Far Eastern University

Institute of Nursing

Hand, foot, mouth disease

Submitted To: C. I Susan Romero

Submitted By: BSN 402- rou! "

#$%ayde, Catherine &ane Busti$$o, 'austine C$aire Ca(estani, )rin%ess Chan%o, Car$o *ane C$ara(a$$, +irstie ,oraine Cunanan, +enneth Bernadeth *imaranan, +ris%he$$e *omin-o, .ar% C$aren%e 'aro$an, &omar 'ernande/, &ohn .i%hae$

012R1I23 0' TH2 *IS2#S2

Hand, foot, and mouth disease is a common viral illness that usually affects infants and children younger than 5 years old. However, it can sometimes occur in adults. Symptoms of hand, foot, and mouth disease include fever, blister-like sores in the mouth (herpangina), and a skin rash. t is caused by viruses that belong to the !nterovirus genus (group). "his group of viruses includes polioviruses, co#sackieviruses, echoviruses, and enteroviruses. "he viruses that cause hand, foot, and mouth disease (H$%&) can be found in an infected person's nose and throat secretions (such as saliva, sputum, or nasal mucus), blister fluid, and feces (stool). (n infected person may spread the viruses that cause hand, foot, and mouth disease through close personal contact, the air (through coughing or snee)ing), contact with feces, and contaminated ob*ects and surfaces. "here is no specific treatment for hand, foot and mouth disease. However, some things can be done to relieve symptoms, such as taking over-the-counter medications to relieve pain and fever and using mouthwashes or sprays that numb mouth pain I. BI0 R#)HIC *#T# +ame, (ddress, (ge, 3ender, 4lace of 5irth, &ate of 5irth, +ationality, /eligious (ffiliation, &ate and time of confinement, /eason for confinement, (dmitting diagnosis, (ttending physician, Source of information, -.hild ++!/0 "ondo, %anila 1 year old, 2 mos %ale "ondo, %anila 6anuary 17, 8918 $ilipino /oman .atholic 6uly 8:, 891: ; 18,85pm $ever, cough and rashes hand, $oot and mouth disease &r. %iranda 4atient's %other and 4atient's .hart

II. N4RSIN

HIST0R5

#. )ast Hea$th History (ccording to the mother, .hild ++!/ was born through normal spontaneous delivery. His mother said that she had no complications and had taken vitamin supplements and nutritious foods during her pregnancy with .hild ++!/. .hild ++!/ has completed his immuni)ation appropriate for his age and has no known allergies to foods or medicines. He also hasn't e#perienced any kind of accidents. (ccording to the mother, it is .hild ++!/'s first time to be hospitali)ed and his previous visits to the hospital were because of the child baby wellness checkups since he was a newborn. "he patient is not taking any medication before his hospitali)ation and before he was discharged, he has been receiving drugs namely (mpicillin, (cyclovir, +ystatin, 4aracetamol, <inc S=7, and 4rote#in. "he patient has no foreign travels. B. History of )resent Hea$th I$$ness t all started with fever and a little cough. .hild ++!/ started e#periencing elevation of temperature last Sunday, 6uly 81, 891: which was followed by cough. %rs. /eyes said, Sumunod bigla nung Monday na nagkaroon sya ng rashes sa bandang ari nya. Akala pa namin diaper rash lang e kaso dumami na ng sumunod na time. She said that the rashes reached .hild ++!/'s legs and arms and a little on the client's chest and back. -Nag-alala na kami kaya dinala namin sya dito nung Martes, said .hild ++!/'s mother. %rs. /eyes also said that the rashes of .hild ++!/ do not hurt because she tried touching the lesions in her child's legs and inguinal area before putting some ointment that was prescribed by the doctor but he is not complaining. "he lesions are reddish during his first confinement and his temperature was above normal. C. 'ami$y Ba%6-round .hild ++!/ is third among the : children of %r. and %rs. /eyes. "heir family is from "ondo, %anila. "hey are staying in their own house there where all 5 of them in the family with %rs. /eyes' mother and her older sister. %r. and %rs. /eyes are married. (ccording to authority, the family is patriarchal for the father is the one who makes decisions within the house and health matters. "he family's source of income is from %r. /eyes' *ob who is a police officer and %rs. /eyes' little buy and sell business of breads and meat (tocino, tapa).

>hen it comes to the educational attainment of the family, only %r. /eyes is a college graduates. He finished 5S .riminology while %rs. /eyes is a high school graduate. "heir eldest child is currently in : rd grade and their middle child is in 1st grade. n terms of family diseases, %rs. /eyes verbali)ed that the only disease she knows that her parents and one of her sisters have is asthma while the family of her husband, %r. /eyes, have diabetes mellitus and hypertension. III. )#TT2RNS 0' '4NCTI0NIN 7. )S5CH0,0 IC#, H2#,TH 4atient ++!/ is an active and friendly baby. His mother verbali)ed, -Takot lang siya sa mga nakaputi eh. Umiiyak pa siya pag may lumapit na mga nurses saka doctor. "he patient's mother also added that her son plays with the health care team as they get along well and as long as the child doesn't get hurt. She mentioned that as long as the child is with his mother, he stays calm and comfortable. #na$ysis: (ccording to !rickson's 4sychosocial "heory, as the child enters the toddler years, gaining a greater sense of personal control becomes increasingly important. "asks such as learning how to use the toilet, selecting foods and choosing toys are ways that children gain a greater sense of independence. 5ased on the theory of psychose#ual by $reud, the anal stage is directly related to a child's awareness of bowel control and gaining pleasure through the act of eliminating or retaining feces. Inter!retation: Since the patient's developmental functioning falls at the right time, the patient will not have any problems in the future regarding the autonomy, patient wont doubt and be ashamed on the things she wishes to do. Since the patient is not yet able to be toilet trained, he *ust wears diaper. However, this is still unremarkable since toilet training can be developed during toddler and he is *ust at the start of the said stage. %oreover, the patient displays mistrust to strangers.

2. S0CI0-C4,T4R#, )#TT2RN "he patient's family's primary spoken language is $ilipino. "he patient lives with her parents and 8 other siblings. His mother is from 5atangas while his father was raised in %anila. /egarding his recreational pattern, his mother said he spends most of his time watching "? especially cartoons and playing with his family. His relationship with his family is good. His siblings visit him

every day. /egarding the family's tradition on health, the mother said, Minsan, nagpapahilot kami lalo na sa likod. (side from this, they don't practice any other traditional practices regarding health. n addition, the patient's environment according to his mother is good. She stated, - Maayos naman at malinis sa bahay namin kasi sakto lang yung laki niya tapos maayos din yung mga drainage sa kalsada yun nga lang meron pa ring mga basura sa paligid. #na$ysis: .ulture plays a critical role in the sociali)ation agenda of a person through particular views of child development. ( o!ier pp. "#$%. !nvironmental factors that support positive change should be used to reinforce the clients efforts to change lifestyle. (ll groups of people face issues in adapting to their environment@ providing nutrition and shelter, controlling disease and maintenance of health. & o!ier pp."''% $amily members support one another and have the ability to listen, empathi)e, and reach out to one another in times of crisis. >hen the needs of family members are met, they are able to reach out to meet the needs of others in society. (Ao)ier, p.1B:) Inter!retation: "he child is able to sociali)e well with others especially with his family who is the one supporting and caring for him. "he family members reach out and help one another in caring for patient +/. "he patient's environment is good and secured especially with his caring family who is concerned with him. "he conte#ts of family and environment are where the child develops his feelings and e#periences.

8. S)IRIT4#, H2#,TH 4atient ++!/ and his family's religion is /oman .atholic. (ccording to the patient's mother, they are only able to attend masses twice a month. She verbali)ed, -Madalang lang kaming magsimba eh. (ala kasing oras. However, the patient mother added that they pray every day especially for their son, patient +/. #na$ysis: Spiritual health is the ability to develop one's inner nature to its fullest potential Spiritual beliefs can affect a person's interpretation of events in his or her life. (Ao)ier pp. 8C7) Inter!retation:

!ven if the family rarely attends to church services, they still value their spirituality. %oreover, it is an une#ceptional thing that his family shares common religious beliefs which can influence each member of the family. *. *e(e$o!menta$ History )sy%hose9ua$ Theory of *e(e$o!ment by Si-mund 'reud Sigmund $reud thinks that from birth, humans have instinctual se#ual appetites (libido) which unfold in a series of stages. !ach stage is characteri)ed by the erogenous )one that is the source of the libidinal drive during that stage. "hese stages are, in order, oral, anal, phallic, latency, and genital. Sta-e *es%ri!tion "his occurs about age 1 to : years old. Here, individuals have their first encounter with rules and regulations, as they have to be toilet trained. "his encounter with rules and regulations will dictate the later behavior with rules and regulations. "he libido is focused anally, and frustration may arise from having to learn a comple# cognitive and motor response. 5eing fi#ated at this stage can result in stinginess, stubbornness, or orderliness, as well as messiness. !ssentially, behavior related to retention and e#pulsion may be related to e#periences at this stage. Resu$t &ustifi%ation n this psychose#ual developmental stage, .hild ++!/ is still in the process of controlling the drives that come along with it. (lthough he still doesn't show off startling degree of independency wherein he can be left along by his mother to some strangers without any complains, it was observed that .hild ++!/ could be obedient to some commands made by his mother. "he child is not yet toilet trained since he is still at the beginning of this stage. (lthough he is confined and is having an ? infusion on his right foot, he can still manage himself around his crib with or without his mother beside him.

(nal Stage

+=" D!" (.H !?! &

I1. #CTI1ITI2S 0' *#I,5 ,I1IN

#*, Nutrition

Before Hos!ita$i/ation (ccording to the mother the client has no problem regarding food consumption. She verbali)ed, -Mataka) pa nga yan sa pagdedede eh.0 She said that her child seldom eats solid or soft foods and seldom drinks beverages like orange and apple *uices. .hild ++!/'s usual diet is either breast milk or formula milk and E glass of water.

*urinHos!ita$i/ation "he client is on diet as tolerated. "he mother uses breast milk in feeding .hild ++!/. &uring their :rd day in the hospital, she fed her child with rice and a little amount of soup in it and an estimation of F9ml of orange *uice and some sips of water. &uring nights of their stay, .hild ++!/ is being breastfed but his mother.

Inter!retation and #na$ysis "he client is not choosy when it comes to eating foods. His appetite does not change even he is in the hospital. %oreover, it is also good that the child is still being breastfed by his mother. #na$ysis: (n individual's food preferences and habits are often a ma*or factor affecting actual food intake. Habits about eating are influenced by developmental considerations , gender , ethnicity and culture, beliefs about food, personal preferences , religious practices, lifestyle economics, medications and therapy, health , alcohol , consumption, advertising and physiological factors. 5reast milk is the most desirable complete food for the first F months of child's life. /ef. (p.18:2 , Ao)ier and !rb's $undamentals of +ursing , Cth !dition , ?olume )

2$iminatio n

"he mother verbali)ed that before the child was hospitali)ed, she changes .hild ++!/'s diaper : to 5 times a day. She

"he mother said that she freGuently changes her child's diaper about 7 to F times from morning that

Inter!retation: "he client urinates and defecates normally even before and during hospitali)ation. #na$ysis:

said that sometimes it has soft brown stools, or *ust filled with light yellow colored urine. %rs. /eyes also said that .hild ++!/ usually likes to drink either water, breast milk or formula milk that makes him have his diaper full of urine. "he mother bathes the client twice daily.

Hy-iene

her child wakes up until the night he sleeps. &uring his stay, %rs. /eyes said that last 6uly 85, the client has been defecating yellow watery stool freGuently which started in the morning and lessened during the night. "he urine appeared to be light yellow in color. "he mother cleans the patient while in bed or seated in her lap.

Successful elimination in human beings depends on individual having an intact and fully functional urinary tract, gastrointestinal tract and nervous system. "hrough variation of what is normal occur in every individual, there is a pattern in elimination that every individual must have. ($undamentals of +ursing 8th edition pp.852 by 6ose Huiambao - Idan)

She said that she trims her kids' nails every week. .hild ++!/'s parents usually carry him around the house because he needs assistance before wearing slippers inside and outside the house.

Inter!retation: +ormal since the mother gives importance to the client's hygiene, but the day he has been confined to the She is also able to hospital there is no regular trim .hild ++!/'s bath. nails during their stay in the #na$ysis: hospital. Hygiene is the science of health and its maintenance. 4ersonal hygiene is the selfcare by which people attend to such functions as bathing, toileting, general body weight and grooming. Hygiene is highly a personal matter determined by individual values and practices. ($undamentals of nursing 2th edition p.11F7, by Ao)ier) Inter!retation: "he sleep pattern of the client is normal since. %ost infants between reGuire about 18-17 hours of sleep a

S$ee! and Rest

(ccording to his mother the client usually sleeps B 19 hours at night.

(ccording to his mother the client usually sleeps C19 hours at night but sometimes,

"he client doesn't have any difficulties in sleeping.

his sleeping pattern is being disturbed due to the visits of his doctors andJor the nurses on duty.

day. He gets enough of sleep. "here is no sleep deprivation. #na$ysis: Sleep is the basic human need. t is biological process common to all people. >e reGuire sleep to cope with daily stresses, to prevent fatigue, to conserve energy, to restore the mind and body and to en*oy life more fully. Sleep enhances daytime functioning. t is vital for not optimal psychological functioning but also psychological functioning as rate of healing of damaged tissue is greatest during sleep. t is an important factor in person's Guality of life. ($undamentals of nursing 2th edition p.11F7, by Ao)ier)

1. )H5SIC#, #SS2SS.2NT

1I. )#TH0)H5SI0,0 5 )R2*IS)0SIN '#CT0RS (ge, K19 years old )R2CI)IT#TIN '#CT0RS .ontact with someone who is affected Causati(e a-ent: .o#sachievirus (1F

-Lymphocyte 9.F1 -increase rate of infection

!#posure to ?irus particles implanted pathogen initially in the buccal and ileal Spread into the ?iremia mucosaJ 3 tract

-$ever -Sorethroat

-4ainful blister like lesion in the buccal mucosa, tongue, gums, and hard palate. /ed rashes, sore blister -palm, soles of the foot,

nvasion of the skin and mucous membrane Com!$i%atio ns: - ?iral meningitis

Hand 'oot .outh *isease

.edi%ations: - (mpicillin 859mg " ? G Chrs (cyclovir 899mg J 5ml G Fhrs 4= +ystatin drops 1ml :# a day 1hr +4= after intake 4aracetamol drops 1ml G 7hrs 4/+ <inc s97 drops 1ml =&

Nursin- inter(entions: - 4romote hand hygiene especially after changing diaper - nstruct to avoid close contact with children with H$%& -(dminister medication prescribed by the &octor -!ncourage to drink cold beverages such as milk or ice water and avoid citrus fruits and acidic food. - nstruct to increase fluid

,aboratory: - "hroat swab -Stool specimen

1II. )R0B,2. I*2NTI'IC#TI0N Cues Inferen%e Nursin- *ia-nosis

.ough

-rashes sa bandang ari nya0 as verbali)ed by the mother.

.ommon cold nfluen)a (flu) nhaling an irritant 4neumonia (sthma (llergies ?iral infection ?iruses f the child also has a cold, a cough, or diarrhea

neffective airway clearance rJt secretions secondary to infection

mpaired tissue integrity rJt inflammatory response secondary to viral infection

rashes on both legs and arms and a little on the clients chest and back
1III. )R0B,2. )RI0RITI:#TI0N Nursin- )rob$ems Identified Cues &ustifi%ation

neffective airway clearance rJt secretions secondary to infection

.ough

.as$o;<s Hierar%hy "he problem is on physiologic needs of the client *e-ree of )rob$em "his the highly prioriti)ed problem because according to %aslow's hierarchy of needs under biological and physiological needs, it stated that air together with food, water, shelter, rest, sleep, activity and temperature maintenance are crucial for survival of an individual. =#ygen is necessary for proper functioning of all living cells. Secretions in the airway could affect breathing of the client for it blocks the entrance and e#it of air in the lungs going to the

different organs. f it is not treated further complication will occur and even death. Inter!retation "his is highly prioriti)ed because this is an actual problem. "he nurse or the health care provider has the necessary resources to solve this problem such as time, skills, knowledge and money. !liminating this problem may help to prevent further complications and completely eliminate the actual problem. *e+erence, o!ier and -rb. .undamentals o+ Nursing, /th edition. 0olume ", pp. #1'-#12 o!ier and -rb. .undamentals o+ Nursing, /th edition. 0olume #, p. "'31 mpaired tissue integrity rJt inflammatory response secondary to viral infection Sub*ective, -rashes sa bandang ari nya0 as verbali)ed by the mother. .as$o;<s Hierar%hy "he problem is on the physiologic need of the client

*e-ree of )rob$em -rashes on both legs and arms and a little on the client's chest and back "he problem is moderately prioriti)ed because the problem needs immediate action yet it isn't life threatening.

Inter!retation "his is moderately prioriti)ed because this is an actual

problem. "he nurse or the health care provider has the necessary resources to solve this problem such as time, skills, knowledge and money. !liminating this problem may help to prevent further complications and completely eliminate the actual problem.

*ISCH#R 2 ),#N .edi%ations %ake sure that the client will take all his medications listed such as (mpicillin 859mg " ? G Chrs (cyclovir 899mg J 5ml G Fhrs 4= +ystatin drops 1ml :# a day 1hr +4= after intake 4aracetamol drops 1ml G 7hrs 4/+ <inc s97 drops 1ml =& 4rote#in (restore) =& &escribe the importance of regularly taking of prescribed medications including the potential unpleasant effects of non compliance. nstruct the mother of the client to continue with follow up medical care. (dvise the mother of the client not to miss the intake of medications given by their physician upon discharge. %aintain a Guiet, environment to promote rela#ation. 4rovide clean and comfortable environment. !ncourage client to continue deep breathing e#ercises, also instruct the family for the e#ercise needed. "his is to promote circulation of blood, rela#ation also.

2n(ironment #nd 29er%ise

Treatments

!#ercise that appropriate for the clients age . Such as active and passive range of motion. .ontinue home medications. $or the follow-up check-up repeat. !ncourage patient to take multivitamins for immunity. $ollow doctors advise nstruct the mother of the client that the client must always wash his hands. 4erform good oral and personal hygiene 4rovide a clean environment t can reduce the risk of having footmouth disease by always performing hand washing *isinfe%t %ommon areas Tea%h -ood hy-iene. Show your children how to practice good hygiene and how to keep themselves clean. !#plain to them why itMs best not to put their fingers, hands or any other ob*ects in their mouths. 2n%oura-e the %$ient to In%rease f$uid inta6e

Hea$th Tea%hin-s

0ut )atient 'o$$o; u!

4atient will be advised to go back in the hospital in a specific date to have a follow-up check up after discharge. .onsult doctor for any problems or complications encountered such as, -?omiting -$ever of 199.7o$ or higher -Shaking .hills (lso if the physician advise the client to go back for a follow up check up for continuity of care

*iet

&epends on physician order but

here are some home remedies Low salt low fat diet &rink cold beverages, such as milk or ice water (void acidic foods and beverages, such as citrus fruits, fruit drinks and soda (void salty or spicy foods !at soft foods that donMt reGuire much chewing /inse your mouth with warm water after meals