I.

Introduction

A. Overview of the Case

Health is definitely a significant element of life optimization. If there is something
wrong with our health, all other activities will be disturbed and there is no way we can
optimize our life. Alternatively, by maintaining our health not only we can avoid
something wrong from happening in our body, we can also amplify our liveliness level.
Increased energy intensity means that we will have more vigor to do all our activities
which will in turn increase our output.

Measles is a acute highly communicable infection characterized by fever, rashes

and symptoms referable to upper respiratory tract; the eruption is preceded by about 2
days or coryza, during which stage grayish pecks (Koplik spots) may be found on the
inner surface of the cheeks. A morbilliform rash appears on the 3rd or 4th day affecting
face, body and extremities ending in branny desquamation.Measles is one of the
leading causes of death among young children even though a safe and cost-effective
vaccine is available.

Targeted vaccination campaigns have had a major impact on reducing measles

deaths. From 2000 to 2008 nearly 700 million children aged 9 months to 14 years who
live in high risk countries were vaccinated against the disease. Global measles deaths
decreased by 78% during this period. People who recover from measles are immune for
the rest of their lives.

Having a health complication could be devastating in one’s life. Patient KNE, a

four year old child was being diagnosed with Viral Exanthema Prob. Measles. Seeing a
child experiencing some sickness is so disturbing. Appropriate measures should be
done to the patient to achieve the patient’s optimal health.
B. Objective of the Case

The objective of this study is as follows;

 Learn the disease process of the condition.

 Recognize the different intervention and management applied to the patient.
 Render appropriate health teachings regarding patient’s condition
 Formulate and implement an effective nursing care plan especially designed
for client’s problems as identified in the nursing assessment.

C. Scope and Limitation of the Study

The scop and limitation of the study focuses towards Patient KNE who was
admitted in Polymedic General Hopital. It focuses on the disease process and the
appropriate nursing intervention to be rendered to the patients. It also includes datas
which are essential to the plan of care towards the patient. Confidentiality is highly
observed for patients safety.
II. HEALTH HISTORY
PATIENT’S PROFILE

Name: Patient KNE

Date of Birth: December 9, 2005

Age: 4 years old

Gender: Female

Weight: 13.5 kgs

Height: 123 cm

Religion: Baptist

Nationality: Filipino

Address: Zone 1, Patag, Camp. Evangelista, Cagayan de Oro City

Mother: Mrs. AE

Father: Mr. FJE

Heredo-familial desease:

Maternal : Asthma

Paternal : None
CLINICAL/ADMITTING DATA

Date and Time Admitted: August 22, 2010; 06:15 pm

Admitting Diagnosis: T/C Acute Bronchitis and hyperpyrexia

Admitting Physician: Dr. Petilla

Chief Complaint: Cough and Fever

Admitting Diagnoses: Exanthema Prob. Measles

Admitting Physician: Dr. Lorna Tabasuares / Dr. Joy Diola

HISTORY OF PRESENT ILLNESS

This is a case of Patient KNE, 4 years old, female, in due to fever and rashes. Admitted
for the first time this year. Six days prior to admission, onset of low grade fever with
cough and colds. 4 days prior to admission severe rashes was noted. 3 days prior to
admission, fever persisted associated with rashes on face which progresses down to
trunk and extremities.
III. Developmental Data

Freud’s Stages of Psychosexual Development

Freud believed that we develop through stages based upon a particular erogenous
zone. During each stage, an unsuccessful completion means that a child becomes
fixated on that particular erogenous zone and either over– or under-indulges once he or
she becomes an adult.

Phallic Stage (ages three to six). The pleasure zone switches to the genitals. Freud
believed that during this stage boy develop unconscious sexual desires for their mother.
Because of this, he becomes rivals with his father and sees him as competition for the
mother’s affection.

Implication:

For the time span of my nursing care to patient KNE, I had noticed that my patient was
more closed to her father. She obeys more orders from her father than her mother.
But, nevertheless, Patient KNE loves both her parents.

Erikson's Theory of Psychosocial Development.

Where Freud looked at ways that mental illness develops, Erikson looked at actions that
lead to mental health and describes eight stages across a life span. At each stage there
is conflict between two opposing forces.

Preschooler - Initiative vs. guilt - Learning initiative is learning how to do things.

Children can initiate motor activities of various sorts on their own. Giving freedom &
opportunity to initiate motor play i.e. running, bike riding, sliding, wrestling, or play with
materials such as finger paints, sand, water & modeling clay; Parent's answering
questions; Not inhibiting creative or fantasy play, all enforce their sense of initiative.

Implication:

Children at this age are becoming more aware of themselves as individuals. They work
hard at "being responsible, being good and doing it right." They are now more
reasonable to share and cooperate. Patient KNE was eager to learn new things despite
of having some sickness. She shares her toys and things to her sisters as well.

Piaget's Theory of Cognitive Development

Stage Characterized by

Pre-operational Learns to use language and to represent objects by images and words
(2-7 years)
Thinking is still egocentric: has difficulty taking the viewpoint of others

Classifies objects by a single feature: e.g. groups together all the red blocks
regardless of shape or all the square blocks regardless of color

Implication:

In Piaget’s Theory of Cognitive Development my patient falls in pre-operational stage.

My patient loves to talk and loves to learn something new. Though she doesn’t
understand everything yet, she still listen and asks questions to help her understand the
situation. But sometimes she doesn’t listen on whatever you say, it depends on her
mood .

Kohlberg's Theory of Moral Development

Is a theory on moral reasoning or the way that children gain knowledge of right and
wrong. Recognizing these stages can help identify how a child may feel about their
illness & whether the child can be depended on to carry out self-care activities such as
self-administered medicine.

• Preconventional (Level I) About 2-7 years old

o Infants - have little concept but they do learn that when they do certain
actions, parents give affection and approval.
o Toddlers - reason for doing the 'right thing' is centered most strongly in
mother or father 'saying so', rather than spiritual or societal motivation.
However, they may not obey requests from people other than their parents
as they do not view their authority at the same level (may be necessary for
parents to reinforce instructions).
 o Preschoolers - tend to 'do good' out of self-interest rather than out of true
intent to do good or because of a strong spiritual motivation.\
Implication:

Patient KNE falls in the Preconventional stage. This is very much true in my patient.
She follows the instructions of her parents to avoid being scolded. She also does things
to get rewarded like having new toy or food. However, she follows the nurses and her
person older than her beside from her parents.