LICEO DE CAGAYAN UNIVERSITY

COLLEGE OF NURSING

NCM501202

RELATED LEARNING EXPERIENCE

A Case Study

of

A 6 Month Old Client with

Acute Gastroenteritis with some Dehydration

Submitted to:

Mrs. Annaliza Arellano, R.N.

In Partial Fulfillment of NCM 501202 RLE

RLE GROUP

CLUSTER II – B7

Submitted by:

Sabsal, Marylee S.

I. INTRODUCTION

A. Overview of the Case

Gastroenteritis is a condition that causes irritation and inflammation of the

stomach and intestines (the gastrointestinal tract). An infection may be caused by

bacteria or parasites in spoiled food or unclean water. Some foods may irritate

your stomach and cause gastroenteritis. Lactose intolerance to dairy products is

one example. Acute diarrhoea or gastroenteritis is the passage of loose stools

more frequently than what is normal for that individual. This increased frequency

is often associated with stools that are watery orsemisolid, abdominal cramps

and bloating. Acute watery diarrhoea is an extremely common problem, and can

be fatal due to severe dehydration, in both adults and children, especially in the

very young and the old or in those who have poor immunity such as individuals

with HIV infection or patients who are using certain medications that suppress

the immune system.In healthy adults, however, it is often no more than a

nuisance. Because it may interfere with ones ability to work, it can also adversely

affect the individual’s income.

B. Objectives and Purpose of the Study

This study generally aims to investigate the condition of a client and

further understand the extent of the case. Specifically the student nurse sought

to:

Perform Physical Assessment, Data Base and History Taking that

solidifies the present diagnosis of the client.

Identify Signs and Symptoms associated with the disorder.

Identify priority nursing problems which will be the basis of the care plan.

Develop Plan of Care and Implement nursing interventions relevant and

suitable to the case.

Evaluate the effectiveness of the interventions and detect any progress or

regression of the client’s disease condition.

The purpose of the study is to gather significant data to broaden my

knowledge of the disease process and to improve my abilities as future

healthcare provider. This is done to be able to aid in the recovery process of the

client. Moreover this case study will enable me to apply the acquired skills I have

obtained in the classroom set-up.

C. Scope and Limitation of the Study

The scope of the study consists of one pedia ward client of the Talakag-

Bukidnon Provincial Hospital. Significant others was interviewed specially her

mother to know more about the client and her condition.

The time period for which the study was conducted and completed, was

constrained and limited to a span of 1 week. The first assessment done was last

January 27, 2009, at around 5:00 pm. Then continuous assessment was done in

the span of my duty in the said ward from January 28 and 29.The said

assessment dates were maximized to gather of information including profile, data

base, history of present illness, chart data and many others.

II. HEALTH HISTORY

A. Patients Profile

Name of Patient: John Dave Salungayan

Sex: Male

Age: 6 month old

Birthday: July 15, 2008

Birthplace: Talakag, Bukidnon

Religion: Roman Catholic

Civil Status: Child

Mother: Cecile Salungayan

Father: Aaron Salungayan

Nationality: Filipino

Date Admitted: January 26, 2009

Time Admitted: 4:15 pm

Informant: Mother

Temperature: 37.6 ̊C

Pulse Rate: 140 bpm

Respiration: 35 cpm

Attending Physician: Dr. Joseph J. Borong, M.D.

B. Personal Health History

My patient John Dave Salungayan was born through a normal vaginal

delivery. He had completed all his immunization. He has not received any blood

from the past. It was his first time to be admitted in the hospital. He has no known

food and medicine allergies. The patient had no previous history of surgery. He

had experienced cough, colds, and fever that don’t necessitate the patient to be

admitted at the hospital.

C. Chief Complains and History of Present Illness

John Dave Salungayan, a 6 month old child from Talakag, Bukidnon was

admitted for the first time due to diarrhea and vomiting, with the initial vital signs

of: temperature- 36.5 ˚C, respiratory rate- 27 cpm, and a pulse rate of 140 bpm.

The result of his physical assessment was that he has respiratory distress.

Two days prior to admission the patient is already suffering from diarrhea.

There was no skin lesions observed upon admission. The doctor’s admitting

diagnosis is acute gastroenteritis with some dehydration.

III. DEVELOPMENT DATA

Sigmund Freud’s Theory (Psychosexual Theory)

The 0-2 years of age is under the oral stage of Freud’s psychosexual

theory. Early in your development, all of your desires were oriented towards your

lips and your mouth, which accepted food, milk, and anything else you, could get

your hands on (the oral phase). The first object of this stage was, of course, the

mother's breast, which could be transferred to auto-erotic objects (thumb-

sucking). The mother thus logically became your first "love-object," already a

displacement from the earlier object of desire (the breast). When you first

recognized the fact of your father, you dealt with him by identifying yourself with

him; however, as the sexual wishes directed to your mother grew in intensity, you

became possessive of your mother and secretly wished your father out of the

picture (the Oedipus complex). This Oedipus complex plays out throughout the

next two phases of development. Feeding, crying, teething, biting, thumb-

sucking, weaning - the mouth and the breast are the centre of all experience. The

infant's actual experiences and attachments to mum (or maternal equivalent)

through this stage have a fundamental effect on the unconscious mind and

thereby on deeply rooted feelings, which along with the next two stages affect all

sorts of behaviours and (sexually powered) drives and aims - Freud's 'libido' -

and preferences in later life.

John Dave is under the oral stage of Freud’s psychosocial theory in which

he find more pleasure in sucking his thumb every time he is going to bed. I had

also observed that John Dave is a mama’s boy because he won’t go to sleep

unless her mother would carry him.

Erik Erikson’s Theory

The infant will develop a healthy balance between trust and mistrust if fed

and cared for and not over-indulged or over-protected. Abuse or neglect or

cruelty will destroy trust and foster mistrust. Mistrust increases a person's

resistance to risk-exposure and exploration. "Once bitten twice shy" is an apt

analogy. On the other hand, if the infant is insulated from all and any feelings of

surprise and normality, or unfailingly indulged, this will create a false sense of

trust amounting to sensory distortion, in other words a failure to appreciate

reality. Infants who grow up to trust are more able to hope and have faith that

'things will generally be okay'. This crisis stage incorporates Freud's

psychosexual Oral stage, in which the infant's crucial relationships and

experiences are defined by oral matters, notably feeding and relationship with

mum. Erikson later shortened 'Basic Trust v Basic Mistrust' to simply Trust v

Mistrust, especially in tables and headings.

Hope & Drive (faith, inner calm, grounding, basic feeling that everything

will be okay - enabling exposure to risk, a trust in life and self and others, inner

resolve and strength in the face of uncertainty and risk).

My patients is irritable and crying when he cannot see her mom or when

his mom is not around. But when her mother came and he recognized the voice,

the touch, John Dave will stop from crying.

Jean Piaget’s Theory (Cognitive Theory)

Sensorimotor stage. In this period, intelligence is demonstrated through

motor activity without the use of symbols. Knowledge of the world is limited (but

developing) because it’s based on physical interactions / experiences. Children

acquire object permanence at about 7 months of age (memory). Physical

development (mobility) allows the child to begin developing new intellectual

abilities. Some symbolic (language) abilities are developed at the end of this

stage.

My patient learns many things by what he saw. At this moment he is still

developing his motor skills. He is aware only of their sensations, fascinated by all

the strange new experiences his bodies is having. He like little scientists

exploring the world by shouting at, listening to, banging and tasting everything.

IV.MEDICAL MANAGEMENT

a. Medical Orders and Rationale

DOCTOR’S ORDER

Date / time Order Implication

January 26,

2009

4:15 pm

Please admit under the

care of Dr. Borong

Secure consent

Temperature, pulse and

respiration every q 30 min.

For individualized care and

monitoring

For legal and

documentation purposes

For closer monitoring of

the patient’s vital signs

and also to know if there’s

changes from the baseline

January 27,

2009

January 28,

2009

January 28,

2009

Start with D5O.3% NaCl

500cc, regulate at 40cc/hr

Medicines:

Cotrimoxazole 3-4 tsp

BID, P.O.

Chlorpromazine 3-4 tsp

BID, P.O.

Laboratory:

Fecalysis

Urinalysis

DAT, increased fluid intake

(ORESOL)

For x-ray

V/S q 4, I and O q shift

Moderate high back rest

To follow D5O.3% NaCl

500cc, regulate at 40cc/hr

Same IVF to follow same

rate

Refer for unusualities

To consumed IVF

MGH

vital signs

For fluid and electrolyte

imbalance

For infection control

Relieves nausea and

vomiting

To identify presence of

microorganisms in the

feces

To check presence of

microorganisms in the

urine

To restore fluid loss

X-Ray- to monitor disease

activity and progression.

To monitor vital signs.

To maintain airway

patency

For fluid and electrolyte

replacement]

For fluid and electrolyte

replacement

For monitoring purposes

Laboratory/ Diagnostic Examinations

FECALYSIS:

Date: January 26, 2009

Macroscopic appearance:

Color: yellow Consistency: Soft

Microscopic appearance:

Pus cells: few

RBC: none seen /hpf

Fat globules: none seen / hpf

URINALYSIS

Date: January 26, 2009

Color: Yellow

Appearance: Clear

Specific gravity: 1.025

Protein (Albumin): Negative

Glucose: Negative

Bacteria: Few

V. PATHOPHYSIOLOGY WITH ANATOMY AND PHYSIOLOGY

A. Anaphysiology

Your digestive system started working even before you took the first bite of

your pizza. And the digestive system will be busy at work on your chewed-up

lunch for the next few hours — or sometimes days, depending upon what you've

eaten. This process, called digestion, allows your body to get the nutrients and

energy it needs from the food you eat. So let's find out what's happening to that

pizza, orange, and milk. The Mouth Starts Everything Moving. Even before you

eat, when you smell a tasty food, see it, or think about it, digestion begins. Saliva

or spit, begins to form in your mouth. When you do eat, the saliva breaks down

the chemicals in the food a bit, which helps make the food mushy and easy to

swallow. Your tongue helps out, pushing the food around while you chew with

your teeth. When you're ready to swallow, the tongue pushes a tiny bit of

mushed-up food called a bolus toward the back of your throat and into the

opening of your esophagus, the second part of the digestive tract.

The esophagus is like a stretchy pipe that's about 10 inches (25 centimeters)

long. It moves food from the back of your throat to your stomach. But also at the

back of your throat is your windpipe, which allows air to come in and out of your

body. When you swallow a small ball of mushed-up food or liquids, a special flap

called the epiglottis flops down over the opening of your windpipe to make sure

the food enters the esophagus and not the windpipe.If you've ever drunk

something too fast, started to cough, and heard someone say that your drink

"went down the wrong way," the person meant that it went down your windpipe

by mistake. This happens when the epiglottis doesn't have enough time to flop

down, and you cough involuntarily (without thinking about it) to clear your

windpipe.

Once food has entered the esophagus, it doesn't just drop right into your

stomach. Instead, muscles in the walls of the esophagus move in a wavy way to

slowly squeeze the food through the esophagus. This takes about 2 or 3

seconds.

B. Pathophysiology

Definition: Gastroenteritis is a condition that causes irritation and inflammation of

the stomach and intestines (the gastrointestinal tract).

Person to person Contaminated food or H20 Animal Pets

Escherichia Coli, Shigella, Salmonela, Staphylococcus Aureus

Invasion of Gastrointestinal tract

Exterotoxin production Destruction of epithelial cells System invasion

Interacts with mucosa Superficial ulceration of Mucosa Inflammation of layer

Prufuse secretion of H20 Blood, mucus in stool of tissue beneath

and electrolytes epithelium of mucosa

Hyperemia and edema

Diarrhea Excretion of intestinal Access to

Dehydration/ Detorioration fluids systemic circulation

and collapse

Infection in another

part of body

Nursing Assessment II

SUBJECTIVE OBJECTIVE

COMMUNICATION:

[ ] hearing loss

[ ] visual changes

[X] denied

Comments: Not

applicable

[ ] glasses [ ] languages

[ ] contact lenses [ ] hearing aide

[ ] speech difficulties

Pupil size: 3-5 mm

Reaction: PERRLA

OXYGENATION:

[ ] dyspnea

[ ] smoking history

[x] cough

[ ] sputum

[ ] denied

Comments: Not

applicable

Resp. [x] regular [ ] irregular

Describe: _has a regular breathing

pattern

R: Right lung is symmetric to the left

lung

L: Left lung is symmetric to the right

lung.

CIRCULATION:

[ ] chest pain

[ ] leg pain

[ ] numbness of

extremities

[X] denied

Comments: Not

applicable

Heart Rhythm [X] regular [ ]

irregular

Ankle Edema: no presence of unkle

edema

Pulse Car Rad. DP Fem*

R: 125 96 92 91

L: 112 101 114 120

Comments: pulses are strongly

palpable.

NUTRITION:

Diet:DAT,(dry

foods,Increased

fluid intake)

Comments: Not

applicable

[ ]dentures [X]none

Full Partial with patient

Upper [ ] [X] [ ]

[ ] N [ ] V

Character

[X] recent change in

weight appetite

[x] swallowing

difficulty

[ ] denied

Lower [ ] [ ] [ ]

ELIMINATION:

Usual bowel pattern

Once daily

.

[ ] constipation

remedy

None

.

Date of last BM

1-28-09

[X] diarrhea

Character

Watery

[]rinary frequency

8 times a day

[ ] urgency

[ ] dysuria

[ ] hematuria

[ ] incontinence

[ ] polyuria

[ ] foley in place

[X] denied

Comments : Bowel sounds:

Normal active bowel audible

Sound upon Abdominal

Distention

Auscultation Present [ ] yes

[x] no

Urine(color,

consistency, odor)

urine color is yellowish with

aromatic odor

MGT. OF HEALTH & ILLNESS:

[ ] alcohol [ ] denied

(amount & frequency)

N/A

[ ] SBE Last Pap Smear: N/A

LMP: N/A

Briefly describe the patient’s

ability to follow treatments

(diet, meds, etc.) for chronic

health problems (if present):

following medication and

therapeutic regiments

SKIN

INTEGRITY:

[X] dry

[ ] other

[ ] denied

Comments: Not

applicable

[X] dry [ ] cold [ ]

pale

[ ] flushed [X] warm

[ ] moist [ ] cyanotic

*rashes, ulcers, decubitus

(describe size, location, drainage:

No presence of rashes, ulcers,

decubitus.

ACTIVITY/

SAFETY:

[ ] convulsion

[ ] dizziness

[ ] limited motion

of

Joints

Limitation in

Ability to

[ ] ambulate

[ ] bathe self

[ ] other

[X] denied

Comments: Not

applicable

[ ] LOC and orientation:

Conscious.

Gait: [ ] walker [ ] cane [ ]

other

[X] steady [ ] unsteady

sensory and motor losses

in face and

Extremities: Sensitivity in hands

& feet

[ ] ROM limitations: Normal ROM

limitation

COMFORT/

SLEEPAWAKE:

[ ] pain

(location)

Frequency

Remedies

Comments; Not

applicable

[ ] facial grimaces

[ ] guarding

[X] other signs of pain pain in

the infusion site(pt. is irritable)

[ ] side rail release N/A

[ ] nocturia

[ ]sleep

difficulties

[X] denied

COPING:

Occupation: N/A

Members of household: 3

Most supportive person: Aaron Salungayan

Observed non-verbal behavior:

His soft spoken but responsive

when addressed

The person and his phone

number that can be reached

anytime: N / A

VII. NURSING MANAGEMENT

A. Ideal nursing Management

NURSING DIAGNOSIS:

Fluid volume deficient may related to excessive fluid loss, oral intake

INTERVENTION and RATIONALE

Independent:

Assess vital sign changes.

(Elevated temperature/ prolonged fever increases metabolic rate and fluid

loss thought evaporation)

Asses skin turgor, moisture of mucous membranes (lips, tongue).

(Indirect indicators of adequacy of fluid volume, although oral mucous

membranes may be dry because of mouth breathing and supplement oxygen)

Monitor intake and output(I&O), nothing color, character of urine.

Calculate fluid balance. Be aware of insensible losses. Weigh as

indicated.

(Provide information about adequacy of fluid volume and replacement needs)

Dependent:

Provide supplemental IV fluids as necessary.

(In presence of reduced intake/ excessive loss, use of parenteral route may

correct/ prevent deficiency)

NURSING DIAGNOSIS:

Risk for infection related to inadequate primary defenses, inadequate

secondary defenses

INTERVENTION and RATIONALE

Independent:

Monitor vital signs closely, especially during initiation of therapy.

(During this period of time, potentially fetal complications (hypotension/

shock) may develop)

Instruct patient concerning the disposition of secretion and reporting

changes in color, amount, odor of secretion)

Limit visitors as indicated

(Reduce likelihood of exposure to other infectious pathogens)

Demonstrate/ encourage good handwashing technique.

(effective means of reducing spread or acquisition of infection)

Dependent:

Prepare for/ assist with diagnostic studies as indicated.

(Fiberoptic bronchoscopy (FOB) may be done in patients who do not respond

rapidly (within 1-3 days) to antimicrobial therapy to clarify diagnosis and therapy

needs.)

NURSING DIAGNOSIS:

Knowledge deficient regarding condition, prognosis, treatment, self-care, and

discharge needs as related to unfamiliarity with resources and information

misinterpretation

INTERVENTION and RATIONALE

Independent:

Determine the mother’s perception of disease process. (Establishes

knowledge base and provides some insight into individual learning needs)

Review disease process, cause/effect relationship of factors that

precipitate symptoms, and identify ways to reduce contributing factors.

Encourage questions. (Precipitating/aggravating factors are individual;

therefore, the mother needs to be aware of what foods, fluids, and lifestyle

factors can precipitate symptoms. Accurate knowledge base provides

opportunity for the mother to make informed decisions/choices about

future and control of chronic disease. Although most others know about

their own disease process, they may have outdated information or

misconceptions)

Review medications, purpose, frequency, dosage, and possible side

effects. (Promotes understanding and may enhance cooperation with

regimen)

Stress importance of good skin care, e.g., proper handwashing techniques

and perineal skin care. (Reduces spread of bacteria and risk of skin

irritation/breakdown, infection)

Emphasize need for long-term follow-up and periodic reevaluation.

(Patients with IBD are at risk for colon/rectal cancer, and regular

diagnostic evaluations may be required)

B. Actual Nursing Management

S Not applicable

Pale

Dry skin

O Appears weak

Poor capillary refill (3 sec.)

A Fluid volume deficit related to dehydration

P

Long term: At the end of 1 day, the patient’s mother will be able to

demonstrate understanding and follow treatment regimens for her

daughter.

Short term: At the end of 30 minutes, the patient’s mother will be

able to demonstrate understanding and follow treatment regimens

for her daughter.

I

Independent:

Encouraged adequate rest

(To maximize rest)

Increased fluid intake as tolerated.

(For adequate hydration)

Give ORESOL

(To restore fluid & electrolyte loss)

Monitor intake and output (I&O), noting color, character of

urine. Calculate fluid balance.

(indicators of adequacy of fluid volume)

Dependent:

IV administration (D50.3% NaCl 500cc, regulated at

35cc/min)

( to correct fluid and electrolyte loss)

E At the end of 30 minutes, the patient’s was able to demonstrate

understanding and follow treatment regimens

S Not applicable

Loss of appetite

O

Present weight (5 kls)

Appears weak

Vomiting

A Nutritional imbalance nutrition, less than body requirements.

P

Long term: At the end of 1 month, the pt. body weight will increased

at least 0.5 kilo.

Short term: At the end of 30 min. pt. will be able to improve her

appetite in eating.

I

Independent:

Identify factors contributing to nausea and vomiting

Assess with or encourage oral hygiene

(Eliminate noxious sights, smell, and taste to prevent

vomiting)

Provide small frequent meals including dry foods and that

are appealing to the patient

(These measures may enhance intake even though appetite

may be slow to return)

Evaluate general nutritional state, obtain baseline weight

( Presence of chronic conditions or financial limitations can

contribute to malnutrition, lowered resistance to infection)

Encouraged snacks.

(To increase total nutrient intake)

E At the end of 30 min. pt. was able to improve her appetite in eating.

VIII. REFERRALS and FOLLOW-UP

Once the client will be discharged, I had instructed her mother encouraged

my client to drink his home medications religiously to prevent further infection. I

have also instructed her mother to let her son have a daily exercise like deep

breathing pattern and I’d teach the mother some of the range of motion exercises

in order to promote proper blood circulation and attain proper oxygenation. And I

have also reminded her mother to stick with her son’s diet and to have adequate

amount of it to meet nutritional needs and attain full wellness.

IX. EVALUATION AND IMPLICATION

At the end of my hospital duty, I was able to render care to my patient to

help him resolve his health condition. Through observing the patient’s status, I

was able to identify priority problems related to his health.

The patient’s mother was willing to pursue the medical therapy just to

promote health and wellness for the betterment of her son’s condition.

I have also made the patient’s mother realize the importance of

completing the course of therapy by taking the medicines prescribed or ordered

for his son by his physician. In addition, eating healthy or nutritious foods that

were prescribed to him by the health providers was further been explained to his

mother especially the benefits he will gain in eating those foods.

Moreover, this several interventions given to the patient made her body

conditioning normal and I can say that our patient has somehow recovered from

his illness.

X. BIBLIOGRAPHY

BOOKS

Doenges, Marilynn, et al. Nursing Care Plans, Guidelines for

Individualizing Patient Care (7th Edition) F.A. Davis Company. Copyright 2000.

Kozier, Erb, Blais, Wilkinson. Fundamentals of Nursing (7th edition).

Addison Esley Longman Inc. 1998.

Smeltzer, Suzanne C. and Bare, Brenda G. Medical-Surgical Nursing.

(10th Edition). Volume 2. Lippincott Williams and Wilkins.2004

Luckman and Sorensen, Medical-Surgical Nursing. 3rd Edition W.B.

Saunders Company (1987)

Jacob, S, et al Structure ad Function in Man. 5 th Edition W.B. Saunders

Company (1982)

INTERNET

http://www.medicinenet.com/pneumonia/page4.htm

http://www.merck.com/pubs/mmanual_ha/sec3/ch41/ch41d.html

http://fog.ccsf.cc.ca.us/~jgrass/Content/Lessons/skeletal.html

http://web.indstate.edu/thcme/mwking/nucleotide-metabolism.htm

NURSING SYSTEM REVIEW CHART

EENT:𓀿 Impaired vision 𓀿 blind 𓀿 pain 𓀿 reddened 𓀿 drainage𓀿 gums 𓀿 hard of hearing 𓀿 deaf𓀿 burning 𓀿 edema 𓀿 lesion 𓀿 teethAsses eyes, ears, noseThroat for abnormality [x] no problemRESPIRATION𓀿asymmetric 𓀿 tachypnea𓀿 apnea 𓀿 rales [x] cough 𓀿 barrel chest𓀿 bradypnea 𓀿 shallow 𓀿 rhonchi𓀿 sputum 𓀿 diminished 𓀿 dyspnea𓀿 orthopnea 𓀿 labored 𓀿 wheezing𓀿 pain 𓀿 cyanoticAsses resp. rate, rhythm, depth, patternbreath sounds, comfort 𓀿 no problemCARDIO VASCULAR𓀿 arrhythmia 𓀿 tachycardia 𓀿 numbness𓀿 diminished pulses 𓀿 edema 𓀿 fatigue𓀿 irregular 𓀿 bradycardia 𓀿 murmur𓀿 tingling 𓀿 absent pulses 𓀿 painAssess heart sounds, rate, rhythm, pulse, bloodpressure, etc., fluid retention, comfort[x] no problemGASTRO INTESTINAL TRACT𓀿 obese 𓀿 distention 𓀿 mass𓀿 dysphagia 𓀿 rigidity 𓀿 painAsses abdomen, bowel habits, swallowing, bowel sounds, comfort [x] no problemGENITO-URINARY and GYNE𓀿 pain 𓀿 urine color 𓀿 vaginal bleeding𓀿 hematuria 𓀿 discharge 𓀿 nocturiaAssess urine freq., control, color, odor, comfort/Gyn-bleeding, discharge [x] no problemNEURO𓀿 paralysis 𓀿 stuporous 𓀿 unsteady 𓀿 seizures𓀿 lethargic 𓀿 comatose 𓀿 vertigo 𓀿 tremors𓀿 confused 𓀿 vision 𓀿 gripAssess motor function, sensation, LOC, strength, grip, galt, coordination, orientation, speech.[x] no problemMUSCULOSKELETAL and SKIN𓀿 appliance 𓀿 stiffness 𓀿 itching 𓀿 petechiae𓀿 hot 𓀿 drainage 𓀿 prosthesis 𓀿 swelling𓀿 lesion [x] poor turgor 𓀿 cool 𓀿 deformity𓀿 wound 𓀿 rash 𓀿 skin color 𓀿 flushed𓀿 atrophy 𓀿 pain 𓀿 ecchymosis 𓀿 diaphoretic [x] moistAsses mobility, motion, galt, alignment, joint function /skin color, texture, turgor, integrity 𓀿 no problem

Place an (X) in the area of abnormality. Comment at thespace provided. Indicate the location of the problem inthe figure if appropriate, using (x)

Name: John Dave Salungayan Date: January 28, 2009Vital Signs:Pulse: 140 bpm Temp: 37.6 ̊C Respi: 35 cpm

Vomiting

Poor skin turgor (2-3 sec.)

IV site (D50.3% NaCl 500cc regulated @ 40gtts/min)

Cough

Moist skin

Poor capillary refill

Diarrhea