Grand Case Presentation

I.
ACKNOWLEDGEMENT
As a sincere appreciation, I, Kate L. Mayuga, a second year Bachelor of Science in Nursing

group three here by acknowledging and recognize full heartedly.
First to our Almighty God whose infinite wisdom gives me capability to come up with this
Case Study. To our beloved University, College of Nursing and Health Sciences for giving me
the chance to enroll in this program.
To my Clinical Instructor, Mr Johnard B. Rebato, RN, MSN for his guidance and support;
for patiently supervising with his knowledge and skills, as I go through the process of doing the
Case Study.
My sincerest thanks:
For the trust and support of the staff of Ospital Ng Palawan and thank you for the guidance
and for helping us to adjust, to deal with our patient and for allowing us to work with them.
To my patient, for the generous time given to me to explore their case; and for giving me
their trust, cooperation and kindness that helped me to accomplish and to complete the needed
information for this study.
To my family, for their kind understanding when I am away from our home while doing this
case study.
All those things are gratefully appreciated.
Thank you!
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BSN2 GROUP3 SPLENOMEGALY
II. INTRODUCTION
2
DEFINITION OF TERMS
III.PATIENTS PROFILE
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NAME: J.R.B
GENDER: Male
STATUS: Single
ADDRESS: Brgy. Mauyon, PPC
AGE: 11 years old
EDUCATIONAL ATTAINMENT: Elementary Level (Grade 2)
OCCUPATION: N/A
RELIGION: Roman Catholic
DATE AND TIME ADMITTED: January 9, 2018 at 10:00 am
CHIEF COMPLAINTS: On and off fever and mass on the Left Upper Quadrant
ATTENDING PHYSICIAN: Dr. A
ADMITTING DIAGNOSIS: T/C Splenic Abcess
INITIAL DIAGNOSIS: Splenomegaly
IV. HEALTH HISTORY
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A. Present Illness
Last December 26, 2017 at around 3:30 pm, the patient complain to his father that his
stomach is aching. The patient told his father that it’s like a pricking sensation. His father
brought him to a quack doctor and gave them some medicinal plants to put on to his stomach.
According to his father, patient J.R.B has a on and off fever. He didn’t bring his son immediately
to the hospital because he thinks that it’s just only a simple fever that every child has. Tuesday
of January 9, 2018 around 10:00 am, Mr L, the father of patient J.R.B decided to bring his child
to the hospital via public transportation (bus) from Brgy. Mauyon, PPC to San Jose Terminal and
from the terminal they ride a cab to Ospital ng Palawan. While on their way to ONP, Patient JRB
experience pain on his stomach and had a fever. They arrived around 10:00 am at Emergency
Room with admitting diagnosis of T/C Splenic Abcess. Patient JRB assessed by the nurse for
about 5-8 minutes for further assessment. After, he transferred to the pediatric ward for IVF
insertion and other diagnostic test and labolatory test to conduct.
B. Past Health History
When asked, Mr. L said that his son JRB was hospitalized last 2011 due to dengue. Also, JRB
experiences simple cough and cold and fever that don’t last for a long period of time. Mr. L said
that his son didn’t experience childhood diseases such as chicken pox, mumps and measles. He
also said that the vaccines of his son are complete.
C. Family History and Genogram
Father: Mr L 42 yrs. old
Mother: Mrs B 38 yrs. old
Children:
1. 1stChild: JP 14 yrs. Old
2. 2ndChild: JRB 11 yrs. Old
3. 3rd Child: PN 7 yrs. Old
JRB is the second child in the family of 3 children. He is now 11 years old and he
is a Grade 2 student at Mauyon Elementary School. The first child of Mr L and Mrs B is
now 14 years old and their 3rd child is now 7 years old. Mr L stated that their 1st child is a
premature baby and sometimes experiences fever, cough and cold. Their 3rd child also
experiences fever, cough and cold that lasts for a short period of time. Whenever their
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children become sick they go to the nearest health station to seek medical attention and
also they give Paracetamol to their child if they ahd fever. He also stated that their 3
children didn’t experiences childhood illnesses such as mumps, measles and chickenpox.
Mr L perceived that he has a history of asthma. He also had UTI and sometimes
experiences fever. His wife, Mrs B also had a UTI and sometimes experiences head ache.
Mr L is non-smoker but he drinks alcoholic beverages. There is no other Heredo Familial
Disease noted in the family.
When it comes to their needs, Mr L took the responsibility for his family. He is a
farmer. Through his farming, he supports the needs of his family every day. He is not
depending in his wife. He does his best to support the needs of his children as well as his
wife. His wife is the one who buys their supplies for everyday use and keeps the house
and take good care of their kids. .
All family members have no recorded accidents and operations. Their 1st child, 2nd
child and 3rd child completed their immunizations because they bring them regularly to
the health canter. The family is occasionally inflicted with cough, colds and fever. Self-
medication of over the counter drugs and bed rest afforded relief.
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E. GENOGRAM
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V. GROWTH AND DEVELOPMENT
ERIK ERIKSON-Psychosocial development theory
ERIK ERIKSON’S THEORY OF PSYCHOSOCIAL DEVELOPMENT
STAGE TASK MANIFESTATION
5-12 years old Industry vs. Inferiority

Young Adulthood
It is at this stage that the child’s peer group will gain greater
(JRB 11 years old)
significance and will become a major source of the child’s self-
esteem. The child is coping with new learning and social demands.
Success leads to a sense of competence, while failure results in
feelings of inferiority.
Erikson’s theory describes the impact of social experience across the whole lifespan. In each stage, Erikson believed people experience a
conflict that serves as a turning point in development. In Erikson’s view, these conflicts are centered on either developing a psychological quality or failing
to develop that quality. During these times, the potential for personal growth is high, but so is the potential for failure.
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Each step builds on skills learned in previous steps. Erikson
believed that a strong sense of personal identity was important for
developing intimate relationships. Studies have demonstrated that
those with a poor sense of self do tend to have less committed
relationships and are more likely to suffer emotional
isolation, loneliness, and depression.
Successful resolution of this stage results in the virtue

known as love. It is marked by the ability to form lasting,
meaningful relationships with other people.
During early adulthood most people fall in love, gets married and
starts building their own family. If a person is unable to develop
intimacy with other at this age (whether through marriage or close
friendships), they will probably continue on into adulthood.
Young adults seek companionship and love with other

person or become isolated from others by fearing reflection or
disappointment.
The young adult must develop intimate relationships or

suffer feelings of isolation.
Young people work on establishing intimate ties to others. Because
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of earlier disappointments some individuals cannot form close
relationships and remain isolated from others.
“Intimacy achieving relationships with family and marital or

mating partners.
SIGMUND FREUD-Psychosexual Development theory
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Freudian theory suggests that as children develop, they progress through a series of psychosexual stages. At each stage, the libido’s pleasure-seeking energy
is focused on a different part of the body. The successful completion of each stage leads to a healthy personality as an adult. Freud’s theory which emphasized that
how parents manage their child's sexual and aggressive drives in the first few years is crucial for healthy personality development
SIGMUND FREUD THEORY OF PSYCHOSEXUAL DEVELOPMENT
This theory is through adolescence. He studied the effects of our

GENITAL STAGE
internal drives on the emotional outcome on the individual. He Mrs. E has established a relationship with a boy even
Age 12 and up
only conceptualized this development spanning the period from without the approval of his parents Mrs. E we have two children
(Mrs. E 24 years old)
birth until adolescence. This theory is rarely used for research, but with a different father. If Mrs. E successfully resolves the
it continues to influence our thinking. conflicts in each psychosexual stage, he would develop a loving,
Genital Stage healthy and mature adult personality.
Freud's last stage of personality development, from the onset of
puberty through adulthood, during which the sexual conflicts of
childhood resurface (at puberty) and are often resolved during
adolescence).
The final stage in Freud's theory, beginning in adolescence, in
which sexual maturation is complete and sexual intercourse
becomes a major goal. (Psychoanalysis) the fifth sexual and social
stage in a person's development occurring during adolescence,
puberty, search for partner, gratification from relationships.
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Psychosexual development usually attained at adolescence, in
which heterosexual interests and activities are generally
predominant.
JEAN PIAGET-Cognitive Development
Piaget’s theory described how a child’s thinking and learning develops. He believed that knowledge is built by the child over the time.
Children are active learners in their environment and knowledge is the result of interaction between the child and the environment.
JEAN PIAGETTHEORY OF COGNITIVE DEVELOPMENT
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FORMAL Mrs. E grew up well and responsible without the supervision of his
The final stage of Piaget's theory involves an increase in logic, the
OPERATIVE STAGE parents, he is able to cope up easily with the kinds of living he has
ability to use deductive reasoning, and an understanding of abstract
right now. He understands that even though his parents is away
Age 12 and up ideas. At this point, people become capable of seeing multiple
from him, he still have to continue everything including his
(Mrs. E 24 years old) potential solutions to problems and think more scientifically about
responsibility to her children because she is a single mother and
the world around them.
also for the financial for her children’s.
The ability to thinking about abstract ideas and situations is the key
hallmark of the formal operational stage of cognitive development.
The ability to systematically plan for the future and reason about
hypothetical situations are also critical abilities that emerge during
this stage.
The formal operational stage (adolescence – adulthood) - children

think about abstract concepts- consequences of actions and develop
understanding in deductive logic/reasoning and systematic planning.
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VI. PATTERNS OF FUNCTIONING AND
CLINICAL EXAMINATION
PATTERNS OF CLINICAL OTHER SOURCES

FUNCTIONING EXAMINATION
1. RESPIRATORY
 Does not have
difficulty of breathing
NONE
 Non-smoker
2. CIRCULATORY
 BP: 90/60 mmHg CBC Result:
 No history of any heart
 PR: 82 bpm Haemoglobin 122 g/L - The
problems.
 <2 seconds capillary result is within normal range.

refill Hematocrit 40 vol% - The
 (-) edema result is within normal range.

WBC 6.23 ×109/L - The result
is within normal range
 He was having his

3. FOOD & FLUID  IVF: PNSS
breakfast and lunch the
INTAKE Single-dose 500ml and
same time at home
 Usually eat meals 3 except dinner because 1000ml flexible plastic
times a day. Breakfast he ate late when he is containers.
at 8:00 am, Lunch at in the hospital 1000ml @ 70 cc/hour as
12:00pm and Dinner at prescribed by the physician.
 Good skin turgor < 2
8:00pm.
seconds
 Their usual viand is
vegetables and fish.
They eat meat seldom.
 Consumes 1 cup of
milk every morning
and drinks 6-8 glasses
of water a day.
 Never consumed an
alcohol.
 (-) food allergies  yellowish urine
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 (-) stool NONE
4. ELIMINATION
 Usually void once a
day
 Urinate 2-3x a day
 Did not experience
 Axillary temperature NONE
diarrhea.
of 38.3 ºc
5. REGULATORY
MECHANISMS
 Hair is evenly NONE
 He has an on and
distributed.
off fever  No presence of
6. HYGIENE dandruff, lesions and
 He takes a bath every lice
day and changes his  Nail is clean and short
clothes regularly..  (-) allergies in hygienic
 He brushes his teeth products
ever morning after
breakfast, after lunch
NONE
and evening before
sleeping.
 He could walk alone
when he wishes to go
7. ACTIVITY & to the toilet.
NONE
EXERCISE
 Client said he does
house chores like  He had an irregular
pithing of water and it pattern of sleep due to
serves as his exercise. uncomfortable

surrounding
8. REST & SLEEP

 He usually sleeps at
9:00 pm and wake up
at 7:00am
 He takes a nap every NONE
afternoon for about 2
EYE
hours
 Eyelashes is evenly
 Uses 1 pillow for head
distributed and
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and prefer a side lying symmetrical
position EAR
 Color of the auricles is
9. COMMUNICATION same as facial skin
& SPECIAL SENSES  Symmetrical
 No history of visual,  No presence of heavy
auditory and speech earwax and any
disturbances discharges
 He speaks Tagalog VOICE

 Able to responds when
 He is a right handed
asked in a soft voice NONE
 He is oriented to place,
time and person NONE
 Responds to verbal and

tactile stimulant
10. COGNITION &
PERCEPTION
(Sensory) NONE
 He complains pain
 Does not have history whenever his LUQ is
of convulsion, loss of being touch.
consciousness or
epilepsy
 When he is awake, he
11. PAIN & NONE
always talks to his
DISCOMFORT father and plays a
 He experience pain on game on his father’s
his LUQ and sleep is phone.
his pain management.
NONE
12. RECREATION &  He prayed before he
DIVERSION had his meals as well

as before he sleeps.
 He plays a game on the
phone of his father
13. RELIGIOUS
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LIFE
 He is a Roman
Catholic  She talks to her sisters
 He went to church and other mothers at
twice a month together the hospital to at least
with his family alleviate the pain she

was experiencing
emotionally and
physically. And she
14. COPING
sleeps whenever she NONE
MECHANISMS
felt the pain.
 When they had
problems in the family
she listens to each side
and pray.
 While she was

admitted at the hospital
she was with her
sisters.
15. ROLE &
RELATIONSHIPS
 She has a good
relationship with her
mother and siblings.
 Her partner left her
when her 1st child was
2 years old and 9
months.
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VII. PHYSICAL ASSESSMENT
DATE AND
TIME OF VITAL NORMAL RESULT INTERPRETATION
ASSESSMEN SIGNS VALUES
T
September 14, Blood 120/90 mmHg 120/90 Within normal range

2017 pressure mmHg
8:30 am
September 14, Respiration 16-20 bpm 19 bpm Within normal range

2017
8:32 am
September 14, Pulse Rate 60-100 bpm 77 bpm Within normal range
2017
8:33 am
September 14, Temperature 60-100 bpm 36.6°C Within normal range

2017
8:35 am
TECHNIQUE NORMAL ACTUAL

VALUES FINDINGS
HAIR AND SCALP  Inspection  Smooth &  Hair color is

soft black, long,
 color black, wavy and
short and evenly
wavy, evenly distributed
distributed oily
oily  No presence
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 no presence of of dandruff,
HEAD  Inspection parasites(lice) lesion and any
 Palpation masses.
 No presence
 face is of lice
symmetrical,  Round and
centered-head Symmetric, no
position lesion visible.
 No
involuntary
movement
 Face is
elongated in
appearance
and symmetric
NECK  Inspection  Smooth and  No presence

 Palpation controlled of lesion,
movements swelling, scars
 Lympnodes and burn.
palpated  Able to move
neck without
discomfort
SKIN  Inspection  light dark  Client Skin is
brown & feels fair,
 palpation warm Unblemished,
 no swelling good skin
turgor,
 no presence
of rashes, and
any odor, skin
temperature is
normal limit
35°.5C.
 No presence
of scars
EYES  inspection  blinking  Eyelashes and

symmetrical, eyebrow are
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EYE BROWS involuntary & well
approximately distributed;
EYE LASHES 15/min eyelashes are
EYE LIDS  evenly equal;
distributed eyebrows are
PUPIL horizontally
 Eye lashes are aligned with
short each other.
 eye lid margin  No presences
moist & pink of swelling or
 pupil is redness on
equally round both eyes
and reactive  Pupils are
to light round with
accommodati regular
on border, black
 uniform in in color, and
color both reactive
to light
 Sclera
appeared
white
 Eyelids no
presence of
discharge and
discoloration
 Can move in 6
cardinal
movements
NOSE  inspection  color of the  Color of the

nose is same nose is same
 palpation as the skin as the skin
 symmetrical  When lightly
appearance palpated, No
 no redness in presences of
the nasal lesion,
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mucosa tenderness,
masses and
inflammation
 No presences
of nasal
flaring
 No presence
of nasal
discharge
 Can able to
sniff in each
nostril
EARS  Inspection  ears of equal  Ears are equal

 palpation size & similar in size
appearance bilaterally
 skin in the  Color of the
external ear is skin is same
smooth and as the color of
color pink his skin
 Can hear in
both ears
 When
palpating the
texture, the
auricles re
mobile firm
 No presences
of discharge
MOUTH  Inspection  Pink in color  No presence

 palpation  Dry of lesion and
 Smooth moist tenderness in
with no the lips
lesions  color of the
lips is pinkish
 Gums appear
pinkish and
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firm, no
presence of
lesion
TEETH  Inspection  32 complete  32 complete
no. of teeth no. of teeth
 Color of the
teeth is
Whitish
THORAX AND LUNGS  Auscultate  vesicular  NO presence
 Inspection breath sounds of tenderness,
 Palpation  equal chest scars, wounds
 percussion expansion or lesions on

 resonant, 3-5 chest
cm  Symmetric
diaphragmatic chest wall
excursion movement
 no presence of  normal breath
tenderness, sound without
scars, wounds dyspnea,
or lesions on respiratory
chest rate of 19 bpm
CARDIOVASCULAR  Inspection  vital signs  Vital sign is
stable stable
 no cardiac  No cardiac
heaves or lifts heaves or lifts
UPPER EXTREMITIES  inspection  no jugular  no jugular
 palpation venous venous
distention distention
 pulse strong  No presence
& equal of lesion,
(radial pulse) discharge,
 mobile wounds scars
 intact on both hands.
condition of  Skin is
the skin in smooth
arms.  Arms can be
 No lesions, no flexed and
swelling extended
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 No hard
masses on
both arms
 No tenderness
upon
palpation
 Complete
number of
nails
 Nails are well-
trimmed
 Pinkish nail
beds
 Fingers can be
flexed and
extended
 Finger nails
are short and
clean
ABDOMEN  inspection  no rashes or  No presence

 auscultatio lesions of rash and
n  umbilicus is lesion
 percussion centrally  Umbilicus
 palpation located located at the
 rounded abdominal
abdomen midline
 symmetrical  No tenderness
 high pitched, upon
irregular palpation
gurgles 5-35  Abdomen
times/min rises with
 abdomen rises inspiration in
with synchrony
inspiration in with chest
synchrony
with chest
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LOWER EXTREMITIES  inspection  bilaterally  No presence
symmetrical of rashes,
and equal lesion and
 right foot has masses
no lesions, no  No presence
swelling of scars and
 left foot has wounds
no lesions, no  Able to walk
swelling to do physical
 skin color is activities
the same as  Toenails are
the other part short and
of the body clean
 no scars and
wounds
 Inspection  Face moves  Can express
NEUROLOGICAL AND symmetrical herself very
MUSCULOSKELETAL when she well
smiles, frown,  Patient face
wrinkle, moves
forehead and symmetrical
puff cheeks when she
smiles, frown,
wrinkle,
forehead and
puff outs
cheeks
VIII. ANATOMY and PHYSIOLOGY
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Internal Structures
Ovaries
 The ovaries are the ultimate life-maker for the females.

 For its physical structure, it has an estimated length of 4 cm and width of 2 cm and is 1.5
cm thick. It appears to be shaped like an almond. It looks pitted, like a raisin, but is
greyish white in color.
 It is located proximal to both sides of the uterus at the lower abdomen.
 For its function, the ovaries produce, mature, and discharge the egg cells or ova.
 Ovarian function is for the maturation and maintenance of the secondary sex
characteristics in females.
Fallopian Tubes
 The fallopian tubes serve as the pathway of the egg cells towards the uterus.
 It is a smooth, hollow tunnel that is divided into four parts: the interstitial, which is 1 cm
in length; the isthmus, which is2 cm in length; the ampulla, which is 5 cm in length; and
the infundibular, which is 2 cm long and shaped like a funnel.
 The funnel has small hairs called the fimbria that propel the ovum into the fallopian tube.
 The fallopian tube is lined with mucous membrane, and underneath is the connective
tissue and the muscle layer. The muscle layer is responsible for the peristaltic movements
that propel the ovum forward.
 The distal ends of the fallopian tubes are open, making a pathway for conception to
occur.
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Uterus
 The uterus is described as a hollow, muscular, pear-shaped organ.
 It is located at the lower pelvis, which is posterior to the bladder and anterior to the
rectum.
 The uterus has an estimated length of 5 to 7 cm and width of 5 cm. it is 2.5 cm deep in its
widest part.
 For non-pregnant women, it is approximately 60g in weight.
 Its function is to receive the ovum from the fallopian tube and provide a place for
implantation and nourishment.
 It also gives protection for the growing fetus.
 It is divided into three: the body, the isthmus, and the cervix.
 The body forms the bulk of the uterus, being the uppermost part. This is also the part that
expands to accommodate the growing fetus.
 The isthmus is just a short connection between the body and the cervix. This is the
portion that is being cut during a cesarean section.
 The cervix lies halfway above the vagina, and the other half extends into the vagina. It
has an internal and external cervical os, which is the opening into the cervical canal.
Vagina
• The vagina is a muscular, ridged sheath the external genitals to the uterus, where the
embryo grows into a fetus during pregnancy. In the reproductive process, the vagina
functions as a two-way street, accepting the penis and sperm during intercourse and
roughly nine months later, serving as the avenue of birth through which the new baby
enters the world.
Cervix
• The vagina ends at the ends at the lower portion or neck of the uterus. Like the vagina,
the cervix has dual reproductive functions.
• After intercourse, sperm ejaculated in the vagina pass through the cervix, then proceed
through the uterus to the fallopian tubes where, if a sperm encounters an ovum(egg),
conception occurs. The cervix is lined with mucus, the quality and quantity is governed
by monthly fluctuations in the levels of the two principle sex hormones, estrogen and
progesterone.
27
External Structures
Our overview of the reproductive system begins at the external genital area-or
vulva-which runs from the pubic area downward to the rectum. Two folds of fatty, fleshy
tissue surround the entrance to the vagina and the urinary opening: the labia or outer
folds, and the labia minora, or inner folds, located under the labia majora.
Mons Veneris
 The mons veneris is a pad of fat tissues over the symphysis pubis.
 It has a covering of coarse, curly hairs, the pubic hair.
 It protects the pubic bone from trauma.
Labia Minora
 The labia minora is a spread of two connective tissue folds that are pinkish in color.
 The internal surface is composed of mucous membrane and the external surface is skin.
 It contains sebaceous glands all over the area.
Labia Majora
 Lateral to the labia minora are two folds of fat tissue covered by loose connective tissue
and epithelium, the labia majora.
 Its function is to protect the external genitalia and the distal urethra and vagina from
trauma.
 It is covered in pubic hair that serves as additional protection against harmful bacteria
that may enter the structure.
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Vestibule
 It is a smooth, flattened surface inside the labia wherein the openings to the urethra and
the vagina arise.
Clitoris
 The clitoris is a small, circular organ of erectile tissue at the front of the labia minora.
 The prepuce, a fold of skin, serves as its covering.
 This is the center for sexual arousal and pleasure for females because it is highly sensitive
to touch and temperature.
Skene’s Glands
 Also called as paraurethral glands, they are found lateral to the urethral meatus and have
ducts that open into the urethra.
 The secretions from this gland lubricate the external genitalia during coitus.
Bartholin’s Gland
 Also called vulvovaginal gland, this is another gland responsible for the lubrication of the
external genitalia during coitus.
 It has ducts that open into the distal vagina.
 Both of these glands secretions are alkaline to help the sperm survive in the vagina.
Fourchette
 This is a ridge of tissue which is formed by the posterior joining of the labia minora and
majora.
 During episiotomy, this is the tissue that is cut to enlarge the vaginal opening.
Perineal Body
 This is a muscular area that stretches easily during childbirth.

 Most pregnancy exercises such as Kegel’s and squatting are done to strengthen the
perineal body to allow easier expansion during childbirth and avoid tearing the tissue.
Hymen
 This covers the opening of the vagina.
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 It is tough, elastic, semicircle tissue torn during the first sexual intercourse.
Menstrual cycle
The entire duration of a menstrual cycle can be divided into four main phases:
1. Menstrual phase (from day 1-5)

2. Follicular phase (From day 1-13)
3. Ovulation phase (Day 14)
4. Luteal phase (from day 15-28)
Menstrual phase
Menstrual phase begins on the first day of menstruation and lasts still the 5th day of the menstrual
cycle. The following events occur during this phase:
 The uterus sheds its inner lining of soft tissue and blood vessels which exits the body
from the vagina in the form of menstrual fluid.
 Blood loss of 10 ml to 80 ml is considered normal.
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 You may experience abdominal cramps. These cramps are caused by the contraction of
the uterine and abdominal muscles to expel the menstrual fluid.
Follicular phase (day 1-13)
This phase also begins on the first day of menstruation, but it lasts till the 13th day of the
menstrual cycle. The following events occur during this phase:
 The pituitary glands secretes a hormone that stimulates the egg cells begins in the ovaries
to grow.
 One of these egg cells begins to mature in a sac-like-structure called follicle. It takes 13
days for the egg cell to reach maturity.
 While the egg cell matures, its follicle secretes a hormone that stimulates the uterus to
develop a lining of blood vessels and soft tissue called endometrium.
Ovulation phase (day 14)
On the 14th day of the cycle, the pituitary gland secretes a hormone that causes the ovary to
release the matured egg cell. The release egg cell is swept into the fallopian tube by the cilia of
the fimbriae. Fimbriae are finger like projections located at the end of the fallopian tube close to
the ovaries and cilia are slender hair like projections on each Fimbria.
31
Luteal phase (15-28)
This phase begins on the 15th day and lasts till the end of the cycle. The following events
occurring during this phase:
 The egg cell released during the ovulation phase stays in the fallopian tube for 24 hours.
 If a sperm cell does not impregnate the egg cell within that time, the egg cell
disintegrates.
 The hormone that causes the uterus to retain its endometrium gets used by the end of the
menstrual cycle. This causes the menstrual phase of the next cycle to begin.
32
IX. LABORATORY STUDY
DATE LABORATORY RESULT NORMAL INTERPRETATION SIGNIFICANCE
VALUES
September Haemoglobin 90 g/L 120-160 g/L The result is below normal  A Low hemoglobin level indicates anemia.
13, 2017 range.
 Hemoglobin findings are even more dependent upon the total
number of RBC's. In other words, for the diagnosis of anemia,
the number of RBC's is as important as the hemoglobin level.
Hematocrit 30.8 vol% 38-47 vol% The result is below normal A low RBC count and low hemoglobin indicates anaemia.
range.  Often used to check for anaemia along with a haemoglobin or as
part of a complete blood count (CBC). The test was used to
screen and diagnose diseases that affect the proportion of the
blood made up of red blood cells (RBCs).
 Help make decisions about blood transfusions or other

treatments if anaemia is severe.
WBC 10.54 5.0-10.0 × The result is slightly above A low white blood cell count (leukopenia) may be caused by a
×109/L 109/L normal range. medical condition, such as an autoimmune disorder that destroys
white blood cells, bone marrow problems or cancer. Certain
medications also can cause white blood cell counts to drop.
33
If your WBC count is higher than normal, you may have an
infection or inflammation. Or, it could indicate that you have
immune system disorder or a bone marrow disease.
Neutrophils 82.8% 50-70% The result is above normal Neutrophils are very important defence against most type of
range. infection. When looking at your risk of getting an infection, doctors
look at the number of neutrophils you have.
Eosinophil 1.2% 2-6% The result is below normal These help cells combat parasites infections. Like basophils and
range. mast cells, they play a role in allergic reactions, asthma, and
fighting parasites pathogens. They also develop in the bone marrow
before moving into your blood.
Basophils 0.5% 0-1% The result is within normal Basophils are granulocytes. This group of white blood cell contain
range. granules full of enzymes. These enzymes are released if an
infection is detected and if an allergic reaction or asthma attack
takes place. They originate and mature in the bone marrow.
Lymphocytes 8.9% 25-40% The result is below normal. These cells are part of your immune system. They attack
pathogens, including bacteria and viruses.
Monocytes 6.6% 3-8% The result is within normal These cells are part of your immune system. They fight infections,
range. help removed damaged tissue, and destroy cancer cells.
9
Platelet count 217 × 10 /L 150-450 × The result is within normal A platelet count that’s lower than normal (thrombocytopenia) or
109/L range. higher than normal (thrombocytosis) is often sign of underlying
medical condition, or it may be a side effect from medication.
Blood type “B” - - -
34
X. DRUG STUDY
DOSE, SIDE
ROUTE EFFECTS
NAME OF CLASSIFICATIO MECHANISM INDICATION CONTRAINDICATIO NURSING
AND AND
DRUG N OF ACTION S NS RESPONSIBILITIES
FREQUENC ADVERSE
Y REACTIO
N
Generic Name:  Antibiotic Dosage:  Second-  Pharyngitis,  Contraindicated in Body as a  Determine history of
CEFUROXIME  Cephalosporin 1-tab 500mg generation tonsillitis, patient’s Whole: hypersensitivity
(second cephalosporin infections of hypersensitivity to Thromboph reactions to
Brand Name: generation) Route: that inhibits the urinary drug lebitis (IV) cephalosporin’s,
ZOLTAX PO (Per cell-wall and lower  Use cautiously in site; pain, penicillin’s and
Orem) synthesis, respiratory patients hypersensitive burning, history of allergies
promoting tracts, and to penicillin because of cellulitis particularly to drugs
Frequency: osmotic skin and skin- possibility of cross- (IM site); before therapy is
BID (twice a instability; structure sensitivity with other super initiated.
day) usually infections beta-lactam antibiotics infections,  Report onset of loose
bactericidal caused by  Use with caution in positive stools
Streptococcus breast-feeding women Coombs’  Absorption of
pneumonia and in patients with test cefuroxime is
and history of colitis or GI: enhanced by food.
Streptococcus renal sufficiency Diarrhea,  Notify prescriber
pyogenes, nausea, about rashes or super
Haemophillus antibiotic- infections
influenza, associated
35
Staphylococc colitis
us aureus, Skin: Rash,
and pruritus,
Escherichia urticaria
coli. Urogenital:
Increased
serum
cretonne
and BUN,
decreased
creatinine
clearance
DOSE, SIDE
ROUTE AND EFFECTS
NAME OF CLASSIFICATIO MECHANISM INDICATION CONTRAINDICATIO NURSING
FREQUENC AND
DRUG N OF ACTION S N RESPONSIBILITIES
Y ADVERSE
REACTIO
N
Generic Therapeutic: Dosage:  Ferrous Sulfate  The  Patients receiving  Large  Store all forms at
Name: Anti-anemics 2-3 mg/kg is an essential prevention or repeated blood doses room temperature.
FERROUS component in treatment of transfusions; anaemia may  Give between meals
36
SULFATE Pharmacologic: Route: the formation iron not due to iron aggravate with water but may
Iron Supplements PO (Per Orem) of hemoglobin, deficiency deficiency. peptic give with meals if
Brand myoglobin and anaemia due ulcer, gastrointestinal
Name: Frequency: enzymes. It is to inadequate regional discomfort occurs.
FERROUS Once a day necessary for diet, enteritis,  Avoid simultaneous
SULFATE effective malabsorption and administration of
erythropoiesis pregnancy, ulcerative antacids or
and transport or and blood colitis. tetracycline.
utilization of loss.  Severe  Do not crush
oxygen. Iron sustained-released
Poisoning preparations.
:  Eggs and milk inhibit
- Vomiting absorption.
- Severe  Monitor serum iron,
abdomina total-iron building
l pain capacity, reticulocyte
- Diarrhea count, hemoglobin,
- Dehydrati and ferritin.
on  Monitor daily pattern
- Hyperven of bowel activity and
tilation stool consistency.
- Pallor or  Assess for clinical
37
cyanosis improvement, record
- Cardiovas of relief of symptoms
cular (fatigue, irritability,
collapse pallor, paraesthesia,
and headache).
DOSE, SIDE
ROUTE AND EFFECTS
NAME OF CLASSIFICATIO MECHANIS INDICATION CONTRAINDICATION NURSING
FREQUENCY AND
DRUG N M OF S S RESPONSIBILITIES
ADVERSE
ACTION
REACTIO
N
Generic  Central Nervous DOSAGE:  Anti-  Relief of  Contraindicates with  CNS:  Assess patients who
Name: System Agent inflammator moderate hypersensitivity to headache develop severe
MEFENAMI  Analgesic Mild to y, analgesic, pain when Mefenamic acid, aspirin , diarrhea and vomiting
C ACID  NSAID moderate Pain and anti- therapy will allergy, and as treatment dizziness for dehydration and
 Antipyretic Adult: PO pyretic not exceed 1 of perioperative pain , electrolyte imbalance.

Brand Loading Dose activities week. with coronary artery somnolen  Be aware that patient
Name: 500 mg related to bypass grafting. ce, may be at increased
PONSTAN, inhibition of  Use cautiously with insomnia risk for CV events, GI
PONSTEL Route: prostaglandi asthma, renal or hepatic , fatigue, bleeding; monitor
PO (Per Orem) n synthesis; impairment, peptic ulcer tiredness, accordingly
exact disease, GI bleeding, tinnitus, - Give with milk or food
38
mechanism hypertension, heart and to decrease GI upset
reaction is failure, and pregnancy ophthalm - Arrange for periodic
not known. lactation. ic effect ophthalmologic
 Dermato examinations during
logic: long-term therapy.
rash,
pruritus,
sweating,
dry
mucous
membran
es, and
stomatitis
 GI:
nausea,
dyspepsi
a, GI
pain,
diarrhea,
vomiting,
constipati
on
39
flatulenc
e, ulcers,
and GI
bleed
 GU:
dysuria,
renal
impairme
nt
 Hematol
ogic:
bleeding,
platelet
inhibition
with
higher
doses,
neutrope
nia,
eosinophi
lia and
leukopen
40
ia.
NAME OF CLASSIFICATIO DOSE, MECHANISM INDICATIONS CONTRAINDICATIO SIDE NURSING
DRUG N ROUTE AND OF ACTION NS EFFECTS RESPONSIBILITIE
FREQUENC AND S
Y ADVERSE
REACTIO
N
Trade Pharmacologic  I.V.: 10-40 Synthetic form Antepartum:  Significant  CV: Before:
Name: class: Posterior units by I.V. of an - to initiate or cephalopelvic cardiac - Assess for
OXYTOCIN Pituitary Hormone infusion in endogenous improve uterine disproportion, arrhythm significant
1000ML of hormone contractions to unfavorable fetal ias, cephalopelvic
Therapeutic Class: intravenous produced in the achieve early positions or PVCs, disproportion,
Uterine-active fluid at a rate hypothalamus vaginal presentations, obstetric HPN, unfavourable fetal
Agent of sufficient and stored in the delivery; emergencies that favor subarach positions or
to control posterior stimulation or surgical intervention, noid presentations,
Pregnancy uterine pituitary; reinforcement of prolonged use in severe haemorrh severe toxaemia,
Category: X atony. stimulates the labor in selected toxaemia, uterine age uterine inertia,
uterus, cases of uterine inertia, hypertonic  Fetal hypertonic uterine
especially the inertia; uterine patterns, effects: patterns, previous
gravid uterus management of induction or fetal caesarean section
just before inevitable or augmentation of labor bradycar - Assess fetal heart
parturition, and incomplete when vaginal delivery is dia, rate
causes abortion; second contraindicated, neonatal - Ensure fetal
41
myoepithelium trimester previous cesarean jaundice, position and size
of the lacteal abortion section, pregnancy low and absence of
glands to Postpartum: (nasal) APGAR complications
contract, which - to produce  Use cautiously with scores During:
results in milk uterine renal impairment  GI: - Infuse via constant
ejection in contractions nausea, infusion pump to
lactating during the third vomiting ensure accurate
mothers. stage of labor  GU: control of rate; rate
and to control postpartu determined by
postpartum m uterine response;
bleeding or haemorrh begin with 1-
haemorrhage age, 2ml/min and
- Lactation uterine increase at 16 to 60
deficiency rupture, min intervals
- Unlabelled use: pelvic - Do not combine in
to evaluate fetal hematom solution with
distress a, uterine fibrinolysis or
(oxytocin hyper heparin
challenge test), tonicity, - Monitor maternal
treatment of spasm, BP
breast tetanic - Monitor neonate
engorgement. contracti for jaundice.
42
on, - Discontinue drug
rupture and notify
of the physician at any
uterus sign of
with hypertensive
excessive emergency.
dosage or After:
hypersen - Educate client on
sitivity the side effects of
 Hyperse the medication and
nsitivity: what to expect.
anaphyla - Document that
ctic drug has been
reactions given.
 Other:
maternal
and fetal
deaths
when
used to
induce
labor or
43
in 1st or
2nd stages
of labor;
afibrinog
emia;
severe
water
intoxicati
on with
seizures
and
coma,
maternal
death
44
DOSE, SIDE
ROUTE AND MECHANISM EFFECTS
NAME CLASSIFICATIO INDICATIONS CONTRAINDICATION NURSING
FREQUENC AND
OF N OF ACTION S RESPONSIBILITIES
Y ADVERSE
DRUG
REACTIO
N
Generic Non-steroidal Anti- DOSAGE  Ibuprofen is a  Management of  Known or history of  GIT  Monitor for and report
Name: Inflammatory Adults: powerful mild to hypersensitivity to ASA irritation promptly S&S of CV
Ibuprofen Drugs (NSAIDs) Ibuprofen prostaglandin moderate pain or any other NSAIDs. and thrombotic events (i.e.,
Arginine arginine synthesis and Patient with previous or bleeding; angina, MI, TIA, or
(FASPIC) 400 inhibitor and inflammation in active peptic ulceration; anorexia, stroke).
Brand mg Film- exerts its conditions e.g., cardiac, liver and renal nausea,  Observe patients with
Name: Coated activity by dysmenorrhea, disease; asthma, vomiting, history of cardiac
Advil, Tablets: 2 – 4 inhibiting its headache urticarial, angioneurotic dyspepsia decompensation closely
Motrin, tablets daily, synthesis including edema or other allergic , gastric for evidence of fluid
Propinal, according to peripherally. migraine, post- reactions; GI bleeding; pyrosis, retention and edema.
IBU the advice of op pain, dental intestinal inflammatory abdomina  Monitor for and report
the physician. pain, disease; severe hepatic l promptly S&S of GI
The maximum  The musculoskeletal and renal failure; SLE disturban ulceration or bleeding.
45
daily dose mechanism of and joint and collagen disease; ce, Significant GI bleeding
must not action of disorders haemorrhagic diathesis diarrhea. may occur without
exceed 1600 ibuprofen (in  Also used to or other coagulation Headache warning.
mg per 24 situ formation reduce fever. alterations. ,  Auditory and
hours. of L-arginine confusion ophthalmologic
salt) is linked , tinnitus examinations are
to the and recommended in patients
reversible somnolen receiving prolonged or
inhibition of ce. Toxic high-dose therapy.
the COX amblyopi  Note: Symptoms of
enzyme, a, blurred acute toxicity in children
responsible vision, include apnea, cyanosis,
for the color response only to painful
conversion of blindness stimuli, dizziness, and
arachidonic . Skin nystagmus.
acid into and  Monitor lab tests:
cyclic hypersens Baseline and periodic
endoperoxyde itivity Hgb, renal function tests,
s, hence reactions, LFTs.
reducing the hematolo
synthesis of gic,
thromboxane hepatic
46
(TXA2), and renal
prostacyclines function
(PGI2) and alteration
prostaglandin s.
s (PG).
DOSE, SIDE
ROUTE AND EFFECTS
NAME OF CLASSIFICATIO MECHANIS INDICATION CONTRAINDICATION NURSING
FREQUENC AND
DRUG N M OF S S RESPONSIBILITIES
Y ADVERSE
ACTION
REACTIO
N
5% Dextrose  Hypertonic DOSAGE:  Hypertonic  Treatment for  Renal failure  Increased  Do not administer
in Lactated  Nonpyrogenic  D5LR is solutions are persons  Heart disease serum unless solution is
Ringer’s  Parenteral fluid supplied in those that needing extra  Dehydration osmolality clear and container is
(D5LR)  Electrolyte single-dose have an calories who  Liver dysfunction  Hypernatr undamaged.
Contents: 500 and effective cannot emia  Caution must be
 Nutrient  Diabetes mellitus
Electrolytes in 1000ml osmolality tolerate fluid  Hypokale exercised in the
replenished  Lactic acidosis
1000ml flexible greater than overload. mia administration of
 Alkalosis
47
Sodium- plastic the body  Treatment of  Hyperkalemia  Altered parenteral fluids,
130mmol containers. fluids. This shock. thermoreg especially those
Potassium-  1000ml @ pulls the ulation containing sodium ion
4mmol 30 gtts/min fluid into the  Pulmonar s to patients receiving
Calcium- or as vascular y edema corticosteroids or
1.4mmol prescribed by osmosis r  Cardiovas corticotrophin.
Chloride- by the esulting in an cular  Solution containing
109mmol physician. increase overload dextrose should be
Lactate- vascular used with caution in
28mmol volume. It patients with known
raises subclinical or
intravascular overt diabetes
osmotic mellitus.
pressure and  Properly label the IV
provides Fluid.
fluid, electrol  Observe aseptic
ytes and technique when
calories for changing IV fluid.
energy.  Check the intravenous
site for any
infiltration and/or
swelling.
48
 Change/transfer IV
sites every three days
to avoid infection.
X1. NURSING CARE PLAN

Assessment Nursing Planning Nursing Intervention Rationale Evaluation
Diagnosis
Subjective: Acute pain related to After 8 hours of nursing After 8 hours of nursing care,
 “Sumasakit right medio lateral care, the client will be  Provide rapport with  To gain trust and full the client:
yung tahi ko episiotomy. able to: the patient cooperation during the  Expressed alleviation
tuwing apat na  Express pain alleviation periods of pain from scale 6/10
oras” as alleviation of pain  Teach different – 3/10
verbalized by from scale of 6 to techniques how to  To aid in alleviation of
the client. 2 alleviate pain pain  Knew and perform
 Pain (Breathing technique) some techniques in
Scale:6/10  To know different alleviating pain
Objective: techniques in  Provide therapeutic
 Facial grimace alleviating pain environment  To assist the level of
49
pain  Comfortably fell asleep
 Slowed  Comfortably fall
movement asleep  Monitor Vital signs
 Vital signs altered
 G2, P2. 4hrs during acute pain
after delivery  Encourage
Verbalization of
 3 stiches feeling  To assess in alleviation
of pain
 Lochia Rubra -  Encourage to do
Moderate diversional activities
 To Alleviate pain
Vital Signs taken as:  Encourage to rest and
 BP – 120/90 sleep
mmHg
T – 36.6 ° C  To regain energy
RR – 19 bpm
PR – 77 bpm
50
Assessment Nursing Diagnosis Planning Nursing Intervention Rationale Evaluation
Subjective: Risk for infection After 8 hours of nursing care,  Provide perineal care  Promotes healing, After 8 hours of nursing
“Kaninang madaling related to lochia and the client will be able to: comfort, and intervention, the client was
araw lang ako episiotomy  Promote perineal Reduce perineal able to:
nanganak at may tahi Short Term: self-care edema.
ako” stated by the  Identify the risk factors
client. that are present  Assess signs and  Patient was free from
 Have partial symptoms of  Fever maybe any signs and
Pain Scale: 6/10 understanding about infection especially secondary to symptoms of
infection control temperature. infection. infection
Objective:  To know the
 Sutures importance of perineal  Keep area around
 VS: BP – hygiene clean and dry  Wet area can be
120/90 lodge for bacteria
mmHg Long term:  Emphasize the  Understand the risk
T – 36.6 °C  Be free from any signs importance of  It serves as the factors of infection
RR – 19 bpm and symptoms related handwashing first line of
PR – 77 bpm to infection technique. defense against
 Weak  Clients full infection.  Expressed alleviation of
appearance understanding to the  Maintain aseptic pain from scale 6/10 –
 Presence of risk factors of infection technique when 3/10
51
Lochia Rubra changing  Promotes fast
dressing/caring for healing and drying
the wound of wound
 Obtain clients  To assess the

baseline Vital Signs effectiveness of
including pain scale the nursing
interventions and
obtain baseline for
future comparison
 Apply ice to the

perineum  Reduce pain
52
Assessment Nursing Planning Nursing Intervention Rationale Evaluation
Diagnosis
Subjective: “Hindi Risk for Constipation After 8 hours of nursing After 8 hours of nursing care,
ako nakakadumi related to recent care, the client will be able  Encourage Increase  This will help moisten the client was able to:
simula kahapon, environmental change to: oral fluid intake the GI tract, that can
namamahay kasi  Feel (2500 – 3000 ml/day. soften stool and can be a  Defecate
ako.” stated by the comfortable stimulant to defecation
client.  Explain the  Feel comfortable
 Defecate importance of  To make the client know
Objective: defecating the importance of  Enumerate the
 Return to defecating importance of
 Vital signs: normal patterns eliminating body waste
PR – 77 bpm of bowel  Auscultate bowel
BP – 120/90 functioning sounds  To know if her bowel
RR – 19 bpm sounds is normal
T – 36.6 ˚c  Encourage patient to
eat high-fiber rich
 No presence foods
of stool on  Fiber rich food promotes
her diaper. the movement of
 Dry lips material through
 Pale digestive system and
increases stool bulk and
help to regain energy
 Advised patient to
perform some
physical exercise
 Exercise can regain

control of muscle and it
can stimulate
contractions of the
intestine thus producing
53
a bowel movement
54
XII. DISCHARGE PLAN
Nursing Order Discharge instruction Rationale

Medication  Instruct to take prescribed  To avoid drug toxicity,
medications (Cefuroxime, ferrous to minimize the effects
sulfate and Mefenamic acid) of the drugs and
 Emphasize the correct dosage, factors that contributes
time and other special instruction to it
or precautions
Exercise  Encourage the client to take a  To strengthen her
daily walk as she got home if her pelvic floor muscles
physician says it’s okay and relieve discomfort
 Repeat 3 to 5 times. caused by episiotomy
 Kegels (pelvic floor exercises)  To promote healing of
 Abdominal strengthening.
the episiotomy
 Abdominal muscle separation.
 Arm and upper back stretch.  Educating the
 Sit-backs. importance of
 Diagonal sit-up (waistline vaccinations ad
exercise)
explaining in simple
 Aerobic activity.
manner about the
 Protect your back.
importance of
vaccinations can
influence the parent to
have an initiative to
go to the health center
ad have their child
vaccinated
Treatment  Teach the proper latch on and  Warm water used to
exclusive breastfeeding
soothe soreness, cold
 Encourage the patient to
breastfeed her baby water to reduce
 Instruct the patient to do Sitz swelling
bath  To reduce swelling
 Advise the patient to use gel pads
 To treat cracked and
or express small amount of
bleeding of the
breast milk and let air dry on
nipples
nipple when sore
 Engorgement of the breast occur,
55
instruct the patient to apply cold
compresses every 3-4 hours for
15-2- minutes as needed
Hygiene  Instruct the patient to perform  To avoid infection
perineal care  To promote proper
 Instruct the patient to change her hygiene
sanitary pads often (every four  To prevent nipple
hours) soreness
 Advice the client to wipe herself
from front to back after going to
the bathroom
 Encourage the patient to take a
daily shower avoiding direct
water spray and soap on nipples
OPD  Advice the patient to go to OPD  For follow u check-up
after 5 days or as recommended  Inforcing follow up
by her physician check-up vaccinations
 Discuss the importance of follow can change the
up check up
behavior of the parent
 Discuss the importance of
vaccinations to be at a health
seeking behavior
back-up with its
importance
Diet  Encourage the client to eat a  To provide body with
nutritious, low-fat and well- the energy it needs
balanced diet  To prevent
 Encourage the client to drink Hemorrhoids
fluids (8 glasses a day)  To prevent
 Encourage the patient to eat 3-6 constipation
servings of fruits, vegetables, and  These foods may
whole grains daily (e.g. banana, cause baby fussiness
avocado, mango, orange, apple and gas
& grapes)  The physician can
 Lean protein, like fish, beef, and advise on how many
soy foods.
calories she need to
 Dairy — choose skim or low-fat
milk. stay healthy and to
 Leafy greens.
maintain a good figure
 Iron, especially if you suffer
from postpartum symptoms. ...
 Vitamin C, which can help with
56
wound healing for mothers who
delivered via C-section.
 Encourage the patient to refrain
from diet
Spirituality  Encourage the patient to pray for  To immense her faith
their good health and strengthen her
belief in God
DOCUMENTATION
57
REFERENCE
58
I. Nurse’s Pocket Guide (Diagnoses, Prioritized Interventions, and Rationales) by
Marilyn E. Doenges, Mary Frances Moorhouse & Alice C. Murr
II. Maternal and child health nursing (care of the childbearing family) by
adelepilliteri- 5th edition Lippincott Williams & Wilkins
III. Drug guide for nurses by Amy M. Karch – 2007 edition Lippincott Williams &
Wilkins
IV. https://www.nursingrib.com
V. https://www.scribd.com
59

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I.

As a sincere appreciation, I, Kate L. Mayuga, a second year Bachelor of Science in Nursing

All those things are gratefully appreciated.

ADDRESS: Brgy. Mauyon, PPC

AGE: 11 years old

EDUCATIONAL ATTAINMENT: Elementary Level (Grade 2)

RELIGION: Roman Catholic

DATE AND TIME ADMITTED: January 9, 2018 at 10:00 am

ATTENDING PHYSICIAN: Dr. A

ADMITTING DIAGNOSIS: T/C Splenic Abcess

INITIAL DIAGNOSIS: Splenomegaly

IV. HEALTH HISTORY

B. Past Health History

C. Family History and Genogram

Father: Mr L 42 yrs. old

Mother: Mrs B 38 yrs. old

1. 1stChild: JP 14 yrs. Old

2. 2ndChild: JRB 11 yrs. Old

3. 3rd Child: PN 7 yrs. Old

STAGE TASK MANIFESTATION

5-12 years old Industry vs. Inferiority

Successful resolution of this stage results in the virtue

Young adults seek companionship and love with other

The young adult must develop intimate relationships or

Young people work on establishing intimate ties to others. Because

“Intimacy achieving relationships with family and marital or

SIGMUND FREUD-Psychosexual Development theory

SIGMUND FREUD THEORY OF PSYCHOSEXUAL DEVELOPMENT

STAGE TASK MANIFESTATION

This theory is through adolescence. He studied the effects of our

JEAN PIAGET-Cognitive Development

JEAN PIAGETTHEORY OF COGNITIVE DEVELOPMENT

The formal operational stage (adolescence – adulthood) - children

PATTERNS OF CLINICAL OTHER SOURCES

 (-) edema result is within normal range.

 He was having his

pithing of water and it pattern of sleep due to

serves as his exercise. uncomfortable

& SPECIAL SENSES  Symmetrical

 No history of visual,  No presence of heavy

auditory and speech earwax and any

 He speaks Tagalog VOICE

 Responds to verbal and

DIVERSION had his meals as well

 He went to church and other mothers at

twice a month together the hospital to at least

with his family alleviate the pain she

 While she was

September 14, Blood 120/90 mmHg 120/90 Within normal range

September 14, Respiration 16-20 bpm 19 bpm Within normal range

September 14, Temperature 60-100 bpm 36.6°C Within normal range

TECHNIQUE NORMAL ACTUAL

HAIR AND SCALP  Inspection  Smooth &  Hair color is

NECK  Inspection  Smooth and  No presence

EYES  inspection  blinking  Eyelashes and

NOSE  inspection  color of the  Color of the

EARS  Inspection  ears of equal  Ears are equal