NURSES' ASSIGNMENTS
Wednesday, June 13, 2012
Tuesday, June 12, 2012
PEDIATRIC FUNCTIONAL HEALTH PATTERN (sample)
PEDIATRIC FUNCTIONAL HEALTH PATTERN
A. Health Perception-Health Management Pattern
Usually the child’s health is fair
as describe by the mother but now it’s already poor. She said that in
maintaining the child’s health she provided the child with nutritious food as
much as possible and giving all the needs of the child like nice dress and
proper hygiene. She gave the child time to play with other kids. The child’s
immunization was complete.
The child was admitted to the
hospital because of the on & off fever for 2 days PTA. The mother did not
know really the real cause of the illness because it occurs suddenly. It began
on May 1, 2010 in the afternoon that the child was warm to touch and feels
headache. The child was given paracetamol to relieve the fever but his fever
didn’t subside. The child was hospitalized last February 2009 because of
typhoid fever as stated by his mother. They expect that the child will get well
soon as soon as possible so that the child will not suffer from staying in the
hospital.
During her pregnancy, the mother had
her complete pre-natal check-up during her pregnancy stage. She did not take
any medications & no complications during pregnancy.
B.
Nutritional-Metabolic Pattern
The child’s appetite is usually good
but upon hospitalization the child’s appetite is poor. He doesn’t like to eat
rice and vegetables. He was breastfed for 2 years and 4 months and then switch
to formula fed. He can consume 4-5 bottles of Bearbrand milk in 24hrs but with
mixed feeding of “lugaw” and rice with soup. Each feeding of milk is 250 ml.
She started to introduce solid food when her child was 6 months old. The child
likes to eat vegetables and fruits. They were not fun of going to fast food or
restaurants. The mother was concern about the child’s health because he usually
bought street foods rather than eat his mother prepared food.
C.
Elimination Pattern
The child defecates once a
day, usually every morning with soft, brown, formed & moderate in amount
stool. He was toilet trained. The child doesn’t have any problems in his
urination. He doesn’t have any trouble in his skin.
D.
Activity-Exercise Pattern
Walks with steady gait, runs with
few falls, walks on toes, stands on one foot, jumps, kicks ball, throws ball
overhand. He participated in basketball games.
The child could eat using spoon and
fork. He doesn’t want to be helped. The child doesn’t need help in toileting
since he knows where to defecate and urinate. He defecates and urinates on
their comfort room. The child can dress by himself, bath and brush his teeth.
The child watches TV for more than
an hour He loves to watch cartoons. He watches with his parents. He was
prohibited watching action movies to avoid being violent when he grows up.
E. Sleep-Rest Pattern
The
child usually sleeps 8pm & wakes at 6am. He sleeps 10 hrs a day without
naps. The child’s usual sleep routine was singing with his parents &
listening bedtime stories. He had no
usual sleep pattern problem.
F. Cognitive-Perceptual Pattern
The child did not have any sensory
perception deficits. He was 7 years old and a grade 2 pupil. He is an average
pupil in his class.
G. Self-Perception Pattern
The mother feels bad about her
child’s illness and she was concerned about the wellness of the child. The
child verbalizes that he feels restless.
H. Role-Relationship Pattern
The child uses
appropriate words for his age. Spoken language in their home is bisaya. The
child has one sibling. He was the eldest. Both the child’s parents do the
decision making and in disciplining the child.
There was no marital problem and violence in the family.
I. Sexuality-sexual Functional Pattern
The child did not verbalize any
sexual curiosity according to her mother. The child always plays with boys and
he loves to play basketball.
J. Coping-Stress Management Pattern
The child learns to decide for
himself and if greater decisions are to be made he would ask approval from his
parents. There were no losses for the past year. When the child is stress he
turns to her mother. When the child was frustrated he plays with his playmates.
He was afraid of her mother when she brings stick to spank him.
K. Value-Belief System
The whole family was Roman
Catholic as claimed by the mother. The mother just likes to be prayed for her
child’s wellness.
Health History Write-Up Sample
HEALTH
HISTORY
Reason
for Seeking Care
“Fever
with rashes for 6 days PTA”
Present
Health History
Last February 4, 2010 at 4:00 in the afternoon, Bebe Kho was requested
by her teacher to sweep the scattered garbage and clean the comfort rooms
located just behind their classroom. There, she claimed that she was bitten by
a stripe-colored mosquito. She also verbalized that there are plenty of
mosquitoes in their house that bite her from time to time.
On February 8, 2010, patient’s voice became hoarse. Two days after,
February 10, 2010, Bebe Kho experienced fever associated with left temporal
non-radiating continuous headache with a pain scale of 7/10. However, there was
no sign of bleeding such as epistaxis and hematemesis. Her tonsils were already
enlarged and have purulent exudates. She was then brought to the nearby clinic in
Simbulan for check-up. Bebe Kho was diagnosed with Acute Tonsillitis and was
given antibiotic, Cefalexin 50mg, orally for 5 days. The patient claimed that
she had loss of appetite, body malaise, and pain during swallowing which she
scaled 3/10. Home management included cold compress applied on the forehead and
a mixture of one tablespoon of salt in a glass of water which the patient gargled
every four hours. Despite the effort to manage the fever, it still persisted
for three days.
On February 13, 2010, rashes were noted on Bebe Kho’s trunk. At home, she
was asked to drink at least 2 glasses of tawa-tawa
decoction a day because her father anticipated that she might have acquired
dengue since it’s also rampant in their place. Moreover, one of their neighbors
has had dengue fever a week prior to the onset of Bebe Kho’s fever. The next
day, her headache subsided but she still had fever.
Bebe Kho continued to be
febrile for 6 days and the rashes spread to her entire body despite the home
management. On the morning (unrecalled time) of February 16, 2010, Mr. and Mrs. Kho decided to bring the patient at
Simbulan General Hospital. CBC was done in the hospital with the following
results: Hgb-14.0g/dL, Hct-42.1vol.%, WBC-2.4x103µL, RBC-3.49x103µL,
MCV-86.2fL, MCH-26.9pg, MCHC-31.2g/dL, and platelet count-53(120x103)µL.
Differential count of: Segmenters-48% and Lymphocytes-52%. These results
prompted Bebe Kho’s parents to admit her to Valencia Sanitarium and Hospital.
They left for VSH at 6PM riding on a motorcycle.
Bebe Kho together with her
parents arrived at Valencia Sanitarium and Hospital Emergency Room at 8:38PM on
February 16, 2010 with vital signs of: T-35.9oC, PR-80bpm, RR-28bpm,
BP-100/70mmHg. Physical Examination findings: enlarged tonsils without
exudates, dry parched lips, Petechial rashes multiple in abdomen and upper
extremities. IV infusion of PLR ŤL @ 35 gtts/min on right
arm was started.
The doctor ordered the following:
ü DAT except dark colored
foods
ü Labs:
o repeat CBC
o platelet count serial
o Hct and platelet every 4
hours
o U/A
o serum albumin
o SGPT, APTT, PTT
o ABO blood typing
ü 3 units of fresh frozen
plasma properly crossmatched with patients blood type
ü monitor v/s q 30 min.
ü record and monitor I &
O q shift.
At 9:50 pm new doctor’s
orders were made. This included fast drip 100 cc of Plain Lactated Ringer’s;
refer for systolic BP ≤ 70 mmHg, diastolic BP ≤ 50 mmHg; narrow pulse pressure
≤ 20 mmHg or any unusualities; IV to follow PLR ŤŤL @ 31 gtts/min.
On Feb. 17 at 12:20 pm
during doctor’s rounds, orders were made such as changing the IVF to D5LR
ŤL. During the doctor’s rounds at 2:15PM, the patient
still had fever and inflamed tonsils, thus, the doctor ordered to start
Paracetamol 750 mg/3 mL q 4h for 37. 8OC or above.
Past
Health History
Bebe Kho’s family lives in Purok Daghang Lamok,
Fantasea, Bukidnon. Their house is located approximately 10 meters away from a
banana plantation and is surrounded by huge trees. Mrs. Kho mentioned that during
rainy months, the incidence of dengue fever is increased. Some of her control
measures included the use of mosquito nets, changing of water and scrubbing the
sides of their flower vase once a week, and destroying breeding places of
mosquito by cleaning their surroundings. However, she added that when it is
raining, she hangs their washed clothes just below their roof’s eaves. She also
said that she has a collection of potted bromeliads placed outside the house.
Further, she mentioned about the tadjao
(a rubber made jar) with cover they placed outside their house that serves as
rain water reservoir. She’s aware that these are potential breeding sites for
mosquitoes.
Bebe Kho was born, together
with her twin sister Bubu Kho, on August 9, 2000, full term, at Maternity
Hospital in Cagayan de Oro City via elective Caesarean Delivery. According to
the mother, it took more or less 20 seconds before the baby was able to cry.
She also observed that Bebe Kho’s upper and lower extremities were slightly
cyanotic. Bebe Kho suffered from respiratory distress resulting to her prompt
confinement in NICU; however, her mother cannot recall the medications and
treatment that were given to the neonate. After one week, the patient was
discharged with improved condition evidenced by pinkish body and extremities
and good cry. Patient had her BCG vaccine right after birth. She received her
first dose of DPT and OPV six weeks after birth. DPT2 and OPV2 were given four
weeks thereafter. She completed the third dose of DPT and OPV before she
reached 5 months old. When she was 9 months old, she was immunized with measles
vaccine, thus completing her immunization before reaching one year old.
Mrs. Kho claimed that she breastfed the patient for a
week only following her discharge, because she thought that her twins were not
satisfied of the breast milk and that they were not getting adequate nutrition
from it. So she decided to give the twins formula milk, specifically Bonna, as
a substitute.
At 6 months of age, mother
recalled that Bebe Kho was dyspneic and had fever which prompted her to admit Bebe
Kho to Laviña Hospital in Valencia City. Patient was diagnosed of Pneumonia. As
far as Mrs. Kho remembered, Dr. Kisteria, patient’s pediatrician, ordered
Salbutamol 1/2 nebule via face mask to be administered TID for 7 days.
At 1 year old, patient was
admitted to Laviña Hospital after an episode of dyspnea for at most 3 hours.
She was then given Salbutamol 1 nebule via face mask TID. The attending
physician diagnosed the patient as asthmatic. Mother claimed that they use
Baygon Katol, placed approximately 1 meter away from child’s bed, every night. The
doctor instructed her parents to stop using Baygon to prevent the episode of
dyspnea.
The patient was 4 years old
when she had a fall. Bebe Kho’s mother was watching television in the living room while her twins were playing. The client accidentally fell from
the bench which stood 14 inches from the floor. Mrs. Kho was fully unaware of
what happened until their housemaid called her attention. Mrs. Kho managed it
by applying cold compress over the patient’s left shoulder and she shifted to
warm compress after four hours.
When the patient was
already 6 years old, she had fever again which prompted immediate check up at Dr.
Osorno’s clinic in Simbulan. Dr. Osorno advised the patient’s mother to admit
the child in the hospital to confirm if she has UTI. The patient was prescribed
of Cefalexin 50 mg TID. Since then, Mrs.
Kho managed the patient’s fever with Paracetamol 250mg every 4 hours until it
subsided. During this time, mother noticed that the patient is allergic to
Cotrimoxazole, her medication for UTI, and in chicken’s egg and chicken meat.
The patient was transferred
from a private Baptist school to Fairy Land Elementary School when she was in
Grade 2 due to financial reasons. A man-made pond that contained tilapia and water lilies occupied the
east side of the school. Located behind the classrooms were 4 public comfort
rooms and nearby was an unused water-containing drum. The southern part of the
school was all-laden with tall talahib grass.
Last August 2008, she had
been hospitalized at Simbulan General Hospital due to Amoebiasis with Dr.
Osorno as the attending physician. One day prior to that admission, she
experienced abdominal pain and passed greenish watery stools. Bebe Kho’s
parents were unable to remember the drugs prescribed by the doctor. She stayed
in the hospital for 3 days. Mrs. Kho believed that it was due to the water that
Bebe Kho drank two days before she manifested the symptoms. In addition, the
family ceased drinking mineral water two days prior to the onset of the
illness; instead, they got their water source from the faucet.
On the same year (exact
date not remembered), the patient complained of dysphagia associated with fever
for 3 consecutive days. Upon inspection, the mother noted red and swollen tonsils.
Days prior to that, patient ate chocolates especially cloud 9. She could actually
consume one big pack of chocolate a day. Again, she was brought for check up at
Dr. Osorno’s clinic and was diagnosed of Acute Tonsillitis. The following
medications were prescribed: Gargle of Bactidol TID, and erythromycin. Bebe Kho
was also given maintenance multivitamins such as Ceelin syrup (alternate with
Neotroplex syrup) and Growee syrup one tablespoon every after breakfast.
Introductions for Dengue fever (sample)
INTRODUCTION
Dengue
fever, also known as breakbone fever, dandy fever (because of pain in the
joints and bones and the way the patient seems to be walking on his toes) is an
acute febrile disease caused by infection with one of the serotypes of dengue
virus which is transmitted by mosquito genus Aedes; a benign syndrome caused by
several arthropod-borne viruses, is characterized by biphasic fever, myalgia or
arthralgia, rash, leukopenia, and lymphadenopathy.
There
are at least four distinct antigenic types of dengue virus, members of the
family Flaviviridae. In addition, three other arthropod-borne (amboviruses)
cause similar or identical febrile diseases with rash.
The
causative agent is the arbovirus, namely, Onyong-onyong, Chikungunya, West
Nile, Flavirus; it is transmitted by bite of an infected mosquito, principally
the female Aedes Aegypti, it is a day biting (they appear two hours after
sunrise and two hours before sunset), it has a limited and low- flying
movement, breeds on clear- stagnant water for drinking or bathing and in
rainwater collected in any container, has grey wings and white stripes on the
body and white bands on the legs.
It is characterized by
capillary permeability, abnormalities of homeostasis, and in severe cases, a
protein- losing shock syndrome (dengue shock syndrome). It is currently thought to have an
immunopathologic basis.
Epidemics
were common in temperate areas of the America, Europe, Australia, and Asia
until early in the 20th century. Dengue fever and dengue-like
disease are now endemic in tropical Asia, tropical Africa. Dengue fever occurs
frequently among travelers to these areas.
Most
disease occurs in older children and adults. Because A. aegypti has a limited
range, spread of an epidemic occurs through viremic human beings and follows
the main lines of transportation. Sentinel cases may infect household
mosquitoes; a large number of nearly simultaneous secondary infections give the
appearance of a contagious disease. Where dengue is endemic, children and
susceptible foreigners may be the only persons to acquire overt disease, adults
having become immune.
The
incubation period is 5-7 days. The clinical manifestations are variable and are
influenced by the age of the patient, in infants and young children the disease
may be undifferentiated or characterized by fever for 5-7 days, pharyngeal
inflammation, rhinitis, and mild cough. A majority of infected older children
and adults experience sudden onset of fever, with temperature rapidly
increasing to 39.4-41.1 degree Celsius, usually accompanied by frontal or
retro-orbital pain, particularly when pressure is applied to the eyes.
Occasionally, severe back pain precedes the fever (black-break fever). A
transient, macular, generalized rash that blanches under pressure may be seen
during the first 24-48 hr of fever. Myalgia and arthralgia occur soon after the
onset and increase in severity. Joint symptoms may be particularly severe in
patients with chikungunya or onyong-onyong infection. From the 2nd-6th
days of fever, nausea and vomiting are apt to occur, and generalized
lymphadenopathy, cutaneous hyperesthesia or hyperalgia, taste aberrations, and
pronounced anorexia may develop. The
pathopnomonic sign of Dengue/Hemorrhagic Fever is Herman’s sign. It appears on
the upper and lower extremities, purplish or violaceous red with blanched areas
about 1 cm or less in size.
Grade 1 manifestations/ and signs and
symptoms.
·
Sudden high fever for 5-7 days; sore throat
·
Redness
of the eyeballs, swollen face
·
Pain:
periorbital, joints, bones, abdomen, head, on eye movement
·
Nausea
and vomiting
Pathological
changes
a.
Petechiae
b.
Herman
sign: general redness of the skin
c.
Macular
or measles-like rash on the palms and spreads up the arms, body and legs. Fades
slowly and followed by branny desquamation of the skin.
Grade 2- signs and symptoms of grade 1
plus
·
Bleeding
a.
Epistaxis
(nose)
b.
Gums
c.
Gastric
*
Hematemesis (vomiting of blood)
*
Melena (passage of blood)
*
Hematochezia (stool with fresh blood)
Grade
3- signs and symptoms of grade 2 plus evidence of circulatory failure
·
Cold,
clammy skin
·
Hypotension
·
Very
rapid but weak pulse
·
Very
rapid respiration
Grade
4-signs and symptoms of grade 3 plus signs of hypovolemic shock (due to
excessive bleeding/ blood loss). May lead to death if uncontrolled.
The Diagnostic and laboratory exams to be considered are
Tourniquet or Rumpel Leede Test; it is a presumptive test for capillary
fragility, Platelet count that it should be below or <150,000cu.Mm for
positive results of dengue and it should be done every six hours, and
hematocrit count that it should be above or > 0.34-0.54 because of
hemoconcentration.
Life
Cycle of a Mosquito
Under optimal
conditions, the egg of a mosquito of the genus Aedes can hatch into larvae in
less than a day. The larva then takes about four days to develop in a cocoon
from which adult mosquitoes will emerge after two days. Three days after the
mosquito has bitten someone and taken in the blood, she will lay eggs and the
cycle begins again.
Some facts
about mosquitoes:
·
Only the female Aedes mosquito bites as it needs protein in
blood to develop eggs.
·
The mosquito becomes infectious after about 7 days, it has
bitten a person carrying the virus. It is the extrinsic incubation period,
during which the virus replicates in the mosquito and reaches the salivary
glands.
·
Peak is bite at dawn and dusk.
·
The average lifespan of a mosquito of the genus Aedes in Nature
is 2 weeks
·
Mosquitoes may lay eggs about 3 times in his life, and about 100
eggs are produced each time.
·
The eggs can live in dry conditions until approximately 9
months, after which they can hatch if it is subject to conditions,
example: food and water
|
DIAGNOSTIC TESTS (sample)
DIAGNOSTIC TESTS
February
16, 2009 Simbulan General Hospital
|
Results
|
Normal
range
|
Interpretation
|
|
Hematocrit
|
42. 1%
|
32%-42%
|
Slightly
elevated
hemoconcentration
|
|
Hemoglobin
|
14.0 g/dl
|
10-17
g/dl
|
normal
|
|
RBC
|
3.49 x 103/µL
|
4.8-7.2 x 103/µL
|
Decreased
Iron
deficiency anemia, hemorrhage or blood loss, anemia, chronic infection
|
|
WBC
|
2,400 mm3
|
6,000-17,000
mm3
|
Decreased
Leucopenia,
hematopoietic disease, viral infection
|
|
Differential
count:
|
|
|
|
|
Segmenters
|
48%
|
32%
|
Increased
Viral infection
|
|
Lymphocytes
|
52%
|
25%-35%
|
Increased
Viral infection
|
|
Platelet
count
|
53,000 mm3
|
200,000-475,000
mm3
|
Decreased
thrombocytopenia
|
|
MCV
|
82.6 fL
|
82-98fL
|
Normal
|
|
MCH
|
26.9 pg/cell
|
26-34pg/cell
|
Normal
|
|
MCHC
|
31.2g/dl
|
32-36g/dL
|
decreased
|
|
RDW-CV
|
14%
|
|
|
|
February
17, 2009 10PM
|
Results
|
Normal range
|
Interpretation
|
|
Hematocrit
|
42.2 gms%
|
32%-42%
|
Slightly increased
|
|
Hemoglobin
|
13.3 gms%
|
10-17
g/dl
|
normal
|
|
RBC
|
4.69 x 103/µL
|
4.8-7.2
x 103/µL
|
(in
lower limit) Iron deficiency anemia, hemorrhage or blood loss, anemia,
chronic infection
|
|
WBC
|
2,300
mm3
|
6,000-17,000
mm3
|
Decreased
Leucopenia,
hematopoietic disease, viral infection
|
|
Differential
count:
|
|
|
|
|
Segmenters
|
48%
|
32%
|
Increased
Viral
infection
|
|
Lymphocytes
|
46%
|
25%-35%
|
Increased
Viral
infection
|
|
Monocytes
|
06%
|
4%-9%
|
normal
|
|
Control
|
11.6 sec.
|
|
|
|
Test
|
12.3 sec.
|
|
|
|
% activity
|
97.6%
|
100%
|
|
|
Ratio
|
1.03
|
|
|
|
INR
|
1.02
|
1.00-1.30
|
NORMAL
|
|
APTT:
Control
Test
Ratio
|
36.0 sec.
33.9 sec.
0.9
|
33-45 sec
|
NORMAL
|
|
Clinical Chemistry:
|
|
|
|
|
Albumin
|
3.1g/dl
|
4-5.9g/dL
|
Hypoalbuminemia
|
|
SGPT
|
25.4vol/L
|
4-36vol/L
|
|
|
Platelet
count
|
83,000 mm3
|
150,000-400,000
mm3
|
Decreased
Idiopathic
thrombocytopenic purpura, multiple myeloma, leukemias, anemias, acute
rheumatic fever,
|
|
Feb 17, 2010
@7:45am
|
Results
|
Normal range
|
Interpretation
|
|
Hematocrit
|
35.9
|
32%-42%
|
Normal
|
|
Platelet
count
|
86,000
|
150,000-400,000
mm3
|
Decreased thrombocytopenia
|
|
|
|
|
|
|
Feb 17, 2010
@ 1:15am
|
Results
|
Normal
range
|
Interpretation
|
Hematocrit
|
36.5
|
32%-42%
|
Normal
|
Platelet
count
|
80,000 mm3
|
150,000-400,000
mm3
|
Decreased
thrombocytopenia
|
Feb 17, 2010
@ 9:00 am
|
Results
|
Normal
range
|
Interpretation
|
Hematocrit
|
37.3
|
32%-42%
|
Normal
|
Platelet
count
|
92,000
|
150,000-400,000
mm3
|
decreased
|
Feb 17, 2010
@ 1:35 pm
|
Results
|
Normal
range
|
Interpretation
|
Hematocrit
|
35.2
|
32%-42%
|
Normal
|
Platelet count
|
110,000
|
150,000-400,000
mm3
|
decreased
|
|
|
|
|
Feb 17, 2010
@ 5:00 pm
|
Results
|
Normal
range
|
Interpretation
|
Hematocrit
|
35.4
|
32%-42%
|
Normal
|
Platelet count
|
118,000
|
150,000-40,000
mm3
|
decreased
|
Feb 18, 2010
@ 7:30 am
|
Results
|
Normal
range
|
Interpretation
|
Hematocrit
|
35.4
|
32%-42%
|
Normal
|
Platelet count
|
124,000
|
150,000-400,000
mm3
|
decreased
|
|
|
|
|
Feb
19, 2010
@
8:40 am
|
Results
|
Normal range
|
Interpretation
|
Hematocrit
|
33.3
|
32%-42%
|
Normal
|
Platelet count
|
180,000
|
150,000-400,000
mm3
|
Normal
|
Valencia
Sanitarium & Hospital
Feb.
17, 2010
|
Results
|
Normal range
|
Interpretation
|
Urinalysis
|
|
|
|
Color
|
light yellow
|
Straw to dark
yellow
|
Color change-
due to drugs, diet or disease
|
Transparency
|
clear
|
|
Normal
|
pH
|
6.5
|
4.6-6.5
|
normal
|
Specific Gravity
|
1.005
|
Newborn:
1-1.02
Infants:
1.002-1.006
Adults:
1.016-1.022
|
decreased
|
Albumin
|
negative
|
30-50 g/
|
|
Glucose
|
negative
|
Negative
|
normal
|
Pus cells
|
1-4
|
|
|
Epithelial cells
|
few
|
Small
amounts
|
Excessive –
renal disease
|
Bacteria
|
few
|
None
|
If present-
GUT infection/contamination of external genitalia
|
References:
Fishbach (2004) Manual of Laboratory
and Diagnostic test, p. 72-73
Cherbecky (1997) Laboratory test and Diagnostic
Procedures 2nd ed. p. 592
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