ASSESSMENT SUBJECTIVE: Bakit kaya madalas ako mahilo? (Why do I always feel dizzy?) as verbalized by the patient.

OBJECTIVE: Request for information. Agitated behavior Inaccurate follow through of instructions. V/S taken as follows: T: 37.2 P: 84 R: 18 BP: 180/110

PLANNING After 8 hours of nursing interventions, the patient will verbalize understanding of the disease process and treatment regimen.

INTERVENTION -Define and state the limits of desired BP. Explain hypertension and its effect on the heart, blood vessels, kidney, and brain. Assist the patient in identifying modifiable risk factors like diet high in sodium, saturated fats and cholesterol. Reinforce the importance of adhering to treatment regimen and keeping follow up appointments. Suggest frequent position changes, leg exercises when lying down. Help patient identify sources of sodium intake. Encourage patient to decrease or eliminate caffeine like in tea, coffee, cola and chocolates. Stress importance of accomplishing daily rest periods. COLLABORATIVE: Provide information regarding community resources, and support patients in making lifestyle changes.

RATIONALE -Provides basis for understanding elevations of BP, and clarifies misconceptions and also understanding that high BP can exist without symptom or even when feeling well. These risk factors have been shown to contribute to hypertension.

EVALUATION After 8 hours of nursing interventions, the patient was able to verbalize understanding of the disease process and treatment regimen.

Lack of cooperation is common reason for failure of antihypertensive therapy. Decreases peripheral venous pooling that may be potentiated by vasodilators and prolonged sitting or standing. Two years on moderate low salt diet may be sufficient to control mild hypertension. Caffeine is a cardiac stimulant and may adversely affect cardiac function. Alternating rest and activity increases tolerance to activity progression. Community resources like health centers programs and check ups are helpful in controlling hypertension.

What Is It? Gastroenteritis is an inflammation of the intestines that causes diarrhea, abdominal cramps, nausea, loss of appetite, and other symptoms of digestive upset. In adults, the two most common causes of gastroenteritis are viral and bacterial infections: Viral gastroenteritis. In otherwise healthy adults, viral infections of the digestive tract are often responsible for mild episodes of gastroenteritis. These viral infections include the Norwalk virus, rotaviruses, adenoviruses and other agents. The viruses are very contagious and usually spread from one person to another on unwashed hands, or by close contact with an infected person, such as sharing food or eating utensils. Viral gastroenteritis often spreads very easily in institutions and other situations where people live in close quarters, such as prisons, nursing homes, cruise ships, schools, college dorms and public campgrounds. The viruses also can be spread when someone either touches an infected person's stool or touches surfaces contaminated with infected stool. For this reason, health care professionals and child care workers have an especially high risk of viral gastroenteritis, particularly if they do not wash their hands thoroughly after dealing with soiled diapers, bedpans or bathroom fixtures. In some circumstances, the agents that cause viral gastroenteritis also can be carried in water or food, especially in drinking water or commercial shellfish that have been contaminated by sewage runoff. Infected food handlers who don't follow proper sanitary procedures also can spread viral gastroenteritis in meals served in restaurants and cafeterias. Bacteria. Salmonella, shigella, Campylobacter jejuni, E. coli and many other types of bacteria can cause gastroenteritis. They can be spread by close contact with an infected person, or by drinking or eating infected food or water. In some cases, the disease is caused by a toxin that is produced by bacteria growing on food that has been prepared or stored improperly. If a person eats this germ-filled food, symptoms of gastroenteritis are triggered either by the bacteria themselves or by their irritating byproducts. Symptoms from a toxin usually begin within a few hours. Symptoms from the bacteria can occur within a few days. Each year in the United States, millions of people develop gastroenteritis by eating contaminated food, while millions more suffer from mild bouts of viral gastroenteritis. In otherwise healthy adults, both forms of gastroenteritis tend to be mild and brief, and many episodes are never reported to a doctor. However, in the elderly and people with weakened immune defenses, gastroenteritis sometimes can produce dehydration and other dangerous complications. Even in robust adults, certain types of aggressive bacteria occasionally cause more serious forms of food poisoning that can cause high fever and severe gastrointestinal symptoms, such as bloody diarrhea. Symptoms In adults, symptoms of gastroenteritis typically include mild diarrhea (fewer than 10 watery stools daily), abdominal pain and cramps, low-grade fever (below 101 degrees Fahrenheit), headache, nausea and sometimes vomiting. In some cases, there can be bloody diarrhea. Diagnosis Your doctor will ask whether you recently have been exposed to anyone who has diarrhea, or whether you have recently eaten at a restaurant or social function where the food was left at room temperature for prolonged periods. If you can remember eating a meal within the last week that smelled or tasted strange, be sure to mention it to your doctor. Since gastroenteritis is especially common where sanitation is poor, your doctor also will ask whether you have recently traveled to an underdeveloped country or to any location where the drinking water is not tested routinely. This includes rural streams, lakes or swimming holes in the United States. In most cases, your doctor can diagnose mild gastroenteritis based on your symptoms, your history of exposure to spoiled food, impure water or someone with diarrhea, and the results of your physical examination. Rarely, special laboratory testing may be needed if you have unusually severe symptoms, such as: A fever over 101 degrees Fahrenheit Severe diarrhea (more than 10 watery stools daily) Signs of significant dehydration (dry mouth, intense thirst, weakness) Stool that contains blood or pus This testing usually involves taking one or more stool samples to be tested in a laboratory for the presence of bacteria (especially campylobacter, salmonella, or E. coli), or examined for microscopic parasites. Expected Duration Most cases of mild, uncomplicated gastroenteritis last one to seven days. Prevention To help prevent gastroenteritis, you can: Wash your hands frequently, especially after using the toilet, changing diapers or caring for someone who has diarrhea. Wash your hands before and after preparing food, especially after handling raw meat.

Wash diarrhea-soiled clothing in detergent and chlorine bleach. If bathroom surfaces are contaminated with stool, wipe them with a chlorine-based household cleaner. Cook all meat thoroughly before you eat it, and refrigerate leftovers within two hours. Make sure you don't transfer cooked foods onto unwashed plates that held raw meat. Wash kitchen countertops and utensils thoroughly after they have been used to prepare meat. Never drink unpasteurized milk or untreated water. Drink only bottled water or soft drinks if you travel to an area where sanitation is poor. In these areas, also avoid ice, uncooked vegetables or fruit that you have not peeled yourself.

Treatment In otherwise healthy adults, most cases of mild gastroenteritis go away within a few days. You can try the following suggestions until your symptoms subside: To prevent dehydration, drink plenty of fluids -- water, soft drinks, sports drinks, broth or over-the-counter, oral rehydration fluids. If you are too nauseated to drink several ounces at once, try taking many smaller sips over a longer period. Once your nausea starts to subside, gradually resume a normal diet. Begin with clear soups, broth or sweetened gelatin desserts, then build up to rice, rice cereal and more substantial foods. Temporarily avoid milk products and foods that contain wheat flour (bread, macaroni, pizza), since your digestive tract may be unusually sensitive to them for a few days. Also temporarily avoid high-fiber foods, such as fruits, corn and bran. Use over-the-counter antidiarrhea medicines cautiously. Rest in bed. If you have symptoms of severe gastroenteritis, your doctor may prescribe medications to ease your nausea, vomiting and diarrhea; intravenous fluids for symptoms of severe dehydration; and antibiotics if stool tests confirm that a serious bacterial infection is causing your gastroenteritis. When To Call a Professional Call your doctor promptly if you have symptoms of gastroenteritis together with any of the following: A fever above 101 degrees Fahrenheit Blood or pus in your stool Diarrhea that lasts more than one week Symptoms of significant dehydration, including dry mouth, intense thirst, and weakness A history of recent travel to a developing country or to any area where sanitation is poor Any medical condition that either weakens the immune system or is treated with immune-suppressing medication Also, call your doctor promptly if you are taking oral medication for a chronic medical condition and you are either too nauseated to swallow your medicine or have vomited after taking it. Prognosis Overall, the outlook is excellent. Almost all adults with mild gastroenteritis recover completely without complications.
SKIN: The patients skins moisture is dry due to dehydration. The texture is rough due to aging and signs of dehydration. HEAD: The patients head was round and in proportion w/ the body. Hair color is white and has no dandruff and lice. The patients general appearance of face indicates a feeling of weakness. NECK and SHOULDERS: The veins and clavicle are visible. The shoulders are asymmetrical. The neck muscles are weak. EYES: The patients eyes are symmetrical to the ears. She manifested a blurred vision due to aging. Pale conjunctivae was noted. A sunken eye was observed. The eyes appeared dry due to dehydration. EARS: The clients ear manifested a good hearing balance. There were no discharges noted. NOSE: The clients nasal septum is intact and in the midline. There were no discharges noted. Airs move freely as the client breathes through the nose. MOUTH and THROAT: The clients mouth has presence of lesions due to frequent vomiting. The lips were dry due to dehydration. The throat was functioning well. No dentures. (+) tartar. There is a black discoloration in the enamel. (+) breath odor. CHEST: The chest is symmetric. The skin was sagged. The thorax is elliptical. ABDOMEN: The skin of the abdomen is unblemished and uniform in color. Symmetric abdominal contour flattened and rounded. Audible bowel sounds. Symmetric movements cause by respiration. No tenderness noted. EXTREMITIES: The fingers in both hands and feet are complete. The shape of the nails is spoon-shape, the consistency is smooth and the color is pinkish white. SPINE: The spine of the patient is slightly curved. No presence of defects. A. SLEEP Prior to Hospitalization: Her sleeping pattern before was normal. She was able to consume normal 8-hour sleeping time. During Hospitalization: During her stay at the hospital she said that she was experiencing difficulty of sleeping. B. ACTIVITY AND EXERCISE Prior to Hospitalization: Mrs. Green was a street sweeper and a hog-raiser. During Hospitalization: During her stay at the hospital, she was not able to perform activities because of restlessness due to her illness. C. NUTRITION Prior to Hospitalization: She has good appetite. During Hospitalization: During her stay at the hospital, she loses her appetite because of her illness. DIGESTIVE SYSTEM The human digestive system is a complex series of organs and glands that processes food. In order to use the food we eat, our body has to break the food down into smaller molecules that it can process; it also has to excrete waste. Most of the digestive organs (like the stomach and intestines) are tube-like and contain the food as it makes its way through the body. The digestive system is essentially a long, twisting tube that runs from the mouth to the anus, plus a few other organs (like the liver and pancreas)that produce or store digestive chemicals. The Digestive Process The start of the process the mouth: The digestive process begins in the mouth. Food is partly broken down by the process of chewing and by the chemical action of salivary enzymes (these enzymes are produced by the salivary glands and break down starches into smaller molecules). On the way to the stomach: the esophagus After being chewed and swallowed, the food enters the esophagus. The esophagus is a long tube that runs from the mouth to the stomach. It uses rhythmic, wave-like muscle movements (called peristalsis) to force food from the throat into the stomach. This muscle movement gives us the ability to eat or drink even when we're upside-down In the stomachThe stomach is a large, sack-like organ that churns the food and bathes it in a very strong acid (gastric acid). Food in the stomach that is partly digested and mixed with stomach acids is called chime. In the small intestineAfter being in the stomach, food enters the duodenum, the first part of the small intestine. It then enters the jejunum and then the ileum (the final part of the small intestine). In the small intestine, bile (produced in the liver and stored in the gallbladder), pancreatic enzymes, and other digestive enzymes produced by the inner wall of the small intestine help in the breakdown of food In the large intestine- After passing through the small intestine, food passes intothe large intestine. In the large intestine, some of the water andelectrolytes (chemicals like sodium) are removed from the food. Many microbes (bacteria like Bacteroides, Lactobacillusacidophilus, Escherichia coli , and Klebsiella) in the large intestine help in the digestion process. The first part of the large intestine is called the cecum (the appendix is connected to the cecum).Food then travels upward in the ascending colon. The foodtravels across the abdomen in the transverse colon, goes backdown the other side of the body in the descending colon, and then through the sigmoid colon. The end of the processSolid waste is then stored in the rectum until it is excreted via the anus. Digestive System Glossary: anus - the opening at the end of the digestive system from which feces (waste) exits the body. Appendix- a small sac located on the cecum. Ascending colon- the part of the large intestine that run upwards; it is located after the cecum. Bile - a digestive chemical that is produced in the liver, stored in the gall bladder, and secreted into the small intestine.

Cecum - the first part of the large intestine; the appendix is connected to the cecum. Chime - food in the stomach that is partly digested and mixed with stomach acids. Chyme goes on to the small intestine for further digestion. Descending colon - the part of the large intestine that run downwards after the transverse colon and before the sigmoid colon. Duodenum- the first part of the small intestine; it is C-shaped and runs from the stomach to the jejunum. Epiglottis - the flap at the back of the tongue that keeps chewed food from going down the windpipe to the lungs. When you swallow, the epiglottis automatically closes. When you breathe, the epiglottis opens so that air can go in and out of the windpipe. Esophagus- the long tube between the mouth and the stomach. It uses rhythmic muscle movements (called peristalsis) to force food from the throat into the stomach. Gall bladder a small, sac-like organ located by the duodenum. It stores and releases bile (a digestive chemical which is produced in the liver) into thesmall intestine. Ileum- the last part of the small intestine before the large intestine begins. Jejunum- the long, coiled mid-section of the small intestine; it is between theduodenum and the ileum. Liver - a large organ located above and in front of the stomach. It filters toxinsfrom the blood, and makes bile (which breaks down fats) and someblood proteins. Mouth - the first part of the digestive system, where food enters the body.Chewing and salivary enzymes in the mouth are the beginning of thedigestive process (breaking down the food). Pancreas- an enzyme-producing gland located below the stomach and abovethe intestines. Enzymes from the pancreas help in the digestionof carbohydrates, fats and proteins in the small intestine. Peristalsis- rhythmic muscle movements that force food in the esophagusfrom the throat into the stomach. Peristalsis is involuntary - you cannotcontrol it. It is also what allows you to eat and drink while upside-down. Rectum- the lower part of the large intestine, where feces are stored before they is excreted. Salivary glands- glands located in the mouth that produce saliva. Salivacontains enzymes that break down carbohydrates (starch) into smaller molecules. Sigmoid colon- the part of the large intestine between the descending colon and the rectum. Stomach- a sack-like muscular organ that is attached to the esophagus. Both chemical and mechanical digestion takes place in the stomach. When food enters the stomach; it is churned in a bath of acids and enzymes. Transverse colon- the part of the large Intestine that runs horizontally across the abdomen.

A. History of Present Illness Prior to admission, the client was vomiting and defecating. Her stool was watery and its color is green. At first, they to the barangay health center and the midwife gave them medication. According to the midwife, the medication is for LBM, but after drinking the medication, the client was still defecating and vomiting so the family decided to rush the client at Emilio G. Perez Memorial District Hospital the next day. B. Past History The client had fever, cough and colds. She had completed all vaccinations including BCG, DPT, Oral Polio Vaccine, MMR and Hepatitis B vaccine. The patient had never been any of the childhood disease such as measles, mumps and chicken pox. The patient had no history of accident or any injury. She does not have allergy in any food or drug. She was not hospitalized before and she does not take any medication or supplements to maintain her health. C. Family History According to the significant others of BB they have a familial disease of asthma, both on her father and mother's side. And an incident of hypertension on his father's side. ACTIVITIES OF DAILY LIVING Functional Health Perception Prior to Hospitalization During Hospitalization Nutritional Metabolic Pattern The client eats four times a day including breakfast, lunch, merienda and dinner. According to the significant others, she always eats rice and soup. She can drink 4 glasses of water in a day. She has no eating discomforts. She does not have any dental problems because she has a complete set of teeth. -The client defecates everyday and her stool is soft but formed and its color is brown and has a foul odor. She Urinates five times a day and is yellowish in color. She has no discomfort in defecating and urinating. - The client has sufficient energy for completing her desired required activities The client sleeps about 10 hours a day. From 8pm to 6am. She has no problem falling asleep and does not take sleep medications. Her sleep is always continuous especially when she is tired. She takes a nap during The client seldom eats at the hospital. She does not have appetite for eating. She seldom drinks water or other fluids

Elimination Pattern

The client defecates three times a day. Her stool is watery and its color is green. She urinates twice a day and it is yellowish in color.

Activity-exercise Pattern Sleep rest pattern

The client does not have sufficient energy for completing her desired required activities. The client still sleeps 10 hours a day. She only wakes up when her medications are due. She has no problem falling asleep and does not take any sleep medications. She does not take naps.

afternoon. From12:30pm to 3pm. Cognitive-Perceptual Pattern The client does not have difficulty in hearing and has no hearing aid. According to the significant others, whenever the client feels pain or any discomfort, they always give her medications. The client lives with her mother, father and grandparents. The structure of her family is extended. And just like the typical family, their family has problems wherein they have difficulty in handling, as stated by the grandmother The client is a born again Christian. According to the significant others, they attend mass every Sunday. NORMAL FINDINGS Moisture in skin folds and axillae Smooth Springs back immediately to previous state Pink in color, soft moist, smooth texture, symmetrical no tenderness, no lesions Uniform pink color Pink gums, moist, firm texture Audible bowel sounds The client takes medications to relieve any discomforts

Role-relationship Pattern

The Family of the patient especially her parents are supportive and more caring.

Value-belief Pattern

BODY PARTSASSESSED 1.Skin a. Moisture b Texture c. Turgor 2. Mouth a. Lips b. MucosaI c. Gums 3. Abdomen Bowel sounds

TECHNIQUES Palpation Palpation Inspection and Palpation inspection

ACTUAL FINDINGS Dry skin Rough Moves back slowly Dry lips

INTERPRETATION Deviated due to slight dehydration . Deviated due to slight dehydration Deviated due to slight dehydration Deviated due to slight dehydration Deviated from normal due to slight dehydration Deviated from normal due to slight dehydration Deviated due to diarrhea

Inspection and Palpation Inspection and Palpation Auscultation

Dry and slightly pink in color Pink gums, dry, firm texture Hyperactive bowel sound