CASE STUDY CASE STUDY

ACUTE CASTRO ACUTE CASTRO

ENTER!T!S ENTER!T!S
!NTRODUCT!ON
Gastroenter|t|s ls a caLchall Lerm for lnfecLlon or
lrrlLaLlon of Lhe dlgesLlve LracL parLlcularly Lhe sLomach
and lnLesLlne lL ls frequenLly referred Lo as Lhe sLomach
or lnLesLlnal flu alLhough Lhe lnfluenza vlrus ls noL
assoclaLed wlLh Lhls lllness Ma[or sympLoms
lnclude nausea and vomlLlng dlarrhea and abdomlnal
cramps 1hese sympLoms are someLlmes also
accompanled by fever and overall weakness
CasLroenLerlLls Lyplcally lasLs abouL Lhree days AdulLs
usually recover wlLhouL problem buL chlldren Lhe
elderly and anyone wlLh an underlylng dlsease are
more vulnerable Lo compllcaLlons such as dehydraLlon
CasLroenLerlLls ls an uncomforLable and lnconvenlenL
allmenL buL lL ls rarely llfeLhreaLenlng ln Lhe unlLed
SLaLes and oLher developed naLlons Powever an
esLlmaLed 220000 chlldren younger Lhan age flve are
hosplLallzed wlLh gasLroenLerlLls sympLoms ln Lhe
unlLed SLaLes annually Cf Lhese chlldren 300 dle as a
resulL of severe dlarrhea and dehydraLlon ln
developlng naLlons dlarrheal lllnesses are a ma[or
source of morLallLy ln 1990 approxlmaLely Lhree
mllllon deaLhs occurred worldwlde as a resulL of
dlarrheal lllness
1he mosL common cause of gasLroenLerlLls ls vlral
lnfecLlon vlruses such as roLavlrus adenovlrus
asLrovlrus and callclvlrus and small roundsLrucLured
vlruses (S8Svs) are found all over Lhe world Lxposure
Lyplcally occurs Lhrough Lhe fecaloral rouLe such as by
consumlng foods conLamlnaLed by fecal maLerlal
relaLed Lo poor sanlLaLlon Powever Lhe lnfecLlve dose
can be very low (approxlmaLely 100 vlrus parLlcles) so
oLher rouLes of Lransmlsslon are qulLe probable
acLerlal gasLroenLerlLls ls frequenLly a resulL of poor sanlLaLlon
Lhe lack of safe drlnklng waLer or conLamlnaLed foodcondlLlons
common ln developlng naLlons naLural or manmade dlsasLers
can make underlylng problems ln sanlLaLlon and food safeLy
worse ln developed naLlons Lhe modern food producLlon
sysLem poLenLlally exposes mllllons of people Lo dlseasecauslng
bacLerla Lhrough lLs lnLenslve producLlon and dlsLrlbuLlon
meLhods Common Lypes of bacLerlal gasLroenLerlLls can be
llnked Lo 5olmooello and compyloboctet bacLerla
however Lscherlchla coll and llstetlo mooocytoqeoes are
creaLlng lncreased concern ln developed naLlons Cholera and
Shlgella remaln Lwo dlseases of greaL concern ln developlng
counLrles and research Lo develop longLerm vacclnes agalnsL
Lhem ls underway
#AT!ENT #ROF!LE
-ome uC
qe 18 monLhs old
5ex Male
5totos Slngle
tess Alaska Mamballng Cebu ClLy
-ome of nospltol Cebu ClLy Medlcal CenLer
uote of mlssloo SepLember 23 2011
wot oo 8e -o edlaLrlc Ward #11
cose -o 8331
cblef complolot M
Melcol uloqoosls ACL wlLh no uPn SCu edemaLous
severe wasLlng
uevelopmeotol 1osk
Lr|kson Autonomy vs Shame and Doubt
8as|c Strengths Se|fcontro| Courage and W|||
uurlng Lhls sLage we learn Lo masLer skllls for
ourselves noL only do we learn Lo walk Lalk and feed
ourselves we are learnlng flner moLor developmenL as
well as Lhe much appreclaLed LolleL Lralnlng Pere we
have Lhe opporLunlLy Lo bulld selfesLeem
and autonomy as we galn more conLrol over our bodles
and acqulre new skllls learnlng rlghL from wrong And
one of our skllls durlng Lhe 1errlble 1wos ls our ablllLy
Lo use Lhe powerful word nC! lL may be paln for
parenLs buL lL develops lmporLanL skllls of Lhe wlll
lL ls also durlng Lhls sLage however LhaL we can be very
vulnerable lf were shamed ln Lhe process of LolleL
Lralnlng or ln learnlng oLher lmporLanL skllls we may
feel greaL shame and doubt of our capablllLles and
suffer low selfesLeem as a resulL
1he mosL slgnlflcanL relaLlonshlps are wlLh parenLs
Ireud Ana| Stage 18 months 3S years (approx)
hys|ca| focus anus (ellmlnaLlon) unLll now Lhe baby
has had lL preLLy easy now baby ls supposed Lo conLrol
bowels lreud belleved baby s sexual pleasure cenLred
around Lhe anus aL Lhls Llme
sycho|og|ca| theme selfconLrol/obedlence 1hese
Lhlngs are noL [usL relaLed Lo LolleL Lralnlng buL also Lhe
baby musL learn Lo conLrol urges and behavlours
(Lerrlble Lwos) WhaL goes wrong here ls elLher parenLs
belng Loo conLrolllng or noL conLrolllng enough (lreud
was a greaL bellever ln moderaLlon)
Adu|t character anally reLenLlve (rlgld overly
organlsed subservlenL Lo auLhorlLy) vs anally expulslve
(llLLle selfconLrol dlsorganlsed deflanL hosLlle)
EALT ASSESSNENT
n|story of resent I||ness
days 1A cllenL had pasL of M 3 Llmes per day wlLh nausea
and vomlLlng no meds glven and blpedal edema
unLll Monday 1A due Lo perslsLence of blpedal edema cllenL
soughL consenL
2 Iunct|ona| nea|th atterns
21 nea|th ercept|on and nea|th Ma|ntenance
CllenL's SC percelved healLh as maayo ang panglawas" 1akes
vlLamlns exerclses regularly eaLlng a healLhy meal such as
vegeLables flsh meaL and frulLs uurlng her chlld's conflnemenL
she percelved healLh as an lmporLanL maLLer ln llfe
22 Nutr|t|ona| atterns
1he cllenL eaLs 12 meals a day such as lugaw or someLlmes rlce
wlLh soup and vegeLable or blhon or someLlmes noLhlng aL all
someLlmes wlLhln beLween snacks 1akes vlLamlns such as Llkl
Llkl noL regularly fed wlLh mllk due Lo flnanclal problems uurlng
conflnemenL cllenLs eaL whaL Lhe hosplLal glven and wlLh 1 glass
of mllk every afLer meal
23 L||m|nat|on atterns
1he cllenL usually defecaLes 12 Llmes a day durlng anyLlme of
Lhe day urlnaLes ln hls dlaper uurlng conflnemenL Lhe cllenL
defecaLes more Lhan 3 Llmes a day and urlnaLes ln dlaper
24 Act|v|ty and Lxerc|se atterns
CllenL ls acLlve before experlenclng hls lllness Pe en[oy every
Llme hls broLhers are Lhere aL home Lo play wlLh hlm uurlng
conflnemenL cllenL sLays aL hls crlb lylng down someLlmes
carrled by hls moLher Lo sLop from crylng
2S S|eep and kest atterns
1he cllenL sleep around 7 or 8 ln Lhe evenlng undlsLurbed sleep
durlng nlghL Llme and wakes up aL 7 am have a nap durlng for 1
3 hours ln Lhe mornlng and afLernoon uurlng conflnemenL Lhe
cllenL was able Lo have Lhe same sleeplng hours dlsLurbed sleep
for sLaff's monlLorlng and lack of venLllaLlon 1akes a nap buL noL
able Lo have lL enough because of poor venLllaLlon
26 Sexua||ty
n/A
27 ko|es ke|at|onsh|p and Se|f Concept
1he cllenL have slbllngs buL only 2 of hls slbllngs are
sLaylng aL Lhelr home of hls slsLers are llvlng ln Lhe
monasLery wlLh Lhe nuns due Lo parenLs lnablllLy Lo fed
Lhem 3 Llmes a day and cause Lhem Lo be
malnourlshed MoLher verballzes LhaL maghagwa
hagwa slla sa lyang mga kuya labl na ug walay clase"
28 ersona| nab|ts
MoLher sLaLe LhaL her husband ls a Lrlslkad drlver and havlng Lhls
bad hablL llke smoklng drlnklng alcohol and use of lllegal drugs
Pe smokes usually 1pack of clgareLLe a day and drlnks alcohol
frequenLly and use of lllegal drugs MoLher ls a housewlfe Lakes
care of Lhelr baby
29 Stress and Cop|ng
1he chlld usually has LanLrums when one of hls needs ls noL meL
Pe crles when hls moLher lefL hlm or puL hlm ln Lhe crlb MoLher
usually carry hlm ouL and Lake a small walk and play wlLh hlm
#YS!CAL ASSESSNENT
Genera| survey Lxamlned paLlenL lylng on bed awake
and consclous no lvl wlLh Lhe followlng vlLal slgns 1
3C 11bpm 83cpm 1he paLlenL and SC
exhlblLed frlendly aLLlLude and very cooperaLlve
behavlor durlng lnLervlew
SkIN dark spoLs all over hls skln are noLed oor skln
Lurgor dry
NAILS long and uncuL nalls C81 reLurns wlLhln 23
seconds
nAIk dry unkepL Lhln and black
nLAD leslons noLed
LLS pale con[uncLlva
LAkS cerumen noLed
NCSL wlLh waLery mucus secreLlons noLed
SINUSLS no abnormallLles noLed
MCU1n dry and pale llps noLed
NLCk AND LMn NCDLS no abnormallLles noLed
CnLS1] 1nCkAk barrel chesL noLed and crackles ls
heard all over her lungs
nLAk1 hearL sounds lubdub noLed wlLh hearL raLe of
1 rhyLhm ls regular and perlpheral pulse noLed
MUSCULCSkLLL1AL malnourlsh and Lhln ln shape
A8DCMLN dlsLended and rlgld
DD
l 10 yo l 10 yo
l 3 yo l 3 yo
l 7 yo l 7 yo
l 8 yo l 8 yo
M 9
yo
M 9
yo
M 3
yo
M 3
yo
18
mos
18
mos
MoLher MoLher
laLher laLher
SlsLer SlsLer
roLher roLher
cllenL cllenL
PearL
dlsease
PearL
dlsease
ulabeLes ulabeLes
DD
Diagnostic and Diagnostic and
Laboratory Test Laboratory Test
September 11, 2011
W Ieca|ys|s normal range no ova and paraslLe
W Ur|na|ys|s normal range
W nemato|ogy
CCMLL1L 8LCCD CCUN1
1est Norma|
Va|ues
at|ent's
kesu|t
Interpretat|on
Pemoglobln 1 year
11010
83 g/
1he paLlenL's hemoglobln level ls below Lhe
normal range whlch ls lndlcaLlve LhaL Lhe
paLlenL's blood ls noL an effecLlve oxygen
carrler ow amounL of hemoglobln ln blood
lowers Lhe synLhesls of eryLhropoleLln whlch
ls needed Lo sLlmulaLe Lhe red bone marrow
Lo produce red blood cells
1est Norma| va|ues at|ent's
resu|t
|nterpretat|on
PemaLocrlL 1 year
027 0
023 g/ PemaLocrlL values decrease when
Lhe slze or number of red cells
decrease 1hls ls mosL common ln
anemla buL oLher condlLlons have
slmllar effecLs damaged cells due
Lo a mechanlcal hearL valve llver
dlsease and cancers affecLlng Lhe
bone marrow PemaLocrlL reflecLs
Lhe raLlo of packed 8C volume Lo
full blood 1he hemaLocrlL of my
paLlenL ls lower LhaL slgnlfles LhaL
Lhe raLlo of packed 8C volume Lo
full blood ls low
C D!FFERENT!AL COUNT
1est Norma| va|ues at|ents resu|ts Interpretat|on
SegmenLer's 03100 070 lncrease ls Lhe presence of more
maLure as seen wlLh llver dlsease and
pernlclous anemla
ymphocyLes 0009 030
uecrease ls rlsk of lnfecLlon lack of
anLlbodles responslble for desLroylng
mlcroorganlsms conLrlbuLes Lo allerglc
reacLlons and regulaLlon of Lhe
lmmune sysLem
"0tober 3, 2011
W Ieca|ys|s normal range no ova and paraslLe
W Ur|na|ys|s normal range
W nemato|ogy
CCMLL1L 8LCCD CCUN1
1est Norma| va|ues at|ent's resu|t Interpretat|on
Pemoglobln 1 year
11010
9 g/ 1he paLlenL's hemoglobln level ls
below Lhe normal range whlch ls
lndlcaLlve LhaL Lhe paLlenL's blood ls
noL an effecLlve oxygen carrler ow
amounL of hemoglobln ln blood
lowers Lhe synLhesls of
eryLhropoleLln whlch ls needed Lo
sLlmulaLe Lhe red bone marrow Lo
produce red blood cells
PemaLocrlL 1 year
027 0
029 g/ normal range
C D!FFERENT!AL COUNT
1est Norma| va|ues at|ent's resu|t Interpretat|on
SegmenLer's 03100 03 normal range
ymphocyLes 0009 01 normal range
Anatomy S #ysiology
#atopysiology
W kefer to word f||e
D!SCARCE #LAN
W A case of u 1 year and monLhs old male
8oman CaLhollc from Alaska Mamballng Cebu
ClLy was admlLLed ln Cebu ClLy Medlcal CenLer
PosplLal lasL SepLember 23 2011 wlLh chlef
complalnLs of osL owel MovemenL aLlenL
was dlscharge Pome AgalnsL Medlcal
AsslsLance due Lo flnanclal problem lasL
SepLember 7 2011
Nedi0.tions
W lnsLrucL moLher Lo admlnlsLer Lo Lake all Lhe
prescrlbed medlcaLlons as ordered by Lhe physlclan
ln charge
W vlLamln A 200 mg Cu
W lollc Acld 300 mg Cu
W araceLamol 73 mg 8n
Environment
W Advlse paLlenL Lo keep clean dusLfree
safe and hazard free envlronmenL
Tre.tment
W lnsLrucL paLlenL Lo have a followup checkup afLer
one week (CcLober 7 2011) ln CuLaLlenL
ueparLmenL Lo monlLor healLh sLaLus
e.3th Te.0hings
W Advlse moLher Lo rellglously admlnlsLer her chlld's
medlcaLlons
W Advlse moLher Lo lncrease oral fluld lnLake of her
chlld
W Advlse moLher Lo pracLlce proper hand washlng
and good sanlLaLlon