I.

INTRODUCTION

Gastroenteritis is a catchall term for infection or irritation of the digestive

tract, particularly the stomach and intestine. It is frequently referred to as the
stomach or intestinal flu, although the influenza virus is not associated with this
illness. Major symptoms include nausea and vomiting, diarrhea, and abdominal
cramps. These symptoms are sometimes also accompanied by fever and overall
weakness. Gastroenteritis typically lasts about three days. Adults usually recover
without problem, but children, the elderly, and anyone with an underlying disease
are more vulnerable to complications such as dehydration. (www.wikipedia.com)

Bacterial gastroenteritis is frequently a result of poor sanitation, the lack of

safe drinking water, or contaminated food—conditions common in developing
nations. Natural or man-made disasters can make underlying problems in sanitation
and food safety worse. In developed nations, the modern food production system
potentially exposes millions of people to disease-causing bacteria through its
intensive production and distribution methods. Common types of bacterial
gastroenteritis can be linked to Salmonella and Campylobacter bacteria; however,
Escherichia coli 0157 and Listeria monocytogenes are creating increased concern in
developed nations. Cholera and Shigella remain two diseases of great concern in
developing countries, and research to develop long-term vaccines against them is
underway.( www.emedicines.com)

Gastroenteritis is an uncomfortable and inconvenient ailment, but it is rarely

life-threatening in the United States and other developed nations. However, an
estimated 220,000 children younger than age five are hospitalized with
gastroenteritis symptoms in the United States annually. Of these children, 300 die
as a result of severe diarrhea and dehydration. In developing nations, diarrheal
illnesses are a major source of mortality. In 1990, approximately three million
deaths occurred worldwide as a result of diarrheal illness.(www.emedicines.com)

Locally, In July 22, 2004, the Department of Health (DOH), Philippines declared an
epidemic (outbreak) of a water/food-borne disease called acute gastroenteritis in 45 towns in
Central Pangasinan. Acute gastroenteritis is a human enteric (intestinal) disease primarily caused
by ingestion of spoiled or bacterial contaminated water or food.

According to the DOH Secretary, Dr. Manuel Dayrit, a total of 2,778 cases of the said
intestinal infection were recorded in just 45 days (from May 31 to July16, 2004). From the
studies on the medical diagnoses of 81 cases, Dayrit concluded that infectious (transmittable)
cholera disease was the main cause of the epidemic.(www.doh.gov.ph)
 Locally, here in Tagum City, at Davao Regional Hospital pediatric department acute
gastroenteritis was considered number 3 among the most common pediatric cases. It is common
in this area because some of the people are not aware regarding the proper handling and
preparation of food.

Gastroenteritis is a general term referring to inflammation or infection of the

gastrointestinal tract, primarily the stomach and intestines.[1] It can be caused by infection with
bacteria, viruses, or other parasites, or less commonly reactions to new foods or medications. It
often involves stomach pain (sometimes to the point of crippling), diarrhea and/or vomiting, with
noninflammatory infection of the upper small bowel, or inflammatory infections of the colon. It
usually is of acute onset, normally lasting fewer than 10 days and self-limiting. Sometimes it is
referred to simply as 'gastro'. It is often called the stomach flu or gastric flu even though it is not
related to influenza. If inflammation is limited to the stomach, the term gastritis is used, and if
the small bowel alone is affected it is enteritis. As such, this has a relationship on the concept
fluids and electrolyte. Because dehydration the most common complication of gastroenteritis if
not treated or no immediate intervention done it could lead to shock and eventually can lead to
death.
OBJECTIVES

General:

1. To fully understand the underlying disease process of aplastic anemia.

Specific:

1. To identify the epidemiological data of aplastic anemia globally,

nationally and locally.
2. To learn about the major etiologies of aplastic anemia.
3. To determine the previous and present clinical history of the patient.
4. To perform physical assessment with special attention on the systems
focus.
5. To show the laboratory examination results with the corresponding
normal values, actual result from the patient, and it interpretation.
6. To understand the anatomy and physiology of the blood and blood
formation and its pathology during aplastic anemia.
7. To trace and understand the pathophysiology of aplastic anemia.
8. To learn the basic principle of medical management of aplastic anemia.
9. To use the nursing process to identify nursing problems from the client
and provide the appropriate nursing care plan.
 10. To understand the pharmacological management set on the client and
provide nursing interventions.
11. To identify the discharge plan for the patient’s rehabilitation to conduct
an evaluation of the client’s condition from admission to present.

II. ASSESSMENT

A. BIOGRAPHIC DATA

Name : Bb. Zoo Sy

Case Number : 185098

Age : 3 months old

Sex : Male

Weight (upon admission) : 43 kgs.

Civil Status : Single

Birthdate : January 8, 2007

Address : Prk. 1 #96 Linoan Montevista, ComVal

Nationality : Filipino

Attending Physician : Dr. Dagooc

B. CHIEF COMPLAINT
 Based on the patient’s chart, it appears that seizure, dyspnea,
weakness, poor suckling, LBM with watery stool were the chief
complaints experience by Bb. Zoo Sy which eventually made her family
sought for admission.

C. HISTORY OF PRESENT ILLNESS

One week prior to admission, patient experienced on and off

fever, no consultation and medicines given to the patient at home.
Until 3 days prior to admission patient was positive of several episodes
of LBM, yellowish to greenish in color, mucoid, non blood streaked and
positive fever again no consultation done. Upon admission, the patient
experienced 2 episodes of upward rolling of eyeballs with cycling
motion of extremities at the ER. With admitting vital signs of BP- 70/50
mmHg, CR- 140bpm, RR- 58cpm, Temp- 36.4˚C, with pulse oxymeter
reading of 96% O2 saturation.

D. PAST MEDICAL HISTORY

E. PERSONAL, FAMILY AND SOCIO-ECONOMIC

Bb. Zoo Sy was born January 8, 2007. He was the youngest of the
4 children in the family. Two weeks prior to admission Bb. Zoo Sy
together with his siblings were left by their mother. While his father
was a hardworking businessman who was then at GenSan. The income
of his father is just enough to support their basic needs.

III. REVIEW OF SYSTEMS (PHYSICAL ASSESSMENT)

A. GENERAL SURVEY
 Bb. Zoo Sy was lying flat on bed, lethargic with sunken fontanels,
sunken eyeballs, dry pale lips, dyspnea, and distended abdomen.

B. VITAL SIGNS

Date Shift Time Temp BP RR PR Intak Outpu

e t

05/03/0 11pm- 1:15 am 36.4 70/50 58 140

7 7am

3:50am 36.2 70/50 56 156

5:00am 36 70/50 42 132

7:00am 36.5 70/50 38 123

7am- 8:50am 36.4 70/50 42 120

3pm

9:55 am 36.8 90/60 48 127

11:16 am 37 80/50 48 130

12:20pm 37 80/50 46 134

1:26 pm 36.9 90/60 49 128

2:55pm 37.6 90/50 52 136 u-350cc

3-11pm 5:00pm 37.3 100/60 43 118

6:15pm 37.4 90/60 43 120

7:15pm 37.5 100/60 33 115

8:20pm 37.6 90/50 37 103

9:50pm 37.2 90/50 40 130 u-200cc

10:45 37.2 90/50 38 100

pm
05/04/0 11pm- 12:30am 36.9 90/50 34 133
7 7am

1:54 am 36.8 90/60 43 124

3:06 am 36.8 90/50 40 109

4:15am 36.8 80/50 37 118

5:50am 36.5 90/60 37 129 u-290cc

6:40am 36.5 80/50 40 110

05/04/0 7am- 8:39am 37 90/60 38 112

7 3pm

10:08am 37..3 80/50 38 116

11:35am 37 90/50 40 120

12:45pm 37.7 80/50 34 124 u-170cc

1:40pm 38.8 90/50 36 126

2:51pm 38.1 90/50 37 128

05/04/0 3-11pm 4:50pm 38 80/50 37 110 OF-30cc

7
6:30pm 37.3 80/50 40 108 u-110cc

7:45pm 36.8 80/50 45 81 OF-30cc

9:10pm 37 80/50 43 99

10:30pm 36.3 80/50 41 107

05/05/0 11pm- 12:25am 36.4 80/50 45 95

7 7am

2:10am 36.7 90/50 43 102

4:20am 37.1 90/50 42 128 OF-30cc

6:00am 37.1 90/50 46 132 u-130cc

7:00am 37 42 123

05/05/0 7am- 8:42am 36.5 80/50 48 120 OGT-30cc

7 3pm
 9:56am 36.8 90/50 44 118

10:54am 37 90/50 47 122 u-80cc

12:22pm 37.8 90/50 42 128 OGT-50cc

1:18pm 38.3 46 132

2:40pm 37 90/50 40 128 OGT-50cc

05/05/0 3-11pm 4:48pm 38.5 90/50 49 118 OGT-130cc

7
6:13pm 38 90/50 42 135

7:27pm 37.3 90/60 45 110 u-100cc

8:34pm 37.7 90/60 40 137

10:31pm 37.5 90/50 45 120

05/06/0 11pm- 12:55am 37 90/60 48 125 Milk-50cc

7 7am

2:15am 37 90/60 44 130 u-90cc

3:40am 37 90/60 49 127 Milk-50cc

5:10am 36.9 90/60 40 135

6:30am 36.9 90/60 43 132

05/06/0 7am- 8:36am 36.8 90/60 40 128

7 3pm

10:25am 37.2 90/60 44 132

12:00pm 37 90/60 46 135 u-100cc

05/06/0 3-11pm 6:10pm 36.2 90/50 43 140 Milk-90cc u-100cc

7 H2O-10cc

05/07/0 11pm- 1:30pm 37.2 90/60 41 127 u-100cc

7 7am

05/07/0 7am- 9:00pm 37.3 39 136 u-50cc

7 3pm
05/07/0 3-11pm 6:30pm 36.2 43 132 milk-90cc u-90cc
7

05/08/0 11pm- 12:00am 37 90/50 40 120 Milk-70cc

7 7am

4:00am 37.2 90/60 36 115 u-100cc

05/08/0 7am- 8:00pm 36.4 90/50 38 108 u-30cc

7 3pm

12:00pm 36 90/60 36 120 u-90cc

3-11pm 6:00 37 90/50 40 138

11pm- 12:00 36.6 90/50 28 113 H2O-180cc u-340cc

7am

4:00 36.8 90/60 37 118

05/09/0 7am- 8:00 36.4 90/60 28 120 H2O-90cc u-60cc

7 3pm

12:00 36.8 90/60 34 125

3-11pm 3:00 37.1 90/60 39 140 H2O-90cc u-60cc

05/10/0 11pm- 1:30 37.1 90/50 40 142 H2O-60cc u-100cc

7 7am

7am- 9:30 36.5 40 143 H2O-407cc u-100cc

3pm

05/11/0 11pm- 1:50 38.9 90/60 42 148 u-120cc

7 7am

7am- 9:00 36.7 90/60 40 142 Milk-40cc u-140cc

3pm

3-11pm 5:25 36.5 80/50 43 137 Milk-30cc u-110cc

05/12/0 11pm- 2:00 36.7 80/50 30 138 Milk-2.5 oz u-120cc

7 7am

7am- 11:00 37.5 90/50 46 156 Milk-4 oz u-350cc

3pm

6:15 36.8 90/60 29 135 u-150cc

05/13/0 11pm- 12:50 37 90/50 45 133 Milk-2 oz u-100cc

7am
7
7am- 10:00 37.1 90/60 48 160 Milk-8 oz u-50cc
3pm

3-11pm 6:30 37.3 80/50 32 130 Milk-4 oz u-130cc

05/14/0 11pm- 1:45 36.9 90/60 34 136 Milk-6 oz u-100cc

7 7am

7am- 10:30 36.8 90/60 36 140 Milk-6 oz u-120cc

3pm

3-11pm 5:45 36.7 80/50 34 120 Milk-3.5 oz u-90cc

05/15/0 7am- 8:10am 36.7 100/70 37 123 Milk-70cc u-200cc

7 3pm

12:30pm 36.5 90/70 36 124 Milk-50cc

3-11pm 5:30pm 37.4 90/50 40 144 Milk-3.5 0z u-140cc

05/16/0 11pm- 1:30am 36.5 90/60 36 140 Milk-4 oz u-90cc

7 7am

05/16/0 7am- 8:00am 36.8 90/50 42 128 Milk-60cc u-100cc

7 3pm

12:00pm 36.5 90/50 38 126 Milk-135cc

C. NUTRITIONAL STATUS

Upon admission, patient was placed on NPO with OGT F8

and keep distal and open. Admitting weight was 5.2kg. During
our shift patient was on dropper feeding.
D. NEUROLOGIC STATUS

Patient was lethargic as observed by NOD.

E. INTEGUMENTARY SYSTEM

Fine and evenly distributed, thin and dry hair was noted.
His nails were in convex shape, smooth in texture , capillary refill
of five seconds an untrimmed finger nails with poor skin turgor.
His skin was pale, dry, with fine and fare complexion

F. HEENT

The size of head was in proportion with the body. The eyes
were symmetrical with the ears; with sunken fontanels and eyes.
When the eyes were tested papillary reaction to light, the pupil
constricted to 2mm. Ear had no discharges noted. Nasal septum
were intact and in the midline. Patient had cleft lip. The throat
was functioning well and in normal condition.

G. PULMONARY SYSTEM

Respiratory rate was 58 cpm and dyspnic. Upon

auscultation, crackles were heard and with symmetrical chest
expansion. With history of Pneumonia.

H. CARDIOVASCULAR SYSTEM
 Patient’s CR was 140 bpm which is normal. No murmur
heard upon auscultation. There was no history of
cardiopulmonary disease.

I. GASTROINTESTINAL SYSTEM

The abdomen was distended, soft and there was no

palpable mass felt upon palpation. Hypoactive bowel sound
heard upon auscultation. The patient vomited 3-5 times a day
and defecated more than 6 times a day with watery stool.

J. MUSCULOSKELETAL SYSTEM

The patient manifested good posture and moved

voluntarily; he had symmetrical musculature on both sides of the
body. Weakness was noted.

K. GENITO- URINARY SYSTEM

Patient voided 60 – 350 cc per shift as weighed and yellow

in color.

IV. LABORATORY AND DIAGNOSTIC EXAMINATION

LABORATORY NORMAL RESULT INTERPRETATION

EXAM VALUE
Hemoglobin Male- 13.5-18 83.3 This shows that the
mass g/dl hemoglobin level is very
concentration low than normal that
indicates decrease tissue
pefusion.
 Leukocyte 5-10x10 9/l 17.9 This indicates low level of
number sodium in the blood or
concentration hyponatremia
Neutrophils 0.55-0.65 0.35 Neutrophils is lower than
normal which indicatates
risk for infection.
Eusinophils 0.22-0.04 0.79 The eusinophils is higher
than normal range which
involved in allergic
reactions(neutralizes
histamine; digest foreign
proteins).
Lymphocytes volume0.22 0.79 Lymphocytes is higher
than normal range which
may help in fighting
against infection.
Sodium 1.35-148 130.4 mmol/L This indicates that the
mmol/L level of sodium is slightly
lower than normal.
Potassium 3.5-5 mmol/L 3.15 mmol/L The potassium level is
slightly below than normal
range.
Calcium 1.13-1.32 0.84 mmol/L This indicates that the
mmol/L level of calcium is lower
than normal range.
RBS 3.9-6 mmol/L 0.84 mmol/L The RBS is just within the
normal range.
Erythrocytes 0.25 0,25 This shows that the
volume fraction erythrocyte volume
fraction level is just within
the normal range.
Erythrocyte 7.5 mmol/L
number
concentration
Stool exam No ova found
Thrombocytes 150,000-
(Platelet) 450,000
/mm3

SYMPTOMATOLOGY
 Clinical Present Rationale
manifestations in the
patient

Abdominal pain or Decreased circulating

cramping oxygen in the body can
lead to excessive blood
Nausea
loss & bone marrow
destruction

Vomiting /

Fever / To compensate with the

diminishing blood
Poor feeding /
supply to all body
Unintentional weight / systems.
loss

Excessive sweating

Clammy skin / Due to the decreased

platelets in the blood

Muscle pain or joint

stiffness

Incontinence (loss of
bowel control)

Extreme thirst Due to decreased

platelets in the blood

Urine that is darker in

color

Dry skin / Due to decreased

clotting factor in the
blood

Dry mouth /

Sunken cheeks or eyes /

 In infants, dry diapers
(for more than 4-6 hrs)

V. ANATOMY AND PHYSIOLOGY

Anatomy of the Digestive System

If a human adult’s digestive tract were stretched out, it would be 6 to 9 m (20

to 30 ft) long. In humans, digestion begins in the mouth, where both mechanical
and chemical digestion occur. The mouth quickly converts food into a soft, moist
mass. The muscular tongue pushes the food against the teeth, which cut, chop, and
grind the food. Glands in the cheek linings secrete mucus, which lubricates the food,
making it easier to chew and swallow. Three pairs of glands empty saliva into the
mouth through ducts to moisten the food. Saliva contains the enzyme ptyalin, which
begins to hydrolyze (break down) starch—a carbohydrate manufactured by green
plants.

Once food has been reduced to a soft mass, it is ready to be swallowed. The
tongue pushes this mass—called a bolus—to the back of the mouth and into the
pharynx. This cavity between the mouth and windpipe serves as a passageway both
for food on its way down the alimentary canal and for air passing into the windpipe.
The epiglottis, a flap of cartilage, covers the trachea (windpipe) when a person
swallows. This action of the epiglottis prevents choking by directing food from the
windpipe and toward the stomach.

Mouth

The mouth plays a role in digestion, speech, and breathing. Digestion begins
when food enters the mouth. Teeth break down food and the muscular tongue
pushes food back toward the pharynx, or throat. Three salivary glands—the
sublingual gland, the submandibular gland, and the parotid gland—secrete enzymes
that partially digest food into a soft, moist, round lump. Muscles in the pharynx
swallow the food, pushing it into the esophagus, a muscular tube that passes food
into the stomach. The epiglottis prevents food from entering the trachea, or
windpipe, during swallowing.

Esophagus

The presence of food in the pharynx stimulates swallowing, which squeezes

the food into the esophagus. The esophagus, a muscular tube about 25 cm (10 in)
long, passes behind the trachea and heart and penetrates the diaphragm (muscular
wall between the chest and abdomen) before reaching the stomach. Food advances
through the alimentary canal by means of rhythmic muscle contractions
(tightenings) known as peristalsis. The process begins when circular muscles in the
esophagus wall contract and relax (widen) one after the other, squeezing food
downward toward the stomach. Food travels the length of the esophagus in two to
three seconds.

A circular muscle called the esophageal sphincter separates the esophagus

and the stomach. As food is swallowed, this muscle relaxes, forming an opening
through which the food can pass into the stomach. Then the muscle contracts,
closing the opening to prevent food from moving back into the esophagus. The
esophageal sphincter is the first of several such muscles along the alimentary canal.
These muscles act as valves to regulate the passage of food and keep it from
moving backward.

Stomach

The stomach, located in the upper abdomen just below the diaphragm, is a
saclike structure with strong, muscular walls. The stomach can expand significantly
to store all the food from a meal for both mechanical and chemical processing. The
stomach contracts about three times per minute, churning the food and mixing it
with gastric juice. This fluid, secreted by thousands of gastric glands in the lining of
the stomach, consists of water, hydrochloric acid, an enzyme called pepsin, and
mucin (the main component of mucus). Hydrochloric acid creates the acidic
environment that pepsin needs to begin breaking down proteins. It also kills
microorganisms that may have been ingested in the food. Mucin coats the stomach,
protecting it from the effects of the acid and pepsin. About four hours or less after a
meal, food processed by the stomach, called chyme, begins passing a little at a
time through the pyloric sphincter into the duodenum, the first portion of the small
intestine.
Liver

The liver is the largest internal organ in the human body, located at the top of
the abdomen on the right side of the body. A dark red organ with a spongy texture,
the liver is divided into right and left lobes by the falciform ligament. The liver
performs more than 500 functions, including the production of a digestive liquid
called bile that plays a role in the breakdown of fats in food. Bile from the liver
passes through the hepatic duct into the gallbladder, where it is stored. During
digestion bile passes from the gallbladder through bile ducts to the small intestine,
where it breaks down fatty food so that it can be absorbed into the body. Nutrient-
rich blood passes from the small intestine to the liver, where nutrients are further
processed and stored. Deoxygenated blood leaves the liver via the hepatic vein to
return to the heart.

Small Intestine

Most digestion, as well as absorption of digested food, occurs in the small

intestine. This narrow, twisting tube, about 2.5 cm (1 in) in diameter, fills most of
the lower abdomen, extending about 6 m (20 ft) in length. Over a period of three to
six hours, peristalsis moves chyme through the duodenum into the next portion of
the small intestine, the jejunum, and finally into the ileum, the last section of the
small intestine. During this time, the liver secretes bile into the small intestine
through the bile duct. Bile breaks large fat globules into small droplets, which
enzymes in the small intestine can act upon. Pancreatic juice, secreted by the
pancreas, enters the small intestine through the pancreatic duct. Pancreatic juice
contains enzymes that break down sugars and starches into simple sugars, fats into
fatty acids and glycerol, and proteins into amino acids. Glands in the intestinal walls
secrete additional enzymes that break down starches and complex sugars into
nutrients that the intestine absorbs. Structures called Brunner’s glands secrete
mucus to protect the intestinal walls from the acid effects of digestive juices.
 The small intestine’s capacity for absorption is increased by millions of
fingerlike projections called villi, which line the inner walls of the small intestine.
Each villus is about 0.5 to 1.5 mm (0.02 to 0.06 in) long and covered with a single
layer of cells. Even tinier fingerlike projections called microvilli cover the cell
surfaces. This combination of villi and microvilli increases the surface area of the
small intestine’s lining by about 150 times, multiplying its capacity for absorption.
Beneath the villi’s single layer of cells are capillaries (tiny vessels) of the
bloodstream and the lymphatic system. These capillaries allow nutrients produced
by digestion to travel to the cells of the body. Simple sugars and amino acids pass
through the capillaries to enter the bloodstream. Fatty acids and glycerol pass
through to the lymphatic system.

Large Intestine

A watery residue of indigestible food and digestive juices remains

unabsorbed. This residue leaves the ileum of the small intestine and moves by
peristalsis into the large intestine, where it spends 12 to 24 hours. The large
intestine forms an inverted U over the coils of the small intestine. It starts on the
lower right-hand side of the body and ends on the lower left-hand side. The large
intestine is 1.5 to 1.8 m (5 to 6 ft) long and about 6 cm (2.5 in) in diameter.

The large intestine serves several important functions. It absorbs water—

about 6 liters (1.6 gallons) daily—as well as dissolved salts from the residue passed
on by the small intestine. In addition, bacteria in the large intestine promote the
breakdown of undigested materials and make several vitamins, notably vitamin K,
which the body needs for blood clotting. The large intestine moves its remaining
contents toward the rectum, which makes up the final 15 to 20 cm (6 to 8 in) of the
alimentary canal. The rectum stores the feces—waste material that consists largely
of undigested food, digestive juices, bacteria, and mucus—until elimination. Then,
muscle contractions in the walls of the rectum push the feces toward the anus.
When sphincters between the rectum and anus relax, the feces pass out of the bod
VII. PLANNING

A. COURSE IN THE WARD

DOCTORS ORDER

May 3, 2007

2:30 am - to CIU

- suction secretions now

- insert OGT F8 and keep distal end open

- O2 @ 4 Lpm via face mask

- Diazepam 1.5 mg IVTT now then PRN for frank seizures

- Give PLR 156 cc IV bolus now x 1 hr

- Admit to pedia ICU

- Secure signed consent to care

- NPO

Labs:

-CBC, BT, U/A, CXR-APL, blood CS, S/E

-RBS stat, ABG stat, serum electrolytes stat

 Meds:

1. Ceftriaxone 500 mg IVTT now then OD

2. Ampicillin 260 mg IVTT every 6 hrs

3. Phenobarbital 104 mg IVTT now as LD then 13 mg IVTT q 12 hrs

4. Paracetamol 60mg IVTT q hrs, PRN for Temp=37.8 C

- Monitor vs q hourly and record

- I and O q shift and record

- Hook to pulse oximeter and maintain O2 sat >90% or =90%

- Maintain on MHBR

- Replace GI losses, v/v replacement, with PLR

- Refer accordingly

- Place under droplight. Keep thermoregulated.

- Secure 1 unit of FFP of patient’s blood type and transfuse 78 cc x 4 hrs x 3 cycles
after proper retyping

- IVF to follow: PLR 156 cc to run for 1 hr then refer

May 3, 2007

3:35am -IVF to follow PLR to run @ 10 cc/hr x 2 hr then refer

May 3, 2007

6:00am -IVF to follow: D5LR 1L to run @ 86cc/hr x 6 hr then refer

May 3, 2007

7:00am -(Change present IVF to D5 IMB 500 cc + 10 mEq KCl @ 22 cc/hr x 24 hrs)-HOLD

- start Dopamine @ 2 cc/hr, hook to infusion pump

- follow up to FFP transfusion and all labs

- disregard all IVF to patient

- give PLR 100cc IV bolus x 1 hr then refer

- start another line with D5 0.3 NaCl @ KVO rate, sidedrip with Dopamine @ 2cc/hr

-RBS monitoring q 6 hrs

May 3, 2007

9:00am - give another PLR 100cc IV bolus x 1 hr then refer

10:00am - give D10 water 10cc IV bolus now

- IVF to follow: D5LR 1L @32cc/hr x 8hrs then refer

RBS 49mg/dL,for repeat RBS after 30 runs

 4:15pm - refer surgery for venous cutdown

8:20pm - referred for IVF insertIion

- May not do cutdown

May 4, 2007

3:15pm - IVF to follow D5 IMB @ 28-29 cc/hr x 6 hrs then refer

- cutdown drip

- D/C all IVF to follow

- IVF to follow: D5 IMB 500cc @ 20cc/hr, SD with Dopamine @ 2cc/hr, hook to infusion
pump

- D/C D5 LR attach to heplock

- Refer to social worker for assistance and availability of meds (ceftriaxone)

- Still for U/A, ABG

- May have milk feeding @ 30cc q 3hrs per OGT

May 5, 2007
 11:30 am - IVF to ff : D5 IMB 500 cc @ 3 cc/hr x 24 hours (50 kcal)

- increase milk feeding @ 50 cc @ 3 hours

- continue meds

- decrease 02 to 2 LPM via nasal cannula

9:40 pm - may have dropper feeding @ 50 cc every 3 hrs with SAP

May 6, 2007

7:45 am - Transferred patient to GW-Gastro

- VS monitoring q 4 hours and meds

- D/C 02 inhalation

- IVF to ff D5IMB 500 cc to run @ 5 cc/hr x 24

- Still for U/A and fecalysis

- D/C dopamine drip

May 7, 2007

8:30 am - C/D IVF and attach to heplock

- continue meds
May 8, 2007

9:30 am - continue meds

- increase dropper feeding + 70 cc/hr with SAP (71 kcal)

- Pls. ff up cranial CT scan, U/A, blood CS, fecalysis., serum electrolyte

- For repeat CBC plt. Today

May 9, 2007

10:40 am - for LP today

- Pls. secure consent for LP

- Ff up cranial CT scan

- Continue meds

- Shift Phenobarbital IV to PO Phenobarbital 6 g/tab. Dissolve 1 Tab into 5 cc give it to

BID

May 10, 2007

9:30 am - Silver sulfadiazine cream apply to affected area TID

- Still for LP
 - Continue meds

May 11, 2007

9:55 am - for LP today

- NPO x 4 hrs starting 12 pm

- Pls. give Diazepam 1.5 g IVTT prior to LP

- Continue meds

May 12, 2007

6:45 am - Post LP order

- NPO x 4 hrs

- Feed on bed x 4 hrs

- For RBS stat

- Refer for cyanosis, apnea, dyspnea and other S/S

- Refer accordingly

May 13, 2007

9:30 am - Transfer to neuroservice under Dr. Gazmen/Golingay

 - Continue meds

May 14, 2007

12:00 nn - for compliance of Ceftriazone

- measure head circumference

- increase Ampicillin + 400 mg IVTT q 6hr

- for urine culture

- for repear CBC, plt

- FeSo4 (1 tab) 4 ml accordingly

- Multivita 0.3 ml accordingly

- Still for cranial CT scan

- Vit K 1 mg IM

May 15, 2007

9:30 am - Ff up CSF culture result

- Continue meds

- Still for Vit. K 1 ml IM as previously ordered (5/14/07)

- Still for cranial CT scan

 - Measure head circumference pls and chart

- Still for repeat CBC, plt, pls facilitate

May 16, 2007

7:00 am - Continue meds

- for cranial ultrasound pls give request

- facilitate repeat CBC plt

- Transfer to MR

NURSES’ NOTES

May 3,2007

11pm-7am 1:15am>Admitted this 3 months old, male child, lethargic, afebrile, dyspneic in due to
difficulty in breathing. Vital signs checked. Seen and examined by Dr. Dagooc with orders
made. Lab exams requested. IVF of PLR IL @ 156 cc as IV bolus. OGT inserted. O2
inhalation @ 4 Lpm per face mask. Suctioning of secretions done. For CXR-ADL. Ushered
to ward per wheelchair. Endorsed to NOD.

2:50am>In from ER per wheelchair, stupurous. On NPO with Ogt distal end to bedside
bottle. With an IVF of PLR, with ongoing infusion of 156ccx1hr. with O2 inhalation on @
4Lpm via face mask. Ushered to room. Placed on bed comfortably. O2 inhalation
continued. vs checked and recorded. Lab exams and medicines prescribed followed up.
Watched for.
May 3,2007

7am-3pm 7:00am>On bed, stupurous. On NPO with OGT open to bedside bottle. With PLR @104cc
in 2 hrs. with O2 inhalation @ 4Lpm via face mask. With pulse oximeter with O2
saturation @ 99%. To secure 1 unit Fresh Frozen Plasma for transfusion. Lab exams
followed up. vs taken and recorded. Medicated. Seen and examined by Dr.Dagooc with
orders made and carried out. Cared for.

May 3,2007

3-11pm 3:00pm> on bed stupurous and afebrile. On NPO with Ogt open to bedside bottle. With
IVF @ right arm D5 o.3 NaCl @ KVO rate, with side drip of dopamine @ 2 cc/hr via
infusion pump. With D5 LR @ 32 cc/hr x 8 hrs, on KSS. Still for insertion. On O2
inhalation. Still to secure FFP for transfusion. Vs checked and recorded. Lab exams
followed-up. due meds given. Watched for any unusualities.

4:15pm>Seen by Dr.Tiongco, ordered for IV cutdown, refer to surgery by Dr. Gazmen.

May 3,2007

11-7 am 11:00pm> Received asleep on bed, afebrile. On NPO

7-3 pm 7:00am> On bed awake, weak, pallor, coherent and responsive, on MHBR, with 02
inhalation @ 5 Lpm via face mask. With ongoing BT #2 FWB 500 cc with serial # 112-07-
23172 blood type A+. On left arm is PNSS 1L @ 200 cc/hr. Due meds given. With FBC to
urobag. Endorsed to NOD.
 3-11pm 3:00pm> Received lying on bed, awake, responsive, and coherent to verbal
communication. On MHBR position. With droopy eyes noted. With pale lips, dry and warm
skin noted, capillary refill less than 2 seconds. Established rapport. On NPO except
medications. With 02 inhalaltion @ 5 lpm via nasal cannula. With double line IVF- #7
PNSS 1L @ 200 cc/hr infusing well @ L brachial vein, #8 PNSS 1L @ 100 cc/hr infusing
well @ R basilica vein. With FBC attached to urobag draining amber colored urine. On
CBR without BRP-reinstructed.

4:00pm> VS, I & O checked and recorded every hour.

4:25pm> Above IVF consumed and followed-up with #9 PNSS 1L @ KVO rate @ R basilic
vein.

5:20pm> Temp. 37.8 C, NOD aware. TSB done

6:00pm> Above IVF consumed and followed-up with #9 PNSS 1L @ KVO rate @ R basilic
vein.

10:00pm> Still to secure 6 units of platelet and 3 units of fresh whole blood. Advise for
bone marrow biopsy, still undecided.

11:00pm> Watched and monitored for any unusualities. Endorsed to NOD.

May 4, 2007
 11.7 11 pm> Received asleep on bed, afebrile, on milk feeding 30cc every 3 hours per OGT, With
IVF of D5IMB @ 20 cc/hr with side of 2 cc/hr, with heplock @ left and right foot, with O2 @4
Lpm, to secure another unit of fresh frozen plasma followed-up, V/S checked, due meds given,
cared and watched for.

May 5, 2007

7.3 7 am> On bed, on milk feeding/OGT 30cc every 1hr, # 4 D5IMB @ 20cc/hr, with side drip to
run @ 2cc/hr, O2 @ 4cc/mask. To secure 1 unit Fresh Frozen Blood for transfusion. Watched and
cared for.

3.11 3 pm> Received patient on bed awake, febrile. On milk feeding 30cc every 3hr per OGT,
checked patency, with Ivf ofD5IMB 500cc @3cc/hr infusing well, withside drip dopamine @
2cc/hr per infusion pump, with O2 inhalation @ 5Lpm via face mask, still to secre fresh frozen
plasma followed-up. V/S checked once recorded. Watched and cared for.

11.7 11pm> On bed asleep, on dropperfeeding 50cc every 3hr, with IVF of D5IMB @ 3cc/hr x
24hr, infusing well @ the level of 400cc/hr, with side drip of dopamine @ 2cc/hr infusing via
infusion pump. O2 @5 Lpm via face mask. Still to secure fresh frozen plasma for transfusion.
V/S checked and recorded. Lab exams followed-up,due meds given. Watched for any
unusualities.

May 6, 2007
 7.3 7am> On bed asleep, on dropper feeding 50cc every 3hr, with IVF D5IMB @ 3cc/hr x 24hr, with
attached O2 @ 5Lpm via face mask, to secure kit fresh frozen plasma for transfusion. Lab
exams followed-up. V/S taken and checked. Endorsed to NOD.

7:45> seen and examined by Dr. Garingalao with orders made and carried out. Transferred to
Cardio Ward as ordered.

3-11 3pm> On bed, asleep, dropper feeding, with IVF of D5IMB @ 5cc/hr.

Still for blood CS. still to secure urine and stool exam. Followed up availability of fresh frozen
plasma. V/S checked. Meds given. Endorsed to NOD.

11.7 11pm. Received on bed asleep, on dropper feeding 50cc every 3hr, with IVF of D5IMB @ 5cc/hr
on KSS. V/S checked and recorded. Meds followed up. Cared for.

May 7, 2007

7.3 7am> on bed awake, dropper feeding, with IVF regulated infusing well. V/S checked and
recorded. Meds cut off. Watched and cared for.

3-11 3pm> Received on bed awake, on dropper feeding, helock KSS, labs followed up. still to secure
blood followed up. V/S checked and recorded, medicated, watched and cared for,

11-7 11pm> received lying on bed, awake, patient not in respiratory distress, minimal wheezes
heard upon auscultation, with cleft lip, with good capillary refill, with good skin turgor, warm to
touch, with heplock on right metatarsal vein. On dropper feeding, for blood CS, U/A, S/E, ABG.

12am> VS checked and recorded, afebrile. Bedside care done; linens stretched and tucked
well. Health teachings rendered to mother such as increasing OFI, encouraged to promote
 good hygiene. Instructed to keep child away from allergens such as dust, smoke,
ect...instructed to refer any unusualities and to comply medical regimens. Infant was able to
defecate 180cc- soft in characteristics and yellowish in color.

4am> V/S checked and recorded; afebrile; watched and cared for.

5am> morning care done. Intake and output summed up and recorded.

7am> Left on bed with watcher. Endorsed to NOD.

May 8, 2007

7.3 7:30am> received on bed awake with mother on side, with cleft lip palate, with heplock on
right metatarsal vein; on on respiratory distress. On syringe feeding, able to consume milk
feeding 50cc, able to defecate with semisolid character of stool and yellowish in color about
30cc. VS checked and recorded, afebrile T: 36.4, PR:109, RR:39, BP:90/50. Bedside care done.
Instructed mother to increase OFI and to report for vomiting and type of stool and its
consistency. V/S rechecked and documented. Give ample time for sleeping.

3pm> Health teaching given regarding proper hygiene, milk preparation, proper feeding
techniques and burping of the baby after each feeding. Observed closely for sign of intolerance
like vomiting and nausea.

3.11 3pm> Received on bed, awake on dropper feeding 70cc every 3hr, with heplock attached; still
patent. V/S checked and recorded, afebrile; lab exams followed up. due meds given, watched
and cared for.
 11-7 11pm> Received on bed asleep ,with watcher on side, not in distress, with cleft lip, with good
skin turgor and warm to touch, with heplock in right metatarsal; V/S checked and recorded
afebrile; bedside care done. Linens stretched and properly tucked; left on bed comfortably.
Health teachings rendered to watcher such as increasing OFI of patient, promote good
ventilation and relaxation, encouraged mother to breastfed.

May 9, 2007

7.3 7am> Received patient on bed, sleeping with mother on side, with heplock @ right metatarsal
vein, on bottle feeding, able to consumed 90cc. V/S checked and recorded, afebrile, T:36.4,
PR:120, RR:28,BP:90/60. instructed mother to feed baby every 3-4 hours and should prepare
milk formula using sterile or distilled water and to report any sign of dehydration such as
cracked lips and sunken fontanels.

3pm> Endorsed to NOD.

3-11 3pm> received patient on bed awake, on dropper feeding, with heplock attached on; V/S
taken and recorded, afebrile. Followed up availability of meds. Watched and cared for.

11-7 11pm> Received asleep on bed, afebrile; on dropper feeding with aspiration precaution, with
heplock attached, still for lumbar puncture, with consent, lab exams followed up, meds
followed up, V/S checked an recorded. Watched and cared for.
May 10, 2007

7-3 7am> On bed awake, on breast feeding with heplock, patent and intact. V/S checked and
recorded, labs followed up, medicated, watched and cared for.

3-11 3pm> Received on bed, awake, on dropper feeding 70cc every 3hrs; with heplock attached.
Still patent. V/S checked and recorded, afebrile. Lab exams followed up. Due meds given.
Cared for.

11-7 11pm> Received on bed, asleep, on dropper feeding; with heplock attached; V/S checked and
recorded; meds given, cared for.

May 11, 2007

7-3 7am> On bed, awake, on dropper feeding, with attached on. V/S checked and recorded, meds
given. Cared for.

3-11 3pm> Lying on bed asleep, on NPO temporarily; for lumbar puncture any time today with
consent. Still for cranial CT scan. V/S checked and recorded. Medicines provided, followed up
intervention.
 11-7 11pm> Received asleep on bed, afebrile, on dropper feeding, with heplock attached, still for LP
with consent. Lab exams and medicines followed up. V/S checked, cared for.

May 12, 2007

7-3 7am> On bed awake, NPO for 4 hours reminded, flat on bed x 4 hours, instructed, with
heplock, patent and intact, watched and cared for.

3-11 3pm> On bed asleep, on dropper feeding 79cc every 3 hours, with heplock attached on. V/S
checked and recorded. Lab exams followed up. Due meds given; watched for.

11-7 11pm> received asleep on bed, afebrile; on dropper feeding, with strict aspiration precaution,
with heplock attached, cranial ultrasound and lab exams followed up, V/S checked, meds
followed up, cared for.

May 13, 2007

 7-3 7am> On bed, awake, with heplock patent and intact, V/S checked and recorded, labs followed
up, meds prescribed, watched and cared for.

3-11 3pm> Received on bed, awake; on dropper feeding every 3 hours. With heplock attached, still
patent. V/S cheched and recorded; afebrile. Lab exams followed up. Due meds given. Cared for.

11-7 11pm> Received asleep on bed; afebrile, on dropper feeding, with heplock attached. Urinalysis
and cranial ultrasound followed up, V/S checked, due meds given, cared for.

May 14, 2007

7-3 7am> Received patient cuddled by mother, awake. On breastfeeding, with heplock attached
on. V/S taken and recorded. Afebrile. Medicated. Watched and cared for.

3.11 3pm> On bed, afebrile, dropper feeding, with heplock attached; followed up cranial
ultrasound; urine CS followed up, fresh frozen plasma was available.

11-7 11pm> Received on bed, asleep, on dropper feeding, with heplock; V/S taken and recorded,
meds given; cared for.
May 15, 2007

7.3 7am> Received lying flat on bed, asleep with watcher at bedside. With heplock attached to
right metatarsal vein; still patent and intact. With cleft lip and dry skin warm to touched. With
normal capillary refill less than 2 seconds, with good skin turgor. Instructed on dropper feeding
every 3-4 hours.

8am> V/S checked and recorded; within normal ranges. Intake and output monitored closely as
ordered. Instructed watcher to report any signs of dehydration such as dry lips and skin,
sunken eyes and fontanels, vomiting, LBM, and weakness.

9am> Bed linen stretched and tucked well. Arranged things properly. Provided with restful
environment conducive for sleep. Changed soiled diaper into clean one, with semi-solid stool,
yellow in color weighing 70gs.

10am> Vitamin K given 1mg IM as ordered. Watched out for any signs of adverse reactions,
not noted. Able to consumed 70cc of milk via bottle feeding.

10:40am> Changed soiled diaper into clean one, with semi- solid formed stool, yellow in color
weighing 80gs. Measured head circumference as ordered: 40cm. health teaching imparted on
proper hygiene, importance of proper feeding and burping after each feeding, and to observe
for vomiting and LBM. IVTT meds given by NOD; watched out for any signs of adverse reaction,
not noted.
 12nn> V/S rechecked and recorded. Intake and output monitored closely as ordered. Watched
out for any unusualities, not noted. Provided with restful environment conducive for sleep.
Needs attended to and cared for.

3pm> Endorsed to NOD.

3-11 3pm> On bed asleep. On dropper feeding 70cc every 3 hours, with heplock attached. V/S
checked and recorded. Watched and cared for.

11-7 11pm> Received on bed, asleep. On dropper feeding 70cc every 3 hours. With heplock
attached. V/S checked and recorded. Meds given, cared for.

May 16, 2007

7-3 7am> Received carried by watcher per arm, awake andconscious. With no heplock
attached. With cleft lip and dry skin warm to touch. With normal capillary refill less than
2 seconds, with good skin turgor. Instructed on dropper feeding every 3-4 hours. Still for
cranial ultrasound; repeat CBC, platelet; for transfer to miscellaneous room.

8am> V/S checked and recorded; within normal ranges. Intake and output monitored
closely as ordered. Bed linens stretched and tucked well. Provided with restful
environment conducive for sleep. Able to consume 60cc of milk via bottle feeding with
good appetite. Instructed watcher to report any signs of dehydration such as dry lips and
skin, sunken fontanels, vomiting and diarrhea.
 9am> Asleep; provided with restful and safe environment.

10am> Transferred to miscellaneous room as ordered. Bed linens stretched and tucked
well. Arranged things in proper place.

11am> IVTT meds given by medicating NOD as ordered. Watched out for any signs of
adverse reations, not noted. Instructed watcher to bottle feed within 3-4 hours.

12:30pm> V/S rechecked and recorded. Intake and output monitored closely as ordered.
Watched out for any unusualities, not noted. Needs attended and cared for.

3pm> Endorsed to NOD.

NURSING CARE PLAN

D Assessment Need Nursing Objective Nursing Intervention Evaluation

ate Diagnosis of Care

M S/O: P Fluid volume Within 2 • Maintained accurate After 8 hrs of

deficit r/t severe days of Intake and Output nursing care,
• Watery,loose h
A dehydration to providing
stool(6x/day) GOAL PARTIALLY
consider nursing care, -patient may reduce fluid
 Y in mod. amt y electrolyte will maintain intake during periods of MET
imbalance 2˚ fluid and crisis because of malaise,
• Vomited s Acute electrolytes anorexia,and so on. Patient regained
5x/shift with and maintained
Gastroenteritis volume at a
sticky i
vomitus in functional • Monitored v/s,comparing fluid volume at
Rationale: level as with patient’s normal/ a functional
scanty o
, amount evidenced previous readings level as
Acute evidenced by:
l by:
• Sunken Gastroenteritis is - reduction of circulating
2
fontanel an inflammation - will blood volume can occur BP=110/70mmH
noted
o on the stomach & g
0 defecate from ↑fluid loss resulting in
GI tract which is semi-formed hypotension and
• Sunken
g PR=96bpm
manifested by tachycardia
0 eyeballs
stool at lest
i diarrhea, 2 times a
noted Urine Output=
abdominal pain • Observed for fever,
7 day 30cc/hr
• Dry lips & c associated with changes in LOC,skin
mucus nausea, vomiting, - there will turgor, dryness of skin
7am –
membrane Fluids & fever, and be decrease and mucous membranes,
noted. Electrolyte abdominal occurrence pain.
3pm
s distention& of vomiting
• Distended excessive at least 12 - symptoms reflective of
abdomen DHN/ hemoconcentration
elimination of times a day
noted with consequent
waste caused
electrolyte - will vasoocclusive state.
• Poor sucking
noted imbalance manifest
moist lips • Monitored v/s closely
• Delayed and mucous during blood transfusions
capillary refill membranes and noted presence of
noted and capillary dyspnea,
refill in 2-3 crackles,ronchi,wheezes,
• Pale skin Reference: Medical
seconds diminished breath sounds
Surgical Nsg. 10th Ed by
• Wt=5.2kgs. Brunners & Suddarth cough and cyanosis.
- weight of
• FFP @ 78ccx 5.2 kgs will - patient’s heart may be
4 hrs x 3 increase to already weakened and
cycles. With prone to failure due to
 serial # 111- 5.7 kgs chronic demands,placed
06-13473 on it by the anemic state.
type B+ - fever will Heart may be unable to
subside with tolerate the added fluid
• Serum the
Na=130.4mE volume from the
temperature transfusions or rapid IV
q
of less than fluid administered to heart
• Serum Ca= 37.5 crisis/shock
0.84mEq
•Administered fluids as
• Serum indicated
K=3.15 mEq
- replaces losses/deficits.
Fluids must be given
immediately to decrease
hemoconcentration and
prevent further interaction

D Assessment Need Nursing Objective Nursing Intervention Evaluation

ate Diagnosis of Care

A Subjective: Activity Within 8 hrs • Assessed the degree of After 2 days of

Intolerance r/t of nurse- dehydration. providing
“Dili man ko
P ganahan
imbalance patient nursing care,
- to provide baseline
mulihok ky dali between O2 interaction,
information. GOAL PARTIALLY
R ra man ko supply and will
kapuyon”, as demand 2˚ demonstrate • Established a 24 hour MET
verbalized. Hypovolemic a ↓ in fluids and electrolytes
 I Objective: Safety shock physiologic replacement needs and As evidenced
signs of routes (IV,PO) to be used. by:
• Pale lips Rationale:
L & intolerance
- prevents peak/valleys in
as
• Tachycardia Hypovolemic fluid level.
3 (PR=101bpm) Security shock results evidenced
- defecated
from loss of by: • Administered IV fluids as
semi-solid stools
0, • O2 inhalation fluids & occurs indicated and regulated
more rapidly -PR,RR, & BP well at prescribed rate. at lest 2 times a
@ 5L/min via
than fluid intake will remain day
2 nasal cannula
which results to within - to correct fluid losses.
the imbalance - vomited at
0 • Weakness, Energy normal
of O2 supply and • Administered one unit least twice a day.
body ranges
demand to the fresh frozen plasma.
malaise,fatig
0 Mgt. body. This - manifested
ue -decrease in - to replace electrolyte
oftenly causes moist lips and
7 fatigue 7 fatigue losses.
• Hemoglobin mucous
Mass weakness which membranes and
can interfere -increase • provided nutritious diet via
3– Concentratio
ability to capillary refill of
n= 20. with the NGT.
individual’s participate at least 2-3
11pm ability to work. in activities, - to meet the body’s seconds..
• BP=80/60mm
Hg such as nutrient requirements.
Reference: Medical - weight
Surgical Nsg. 10th Ed personal
• RR=28cpm • administered anti- infective increased to 5.5
by Brunners & hygiene &
Suddarth nail care. as ordered by the physician. kgs from 5.2 kgs

- prevents the spread of - fever subsided

enteropathogen with a
temperature of
Encougaged to properly
sterilize water.

-inhibits the growth of

microorganism.

Monitored the I & O, and

weight everyday.
 - to assess the fluid level.

Administered Paracetamol
for fever as ordered.

- to lower down doy

temperature to normal
range.

Instructed watcher to
perform TSB.

- provide comfort an
lowered body temperature.

D Assessment Need Nursing Objective Nursing Intervention Evaluation

ate Diagnosis of Care

A Risk Factors: Risk for Within 8 hrs of • Washed hands before & After 8 hrs of
Infection r/t nurse-patient after each care activity ,
• Decreased
 P hemoglobin inadequate interaction, even if sterile gloves nursing care,
(20gm/dL) secondary will participate were used
R defenses 2˚ on GOAL MET
• Invasive -Reduces risk of cross -
Aplastic Anemia interventions contamination
procedures Patient was able
I such as foley Safety to prevent/
Rationale: to identify
catheter reduce risk of • Inspected wounds/site of
interventions to
L insertion, & Aplastic anemia infection as invasive devices daily,
paying particular prevent or
blood makes one evidenced by:
attention to parenteral reduce risk of
3 transfusion, Security susceptible to
and starting - Body nutrition lines. Noted infection as
complications
double IV temperature signs of local evidenced by:
0, on RBCs, WBCs
inflammation/infection.
lines & platelets will be within
which gives -Body
2 Objective: normal ranges - May provide portal of
temperature
high risk for entry for infection, primary
infection. WBC, -verbalization down to 37˚C
0 • Febrile @ Infection in particular,
infecting organisms,as well
37.8˚C of as early identification of
fights against -“kinahanglan
0 understanding secondary infections.
Protection foreign jud d I na limpyo
• Not taken a on proper
substances that • Noted signs and pirmi atong
7 bath for 2 enters the body. hygiene
days symptoms of sepsis lawas”, as
(systemic infection): verbalized.
3– • Untrimmed fever, altered LOC.
fingernails Reference:
-To assess causative/
11pm
Medical Surgical contributing factors
Nsg. 10th Ed by
Brunners &
Suddarth

• Monitored temperature
trends.

-fever (38.5ºC - 40˚C) is the

result of endotoxin effect on
the hypothalamus and
pyrogen-released endorphins

•Instructed and educated to

participate in hygienic care

- facilitate in promoting
personal wellness
B. DISCHARGE PLAN

Clients with Acute Gastroenteritis, watchers are instructed to take the following plan for
discharge:

M- Medications should be taken regularly as prescribed , on exact dosage, time, & frequency,
making sure that the purpose of medications is fully disclosed by the health care provider.

E- Exercise should be promoted in a way by stretching hand and feet every morning and
exercise burping every after bottle feeding.

T- Treatment after discharge is expected for patients and watcher with Acute Gastroenteritis
to fully participate in continuous treatment.
 H- Hygiene must be maintained for patients with Acute Gastroenteritis. Promotion of
personal hygiene should be encouraged such as, daily bathing and changing of diapers
when soiled.

O- OPD such as regular follow-up check-ups should be greatly encouraged to clients wather
with Acute Gastroenteritis as ordered by physician to ensure the continuing management
and treatment.

D- Diet should be promoted, since, during admission, the patient was on NPO. Proper
selection of milk that are suitable for babies will help enhance immunity.

VIII. PHARMACOLOGICAL MANAGEMENT

• Diazepam

a. Doctor’s Order: 1.5mg IVTT now then PRN for frank seizures

b. Indication: Management of general anxiety disorder, panic disorders, and provides pre-
operative sedation.

c. Mechanism of Action: Depresses all levels of CNS, including the limbic and reticular formation,
probably through the increased action of GABA, which is a major inhibitory neurotransmitter in
the brain.

d. Nursing Responsibilities:

 Assess effectiveness of therapy according to diagnosis – seizure.

 Monitor RR, HR and BP.

 Do not overuse or miss regularly scheduled doses. Administer drug properly as ordered.

 If used or seizures, report immediately lack of seizure control.

• Ceftriaxone

a. Doctor’s Order: 500mg IVTT now then OD

b. Indication: Treatment for lower respiratory tract infection

c. Mechanism of Action: Inhibits bacterial cell wall synthesis by binding to one or more o the
penicillin binding protein.

d. Nursing Responsibilities:
  Assess for previous history of reaction to other cephalosphorin or penicillin. Monitor for allergic
reactions.

 Assess for bowel function (if severe diarrhea occurs, discontinue drug).

 Monitor urine output (if decreased, notify the physician)

• Ampicillin

a. Doctor’s Order: 260mg IVTT q 6hrs

b. Indication: For susceptible bacterial infections

c. Mechanism of Action: Interferes with bacterial cell wall synthesis during active multiplication,
causing cell wall death and resultant bactericidal against susceptible bacteria.

d. Nursing Responsibilities:

 Monitor effectiveness of therapy and active reaction, including development of opportunistic

infections.

• Phenobarbital

a. Doctor’s Order: 104mg IVTT now as LB/13mg IVTT q 12hrs

b. Indication: For generalized tonic clonic (grand mal) and partial seizures.

c. Mechanism of Action: Interferes with transmission of impulses from the thalamus to the cortex
of the brain, resulting in an imbalance and facilitatory mechanism.

d. Nursing Responsibilities:
  Constant observation and frequent monitoring of BP, RR and HR.

 Monitor infusion site for irritating extravasations.

• Paracetamol

a. Doctor’s Order: 60mg IVTT q 4hrs (PRN for temp ≥ 37.8 °C)

b. Indication: For mild to moderate pain and fever.

c. Mechanism of Action: Reduces fever by acting on the hypothalamus to cause vasodilation and
sweating.

d. Nursing Responsibilities:

 Monitor for effectiveness o therapy.

 Recheck Temp 15minutes after administration.

• Dopamine

a. Doctor’s Order: 2cc/°.

b. Indication: Treatment of shock which persist after adequate fluid volume replacement.

c. Mechanism of Action: Stimulates both adrenergic and dopaminergic receptors, lower doses are
mainly dopaminergic stimulating and produce renal and mesenteric vasodilation, higher doses
also are both dopaminergic and Beta1 adrenergic stimulating and produce cardiac stimulation
and renal vasodilation.

d. Nursing Responsibilities:
  Monitor infusion site for extravasation.

 Monitor closely for AR and S/S of overdosage.

• Silver Sulfadiazine

a. Doctor’s Order: Apply to affected area TID.

b. Indication: prevention and treatment of infection and burns.

c. Mechanism of Action: Acts upon the bacterial cell wall and cell membrane.

d. Nursing Responsibilities:

 Monitor development of granulation.

 Observe for hypersensitivity reactions (irritation, redness, burning or itching in unburned areas).

IX. EVALUATION
X. BIBLIOGRAPHY

A. BOOKS

 Doenges, Marielyn E., ET. Al. (2002) Nursing Care Plans, Guidelines for Individualizing Patient
Care. (6th Edition)

 Doenges, Marielyn E., ET. Al. (2004). Nurse’s Pocket Guide. (9th Edition)

 Kozier, Barbara ET. Al. (2004). Fundamentals of Nursing, Concepts, Process and Practice. (7th
Edition)

 Marieb,Elaine N. (2004). Essential of Human Anatomy and Physiology. (7th Edition).

 MIMS. (105th Edition, 2005)

 Smeltzer, Suzanne C. ET. Al. (2000). Textbook of Medical-Surgical Nursing. (9th Edition).

 Smeltzer, Suzanne C. ET. Al. (2000). Textbook of Medical-Surgical Nursing. Volume 1 (10th
Edition)
  Turkoski, Beatrice B., ET. Al. Drug Information Handbook for Nursing including Assessment,
Administration, Monitoring Guidelines and Patient Education (2000-01).

B. INTERNET

http://en.wikipedia.org/wiki/Aplastic_anemia

http://www.aamds.org

C. OTHERS

Microsoft Encarta Encyclopedia 2007.

A Case Study

On

Aplastic Anemia

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Presented to:

Ms. Zosi Farah W. Fernandez, RN

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 In Partial Fulfillment of the Requirements

In

Related Learning Experience

Presented by:
Cabibil, Ervin Rol C.
Colita, Arven Troy L.
Abundo, Jissa A.
Albero, Karren Rose A.
Aquino, Sunshine S.
Benilan, Melody E.
Cadiente, Joyce C.
Haguyahay, Faith E.
Hinay, Rodelyn B.
Javier, Kathleen Alyce B.
Legal, Chinki C.
Travilla, Allen Rose Y.
BSN3 A1