NCM 107

Porfolio in
NCM 107
Submitted by:
JAN RAE B. ATIENZA
Submitted to:
MARK DENVER V. MANUEL
NCM 107
Jan Rae B. Atienza 2A
Unit 2 Activity
1. What are the hormones involved in the process of menstruation
and discuss how these affect the menstrual cycle?
Everything starts out with the Hypothalamus producing Gonadotropin Releasing Hormones
(GnRH) which then signals the Anterior Pituitary Gland to secrete gonadotropin hormones:
Follicle Stimulating Hormones (FSH) and Lutenizing Hormones (LH). Physiologically,
women have a lot of follicles in their ovaries, and some of these follicles will mature into
primary follicles because of the stimulation of FSH and as they mature further as a
secondary follicle, they produce the hormone Estrogen—the hormone responsible for the
endometrium growth.
In early stages, Estrogen only exists in low concentrations which provides a negative
feedback that inhibits the release of LH. However, as more follicles mature, more Estrogen
are produced and eventually in higher concentrations, it provides a positive feedback that
stimulates the secretion of LH.
With the rise in levels of LH, ovulation of only the most mature follicle in the ovary occurs,
and this releases what we call the oocyte. After ovulation, the follicle turns into a corpus
luteum and slowly degrades while secreting the following hormones: Estrogen, Inhibin,
and Progesterone. First off, Inhibin inhibits the secretion of FSH which then halts the
maturation of more follicles. Meanwhile, Progesterone by itself inhibits the GnRH (which
also halts the secretion of FSH and LH); along with Estrogen however, they stimulate
endometrial growth—which is the lining in the uterus that sheds off each month if not
implanted by a fertilized oocyte.
The cycle restarts itself as the corpus luteum completely disintegrates because Estrogen,
Inhibin, and Progesterone levels will drop, and GnRH will once again signal the Anterior
Pituitary Gland to secrete FSH and LH.
2. Give two kinds of contraception and explain its procedure.

Intrauterine Device (IUD) – These are T-shaped plastic devices that fit inside the uterus;
they are either fitted with copper, or progestin. Before the insertion, pelvic examination,
pregnancy test, and tests for STIs and cervical cancer are usually performed.
They are inserted by health professionals like doctors and midwives—usually, the health
care providers will first measure the dimensions of the uterus with if the IUD can fit and
then insert a speculum into the vagina to be able to clean the vagina and cervix with an
antiseptic solution. The IUD is inserted with its arms folded down using an applicator tube
and then released into the uterus. The client might need to take pain reliever before the
procedure in order to counteract the discomfort and possible cramping that ensues
afterwards.
The copper IUDs (commonly, Paragard) can last upto 10 years and prevents pregnancy as
copper is toxic to sperms and eggs. Meanwhile, the hormonal IUDs (progestin) lasts upto
5 years and prevents pregnancy by preventing the release of ovum, thickening the
cervical mucus to prevent the passage of sperm cells, and thinning the uterine lining to
prevent implantation if fertilization does occur.
Barrier Methods – Perhaps the most common type of barrier method is the male condom,
it works by encasing the male genitalia in a latex barrier that prevents sperm from getting
released into the vagina. There is also a female condom that is inserted in the female
genitalia that acts as a safety net like the male condom. Both of these protects against
Sexually Transmitted Diseases.
There are also what we call Cervical Caps and Diaphragms that also blocks sperm,
although at the cervix. These are usually used in conjunction with chemical barriers such
as Spermicides, Contraception Sponges, and Contraceptive Vaginal Suppositories as these
chemical barriers works by killing off sperm.
3. In your own opinion what is a responsible parenthood.

It is where both parents are mentally, emotionally, and financially stable enough for child
conception and child rearing in the future while also realizing their limits as parents.
Furthermore, this also involves proper planning as to how the parenthood and marriage
will pan out in the future based on past events and current trends.
NCM 107
Jan Rae B. Atienza 2A
Unit 4 Part 2 Activity

1. Discuss what are the nutritional requirements and assessment for
antenatal care?
-A pregnant woman will need to meet the nutritional needs for herself and
the baby within her, and thus would need 1,800 to to 2,400 cal/day.
Furthermore, iron requirements would increase as the pregnancy progress
and would require sufficient iron intake from iron-rich foods such as lean
meat and liver. Iron and folic acid supplements should also be given in
conjunction to iron-rich diet. Generally, calorie and iron intakes are closely
monitored but Protein, Fat, Fluid, Fiber, Vitamins & Minerals are just as
important.
-Antenal assessment includes a 1.) Comprehensive history taking: Personal
Data, Menstrual History, Medical History, Obstetrical History 2.) Computation
of Gestational Age 3.) Assessment of Fundic Height 4.) Laboratory
examination 5.) Oral-dental examination 6.) Physical examination
2. Discuss what nursing interventions to manage for malnutrition

during pregnancy
- Determine the weight while factoring in weight gain or loss depending on
the AOG.
- Refer to a dietitian in order to obtain a thorough nutrition assessment.
- Provide appropriate supplements based on nutritional needs.
3. Enumerate the different types of lochia and define each.
a) Lochia Rubra – this is the discharge that comes first after giving birth;
mainly composed of blood, epithelial cells, and decidua.
b) Lochia Serosa – occurs on 3rd to 10th day after delivery when most discharge
has thinned out and eventually turned brownish or pinkish in color.
c) Lochia Alba – after lochia serosa, this is the discharge that’s whitish to
creamy yellowish in color. Still contains decidua and epithelial cells but has
no odor at all.
4. You identify factors affecting labor and deliver.
a.) Passenger – the position, size, and the presentation of the fetus
b.) Birth Canal – fetopelvic diameter and parity of the pregnant woman
c.) Contractions – the force and frequency of uterine contractions
d.) Placenta – the site of implantation
e.) Mental state – psychological state of the pregnant woman
5. Discuss the first and second stage of labor

The first stage begins when there’s a perceived regular uterine contraction—
these are usually mild and short, lasting 20 to 40 seconds. While second stage
is when there’s a complete cervical dilation and there’s an urge to push down
the baby to the birth canal
6. Discuss the fourth stage of labor
This is when the baby is already born and delivered and nursing right after
birth is suggested to help with the uterus contractions and minimize further
bleeding.
7. Describe placental separation/type of expulsion
-Is when the placenta separates prematurely from the uterus. This usually
leads to the placenta folding itself and presenting at the vaginal opening.
8. Identify Nursing Interventions to high risk pregnancy
a.) Encourage the development of Rubins task (learning to give of oneself on
behalf of the child) by acknowledging the woman’s sacrifices and
providing positive reinforcement for her effort to protect the fetus.)
b.) The nurse clarifies information about the high-risk conditions, treatment
options, test results, and possible outcomes to help the family
c.) Encourage the woman to participate in care and decision making.
d.) Encourage the woman to continue some of her family roles.
e.) The woman and her family continue to prepare to give birth and become
parents thru childbirth education and parenting information.
f.) Encourage family support and care throughout the entire pregnancy.
9. Causes, Risk factor, Signs and Symptoms, Laboratory Test, Types,

Stages of Cervical Cancer
- Typically caused by human papillomavirus (HPV) contracted from sexual
intercourse with an infected individual.
- Risk factors include sexual intercourse at a young age, multiple sexual
partners, cigarette smoking, and having weakened immune system.
- Symptoms include irregular vaginal bleeding or bleeding right after
intercourse. Although they might only occur during later stages when the
cancer has metastasized.
- They can be detected via pap test, HPV test, or Biopsy
- Stage 1 is when the cancer is only within the cervix, and when it has spread
to nearby regions like the upper part of vagina it is Stage 2. It has
progressed into stage 3 when the cancer has spread throughout the pelvis
or have caused kidney to malfunction. Stage 4 is when it has metastasized
into distant organs.
10. Differentiation between normal fetal heart rate and abnormal
fetal heart rate
- Normal FHR reads 110 to 160 bpm, with accelerations but no decelerations.
FHR that’s below 110bpm is considered bradycardia while FHR above 160 is
tachycardia.
In Partial Fulfillment of the Requirement for the
Clinical Duty
CASE ANALYSIS
Submitted By:
Ariola, Mary Kathleen M
Atienza, Jan Rae B.
Bongalao, Michaella I.
Buscato, Cj R.
SN’23
Submitted To:
Archito L. Dela Cruz, MAN, RN
Clinical Instructor
CHAPTER
Overview
The first chapter of this case analysis focuses mainly on the purpose as to
why this case analysis is done. Furthermore, it also presents the relevant
background info regarding the case being discussed and the patient history. Lastly,
it also discusses the findings of the cephalocaudal physical assessment of the
patient.
General Objective
This study aims to provide student nurses and other Health Care
professionals with an overview of the patient’s condition, possible complications,
treatment plan, and medical & nursing intervention.
Specific Objectives
Specifically, this case analysis aims to:
 Present a thorough general assessment of the client which includes physical
assessment and family history
 Understand the pathophysiology and etiology of the case being presented.
 Appropriately apply nursing interventions necessary for the patient’s
condition in reference with the learned theories and concepts of the disease.
Introduction
Pregnancy related low back pain (LBP) is a common complaint among
pregnant women. It can potentially have a negative impact on their quality of life
(Katonis et al., 2011). Various explanations on the pathophysiology leading to LBP
in the antenatal period have been advocated, these includes possible weight gain
coupled with the weight of the baby, posture changes to accommodate the weight,
and hormonal changes that loosen up the ligaments.
While LBP wouldn’t be a major concern during pregnancy, respiratory
diseases on the other hand may pose a potential threat during pregnancy.
According to John Hopkins Medicine, people who smoke increases their risk of lung
diseases such as chronic and acute bronchitis, emphysema, and asthma.
The airways in a person with asthma are very sensitive and can react to
many things, or "triggers." Coming into contact with these triggers often produces
asthma symptoms. Tobacco smoke is a powerful asthma trigger. Furthermore,
cigarette smoking is the number one risk factor for developing chronic bronchitis
because smoking damages the bronchial tree which makes it easier for viruses and
bacteria to cause infection.
During pregnancy, respiratory diseases such as asthma significantly
increases the risk of preeclampsia based on the 2017 research done by J.
Stokholm, A. Sevelsted, U. Anderson, and H. Bisgaard. This problem may lead to

the increase the risk of restricted fetal growth, premature birth, and the need of C-
section during delivery.
References
Hopkins, J. (n.d.). Bronchitis. Retrieved from Hopkins Medicine:
https://www.hopkinsmedicine.org/health/conditions-and-diseases/bronchitis
Katonis, P., Kampouroglou, A., Aggelopoulos, A., Kakavelakis, K., Lykoudis, S.,
Makrigiannakis, A., & Alpantaki, K. (2011). Pregnancy-related low back pain.
HIPPOKRATIA, 1.
Stokholm, J., Sevelsted, A., Anderson, U. D., & Bisgaard, H. (2017). Preeclampsia
Associates with Asthma, Allergy, and Eczema in Childhood. National Library of
Medicine.

CLIENT PROFILE
Name of Patient: X
Sex: Female
AOG: 37 6/7 weeks
Blood Type: O+
Date of Admission: August 24, 2020
Admitting Diagnosis: Lumbo-sacral pain
Address: Acropolis North, Sumacab, Cabanatuan City

Birth date: February 14, 2004
Place of Birth: Cabanatuan City
Educational Level: Highschool Level
Occupation: Student
Age: 16-year-old
Religion: Roman Catholic
Marital Status: Married
Siblings: None
Family History
Upon taking the history of the family, it was discovered that the mother’s
side of the patient has a history of Asthma, in which the mother turned out to
have Hypertension as well. Meanwhile, the patient’s father was a frequent smoker
and died due to lung cancer.
Family Genogram
Figure 1. Genogram of the Patient

OB/Gyne History
Patient is a G2P0 PU 37 6/7 weeks upon admission on August 24, 2020. First
pregnancy was an ectopic pregnancy which had to be surgically removed for
health reasons. LMP was December 3, 2019 and EDD is on October 10, 2020.
Admitting History
Two days prior the admission, the patient was initially experiencing a
recurring lumbosacral pain. Then the next day, the pain was accompanied by
frequent coughs with wheezing sounds
Status of Present Illness
Patient’s chief complaint since August 22, 2020 was a recurring Lumbo-
sacral pain, exacerbated by physical activities and alleviated through pain
medications. Using a pain scale of 1(barely noticeable) to 10 (worst pain), patient
described the pain as 8 and enough to keep her awake through the night.
On August 24, 2020, after admission, patient began having deep coughs
that can often bring about discolored sputum, along with the difficulty of
breathing. Patient displayed elevated Pulse Rate, Respiratory Rate, and Blood
Pressure. Furthermore, Complete Blood Count of the patient revealed elevated
WBC count, particularly Neutrophils, which indicates a high possibility of bacterial
infection and was later revealed as an acute bronchitis after a chest x-ray.
Nutrition and Metabolic Pattern
Usual Food Intake
Client usual food intake are high in carbohydrates such as rice, cereals,
breads and pasta, high in proteins such as pork, beef, chicken meats, fish, eggs
and she also intakes fruits and vegetables.
Food Restrictions
Client is on NPO as per doctor’s order.
Food Allergies
Client has no food allergies.
Problem with Ability to Eat
Client has no problem with ability to eat.

Supplements (Vitamins) and Other Medications taken by client
Client stated that she takes Multi-vitamins that contains Sodium ascorbate
(Vitamin C), Calcium, Zinc Sulfate, Pyrodoxine Hydrochloride (Vitamin B6),
Thiamine Mononitrate (Vitamin B1), Riboflavin (Vitamin B2), Cyanocobalamin
(Vitamin B12) and Cholecalciferol (Vitamin D3)to boost her immune system.
Elimination Pattern
Bowel Habits
The client’s bowel elimination pattern is normal, as evidenced by one to

three formed, soft and brown stool. The client states that she has no pain or
cramping. Weight remains stable. Skin remains intact with no signs of redness or
excoriation.
Bladder Habits
The client usually voids four to five times a day with yellowish urine output.
The urine output does not exceed the fluid intake.
Activity and Exercise Pattern
0 1 2 3 4
Eating /
Bathing /
Dressing /
Toileting /
Bed Mobility /
Transferring /
Ambulating /
Stairs /
Shopping /
Cooking /
Home /
Maintenance
Table 1. Self-Care Ability
0 – Independent
1 – Assistive
2 – Assistive from Others
3 – Assistance from person and equipment
4 – Dependent/Unable
The table shows the self-care ability of the client which ranges from 0-4. 0
for having an independent state, 1 for assistance, 2 for having assistance from
others, 3 for having assistance from person and with the use of equipment and
lastly, 4 for being in the dependent state. The client needs assistance and in some
aspect she requires assistance from people and equipment and experience a
dependent state.
Usual Daily Activity and Exercise
The client usually stays at home and has a bad habit of smoking 1 ½ packs
of cigarette per day and a moderate drinker of alcohol. For the past 2 days, she’s
experiencing the on and off lumbo-sacral pain.
Limitations to Physical Activities
The client is limited in performing strenuous activities that requires heavy

lifting and overuse of joints. Whenever she’s feeling the pain she will immediately
stop whatever she’s doing and just rest for a while.
Cardiovascular
The client is observed to have an elevated pulse rate and blood pressure. A
pulse rate of 108bpm and a blood pressure of 140/100mmHg is considered
abnormal during pregnancy. The elevated results of the vital signs will be referred
to the physician in charge.
Respiratory
The observed respiratory rate of 25cpm for a pregnant woman exceeded the
normal range and is considered abnormal. The client manifested slightly shallow,
quick and labored respirations. She also states having an “air hunger” or dyspnea.
Sleep and Rest Pattern
The client showed insufficient sleep in relation to the pain felt in the lumbar-
sacral pain and she also stated she was having difficulty sleeping due to
overthinking.
Cognitive and Perceptual Pattern
The client was able to comprehend what was explained to her, well aware and
her sensory functions were equally able as she had described her pain.
Self-Perception and Self-Concept
The client perceived herself as scared, tense, and anxious about her sudden
pregnancy.
Roles and Relationship
According to and verbalized by the client, she suffers emotional distress in

pregnancy, she felt empty, in shock, and most of the time blames herself but she
doesn’t want to abort the baby. She also stated that she detached herself from
other people to avoid them.
Sexuality and Reproductive
The client stated that she was sexually active, but she was not properly
educated and doesn’t have enough knowledge about the reproductive system.
Coping and Stress Tolerance
As stated by the client, even though she has emotional distress she still does
her best to take care of the baby but most of the time the client handled stress
through drinking and smoking.
Vital Signs
Fetal
Date and Blood Respiratory Pulse
Temperature Heart IE
Time Pressure Rate Rate
Rate
08-24-2020
130/90mmHg 37C 28cpm 110bpm 142bpm 2cm
8:00 AM
08-24-2020 140/100mmH
37.4C 25cpm 108bpm 155bpm 6cm
12:00 NN g
Table 2. Vital Signs
Upon admission, the patient was already displaying elevated pulse rate and
respiratory rate. Meanwhile, the Blood Pressure increased into above normal levels
four hours after admission. It should also be noted that IE revealed only 2cm
dilation at 8AM but further increased into 6cm at 12NN.
Height and Weight
The patient was measured 150cm from head to toe using a tape measure
and weighted with a mechanical weighing machine which read 48kg.
Body Mass Index

The BMI was taken by diving the weight in kg by the height in meters
squared. The result showed that the client has a normal BMI for a 16-year-old.
48 kg
=21.3
( 1.5 )2
PHYSICAL ASSESSMENT
Head to Toe Physical Assessment
BODY PARTS TYPE OF NORMAL ACTUAL RESULT
ASSESSMENT FINDINGS FINDINGS
Rounded The head of No

(normocephalic the client is
and symmetric, rounded; abnormalities
Inspection with frontal, normocephalic
SKULL and parietal, and and
Palpation occipital symmetrical.
prominences);
smooth skull There are no
contour nodules or No
masses and
depressions abnormalities
when
palpated.
Evenly Evenly
HAIR & SCALP distributed hair distributed No
hair.
Inspection Thick hair With short, abnormalities
and black and
Palpation Silky, resilient shiny hair.
hair
No presence No
No infection or of infestation.
infestation abnormalities
FACE Symmetric or No
Inspection slightly The face of abnormalities
asymmetric the client has
facial features; symmetric
palpebral features and No
fissures equal in appeared abnormalities
size; symmetric smooth and
nasolabial fold has uniform
consistency.
No presence
No edema of nodules or
masses.
External The client’s

Features eyebrows are No
Hair evenly symmetrically abnormalities
distributed; aligned and
EYES skin intact showed equal
Eyebrows movement
symmetrically when asked to
Inspection aligned; equal raise and
movement lower
eyebrows.
No
Equally Eyelashes abnormalities
distributed; appeared to
curled slightly be equally
outward distributed
and curled
Skin intact; no slightly
discharge; no outward.
discoloration
No
Lids close There are no abnormalities
symmetrically presence of
Approximately discharges,
15 to 20 lids close
involuntary symmetrically
blinks per with No
minute; involuntary abnormalities
bilateral blinks
blinking When approximately
lids open, no 15-20 times
visible sclera per minute.
above corneas,
and upper and
lower borders The Bulbar
of cornea are conjunctiva
slightly covered appeared No
white color abnormalities
Transparent; few capillaries
Inspection capillaries evident.
sometimes
evident; sclera
appears white The sclera No
(darker or appeared abnormalities
yellowish and white
with small
brown macules
in dark-skinned The palpebral No
clients) conjunctiva abnormalities
appeared
Transparent, shiny, smooth
shiny, and and pink
smooth; details
of the iris are
visible In older There is no
people, a thin, edema or No
grayish white tearing of the abnormalities
ring around the lacrimal gland
margin, called
arcus senilis,
may be evident Cornea is
transparent,
Black in color; smooth and
equal in size; shiny and the
normally 3 to 7 details of the
mm in iris are visible. No
diameter; The client abnormalities
round, smooth blinks when
border, iris flat the cornea
and round was touched.
When looking
straight ahead, The pupils of
client can see the eyes are No
objects in the black and abnormalities
periphery equal in size
Temporally,
Inspection peripheral
objects can be
The client can
seen at right
see objects in
angles (90°) to
the periphery
the central
when looking
point of vision.
straight
The upward
ahead.
field of vision is
normally 50°, No
because the abnormalities
orbital ridge is
in the way. The
downward field
of vision is
normally 70°,
because the
cheekbone is in
the way.
Both eyes of
Extraocular
the client
Muscle Tests
coordinately
Both eyes
moved in
coordinated,
unison with
move in unison, No
parallel
with parallel abnormalities
alignment.
alignment
Patient was
Light falls
able to read
symmetrically
the newsprint
(e.g., at “6
at a distance
o’clock” on both
of 8 inches
pupils)
No
Uncovered eye abnormalities
does not move
Able to read
newsprint
Auricles Client’s color
Color same as of the auricles
facial skin. is same as
Symmetrical facial skin, No
Auricle aligned symmetrical, abnormalities
with outer auricle is
EARS canthus of eye, aligned with
about 10°, from the outer
vertical canthus of the
eye, mobile,
Mobile, firm, firm, non-
Inspection & and not tender; tender, and
Palpation pinna recoils pinna recoils
after it is folded after it is
Gross Hearing being folded.
Acuity Tests No
Normal voice abnormalities
tones audible
Able to hear
Able to repeat ticking on
the phrases right ear at a
correctly in distance of
both ears one inch and
was able to
Sound is heard hear the
in both ears or ticking on the
is localized at left ear at the
the center of same
the head distance.
(Weber
negative)
Lips And
Buccal
Mucosa Client’s lips
Uniform pink are
color (darker, symmetrical
MOUTH Inspection e.g., bluish hue, has dark With
in brown color abnormalities
Mediterranean lips, brownish
groups and gums and
darkskinned gum stains
clients) Soft, and able to
moist, smooth purse lips.
texture With
Symmetry of abnormalities
contour. Ability
to purse lips
With dental
Teeth And caries, yellow-
Inspection Gums stained teeth
and Pink gums and decayed
Palpation (bluish or lower molars
brown patches
in dark-skinned No
clients) Moist, abnormalities
firm texture to Moves when
gums asked to
move without
No retraction of difficulty and
gums without
tenderness
Tongue/Floor upon
Of The Mouth palpation.
Inspection Central position

Pink color
(some brown
pigmentation
on tongue
borders in dark-
skinned No
clients); moist; abnormalities
slightly rough; Central
thin whitish position, pink
coating but with
Smooth, lateral whitish
margins; no coating which
lesions Raised is normal,
papillae (taste with veins
buds) prominent in
Tongue moves the floor of
freely; no the mouth
tenderness No
abnormalities
Smooth tongue
base with
prominent veins
Palates And
Uvula Client’s uvula
Positioned in positioned
midline of soft midline of soft
palate, rises plate
during
vocalization
Muscles equal The neck

in size; head muscles are No
centered equal in size. abnormalities
Coordinated, The client
smooth showed
movements coordinated,
with no smooth head
Inspection & discomfort movement
NECK Palpation with no
discomfort. No
abnormalities
Lymph Nodes The lymph
Not palpable nodes of the
client are not No
palpable. abnormalities
Trachea
Central The trachea is
placement in placed in the
midline of neck; midline of the
spaces are neck.
equal on both
sides The thyroid
gland is not No
Thyroid Gland visible on abnormalities
Not visible on inspection and
inspection the glands
ascend during
swallowing
but are not
visible.
Symmetric The chest wall

chest shape. is intact with No
no tenderness abnormalities
Normal chest and masses.
shape, with no There’s a full
Inspection, visible and
CHEST Palpation, deformities, symmetric
Percussion & such as a chest expansion and
Auscultation barrel kyphosis, the thumbs
or scoliosis separate 2-3
cm during
deep
inspiration
when
assessing for
the
A regular respiratory With
respiratory excursion. abnormalities
rhythm, with
expiration
taking about The client
twice as long as manifested
inspiration slightly
shallow, quick
and labored
A respiratory respirations. With
rate of 12-20 in abnormalities
an adult
A respiratory
rate of of 25
cpm
Posterior Chest
Inspection, Thorax and symmetrical
THORAX/LUNG Palpation, Anterior Spine No
S Percussion & Thorax vertically abnormalities
Auscultation Anteroposterior aligned, spinal
to transverse column is
diameter in straight, left
ratio of 1:2 and right
Thorax shoulders and
symmetric hips are at the
Spinal column same height.
is straight, right
and left
shoulders and With
hips are at Wheezing abnormalities
same height. breath
Skin intact, sounds.
uniform Client
temperature experiencing
“air hunger”
Quiet, or dyspnea.
rhythmic, and
effortless
respirations
Full and
symmetric
thorax
expansion
Unblemished Unblemished No
skin skin abnormalities
Uniform color
Inspection
The fundus
ABDOMEN Flat, rounded shape of the
(convex), or client is
scaphoid normal to the No
(concave) gestation abnormalities
weeks.
Both
extremities are
The
equal in size.
Have the same extremities
contour with are
prominences of symmetrical No
EXTREMITIES Inspection joints. in size and abnormalities
and length.
No edema,
Palpation
Color is even.
Without scars
on both
extremities.
Can perform
complete range
With
of motion.
abnormalities
No crepitus
Compressing
must be noted
nerve roots
on joints.
causing Lower
Can counteract
back pain
gravity and
resistance on
ROM
Skin is uniform
in color,
Client’s skin
unblemished
SKIN color is With
Inspection and no
yellowish and abnormalities
and presence of any
dry
Palpation foul odor. Good
skin turgor and
skin’s
temperature is
within normal
limit
Pubic skin is No lesions and No
intact, no the skin is abnormalities
lesions intact
Skin of vulva
Membranes
area slightly
Inspection ruptured and
GENITAL AREA darker than the
and leaking clear
rest of the With
Palpation fluid, Fetal
body.Labia baseline is abnormalities
round, full and 150 with
relatively minimal
symmetric in variability and
adult females. moderate
No enlargement variable
or tenderness decelerations
Table 3. Physical Assessment
Upon interpretation, there were no significant findings found on the skull,

HAIR & scalp, face, eyes, ears, neck, abdomen, and extremities as they are
normal. On the actual findings and results on the chest, the client manifested
slightly shallow, quick and labored respirations and in her thorax the client findings
are wheezing breathing sound and experiencing dyspnea. The client's lower back
pain was located in extremities and also due to smoking the client's skin is dry and
yellowish. Lastly, the genital area has no abnormalities but because the client is
currently in labor her actual findings showed membranes ruptures, leaking clear
fluid, with minimal variability and moderate variable decelerations.
CHAPTER II
CASE DISCUSSION AND PRESENTATION
Overview
This chapter is reffered to the case discussion and presentation regarding
this case study about having an acute bronchitis during pregnancy. This chapter is
composed of the definition, anatomy and physiology, pathophysiology, clinical
manifestations, risk factors, causes of the disease, medical management, nursing
management and the preventive measures.
Definition
Bronchitis is known as the transient airway inflammation confine to the
respiratory mucosa of the central airways and clinically characterized by cough and
sputum production. Having inflammation in our airways causes the difficulty of
breathing and infection in the mucous membrane causes to develop an extra
mucous which hindering the bronchi to purify themselves. During pregnancy, the
pregnant woman is usually susceptible to different common illness due the
changes in their immunity so catching a cold or flu may cause a longer effect on
them.
Acute tracheobronchitis is an acute self-limiting inflammation of the mucous

membranes of the trachea and the bronchial tree, often follows infection of the
upper respiratory tract. It is the reason for 10% of all clinical visits and 100 million
ED visits per year. A patient with a viral infection has decreased resistance and
can readily develop a secondary infection. Most acute bronchial infections are
caused by the viruses and bacterias. Also some come from the inhalation of the
physical and chemical irritants, gases, air contaminants, chronic sinusitis and
asthma that serves as an stimulant to have an acute bronchial irritation. The
adequate treatment of the upper respiratory tract infection is one of the factors in
order to prevent having an acute bronchitis.
(Smeltzer, S. C., & Bare, B. G. (2003). Brunner and Suddarth's textbook of

medical-surgical nursing. 10th ed (10th ed.). Lippincott Williams &
Wilkins.)
Anatomy and Physiology
Figure 2. Respiratory System

(Image Source: adapted from iStock Photos)
The
respiratory system is divided into two parts: upper respiratory tract and lower
respiratory tract. These tracts are reponsible for the ventilation or the movement
of the air in and out of the airways. The upper respiratory tract is consists of nose,
paranasal sinuses, conchae, pharynx, adenoids, tonsils, larynx and trachea. While,
the lower respiratory tract includes:lungs, pleura, mediastum, lobes, bronchi and
brionchioles and alveoli. The upper respiratory tract is responsible in warming and
filtering the air inorder for the lower respiratory tract (the lungs) to execute or
accomplish the gas exchange. Gas exchange involves delivering oxygen to the
tissues through the bloodstream and expelling carbon dioxide through expiration.

Wilkins.)
Anatomy of the Upper Respiratory Tract
The upper respiratory tract is consists of nose, paranasal sinuses, conchae,
pharynx, adenoids, tonsils, larynx and trachea.
 Nose – The nose serves as a passageway in which air enters into and exits
from the body. It simply filters the impurities and humidifies and warms the
air as it is inhaled. Also, it is composed of the external and internal portion
and responsible for olfaction.
 Paranasal Sinuses - The paranasal sinuses include four pairs of bony

cavities that are lined with nasal mucosa and ciliated pseudostratified
columnar epithelium. These air spaces are connected by a series of ducts
that drain into the nasal cavity. It serves as a resonating chamber in speech
and known as the common site of infection.
 Conchae - Conchae or turbinate bones has shell-like appearance. These

curves increases the mucous membrane surface of the nasal passages and
slightly obstruct the air flowing through them.
 Pharynx – The pharynx or throat is a tube-like structure that connects the

nasal cavity and oral cavity to the the back of the mouth to other structures
lower in the throat including the larynx. It is divided into three parts:
nasopharynx (connects the upper part of the throat with the nasal cavity),
oropharynx (positioned between the top of the epiglottis and soft palate) and
laryngopharynx (located below the epiglottis). Also, it serves as the
passageway for the respiratory and digestive tracts.
 Adenoids and Tonsils - The tonsils, the adenoids, and other lymphoid
tissue encircle the throat. These structures are important links in the chain
of lymph nodes guarding the body from invasion by organisms entering the
nose and the throat.
 Larynx - The larynx or the voice box which is a cartilaginous epithelium-

lined structure that connects the pharynx and the trachea and helps to
conduct air through the respiratory tract. A very important function of the
larynx is protecting the trachea from aspirated food. When swallowing
occurs, the backward motion of the tongue forces a flap called the epiglottis
to close over the entrance to the larynx. This prevents swallowed material
from entering the larynx and moving deeper into the respiratory tract. If
swallowed material does start to enter the larynx, it irritates the larynx and
stimulates a strong cough reflex. This generally expels the material out of
the larynx and into the throat.
 Trachea - The trachea or windpipe is composed of smooth muscle with C-
shaped rings of cartilage at regular intervals. The cartilaginous rings are
incomplete on the posterior surface and give firmness to the wall of the
trachea, preventing it from collapsing. The trachea serves as the passage
between the larynx and the bronchi.
Anatomy of the Lower Respiratory Tract

The lower respiratory tract includes: lungs, pleura, mediastum, lobes,
bronchi and brionchioles and alveoli.
 Lungs – The lungs is a pair of spongy, pinkish organ which composed of
elastic structures enclosed in the thoracic cage, which is an airtight chamber
with distensible walls. It is responsible for removing carbon dioxide from the
blood and adding oxygen into it. It is located on either side of the
breastbone in the chest activity and are divided into five sections of lobes.
 Pleura - The lungs and wall of the thorax are lined with a serous membrane
called the pleura. The visceral pleura covers the lungs; the parietal pleura
lines the thorax. The visceral and parietal pleura and the small amount of
pleural fluid between these two membranes serve to lubricate the thorax
and lungs and permit smooth motion of the lungs within the thoracic cavity
with each breath.
 Mediastinum - The mediastinum is in the middle of the thorax, between the

pleural sacs that contain the two lungs. It extends from the sternum to the
vertebral column and contains all the thoracic tissue outside the lungs.
 Lobes - Each lung is divided into lobes. The left lung consists of an upper
and lower lobe, whereas the right lung has an upper, middle, and lower lobe.
Each lobe is further subdivided into two to five segments separated by
fissures, which are extensions of the pleura.
 Bronchi and Bronchioles - There are two main bronchial tubes, or bronchi,
called the right and left bronchi. The bronchi carry air between the trachea
and lungs. Each bronchus branches into smaller, secondary bronchi; and
secondary bronchi branch into still smaller tertiary bronchi. The smallest
bronchi branch into very small tubules called bronchioles. The tiniest
bronchioles end in alveolar ducts, which terminate in clusters of minuscule
air sacs called alveoli into the lungs.
 Alveoli - There are three types of alveolar cells. Type I alveolar cells are
epithelial cells that form the alveolar walls. Type II alveolar cells are
metabolically active. These cells secrete surfactant, a phospholipid that lines
the inner surface and prevents alveolar collapse. Type III alveolar cell
macrophages are large phagocytic cells that ingest foreign matter (eg,
mucus, bacteria) and act as an important defense mechanism.

Wilkins.)
Functions of the Respiratory System

The respiratory system is responsible for gaseous exchange that involves the
transfer of oxygen and carbon dioxde between the atmosphere and the blood. The
following functions are performs to facilitate the life-sustaining processes such as
oxygen transport, respiration and ventilation, and gas exchange.
a. Gas Exchange - The respiratory system allows oxygen from the air to enter
the blood and for carbon dioxide to leave the blood and enter the air.
b. Regulation of the Blood pH - It can alter the blood pH by changing blood

carbon dioxide levels.
c. Voice Production - Air movement past the vocal cords which makes the
sound and speech possible.
d. Olfaction - The sensation of smell occurs when airborne molecules are

drawn into the nasal cavity.
e. Innate Immunity - It provides protection against some microorganisms by

preventing their entry into the body and by removing them from the
respiratory surfaces.
(Dirksen, L. H. (n.d.). Medical-Surgical Nursing: Assessment and

Management of Clinical Problems (5th ed.))
Physiology of Gas Exchange
Each
Figure 3. Gas Exchange between Alveoli and Capillaries
brand of
(Image Source: www.enotes.com) the
bronchial tree eventually sub-divides to form very narrow terminal bronchioles,

which terminate the alveoli. There are many millions of alveoli in each lung, and
these are the areas responsible for gaseous exchange, presenting a massive
surface area for exchange to occur over.
Each alveolus is very closely associated with a network of capillaries
containing deoxygenated blood from the pulmonary artery. The capillary and
alveolar walls are very thin, allowing rapid exchange of gases by passive difusion
along concentration gradients. CO2 moves out of the alveolus as the continuous
flow of blood through the capilaries prevents saturation of the blood with O2 and
allows maximal transfer across the membrane.
The lung can be conseptualized as a collection of 300 million bubbles
(alveoli), each 0.3 mm in diameter. The alveolar surface is composed of two kinds
of cells: Type I and Type II. Type I cells provide structure and type II cells secrete
surfactant.
Surfactant lowers surface tension in the alveoli, thereby reducing the
amount of pressure needed to inflate the alveoli and decreasing the tendency of
the alveoli collapse. This sigh stretches the alveoli and causes surfactant to be
secreted by type II cells.
(Dirksen, L. H. (n.d.). Medical-Surgical Nursing: Assessment and

Management of Clinical Problems (5th ed.).)
Overview of the Disease
Figure 3. Normal Bronchiole vs. Bronchiolotis
(Image Source: https://kidshealth.org/en/parents/bronchiolitis.html )
The respiratory system plays a vital role in terms of exchanging gases in the
body wherein it brings oxygen to the lungs and disposes carbon dioxide. The air
enters the body via mouth or nose through breathing process. Then, it moves
down towards the lungs through the airway. The airway leads to the chest, where
it splits into two – the bronchioli. Each of the bronchioli split into smaller tubes
until they reach the nodes in the lungs. If the bronchioli are blocked, less oxygen
reaches the lungs, resulting in respiratory problems. The lining of the bronchiole
has a number of glands which secrete mucus.
Brochitis is characterised by an increase in mucus production and damaged
cilia in the bronchi. As a result, the bronchi become clogged with mucus, which
continues to stimulate the airway’s irritant receptors, producing a cough. This
chronic irritation causes inflammation and the bronchial wall thickens, causing
airway obstruction.
The lack of functioning cilia makes mucus clearance difficult and as a result,
mucus collects and blocks the smaller airways. Secondary infections then occur,
causing yet more irritation and inflammation. As more and more airways become
blocked, external respiration is reduced and less oxygen is transferred into the
bloodstream. The pathophysiological processes behind increased mucus production
and cilia dysfunction are thought to involve an inflammatory response to the
constant bombardment by cigarette smoke (MacNee, 2006).
(Peate, I., & Nair, M. (2003). Fundamentals of applied pathophysiology:

An essential guide for nursing and healthcare students. Hoboken, NJ:
Wiley Blackwell.)
Pathophysiology
Figure 4. Pathophysiology of Acute Bronchitis
( Timby, B. K., & Smith, N. E. (2009). Introductory Medical-Surgical

Nursing (Lippincott's Practical Nursing) (10th ed.). Lippincott
Williams & Wilkins.)
The pathophysiology of the acute tracheobronchitis based on the
Introductory Medical-Surgical Nursing of Lippincott's Practical Nursing by Barbara
K. Timby and Nancy E. Smith.
This figure showcases the pathophysiology of the acute bronchitis. It is
based on the “Introductory Medical-Surgical Nursing of Lippincott's Practical
Nursing” by Barbara K. Timby and Nancy E. Smith. As we can depict from the
figure there are different factors that serves as a stimulant to have an acute
bronchitis. For the predisposing factors, we have genetic predisposition, the
gender which is female and the age of the patient which is 16 years old. For the
precipitating factors in composes of cigarette smoking, chemical irritants (noxious
fumes, gases and air contaminants), bacteria (Streptococcus pneumoniae,
Haemophilus influenzae, Moraxella catarrhalis, Mycoplasma pneumoniae and
Bordetella pertussis) and the respiratory viruses ((rhinovirus, adenovirus,
echovirus, influenza virus, parainfluenza virus, coronavirus, and respiratory
syncytial virus (RSV)).
Acute bronchitis happens when the microorganisms enter the respiratory
tract and causes a widespread inflammation from the major bronchi and its
branches. As a result of the inflammation, the cells of the bronchial-lining tissue
becomes irritated and the mucous membrane turns to be hyperemic and
edematous, diminishing bronchial mucociliary function. Consequently, the air

passages become clogged by the debris and irritation increases even more. In
response, the secretory cells of the mucosa produce increased mucopurulent
sputum. This causes the narrowing and the obstruction of the airways which
results to difficulty in breathing. With the immobilization of the cilia which filters
and sweep the foreign irritants, the brochial passages become more vulnerable to
the infection and spread of tissue damage that urges the occurence of acute
bronchitis.
Clinical Manifestations
ACUTE BRONCHITIS
(BOOK BASED)
Dry, Irritating and Nonproductive Cough
Sputum Production
Sternal Soreness
Hypertension
Headache
Fever or Chills
Malaise
Hoarseness
Myalgias
Dyspnea
Wheezing
Rhonchi
Chest Pain
Fatigue
Table 4. Clinical Manifestations of Acute Bronchitis During Pregnancy
( Timby, B. K., & Smith, N. E. (2009). Introductory Medical-Surgical

Nursing (Lippincott's Practical Nursing) (10th ed.). Lippincott
Williams & Wilkins.)
This table shows the clinical manifestations of acute bronchitis during
pregnancy. Initially, the patient has a dry, irritating cough and expectorates a
scanty amount of mucoid sputum. The patient complains the sternal soreness due
to coughing. The patient also has a fever or chills, night sweats, headache, and
general malaise. As the infection progresses, the patient may experience the
shortness of breath (dyspnea), noisy inspiration and expiration (inspiratory stridor
and expiratory wheeze), and produce purulent (pus-filled) sputum. If severe
tracheobronchitis occurs, a blood-streaked secretions may be expectorated as a
result of the irritation of the mucosa of the airways.

Wilkins.)
Risk Factors
The following are the risk factors of having acute bronchitis during
pregnancy.
 Conditions that produce mucus or bronchial obstruction and interfere with
normal lung drainage (eg, cancer, cigarette smoking, COPD)
 Smoking; cigarette smoke disrupts both mucociliary and macrophage
activity
 Prolonged immobility and shallow breathing pattern
 Depressed cough reflex (due to medications, a debilitated state, or weak
respiratory muscles)
 Antibiotic therapy (in very ill people, the oropharynx is likely to be colonized
by gram-negative bacteria)
 Alcohol intoxication (because alcohol suppresses the body’s reflexes, may be
associated with aspiration, and decreases white cell mobilization and
tracheobronchial ciliary motion)
 General anesthetic, sedative, or opioid preparations that promote respiratory
depression, which causes a shallow breathing pattern and predisposes to the
pooling of bronchial secretions and potential development of pneumonia
 Respiratory therapy with improperly cleaned equipment

Wilkins.)
Causes
The following are the causes of acute bronchitis during pregnancy.
a. Respiratory viruses are the most common causes of acute bronchitis which
includes the rhinovirus, adenovirus, echovirus, influenza A and B,
parainfluenza virus, coronavirus, and respiratory syncytial virus (RSV).
b. The bacteria that causes acute bronchitis are Streptococcus pneumoniae,

Haemophilus influenzae, Moraxella catarrhalis, Mycoplasma pneumoniae and
Bordetella pertussis.
c. For the chemical irritants, it includes noxious fumes, gases and air
contaminants.
d. Other irritants that causes acute bronchilitis are pollution, chemicals, and
tobacco smoke.
(Jazeela Fayyaz, D. (2020, September 18). Bronchitis. Retrieved October 01,
2020, from https://emedicine.medscape.com/article/297108-overview)
Medical Management
Antibiotic treatment may be indicated depending on the symptoms, sputum

purulence, and results of the sputum culture. Antihistamines are usually not
prescribed because they may cause excessive drying and make secretions more
difficult to expectorate. Expectorants may be prescribed, although their efficacy is
questionable. Fluid intake is increased to thin the viscous and tenacious secretions.
Copious, purulent secretions that cannot be cleared by coughing place the patient
at risk for increasing airway obstruction and the development of a more severe
lower respiratory tract infection, such as pneumonia. Suctioning and bronchoscopy
may be needed to remove secretions. Rarely, endotracheal intubation may be
required in cases of acute tracheobronchitis leading to acute respiratory failure.
This may be necessary for patients who are severely debilitated or who have
coexisting diseases that also impair the respiratory system.
In most cases, treatment of tracheobronchitis is largely symptomatic. The
patient is advised to rest. Increasing the vapor pressure (moisture content) in the
air will reduce irritation. Cool vapor therapy or steam inhalations may help relieve
laryngeal and tracheal irritation. Moist heat to the chest may relieve the soreness
and pain. Mild analgesics or antipyretics may be indicated.

Wilkins.)
Nursing Management
Acute tracheobronchitis is frequently treated in the home setting. A primary

nursing function is to encourage bronchial hygiene, such as increasing fluid intake
and directed coughing to remove secretions. The nurse should encourage and
assist the patient to sit up frequently to cough effectively and to prevent retention
of mucopurulent sputum. If the patient is treated with antibiotics for an underlying
infection, it is important to emphasize the need to complete the full course of
antibiotics prescribed. Fatigue is a consequence of tracheobronchitis; therefore,
the nurse must caution the patient against overexertion, which can induce a
relapse or exacerbation of the infection.

Wilkins.)
Prevention
The following are the preventive measures of acute bronchitis during
pregnancy.
 Practice good hand hygiene.
 Encourage smoking cessation and avoid secondhand smoke.
 Encourage to reduce or to moderate the alcohol intake (in case of alcohol
stupor, position patient to prevent aspiration).
 Initiate special precautions against infection and make sure to up-to-date
with all the recommended vaccines.

 Stay away from or try to reduce your time around things that irritate your
airway (nose, throat, and lungs). Irritants can include dust, mold, pet
dander, air pollution, smoke, and cleaners.
 Always cover your mouth and nose when coughing or sneezing.
 Keep your distance from others when you are sick, if possible.
 Reposition frequently and promote lung expansion exercises and coughing.
 Promote frequent turning, early ambulation and mobilization, effective
coughing, breathing exercises, and nutritious diet.
(Preventing and Treating Bronchitis [Brochure]. (n.d.). Retrieved from

https://www.cdc.gov/antibiotic-use/community/downloads/Flyer-
Bronchitis.pdf)
Chapter III
Laboratory Results
Overview
This chapter contains the purpose of the laboratory test, laboratory test of
the patient which includes the RBC TOTAL COUNT AND WBC TOTAL COUNT and we
can also see the normal ranges for each test and its interpretation.
Purpose of the Laboratory Test
Hematologic Studies
The complete blood cell count (CBC) identifies the total number of white and
red blood cells, the platelet count, and the hemoglobin and hematocrit. The CBC is
carefully monitored in patients with CVD. White blood cell counts are monitored in
immunocompromised patients, including patients with transplanted hearts, and in
situations where there is concern for infection (eg, after invasive procedures or
surgery). The red blood cells carry hemoglobin, which transports oxygen to the
cells. The hematocrit is a measure of the relative proportion of red blood cells and
plasma. Low hemoglobin and hematocrit levels have serious consequences for
patients with CAD, such as more frequent angina episodes. Platelets are the first
line of protection against bleeding. Once activated by blood vessel wall injury or
rupture of atherosclerotic plaque, platelets undergo chemical changes that form a
thrombus.
Frequently Used Laboratory Tests in Hematology
TEST NORMAL DECRIPTION INDICATIONS/COMMENT

RANGE S
Complete General survey of Important to note changes
Blood Count bone marrow over
(CBC) function; time; many hematologic
evaluates all conditions show changes in
three cell CBC
lines (WBCs, long before patient
RBCs, platelets) becomes
symptomatic
Red blood M: 4.7–6.1 Carries
cells (RBCs) × 106 hemoglobin;
F: 4.2–5.4 × survival time,
106 120 days
Hemoglobin M: 13.5– Delivers O2 Decreased in anemia;
(Hgb) 17.5 g/dL through increased in
F: 11.5–15.5 circulation polycythemia
g/dL to body tissues
and returns CO2
from tissues to
lungs
Hematocrit M: 40–52% Indicates relative Usually three times the Hgb
(Hct) F: 36–48% proportions of
plasma and RBCs
(volume of
RBCs/L whole
blood)
Mean Indicates size of If < 80, cells are
corpuscular 81–96 µm3 RBCs; very useful microcytic; if
volume (MCV) in differentiating > 100, cells are macrocytic
types of anemia
Mean Average
corpuscular 33–36 g/dL concentration of
hemoglobin Hgb in
concentration RBCs;
(MCHC) independent of
cell size
Red cell 11–14.5% Measures degree
distribution of variation in
width (RDW) size of RBCs
Reticulocyte 0.5–1.5% Measure of Indicates marrow’s
count marrow response to anemia (when
production of anemia is present,
erythrocytes; 1% reticulocyte leveL should
of RBC mass is rise)
produced daily
(to replace the
1%
of old cells that
die)
Platelets 150,000– Total number of Thrombocytopenia: <
400,000/mm platelets in 20,000/mm3
3
circulation; ,
average life span, serious; < 10,000/mm3,
7–10 days potentially life-threatening
White blood 4,500– Total WBC count
cells (WBCs) 11,000/mm3
Differential
Differential Percentages % of cell type × Left shift: bone marrow ↑
of various total WBC = production of WBCs; more
types of absolute number immature
WBCs of that cell type forms released into the
bloodstream
Prothrombin Varies Measure time Increased in liver disease,
time (PT) (compare elapsed until clot disseminated intravascular
with forms; measures coagulation (DIC),
control), extrinsic and obstructive biliary disease,
11–12.5 sec common clotting factor depletion,
pathways warfarin
(Coumadin) use
International 1.0 A standard Increased with
normalized Standard method of anticoagulant excess
ratio (INR) warfarin measuring and conditions that cause
(Coumadin) PT independent of increased PT; decreased
treatment, the with insufficient
2.0–3.0 INR; thromboplastin anticoagulant and
high-dose reagent used in conditions that cause
warfarin the test; decreased PT
(Coumadin) calculated by
treatment, dividing the PT
3.0–4.5 INR result by the
mean normal PT
Partial Varies Surface active Increased in clotting factor
thromboplasti (compare agent added to depletion, DIC, liver
n time with plasma; disease, biliary
(PTT) control): measures time obstruction, circulating
25–35 sec elapsed anticoagulants (heparin)
until clot forms;
measures
intrinsic and
common
pathways
Thrombin Varies Tests conversion Time to clot is inversely
time (TT) (compare of fibrinogen to proportional to fibrinogen
with fibrin level
control),
8–11 sec
Fibrinogen 170–340 Measurement of Decreased in bleeding
mg/100 mL fibrinogen disorders,
concentration pregnancy, malignancy,
within plasma inflammatory disease
available for
conversion to
fibrin clot
D-dimer 0–0.5µg/mL Measures the Increased with fibrinolytic
amount of activity,
fragments rheumatoid arthritis,
of fibrin when it is ovarian
lysed (broken cancer (with increased CA
down); useful for 125)
distinguishing
fibrinolysis from
fibrinogenolysis
Fibrin <10µg/mL Byproduct of >40 µg/mL indicates DIC
degradation fibrinolysis
products
(FDP)
Neutrophils 40–75% Essential in If >8,000: infection, some
(2,500– preventing/limitin inflammatory states, stress,
7,500/mm3) g steroids,
bacterial other drugs,
infection; average myeloproliferative
life disease
span: 2–4 hr
Absolute neutrophil count
(ANC)
<500: increased risk for
infection;
ANC <100: infection certain
(if neutropenia persists)
Lymphocytes 20–50% Integral <1,500: lymphopenia;
(1,500– component of >4,000:
5,500/mm3) immune lymphocytosis; increased in
System convalescent phase after
bacterial or
viral infection,
lymphoproliferative disease
Monocytes 1–10% Enter tissue as Increased in acute and
(100– macrophages; chronic infection,
800/mm3) phagocytosis inflammation, some
myeloproliferative
disorders,
chronic myelomonocytic
leukemia (CMML)
Eosinophils 0–6% (0– Involved in Increased in allergic states,
440/mm3) allergic reactions medications, parasites,
(neutralizes chronic myeloid
histamine); leukemia (CML),
digest foreign metastatic/
Proteins necrotic tumors
Basophils 0–2% (0– Contain Increase is very rare (CML)
200/mm3) histamine;
integral part of
hypersensitivity
reactions

Wilkins.)
This table shows the frequently used laboratory test in hematology.

It consists of the actual test, normal range, description and indications. It
will be a useful basis in terms of evaluating and analyzing the laboratory
results of our patient in hematology.
Laboratory Results
Name of Patient: XXXX Date:
Address: Sumacab, Cabanatuan City Laboratory/Hematology I
INVESTIGATION FINDING UNIT BIOLOGICA METHOD
S L
REFERENCE
COMPLETE BLOOD
COUNT – HE
AUTOMATE
RBC INDICES: D
ANALYZER
HAEMOGLOBIN L 10.9 gm/dl 12.00-15.50
RBC COUNT H 5.52 million/c 3.9-5.03 WITH 5
m PART
HAEMATOCRIT/PC L 34 % 35.00-45.00 DIFFERENC
V E
MCH L 19.8 pg 27-33
MCHC 32.1 g/dl 32-36
MCV L 61.7 fL 79-99
RDW H 15.7 % 11.9-15.5
TOTAL WBC
COUNT:
TOTAL WBC COUNT H 14500 /cumm 3500-10500
WBC
DIFFERENTIAL
COUNT:
NEUTROPHILS H 10919 /cumm 1800-7000
Absolute count
NEUTROPHILS: 75.3 %
LYMPHOCYTES 2436 /cumm 900-2900
Absolute Count
LYMPOCTES: 16.8 %
MONOCYTES 711 /cumm 300-900
Absolute Count
MONOCYTES: 4.9 %
EOSINOPHILS 406 /cumm 50-500
Absolute Count
EOSINOPHILS: 2.8 %
BASOPHILS 29 /cumm 0-300
Absolute Count
BASOPHILS: 0.2 %
IMMATURE % 0.00-0.5
GRANULOCYTES
PLATELET COUNT 20200 /cumm 150000-
0 450000
MPV 9.1 fL 6.5-12
COMMENTS
REMARK
Table 4. Laboratory Results
This table showcases the laboratory result of our patient in hematology. As
we can depict from the table, the values or the result for some test exceeded the
normal range which indicates the problem of the patient. The tests that exceeded
the normal range are: RBC COUNT (MCH and RDW) and WBC COUNT
(NEUTROPHILS). Based on the results, we can conclude that the patient has an
infection or inflammation on the body due to the increase of neutrophils. According
to our basis, if the range is >8,000 that indicates as a sign infection, some
inflammatory states, stress, steroids, other drugs, myeloproliferative disease.

Figure 5. Chest X-ray Result
(Image Source: www.wisegeek.com/what-is-bacterial-bronchitis.htm)
This figure shows the chest x-ray result that confirms the patient’s acute
bacterial bronchitis.
CHAPTER IV
Nursing Care Plan
Overview
This chapter contains the nursing care plan, and it includes the organized assessment, identification
of patient problems, setting of goals, the establishment of methods and strategies that the nurse will
apply to resolve the client's diagnosis, and to achieve health care outcomes.
DIAG- EVALUA-
ASSESSMENT OUTCOME PLANNING INTERVENTIONS RATIONALE
NOSIS TION
Subjective: Ineffective Client will Client will INDEPENDENT The most After the
“Hindi ako airway maintain manifest signs Teach the patient convenient way nursing
makahinga minsan” clearance optimal of decreased the proper ways of to remove most Interventions
as verbalized by the breathing respiratory coughing and secretions is the patient was
client. pattern AEB effort AEB: breathing. (e.g., coughing. So, it able to
Objective: relaxed >Absence of pursed lip is necessary to demonstrate
(+) Wheezing breathing at dyspnea, cough, breathing and assist the pursed lip
Breathing Sounds normal and sputum. cough two or three patient during breathing and
(+) Dyspnea respiratory times in this activity. productive
(+) Mucous rate or Client will succession). Deep breathing,
cough to
secretions pattern, and verbalize DEPENDENT on the other
improve airway
absence of understanding Give medications hand, promotes
clearance.
Risk Related dyspnea while of causative as prescribed, such oxygenation
The antibiotics
Factors: also factors and as antibiotics, before controlled
History of smoking maintaining demonstrate mucolytic agents, coughing. prescribed
and drinking clear, open behaviors that bronchodilators, A variety of helped alleviate
Family history of airways as would improve expectorants, medications are the underlying
respiratory problem evidence by breathing noting prepared to cause of
normal breath pattern effectiveness and manage specific breathing
sounds, rate, side effects. problems. Most problems.
depth of COLLABORATIVE promote
respirations, Coordinate with a clearance of
and ability to respiratory airway
effectively therapist for chest secretions and
cough up physiotherapy and may reduce
secretions nebulizer airway
after management as resistance.
treatments indicated. Chest
and deep physiotherapy
breaths. includes the
techniques of
postural
drainage and
chest percussion
to mobilize
secretions from
smaller airways
that cannot be
eliminated by
means of
coughing or
suctioning.
DIAG- EVALUA-
ASSESSMENT OUTCOME PLANNING INTERVENTIONS RATIONALE
NOSIS TION
Subjective: Ineffective Client will Client will INDEPENDENT A sitting After the
“Kinakapos ako ng breathing maintain optimal manifest signs Place the client with position nursing
hininga kahit light pattern breathing pattern of decreased proper body permits Interventions
physical activity AEB relaxed respiratory alignment for maximum lung the patient was
lang” as verbalized breathing at effort AEB: maximum excursion and able to return
by the client. normal >Absence of breathing pattern chest to normal
respiratory rate dyspnea, DEPENDENT expansion. breathing rate,
Objective: or pattern, and cough, and Ambulate patient as Ambulation can depth, timing,
(+) Dyspnea absence of sputum. tolerated with further break rhythm, and
dyspnea while Client will doctor’s order three up and move
sounds.
Risk Related also maintaining verbalize times daily. secretions that
Furthermore,
Factors: clear, open understanding COLLABORATIVE block the
congestions
airways as
evidence by airways.
normal breath COPD may
sounds, rate, cause
of causative
depth of malnutrition within the
factors and
respirations, and which can
History of smoking demonstrate Consult dietitian respiratory
ability to affect breathing
and drinking behaviors that for dietary tract were
effectively cough pattern. Good
Family history of would modifications. being
up secretions nutrition can
respiratory problem improve alleviated.
after treatments strengthen the
breathing
and deep functionality of
pattern
breaths. respiratory
muscles.
CHAPTER V
Drug Study
Overview
This chapter includes the study of drugs, wherein it tackles about the mechanism of action,
Indications, Contraindications, and the adverse effects of drugs given to the client and nursing
considerations for the safety and protection of the client.

NAME ACTION INDICATION CONTRAINDICATIO ADVERSE EFFECT NURSING
N CONSIDERATION
Generic Bactericidal It is effective for Contraindicated in CV Determine history of
Name: agent that the treatment of hypersensitive to Phlebitis hypersensitivity reactions to
drug. Thrombophlebitis cephalosporins, penicillin’s and
Cefuroxime acts by penicillinase- history of allergies particularly
inhibition of producing Cefuroxime is GI to drugs before therapy is
1.5 g, bacterial cell Neisseria contraindicated in Pseudomembraneous initiated. Note reason for
patients with known colitis, nausea, anorexia, therapy, baseline assessments.
ANST wall gonorrhea allergy to the vomiting, diarrhea Assess for anemia, renal
Brand synthesis, (PPNG). cephalosporin group dysfunction reduce dose with
Name: promoting Effectively treats of antibiotics Hematologic impaired renal function. Inform
Zinacef osmotic bone and joint patient need and importance of
Use with caution
Q8H, IVP instability. infections, Transient drug to him/her.
in breast-feeding
bronchitis, neutropenia,
women and in Culture infection, and arrange
meningitis, eosinophilia,
patients with for sensitivity tests before and
gonorrhea, otitis haemolytic, anemia,
history of renal during therapy if expected
media, thrombocytopenia response is not seen. Monitor
sufficiency.
pharyngitis/tonsili BUN and creatinine clearance.
tis, sinusitis, Skin
lower respiratory Do skin-test before
tract infections, Rash,pruritis, administering the drug
skin and soft urticaria, pain, sterile
abscess, temperature Inspect IV Injection sites for
tissue infections, sign of phlebitis
urinary tract elevation, induration,
infections and is tissue sloughing Monitor for manifestations of
used for surgical hypersensitivity. Discontinue
prophylaxis, Urogenital drug and report their
reducing or Increased serum appearance promptly.
eliminating cretonne and BUN,
infection. decreased creatinine Monitor I & O rates and pattern:
clearance. Especially important in severely
ill patients receiving high doses.
Report any significant changes.
Tell the client to report loose
stools or diarrhea promptly.
Avoid alcohol while taking this
drug to avoid severe reaction.
May experience these side

effects: Stomach upset or
diarrhea.
Report severe diarrhea,

difficulty breathing,
unusual tiredness or
fatigue, pain at injection
site.
Generic Inhibits Relief of smooth Hypersensitivity CNS: dizziness, Drug compatibility should be
Name: acetylcholine muscle spasm of to drug contents anaphylactic reactions, monitored closely in patients
requiring adjunctive therapy
at receptor the anaphylactic shock,
HYOSCIN site in gastrointestinal Tachycardia increased ICP,
E- Avoid driving & operating
automatic and genitourinary disorientation, machinery after parenteral
BUTYLBR nervous systems. restlessness, irritability, administration & Avoid strict
OMIDE system, which dizziness, drowsiness, heat.
controls headache, confusion,
(HNBB) Raise side rails as a precaution,
secretions, hallucination, delirium,
2 amps, some patient become
ANST free acids in impaired memory temporarily excited or
the stomach, CV: hypotension, disoriented and some develop
Brand blocks central tachycardia, palpitations, amnesia or become drowsy.
Name: muscular flushing
Buscopan receptors GI: Dry mouth, Reorient your client that
Q4H, IVP which tolerance may develop when
constipation, nausea, therapy is prolonged.
decreases epigastric distress
involuntary DERM: flushing, Atropine-like toxicity may cause
movements. dyshidrotic dose related adverse reactions.
GU: Urinary retention, Individual tolerance varies
urinary hesitancy greatly
Resp: dyspnea,
Overdose may cause curare-like
bronchial plugging, effects, such as respiratory
depressed respiration paralysis. Keep emergency
EENT: mydriasis, dilated equipment available.
pupils, blurred vision,
photophobia, increased
intraocular pressure,
difficulty of swallowing.
Chapter VI
Summary, Findings, Related Nursing Theory, and Recommendation
Overview
In this chapter, the main findings with regards to the client medical
conditions are summarized, the related nursing theory and recommendations
are based on the findings of the studies presented in this are described.
Summary
The client is a sixteen-year-old, a Filipino, born in Cabanatuan City.
She was admitted on August 24, 2020 at 8 o’clock in the morning due to on
and off Lumbo Sacral Pain two days prior to admission. She stated that she
smokes one and a half packs of cigarettes per day and drinks moderately.
She began prenatal care late during the pregnancy and has been
inconsistent with appointments. She has a history of respiratory problem in
her family. She had to abort last July 16, 2018 due to ectopic pregnancy.
The latest vital signs are: Temperature of 37.4°C, Pulse rate of 108
beats per minute, Respiratory rate of 25 cycles per minute, Blood pressure
of 140 over 100 millimeters of mercury, Fetal heart rate of 142 beats per
minute and latest cervix dilation is 6 centimeters.
Findings
Through assessment and data gathering, certain problems were
identified. Aside from Bronchitis such as abnormalities in the mouth,
extremities, chest, lungs, skin, and genital areas were observed which led to
increasing awareness and knowledge regards to client’s condition. This study
enlightened the student nurses to render clients care more efficiently and
competently to achieve effective and quality nursing care. The following are
some of the evaluations and findings:
1. There are abnormalities in the mouth, extremities, chest, lungs, skin,
and genital areas.
2. Client has a family history of respiratory problems. Furthermore, risk
factors such as smoking and drinking were also present.
3. The pathophysiology and etiology of bronchitis of the client were
explored: bronchitis may have been due to hereditary factors
(mother) or acquired factors (smoking).
4. Health teaching about the risks of smoking & drinking alcohol, and as
well as the importance of taking prescribed medications, scheduling
activities, and breathing & relaxation techniques were applied.
Related Nursing Theory

This study was related to the theory of Dorothea Orem’s Self-care
Deficit theory. It determines the self-care need of pediatric client with
bronchitis according to Orem's Self-care Theory and to present them for
nursing care. Establishing a scientific ground is one of the primary purposes
of a professional discipline as well as a sine qua non of professionalization.
Nursing is an applied medical discipline based on a professional philosophy,
theory, practice and research. Orem, a leading theorist of nursing practice,
points out an interaction between human beings and their environment.
Orem also argues that human beings are unique and unitary beings and that
they cannot be separated from their environment and accordingly,
delineates the components of her nursing theory into humans, health,
environment, and nursing practice.
Recommendation
The client must be able to recover health and prevent further
complications as possible. This, in turn, will consider having a healthier
status – be it physically, emotionally, mentally, and spiritually. For the
patient, recommendations would include but not limited to the following:
Medication
Client may take Antibiotics to treat worsening coughs, breathlessness,
and mucus production caused by infections. Anti-inflammatory drugs, such
as corticosteroids (also called steroids), to reduce swelling and mucus
output. Bronchodilators (inhaled medicines that help open the airways) and
combination drugs that contain a mix of steroids and long- or short-acting
bronchodilators.
Treatment
Client must stop smoking and drinking alcohol, get plenty of rest and
drink plenty of fluids because it may help to disappear more quickly. Client
may sleep near a humidifier or sitting in a steamy bathroom.
Exercise
Advise the client to do breathing and relaxation techniques and to do
passive to active ROM exercises to help the client return to activities of daily
living and avoid lifting and stressful activities.
Health Teaching
Instruct the client and the family about the risks of smoking and drinking
alcohol to the health of client and neonate, the need to take medications as
prescribed and check with the physician before taking any new medication.
Remind the client to express any discomfort in order for the healthcare
provider to carry out certain measures and advise the client to establish
direct open communication with her partner and healthcare practitioner to
link care needs.
OPD (Follow-Up Checkup)
Instruct the patient to comply with the prescribed medication and
remind the client about the follow-up visits and succeeding visits prescribed
by the health care provider.
Diet
Client is advised on healthy diet of eating plenty of fruits, vegetables,
and whole grains. Client can also eat meats that are low in fat, chicken, fish,
and low-fat or non-fat dairy. Also, the client must drink plenty of water
because this is essential for the client’s medical condition.
Spirituality
Interpreting and understanding the diversity of religious and spiritual
needs of the client.
Jan Rae B. Atienza
BSN 2A
1 & 3. Make a table of comparison of the different theories of development. Make a

table of comparison of the different developmental theories of an infant.
Psychosocial Psychosexual Moral Cognitive Faith/Spiritual
Infant Infants wonder if Infants possess only Pre-conventional Infants utilize their Infants cannot find
people around can be Id where they satisfy Morality is present five senses to perceive distinction between
trusted and thereby their basic needs where behavior is and understand their real and imaginary.
making the mother through sucking based on avoiding surroundings. Therefore, faith is
usually the most (breastfeeding). punishment from their However, they may implanted into them.
responsible whether a Excessive of this parents. also start
child will become activity may lead to understanding object
trustful or doubtful. oral fixation. permanence.
Toddler Toddlers learn to Id and ego forces are Toddlers have a mix Toddlers pick up the
discover themselves now present and play of sensorimotor and concept of God
by exploring and thus a role during toilet preoperational stages. through the use of
builds self-confidence. training. Where Id Toddler stage is the communication.
Consequently, if they warrants the toddler to transition from
Same with the Infant,
fail or unallowed to do go to the toddler and sensorimotor and
Toddlers and Pre-
so, they become the ego convinces the preoperational where
schoolers tend to
shameful. toddler to not get instead of relying on
avoid punishment and
embarrassed from five senses, toddlers
thereby base their
soiling their pants. would incorporate the
behaviors off this.
use of words.
However, they may
also opt to make
choices that offers
interest or rewards
Pre-schooler Pre-schoolers learn Pre-schoolers seek them in the process. Pre-schoolers now
new things and often affection from their utilize language to
contemplates whether mothers/fathers to the express themselves
it’s okay or not. point that they see and pictures to
Support for pre- their fathers/mothers represent objects.
schoolers builds their as competition. They are also
initiative. egocentric at this Pre-schoolers and
stage schooler understand
stories told to them
literally and they
understand God in
Schooler Schoolers put value The schooler Logical reasoning is physical form.
on peer feedbacks that continues to develop now established for
it plays a factor in without any particular this stage. They start
Schoolers and
their development. conflicts. However, to understand from
Adolescents are now
Positive feedback any conflict from the the viewpoint of other
exposed to the society
entails motivation previous stages may people.
and thus understands
while negative carry on to this stage.
that there are rules
feedbacks make them
that must be
feel inferior.
conformed to.
Conventional Morality
and Post-Conventional
Morality may be
Adolescence Adolescents Adolescence is where established depending Abstract thought and Adolescents perceive
acknowledges and they try to deal with on how the child was hypothetical thinking other faith that exists
assumes roles in the the conflicts from raised. arise. Consequences of outside their beliefs.
society. They find their earlier stages of actions are also Because of this, they
own identity through development. considered by may start establishing
independence while adolescents. They also their own belief
they may experience exhibit problem- system.
role confusion if they solving skills
are enclosed to the
parents’ beliefs.
2. Which of the theories do you think is the essential assessment tool in a child's development?
>Psychosocial Theory by Erik Erikson — because it tackles how a child thinks through the different stages of his life.
4. Choose 1 Nursing diagnoses from the list of possible nursing diagnoses for infants and make a complete NCP for that.
5. Choose 1 Nursing diagnoses from the list of possible nursing diagnoses for toddlers and make a complete NCP for that.
6. Assess a Toddler, note the characteristics that are present, and make a table comparing it to the typical characteristics.
Psychosocial Psychosexual Moral Cognitive Faith/Spiritual
Id and ego forces are now Same with the Infant, Toddlers Toddlers have a mix of
Toddlers learn to discover present and play a role during and Pre-schoolers tend to avoid sensorimotor and preoperational
themselves by exploring and toilet training. Where Id punishment and thereby base stages. Toddler stage is the
their behaviors off this. Toddlers pick up the concept of
thus builds self-confidence. warrants the toddler to go to the transition from sensorimotor and
Theory Consequently, if they fail or toddler and the ego convinces However, they may also opt to preoperational where instead of
God through the use of
communication.
unallowed to do so, they the toddler to not get make choices that offers interest relying on five senses, toddlers
become shameful. embarrassed from soiling their or rewards them in the process. would incorporate the use of
pants. words.
The toddler is following strict

rules imposed by parents and
thus unable to explore enough The toddler is disciplined and Follows the rules imposed by The toddler is capable of The toddler believes and worship
Assessment outside comfort. Feels shy when
approached, waits for parent’s
knows when she needs to do
toilet.
parents in fears of getting
punished.
expressing and comprehending
words
God as evidenced by joining in
prayers.
approval before doing an
activity, talks less.
Atienza, Jan Rae B. BSN 2A
Preschoolers:
1. In assessing a preschooler, how are you going to do health teaching regarding

psychosexual development, what will be your plans and interventions?
- Psychosexual development pertains to the urges, needs, or desires; it is important for

pre-schoolers to express themselves in a modest manner. This can be done by offering
them what they need but at the same time maintaining the control as to when and how it
is given. This is to ensure that they won’t get spoiled by doing so. For instance, pre-
schoolers yearn for the affection of their opposite sex parents, it is important to satisfy
this yearning but at the same time
2. Make a journal on how it explains the factors contributing to the development of

initiative/guilt in the pre-schooler
- In this stage, the child engages in various activities in order discover more. They learn
to set objectives such as learning how to do quadratic equation, regardless of the
consequences. As children begin to take initiative, they are then exposed to various risks
that may entail guilt on their part. Oftentimes, children may be discouraged by their peers
and thereby making them feel shameful. The reward comes when they have successfully
achieved the goal which in turn makes them more confident about themselves.
3. The moral development of a preschooler is on the preconventional stage; as a

nurse, how are you going to relate it to the moral development of a Toddler?
- They’re pretty much the same whereas they both driven by their self-interest and
satisfactory. Consequently, they’re also deterred by the concept of punishment. Both
Preschoolers and Toddlers still haven’t grasped the concept norms, tradition, and social
approval and thus excludes from Conventional stage.
School age:
4. Assess a schooler and evaluate the child's extent of self-reliance and socialization
and make a plan on ways of developing it.
1. Solving Allowing them to solve problems by themselves will teach them how to
Problems deal with problems early-on. Notwithstanding, offering a little advice or
Themselves help to them from time to time will remind them that some problems
require help from other people.
2. Scheduling Setting a schedule or timetable for schoolers to adhere to will teach them
Routine Tasks to be responsible and consistent with their work. Just make sure to have
them stick to the plans.
3. Managing This is the by-product of the previous skill. As they develop the previous
Their Time skill, time-management will naturally come to them.
4. Developing Giving kids options allows them to think and choose for themselves. This
Independent is the first step toward independent thought at a much higher level later
Thought on.
6. Making Friends As kids make friends, they learn to build up positive images of
themselves while expressing care and empathy for their peers.
7. Completing Some tasks may be too hard or boring that schoolers might just stop
What They Begin halfway. In order to avoid this, give only short and simple tasks for them
that will condition them to finish what they’ve begun. This will build their
confidence for when the time comes that they have a tedious task, they
will learn to persevere.
8. Tidying Up Such a basic self-reliance skill that most of us probably can’t recall when
After Themselves or where we learned it the first time around. It provides a sense of
stability and predictability—but more importantly, a means for achieving
it. This can be valuable for dealing with turmoil or adversity in more
serious scenarios.
9. Asking for help One of the most basic skill but often neglected. Most children grow up
shy or afraid of asking questions in fear of being shamed. By reminding
children that it’s always okay to ask questions and then answer them
truthfully, children will be keener to ask questions as they will realize
that asking questions can help them.
5. Make a journal on how it explains the factors contributing to the development of
industry/inferiority in the school-age children
- School-age is where children will learn to interact and cooperate with other children.
They will experience the joy getting praised and feeling ashamed from negative
feedbacks. Ultimately, it is the people around the children that pushes them towards
becoming more productive by giving compliments or become discouraged through hurtful
words.
Adolescence:
6. Describes the adolescent`s behavior concerning the developmental task of identity

vs. role confusion
- Adolescents are actively seeking their identity, and this is done through the pursuit of
their independence and developing a sense of self. By facing obstacles in life, adolescents
develop primary virtues that contribute to their overall identity. The major question is
"Who am I?" As they transition from childhood to adulthood, teens may begin to feel
confused or insecure about themselves and how they fit into society. As they seek to
establish a sense of self, teens may experiment with different roles, activities, and
behaviors. According to Erikson, this is important to the process of forming a strong
identity and developing a sense of direction in life. During the identity versus confusion
stage, the conflict is centered on developing a personal identity. Successfully completing
this stage leads to a strong sense of self that will remain throughout life
7. Make a journal or portfolio of being an adolescent, developmental task milestone, and
experiences in growing up
1. Achieving new Adolescents learn through interacting with others in more adult
and more mature ways. Physical maturity plays an important role in peer relations.
relations with Adolescents who mature at a slower or faster rate than others will
others, both boys be dropped from one peer group and generally will enter a peer
and girls, in one's group of similar maturity. For early-maturing girls (girls whose
age group. bodies are fully developed at a young age), entering into a peer
group of similar physical maturity can mean a greater likelihood of
early sexual activity. Parental monitoring can be a useful
boundary-setting tool during the accomplishment of this
developmental task because it allows parents to place limits on
adolescents' outside activities.
2. Achieving a Each adolescent develops his or her own definition of what it

masculine or means to be male or female. Most adolescents conform to the sex
feminine social role. roles of our cultural view of male (assertive) and female (passive)
characteristics. As adults, we need to provide opportunities for
adolescents to test and develop their masculine and feminine
social roles. For example, we need to encourage males to express
their feelings and encourage females to assert themselves more
than they have in the past.
3. Accepting one's The time of the onset of puberty and the rate of body changes for
physique. adolescents vary greatly. How easily adolescents deal with these
changes will partly depend on how closely their bodies match the
well-defined stereotypes of the “perfect" body for young women
and young men. Adolescents whose bodies do not match the
stereotypes may need extra support from adults to improve their
feelings of comfort and self-worth regarding their physiques.
4. Achieving Children derive strength from internalizing their parents' values

emotional and attitudes. Adolescents, however, must redefine their sources
independenc of personal strength and move toward self-reliance. This change
e from is smoother if adolescents and parents can agree on some level of
parents and independence that increases over time. For example, parents and
other adults. adolescents should set a curfew time. That curfew should be
extended as the adolescent matures.
5. Preparing for Sexual maturation is the basis for this developmental task.
marriage and family Achievement of this developmental task is difficult because
life. adolescents often confuse sexual feelings with genuine intimacy.
Indeed, this developmental task is usually not achieved until late
adolescence or young adulthood. Until that time comes, the best
way for parents to help is to set aside time to talk to their early
and middle adolescents about sex and relationships.
6. Preparing for an This task has become more difficult now than in the past because
economic career. the job market demands increased education and skills. Today,
this developmental task is generally not achieved until late
adolescence or young adulthood, after the individual completes
his/her education and gains some entry-level work experience.
7. Acquiring a set of Adolescents gain the ability to think abstractly and to visualize
values and an possible situations. With these changes in thinking, the adolescent
ethical system as a is able to develop his or her own set of values and beliefs.
guide to behavior; Discussing these newly forming ethical systems with parents and
developing an other adults can be a great help to adolescents in accomplishing
ideology. this developmental task. In addition, parents may want to provide
adolescents with hypothetical situations that challenge their
emerging values, to help the adolescents evaluate the strength
and appropriateness of those values.
8. Desiring and The family is where children learn to define themselves and their
achieving socially world. Adolescents must learn to define themselves and their
responsible world in the context of their new social roles. Status within the
behavior. community beyond that of family is an important achievement for
older adolescents and young adults. Adolescents and young adults
become members of the larger community through financial and
emotional independence from parents, which in turn teaches them
the value of socially responsible behavior.
Parents and other adults who work with adolescents walk a tightrope. Adolescents need
them to play an active role in their lives. However, adults also need to provide
adolescents some room to make their own decisions and to be accountable for the
consequences of those decisions.
NURSING CARE PLAN
1. Make an NCP about the nutritional status of a preschooler.
2. Make an NCP about the fears of a preschooler.
3. Make an NCP about the schooler
4. Make at least 1 NCP for adolescents.

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Porfolio in

2. Give two kinds of contraception and explain its procedure.

3. In your own opinion what is a responsible parenthood.

Unit 4 Part 2 Activity

2. Discuss what nursing interventions to manage for malnutrition

5. Discuss the first and second stage of labor

9. Causes, Risk factor, Signs and Symptoms, Laboratory Test, Types,

professionals with an overview of the patient’s condition, possible complications,

treatment plan, and medical & nursing intervention.

Specifically, this case analysis aims to:

 Present a thorough general assessment of the client which includes physical

assessment and family history

 Understand the pathophysiology and etiology of the case being presented.

 Appropriately apply nursing interventions necessary for the patient’s

Pregnancy related low back pain (LBP) is a common complaint among

(Katonis et al., 2011). Various explanations on the pathophysiology leading to LBP

and hormonal changes that loosen up the ligaments.

While LBP wouldn’t be a major concern during pregnancy, respiratory

diseases such as chronic and acute bronchitis, emphysema, and asthma.

asthma symptoms. Tobacco smoke is a powerful asthma trigger. Furthermore,

bacteria to cause infection.

During pregnancy, respiratory diseases such as asthma significantly

increases the risk of preeclampsia based on the 2017 research done by J.

Stokholm, A. Sevelsted, U. Anderson, and H. Bisgaard. This problem may lead to

section during delivery.

Address: Acropolis North, Sumacab, Cabanatuan City

Figure 1. Genogram of the Patient

Status of Present Illness

Usual Food Intake

Client is on NPO as per doctor’s order.

Client has no food allergies.

Problem with Ability to Eat

Client has no problem with ability to eat.

The client’s bowel elimination pattern is normal, as evidenced by one to

2 – Assistive from Others

3 – Assistance from person and equipment

Limitations to Physical Activities

The client is limited in performing strenuous activities that requires heavy

Cognitive and Perceptual Pattern

Self-Perception and Self-Concept

Roles and Relationship

According to and verbalized by the client, she suffers emotional distress in

Sexuality and Reproductive

Table 2. Vital Signs

Height and Weight

Body Mass Index

Head to Toe Physical Assessment

BODY PARTS TYPE OF NORMAL ACTUAL RESULT

ASSESSMENT FINDINGS FINDINGS

Rounded The head of No

External The client’s

Inspection Central position

Muscles equal The neck

Symmetric The chest wall

Upon interpretation, there were no significant findings found on the skull,

Acute tracheobronchitis is an acute self-limiting inflammation of the mucous

(Smeltzer, S. C., & Bare, B. G. (2003). Brunner and Suddarth's textbook of

Figure 2. Respiratory System

(Smeltzer, S. C., & Bare, B. G. (2003). Brunner and Suddarth's textbook of

 Paranasal Sinuses - The paranasal sinuses include four pairs of bony

 Conchae - Conchae or turbinate bones has shell-like appearance. These

 Pharynx – The pharynx or throat is a tube-like structure that connects the

 Larynx - The larynx or the voice box which is a cartilaginous epithelium-