Davao Doctors College Inc.

General Malvar St., Davao city

Nursing program

A Case Study on the Care of Well Mother and Child;

GROWTH AND DEVELOPMENT OF INFANT

A Case Study Presented to the Nursing Clinical Instructors

of Davao Doctor’s College, Inc.

In Partial Fulfillment of the Requirements in

NRG 203: Care of Mother, Child, and Adolescent (Well Clients)

Members:
Edullantes, Ana Mae M.
Elegino, Hero Nicole P.
Eria, John Sirio S.
Gaurana, Lady Alyssa Q.
Lamosa, Jefmarie S.
Lardera, Crizza Mae
Macalos, Keithly Jjhoy C.
Macapala, Melonie Ann C.
Miralles, Ethan Andrei M.

November 7, 2022

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 TABLE OF CONTENTS
I. Objectives …………………………………………………………..…..… 3
i. General Objectives ………………………………………………….. 3
ii. Specific Objectives ………………………………………………...... 3
II. Introduction …………………………………………………………….... 4
III. Patient’s Profile ………………………………………………………..… 8
i. Biographic Data ……………………………………………………… 8
ii. Clinical Data ………………………………………………………….. 8
iii. Past Health History ………………………………………………...... 9
iv. Present Health History ………………………………………………. 9
v. Family History (with Genogram) …………………………………… 9
IV. Health Assessment ……………………………………………………… 10
V. Review of Anatomy and Physiology ……………………………….... 12
VI. Pathophysiology ………………………………..................…………… 17
i. Definition of Diagnosis ………………………………………………. 17
ii. Etiology ……………………………………………………………….. 17
iii. Symptomatology …………………………………………………….. 21
iv. Schematic Diagram ………………………………………………….. 25
v. Narrative ……………………………………………………………… 26
VII. Course in the Ward/Treatment/Interventions ……………………..... 28
i. Medical Management ……………………………………………….. 28
1. Doctor’s Progress Notes ………………………………….......... 28
2. Laboratory/Diagnostic Examinations ……………………...…... 37
3. Surgical Management ………………………………………....... 42
ii. Nursing Management ……………………………………………….. 43
1. Nurse’s Notes …………………………………….……..……..... 43
2. Clinical Reasoning Questions-Collaboration ………...……….. 49
3. Clinical Reasoning Questions-Ethico-Moral-Legal …………… 49
4. Discharge Plan……………………………………………………. 51
VIII. References …………………………………………………………..… 51

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 OBJECTIVES

General Objectives
The Bachelor of Science in Nursing, 12F - Group 23, aims to ensure that
within a week of modular activity and case study analysis, the group will be able
formulate a comprehensive case study on the topic of care of mother, child, and
adolescent in well clients. In participation of learning the relevance and importance
of overall health through case study analysis, organizing a drug study, and creating
an effective care plan with appropriate teachings and interventions that address
specific concerns under the abovementioned topic. Thus, it would improve our
knowledge and broaden our analytical skills in carrying out an appropriate and
effective nursing process approach.

Specific Objectives
Within the span of modular activity and nursing care analysis, the following
specific objectives will guide us to accomplish our general objectives. Particularly,
this group aims to attain the following objectives:
a. Be able to analyze our patient’s case in our case study analysis;
b. Develop an appropriate and effective nursing care plan for our patients;
c. Create an introduction that contains an overview of the case study;
d. Construct objectives that are specific, measurable, attainable, realistic, and
time-bounded;
e. Gather personal and clinical information that will serve as baseline data;
f. Present the client’s past health history up to her present health condition
status;
g. Define diagnosis of the client;
h. Discuss possible interventions that will aid the client’s needs.

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 INTRODUCTION

The earliest years of a child's life are crucial. This is known as the "golden
age," the "window of opportunity," and the critical period—a time of growth and
development. The "golden age" is the period when nerve cell and synaptic growth
is so rapid that complex brain tissue grows and absorbs information at the highest
rate (Maida, 2018). It is the time when the child has the most opportunities to fulfill
his or her full potential, when adequate nourishment, good health, correct
parenting, and appropriate stimulation enable the child achieve maximum
potential. It is also known as a "sensitive period" since malnutrition during this time
has long-term and potentially permanent effects. As a result, it is essential to guide
and monitor the newborn throughout their development to prevent serious
problems that may compromise their health (Lubis, 2018).

Growth and development are significant indices in pediatric public health

because they set the way for a child's cognitive and social development (Mendez
2019). Growth, as an umbrella term, is a very important public health
anthropometric tool, measured by numerous parameters such as weight, height,
head circumference, and skin fold thickness (Hirschfeld 2016). According to WHO
(2015), it does not only indicate the level of optimal nutrition, but it is also a very
sensitive indication of the advancement of numerous diseases (such as diabetes,
tuberculosis, HIV/AIDS, and others).

According to research conducted in Indonesia, the high frequency of

stunting (37.2%), wasting (12.1%), and underweight (19.6%) has caused growth
disruption, and 12.8-28.5% of children under the age of two have developmental
abnormalities. Lack of nourishment during the first years of infancy produces a 15-
20% loss in brain cells. Developmental abnormalities such as psychomotor,
cognitive, and social disorders result from this process (Noyze, 2014).
Furthermore, Ukegbu et al. (2011) compares growth patterns (mean body weight
and length) in exclusively breastfed infants to non-exclusively breastfed infants

4
using the WHO growth curve. The study found that exclusive breastfeeding
promotes optimal growth in the first 6 months of life. Breastfeeding has been
demonstrated to have a favorable influence on cognitive development in
systematic review studies and meta-analyses (Lee, 2011).

In the Philippines, a study conducted in Cebu City, Philippines, by Rohner

et al (2013) found that the prevalence of stunting and underweight among children
under the age of five has remained steady, with almost a quarter of this age group
affected in 2008. Stunting, being underweight, and wasting have all been identified
as contributors to death, hence achieving MDG 5 will also depend on reducing
stunting, being underweight, and wasting (Lebanan, 2013). Solon (2013) added
that the prevalence of anemia among children under the age of two has remained
continuously high in the Philippines, despite significant reductions in anemia
among older children and pregnant and lactating women. According to anemia
data from the 2008 National Nutrition Survey, approximately 20% of the overall
population was anemic. These malnutrition and micronutrient deficiencies are
caused by children from low-income households, a lack of parental education,
neglected child health status, and inadequate sanitation (Saniel, 2014).

In line with these child morbidity and malnutrition statistics, the World Health
Organization (WHO) highlights the importance of infant growth and development.
WHO recommends that complementary feeding should be timely, which means
that all infants should begin receiving foods other than breast milk at the age of six
months; adequate, which implies that the nutritional value of complementary foods
be adequate for the rapidly growing child; and appropriate, indicates that foods
should be diverse, has appropriate texture, and given in sufficient quantity (WHO,
2022).

Moreover, Homa et al. (2020) stated that growth must be followed as a

screening program to detect any growth condition caused by malnutrition or
infection to ensure that newborn is growing adequately. In addition, monitoring for

5
height has a limited predictive value in finding disease reasons in stunted children;
weight is the most accurate and sensitive metric of growth. Growth monitoring
entails taking serial anthropometric measures of babies and comparing the
findings to the growth of a large sample population of children of the same age as
indicated on a specific growth chart (Nozyce 2014). Children's weight, height, or
length, and head circumference measures serve to confirm growth or are used to
detect early nutritional problems (Canada Pediatric Society, 2010).

Furthermore, Onis (2011) highlighted that developmental milestones are

the foundation of the majority of standardized testing and screening techniques.
Although these screening methods give the clinician a controlled way to observe
the infant's progress and assist define a developmental delay, many of them are
insensitive. Parental concern in the face of normal developmental screening
findings should not be disregarded (Johnson, 2017). Strictly focusing on discrete
milestones may miss atypical organizing mechanisms involved in the child's
developmental growth. Thus, it is essential to analyze all milestones in the context
of the child’s history, growth, and physical examination as part of a continuous
surveillance program. Only then is it possible to formulate an overall impression of
the child’s true developmental status and the need for intervention (Blasco, 2017).

On the other hand, an infant care for well clients was involved in this study.
The group was assigned for Joseph Andrew Camintal, 11-month-old, male. Patient
was admitted on September 22, 2022 @8:00 AM with an admitting diagnosis of
acute gastroenteritis, and mild dehydration. He is admitted due to the complaint of
vomiting and loose bowel movement of 5x/day with color of greenish brown stool
for the past week. During physical examination, the patient is always crying and
does not drink much milk. He appears weak, and irritable. He appears to be
breathing a bit faster than normal, O2 sat is 94% with slightly cyanotic skin color.
His abdomen is a little bulging, soft and non-tender with 40 bowel sounds heard
per minute. He is warm to touch with a body temperature of 38.5 °C with occasional
complaints of abdominal pain. His eyes appear a bit sunken. He weighs 9 kgs and

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likes to sleep a lot. Vital signs results were HR – 100bpm, RR 34cpm, BP of
100/60mmHg.

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 PATIENT’S PROFILE

Biographic Data
Name Joseph Andrew Camintal
Age 11 Months
Gender Male
Birthday October 11, 2021
Civil Status -
Religion -

Clinical Data
Chief Complaint Acute Gastroenteritis
Date of Admission September 22, 2022
Time of Admission 8:00 AM
Hospital -
Room and Bed Number Pediatric Ward
Attending Physician Dr. Gin Min Who
Tentative Diagnosis -
PR 100 bpm
RR 34 cpm
Vital Signs BP 100/60 mmHg
Temperature 38.5 °C
O2 Sat 94%
Height -
Weight 9kg
Blood type -
General Parameter WBC count 11.6
Sp. Grav. 1.036
Urine Dark yellow
Stool Present bacteria

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 IVF D5IMB 500cc @ 60cc/hr

Past Health History

Patient has no past medical history.

Present Health History

In the past week JAC has been feeling sick, he hasn’t been drinking his milk
as much and he is always vomiting, three times a day and has loose bowel
movement. Nathalie had to change his diapers 5 times a day with watery stool.
She also noticed that the color of the poop is greenish brown. Baby JAC is starting
to feel weak and doesn’t interact much and cries and is irritable most of the time.

Family Healthy History

No familial diseases indicated for both parents.

John Jacob Camintal Nathalie Drew Camintal

Father Mother

John Jacob Camintal (Father)

Nathalie Drew Camintal (Mother)

Joseph Andrew Camintal (Patient)

Patient
Joseph Andrew Camintal

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 HEALTH ASSESSMENT

General Survey
11-month-old Joseph Andrew Camintal, a boy, was hospitalized after
complaining of vomiting and loose stools that were 5 times/day and a greenish
brown color for the previous week. Jac is currently attempting to stand and weighs
around 9 kg. Following a comprehensive evaluation and an interview with Jac's
mother, she reported that over the previous week, Jac had been feeling unwell,
not drinking much milk, and frequently throwing up three times per day in addition
to having loose stools. With watery stools, his mother had to change his diapers
five times per day. She also observed that the excrement has a greenish-brown
tint.

Upon assessment, the patient appears to be a little lethargic and agitated

and he continuously sobbing. The patient appeared to have tachypnea. His vital
signs are as follows: Heart rate is 100bpm, Respiratory rate is 34CPM, Blood
pressure is 100/60mmHg, Temperature is 38.5 °C, and O2 sat is 94%. Additionally,
the patient has a weak cry, dry mucous membranes, and somewhat sunken eyes.

Upon inspection, the patient’s skin is somewhat cyanotic. His head appears
to be asymmetrical. His eyes are normal, pupils are equally round and reactive to
lights. The patient’s ears are symmetrical with clear tympanic membranes and has
clear bilateral canals. His nose is located at the midlines of the face with no nasal
septal deviation. Also, a little bit of nasal flaring is noted. He has a cracked and dry
mouth. On the top and bottom of his mouth, lateral and central incisors can be
seen. His oropharynges are pink and wet, without any erythema or tonsil
hypertrophy noted. Moreover, the neck is in the middle of the body, and there is
no tracheal deviation visible.

Upon auscultation, the patient's heart beats regularly at a rate of about 100
bpm. S1 and S2 sounds from the heart are heard. No rumbles, rubs, or gallops

10
were heard. With a respiratory rate of 34 bpm, the chest looks to be normal. He
seems to be breathing slightly more quickly than usual, there is nasal flaring, and
he is using his accessory muscles. His O2 sat is 94%, he has a slightly protruding,
soft, non-tender belly and 40 bowel movements per minute. The patient is able to
stand with assistance and can move his arms and legs. He is awake, agitated, and
a little drowsy.

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 REVIEW OF ANATOMY AND PHYSIOLOGY

THE DIGESTIVE SYSTEM

The gastrointestinal (GI) tract, as well as your liver, pancreas, and

gallbladder, comprise the digestive system. The GI tract is a collection of hollow
organs that connect from your mouth to your anus. The organs that make up your
GI tract are, in order of connection, your mouth, esophagus, stomach, small
intestine, large intestine, and anus. The digestive system is uniquely designed to
convert your food into the nutrients and energy you require to survive. After that, it
neatly packages your solid waste, or stool, for disposal when you have a bowel
movement.

MOUTH
The mouth is an oval-shaped cavity inside the skull. The two main functions
of the mouth are eating and speaking. Parts of the mouth include the lips, vestibule,
mouth cavity, gums, teeth, hard and soft palate, tongue and salivary glands.

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ESOPHAGUS
Located in your throat near your trachea (windpipe), the esophagus
receives food from your mouth when you swallow.

STOMACH
The stomach is a hollow organ that serves as a "container" for food as it is
combined with stomach enzymes. After food enters your stomach, the stomach
muscles mix the food and liquid with digestive juices. The stomach slowly empties
its contents, called chyme, into your small intestine.

THE SMALL INTESTINE

The longest part of the gastrointestinal tract, or the lengthy, continuous

course that food takes through your digestive system, is the small intestine. Food
is converted into liquid and the majority of its nutrients are absorbed in the small
intestine. It consists of the following three parts:
• The duodenum – This C-shaped first part is where enzymes from the
pancreas and bile from the liver are added to the chyme.
• The jejunum – This coiled middle part further digests the chyme and
absorbs nutrients.

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 • The ileum – The final section that leads into the large intestine absorbs
nutrients, vitamin B12, and bile acids.

PANCREAS
It is in the back of your stomach, inside the abdomen. Its size is comparable
to your hand. Your pancreas produces pancreatic fluids called enzymes that aid in
digesting. These enzymes disintegrate carbohydrates, lipids, and sugars.

LIVER
It is located beneath the rib cage in the right upper abdomen. The liver is
the largest solid organ in the body. It removes toxins from the body's blood supply,
maintains healthy blood sugar levels, regulates blood clotting, and performs
hundreds of other vital functions.

GALLBLADDER
A small, pear-shaped organ in your upper right abdomen. Your gallbladder
stores and releases bile to help your digestive system break down fats.

THE LARGE INTESTINE

The large intestine's main job is to remove water from the undigested matter
and form solid waste (poop) to be excreted.

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TRANSVERSE COLON
The transverse colon is the longest and most mobile part of the colon. It
runs from the right to the left of the abdomen and connects the end of the
ascending colon to the start of the descending colon. The main role of the
transverse colon is to absorb water and salts from indigestible food matter.

ASCENDING COLON
The ascending colon is located on the right side of the abdomen. It receives
digesting food from the small intestine. At its start, it is connected to the cecum,
which is the first part of the large intestine.

DESCENDING COLON
The descending colon is a section of the large intestine. It is the left part of
the colon that passes downward. It is responsible for storing the remains of
digested food before they pass through the rest of the colon and rectum for
elimination.

SIGMOID COLON
The sigmoid colon is the last section of the bowel — the part that attaches
to the rectum. It's about a foot and a half long (around 40 centimeters) and is
shaped like the letter “s.” Its job is to hold feces until you're ready to go to the
bathroom.

CECUM
The beginning of the large intestine. It absorbs fluids and salts that remain
after completion of intestinal digestion and absorption and to mix its contents with
a lubricating substance, mucus.

APPENDIX
The appendix sits in the lower right abdomen. The appendix is a narrow,
finger-shaped pouch that projects out from the colon.

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RECTUM
The rectum is a straight, 8-inch chamber that connects the colon to the
anus. The rectum's job is to receive stool from the colon, let you know that there is
stool to be evacuated (pooped out) and to hold the stool until evacuation happens.

ANUS
The anus is the last part of the digestive tract. It's at the end of the rectum. It's
where stool comes out of the body. It consists of a muscular ring (called a
sphincter), that opens during a bowel movement to allow stool (feces) to pass
through, as well as flat cells that line the inside of the anus.

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 PATHOPHYSIOLOGY

Definition of Diagnosis
Diagnosis: Acute Gastroenteritis
Definition: Acute gastroenteritis is a common and costly clinical condition in
children. It is a self-limiting illness with numerous etiologies. A thorough history and
physical examination of the child with acute gastroenteritis are required to rule out
other illnesses with similar symptoms. Gastroenteritis (GE) is an inflammation of
the gastrointestinal mucous membranes that causes vomiting and/or diarrhea
(Starr, 2015). According to Elizabe (2016), viruses are the most common cause,
but bacterial, protozoal, and helminthic GE can occur, especially in impoverished
areas. In children, vomiting and diarrhea can be vague symptoms, and the
diagnosis of viral GE should only be made after all other causes have been ruled
out.

Etiology
Etiology of the patient’s condition will help to determine the predisposing
and precipitating factors to the development of the patient’s condition.
Predisposing Factors Present Justification
Age ✓ In this case, the patient is
an 11 month old baby,
where this type of
disease is prone to
happen, for the reason
that they are considered
to be
immunocompromised
hosts or those that do not
have the ability to
respond normally to an
infection because of an

17
 impaired or weakened
immune system (Rivera,
2021).
Psychological factor: ✓ A loss of appetite can be
Unwillingness to eat physical or
psychological. It is often
temporary due to factors
such as infections or
digestive issues, in which
case appetite will come
back when a person has
recovered (Sissons,
2018).
Upon interview with the
mother, she verbalized
“Dili na kayo muinom ug
gatas si Jac, unya kung
makainom sya kay isuka
man dayon niya.”
Infection/Viruses ✓ Viruses or bacterial
infections are frequently
to blame for
gastroenteritis. Infections
with rotavirus, Norwalk
virus, Escherichia coli,
campylobacter, and
salmonella are a few of
the major causes of
gastrointestinal
discomfort. The most
common reason for

18
 acute gastroenteritis to
appear in the ED is
viruses. The majority of
acute gastroenteritis
episodes are self-
limiting, however some
individuals may present
with life-threatening
dehydration and shock if
they have a more serious
infection brought on by
invasive bacterial and
parasite species. In the
case presented, the
patient is experiencing
watery stool and vomiting
which are symptoms of
these diseases caused
by viruses (Cochran,
2022).
Precipitating Factors Present Justification
Fever ✓ Since gastroenteritis is
also referred to as the
stomach flu, a patient
who has been diagnosed
with this condition may
have a fever. When the
body is battling an
infection, a fever may be
present. The patient may
experience chills,

19
 clammy skin, sweating,
headaches, or bodily
aches all over (Cleveland
Clinic, 2022). The patient
in this instance has a
fever, is perspiring, and
has chills.
Pain ✓ A baby may also
experience pain due to
illness or injury. Just like
adults, each baby’s
reaction to pain is
different, but unlike
adults, babies can’t tell
you how they are feeling,
so they rely on you to
recognise their pain and
help them through it.
They may cry or
whimper, and be unable
to settle (Cleveland
Clinic, 2022).
Diarrhea ✓ Occasional baby
diarrhea is pretty
common and very
normal. New little one is
just beginning to explore
food and is still getting
used to this digestion
thing. But too much
diarrhea can lead to too

20
 much water loss for a tiny
baby (Iftikhar, 2020). In
this case, the patient is
experiencing diarrhea.
Dehydration ✓ Patients with
gastroenteritis also show
signs of dehydration
because this form of
illness is accompanied
by diarrhea and vomiting
(Hall, 2022). In this case,
the patient is seen to
have sunken eyes and
cracked, and dry lips.

Symptomatology
Signs/Symptoms Present Justification
Vomiting ✓ Vomiting is a common
symptom of acute
gastroenteritis. Vomiting,
or throwing up, is a
forceful expulsion of
stomach contents. It can
be a one-time
occurrence connected to
something that upsets
the stomach. Underlying
medical issues may be
the cause of recurrent
vomiting (Cherney,
2019).

21
 Upon interview with the
mother, she verbalized
“Dili na kayo muinom ug
gatas si Jac, unya kung
makainom sya kay isuka
man dayon niya.”
Abdominal Pain ✓ Acute gastroenteritis is
accompanied by cramps
or pain in the abdomen.
Food sensitivities,
bacterial or viral
illnesses, usage of
medications or alcohol
are some of the most
frequent reasons
(Leonard, 2020).
A baby may also
experience pain due to
illness or injury. Just like
adults, each baby’s
reaction to pain is
different, but unlike
adults, babies can’t tell
you how they are feeling,
so they rely on you to
recognise their pain and
help them through it.
They may cry or
whimper, and be unable
to settle.

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Hyperactive Bowel ✓ Hyperactive is a term that
Sound refers to excessive
activity or occurrence.
When someone has
diarrhea, it's common to
notice that their bowel
movements are more
vigorous than usual. In
the intestines, gas, fluid,
and muscular motions all
rise during diarrhea. The
sounds of watery stools
splashing through the
intestines get louder as a
result (Abdominal
Noises, n.d).
Upon auscultation a 40
bowel sounds are heard
per minute which is
higher than the normal
range of 10-30 bowel
sounds per minute.
Bowel Urgency ✓ Bowel urgency is the
term used to describe the
sudden impulse to use
the restroom to relieve
oneself. It is a typical and
occasionally crippling
sign of diarrheal
illnesses, such as
inflammatory bowel

23
 disease and diarrhea-
predominant IBS (IBS-D)
(Singh et al., 2019).
Upon monitoring, the
mother said she was able
to change diapers 8
times and 4 of them had
water stool within 8
hours.
Watery Stool ✓ Everyone occasionally
has diarrhea, often
known as liquid bowel
movements. They
happen if you pass liquid
rather than formed
stools. A short-term
ailment like food
poisoning or a virus is
typically to blame for
liquid bowel motions.
Nevertheless, they can
occasionally be the result
of an underlying medical
issue. (Nall, 2022).
Patient was admitted due
to loose bowel
movement of 5x/day with
color greenish brown.

24
Schematic Diagram

25
Narrative
Acute gastroenteritis is an infectious condition characterized by diarrhea,
which may be accompanied by fever, vomiting, or abdominal pain. It is the fourth
most common cause of child deaths worldwide; about 68% of people with diarrheal
disease are young children. Acute gastroenteritis is the passage of loose stools
more frequently than what is normal for that individual. Since the gastrointestinal
(GI) system is so long and so diverse, a multitude of possible disorders can occur
along the tract, including both congenital disorders and acquired illnesses. Also,
because the GI system is responsible for taking in and processing nutrients for all
parts of the body, any problem with the system can quickly affect other body
systems and, if not adequately treated, can affect overall health, growth, and
development. The best way to treat and determine if there is an anomaly with the
GI system, is to undergo several typical procedures, such as an endoscopy, small
intestine wireless enteroscopy (capsule endoscopy), colonoscopy, and radiology
studies, which are used in the diagnosis and therapy of GI disorders. Therapy may
include alternative methods of feeding such as enteral (nasogastric or gastrostomy
tube feedings) or nutrition sources such as total parenteral nutrition and
intravenous (IV) therapy to rest the GI tract. A colostomy or ileostomy may be
created to further rest the GI tract.

One of the possible gastrointestinal disorders that an infant can encounter

during their development is gastroenteritis. Gastroenteritis is inflammation of the
stomach, small intestine, or large intestine. Acute gastroenteritis is a type of
gastroenteritis that usually lasts fewer than 14 days. It is a common infectious
disease syndrome that causes a combination of nausea, vomiting, diarrhea, and
abdominal pain. This GI disorder is caused by different things, including viruses,
bacteria, bacterial toxins, parasites, particular chemicals, and some drugs. It is
usually ingested through food or drink. Loss of appetite, bloating, nausea, vomiting,
abdominal cramps, abdominal pain, diarrhea, bloody stools in some cases, and
generally feeling unwell are some of the signs and symptoms that patients
experience when they are at risk of acquiring acute gastroenteritis. In this module,

26
the symptoms Baby JAC experienced were loss of appetite, vomiting, abdominal
pain, and lethargy.

Children with GI disorders quickly need to be assessed for signs of fluid

loss, such as poor skin turgor, dry mucous membranes, or lack of tearing. Also, a
patient who is experiencing acute gastroenteritis should be closely monitored in
checking and balancing the input and output of the patient. Some treatment should
be done to prevent a worst-case scenario. Preventing dehydration or providing
appropriate rehydration is the primary supportive treatment of acute
gastroenteritis. Babies under 6 months old can become ill quickly with
gastroenteritis, in treating they need extra fluids to replace fluids lost by diarrhea
and vomiting. If breastfeeding, continue to feed with milk from the mother. If bottle
feeding, give clear fluids for the first 12 hours, then give the normal formula in
smaller, more frequent amounts. When possible, an age-appropriate diet and fluids
should be continued. When rehydration is achieved, an age-appropriate diet
should be promptly resumed.

In terms of preventing the occurrence of GI disorder, practicing proper

handwashing before and after touching the baby, and her things, and preparing
food should be done. Second, clean the baby’s toys, bottle, bed, and everything
that surrounds her daily. Lastly, ensuring safe and clean fluids and foods should
be intake. When all of these will be achieved, the baby’s probability of getting GI
disorders will be low.

27
 COURSE IN THE WARD/TREATMENT/INTERVENTIONS

MEDICAL MANAGEMENT
Doctor’s Progress Notes

DATE & TIME PHYSICIAN’S ORDER RATIONALE

September 22, 2022 LABS:
@ 8:00 AM CBC To estimate blood loss
during delivery and to
identify patients who will
need blood transfusions.
Also, to determine any
abnormalities present in the
cells of the patient.

Urinalysis To identify illnesses like

genetic conditions like
diabetes, particularly when
the patient is unaware of
any hereditary or family
conditions she may have.
Additionally, this might
check for infections,
preeclampsia, and
dehydration in the patient.

Chest X-ray A chest X-ray is an imaging

test that uses X-rays to look
at the structures and organs
in your chest. It can help
your healthcare provider
see how well your lungs and

28
 heart are working. Certain
heart problems can cause
changes in your lungs.
Certain diseases can cause
changes in the structure of
the heart or lungs.

ECG An electorcardiogram is
often used alongside other
tests to help diagnose and
monitor conditions affecting
the heart. It can be used to
investigate symptoms of a
possible heart problem,
such as chest pain,
palpitations, dizziness and
shortness of breath.

Basic Metabolic Panel A basic metabolic panel

(BMP) is a test that
measures eight different
substances in your blood. It
provides important
information about your
body's chemical balance
and metabolism.

Stool Exam A stool analysis is a series

of tests done on a stool
(feces) sample to help
diagnose certain conditions
affecting the digestive tract.

29
 These conditions can
include infection (such as
from parasites, viruses, or
bacteria), poor nutrient
absorption, or cancer.

September 22, 2022 MEDICATIONS:

@ 8:00 AM ORS vol/vol Oral rehydration solutions
replacement (ORS) are used to treat
dehydration caused by
diarrhea.

Paracetamol Paracetamol is a mild

1250mg/5mL 2.5mL q 4 analgesic and antipyretic,
hrs PRN for fever & pain and is recommended for the
treatment of most painful
and febrile conditions, for
example, headache
including migraine,
toothache, neuralgia, colds
and influenza, sore throat,
backache, rheumatic pain
and dysmenorrhoea.

Racecadotril 10mg TID Racecadotril is used for the

PO, may be added to treatment of acute diarrhea
food/feeding bottle in children and adults and
has better tolerability than
loperamide, as it causes
less constipation and
flatulence. Several
guidelines have

30
 recommended racecadotril
use in addition to oral
rehydration treatment in
children with acute
diarrhea.

Erceflora 5mL/amp Adjunctive treatment to help

q4hrs PO restore intestinal bacterial
flora that has been altered
by antibiotic or
chemotherapy treatments.
Treatment of acute and
chronic gastrointestinal
disorders in breast-feeding
infants caused by
intoxication or intestinal
flora imbalance with
dysvitaminosis.

September 22, 2022 OTHER ORDERS:

@ 8:00 AM Secure consent to care To allow patient to
participate in his own
healthcare and enable
him/her to decide which
treatments he/she wants
and doesn't want. This is to
respect the rights of the
patient to receive
information about the
treatment and his/her
freedom to choose.

31
T/C AGE with mild DHN To recognize the need of
intravenous therapy or oral
rehydration in treating mild
dehydration in acute
gastroenteritis.

NPO except meds for Nothing by mouth is

24hrs, then continue prescribed as a safety
breastfeeding per precaution. Without it, the
demand & incorporate patient could become
BRAT nauseous once contrast or
sedation is administered
because there’s something
in the stomach which can
lead to aspiration, meaning
the patient might uptake the
stomach contents into their
lungs.

Start IVF of D5IMB Dextrose 5% in water is

500cc, fast drip 50cc used to treat low blood
now, then regulate @ sugar (hypoglycemia),
60cc/hr insulin shock, or
dehydration (fluid loss).
Dextrose 5% in water is also
given for nutritional support
to patients who are unable
to eat because of illness,
injury, or other medical
condition.

32
 IVFTF D5IMB X 2 @ Is used to treat low blood
60cc/hr sugar (hypoglycemia),
insulin shock, or
dehydration (fluid loss).

V/S q4 hours To detect and monitor the

medical problem of the
patient. Vital signs measure
the body’s basic functions
so it is important to monitor
the patient’s progress
during hospitalization.

I & O q shift To ensure that the patient

has proper intake of fluids
and other nutrients, and
determine if there’s
adequate output of urine
and normal defecation.

BM monitoring q shift & To ensure that the patient is

record character, having regular soft bowel
frequency, and amount movements and adequate
urination. This is also done
to identify abnormal
patterns of the character,
frequency, and amount of
the patient’s stool.

September 23, 2022 Continue meds Medicines are used to treat

@ 8:00 AM symptoms, stop or prevent

33
 sickness, prevent illness, or
diagnose diseases.

D/C IVF D5IMB It is used to treat low blood

sugar (hypoglycemia),
insulin shock, or
dehydration (fluid loss).

TF D5NSS 500 cc Nutrient solutions helps in

@50cc/hr preventing dehydration and
ketosis.

Continue vol/vol Fluid replacement aims to

replacement restore circulatory volume
(and thereby increase the
rate of ketone clearance)
and correct electrolyte
imbalances.

Watch out for any To immediately address the

unusualities signs of abnormalities and
prevent the condition from
getting worse by prompt
and proper intervention.

September 24, 2022 May go home To indicate that the patient

@ 8:00 AM is now allowed or ready to
go home and be
discharged.

D/C IVF IV fluids are specially

formulated liquids that are
injected into a vein to

34
 prevent or treat
dehydration.

Increase OFI To regulate body

temperature, keep joints
lubricated, keep organs
functioning properly, deliver
nutrients to cells, prevent
infections, and be well-
hydrated. Also, it helps in
preventing dehydration and
other serious complications.

Proper hygiene & To deter microorganisms

handwashing and prevent cross-
contamination. This is done
to avoid getting sick due to
the spread of germs in the
body and to and from the
others.

Use distilled/mineral To drink clean and healthy

water water since distilled/mineral
water is free from
contaminants due to the
process of distillation that
removes waterborne
pathogens.

Ff-up on October 6, This is for health problems

2022 10am at OPD or that may occur months or
earlier if with complaints years after treatment ends.

35
 Instruct discharge plan To help patient’s prevent
future readmissions by
instructing him/her and the
family regarding the care at
home, including
medications, diet, therapy,
and follow-up
appointments.

September 24, 2022 HOME MEDICATIONS:

@ 8:00 AM Paracetamol Paracetamol is a mild
250mg/5mL 2.5mL analgesic and antipyretic,
q4hrs PRN for fever and and is recommended for the
pain treatment of most painful
and febrile conditions, for
example, headache
including migraine,
toothache, neuralgia, colds
and influenza, sore throat,
backache, rheumatic pain
and dysmenorrhoea.

Erceflora 5mg/amp, 1 Adjunctive treatment to help

amp TID PO x 3 more restore intestinal bacterial
days flora that has been altered
by antibiotic or
chemotherapy treatments.
Treatment of acute and
chronic gastrointestinal
disorders in breast-feeding
infants caused by

36
 intoxication or intestinal
flora imbalance with
dysvitaminosis.

Laboratory/Diagnostic Examinations
NORMAL NURSING
PROCEDURE PURPOSE RESULT
RANGE MANAGEMENT
Complete This test WBC: 4.0- 11.5 • Introduce self and verify
Blood Count assesses the 10.5 (HIGH) the patient's identity
(CBC) components using two identifiers.
and properties RBC: 4.10- 5.27 • Educate the patient that
of the blood, 5.60 this test can help
such as red determine the amount
blood cells, Hemoglobin: 15.4 of hemoglobin in the
white blood 12.5-17.0 blood, which can help
cells, and with diagnosis and
platelets. A Hematocrit: 44.1 treatment monitoring.
CBC can aid in 36.0-50.0 • Encourage the patient
the diagnosis to avoid and decrease
of a number of MCV: 80-98 84 stress as a result of
health issues, changed physiologic
including MCH: 27.0- 29.2 status normal effects
anemia, 34.0 and changes in
clotting hematologic
disorders, and MCHC: 32.0- parameters.
infections. 36.0 34.9 • Keep track of any
recent procedures that
RDW: 11.7- may have
15.0 13.7 compromised the test
results. Collect a list of
Platelets: the patient's current
140-415 268 prescriptions, as well as
herbal and nutritional
Neutrophils: supplements.
40-74 47

Lymphs: 14-
46 46

Monocytes:
4-13 6

Eos: 0-7

37
 1
Basos: 0-3
0
Neutrophils
(Absolute): 2.6
1.8-7.8

Lymphs
(Absolute): 2.6
0.7-4.5

Monocytes
(Absolute): 0.4
0.1-1.0

Eos
(Absolute): 0.1
0.0-0.4

Baso
(Absolute): 0.0
0.0-0.2

Immature
Granulocytes: 0
0-1

Immature
Grans (Abs): 0.0
0.0-0.1
Urinalysis The purpose of Color: Dark • Instruct the patient to
the urinalysis is Yellow Yellow void directly into a dry,
to screen out clean container.
conditions such Appearance: - • Monitor lab result for
as urinary tract Clear any indication of UTI.
infection (UTI), • Fill out a lab request
by checking for Specific 1.036 form requesting an
sugar, protein, Gravity: (HIGH) HCG test then label the
ketones, 1.005-1.025 specimen cup with the
bacteria, and patient's identification
blood cells. pH: 7.5 information. Submit
5.0-8.0 both to the lab.

Glucose: -
Negative

38
Bilirubin: Negative
Negative

Ketone: Negative
Negative

Occult Blood: -
Negative

Protein: Negative
Negative

Nitrite: Negative
Negative

Leukocyte Negative
Esterase:
Negative

WBC: <= 5 0-2

WBC/HPF

RBC: <= 2 0-2

WBC/HPF

Squamous
Epithelial: <=
5 HPF None Seen

Bacteria:
NONE SEEN
HPF Negative

Crystals:
NONE SEEN
HPF Negative

Triple
Phosphate
Crystals: None Seen
NONE SEEN
HPF

Casts: NONE
SEEN LPF
None Seen

39
 Yeast: NONE
SEEN HPF
None Seen

Chest X-ray The state of the Normal Chest Normal • Identify the patient's
lungs can be X-ray findings Chest X- identification through
determined ray name and birthday and
using a chest findings confirm it according to
X-ray. Chest X- the patient’s wristband
rays can and facility policy.
identify cancer, • Explain to the patient
infections, or about the procedure.
air buildup • Instruct patient to
around lungs remove all metal
that could lead related things
to lung
collapse. They
can also
demonstrate
chronic lung
diseases like
emphysema or
cystic fibrosis,
as well as their
side effects.
ECG An Essentially Essentially • Explain the procedure
electrocardiogr normal ECG normal to the patient. Tell who
am (ECG) is a findings ECG will perform the test,
quick test that findings where it will take place,
can be used to and that it’s safe,
examine the painless, and is
electrical noninvasive.
activity and • Ensure to empty the
rhythm of the bladder. Instruct patient
heart. It can be to void prior and to
used to detect change into a gown.
either an • Encourage the patient
exceptionally to cooperate. Advise
slow the patient to remain
(bradycardia) still during the test
or fast heart because movement
rate may distort results.
(tachycardia). • Inform that a
conductive gel is
applied to the chest

40
 area and make sure to
remove it after the
procedure.
Basic A blood test Sodium: 135- 130 (LOW) • Instruct the patient
Metabolic called the basic 147 mmol/L beforehand to fast for at
Panel metabolic least eight hours or
panel (BMP) Potassium: 3.5 overnight before you
contains data 3.5-5.2 have your blood taken
about the mmol/L for BMP.
body's • Aware patient that a
electrolyte Chloride: 95- 100 healthcare provider
levels, 107 mmol/L would collect blood.
including salt • Inform the patient that
and potassium, CO2: 22-30 24 the procedure can
and kidney mmol/L cause a little stinging
function. pain.
Urea 20 • Instruct patient to apply
Nitrogen pressure to the site for
(BUN): 7-20 a few minutes to reduce
mg/dL bruising.
• Encourage the patient
Creatinine: 1.2 to eat afterwards.
0.5-1.2 mg/dL

Glucose: 60- 100

110 mg/dL
Stool Exam The test helps Colour Greenish • Encourage the patient
in the diagnosis Brown to urinate before
of illnesses Consistency Semi Solid collecting to avoid
such contaminating the stool
inflammatory Reaction ALKALINE with urine.
bowel disease, • Instruct the patient to
stomach or Blood Absent scoop stool for at least
colon cancer, the tip of the pinky
anal fissures, Mucus Present (+) finger.
hemorrhoids, • Instruct the patient how
as well as the Ova of Hook Absent to do proper
finding of blood worm handwashing.
in a stool
sample. Larva of Absent
S.Stercoralis

Ascarris Absent
lumbricoides

E.Histolytica Absent

41
 E.Coli Absent

Giardia Absent
Lamblia

Trichomonas Absent

R.B.C. NIL

Pus Cells PLENTY

Macrophages Absent

Vegetable Present
Cells

Yeast Cells Absent

Fat globules Absent

Bacterial PRESENT
Flora

Epithelial Cell 1-2

Crystals Absent

Surgical Management
SURGICAL NURSING
INDICATION RESULT
PROCEDURE MANAGEMENT
None None None None

None, because there is no surgical procedure conducted in the case

scenario.

42
 NURSING MANAGEMENT

Nurse’s Notes
Nurses Bedside Notes

11months/M Pediatric Ward

Camintal Joseph Andrew Dr. Gin Min Who
10,11,2021 DDC-000
8:00AM

09,22,2022

PERRLA

KEITHLY JJHOY MACALOS

43
 8:00am Dr. Gin Min Who

8:00am CBC DONE

Plt, Hct DONE
Na, K DONE
Urinalysis DONE
Stool exam DONE
CXR, ECG DONE

8:00am (+) vomiting

(+) weak cry
(+) dry mucous membranes
(+) slight sunken eyeballs

D51MB 500

8:00 AM

KEITHLY JJHOY MACALOS

44
Vital Signs Sheet

45
TPR Graphing Sheet

46
I.V. Flow Sheet

47
I&O Monitoring Sheet

48
Clinical Reasoning Questions
Collaboration:

I am concerned about the patient acquiring an injury from the

C fall. It might become a serious injury if not taken care of

immediately since he fell from the table.

I am uncomfortable with how he cries out loud. I’m worried that

he would not be able to withstand the pain he’s feeling after the
U
fall. He could be stressed out from constant crying, and feeling
overwhelmed from the pain.

This is a safety issue since it might result in a bruise, fracture,

cuts, or a head injury. If not addressed, it might become serious

S considering he’s still 6-months-old. I think we should check him

out and assess his head and body for bruises, deformities,
fractures, bleeding, or other injuries that are fatal for the baby.

Ethico-Moral-Legal Considerations:

The nursing action in this situation is to explain and help the

student nurse realize that what she did was wrong morally and
went against the standards that nurses should uphold. Make
Nursing
the student sincerely apologize to the child's parents and make
Action
her fully commit that she won't do it again. Teach her strategies
for reacting in a similar scenario in the future so that she will be
aware of what she did to the baby and prevent it in the future.

The ethical principles that are being upheld are fidelity,

Ethical beneficence, and accountability.
Principle Fidelity – means keeping one's word. It will deliver competent,
Upheld high-quality care to the patient by helping the student nurse see
her mistake and making a promise to never repeat it.

49
 Beneficence – is doing good and the right thing for the patient.
Reprimanding the student nurse will reduce the likelihood that
she will repeat her error, thereby ensuring the security and
comfort of our patients.
Accountability – is accepting responsibility for one’s own
action. The student nurse should embrace any professional and
personal repercussions that arise from her actions, such as
pinching the infant's thighs and scolding it saying "BAD BABY!”.

Discharge Plan
Discharge planning is the creation of a personalized plan to ensure that a
patient's transfer from a health organization such as a hospital to wherever the
patient is going next goes as safe and smooth as possible. Nurses would assist
and ensure that the patients and their relatives are aware of the things to do in
order to prevent future readmissions, avoid possible risks, and help aid in
rehabilitation.
• Instruct the mother/parents of the infant to give the infant the
prescribed home medications on time such as Paracetamol
25- mg/5mL, 2.5mL q4hrs PRN if fever and pain occurs &
Medications
Erceflora 5mg/amp, 1 amp TID PO x 3 more days.
• Remind the mother/parents to put away the medicines in a
high cabinet immediately after use.
• Encourage mother/parents to take the infant outside in
stroller or carriage for a walk.
• Remind mother/parents to always watch out for every
Exercise
infant’s move as some infant’s activities such as head
banging to playpen/crib rails and picking up small objects
impose dangers to them.
• Instruct the mother/parents to give the infant a complete bed
Treatment
rest. Rocking the baby to sleep would be a great help.

50
 • Remind the mother/parents to increase fluid intake every
day.
• Educate the mother/parents of the infant to use only
distilled/mineral water for infant.
• Instruct mother/parents to monitor and observe the infant’s
well-being time to time.
• Educate the mother/parents to not leave infants alone in
bathtub or unsupervised near water.
• Educate the mother/parents that an infant does not need
complete bath every day, except if it’s hot weather.
Hygiene
• Educate the mother/parents on proper hand hygiene before
touching the infant.
• Encourage mother/parents to frequently change the infant’s
diaper.
• Instruct mother/parents to continue follow-up check-ups
with the doctor to monitor the health of the infant.
• Encourage the mother/parents to ask
Outpatient
(Check-up) questions/clarifications during the appointment.
• Inform the parents to seek immediate medical care if
complications arise after discharge.
• Instruct mother/parents that the infant should drink a lot of
water, at least 8-10 glasses of water a day, as well as, milk.
• Instruct mother/parents of the infant to give complementary
Diet foods that are nutritious to baby such as mashed potato. and
mashed bananas.
• Remind the mother/parents to observe what foods the
infant’s allergic to.
• Advise the mother/parents to maintain a good and safe
Spirituality
environment for the sake of infant’s well-being.

51
• Encourage the mother/parents to strengthen her faith, not
to lose hope, and be rational, especially if their baby’s well-
being is at risk.

52
 REFERENCES

Ananta, Y., Gandaputra, E., Waiman, E., Partiwi, I. G. A., Marzuki, N., Yohmi, E.,
Panjaitan, E., Oswari, H., & Hegar, B. (2016). Exclusive breastfeeding rate
and factors associated with infant feeding practices in
Indonesia. Paediatrica Indonesiana, 56(1), 24-31.
https://doi.org/10.14238/pi56.1.2016.24-31
Better Health Channel. (2021). Gastroenteritis in children.
https://www.aafp.org/pubs/afp/issues/1999/1201/p2555.html
Blasco, P. A. (1993). Early developmental indicators of intellectual deficit. Pediatric
Rounds, 2, 1-3.
Burkhart D. M. (1999). Management of acute gastroenteritis in children. American
family physician, 60(9), 2555–2566.
https://pubmed.ncbi.nlm.nih.gov/10605991/
Cleveland Clinic. (2020). Respiratory system.
https://my.clevelandclinic.org/health/articles/21205-respiratory-system
Cleveland Clinic. (2021). Digestive system.
https://my.clevelandclinic.org/health/body/7041-digestive-system
Cochrane, S. H., Leslie, J., & O'Hara, D. J. (1982). Parental education and child
health: intracountry evidence. Health policy and education, 2(3-4), 213–
250. https://doi.org/10.1016/0165-2281(82)90011-x
Elliott, E. J. (2007). Acute gastroenteritis in children. The BMJ.
https://www.bmj.com/content/334/7583/35?grp=
Flagg, J. & Pillitteri, A. (2018). Maternal and Child Health Nursing 8th Edition.
Wolters Kluwer.
Johnson, L., van Jaarsveld, C. H., Llewellyn, C. H., Cole, T. J., & Wardle, J. (2014).
Associations between infant feeding and the size, tempo and velocity of
infant weight gain: SITAR analysis of the Gemini twin birth
cohort. International Journal of Obesity (2005), 38(7), 980–987.
https://doi.org/10.1038/ijo.2014.61

53
National Statistics Office (NSO). (2017). National Demographic and Health Survey
2008.
https://microdata.worldbank.org/index.php/catalog/1476#:~:text=The%202
008%20National%20Demographic%20and%20Health%20Survey%20(200
8%20NDHS)%20is,(clusters)%20throughout%20the%20Philippines.
New Health Advisor. (2022). Gastroenteritis in babies: Causes, symptoms,
treatments and prevention.
https://www.newhealthadvisor.org/Gastroenteritis-in-
Babies.html?fbclid=IwAR3vi1HS5LuXXWcz97zU1e42DShzyuCg28obBBC
CZrVvs6qkz27YlcFqLN0
Prescilla, R. P. (2018). Pediatric gastroenteritis.
https://emedicine.medscape.com/article/964131-overview
Promoting optimal monitoring of child growth in Canada: Using the new World
Health Organization growth charts - Executive Summary.
(2010). Paediatrics & child health, 15(2), 77–83.
https://doi.org/10.1093/pch/15.2.77
Qasem, W., Fenton, T., & Friel, J. (2015). Age of introduction of first
complementary feeding for infants: a systematic review. BMC
pediatrics, 15(1), 1-11. https://doi.org/10.1186/s12887-015-0409-5
Ukegbu, P. O., & Uwaegbute, A. C. (2013). Growth pattern exclusively and non-
exclusively breastfed infant in Umuahia urban, Nigeria. Journal of
Community Nutrition & Health, 2(1), 68-75.
https://www.proquest.com/openview/557b04199fb5b00841b0cc01d5056b
16/1?pq-origsite=gscholar&cbl=2030321
UNICEF. (2013). Improving child nutrition: The achievable imperative for global
progress. https://reliefweb.int/report/world/improving-child-nutrition-
achievable-imperative-global-progress
World Health Organization. (2001). Iron deficiency anaemia: assessment,
prevention and control. https://www.who.int/publications/m/item/iron-
children-6to23--archived-iron-deficiency-anaemia-assessment-prevention-
and-control

54
World Health Organization. (2015). Stunting in a nutshell.
https://www.who.int/news/item/19-11-2015-stunting-in-a-nutshell
World Health Organization. (2022). Complementary feeding.
https://www.who.int/health-topics/complementary-feeding#tab=tab_1

55