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COLLEGE OF NURSING
CASE STUDY
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INTRODUCTION
Organization (WHO) that health is a state of complete physical, mental and social well-
being not merely the absence of disease. However, illnesses are the abnormalities or
disorders that any one can have. These might be fatal or not. And being healthy is one
of the rights of every individual, thus when an individual becomes ill, he/she demands
This is a case study of a child named James Gabriel Lugsanay, 2 years and 3
months of age, a Roman Catholic admitted at Polymedic General Hospital, Velez St.
Cagayan de Oro City. His chief complaints are Loose Bowel Movement (LBM), oral
ulcers, fever, and loss of appetite. Three days prior to admission, James has acute
onset and moderate grade fever associated with loose watery stool, moderate and
blood stricked every two (2) hours. And two (2) days prior to admission, James has
James Gabriel was diagnosed with Role-In Infectious Diarrhea and Oral Thrush.
bacteria, viruses or protozoa that infect the intestinal tracts of humans and animals. The
food. Some of the more well-known organisms causing infectious diarrhea include
Campylobacter, enterotoxigenic or Shiga toxin-producing E. coli, Salmonella, Shigella,
infectious diarrhea can, however, lead to dehydration and even death. Persistent or
chronic diarrhea often associated with intestinal protozoan infections can also cause
the lining of your mouth. Oral thrush causes creamy white lesions, usually on your
tongue or inner cheeks. The lesions can be painful and may bleed slightly when you
scrape them or brush your teeth. Sometimes oral thrush may spread to the roof of your
mouth, your gums, tonsils or the back of your throat. Although oral thrush can affect
anyone, it occurs most often in babies and toddlers, older adults, and in people with
compromised immune systems. Oral thrush is a minor problem for healthy children and
adults, but for those with weakened immune systems, symptoms of oral thrush may be
www.mayoclinic.com)
B. Objectives of the study
The case study is designed to identify health problems or potential health threats
that could arise in our patient. As a student nurses, it is expected from us that we will
apply what we have learned from our class lectures in the actual settings.
The study focuses to accomplish the following objectives to our patient with Role-
The study focuses on the admitting diagnosis of patient James Gabriel Lugsanay
which is the Role-in Infectious Diarrhea and Oral Thrush, where he was confined at
The study covers the patient’s health history, present illness, developmental
The study is also limited from the information being collected from the patient and
his personal chart. The data gathering was also limited during the confinement of the
HEALTH HISTORY
Sex: male
Nationality: Filipino
Allergies: none
Upon interview, the mother of the patient admitted that her child James Gabriel
loves to put anything he holds into his mouth. Before admission, the child already had a
cough, fever and started to loss his appetite because of the oral ulcers in his mouth.
The patient’s chief complaint was Loose Bowel Movement (LBM), oral ulcers,
fever, and loss of appetite. Three (3) days prior to admission, patient James Gabriel
was having an acute onset and moderate grade fever associated with loose watery
stool, moderate and blood stricked every two (2) hours. Two (2) days prior to admission,
patient James Gabriel has onset oral ulcers with loss of appetite persistent of condition.
Then the patient was admitted with diagnosis RI Infectious Diarrhea and Oral Thrush.
Chapter III
DEVELOPMENTAL THEORY
ERIK ERIKSON
autonomy)
If denied independence, the child will turn against his/her urges to manipulate
and discriminate; shame develops with the child’s self-consciousness. Doubt has to do
with having a forth and back – a “behind” subject to its own rules. Left over doubt may
become paranoia. The sense of autonomy fostered in the child and modified as life
progresses serves the preservation in economic and political life of a sense of justice.
When a child reaches the age of one to the age of three, Erikson explains, the
child is developing a sense of autonomy, during this age; the toddler discovers he/she is
no longer attached to the primary caregiver but is a separate individual. Autonomy is the
way of forming their own identify away from their caregivers. This stage is a time where
a toddler has the “will” to become independent. Shame and doubt are likely to occur
when the toddler is not given any choices or boundaries because the toddler is
determined to become independent. The strong will of a toddler may cause conflict
between the child and caregiver. Many parents are unaware of how to properly handle
difficult situations in which they find themselves. Parents who are assertive and too
ROBERT HAVIGHURST
distress, for the purpose of survival. The forming of attachments is considered to be the
life. Attachment and attachment behaviors tend to develop between the ages of 6
months and 3 years. Infants become attached to adults who are sensitive and
responsive in social interactions with the infant, and who remain as consistent
caregivers for some time. Parental responses lead to the development of patterns of
attachment which in turn lead to “internal working models” which will guide the
individual’s feelings, thoughts, and expectations in later relationships. There are number
“organized”) and “disorganized”, some of which are more problematic than others. A
Neonates
A human infant less than a month old is a newborn or a neonate. The term
“newborn” includes premature infants, post mature infants, and full term newborns.
Toddlers
Upon reaching the age of one or beginning to walk, infants are referred to as
For example, learning to walk, talk, and behave an acceptably with the opposite
For example, those emerge from the maturing personality and take the forms of
personal values and aspirations, such as learning the necessary skills for job
success.
A. Pathophysiology of Diarrhea
of the most common clinical signs of gastrointestinal disease, but also can reflect
primary disorders outside of the digestive system. Certainly, disorders affecting either
the small or large bowel can lead to diarrhea. For many people, diarrhea represents an
mostly children, die from the consequences of diarrhea each year. There are numerous
causes of diarrhea, but in almost all cases, this disorder is a manifestation of one of the
http://arbl.cvmbs.colostate.edu/hbooks/pathphys/digestion/smallgut/diarrhea.html).
DIGESTION PROCESSES:
INGESTION
(Voluntary process of taking foods)
PROPULSION
(Movement of food along the digestive tract)
DIGESTION
(Breakdown of foods)
ABSORPTION
(The passage of digested foods from digestive
tract and distributed to other body system)
DEFECATION
(Elimination)
Fig.1 The Digestive system
All segments of intestine from duodenum to distal colon have mechanisms for
both absorbing and secreting water and electrolytes. Diarrhea results when the
remarkable efficiency of the gut for absorbing water, electrolyte, and nutrients is
impaired. About 9-10 liters of water and electrolyte enter the upper jejunum daily, of
which one liter is delivered to the cecum, and one-tenth of a liter is delivered to the
outside world. Decreasing this efficiency from 99% to 98% would double fecal water to
produce potentially a wetter stool. A great variety of drugs, toxins, pathogens, and food
stuffs can impair the efficiency of salt and water absorption. (Lonny M. Hecker, M.D.,
http://www.uwgi.org/guidelines/ch_04/CH04TXT.HTM)
delivery of food and drink to the small intestine so that the absorptive capacity of the
Carbohydrate and protein in the small and large intestines are especially
important in increasing the efficiency of sodium and water absorption. Soluble starches
are digested by pancreatic amylase into small chains of glucose molecules which,
together with the ingested disaccharides (lactose and sucrose), are hydrolyzed to
galactose, especially in the duodenum and jejunum. Much of the available sugars have
been absorbed when chyme arrives in the ileum, where sodium absorption relies on
nutrients for colonic absorptive cells. By the time feces reach the left colon, most of the
similar to those described for carbohydrate. Amino acids and sodium are absorbed by
coupled transport, and short-chain fatty acids derived from amino acids in the right
fatty acids (LCFA). In fact, the double bonds of dietary LCFA may be hydroxylated so
that the excreted LCFA bears little resemblance to the dietary LCFA, and they may
measuring the transit of the head of the meal (HOMTT), or of the whole meal (WMTT).
normal subjects [Cummings, 1976], [Metcalf, 1987]. Pellets have the longest residence
in the colon, and fecal weights are inversely proportional to the time of colonic residence
[Vassallo, 1992]. Head of meal transit time (HOMTT) is measured with a poorly-
absorbed colored substance, and it is the time between ingestion and the first
appearance of the color in the stools. HOMTT averaged 36 hours after 14 healthy
subjects ingested carmine red with an English breakfast; diarrhea ensued when the
The punch-line: the overall balance for the absorption of sodium is 99%; of
starch, 99%; of protein, 95%; and of LCFA, 95%, and these remarkable efficiencies
depend on adequate lumenal digestion, absorptive cell surface, and transit time.
increases in crypt cell secretion, and by too rapid transit of intestinal contents. Most
volume of intestinal contents can speed intestinal transit; cytokines from mural
inflammatory cells can enhance cryptal secretion, and can influence the enteric nervous
system to speed transit; bile salts, and long-chain fatty acids, malabsorbed in the small
reserve capacity by which it can absorb 2-3 extra liters of water and electrolyte
Colonic bacteria ferment soluble carbohydrate and protein, which escaped small
intestinal absorption, into absorbable gases and short-chain fatty acids. Otherwise,
C albicans causes thrush when normal host immunity or normal host flora is
cells and accumulation of bacteria, keratin, and necrotic tissue. This debris combines to
form a pseudomembrane, which may closely adhere to the mucosa. This membrane is
usually not large but may rarely involve extensive areas of edema, ulceration, and
the birth canal. Hence, the risk for thrush is increased when the mother has an active
breasts (for breastfed infants), hands, and/or improperly cleaned bottle nipples. Kissing
and adults, and the GI tract has been implicated as a reservoir for yeast contamination
of the perineum. Thus, candidal diaper rash frequently occurs in conjunction with thrush.
overview)
HEALTH TEACHINGS IN RI INFECTIOUS DIARRHEA
MEDICATION medicines and its side effects are also given. The following
EXERCISE rest and intake of plenty of fluids to replace the lost liquids
in the body.
The patient was encouraged to wash hands well and
OUT- PATIENT/ week after the discharge for a follow-up check-up. Also to
and water.
MEDICATION and its side effects are also given. The following
oral thrush
EXERCISE The patient was taught to have his rest and complete
care.
The patient was encouraged to practice good oral
TREATMENT the toys used after using them and proper compliance of
doctor.
The patient was instructed to report to his physician
FOLLOW- UP and for further treatments and /or medications. Also to take
medicines promptly.
The patient is advised to try limiting the amount of
Chapter VII
NURSING MANAGEMENT
Interventions: Rationale:
Observe and record stool frequency, Help differentiates individual disease and
factors.
Identify foods and fluid intake that Avoiding intestinal irritants and promote
Restart and fluid intake gradually. Offer Provides colon rest by omitting or
clear liquids hourly; avoid cold fluids. decreasing the stimulus of foods/fluids.
intestinal motility.
Interventions: Rationale:
Assess abilities and level of deficit Aids in participating/planning for meeting
Interventions: Rationale:
Assess nutritional status continually, Provides the opportunity to observe
during daily nursing care, noting energy deviations from normal patient baseline;
level; condition of oral cavity; desire to eat. and influence choice of intervention.
4.) Hyperthermia
Interventions: Rationale:
To assess causative/contributing factors. Identify the underlying cause.
hyperthermia.
RR: 33 cpm
Flushed
skin
CUES: NURSING DX: OBJECTIVES: INTERVENTIONS: RATIONALE: EVALUATIONS:
Subjective: Acute Pain related At the end of the 1. Promote oral To lessen After the nursing
to milky curds, nursing care, the hygiene. infection. care, the patient’s
“Gapula iyang lesions and patient’s pain will pain was
baba, ug ga dugo. blisters in the be minimized 2. Divert the To divert and minimized.
Sakit pud daw.” As mouth. patient’s lessen pain.
verbalized by the attention to
mother. relaxing
activities.
swollen
gums
presence of
blood
inflammatio
n in the mouth
facial
grimaces
CUES: NURSING DX: OBJECTIVES: INTERVENTIONS: RATIONALE: EVALUATIONS:
Subjective: Altered nutrition At the end of the 1. Promote To minimize oral Outcome slightly
related to nursing care, the proper oral thrush. met and still
“Dili ga kaon, inadequate food patient shall hygiene. improving after the
sakitan siya kung intake due to oral regain his appetite nursing care.
mo didi sa thrush. slowly. 2. Instruct SO to To prevent
beberon, ug dili ka sterilize contamination.
tulon” as feeding bottles.
verbalized by the
mother. 3. Instruct SO to To prevent
clean all contamination,
materials used
Objective: including the
toys.
loss of
appetite 4. Encourage soft To promote
diet. nutrition balance.
Chapter VIII
The mother of the patient has been always given detailed instructions to become
proficient in special care needs by her son when they are discharged. We advised the
mother of the patient to refer to his attending physician, and arrange schedule of
We also reminded the mother of the patient to follow promptly the medications
prescribed by the physician to her son and to report any side effects or adverse
reactions may observed. Avoid contaminated foods that would trigger his condition.
Chapter X
DOCUMENTATION
Chapter XI
BIBLIOGRAPHY
http://www.ecureme.com/emyhealth/data/Infectious_Diarrhea.asp
http://www.mayoclinic.com/health/oral-thrush/DS00408
http://www.mayoclinic.com/health/oral-thrush/DS00408/DSECTION=symptoms
http://www.mayoclinic.com/health/oral-thrush/DS00408/DSECTION=causes
http://www.mayoclinic.com/health/oral-thrush/DS00408/DSECTION=risk%2Dfactors
http://www.mayoclinic.com/health/oral-thrush/DS00408/DSECTION=when%2Dto
%2Dseek%2Dmedical%2Dadvice
http://www.mayoclinic.com/health/oral-thrush/DS00408/DSECTION=tests%2Dand
%2Ddiagnosis
http://www.mayoclinic.com/health/oral-thrush/DS00408/DSECTION=complications
http://www.mayoclinic.com/health/oral-thrush/DS00408/DSECTION=treatments%2Dand
%2Ddrugs
http://www.mayoclinic.com/health/oral-thrush/DS00408/DSECTION=prevention
http://www.mayoclinic.com/health/oral-thrush/DS00408/DSECTION=lifestyle%2Dand
%2Dhome%2Dremedies
Lonny M. Hecker, M.D., David R. Saunders, M.D., and David Losh, M.D.
http://www.uwgi.org/guidelines/ch_04/CH04TXT.HTM