NAME: Kenyon Gabe Dondoyano

GENDER: Male
AGE: 6 years old
ADDRESS: Babatngon Leyte
BIRTHDATE: 10/4/2012
CIVIL STATUS: Single
NATIONALITY: Filipino
RELIGION: Roman Catholic
OCCUPATION: Pupil
CHIEF COMPLAINT: Seizure
ADMISSION DATE & TIME: 3/23/19
ADMISSION DIAGNOSIS: Status Epilepticus from Complex Febrile Seizure vs CNS infection

HISTORY OF PRESENT ILLNESS

Patient is known to have a case of Status Epilepticus.
3 days prior to admission, the patient now had another episode of seizure lasting for 1-2
minutes. The patient had a fever with a temperature of 39.1 degrees Celsius but they did not consult
him to a doctor.

Few hours prior to admission, patient complained difficulty of breathing and had his seizure
lasting for 1 minute which prompted the parents of the patient to seek consultation at EVRMC.

PAST MEDICAL HISTORY

Patient has not been admitted to the hospital until prior to present admission. He has an
allergy of egg.

FAMILY HISTORY
There’s no history of any diseases in both maternal and paternal side.

PSYCHOSOCIAL HISTORY
He is in pre-elementary pupil at Babatngon Leyte. His father works as a construction
worker and his mother is a housewife. They live in a semi-concrete house located along the road.

Patient usually wakes up at 9am and sleeps at around 7pm. He loves playing outside with
his friends.

Patient usually drinks milk everyday. Client’s favourite food is longganisa. He drinks 1-
2L of water per day. Client has normal bowel movement with a brown in color and hard in
consistency stool. He defecates 2 times a week and usually voids 4-5 times per day with a yellow-
colored urine amounting to 500ml a day. Patient is a Roman Catholic but doesn’t go to church
often with his family.

GORDONS TYPOLOGY
HEALTH PERCEPTION-HEALTH MANAGEMENT PATTERN
Client’s rating of her condition (10 as the highest):

Before: “Makusog man it hiya mag dinalagan hadto, makikita ko talaga nga waray niya problema”
as verbalized by S.O
Now: “ Maluyahon naman gud hiya yana’ as verbalized by S.O.

Client is cooperative. He has no problem in hearing. Nail beds are normal in color with no
clubbing observed and capillary refill is less than 3 seconds.

NUTRITIONAL-METABOLIC PATTERN
Before: “Tig 3 ka beses hiya nakaon ha usa ka adlaw, maki longanisa man gud gihap hiya tas maki
gatas gihap.” as verbalized by S.O

After: “Nakaka kaon man hiya pero hinay hinay la man gud yana, tas igin papainom ko hiya hin
damo nga tubig kay amo man an yakan haak han doctor .” as verbalized by S.O
Patient usually drinks about 1-2L per day. Patient has no complaints of difficulty on
swallowing. Skin turgor is firm.
Gums is normal and without bleeding. Gag reflex is present.

ELIMINATION PATTERN
Bowel habits
Before: “Ikakaduha ha usa ka simana hiya nauro.” As verbalized by S.O
Stool is brown in color and hard in consistency.
Now: “Amo gihap , di gud hiya masukot nga nauro.” As verbalized by S.O.
Stool is brown in color and soft in consistency.

Bowel sounds present upon auscultation of the abdomen. Abdomen is soft, tender and no
masses observed.
Before: “Pirmi hiya nag-iinihi kay damo it iya gin-iinom na tubig.” As verbalized by S.O
Now: “Pirmi hiya nag-iinihi kay damo man it akon gin papainom ha iyaa.” As verbalized by S.O
Patient urinates 4-5 times with a yellow-colored urine with an output of about 500 mL
Patient has no complaints on difficulty of urinating.

ACTIVITY-EXERCISE PATTERN
Before: “It iya pakigmulay ha iya mga sngkay amo man gud it iya buruhaton ha balay” As
verbalized by S.O
After: “Gin papalakat lakat ko hiya ha gawas hit kwarto para baga ma exercise it iya lawas” As
verbalized by S.O

SLEEP-REST PATTERN
Patient sleeps at 9pm and wakes up at around 7am, and is easily aroused by environmental
noise. Patient has no difficulty in sleeping and waking up.

COGNITIVE-PERCEPTUAL PATTERN
Patient can understand the instructions given to him.

SELF-PERCEPTION & SELF-CONCEPT PATTERN

“Gusto ko maging police ngan bulig ko balay” As verbalized.

The client appears calm. Sometimes she pauses first for a while before answering some
questions. Patient wants to become a police and wants to help his parents.

ROLE-RELATIONSHIP PATTERN
“Mabulig kanda mama ngan papa” As verbalized.

Client is able to speak Waray-waray. No speech problems noted during the interview.
Patient believes that he will be able help his family when he grows up.

SEXUALITY-REPRODUCTIVE PATTERN
Patient likes to play with his friends that are boys.

COPING-STRESS TOLERANCE
He usually would go out to calm his self. The family copes up by prayer.

VALUE-BELIEF PATTERN
Patient is a Roman Catholic, and he knows that God wants him to be healed. He claims
that he is a believer of Christ.