ncs part 2 2010-2011

Systemic Viral Infection

A Case Study Presented the

Faculty of the College of Nursing

Of University of Saint La Salle

Bacolod City

In Partial Fulfillment

Of the Requirements for the

Degree in Bachelor of

Science of Nursing

Submitted by:

Karin Agramon

BSN 3K

August 23, 2010

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Table of Contents

Title page 1

Table of Contents 2

Introduction 3

Objectives 4

Anatomy and Physiology 5

Definition of Terms 11

Baseline Data 12

Physical Assessment 13

Nursing History

Gordon’s Functional Pattern 14

Health History 18

Laboratory and Radiology 20

Nursing Care Plan

Risk for Infection 25

Tissue Perfusion 26

Hyperthermia 27

Drug Study

Omepron 28

Ambroxol 29

Health Teaching 30

References 31

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I. INTRODUCTION

Infection is the invasion and multiplication of microorganisms in or on body tissues that

cause signs, symptoms, and an immune response. Such reproduction injuries the host by causing

cell damage from toxins produced by the microorganisms or from intracellular multiplication or

by competing with host metabolism. Infectious diseases ranges from relatively mild illnesses to

debilitating and lethal conditions: from the common cold through chronic hepatitis to acquired

immunodeficiency syndrome. The severity of the infection varies with the pathogencicity and

number of invading microorganisms and the strength of host defenses.

For infection to be transmitted, these factors must be present: causative agent, infectious

reservoir with a portal of exit, mode of transmission, a portal of entry into the host, and a

susceptible host.

As for the Systemic Viral Infection it is an Infection where in all systems are susceptible to

kinds of microorganism in a way that the entire organs contribute to each other to be infected.

I chose this case because of the fact that having this kind of disease is very much dangerous

in terms of its effects. We can get a lot of ideas on how we can prevent complications that may

alter our normal conditions, considering that we are prone to it because we are in a tropical

country and we can easily acquire diseases because of the fact that we Filipinos are very

hospitable enough that we can’t say no in helping a person even we know that he or she is a

carrier of a contagious disease.

The significance of conducting this study is that knowing the disease and its underlying

causes will serve as a basis for the plan of care in which will cater comfort and improvement of

the client. The goals of care are mostly directed to the client who will be presented in this study.

This study hopes to answer the questions about Systemic Viral Infection; what is it and how it

affects the lives of ordinary people.

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II.OBJECTIVES

General Objectives

After 40 hours of nurse-client intervention, the student nurse

will be able to:

1. Identify the nature of SVI.

2. Determine the process involved in having this kind of disease.

3. Discuss the appropriate nursing interventions in the management of

SVI.

Specific Objectives

After 40 hours of nurse-client interactions, the student nurse

will be able to:

1. Discuss the nature, causes, signs and symptoms, treatment and

diagnostic procedures of the disease.

2. Determine the deviations on laboratory tests and its significance to the

disease.

3. Illustrate the pathophysiology of SVI.

4. Formulate a nursing care plan which addresses the specific needs of

the client.

5. Perform through drug study on medications prescribed to client with

SVI.

6. Conduct health teaching regarding client’s condition.

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III. ANATOMY and PHYSIOLOGY

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IV. DEFINITION of TERMS

Circulation – the movement of blood, through the vessels of the body caused by the pumping of

the heart

Circulatory System – system of blood, blood vessels and lymphatics and heart concerning the

circulation of the blood and lymph

Corpuscles – a minute particle, a living cell. One red blood cell or one white blood cell.

Platelets – one of the minute discs of vertebrate blood clot that assists in blood clotting.

Acute Infection – short duration of the order of several days.

Chronic Infection – long duration of the order of weeks or months.

Systemic infection – the infection is widespread throughout the body and must be assumed to be

in all organs.

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V. BASELINE DATA

Name: Patient N.Y.

Address: B8, Lt2, Jesusa, Estefania, Bacolod City

Birth Date: January 6, 1993

Birth Place: Japan

Age: 17 years old

Gender: Female

No. of Dependants: none

Marital Status: Single

Religion: Christian

Educational Level: Secondary Level

Nationality: Filipino

Occupation: Student

Person next to kin: Mother

Admission Date: August 16, 2010

Attending Physician: Dr. Joaquin Moreño, MD

Chief Complaint: fever and cough

Diagnosis: Systemic Viral Infection

Date of Surgery: not applicable

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VI. PHYSICAL ASSESSMENT

CEPHALO-CUADAL APPROACH

LOC:

On bed, Awake

Responsive to both verbal and non-

verbal stimuli.

Oriented to time, place, date, and

person

HEENT:

Pupil Equally Round Reactive to

Light and Accommodation.

With pale conjunctiva

With anecteric sclera

Without nasal discharges

Hearing Intact. Landmarks visible;

no bleeding or drainage

CARDIOVASCULAR:

With IVF # 5 D5LR x 125 cc/hr @ L

metacarpal vein with a remaining

solution of 480 cc.

With poor capillary refill longer than

3 seconds.

With BP of 90/60 mmHg; taken @ R

arm in sitting position.

With Pulse rate of 80 bpm; taken @

R radial pulse.

RESPIRATORY:

Breathes spontaneously to room air.

With RR of 25cpm.

GASTROINTESTINAL:

On DAT; with poor appetite.

GENITOURINARY:

Not able to defecate upon

assessment.

Able to urinate without assistance @

approximately 250 cc

MUSCULOSKELETAL:

Able to perform both active and

passive ROM.

Able to ambulate without assistance.

INTEGUMENTARY:

With good skin turgor.

Mucous Membrane not noted.

With pale color r/t race of father

(JAPANESE).

With dry skin, and warm to touch.

With Temperature of 38.6

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VII. PATHOPHYSIOLOGY

Precipitating Factors Predisposing Factors

Age: 17 years old Emotional and Physical Hematologic State: Stressors

↓ RBC Poor appetite↓ WBC not eating balance diet↓ HgB and Hct↓ Platelet count

Immunocompromised

Pathogen replicates, thus duration of disease occur and range from instantaneous years.

Inflammation occurs as a major reactive defense mechanism in the battle against infective agents

Arterioles at or near the site WBC’s and platelet move towardOf the injury briefly constrict and thus dilate, the damaged cells.Thus ↑ in fluid pressure in capillaries. At the same time inflammatory cells release histamineAnd Bradykinin w/c further ↑ capillary permeability.

RBC’s and fluid into the interstitial space, Phagocytosis of dead cells and Contributing to edema. Microorganisms begin.

↓ of platelet count is seen during CBC,

Together with the RBC, Hgb, Hct, and the rest of the hematological count in the test.

Signs and Symptoms

A. FeverB. CoughC. Abdominal painD. HeadacheE. Joint painsF. Sleeping disturbancesG. ConstipationH. Hematoma in upper extremities

VIII. Nursing History (Gordon’s Functional Health Pattern)

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A. Health Maintenance – Perception Pattern

Patient is aware of her condition. She perceived health is very important

especially to her as a student. She claimed of having Systemic Viral Infection and very

optimistic towards her condition. She consulted her Pedia on the moment she suspected

of the symptoms of her illness. She is a non-smoker as well as non-drinker. Patient also

stated that she does not have any OTC drug or food allergy.

B. Nutrition – Metabolic Pattern

Client is not wearing dentures in both upper and lower teeth. Her usual diet is

more in chicken and pork. She ate trice a day with snack between it, but she has a poor

appetite. She has no difficulty in swallowing, thus she is independent in eating and

drinking. She stated that she doesn’t drink very often fluids. She also stated that every

time she had wounds, the healing pattern of such is very fast especially if it is just a

normal scratch.

C. Elimination Pattern

Patient can void freely at home within normal frequency at the normal pattern

three times a day with approximately 240cc/urination. She can defecate twice in a week

, but sometimes she has difficulty in eliminating it.

D. Activity and Exercise Pattern

Patient is studying. Her activities include walking, bathing, and dancing as a part

of her extra-curricular activities in school. She stated that she is exercising every

morning as a part of her daily routine.

E. Sleep and Rest Pattern

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Patient usually sleeps eight hours at night and sometimes less than her usual

pattern. She stated that sometimes she sleeps late at night because she needs to study

her lesson for the next day or finish her assignments and projects as a part of her

requirements in her respective subjects.

F. Cognitive Perception Pattern

Patient is on the Formal Operational Stage of Jean Piaget’s Cognitive

Development. She answers all my questions without any sensory deficit. She is good in

logical thinking as well as in reasoning and conceptualization. She also can deal

hypothetical situations, and questions. Right now she is currently enrolled in high

school here in Bacolod city as a second year high school student. She doesn’t have any

disease that can affect her mental or sensory functions.

G. Self-Perception Self-Concept Pattern

Client was able to view her life in a positive way. She is very comfortable in her

appearance, she is grateful to have her body as graceful as others even if she is in the

hospital. She is very confident in dealing with other people. She said that sometimes

she is affected in some of the problems of her friends and family members that’s why

she is not use to just look but she is helping her friends or family members to find a

solution in the problem, that’s why she felt so stress.

H. Role and Relationship Pattern

Patient is on the Adolescence Stage of Erik Erikson’s Psychosocial Development.

She stands as the only child in the family, and a friend. She is open to her friends

especially when it is all about her family. She says that her friends are more likely

important at this stage of her life because she doesn’t want to be lonely at school.

Currently she have her boyfriend at her side and her mom, she said that whatever she

does or whoever she chose she knows that her mother and father will support her and

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understands her. She doesn’t have any problem in socialization, in communication and

in her family and friends.

I. Sexuality and Reproductive Pattern

Patient is on the Genital Stage of Sigmund Freud’s Psychosexual Stage. She currently

has a boyfriend, and they have good relationship with one another. As a student and a

daughter she sees herself a mother in the future but not in this time. She said that she

will first focus in her studies. She also said that she knows her limitation as a lady. She

does not want to be a burden of her mother. Patient doesn’t have any problem regarding

her reproductive system. Her menarche started at the age of 14 years old, and stated that

she could consume 3-5 pads a day.

J. Coping Stress Pattern

Client said that she copes with her problem through crying and sharing it to her

friends; she also added that she experienced to have a counseling session to their

Guidance Councilor in their school. She said that those practices of her were a very

great help to her in accepting her problem and to learn from it. She don’t drink any

medicines just to be kept calmed, she can manage her problems, and stress without any

of those. She said that she is accepting the major changes that happened and will be

happening to her.

K. Values and Belief Pattern

As a child she had encountered a lot of mistakes, failure, and success. Being

Responsible in all her actions is one of the greatest values she have learned. She also

believed in the saying, “NO MAN IS AN ISLAND.”

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IX. HEALTH HISTORY

1. History of Present Illness

Two days prior ---- patient had sudden onset of high fever (39.5ᵒc).

Non-produsctive cough and nasal catarch.

Fever was lysed with Paracetamol

One day prior ----- persistence of above signs and symptoms on the day of consult.

(-) chills, (-) vowel movement changes, (+) loss of appetite

1. Past Health History

A. Childhood Illnesses

The patient claims to have a normal state of health. She rarely experienced

childhood illnesses like fever, flu, cough and colds. She also said that she doesn’t

have any food or drug allergy.

B. Past Hospitalization

She said it was her first time to be admitted in the hospital. She hasn’t

encountered some serious illness or diseases that could lead her to the hospital.

C. Previous surgery

Patient N has never gone into surgery.

2. Family and Social History

Upon Assessment, patient claimed that her DAD is hypertensive and her MOM is

anemic. She doesn’t know about her family’s health history. She is not sure if her

relatives have illnesses that can be genetically acquired.

3. Psychosocial History

a. Social Habits

- The patient is currently employed as a government teacher. She is a non-smoker,

non-alcoholic beverage drinker and non-user of illicit drugs.

b. Sleeping patterns

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- She has lots of time to sleep especially if she doesn’t have any homework to do.

She wakes up early in the morning to prepare herself to go to school. She’s not

used to take naps in the afternoon taking into consideration that she is in school

and have a class.

c. Dietary Patterns

- She usually ate three times a day. Her usual meal is composed of rice, pork and

chicken. She claimed to drink 3-5 glasses of water per day.

4. OB-Gyne History

- Her menarche started at the age of 14. And claimed to have an irregular

menstrual cycle. She also said that she can consumed 3-5 pads per day.

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X. Laboratory and Radiology

A. CLINICAL MICROSCOPY SECTION

August 16, 2010

Patient Name: N.Y Date Requested: August 16, 2010

Urinalysis (routine)

Physical Examination Microscopic ExamColor: Straw RBC: 0-1/hpfCharacter: Slightly Turb. Pus Cells: 1-4/hpfReaction: 6.5 Epithelial Cells: MANYSpecific gravity: 1.015 Renal: occasional Mucus Threads: occasional Bacteria: Few

Chemical Exam CastAlbumin: Negative Hyaline: /lpfSugar : Negative Fine Gran: /lpf Course Gran: /lpf Others:

CrystalUric Acid: Urates: FewCalcium Oxalate: Amor Phosphate: Triple Phosphate:

IMPLICATION:

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B. SPECIMEN: BLOOD

August 16, 2010

Patient Name: N.Y. Date Requested: August 16,2010

Specimen: BloodEXAM Result Normal Values Result Normal Values (S.I.) (C.U.)Sodium 137.00 137-146 mmol/L 137.00 137-145 mEq/dLPotassium 4.43 3.6-5.1 mmol/L 4.43 3.6-5.1 mEq/dLRBS (Random 4.89 4.4-7.7 88.89 80-140 mg/dLBlood Sampling)Creatinine 54.81 53.0-114.92 mmol/L 0.62 0.6-1.3 mg/dL

IMPLICATIONS:

C. HEMATOLOGY

Laboratory/ Diagnostic test

Result Normal Values Interpretation Implication

CBC(COMPLETE BLOOD COUNT)

Hemoglobin 115 g/L 120.00-170.00 g/L

Below Normal Standard evaluation test before surgery

Hematocrit 0.33 0.38-0.47 Below Normal Indicates dehydration

RBC count 3.52 4.60-6.00 x 10^12/L

Below Normal Indicates anemia

Coagulation Profile

Platelet count 126 /L150.00-400 x

10^9/L Below Normal Immunocompromised

WBC 2.2 /L5.00-10.00 x

10^9/L Below Normal Infection

Differential Values

Segmenter 0.70 0.50-0.70 Normal Normal

Eosinophils 0.04 0.00-0.05 Normal No Parasitic Infection

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Monocyte 0.03 0.00-0.07 Normal Normal

Lymphocyte 0.23 0.20-0.40 Normal No Chronic Infection

Remarks:

NORMOCYTIC, NORMOCHRONIC RBC

D. HEMATOLGY

August 17, 2010




Hemoglobin 109 g/L 120.00-170.00g/L

Below NormalStandard evaluation test before surgery

Hematocrit 0.32 0.38-0.47 Below NormalIndicates

dehydration

RBC count 3.34 4.00-5.50 x 10^12/L


Coagulation Profile

Platelet count 99 150-400 Below Normal Immunocompromised

WBC 1.2 5.00-12.00 x 10^9/L

Below Normal Infection

Differential Values



Lymphocyte 0.32 0.20-0.40 Normal No Chronic Infection

Remarks:

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E. HEMATOLOGY

AUGUST 17, 2010




Hemoglobin 105 g/L 120.00-170.00

g/L Below NormalStandard evaluation test before surgery

Hematocrit 0.32 0.38-0.47 Below Normal Indicates dehydration

RBC count3.34

4.60-6.00 x 10^12/L


Coagulation Profile

Platelet count 87 /L 150.00-400 x 10^9/L Below Normal Immunocompromised

WBC 1.4 /L 5.00-10.00 x 10^9/L

Below Normal Infection

Differential Values



Lymphocyte 0.46 0.20-0.40 NormalNo Chronic Infection

F. HEMATOLOGY

PLATELET COUNT AUGUST 18, 2010



Platelet count87 /L 150.00-400 x


G. RADIOLOGICAL REPORT

CHEST X-RAY AUGUST 16, 2010

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Name: N.Y

Examination: Chest PA

Result: Chest PA shows no gross lung infiltrates heart is not enlarged. Diaphragm and costophrenic sulci are intact. No other remarkable findings of note.Remarks: Essentially normal chest findings.

H. HEMATOLOGY






I. HEMATOLOGY






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Name of Patient: patient N.K Age: 17 years old Sex: Female Status: SingleMedical Diagnosis:

Assessment Nursing Diagnosis Rationale Desired Outcome Nursing Interventions Justification Evaluation

Actual/ abnormal cues:

RISK FACTORS: ↓ HgB ↓ Platelet

Count ↓ RBC and

WBC Insufficient

knowledge to avoid exposure to pathogens.

STRENGTH: Good family

support. Good financial

support Strong faith in

GOD.

Risk for infection r/t inadequate secondary defenses.

DEFINITION: At increased risk for being invaded by pathogenic organisms.

Source:Doenges, M., et al.Nursing Care Plans Guidelines for individualizing Patient care 6th ed. (2002).Davis Company.Thailand.

Predisposing Precipitating - 17 yrs old - environmental -hematologic stressors State such as: - emotional ↓Hgb, Hct, and physical RBC, WBC, stress And platelet - poor appetite Count.

Inflammation occurs as a major mechanism defense.

Pathogens enter the system, and battle against infection occurs.

Decrease of WBC, RBC, HgB, Hct, and platelet count in the

hematological report.

Hospitalization

Risk for Infection

Source: Medical Surgical Nursing

After 40 hours of nurse-client intervention the client will be able to:

1. Identify interventions to reduce the risk of infection.

2. Verbalized understanding of individual risk factors.

3. Identify techniques, and lifestyle changes to promote safe environment.

INDEPENDENT1. Monitor vital

signs especially the temperature.

2. Asses and document skin conditions with or without insertions.

COLLABORATIVE:1. Stress proper

hand washing techniques by all caregivers between therapies/clients.

2. Encourage early ambulation.

- Fever signifies inflammation thus infection occurs.

- To prevent inflammation on skin surfaces.

- A first line defense against cross contamination.

- For mobilization of respiratory secretions.

After 40 hours of nurse-client relationship the client

1. Goal met. The patient was able to identify interventions to prevent her from infection.

2. Goal met. She was able to verbalize the risk for infection especially with her conditions.

3. Goal met. Patient was able to identify techniques, etc. to promote safe environment such as proper waste disposal.

XI. NURSING CARE PLAN

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Name of Patient: Age: Sex: Status:Medical Diagnosis


Actual/ Abnormal Cues:

4 napkin pads in 8 hours shift.

Napkin fully soaked with blood.

Capillary refill longer than 3 seconds

Skin temperature changes; TR- 38.6

Risk Factors:

Strengths:

Good financial support.

Good Family Support.

Strong believes in GOD.

Ineffective tissue perfusion r/t decreased in HgB concentration in blood aeb restlessness, and fatigue.

DEFINITION:Decrease in oxygen resulting in the failure to nourish the tissues at the capillary level.

Source:Doenges, M., et al.Nursing Care Plans Guidelines for individualizing Patient care 6th ed. (2002).Davis Company.Thailand.




Decrease of WBC, RBC, HgB, Hct, and platelet count in the hematological report.

Stress in the myometrium

Heavy bleeding during menstrual cycle

Hospitalization

Ineffective Tissue Perfusion


After 40 hours of nurse-client relationship the client will be able to:

1. Verbalized understanding of condition, therapy regimen, and side effects of medications.

2. Demonstrate behaviors/lifestyle changes to improve circulation.

3. Demonstrate increased perfusion as individually appropriate.

INDEPENDENT:1. Identify

changes r/t systemic and peripheral alterations in circulation.

2. Evaluate for signs of infection especially when immune system is compromised.

3. Note customary baseline data.

4. Encourage early ambulation

COLLABORATIVE:1. Administered

medications with caution.

- Changes in both can be a sign of tissue damaged or infection.

- To be given the right way of care and proper medication.

- Provides comparison with current findings.

- Promotes venous return.

- Drug response may be altered any decreased tissue perfusion.

X.NURSING CARE PLAN

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Name of Patient: Age: Sex: Status:Medical Diagnosis


Actual/ Abnormal Cues:

Headache as patient verbalized

Skin warm to touch

Increase in body temp above normal range TR=39.4

Risk Factors:

Strengths: Good financial

support. Good Family

Support.Strong believes in GOD.

Hyperthermia r/t inability to perspire aeb skin warm to touch.

DEFINITION:Body temperature elevated above normalRange. Source:Doenges, M., et al.Nursing Care Plans Guidelines for individualizing Patient care 6th ed. (2002).Davis Company.Thailand.




Decrease of WBC, RBC, HgB, Hct, and platelet count in the hematological report.

Hospitalization

Chills, inability to perspire, headache, fatigue

Hyperthermia


After 8 hours of nurse-client relationship the client will be able to:

1. Maintain core temperature within normal range.

2. Demonstrate behaviors to monitor and promote normothermia

INDEPENDENT:1. monitor

respirations.

2. monitor intake and output.

3. Monitor laboratory results.

COLLABORATIVE:1. Administered

antipyretics, orally.

2. Provide high caloric diet.

- Hyperventilation may initially present, but ventilator effort may eventually be important by hematologic state.

- To replace GI losses if there is.

- To note if there is a change in any electrolytes and other enzymes.

- To have normothermia.

- To meet increased metabolic demands.

After 8 hours of nurse-client intervention the client was able to:

1. Goal met. Patient was able to normalize and maintain the temperature in normal range.

2. Goal met. She was able to demonstrate behaviors to promote normothermia such as Tepid Sponge Bath.

X.NURSING CARE PLAN

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Name of Patient: Patient N.Y. Age: 17 years old Sex: Female Status: Single

Medical Diagnosis:

Name of Drug Route, Dosage, and Frequency

Mechanism of Action Indication Contraindication Adverse Reactions Nursing Interventions

Generic Name:

Omeprazole (Omepron)

Brand Name:

Losec, Prilosec, Prilosec OTC,Zegerid

Classification:

Proton Pump Inhibitor

20 mg capsule,Given Per Orem,OD

An antisecretory compound that is a gastric acid pump inhibitor.

It suppresses gastric acid secretion by inhibiting the H+, K+ ATPase enzyme system [the acid (proton H+) pump] in the parietal cells.

Duodenal and Gastric Ulcer.

Gastroesophageal reflux disease including severe erosive esophagitis (4-8 wk treatment).

Long term treatment of pathologic hypersecretory conditions such as Zollinger-Ellison syndrome, multiple endocrine adenomas, and systemic mastocytosis.

In combination with clarithromycin to treat duodenal ulcers associated with Helicobacter pylori.

Long term use for Gastroesophageal reflux disease (GERD).

Duodenal ulcers

PPI hypersensitivity in children <2 yrs. Old

OTC formulation in children <18 yrs. Old or bleeding.

Use of Zegerid in metabolic alkalosis, hypocalcemia, vomiting, and GI bleeding.

CNS: Headache Dizziness Fatigue

GI: Diarrhea Abdominal

pain Nausea Mild Transient

increase in Liver function tests.

UROGENITAL: Hematuria Proteinuria

SKIN: Rash

Laboratory Test: Monitor Urinalysis for Hematuria and Proteinuria.

Report for any changes in urinary elimination such as pain, discomfort associated with urination.

Monitor vital signs.

Report if diarrhea is present.

XII. DRUG STUDY

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Name of Patient: Age: Sex: Status:Medical Diagnosis:

Name of Drug Route, Dosage, and Frequency

Mechanism of Action Indication Contraindication Adverse Reactions Nursing Interventions

Generic Name:

Ambroxol

Brand name:

Classification:

Muculytic

75 mg. tabletGiven Per OremOD

Adjuvant

therapy inpatients withabnormal, viscid, orinspissated mucoussecretions in acuteand chronicbronchopulmonarydiseases, and inpulmonarycomplications ofcystic fibrosis andsurgery,tracheostomy, andatelectasis.

There is no absolutecontraindication but inpatients with gastriculceration relativecaution should beobserved.

Occasionalgastrointestinalside effects mayoccur but theseare almostinvariably mild.

Monitor for Vital signs

Monitor for signs and symptoms.

XI.DRUG STUDY

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Name of Patient: Age: Sex: Status:Medical Diagnosis:

Medications Exercise Treatment Hygiene Outpatient Diet

A. Omeprazole (Omepron)Proton Pump Inhibitor20 mg capsule, Given Per Orem, OD (8 am)

An antisecretory compound that is a gastric acid pump inhibitor.

B. Ambroxol Muculytic 75 mg. tablet given per Orem OD (8am).

Active and Passive ROM

- For venous return- To stimulate both

upper and lower extremities.

Ambulation- To prevent pain

from joints as a effect of not ambulation.

IVF Therapy- To replace the

fluids and electrolytes in our body.

Laboratories:a. CBC (Complete

Blood Count)b. Urinalysis

Oral care- These can prevent

microbes to accumulate in the mouth.

Changing of Clothes

Changing of napkin pads every 2-3 hours.

- For hygienic purposes and to monitor the pads and the blood that are

Environmental sanitation

- Promote healthy individual.

- Prevent illness that bought by

Proper Hand washing

On DAT (DIET AS TOLERETAD)

- Any foods can be given without any restrictions

Increase fluid intake

Increase in iron intake.

XIII. HEALTH TEACHING PLAN

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REFERENCES:

Doenges, M., et al.Nursing Care Plans Guidelines for individualizing Patient care 6th ed.

(2002).Davis Company.Thailand.

Daniels, R., et al.Contemporary Medical-Surgical Nursing Thomson Asian Ed.(2007).

Delmar Learning.Asia.

Stedman’s Medical Dictionary. 27th edition.

Sanders.Scanlon.Essentials of Anatomy and Physiology.(2007). F.A. Davis Company.

Taiwsn.

Patient’s chart.

Client herself.

Prentice hall. Nurse’s Drug Guide.(2007). Pearson Education Inc. New Jersey.

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Documents

ncs part 2 2010-2011