Introduction

This is a case of a 7 year old boy, residing at TBoli South Cotabato. Admitted last
February 9, !"! #ith an admitting diagnosis of Acute $astroenteritis #ith se%ere
dehydration.
As the boy #as admitted, chest &'ray results re%ealed ()A another e*amination+ Abdominal
ultrasound #as done #hich re%ealed a bolus of ascaris. ,hich gi%e birth to a ne# diagnosis+
Intestinal -bstruction secondary to bulos of ascaris. .*/loratory la/arotomy #as done to
remo%e the identified s/ecimen.
Ascariasis is a disease cause by an infestation of the /arasitic #orm A. lumbricoides.
Adult #orm in the intestines can cause abdominal /ain, %omiting, consti/ation and diarrhoea.
0arge numbers cause obstruction. The /resence of migrating lar%ae in the lungs can /ro%o1e
/neumonia. Ascariasis occur /rimarily in areas of /oor sanitation.
The grou/ had chosen this case to /onder on and disco%er more dee/ly into the
/atients conundrum. The grou/ ha%e im/lemented nursing care for this /atient. 2ay this
study of our im/art 1no#ledge, s1ills and attitude in dealing to /atient #ith same condition.
Family Bac1ground
Cas/er is a 7 year old boy, born at Barangay Tambuling, TBoli South Cotabato #ith
his family. The ty/e of Cas/ers family structure can be classified as )uclear for it com/rises
its 3 siblings and his /arents.
As the history ta1ing dee/ens, #e ha%e in4uired about the childs education. 2rs. C
acti%ely tells that the elementary school is situated on a hill #hich #as a bit far from their
home5 estimated " 1m #al1 from home to school. Cas/ers father shares that his son is fond
of s#imming on ri%ers all the #ay to the #here the school is, and returns home #et5 that their
childs routine. And sometimes the 1id goes home late at night usually 6o cloc1 in the
e%ening due to /layfulness and hanging u/ #ith friends. The familys #ater source is a
/itcher /um/ #ith is relati%ely a#ay from their #ater sealed toilet facility.
The familys source of income is through his /arents effort in farming. The familys
estimated monthly income is around 7,!!! to 8,!!! /esos #hich is still not enough in
sufficing the familys needs es/ecially /re/aring nutritious foods. They usually eats instant
food and camote to/s in the bac1yard5 dried fish, noodles, for it is only the food the family
can afford. 9o#e%er, the li%es sim/ly ha//y and still aiming for a better life for their 1ids
Based on 2rs. C the routine of acti%ities #ith in the family is sim/ly, after #a1ing u/
in bed, assemble in the round table for brea1fast, then after #hich /re/are for school, and
/re/are for #or1 for the /arents.
,ith regards to their social su//ort systems, 2rs. C relays that her child #as %isited
only once throughout the confinement by their relati%es #ay bac1 at TBoli. 2rs. C also tal1s
about the familys religion #hich is (rotestant. According to 2rs. C, the church members
ha%e hel/ in the hos/itali:ation, but still, the money is not enough to sustain her sons
medical needs. -n the other hand, the family greatly a//reciated the act.
;ero in to the familys history of heredofamillial disease, 2rs. C says that her father
died due to com/lications of 9y/ertension and she didnt e%en remembered his fathers age
because birthdays are rarely celebrated.
In line #ith heredity, 2r. Cs father died in an un1no#n disease and his mother died
in com/lications of 9y/ertension, same #ith 2rs. C, 2r. C doesnt remember their ages
either.
Based on the history ta1en, the familys blood line has a genetically embedded
/redis/osition of hy/ertension of #hich 2rs. C has. She said, she has e*/erience blood
/ressure fluctuation and feels giddy after #or1 and is easily fatigue.
The family also utili:es herbal /lants, li1e decoction of gua%a lea%es for #ound
cleansing and <Ta#a'ta#a= for fe%er. -%er the counter drugs is also utili:ed by the family in
cases of headache, stomach ache, and fe%er. They /urchase mefenamic acid, dicyclo%erine,
and biogesic res/ecti%ely.
2rs. C has al#ays been a concern to her childrens health and so as a /rimary
/re%ention, she faithfully com/leted all their re4uirements such as " dose of BC$, 7 doses of
-(> and ?(T as #ell as measles %accine and 9e/a B %accine #ith boosters as #ell.
The family en@oys church acti%ities and gatherings. They also attend in Barangay
fiesta for recreation and sociali:ation.'
9istory of (resent Illness
Cas/er #as @ust as healthy as he is before the disease stri1e him. Cas/er #as caught
una#are #hat is ha//ening inside him, that he had in him the genus of a /arasitic nematode
#orms the Ascaris Lumbricoides.
Based on 2rs. C #ee1s /rior to admission the child e*/eriences fe%er for a cou/le
of days and a gradually e%ident #ea1ness and a change in body mass and structure. The child
is easily e*hausted and his condition is %ague. 9e #as absent from school for about a #ee1.
According to 2rs. C the school /ro%ides anti /arasitic drugs for the student and t#o days
after ta1ing the drugs, Cas/er /ass a number of #orms on his stool /erha/s sedated, but
unfortunately the o%a is left burro#ed on the intestines through res#allo#ing.
According to 2rs. C his son had diarrhoea for 7 days #ith #atery stools for
fre4uency of not /atterned inter%al.
A day /rior to admission, Cas/er e*/eriences se%ere abdominal /ain that is contained
into his belly and he cant handle it anymore. 9e also had a cough, and according to 2rs. C
he %omited a number of #orms, relati%ely thin and ali%e. This filthy thing ha//ened
#hene%er his son coughs /ersistently.
(rior on consulting the A9B, 2rs. C o/ted first to herbal alternati%es, she said she
uses lea%es instructed by their elders, but didnt e%en 1no# its effect to his son, #hen the
condition #orsens, she immediately consults the A9B, but #as referred at SC(9 #ith the
ho/e that her son #ell be treated and managed.
B/on admission the child is se%erely dehydrated, #ith enlarged abdomen, and
dys/nic, suffering from cough and se%ere abdominal5 /ain as the chief com/laint. The child
#as then admitted under ?r. ?ecolongon e*/ertise. The ?r. diagnosed the child ha%ing Acute
Gastroenteritis with severe dehydration.
The /rimary management is to hydrate the /atient immediately #ith ?30A i0 for
7!gttsCmin and for I>TT meds access for Ceftria:on, and Benotri*, and Salbutamol #as also
ordered for nebulisation and to aid the childs breathing.
Chest &'ray #as also done to chec1 the condition of the lungs and #as found out that
the child has (neumonia. Another test #as abdominal ultrasonogra/hy and results re%eals a
bolus of ascaris Da ball #ith minimal mo%ement in itE.
The child is then diagnosed of Intestinal -bstruction secondary to bolus of Ascaris.
This diagnosis made the child a sub@ect for Exploratory laparotomy. Truly the o/eration #as
/erformed and done F s/ecimen+ Bulos of Ascaris. 2anagement #ere done after surgery, but
due to financial crisi did not reco%er from /ost o/erati%e com/lication, /rimarily due to
standing /neumonia and lac1 of medical com/liance.
Bnfortunately, on 2arch G, !"!, Cas/ers body system did not #ithstand his
#orsening condition anymore. 9o#e%er, Cas/er #as discharge hori:ontally the %ery same
day.
9istory of (ast Illness
As a normal de%elo/ment of a human /erson, Cas/er #as not e*em/ted to e*/erience
the childhood illnesses. But as a concern mother, 2rs. C sub@ected all her children to
%accination as /rimary /re%ention against childhood illnesses. -ne dose of BC$, 7 doses of
?(T and -(>, measles %accine and 9e/a %accine.
The %accine #as tested #hen Cas/er #as 7 years old. Cas/er #as stri1e by %iral strain
of chic1en/o* and at age 8 he had this measles. But by %irtue of acti%e immunity, the illness
did not manifest these illnesses e%er again until age 7.
,ith regards to chic1en/o*, 2rs. C uses gao'gao baths to relie%e itch and further
s/reading of the ailment as instructed by the A9B. As for measles only bed rest and
tem/orary isolation is done.
Cas/ers medical history #as February 9 until 2arch G at South Cotabato (ro%incial
9os/ital.
.ffects of Illness to Self and Family
To Self+
From a nurse ad%ocate /oint of %ie#+
Cas/er #as totally immobili:ed #ith his disease5 that he needs to be absent from school for
hos/itali:ation /ur/oses. 9is de%elo/mental tas1 #as also altered for hes not able to achie%e
the tas1 a 7 year old must do.
To Family+
The family #as so #orried about the condition of their child. They are #orried
that there #ill be more com/lication that can arise to @eo/ardi:e the life of their family
member. The /arents heart is ri//ing into /ieces, #hen they see their child struggling for his
life, 1no#ing that they themsel%es cant hel/ the child.
.*/ectation of (atient to Self and to Family
To Self+
Cas/er can no longer tal1, but as an ad%ocate, #e s/ea1 for their behalf.
-nce a /erson becomes a /atient under medical treatment, he al#ays e*/ects that the
management #ill ma1e him #ell, and be discharge soon #ith self in a state of o/timal health.
To Family5
Cas/er has al#ays been e*/ecting that his su//ort system #ill really gi%e their
undying su//ort to him. In terms of medical com/liance and most es/ecially, the mere
/resence of his family is @ust alright for him. 9e also e*/ects that he and his family #ill go
home.
$enogram
)H?
9()
9()
)H?
3! oy
A(
8!
yo
87 yo
83 yo
9()
83yo
)H?
87yo
>A
87yo
9()
yo
"8y
o
A$.
#ith se%ere
dehydration
(-ST
.&0A(
"9 yo
7 yo
0.$.)?+

2ale

Female
Blood related
)ot blood related
A(' A//endicitis
9()'9y/ertension
)H?')o 1no#n dse.
>A F >ehicular accident
' (atient
' ?eceased
$ro#th and ?e%elo/ment
)ame+ Cas/er
Age+ 7 years old
Theory+ .ri1sons .ight Stages of ?e%elo/ment
Theorist+ .ri1 .ri1son
?efinition of the theory+
I.ri1son en%isions life as a se4uence of le%els of achie%ement. .ach stages signal a
tas1 that must be achie%ed. The resolution of the tas1 can be com/lete, /artial, or
unsuccessful. 9e belie%e that the greater the tas1 achie%ement, the healthier the /ersonality
of the /erson5 failure to achie%ed a tas1 influences a /ersons ability to achie%e the ne*t tas1.
These can be %ie#ed as a series of crises, and successful resolution. Failure to resol%e the
crises is damaging to the ego.
Tas1 Tas1 achie%ed Justification
IIndustry %ersus Inferiority
IIndication of /ositi%e
Aesolution.
IBeginning to create,
de%elo/, K mani/ulate.
I?e%elo/ing sense of
com/etence and
/erse%erance
ICas/er, /rior of being ill5
Cas/er #as an energetic boy
and curios in e%ery little
things.
IAccording to 2rs. C his son
can o/erate a radio, turn it on
and off, sets the fre4uency.
The child also de%elo/s a
sense of uni4ueness #ith in
the family.
IAs a grade " student,
Cas/er is as acti%e student
until the illness ha%e come to
ruin his education. Though
suffering from illness, Cas/er
/erse%ered in s/ite of
difficulty and a little chance
of sur%i%al.
Achie%ed
Achie%ed
$ro#th and ?e%elo/ment
)ame+ Cas/er
Age+ 7 years old
Theory+ ?e%elo/mental tas1 theory
Theorist+ Aobert 9a%ighurst
?efinition of the theory+
IAccording to Aobert 9a%ighurst a de%elo/mental tas1 is a tas1 #hich arises
at or about a certain /eriod in the life on an indi%idual, successful achie%ements leads his
ha//iness in the, and success #ith later tas15 #hile failure leads to unha//iness in the
indi%idual, disa//ro%al by society and difficulty #ith later tas1.
Tas1 Tas1 achie%ed Justification
2iddle Childhood+
". 0earning /hysical
s1ills necessary for
ordinary games.
. Building #holesome
attitudes to#ard
oneself as a gro#ing
organism.
7. 0earning to get along
#ith age'mates
8. 0earning an
a//ro/riate masculine
or feminine social
role
3. ?e%elo/ing
Fundamental s1ills in
reading, #riting, and
calculating.
G. Achie%ing /ersonal
inde/endence.
ICas/er #as as /layful as he
is5 sometimes he gets home
late at night hanging u/ #ith
friends.
IAs a biological entity the
self /reser%ation /rinci/le is
also elicited in terms of the
need to eat, clean oneself and
be #ith /eo/le.
ICas/er has friends, of
#hom he s/ends time doing
acti%ities a//ro/riate to age
li1e /laying and getting
along #ith others.
IAs a normal de%elo/ment
of school age+ Dmale to male5
female to female also called
gang ageE, Cas/er get along
#ith male com/any.
ICas/er can #rite and read
his name and can calculate
sim/le math.
ICas/er is inde/endent in
terms of self grooming such
as changing clothes alone,
choosing clothes according
to discretion.
Achie%ed
Achie%ed
Achie%ed
Achie%ed
Achie%ed
Achie%ed

$ro#th and ?e%elo/ment
)ame+ Cas/er
Age+ 7 years old
Theory+ (sychose*ual Tas1 theory
Theorist+ Sigmund Freud
?efinition of the theory+
IAccording to Freud, the unconscious mind is the /art of a /erson mental life
that the /erson is una#are of. The id resides in the unconscious, and o/erating on the
/leasure /rinci/le, see1s immediate /leasure and gratification. The ego, o/erating on the
reality /rinci/le, balances the gratification demands id #ith the limitations of social and
/hysical circumstances. The superego, contains the conscience and the ego idea.
Tas1 Tas1 achie%ed Justification
0atency+ Gyo to /uberty
". .nergy is directed to
/hysical and
intellectual acti%ities.
. Se*ual im/ulses tend
to be re/ressed.
7. ?e%elo/ relationshi/s
bet#een /eers of the
same se*
ICas/er enters school for
intellectual /ur/oses as #ell
as for /hysical gro#th #ith
age mates5 as in doing
acti%ities in the le%el of
thin1ing.
IAccording to 2rs. C his son
doesnt mani/ulate his
genitals nor as1 4uestions
about it.
ICas/er has com/any of
male /eers. 9is age mates,
es/ecially males, acti%ely
/artici/ate in e%ery acti%ity
they do.
Achie%ed
Achie%ed
Achie%ed
Aeference of all Theories+ Aegarding $ro#th and ?e%elo/ment
Fundamentals of )ursing 7
th
edition by Barbara Ho:ier, $lenora .rb, Audrey Berman, Shirlee
Snyder. (age 738 ' 73G
PROGNOSIS
PROGNOSIS GOOD FAIR BAD JUSTIFICATION
-nset of Illness A #ee1 before the admission, the /t. did not
undergone chec1 u/ for the enlargement of
his abdomen and fi%e days /rior to that, his
/arents decided to admit him to SC(9.
?uration of Illness (atient stayed at the .mergency room for
days and #as transferred to surgical #ard.
The /atient stayed for G days until he died.
9ygiene (atients hygiene is /oor because he does not
change his clothes due to the difficulty in
mo%ing because of the o/eration done to him.
But his mother /erform a te/id s/onge bath.
?iet According to her mother /atient does not eat
#ell because of loss of a//etite and also they
ha%e financial instability.
Age The age of the /t. is 7 years old. This age is
lo# in ca/able of stri%ing because on his
young age he undergone a e*/loratory
la/arotomy.
(erformance 0e%el (atient is %ery #ea1 and fatigue, cant
ambulate, bed ridden.
,illingness to
undergo treatment
The reason #hy he #as brought to hos/ital is
for /ro/er management. The /atient and
family are %ery much #illing to let the
/atient undergo treatment.
Family Su//ort -nly the mother and the father is /resent
during his hos/itali:ation. .%enthough they
ha%e a financial /roblem they are ho/ing that
their son #ould be reco%ered as soon as
/ossible.
Inter/retation+ $ood+ "C6 * "!! L ".3M
Fair+ 7C6 * "!! L 77.3M
(oor+ 3C6 * "!! L 3!M
NNNNN
"!!M
The /rognosis of the /t. is /oor because of the /rolonged hos/itali:ation for almost
G days in the hos/ital and he did not com/ly his medications due to financial /roblem that
leads to further com/lications that causes his death.
Etiology
PREDISPOSING
FACTOR
RATIONALE REMARKS
Age
Sex
Any age group can be affected by the disease specially the
children.
Both male and female can be affected by the disease.
Present
Present
PRECIPITATING
FACTORS
Lifestyle
Diet
Malnutrition
RATIONALE
The pt. adapts the lifestyle of the family because they
lack on information on ho to impro!e their ay of li!ing.
The pt. is suffering loss of appetite due to the
complications to his condition.
The pt"s diet is imbalanced because he can"t eat hat he
ants due to his condition# and he appears !ery thin and
eak. Based on Microbiology# Parasitism ill caused
se!ere malnutrition for it absorbs the nutrients intended
REMARKS
Present
Present
Present
Po!erty
for the child
The patient belongs to a family ith lo income# not
enough to accommodate all their needs. Ascariasis
occurs most in areas of poor sanitation.
Present
Symptomatology
Symptoms Remarks Jsti!i"atio#
$e!er Present
The pt. has a
increased in body
temperature of %&
degree 'elsius.
Abdominal Pain Present
The patient
experiences
abdominal pain
due to the infection
to the intestines
cause by the
Ascariasis.
'ough Present
An inflammatory
response to the
infection of
respiratory tract.
Loss of appetite Present
The patient
experience loss of
appetite due to g.i
discomfort.
(hysical Assessment
?ate+ 2arch , !"!
Time+ 3+!!/m
$eneral sur%ey+
(atient Cas/er is a 7 year old male, generally ectomor/hic. (atient recei%es an
intra%enous infusion of ?3.7)aCl 3!!cc regulated at 7!gttsCmin, hoo1ed at the left ce/halic
%ein, intact and infusing #ell. A//ears #ea1, lethargic, conscious but incoherent, restless,
#ith facial grimacing u/on mobili:ation, and bony /rominences are relati%ely e%ident more
li1e to that of the /atella, olecranon, cla%icle, rib cage and facial bones as #ell.. Integument
is /ale es/ecially on /alms, /lantar, and the con@uncti%a. Cas/er does not #ear clothes only
blan1et and a dia/er. ?ressing noted on the abdomen #ith serosanguiaous fluid collection on
the dressing.
>ital signs+
Tem/erature+ 7G.3
o
C
Aes/iratory rate+ 9c/m
(ulse rate+ 97 b/m
S1in, 9air, and )ails
I Ins/ection+
S1in is /ale es/ecially on the lo#er e*tremities, generally dry and scaly. S1in
is a//ro*imate to the bones5 no signs of @aundice nor ecchymosis. 9air is blac1, long, thin
and e%enly distributed. )ail beds are /ale, untrimmed and soiled.
I (al/ation+
S1in is dry, #ith s1in turgor returns I7 seconds #hen /inched. Bones are
easily /al/able #hen s1in is touched. 9air is coarse, tangled and brittle. ?andruff noted but
lice are not. Ca/illary refills I7 seconds Don toes and fingersE.
.ars and 9earing
I Ins/ection+
Auricles are symmetrical #ith minimal cerumen noted, no abrasion and
deformities noted.
I (al/ation+
Auricles recoil #hen folded, neither mass nor tenderness noted.
Hearing: Cas/er can hear a #his/er " F feet a#ay from him.
.yes and >ision
I Ins/ection+
.yebro#s and eyelashes are e%enly distributed. (tosis noted on both eyes.
Blac1 circles under the eyes noted. (u/ils are e4ually rounded and react to light and
accommodation. Iris is bro#n #hen illuminated #ith /u/il dilatation of 7mm and constricts
at mm. Sclera is shiny and con@uncti%a is /ale. .yeballs mo%e freely, and Cas/er can
described ob@ects 3'"3 ft. a#ay from his bed.
)ose and Sinuses+
I Ins/ection+
.*ternal nose has uniform com/le*ion #ith face. )asal se/tum is intact and
centered. Inflammation not noted. ?ried nasal debris noted on minimal amount. 9airs in the
nostrils are e%enly distributed.
I (al/ation+
)asal cartilage returns to normal #hen being /inched. Sinuses are not
inflamed.
2outh and (haryn*
I Ins/ection+
0i/s are /ale, and gums as #ell, oral mucosa is dry #ith minimal sali%ary
secretions. ?ental caries noted #ith offensi%e mouth breath. Tongue is mobile and /haryn* is
not inflamed. B%ula is centered, tonsils are not inflamed. Cough noted.
)ec1
I Ins/ection+
Acti%e A-2 De*tension and fle*ionE of the nec1 noted. )either abrasion nor
lesions is not noted. 9as uniform com/le*ion #ith the body
I (al/ation+
2oist on the s1in folds is felt. Cer%ical lym/h nodes are not enlarged. )o
tenderness noted.
Thora* and 0ungs
I Ins/ection+
(atient is dys/nic. Chest configuration is abnormal and not symmetrical.
Cas/er has irregular breathing /attern and #ith unsymmetrical chest e*/ansion and
de/ression. Aibs are e%ident.
I (al/ation+
Fremitus felt on a/e* and middle /ortion of both lungs, but fremitus is
diminished on the basal lung.
I (ercussion+
B//er lung is resonant but basal lobe has dull sound.
I Auscultation+
Crac1les noted on both lungs on basal area.
Abdomen
I Ins/ection+
Substernal incision #ith dressing noted. .*udates collect on either side of the
dressing.
I(al/ation+
Tenderness noted on the incision site.
ABO F li%er is not enlarge and not tender.
A0O F A//endi* is not tender.
00O F S/leen is not enlarged and tender.
0BO F Stomach is em/ty.
I(ercussion+
Abdomen is unable to /ercuss due to surgical incision and tenderness.
IAuscultation+
?ecrease bo#el sounds. Clic1s and gurgles are diminished.
$enitalia
IIns/ection+
(enis is uncircumcised, /ubic hairs are not yet gro#n, neither #arts nor lice
noted. Brethral meatus is intact. Scrotum is intact, no hydrocele nor herniation noted, and no
rashes as #ell.
Anus, Aectum and (rostate+
)ot assessed but urination is not difficult nor /ainful.
(eri/heral >ascular
IIns/ection+ DArmsE
0ateral arms are symmetrical and relati%ely thin and se%ere muscle #asting is
e%ident. S1in has /oor s1in turgor.
I(al/ation+
Aadial /ulse+ 97 b/m DPE
Brachial P
0.$S+
0ateral legs are /ale, relati%ely thin and se%ere muscle #asting is also e%ident.
A-2 is decreased such as, adduction and abduction5 fle*ion and e*tension.
I(al/ation+
Cool to touch. Bony /rominences are /al/able.
?
?orsalis /edis+ 7P
Aeference+ Bates (hysical Assessment $uide.