COR JESU COLLEGE, INC.

COLLEGE OF HEALTH SCIENCES

Tres de Mayo, Digos City, Davao del Sur

Bachelor of Science in Nursing

1st Semester; AY: 2022 – 2023

NCM 105 ACTIVITY 10-15

NAME: (LASTNAME, FIRST NAME, MI.)

G E R S A L I A C H R I S T I E N N I K K I R
SECTION: BSN 2A DATE: November 21, 2022

Case in Point—Michael: Discovering a Shellfish Allergy

Michael is visiting his wife’s family in Boston, Massachusetts. Michael and Robin had eloped and have been
married for one year. He is not looking forward to the visit since this is the first time he will be meeting her
parents. Robin and Michael’s flight arrived at Logan Airport at 6:00 p.m. When Robin’s parents picked Michael
and Robin up, they suggested that they eat at their favorite restaurant, Anthony’s Pier 4. Michael is from Iowa.
He is a farm boy who loves his meat and potatoes. However, he is not shy about trying new foods. At
Anthony’s Pier 4, Michael tries lobster for the first time. It has a fresh sea taste that he loves. Michael also
tried clams and oysters on the half shell. He was okay with the clams but did not like the appearance or taste
of the oysters.
After their meal, the family arrived home and spent some time getting to know one another. Michael and
Robin were tired after their long flight from Los Angeles, so they turned in at 10:00 p.m. During the night
Michael awoke with severe stomach pains, and he was dizzy and nauseated. He woke Robin up, and they
decided to go to the local ER for help when Michael started to complain of difficulty breathing.
ASSESSMENT
1. What complaints did Michael have during the night?
- Michael awoke with severe stomach pains, and was dizzy and nauseated.
2. What objective data could be gathered by the ER nurse?
- Michael started to complain of difficulty breathing.
3. What would you expect to be the problem?
- The cause of the problem must be food allergy
4. Which foods were most likely the cause of the problem?
- Seafoods specifically the oysters since Michael does not like the appearance or taste of the oysters.

DIAGNOSIS
5. Michael’s abdominal pain and nausea could have been caused by food allergy.
6. What information should be gathered during his initial assessment?
- Vomiting
- Abdominal pain
- Nausea

PLAN/GOAL
7. What is the immediate goal for Michael?
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 - Provide antihistamines to reduce the signs and symptoms of the allergy
- If it’s a severe allergic reaction it is a anaphylaxis
8. What is the long-range goal?
- Strictly eliminate the allergic foods this is the only way to avoid allergic reaction that cause signs
and symptoms.
IMPLEMENTATION
9. In the ER, what should Michael and Robin discuss with the physicians?
- The Doctor may instruct to treat a mild allergic reaction with medications such as antihistamines to
reduce the signs and symptoms. If having a severe allergic reaction which is anaphylaxis, this may
likely to take a epinephrine injection.
10. Does it appear that Michael may have a food allergy?
- It is possible for Michael that he may have a food allergy since the signs and symptoms are shown
related to food allergy.
11. Is the doctor able to verify that this is an allergy?
- Yes because the symptoms shows a similar of food allergy.
12. What is the most likely recommendation for Michael?
- Avoid foods specifically that can trigger the symptoms
13. What should Michael be cautioned about in the future about dining out?
- Anything except seafoods especially shellfish types
EVALUATION/OUTCOME CRITERIA
14. When the intervention is complete, how will Michael know it has been effective?
- The symptoms of food allergy is neutralized such as nausea, vomiting, and stomach pain.

Case in Point—Monica: Teenage Pregnancy

Monica was a blonde, blue-eyed 17-year-old high school junior. She was smart, had an A average, and had
career ambitions after her graduation. Monica was very popular and was liked by all her classmates. She was
very active in sports and extracurricular activities. She even volunteered for the local Boys and Girls Club in her
city.
Monica attended the junior prom with Eric. He was the captain of the football team and was very handsome.
After the prom, Monica and Eric attended the after prom parties at the local Holiday Inn. They swam in the
Olympic-size pool, partied, and stayed overnight. During summer vacation, Monica worked at McDonald's. She
had the 6:00 a.m. shift. Monica seldom ate breakfast, and the smell of the frying food at McDonald's made her
sick to her stomach. She was exhausted by the time her shift ended and went home and slept. Monica missed
her June and July periods. The over-the-counter pregnancy test she purchased declared that she was
pregnant. Monica confided in her mother, and they made an appointment for her first prenatal visit. During
the visit she was asked about her smoking and alcohol consumption and her eating habits. She was instructed
to stop smoking. She was given prenatal vitamins and was told to increase her calories and iron intake. Monica
made and kept her follow-up visits. She wanted to have a healthy baby, but she did not want to be fat. She
gained 15 pounds during her pregnancy and smoked when the stress level got too much for her.

Monica’s baby was born at 37 weeks’ gestation. He was 5 pounds 3 ounces and 18 inches long. He had periods
of apnea in which he temporarily stopped breathing, so he had to wear an apnea monitor when he went
home. Monica and her mother were instructed in infant CPR and were taught how to treat apnea at home.

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ASSESSMENT
1. What objective data do you have about Monica?
- Nausea with or without vomiting
- Nasal congestion
- Fatigue
- Bloating
2. What caused Monica to eat the way she did?
- She wanted the baby to be healthy so she followed the doctor’s order to increase her calories and
iron intake.
3. What was the cause of Monica’s noncompliance?
- The reason for that is she doesn’t want to get fat, and other than that she did not totally quit
smoking while she is pregnant.
4. Which prenatal behaviors of Monica were helpful? Which were not?
- Monica followed the Doctor’s order which increases her calorie and iron intake and it was helpful
during her pregnancy but she still smoked which risking the baby’s health.

DIAGNOSIS
5. Complete the following diagnosis statement: Monica’s baby’s risk for disproportionate growth was
related to apnea.
6. Complete the following statement: Monica was at high-risk for Gestational diabetes secondary to
Adverse pregnancy outcome.
7. Complete the following diagnosis statement: Monica’s deficient knowledge about a healthy pregnancy
and infant health is demonstrated by her lack of compliance with cessation of smoking.

PLAN/GOAL
8. What is your plan for Monica’s health after the birth?
- Monica should choose foods high in potassium such as vegetables and fruits to prevent water
retention from sodium.
- Instruct to take vitamins
- Educate about her smoking habits
- Also instruct Monica to drink or fill up about 2 liters of water per day.
9. What is your goal for the baby’s health related to reducing the risk of SIDS and delayed development?
- Place the baby to sleep on their back
- Pacifier
- Breastfeeding
- Keep baby warm
- Immunization
- Breast-feeding for at least six months lowers the risk of SIDS.
- Start CPR if necessary
- Gently tap the sole of your baby's foot. Rub his or her back
IMPLEMENTATION
10. What topics does Monica need to be taught about her baby’s health and development? What does she
need to know about apnea and SIDS? What does she need to learn about normal infant growth and
development?
- Monica needs to be informed about her baby’s condition, she should know about the risks. Monica
needs to know about the complications that can arise from a low birth weight. She needs to be
taught about the causes of SIDS, this may suggests that both illnesses are caused by a restricted
upper airway which related to apnea. Monica should know about the normal growth and
development.

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 11. Who else needs to be present for the teaching?
- Monica’s mother, should also be presented for the teaching so that she can help Monica to
understand the situation and to strictly follow the instructions for the baby’s health.

12. As a teenage mother with a low-birth-weight baby, Monica needs what type of medical and nursing
follow-up? Would home health care nursing visits help?
- An home health care nursing visits would be helpful to Monica since she doesn’t comply to the
instructions. Visiting at home can help her to remind so that she can apply all the health teachings
that taught her for taking care of her health and also the baby’s health.

13. What is your primary concern for the baby?

- The primary concern for a low-birth-weight baby is low oxygen levels and the inability to maintain
body temperature.
EVALUATION/OUTCOME CRITERIA
14. At the next visit, what criteria will the nurse practitioner be using to see if Monica and her baby are
healthy?
- The nurse would provide a physical examination for both Monica and her baby.

Case In Point—Madison: Establishing Healthy Preteen Eating Habits

Madison is a 10-year-old African American girl. She loves playing the piano and composing her own music. She
is an avid computer whiz, taking after her father. She has designed all the family birthday cards and loves
playing video games. When she comes home from school, she has a snack, finishes her homework, and goes
straight to the piano to practice. She spends hours at the keyboard, and by mealtime she says she is hungry.
Madison is 48 inches tall and weighs 98 pounds. Knowing that the family has a tendency to be heavier, her
mother, Amy, is concerned about Madison’s weight; Amy has been on and off Weight Watchers program for
15 years. Amy feels Madison should have more physical activity and needs to stop snacking on cupcakes and
sweets. Madison is due for a preschool checkup. Amy is planning to ask the doctor for help with Madison’s
weight.

ASSESSMENT
1. What objective data do you have about Madison?
- Madison is a 10-year-old at 48 inches tall and weighs 98 pounds.

2. Using Figure 13-4, in what percentile weight and height is Madison for a 10-year-old girl?
- 29.9

3. How do diet, activity, heredity, and family lifestyle impact her current weight?
- African Americans have the highest rates in obesity compared to other races. Madison’s lifestyle
doesn’t involve in physical activities which may impact to her current weight.

4. How significant is this problem?

- It is very significant since the high prevalence in obesity may lead to an array of diseases in the
future.
DIAGNOSIS
5. Complete the following diagnostic statement: Imbalanced nutrition; more than body requirements
related to OBESITY .
6. Complete the following diagnostic statement: Deficient knowledge related to INSUFFICIENT
INFORMATION.

PLAN/GOAL
7. State two reasonable, measurable goals for Madison.
- Madison should limit her piano and computer hours so that she can lend time in physical activities.
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 - Her intake of sweets should also be lessened

8. What referral might be helpful for Madison?

- To dietitian
IMPLEMENTATION
9. What information does the dietitian need to know to help Madison?
- The dietitian should know about the prevalence of obesity towards African American, her heritage,
Amy’s history, and her activities.

10. Who needs to be involved in the plan for it to be successful?

- Madison and her family

11. What are the two big changes that need to occur to help Madison stop gaining weight?
- Limit her piano practice, video games, and eating sweets.

12. What strategies could you suggest so Madison would be successful but have fun in the process?
- Engaging Madison to do fun physical activities like outdoor games, sports or an outdoor hobby that
she will like.

13. How can playing outdoors with friends be helpful?

- Playing outdoors with friends can be helpful because it can motivate Madison in engaging to do
outdoor activities.

14. How can her family help?

- Madison’s family can help her by encouraging her in going outside and play.
EVALUATION/OUTCOME CRITERIA
15. How often should Madison be weighed?
- Every 3 months

16. What outcome is reasonable in three months? In six months?

- Her weight would slowly subside and not exceed from 100 pounds

Case in Point—Chester: Treating Bone Density Loss

Chester and Mildred have been married for 54 years. They have enjoyed retirement in their Florida home.
From the time they were in their 40s, they have tried to eat right, exercise, and be proactive about their
health. Since Mildred had her hysterectomy, Chester has made sure she takes her estrogen. Mildred has been
concerned about Chester recently because he cracked a molar and had to have a replacement. When the
dentist saw the X rays, he commented that Chester had lost some bone density in his jaw. The dentist also
noticed that two of Chester’s teeth were loose. Chester told Mildred that the dentist gave him a questionnaire
to fill out with questions like, “Have you noticed a loss of height?”

ASSESSMENT
1. What do you know about Chester’s health?
- Chester had been eating right along with exercise making Chester proactive about his health along
with Mildred. Chester also had a cracked molar and needs replacement, the Dentist told him that
he had lose some bone density on his jaw.

2. What did the dentist suspect about Chester?

- Experiencing bone density loss which may cause Osteoporosis as shown on his X-ray result due to
the signs of bone atrophy on his jaw.

3. How significant is this problem?

- It’s very significant because low bone density can lead to serious medical conditions that could
result fractures and this may interfere with his daily routine which may be difficult since chronic

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 pain and muscle weakness will be prevalent.

4. How common is this problem in the elderly?

- Studies suggest that 1 in 2 women and 1 in 4 men over the age of 50 because as they age their
osteoclast production are more rapid that osteoblasts that will result to the loss of bone density.

DIAGNOSIS
5. Write a diagnosis for Chester’s alteration in health maintenance and its cause.
- Chester’s alteration in health maintenance is caused by the demands of care needed by his wife’s
condition. Also Chester’s participation in regular exercise which potentially result in excellent bone
maintenance modification lifestyle.

6. Write a diagnosis for Chester’s deficient knowledge and the type of education he needs.
- Chester’s deficient knowledge with the signs and symptoms of osteoporosis, he should know that
his bracket is prone to disease such as osteoporosis. Chester may learn about treating bone density
loss through an internet or with the help of a Doctor that specialized in bones such as a Orthopedic
to gain knowledge about it. He should reevaluate his diet and start supplementing with calcium rich
foods and vitamin D with regular exercises.
PLAN/GOAL
7. What needs to change in Chester’s diet?
- Chester should refrain drinks like caffeine, carbonated drinks, and alcohol also refrain using
cigarettes, this may consume more good sources of calcium. For foods lessen eating some
processed foods because of the empty calorie and it has high in sodium. Focus to eat with calcium
rich foods and take some supplementary vitamins specifically to vitamin D.

IMPLEMENTATION
8. What additions or alterations in Chester’s diet would prevent further osteoporosis? What are the best
sources of calcium?
- Refrain from consuming caffeine, cigarettes, carbonated drinks, and alcohol.
- For good sources of calcium are dairy products, almonds, broccoli, kale, canned salmon with bones, sardines
and soy products, such as tofu.

9. What information does Chester need to make this change?

- Posture enhancing position
- Aggravating and alleviating factors

10. Who can help him learn?

- Orthopedist
- Dietitian
- Physical Therapists

11. Why doesn’t Mildred show any of these signs?

- Because of Mildred’s estrogen supplements.

12. How can regular exercise help?

- Regular exercise may maintain bone density as it becomes active and can help to produce more
osteoblasts and build bone tissues.

EVALUATION/OUTCOME CRITERIA
13. In six months, when the dentist examines Chester again, what will Chester report?
- There will be improvements of his jaw and his stability, also good teeth condition.
14. How long will it take before the dentist can measure an improvement on an X ray?
- Maybe a year since it is not advisable to frequently undergo x-ray procedure due to harmful
radiations.

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