Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                

Acute Gastroenteritis: Nueva Ecija University of Science and

Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 35

Republic of the Philippines

NUEVA ECIJA UNIVERSITY OF SCIENCE AND


Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING

CASE PRESENTATION:

ACUTE GASTROENTERITIS
IN PEDRIATRIC PATIENT

In Partial Fulfilment of the Requirements for the Subject


RELATED LEARNING EXPERIENCE
NCM 109

Prepared by:
Jamaica Jane J. Azarcon
Andrea Lorraine G. Benedicto
Lyca B. Berin
BSN II-C

Golda Mir Macabitas


Head Student Nurse

Sevilla C. Guinto MAN., RN.


Clinical Instructor

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
CHAPTER I

General Objectives

As a level 2 NEUST-CON student nurse, the general objective of this case study is to be able to

gain more knowledge, improved our skills and acquiring a good attitude as necessary in dealing with

different patients, perform basic nursing skills with confidence and competence as well as providing an

appropriate nursing management to a pediatric patient dealing with Acute Gastroenteritis.

Specific Objectives

At the end of the clinical duty the student-nurses will be able to:
1. Assess the client from head to toe, focusing on the parts affected by the Acute
Gastroenteritis;
2. Obtain, document, and present a comprehensive medical history;
3. Explain the anatomy and physiology of Digestive System;
4. Define the Acute Gastroenteritis, become familiar with the important
diagnostic/laboratory examinations that will be used in the confirmatory and management
of Acute Gastroenteritis;
5. Understand the pathophysiology of Acute Gastroenteritis
6. Recognize the different medications used, its action, side effect and its action in the
management of Acute Gastroenteritis;
7. Understand the suggested medical management, employed to resolve problems;
8. Formulate appropriate Nursing Care Plan utilizing the Nursing Process; and
9. Identify nursing priorities; provide prompt nursing intervention that would help alleviate
the condition of the client thus increasing their capacity to function.

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
Introduction
Gastroenteritis is characterized by diarrhea or vomiting and is described as inflammation

of the mucus membranes of the gastrointestinal tract. It's a very common childhood illness.

Children in developing countries are at a higher risk of morbidity and mortality than children in

developed countries. Although the exact burden and cost of FWBDs are uncertain, they are

expected to be significant. The incidence of diarrheal diseases is estimated to be 3.6 percent of

overall Disability Adjusted Life Years (DALY) worldwide, according to the World Health

Organization (WHO). According to the most recent Department of Health (DOH) survey, acute

watery diarrhea (AWD) is the seventh leading cause of morbidity, affecting 76.3 people per

100,000. With a prevalence of 0.5 per 1,000 live births, AWD is also the seventh leading cause

of child mortality. Diarrhea is a leading cause of death in children under the age of five in

developing countries, with an estimated 2 million deaths per year. Acute gastroenteritis (AGE) is

still a leading cause of death and morbidity in people of all ages. Human noroviruses and

sapoviruses, among other enteric caliciviruses, are now recognized as essential etiologic agents

of this disease. Almost all acute infectious diarrhea, however, was thought to be caused by

bacteria or parasites. Acute diarrhea is characterized by a sudden rise in recurrence and changes

in stool consistency. It's usually caused by an infectious agent in the GI tract, but it may also be

caused by upper respiratory or urinary tract infections. Antibiotic treatment or the use of

laxatives can increase the risk of acute diarrhea in children.If dehydration does not cause serious

problems, it is normally self-limited within 14 days and no new therapy is needed.From 2008 to

2015, the mortality rate for acute watery diarrhea and acute bloody diarrhea decreased, following

the pattern for diarrhea and gastroenteritis of suspected infectious origin. However, since the

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
mortality rate for acute watery diarrhea cannot be calculated, separate reporting would be

required in the future.

CLIENT’S INFORMATION

I. Patient’s Profile
Name: Patient X
Age: 6 Years Old
Date of Birth: March 14, 2015
Sex: Male
Civil Status: Child
Nationality: Filipino
Religion: Roman Catholic
Address of parents: Mabini St. Cabanatuan City
Date of Admission: April 8, 2021
Attending Physician: Dr. X
II. Presenting Complaints
 Diarrhea
 Fever
 Poor appetite
 Vomiting
 Restlessness

III. Family History


No family history of the disease.

IV. Past History (History of infections)


 The client has had diarrhea 3 months ago
 Treated, resolved

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING

V. Birth History ( Postnatal History)


Birth Weight: 2.5 kg
Length : 50 cm

VI. Immunization
 Hepatitis (B)
 BCG
 Polio (IPV) (4th dose)
 Measles, mumps, and rubella (MMR) (2nd dose)
 Chickenpox (Varicella) (2nd dose)
 Influenza (Flu) (every year)

VII. DRUG HISTORY

Medication used:

 Generic Name: Ampicillin
 Brand Name:  Omnipen
 q8hr, PO

Adverse effects:

 nausea
 vomiting
 diarrhea
 rash

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
Admitting History
On April 8, 2021 at around 10:00 AM, a 6-year-old male client named X is admitted in
the Pediatric ward of ELJH with his parents. According to his mother complain, the client
experienced diarrhea and vomited for 3 times. The client experienced restlessness and also fever
and the client’s temperature is at 38.4 C.
The client’s final diagnosis was Acute Gastroenteritis. The client is now receiving an IV fluid of
D5 0.3 NaCL 500ml bottle, connected to a microset, to run for 8 hours.

Admitting Vital Signs


Temperature: 38.4°C
Pulse Rate: 120 bpm
RespiratoryRate: 26 cycles per minute
Blood Pressure: 90/70 mmHg

Preliminary Tests done

The preliminary test that is done is Fecalysis


Notable observation: Yellowish and loose watery stool

Status of Present Illness

The client shows weakness of the body due to poor appetite and diarrhea. The mother
also observes that her child has an intermittent fever. But due to multiple defecations and
vomiting the mother decided to admit the client in the hospital to know the proper treatment of
the child’s condition.

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
Physical Assessment

Body Part Normal Findings Result


Generally, round with the Normal
prominence in the frontal The client’s skull is generally
Skull to occipital. There are no round and no tenderness
nodules and masses when noted upon palpation
palpated
The client’s scalp has no Normal
No lesions, no tenderness lesions, nor masses, fontanelle
Scalp
nor masses on palpation is sunken noted upon
palpation
The client’s hair is black and Normal
Evenly distributed, covers
Hair evenly distributed and covers
the scalp
the whole scalp.
White sclera, pink The client’s eyes are sunken. Abnormal
Eyes conjunctiva. Clear pupils
and reactive to light.
The client’s face is oval, there Normal
Shape may be oval or is no involuntary muscle
Face
rounded. movement. Has facial
grimace.
Color is the same with The client’s ears are not the Normal
face. Clear hearing same with his face, clear
Ears & Hearing senses. Absence of hearing senses and absence of
wounds and abnormal wounds and abnormal
discharges. discharge
The client’s nose has no Normal
No discharges, airways discharges, airways are
Nose & Sinuses are patent. No tenderness patent. No tenderness and
and lesions. lesions.

The client’s lips are Abnormal


Normal, lips are pinkish
Mouth symmetrical. His lips are pale
and symmetrical.
and very dry due to vomiting.

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
Normal
The client’s neck’s muscles
Muscles are equal in size, are equal in size, no inflamed
no inflamed nodules, and nodule and neck veins not
Neck
smooth movement with dilated.
no discomfort.

The client’s chest is Normal


symmetrical, right and left
shoulders are aligned with the
Symmetrical, right and right and left hips. His
left shoulders are aligned breathing is normal.
Chest
with the right and left
hips.
RR: 26 cpm

Abdomen is normally flat The client’s abdomen is Normal


Abdomen to round midline normally
umbilicus round. The abdomen is soft
during palpation.

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING

Normal
The client’s lower
extremities are normal, no
presence of bone
No presence of bone
deformities, tenderness
deformities, tenderness
and swelling. Normally
Lower and swelling. Normally
firm and movements are
Extremities firm and movements
coordinated.
should be coordinated.

The skin is normally The client’s skin is flushed Abnormal


uniform, whitish pink and warm to touch. Skin
or brown in color turgor is performed
Skin
defending on the race
Temp: 38.4 degree Celsius
of client, should be
moist and soft.
The client’s nails have no Normal
Normal. No cracks. crack, pale and capillary
Nails Has good capillary refill >2 seconds.
refill.

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
CHAPTER II
Definition of the Case
Acute gastroenteritis (AGE) is a diarrheal disease with a rapid onset and a variety of
symptoms and signs, including nausea, vomiting, fever, and abdominal pain. It occurs when
pathogenic microorganisms (such as Clostridium perfringens, Vibrio cholera, and E. Coli) or
their toxins are consumed in food or water. Nausea, vomiting, diarrhea, and abdominal pain are
some of the symptoms. A viral or bacterial infection, as well as a parasitic infection, is the most
common causes of gastroenteritis.

Norovirus and rotavirus are the most common causes of viral gastroenteritis. The most
common causes of bacterial gastroenteritis are Escherichia coli (E. Coli), Salmonella, and
Campylobacter. Giardia is the most common cause of parasitic gastroenteritis. Gastroenteritis
outbreaks, which occur when a large number of people are sick at the same time and in the same
location, are most often caused by viral gastroenteritis. Children and adults may be affected by
norovirus outbreaks, while babies and children are often affected by rotavirus.

Although often considered a benign disease, acute gastroenteritis remains a major cause
of morbidity and mortality in children around the world, accounting for 1.34 million deaths
annually in children younger than 5 years, or roughly 15% of all child deaths. As the disease
severity depends on the degree of fluid loss, accurately assessing dehydration status remains a
crucial step in preventing mortality. Luckily, most cases of dehydration in children can be
accurately diagnosed by a careful clinical examination and treated with simple, cost-effective
measures. Although dehydration technically refers to pure water loss and can be associated with
euvolemic or even hypervolemic states in certain pediatric disorders, the term is used throughout
this article in its more general sense to mean overall fluid or volume loss due to diarrhea.

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
Cases of Acute Gastroenteritis Globally
Acute gastroenteritis is a very common disease in babies and children all over the world.
Acute diarrhea causes more than 1.5 million outpatient visits, 200,000 hospitalizations, and 300
deaths among children in the United States per year, according to the Centers for Disease Control
and Prevention (CDC). Diarrhea is a leading cause of death in children under the age of five in
developing countries, with an estimated 2 million deaths per year. Gastroenteritis affects two
million to three million children under the age of five in the United States per year, resulting in 2
million to 3 million office visits and 10% of all pediatric hospital admissions. Furthermore,
rotavirus is responsible for about one-third of all hospitalizations for diarrhea in children under
the age of five, with an estimated direct cost of $250 million.

Anatomy and Physiology of Acute Gastroenteritis


Gastroenteritis is the irritation of the digestive track caused by a viral, bacterial, or
parasitic infection.

The gastrointestinal (GI) tract, also known as the digestive tract, as well as the liver,
pancreas, and gallbladder, make up the digestive system. From the mouth to the anus, the GI
tract is made up of a series of hollow organs connected by a long, twisting tube. The mouth,
esophagus, liver, small intestine, and large intestine, which includes the rectum and anus, are the
hollow organs that make up the GI tract. Food enters the mouth and travels through the GI tract’s
hollow organs to the anus. The stable organs of the digestive system are the liver, pancreas, and
gallbladder. The digestive system aids in the digestion of food.

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING

Figure 1: Gastrointestinal Tract


Source: https://images.app.google

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING

Book-Based Pathophysiology

Toxicogenic agents
*E.coli Pathogenic agents
*Shigella strains *Rotaviruses
*Salmonella species

Toxicogenic agents penetrate the mucosa Attached to the mucosal


of the small bowel wall

Release an exotoxin
Destroy cells in the
intestinal villa

Impairs intestinal
absorption
malabsorption of
electrolytes

Cause cellular destruction, necrosis,


ulceration, bleeding, and exudation
of protein-rich fluid.

Increased Gastrointestinal Increased secretion of fluid


motility electrolytes

Fig 2: Pathophysiology of AGE


Source: Mosby’s Handbook of Diseases pg. 263

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING

Book Based Pathophysiology of Acute Gastroenteritis

The pathological conditions depend on the causative agent. Toxicogenic agent such as some
E.coli, and Shigella strains, release an exotoxin that impairs intestinal absorption. Invasive pathogens
such as some Shigella and Salmonella species and E.coli, penetrate the mucosa of the small bowel,
causing cellular destruction, necrosis, ulceration, bleeding, and exudation of protein-rich fluid. Pathogens
such as rotaviruses attach to the mucosal wall and destroy cells in the intestinal villa, causing
malabsorption of electrolytes. Parasites and toxins also interfere with intestinal functioning. The general
result of all pathogenic agents increased gastrointestinal motility and increased secretion of fluids and
electrolytes.

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING

Client-Based Pathophysiology

Modifiable Factors

 Poor Hygiene Non- Modifiable Factors


 Poor Sanitation (Contaminated
foods and water)  Age
 Presence of Bacterial Infection  Sex
(E.coli, Shigella and Salmonella)

Ingestion of contaminated food and


water

Sign and Symptoms

 Diarrhea
 Fever
 Poor appetite
 Vomiting
 Restlessness

Fluid and Electrolyte


Imbalance

Dehydration

Acute Gastroenteritis

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING

Pathophysiology of Acute Gastroenteritis with Severe Dehydration


The diagram above shows the client-based pathophysiology of a pediatric patient
experiencing Acute Gastroenteritis. The modifiable factors are poor hygiene; poor sanitation like
in their environment there was a contaminated food and water and presence of bacteria such as
E.coli, Shigella and Salmonella that will be ingested. The client developed signs and symptoms
of having diarrhea, fever, poor appetite, vomiting and feeling of restlessness which results to
have a fluid and electrolyte imbalance that leads to dehydration and furthermore diagnosed with
Acute Gastroenteritis.

Risk Factors

People who may be more susceptible to gastroenteritis include:

 Young children. Children in child-care centers or elementary schools may be especially


vulnerable because it takes time for a child’s immune system to mature.

 Older adults. Adult immune systems tend to become less efficient later in life. Older
adults in nursing homes, in particular, are vulnerable because their immune systems
weaken, and they live in close contact with others who may pass along germs.

 Anyone with a weakened immune system. If your resistance to infection is low — for
instance, if your immune system is compromised by HIV/AIDS, chemotherapy or another
medical condition — you may be especially at risk.

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING

Clinical Manifestation
Book-based Client-based

Dehydration (mild, moderate, severe)  Diarrhea


Electrolyte disturbances  Fever
Abdominal cramps
Malnutrition  Poor appetite
Nausea and Vomiting  Vomiting
Diarrhea with or without blood and mucus
 Restlessness
Anorexia
General Malaise
Muscle ache

Source: Mosby’s Handbook of Diseases page.263

Medical Management
Medical treatment for gastroenteritis include:

 Oral rehydration solution (ORS) is the treatment of choice for children with mild-
to-moderate gastroenteritis in both developed and developing countries, according to
the American Academy of Pediatrics (AAP), the European Society of Pediatric
Gastroenterology and Nutrition (ESPGAN), and the World Health Organization
(WHO).

 IV rehydration. In extreme dehydration, IV access should be provided, and patients


should receive a 60-minute bolus of 20-30 mL/kg lactated Ringer (LR) or regular
saline (NS) solution.
 Diet. In general, children with gastroenteritis should be put back on a regular diet as
soon as possible; early eating shortens the length of the illness and improves
nutritional outcomes.

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING

NURSING MANAGEMENT

 Reduce infection transmission. All caregivers must wear gowns; when handling


feces-contaminated articles, gloves must be worn; contaminated linens and garments
must be placed in specially designated containers to be handled according to facility
policy; guests are restricted to family members only; teach and follow the principles
of aseptic technique; and good hand washing must be practiced.

 Promote skin integrity. Cleanse the buttocks and genital region regularly and apply
a calming protective preparation such as lanolin A or D ointment to minimize itching
and excoriation; change diapers as soon as practicable, and putting disposable pads
under the baby may promote simple and regular changing.

 Prevent dehydration. Count and weigh diapers to accurately calculate the infant’s


output; assess each voiding in the older child; and keep track of the number and type
of stools, as well as the volume and type of vomitus.

 Maintain adequate nutrition. Weigh the child on the same scale every day; take
measurements in the early morning before the morning feeding; and keep a close eye
on his or her intake and production. When a child is NPO, good oral hygiene is
essential; when oral fluids are added, the child is given oral replacement solutions; if
the child tolerates these solutions, half-strength formula may be introduced.
 Maintain body temperature. If there is a fever, monitor vital signs at least every 2
hours, follow effective fever-reduction protocols, and administer antipyretics and
antibiotics as prescribed.

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING

CHAPTER III
Laboratories
Fecalysis

02/17/21 Interpretation
Color Yellowish Normal
Consistency Loose watery Sign of Diarrhea
Parasites No OVA or Parasite seen Normal

Hematology

02/17/21 Results Normal Value Interpretation


Hemoglobin 12.5 11.3 – 14.1 Normal
Hematocrit 0.45 0.31 – 0.41 Increased, dehydration
RBC 4.98 4.6 – 5.2 Normal
WBC 19.1 5 – 10 x 10/L Increased, Infection
Neutrophils 9000 1500-8500 Increased, acute
bacterial infection
Lymphocytes 9700 3000-9500 Increased, Infection
Platelets 297 140 – 340 x 10/L Normal
MCV 77.3 86 – 100 Normal
MCH 26.7 26 – 31 Normal
MCHC 31.9 31 – 37 Normal

Blood Chemistry

02/17/21 Results Normal Value Interpretation


BUN 11 7 – 17 Normal
Creatinine 0.5 0.2-0.5 Normal

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
Laboratory Results and Interpretation

1. High hematocrit – This means that the body has more red blood cells than what’s
considered to be healthy. High hematocrit levels could indicate underlying medical
conditions like dehydration.

2. High white cell count – A high white blood cell count may indicate that the immune
system is working to destroy an infection.

3. High neutrophils – Having a high percentage of neutrophils in the blood is called


neutrophilia. This is a sign that the body has an infection. Neutrophilia can point to a
number of underlying conditions and factors, including infection, most likely bacterial.

4. High lymphocytes – High lymphocyte blood levels indicate that the body is dealing with
an infection or other inflammatory condition.

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
CHAPTER IV
NURSING CARE PLAN

Outcome
Assessment Diagnosis Planning Intervention Evaluation
Identification
Subjective data: Risk of fluid After 8 hours Short term: Independent: After 8
volume deficit of nursing hours of
“Naka apat na beses na After 4 hours Establish rapport
related to intervention nursing
siyang sumuka sa bahay” as of nursing
vomiting as the client will -to gain trust and intervention
verbalized by the mother. intervention,
evidenced by maintain fluid participation from the the client is
the client will
dry lips and volume at client continuosly
exhibit moist
poor skin functional level and
Objective data: mucous Assess vital signs.
turgor. as evidenced gradually
membrane and
by stable vital regaining
 Dry lips good skin -Fever that occurs with
signs, moist his/her
 Restlessness turgor. gastroenteritis
mucous energy.
 Sunken eyes increases fluid loss
membranes
 Poor skin turgor through perspiration
and good skin
Vital signs: turgor. Long term: and increased Goal was
After 8 hours respiration.The change partially
 Temp: 38.4°C of nursing in HR is a met
 PR:120 bpm intervention compensatory
 RR:26 cpm no signs of mechanism to maintain
 BP:90/70mmHg dehydration
cardiac output.
will be noted.
Usually, the pulse is
weak and may be
irregular if electrolyte
imbalance also
occurs. Hypotension is
evident in hypovolemia.
Assess skin turgor
-Fluid loss occurs first in
extracellular spaces,
resulting in poor skin
turgor and dry mucous
membrane
Place the client in a
position of comfort-
upright or lateral

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
recumbent as tolerated
and monitor the airway
status
-to prevent caspiration
Do not give the client any
food or drinks for several
hours of vomiting
-----
Instruct the client to sip
small amounts of water
or suck ice chips every 15
mins for 3-4 hours.Next,
sip clear liquids every 15
mins for 3-4 hours.
Examples include water,
clear broth, gelatin and
apple juice.
-----
Avoid foods spicy foods,
fats/oils, milk and citrus
juice.
-it can irritate your
stomach or may be
difficult to digest.
When client can tolerate
clear liquids for several
hours without vomiting
and if the client is hungy,
try to feed in small
amounts of bland diet
(example) for 24-48 hours
after the last period of
vomiting.
When the client can
tolerate bland food, client
can resume normal diet.
-------

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING

Place a towel on clients


chest and provide tissues
and emesis basin to catch
the clients vomit
-
Keep the emesis basin out
of sight but within the
client’s reach
-
Rinse client’s mouth with
water
-to
Assess intake and output
every shift and assess the
color and amount
of urine.
-A decrease in urine
volume and concentrated
urine, as evidenced by a
darker urine color,
denotes fluid deficit.

Provide the client with a


well-ventilated room
-a well-ventilated room
promote easier breathing
and relaxation .
Change linens if
necessary
-to

Dependent:

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING

Administer parenteral
fluids as prescribed.
- if vomiting persists, IV
infusion is used to
achieve rehydration.
Admister anti emetic as
ordered

-these drugs will


reduce vomiting and
the risk for fluid
volume deficit.

Source: https://nurseslabs.com

Outcome
Assessment Diagnosis Planning Intervention Evaluation
Identification

Subjective: Diarrhea After nursing Short term: Independent: After 8 hours of


related to intervention, After 8 hours nursing
“Tatlong beses Establish rapport
presence of client is able to of nursing intervention the
ng dumudumi -to gain trust and promote
toxin as re-establish intervention clients’ mother
ang anak ko ng cooperation with the client
evidenced by and maintain the clients’ reported
lusaw” as
frequent normal bowel mother will decrease in
verbalized by the Ask the client about the recent
elimination functioning. report decrease frequency of
mother history of drinking
of watery in frequency elimination of
contaminated water or ingestion
stools. of elimination stools.
of uncooked food.
of stools.
-Ingestion of contaminated food
or drink may predispose the
Objective: After 3 days of
Long term: client to intestinal infection.
nursing

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
- Dry lips After 3 days of intervention, the
-Restlessness nursing client defecated
Evaluate the pattern of
-Sunken eye intervention, formed soft
defecation.
-Poor skin turgor the client will stool daily.
- Defecation pattern can
defecate
promote immediate treatment.
Vital Signs taken formed soft
as: stool daily. Goal was met.
T: 38.6 C Assess for abdominal pain,
PR: 120 bpm abdominal cramping,
RR: 28 cpm hyperactive bowel sounds.
BP: 90/70 mmHg - These assessment findings are
commonly connected with
diarrhea.

Teach the client about the


importance of hand washing
after each bowel movement and
before preparing food for
others.
- Handwashing is the most
efficient way to prevent the
transmission of infection to
others.

Instruct the client’s mother to


boil drinking water.
- To ensure that drinking water
is safe and clean.

Instruct the mother of the client


to avoid giving BRAT
(bananas, rice, apples, and
toast) diet.
-They provide excessive
carbohydrates and, overall, are
also low in electrolytes.
.
Dependent:
Administer antidiarrheal
medications as prescribed:
Erceflora
-Antidiarrheals are commonly

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
used for treating the diarrhea
of gastroenteritis.

Source: https://nurseslabs.com/gastroenteritis-nursing-care-plans/

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED

COLLEGE OF NURSING

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED

COLLEGE OF NURSING
ASSESSMENT DIAGNOSIS OUTCOME PLANNING INTERVENTION EVALUA
IDENTIFICATION
Subjective: Hyperthermia The client will Short term: Independent: After 1 hour o
related to maintain normal body Establish rapport nursing interv
“Pagkagising ng anak dehydration as temperature. *After 1 hour of To gain trust and the patient’s
ko ay mainit na siya” as evidenced by performing promote cooperation temperature
verbalized by the elevated body nursing with the client. decreased to
mother of the client. temperature. intervention, the
patient’s *Monitor Vital signs.
Objective: temperature will To provide more
decrease from accurate indication After 4 hours
 hot, flushed skin nursing interv
38.6C to 37.5C. of core temperature.
 warm to touch the patient’s v
*Provide tepid signs returned
 increased sponge bath. normal range
respiratory rate. Long term: TSB helps in
lowering the body
Vital signs: After 4 hours of temperature.
performing The goal was
Temp: 38.9 C nursing *Encourage ample
intervention, the fluid intake by
PR: 120bpm
patient’s vital mouth.
RR; 26cpm signs will return to the patient is
normal range: a dehydrated ,
BP: 90/70mmHg temperature of therefore fluid loss
36.5C to 37.5C, a contributes to fever.
pulse rate of 60-
100bpm and a *Promote a well
ventilated room
respiratory rate of
Opening the window
12-20cpm.
can supply fresh air
for the patients that
can help them to
improve their health.

Dependent:

*Administer anti-
pyretic medication as
prescribed by the
physician.
Antipyretic
medication are used
to treat fever by
reducing body
temperature.

Source:https: //nurseslabs.com/gastroenteritis-nursing-care-plans/

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED

COLLEGE OF NURSING

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED

COLLEGE OF NURSING

CHAPTER V
DRUG STUDY
NAME OF THE MECHANISM DOSAGE INDICATIONS CONTRAINDICATIO ADVERSE NURS
DRUG OF ACTION NS EFFECT CONSIDE
Generic name: Acts as Prevention of Metoclopramide is con Drowsiness Before:
Metoclopramide antiemetic by 1-3 years- nausea/ traindicated in children Restlessnes -Observe t
blocking 1 mg vomiting aged less than 1 year. s rights of dr
Brand name: dopamine (1ml) PO due to an increased Rash administra
Reglan receptors and risk of extrapyramidal Seizures -Assess for
promotes GI 3-5 years- disorders Swelling to metoclo
motility by 2 mg (especially -Assess for
Classification: enhancing the (2ml) PO hands and contraindic
Antiemetic response to feet)
GI stimulant acetylcholine 5-9 years- Constipatio During:
of tissue in 2.5 mg n or - Monitor
upper GI tract (2.5ml) diarrhea carefully d
causing PO administra
enhanced - Monitor f
motility and extrapyram
accelerated reactions, a
gastric consult phy
emptying they occur
without -For IV inf
stimulating give over a
gastric, biliary, minutes.
or pancreatic
secretions and After:
increases lowe -Educate th
esophageal parents abo
sphincter tone possible si

-Disposed
materials p

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED

COLLEGE OF NURSING
Name of Mechanism of Adverse Nursing
Dosage Indication Contraindication
Drug Action Effects Consideration
Generic Children 2- Contributes to the Acute Ascertained No known Before:
Name: 11 years: recovery of the diarrhea hypersensitivity adverse -Observe the 12
1-2 vials of intestinal with towards the effects. rights of drug
Bacillus administration
2 billion/ 5 microbial flora duration of components of
Clausii
mL altered during the <14 days the product.
suspension course of due to -Check and verify
with doctor’s order
microbial infection,
Brand Name: and Kardex.
disorders of drugs or
Route:
Erceflora diverse origin. It poisons. During:
Oral produces various Chronic or -Administer drug
vitamins, persistent orally.
particularly group diarrhea
Classification:
Frequency: B vitamins thus with After:
Anti- contributing to duration of
diarrheal OD correction of >14 days. -Monitor patient for
vitamin disorders any unusual effects
caused by from drug.
antibiotics &
chemotherapeutic -Disposed of used
agents. Promotes materials properly
normalization of
intestinal flora.

Source: https://www.mims.com/philippines/drug/info/erceflora?type=full

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED

COLLEGE OF NURSING

NAME OF THE MECHANISM DOSAGE INDICATION CONTRAINDIC ADVERSE NURSING CONSI


DRUG S OF ACTION ATION REACTION

Generic Paracetamol Dosage: Used in the Contraindicate Thrombocyto Before:


-Observe the 12
Name: is an 60mg/kg relief of mild d in patients paenia,
drug administrat
Paracetamol analgesic and to moderate with known anaphylaxis, -Verify the clien
antipyretic. Route: fever. hypersensitivit skin rashes, using agency pro
Brand Name: It’s Oral y to and -Explain to the c
Calpol mechanism paracetamol angioedema. relatives what ar
of action is Frequenc or any other possible side eff
medication.
Classification: believed to y: components of -Check that the pa
Antipyretic include q4h the taking any other m
and Analgesic inhibition of formulation. containing paracet
prostaglandin Stock on
synthesis, hand: During:
-Shake well before
primarily 120mg/5 -Make sure that th
within the ml must not exceed th
central suspensio recommended dos
nervous n
system.
After:
.-Monitor any adv
reaction towards m
-Stores at tempera
exceeding 30c. ke
direct light exposu
-Keep out of reach
children.

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED

COLLEGE OF NURSING
Source: https://www.mims.com/philippines/drug/info/calpol?type=full

CHAPTER VI
Evaluation and Findings
After conducting the study, the student-nurses were able to appreciate more the essence of
utilizing the nursing process by providing clinical care and management for the pediatric client. Acute
diarrhea is an abrupt increase in recurrence and changes in consistency of stools. Infants and children are
in danger or at risk for the development of dehydration and malnutrition which is two significant
outcomes of the diarrhea.
Acute Gastroenteritis is an inflammation of the gastrointestinal tract in both the stomach and
small and large intestine. The digestive system is concerned with digestion and absorption of food.
Therefore, the inner lining of the digestive tract serves as a protective barrier to those indigestible and
harmful materials while allowing for the specific absorption of nutrients across the wall of the digestive
tract. Once across the wall of the digestive tract, the nutrients enter the blood and are distributed to the
tissues of the body.
Early accurate detection is important to improve patient outcomes. This study provides the
student-nurses a huge knowledge and understanding with regards on taking good care of a pediatric client
in the real clinical setting and taught the student-nurses to provide client’s care more efficiently and
competently to achieve an effective and quality nursing care.

Recommendation
 Children who are old enough should be taught to wash their hands and avoid improperly stored
food and contaminated water.
 All of the food that is placed out for consumption should be consumed within an hour.
 Parents should encourage their child to drink fluids even if just in small frequent amounts.
 Parents should not allow their children to swim in public water if they have diarrhea.
 Children who are vomiting should be given small amounts of fluid to prevent dehydration.

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED

COLLEGE OF NURSING
 Infants and children with weakened immune system should not touch reptiles, birds or
amphibians because these types of animals typically carry salmonella bacteria that can cause
severe infection and diarrhea.
 Parents should teach their children to avoid swallowing of water when they swim.

References:

Introduction

https://doh.gov.ph/sites/default/files/publications/CPG%20AID_Full%20version.pdf

https://pedsinreview.aappublications.org/content/33/11/487

https://www.sciencedirect.com/topics/medicine-and-dentistry/acute-gastroenteritis

Definition of the case


https://www.aafp.org/afp/1999/1201/p2555.html
https://www.sciencedirect.com/topics/nursing-and-health-professions/acute-gastroenteritis
https://www.southerncross.co.nz/group/medical-library/gastroenteritis-causes-symptoms-
treatment
Cases of acute gastroenteritis globally
https://pedsinreview.aappublications.org/content/33/11/487
Anatomy and Physiology
http://www.ibdclinic.ca/what-is-ibd/digestive-system-and-its-function/
Pathophysiology
Mosby’s Handbook of Diseases
Medical management
https://nurseslabs.com/gastroenteritis/

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED

COLLEGE OF NURSING
Nursing management
https://nurseslabs.com/gastroenteritis/

Transforming Communities through Science and Technology Contact No.Contact No. (044) 600-3970
(044) 600-3970
Email: nursing@neust.edu.ph
Email: nursing@neust.edu.ph
neustcollegeofnursing@gmail.com
neustcollegeofnursing@gmail.com
www.neust.edu.ph
www.neust.edu.ph

You might also like