BFS Uti 111

SURIGAO EDUCATION CENTER
Km. 2, National Highway, Surigao City
College of Allied Medical Sciences
Department of Nursing
A Case presentation of
Benign Febrile Seizure, Urinary Tract Infection
Presented by:
Fernandez, Gracelie H.
BSN 3
Presented To:
Ms. Lynnce Mae B. Salmayor ,RN
1
INTRODUCTION
Febrile seizures are among the most common reasons that patients present with to pediatric
emergencies. Scientist used to think of febrile seizures as a benign condition, warranting nothing
apart from reassurance. (Khair, 2015)
Febrile seizures are convulsions brought on by a fever in infants or small children. During
afebrile seizure, a child often loses consciousness and shakes, moving limbs on both sides of the
body. Less commonly, the child becomes rigid or has twitches in only a portion of the body, such
as an arm or leg, or on the right or the left side only. Most febrile seizures last a minute or two,
although some can be as brief as a few seconds while others last for more than 15 minutes (Winberj,
2007)
Approximately one in every 25 children will have a least one febrile seizure. Febrile
seizures usually occur in children between the ages of 6 months and 5 years, with the risk peaking
in the second year of life. (neurologyfoundation.com)
Urinary tract infection (UTI) is one of the most common pediatric infections. It distresses
the child, concerns the parents, and may cause permanent kidney damage. Occurrences of a first-
time symptomatic UTI are highest in boys and girls during the first year of life and markedly
decrease after that.Febrile infants younger than 2 months constitute an important subset of children
who may present with fever without a localizing source. The workup of fever in these infants
should always include evaluation for UTI. (Fisher, 2019)
Patient E a 8 months old, residing at Purok 8, Brgy, Capalayan, Surigao City, Surigao del
Norte. She was admitted last April 24, 2019 at 8:443 a.m with a chief complaint of fever and was
later on diagnosed with Benign Febrile Seizure, Urinary tract Infection, under the care of Dra.
Sheryl M. Ochea M.D
I chose this case study to learn more and share to others what they need to learn. I aim to
spread an awareness about disease. This case study will let you acquire some knowledge that might
help you on how to maintain your children wellness state and to be able to prevent from any
complications. Hope I can share important facts that can prevent the illness.
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Related Review of Literature
Benign Febrile Seizure
Febrile seizures are generally defined as seizures occurring in children typically 6 months
to 5 years of age in association with a fever greater than 38C, who do not have evidence of an
intracranial cause (e.g infection, head trauma, and epilepsy), another definable cause of seizure
(e.g electrolyte imbalance, hypoglycemia, drug use, or drug withdrawal) or a history of afebrile
seizure. (Hirtz 2006)
The immune system is responsible for knowing the difference between normal bodily
substances and foreign ones, as well as protecting the body from infections and foreign substances.
Different immune response can be perceived if an opportunistic microorganism is introduced in
the body. Once common response of the body seen in children from infection is fever. It is a
physiologic response of the body that accompany childhood illness, especially infections. (Hirtz
2006)
Etiology
A higher than normal body temperature causes febrile seizures. Even a low-grade fever can
trigger a febrile seizure. Infection are usually caused by a viral infection, and less commonly by a
bacterial infection. Influenza and the virus that cause roseola, which often are accompanied by
high fevers, appear to be most frequently associated with febrile seizures. Post-immunization
seizures may increase after some childhood immunizations. A child can develop a low-grade fever
after a vaccination. The fever, not the vaccination, causes the seizure. (Hirtz 2006)
Epidemiology
Febrile seizures occur in approximately 2% to 4% of young children in the United States,

South America, and Western Europe. They are reported to be even more common in Asian
countries. Several large prospective studies have determined that in approximately 20% of cases,
the first febrile seizure was complex (i.e., lasted more than 15 minutes, was focal, or involved at
least two seizures within 24 hours). The most common age of onset is in the second year of life.
Febrile seizures are slightly more common in males. (Hirtz 2006)
Therapeutic Management
3
The approach to long-term management should focus on decreasing parental anxiety.
Whether prophylaxis with medication is effective is controversial. Side effects occur, and
antipyretics alone have not been shown to be effective in preventing febrile seizure recurrences.
There is no evidence that the treatment to prevent recurrences can prevent the subsequent
development of epilepsy. Diazepam and phenobarbital have been used to prevent recurrences of
febrile seizures, although not all studies have confirmed their efficacy. Prescription of prophylaxis
should be reserved only for the rare cases in which multiple seizures have occurred in a child who
still is very young, there has been focal paralysis following a seizure, or the parents’ anxiety level
remains very high even after reassurance. (Hirtz 2006)
Prognosis
Febrile seizures now are recognized as a benign syndrome determined largely by genetic
factors, manifested by an age-related susceptibility to seizures that eventually is outgrown.
Although febrile seizures are extremely frightening to parents, children almost always do quite
well. Only a small minority will develop epilepsy or recurrent nonfebrile seizures later. Unless
seizures are exceedingly long, there is no evidence of risk of brain damage, and large studies have
documented the lack of later intellectual and motor handicap as a result of febrile seizures. (Hirtz
2006)
Long-term management of febrile seizures should focus on decreasing parental anxiety.

Treatment to prevent recurrences has not been shown to prevent the later development of epilepsy.
Treatment to prevent recurrences should be recommended in only a small minority of children
who have febrile seizures. Potential risks of anticonvulsant therapy should be weighed against
benefits. No currently available treatment has been shown to be both completely safe and effective.
Fortunately, the majority of children who have febrile seizures will require no treatment other than
parental reassurance and will have a good outcome. (Hirtz 2006)
Pathogenesis
4
Febrile seizures are strongly age-specific, and mechanisms of seizure development are
related to the identified risk factors, environment (fever) and genetics. Animal models have shown
that brain hyperthermia can lead to seizures in all species of rats and mice. Certain strains have
different seizure - threshold temperatures, implying genetic influences on susceptibility. Various
mechanisms have been proposed in the pathogenesis of febrile seizures, including temperature
sensitive e ion channels altering neuronal function, and inflammatory processes promoting
secretion of cytokines (known to increase neuronal excitability). (Hirtz 2006)
Urinary Tract Infection
Definition
Urinary tract infections (UTIs) are common in childhood. Nearly all UTIs are caused by
bacteria that enter the opening of the urethra (the tube that drains urine from the bladder out of the
body) and move upward to the urinary bladder and sometimes the kidneys. Rarely, in severe
infections, bacteria may enter the bloodstream from the kidneys and cause infection of the
bloodstream (sepsis) or of other organs. (Hockenberry & Wilson, 2015)
During infancy, boys are more likely to develop urinary tract infections. After infancy, girls
are much more likely to develop them. UTIs are more common among girls because their short
urethras make it easier for bacteria to move up the urinary tract. Uncircumcised infant boys
(because bacteria tend to accumulate under the foreskin) and young children with severe
constipation (because severe constipation also interferes with normal passage of urine) also are
more prone to UTIs. (Hockenberry & Wilson, 2015)
Etiology
A variety of organisms can be responsible for UTI. Escherichia coli (80% of cases) and
other gram-negative enteric organisms are most commonly implicated; all are common to the anal,
perineal, and perianal region. Other organisms associated with UTI include proteus, Pseudomonas,
klebsiella, Staphylococcus aureus, Haemophilus, and coagulase-negative staphylococci. A number
of factors contribute to the development of UTI, including anatomic, physical, and chemical
conditions or properties of the host’s urinary tract. (McElhinney,2000)
Clinical Manifestation
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 fever
 Irritability
 vomiting
 frequent urination
 wetting during day and or night
 poor feeding
Risk factor
 Age - Children 2 to 71 months of age who had experienced 1 or 2 febrile or

symptomatic urinary tract infections (UTI) were eligible. Fever was defined as a
documented temperature of at least 38°C (measured anywhere on the body), either at home
or in the office, within 24 hours before or after urine collection.
 Gender - Females are more prone to urinary tract infections than are males. This is because
the urethra is shorter which cuts down the distance that bacteria have to travel to reach the
bladder. The urethral opening is also much closer to the anus and can come into contact
with bacteria more readily. Females lack the prostatic secretions which are present in
males.
 Incomplete bladder emptying, which allows the residual urine to be rapidly infected by
bacteria present that may cause bladder, uterine or any other pelvic organ prolapse.
 Sexual intercourse, which seems to trigger a UTI infection in many women, although the
reason for this is unclear.
 Use of diaphragm and condoms with spermicidal foam as contraceptives
 Immunosuppression with certain medications or drugs
 Diabetes - increased risk of getting UTIs is high levels of glucose in the urine. The more
glucose in the urine, the higher the risk of getting a UTI. Urinary tract infections can often
result from not fully emptying the bladder.
 Abnormalities of the urinary tract, such as kidney or renal stones, which act as a focus for
infection
 Instrumentation of the urinary tract (e.g. catheterisation, cystoscopy)
Pathogenesis
6
Bacterial clonal studies strongly support entry into the urinary tract by the fecal-perineal-
urethral route with subsequent retrograde ascent into the bladder. Because of differences in
anatomy, girls are at a higher risk of UTI than boys beyond the first year of life. In girls, the moist
periurethral and vaginal areas the growth of uropathogens. The shorter urethral length increases
the chance for ascending infection into the urinary tract. Once the uropathogen reaches the bladder,
it may ascend to the ureters and then to the kidneys by some as-yet undefined mechanism.
Additional pathways of infection include nosoco-mial infection through instrumentation,
hematogenous seeding in the setting of systemic infection or a compromised immune system, and
direct extension caused by the presence of fistulae from the bowel or vagina. The urinary tract (ie,
kidney, ureter, bladder, and urethra) is a closed, normally sterile space lined with mucosa
composed of epithelium known as transitional cells. The main defense mechanism against UTI is
constant ante grade flow of urine from the kidneys to the bladder with intermittent complete
emptying of the bladder via the urethra. This washout effect of the urinary flow usually clears the
urinary tract of pathogens. The urine itself also has specific antimicrobial characteristics, including
low urine pH, polymorphonu clear cells, and Tamm-Horsfall glycoprotein, which inhibits bacterial
adherence to the bladder mucosal wall. (Ernesto Figueroa, 2016)
Epidemiology
Urinary tract infection (UTI) is one of the most frequent bacterial infections in infants and
young children. Its incidence is influenced by age and sex, and it is difficult to estimate, as the
existing epidemiological studies are very heterogeneous, with varying definitions of UTI,
populations studied and methodologies used for collecting urine specimens. In addition, children
with UTI, especially smaller children, have non-specific symptoms, which means UTI sometimes
goes unnoticed. (Winberg J, 2007)
This situation is further complicated by the fact that accurate diagnosis depends on both
the presence of symptoms and a positive urine culture, although in most outpatient settings this
diagnosis is made without the benefit of culture. Women are significantly more likely to experience
UTI than men. Urinary tract infections (UTIs) are considered to be the most common bacterial
infection. According to the 1997 National Ambulatory Medical Care Survey and National Hospital
Ambulatory Medical Care Survey, UTI accounted for nearly 7 million office visits and 1 million
emergency department visits, resulting in 100,000 hospitalizations. (Foxman B. 2002).
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Therapeutic Management
The objectives of treatment of children with UTI are two (1) eliminate the current infection,
(2) identify contributing factors to reduce the risk recurrence. (3) prevent urosepsis, and (4)
preserve renal function. Nonetheless, empiric therapy on the basis of the child’s history and
presenting symptoms may be necessary when fever or systemic illness complicates. UTI. Common
anti-infective agents used for UTI include the penicillin, sulfonamide (including trimethoprim and
sulfamethoxazole in combination, the cephalosporin’s, nitrofurantoin, and the tetracycline. All
antibiotics may cause side effects or prove ineffective because of bacterial resistance. Children
with suspected pyelonephritis and fever are admitted to the hospital and given appropriate
intravenously for a minimum of 48hrs. Blood and urine cultures are obtained on admission and
after therapy. Urine cultures are usually repeated are monthly intervals for 3 months and at 3-
months intervals for another 6 months. (McElhinney,2000)
Nursing Care Management:
Objectives of nursing care include identification of children with UTI and education of
parents and children regarding prevention and treatment of infection. Aside from the influence of
renal abnormalities, girls between the ages of 2 and 6 years are in the general high-risk group.
Because they are not a captive population, mass screening is difficult. However, the annual health
examination should include a routine urinalysis. In addition, nurses should instruct parents to
observe regularly for clues that suggest UTI. Unfortunately, the signs of UTI are not as evident as
those of upper respiratory tract infection. Therefore many cases go undetected because no one
thought to investigate this common problem. (McElhinney,2000)
Diagnostic Evaluation
The diagnostic of UTI depends on high degree of suspicion, evaluation of the history and
physical examination and urinalysis and culture. Urine with a possible infection appears cloudy,
hazy, or thick with noticeable strands of mucus and pus; it also smells unpleasant, even when fresh.
a presumptive UTI diagnosis can be made on the basis of microscopic examination of the urine,
which often reveal pyuria (5 to 8 white blood cells0ml of uncentrifuged urine) and the presence of
at least one bacterium in a Gram stain. However, a normal urinalysis may also be present of
asymptomatic bacteraemia. The diagnosis of UTI is confirmed by the detection of bacteria in the
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urine culture, but urine collection is often difficult, especially in infants and very small children.
Several factors may alter a urine specimen. Contamination of a specimen by organism from
sources other than the urine is the most common cause of false-positive results. Bag urine specimen
are commonly contaminated by perineal and perianal flora and are usually considered inadequate
for a definitive diagnosis. As per recommendation that urine must be collected by the bag be used
to determine whether it is necessary to obtain a catherized urine specimen for culture. (McElhinney,
2000)
Unless the specimen is a first morning sample, a recent high fluid intake may indicate a
falsely low organism count. Therefore children should not to be encouraged to drink large volumes
of water an attempt to obtain a specimen quickly. (McElhinney, 2000).
Medical treatment
Children with uncomplicated UTI are likely to respond to amoxicillin, sulphonamides,

trimethoprim-sulfamethoxazole (cotrimoxazole) or cephalosporins, as these antibiotics are
concentrated in the lower urinary tract. Parenteral antibiotics should be considered in children
who are toxic, vomiting or dehydrated, or who have an abnormal urinary tract (Riccabona 2003).
The authors state that oral antibiotics, chosen to cover local uropathogens are as safe and effective
as intravenous antibiotics in children with a clinical diagnosis of acute pyelonephritis and
intravenous antibiotics should be reserved for those who are seriously ill or have persistent
vomiting (Craig and Hodson 2004).
Prognosis
UTI in young children may be a marker for abnormalities of the urinary tract including
vesico-ureteric reflux (VUR) and reflux nephropathy (renal scarring). VUR is the commonest
abnormality with a prevalence of 1% in all children and 35% in children following first UTI. Data
in both humans and animals have demonstrated that UTI in the presence of VUR may lead to acute
pyelonephritis and renal scarring. Renal scarring is associated with subsequent renal damage,
hypertension and end stage renal disease (ESRD). Reflux nephropathy has been estimated to
account for 7-17% of ESRD (Craig, Irwig et al. 2000).
Until recently, standard practice after diagnosing UTI has been to image the urinary tract
of children for abnormalities by performing a renal ultrasound and micturating cystourethrography
9
(MCU). This was on the assumption that prevention of UTI recurrence through administering
prophylactic antibiotics would reduce the risk of developing renal scarring and thus ESRD. A
systematic review of long-term antibiotics for preventing recurrent UTI in children, has suggested
problems with the existing published trials and that further research is required (Williams2004).
PATIENT HEALTH HISTORY

BIOGRAPHIC DATA
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Name : Patient E
Address : Purok 8, Brgy Capalayan, Surigao City, Surigao del Norte
Date of Birth : August 26, 2018
Age : 8 months
Sex : Female
Civil Status : Child
Birth of Place : Surigao City
Religion : Roman Catholic
Nationality : Filipino
Health Care Financing & Usual Source of Medical Care: PhilHealth
Source and Reliability of Data Gathered: Patient Chart, Significant Other
ADMISSION DATA
Hospital: : Caraga Regional Hospital
Hospital Case Number : 0001942
Room Type: : Level 4
Date Admitted: : April 24, 2019
Time : 5: 21 am
Mode of Admission: : Via Ambulance
Admitting Vital Signs:
Temperature : 37.6oC
Respiratory Rate : 31cpm
Heart Rate : 122bpm
Weight: : 6.3kg
Admitting diagnosis : Benign Febrile Seizure, Urinary tract Infection
Admitting Physician: : Dr. Sheryl M. Ochea, M.D
Attending Physician: : Dr. Sheryl M. Ochea M.D
History of present illness (HPI): One week prior to admission the patient has on and off fever,
the patient’s mother bring her to the health center for check-up and was given a paracetamol for
her fever and still the health status of the patient was the same. So they decided to admit her in
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Caraga Regional Hospital for further medical interventions. Upon on the day of my assessment,
the patient has a three days of non-productive cough and afebrile. She also stated that client had
been so irritable and always crying.
HEALTH PERCEPTION-HEALTH MANAGEMENT PATTERN
Before hospitalization at Caraga Regional Hospital patient’s weight is 6.7kg.
During hospitalization at Caraga Regional Hospital patient’s present weight is 6.3kg as per
verbalized by the patient’s mother.
NUTRITIONAL METABOLIC PATTERN
Before hospitalization at Caraga Regional Hospital patient’s daily food intake is cerelac
and sometimes breast milk of the mother.
During hospitalization at Caraga Regional Hospital patient’s daily food intake is the breast
milk of the mother.
ELIMINATTION PATTERN
Bowel habits:
Before hospitalization at Caraga Regional Hospital patient eliminates soft stool, three to
four times, light yellow color.
During hospitalization at Caraga Regional Hospital patient eliminates, one to two times,
light yellow color
Bladder Habits:
Before hospitalization at Caraga Regional Hospital. According to patient’s mother, she
can’t measure the exact amount and frequency of urination of the patient because patient is always
on diaper and she changes the diaper more or less ten times a day as it is minimal in amount and
it was light yellow in color.
During hospitalization at Caraga regional Hospital. According to patient’s mother, she
change the diaper of the patient five to four times a day with a little amount of urine, strong
smelling urine and darker in color than usual.
SLEEP-REST PATTERN
Before hospitalization the patient’s usual sleep time around 6pm and wakes up at 5am with
uninterrupted sleep. The patient mother claimed that her daughter has no difficulty of sleeping.
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During hospitalization the patient has an intermittent sleeping pattern as she was disturbed
every time her vital signs was taken and may start on crying.
COPING-STRESS TOLERANCE PATTERN
Every time the patient throws tantrums, her mother will console and cuddle her
immediately. Patient support system is her family and the communication between the families is
good. Patient’s S.O always visit her every day.
PAST HEALTH HISTORY

CHILDHOOD ILLNESSES:
According to his mother he did not experience any other childhood illness such as
chickenpox, mumps, measles and rubella but the mother added that fever, cough and colds were
very common to the patient.
CHILDHOOD IMMUNIZATIONS:
The patient E had been immunized including BCG, DPT, Oral Polio Vaccine, and Hepatitis
B vaccine.
HISTORY OF HOSPITALIZATION:
Patient had no history of hospitalizations.
SURGICAL HISTORY:
Patient had no history of any surgery.
ALLERGIC REACTION:
No known allergy to food, drugs, insects or other environmental agents according to the
patient.
ACCIDENTS AND INJURIES:
Patient had no history of any accidents and injuries.
FAMILY HEALTH HISTORY:
Upon interviewing the patient’s mother said that on her maternal side, her mother have an
arthritis, while her brother had a tuberculosis. On the patient’s paternal side, her father had a high
blood pressure while the youngest son had asthma.
PHYSICAL EXAMINATION
Date: April 25, 2019
13
Time: 8:43 a.m.
General Survey
Patient “E” appears to be 8 months old. Patient appears irritable, weak and lying on bed.
Patient wears dirty light clothing top and diaper and dirty nails. Hooked with 500ml IVF of PLR
infusing well at right metacarpal vein of 150ml left at 20 gtts/min. With the vital signs of pulse
rate 122bpm, respiratory rate 31cpm, temperature 36.2oC. Present of superficial phlebitis at her
left foot.
SKIN
Skin is smooth and warm to touch. Patient had presence of superficial phlebitis on her left
foot noted. Pinched-up skin returns immediately to original position. noted. Good skin turgor
noted. No lesion.
NAILS
Patient’s nail bed is pink in colour, finger untrimmed and dirty, no clubbing and medium
length and thickness. Nails are round, firm, and immobile. Capillary refill returns to 2-3 seconds.
HEAD AND FACE
Patients head is symmetrically. Minimal smooth hair noted. Skull is round in shape, no
masses noted. Hair is evenly distributed over the scalp. No scars and wounds noted. Patient
symmetrical face, no deformities. No tenderness of frontal and maxillary sinuses. Noted.
EYES
Has symmetrical eyebrows movement, shape and hair distribution. Eyebrows have same
color with hair. Eyelashes are evenly distributed and curled outward. Patient’s palpebral
conjunctiva are pinkish in color while pupil constricted to light, round in shape.
EARS AND NOSE
Ears
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Auricles has same color with the skin, has symmetrical shape and aligned with the outer
canthus of the eye. Noted. Pinna is slightly curved. No sign of any abnormal discharges noted. No
inflammation or tenderness noted.
Nose
Nose is symmetrical to the midline of the face, no lesions or swelling, nasal mucosa is
pinkish in colour, has no discharges and no lesions. No tenderness of sinuses noted.
MOUTH AND THROAT
Lips is pink, moist, and smooth with no lesions. Noted. Gums are pinkish with no bleeding.
Noted. Absence of deciduous teeth. The tongue is in central position and can move freely without
difficulty. Uvula is found well placed in midline of soft palate. Mucosa is pinkish in colour. Tonsils
are not inflamed. Noted.
NECK
Trachea is in midline. Clavicles are symmetrical and intact. No enlargement of the neck
noted. Patient able to flex and extend neck and move it laterally left and right.
ANTERIOR CHEST
Patient has a respiratory rate of 31 cycles per minute. She has no difficulty of breathing.
Equal chest expansion and registers a clear breath sound. Patient’s skin intact and uniform in
temperature. There no masses noted. Absence of adventitious sound upon auscultation. Noted.
ABDOMEN
Patient is food intake is cereal and the breast of the mother. Uniform in colour with the rest
of the body upon inspection. Moist skin noted. No rashes, lesions. Mass and tenderness noted. Her
Abdomen rounded symmetrical without masses, lesions, pulsations or peristalsis noted. Umbilical
in midline, without swelling or discoloration. Abdomen is distended noted.
HEART
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Patient has a regular rhythm with 128 beats per minute. S1 and S2 heart sound evident. No
evidence of gallops, murmurs, or rubs. No vibrations or pulsations are palpated in aortic, pulmonic
or tricuspid area. No presence of jugular vein distention noted.
MUSCULOSKELETAL SYSTEM
Movements are equal in flexibility and strength. Upper and lower limbs are symmetrical
in length. Movements gradually become smoother and continues. Shoulders symmetrical, parallel
with hips. Shoulders scapulae, iliac crests symmetrical. Plantar crease is visible on each foot. No
tenderness to palpation of joints. Noted. Five fingers on each extremity, no hand noted tremors, no
lesions, scars and redness noted. Muscle strength is equal on both sides of the upper and lower
extremities. Presence of superficial phlebitis noted.
REPRODUCTIVE SYSTEM
Patient has a presence of rashes in inguinal area noted. Redness and lesions noted. Strong-
smelling of urine upon inspection. She has no vaginal discharge, swelling, or lesions.
NEUROLOGIC EXAMINATION
Patient E is awake and lying on bed, the patient is irritable noted.
CRANIAL NERVES ASSESSMENT
April 25, 2019
Cranial nerves Type of Function Results

Impulse
I Olfactory Sensory Carries smell impulses Difficult to test.
from nasal mucous
membrane to brain.
II Optic Sensory Carries visual acuity Patient has a good vision.
from eye to brain.
III Oculomotor Motor Contracts eye muscles to Pupils equally round and
control eye movements reactive to light and
(inferior lateral, medial accommodation.
and superior), constricts
pupils, and elevates
eyelids.
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IV Trochlear Motor Contracts one eye Both eyes are able to move
muscle to control downward and laterally
inferomedial eye without any discomforts.
movement.
V Trigeminal Sensory Carries sensory Patient was able to feel the

impulses of pain, touch, touch on her face.
and temperature from
the face to the brain.
Motor Influences clenching Patient doesn’t experiences
and lateral jaw any discomfort when
movements (biting, swallowing.
chewing).
VI Abducens Motor Controls lateral eye Patient was able to move her
movements. eyeballs with no discomfort
noted.
VII Facial Sensory Contains sensory fibers Patient has no difficulty in

for taste on anterior two tasting of foods.
thirds of tongue and
stimulates secretions
from the salivary glands
(submaxillary and
sublingual) and tears
from lacrimal glands.
Motor Supplies the facial The patient has facial
muscles and affects expressions that correlates
facial expressions with mood.
(smiling, frowning,
closing eyes).
VIII Acoustic, Sensory Contains sensory fibers Patient is able to hear with
vestibulocochlear for hearing and balance. both ears.
IX Glossopharyngeal Sensory Contains sensory fibers Patient’s ability to taste foods
for taste on posterior has no problems.
third of tongue and
sensory fibers of the
pharynx that result in
the “gag reflex” when
stimulated.
Motor Provides secretory fibers Patient doesn’t experiences
to the parotid salivary any sore throat and discomfort
glands; promotes during swallowing of foods.
swallowing movements.
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X Vagus Sensory Carries sensations from Patient has no discomfort on
the throat, larynx, heart, swallowing.
lungs, bronchi,
gastrointestinal tract,
and abdominal viscera.
XI Accessory Motor Elevate shoulder turn The shoulders are
head symmetrical
XII Hypoglossal Motor Tongue movements Patient had no difficulty of

swallowing
April 25, 2019
Reflex Function Stimulation Response

Eye blink Protects infant from Shine bright light at Patient quickly closes
strong stimulation eyes or clap hand near eyelids
head
Rooting Helps infant find Stroke cheek near Patient head turns
the nipple corner of mouth towards source of
stimulation
Sucking Permits feeding Place finger in infant’s Patient suck fingers
mouth rhythmically
Moro In human Hold infant Patient makes an
evolutionary past horizontally on back ‘embracing motion by
may have helped and let head drop arching, back,
infant cling to slightly, or produce a extending legs,
mother. sudden loud sound throwing arms
against surface outward, and then
supporting infant. bringing arms in
toward the body.
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Palmar grasp Prepares infant for Place finger in infant’s Patient finger
spontaneous grasp
voluntary grasping. hand and press against
palm
Tonic neck May prepare infant Turn infant’s head to Patient turn head and
for voluntary one side while she/he is look in direction of
reaching lying awake on back new sound.
Stepping Prepares infant for Hold infants under Patient lifts one foot
voluntary walking arms and permit bare after another in
feet to touch a flat stepping response.
surface.
Babinski Stoke sole of foot Patient toes fan out and
from toe toward curl as foot twist in
heel
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REVIEW OF SYSTEM
Date: April 25, 2019
Time: 8:43 a.m.
GENERAL SURVEY
Received patient E awake an eight month old infant, appears to be irritable, awake and
lying on bed. May show of distress during vital signs taking. Patients usual weight 6.7 Recent
weight of the patient is 6.3 kg. Presence of superficial phlebitis at her left foot.
INTEGUMENTARY SYSTEM
Patient’s mother stated that client had no history of itching, lesion, abrasion pigmented
spots nor bruises. No history either of excessively dry skin nor moist skin. No previous skin
infections noted.
HEAD, EYES, EARS, NOSE, AND THROAT (HEENT)
During the assessment patient’s mother stated that client had no history of eye injury,
surgery. No history of head injury. Patient had no history of nasal stuffiness. No history of
nosebleed. She had no history of nasal allergies, no history of neck lumps and thyroid problem.
No presence of sore throat and bleeding gums. No history of mouth ulcers or other lesions.
Auricles doesn’t have any deformities, lump or lesions. Patient had no history of any ear infection
or discharges.
RESPIRATORY SYSTEM
There is no presence of signs and symptoms of disease such as pneumonia and asthma.
Patient has no episodes of apnea, no history of dyspnea. Upon assessment patient has a non-
productive cough.
CARDIOVASCULAR SYSTEM
Patient’s heart rate a regular rhythm with 121 beats per minute. S1 and S2 is heard during
auscultation. No history of chest pain and cyanosis. No history of edema. No history of orthopnoea
or heart troubles. Absence of cardiopulmonary diseases.
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GASTROINTESTINAL SYSTEM
Patient has a poor feeding. Patient no history of nausea, vomiting and hematemesis, no
history of dysphagia. Umbilicus midline without swelling or discoloration. No history of diarrhea
and bleeding. No pain and jaundice, gallbladder or liver problems.
REPRODUCTIVE SYSTEM
The patient experience dysuria, present of rashes on her inguinal area. No history of itching
and sores, no history of polyuria and nocturia. Her mother changes her diaper when full or stained.
MUSCULOSKELETAL SYSTEM
The patient manifested good posture and moved voluntarily. No history of redness,
swelling, stiffness. She has symmetrical musculature on both sides of the body. No history of
swelling, arthralgia or myalgia. No history of stiffness and joint pain.
NEUROLOGIC SYSTEM
Patient had no history of difficulty on unconsciousness, and tremors. During the assessment
the patient is irritable.
21
The Urinary System
A group of organs in the body concerned with filtering out excess fluid and other
substances from the bloodstream. The substances are filtered out from the body in the form
of urine.
Urine is a liquid produced by the kidneys, collected in the bladder and excreted through
the urethra. Urine is used to extract excess minerals or vitamins as well as blood corpuscles from
the body. The Urinary organs include the kidneys, ureters, bladder, and urethra. The Urinary
system works with the other systems of the body to help maintain homeostasis.
The kidneys are the main organs of homeostasis because they maintain the acid base
balance and the water salt balance of the blood.
Function of the Urinary System
One of the major functions of the Urinary system is the process of excretion. Excretion is the
process of eliminating, from an organism, waste products of metabolism and other materials that
are of no use. The urinary system maintains an appropriate fluid volume by regulating the amount
of water that is excreted in the urine.
Six important roles of the kidneys are:
Regulation of plasma ionic composition- Ions such as sodium, potassium, calcium, magnesium,
chloride, bicarbonate, and phosphates are regulated by the amount that the kidney excretes.
Regulation of plasma osmolality- The kidneys regulate osmolality because they have direct
control over how many ions and how much water a person excretes.
22
Regulation of plasma volume- Your kidneys are so important they even have an effect on your
blood pressure. The kidneys control plasma volume by controlling how much water a person
excretes. The plasma volume has a direct effect on the total blood volume, which has a direct effect
on your blood pressure. Salt (NaCl)will cause osmosis to happen; the diffusion of water into the
blood.
Regulation of plasma hydrogen ion concentration (pH)- The kidneys partner up with the lungs
and they together control the pH. The kidneys have a major role because they control the amount
of bicarbonate excreted or held onto. The kidneys help maintain the blood Ph mainly by excreting
hydrogen ions and reabsorbing bicarbonate ions as needed.
Removal of metabolic waste products and foreign substances from the plasma-One of the
most important things the kidneys excrete is nitrogenous waste. As the liver breaks down amino
acids it also releases ammonia. The liver then quickly combines that ammonia with carbon dioxide,
creating urea which is the primary nitrogenous end product of metabolism in humans. The liver
turns the ammonia into urea because it is much less toxic. We can also excrete some ammonia,
creatinine and uric acid.
The creatinine comes from the metabolic breakdown of creatine phosphate (a high-energy
phosphate in muscles). Uric acid comes from the breakdown of nucleotides. Uric acid is insoluble
and too much uric acid in the blood will build up and form crystals that can collect in the joints
and cause gout.
Secretion of Hormones -The endocrine system has assistance from the kidneys when releasing
hormones. Renin is released by the kidneys. Renin leads to the secretion of aldosterone which is
released from the adrenal cortex. Aldosterone promotes the kidneys to reabsorb the sodium (Na+)
ions. The kidneys also secrete erythropoietin when the blood doesn't have the capacity to carry
oxygen. Erythropoietin stimulates red blood cell production
Organs in the Urinary System
Kidneys and Their Structure
Kidneys are a pair of bean shaped, brown organs about the size of your fist. It measures
10-12 cm long. They are covered by the renal capsule, which is a tough capsule of fibrous
connective tissue. Adhering to the surface of each kidney is two layers of fat to help cushion them.
23
Renal Vein
The renal veins are veins that drain the kidney. They connect the kidney to the inferior
vena cava. Because the inferior vena cava is on the right half of the body, the left renal vein is
generally the longer of the two. Unlike the right renal vein, the left renal vein often receives the
left gonadal vein (left testicular vein in males, left ovarian vein in females). It frequently receives
the left suprarenal vein as well.
Renal Artery
The renal arteries normally arise off the abdominal aorta and supply the kidneys with
blood. The arterial supply of the kidneys are variable and there may be one or more renal arteries
supplying each kidney. Due to the position of the aorta, the inferior vena cava and the kidneys in
the body, the right renal artery is normally longer than the left renal artery. The right renal artery
normally crosses posteriorly to the inferior vena cava. The renal arteries carry a large portion of
the total blood flow to the kidneys. Up to a third of the total cardiac output can pass through the
renal arteries to be filtered by the kidneys.
Ureters
The ureters are two tubes that drain urine from the kidneys to the bladder. Each ureter is
a muscular tube about 10 inches (25 cm) long. Muscles in the walls of the ureters send the urine
in small spurts into the bladder, (a collapsible sac found on the forward part of the cavity of the
bony pelvis that allows temporary storage of urine). After the urine enters the bladder from the
ureters, small folds in the bladder mucosa act like valves preventing backward flow of the urine.
The outlet of the bladder is controlled by a sphincter muscle. A full bladder stimulates sensory
nerves in the bladder wall that relax the sphincter and allow release of the urine. However,
relaxation of the sphincter is also in part a learned response under voluntary control. The released
urine enters the urethra.
Urinary Bladder
The urinary bladder is a hollow, muscular and distendible or elastic organ that sits
on the pelvic floor (superior to the prostate in males). On its anterior border lies the pubic
symphysis and, on its posterior border, the vagina (in females) and rectum (in males). The urinary
bladder can hold approximately 17 to 18 ounces (500 to 530 ml) of urine, however the desire to
24
maturate is usually experienced when it contains about 150 to 200 ml. When the bladder fills with
urine (about half full), stretch receptors send nerve impulses to the spinal cord, which then sends
a reflex nerve impulse back to the sphincter (muscular valve) at the neck of the bladder, causing it
to relax and allow the flow of urine into the urethra. The Internal urethral sphincter is involuntary.
The ureters enter the bladder diagonally from its dorsolateral floor in an area called the trigone.
Urethra
The urethra is a muscular tube that connects the bladder with the outside of the body. The
function of the urethra is to remove urine from the body. It measures about 1.5 inches (3.8 cm) in
a woman but up to 8 inches (20 cm) in a man. Because the urethra is so much shorter in a woman
it makes it much easier for a woman to get harmful bacteria in her bladder this is commonly called
a bladder infection or a UTI. The most common bacteria of a UTI is E-coli from the large intestines
that have been excreted in fecal matter.
In the human female, the urethra is about 1-2 inches long and opens in the vulva between
the clitoris and the vaginal opening.
Nephrons
A nephron is the basic structural and functional unit of the kidney. The name nephron
comes from the Greek word (nephros) meaning kidney. Its chief function is to regulate water and
soluble substances by filtering the blood, reabsorbing what is needed and excreting the rest as
urine. Nephrons eliminate wastes from the body, regulate blood volume and pressure, control
levels of electrolytes and metabolites, and regulate blood pH. Its functions are vital to life and are
25
regulated by the endocrine system by hormones such as antidiuretic hormone, aldosterone, and
parathyroid hormone.
Each nephron has its own supply of blood from two capillary regions from the renal artery.
Each nephron is composed of an initial filtering component (the renal corpuscle) and a tubule
specialized for reabsorption and secretion (the renal tubule).
Glomerulus
The glomerulus is a capillary tuft that receives its blood supply from an afferent arteriole
of the renal circulation. The glomerular blood pressure provides the driving force for fluid and
solutes to be filtered out of the blood and into the space made by Bowman's capsule. The remainder
of the blood not filtered into the glomerulus passes into the narrower efferent arteriole. It then
moves into the vasa recta, which are collecting capillaries intertwined with the convoluted tubules
through the interstitial space, where the reabsorbed substances will also enter.
Abnormal Anatomy
You are more likely to get a UTI if your urinary tract has an abnormality or has recently had
a device (such as a tube to drain fluid from the body) placed in it. If you are not able to urinate
normally because of some type of blockage, you will also have a higher chance of a UTI.
Anatomical abnormalities in the urinary tract may also lead to UTIs. These abnormalities are
often found in children at an early age but can still be found in adults. There may be structural
abnormalities, such as outpunching’s called diverticula, that harbor bacteria in the bladder or urethra
or even blockages, such as an enlarged bladder, that keep the body from draining all the urine from
the bladder. Although UTIs can be treated with antibiotics, it's important for a doctor to rule out
any underlying abnormalities in the urinary system when UTIs happen repeatedly. Kids with
recurrent infections should see a pediatric urologist to see what is causing the infections.
Some problems can be found even before birth. Hydronephrosis that develops before birth
can be detected in a fetus by ultrasound as early as 16 weeks. In rare cases, doctors may consider
neonatal surgery (performing surgery on an unborn baby) if hydronephrosis affects both kidneys
and poses a risk to the fetus. Most of the time, though, doctors wait until after birth to treat the
condition, because almost half of all cases diagnosed prenatally disappear by the time a baby is
born.
26
Once a baby suspected to have hydronephrosis or another urinary system abnormality is
born, the baby's blood pressure will be monitored carefully, because some kidney problems can
cause high blood pressure. An ultrasound may be used again to get a closer look at the bladder and
kidneys. If the condition appears to be affecting both kidneys, doctors usually will order blood
tests to measure kidney function.
27
PATHOPHYSIOLOGY
Predisposing factors: Precipitating Factors:
Age (8 months old) Lifestyle
Gender (female) Poor hygiene
Anatomical Abnormalities Urinary retention
Immunosuppression Enlarged prostate
Sexual Activity
Catheterization
Diabetes
Bacterial invasion
(Escherichia coli)
Colonization in the
urethra, bladder
Client manifestation:
 Pelvic pain
 Pelvic discomfort -------- Cystitis
 Dysuria
Sign and symptom

Neutrophil infiltration  Fever
Client manifestation: ------------ ------------  chills
-------------
 Febrile Seizure  Fatigue
 Headache
Inflammatory response  Loss of appetite
Immune system Evasion
Macrophages trap and kills

bacteria
Activates messenger protein
Dendritic cells activates T

cells
T cells activates B cells
28
Client manifestation: ___---------
 Increased WBC B cells releases antibodies
(42) --
Antibodies help the cells to

kill the bacteria
Formation of biofilm in ------- Sign and symptom

which to allow bacteria to  diarrhea
survive
If left untreated:
Ascension to the kidney
Colonization of
kidney
Sign and symptom
 poor circulation of
Bacteremia blood
--------  palpitation --
------ Sign and symptom

Septic Shock
--  Decrease blood
pressure
Organ
Failure
Death
LEGEND:
Disease process
Sign and symptom
Client Manifestation
Left untreated
29
Narrative:
For infection to occur bacteria like Escherichia coli must gain access to the urethra, attach
to and colonize the epithelium of the urethra to avoid bring washed out and to be able to initiate
inflammation. In the cystitis pelvic pain, pelvic discomfort, dysuria is manifest to the client. During
infection dysuria will manifest and will inflammation. The immune system responds by flooding
the lower urinary tract with white blood cells that may cause fever, chills, fatigue, headache will
be the sign and symptom. Macrophages are the first to attack at the infected site trapping and
killing each bacterium. Blood vessels release water into the infected part so that fighting becomes
easier. when the macrophages fight for too long, they call in heavy backup by releasing messenger
protein that communicates with neutrophils. Neutrophils leave their patrol routes in the blood and
moves into bladder to fight against the bacteria. If evasion doesn’t stop the brain immune system
kicks in which is dendritic cells. The dendritic cells start collecting samples from the enemies and
make an army of bacterial killers. It travels to the lymph nodes and activates helper T cells. The t
cells will duplicate itself for thousand times, some becomes memory helper T cells, some will
travel to the urethra to fight off, and some will travel to center of lymph nodes activate B cells and
produce antibodies. The client will increase white blood cells.
If the condition is left untreated bacteria may ascend into the ureter and the kidney. This
will make the bacteria in the kidney occurs, this will make the bacteria colonize one or both
kidneys. If colonization of the bacteria in the kidney this may lead to inflammation of the kidney
caused by the bacteria. This will have a sign and symptoms of palpation and poor circulation of
blood. This will lead to sepsis and if uncontrolled this will lead to septic shock that may cause
multiple organ dysfunction and death.
30
DRUG STUDY NO.1
Brand Name: Paracetamol

Generic Name: Tempra
Classification: Anti-pyretics; analgesics
Dosage: 100mg, 1ml drops q4hr
Indication:
Mild pain. Fever.
Action:
Inhibits the synthesis of prostaglandins that may serve as mediator of pain and fever
primarily in the CNS. Has no significant anti-inflammatory properties of GI toxicity. Analgesics,
antipyretics.
Contraindications/ Precaution:
Contraindicated in: previous hypersensitivity; products containing alcohol, aspartame,
sugar, tartrazine, should be avoided in patients who have hypersensitivity or intolerance to these
compounds.
Adverse Reaction:
GI: hepatic failure; hepatotoxicity. GU: renal failure. HEMAT: neutropenia; pancytopenia,
leukopenia. DERM: rash, urticaria
Nursing Implication:
• Assess fever; note presence of associated signs.
• Administer with full glass of water.
• May be taken with food or on an empty stomach.
• Advise patient to take medication as directed.
• Inform patient with diabetes that acetaminophen may alter results of blood glucose
monitoring. Advise patient to notify health care professional if changes are noted.
31
DRUG STUDY NO.2
Brand Name: Diazepam

Generic Name: Valium
Classification: Antianxiety agents, anticonvulsants, sedative/hypnotics, skeletal muscle relaxants
Dosage: 1.5mg IVTT q8hrs
Indication:
Adjunct in the management of: Anxiety Disorder, Athetosis, Anxiety relief prior to
cardioversion (injection), Stiffman Syndrome, Preoperative sedation, Conscious sedation
(provides light anesthesia and anterograde amnesia). Treatment of status epilepticus/uncontrolled
seizures (injection). Skeletal muscle relaxant. Management of the symptoms of alcohol
withdrawal. Unlabeled Use :Anxiety associated with acute myocardial infarction, insomnia.
Action:
Depresses the CNS, probably by potentiating GABA, an inhibitory neurotransmitter.
Produces skeletal muscle relaxation by inhibiting spinal polysynaptic afferent path-
ways. Has anticonvulsant properties due to enhanced presynaptic inhibition.
Thera-peutic Effects :Relief of anxiety. Sedation. Amnesia. Skeletal muscle relaxation. Decreased
seizure activity.
Contraindicated in:Hypersensitivity; Cross-sensitivity with other benzodiazepines may
occur; Comatose patients; Myasthenia gravis; Severe pulmonary impairment; Sleep apnea; Severe
hepatic dysfunction; Pre-existing CNS depression; Un con-trolled severe pain; Angle-closure
glaucoma; Some products contain alcohol,propylene glycol, or tartrazine and should be avoided
in patients with known hypersensitivity or intolerance risk of congenital malformations; Pedi:
Children 6mo (for oral; safety not established);Lactation: Recommend to discontinue drug or
bottle-feed.
Adverse Reaction:
CNS: dizziness, drowsiness, lethargy ,depression, hangover, ataxia, slurred
speech,headache, paradoxical excitation. EENT: blurred vision. Resp: RESPIRATORY
DEPRESSION CV: hypotension (IV only). GI: constipation, diarrhea (may be caused by
32
propylene glycol content in oral solution), nausea, vomiting, weight gain. Derm: rashes. Local:
pain (IM), phlebitis (IV), venous thrombosis. Misc: physical dependence, psychological
dependence, tolerance
 Monitor temperature, pulse, and respiratory rate prior to and periodically throughout
therapy and frequently during IV therapy.
 Assess IV site frequently during administration; diazepam may cause phlebitis and
venous thrombosis.
 Geri: Assess risk of falls and institute fall prevention strategies.
 Seizures: Observe and record intensity, duration, and location of seizure activity. The
initial dose of diazepam offers seizure control for 15 – 20 min after administration. Institute
seizure precautions
 Muscle Spasms: Assess muscle spasm, associated pain, and limitation of movement prior
to and during therapy.
33
DRUG STUDY NO.3
Brand Name: Phenytoin

Generic Name: Dilan
Classification: Antiarrhythmics (group IB), Anticonvulsants
Dosage: 105mg IVTT OD

Indication:
Treatment/prevention of tonic clonic (grand mal) seizures and complex partial seizures.
Unlabeled Use: As an antiarrhythmic, particularly for ventricular arrhythmias associated with
digoxin toxicity, prolonged QT interval, and surgical repair of congenital heart diseases in
children. Management of neuropathic pain, including trigeminal neuralgia.
Action:
Limits seizure propagation by altering ion transport. May also decrease synaptic
transmission. Antiarrhythmic properties as a result of shortening the action potential and
decreasing automaticity. Therapeutic Effects: Diminished seizure activity. Termination of
ventricular arrhythmias.
Contraindicated in: Hypersensitivity; Hypersensitivity to propylene glycol (phenytoin
injection only); Alcohol intolerance (phenytoin injection and liquid only); Sinus bradycardia,
sinoatrial block, 2nd- or 3rd-degree heart block, or Stokes-Adams syndrome (phenytoin injection
only); Concurrent use of delavirdine. Use Cautiously in:All patients risk of suicidal
thoughts/behaviors); Hepatic or renal disease risk of adverse reactions; dose reduction
recommended for hepatic impairment); Patients with severe cardiac or respiratory disease (use of
IV phenytoin may result in an risk of serious adverse reactions); OB: Safety not established; may
result in fetal hydantoin syndrome if used chronically or hemorrhage in the newborn if used at
term; use with extreme caution; Lactation: Safety not established; Pedi: Suspension contains
sodium benzoate, a metabolite of benzyl alcohol that can cause potentially fatal gasping syndrome
in neonates; Geri: Use of IV phenytoin may result in an risk of serious adverse reactions. Exercise
Extreme Caution in: Patients positive for HLA-B*1502 allele (unless exceptional circumstances
exist where benefits clearly outweigh the risks).
34
Adverse Reaction:
Most listed are for chronic use of phenytoin CNS: SUICIDAL THOUGHTS, ataxia,
agitation, confusion, dizziness, drowsiness, dysarthria, dyskinesia, extrapyramidal syndrome,
headache, insomnia, weakness. EENT: diplopia , nystagmus CV: hypotension with IV phenytoin),
tachycardia. GI: gingival hyperplasia, nausea, constipation, drug-induced hepatitis, vomiting.
Derm: STEVENS JOHNSON SYNDROME ,TOXIC EPIDERMAL NECROLYSIS,
hypertrichosis, rash, exfoliative dermatitis, pruritus, purple glove syndrome. Hemat:
AGRANULOCYTOSIS, APLASTIC ANEMIA , leukopenia, megaloblastic anemia,
thrombocytopenia. MS: osteomalacia, osteoporosis. Misc: fever, lymphadenopathy.
 Instruct the S.O to assess oral hygiene. Vigorous cleaning beginning within 10 days
of initiation of phenytoin therapy may help control gingival hyperplasia.
 Assess patient for phenytoin hypersensitivity syndrome (fever, skin rash
lymphadenopathy). Rash usually occurs within the first 2 wk of therapy.
Hypersensitivity syndrome usually occurs at 3–8 wk but may occur up to 12 wk
after initiation of therapy. May lead to renal failure, rhabdomyolysis, or
hepaticnecrosis; may be fatal.
 Seizures: Assess location, duration, frequency, and characteristics of seizure
activity. EEG may be monitored periodically throughout therapy.
 Monitor Vital signs , ECG, and respiratory function continuously during
administration of IV phenytoin and throughout period when peak serum phenytoin
levels occur (15 – 30 min after administration).
35
DRUG STUDY NO.4
Brand Name: Ceftriaxone

Generic Name: Rocephin
Classification: Anti-infectives
Dosage:360mg IVTT q12hr
Indication:
Treatment of: Skin and skin structure infections, Bone and joint infections, Complicated
and uncomplicated urinary tract infections, Uncomplicated gynecological infections including
gonorrhea, Lower respiratory tract infections, Intra-abdominal infections, Septicemia, Meningitis,
Otitis media. Perioperative prophylaxis.
Action:
Binds to the bacterial cell wall membrane, causing cell death. Therapeutic Effects:
Bactericidal action against susceptible bacteria. Spectrum: Similar to that of second generation
cephalosporins, but activity against staphylococci is less, while activity against gram-negative
pathogens is greater, even for organisms resistant to first- and second-generation agents. Notable
is increased action against: Acinetobacter, Enterobacter, Haemophilus influenza (including
lactamase-producing strains), Haemophilus parainfluenzae, Escherichia coli, Klebsiella
pneumoniae, Morganella morganii , Neisseria, Proteus, Providencia, Serratia, Moraxella
catarrhalis. Has some activity against anaerobes, including Bacteroides fragilis .Notactive against
methicillin-resistant staphylococci or enterococci.
Contraindicated in: Hypersensitivity to cephalosporins; Serious hypersensitivity to
penicillins; Pedi: Neonates 28 days (use in hyperbilirubinemic neonates may lead to kernicterus);
Pedi: Neonates 28 days requiring calcium-containingIVsolutions (risk of precipitation formation).
Use Cautiously in: Combined severe hepatic and renal impairment (dose reduction dosing interval
recommended); History of GI disease, especially colitis; OB, Lactation: Pregnancy and lactation
36
Adverse Reaction:
CNS: SEIZURES (high doses). GI: PSEUDOMEMBRANOUS COLITIS, diarrhea,
cholelithiasis, gallbladder sludging. Derm: rashes, urticaria.Hemat: bleeding, eosinophilia,
hemolytic anemia, leukopenia, thrombocytosis.Local: pain at IM site, phlebitis at IV site. Misc:
allergic reactions including ANAPHYLAXIS ,superinfection.
 Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at
beginning of and throughout therapy.
 Before initiating therapy, obtain a history to determine previous use of and reactions to
penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may
still have an allergic response.
 Obtain specimens for culture and sensitivity before initiating therapy. First dose
may be given before receiving results.
 Pedi: Assess newborns for jaundice and hyperbilirubinemia; can increase bilirubinemia
and should not be administered to jaundiced neonates, especially premature neonates.
 Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema,
wheezing). Discontinue the drug and notify health care professional immediately if these
symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close
by in the event of an anaphylactic reaction.
 Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should
be reported to health care professional promptly as a sign of pseudomembranous colitis.
May begin up to several weeks following cessation of therapy
37
NURSING CARE PLAN NO.1
Assessment:
Objective cues:
MACROSCOPIC EXAMINATION
ABBR ITEM NAME RESULT REFERENCE
RBC RED BLOOD 5 0.3 Infection
CELL
WBC White blood cell 42 0.4 Infection
BACT Bacteria 299 0-10 Infection
Nursing Diagnosis: Infection related to compromised host defences as evidenced by increased

white blood cells, red blood cell and bacteria.
Planning: With in 2days of rendering nursing intervention patient lab result will able to be free
from infections as evidenced by normal WBC, RBC and bacteria decrease.
NURSING INTERVENTION
Independent: Rationale
1. Assess for signs and symptoms of urinary Common symptoms includes fever, chills,
tract infection. cloudy urine, reports of frequency, urgency, or
burning on urination;
2. Monitor white blood cell (WBC) count An increasing WBC count indicates the body’s
efforts to combat pathogens. Rates are as
follows:
Low: Below 4,500
Normal: 4,500—11,000
High: Above 11,000
3. Teach the S.O about the importance of The goal of client teaching is to resolve the
preventing urinary tract infection. current infection and prevent recurrence.
38
4. Hygienic measures (showering rather than Bacteria in the bath water may enter the
bathe in a tub). urethra.
5. The importance of frequent bladder Completely emptying the bladder prevents

emptying. bladder distention and compromised blood
supply to the bladder wall. These predispose
the client to UTI.
6. Instruct the S.O client to wipe the area from Proper perineal care helps in minimizing the
front to back and the avoidance of bath tubs. risk of contamination and re-infection.
7. Maintain an acidic environment of the To prevent the occurrence of bacterial growth.
bladder by the use of agents such as Vit.C,
Mandelamine (a urinary antiseptic) when
appropriate.
8. investigate pain, noting Location, duration, To assist in different entiating between bladder
intensity; presence of bladder spasms; or back the presence and kidney as cause of
pain or flank pain dysfunction.
9. Ascertain the client’s previous pattern of For comparison with current situation.
elimination.
Dependent:
1. Administer anti-infectives as per physician’s Treatment of uncomplicated urinary tract
prescribed: ceftriaxone IVTT q 12 infection.
EVALUATION
Goal met after 2days of rendering nursing intervention patient client is now be free from infections
as evidenced by normal WBC, RBC and bacteria decrease.
39
ASSESSMENT
Subjective:
“Kung mangihi sya ma’am kay mo hilak sya” as verbalized by the S.O
Objectives cues:
 Dysuria
FLACC rating scale used upon assessment:
 Occasional grimace
 Restless
 Uneasy
 Shifting back and forth
 Inconsolable crying and may scream sometimes.
Nursing Diagnosis:
Acute pain related to inflammation of the urinary tract structures.
Planning:
After 8hrs of nursing interventions the patient’s pain will be experience relief of controlled
pain and will be able to demonstrate relaxation.
1. Assess pain noting location, intensity Provides information to aid in determining
duration. choice of effectiveness of interventions.
2. Encourage increased fluid intake. Increased hydration flushes bacteria and
toxins.
40
3. Investigate report of bladder fullness. Urinary retention may develop, causing tissue
distention (bladder or kidney) and potentials
risk for further infection.
4.Observe for changes in mental status, Accumulation of uremic waste and electrolyte
behavior or level of consciousness. imbalances may be toxic to CNS.
5. Provide comfort measure like back rub, Promotes relaxation refocuses, attention and
helping patient assume position of comfort. may enhance coping abilities.
Suggest use of relaxation technique and deep
breathing exercise.
6. Instruct the S.O client to wipe the area from Instruct the S.O client to wipe the area from
front to back and the avoidance of bath tubs. front to back and the avoidance of bath tubs.
appropriate.
8. investigate pain, noting Location, duration, To assist in different entiating between bladder
intensity; presence of bladder spasms; or back the presence and kidney as cause of
elimination.
Dependent:
1. Administer paracetamol 100mg, 1ml This will help lessen the pain experienced by
drops q 4hrs, as prescribed by the the patient.
physician.
2. Administer antibacterial as prescribed. Reduces bacteria present in urinary tract and
those introduced by drainage system..
EVALUATION
Goal partially met after 8 hours of rendering nursing intervention patient S.O of client will report
that the patient relieved.
41
Assessment:
Subjective cues:
“permi man sya mag ihi’ihi ma’am” as verbalized by the patient
Objective cues:
 Dysuria
 Irritability
 Once a day change of diaper
 Urinary incontinence
Nursing Diagnosis:
Impaired Urinary Elimination related urinary tract infection
Planning:
Within 8hrs of rendering nursing intervention, Patient will achieve normal elimination
pattern or participate in measure to correct compensate for defects.
1. Assess the patient’s pattern of elimination. Serve as a basis for determining appropriate
interventions.
2. Note client’s age and gender. UTIs are more prevalent in women and older
men.
3. Palpate the client’s bladder every 4 hours. To determine the presence of urinary retention
4 Encourage increased fluid intake (3-4 liters a To help improve renal blood flow.
day if tolerated).
42
5. Encourage the client to void every 2-3 hours. To prevent the accumulation of urine thus
limiting the number of bacteria.
6. Instruct the S.O client to wipe the area from Proper perineal care helps in minimizing the
front to back and the avoidance of bath tubs. risk of contamination and re-infection.
appropriate.
8. investigate pain, noting Location, duration, To assist in different entailing between
intensity; presence of bladder spasms; or back bladders the presence and kidney as cause of
elimination.
Dependent:
1. Assist with physical examination (e.g. test Note severe coughing and cyanosis associated
for incontinence, palpation for bladder with eating and drinking or changes in the
retention or masses, prostate size and vocal quality after swallowing indicate onset
observation for urethral stricture. of respiratory symptoms associated with
aspiration and require immediate intervention.
2. Rule out gonorrhea in men when urethritis To diagnose bacterial infection of the kidney
with a penile discharge is present and there are or prostate.
no bacteria in the urine. Obtain specimen for
antibody-coated bacteria asssy.
EVALUATION
Goal met after 8hrs of rendering nursing intervention patient will achieve normal elimination
pattern or participate in measure to correct compensate for defects.
43
NURSING CARE PLAN NO. 4
Assessment:
Subjective cues:
“Ni hubag ija tiil man” as verbalized by the S.O
Objective cues:
 Superficial phlebitis noted.

 Tenderness along the vein
 Skin redness
 Warmth at the area
Nursing Diagnosis: Impaired skin integrity related to impaired circulation
Planning: Within 2days of rendering nursing intervention patient’s S.O will be verbalize
understanding of condition and causative or risk factors.
1. Determine client’s age and developmental Newborn/infant’s skin is thin and provides
factors or ability to care for self. ineffective thermal regulation, and nails are
thin.
2. Evaluate client’s skin care practice and Individual’s skin may be oily, dry and scaly, or
hygiene issues. sensitive and affected by bathing frequency (or
lack bathing), temperature of water, types of
soap and other cleansing agents.
3. Review with client skin care practices and That may indicate particular vulnerability.
hygiene issues.
44
4. Assess blood supply (e.g. capillary return To provide comparative baseline and
time, color, and warmth) and sensation of skin opportunity for timely intervention when
surfaces and affected area on a regular basis. problems are noted.
5. handle client gently (particularly infant, Epidermis of infants and very young children
young child, elderly). is thin and lacks subcutaneous depth that will
develop with age.
6. Determine if wound is acute (e.g injury from Which affects healing time and the client’s
surgery or trauma) or chronic (e.g venou or emotional and physical responses.
arterial insufficiency).
7. Perform routine skin inspections, assessing Systematic inspection can identify developing
color, temperature, surface changes texture problems and promotes early intervention, thus
and contours. Evaluate color changes in areas reducing likelihood of progression to skin
of least pigmentation (e.g sclera, conjunctiva, breakdown.
nailbeds, buccal mucosa, tongue, palms, sole
of feet)
8. Observe for reddened or blanched areas or Reduces likelihood of progression to skin

skin rashes, and institute treatment breakdown.
immediately.
9.Provide optimum nutrition, including To provide a positive nitrogen balance to aid in
vitamins (e.g A, C, D, E) protein skin and tissue healing and to maintain general
good health.
Dependent:
1. Consult with wound or stoma specialist, as To assist with developing plan of care for
indicated. problematic or potentially serious wounds.
2. Obtain psychological assessment of client’s For emotional pattern.
emotional status, as indicated.
EVALUATION
Goal met after 2days of rendering nursing intervention patient S.O display timely healing of skin
lesions, wounds or pressure sores without complications.
45
Assessment:
Subjective cues:
“gamay ra ma totoy sa ako bata, kay gamay ang mo gawas na gatas sa ko dede ma’am ” as
verbalized by the SO.
Objective cues:
 Inadequate infant stooling

 Unresponsive to comfort measures
 Infant crying within the first hour after breastfeeding
 Infant arching/crying at the breast
 Unsustained suckling at the breast
Nursing Diagnosis: Ineffective breastfeeding related to inadequate milk supply.
Planning: After 8hrs rendering nursing intervention SO demonstrate techniques to enhance

breastfeeding experience.
1. Note prematurity and/ or infant anomaly To determine special equipment/ feeding
(e.g cleft lip/ palate ) needs.
2. determine whether the baby is content after Suggesting unsatisfactory breastfeeding
feeding or exhibits fussiness and crying within process.
the first hour after breastfeeding.
3.Provied emotional support to the mother. To assist with induced lactation techniques. .
Use one to one instruction with each feeding
46
during hospitalization with each feeding
during hospital stay and clinic or home visit.
4.Discuss early infant feeding cues (e.g rooting Early recognition of infant hunger promotes
lip smacking, and sucking fingers/ hand) time/more rewarding feeding experience for
versus late cue of crying. infant and mother.
5. Demonstrate the use of hand expression, To maintain or increase the milk supply.
hand pump, and piston-type electric breast
pump with bilateral collection chamber when
necessary.
6.weigh the infant at least every third day To verify adequacy of nutritional intake.
initially as indicated and record
Dependent:
1.schedule a follow-up visit with the For evaluation of milk intake/ breastfeeding
healthcare provider 48hrs after hospital and 2 process and to answer the mother’s questions.
weeks after birth
EVALUATION
Goal met. After hours of rendering nursing interventions S.O demonstrate techniques to enhance
breastfeeding experience.
47
Assessment:
Subjective cues:
“kaniwang sa ako bata ma’am” as verbalized by the S.O
Objectives cues:
Average weight for 8 month old baby girl is 17.5 lbs or 7.9kg
Before Hospitalization During Hospitalization

6.7 kg 6.3 kg
• Hyperactive bowel sounds
• Inadequate breast milk
• Lack of interest in food
• Poor feeding
Nursing Diagnosis: Imbalanced Nutrition: less than body requirements related to inability to
procure adequate amounts of food
Planning: With in 8hrs of rendering nursing intervention patient’s caregiver verbalizes and
demonstrates selection of foods or meals that will accomplish a termination of weight loss.
Note real, exact weight; do not estimate. These anthropomorphic assessments are vital
that they need to be accurate. These will be
used as basis for caloric and nutrient
requirements.
Take a nutritional history with the participation Family members may provide more accurate
of significant others. details on the patient’s eating habits, especially
if patient has altered perception.
48
Ascertain healthy body weight for age and Experts like a dietician can determine nitrogen
height. Refer to a dietitian for complete balance as a measure of the nutritional status
nutrition assessment and methods for of the patient. A negative nitrogen balance may
nutritional support. mean protein malnutrition. The dietician can
also determine the patient’s daily requirements
of specific nutrients to promote sufficient
nutritional intake.
Provide a pleasant environment. A pleasing atmosphere helps in decreasing
stress and is more favorable to eating.
Promote proper positioning. Elevating the head of bed 30 degrees aids in
swallowing and reduces risk for aspiration
with eating.
If patient lacks strength, schedule rest periods Nursing assistance with activities of daily
before meals and open packages and cut up living (ADLs) will conserve the patient’s
food for patient. energy for activities the patient values. Patients
who take longer than one hour to complete a
meal may require assistance.
Determine time of day when the patient’s Patients with liver disease often have their
appetite is at peak. Offer highest calorie meal largest appetite at breakfast time.
at that time.
Keep a high index of suspicion of malnutrition Impaired immunity is a critical adjunct factor
as a causative factor in infections. in malnutrition-associated infections in all age
groups.
Once discharged, help the patient and family Change is difficult. Multiple changes may be
identify area to change that will make the overwhelming.
greatest contribution to improved nutrition.
EVALUATION
Goal met, after 8hrs of rendering nursing intervention patient’s caregiver verbalizes and
demonstrates selection of foods or meals that will accomplish a termination of weight loss.
49
Assessment:
Subjective cues:
“Di man kaayo sija katuyog ma’am” as verbalized by the S.O
Objective cues:
 Alteration sleep pattern

 Irritability
 expressive behavior (crying)
 undisrupted sleep (uncomfortable setting)
 During hospitalization sleep pattern (irritable and always crying)
Nursing Diagnosis: Disturbed Sleep Pattern related to unfamiliar setting
Planning: Within 8hrs of nursing intervention. The S.O of the Client will report improvement in
sleep/rest pattern.
1. Identify the client’s sleeping habits/routine To determine usual sleep pattern and
and changes. appropriate interventions.
2. Provide comfort measures such as warm To increase relaxation and improve the
bath, back rub. sleeping pattern.
3. Teach the S.O encourage the client to drink L-tryptophan in milk helps induce and
milk. maintain sleep.
4. Reduce environmental distraction such as Provide a situation conducive to sleep.
noise and light.
5. Limit fluid intake during night time. To minimize the need to urinate in the evening.
50
6. Assess client’s usual sleep patterns and To ascertain intensity and duration of problem.
compare with current sleep disturbance,
relying on significant other report of problem.
7. Identify presence of factors known to Sleep problems can arise from internal and
interfere with sleep, including current illness, external factors and may require assessment
hospitalizations, new baby. over time differentiate specific causes.
8. Adjust ambient lighting To maintain daytime light and night time dark.
9. Encourage significant others appropriate Helps in promotion of normal sleep- wake
indoor light settings during day and night, patterns.
especially exposure to bright light or sunlight
in the morning, avoidance of daytime napping
as appropriate for age and situations being
active during day and more passive in evening.
Dependent:
1. Refers to physician or sleep specialist as For specific interventions and or therapies
indicated. including medications.
2. Instruct the family members in the home The child and the family members must
care plan. demonstrate the ability to ensure adequate
home care before discharge.
EVALUATION
Goal met after 8hrs of rendering nursing intervention patient S.O client report increased sense of
well-being and feeling rested.
51
Assessment:
Subjective cues:
“luyahon kuman ako bata, di naman parehas sa una ma’am” as verbalized by the S.O
Objectives cues:
 Failure to maintain usual routines

 Inability to recover and restore energy, even after sleep
 Lethargic or sluggish
 Decreased performance
Nursing Diagnosis: Fatigue related to anxiety as evidenced by frequent crying.
Planning: With in 8hrs of rendering nursing intervention patient will perform ADLs and
participate in desired activities at level of ability.
Evaluate the patient’s fatigue: severity, Using an appropriate quantitative scoring
changes in severity over time, aggregating
scale, 1 to 10 for example, can aid the patient
factors or alleviating factors.
formulate the amount of fatigue experienced.
Further scoring scales can be developed by
using pictures or descriptive language. This
system allows the nurse to weigh against
changes in the patient’s fatigue level over time.
It is important to conclude if the patient’s level
of fatigue is constant or if it varies over time.
52
Determine possible causes of fatigue, such as: Identifying the related factors with fatigue can
 Last physical illness benefit in recognizing potential causes and
 Pain building a collaborative plan of care.
 Emotional stress
 Depression
 Side effects of medication
 Anemia
 Sleep disorders
 Imbalanced nutritional intake
 Extended responsibilities and
demands at home or work
Assess the patient’s ability to perform ADLs, Fatigue can restrict the patient’s ability to
instrumental activities of daily living (IADLs),
participate in self-care and do his or her role
and demands of daily living (DDLs).
responsibilities in the family and society, such
as working outside the home.
Aid the patient with developing a schedule for Vivid lighting, noise, visitors, numerous
daily activity and rest. Emphasize the distractions, and litter in the patient’s physical
importance of frequent rest periods. surroundings can limit relaxation, disturb rest
or sleep, and contribute to fatigue.
Promote sufficient nutritional intake. The patient will need properly balanced intake
of fats, carbohydrates, proteins, vitamins, and
minerals to provide energy resources.
Provide comfort such as judicious touch or These may reduce nervous energy that lead to
massage, and cool showers. relaxation.
Educate the patient’s family about task Organization and management of time can
organization methods and time organization assist the patient save energy and avoid
methods. fatigue.
Aid the patient develop habits to promote Promoting relaxation before sleep and
effective rest/sleep patterns. providing for several hours of uninterrupted
sleep can contribute to energy restoration.
53
EVALUATION
Goal met, after 8hrs of rendering nursing intervention patient performed ADLs and participate in
desired activities at level of ability.
Assessment:
Subjective cues:
“Medyo na okay na ija pangihi kuman, dili na parehas sa una na murag maglisod sija
ma’am” as verbalized by the S.O
Nursing Diagnosis: Readiness for enhanced urinary elimination as evidenced by expresses desire
to enhance urinary elimination.
Planning: After 8hrs of rendering nursing intervention patient “S” will maintain regular and
acceptable elimination pattern emptying bladder and voiding in appropriate amounts.
1. Determine the client’s usual pattern of This provides the baseline for the future
elimination and compare with the current comparison.
situation.
2. encourage fluid intake, including water and To help maintain renal function and prevent
cranberry juice infection.
3. Restrict fluid intake 2 to 3hrs before bedtime To reduce voiding during night.
and if indicated.
4instruct SO in case that client’s needs, such as To assist client in continued continence,
voiding on routine schedule. especially when in unfamiliar surroundings.
5create an environment in which relationships Learning is more effective when individuals
can be developed and needs of each individual feel safe.
met.
Dependent:
54
1. Refer to appropriate resources. For assistance as desired/needed to promote
self-
care.
EVALUATION
Goal partially met after 8hrs. Patient demonstrated frequent urination but was able to void at
appropriate amounts with no dribbling of urine.
55
ASSESSMENT
Subjective cues:
“Karun pa man ini nahitabo ang ma-ospital ako bata, amo jaun waya ko kabayo kung unsa
ang ako himoon ma’am” as verbalized by the S.O.
Objective cues:
 Lack of source of information
 Primipara Mother
NURSING DIAGNOSIS
Knowledge deficit related to insufficient knowledge of resources.
PLANNING
Within 2days of rendering nursing intervention patient S.O will be able to identify interferences to
learning and specific action(s) to deal with them.
Identify the learner: the patient, family, Some patient’s especially older adults or the
significant other, or caregiver. terminally ill view themselves as dependent on
the caregiver, therefore will not allow
themselves to be part of the educational
process.
Provide clear, thorough, and understandable Patients are better able to ask questions when
explanations and demonstrations. they have basic information about what to
expect.
56
Determine priority of learning needs within This is to know what needs to be discussed
the overall care plan. knowing what to prioritize will help prevent
wasting valuable time.
Allow the patient to open up about previous Older patients often share life experiences to
experience and health teaching. each learning session. They learn best when
teaching builds on previous knowledge and
experience.
Determine the patient’s self-efficacy to learn Self-efficacy refers to a person’s confidence
and apply new knowledge. and ability to perform a behavior. A first step
in teaching maybe to foster increased self-
efficacy in the learner’s ability to learn the
desired information or skills. Some lifestyle
changes.
Provide an atmosphere of respect, openness, Conveying respect is especially important
trust, and collaboration. when providing education to patients with
different values and beliefs about health and
illness.
Assess barriers to learning (e.g., perceived The patient brings to the learning situation a
change in lifestyle, financial concerns, and unique personality, established social
cultural patterns, lack of acceptance by peers interaction patterns, cultural norms and values,
or coworkers). and environmental influences.
Dependent:
Include S.O in creating the teaching plan, Goal setting allows the learner to know that
beginning with establishing objectives and will be discussed and expected during the
goals for learning at the beginning of the session. Adults tends to focus on here-and-
session. now, problem-centered education.
Consider what is important to the patient Allowing the S.O to identify the most
S.O. significant content to be presented first is the
most effective.
EVALUATION
57
Goal not met. After 2days of rendering nursing intervention patient S.O identify interferences to
learning and specific action(s) to deal with them as evidenced by questioning members of health
care team.
GENOGRAM
65 Arthritis 60 A&W 59 HBP 62 HPN
20 Asthma 25 A&W
BFS UTI
58
Female=
Male=
A&W= Alive and Well
Client=
APPENDICES
59
URINALYSIS
Abbr Item name Result Reference Significance

LBG UROBILINOGEN 3.4 3.4-17.0 Normal
BIL BILIRUBIN 0.16 Normal
KET KETONE 0.04 Normal
CRE CREATINE 4.4 4.4-17.7 Normal
*BLD BLOOD <Ca10 Normal
*PRO PROTEIN 0.0.1 Normal
MALB MICROALBUMIN 10.0 Normal
NIT NITRATE Normal
LEU LEUKOCYTE >=Ca500 <Ca15 Normal
*GLU GLUCOSE 0.56 Normal
PH PH 6.0 0-5.6 Normal
VC ASCORBIC ACID 0 <3.4 Normal
A:C A:C <3-4 Normal
60
CA URINARY <=1.0 Normal
CALCIUM
MACROSCOPIC EXAMINATION
SG SPECIFIC 1.007 1.015-1.25 Kidneys
GRAVITY functionally
normally.
COLOR COLOR light yellow Normal
TURBID TURBIDITY clear Nomal
Rationale:
Increase specific Gravity indicates kidneys is functionally normally.
ABBR ITEM NAME RESULT REFERENCE Significance

RBC RED BLOOD 5 0.3 Infection
CELL
WBC White blood cell 42 0.4 Infection
BACT Bacteria 299 0-10 Presence of
bacteria
UNCA Unclassified 0 0.28 Normal
crystal
SQEP Squamous 16 0.7 Cell
carcinoma
NSB Non squamous 0 0.1 Normal
HYAL Hyaline cast 0 0.1 Normal
UNCC Unclassified cast 0 0.2 Normal
WBCC White blood cell 0 0.1 Normal
cast
MUCS Mucus 0 0.3 Normal
61
SPRM Sperm 0 0.82 Normal
Rationale:
Increased WBC and RBC indicates that the patient have infection.
Increased Squamous indicates that the patient had a cell carcinoma.
Increased Bacteria in the urine is considered abnormal and may suggest a urinary tract
infection
BLOOD CHEMISTRY
Exam Name Result Reference Values Significance

Sodium 135.60 135-145 mmol/L Normal
Potassium 4.89 3.5-5.5 mmol/L Normal
Chloride 102.30 98-108 mmol/L Normal
DISCHARGE PLAN
Medication
 Instruct and explain to the mother that the medication, especially the antibiotics, is
important to continue depending on the duration that the doctor ordered for the total
recovery of the patient.
 Inform the mother of the side and adverse effects of the drugs she is giving to her daughter.
 Instruct to report immediately any side or adverse effects when taking the prescribed drug
such as nausea, vomiting, diarrhea, rashes.
 Take the entire course of any prescribed medications. After a patient’s temperature returns
to normal, paracetamol is administered if fever occurs. Avoid using paracetamol more than
5 days.
 Instruct the mother to avoid over-the-counter drugs without the consultation of the
physician to avoid any drug-drug interaction.
 Remind mother to report to the physician if adverse effects occur.
62
Environmental Consideration `
 Encourage significant others to provide a peaceful environment conducive for fast recovery
and healthy living.
 Home environment must be free from slipping or accident hazards.
 Encourage the mother to have her daughter rest from time to time for faster recovery
 Advise significant others to keep surroundings clean and stress-free.
 Advise significant others to reduce environmental destruction as much as possible so that
the client could have an undisturbed sleep.
Treatment
 Encourage patient to have a lifestyle modification to reduce symptoms and the underlying
cause.
 Comply with the established treatment regimen given by the doctors including prescribed
medications.
 The family members must provide the patient with adequate emotional support, care, and
may pray for the patient.
 Tell mother to follow advice of physician or any other health care provider
 Instruct parents to have complete bed rest
Hygiene
 Intercut mother of importance of aseptic technique in food preparation.

 Encourage and explain to the mother that it is vital to maintain proper hygiene by frequently
washing her hands.
 Instruct client to comply with the prescribed medications of as well as treatments and
medications.
 Instruct the mother to serve variety of fruits and vegetables. These foods may help in the
healing process and may keep her body healthy.
 Instruct client to comply with the prescribed medications of as well as treatments and
modifications.
Out patient
63
 Instruct clients mother to attend follow-up checkup of her daughter gave by the
physician.
 Inform mother to report for any abnormalities as soon as possible to prevent further
complications.
Diet
 Encourage the mother to continue breastfeeding the patient. Instruct the mother that the
head must be in upright position when breastfeeding to avoid aspiration and let the
baby burp after feeding.
 Encourage the mother for clean bottle feed for baby’s milk.
 Drink of water everyday
 Encourage the mother before preparing a milk or food of the baby, makes sure the
mother perform hand washing for the clean preparation.
 Encourage the mother a preparation of formula of the baby.
REFERNCES
Book References
 Doenges, M, Moorhouse M, & Murr A 2006, Nursing Care Plans 7th edition, F.A. Davis
Comp., Pennsylvania
 Doenges, M, Moorhouse M, & Murr A 2008, Nurse’s Pocket Guide 11th edition, F.A. Davis
Comp., Pennsylvania
 Hockenberry M, & Wilson D 2011, Wong’s Nursing Care of Infants and Children 9th
edition, Mosby Inc. Missouri
 Lefever, K, 2007, Laboratory and Diagnostic tests with Nursing Implications 7th edition,
Pearson Education South Asia Pte. Ltd., Philippines.
 Marieb, E 2008, Essentials of Human Anatomy and Physiology 9th edition, Pearson,
Philippines
 Mhairi G., MacDonald M., Muilett M 2005, Avery’s Neonatology: Pathophysiology &
Management of the Newborn, Lippincott Williams & Wilkins
64
 Russo P, Ruchelli E, Piccoli D 2012 Pathology of Pediatric Gastrointestinal and Liver
Disease, Springer Science & Business Media, USA
 Sahota P,Popp J. Hardishty J., & Gopinath C 2013, Toxicologic Pathology: Nonclinical
Safety Assessment, CRC Press
Electronic References:
 http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0090784
 http://www.pediatric.theclinics.com/article/S0031-3955(11)00089-7/pdf
 http://www.pidsphil.org/pdf/Journal_12312011/jo39_ja04.pdf
 http://www.who.int/elena/titles/donormilk_infants/en/
 https://embryology.med.unsw.edu.au/embryology/index.php/Neural_Exam_-
_Newborn_cranial_nerves
 https://neurology.mhmedical.com/content.aspx?bookid=459&sectionid=41027707&jump
sectionID=41032921
 https://www.healthline.com/health/septic-shock
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4425030/
 https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/paneth-cell
 https://www.google.com/search?biw=1366&bih=657&tbm=isch&sa=1&ei=nz7KXKP5
M82m0wSU
 https://www.ncbi.nlm.nih.gov/pubmed/30028521
 https://en.wikipedia.org/wiki/Benign_fasciculation_syndrome
 https://www.researchgate.net/publication/259112485_Febrile_Seizures
65

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SURIGAO EDUCATION CENTER

Km. 2, National Highway, Surigao City

College of Allied Medical Sciences

Benign Febrile Seizure, Urinary Tract Infection

Ms. Lynnce Mae B. Salmayor ,RN

Benign Febrile Seizure

Febrile seizures occur in approximately 2% to 4% of young children in the United States,

Long-term management of febrile seizures should focus on decreasing parental anxiety.

Urinary Tract Infection

 Age - Children 2 to 71 months of age who had experienced 1 or 2 febrile or

Nursing Care Management:

Children with uncomplicated UTI are likely to respond to amoxicillin, sulphonamides,

PATIENT HEALTH HISTORY

PAST HEALTH HISTORY

Date: April 25, 2019

HEAD AND FACE

EARS AND NOSE

MOUTH AND THROAT

Patient E is awake and lying on bed, the patient is irritable noted.

CRANIAL NERVES ASSESSMENT

April 25, 2019

Cranial nerves Type of Function Results

V Trigeminal Sensory Carries sensory Patient was able to feel the

VII Facial Sensory Contains sensory fibers Patient has no difficulty in

XII Hypoglossal Motor Tongue movements Patient had no difficulty of

April 25, 2019

Reflex Function Stimulation Response

Date: April 25, 2019

Time: 8:43 a.m.

HEAD, EYES, EARS, NOSE, AND THROAT (HEENT)

history of dysphagia. Umbilicus midline without swelling or discoloration. No history of diarrhea

and bleeding. No pain and jaundice, gallbladder or liver problems.

Function of the Urinary System

Six important roles of the kidneys are:

Organs in the Urinary System

Kidneys and Their Structure

Sign and symptom

Immune system Evasion

Macrophages trap and kills

Activates messenger protein

Dendritic cells activates T

T cells activates B cells

Antibodies help the cells to

Formation of biofilm in ------- Sign and symptom

------ Sign and symptom

Sign and symptom

Brand Name: Paracetamol

Brand Name: Diazepam

Dosage: 1.5mg IVTT q8hrs

Brand Name: Phenytoin

Dosage: 105mg IVTT OD

Brand Name: Ceftriaxone

Dosage:360mg IVTT q12hr

Nursing Diagnosis: Infection related to compromised host defences as evidenced by increased

5. The importance of frequent bladder Completely emptying the bladder prevents

FLACC rating scale used upon assessment:

Acute pain related to inflammation of the urinary tract structures.

“permi man sya mag ihi’ihi ma’am” as verbalized by the patient

Impaired Urinary Elimination related urinary tract infection

“Ni hubag ija tiil man” as verbalized by the S.O

 Superficial phlebitis noted.

8. Observe for reddened or blanched areas or Reduces likelihood of progression to skin

 Inadequate infant stooling