Case Study On Typhoid Fever

FATHER SATURNINO URIOS
UNIVERSITY
NURSING PROGRAM
Butuan City
An Individual Case Study
On
TYPHOID
FEVER
Bondoc, James Aurelle S.

Student Nurse
Ms. Edgracia Airrane A. Vega, RN

Supervising Clinical Instructor
Introduction
Typhoid fever , otherwise known as enteric fever, is an acute illness associated with
fever caused by the Salmonella typhi bacteria. S. typhosa is a short, plump, gram negative rod
that is flagellated and actively motile. Contaminated food or water is the common medium of
contagion.
The disease follows four stages. The first stage is known as incubation period, usually 10-
14 days in occurrence. In this stage generalization of the infection occurs. In the second stage,
aggregation of the macrophages and edema in focal areas indicates bacterial localization
(embolization) and resultant toxic injury which disappear after few days. The third stage of
disease is dominated by effects of local bacterial injury especially in the intestinal tract,
mesenteric lymph nodes, spleen, and liver. The fourth stage, or the stage of lysis, is the stage
wherein the infectious process is gradually overcome. Symptoms slowly disappear and the
temperature gradually returns to normal.
The symptoms of typhoid fever include high fever, chills, cough, muscle pain, weakness,
stomach pain, headache and a rash made up of flat, rose-colored spots. Diarrhea is a less
common symptom of a typhoid fever, although it is a gastrointestinal disease. Sometimes there
are mental changes, know as ‘typhoid psychosis’. A characteristic feature of typhoid psychosis
is plucking at the bedclothes if patient is confined to bed.
Risk factors for acquiring typhoid fever likely include improper food handling, eating
food from outside sources like carinderia, drinking contaminated water, poor sanitation and even
poor hygiene practices. War and natural disasters as well as weak, non existent of health care
infrastructure may also contribute. Both genders do have equal chances on acquiring such
disease. Asian, African and Americans are at greatest risks of acquiring the disease since
geographical locations play a part.
Complications of typhoid fever are secondary conditions, symptoms, or other disorders

that are caused by typhoid fever. Complications include overwhelming infection, pneumonia,
intestinal bleeding, and intestinal perforation may eventually lead to death.
Typhoid fever is one of the most protean of all bacterial diseases thus laboratory
procedures are usually depended on to confirm or disprove suspicion of such disease. The place
of blood culture, serologic studies and bacteriologic examination feces and urine are useful in
establishing the diagnosis. Agglutination (Widal) for typhoid fever is done to determine antibody
response against different antigenic fractions of organisms.
Typhoid fever is treated with antibiotics which kill the Salmonella bacteria. Several
antibiotics are effective for the treatment of typhoid fever. The choice of antibiotics needs to be
guided by identifying the geographic region where the organism was acquired and the results of
cultures once available. Two new vaccines are currently licensed and widely used worldwide, a
subunit (Vi PS) vaccine administered by the intramuscular route and a live attenuated S typhi
strain (Ty21a) for oral immunization.
In most cases, typhoid fever is managed at home with antibiotics and bed rest. For
hospitalized patients, effective antibiotics, good nursing care, adequate nutrition, careful attention
to fluid and electrolyte balance, and prompt recognition and treatment of complications are
strategies to avert the possibility of death.
I choose this topic since it catches my interest from the time being I was able to handle
patient having typhoid fever. It gives me the motivation to look for the things that governs such
disease. Typhoid fever as my case study allows me to find for ways to contribute something for
the alleviation of the condition of its victims may it be in my own little ways perhaps. May this
case study of mine serves as advent to understand more fully the existence of such disease and
the proper interventions needed to be rendered upon to address such condition looking to a new
perspective of life.
Nursing health history is the first part and one of the most significant aspects in case
studies. It is a systematic collection of subjective and objective data, ordering and step-by-
step process inculcating detailed information in determining client’s history, health status,
and functional status and coping pattern. These vital informations provide a conceptual
baseline data utilized in developing nursing diagnosis, subsequent plans for individualized
care and for the nursing process application as a whole. It is needed for solving and
determining a client’s problem and for the nurse to know what interventions to be applied
and rendered upon and what may be the cause of the illness. It aims to determine the
biographic data of the client, chief complaint history of present illness, social data
psychological data, lifestyle patterns and se of health care systems among others
It was the 19th day of April, 2010 when our group was first exposed to the world of
pediatric nursing. Under the supervision of Ms. Edgracia Airrane A. Vega, RN, all of us
practiced our skills by applying the concepts we learned from school. Then we were told by
our C.I to make an individual case study regarding on the cases of the children we were able
to care with. I was able to care patient with typhoid fever last April 20, 2010. So I chose to
work on the case of typhoid fever after obtaining the permission of the patient as well to her
significant others
For the purpose of confidentiality and respect to the identity of my patient, I decided to
withhold her real identity and decided to address her as Patient R. We will also address her
mother as Mother A, grandmother as Grandmother B and aunt as Aunt C.
Patient R is a native of Agusan and true Filipino in blood. She first saw the light last
October 11, 1995. She is fourteen years old at present and an Iglesia ni Cristo in faith.
Prenatal History
The pregnancy of Patient R was expected by the couple. “Wala man ko nasakit adtong
nagbuntis ko niya” as verbalized by Mother A when asked about any history illnesses during
pregnancy. According to her, she took iron supplements such as Ferrous Sulfate during the
course of pregnancy as prescribed to her. She also had her regular check up to the barangay
health center and vaccinated with tetanus toxoids respectively.
Mother A gave birth to 7 lbs baby girl on the 11th day of October, 1995 through
Normal Spontaneous Vaginal Delivery at Agusan del Norte Provincial Hospital, Libertad,
Butuan City. According to Mother A, the labor took for three days and the length of
hospitalization was also three days. She was then breastfed hours after birth. Breastfeeding
continued up to 6 months of life of Patient R.
“Kumpleto jud na siya ug bakuna” as verbalized by Mother A when asked about

immunization status of the patient.
Developmental Milestones
Between the 1st and 2nd months, client M can already flex her elbows.
She was about 3 months old when the first smile was noted by Mother A.
On the 4th month of life, she can lift upper part of he body while in prone position.
She was about 5 to 6 months old when client M can already rest weight on her forearm
when in prone position. She can also turn from front to back. “Sige man to siya ug hilak basta
magligid- ligid siya” as verbalized by Mother A. Her first tooth erupted at the age of 6 months.
It was between the 7th and 8th month when Patient R can already crawl as what being
mentioned by Mother A.
Between the 9th to 11th months, client M can sit momentarily but with support from her
mother. “Mohilak gale siya kung kugoson sa uban” as verbalized by Mother A. when asked bout
the client’s reaction if held by others.
At the age of 1, Patient R can already walk but with support. She was 1 year and 2
months old where she can already walk without support. She was then toilet trained at the age of
2. She was able to dress herself at the age of seven.
Family History of Illness
Patient R is the 2nd child among the 5 siblings. Brother D , the eldest, is 17 years of age
and currently working as a miner. “Okey ra man to siya, wala man to siya’y balatian” as
verbalized by Mother A. Brother E, the 3rd sibling, is 13 years of age. According to Mother A, he
is in good health condition. . Sister F, the fourth sibling, is 7 years of age at present. According to
Mother A, she is in good health condition at present and she didn’t have any health problems.
Brother G is 4 years old and still in good health condition at present. “Kanang hypertension man
ang problema o sakit sa amo kaliwat” as verbalized by Mother A. “Wala man ko’y nahibaw an
nga sakit sa side sa akong bana” as verbalized by Mother A when asked about any health
problems from the family.
Social Data
According to Mother A, the family relationships they have are strong and stable. She
seldom quarrels with her husband. Mother A ensures that all her children are on the right track as
much a possible. “Wala jud ko nagkulang ug pahinumdum ug hatag tambag sa akong mga anak”
as verbalized by Mother A. Being an Iglesia ni Cristo in faith, the family goes to church every
Thursday and Sunday. Patient R graduated at Guiasan Elementary School during her elementary
years at the year 2007. “Dili man ko apil sa honor roll sa among klase sa elementary ko maski
karon sa high school” as verbalized by Patient R when asked about her academic achievements.
She is presently enrolled at Pipisan Maug National High School at Tagum City. “Simple ra man
among kinabuhi, kanang okey ra ang kadak on sa sa among panimalay para sa among pamilya”
as verbalized by Patient R when asked about their way of living or present economic status.
According to Mother A, her income along with his husband’s income is just enough to sustain
the family’s basic needs.
Lifestyle
“Hilig ra man na siya ug dula- dula uban iya mga amigodidot sa Davao”, as verbalized
by Aunt C when asked about play activities of the patient. Patient R is socially interactive in
nature as observed. Pertaining to diet preference, Patient R is fun of eating fruits, vegetables and
loves eating ‘kinilaw’. “Na hilig jud na siya ug kaon kinilaw”,as verbalized by Mother A. When
it comes sleep/rest patterns of the patient, Patient R verbalized that “Matulog ko ug 9 sa gabie ug
mumata dayon ko ug 6 sa buntag..Mao na ako naandan. Dili kayo ko tigtulog ug hapon.” When it
comes to her recreational activities, she added “Laag lag kauban sa akong mga amigo ug apil ug
mga activities sa among lugar”.
Past Health History
When talking about childhood illnesses, Patient R only experienced common cough and
colds. She also experienced mumps and chicken pox. “Wala man na siya niagi ug grabe nga
sakit. Bale first time niya mahospital karon”, as verbalized by Grandmother B. When Patient R
was asked about allergies, she verbalized that, “Wala man ko’y mga allergy, maski unsa gale
akong imnon ug kaonon”. There were no also reported accidents and injuries wherein she has
been subjected to. “Vitamins ra man iya ginatumar sukad sauna ra”, as verbalized by Mother A
when asked about medications taken by Patient R from the past years up to the present.
History of Present Illness
Naghilanat man ko adtong nagbakasyon ko sa Magallanes” as verbalized by Patient R.

She experienced fever and chils for about 9 days which started last April 12, 2010. According to
Aunt C, she observed that Patient R would complain of headache, lethargy, fatigue, body
weakness and pain”. Pateint R also experienced diarrhea. “Ako nahinumduman , nagkaon man
me adto ug kinilaw kadtong naa pa ko sa Davao mao kadtong pag anhi nako sa Magallanes
nagsugod na dayon akong hilanat ug apil takig” she verbalized. She was then brought to Agusan
del Norte Provincial Hospital last April 20, 2010. She got admitted that day around 12:40 in the
afternoon under the management of Dr. Bungabong. She was admitted at ARI( Acute
Respiratory Infection) Ward .
It was on the 20th day of April, 2010, wherein our group had our duty at the Pediatric
Ward of Agusan del Norte Provincial Hospital. On the same day, Patient R was admitted to the
said hospital. Her admitting impression was to consider typhoid fever basing form the chief
complaint of fever associated with chills. Her temperature upon admission was 38.8 C and
weight of 40.5 kgs.
At 1:00 pm, Dr Bungabong made the following orders:
.> TPR q4h

> DAT except dark colored foods
> IVF PNSS 1L @ 30 gtts/min
> IVF TF PLR 1L @ 20 gtts/min
> Paracetamol 500mg 1 tab P.O now, then q4h PRN for fever
> Chloramphenicol 500mg 1 tab P.O now q6h
> CBC with platelet count
> UA/ SE
> Widal test, BSM
Patient R was received on bed on left side lying position; awake and coherent with IVF
# 1 PNSS 1L@ the level of 900 cc, regulated at 30 gtts/min hooked @ right metacarpal vein,
infusing well around 4:10 in the afternoon.
Patient R was observed grimacing, diaphoretic and self-focusing. Initial vital signs were
taken and recorded as follows:
T: 37.5oC RR: 24 bpm PR: 97 bpm BP: 90/70 mmHg
“Ngutngot akong kamot ganiha ra ni siya human gisuksukan… Mga 5 kung

sukdon.”Patient R verbalized when asked about discomfort felt upon admission. With the cues
noted, a nursing care plan was formulated with a nursing diagnosis of Acute Pain related to
presence of traumatized tissue from IV insertion. Independent interventions were rendered to
address such problem like changing bed positions, positioning patient’s affected arm,
emphasizing to client not to use affected arm unnecessarily. Around 6:00 pm, widal and CBC
results was brought to the station. I referred the laboratory results to Dr. Bungabong. There were
no doctor’s orders being carried out.
Around 9:30 in the evening, patient R was observed weak. Upon assessment, her skin
was warm to touch, flushed skin and is not diaphoretic. Mucous membrane was dry and lips were
cracked and dried. Vital signs were taken and recorded as follows:
“Init napud balik akong paminaw” patient R verbalized. With the cues, another problem
was identified with a diagnosis of hyperthermia related to underlying disease process.
Independent interventions were being rendered like initiating tepid sponge bath, encouraging
adequate fluid intake and promoting surface cooling by means of removing some body covers
from the patient’s body.
On the second day of duty, Dr. Amoroso made the following orders around 8:30 in the
morning as follows:
➢ Cotrimoxazole 800 mg 1 tab P.O BID
➢ Paracetamol 500 mg 1 tab RTC
➢ Continue chloramphenicol P.O
➢ Ascorbic acid 500 mg 1 tab P.O OD
Around 4:10 in the afternoon, I received patient R lying on bed on supine position, awake
and coherent with IVF #2 PLR 1 liter at the level of 400 cc; regulated at 20 gtts/min hooked at
the right metacarpal vein; infusing well. Vital signs were taken and recorded as follows:
“Wala pa ko kalibang gikan adtong gi-admit ko”as verbalized by patient R. patient R was
observed with dry skin, absence of sweating and claimed having positive flatus that day. She also
needs assistance upon getting up/out in bed. Patient R refused to get up on bed and slowed
movement noted.
With the cues gathered, a problem was identified with a diagnosis of “Risk for
Constipation related to insufficient physical activity. Independent nursing interventions were
rendered to address the said problem like encouraging intake of balanced fiber and bulk in diet
such as fruits, vegetables and whole grain; emphasizing DAT except for dark colored foods and
encouraging activity/exercise within limits of individual activity.
Due oral medications were given in due timing. Around 9:30 in the evening, above IVF
#2 was terminated and followed up with IVF #3 D5NM 1 liter regulated at 20 gtts/min as
ordered. At 10:00 pm, patient R verbalized that “init napud balik akong paminaw… arang
inita.”As observed, patient R’s skin was warm to touch, flushed skin, dry lips, not diaphoretic,
poor skin turgor and slowed movement were observed. Vital signs were taken and recorded as
follows:
T: 38oC RR: 29 bpm PR: 91 bpm BP: 90/70 mmHg
Another problem was identified with a diagnosis of Hyperthermia related to underlying

disease process was formulated. Interventions were rendered to the patient to address the
problem.
On April 22, 2010, around 4:20 in the afternoon, I received patient lying flat on bed with
IVF #3 D5NM 1 liter regulated at 20 gtts/min hooked at the right metacarpal vein at level of 50
cc which was temporarily stopped from the time being. Vital signs were taken and recorded as
follows:
Upon interaction, patient R was noted with slowed movement, body weakness and
yawning. Poor skin turgor was observed and dry skin is noted. She needed assistance upon
getting up in bed. When I asked patient to perform range of motion exercises and to walk upon
the hospital’s vicinity, she refused to do so while saying “kapoy ibakod.”
With the gathered cues, a problem was identified with a diagnosis of Impaired Physical
Mobility related to reluctance to initiate movement. Interventions were rendered to address the
said problem like positioning patient on bed comfortably, explaining importance of ambulation
to avoid possible skin breakdown and encouraging patient to have adequate rest periods every
activity performance.
Around 5:30 in the afternoon, Dr. Amoroso made the following order:
➢ D5NM 1 liter at same rate
Around 6:10 in the evening, above IVF #3 was consumed and followed up with IVF #4
D5NM 1 liter regulated at 20 gtts/min. IVF was regulated properly and frequently checked.
At 10:00 pm, patient R experienced flushed skin and drying of lips. Her skin was warm to
touch. Poor skin turgor in noted. Dry mucous membrane was observed along with slowed
movement. “Nag-init na pud balik akong pamati,”as verbalized by patient R. Hyperthermia
related to underlying disease process was identified.
On April 23, 2010, Dr. Amoroso made the following orders at around 8:00 in the
morning:
➢ TWC
➢ Continue all oral meds
➢ For billing
➢ DAT
Around 4:00 in the afternoon, patient R was received lying supine on bed, awake and
coherent; with IVF #4 D5NM 1 liter regulated at 20 gtts/min hooked at right metacarpal vein at
the level of 100 cc; infusing well. Vital signs were taken and recorded as follows:
T: 37oC RR: 28 bpm PR: 81 bpm BP: 90/60 mmHg
Upon interaction with the patient, she verbalized that “Gusto nako diretso akong tulog
inig gabie bahala ug igang ug saba.”As observed, patient R was frequently yawning. Body
weakness, slowed movement and reaction were noted.
A nursing problem was identified basing from the cues gathered. Nursing care plan was
made with a diagnosis of Readiness for Enhanced Sleep. Interventions and health teachings were
given to address such problem like recommending patient to limit intake of chocolate and
caffeine or alcoholic beverages prior to sleep, instructing significant others to ensure quiet
environment and instructing client to limit/avoid afternoon naps as possible.
Around 6 in the evening, above IVF was consumed and terminated as ordered aseptically.
Due oral medications were given and IVF was regularly checked and regulated.
On April 24, 2010, around 8:00 in the morning, Dr. Bungabong made the following
orders:
➢ Re-insert IVF D5LR 1L at 20 gtts/min
➢ Hold chloramphenicol P.O
➢ Continue cotrimoxazole
➢ DAT
No interaction was made since our group was having activities such as NCP conference,
annotated reading reporting and quiz respectively at the conference hall.
On April 25, 2010, around 8 o’clock in the morning, Dr. Bungabong made the following
order:
➢ D5NM 1 liter at same rate
In our second week of duty, we had our morning shift. Around 8 o’clock in the morning,
Dr, Bungabong made the following order:
➢ MGH w/ chloramphenicol P.O meds to continue at home
At 8:30 in the morning, Patient R was received lying on bed on supine position, awake and
coherent with IVF #6 D5NM regulated at 20 gtts/min hooked at the left metacarpal vein at the
level of 600 cc; infusing well. Vital signs were taken and recorded as follows:
Patient R was seen calm and interactive upon interaction. No problems were being
identified. As instructed, discharge plan was written and instructed to patient and to the
significant others. Significant other (grandmother) was instructed to process papers.
On April 27, 2010, patient R was received around 8:20 in the morning; sitting on chair
without IVF. Vital signs were taken and recorded as follows:
No doctor’s orders were made. Patient was seen walking in the vicinity together with her
grandmother. At 2:00 pm, patient R was discharged with home medications. The total length of
stay in the hospital was 7 days.
PHYSICAL ASSESSMENT
Physical examination follows a methodical head to toe format in the cephalocaudal

assessment. This is done systematically using the techniques of inspection, palpation, percussion
and auscultation with the use of materials and investments such as the penlight, thermometer,
sphygmomanometer, tape measure and stethoscope and also the senses. During the procedure, I
made every effort to recognize and respect the patient’s feelings as well as to provide comfort
measures and follow appropriate safety precautions.
Physical assessment is a systematic, comprehensive, continuous collection, validation and
communication of the patient’s data using a variety of methods. The purposes of the physical
assessment are as follows:
-to collect data and establish a need for continued physical assessment;
-to ascertain patient’s level of health condition and physiological functioning;
-to identify factors facing the patient at risk; and
-to determine the areas of preventive nursing.
The physical assessment of Patient R was done last April 21, 2010 at ARI ( Acute
Respiratory Infection) Ward of Agusan del Norte Provincial Hospital around 6 ‘clock in the
evening. The student nurses used the cepholocaudal approach in assessing the patient. The
student brought with him bp apparatus, temperature, stethoscope, wristwatch, ballpen, and
notebook
General Survey:
Patient R was lying on bed; awake and coherent, with D5NM 1L hooked @ right
metacarpal vein, regulated @ 20 gtts/ min @ the level of 400 cc; infusing well. She stands 5 feet
and 2 inches in tall and weighs 40.5 kgs with limited body movements noted.
Vital Signs:
TEMPERATURE: 36. 5 C
HEART RATE: 81 beats/ min
RESPIRATORY RATE: 24 breaths/ min
BP: 90/60 mmHg
Skin:
The skin was brown in color. Muscle tone present. Few abrasions are noted but
nevertheless, the skin was dry. Skin goes back slowly in less than 2 seconds when pinched back.
Head:
The head circumference measures 50 cm, round in shape. The scalp is free from
inflammation and is lighter in color of that of the complexion of the skin. Hair is long, thick
and coarse, straight and evenly distributed. Scalp is smooth and white in color,
minimal lesions
were noted. Dandruff and lice were not seen.
Ears:
Ears were symmetrical, free of abrasions. Color was good, same with the rest of the body
with no pale manifestations. Minimal cerumen noted at both ears. Patient can hear
normally when spoken softly
Eyes:
Eyes are rounded in shape. Inspection of conjunctiva was done by pulling the lower
eyelid slightly down with the finger tip and are pink in color. Eyebrows and eyelashes are evenly
distributed. The scleras of both eyes were clear, equally round and reactive to light
accommodation. The eyes involuntarily blink.
Nose:
With narrow nose bridge, there were no discharges noted upon inspection.
No swelling of the mucous membrane and presence of nasal hairs were seen. No
discharges or flaring noted.
Lips:
Lips are dry but with no pale manifestations. Cracking of lips noted.
Mouth:
She has a complete set of teeth with minimal dental caries noted. Oral
mucosa and gingival are pink in color, moist and there were no lesions nor
inflammation noted. Tongue is pinkish and is free of swelling and lesions. Lips
are symmetrical, appears pale without bits noted upon observation.
Neck
Lymph nodes noted. Neck has strength that allows movement back and
forth, left and right. Patient is able to freely move her neck.
Chest:
Chest circumference measures 43 cm. Color is brown, the same with the rest of the body.
Breasts are symmetrical and rounded in shape. No inflammation or deformities noted.
Lungs and Thoracic Region

No reports of pain during the inhalation and exhalation. Absence of
adventitious sounds upon auscultation noted . Respiratory rate 24 breathes per
minute from the normal range of 20-40 breaths per minute
Heart
Patient R has an audible heart sound. PMI is heard between 4th - 5th
intercostals space upon ausculation. Heart is pumping well with a pulse rate of
81 bpm from the normal rate of 60-100 beats per minute.
Abdomen:
Abdomen is rounded in shape while in sitting position and flat when in supine position.
The rest of the abdomen is of the same color and with no abrasions. Bowel sounds re hears at 15
bowel sounds per minute upon auscultation. Upon palpation, no distention noted.
Back:
No inflammations and lesions observed. No abrasions are noted.
Upper Extremities:
Both hands can be flexed and moved freely. Fingers are symmetrical with no abrasions.
Nails are not trimmed, manifested with dirt.
Skin: Brown in color; no presence of marks/scars of wounds in the arms, neck
and legs. Skin was dry. Skin goes back slowly in less than 2 seconds when pinched back
Hands: Medium in size with 5 fingernails in each side. Nails are short, small
dusty particles are present.
Arms: Able to move through active ROM. Able to extend arms in front or push
them out to the side
Lower Extremities:
Ten fingers are present. Toes are symmetrical, nails are not trimmed. No deformities
and inflammation noted upon inspection. Both feet can be flexed and moved freely. Fingers are
symmetrical with no abrasions.
Bowel and Urine Excretion:

Genitals were not assessed due to patient’s refusal. Patient is able to urinate twice and not
defecated since day of admission.
Neurologic Status:
Behavior – Patient is silent but is conscious and coherent upon interaction. She
sits and walks if she wants to. She has good eye contact upon interaction and is
able to follow simple instructions. She speaks clearly in a soft, moderate voice.
Motor Functioning – Patient R is able to move extremities through active

ROM. She is able to extend arms front and resist active as pushed down/up on
his hands.
Reflexes - Reflexes were present such as the blinking reflex and deep tendon
reflex. Swallowing reflex is evident when patient was asked to drink a glass of
water.
Sensory Functioning – Patient’s sensory system is intact, she was able to

distinguish touch, pain, hot and cold. She was able to read letter ‘E’ when
positioned 10 feet away.
Anatomy and Physiology
Gastrointestinal system
To aid in understanding the disease process, Anatomy and Physiology provides the
necessary information about the normal function of certain body components, its structure and
function. Anatomy and physiology are always related. Anatomy is the study of the structure and
shape of the body and body parts and their relationships to one another. Physiology is the study
of how the body pars work or function.
The gastrointestinal tract (GIT) consists of a hollow muscular tube starting from the oral
cavity, where food enters the mouth, continuing through the pharynx, oesophagus, stomach and
intestines to the rectum and anus, where food is expelled. There are various accessory organs that
assist the tract by secreting enzymes to help break down food into its component nutrients. Thus
the salivary glands, liver, pancreas and gall bladder have important functions in the digestive
system. Food is propelled along the length of the GIT by peristaltic movements of the muscular
walls.
The primary purpose of the gastrointestinal tract is to break down food into nutrients, which can
be absorbed into the body to provide energy. First food must be ingested into the mouth to be
mechanically processed and moistened. Secondly, digestion occurs mainly in the stomach and
small intestine where proteins, fats and carbohydrates are chemically broken down into their
basic building blocks. Smaller molecules are then absorbed across the epithelium of the small
intestine and subsequently enter the circulation. The large intestine plays a key role in
reabsorbing excess water. Finally, undigested material and secreted waste products are excreted
from the body via defecation (passing of faeces). In the case of gastrointestinal disease or
disorders, these functions of the gastrointestinal tract are not achieved successfully. Patients may
develop symptoms of nausea, vomiting, diarrhoea, malabsorption, constipation or obstruction.
Gastrointestinal problems are very common and most people will have experienced some of the
above symptoms several times throughout their lives.
Basic structure
The gastrointestinal tract is a muscular tube lined by a special layer of cells, called epithelium.
The contents of the tube are considered external to the body and are in continuity with the
outside world at the mouth and the anus. Although each section of the tract has specialised
functions, the entire tract has a similar basic structure with regional variations.
The wall is divided into four layers as follows:
Mucosa
The innermost layer of the digestive tract has specialised epithelial cells supported by an
underlying connective tissue layer called the lamina propria. The lamina propria contains blood
vessels, nerves, lymphoid tissue and glands that support the mucosa. Depending on its function,
the epithelium may be simple (a single layer) or stratified (multiple layers).
Areas such as the mouth and oesophagus are covered by a stratified squamous (flat) epithelium
so they can survive the wear and tear of passing food. Simple columnar (tall) or glandular
epithelium lines the stomach and intestines to aid secretion and absorption. The inner lining is
constantly shed and replaced, making it one of the most rapidly dividing areas of the body!
Beneath the lamina propria is the muscularis mucosa. This comprises layers of smooth muscle
which can contract to change the shape of the lumen.
Submucosa
The submucosa surrounds the muscularis mucosa and consists of fat, fibrous connective tissue
and larger vessels and nerves. At its outer margin there is a specialized nerve plexus called the
submucosal plexus or Meissner plexus. This supplies the mucosa and submucosa.
Muscularis externa
This smooth muscle layer has inner circular and outer longitudinal layers of muscle fibres
separated by the myenteric plexus or Auerbach plexus. Neural innervations control the
contraction of these muscles and hence the mechanical breakdown and peristalsis of the food
within the lumen.
Serosa/mesentery
The outer layer of the GIT is formed by fat and another layer of epithelial cells called
mesothelium.
Individual components of the gastrointestinal system
Oral cavity
The oral cavity or mouth is responsible for the intake of food. It is lined by a stratified squamous
oral mucosa with keratin covering those areas subject to significant abrasion, such as the tongue,
hard palate and roof of the mouth. Mastication refers to the mechanical breakdown of food by
chewing and chopping actions of the teeth. The tongue, a strong muscular organ, manipulates the
food bolus to come in contact with the teeth. It is also the sensing organ of the mouth for touch,
temperature and taste using its specialised sensors known as papillae.
Insalivation refers to the mixing of the oral cavity contents with salivary gland secretions. The
mucin (a glycoprotein) in saliva acts as a lubricant. The oral cavity also plays a limited role in
the digestion of carbohydrates. The enzyme serum amylase, a component of saliva, starts the
process of digestion of complex carbohydrates. The final function of the oral cavity is absorption
of small molecules such as glucose and water, across the mucosa. From the mouth, food passes
through the pharynx and oesophagus via the action of swallowing.
Salivary glands
Three pairs of salivary glands communicate with the oral cavity. Each is a complex gland with
numerous acini lined by secretory epithelium. The acini secrete their contents into specialised
ducts. Each gland is divided into smaller segments called lobes. Salivation occurs in response to
the taste, smell or even appearance of food. This occurs due to nerve signals that tell the salivary
glands to secrete saliva to prepare and moisten the mouth. Each pair of salivary glands secretes
saliva with slightly different compositions.
Parotids
The parotid glands are large, irregular shaped glands located under the skin on the side of the
face. They secrete 25% of saliva. They are situated below the zygomatic arch (cheekbone) and
cover part of the mandible (lower jaw bone). An enlarged parotid gland can be easier felt when
one clenches their teeth. The parotids produce a watery secretion which is also rich in proteins.
Immunoglobins are secreted help to fight microorganisms and a-amylase proteins start to break
down complex carbohydrates.
Submandibular
The submandibular glands secrete 70% of the saliva in the mouth. They are found in the floor of
the mouth, in a groove along the inner surface of the mandible. These glands produce a more
viscid (thick) secretion, rich in mucin and with a smaller amount of protein. Mucin is a
glycoprotein that acts as a lubricant.
Sublingual
The sublinguals are the smallest salivary glands, covered by a thin layer of tissue at the floor of
the mouth. They produce approximately 5% of the saliva and their secretions are very sticky due
to the large concentration of mucin. The main functions are to provide buffers and lubrication.
Oesophagus
The oesophagus is a muscular tube of approximately 25cm in length and 2cm in diameter. It
extends from the pharynx to the stomach after passing through an opening in the diaphragm. The
wall of the oesophagus is made up of inner circular and outer longitudinal layers of muscle that
are supplied by the oesophageal nerve plexus. This nerve plexus surrounds the lower portion of
the oesophagus. The oesophagus functions primarily as a transport medium between
compartments.
Stomach
The stomach is a J shaped expanded bag, located just left of the midline between the oesophagus
and small intestine. It is divided into four main regions and has two borders called the greater
and lesser curvatures. The first section is the cardia which surrounds the cardial orifice where the
oesophagus enters the stomach. The fundus is the superior, dilated portion of the stomach that
has contact with the left dome of the diaphragm. The body is the largest section between the
fundus and the curved portion of the J.
This is where most gastric glands are located and where most mixing of the food occurs. Finally
the pylorus is the curved base of the stomach. Gastric contents are expelled into the proximal
duodenum via the pyloric sphincter. The inner surface of the stomach is contracted into
numerous longitudinal folds called rugae. These allow the stomach to stretch and expand when
food enters. The stomach can hold up to 1.5 litres of material. The functions of the stomach
include:
1. The short-term storage of ingested food.
2. Mechanical breakdown of food by churning and mixing motions.
3. Chemical digestion of proteins by acids and enzymes.
4. Stomach acid kills bugs and germs.
5. Some absorption of substances such as alcohol.
Most of these functions are achieved by the secretion of stomach juices by gastric glands in the
body and fundus. Some cells are responsible for secreting acid and others secrete enzymes to
break down proteins.
Small intestine
The small intestine is composed of the duodenum, jejunum, and ileum. It averages approximately
6m in length, extending from the pyloric sphincter of the stomach to the ileo-caecal valve
separating the ileum from the caecum. The small intestine is compressed into numerous folds
and occupies a large proportion of the abdominal cavity.
The duodenum is the proximal C-shaped section that curves around the head of the pancreas. The
duodenum serves a mixing function as it combines digestive secretions from the pancreas and
liver with the contents expelled from the stomach. The start of the jejunum is marked by a sharp
bend, the duodenojejunal flexure. It is in the jejunum where the majority of digestion and
absorption occurs. The final portion, the ileum, is the longest segment and empties into the
caecum at the ileocaecal junction.
The small intestine performs the majority of digestion and absorption of nutrients. Partly
digested food from the stomach is further broken down by enzymes from the pancreas and bile
salts from the liver and gallbladder. These secretions enter the duodenum at the Ampulla of
Vater. After further digestion, food constituents such as proteins, fats, and carbohydrates are
broken down to small building blocks and absorbed into the body's blood stream.
The lining of the small intestine is made up of numerous permanent folds called plicae circulares.
Each plica has numerous villi (folds of mucosa) and each villus is covered by epithelium with
projecting microvilli (brush border). This increases the surface area for absorption by a factor of
several hundred. The mucosa of the small intestine contains several specialised cells. Some are
responsible for absorption, whilst others secrete digestive enzymes and mucous to protect the
intestinal lining from digestive actions.
Large intestine
The large intestine is horse-shoe shaped and extends around the small intestine like a frame. It
consists of the appendix, caecum, ascending, transverse, descending and sigmoid colon, and the
rectum. It has a length of approximately 1.5m and a width of 7.5cm.
The caecum is the expanded pouch that receives material from the ileum and starts to compress
food products into faecal material. Food then travels along the colon. The wall of the colon is
made up of several pouches (haustra) that are held under tension by three thick bands of muscle
(taenia coli).
The rectum is the final 15cm of the large intestine. It expands to hold faecal matter before it
passes through the anorectal canal to the anus. Thick bands of muscle, known as sphincters,
control the passage of faeces.
The mucosa of the large intestine lacks villi seen in the small intestine. The mucosal surface is
flat with several deep intestinal glands. Numerous goblet cells line the glands that secrete
mucous to lubricate faecal matter as it solidifies. The functions of the large intestine can be
summarised as:
1. The accumulation of unabsorbed material to form faeces.
2. Some digestion by bacteria. The bacteria are responsible for the formation of intestinal
gas.
3. Reabsorption of water, salts, sugar and vitamins.
Liver
The liver is a large, reddish-brown organ situated in the right upper quadrant of the abdomen. It
is surrounded by a strong capsule and divided into four lobes namely the right, left, caudate and
quadrate lobes. The liver has several important functions. It acts as a mechanical filter by
filtering blood that travels from the intestinal system. It detoxifies several metabolites including
the breakdown of bilirubin and oestrogen. In addition, the liver has synthetic functions,
producing albumin and blood clotting factors. However, its main roles in digestion are in the
production of bile and metabolism of nutrients. All nutrients absorbed by the intestines pass
through the liver and are processed before traveling to the rest of the body. The bile produced by
cells of the liver, enters the intestines at the duodenum. Here, bile salts break down lipids into
smaller particles so there is a greater surface area for digestive enzymes to act.
Gall bladder
The gallbladder is a hollow, pear shaped organ that sits in a depression on the posterior surface
of the liver's right lobe. It consists of a fundus, body and neck. It empties via the cystic duct into
the biliary duct system. The main functions of the gall bladder are storage and concentration of
bile. Bile is a thick fluid that contains enzymes to help dissolve fat in the intestines. Bile is
produced by the liver but stored in the gallbladder until it is needed. Bile is released from the gall
bladder by contraction of its muscular walls in response to hormone signals from the duodenum
in the presence of food.
Pancreas
Finally, the pancreas is a lobular, pinkish-grey organ that lies behind the stomach. Its head
communicates with the duodenum and its tail extends to the spleen. The organ is approximately
15cm in length with a long, slender body connecting the head and tail segments. The pancreas
has both exocrine and endocrine functions. Endocrine refers to production of hormones which
occurs in the Islets of Langerhans. The Islets produce insulin, glucagon and other substances and
these are the areas damaged in diabetes mellitus. The exocrine (secretrory) portion makes up 80-
85% of the pancreas and is the area relevant to the gastrointestinal tract.
It is made up of numerous acini (small glands) that secrete contents into ducts which eventually
lead to the duodenum. The pancreas secretes fluid rich in carbohydrates and inactive enzymes.
Secretion is triggered by the hormones released by the duodenum in the presence of food.
Pancreatic enzymes include carbohydrases, lipases, nucleases and proteolytic enzymes that can
break down different components of food. These are secreted in an inactive form to prevent
digestion of the pancreas itself. The enzymes become active once they reach the duodenum.
LABORATORY RESULTS
Name of Test Ordering Physician Date Ordered Date Done

Serology Dr. Bungabong April 20, 2010 April 20, 2010
( Widal Test)
Complete Blood Dr. Bungabong April 20, 2010 April 20, 2010
Count
Urinalysis Dr. Bungabong April 20, 2010 April 21, 2010
Fecalysis Dr. Bungabong April 20, 2010 April 22, 2010
Serology
Date Ordered: April 20, 2010
O H AH BH
1:20 HT3 HT3 H2 H2
1:40 H2 H2 +1 +1
1:80 +1 +1 Trace Trace
1:160 Trace Trace neg neg
1:320 neg neg neg neg
Hematology Complete Blood Count

Test Definition Result Reference Interpretation Clinical
Range significance
Hemoglobin It is the main 10.1 (11-16 g/dl) Decreased Decreased level
component of red denotes for
blood cells. Its hemorrhage,
main function is anemia or
to carry oxygen hemodilution (
from the lungs to overhydartion).
the body tissues
and to transport
Carbon Dioxide,
the product of
cellular
metabolism, back
to the lungs.
Hematocrit It is the 27% (36-46%) Decreased Decreased level
measurement of may account for
the percentage of anemia, acute
red blood cells in blood loss or
the total volume hemodilution.
of blood. It is
expressed as the
percentage of red
cells in the total
blood volume.
Leukocytes The total white 6900 (3100-10000) Normal .
(WBC) blood count
(WBC) is the
absolute number
of white blood
cells (leukocytes)
circulating in a
cubic millimeter
of blood.
Platelet Count Also called (205) x 10 ˆ 150-390 Normal
thrombocytes, are g/L
large, non-
nucleated cells
derived from the
megakaryotes
produced in the
bone marrow.
They promote
coagulation.
Differential Count
Test Definition Result Reference Interpretation Clinical

Range significance
Eosinophil They play a role in Not indicated (0.00-0.06)
allergic reactions,
possibly
inactivating
histamine.
Lymphocyte They play a role in 32% (25-35%) Normal
our immune
response.
Basophil They contain Not indicated (0.0-0.1)
histamine and
heparin and appear
to be involved in
immediate
hypersensitivity
reactions.
Monocyte They are the Not indicated (4-6%)
second line of
defense against
bacterial infections
and foreign
substance.
Neutrophils Most numerous 68% (50-70%) Normal
circulating WBC’s
and they respond
more rapidly to the
inflammatory and
tissue injury sites
than other types of
WBCs.
URINALYSIS
Property/Constituents Definition Result Reference Interpretation Clinical

Value significance
Color Yellow Light straw to Normal
dark amber
yellow
Transparency Clear Clear Normal
PH It is the 5.0 4.5-8.0 Normal
hydrogen .
concentration of
the urine. It is a
measurement of
the acid or
alkaline status
of he urine.
Specific Gravity it is the 1.030 1.005-1.030 Normal
measurement of
the
concentration of
urine
Protein Protein found in Negative Qualitative Normal
the urine Analysis
albumin, a > negative
serum protein
that normally Quantitative
does not leak Analysis
into the > 10-100
glomerular mg/24 h
filtrate
Sodium It is the Not 135-1487
principal cation indicated mEq/l
of the
extracelluar
fluids and is the
most important
antelectrolyte
in the
maintenance of
fluid balance in
the body.
Potassium It is one of the Not 3.5-5.5 mEq/l
major indicated
electrolytes in
the body fluid
that is
responsible for
maintaining
life-sustaining
neuromuscular
functioning.
Microscopic Examination of Urinary Sediment
Constituents Definition Result Reference Interpretation Clinical significance

Value
WBC and WBC Casts are formed 1-3/1pf > 4 per lower Decresed Accumulation of
casts within the power field white cells casts
kidney tubules occurs in
from glumerolonephritis,
agglutination of pyelonephritis,and
protein cells, of Rickey
red and white inflammation.
cells of
epithelial cells.
RBC and RBC Casts are formed Not indicated >2/11 pf
casts within the
kidney tubules
from
agglutination of
protein cells, of
red and white
cells of
epithelial cells.
Epithelial Cells Casts are formed Occasional Occasional Normal
within the
kidney tubules
from
agglutination of
protein cells, of
red and white
cells of
epithelial cells.
Fecalysis
Property/constituent Result Reference Value Interpretation Clinical

significance
Consistency Formed Formed Normal

Color Brown Brown Normal
Pus cells
RBC
Fat globules
RESULT: No intestinal parasites/ ova seen
DRUG STUDY
Drug Name Date Ordered Ordering Physician

Chloramphenicol April 20, 2010 Dr. Bungabong
Paracetamol April 20, 2010 Dr. Bungabong
Cotrimoxazole April 21, 2010 Dr. Amoroso

DRUG STUDY NO. 1
Name of Drug: Chloramphenicol
Brand Name: Eticlob
Classification: Anti- Bacterial
Dose and Frequency: 500 mg q6h
Mechanism of Action: Binds to 50s ribosomal subunits which interferes with or inhibits protein
synthesis.
.
Indications: Infections caused by S. typhi
Contraindications: Hypersensitivity, renal disease, severe heapaic disorders, minor infections
Adverse Reactions: Anemia, thrombocytopenia, optic neuritis, nausea, vomiting, diarrhea,

abdominal pain, itching, rashes, headache and depression
Nursing Considerations:
– Alert SO and patient for signs of infection like inflammation, redness, swelling and
presence of pus.
– Assess patient’s infection before and regularly throughout therapy.
– Review patient’s history of allergies.
– Monitor patient for adverse reactions.
– Obtain culture and sensitivity of specimen.
– Monitor renal function, PT and platelet count.
DRUG STUDY NO. 2
Name of Drug: Acetaminophen
Brand Name: Paracetamol
Classification: Non-opioid analgesic, anti-pyretic
Dose and Frequency: 500 mg every 4 hours or PRN
Mechanism of Action: Blocks pain impulses, probably inhibiting prostaglandin or pain receptor
sensitizers. May relieve fever by acting on hypothalamic heat-regulating center.
Indications: Mild pain or fever
Contraindications: Contraindicated to patients hypersensitive to the drugs and use cautiously in

patients with a history of chronic alcohol abuse because hepatotoxicity may occur.
Adverse Reactions:
Hematologic: hemolytic anemia, leukopenia
Hepatic: liver damage, jaundice
Metabolic: hypoglycemia
Skin: rash, urticaria
• Assess patient’s pain and temperature before giving any drugs.
• Assess patient’s drug history and calculate daily dosage accofdingly.
• Be alert for adverse reactions and drug interactions.
• Assess patient and family’s knowledge of drug use.
• Tell patient not to use drug for fever higher than 103 degrees Fahrenheit or
lasts longer than 3 days or recurs.
• Te patient to keep track of daily acetaminophen intake.
DRUG STUDY NO. 3
Name of Drug: Cotrimoxazole
Brand Name: Timizole Forte

Classification: Antibiotic
Dosage/ Frequency: 800 mg, BID
Mechanism of Action: Inhibits susceptible bacteria, including S. typhi
Indications: Urinary Tract Infection
Contraindications: Hypersensitivity to trimethoprim or sulfonamides and severe renal

impairment.
Adverse Reactions: Headache, imsonia, agranulocytosis, muscle weakness, oliguria, anuria,

nausea, vomiting and diarrhea
– Alert SO and patient for signs of infection like inflammation, redness, swelling and
presence of pus.
– Assess patient’s infection before and regularly throughout therapy.
– Review patient’s history of allergies.
– Monitor patient for adverse reactions.
– Obtain culture and sensitivity of specimen.
– Monitor renal function, PT and platelet count.
NURSING CARE PLAN
A nursing care plan outlines the nursing care to be provided to a

patient. It is a set of action the nurse will implement to resolve nursing
problems identified by assessment. The creation of the plan is an
intermediate stage of the nursing process. It guides in the ongoing provision
of nursing care and assists in the evaluation of that care.
Problem list is a means of problem prioritization. The methods used in

prioritizing the identified problems are:
• the date the problem identified
• ABC (Airway, Breathing, Circulation)
• Maslow’s Hierarchy of Needs
Patient’s Name: Patient R

Age: 14 years old
Chief complaint: on and off fever for 9 days associated chills
Problem No. Nursing Problem Date Identified Date Evaluated

1 Acute Pain r/t April 20, 2010 April 20, 2010
presence of
traumatized tissue
resulting from
insertion of IV
2 Hyperthermia r/t April 20, 2010 April 20, 2010
underlying disease
process
3 Risk for Constipation April 21, 2010 April 21, 2010
r/t insufficient
physical activity
underlying disease
process
Impaired Physical April 22, 2010 April 22, 2010
5 Mobility r/t reluctance
to initiate movement
underlying disease
process
7 Readiness for April 23, 2010 April 23, 2010
Enhanced Sleep
Nursing Care Plan No. 1
Problem Identified: Acute Pain

Date Identified: April 20, 2010
Subjective Cues: “Ngutngot akong kamot ganina ra ni siya human gisuksukan. Mga 5 kung
sukdon”
Objective Cues:
➢ Grimacing
➢ Diaphoretic
➢ Self focused
➢ Weak looking
➢ Guarding behavior
➢ With initial v/s taken as follows:
T: 37.5 C P: 97 bpm
R: 24 cpm BP: 90/70 mmHg
Nursing Diagnosis: Acute Pain r/t presence of traumatized tissue resulting from insertion of IV
Planning: Within 6 hours of nursing interventions and giving of health teachings, the patient will
be able to verbalize reduction of felt pain from a scale of 5 to 1.
Interventions:
1. Determine possible pathophysiologic/ psychologic causes of pain.

R: To assess etiology precipitating contributing factors.
2. Observe for non verbal cues.
R. Observations may/ may not be congruent with verbal reports.
3. Accept client’s description of pain.
R: Pain is subjective experience and cannot be felt by others.
4. Encourage verbalization of feelings about pain.
R: To assist client to explore methods to control/ alleviate pain.
5. Encourage us of relaxation techniques such as deep breathing exercises.
R: To assist client to explore methods to control/ alleviate pain
6. Encourage participation in diversional activities like socialization or listening to music.
7. Provide patient with a quiet environment and calm activities.
8. Instruct patient to position affected arm properly.
R: To promote comfort.
9. Instruct patient to not use affected arm unnecessarily.
R: To prevent complications
Collaborative:
10. Administer analgesics as indicated.
R: Inhibits prostaglandin synthesis by decreasing an enzyme needed for biosynthesis.
11. Notify physician for unusualities.
R: For prompt management.
Evaluation:
Goal Met. After 3 hours of nursing interventions, the patient was able to verbalize
reduction of felt pain from a scale of 5 to 1 as evidenced by the verbalization of “ Wala na’y
sakit akong gitusukan nga kamot”.
Date Evaluated: April 2O, 2010
Problem Identified: Hyperthermia

Subjective Cues: “Init napud balik akong paminaw”
Objective Cues:
➢ Skin warm to touch
➢ Flushed skin
➢ Dry, cracked lips
➢ Absence of sweating
➢ Slowed movement
➢ With initial v/s as follows:
T: 39.2 C P: 99bpm R: 28 cpm BP: 90/70 mmHg
Nursing Diagnosis: Hyperthermia r/t underlying disease process
Planning: Within 2 hours of nursing interventions, the patient will be able manifest reduction of
core temperature from 39.2 to a normal range of 36.5 C- 37.5 C
Interventions:
1. Monitor patient’s vital signs.
R: Serves as baseline data for future comparison.
2. Note chronological and developmental age of client.
R: Assess for causative/ contributing factor.
3. Note presence/ absence of sweating.
R: To assess degree of hyperthermia.
4. Initiate tepid sponge bath.
R: Facilitates heat through conduction and evaporation.
5. Promotes surface cooling through undressing or removing extra linens.
R: Facilitates heat loss by radiation
6. Encourage adequate fluid intake.
R: To promote heat loss and hydration.
7. Encourage adequate bed rest.
R: To reduce metabolic consumption and oxygen demands.
8. Instruct patient and SO to report signs and symptoms of hyperthermia like flushed
skin, increasing respiratory rate and body temperature.
R: To promote wellness
9. Maintain patent airway and pad or raise siderails upon turning and positioning.
R: To promote safety.
10. Provide high calorie diet unless contraindicated.
R: To meet increased metabolic demands.
11. Instruct patient and SO to record all sources of fluid loss such as urine, vomiting and
diarrhea.
R: It potentiates fluid and electrolyte losses.
Collaborative
12. Administer paracetamol 500mg, 1 tablet for fever as ordered.
R: Relieves fever by acting in hypothalamic heat regulating center.
13. Administer replacement fluid and electrolytes as needed.
R: To support circulating volume and tissue perfusion.
Evaluation: Goal Unmet. After 1 hour and 45 minutes of nursing interventions, the patient was
not able to manifest reduction of core temperature from 39.2 to normal range with latest
temperature of 38.5 C.
Date Evaluated: April 20, 2010

Problem Identified: Risk for Constipation

Subjective Cues: “Wala pa ko kalibang gikan atong gi admit ko”
Objective Cues:
➢ Dry skin
➢ Needs assistance upon getting up in bed
➢ Refused to ambulate or to do ROM exercises
➢ Slowed movement
➢ (+) flatus
➢ Defecates 3-4 times per week
Nursing Diagnosis: Risk for Constipation r/t insufficient physical activity
be able to verbalize understanding of risk factors and appropriate interventions/ solutions to
individual situation.
Interventions:
1. Auscultate abdomen for presence, location, and characteristics of bowels sounds.
R: Reflects bowel activity.
2. Ascertain client’s belief and practices about bowel elimination.
R: To identify individual risk factors/ needs.
3. Ascertain client’s usual elimination pattern.
R: To assess client’s individual risk factors/ needs.
4. Encourage intake of balanced fiber and bulk in diet.
R: To improve consistency of stool and facilitates passage through colon.
5. Promote increase in fluid intake unless contraindicated.
R: to promote moist/ soft stool.
6. Encourage participation in activity/ exercise within limits of own ability.
R: To stimulate contractions of intestines.
7. Instruct patient to respond to urge to defecate.
R: To promote comfort and prevent complications.
8. Instruct client and SO to ascertain frequency, color, consistency of stool once
defecated.
9. Advise patient to have elimination diary if appropriate
R: To help monitor bowel pattern.
Collaborative:
R: For prompt management
Evaluation: Goal Met. After 4 hours of nursing interventions, the patient was able to verbalize
understanding of risk factors and appropriate interventions/ solutions to individual situation as
evidenced by the verbalization of “ Mobakod nako diri sa higdaanan ug maglakaw lakaw na
dayon ko human” and patient was able to defecate during the shift of duty.


Subjective Cues: “Init napud balik akong pamati…arang inita”
Objective Cues:
➢ Flushed skin
➢ Slowed movement
T: 38 C P: 91bpm R: 29 cpm BP: 90/70 mmHg
core temperature from 38 C to a normal range of 36.5 C- 37.5 C.
Interventions:
diarrhea.
Collaborative
Evaluation: Goal Met. After 1 hour and 45 minutes of nursing interventions, the patient was able
to manifest reduction of core temperature from 38C to normal range with latest temperature of
37.5 C.
Problem Identified: Impaired Physical Mobility

Subjective Cues: “Kapoy ibakod sa higdaanan”
Objective Cues:
➢ Slowed movement
➢ Body weakness noted
➢ Refused to ambulate or to do ROM exercises
➢ Needs assistance upon getting up/ out in bed
➢ Prefers to lie down on bed
Nursing Diagnosis: Impaired Physical Mobility r/t to reluctance to initiate movement
be able to verbalize willingness to and demonstrate participation in activities.
Interventions:
1. Determine degree of mobility.
R: To assess functional ability
2. Assess nutritional status and energy level.
R: To identify causative/ contributing factors.
3. Ascertain client’s perception of activity/ exercise needs.
R: To identify causative/ contributing factors.
4. Have client reposition self on regular schedule as indicated.
R: To promote optimal level of functioning.
5. Instruct in use of siderails upon positioning.
6. Schedule activities with adequate rest periods during the day.
R: To prevent/ reduce fatigue.
7. Encourage client to participate in self care activities.
R: Enhances self- concept and sense of independence.
8. Identify energy- conserving techniques for ADL’s.
R: Limits fatigue, maximizing participation.
9. Instruct patient to promote / have ambulation as necessary.
R: To prevent skin breakdown and maximizes energy production.
10. Instruct patient to eat nutritious foods and drink adequate fluid intake.
R: promotes well being and maximizes energy production.
Evaluation: Goal Met. After 2 hours of nursing interventions, the patient was able verbalize
willingness to and demonstrate participation in activities as evidenced the verbalization of
“Mubakod nako ug maglakaw lakaw dayon paghuman aron dlil ko luyahon ug samot”.
Nursing Care Plan No.6

Subjective Cues: “Nag-init napud balik akong pamati”
Objective Cues:
➢ Flushed skin
➢ Slowed movement
T: 38.8 C P: 91bpm R: 25 cpm BP: 90/70 mmHg
core temperature from 38.8 to a normal range of 36.5 C- 37.5 C
Interventions:
diarrhea.
Collaborative
Evaluation: Goal Unmet. After 1 hour and 45 minutes of nursing interventions, the patient was
not able to manifest reduction of core temperature from 38.8 to normal range with latest
temperature of 38.3 C.

Problem Identified: Readiness for Enhanced Sleep

Subjective Cues: “Gusto nako diritso akong tulog inig gabie bahala igang ug saba”
Objective Cues:
➢ Yawning noted
➢ Finds way to promote sleep like turning on the electric fan
➢ Slowed movement
➢ Doesn’t practice afternoon naps
➢ Sleeps 6-8 hours a day
Nursing Diagnosis: Readiness for Enhanced Sleep
be able to verbalize understanding on ways to promote sleep.
Interventions:
1. Listen to client’s reports of sleep quantity and quality.
R: Reveals client’s expectations and experiences.
2. Obtain feedback from client and SO about usual bedtime, desired rituals and routine.
R: To determine usual sleep pattern and provide comparative baseline data.
3. Note client’s report of potential for alteration for habitual sleep time.
R: Helps identify circumstances that are known to interrupt sleep patterns.
4. Arrange care as necessary.
R: to provide for uninterrupted periods for rest.
5. Explain to patient the necessity of disturbances for hospital procedure like v/s taking.
R: Allows for longer periods of uninterrupted sleep.
6. Provide quiet environment prior to sleep.
R: To promote relaxation and readiness to sleep.
7. Instruct patient to practice proper hygiene practices like washing of hands and feet
before sleeping.
R: To promote relaxation and readiness to sleep.
8. Instruct patient to limit intake of chocolate and caffeine/ alcoholic beverages prior to
bedtime.
R: Substances are known to impair falling or staying asleep.
9. Instruct patient to limit fluid intake in evening.
R: To reduce need for nighttime elimination.
10. Discuss patient’s usual bedtime rituals, expectations for obtaining good sleep time.
R: Provides information on client’s management of the situation and identifies areas that
might be modified.
Evaluation: Goal Met. After 2 hours of nursing interventions, the patient was able to verbalize
understanding on ways to promote sleep as evidenced by the verbalization of “Dili nako
makalimot ug hinlo sa akong lawas adisir ko matulog inig gabie”
DISCHARGE PLANNING
M – Medication
- Advise patient to take home medication following right drug, frequency, dosage and
timing as prescribed by the physician such as follows:
> Chloramphenicol, 500mg 1 tablet taken every six hours
- Encourage patient to follow drug regimen especially antibiotics.
E – Environment
- Instruct patient to stay in calm, quiet environment.
- Home environment must be free from slipping or accident hazards.
- Instruct SO to provide patient with well ventilated room so that patient can rest well.
T – Treatment
- Inform patient to have a follow-up check up after 1- 2 weeks
H – Health Teachings
Inform patient to about proper food handling techniques as necessary.
- Stress the importance of proper hygiene like handwashing, toileting, toothbrushing
and bathing.
- Encourage client to engage to range of motion exercises.
- Instruct patient to drink only purified drinking water or have drinking water boiled
as necessary.
- Advise patient to increase adequate fluid intake for hydration purposes.
- Encourage patient not to participate in strenuous activities
- Tell patient not to hesitate to ask for assistance when waking up in bed or when
going to comfort room.
- Promote rest periods among the client but also encourage ambulation.
- Advise patient to avoid eating foods from outside sources like carinderia.
- Encourage deep breathing and coughing exercises among the client.
O – Observable Signs and Symptoms

- Instruct patient to report signs and symptoms of typhoid fever like high grade fever,
generalized aches and pain, lethargy, fatigue, headache, diarrhea and rashes for
prompt management and to avoid further complications.
D– Diet
- Encourage client to increase intake of fiber to avoid constipation
- Instruct to increase fluid intake
- Instruct to increase intake of nutritious foods rich in Vitamin C such as fruits and
vegetables to boost one’s immune system.
S- Spirituality
– Advise patient to keep believing on God’s holy will so that he could be spiritually
motivated.
– Tell patient to constantly participate to religious activities so that his faith could
be more strengthened.
LEARNING OUTCOMES
Life is indeed full of surprises. Things happen as what expected to them to happen.
No one ever travels the highway of success without ever crossing the road of failures instead.
All we need to is to follow path that leads us to the unknown road. But we should always be
glad that as we get stumbled along the road, we learn to stand on our own feet putting our
heads up. From those experiences, we learn to grow as a person accountable for every action
we take. That’s how learning process takes place. It comes naturally as it may seem.
How could I ever forget the experience I have acquired upon exposure to the Pedia
Ward of Agusan del Norte Provincial Hospital. It was the 19 th day of April, 2010, when I first
entered the innocent world of pediatric nursing. I have to admit on my part that I got anxious
and nervous as I found out that our group was assigned to the pedia ward knowing children
really are stubborn in nature and truly demand for extra attention. Preparations were being
made. I also reviewed my lecture notes on pediatric nursing within that short span of time, if
that would be possible.
As day progressed, I have gained new learnings and insights most especially during
exposure to the said area. It’s just that in pedia ward , there is no room for mistakes perhaps.
A student nurse must practice good therapeutic communication skills in order to gain the
trust of those sick young individuals. It entails cooperation and presence of mind as one
engages to the world of pedia. But patience and dedication area somewhat virtues to keep, so
one should keep the fire burning.
When engagimg oneself to duty, one should be fully prepared. One must be assertive
enough to do all things needed to be carried out. One must be fully equipped with the
knowledge, skills and attitude before exposing to the area so that one could be productive and
useful perhaps since we aim for the recovery of those children. One should really pay
attention so that things would run smoothly.
Upon exposure, I was able to appreciate the call of duty since caring for the young
ones are somewhat a challenging task to be tackled upon. It somehow made me appreciate
myself and lot more becoming a part of the health care team. What a big relief on my part
seeing my patient, wearing a happy smile on his/her face after rendering nursing care to such
patient.
“When you are a nurse, you know that every day you will touch a life or a life will touch
yours”-a quotation on worth to lived for. As for now, I should live my life doing good things
not just for myself but also for others. I should bear in mind that I should not count the
number of times I felt better just because I made them happy. Two weeks of exposure may be
short enough yet with the experiences and learnings I gained, the hardships were all worth it.
The experience was truly superb and remarkable indeed.

Case Study On Typhoid Fever

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FATHER SATURNINO URIOS

An Individual Case Study

Bondoc, James Aurelle S.

Ms. Edgracia Airrane A. Vega, RN

Complications of typhoid fever are secondary conditions, symptoms, or other disorders

“Kumpleto jud na siya ug bakuna” as verbalized by Mother A when asked about

Family History of Illness

Past Health History

History of Present Illness

Naghilanat man ko adtong nagbakasyon ko sa Magallanes” as verbalized by Patient R.

At 1:00 pm, Dr Bungabong made the following orders:

.> TPR q4h

“Ngutngot akong kamot ganiha ra ni siya human gisuksukan… Mga 5 kung

Another problem was identified with a diagnosis of Hyperthermia related to underlying

Physical examination follows a methodical head to toe format in the cephalocaudal

Lungs and Thoracic Region

Bowel and Urine Excretion:

Motor Functioning – Patient R is able to move extremities through active

Sensory Functioning – Patient’s sensory system is intact, she was able to

Individual components of the gastrointestinal system

Name of Test Ordering Physician Date Ordered Date Done

Date Ordered: April 20, 2010

Hematology Complete Blood Count

Date Ordered: April 20, 2010

Test Definition Result Reference Interpretation Clinical

Date Ordered: April 20, 2010

Property/Constituents Definition Result Reference Interpretation Clinical

Microscopic Examination of Urinary Sediment

Constituents Definition Result Reference Interpretation Clinical significance

Date Ordered: April 20, 2010

Property/constituent Result Reference Value Interpretation Clinical

Consistency Formed Formed Normal

RESULT: No intestinal parasites/ ova seen

Drug Name Date Ordered Ordering Physician

Paracetamol April 20, 2010 Dr. Bungabong

Cotrimoxazole April 21, 2010 Dr. Amoroso

Name of Drug: Chloramphenicol

Brand Name: Eticlob

Classification: Anti- Bacterial

Date Ordered: April 20, 2010

Dose and Frequency: 500 mg q6h

Indications: Infections caused by S. typhi

Contraindications: Hypersensitivity, renal disease, severe heapaic disorders, minor infections

Adverse Reactions: Anemia, thrombocytopenia, optic neuritis, nausea, vomiting, diarrhea,

DRUG STUDY NO. 2

Name of Drug: Acetaminophen

Brand Name: Paracetamol

Classification: Non-opioid analgesic, anti-pyretic

Date Ordered: April 20, 2010

Dose and Frequency: 500 mg every 4 hours or PRN

Indications: Mild pain or fever

Contraindications: Contraindicated to patients hypersensitive to the drugs and use cautiously in

DRUG STUDY NO. 3

Name of Drug: Cotrimoxazole

Brand Name: Timizole Forte

Date Ordered: April 21, 2010

Dosage/ Frequency: 800 mg, BID

Mechanism of Action: Inhibits susceptible bacteria, including S. typhi

Indications: Urinary Tract Infection

Contraindications: Hypersensitivity to trimethoprim or sulfonamides and severe renal

Adverse Reactions: Headache, imsonia, agranulocytosis, muscle weakness, oliguria, anuria,

NURSING CARE PLAN