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Group 1A & 1B (BSN 201)

Name: M.A.N

Address: 541 Dapu Dapu Sitio Vito Nemo Camarin, Caloocan City

Age: 17 years old Birth Date: January 9, 2000 Birth Place: Manila
Gender: Male

Religion: Born-again Christian Race/Ethnic Origin: Filipino

Occupation: None Educational Attainment: JHS graduate (currently SHS student)


Marital Status: Single Name of Spouse: N/A
Number of Children: N/A

Chief Complaint(s): Rashes

Date of Admission: February 14, 2017

Room & Bed Number: Rm 502 D

Attending/Admitting Physician: Dr. Genuino (Attending), Dr. Reandelar (Admitting)

Admitting/Final Diagnosis: T/C Immune Thrombocytopenic Purpura

Medical Insurance: PhilHealth


The client experienced bleeding in his gums last February 14, 2017 and
unexpected bruises last February 13, 2017.
He didnt know what caused the rashes and the unexpected bruises to
appear. T
There were no precipitating and alleviating factors. Also there were no effect
to other body parts/functions ad there were no intervention/treatment he
has done.
Complete immunizations
Chicken pox, cough and colds
Fathers side: uncle has asthma
No history of accidents/injuries
Hospitalization (last 2010)- undergone surgery (removal of thyroglossal cyst)
Health Perception- Health Management Pattern
The client verbalized that healthy and strong pa rin ako. He stated that he
may be hospitalized and considered by others as weak or unhealthy but it
doesnt matter to him as he believes that a healthy person depends not just
only physically healthy but also emotionally and spiritually healthy.
Analysis: According to Kozier, in this pattern, a client is able to tell his/her
health behavior such as the actions that he or she understands, his or her
health state, eating wisely, exercising, paying attention to signs of illness and
injuries, reach their maximum potential, able to follow treatment advice, and
managing it. And that if he/she describes the health of a person as a whole
including the emotional and spiritual factors. (Ref: Kozier and Erbs
Fundamentals of Nursing (Tenth Edition, Vol.1) p. 292
Interpretation: The client is able to tell his health holistically since he
mentioned that he believes that a healthy person depends not just only
physically healthy but also emotionally and spiritually healthy. Yet, there are
some instances that he lacks in managing his health.
Cognitive- Perceptual Pattern
The client responds to stimuli verbally and physically, has no sensory deficits
and is oriented to people, time and place.
Analysis: According to Kozier and Erbs Fundamentals of Nursing book page
931 because there are no alterations in this area of development as he is
currently on the adolescent stage and that adolescents and adults have many
learned responses to stimuli and normal physiological changes happen when
they enter the adult stage.
Interpretation: The client has no problem in his cognitive since he can
respond to any stimuli, could be verbally or physically.
Self-perception- Self- Concept Pattern

The client stated that even though he was hospitalized, he still perceives himself
as a healthy and strong person who is comfortable with whom he is. He stated
he has a high self-esteem and believes in himself that he can do well because his
parents are always there to support him.
Analysis: According to Kozier and Erbs Fundamentals of Nursing book page 951,
a person who has a high self-esteem has feelings of significance, of competence,
of the ability to cope with his life, and of control over ones destiny. On page 948
of Kozier and Erbs Fundamentals of Nursing book, an individual possessing a
strong self-concept is able to accept or adapt to changes that may occur over the
lifespan and how one views oneself affects ones interaction with others.
Interpretation: The client is confident and can cope up with his life. Since hes
confident, he can accept or adapt to any changes that may occur in his lifetime.
Role- Relationship Pattern
He is the youngest in the family. He is currently on a relationship-like status.
(mutual understanding or mutual feelings with someone). He has a good
relationship with his parents, siblings, friends, and he can talk about his
problems to them.
Analysis: According to mayoclinic.com, healthy relationships with family,
friends and other loved ones can be a great source of support, comfort and
love. Still, healthy relationships don't necessarily happen by themselves.
Often, healthy relationships require compromise and forgiveness. When
someone you care about hurts you, you can hold on to anger, resentment
and thoughts of revenge or you can embrace forgiveness and move
forward.
Interpretation: The client has a healthy relationship with the people whom he
loves such as his parents, siblings, friends, and to the girl he admires.
Sexuality-Reproductive Pattern
He stated that he has no problems regarding his sexuality as well as his
sexual patterns and that he is currently on relationship-like status with
someone.
Analysis: According to Kozier and Erbs Fundamentals of Nursing book page
961 because the adolescence stage (12-18 years) develops relationship with
interested partners, and that for most people, sexual health is not a concern
until its absence or impairment is noticed. A persons degree of sexual health
is best determined by that individual, sometimes with the assistance of a
qualified professional. Sexual health occurs when sexual relationships are
respectful, safe, and pleasurbable.
Interpretation: The client has no experience on any sexual relationships but
he has no problem in his sexuality.
Coping-Stress Tolerance Pattern
He stated that he does not make himself stressed out too much and if he was
stressed, he would look at things optimistically and as a chance to learn
more. He stated that his way of relieving stress is playing computer games.
Analysis: According to Kozier, page 1007, people who manage their time
effectively usually experiences less stress because they feel more in control of
their circumstances. Having a way of relieving stress could help an
individual to control their emotions and tends to be alert and active in doing
his/her responsibilities.
Interpretation: The client has his own way in dealing stress such as being
optimistic. In that away, he can control his emotions and be cooperative to
others.
Value- Belief Pattern
He stated that he has a strong belief in God and that his mother would
always remind him to read the Bible before going to bed.
Analysis: According to Kozier, page 981, spiritual health results when
individuals intentionally seek to strengthen their spiritual muscles, as it
were, through various spiritual disciples like prayer and meditations. An
individual, who has a strong faith in God/Higher Power, is more likely to have
a positive outlook in life.
Interpretation: The client has his own belief in which it strengthens his
spiritual health and makes him to be more optimistic in his life.
ACTIVITIES OF DAILY LIVING
PHYSICAL ASSESSMENT
LABORATORY RESULTS
Drug Study 1
Drug Study 2
ANATOMY OF BLOOD:
BLOOD:
Blood is a body fluid in humans and other animals that delivers
necessary substances such as nutrients and oxygen to the cells and
transports metabolic waste products away from those same cells.
Blood is circulated around the body through blood vessels by the
pumping action of the heart. In animals with lungs, arterial blood
carries oxygen from inhaled air to the tissues of the body,
and venous blood carries carbon dioxide, a waste product of metabolism
Blood cells are made in the bone marrow. Bone marrow is the soft,
spongy substance in the center of bones. produced by cells, from the
tissues to the lungs to be exhaled.
Blood has four main components : plasma, red blood cells, white blood cells,
and platelets. Blood has many different functions, including: transporting
oxygen and nutrients to the lungs and tissues. forming blood clots to prevent
excess blood loss.
Plasma -helps maintain blood pressure and regulates body temperature. It
contains a complex mix of substances used by the body to perform important
functions.
Red blood cells also remove carbon dioxide from your body, transporting it
to the lungs for you to exhale.
White blood cells- (WBCs), also called leukocytes or leucocytes, are
the cells of the immune system that are involved in protecting the body
against both infectious disease and foreign invaders.
Platelets The primary function of the platelets is to prevent bleeding.
Idiopathic Thrombocytopenia Purpura :
Idiopathic thrombocytopenia Purpura (ITP) is a bleeding disorder in which the
immune system destroys platelets,which are necessary for normal blood
clotting.
People with this disease have too few platelets in the blood.
Idiopathic thrombocytopenia Purpura (ITP) has two distinct clinical
syndromes manifesting as an acute condition in children an a chronic
conditions in adults.
Signs and symptoms of Idiophatic Thrombocytopenic Purpura
Signs include easy and excessive bruising; red, flat spots on the skin; prolonged
bleeding from the nose or of the gums.
Blood in the stool or urine; excessive menstrual flow; and profuse bleeding after
surgery.
Platelet count less than 150,000 per microliter
What causes fewer platelet count?
Low platelet count can be caused by bone marrow problems, aplastic anemia
,Vitamin B-12 deficiency,Iron deficiency ,Viral infections such as Epstein-Barr
virus and chickenpox,Cirrhosis ,Leukemia and myelodysplasia.
A low platelet count can also be a result of the body destroying too may platelets.
This can be due to side effects of certain medications, include diuretics and anti-
seizure medications.
How does low platelet count affect bodily organs?
A platelet count of less than 150,000 per microliter, or thrombocytopenia,
leads to excess bleeding, according to WebMD.
Platelets are important cells that clot the blood and repair cell walls and
tissues.
Severe thrombocytopenia (less that 10,000 per microliter) may cause internal
bleeding that can be fatal.
SCHEMATIC DIAGRAM of ITP
Hypothesis
Exposure to viral infection after 1-4 weeks triggers an autoantibody directed
against the platelet.

Predisposing Factors
Agent: Infectious agent such as a particular virus initiate the disease process
to the 17 year old patient.
Host: An intercurrent infection to the individual could have influence the
individuals exposure to the disease.
Environment: Physical factors such as weather/climate,
temperature/humidity, and air quality could affect the agent and the
opportunity for exposure.
Ecologic Model
Analysis:
In the diagram above, the agent (viral infection) affects the host then the
environment (physical factors such as weather/climate,
temperature/humidity, and air quality) supports the disease causation.
Immune Thrombocytopenic Purpura also known as Idiopathic
Thrombocytopenic Purpura occurs after a recent exposure to a viral infection,
an autoantibody directed against the platelet surface develops with resultant
sudden onset of thrombocytopenia. The disease seems to occur more in late
winter and spring after the peak season of viral infection (in the Philippines
during cold and wet season). As a result, the platelet of the individual attacks
its co-platelet and drops below the normal range of platelet count (150 000
450 000 microliter of blood).
Ref:
Nelson Textbook for Pediatrics (19th Edition)
Mayo Clinic. (2017). Idiopathic Thrombocytopenic Purpura. Retrieved from:
http://www.mayoclinic.org/diseases-conditions/idiopathic-
thrombocytopenic-purpura/home/ovc-20201208
Conclusion and Recommendation:
Based on the analysis and assessments done, it seems that ITP often
happens during a cold weather. Its scarred to think that the individual
platelets attack its co-platelets because the primary function of platelet cells
is to stop bleeding through the proteins in the blood called clotting factors to
form a clot. Well, if a platelet count of the individual drops below the normal
range then that would be very dangerous to his health.
The group think that the best prevention to this disease is to practice healthy
lifestyle such as eating nutritious foods, engaging in exercise, and sleeping on
time. Through these actions, we can prevent having this disease and protect
ourselves from viral infections that we dont know that it may alter our
health.
PLANNING SETTING PRIORITIES
Nursing Care Plan
Teaching Care Plan
EVIDENCE BASED NURSING