LICEO DE CAGAYAN UNIVERSITY
COLLEGE OF NURSING
NCM501202
RELATED LEARNING EXPERIENCE
A Case Study
of
A 6 Month Old Client with
Acute Gastroenteritis with some Dehydration
Submitted to:
Mrs. Annaliza Arellano, R.N.
In Partial Fulfillment of NCM 501202 RLE
RLE GROUP
CLUSTER II – B7
Submitted by:
Sabsal, Marylee S.
I. INTRODUCTION
A. Overview of the Case
Gastroenteritis is a condition that causes irritation and inflammation of the
stomach and intestines (the gastrointestinal tract). An infection may be caused by
bacteria or parasites in spoiled food or unclean water. Some foods may irritate
your stomach and cause gastroenteritis. Lactose intolerance to dairy products is
one example. Acute diarrhoea or gastroenteritis is the passage of loose stools
more frequently than what is normal for that individual. This increased frequency
is often associated with stools that are watery orsemisolid, abdominal cramps
and bloating. Acute watery diarrhoea is an extremely common problem, and can
be fatal due to severe dehydration, in both adults and children, especially in the
very young and the old or in those who have poor immunity such as individuals
with HIV infection or patients who are using certain medications that suppress
the immune system.In healthy adults, however, it is often no more than a
nuisance. Because it may interfere with ones ability to work, it can also adversely
affect the individual’s income.
B. Objectives and Purpose of the Study
This study generally aims to investigate the condition of a client and
further understand the extent of the case. Specifically the student nurse sought
to:
Perform Physical Assessment, Data Base and History Taking that
solidifies the present diagnosis of the client.
Identify Signs and Symptoms associated with the disorder.
Identify priority nursing problems which will be the basis of the care plan.
Develop Plan of Care and Implement nursing interventions relevant and
suitable to the case.
Evaluate the effectiveness of the interventions and detect any progress or
regression of the client’s disease condition.
The purpose of the study is to gather significant data to broaden my
knowledge of the disease process and to improve my abilities as future
healthcare provider. This is done to be able to aid in the recovery process of the
client. Moreover this case study will enable me to apply the acquired skills I have
obtained in the classroom set-up.
C. Scope and Limitation of the Study
The scope of the study consists of one pedia ward client of the Talakag-
Bukidnon Provincial Hospital. Significant others was interviewed specially her
mother to know more about the client and her condition.
The time period for which the study was conducted and completed, was
constrained and limited to a span of 1 week. The first assessment done was last
January 27, 2009, at around 5:00 pm. Then continuous assessment was done in
the span of my duty in the said ward from January 28 and 29.The said
assessment dates were maximized to gather of information including profile, data
base, history of present illness, chart data and many others.
II. HEALTH HISTORY
A. Patients Profile
Name of Patient: John Dave Salungayan
Sex: Male
Age: 6 month old
Birthday: July 15, 2008
Birthplace: Talakag, Bukidnon
Religion: Roman Catholic
Civil Status: Child
Mother: Cecile Salungayan
Father: Aaron Salungayan
Nationality: Filipino
Date Admitted: January 26, 2009
Time Admitted: 4:15 pm
Informant: Mother
Temperature: 37.6 ̊C
Pulse Rate: 140 bpm
Respiration: 35 cpm
Attending Physician: Dr. Joseph J. Borong, M.D.
B. Personal Health History
My patient John Dave Salungayan was born through a normal vaginal
delivery. He had completed all his immunization. He has not received any blood
from the past. It was his first time to be admitted in the hospital. He has no known
food and medicine allergies. The patient had no previous history of surgery. He
had experienced cough, colds, and fever that don’t necessitate the patient to be
admitted at the hospital.
C. Chief Complains and History of Present Illness
John Dave Salungayan, a 6 month old child from Talakag, Bukidnon was
admitted for the first time due to diarrhea and vomiting, with the initial vital signs
of: temperature- 36.5 ˚C, respiratory rate- 27 cpm, and a pulse rate of 140 bpm.
The result of his physical assessment was that he has respiratory distress.
Two days prior to admission the patient is already suffering from diarrhea.
There was no skin lesions observed upon admission. The doctor’s admitting
diagnosis is acute gastroenteritis with some dehydration.
III. DEVELOPMENT DATA
Sigmund Freud’s Theory (Psychosexual Theory)
The 0-2 years of age is under the oral stage of Freud’s psychosexual
theory. Early in your development, all of your desires were oriented towards your
lips and your mouth, which accepted food, milk, and anything else you, could get
your hands on (the oral phase). The first object of this stage was, of course, the
mother's breast, which could be transferred to auto-erotic objects (thumb-
sucking). The mother thus logically became your first "love-object," already a
displacement from the earlier object of desire (the breast). When you first
recognized the fact of your father, you dealt with him by identifying yourself with
him; however, as the sexual wishes directed to your mother grew in intensity, you
became possessive of your mother and secretly wished your father out of the
picture (the Oedipus complex). This Oedipus complex plays out throughout the
next two phases of development. Feeding, crying, teething, biting, thumb-
sucking, weaning - the mouth and the breast are the centre of all experience. The
infant's actual experiences and attachments to mum (or maternal equivalent)
through this stage have a fundamental effect on the unconscious mind and
thereby on deeply rooted feelings, which along with the next two stages affect all
sorts of behaviours and (sexually powered) drives and aims - Freud's 'libido' -
and preferences in later life.
John Dave is under the oral stage of Freud’s psychosocial theory in which
he find more pleasure in sucking his thumb every time he is going to bed. I had
also observed that John Dave is a mama’s boy because he won’t go to sleep
unless her mother would carry him.
Erik Erikson’s Theory
The infant will develop a healthy balance between trust and mistrust if fed
and cared for and not over-indulged or over-protected. Abuse or neglect or
cruelty will destroy trust and foster mistrust. Mistrust increases a person's
resistance to risk-exposure and exploration. "Once bitten twice shy" is an apt
analogy. On the other hand, if the infant is insulated from all and any feelings of
surprise and normality, or unfailingly indulged, this will create a false sense of
trust amounting to sensory distortion, in other words a failure to appreciate
reality. Infants who grow up to trust are more able to hope and have faith that
'things will generally be okay'. This crisis stage incorporates Freud's
psychosexual Oral stage, in which the infant's crucial relationships and
experiences are defined by oral matters, notably feeding and relationship with
mum. Erikson later shortened 'Basic Trust v Basic Mistrust' to simply Trust v
Mistrust, especially in tables and headings.
Hope & Drive (faith, inner calm, grounding, basic feeling that everything
will be okay - enabling exposure to risk, a trust in life and self and others, inner
resolve and strength in the face of uncertainty and risk).
My patients is irritable and crying when he cannot see her mom or when
his mom is not around. But when her mother came and he recognized the voice,
the touch, John Dave will stop from crying.
Jean Piaget’s Theory (Cognitive Theory)
Sensorimotor stage. In this period, intelligence is demonstrated through
motor activity without the use of symbols. Knowledge of the world is limited (but
developing) because it’s based on physical interactions / experiences. Children
acquire object permanence at about 7 months of age (memory). Physical
development (mobility) allows the child to begin developing new intellectual
abilities. Some symbolic (language) abilities are developed at the end of this
stage.
My patient learns many things by what he saw. At this moment he is still
developing his motor skills. He is aware only of their sensations, fascinated by all
the strange new experiences his bodies is having. He like little scientists
exploring the world by shouting at, listening to, banging and tasting everything.
IV.MEDICAL MANAGEMENT
a. Medical Orders and Rationale
DOCTOR’S ORDER
Date / time Order Implication
January 26,
2009
4:15 pm
Please admit under the
care of Dr. Borong
Secure consent
Temperature, pulse and
respiration every q 30 min.
For individualized care and
monitoring
For legal and
documentation purposes
For closer monitoring of
the patient’s vital signs
and also to know if there’s
changes from the baseline
January 27,
2009
January 28,
2009
January 28,
2009
Start with D5O.3% NaCl
500cc, regulate at 40cc/hr
Medicines:
Cotrimoxazole 3-4 tsp
BID, P.O.
Chlorpromazine 3-4 tsp
BID, P.O.
Laboratory:
Fecalysis
Urinalysis
DAT, increased fluid intake
(ORESOL)
For x-ray
V/S q 4, I and O q shift
Moderate high back rest
To follow D5O.3% NaCl
500cc, regulate at 40cc/hr
Same IVF to follow same
rate
Refer for unusualities
To consumed IVF
MGH
vital signs
For fluid and electrolyte
imbalance
For infection control
Relieves nausea and
vomiting
To identify presence of
microorganisms in the
feces
To check presence of
microorganisms in the
urine
To restore fluid loss
X-Ray- to monitor disease
activity and progression.
To monitor vital signs.
To maintain airway
patency
For fluid and electrolyte
replacement]
For fluid and electrolyte
replacement
For monitoring purposes
Laboratory/ Diagnostic Examinations
FECALYSIS:
Date: January 26, 2009
Macroscopic appearance:
Color: yellow Consistency: Soft
Microscopic appearance:
Pus cells: few
RBC: none seen /hpf
Fat globules: none seen / hpf
URINALYSIS
Date: January 26, 2009
Color: Yellow
Appearance: Clear
Specific gravity: 1.025
Protein (Albumin): Negative
Glucose: Negative
Bacteria: Few
V. PATHOPHYSIOLOGY WITH ANATOMY AND PHYSIOLOGY
A. Anaphysiology
Your digestive system started working even before you took the first bite of
your pizza. And the digestive system will be busy at work on your chewed-up
lunch for the next few hours — or sometimes days, depending upon what you've
eaten. This process, called digestion, allows your body to get the nutrients and
energy it needs from the food you eat. So let's find out what's happening to that
pizza, orange, and milk. The Mouth Starts Everything Moving. Even before you
eat, when you smell a tasty food, see it, or think about it, digestion begins. Saliva
or spit, begins to form in your mouth. When you do eat, the saliva breaks down
the chemicals in the food a bit, which helps make the food mushy and easy to
swallow. Your tongue helps out, pushing the food around while you chew with
your teeth. When you're ready to swallow, the tongue pushes a tiny bit of
mushed-up food called a bolus toward the back of your throat and into the
opening of your esophagus, the second part of the digestive tract.
The esophagus is like a stretchy pipe that's about 10 inches (25 centimeters)
long. It moves food from the back of your throat to your stomach. But also at the
back of your throat is your windpipe, which allows air to come in and out of your
body. When you swallow a small ball of mushed-up food or liquids, a special flap
called the epiglottis flops down over the opening of your windpipe to make sure
the food enters the esophagus and not the windpipe.If you've ever drunk
something too fast, started to cough, and heard someone say that your drink
"went down the wrong way," the person meant that it went down your windpipe
by mistake. This happens when the epiglottis doesn't have enough time to flop
down, and you cough involuntarily (without thinking about it) to clear your
windpipe.
Once food has entered the esophagus, it doesn't just drop right into your
stomach. Instead, muscles in the walls of the esophagus move in a wavy way to
slowly squeeze the food through the esophagus. This takes about 2 or 3
seconds.
B. Pathophysiology
Definition: Gastroenteritis is a condition that causes irritation and inflammation of
the stomach and intestines (the gastrointestinal tract).
Person to person Contaminated food or H20 Animal Pets
Escherichia Coli, Shigella, Salmonela, Staphylococcus Aureus
Invasion of Gastrointestinal tract
Exterotoxin production Destruction of epithelial cells System invasion
Interacts with mucosa Superficial ulceration of Mucosa Inflammation of layer
Prufuse secretion of H20 Blood, mucus in stool of tissue beneath
and electrolytes epithelium of mucosa
Hyperemia and edema
Diarrhea Excretion of intestinal Access to
Dehydration/ Detorioration fluids systemic circulation
and collapse
Infection in another
part of body
Nursing Assessment II
SUBJECTIVE OBJECTIVE
COMMUNICATION:
[ ] hearing loss
[ ] visual changes
[X] denied
Comments: Not
applicable
[ ] glasses [ ] languages
[ ] contact lenses [ ] hearing aide
[ ] speech difficulties
Pupil size: 3-5 mm
Reaction: PERRLA
OXYGENATION:
[ ] dyspnea
[ ] smoking history
[x] cough
[ ] sputum
[ ] denied
Comments: Not
applicable
Resp. [x] regular [ ] irregular
Describe: _has a regular breathing
pattern
R: Right lung is symmetric to the left
lung
L: Left lung is symmetric to the right
lung.
CIRCULATION:
[ ] chest pain
[ ] leg pain
[ ] numbness of
extremities
[X] denied
Comments: Not
applicable
Heart Rhythm [X] regular [ ]
irregular
Ankle Edema: no presence of unkle
edema
Pulse Car Rad. DP Fem*
R: 125 96 92 91
L: 112 101 114 120
Comments: pulses are strongly
palpable.
NUTRITION:
Diet:DAT,(dry
foods,Increased
fluid intake)
Comments: Not
applicable
[ ]dentures [X]none
Full Partial with patient
Upper [ ] [X] [ ]
[ ] N [ ] V
Character
[X] recent change in
weight appetite
[x] swallowing
difficulty
[ ] denied
Lower [ ] [ ] [ ]
ELIMINATION:
Usual bowel pattern
Once daily
.
[ ] constipation
remedy
None
.
Date of last BM
1-28-09
[X] diarrhea
Character
Watery
[]rinary frequency
8 times a day
[ ] urgency
[ ] dysuria
[ ] hematuria
[ ] incontinence
[ ] polyuria
[ ] foley in place
[X] denied
Comments : Bowel sounds:
Normal active bowel audible
Sound upon Abdominal
Distention
Auscultation Present [ ] yes
[x] no
Urine(color,
consistency, odor)
urine color is yellowish with
aromatic odor
MGT. OF HEALTH & ILLNESS:
[ ] alcohol [ ] denied
(amount & frequency)
N/A
[ ] SBE Last Pap Smear: N/A
LMP: N/A
Briefly describe the patient’s
ability to follow treatments
(diet, meds, etc.) for chronic
health problems (if present):
following medication and
therapeutic regiments
SKIN
INTEGRITY:
[X] dry
[ ] other
[ ] denied
Comments: Not
applicable
[X] dry [ ] cold [ ]
pale
[ ] flushed [X] warm
[ ] moist [ ] cyanotic
*rashes, ulcers, decubitus
(describe size, location, drainage:
No presence of rashes, ulcers,
decubitus.
ACTIVITY/
SAFETY:
[ ] convulsion
[ ] dizziness
[ ] limited motion
of
Joints
Limitation in
Ability to
[ ] ambulate
[ ] bathe self
[ ] other
[X] denied
Comments: Not
applicable
[ ] LOC and orientation:
Conscious.
Gait: [ ] walker [ ] cane [ ]
other
[X] steady [ ] unsteady
sensory and motor losses
in face and
Extremities: Sensitivity in hands
& feet
[ ] ROM limitations: Normal ROM
limitation
COMFORT/
SLEEPAWAKE:
[ ] pain
(location)
Frequency
Remedies
Comments; Not
applicable
[ ] facial grimaces
[ ] guarding
[X] other signs of pain pain in
the infusion site(pt. is irritable)
[ ] side rail release N/A
[ ] nocturia
[ ]sleep
difficulties
[X] denied
COPING:
Occupation: N/A
Members of household: 3
Most supportive person: Aaron Salungayan
Observed non-verbal behavior:
His soft spoken but responsive
when addressed
The person and his phone
number that can be reached
anytime: N / A
VII. NURSING MANAGEMENT
A. Ideal nursing Management
NURSING DIAGNOSIS:
Fluid volume deficient may related to excessive fluid loss, oral intake
INTERVENTION and RATIONALE
Independent:
Assess vital sign changes.
(Elevated temperature/ prolonged fever increases metabolic rate and fluid
loss thought evaporation)
Asses skin turgor, moisture of mucous membranes (lips, tongue).
(Indirect indicators of adequacy of fluid volume, although oral mucous
membranes may be dry because of mouth breathing and supplement oxygen)
Monitor intake and output(I&O), nothing color, character of urine.
Calculate fluid balance. Be aware of insensible losses. Weigh as
indicated.
(Provide information about adequacy of fluid volume and replacement needs)
Dependent:
Provide supplemental IV fluids as necessary.
(In presence of reduced intake/ excessive loss, use of parenteral route may
correct/ prevent deficiency)
NURSING DIAGNOSIS:
Risk for infection related to inadequate primary defenses, inadequate
secondary defenses
INTERVENTION and RATIONALE
Independent:
Monitor vital signs closely, especially during initiation of therapy.
(During this period of time, potentially fetal complications (hypotension/
shock) may develop)
Instruct patient concerning the disposition of secretion and reporting
changes in color, amount, odor of secretion)
Limit visitors as indicated
(Reduce likelihood of exposure to other infectious pathogens)
Demonstrate/ encourage good handwashing technique.
(effective means of reducing spread or acquisition of infection)
Dependent:
Prepare for/ assist with diagnostic studies as indicated.
(Fiberoptic bronchoscopy (FOB) may be done in patients who do not respond
rapidly (within 1-3 days) to antimicrobial therapy to clarify diagnosis and therapy
needs.)
NURSING DIAGNOSIS:
Knowledge deficient regarding condition, prognosis, treatment, self-care, and
discharge needs as related to unfamiliarity with resources and information
misinterpretation
INTERVENTION and RATIONALE
Independent:
Determine the mother’s perception of disease process. (Establishes
knowledge base and provides some insight into individual learning needs)
Review disease process, cause/effect relationship of factors that
precipitate symptoms, and identify ways to reduce contributing factors.
Encourage questions. (Precipitating/aggravating factors are individual;
therefore, the mother needs to be aware of what foods, fluids, and lifestyle
factors can precipitate symptoms. Accurate knowledge base provides
opportunity for the mother to make informed decisions/choices about
future and control of chronic disease. Although most others know about
their own disease process, they may have outdated information or
misconceptions)
Review medications, purpose, frequency, dosage, and possible side
effects. (Promotes understanding and may enhance cooperation with
regimen)
Stress importance of good skin care, e.g., proper handwashing techniques
and perineal skin care. (Reduces spread of bacteria and risk of skin
irritation/breakdown, infection)
Emphasize need for long-term follow-up and periodic reevaluation.
(Patients with IBD are at risk for colon/rectal cancer, and regular
diagnostic evaluations may be required)
B. Actual Nursing Management
S Not applicable
Pale
Dry skin
O Appears weak
Poor capillary refill (3 sec.)
A Fluid volume deficit related to dehydration
P
Long term: At the end of 1 day, the patient’s mother will be able to
demonstrate understanding and follow treatment regimens for her
daughter.
Short term: At the end of 30 minutes, the patient’s mother will be
able to demonstrate understanding and follow treatment regimens
for her daughter.
I
Independent:
Encouraged adequate rest
(To maximize rest)
Increased fluid intake as tolerated.
(For adequate hydration)
Give ORESOL
(To restore fluid & electrolyte loss)
Monitor intake and output (I&O), noting color, character of
urine. Calculate fluid balance.
(indicators of adequacy of fluid volume)
Dependent:
IV administration (D50.3% NaCl 500cc, regulated at
35cc/min)
( to correct fluid and electrolyte loss)
E At the end of 30 minutes, the patient’s was able to demonstrate
understanding and follow treatment regimens
S Not applicable
Loss of appetite
O
Present weight (5 kls)
Appears weak
Vomiting
A Nutritional imbalance nutrition, less than body requirements.
P
Long term: At the end of 1 month, the pt. body weight will increased
at least 0.5 kilo.
Short term: At the end of 30 min. pt. will be able to improve her
appetite in eating.
I
Independent:
Identify factors contributing to nausea and vomiting
Assess with or encourage oral hygiene
(Eliminate noxious sights, smell, and taste to prevent
vomiting)
Provide small frequent meals including dry foods and that
are appealing to the patient
(These measures may enhance intake even though appetite
may be slow to return)
Evaluate general nutritional state, obtain baseline weight
( Presence of chronic conditions or financial limitations can
contribute to malnutrition, lowered resistance to infection)
Encouraged snacks.
(To increase total nutrient intake)
E At the end of 30 min. pt. was able to improve her appetite in eating.
VIII. REFERRALS and FOLLOW-UP
Once the client will be discharged, I had instructed her mother encouraged
my client to drink his home medications religiously to prevent further infection. I
have also instructed her mother to let her son have a daily exercise like deep
breathing pattern and I’d teach the mother some of the range of motion exercises
in order to promote proper blood circulation and attain proper oxygenation. And I
have also reminded her mother to stick with her son’s diet and to have adequate
amount of it to meet nutritional needs and attain full wellness.
IX. EVALUATION AND IMPLICATION
At the end of my hospital duty, I was able to render care to my patient to
help him resolve his health condition. Through observing the patient’s status, I
was able to identify priority problems related to his health.
The patient’s mother was willing to pursue the medical therapy just to
promote health and wellness for the betterment of her son’s condition.
I have also made the patient’s mother realize the importance of
completing the course of therapy by taking the medicines prescribed or ordered
for his son by his physician. In addition, eating healthy or nutritious foods that
were prescribed to him by the health providers was further been explained to his
mother especially the benefits he will gain in eating those foods.
Moreover, this several interventions given to the patient made her body
conditioning normal and I can say that our patient has somehow recovered from
his illness.
X. BIBLIOGRAPHY
BOOKS
Doenges, Marilynn, et al. Nursing Care Plans, Guidelines for
Individualizing Patient Care (7th Edition) F.A. Davis Company. Copyright 2000.
Kozier, Erb, Blais, Wilkinson. Fundamentals of Nursing (7th edition).
Addison Esley Longman Inc. 1998.
Smeltzer, Suzanne C. and Bare, Brenda G. Medical-Surgical Nursing.
(10th Edition). Volume 2. Lippincott Williams and Wilkins.2004
Luckman and Sorensen, Medical-Surgical Nursing. 3rd Edition W.B.
Saunders Company (1987)
Jacob, S, et al Structure ad Function in Man. 5 th Edition W.B. Saunders
Company (1982)
INTERNET
http://www.medicinenet.com/pneumonia/page4.htm
http://www.merck.com/pubs/mmanual_ha/sec3/ch41/ch41d.html
http://fog.ccsf.cc.ca.us/~jgrass/Content/Lessons/skeletal.html
http://web.indstate.edu/thcme/mwking/nucleotide-metabolism.htm
NURSING SYSTEM REVIEW CHART
EENT:𓀿 Impaired vision 𓀿 blind 𓀿 pain 𓀿 reddened 𓀿 drainage𓀿 gums 𓀿 hard of hearing 𓀿 deaf𓀿 burning 𓀿 edema 𓀿 lesion 𓀿 teethAsses eyes, ears, noseThroat for abnormality [x] no problemRESPIRATION𓀿asymmetric 𓀿 tachypnea𓀿 apnea 𓀿 rales [x] cough 𓀿 barrel chest𓀿 bradypnea 𓀿 shallow 𓀿 rhonchi𓀿 sputum 𓀿 diminished 𓀿 dyspnea𓀿 orthopnea 𓀿 labored 𓀿 wheezing𓀿 pain 𓀿 cyanoticAsses resp. rate, rhythm, depth, patternbreath sounds, comfort 𓀿 no problemCARDIO VASCULAR𓀿 arrhythmia 𓀿 tachycardia 𓀿 numbness𓀿 diminished pulses 𓀿 edema 𓀿 fatigue𓀿 irregular 𓀿 bradycardia 𓀿 murmur𓀿 tingling 𓀿 absent pulses 𓀿 painAssess heart sounds, rate, rhythm, pulse, bloodpressure, etc., fluid retention, comfort[x] no problemGASTRO INTESTINAL TRACT𓀿 obese 𓀿 distention 𓀿 mass𓀿 dysphagia 𓀿 rigidity 𓀿 painAsses abdomen, bowel habits, swallowing, bowel sounds, comfort [x] no problemGENITO-URINARY and GYNE𓀿 pain 𓀿 urine color 𓀿 vaginal bleeding𓀿 hematuria 𓀿 discharge 𓀿 nocturiaAssess urine freq., control, color, odor, comfort/Gyn-bleeding, discharge [x] no problemNEURO𓀿 paralysis 𓀿 stuporous 𓀿 unsteady 𓀿 seizures𓀿 lethargic 𓀿 comatose 𓀿 vertigo 𓀿 tremors𓀿 confused 𓀿 vision 𓀿 gripAssess motor function, sensation, LOC, strength, grip, galt, coordination, orientation, speech.[x] no problemMUSCULOSKELETAL and SKIN𓀿 appliance 𓀿 stiffness 𓀿 itching 𓀿 petechiae𓀿 hot 𓀿 drainage 𓀿 prosthesis 𓀿 swelling𓀿 lesion [x] poor turgor 𓀿 cool 𓀿 deformity𓀿 wound 𓀿 rash 𓀿 skin color 𓀿 flushed𓀿 atrophy 𓀿 pain 𓀿 ecchymosis 𓀿 diaphoretic [x] moistAsses mobility, motion, galt, alignment, joint function /skin color, texture, turgor, integrity 𓀿 no problem
Place an (X) in the area of abnormality. Comment at thespace provided. Indicate the location of the problem inthe figure if appropriate, using (x)
Name: John Dave Salungayan Date: January 28, 2009Vital Signs:Pulse: 140 bpm Temp: 37.6 ̊C Respi: 35 cpm
Vomiting
Poor skin turgor (2-3 sec.)
IV site (D50.3% NaCl 500cc regulated @ 40gtts/min)
Cough
Moist skin
Poor capillary refill
Diarrhea