TAGUM DOCTORS COLLEGE, INC

Nursing Department

A Case Study on
Multiple Abrasions, Cerebral Concussion s/t VIA

Presented To:
Noli Roy E. Biclar, RN., MN.

In partial Fulfillment of the Requirements in

Related Learning Experience 102

By:

September 2019
 I. INTRODUCTION

Going through labor and having a vaginal delivery is a long process that can be physically
grueling and is hard work for the mother. But one of the benefits of having a vaginal birth is that
it has a shorter hospital stay and recovery time.

Women who undergo vaginal births avoid having major surgery and its associated risks, such
as severe bleeding, scarring, infections, reactions to anesthesia and more longer-lasting pain. And
because a mother will be less woozy from surgery, she could hold her baby and may begin
breastfeeding sooner after she delivers.

During a vaginal delivery, muscles involved in the process are more likely to squeeze out
fluid found in a newborn's lungs, which is beneficial because it makes babies less likely to suffer
breathing problems at birth. Babies born vaginally also receive an early dose of good bacteria as
they travel through their mother's birth canal, which may boost their immune systems and protect
their intestinal tracts.

Worldwide, about 140 million women give birth every year. While much is known about the
clinical management of labor and childbirth less attention is paid to what, beyond clinical
interventions, needs to be done to make women feel safe, comfortable and positive about the
experience. The growing knowledge on how to initiate, accelerates, terminate, regulate, or
monitor the physiological process of labor and childbirth has led to an increasing medicalization
of the process. It is now being understood that this approach may undermine a woman’s own
capability in giving birth and could negatively impact her experience of what should normally be
a positive, life-changing experience.

The most important reasons for selecting normal delivery were lower maternal mortality,
delight to see the baby immediately after childbirth, better emotional bonds between mother and
baby, faster recovery, faster return to daily life activities, and lower costs of this method of
delivery, similar to our findings. Investigating the opinions of Brazilian pregnant women, Kasai
reported that the majority of women (70.8%) had considered faster postpartum recovery as the
main reason for selecting natural childbirth.
 For the Philippines, the targets are to reduce MMR (maternal mortality ratio) from 209 to 52
deaths per 100,000 live births and NMR (newborn mortality rate) from 13 deaths to 10 per 1000
live births by 2015. While these targets are ambitious, the goal is attainable. There are inspiring
examples of success from countries that experienced remarkable drops in the maternal mortality
ratio, an indicator of the safety of pregnancy and childbirth and an inspiring reminder that with
the right policies and conditions in place, dramatic and rapid progress is possible.

Tagum City, May 11, 2017 - The Department of Health (DOH) together with World Health
Organization (WHO) launched La Filipina Safe Birthing Facility in Barangay La Filipina,
Tagum City. DOH and WHO collaborated to support the facility to become a Safe Birthing
Facility. The construction of the building was supported by the Department of Health while
WHO through KOICA supported the maternal and medical/health equipment of the facility.

The purpose of this case report is to present the clinical and postpartum evaluation and
management of an 18-year-old woman who undergone vaginal spontaneous delivery.

II OBJECTIVES

A. General Objectives
This case study is designed to identify what are multiple abnormalities of
postpartum patient.

Specific Objectives
The specific objectives are enumerated as follows;
 Gather the biographical data of the client;
 Gather information about the past and present Illness, Medical, Family and Socio-
Economic history of the client;
 Trace down the developmental tasks of Hildegard Peplau, Lydia E. Hall and Katharin
Kolcaba;
 Perform complete Physical Assessment (cephalocaudal format) and also identify the
complaints of the client;
 Review of Diagnostic tests/Examination and its indication that the client had gone;
 Formulate Nursing care plan;
 Identification of drugs taken by the client;
 Presentation of conclusion about the client condition;
 Present recommendations and discharge plan about the client’s condition;
 To widen and enhance the students’ knowledge and skills through additional
research about the nature of the disease, its signs and symptoms, its
pathophysiology, its diagnosis and treatment;
 Present evaluation regarding of this case study

III PATIENT’S ASSESSMENT

A. Biographical Data
Name : Patient X
Age : 31 years old
Sex : Female
Civil Status : Single
Nationality : Filipino
Birthday : May 10, 2001
Birth Place : Prk 1. BE Dujali
Occupation : N/A
Address : Asuncion
Religion : Baptist
Educational Attainment: Graduate of Bachelor of Science in Accountancy
Date of admission: September 26, 2019 at 10:30am Tagum Doctors Hospital
Admitting Diagnosis: Post Partum (normal)
Attending Physician: Dr. Maribeth Juarez
 B. Chief complaint

Multiple Abrasion, cerebral concussion s/t vehicular accident

I. FAMILY BACKGROUND/HEALTH HISTORY

C. Past Medical History

Patient X had a history of Cataract at the right eye and undergoes a Laser Cataract
Surgery (2016).

D. Present Medical History

Patient X was presented to the Emergency Room of Nabunturan Doctors Hospital
with Multiple abrasions, cerebral concussion s/t vehicular accident and refers to Tagum
Doctors Hospital for admission.

E. Family History
Patient X belongs to a nuclear type of family. He is the 4th child among seven
siblings. Patient X’s father died due to an old age. Patient X’s mother has Alzheimer’s
disease at the age of 85. Grandparents of both paternal and maternal side are unknown
because patient can’t remember.

F. Social History
Patient X has a wholesaler business of School supplies located at Nabunturan,
Davao de Oro. According to his daughter, his father is a heavy drinker but not a smoker.
He is not an active in their community because of their business. They live in the
subdivision where people is busy on their own life, they don’t usually communicate in
their neighbourhood because of the busy schedules. He is the one managing their own
school supplies.
IV. FAMILY BACKGROUND/HEALTH HISTORY

G. Past Medical History

Every month Patient J goes for prenatal check-up.

Prenatal check-up dates

 June 18, 2019
 July 5, 2019
 August 16, 2019
 September 10, 2019

H. Present Medical History

Patient X was presented to the Tagum Doctors Hospital with the diagnosis of
G1P1; Pregnancy, uterine, delivered term, cephalic, live birth by vaginal spontaneous
delivery live baby girl, AGA, with a body weight of 3.2kg with urinary tract infection.

I. Family History
Patient J belongs to an extended type of family. She is the 2nd child among three
siblings. According to Patient J, her father has hypertension and asthma due to sedentary
lifestyle. Her grandparents have diabetes mellitus, tuberculosis and hypertension.

J. Social History
Patient J was studying at Dujali National High School. They live in Purok 2 D
Dujali Bacali they usually communicate with their neighbors. Her mother is a hoeskeeper
and her father if a farmer
GENOGRAM
V

V. DEVELOPMENTAL DATA
Theorist/Theory Developmental Normal Findings Actual Findings Interpretation
Stages/ Task
Erik Erikson Stage 1: At this first stage Success in this stage
the infant develop a will lead to virtue of
INFANCY sense of trust if the hope. By
care of the infant is developing a sense
(0 to 18 months) consistent that of trust, the infant
Psychosocial which will carry have the guts to
Theory them to other trust the people
Trust vs. Mistrust relationships and around, it’s easy for
they will be able to her to trust other
feel secure but if because of the
this are not strong foundation
consistently met, build during the
mistrust may infancy period.
develop
Stage 2: Children at this Success in this stage
stage develop a will lead to the
sense of virtue of will.
EARLY independence, they Toddlers at this
CHILDHOOD must taught on how stage, know already
to take basic ways to do basic things
(18 mons. - 3 yrs.) to take care of their by their own and
selves. If a child not relying on
failed to assert they others.
Autonomy vs begin to feel
Shame and Doubt inadequate in their
ability, they overly
dependent upon
others, feel a sense
of shame or doubt I
their own abilities.
Stage 3: At this third stage, Success in this stage
children has the will lead to the
PLAY AGE opportunity to virtue of purpose.
explore their The child learn to
(3-5 yrs.) interpersonal skills initiate and not
through initiating depending on others
Initiative vs Guilt activities, initiate decision. They
activities with other, make task that they
do make up games, know they
begin to plan accomplished by
different activities if their own initiative.
the child develop
this Sense of
initiative they will
feel secure in their
ability to lead others
and make decisions
in their own. But if
the child failed to
 do so and end up
asking for help to
other, a child
develop a sense of
guilt which is too
much guilt can
make them slow to
interact with others.
Stage 4: At this stage that the Success in this stage
child’s peer group will lead to the
SCHOOL AGE will gain greater virtue of
significance and competence. The
(6-12 yrs.) will become a major child at this stage,
source of the child’s gain more confident
Industry vs self-esteem. The as she meets new
Inferiority child now feels the faces that will help
need to win her to build more
approval by self-esteem. The
demonstrating child develop a
specific sense of pride and
competencies that feels the need to
are valued by win approval by
society and begin to demonstrating
develop a sense of specific
pride in their competencies that
accomplishments. valued by the
society.
Stage 5: During this stage, Success in this stage
adolescence search will lead to the
ADOLESCENSE for a sense of self virtue of fidelity.
and personal During this stage
(12-18 yrs.) identity. This is a adolescents need to
major stage of develop a sense of
Identity vs Role development self and personal
Confusion wherein the child identity. Success
has to learn the leads to an ability to
roles he will occupy stay true to oneself,
as an adult. They while failure leads
explore possibilities to role confusion
and begin to form and a weak sense of
their own identity self. In the latter
based on the phases of this stage,
outcome of their the child develops a
explorations. sense of sexual
Failure to establish identity.
a sense of identity
can lead to role
confusion not being
sure about
themselves or in
their place in the
society.
Stage 6 During this period, Success in this stage
we begin to share will lead to the
YOUNG ourselves more virtue of love.
ADULTHOOD intimately with During this period,
 others. We explore intimate relationship
(18-40 yrs.) relationships with others is built
leading toward already. Sharing of
longer-term common interests
Intimacy vs commitments with with each other,
Isolation someone other than exploring
a family member. relationship that
The successful leads toward long
completion of this term relationship
stage can result in commitments.
happy relationships
and a sense of
commitment, safety,
and care within a
relationship.

Theorist/Theory Developmental Normal Findings Actual Findings Interpretation

Stages/ Task
Stage 1: The Oral At this first stage In this stage if a
Sigmund Freud Stage the infant's primary child’s oral needs
source of interaction are not met during
Erogenous Zone: occurs through the infancy, he or she
Psychosocial Mouth mouth the rooting may develop
Theory and sucking reflex negative habits such
(birth to 1 year) is important. the as nail biting or
child also develops thumb sucking to
a sense of trust and meet this basic
Trust vs. Mistrust: comfort through this need.
Learning to Trust oral stimulation.
the World Around
Us
Stage 2: The Anal At this stage the Success at this stage
Stage children primary dependent upon the
focus of the libido way in which
Erogenous Zone: was on controlling parents approach
Bowel and Bladder bladder and bowel toilet training.
Control movements. The Parents who utilize
major conflict at praise and rewards
(1 to 3 years) this stage is toilet for using the toilet
training the child at the appropriate
Autonomy vs. has to learn to time encourage
Shame and Doubt control his or her positive outcomes
bodily needs. and help children
Developing this feel capable and
control leads to a productive.
sense of
accomplishment and
independence.
Stage 3: The At this third stage, The child fears that
Phallic Stage the primary focus of he will be punished
the libido is on the by the father for
Erogenous Zone: genitals. At this age, these feelings, a fear
Genitals children also begin termed castration
to discover the anxiety. proposed
(3 to 6 Years ) differences between that men experience
 males and females. feelings of
Initiative vs. Guilt: The boys begin to inferiority because
Developing a Sense view their fathers as they cannot give
of Purpose a rival for the birth to children, a
mother’s affections. concept she referred
And for the girl’s to as womb envy.
penis envy was
never fully resolved
and that all women
remain somewhat
fixated on this
stage.
Stage 4: The During this stage, This stage is
Latent Period the superego important in the
continues to development of
Erogenous Zone: develop while the social and
Sexual Feelings id's energies are communication
Are Inactive suppressed. skills and self-
Children develop confidence.
(6 to Puberty) social skills, values it is possible for
and relationships children to become
Industry vs with peers and fixated or "stuck" in
Inferiority adults outside of the this phase. Fixation
family. This stage at this stage can
begins around the result in immaturity
time that children and an inability to
enter into school form fulfilling
and become more relationships as an
concerned with peer adult.
relationships,
hobbies, and other
interests.
Stage 5: The Genital During the final The goal of this
Stage stage of stage is to establish
psychosexual a balance between
Erogenous Zone: development, the the various life
Maturing Sexual individual develops areas.
Interests a strong sexual
interest in the If the other stages
(puberty to death) opposite sex. This have been
stage begins during completed
puberty but last successfully, the
How Testing Out throughout the rest individual should
Different Identities of a person's life. now be well-
Is a Part of balanced, warm,
Teenage and caring.
Development
Vi
 VII. Physical Assessment

Physical examination follows a methodical head to toe format in the

cephalocaudal assessment. This is done systematically using the techniques of inspection,
palpitation, percussion and auscultation with the use of materials and investments such as the
penlight, thermometer, sphygmomanometer, tape measure and stethoscope and also the senses.
During the procedure, we made every effort to recognize and respect the patient’s feelings as
well as to provide comfort measures and follow appropriate safety precautions.

A. General Survey

Patient name: Jhonna Lavelle Age: 18 yo Birth date: May 10, 2001

Weight: kg. Height: 5’4 ft.

Upon assessment he is awake, conscious and coherent. Vital Signs taken September 27, 2019 at

11:30 amat Tagum Doctors Hospital Inc.

VITAL SIGNS:

BP: 110/80 mmHg PR: 92bpm RR: 20 cpm T: 36.0º

SYSTEM/ NORMAL ACTUAL INTERPRETATION

METHOD OF FINDINGS FINDINGS
ASSESSMENT

SENSORY AND Level of Level of

NEUROLOGICAL consciousness consciousness
SYSTEM
(Interview and Oriented to time, Oriented to time, Normal, since there
demonstration) people, and place. people, and place. were no abnormalities
Enable to Enable to noted upon
demonstrate demonstrate assessment.
emotion appropriate emotion appropriate
to the scenario. to the scenario.
 Enable to Enable to
comprehend and comprehend and
speak fluently. speak fluently.

Visual recognition Visual recognition

Able to identify Able to identify Normal since there is a
familiar objects by familiar objects by no presence of any
sight near and far sight near and far abnormalities on both
(pencil & ballpen). (pencil & ballpen). eyes.

INTEGUMENTARY The skin is uniform >Fair skin Not normal since the
SYSTEM in color. Soft, uniform in color skin has an edema
smooth skin over (light brown). noted upon inspection.
SKIN the entire body. >Skin temperature
(Inspection and Skin temperature is is within normal Due to
palpation) within normal limit. range upon The affected areas are
assessment. the both arms, and in
>Skin has an edema lower extremities.

HEAD Head is >The head is The head is in normal

(Inspection and normocephalic, normocephalic condition, since there
palpation) with prominences >No sign of skul are no abnormalities
in the frontal and fructure upon upon assessment.
occipital area. inspection.
No tenderness >No sign of lice It will not be normal if
noted upon and nits and the head has deviation
palpation. dundruff. or any sign of
Symmetrical, no >No tenderness abnormalities like
lesions, nodules or upon palpation. lesions, nodules, or
masses. Free from masses upon
lice, nits and palpation.
dandruff. May be
thin or thick hair.
Neither brittle nor
 dry.

Symmetrical, no >Presence of lesion The face is not in

FACE lesions, nodules or noted upon normal condition since
(Inspection) masses. inspection. the patient had a
>Swollen noted vehicular accident that
upon inspection. causes the lesion and
swollen in his face.

No visible mass or >No visible mass or Normal since there is

NECK lumps. No jugular lumps. no mass or lumps
(Inspection) venous distention. >No jugular venous upon inspection.
distention.
VISUAL SYSTEM
EYES Evenly placed and >Normal Normal since there is
(Inspection) in line with each no sign of
other. None abnormalities.
protruding. Equal
palpebral fissure.

Corneal Light
Reflex Test
Corneal Light
Reflex Test Shine light directly
in the eyes; note
Shine light directly position of the light
in the eyes; note reflection off the
position of the light cornea in each eye.
reflection off the Light should be
cornea in each eye. seen symmetrically
Light should be on each cornea.
seen symmetrically
on each cornea.
 GASTRO-
INTESTINAL The lips are
SYSTEM normally
symmetrical, pink,
MOUTH smooth, and moist. >Lips is not dry Upon inspection the
(Inspection) Teeth should be upon inspection. lips is not dry and
clean with shiny >Tongue is there is no
enamel and no symmetrical and abnormalities
decay, white with slightly rough from observed.
shiny enamel and papillae.
smooth surfaces
and edges.
Oral mucosa should
appear moist,
smooth, shiny and
pink.
A healthy dorsal
tongue is
symmetrical, pink
and moist and
slightly rough from
papillae.

ABDOMEN Unblemished skin. >Rounded shaped.

(Auscultation, Uniform in color. >Audible bowel There is no sign of
Inspection and Flat, rounded, or sign. abnormalities in the
Palpation) scaphoid shaped. >No tenderness abdomen upon
No evidence of >Bladder is not auscultation,
enlargement of palpable inspection and
liver and spleen. palpation.
Symmetric contour.
Symmetric
movement caused
by respiration.
Audible bowel
sounds. No
tenderness; relaxed
abdomen with
smooth, consistent
tension. Bladder not
 palpable.

CARDIO-
VASCULAR >The heart rate was The heart rate is below
SYSTEM No pulsation upon 92 bpm and BP of normal since it is 90
palpating the aortic 110/80. bpm and the normal
HEART and pulmonic areas. >No pulsation upon rate for adult female is
(Auscultation) No lift or heaves. assessment on the 80-90 bpm and it is
Heart rate ranges aortic and pulmonic normal.
from 60-100bpm area The BP of the patient
and systolic BP of is not in normal since
<120 and diastolic it is range from 110/80
BP of <80 and this level is
considered as normal
blood pressure.
RESPIRATORY
SYSTEM

LUNGS Chest wall intact; >Chest wall was There is no sign of

(Auscultation) no tenderness; no intact; abnormalities in the
masses. Full and >No tenderness and lungs upon
symmetric chest masses upon auscultation.
expansion. assessment.
>Even chest
expansion.
>No adventitious
sound noted.

GENITO- No pain or burning

URINARY sensation while >No pain or It is normal, since
SYSTEM urinating. Normal burning sensation there were no signs of
(Interview) urine color ranges while urinating; abnormalities upon
from pale yellow to assessment.
deep amber.
VIII. ANATOMY AND PHYSIOLOGY
FEMALE REPRODUCTIVE SYSTEM
The female reproductive system includes the ovaries, fallopian tubes, uterus, vagina,
vulva, mammary glands and breasts. These organs are involved in the production and
transportation of gametes and the production of sex hormones. The female reproductive
system also facilitates the fertilization of ova by sperm and supports the development of
offspring during pregnancy and infancy.
Major parts of female reproductive system:
 Ovaries
 Fallopian tube
 Uterus
 Vagina
 Vulva
 Breast and mammary gland
OVARIES

The ovaries, a pair of tiny glands in the female pelvic cavity, are the most important
organs of the female reproductive system. Their importance is derived from their role in
producing both the female sex hormones that control reproduction and the female
gametes that are fertilized to form embryos.

Each ovary is a small glandular organ about the shape and size of an almond. The
ovaries are located on opposite sides of the uterus in the pelvic cavity and are attached
to the uterus by the ovarian ligament. The open ends of the fallopian tubes rest just
beyond the lateral surface of the ovaries to transport ova, or egg cells, to the uterus.

FALLOPIAN TUBES

The Fallopian tubes, also known as the uterine tubes, are a pair of 4-inch (10 cm) long
narrow tubes connecting the ovaries to the uterus. Ova (egg cells) are carried to the
uterus through the fallopian tubes following ovulation. The ova may also be fertilized
while in the Fallopian tubes if sperm is present following sexual intercourse.

The Fallopian tubes are located in the pelvic cavity extending laterally from the corners
of the superior edge of the uterus and passing superior to the ovaries.
UTERUS

The uterus, also commonly known as the womb, is a hollow muscular organ of the
female reproductive system that is responsible for the development of the embryo and
fetus during pregnancy. An incredibly distensible organ, the uterus can expand during
pregnancy from around the size of a closed fist to become large enough to hold a full
term baby. It is also an incredibly strong organ, able to contract forcefully to propel a full
term baby out of the body during childbirth.

Three distinct tissue layers make up the walls of the uterus:

 The perimetrium is the outermost layer that forms the external skin of the
uterus. It is a serous membrane continuous with the peritoneum that covers
the major organs of the abdominopelvic cavity. The perimetrium protects the
uterus from friction by forming a smooth layer of simple squamous epithelium
along its surface and by secreting watery serous fluid to lubricate its surface.
 Deep to the perimetrium layer, the myometrium forms the middle layer of
the uterus and contains many layers of visceral muscle tissue. During
pregnancy the myometrium allows the uterus to expand and then contracts the
uterus during childbirth.
 Inside the myometrium is the endometrium layer that borders the hollow
lumen of the uterus. The endometrium is made of simple columnar epithelial
tissue with many associated exocrine glands and a highly vascular connective
tissue that provides support to the developing embryo and fetus during
pregnancy.

VAGINA
The vagina is an elastic, muscular tube connecting the cervix of the uterus to the vulva
and exterior of the body. The vagina is located in the pelvic body cavity posterior to the
urinary bladder and anterior to the rectum. Measuring around 3 inches in length and
less than an inch in diameter, the vagina stretches to become several inches longer and
many inches wider during sexual intercourse and childbirth. The inner surface of the
vagina is folded to provide greater elasticity and to increase friction during sexual
intercourse.
During sexual intercourse, the vagina functions as the receptacle for the penis and
carries sperm to the uterus and fallopian tubes. The elastic structure of the vagina
allows it to stretch in both length and diameter to accommodate the penis. During
childbirth, the vagina acts as the birth canal to conduct the fetus from the uterus and out
of the mother’s body.
VULVA
The vulva is the collective name for the external female genitalia located in the pubic
region of the body. The vulva surrounds the external ends of the urethral opening and
the vagina and includes the mons pubis, labia majora, labia minora, and clitoris. The
mons pubis, or pubic mound, is a raised layer of adipose tissue between the skin and
the pubic bone that provides cushioning to the vulva. The inferior portion of the mons
pubis splits into left and right halves called the labia majora. The mons pubis and labia
majora are covered with pubic hairs. Inside of the labia majora are smaller, hairless
folds of skin called the labia minora that surround the vaginal and urethral openings.
On the superior end of the labia minora is a small mass of erectile tissue known as
the clitoris that contains many nerve endings for sensing sexual pleasure.

BREAST AND MAMMARY GLAND

The breasts are specialized organs of the female body that contain mammary glands,
milk ducts, and adipose tissue. The two breasts are located on the left and right sides of
the thoracic region of the body. In the center of each breast is a highly
pigmented nipple that releases milk when stimulated. The areola, a thickened, highly
pigmented band of skin that surrounds the nipple, protects the underlying tissues during
breastfeeding. The mammary glands are a special type of sudoriferous glands that
have been modified to produce milk to feed infants. Within each breast, 15 to 20
clusters of mammary glands become active during pregnancy and remain active until
milk is no longer needed. The milk passes through milk ducts on its way to the nipple,
where it exits the body. The breasts contain many sensitive nerve endings and play a
role in human sexual arousal. Stimulation of the breasts, and especially the nipples and
areola, sends signals of pleasure to the brain. The erectile tissue of the nipples fills with
blood in response to the stimuli of breastfeeding, sexual arousal, and even cool
temperatures.
 IX. ETIOLOGY AND SYMPTOMATOLGY
ETIOLOGY
Etiology Actual findings Implication
PREDISPOSING
FACTORS:

AGE Women after menarche can easily get

pregnant compared to women after age of
30’s.

Married or pre-marital involvement of a

MARITAL STATUS woman have a high tendency of getting
pregnant.

LIFESTYLE Women who doesn’t practice birth control

or Family that doesn’t have family planning
can cause multiple pregnancy.

PRECIPITATING
FACTORS:

Fertility of a woman during conception is

also one of the factors that can cause
FERTILITY pregnancy.
X. GENERAL SURVEY
A. Doctors Order

Date and Time Progress Notes Physician Order

9-24-19 D5LR 1L
711

9-25-19 D5LR 1L 10cc of oxytocin concerned by

117 terminated IVF

9-25-19 Operation Perform Episiotomy & Repair

Home Medicine
9-26-19
8:20 AM Co-amoxiclav BID x 1week 1 tab

Celecoxib 400mg 1cap OD x 3days

Mefenamic A. 500 mg 1cap TID/3days

6-12-6 (as needed for pain)

Lactalace 2 tablespoon @ bedtime

OD 9pm

October. 03, 2019 Check up

Recovery breastfeed

Cefuroximine 750 mg @ 8 once a day

Discharge Plan
9-27-19
4pm D. MGH Still-in
A. Up taken, reinformed to PP. up billing,
none meds as ordered.
 XI DIAGNOSTIC EXAM

HEMATOLOGY RESULT

EXAM NAME NORMAL UNIT RESULTS INTERPRETATION IMPLICATION

VALUES
Hemoglobin 135-170 g/dL 131 -NORMAL If hemoglobin
A hemoglobin level is level of a person
normal. Hemoglobin is is higher than
a protein in red blood normal level, it
cell that carries oxygen may indicate
throughout the body. Polycythemia
Low hemoglobin levels Vera,
usually indicate that a dehydration,
person has anemia. excessive
High hemoglobin vomiting. On the
occurs most commonly other hand, if
when the body hemoglobin level
requires and increased is lower than
oxygen-carrying normal, it will
capacity. indicate Anemia
or depletion of
RBC count.
Erythrocytes 4.5-5.0 3.63 -NORMAL If erythrocyte
Erythrocyte levels are level of a person
normal. This is a type is higher than
of blood cell that is normal level, it
made of bone marrow may indicate
and found in the blood. Polycythemia,
A cell that contains chronic hypoxia
hemoglobin also called and excessive
as RBC. This is to vomiting. Low
facilitate the diffusion erythrocyte level
of oxygen and carbon indicates Anemia,
dioxide. Bone Marrow
failure and renal
problems.
Leukocytes 5.0-10.0 6.6 -NORMAL If leukocytes level
Leukocytes levels are of a person
normal. increases from its
Leukocytes are part of normal level, it
the body's immune means that the
system. They help the bodies’ defense
body fight infection mechanism is
and other diseases. active due to
 injuries or trauma.
Lymphocytes 0.25-0.40 0.33 -NORMAL The lymphocyte
Lymphocyte is in level is at normal
normal level. state. Alteration
Lymphocyte is part of from its normal
the immune system. level indicates
Lymphocytes are inflammation and
responsible to fight severe infection in
against bacteria, the body. Test
antigens, viruses and should be done if
toxins. Increase that may be the
number of lymphocyte result
indicates chronic
infection and types of
blood cancers.
Monocytes 0.02-.06 0.06 -NORMAL Alteration from its
Monocyte level is normal
normal. Monocytes count/level
are a type of white indicates a sign of
blood cell that fight an underlying
certain infections and medical condition.
help other white blood Additional test
cells remove dead or should be done to
damaged tissues, diagnose the
destroy cancer cells, cause.
and regulate immunity
against foreign
substances.
Eosinophil’s 0.01-0.05 0.02 -NORMAL Eosinophil is at
Eosinophils are a type stable level. No
of disease fighting signs of parasitic
WBC. This condition and chronic
most often indicates a infection (by
parasitic infection, blood or tissue
allergic reaction or infection).
cancer. You can have Alteration from its
high levels of normal level
eosinophil in your indicates a sign of
blood (blood underlying
eosinophilia) or tissue medical condition.
at the site of an Additional lab
infection or tests are required
inflammation (tissue to diagnose the
eosinophilia) cause.

Basophils 0.0-.005 0.000 -NORMAL Basophil is at

 Basophil levels are normal level. High
normal. A low basophil of basophil level
(basopenia) can be indicates parasitic
caused by infection, and chronic
severe allergies or an inflammation in
overactive thyroid the body. While
gland. High basophil low basophil level
level (basophilia) can indicates severe
be a sign of chronic allergic reaction.
inflammation in the Therefore,
body. parasitic
infections,
inflammations
and allergic
reaction are
absent.
Hematocrit 0.38-.54 0.39 NORMAL Hematocrit is at
Hematocrit (Hct) stable level. Our
provides information patient is well
about how much of hydrated and has
your blood is a normal level of
comprised of RBC and
red blood cells. A low hemoglobin upon
score on this range having a lab test.
scale may be a sign
that you have too little
iron, the mineral that
helps produce
red blood cells. A high
score could mean
you're dehydrated or
have another
condition.
‘2nd and 3rd Trimester Ultrasound
Fetal surveillance
Presentation- Cephalic
No. of Fetus – Single
Fetal heart rate- 124 Bpm
Amniotic Fluid – Adequate
4.00 4.04
3.12 5.25
Total: 16.41
Gender: Female
Placental-Grade II
Placental position- Posterior high lying

Fetal Biometry
BPD 66.1 mm 26W5D
HC 247.5 mm 26W6D
AC 211.3 mm 25W5D
IC 51.0 mm 27.W2D
Average sonar age 26 weeks 5 days
Estimated Fetal weight 949 GMS(2lbs)
Estimated Date of delivery 10/06/2019 (+1 -21 days)

RESULT
Single live intrauterine pregnancy, 26 weeks 5 days by sonar age female fetus with
good cardiac activity and fetal movements adequate amniotic fluid volume placenta
posterior, Grade II, No previa.

Exam Name Results Interpretation Implication

Color Yellow NORMAL Abnormal urine color may be
Normal urine color ranges caused by infection, disease,
from pale yellow to deep medicines, or food you eat.
amber.
Appearance Hazy NORMAL Cloudy or milky urine is a sign of
 Normal urine is clear but
may appear hazy if very
concentrated in the face of
reduced urine output.
Sugar Negative NORMAL
a negative urine
glucose test could
mean that the level is low,
normal, or slightly elevated
Blood Negative
Bilirubin Negative NORMAL
Bilirubin is negative.
Bilirubin is found in bile, a
fluid in your liver that helps
you digest
food. Bilirubin in urine may
be a sign of liver disease.
Urobilinogen + NORMAL
Urobilinogen is formed from
the reduction of bilirubin.
Bilirubin is a yellowish
substance found in your
liver that helps break down
red blood cells.
Normal urine contains
some urobilinogen.
Epithelial cells +++ NORMAL
Epithelial cells are cells that
come from surfaces of your
body, such as your skin,
a urinary tract infection, which
may also cause a bad smell.
Milky urine may also be caused by
bacteria, crystals, fat, white or red
blood cells, or mucus in the urine.
Elevated levels of glucose in
urine may also be a result of renal
glycosuria.
Bilirubin in your urine may
indicate liver damage or disease.
Evidence of infection.
Elevated levels may indicate
hemolytic anemia (excessive
breakdown of red blood cells
RBC), overburdening of the liver,
increased urobilinogen production,
re-absorption – a large
hematoma, restricted liver
function, hepatic infection,
poisoning or liver cirrhosis.
A raised amount of epithelial
cells in the urine may indicate an
infection or other health
condition. Epithelial
 blood vessels, urinary tract,
or organs. A small number
of epithelial cells in
your urine is normal.
Puss cells TNTC/HPF Pyuria is the condition
of urine containing white
blood cells or pus. Defined
as the presence of 6-10 or
more neutrophils per high
power field of unspun,
voided mid-stream urine. It
can be a sign of a
bacterial urinary tract
infection.
RBC HPF A high count of red blood
cells in the urine can
indicate infection, trauma,
tumors, or kidney stones.
If red blood cells seen under
microscopy look distorted,
they suggest kidney as the
possible source and may
arise due to kidney
inflammation
(glomerulonephritis).
Bacteria ++ A small number
of bacteria may be found in
the urine of many healthy
people. This is usually
cells are cells on the surfaces of
the body that act as a protective
barrier. However, too many
epithelial cells in the urine usually
indicate an underlying health
condition.
The normal range of pus cells in
the urine is 0-5. Since the report
suggests pus cells of 8-10 and
bacteria is present, it is suggestive
of urinary tract infection(UTI).
Ideally you should send
the urine for culture so that the
most sensitive antibiotics can be
used.
It's normal to have one to five
squamous epithelial cells per high
power field (HPF) in your urine.
Having a moderate number or
many cells may indicate: a yeast
or urinary tract infection (UTI)
Urine is normally sterile, which
means that it contains no bacteria.
A small number of bacteria may
be found in the urine of many
 considered to be harmless. healthy people. This is usually
However, a certain level considered to be harmless.
of bacteria can mean that However, a certain level
the bladder, urethra, or of bacteria can mean that the
kidneys are infected. bladder, urethra, or kidneys are
infected.
Ketone + The test High ketone levels in urine may
measures ketone levels in indicate diabetic ketoacidosis
your urine. Normally, your (DKA), a complication of diabetes
body burns glucose (sugar) that can lead to a coma or even
for energy. If your cells don't death.
get enough glucose, your
body burns fat for energy
instead. ...
High ketone levels
in urine may indicate
diabetic ketoacidosis (DKA),
a complication of diabetes
that can lead to a coma or
even death.
Nitrite Negative A urinalysis, also called The presence
a urine test, can detect the of nitrites in urine most commonly
presence of nitrites in means there's a bacterial infection
the urine. in your urinary tract.
Normal urine contains
chemicals called nitrates. If
bacteria enter
the urinary tract, nitrates can
turn into different, similarly
named chemicals called
nitrites. Nitrites in urine may
 be a sign of a urinary tract
infection (UTI).
Leukocytes +++ Leukocyte esterase is an A high number of leukocytes in
enzyme present in the urine may indicate the
most white blood presence of
cells (WBCs). A few white a urinary tract infection
blood cells are normally
present in urine and usually
give a negative chemical
test result. The most
common cause for WBCs
in urine (leukocyturia) is a
bacterial urinary tract
infection (UTI), such as a
bladder or kidney infection.
Reaction Acidic A urine pH level test is As a result, a first
a test that analyzes waking urine specimen is usually
the acidity or alkalinity of highly acidic. Bacteria causing
a urine sample. ... Many a urinary tract infection or
diseases, your diet, and the bacterial contamination will
medicines you take can produce alkaline urine. A diet rich
affect how acidic or basic in citrus fruits, most vegetables,
your urine is. For instance, and legumes will keep
results that are either too the urine alkaline.
high or low can indicate the
likelihood that your body will
form kidney stones
Specific 1.025 Ideally, urine specific Decreased specific
gravity gravity results will fall gravity (hyposthenuria,
between 1.002 and 1.030 if i.e. decreased concentration of
your kidneys are functioning solutes in urine) may be
 normally. Specific
gravity results above 1.010
can indicate mild
dehydration. The higher the
number, the more
dehydrated you may be.
Albumin Negative Albuminuria is a sign of
kidney disease and means
that you have too
much albumin in
your urine. Albumin is a
protein found in the blood. A
healthy kidney doesn't
let albumin pass from the
blood into the urine. A
damaged kidney lets
some albumin pass into
the urine.
associated with renal failure,
pyelonephritis, diabetes insipidus,
acute tubular necrosis, interstitial
nephritis, and excessive fluid
intake (e.g., psychogenic
polydipsia).
Albumin is a type of protein that
is normally found in the blood.
Your body needs protein. But it
should be in your blood, not
your urine. When you
have albumin (protein) in
your urine, it is called
“albuminuria” or “proteinuria.”
 XII DRUG STUDY

Date/Shift Name Dosage/ Indication Contra- Mechanism Side Nursing

of the Time/ indicati of action effects Responsibility
drug Route on
09/26/19 Brand 1 G/ tab It is given Used to Develops -Diarrhea Evaluate for
name: BID 1 to treat treat when the -nausea infection, use
73 BACT week bacterial infection bacteria -vomit barrier
W infections. s able to - contraception,
It is also caused produce Constipation Monitor for S&S
Generi prescribed by enzymes -acid of a rash
c for sinus, certain that stomach (usually
name: urine, skin, bacteria breakdown -headache occurring within
amoxic joints, and . the -appetite few days after of
illin/Cla some Amoxicil antibiotic. loss drug)
vulanic dental lin Clavulanic -bad taste suggestive of a
Acid infections works Acid works hypersensitivity
that is by by stopping reaction. It it
CLAS given killing these occurs, look for
SIFIC before the enzymes, other signs of
ATION some bacteria which allows hypersensitivity
= surgical that the (fever,
Pharm operations causes amoxicillin wheezing,
acothe to prevent infection to kill the generalized
rapeuti from Clavula resistant itching,
c: developing nic acid bacteria. dyspnea), and
(Penici . helps to report to
llin) make physician.
Clinical the
: amoxicil
Antibio lin more
tic effective
. This
Drawin medicati
g: on is
most
commo
nly used
to treat
infection
of the
sinus,
ear,
lung,
skin,
and
bladder.
Date/ Name of Dosage/ Indicatio Contra- Mechanism Side Nursing
Shift the Drug Time/ n indication of Action Effects Responsibiliti
Route es
09/26/ Brand 400 Celebrex is Use in A highly Headach Be aware that
19 name: mg 1 indicated for severe selective e, patient may be
Coxidia tab the hepatic reversible Abdomin at increased
73 orally managemen impairmen inhibitor of al-pain, risk for CV
Generic ODx 3 t of the t, in those the COX-2 indigestio events, GI
name: weeks signs and who have isoform of n, bleeding;
Celecoxib symptoms shown an cyclooxygen diarrhea, monitor
of allergic ase, nausea, accordingly.
Classifica osteoarthriti reaction to celecoxib upset Administer
tion: s, sulphona inhibits the stomach, drug with food
NSAID, rheumatoid mides, or transformati bloating, or after meals if
Analgesic arthritis, in those on of etc GI upset
, Specific juvenile who have arachidonic occurs.
COX-2 rheumatoid experienc acid to Establish
Enzyme arthritis in e asthma, prostaglandi safety
blocker patients 2 urticaria, n measures if
years and or allergic- precursors. CNS, visual
Drawing: older, and type Therefore, it disturbances
ankylosing reactions has occur.
spondylitis, after antipyretic, Provide further
for the taking analgesic comfort
managemen aspirin or and anti- measure to
t of acute other inflammatory reduce pain
pain in NSAIDs properties.
adults, and Use in late
for the pregnancy
managemen (may
t of primary cause
dysmenorrh premature
ea. closure of
ductus
arteriosus)
.

‘.
 Name Classificatio Dosage/ Mechanism Nursing
Date Drawing Indication Side Effects
of Drug n Time/Route of Action Responsibilities
Generic Pharmacothera PO: 15ml orally once This drug is used by Inhibits diffusion Occasional: Baseline assessment
Name: peutic: Lactose a day mouth or rectally to of NH3 into Abdominal Question usual stool
Lactulose derivative treat or prevent blood by cramping, pattern, frequency,
complications of liver converting NH3 flatulence, characteristics. Conduct
Brand disease (hepatic to NH+4 increased thirst, neurological exam in pts
Name: encephalopathy). It enhances abdominal with elevated serum
Contulose does not cure the diffusion of NH3 discomfort. ammonia levels,
problem, but may help from blood to Rare: Nausea, symptoms of
to improve mental gut, where it is Vomiting. encephalopathy. Asses
status. Lactulose is a converted to hydration hydration.
colonic acidifier that NH4; produces Intervention:
works by decreasing osmotic in Encourage adequate fluid
the amount of colon. intake. Assess bowel
ammonia in the blood. sounds . Monitor daily
It is a man-made pattern of bowel activity,
sugar solution stool consistency.
Patient/family teaching
-Evacuation occurs in 24-
48 hrs of initial dose.
-Institute measures to
promote defecation:
increase fluid intake ,
exercise, high fiber diet
-Drink plenty of fluids
-If therapy was started to
treat high ammonia
levels, notify physician if
worsening of confusion,
lethargy, weakness
occurs.
 Name
Classificatio Dosage/ Mechanism Nursing
Date of Drawing Indication Side Effects
n Time/Route of Action Responsibilities
Drug
Generic Pharmacotherap PO: 250/500 mg twice Susceptible mild to .Binds to -Nausea Baseline assessment
Name: eutic: Second a day. moderate infections bacterial cell -serum sickness Obtain CBC, renal function
Cefuroxi generation including membranes, like tests. Question for history of
me cephalosphorins pharyngitis/tonsillitis, inhibits cell wall reaction( fever, allergies, particularly
. acute maxillary synthesis. joint paint ) cephalosporins, penicillins.
Brand sinusitis, chronic Therapeutic Intervention:
Name: bronchitis, acute otitis Effect: Assess oral activity for white
Ceftin media, uncomplicated Bactericidal patches on mucous
skin and skin membranes, tongue (thrush).
structure, UTIs, Monitor daily pattern of
gonorrhea, early Lyme bowel activity, stool
disease. consistency.
Patient/family teaching
-Discomfort may occur with
IM injection
-Doses should evenly
supposed
-Continue antibiotic therapy
for full length of treatment
-May cause GI upset (may
take with food, milk)
XIII. NURSING THEORIES

Interpersonal Relations Theory

By Hildegard Peplau

Hildegard Peplau’s Interperosonal Relations Theory emphasized the

nurse-client relationship as the foundation of nursing practice. It gave
emphasis on the give-and-take of nurse-client relationships that was
seen by many as revolutionary. Peplau went on to form an
interpersonal model emphasizing the need for a partnership between
nurse and client as opposed to the client passively receiving treatment
and the nurse passively acting out doctor’s orders.

Four Components:
Person
Which is a developing organism that tries to reduce anxiety
caused by needs
Environment
Which consist of existing forces outside of the person, and put in
the context of culture
Health
Which is word symbol that implies forward movement of
personality
Nursing
 Which is a significant therapeutic interpersonal process that
functions cooperatively with other human process that make health
possible for individuals in communities

Therapeutic nurse-client relationship

A professional and planned relationship between client and nurse
that focuses on the client’s needs, feelings, problems, and ideas. It
involves interaction between two or more individuals with a common
goal. The attainment of this goal, or any goal, is achieved through a
series of steps following a sequential pattern.
Four Phases of the therapeutic nurse-patient relationship:
1. Orientation Phase
The orientation phase is directed by the nurse and involves
engaging the client in treatment, providing explanations and
information, and answering questions.
2. Identification Phase
The identification phase begins when the client works
interdependently with the nurse, expresses feelings, and begins to
feel stronger.
3. Exploitation Phase
In the exploitation phase, the client makes full use of the services
offered.
4. Resolution Phase
In the resolution phase, the client no longer needs professional
services and gives up dependent behavior. The relationship ends.

Care, Cure, Core Theory

 By; Lydia Elloisa Hall
Lydia Hall’s theory define Nursing as the “participation in care, core
and cure aspects of patient care, where CARE is the sole function of nurses,
whereas the CORE and CURE are shared with other members of the health
team.” The major purpose of care is to achieve an interpersonal relationship with
the individual that will facilitate the development of the core.
Three independent but interconnected circles
 The Care Circle
This circle solely represents the role of nurses, and is focused on
performing the task of nurturing patients. Nurturing involves using the
factors that make up the concept of mothering (care and comfort of the
person) and provide for teaching-learning activities.
 The Core Circle
The core, according to Hall’s theory, is the patient receiving nursing care.
The core has goals set by him or herself rather than by any other person
and behaves according to his or her feelings and values. This involves the
therapeutic use of self and is shared with other members of the health
team.
 The Cure Circle
The cure as explained in this theory is the aspect of nursing which involves
the administration of medications and treatments. Hall explains in the
model that the cure circle is shared by the nurse with other health
professionals, such as physicians or physical therapists.

Major Concepts of Care, Core, Cure

Individual
The source of energy and motivation for healing is the individual care recipient,
not the health care provider. Hall emphasizes the importance of the individual as
unique, capable of growth and learning, and requiring a total person approach.
Health
Can be inferred to be a state of self-awareness with a conscious selection of
behaviors that are optimal for that individual. Hall stresses the need to help the
person explore the meaning of his or her behavior to identify and overcome
problems through developing self-identity and maturity.
Society and Environment
The concept of society or environment is dealt with in relation to the individual, so
that any actions taken in relation to society or environment are for the purpose of
assisting the individual in attaining a personal goal
Nursing
Is identified as consisting of participation in the care, core, and cure aspects of
patient care.
Theory of Comfort
By; Katharin Kolcaba
Kolcaba described comfort existing in three forms: relief, ease, and
transcendence. If specific comfort needs of a patient are met, the patient
experiences comfort in the sense of relief. For example, a patient who receives
pain medication in post-operative care is receiving relief comfort. Ease addresses
comfort in a state of contentment. For example, the patient’s anxieties are
calmed. Transcendence is described as a state of comfort in which patients are
able to rise above their challenges. The four contexts in which patient comfort
can occur are: physical, psychospiritual, environmental, and sociocultural.
In the model, nursing is described as the process of assessing the patient’s
comfort needs, developing and implementing appropriate nursing care plans, and
evaluating the patient’s comfort after the care plans have been carried out.
Nursing includes the intentional assessment of comfort needs, the design of
comfort measures to address those needs, and the reassessment of comfort
levels after implementation. Assessment can be objective, such as the
observation of wound healing, or subjective, such as asking the patient if he or
she is comfortable.
Metaparadigm
Nursing
The intentional assessment of comfort needs of patients, families or
communities; design of comfort measures to address comfort needs, including
re-assessment of comfort level after implementation of comfort measures,
compared to a previous baseline
Patient
An individual, family, or community in need of health care, including primary,
tertiary, or preventative care
Environment
Aspects of patient/family/community surroundings that affect comfort and can be
manipulated to enhance comfort
Health
Optimum function of a patient/family/community facilitated by enhanced comfort
Date/ Assessment Need Nursing Plan of Nursing Evaluation
Shift Diagnosis Care Intervention
with Rationale
09/26 Subjective: Elimina Acute pain After 3 Increase fluid After 3 days
/19 ‘’Sakit kaayo tion related to days of intake of nursing
iihi’’as verbalized pattern infection nursing - Increased intervention
73 by the patient. within urinary interventio hydration s, the
tract as n, the flushes patient pain
Objective: evidenced by patient’s bacteria and was
- Facial grimace painful discomfort toxins. relieved.
urination. will be
Vital signs taken relief or Encourage use
as follows: Rationale: A control. of sitz baths
T:36.4 urinary tract and warm
P:91 infection may soaks to the
R:20 occur in the perineum.
BP:120/80 bladder - Used to
where it is heal and
called cleanse the
urethritis. area around
Upper tract the
infection perineum.
results in
pyelonephritis Suggest use of
. Most UTIs relaxation
results from technique or
ascending provide comfort
infection by measure like
bacteria that back rub.
have entered - Promote
through muscle
urinary relaxation
meatus but
some may be
caused by
hematogenou
s spread.

Reference:
Nurse’s
Pocket Guide
12th Edition
(Doenges,
Moorhouse,
Murr)
Date/S Assessmen Needed Nursing Plan of Care Nursing Evalua
hift t Diagnosis Interventions
with rationale
09/26/1 Subjective Nutritional Scientific After 3 days of Conduct a health After
9 data: -metabolic Base: nursing teaching about interve
‘’Dili ko pattern Ineffective interventions, proper was a
73 makapa- breastfeeding the patient will breastfeeding, her ba
totoy related to be able to breast care and
saakong knowledge breastfeed her care for the
baby’’ as deficit baby. infant.
verbalized Rationale: - Breastfeed
by the Breastfeeding promotes a
patient. is considered healthy
the safest, weight,
Objective: simplest, and prevent
- Facial least breast
grimace expensive cancer,
way to expand the
Vital signs provide supply and
taken as complete capacity for
follows: neonate quality infant
T:36.4 nourishment. and improve
P:91 For them, it outcomes for
R:20 helps in the infants and to
BP:120/80 uterine support
contraction, ongoing
protection health and
from breast well-being.
cancer and
empowerment Encourage the
. For the mother to relax
baby, it gives during
passive breastfeeding.
immunity - It is the calm
during the first state and
months of life, helps to bond
increase brain with the
development baby(euphori
and it is full of a).
nutrients.
Reference:
Nurse’s Increase fluid
Pocket Guide intake
12th Edition - An adequate
(Doenges, fluid supply
Moorhouse, also ensures
Murry that the
mother has
enough
reserves to
tolerate blood
loss during
 the delivery.

XV DISCHARGE PLAN

Medication
- Instruct and encourage the patient or the family to take medication regularly as
prescribed by the doctors.
Exercise
 -Instruct the patient to do early ambulatory and to have moderate exercise for fast
recovery.

Treatment

- Instruct the patient or the family to follow regular checkup as scheduled by the doctor.
- Instruct the patient to rely always to the physician if any complications will occur.
Hygiene

-Encourage the patient to do perineum wash and maintain good personal hygiene.

- Encouraged the patient or the family to maintain cleanliness at home to avoid further
infection.

Out-patient Order

-Instruct the patient to follow regular check up

-Instruct to have moderate physical activities

Diet

-Encourage the patient to drink plenty of water and eat fruits and vegetables regularly to
improve lactation.

-Instruct the patient to limit eating junk foods.

Spiritual

Encourage the patient to always put God as the center in every activity, plans and decisions they
might be dealing.

XVI. RECOMMENDATIONS

"Water is a basic nutrient of the human body and is critical to human life”
World Health Organization - Water Sanitation and Health (WSH)

Increased water intake prevents urinary tract infections. Urinary tract infection (UTI) is
one of the most common infectious diseases in women. It is also an effective preventive measure
for the prevention of kidney stones recurrence and may help reduce the risk of first episodes.
  Instruct the people that drinking enough water every day is good for overall
health. As plain drinking water has zero calories, it can also help with managing
body weight and reducing caloric intake when substituted for drinks with calories,
like regular soda. Drinking water can prevent dehydration, a condition that can
cause unclear thinking, result in mood change, cause your body to overheat,
constipation, and kidney stones.

 Encourage adults and young to take medications with water and to eat water-rich
foods such as Watermelon, Strawberries, Cantaloupe, Peaches, Oranges, Skim
Milk, Cucumber, and Lettuce in order to keep them dehydrated.

Breast milk provides the ideal nutrition for infants. It has a perfect mix of vitamins,
protein, and a fat that everything your baby need to grow. Exclusive breastfeeding is
recommended up to 6 months of age, with continued breastfeeding along with appropriate
complementary foods up to two years of age or beyond.

 The mother should breastfeed the baby to lower the baby’s risk of having asthma or
allergies. Plus, babies who are breastfed exclusively for the 6 months, without any
formula, have fewer ear infections, respiratory illnesses, and bouts of diarrhea.
Breastfeeding should begin right after the delivery and should be “on demand”, as often
as the child wants day and night. Bottles or pacifiers should be avoided.

 For breastfeeding mothers, they should eat nutritious food such as fruits and vegetables
that are rich in nutrients and vitamins and they should also drink a lot of milk and water
in order to produce milk for the infant.
References
 https://www.hindawi.com/journals/ogi/2014/274303
 https://nurseslabs.com/hildegard-peplaus-interpersonal-relations-theory/
 https://nurseslabs.com/lydia-e-halls-care-cure-core-theory/
 http://nursing-theory.org/theories-and-models/kolcaba-theory-of-
comfort.php
 https://sites.google.com/a/northgeorgia.edu/middle-range-nursing-theorist-
presentation/the-comfort-theory