate skin turgor, capillary
previously been employed to treat obesity but was refill, and mucous membranes.
discontinued due to major negative side effects.  Monitor intake and output carefully, and measure
liquid stool.
 Administer IV fluid and electrolytes as indicated.
 Note the reports of burning, itching, or blistering
around the stoma.
 Clean the wound regularly to avoid infection.
22
 XV. Nursing Care Plans

A. Prioritization of Problems
a.1. List of Problems
a) Fluid Volume Deficit
b) Electrolyte Imbalance
c) Imbalanced Nutrition
d) Risk for infection
e) Risk for fall

a.2 Basis of Prioritization

NURSING DIAGNOSIS JUSTIFICATION

1. Fluid Volume Deficit This is the 1st priority because fluid volume deficit is a medical
emergency, since it can lead to organ failure and death. It becomes the
priority because according to Maslow’s Hierarchy of needs, physiological
needs are Treatment of fluid volume deficit involves replenishing the
body's fluids with intravenous fluids. This can help restore the body's fluid
balance and prevent further complications.

Fluid deficit can be justified for Maslow's Hierarchy of Needs in that it is

essential for the physiological needs of humans. In order for people to
survive and thrive, they must have access to clean water and other fluids in
order to stay hydrated. Without adequate hydration, people can suffer from
heat exhaustion, dehydration, and even death. Therefore, having access to
clean fluids is essential for meeting the physiological needs of humans and
is a vital component of Maslow's Hierarchy of Needs.

2. Imbalanced Nutrition According to Maslow's hierarchy of needs, basic physiological needs, such
as food, water, and shelter, are at the bottom of the pyramid and must be
met before an individual can meet higher-level needs. When an individual
Electrolyte Imbalance is not getting enough food, their body's physiological needs are not being
met and they cannot focus on anything else. Imbalanced nutrition can lead
to a range of physical and mental health issues, including fatigue, poor
concentration, and an increased risk of disease. As such, it is essential that
an individual's basic nutritional needs are met in order for them to be able
to focus on and work towards achieving higher-level needs.Fluid and
electrolyte balance are one of the key issues in maintaining homeostasis in
the body, and it also palys important roles in protecting cellular function,
tissue perfusion and acid-base balance. Fluid and electrolyte balance must
also be maintained for the management of many clinical conditions.

3. Imbalanced Nutrition Maslow's Hierarchy of Needs suggests that individuals must satisfy their
basic physiological and safety needs before they are able to address their
higher order needs such as self-actualization. Therefore, a person's
4. Risk for Fall deficient knowledge may be attributed to their lack of access to resources
which can satisfy their basic needs. If someone is struggling to find food or
a safe place to live, they are unlikely to have the energy or opportunity to
focus on acquiring knowledge.This may affect the nutritional sustainment
of cell of the body causing now systematic imbalances. It may be necessary
to support a child's growth and development. In some cases, a diet with
higher amounts of certain nutrients may be needed to ensure that a child is
getting all the necessary nutrients for their age. For instance, young

23
 children may need higher amounts of proteins, fats, and carbohydrates,
while older children may need more vitamins and minerals. Additionally,
some children may need to follow a special diet due to allergies or other
medical conditions. In these cases, an imbalanced diet may be necessary to
ensure the child is getting the proper nutrition for their age and condition.

5. Risk for Infection At the most basic level, Maslow's hierarchy of needs states that
physiological needs, such as food, water, and shelter, must be met before
any other needs can be addressed. This is particularly relevant when
discussing risk for infection, as a lack of basic necessities can leave
individuals vulnerable to illness and disease. If a person does not have
access to proper nutrition, clean water, and adequate housing, they may be
more likely to become infected with a communicable disease. Poor hygiene
and overcrowding can also increase the risk of infection. In order to reduce
the risk of infection, individuals must first have their basic needs met. Once
their physiological needs are addressed, they may be in a better position to
make decisions about their health and safety that can reduce their risk of

An impaired skin
infection.

integrity due to
partial burn is a
deviation in the
physical well-being
that needs an
intervention to meet
the person’s
physiological &
biological needs that
is at the first level of
Maslow’s
hierarchy of needs.
24
 An impaired skin
integrity due to
partial burn is a
deviation in the
physical well-being
that needs an
intervention to meet
the person’s
physiological &
biological needs that
is at the first level of
Maslow’s
hierarchy of needs.
Patients at risk for infection are those whose immune system or natural
defenses are compromised. These patients have inadequate protection from
pathogenic organisms, and it is important to plan nursing interventions and
care to provide additional protection and infection prevention.

6. Deficient KnowledgeRisk for Fall According to Maslow's hierarchy of needs, safety is one of the most basic
and fundamental needs that a person must have in order to feel secure and
safe. A risk of falling is a potential threat to this safety, and can lead to a
feeling of insecurity. By addressing the underlying need for safety, a
person can reduce their risk of falling by making sure their environment is
safe and secure and by engaging in safe activities and behaviors.Safe
sleeping environments are directly related to infant fall risk. The AAP
recommendations for a safe infant sleeping environment should be
modeled and implemented at birth and enforced through discharge with the
support of staff caring for newborns to prevent newborn falls.

25
 B. Nursing Care Plans

NCP 1: Fluid Volume Deficit

EXPLANATION OF THE NURSING

ASSESSMENT OBJECTIVE RATIONALE EVALUATION
PROBLEM INTERVENTION

OBJECTIVE: A 1-year-old and 11-month-old STO: Dx: Goal met

patient with a compromised  Assessed the patient’s  Assessment of the vital
● Vomits ¼ cup Within 8 hours of nursing STO:
immune system has a poor vital signs, paying signs helps determine the
● Sunken eyes interventions the patient
● 4 second skin turgor appetite, inappropriate feeding will be able to particular attention to patient’s status and catch After 8 hours of effective
● Dry oral mucosa and care in early life, an open the signs of hydration fluctuations in circulating nursing interventions the
● Dry skin Ileo-jejunostomy stoma, and a a.) maintain fluid volume such as pulse rate and fluid volume. patient is able to
● Sodium (Na)= maternal risk of smoking habits at a functional level as
evidenced by individually respiratory rate. a.) maintain fluid volume
134.30mmol/L pre-pregnancy has an increased
● Body weight= 5.2 kg adequate urinary output.  Observed and record  This is an indicator of the at a functional level as
susceptibility to health risks. The evidenced by individually
● BMI=9.24 capillary refill time level of dehydration.
loss of fluid absorptive capacity b.) Monitor vital signs adequate urinary output.
● Output=600 mL regularly.  Concentrated urine usually
● Input=300 mL in the colon has caused an and urine output closely
 Recorded intake and is indicative of dehydration. b.) Monitor vital signs
● Brown liquid stool increase in fluid and electrolyte to ensure adequate
loss and relative fluid absorption. output regularly, noting A reduction of urine output and urine output closely
● Intact ileostomy bag hydration.
noted The patient has developed severe for the characteristics is also indicative of a lower to ensure adequate
chronic malnutrition and c.) Provide patient and quality of stool and fluid intake. hydration.
moderate dehydration. She is education on nutrition and urine output such as the
color. c.) Provide patient
Vital signs unable to tolerate and has the importance of
vomited all previous ingested Tx:  To correct circulatory education on nutrition and
T: 36.6°C adequate caloric intake to
PR: 160 bpm food and oral rehydrating  Regulated IV fluid as volume deficit the importance of
promote optimal
RR: 45 cpm solution. The patient weighs 5.2 ordered  To aid in the general health adequate caloric intake to
hydration.
SPO2: 98% kg and has abnormal vital signs  Vitamins given as of the patient promote optimal
that consist of a 4-second skin ordered  To decrease gastrointestinal hydration.
Nursing diagnosis: Fluid
volume deficit turgor, dry oral mucosa and skin,  Administered motility and minimize fluid
LTO:
a sodium level of 134.30 antidiarrheal losses
mmol/L, and an input and output Within 3 days of effective medications, as ordered LTO:
of 600 mL. These symptoms have nursing interventions the
patient will be able to After 3 days of nursing
26
 confirmed that the patient has a a.) demonstrate behaviors Edx:  Increasing the oral fluid intervention, the patient is
deficit in fluid volume. to prevent development of  Advised the mother of the intake of the patient to more able to
fluid volume deficit by
patient to increase fluid than 8-32 ounces per day a.) demonstrate behaviors
increasing oral fluid
intake. intake of the patient helps prevent the patient to prevent development of
Reference: NANDA from suffering dehydration. fluid volume deficit by
b.) verbalize  For hydration increasing oral fluid
understanding of intake.
 Encouraged mother to
causative factors and
purpose of individual feed the patient with fruits b.) verbalize
therapeutic interventions with high fluid content understanding of
and medications. such as watermelon and causative factors and
purpose of individual
grapes
c.) Monitor and maintain therapeutic interventions
fluid balance by  Provided a comfortable  Drop situations where and medications.
monitoring intake and environment by covering patients can experience
output accurately. the patient with light overheating to prevent c.) Monitor and maintain
fluid balance by
sheets. further fluid loss.
monitoring intake and
output accurately.

NCP 2: Deficient Knowledge related to lack of exposure to information about preventing or detecting dehydration

NURSING
ASSESSMENT EXPLANATION OF THE PLOBLEM OBJECTIVE RATIONALE EVALUATION
INTERVENTION
Objective: Deficient knowledge is the lack of STO: Dx: Goal Met
● Vomits ¼ cup understanding or lack of access to After 8 hours of  Assessed level of  Assessment of the patient's
● Sunken eyes information that results in an incomplete nursing intervention, knowledge, including current knowledge is needed STO:
● 4 second skin the patient will: anticipatory needs. to determine areas of
understanding of a concept, idea, or After 8 hours of
turgor deficiency in order to
problem. It can occur due to a lack of  Participate in provide appropriate effective nursing
● Dry oral mucosa
● Dry skin education, experience, or resources, or learning process. education. interventions the patient
● Sodium (Na)= simply a lack of interest in a particular  Exhibit increased  Determined SO’s ability,  The SO may not be has:
134.30mmol/L readiness and barriers to physically, emotionally, or
27
 ● Body weight= subject. As for the SO of patient, she has interest and learning. mentally capable.  Participate in
5.2 kg a lack of exposure to information about assume  Assessed the level of the  The SO may need help to learning process.
● BMI=9.24 the condition of her daughter which she responsibility for SO’s capabilities and the learn.
 Exhibit increased
● Output=600 mL and the possibilities of
● Input=300 mL has done inappropriate feeding and care own learning by interest and assume
the situation
● Brown liquid in the early life of his daughter which beginning to look responsibility for
stool leads to the nursing diagnosis of deficient for information Tx: own learning by
● Intact ileostomy knowledge. and ask questions  Provided information beginning to look
bag noted relevant only to the  Reducing the amount of
 Identifying gaps for information and
situation. information at any one given
in knowledge and ask questions
time helps to keep the SO
Reference: NANDA understanding. focused an prevents from  Identifying gaps in
feeling overwhelmed. knowledge and
Vital signs LTO:  Provided positive  This could encourage understanding.
After 3 days of reinforcement. continuation of effort.
T: 36.6°C
nursing intervention  Assisted the SO to  The ability to apply increases
PR: 160 bpm
identify ways to integrate the desire to learn and retain
RR: 45 cpm the patient will:
and use information in information,
SPO2: 98%  Verbalize all applicable areas.
understanding of LTO:
her child’s After 72 hour of nursing
Nursing Diagnosis: Edx:
condition, disease intervention, the patient
Deficient Knowledge  Educated the SO about  This will make her
process and has
related to lack of the disease process, understand the situation of
treatment. causes and her child.  Verbalize
exposure to
information about  Identify complications. understanding of her
preventing or appropriate  Discussed the  This will make the SO child’s condition,
detecting interventions to importance of different understand why they need to disease process and
address the diagnostic tests. do some diagnostic tests.
dehydration treatment.
 Ensured that the  Inappropriate information
patient’s needs.  Identify appropriate
information given to the may give falls hope to the
 Identify client is appropriate. SO. interventions to
interferences o address the patient’s
learning and needs.
specific actions to  Identify
deal with her interferences o
child’s condition. learning and specific
28
 actions to deal with
her child’s condition

NCP 3: Imbalanced Nutrition: less than body requirements

ASSESSMENT EXPLANATION OF THE PLOBLEM OBJECTIVE NURSING INTERVENTION RATIONALE EVALUATION

Objective: A 1-year-old and 11-month-old patient STO: Dx: Goal met
● Vomits ¼ cup with a compromised immune system Within eight hours of  Assessed nutritional history  Identify deficiencies,
● Sunken eyes has a poor appetite, inappropriate rendering appropriate including preferred food. suspect the possibility of STO:
● 4 second skin feeding and care in early life, an open nursing intervention, specific interventions After effective nursing
turgor
Ileo-jejunostomy stoma, and a the patient will be able  Assessed eating patterns and  To ascertain treatment/ interventions the patient’s
● Dry oral mucosa
● Dry skin maternal risk of smoking habits pre-  Increase food/ fluid choices in interventions that may be  Increase consumption of
● Sodium (Na)= pregnancy has an increased consumption of relation to any health-risk needed in addition to nutrient dense foods,
134.30mmol/L susceptibility to health risks. The loss nutrient dense foods, factors and health goals weight management. such as fruits and
● Body weight= 5.2 of fluid absorptive capacity in the such as fruits and  Assessed weight, measure  Establish baseline vegetables, legumes,
kg colon has caused an increase in fluid or calculate body fat. parameter.
vegetables, legumes, whole grains, and lean
● BMI=9.24 and electrolyte loss and relative fluid
● Output=600 mL whole grains, and proteins.
absorption. The patient has developed lean proteins. Tx:  Supplement with
● Input=300 mL
● Brown liquid severe chronic malnutrition and  Offered solid foods before
 Supplement with multivitamins and
29
 stool moderate dehydration. This has led to multivitamins and formula or breast milk.  To facilitate swallowing. minerals to meet specific
● Intact ileostomy her not being able to properly absorb minerals to meet Place solid foods in the Older infants and young nutrient needs.
bag noted sugar, fatty acids, and amino acids. specific nutrient center of the tongue, using a toddlers may resist solid  Increase caloric intake to
The patient has a sodium level of needs. small spoon to press foods, preferring milk or meet daily energy needs
134.30 mmol/L and consumes 40% of  Increase caloric downward slightly. formula.
the food being served. She weighs 5.2 intake to meet daily  Provided small, frequent
kilograms and is 75 cm tall with a BMI energy needs. feedings or eat in between  Little food can reduce
of 9.24, which proves that she is meals. vulnerabilities, fatigue and
Vital signs
malnourished, which is less than increase input and also
T: 36.6°C
normal body requirements. prevents gastric distention.
PR: 160 bpm
RR: 45 cpm  Provided a diet that meets  To help meet the child’s
LTO: child’s daily caloric maintenance and growth LTO:
SPO2: 98%
After three days of requirements. Daily caloric needs. After effective nursing
REFERENCE: NANDA
rendering appropriate intake depends on age, interventions, the patient:
Nursing Diagnosis: nursing intervention the metabolic status, and  Demonstrate appropriate
Imbalanced Nutrition patient will: activity level. changes in eating patterns,
related to poor  Demonstrate Edx: food quantity and quality.
food/fluid intake appropriate changes  Encouraged child and  Increase and maintain
in eating patterns, parent to choose  To assist patient in finding weight at a satisfactory
food quantity and nutritious food such as preferred healthy options. level for height, body
quality. vegetables, fruits, and build, age, and gender.
 Increase and maintain low-fat foods.  Display normalization of
weight at a  Recorded and described laboratory values and be
satisfactory level for food intake. Refer family  A dietitian or nutritional free of signs of
height, body build, members to a dietitian or support team can malnutrition.
age, and gender. nutritional support team individualize the child’s
 Display normalization for dietary management. diet within prescribed
of laboratory values  Encouraged parent’s restrictions.
and be free of signs of patient to avoid food that
malnutrition. stimulate gas production.

 To lower distention and

30
 gastric irritation.

NCP 4: Risk for infection

EXPLANATION OF THE NURSING

ASSESSMENT OBJECTIVE RATIONALE OUTCOME
PROBLEM INTERVENTION

Objective Due to the past surgery to fix the STO: Dx: Goal Met
condition, there was an open stoma that  Monitor vital signs  Reflective of
● Vomits ¼ After 8 hours of nursing especially temperature. inflammatory process/
was done to put the colostomy which STO:
cup intervention, the patient’s infection requiring
make the patient risk for infection.
● Sunken eyes SO will be able to  Asses wound site evaluation After 8 hours of nursing
● 4 second  To have baseline on the intervention, the patient’s SO
skin turgor  Identify  Examine wounds daily, site to be cared.
● Dry oral is able to
interventions to note changes in  Identifies presence of
mucosa prevent or reduce appearance, odor, quality healing and provides for
● Dry skin  Identify
Reference: NANDA risk for infection. of drainage early detection of burn-
● Sodium Tx: wound infection interventions to
(Na)=  Keeping the prevent or reduce
 Clean the wound area,
134.30mmol surgical site clean risk for infection.
 Use strict aseptic  To promote healing
/L and dry to prevent technique during wound  Keeping the surgical
● Body bacteria from care  Prevents exposure to site clean and dry to
weight= 5.2 growing.  Keep are around wound infectious organisms
kg prevent bacteria
 Maintaining strict clean and dry from growing.
● BMI=9.24  Wet area can lodge are
● Output=600 hand hygiene and  Maintaining strict
using proper Edx: of bacteria
mL hand hygiene and
 Emphasize importance of
31
 ● Input=300 cleaning handwashing technique using proper
mL techniques.  Educate the teaching cleaning techniques.
● Brown about identification of  It serves as a first line of
liquid stool LTO: environmental risk defense against infection
● Intact factors that could add up
ileostomy After 3 days of nursing on infection.  To help SO
bag noted intervention, the patient  Emphasize necessity of modify/avoid some of
Vital signs will be able to: frequent changing of the environmental LTO:
 Be free of signs and ileostomy bag when full. factors present.
T: 36.6°C After 3 days of nursing
PR: 160 bpm symptoms of
infections intervention, the patient is
RR: 45 cpm  To provide comfort and able to:
SPO2: 98%  Free of exudates or avoid growth of bacteria
discharges form the around the area.  Be free of signs and
stoma
Nursing diagnosis: symptoms of infection
 Achieve timely wound
Risk for infection  Free of exudates or
related to post healing
discharges form the
double barrel jejuno- stomach
ileostomy
 Achieve timely wound
healing

NCP 5: Risk for fall

ASSESSMENT EXPLANATION OF THE PROBLEM OBJECTIVE NURSING INTERVENTION RATIONALE OUTCOME
Objective: A 1-year-old and 11-month-old patient STO: Dx: Goal Met
with a compromised immune system has After 8 hour of nursing  Evaluate the client's current  Acute, even short-
● Vm a poor appetite, inappropriate feeding and disorders/conditions that term, situations can STO:
interventions the patient will
omits ¼ could enhance risk potential affect any client, such After 8 hour of nursing
care in early life, an open Ileo- be able to: as sudden dizziness,
cup for falls. interventions the patient are
● Sunken jejunostomy stoma, and a maternal risk of  Modify environment as positional blood
smoking habits pre-pregnancy has an indicated to enhance pressure changes, new able to:
eyes  Evaluate the client's general
● 4 second increased susceptibility to health risks. safety. and hip muscle strength, medication, change in  Modify environment as
 Be free from injury. postural stability, gait and glasses prescription, indicated to enhance
skin The loss of fluid absorptive capacity in
 Educate the patient standing balance, and gross recent use of safety.
turgor the colon has caused an increase in fluid
and family members and fine motor coordination. alcohol/other drugs,  Be free from injury.
● Dry oral and electrolyte loss and relative fluid and so on.  Educate the patient and
32
 mucosa absorption. The patient has developed on the risk of falls and family members on the
● Dry skin severe chronic malnutrition and moderate how to reduce it.  Assess mood, coping  An individual's risk of falls and how to
● Sodium abilities, and personality temperament, typical reduce it.
dehydration. She is unable to tolerate and
(Na)= styles. behavior, stressors,
has vomited all previous ingested food and level of self-
134.30mm LTO:
ol/L and oral rehydrating solution. Excessive esteem can affect
After 3 days of nursing LTO:
● Body vomiting has caused a decrease in Tx: attitude toward safety
interventions the patient will issues, resulting in After 3 days of nursing
weight= circulating blood, which has caused an  Assist in treatments and
be able to: carelessness or interventions the patient SO
5.2 kg increase in heart rate to 160 bpm to provide information
regarding the client's increased risk taking are able to:
● BMI=9.24 compensate for it. This could lead to  Verbalize
disease/condition(s) that may without consideration
● Output=6 postural hypotension, which can increase understanding of
result in increased risk of of consequences.  Verbalize
00 mL individual risk Studies have
the risk of falling. falls.  understanding of
● Input=300 factors that confirmed that use of individual risk factors
mL contribute to the four or more
Reference: NANDA  Place the bed in the lowest that contribute to the
● Brown possibility of falls. medications possibility of falls.
liquid possible position, use a raise
 Demonstrate (polypharmacy)  Demonstrate
stool edge mattress, pad floor at
behaviors and side of bed, or place mattress increases the risk of behaviors and
● Intact lifestyle changes to falls. lifestyle changes to
on floor as appropriate and
ileostomy reduce risk factors reduce risk factors
raise side rails.
bag noted and protect self and protect self from
Vital signs from injury.  Assist with transfers and  To avoid fall that can injury.
 Keeping the ambulation. harm the client  Keeping the
T: 36.6°C environment free  Client/caregivers may environment free
PR: 160 bpm from hazards. need financial
Edx: from hazards.
RR: 45 cpm assistance, home
SPO2: 98% modifications,
 Advise the client’s SO to referrals for
maintain a safe environment. counseling, home care,
 Advise the client’s SO not to sources for safety
Nursing diagnosis: leave the patient unattended. equipment, or
Risk for fall  Reiterate importance of placement in
monitoring client/intervening extended-care facility.
in conditions.  To ensure the client’s
safety
33
C. Discharge Plan

Health Teaching
1. Emphasize the importance of medication adherence.
2. Educate the client about the importance of taking her
Medication prescription on schedule.
3. Instruct patient on how to take the medications.
4. Instruct patient how the drug works to be aid of.

1. Increase oral fluid intake.

Activity 2. Bed rest

1. Discussed proper diet such as foods rich in Vitamin C that will

help strengthening the immunity.
2. Emphasized eating nutritious foods; vegetables, meat and lots
of fruits. Easily digestible foods. Eat "fortified" foods that
Nutrition/Diet contain extra nutrients
3. Drink plenty of fluids to stay hydrated.
4. Instructed to avoid foods that are hard to chew and/or swallow,
like nuts, raw carrots and gum.
5. Advised the patient to gain and maintain a healthy weight.

1. Promoted bed rest as much as possible.

2. Encouraged to do limited range of motion as tolerated.
3. Instructed client to have quiet and calm environment.
4. Instructed to avoid excessive activities that may result to
Others
stress.
5. Encouraged to drink fluid regularly during physical activity
and drink several glasses of water or other fluid after the
physical activity is completed.

34
XVI. Learning Insights

A. AMOSLO, KIMBERLY
I was able to get a critical understanding of these situations due to Vomiting with
Moderate Signs of Dehydration; Severe Chronic Malnutrition; and Complete Intestinal
Obstruction Secondary to Intestinal Malrotation with Volvulus Status Post Double Barrel
Jejuno-Ileostomy. Prior to learning the principles and proficiency in this course of study, I
was also able to appreciate healthcare providers. My knowledge of medicine taught me to be
more diligent in how I handled my obligations and duties. I became aware of the need of
evaluating my patient by monitoring their vital signs. Our group and capabilities helped us to
comprehend the importance of critical thinking and teamwork in completing a variety of
positions.

B. BANDAO, MARC JOSEPH

In this case, the patient has multiple medical issues, including vomiting with
moderate signs of dehydration, severe chronic malnutrition, and a complete intestinal
obstruction secondary to intestinal malrotation with volvulus status post double jejuno-
illeostomy. Throughout the course of compiling this study, I have observed that the patient's
overall health and well-being have been significantly impacted by each of these medical
conditions and have interacted with one another to provide a more complicated and difficult
clinical picture. Further, I have learned about its causes, symptoms, diagnosis, treatment, and
prevention, wherein this knowledge can help in treating the disease and education about it
that can lead to better outcomes for those affected by it.

C. CHAN, OLIVIA
With the readings that I did about the case of our patient 'Vomiting with Moderate
Signs of Dehydration; Severe Chronic Malnutrition, Complete Intestinal Obstruction
Secondary to Intestinal Malrotation with Volvulus Status Post Double Barrel Jejuno-
Ileostomy', I have acquired a new knowledge about what malrotation and volvulus is and that
it is vital to aid intestinal obstruction as soon as possible as this will affect not only the bowel
movement of the body but also it has a secondary effect with the absorption of nutrients from
the food that we eat.

D. DE ASIS, SHEILA
Upon collaborating about the study, I now understand how Vomiting with Moderate
Signs of Dehydration; Complete Intestinal Obstruction Secondary to Intestinal Malrotation
with Volvulus Status Post Double Barrel Jejuno-Ileostomy affects the human body. I was able
to broaden my knowledge on how we should monitor and treat patients by closely monitoring
their vital signs, input and output and the food and medications they need since this disease
affects the whole digestive system. It was also important to brainstorm with my groupmates
as this provides a more collaborative output.

E. DULNUAN, JHANE
Honestly, in the first place I thought that this case is very complicated for us to do
because when we got the case, most of the patient’s diagnosis was common and we thought
that other groups did get it so we have no choice but to proceed with this, So, as we do the
entire paper it, I realize that this case was very informative and educational to us because
honestly it is my first time handling a patient that have this case. The researches and diagnosis
that we have done was hard but at the same time it helps me to further understand the case of
the patient. Researches and journals that was used in this study broaden and help me

35
 understand the essence of this case. In the process of making, even though this is our second
time making this case study, it is still hard for me to evaluate If the ones that we have done is
correct and understandable. Participation and understanding the case is very important so that
I can make a good and comprehended case study.

G. DUMAG, ELAIJAH
Even though this is our second time having a case study, it is still hard but lesser
compared to the first experience we had. Although it is difficult to make, I learned and
understand a lot about Vomiting with Moderate Signs of Dehydration; Severe Chronic
Malnutrition; and Complete Intestinal Obstruction Secondary to Intestinal Malrotation with
Volvulus Status Post Double Barrel Jejuno-Ileostomy, especially in the pathophysiology
section as it paved way for me to correlate these diagnoses to each other, the causes, and how
the disease affects the systems of the body. As a future nurse, I believe that understanding the
causes and signs and symptoms of the disease will help me in providing correct treatment for
the patient which will avoid to an occurrence of a more serious complication. As a student
nurse, my goal is to promote healthy lifestyle and importance of adherence to medication
treatment through health education. Furthermore, making this case study has also taught me
that cooperation and a pooled understanding will make a task easier and more comfortable to
do.

H. GOYALA, JANELLA HANNES

Vomiting with Moderate Signs of Dehydration; Severe Chronic Malnutrition,
Complete Intestinal Obstruction Secondary to Intestinal Malrotation with Volvulus Status
Post Double Barrel Jejuno-Ileostomy', I have gained a new knowledge about this disease.
When the intestine does not twist properly, it develops an abnormality known as intestinal
malrotation, or twisted intestines. Instead, the way it twists prevents the passage of food.
Sometimes, aberrant tissue known as Ladd's bands connects the cecum to the duodenum
(beginning of the small intestine), which can result in a blockage.

I. ORPILLA, ALYSSA MEGAN

Vomiting with Moderate Signs of Dehydration; Severe Chronic Malnutrition;
Complete Intestinal Obstruction Secondary to Intestinal Malrotation with Volvulus Status
Post Double Barrel Jejuno-Ileostomy" was the diagnosis in our case.
I now have a thorough understanding of how malrotation and intestinal volvulus malrotation
effect the body's processes. Additionally, I now know what causes, symptoms, a diagnosis is,
how to treat it, and how to prevent it. And one of my responsibilities as a student nurse is to
mold myself as a health educator and promoter. My understanding of this can help treat the
ailment and educate people about it, which can improve the outcomes for those who are
affected by it.

J. WAG-E, DAWNMURPH DHARLENE

During the process of putting this study together, I was able to broaden my
knowledge of the different signs and symptoms of dehydration and severe malnutrition. A

36
new topic was also introduced, which is Intestinal Obstruction, Intestinal Malrotation, and
Volvulus Status Post Double Barrel Jejuno-Ileostomy. These illnesses reminded me of the
importance of closely monitoring the patient; this also enlightened me on how I, as a student
nurse, can help alleviate some of the discomforts the patient was feeling. Research-wise, the
study helped me understand how the illness progressed and how it can be cured. Additionally,
when working with a group, I learned the importance of communication to be able to
accomplish the study in a more organized and efficient way. Understanding all the parts of the
study is also necessary to see how every sign and symptom can be connected to the diseases.

37
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40