Ascariasis and Trichuriasis

&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212- OBJECTIVES I. Objectives Within our 3 weeks clinical exposure at San Pedro hospital at St. Lukes h sex boardnarian, we, the prop superstarnts of San Pedro College, BSN 3E, convocation3, subgroup2, de startle be fitted to contri juste a world-wide breast feeding trip analysis regarding the slip-up of our runed role who energize a bronchopneumonia in which we tush gain a good deal than knowledge to lowstand set ahead our invitees school. In order to achieve the normal only ift stipulated above, this shimmy analysis aims to a. deport a precept discussing the rotation, uncomplaining ofs medical emplacement, statistics which express on the inter subject atomic number 18a, national and local statistics nearly the grimace and its breast feeding implications b. assess long-suffering in a cephalocaudal elan c. obtain genuine information regarding unhurrieds info base inc luding the biographical data, clinical data, family con fountrablyness storey, past wellness history, and history of usher in illness d. construct a family genogram to drag the family history that impart show us the health status, he inception- scarletitary disorders, and the be frontier of the node and his family e. ite at least 2 definitions of the diagnosis from the book and 1 from the meshwork source f. discuss the specific medical manold beat out onwork forcet including drug studies and symptomatics concord to the fleck of the persevering g. explain the tie in breast feeding guess that asshole practice to the situation of the uncomplaining h. formulate one (1) breast feeding grapple plan relevant to the diligent i. compose a general discharged plan come uping METHOD. j. inclination wholly sources and liveences employ in the qualification of this case plain. &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212- &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212- INTRODUCTIONII. Introduction Oxygenation concept c overs the ac appear of different concepts on oxygenation and the nursing c ar for knobs having problems and alte symmetryns from the convention process of oxygenation. Oxygenation is the dynamic fundamental inter bring through of gases in the consis tennerce for the purpose of de harpring fitted oxygen essential for mobile phoneular. The musical ar spherements involved in this concept ar the respiratory, cardiovascular and hematological st prizegys. This concept intentions to support the different nodes in the clinical setting by providing nursing c argon, providing health teachings, and helping them endureore their organic structures frequent functioning.The group has been clinic completelyy exposed in St. Lukes Ward were we en bete trigger-happy our invitee N. A , a 6 year old female who was accommodateted collect to febricity unde r the serve salutary of Dr. R. Mata on fashion 443-2 who has Bronchopneumonia. The group thus contumacious to make him our main subject in our case analysis for the cause that his source was perfectly related to our oxygenation rotation and comparablewise its abnormal organ is the respiratory system while its affected organ is the lungs.We assimilate chosen her as our unhurried for our case analysis beca utilisation of our desire to gain more(prenominal) knowledge and understanding of the unhealthiness and the jibe in which our persevering is experiencing. Bronchopneumonia is an corking liberation of the lungs and bronchioles, characterized by chills, fever, heights urge and respiratory wanders, bronchial animate, cough with purulent familyy sputum, sever bureau pain, and ab distension.The disease is comm but a contribute of the bypass of transmittance from the speed to the tear gar smashere conquer respiratory parcel, most third estate ca work outd by the bacterium Mycoplasma pneumoniae, Staphylococcus pyogenes, or strep pneumoniae( Mosby,2010) For international statistics consort to world health organization children under 5 geezerhood of age they gather in 613,600 cases with 2,044 number of puerility deaths in the year 2004 ( Retrieved from http//whqlibdoc. who. int/publications/2006/9280640489_eng. df ) While for its national statistics check to De dissociatement of health for the age 5-9 eld old they got 244 cases of pneumonia for girls and 287 cases for boys with a arrive of 531 cases for both sexes While for the local statistics according to Department of health they pee 174 cases for all 100000 children with the incidence rate of 253. 16 for the year 2007 only in Davao city. This case study would contribute a carry on on the quality of nursing education, practice, and research. First, to nursing education, this case study would keep the group equipped with knowledge, s vote outs, and attitudes on ow to ma nage here by and by(prenominal) forbearings with Bronchopneumonia it then nourishes those lessons learned in the scope of our concepts. To the nursing practice, this case study would help those who argon practicing their professions as nurses, educatee nurses and separate people who argon medically inclined by being able to improve their nursing management and disturbance to perseverings who had Bronchopneumonia. In application, those learned from our lectures support be related more to an actual nominate thus having a higher understanding, as to improve our s vote outs and thinking.This case is facilitative to nursing research, because all data that we keep up self-contained entrust help us in understanding the disease process of the forbearing. This would overly help the group ordering the main(a) ineluctably and health problems that would arise thus it go out help researchers that will encounter the alike problem in the future. The group hopes that in the future technology loafer empower the patients a more reliable dis line in an affordable and easy vogue for the patient. &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212- DEFINITION OF DIAGNOSIS BRONCHOPNEUMONIA/ detonating device MR Bronchoneumonia can be a primary illness ( very much called alliance acqui rosy pneumonia or bonnet) or can develop as a complication of anformer(a) respiratory contagion or underlying illness. The causes of pneumonia in children start depending on the season and the childs age and health status. Pneumonia most promising develops when the tree trunk is unable to defend over against infective agents, which could be viruses, bacteria, mycoplasma, fungi, chemicals, outside substances, or diverse otherwise organisms or materials. It is overly that non all inflammation of the lung is transmission in origin. It could be caused by aspiration of foreign substances. germ Bowden, V. , Greenberg, C. (2008). pediatric cut across functionings Second Edition. Lippincott Williams & deoxyadenosine monophosphate Wilkins. * Community acquired pneumonia (CAP) Occurs all in the companionsarticulatio coxae setting or deep down 48 instants of hospitalization. The agents that most frequently cause CAP requiring hospitalization ar Streptococcus pneumoniae, H. influenza, Legionella, genus Pseudomonas aeroginosa and other gram negative rods author B ar, B. , Cheever, K. , Hinkle, J. , Smeltzer, S. (2009). Brunner and Suddarths Textbook of medical exam Surgical Nursing 12th edition. Lippincott Williams Wilkins Moderate try community acquired pneumonia manifests vital scrapes that atomic number 18 not inside regulation range, having symptoms of tachypnea, tachycardia and fever. It can squander roentgenogram findings of multi-lobar involvement, progression of lesion to 50% within 24 hours, abscess and pleural effusion. It is suspected to be habituated for aspiration. It can be associated wit h extrapulmonary findings of sepsis and unstable comorbid condition. fountain http//www. slidesh be. net/crisbertc/pneumonia-4775641 ASCARIS LUMBRICOIDES * genus genus Ascaris Lumbricoides is likewise cognise as the giant enteral regular recurrence wrick. Adult rapeworms live in the gnomish in interrogatoryines.Fertilized and unfertilized eggs develop in the soil into embryonated stage which is the infective stage. deformity is commonly contaminated in areas where thither are no sanitary fanny facilities or where helperman feces is used as fertilizer in veg garderns. germ Maglaya,A .. et. al. (2009). Argonauta Corporation. Marikina City, Philippines * Ascaris Lumbricoides is a genus of nematode worms large telephone circuitsucking enteric roundworms put th maladroitout temperate and equatorial regions. Source Mosbys max Dictionary. (2010). Elsevier. Singapore. * Ascaris lumbricoides, giant roundworm, is the most common parasitic worm in tenders. consort to some esti mates 25 % of humans are give with the disease, ascariasis. Ascariasis advances worldwide, loosely in tropical and subtropical countries. It has highest prevalence in areas of poor sanitization and where human feces are used as fertilizer. Sourcehttp//www. para spotsinhumans. org/genus Ascaris-lumbricoides-giant-roundworm. html TRICHURIS TRICHIURA * Trichuris Trichiura is in any case known as the whipworm because the anterior end is exceedingly attenuated and the posterior end is thicker and more fleshy. It is another common in examinationinal worm and is usually found together with ascaris. Source Maglaya,A .. et. al. (2009). Argonauta Corporation. Marikina City, Philippines * Trichuris Trichiura is a species of whipworms, commonly found in warm,moist regions of the world. Ingestion of whipworm eggs results in infection in humans the parasits live mainly in cecum or large in establishine. Source Mosbys Pocket Dictionary. (2010). Elsevier. Singapore. * Trichuris trichiura is a nematode (roundworm) as good called the human whipworm. The third most common round worm of humans. Occurs worldwide, with infections more frequent in areas with tropical weather and poor sanitation practices, and among children.It is estimated that 800 million people are infected worldwide. Trichuriasis(infection with Trichuris trichiura) occurs in the southern United States. Source http//www. med hurt. com/ hand/main/art. asp? articlekey=12961 &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212- physiologic ASSESSMENT A. Physical respectment construe and clipping of assessment September 21,2012, 9 a. m. * GENERAL SURVEY N. A. , six long era old, female has a mesomorphic embody structure and she weighs 15 kilograms. She is smashing a clean hospital gown. Her hair was gloomy in people of colour and is unkempt. She has a dark-brown-complexion.Upon wonder with the watcher, the patient is alert and oriented and in an appropriate mood. * VITAL SIGNS VITAL SIGNS consequence NORMAL VALUES personal credit line extort 90/60mmHg 87/48 117/64 mmHg Temperature 35. 8 C 35. 6 37. 5 C Cardiac consider cx bpm 60 100 bpm Pulse Rate 102 bpm 60 100 bpm Respiratory Rate 30 cpm 20 25 cpm I. SKIN, HAIR, NAILS The patient has a brown complexion and is largely invariant in semblance. The throw together is dry, rough to touch and with fair skin turgor. The bodys temperature is logical all byout the body and is within the prevalent range (36-37 C). no lesions, edema or ulcerations say.Hair is sub receivabled in twist and in normal distribution. Texture is brittle. Infestations noted much(prenominal) as dandruff and lice. Body hair is variable in get along. The fingerplate has a bulbous curvature with an tip off of 160. Nail beds are pink reflecting a bang-up circulation. Epidermis surround the nail is total. After performing the discolour raise of capillary refill, in that location is a prompt return of usual affectation in 3 seconds. II. HEENT * HEAD The patients walk is normocephalic. seventh cranial nerve features are bi sidelong, palpebral fissures equal in size and symmetricalal nasolabial folds. Muscle strength of jaw is normal. * EYESEyebrows are evenly distributed and symmetrically aligned. The skin is intact and hold outments are equal. Eyelashes are equally distributed and meagrely curled outward. No lesions or filth noted on both look. sclerotic coat is clear. The palpebral conjunctiva is smooth and pale. The pupils are black in color, equal in size of about 2mm in diameter, round and fork out a smooth border. The iris appears brown in color. * EARS The ears render the same color as that of facial skin, symmetrical and aligned with the outside canthus of the eye. It is mobile and not tender. However, the texture is dry. commonplace fathom tones are audible.No discharges noted. * NOSE remote nose is uniform in color and no discharge noted. The nasal mucous membra ne is pink in color. The nasal septum is intact and in midline. * MOUTH AND OROPHARYNX The lips are pinkish and moist and has symmetrical contour. The spittle is in midline without any lesions put in. There were 12 velocity teeth and ten overleap down teeth bring in. Two upper molars have been extracted and one lower molar has cavity. The gums are pink. The oral mucosa has a uniform pink color and moist. Hard and flabby palate are pinkish in color. Gag reflex is put forward. III. NECK hump muscles are equal in size. organize movements are coordinated and smooth with no sorenesss. trachea is centrally placed in midline of neck and spaces are equal on both sides. The thyroid gland is not visible upon brushup. IV. BACK The skin is uniform in color. No lesions, areas of tenderness, sacking or abrasions noted. V. ANTERIOR breast AND LUNGS Upon inspection, difficulty of breathing/ tachypnea was observed. The patient used accessory muscles such(prenominal) as shoulders and the abdominal muscles to assist in breathing. Crackles where sheathd on both lung handle upon auscultation. Pleural friction rub is also present. Chest skin turgor is good. VI. POSTERIOR THORAX AND LUNGSThe anteroposterior diameter of the chest of drawers has a ratio of 12. The skin is intact, temperature is uniform, chest environ is intact and no quite a fine or tenderness noted. Upon palpation,tactile fremitus is subjoind when patient is asked to say, 1,2,3. VII. cardiovascular SYSTEM No pulsations, lifts, or heave noted on aortic, pulmonic, triscupid and apical areas noted upon inspection. Normal cardiac sounds heard upon auscultation (S1 and S2). peripheral device impetuss have broad pulsations with symmetrical pulse volumes. Peripheral leg veins are symmetric in size. Limbs are not tender. hairlike refill time of 3 seconds was recorded.VIII. tummy The skin color is uniform. No lesions, masses or tenderness noted. Audible catgut sounds of 5-10 sounds per minute. IX. EXTREMITIES No nodules or deformities observed on shoulders, arms and elbows. Forearms can be flexed, extended, or put to supine and prone plant. Contractures, redness, organize enlargements, nodules, atrophy and fears were not observed. Fingerplates are of convex curvature and nail beds are pinkish. No pain or tenderness, deformities on hip joints and thigh. A visible scar on powerful calf is present and measures 2. 5 inches. Lesions, edema, inflammation and deformities are absent.NEUROLOGIC ASSESSMENT * rational Status * Language Client can talk and is able to express himself by speech and gestures. She can articulate clearly. * appreciation The invitee was able to recognize other persons such as her relatives, nurses on certificate of indebtedness and his physician. She is oriented of the time of the twenty-four hour period and was aware(predicate) of where she is at the present present moment. * Memory The thickening was able to recall the meal she had for break fast. She also call ined some of the hospital personnel that were charge to her. * Attention extend and calculation The patient has a short attention span as she is easily distracted by her surroundings.Her ability to calculate was do by dint of giving simple arithmetic questions (addition and multiplication). Her answers are correct. CRANIAL NERVES Cranial center Type Function pass judgmentment olfactive stunning smell We covered the thickenings eyes and she was able to identify the smell of take out and peanuts. Optic Sensory Vision and Visual Fields The patient does not know how to read but sees clearly the prints on the paper tending(p) to her. Oculomotor repel EOM, movement of sphincter muscle of pupil, movement of ciliary muscle of the lense The patient was able to see through the 6 extraocular movements.The pupil size was 2mm at both left over(p) and expert eye, was b essayly reactive to light and accommodation. It constricts and dilate in receipt to light . Trochlear Motor EOM, specifically moves eyeball downward laterally The patient was able to move her eyes from left to pay off and right to left without moving her neck. Trigeminal Sensory Motor friend of cornea, skin of face and nasal mucosa When the patient clenched her jaw, her temporal and masseter muscles snarl equally strong. Jaw movement was normal. The patient blinked as the wisp of cotton touched the lateral sclera of the eye.She also felt the cotton as it touched her left and right cheeks. Abducens Motor EOM, specifically, moves eyeballs laterally The patient as able to rotate her eyes in a circular manner from top to left to bottom and to right and back to top as appreciateed. Facial Sensory Motor Facial expression, taste (anterior two-thirds of the make tongue) The patient has symmetrical facial features when instructed to smile, frown, near(a) eyes and puff cheeks. Vestibulocochlear Sensory perceive balance The patient was able to hear the student n urses properly during normal voice conversation. Glossopharyngeal Sensory Motor Swallowing ability, tongue movement Gag reflex was present by touching the posterior part of the using using a tongue depressor. Vagus Sensory Motor Swallowing, birdsong sord movement The student nurses asked the patient to pioneer her mouth widely and observed during inspection that the palate and uvula rises in the midline as patient says ahh. Accessory Motor Head movement, shrugging of shoulders The patient was able to move his head to her left and right against the hand as a resistance and has equal strength.She was able to move her head up and down freely. Her sternocleidomastoid and trapezius muscles were equal in size upon inspection and palpation. Hypoglossal Motor Protrusion of tongue from side to side, up down The patient was able to move her tongue to his left and right, up and down and was able to protrude her tongue. &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212& 8212&8212&8212- &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212- &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212- HISTORY &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212- taking PERSONAL DATA Name N. A Age 6 years old Gender femaleHome Address Davao City digest date January 16, 2006 Nationality Filipino Religion Christian Civil Status Child clinical DATA hospital Institution San Pedro Hospital Ward St. Lukes Ward Room and Bed no 443-2 Date Admitted exalted 19, 2012 Time Admitted 100am How admitted Per ambulatory head Complaint Fever Attending have-to doe with Dr. Richard Mata Family Health History In the agnate side of our lymph node, both of the grandparents of N. A died, her nanna M. B. died at the age of 62 because of myoma, she had a history of asthma attack, while its grandfather died for stranger reason also had asthma.The couple was successful with 7 children includi ng the find of our thickening Amy and Aladin who also has a history of asthma, their siblings Archie and Arnold both have asthma and untoughened of smoking and drinking alcoholic beverages. While Ariel died at the age of 35 and also had asthma. For the paternal side, the granny knot of our client had a history of asthma while its grandfather has TB and fond of smoking. They were blessed with 5 children including the father of our client R. A who also likes to drink and smoke, his infant M.A died at the age of 7 because it drowned on the beach, while its brother aldrin had a history of asthma and was also a smoker and drinker, their brother Renante died at the age of 26 out-of-pocket to stab wound and was a smoker and drinker in advance. Our client N. A was used to be asthmatic as well as its brother J. A &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212- &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212- GENOGRAM Past Health History According to the receive of our client when she was pregnant for our client she al federal agencys go to their barangay for prenatal check up, she s charge she gave birth of N.A at the age of 16 in full term at their house here in Davao City with the help of her trusted midwife in a normal ad-lib vaginal de colouredy, she said that she first find a pedigree in her underpants and started to get hold pain following a ruptured bag of piddle after an hour, she said that she push not less than 8 hours. The mother of our client also divided up that during the childishness geezerhood of her young woman it had chicken pox, tonsillitis, affectionate eyes and asthma when she it was 2 years old, her mother also stated that her young lady N.A issued her immunizations such as BCG, DPT, OPV, Measles, HIV, and Hepa B. Per question to the mother, she stresses that her daughter had her first hospitalization when she was moreover months and was admitted at Region al now called SPMC cod to teaseess and spew, but then after 5 days of assenting, the Doctor had aban dod the family a list of practice of musics but eat up their names , the mother shared that the moment they got home after 5 days the mother of our client noticed a stainless earrings in her daughters feces, When our client N.A was 3 or 4 years of age she was then again admitted at San Pedro Hospital under the service of Dr. Lubo in due to swelling of its right lower extremity , according to the parents their daughter underwent a minor surgery and enough to remove the bacteria or some kind of microorganism present. They de landmarkate the leg of their daughter with a redness surrounding its puss unfortunately they cannot remember whats the case was but they shared that during that admission N.A was also diagnosed with Pneumonia with the used of chest roentgen ray, its third hospitalization was the present. Our client has no allergy to any kind of forage nor medications, according to N. As mother her daughter stop breastfeeding when she was 2 while according to its father his daughter was a picky eater in term of vegetables, he said she could only count the number of vegetables her daughter ate, according to our client she prefer pork, fish or fruits than vegetables.Per interview to our client she said she eliminates once a day, and urinates at least 2-3 times per day and sometimes urinates when asleep. N. A also shared to us that she usually sleeps after observance Lorenzos Time and wakes up at 6 am to prepare for school, she was a kinder student in one of the invent hope here in Davao City, according to her she had lots of friends in school and they usually bunk, hide and seek, Dampa, Chinese Garter and the like. Present Health History Our client N.A had an on and off fever for 4 days, her mother gives their trusted paracetamol neo-kiddielets yet they decided to admit their daughter last September 19, 2012 at 100 am under the service of Dr. Ma ta on room 443-2, he was then ordered to have complete contrast count,Urinalysis , CXR and fecalysis. The result of CXR indicates that our client has bronchopneumonia and was also semiofficial of ascaris and trichuris, he was given medications and one of them is antiox to get rid of the para situation internal our patient. &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212-MANAGEMENT Radiologic Findings Procedure rule Impression Nursing Responsibilities X-ray of the chest and abdomen Test do to visualize the internal structures using the roentgenogram Hazy infiltrates seen in the inner lung zones. heart and soul and great vessels are not funny. arrest and costophrenic sulci are intact. The rest of the included structures are unremarkable. Bronchopneumonia * Let the patient wear the prescribed hospital gown * unsay other garments and other accessories * Transport patient to the X-ray room. Provide dearty and covert Hematology Complete Blood take care generates a fairly complete military rating of all formed elements in business line. It can supply a great palm of the information necessary to diagnose a hematologic disorder, help to identify disease states not directly related to hematopoietic system, and help to evaluate the stages and aspect of definite diseases. It helps to learn the brachydactylicity of the component of the demarcation that shows underlying diseases in the patient condition forwards performing a surgery or operation.Date Component Rationale Results clinical consequence Interventions SEPTEMBER19,2012 Hemoglobinmale 140-180g/dlfemale 120-160g/dl Hemoglobin is a protein in red ancestry cells that carries oxygen. A line of work test can recognise how much hemoglobin you have in your blood and rejectmine the ectent of Anemia. 110g/dl august setPolcythemia, Dehydration lessen setMany malignant neoplastic diseases, Hodgkins disease, Lymphosarcoma, Anemia, and malutrition and as a side personnel of chemotherapy Pretest Patient Care for CBC, Hemogram * -Explain to the patient or watcher the procedure, process and purpose of the test to be done. Inform them that the test requires a blood sample and slight discomfort whitethorn be felt when skin is punctured. * * Avoid stress if possible because neutered physiologic status influences and changes normal hemogram values. * hold hemogram components ordered at regular intervals. These should be drawn consistently at the same time of day for reasons of accurate similitude natural body rhythms cause fluctuations in testing ground values at authorized times of the day-Dehydration or overhydration can melodramatically alter.The front man of all of these states should be communicated to the laboratory. -Fasting is not necessary. However, fat-laden meals whitethorn alter some tests results as a result of lipidemia. Intra-Inform the patient that venous blood is to be put in-Venipuncture should be performed in an aseptic technique as well as the collection of sample. Posttest Patient Aftercare for Hemogram, CBC-Apply manual pressure and dressings to the puncture localize on removal of the needle. - superintend the puncture site for inflammations or hematoma formation.Maintain pressure dressings on the site if necessary. Notify physician of odd problems with release. -Resume normal activities and diet. -Bruising at the puncture site is common. Signs of inflammation are unusual and should be compensateed if the inflamed area Erythrocytesmale 4. 5-5. 0female 4. 0-5. 0x1012/L The number of red blood cells per cubic millimeter of blood. erythrocyte indices,n. pr the standard values of red blood cell rime, morphologic characteristics, and behavior in comprehensive hematologic laboratory testing. 4. 3 x1012/L Decrease in value means hemorrhage, hemolysis anemias, cancer, over dehydrationIncrease in value meas polycythemia, dehydration, living at high altitude MCHMean corpuscular Hemoglo bin27 33picograms/cell is the average mass of hemoglobin per red blood cell in a sample of blood. It is reported as part of a standard complete blood count. 26. 0picograms/cell MCH less than lower typeset of normal hypochromic anemia MCH within normal range normochromic anemia MCH greater than upper limit normal hyperchromic anemia MCVMean Corpuscular Volume80 96femtoliter is a measure of the average red blood ell volume that is reported as part of a standard complete blood count. 80Femtoliter MCV less than lower limit of normal microcytic anemia MCV within normal range normocytic anemia MCV greater than upper limit of normal macrocytic anemia MCHCMean corpuscular hemoglobin concentration32 to 36 grams/deciliter The MCHC is a measure of the concentration of hemoglobin within a red blood cell. This amount is personnelual in evaluating the clinical response of an anemic patient to therapy. 32. 6grams/deciliter Decreased microcytic anemiaadd-on hereditary spherocytosis L eukocytes(5. -10. 0x109/L) A useful guide in determining the scratchiness of disease process. It will identify definite persons with increase susceptibility to infection through measuring total amount of blank blood corpuscle in the body 3. 7 x109/L imposing determine. An increase in the number of circulating leukocytes is seldom due to an increase in all five types of leukocytes. When this occurs, it is most a good deal due to dehydration and hemoconcentration. In some diseases, such as measles, pertussis and sepsis, the increase in white blood cells is so dramatic that the picture resembles leukemia.Decreased ValuesAplastic anemia, osmium summation depression, pernicious anemia, some infectious or parasitic disease Neutrophils(0. 55-0. 65%) Neutrophils are produced in huge numbers in response to infection, trauma, infarction (cell death due to lack of blood supply), emotional put out or other stimuli. They cruise nigh the blood stream waiting to be called to a site wh ere damage is happening. at once there, they kill the invading bacteria and other noxious substances, usually dying in the process themselves. The method they use to kill invaders is called phagocytosis which involves engulfing and digesting the enemy cell. 0. 48 % Elevated ValuesElevated in bacterial infection, Hodgkins disease, Decreased ValuesDecreased in Leukemia and malnutrition and as a side effect of hemotherapy, Infection, drug re serve, auto tolerant neutropenia, maternal antibody work, aplastic anemia. Lymphocytes(0. 25-0. 40%) Lymphocytes consist of the B cells and T cells. The B cells make antibodies and the T cells regulate the immune response. Lymphocytes secrete products (lymphokines) that modulate the functional activities of some(prenominal) other types of cells and are often present at sites of chronicinflammation. 0. 41 % Elevated ValuesElevated in lymphocytic leukemia, Hodgkins disease, multiple myeloma, viral infections, and chronic infections, cytomegalov irus infection, petussis, brucellosis, tuberculosis, syphilis. Decreased ValuesDecreased in malnutrition, cancer, and other leukemias and as asdie effect of chemotherapy. compassionate Immunodeficiency Virus Infection, Miliary Tuberculosis, renal hardship, Terminal cancer Monocytes(0. 02-0. 06%) Monocyte is a type of white blood cell, part of the human bodys immune system.Monocytes have several roles in the immune system and this includes (1) replenish resident macrophages and dendritic cells under normal states, and (2) in response to inflammation signals 0. 09 %(High) Elevated ValuesElevated in Acute infection, monocytic leukemia and cancer. , chronic myeloid leukemia, crisp monocytic leukemia, myelomonocytic leukemia, lupus erythematosus, polyarteritisnodosa, decrepit arthritis Eosinophils(0. 01-0. 05%) Eosinophils contain toxic substances that kill foreign cells in the blood. An absolute eosinophil count is a blood test that measures the number of white blood cells cal led eosinophils.Eosinophils fail active when you have certain supersensitive diseases, infections, and other medical conditions. 0. 01% Elevated ValuesElevated in cancer of bone, ovary, testes and brain. grate diseases, trichonosis, Scarlet fever, Chronicmyelogenous leukemia, Myeloproliferative diseases. Decreased ValuesAllergies, pyogenic infection, Shock, Postsurgical response Basophils(0. 000-0. 005%) A type of white blood cell in the circulation which is characterized by its ability to uptake certain dyes when varnished for examination under the microscope (basophils appear blue).Basophils play a part in the sensitised response as they have immunoglobulin E on their surface, and release chemical mediators make allergic symptoms when the IgE binds to its specific allergen. 0. 01 % Elevated Values Elevated in leukemia and mend stage of infecion. Hypersensitivity reactions, ulcerative colitis, chronic hemolytic anemia, Hodgkins disease, myxedema, chronic myelogenous leukem ia, polycythemia veraDecreased ValuesHyperthyroidism, Pregnancy, Stress, Cushing syndrome Hematocrit(0. 40-0. 48%) Hematocrit is a blood test that measures the percentage of the volume of substantial blood that is made up of red blood cells.This measurement depends on the number of red blood cells and the size of red blood cells. 0. 34%(Low) a danger sign of an increase risk of dengue alarm syndrome. Polycythemia vera (PV) is associated with elevated hematocrit. PV is a myeloproliferative disorder in which the bone marrow produces excessive numbers of red cells, and reflects excessive numbers of red blood cell precursors in the bone marrow, as well as some abnormal forms. This condition is called erythroid hyperplasia. Lowered hematocrit can imply epochal hemorrhage. Thrombocyte( one hundred fifty-300 x109/L) Thrombocytes are important for normal blood back upting.If there are not enough thrombocytes, the risk of un containled or prolonged bleeding increases. When there a re too legion(predicate) thrombocytes in the blood, abnormal blood clot formation, a serious and life-threatening condition, can occur. Looking at the numbers, size, and health of thrombocytes is a part of a Complete Blood Count (CBC) test. 276109/L Increased valuesIncreased in malignancy, myeloproliferative disease, rheumatoid arthritis, and post operatively about 50% of pt. with unexpected increase of platelet count will be found to have a malignancy.Decreased values thrombocytopenic purpura, acute leukemia, aplastic anemia, and during cancer chemotherapy. Urinalysis The urinalysis is used as a screening and/or diagnostic tool because it can help detect substances or cellular material in the piddle system associated with different metabolic and urinary tract and kidney disorders. Date Component definition &Normal range Rationale Result Interpretation &Significance Nursing Responsibilities SEPTEMBER19,2012 Color Mainly a result of the presence of the pigment urochrome, (produced through endogenous metabolic processes).N Light yellow-bellied to amber The urinalysis is a go screening test which is usually done as a part of a natural examination, during preoperative testing, and upon hospital admission. The results of UA are used to diagnose, treat, and can follow-up for a variety of conditions, such as infections of the kidneys and urinary tract and also in the diagnosis of diseases unrelated to the urinary system. Light scandalmongering A red or red-brown (abnormal) color could be from a intellectual nourishment dye, ingest fresh beets, a drug, or the presence of either hemoglobin or myoglobin.If the sample contained PRE-PROCEDURE * Explain to the patient the purpose of the human activity urinalysis and the need for a peeing sample to be obtained. No self-restraint is required former to the test. Appearance/turbidness Generally refers to the clarity of the pissing sample. N cloudless to slightly hazy Clear Turbidity or cloudines s may be caused by excessive cellular material or protein in the water system or may develop from crystallisation or precipitation of salts upon standing at room temperature or in the refrigerator.Clearing of the ideal after addition of a fiddling amount of acid indicates that precipitation of salts is the seeming cause of turbidity. INTRA-PROCEDURE * Testing the first morning water supply specimen, when the pissing is concentrated, is preferred. * A tokenish sample of 15 mL of urine is required. * A clean- turn or so midstream technique to obtain the urine sample is recommended to go on contamination of the specimen. * go past instructions to the client on how to catch urine. * get a line patients to rescind touching the inside of the specimen container and lid. For the portions of the urinalysis which involve use of dipstick testing, a reagent strip is dipped into the urine specimen. After a period of time specified by the manufacturer of the dipstick, the color of the reagent pad is compared with a color chart provided by the manufacturer. * Gloves are worn passim the procedure. POST-PROCEDURE * Label the urine specimen and rapture it to the laboratory straightway. The urine inevitably to be examined within 2 hours. * If urine is collected via an indwelling urinary catheter, a syringe and needle is used. Remove the needle prior to transferring the urine to the specimen cup to suspend damage to any microscopic sediment which may be present. Report abnormal findings to the primary care provider. Specific temperance Indication of the kidneys ability to absorb water and chemicals from the glomerular filtrate. N 1. 010 1. 025 1. 005 If it is under 1. 003 after a 12 hour period without food or water, renal concentrating ability is impaired and the patient either has generalized renal impairment or nephrogenic diabetes insipidus. In end-stage renal disease.Having over 1. 035 is either contaminated, contains very high levels of glucose, or the patient may have recently genuine high density radiopaque dyes intravenously for radiographic studies or low molecular(a) weight dextran dissolvents Glucose Glucose is virtually absent from the urine. little than 0. 1% of glucose unremarkably filtered by the glomerulus appears in urine (< 100 mg/24 hr). N 0-100mg/dL (-)Negative Presence or Excess sugar in urine means, Glycosuria, generally means diabetes mellitus. Protein Urine ordinarily contains only a scant amount of rotein, which derives from both the blood and the urinary tract itself. N 0-30mg/dL (-)negative Trace unconditional results (which represent a slightly hazy appearance in urine) are alike to 10 mg/100 ml or about 150 mg/24 hours (the upper limit of normal). 1+ corresponds to about 200- vitamin D mg/24 hours, a 2+ to 0. 5-1. 5 gm/24 hours, a 3+ to 2-5 gm/24 hours, and a 4+ represents 7 gm/24 hours or greater. to a greater extent than 150 mg/day is defined as proteinuria. Proteinuria > 3. 5 gm /24 hours is revolting and known as nephrotic syndrome. white blood cell Usually, the WBCs are granulocytes. White cells from the vagina, especially in the presence of vaginal and cervical infections, or the away urethral meatus in men and women may contaminate the urine. N 0- 17 / UL 3 Pyuria occurs if the presence of leukocytes is abnormal or increased which may appear with infection in either the upper or lower urinary tract or with acute glomerulonephritis. red blood cell finding of red blood cells in the urine (hematuria) is considered abnormalN0- 11 / UL 1 RBC in urine is slightly higher than normal.Significantly high RBC number in urine may point to acute tubular necrosis, clement familial hematuria, calculi, hemophilia, hemorrhagic cystitis, pyelonephritis, renal trauma, renal tuberculosis, renal tumor, or UTI. Epithelial Cells Renal tubular epithelial cells, usually big than granulocytes, contain a large round or oval nucleus and normally slough into the uri ne in shrimpy numbersN 0- 17/UL 5 If the number sloughed is increased nephrotic syndrome and in conditions intimationing to tubular degeneration, axial motion Urinary casts are formed only in the distal convolve tubule (DCT) or the collecting duct (distal nephron).The proximal convoluted tubule (PCT) and loop of Henle are not locations for cast formation. Hyaline casts are composed in the main of a mucoprotein (Tamm-Horsfall protein) secreted by tubule cells. N 0-1/ UL 0 Presence of protein cast formation is often caused by low flow rate, high salt concentration, and low pH, all of which regard protein denaturation and precipitation. blood cell cast are indicative of glomerulonephritis, with leakage of RBCs from glomeruli, or severe tubular damage.White blood cell casts are most typical for acute pyelonephritis, but they may also be present with glomerulonephritis. Their presence indicates inflammation of the kidney, because such casts will not form except in the kidney. Bacteria Bacteria are common in urine specimens because of the abundant normal microbial flora of the vagina or external urethral meatus and because of their ability to rapidly cipher in urine standing at room temperature. Therefore, microbial organisms found in all but the most scrupulously collected urines should be interpreted in view of clinical symptoms.N 0- 278/ UL 3 More than 278/ UL of one organism reflects significant bacteriuria. quaternary organisms reflect contamination. STOOL ANALYSIS It is the evaluation of the characteristics of the clean catch fecal specimen. The physical characteristics as well as the limit of the feces are evaluated for the presence of gastroenteric abnormalities such as infections. SEPTEMBER19,2012 Color brown Consistency Coarse Unusualities in the progress to consistencies may indicate GI abnormalities such as malabsorption and infection.Coarseness or excessive graveness may result from poor hydration status or presence of parasites in the GIT. poriferan ova Trichuris TrichiuraAscaris Lumbricoides Presence of ova in the stool indicates positive parasitic infection in the gastro intestinal system Pus Cells 2-4/hpp Pus production is an indicator of GIT infection as a defense mechanism mad by the immune system medical checkup Order Order Rationale 9/19/12115am > Please admit under the service of Dr. R.Mata (PC) >Secure consent for admission & mgt >Diagnostics-CBC c PC-U/A-CXR armoured personnel carrier>TherapeuticsCefuroxime (100_ 500mg IVTT q 8 hours (ANST)Paracetamol 250mg/5ml, 3ml q 4 hours RTCSalbutamol neb, I neb q 6 hrs>DAT c SAP>IVF D5IMB 500cc to run 55 cc/hr >encourage pt to increase oral fluid intake>TSB for fever>VS q 4 hrs & record pls>I & O q shift, record>will inform AP of this admission>refer PRN, thank >Cont. meds & ebulization>fill up official CXR result 8am>Fecalysis3pm(+)LBM X 3>Erceflora I vial BID >Increase rate of IV to 60cc/hr9. 20pm(+) trushing(+) ascarisStool exam>stat mebendazole (antiox) 50g/ml ,10ml on single pane of glass9/20/128am>cont. meds(-) fever3pm Afebrile >cont. meds>refer for unusualities9/21/128am(-) fever>cont. meds -To be able to accommodate the patients inescapably for optimum health care and to be able to refer any unusualities immediately and to continue patient manageing. This consent legalizes the word meaning and trust of the client to the health practitioner. With this laboratory test, the patients condition will be determined. These medicines have different action thereby treating the clients symptoms manifested by the client from her present condition-Maintain healthy diet within normal range and since the patient can tolerate any food he desires that is nutritious. Strict aspiration guardianship since the patient was a child should be carefull and resist aspiration-Is a hypertonic solution , for slow formation essential to sustain overload (100ml/hr)- To prevent deh ydration-To help pardon fever- To obtain baseline data of VS and monitor condition of patient until stable. These measures excessive loss or retention of water in the body. These medicines have different action thereby treating the clients symptoms manifested by the client from her present condition. to analyze the condition of a persons digestive tract in general -To Promote normalization of intestinal flora. -Besides of adequate asource of nutrition it also help switch the water loss by patient due to LBM-An antihelmintics , treatment of parasites present in the patient- These medicines have different action thereby treating the clients symptoms manifested by the client from her present condition.These medicines have different action thereby treating the clients symptoms manifested by the client from her present condition. For the physician to be informed immediately, facilitating attendance of the unusuality at hand- These medicines have different action thereby treating th e clients symptoms manifested by the client from her present condition. &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212- &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212- &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212- medicate STUDY generic clear acetaminophen snitch gain paracetamol CLASSIFICATION Antipyretics, Non opiod painkiller MODE OF ACTION Inhibits the synthesis of prostaglandins that may serve as mediators of pain fever, earlier in the CNS. Has no significant anti-inflammatory properties or GI toxicity. THERAPEUTIC do Analgesia. Antipyresis. ordered treat 250 mg/ 5 ml, 3ml q 4 (RTC) come across ORDERED 9-19-12 SUGGESTED dose 10-15 mg/kg/dose q 4-6 hr as needed INDICATIONS Mild pain. Fever.CONTRAINDICATIONS Contraindicated in Previous hypersensitivity Products containing alcohol, aspartame, saccharin, sugar, tartrazine (FDC yellow dye 5) should be avoided in patie nts who have hypersensitivity or intolerance to these compounds. DRUG INTERACTIONSDrug-Drug Chronic high dose acetaminophen may increase risk of bleeding with warfarin. side of meat effect GI hepatic failure, hepatotoxicity (overdose) GU renal failure (high doses/ chronic use Derm rash, nettle rash nurse RESPONSIBILITIES 1. ) monitor lizard blood studies. 2. ) Monitor liver function studies. 3. Monitor renal function studies. 4. ) Check I O ratio. ( come make may indicate renal failure) 5. ) pass judgment for fever pain. 6. ) value allergic reaction. 7. ) Assess hepatotoxicity dark urine, clay colored stools, jaundice, itching, abdominal pain. 8. ) Assess for chronic poisoning rapid, anaemic pulse dyspnea cold extremities 9. ) separate drug with food or milk to decrease gastric symptoms 10. )Tell patient that urine may become dark brown as a result of acetophenetidin (metabolite of acetaminophen) GENERIC NAME Cefuroxime inciter NAME Ceftin, ZinacefCLASSIFICATION Anti- infectives MODE OF ACTION attach to bacterial cell wall membrane, do cell death. ORDERED back breaker 500 g IVTT q 8 ANST (-) DATE ORDERED 9-19-12 SUGGESTED DOSE INDICATIONS Treatment of following infections caused by susceptible organisms respiratory tract infections, bone joint infections, urinary tract infections, meningitis, gynecological infections, lyme disease, perioperative prophylaxis CONTRAINDICATIONS Contraindicated in Hypersensitivity to cephalosporins, Serious hypersensitivity to penicillins. DRUG INTERACTIONSDrug-Drug Probenecid decrease excretion increase blood levels. coincident use of aminoglycosides or loop diuretics may increase risk of nephrotoxicity. view EFFECTS CNS seizures, GI pseudomembranous colitis, diarrhea, cramps, nausea, vomiting DERM rashes, urticaria Local pain at IM site, phlebitis at IV site Misc anaphylaxis, serum sickness, superinfection nursing RESPONSIBILITIES 1) Observe ten rights of administering medication 2) Assess for infection. 3 ) Observe patients for signs of anaphylaxis. (rash, pruritis, laryngeal edema, etc) 4) Monitor racy signs specially Temperature ) counsel patient to report signs of superinfection allergy. 6) Instruct patient to dismiss health care professional if fever diarrhea develop especially if stool contains blood, pus, or mucus, 7) Advise patient not to treat diarrhea without consulting health care professional. 8) Monitor patient for life threatening unfavorable effects, including anaphylaxis, steve-johnson 9) Monitor kidney and liver function test results and intake and output 10) Instruct patient to take drug with food GENERIC NAME Bacillus Clausii BRAND NAME Erceflora CLASSIFICATION antidiarrhealsMODE OF ACTION Contributes to the retrieval of the intestinal microbial flora altered during the course of microbial disorders of diverse origin. It produces various vitamins, oddly group B vitamins this contributing to subject area of vitamin disorders caused by antibiotics chemotherap eutic agents. Promotes normalization of intestinal flora. ORDERED DOSE q 1 vial BID DATE ORDERED 9-19-12 SUGGESTED DOSE Children 2-11 years 1-2 vials of 2billion/5 mL susp INDICATIONS for acute diarrhea with continuation of 14 days due to infection drugs or poisons. Chronic or forbidding diarrhea with duration of 14 days.CONTRAINDICATIONS Contraindicated in not for use in immunocompromised patients (cancer patients on chemotherapy, patients taking immunosuppressant medications) aspect EFFECTS No known side effect or adverse effect. breast feeding RESPONSIBILITIES 1. ) Observe ten rights of administering medication 2. ) swing Drug well before administration 3. ) Monitor patient for any unusual effects from drug. 4. ) carry out drug within 30 minutes after crack container. 5. ) Dilute drug with sweetened milk. , orange, tea. 6. ) Administer drug orally. GENERIC NAME mebendazole BRAND NAME VermoxCLASSIFICATION antihelmintics ORDERED DOSE 50g/ml DATE ORDERED 9/19/12 INDICATIONS Tre atment of whipworm, pinworm, roundworm, hookworm, infections. CONTRAINDICATIONS Contraindicated in Hypersensitivity. DRUG INTERACTIONS Drug-Drug Use with potassium-sparing diuretics or ACE inhibitors or angiotensin ll receptor antagonists may lead to hyperkalemia. Anticholinergics may increase GI mucosal lesions in patients taking wax-matrix potassium chloride preparations. SIDE EFFECTS CNS seizures, dizziness, headache GI abdominal pain, diarrhea, increased liver enzymes. Nausea, vomiting Neuro numbnessMisc fever nursing RESPONSIBILITIES 1. Observe ten rights of administering medication 2. Administer with food. 3. Disinfect commode facilities after patient use. 4. Arrange quotidian for daily laundry of bed linens, towels, undergarments 5. Assess for temperature, bowel sound output 6. floriculture for ova parasites 7. Monitor hematologic and hepatic studies 8. Advise patient to muffle hands before and after eating 9. Teach patient to maintain strict hygiene to prevent reinfe ction 10. Advise patient that dietetical restrictions, fasting, and laxatives arent necessary GENERIC NAME albuterolBRAND NAME salbutamol CLASSIFICATION Bronchodilators MODE OF ACTION Binds to beta-adrenergic receptors in airway smooth muscle, leading to activation of adenyl cyclase increased levels of cyclic-3, 5 ORDERED DOSE 1 neb q 6 DATE ORDERED 9-19-12 INDICATIONS Used as bronchodilator to control prevent reversible airway bar caused by asthma or COPD. CONTRAINDICATIONS Contraindicated in Hypersensitivity to adrenergic amines Hypersensitivity to fluorocarbons. DRUG INTERACTIONS Drug-Drug Concurrent use with other adrenergic agents will have increase adrenergic side effects.Use with monoamine oxidase inhibitors may lead to hypertensive crisis. SIDE EFFECTS CNS nervousness, restlessness, tremor, headache, insomnia CV chest pain, palpitations, angina, arrhythmias, hypertension GI nausea, vomiting Neuro tremor NURSING RESPONSIBILITIES 1. ) Observe ten rights of administering m edication 2. ) Inform patient that albuterol may cause an unusual or giving taste. 3. ) Advise to rinse mouth with water after each inhalation to background dry mouth 4. ) Instruct to notify health care professional if no response to the usual dose. 5. ) Chest tapping after each nebulization. . ) Position patient on high back rest position 7. ) Advise to consult physician before taking OTC med, natural/ herbal products, or alcohol with this therapy. 8. ) do not give a food immediately it can cause vomiting 9. ) Monitor serum electrolyte levels 10. )Monitor for hypersensitivity reactions and paradoxical bronchospasm. &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212- &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212- &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212- RELATED NURSING THEORY &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212- Florence Nightingal eShe stated in her nursing notes that nursing is an act of utilizing the environment of the patient to assist him in his recovery , that it involves the nurses beginning(a) to configure environmental settings appropriate for the in small stages restoration of the patients health, and that external factors associated with the patients surroundings affect life or biologic and physiologic processes, and his development The factors posed great implication during Nightingales time, when health institutions had poor sanitation, and health workers had little education and training and were frequently ham-handed and unreliable in attending to the needs of the patients. Also emphasized in her environmental theory is the provision of a equable or noise-free and warm environment, attending to patients dietary needs by assessment, documentation of time of food intake, and evaluating its effects on the patient.This theory was applicable to our client because of that the disease of our clien t is related to its environment. Our client has brochopneumonia which can be afflicted with our environment plus a weak immune system which gos the disease process. Our client was also positive to Ascaris Lumbricoides and Trichuris Trichiura in which we could really tell that they are having a problem in terms of taking care of themselves like give attention to their personal hygiene and the like in their community,. Environment is such a big factor to use and all other disease process that is done to our client. Environment provides the things that we that may do good or bad to us.Environment is also not always defined by the things around you but also the things that we can provide such as silent and soothe environment which is initially the best type of prevention for us. Know regarding to our client the factors that initiate healing status of our client is that the business enterprise for sanitation it shows that having been infected with ascaris and trichuris is affected by unsanitary environment and other factors such as place of living, modus vivendi etc. We must provide a sanitary environment to help pressurise immune system and ease the way for recovery and also we must initiate a supportive atmosphere to provoke the capabilities of client to rely to boost self confidence in having good prognosis and having a healthy and not nauseated set of mind set. &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212 &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212- NURSING superintend PLAN &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212- DISCHARGE &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212- PLAN practice of medicine * Explain to the patient and significant others the reason why the drugs were prescribed by the doctor. Providing sufficient information about treatment assist patient and family education as well as gains coope ration. * win patient and family not to miss a dose during the whole duration of therapy. It is important to take your medicine exactly as you are told. Medications taken full course give full therapeutic effects to the patient.In addition, this would also prevent the development of antibiotic resistant microorganisms. * Instruct the family to immediately stop medications if adverse reactions occur and refer immediately to the physician. This prevents the occurrence of further progression of life-threatening adverse reactions. * Advice patients significant others to ask before taking any food or herb supplements, vitamins, or medicine that he/she bought at the store. Some of these may negatively interact with the drugs that are being taken. rehearse * Instruct the family to provide adequate rest and sleep. This aids the patients recovery and helps him regain strength. Tell client to continue deep breathing exercises, also instruct family for the exercise needed. This is to p romote good blood circulation and relaxation. * Encourage ambulation and active range of motions. It mobilizes and loosen secretions. Treatment * Encourage the patient to follow the doctors orders It is important to take your medicine and follow instructions exactly as what they are told. * Instruct patient and family to follow-up check-up as indicated by the physician. go along up check-up can help in monitoring the progress, reassessment, and evaluation of patients condition. * Encourage the family to comply with the treatment regime for the patient. This helps by improving the recovery rate of the patient. Hygiene * Encourage the patient and significant others to wash hands more often especially when after using the bathroom. To deter spread of microorganisms which cause various illnesses. * Encourage bathing daily. This is to prevent spread of microorganism and promote self esteem. * Instruct the patient to promote good oral hygiene especially after eating. This lessens t he occurrence of dental consonant caries. * Encourage patient to incorporate in his habit the proper way of backwash her hands and covering her mouth when coughing. This prevents the spread of microorganisms and further contamination. Out-Patient Advise patient and family to go back to the hospital in a specific date for follow-up check-up after discharge. This enables the physician to reassess and evaluate the health status of the patient. * Consult a doctor if there are any problems or any complications encountered. This calls for immediate action or interventions which may prevent furthermore complications. nutriment * Diet as tolerated as much as possible. To meet the daily requirements of the body as well as to have an optimum nutritional diet. * Encourage patient to drink 8 glasses of fluids a day. To improve hydration as well as to excrete wastes accordingly. * Encourage to ensure safe water sources or if necessary, boil water for drinking. This is to eliminate the risk of any bacterial or parasitic infection. * Encourage to avoid eating raw foods such as raw meat. If dealing with fresh vegetables, wash it thoroughly with water. This is to avoid microorganisms which could be present that can cause illnesses * Encourage the family to provide nutritious foods such as fruits and vegetables. Fruits and vegetables are rich in essential vitamins and nutrients, which aid in supplying the optimum nutrition for the patient. &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212- &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212- REFERENCE (s) Reference (s) * Bare, B. , Cheever, K. , Hinkle, J. , Smeltzer, S. (2009).Brunner and Suddarths Textbook of Medical Surgical Nursing 12th edition. Lippincott Williams Wilkins * Bowden, V. , Greenberg, C. (2008). Pediatric Nursing Procedures Second Edition. Lippincott Williams Wilkins. * Maglaya,A .. et. al. (2009). Argonauta Corporation. Marikina City, Phili ppines * Mosbys Pocket Dictionary. (2010). Elsevier. Singapore. * http//www. slideshare. net/crisbertc/pneumonia-4775641 * http//www. parasitesinhumans. org/ascaris-lumbricoides-giant-roundworm. html * http//www. medterms. com/script/main/art. asp? articlekey=12961 * http//whqlibdoc. who. int/publications/2006/9280640489_eng. pdf * Department of Health * World Health Organization