Philippine Christian University

Mary Johnston College of Nursing

#415 Morga Street, Tondo, Manila 1012

CASE Study:
Hepatitis A

Submitted to: Mrs. Janus Villaruel

Submitted by: Ms. Patricia Kyle Dones
 INTRODUCTION
Hepatitis A is a liver disease caused by the hepatitis A virus. The virus is primarily spread when
an uninfected (and unvaccinated) person ingests food or water that is contaminated with the
feces of an infected person The infection does not cause chronic liver disease and is rarely
fatal, but it can cause debilitating symptoms and fulminant hepatitis (acute liver failure), which
is often fatal.
Hepatitis A occurs sporadically and in epidemics worldwide, with a tendency for cyclic
recurrences. The hepatitis A virus is one of the most frequent causes of foodborne infection.
Epidemics related to contaminated food or water can erupt explosively, such as the epidemic in
Shanghai in 1988 that affected about 300 000 people.
In developing countries with poor sanitary conditions and hygienic practices, most children
(90%) have been infected with the hepatitis A virus before the age of 10 years 2. Those infected
in childhood do not experience any noticeable symptoms.
Almost 1.4 million cases of hepatitis A are reported worldwide each year, with approximately
half occurring in the Asian region. Hepatitis A is endemic throughout most of South-East Asia;
however, with different countries experiencing different rates of socio-economic development,
two distinct patterns of epidemiology have emerged in the region.
The first pattern is seen in countries such as Indonesia, the Philippines and Taiwan, where
hepatitis A endemicity remains moderate-to-high and is linked to socio-economic differences
that lead to different standards of hygiene and sanitation being found in close proximity.
Globally, there are an estimated 1.4 million cases of acute hepatitis A and Almost 103,000
people die from hepatitis A.
In the Western Pacific Region, most people in rural and urban areas of poor sanitation have
been infected with hepatitis A during childhood.
A sudden surge of hepatitis A cases were reported in a town in the farthest province of the
region, the Department of Health (DOH)-Cordillera reported. DOH medical officer Dr. Amelita
Pangilinan said the Regional Epidemiological Surveillance Unit reported a rapid increase of
viral hepatitis in Cabugao, Apayao from 22 June to 3 September 2012.
Some 29 cases of hepatitis A were reported during August 2012 due to improper food handling
in a carinderia (food stall) that resulted in a positive viral contamination of specimens taken
from affected persons. Some 17 of the suspected cases of hepatitis A were also confirmed to be
positive for the viral disease after laboratory tests. This prompted the DOH, together with the
Rural Health Unit (RHU) of Cabugao, to close down operations of the food stall as two of its
food handlers tested positive in a hepatitis A screening survey. Pangilinan said some of those
who were affected are students and faculty of Lourdes High School in Cabugao Poblacion.
To address the spread of the viral disease, the RHU conducted information campaigns on food
and waterborne diseases, basic sanitation, waste management and proper hand washing in
nearby schools and villages. The RHU also conducted inspection of food handler’s certificates,
trainings and classes on food safety, and proper handling.
The DoH estimates that 6% to 10% of Filipino adults suffer from chronic hepatitis A infection.
Vaccination is still one of the most potent agents in the fight against hepatitis.
We chose this case it gives a reminder just how important sanitation and hygiene must be
reinforced to the general public because the Hepatitis of this kind is transmitted via oral-fecal
route. From food preparation, handwashing, the handling of food – our health relies a lot on
preventing pathogens from going in so the body does not have to exert much effort in fighting
it off.

DEMOGRAPHIC DATA
NAME: K.D.DP
AGE: 10 years old
DATE OF BIRTH: December 17, 2007
ADDRESS: 6-17 Area D Parola Brgy. 20 Zone 2 Tondo, Manila
GENDER: Female
NATIONALITY: Filipino
RELIGION: Roman Catholic
EDUCATIONAL ATTAINMENT: A Grade IV student in Almario Elementary School
SOURCE OF HEALTHCARE: health centers, clinics and Hospitals
DATE OF ADMISSION: June 25, 2018
CHIEF COMPLAINT: Fever and Vomiting
ATTENDING PHYSICIAN: Dr. Candelaria

NURSING HISTORY:
Five days, prior to admission patient had intermittent fever with a temperature of
39.6°C and was given Tempra 5 mL and was relieved for 3 hours and the fever will occur again.
No consult was done.
Two days prior to admission, patient had 1 episode of vomiting with watery with few
chunks of gastric contents and still had fever with a temperature of 38.7°C. No consultation
was done.
One day prior to admission still had vomiting and fever of 38.5°C. and 4 hours prior to
admission patient had persistent vomiting and fever of 38.1°C hence consulted Attending
Physician and was advised admission and referred to an admitting.

PAST HEALTH HISTORY

IMMUNIZATION:
 complete immunization when he was a child in a health center
CHILDHOOD ILLNESSES:
 measles, German measles and mumps
 SURGICAL HISTORY:
 No surgical history.
MEDICAL HISTORY:
 diagnosed with bronchial asthma when she was 3 years old and was admitted in
Chinese General Hospital and was given nebulization and was being confined for 3 days.
 diagnosed with urinary tract infection last April 2017 and was given unrecalled
antibiotics and was being confined for 5 days here at Mary Johnston Hospital.
FAMILY HISTORY:
 her grandfather on her father’s side has Diabetes Mellitus Type II diagnosed 15 years
ago and was being controlled by unrecalled medications and with regular check-ups.
 her grandfather was also diagnosed with hypertension last 13 years ago and was having
a drug maintenance of losartan with unrecalled dosage and with regular doctor
visitation.
SOCIAL HISTORY
TOBACCO: does not smoke
ALCOHOL: does not drink alcohol beverages
COFFEE: does not drink coffee, instead she drinks milk and milo
PETS: have cats and dogs at home
TRAVEL HISTORY: no travel history but she started going to school last June 4, 2018
ALLERGY HISTORY: no allergies
(+) father NSAIDS but no allergies with any food

GORDON'S FUNCTIONAL PATTERN

 HEALTH MANAGEMENT PATTERN
Before admission:
 ceelin plus (ascorbic acid) was being taken at home as a multivitamins
 no regular check-up unless something is wrong with the physical body
Admitted in the hospital:
 still taking her ceelin plus and no other multivitamins was being order for her
 assessment were done by the doctors
 NUTRITIONAL METABOLIC PATTERN
Before admission:
 Likes to eat junk foods and foods in the fast food chains
 Loves to eat hotdogs being bought outside the school
 When she was going to school, her mother packed foods for her
 Don’t drink much water; drinks 2-3 glasses only
 Loves to drink C2 drinks, zest o and juices being bought outside the school
 Does not like to eat much veggies; she just eat kangkong and eggplants being cooked
with “Sinigang”
Admitted in the hospital:
 don't have the appetite to eat; always requesting to buy her food outside
 on full low salt- fat diet and was encouraged to eat soft/hard candies without chocolate
and fruits as instructed by the doctor
 encouraged to increase fluid intake and hydrate
 ELIMINATION PATTERN:
Before admission:
 defecates once to twice a day with constipation sometimes and brownish to yellowish in
color
 urinates 4-5times a day and it is dark yellow color; no pain when urinating as stated
Admitted in the hospital:
 did not defecate yet since she was being admitted
 she urinates 2-3 times a day and was tea colored urine
 REST AND SLEEP PATTERN
Before admission:
 She always sleeps late at night because of playing video games and doing social media
 She always wake up late in during the day and went to school
Admitted in the hospital:
 “Hindi rin siya masyadong nakakatulog dito eh kasi maya-maya may dumadalaw na
nurse sa kanya pero minsan naman napapahimbing siya sa tulog pero late na nang gabi”
as stated by mother
 She did sleep during the day for 1 hour to two hours
 ACTIVITY AND EXERCISE PATTERN
Before admission:
 She was active in participating school activities and playing outdoor games with her
friends at their place like jumping, running and etc.
Admitted in the hospital:
 She was slightly irritable because of the medication she was taking and was just
spending her time watching television
 ROLE AND RELATIONSHIP PATTERN
Before admission and admitted in the hospital:
 Youngest and the only girl of the 3 siblings
 A sweet daughter to her grandparents
 An obedient daughter to her parents
 A grade 5 student in Almario Elementary School
 SEXUAL AND REPRODUCTIVE PATTERN
Before admission and admitted in the hospital:
 No menstrual period yet
 Grossly female
  COGNITIVE PATTERN
Before admission and admitted in the hospital:
 With good hearing ears
 With clear vision as stated
 No dentures being used
 Alert and responsive to the questions being asked
 COPING STRESS PATTERN
Before admission:
 “ kumakain lang ako ng nagugustuhan komg pagkain kapag nasstress ako at saka
naglalaro lang ako sa cellphone ko” as stated
Admitted in the hospital:
 “Tinutulog ko lang tapos kapag kinakabahan ako natutulog lang ako o kaya minsan
nanonood lang ako ng T.V” as stated
 SELF-PERCEPTION PATTERN
Before admission:
 “Okay naman siya masayahin naman siyang bata at mahilig siyang makipaglaro sa mga
pinsan niya at mga kaibigan” as stated by mother
Admitted in the hospital:
 Minsan irritable din siya dahil nga lagi siyang tinutusok at dahil sa capsule niya na gamot
hindi kasi siya sanay niyan eh” as stated by mother
 VALUES AND BELIEFS PATTERN
Before admission and admitted in the hospital
 Baptized as a Roman Catholic
 does not go to church regularly
 had a Bible at home

PHYSICAL EXAMINATION
A. Vital Signs
 Temperature: 38.2 °C
 Cardiac rate: 101 bpm
 Respiratory rate: 25 bpm
 BP: 90/60 mmHg
B. Skin
 Light complexion
 Afebrile, Good skin turgor (of less than one second)
C. Hair
 With long wavy hair
 Black in color
 No infestations
D. Nails
 Pinkish
 Round in shape
 Capillary refill of 1-2seconds
E. Head
 Proportional; symmetrical
 Can flex and extend
 No bumps or masses
F. Neck
 Supple
 Moves from side to side; can rotate freely
 No palpable lymph nodes
G. Face
 Round in shape
 No lesions
H. Eyes
 Symmetrical
 Yellowish sclera
 Pupils equally rounded and reactive to light
 No discharge and redness of the eye lid
I. Ears
 No discharge
J. Nose
 Symmetrical
 No nasal discharge, bleeding and smelling problem
 No nasal flaring noted
K. Lips
 Pinkish
 Moist lips
 No lesions
L. Teeth and Mouth
 Moist buccal mucosa
 No dentures
 With tooth decays at second molar
M. Lungs
 Symmetrical chest expansion
 Clear breath sounds heard upon auscultation of both lung fields
N. Abdomen
 Flat and soft
 No masses or tenderness
 Normoactive bowel sounds
 O. Extremities
 No cyanosis
 Full, equal pulses
*patient did not experience any kinds of pain in her chest, back and joints. The only symptoms
that we’ve observed was starting jaundice in her sclera.

ANATOMY AND PHYSIOLOGY OF LIVER

The liver is located in the upper right-hand portion of the abdominal cavity, beneath the
diaphragm, and on top of the stomach, right kidney, and intestines.
Shaped like a cone, the liver is a dark reddish-brown organ that weighs about 3 pounds.
There are 2 distinct sources that supply blood to the liver, including the following:
 Oxygenated blood flows in from the hepatic artery
 Nutrient-rich blood flows in from the hepatic portal vein
The liver holds about one pint (13%) of the body's blood supply at any given moment. The liver
consists of 2 main lobes. Both are made up of 8 segments that consist of 1,000 lobules (small
lobes). These lobules are connected to small ducts (tubes) that connect with larger ducts to
form the common hepatic duct. The common hepatic duct transports the bile made by the liver
cells to the gallbladder and duodenum (the first part of the small intestine) via the common bile
duct.

Functions of the liver

The liver regulates most chemical levels in the blood and excretes a product called bile. This
helps carry away waste products from the liver. All the blood leaving the stomach and
intestines passes through the liver. The liver processes this blood and breaks down, balances,
and creates the nutrients and also metabolizes drugs into forms that are easier to use for the
rest of the body or that are nontoxic. More than 500 vital functions have been identified with
the liver. Some of the more well-known functions include the following:
 Production of bile, which helps carry away waste and break down fats in the small
intestine during digestion
 Production of certain proteins for blood plasma
 Production of cholesterol and special proteins to help carry fats through the body
 Conversion of excess glucose into glycogen for storage (glycogen can later be converted
back to glucose for energy) and to balance and make glucose as needed
 Regulation of blood levels of amino acids, which form the building blocks of proteins
 Processing of hemoglobin for use of its iron content (the liver stores iron)
 Conversion of poisonous ammonia to urea (urea is an end product of protein
metabolism and is excreted in the urine)
 Clearing the blood of drugs and other poisonous substances
 Regulating blood clotting
 Resisting infections by making immune factors and removing bacteria from the
bloodstream
  Clearance of bilirubin, also from red blood cells. If there is an accumulation of bilirubin,
the skin and eyes turn yellow.
When the liver has broken down harmful substances, its by-products are excreted into the bile
or blood. Bile by-products enter the intestine and leave the body in the form of feces. Blood by-
products are filtered out by the kidneys, and leave the body in the form of urine.

RISK FACTORS
 poor sanitation
 eating contaminated foods
 lack of safe water;
 use of recreational drugs;
 living in a household with an infected person;
 being a sexual partner of someone with acute hepatitis A infection; and
 Travelling to areas of high endemicity without being immunized.

PATHOPHYSIOLOGY

Risk Factors

 poor sanitation
 eating contaminated foods

Hepatitis A virus replicates in Shed in bile,

Ingestion of contaminated Transported to liver for
oropharynx and GI tract Transported
food (street foods, juice drinks replication to
and buying snacks outside
intestines,
shed in feces

Signs and symptoms

Interventions  Diarrhea
 Paracetamol 250 mg/5Ml syrup;  Fatigue
7 mL given as prn ordered  Loss of appetite
 Tepid sponge bath  Mild fever
 Encouraged to increase OFI  Muscle or joint aches Brief viremia (viruses
 Nausea and vomiting in the blood)
Instructed to eat crackers
Instructed to prevent carbonated drinks  Slight abdominal pain
 Weight loss

 Ranitidine 35 mg TIV as prn

ordered
 Encouraged to do deep Breathing
exercise.
 On low Fat diet.
 DIAGNOSTICS AND LABORATORY TESTS

HEMATOLOGY REPORT
NAME: K.D.P
TAKEN FROM: OPD
DATE: JUNE 25, 2018
HEMOGLOBIN 14.3 12-15 G/L
HEMATOCRIT 0.40 0.38-0.70
RBC 4.79 4.2-5.4 X 1012/1
WBC 6.84 4.5-11 X 10-9/1
DIFFERENTIAL COUNT
SEGMENTERS O.61 0.55-0.65
LYMPHOCYTES L 0.19 0.25-0.35
MONOCYTES 0.05 0.04-0.08
EOSINOPHILES H 0.06 0.02-0.04
PLATELET COUNT 233 X 150-400 X 109/L

NURSING INTERPRATATION: The patient has Lymphocytopenia and Eosinophilia it

indicates infection.
NURSING IMPLICATION: Monitored Vital signs as baseline data.
Monitored For Signs and Symptoms of Infection.

URINALYSIS
Date: JUNE 25, 2018

EXAMINATION RESULT NORMAL VALUE

COLOR YELLOW
CHARACTER CLEAR
REACTION 6.5
SPECIFIC GRAVITY 1.000
SUGAR NEGATIVE
PROTEIN NEGATIVE
WBC 1-2 /HPF

RBC 3-6 / HPF

EPITHELIAL CELL FEW
BACTERIA FEW
NURSING IMPLICATION: The Urinalysis Result is normal.

LABORATORY REPORT

JUNE 26, 2018

EXAMINATION: URINALYSIS
PHYSICAL SPECIMEN: URINE
COLOR: YELLOW
TRANPARENCY: HAZY
CHEMICAL MICROSCOPIC

Blood NEGATIVE Pus cells 3-6/hpf

Bilirubin NEGATIVE Red blood cells 0-3/hpf
Urobilinogen NORMAL Epithelial cells FEW
Ketone NEGATIVE Bacteria FEW
Glucose NEGATIVE Mucus Thread FEW
Protein NEGATIVE Amorphous FEW
material
PH 6.5
Nitrite NEGATIVE
Leukocytes NEGATIVE
Specific Gravity 1.010

NURSING INTERPRETATION: The Urinalysis result is normal.

HEMATOLOGY REPORT
DATE: 06-27-18
COMPLETE RESULT UNIT REFERENCE
BLOOD COUNT VALUE
HEMOGLOBIN 13.3 g/dl 12.5-16.5
HEMATOCRIT 38.9 % 37.0-42.0
RBC COUNT 4.49 10^6/UL 3.8-5.4
MCV 86 Fl 76.0-89.0
MCH H29.6 Pg 23.0-29.0
MCHC 34 g/dl 31.0-35.0
LEUKOCYTE 9.82 10^5/UL 5.0-10.0
COUNT
DIFFERENTIAL
COUNT
SEGMENTERS L25 % 36.0-66.0
 LYMPHOCYTES H64 % 22.0-40.0
MONOCYTES 7 % 4.0-8.0
EOSINOPHILES 3 %/ 1.0-4.0
BASOPHILES 1 % 0.0-1.0
PLATELET 302 10^5/UL 150-400
COUNT

NURSING INTERPRETATION: MCH is high meaning there is decreased

in vit. B12 level. The patient has Neutropenia and Lymphocytosis
it indicates other illness and present of infection.
NURSING IMPLICATION: Monitored Vital signs.
Monitored for signs and symptoms of infection

DRUG STUDY
06-25-18
Doctors Order: Paracetamol 250 mg/5ml syrup, 7 ml q4 for fever >37.8 PRN
Classification: Analgesic
Action: exhibits analgesic action by peripheral blockage of pain impulse generation. It produces
antipyresis by inhibiting the hypothalamic heat-regulating center. Its weak anti-inflammatory
activity is related to inhibition of prostaglandin synthesis in the CNS.
Contraindications: Patient w/ chronic alcoholism, known G6PD deficiency, severe
hypovolaemia, chronic malnutrition. Renal and hepatic impairment. Pregnancy and lactation.
Adverse effects: Thrombocytopenia, leucopenia, pancytopenia, neutropenia, agranulocytosis,
pain and burning sensation at inj site. Rarely, hypotension and tachycardia.
Potentially Fatal: Stevens-Johnson syndrome, toxic epidermal necrolysis, acute generalised
exanthematous pustulosis, acute renal tubular necrosis and hepatotoxicity.
Nursing Considerations: Monitor serum paracetamol levels esp when acute overdosage is
suspected and w/ long-term use.
Why it is given?
 Her chief complaint coming into the hospital is her intermittent fever and thus she is
given Paracetamol for her recurring fevers.

06-25-18
Doctor’s Order: Ranitidine 35mg IV as now ordered
Classification: Histamine-2 (H2) antagonist, Gastric acid secretion inhibitor
Action: Competitively inhibits the action of histamine at the H2 receptors of the parietal cells of
the stomach, inhibiting basal gastric acid secretion and gastric acid secretion that is stimulated
by food, insulin, histamine, cholinergic agonists, gastrin, and pentagastrin.
Contraindications: Contraindicated with allergy to ranitidine, Use cautiously with impaired
renal or hepatic function.
Adverse effects: Headache, malaise, dizziness, insomnia, vertigo, tachycardia, bradycardia,
rash, diarrhea, nausea and vomiting.
Nursing Considerations: Provide concurrent antacid therapy to relieve pain.
Why it is given?
 Patient experienced gastric pains and is ordered Ranitidine for relief.
06-26-18
Doctors Order: Ampicillin 500 mg q6 IV
Classification: Antibiotic
Action: Bactericidal action against sensitive organisms; inhibits synthesis of bacterial cell wall,
Causing cell death.
Contraindications: Contraindicated with allergies to penicillins, cephalosporios, or other
Allegerns.
Adverse effects: Seizures, stomatitis, gastritis, sore mouth, vomiting, diarrhea, abdominal pain,
nonspecific hepatitis, rash, fever, thrombosis at injection site (parenteral).
Nursing Considerations: Check IV site carefully for signs of thrombosis on drug reaction.
Administer oral drug on an empty stomach 1hr or 2hrs before meals
with a full of water.
Why it is given?
 Given that she has viral infection and with her most recent hematology report,
Ampicillin helps against this infection.

06-26-18
Doctor’s Order: Famotidine 10mg every 8hours IV
Classification: Histamine-2 (H2) receptor antagonist
Action: Competitively blocks the action of histamine at the H2 receptor of the parietal cells of
the stomach; inhibits basal gastric acid secretion and chemically induced acid secretion.
Contraindications: Contraindicated with allergy to famotidine; renal failure.
Use cautiously with pregnancy, renal or hepatic impairment.
Adverse effect: Headache, malaise, dizziness, insomnia, rash, diarrhea, constipation, anorexia,
abdominal pain, muscle cramp.
Nursing Considerations: Take this drug at bedtime. Place rapidly disintegrating tablet on tongue
and swallow with or without water.

Why it is given?
 In variation to Ranitidine, she is given Famotidine twice a day for decrease of gastric
acidity that may cause vomiting.
 06-27-18
Doctor’s Order: Essentiale 1cap OD
Classification: Cholelitholytics
Action: Among the pharmacodynamic properties were reported hepatoprotective effects found
in numerous experimental models into acute liver damage, for example induced by ethanol,
alcyl alcohol, carbon-tetrachloride, paracetamol and galactosamine. Moreover, in chronic
models (ethanol, thioacetamide, organic solvents) was seen also the inhibition of steatosis and
fibrosis. As active principles have been suggested accelerated membrane regeneration and
stabilization, inhibited lipid peroxidation and inhibited collagen synthesis.
Condraindications: Known hypersensitivity to soya-bean preparations or to any of the
excipients.
Adverse effect: Occasionally the administration of Essentiale Forte P capsule 300 mg may
provoke gastrointestinal disorders, such as stomach complaints, soft stool and diarrhoea.
On very rare occasions allergic reactions may occur, such as exanthema and urticaria.
Nursing Considerations: Due to the content in soya-bean oil the medicinal product may provoke
severe allergic reactions.
Why it is given?
 As per the diagnosis of Hepatitis A, Essentiale is given for the management in support
of the recovery of the hepatic damage.

COURSE IN THE WARD

 Admitted on June 25, 2018 on 1:50 pm; ambulatory

 Staying in room 214-6, but transferred to 201 on June 28 on the orders of Dr. Candelaria
 Under our care June 28 – June 29
 Given an order for discharge for June 30

June 29, 2018

7:00 am – awake on bed
#6 PNSS 1L x 8 hours infusing well at right metacarpal vein
8:00 am – "Takot siya sa injection. Ayaw na ayaw nya ng nakakakita ng ganun." as stated by
mother
vital signs taken as BP: 90/60 Temp: 36.3 PR: 90 bpm RR: 19bpm O2sat: 98%
active and coherent ; ambulatory
skin warm to touch
good skin tugor of 1-2 sec
capillary refill of 1-2 sec
with symmetrical chest expansion and clear breath sounds
with non-tender and flabby abdomen; symmetrical extremities
 trashes about when about to be extracted with blood
cries inconsolably
refuses to calm down despite orders
had to be restrained
Risk for ineffective coping r/t immobilization of right hand
Allow patient to verbalize concerns
Health teaching on hospital procedures and their importance
Instructed deep breathing exercises and diversional activities
Advised to keep a calm mind
Monitored vital signs accordingly
09:00 am – Consumed lugaw for breakfast; well tolerated
Change of linens done
Seen and examined by Dr. Candelaria
Advised of room transfer as per orders of Dr. Candelaria
Instructed on low fat diet
11:50 am – Consumed rice, vegetables, and fish for lunch; well tolerated

June 29, 2018

7:00 am – awake on bed
#7 PNSS 1L x KVO infusing well at right metacarpal vein
8:00 am – "Wala na siyang problema sa pagtulog. Di na sya naduduwal or nilalagnat" as stated
by mother
vital signs taken as BP: 90/60 Temp: 36.3 PR: 85 bpm RR: 19bpm O2sat: 98%
active and coherent ; ambulatory
skin warm to touch
good skin tugor of 1-2 sec
capillary refill of 1-2 sec
with symmetrical chest expansion and clear breath sounds
with non-tender and flabby abdomen; symmetrical extremities
lying in bed
extremities freely moving
already handling objects with right hand despite IV insite
Risk for injury r/t possible infiltration of IV line
Instructed to avoid strenuous activities
Maintained on moderate high back rest
Instructed to limit use of right hand
Provided rest and relaxation
Monitored vital signs accordingly
09:00 am – Consumed pancakes and milk for breakfast; well tolerated
Seen and examined by Dr. Loksom, Dr. Shristi and Dr. Santos
11:50 am – Consumed rice and spring rolls for lunch; well tolerated
 NURSING THEORY

As the founder of modern nursing, Florence Nightingale's Environment Theory changed the face
of nursing practice. She served as a nurse during the Crimean War, at which time she observed
a correlation between the patients who died and their environmental conditions. As a result of
her observations, the Environment Theory of nursing was born. Nightingale explained this
theory in her book, Notes on Nursing: What it is, What it is Not. The model of nursing that
developed from Nightingale, who is considered the first nursing theorist, contains elements
that have not changed since the establishment of the modern nursing profession. Though this
theory was pioneering at the time it was created, the principles it applies are timeless.

The focus of nursing in this model is to alter the patient's environment in order to affect change
in his or her health. The environmental factors that affect health, as identified in the theory,
are: fresh air, pure water, sufficient food supplies, and efficient drainage, cleanliness of the
patient and environment, and light (particularly direct sunlight). If any of these areas is lacking,
the patient may experience diminished health. A nurse's role in a patient's recovery is to alter
the environment in order to gradually create the optimal conditions for the patient's body to
heal itself. In some cases, this would mean minimal noise and in other cases could mean a
specific diet. All of these areas can be manipulated to help the patient meet his or her health
goals and get healthy.

The Environment Theory of nursing is a patient-care theory. That is, it focuses on the care of the
patient rather than the nursing process, the relationship between patient and nurse, or the
individual nurse. In this way, the model must be adapted to fit the needs of individual patients.
The environmental factors affect different patients unique to their situations and illnesses, and
the nurse must address these factors on a case-by-case basis in order to make sure the factors
are altered in a way that best cares for an individual patient and his or her needs.

We believe that this suited her as keeping anything encompassing the patient’s environment
clean is very vital to her recovery. Not only is her habit of eating out the problem, we consider
not only her room in the hospital and her home environment just involved, also the people who
look after her. We, as nurses armed with knowledge regarding her diagnosis, must further give
the patient and her family measures to prevent her condition from recurring and to also protect
the rest of them from receiving such illness.
 CONCEPTUAL PARADIGM
PROBLEM INTERVENTION OUTCOME
Intermittent fever Frequent monitoring Patient is able to manage with
Medication: Paracetamol her recurring fevers
Sponge baths
Abdominal pain Medication: Ranitidine, Patient’s pain scale changed
Famotidine from unbearable to tolerable
Relaxation techniques during the span of care
Diet modification
Anxiety to needles Relaxation techniques Patient attained level of
Diversional activity rapport and not frightened by
Therapeutic communication the sight of injections as long
Health teaching on its as they’re administered via
significance the IV line
Eating preferences and habits Placing on low fat diet Patient follows with
Advise on eating hard candy instructions during the span
Instructed on food safety to of care
parent

NURSING CARE PLAN

Date: June 27, 2018
Subjective: "Medyo masakit pa yung sa may tagiliran nya." as stated
Objective: Facial grimacing noted
Slight moan when area of pain is palpated
Reluctant when asked to be reassessed
Wary during the whole course of interview
Nursing Diagnosis: Acute pain r/t present condition
Planning: After the 8 hours of duty, the patient will rate her pain from 8/10 to 3 or less.
Interventions:
Build rapport with patient
R: To convince patient to verbalize feelings and to listen intently on health teachings
Encourage discussion on condition
R: To focus on what she wants to learn about her condition
Instructed to take due medication
R: To further improve her condition and discuss why the doctor had them ordered for her
Provide rest and relaxation
R: For her to receive less stimuli that will aid in relieving of her pain
Evaluation: Goal met, patient had no complaints of pain throughout and after the shift.
Date: June 28, 2018
Subjective: "Pag sa swero naman di sya umiiyak, pero yung ayaw na lang nya talaga is yung
tutusukan sya ulit?" as stated
Objective: thrashes about and cries during blood extraction
Engages in conversation but keeps quiet when teased about getting reinserted again
Has a frightened face when teased about being given injections again
No other complaints of pain
Nursing Diagnosis: Anxiety r/t hospital procedures as evidenced by reaction to blood extraction
Planning: After the 8 hours of duty, the patient will keep a straight face when seeing syringes.
Interventions:
Instructed on deep breathing exercises
R: To release tension when faced with stressful situation such as blood extractions
Health teaching on hospital procedures and why they must be done
R: To make her fully understand why she must follow through with the procedures and why
they are beneficial for her
Pray for patient
R: For her to be relieved of anxiety and to look up to God for peace of mind
Evaluation: Goal met, patient had not cried aloud nor gave complaint about syringes.

HEALTH TEACHINGS

 Use your own towels, toothbrushes, eating utensils, or other personal items
 Don’t share food, drinks, or smokes with other people
 Wash your hands with soap and water after using the restroom, and before eating or
preparing food.
 Ask where to get a Hepatitis vaccine if there is somebody they know who has not taken it
yet.
 People who have hepatitis A infection become immune to HAV for the rest of their lives
once they recover. They cannot get hepatitis A twice.
 Do not drink raw (unpasteurized) milk or foods that contain unpasteurized milk.
 Wash raw fruits and vegetables thoroughly before eating.
 Keep the refrigerator temperature at 40ºF (4.4ºC) or lower; the freezer at 0ºF (-17.8ºC) or
lower.
 Use precooked, perishable, or ready-to-eat food as soon as possible.
 Keep raw meat, fish, and poultry separate from other food.
 Wash hands, knives, and cutting boards after handling uncooked food, including produce
and raw meat, fish, or poultry.
REFERENCES:
http://www.who.int/news-room/fact-sheets/detail/hepatitis-a
https://www.sciencedirect.com/science/article/pii/S1201971204000190
https://blogs.uw.edu/apecein/2012/09/14/philippines-health-department-
declares-hepatitis-a-outbreak/#.WzXQ9qIp9qw
http://www.pchrd.dost.gov.ph/index.php/news/library-health-news/5061-
hepatitis-in-the-philippines
https://www.hopkinsmedicine.org/healthlibrary/conditions/liver_biliary_and_pan
creatic_disorders/liver_anatomy_and_functions_85,P00676
https://www.sfcdcp.org/infectious-diseases-a-to-z/d-to-k/hepatitis-a/
Dones, Patricia Kyle
Pathophysiology of Thyroglossal Duct Cyst

•Risk factors: Occurs 65% in people aged <20 years of age, more often in
males, family history of neoplasms
Formation •Asymptomatic, but tolerable and nonthreatening if starting to appear

•Sporadic, no known cause on why the client is particularly afflicted

•Starts off as persistent lymph cells that should be non palpable by time of
Development young adulthood

•Patient undergone ultrasound, which identify the masses as benign

•Hematology reports high leukocyte count
Diagnostic •Urinalysis is unremarkable

•Admitted to Surgery Ward after consult and instructed on NPO for surgery
•Performed Sistrunk operation unilaterally
Removal •Returned to Surgery Ward for dressing cleanings and observation

•Advised to return in six months for removal of the other cyst

•The extracted mass is to be examined and will determine the operation to be
Follow ups undergone