I.

PERSONAL DATA

Name: Peri To
Address: Poblacion, Pagupud, Ilocos Norte
Hospital No.: 1089462
Age: 32y/o
Date oI Birth: August 7, 1979
Place oI Birth: Pagudpud, Ilocos Norte
Sex: Male
Civil Status: Married
Occupation: Fisherman
Religion: Roman Catholic
ChieI Complaint: Right lower Quadrant pain
Date oI Admission: August 28 2011
Time oI Admission: 12:55 A.M
Admitting Diagnosis:
Final Diagnosis: Acute abdomen secondary to middle third ileum medial third ileum with
generalize peritonitis
Admitting Physician: Dr. Stone









II. FAMILY BACKGROUND

Our patient, Peri To, a 32 year old high school level, is a Iisherman. Lives at Pagudpud,
Ilocos Norte with her wiIe, a 30 years old, his daughter, who is 8 years old, and his son, a 7 years
old.
With respect to the source oI income, it comes Irom him. According to our patient, He
goes to work occasionally, sometimes he work as a carpenter or a Iisherman so he usually
receives P1500 to P2000 every month but ocasionally.
This income is broken down and allocated to Iood, electric bill, and allowance oI her
daughter and son in going to school and and other miscellaneous expenses. The estimated

Breakdown oI their expenses are as Iollows:
Food (including groceries) - P800
Electric bill - P200 300
Allowance oI daughter - P100 200
LPG tank (1 tank Ior 2 months, 700/tank) - P350
Others (miscellaneous) - P250
Total - P1700-2000

However, iI they can`t consume the entire allotted budget Ior each breakdown, this
would become their savings which they can use Ior emergency purposes.
In terms oI decision-making, Mr. Peri to and her mother is responsible in deciding Ior
their Iamily. The patient and his wiIe decide together in allocating their budget and on matters
concerning health oI their Iamily members. Whenever emergency cases arise, like when he was
hospitalized, his siblings would help them in covering Ior the expenses iI their savings are not
enough.

III. Health History
Family health history
Peri To is the eldest son oI his Iather and his mother. He is stated that his parent does not
have any serious disease but they are experiencing aging problem like blurring oI vision and
IorgetIulness.
The Iamily members had experienced to have colds and when they experience it, they
managed it through water therapy and taking over the counter drugs such as Neozep (500 mg)
they also experience to have cough and they managed it by taking oregano extract. When one oI
the Iamily experience Iracture or sprain they go to the nearest clinic to ask Ior consultation.
Furthermore the Iamily wake up at around 6 am and go to bed at around 9 pm aIter their
whole day activities. They take a bath once a day and brush their teeth twice a day.
The Iamily love to eat vegetables and Iish. As verbalized by the patient 'mahilig kami ti
kilawen nga dilis, hipon ken monamom. As a merienda they eat chitseria and drink soIt drinks.

Past Health History
Peri To had experience cough and colds which she managed by taking in Neozep and
herbal medicines. Aside Irom taking in those said medications he also increases his oral Iluid
intake. He also keeps himselI rested to prevent complication when he has a Iever.
According to him he experienced chicken pox, measles and other childhood diseases. He
was not able to recall what where the managements done by his parent.
In 1999 he was Iirst admitted and conIined at Governor Roque B. Ablan Sr. Memorial
Hospital due to appendicitis. He experience pain at his right iliac region so they decided to go to
the hospital and ask Ior consultation and the doctor suggested Ior surgery Ior the removal oI his
appendix. A year Irom his Iirst hospitalization he met an accident but acquired only minor injury
to his leIt ankle. He managed the wound by cleansing it with Betadine.
Our client told us he drinks liquor usually about halI oI the bottle trice a week. He also
stated that he does not have any allergies with Ioods and medicines.

Present history
Peri To experience increase in size oI his abdomen and abdominal pain. According to
him he doesn`t have bowel movement Ior one week. He was alarm but still he did not consult
any physicians. He Iirst went to an albolario thought his condition was caused by evil spirits. The
albolario advised him to take herbal medicines but there was still no improvement.
Since his condition did not improve despite taking herbal medicines, they decided to
consult to Bangui District Hospital and reIerred him to GRBASMH Ior Iurther observation,
hence, admitted with a chieI complaint oI right lower quadrant pain. He underwent surgery Ior
the exploration oI his abdomen and they Iound out that he has had intestinal perIoration which
was done by Dr. Stone. AIter the surgery the doctor advised him to stay in the hospital Ior a
week Ior the healing oI the wounds but as observation there`s no improvement to his conditions.
His abdomen is still bloating. To the test that they did aIter 7 days post-operatively, Peri To is
positive to typhoid test conIirming that the cause oI the perIoration oI his intestine is a Salmonela
Thypi.

IV. PATHOPHYSIOLOGY






























1horaclc ducL
Lymph flow
8lood SLream
ln Lhe llver and kldneys Lhe
focal necrosls of parenchymal
cells aL Lhe slLe of colonlzaLlon
lymphold Llssue hyperLrophy
and hyperplasla
88C
abdomlnal paln and Lenderness
edema
8acLeremla
local necrosls and ulceraLlon
Pemorrhage and erforaLlon
of Lhe lnLesLlnes
Llnkage of lnLesLlnal conLenLs
lrrlLaLlon and lnvaslon of
mlcroorganlsm ln Lhe
perlLoneum
k|ght Lower
uadrant a|n
er|ton|t|s
1?PClu lLvL8
Salmonella 1yphosa/1yphl
lnvade Lhe Cl1
(mouLhesophagussLomach)
ConLamlnaLed food/waLer feces flngers
fomlLes and flles
Small lnLesLlnal mucosa
lnLesLlnal lymphaLlc/mesenLerlc
eyer's atches (m|dd|e th|rd
I|eum)
'. PATTERNS OF FUNCTIONING
A. Eating pattern
BeIore illness
During illness
BeIore Hospitalization During hospitalization
He is Iond oI eating 'kilawen(dilis,
hipon). Every meal he can consume 2
cups oI rice. He also eat poultry,
vegetables (pinakbet), chicharon
baboy some times. His merienda
consists oI junk Ioods and camote. He
does not have allergies to Ioods noted.
He can`t able to eat kilawen
anymore. He can cosume halI cup oI
rice only during meals. Although he
can eat chicharon baboy but minimal
amount. He can`t eat junk Ioods
anymore.
He eats halI oI lugaw
and a slice oI banana
about 1 inch. He eats
vegetables like petchay,
marunggay with rabong
but decrease in quantity.
Analysis:
There is a decrease in the intake oI Iood oI the patient due to loss oI appetite brought about by his disease
condition and because oI the pain he is experiencing in his abdomen.
B. Drinking Pattern
BeIore illness
During illness
BeIore Hospitalization During Hospitalization
He drinks 7-8 glasses oI water every
day(1000-1500 ml). He also drinks
soda sometimes (thrice a week) with
an amount oI 250 ml. He does not
have allergies to drinks.
He still drinks 7-8 glasses oI water a
day. But he can`t drink soda
anymore.
He has a decreased
water intake oI 100ml a
day. Soda is already
restricted.
Analysis:
There is a decreased intake oI water due to accumulation oI Iluid in the body causing edema.
C. Bladder Elimination
BeIore illness
During illness
BeIore Hospitalization During Hospitalization
He voids six times a day early in the
morning, at lunch, at dinner, between
meals and late at night. The color is
yellowish. The amount is 1000-1250
ml.
He voids six times a day early in the
morning, at lunch, at dinner, between
meals and late at night. The color is
yellowish. The amount is 1000-1250
ml.
He voids 1-2 times a day
with decreased quantity.
The amount is less than
100 ml a day.
Analysis:
The patient has a decreased Irequency oI voiding and quantity oI urine due to the decreased intake oI
Iluid.
D. Bowel elimination
BeIore illness
During illness
BeIore Hospitalization During Hospitalization
He moves his bowel in the morning
and in the aIternoon. The color is
yellow and semi-solid in consistency.
He didn`t deIacated Ior a week since
the onset oI his disease.
He is now using diapers
with watery stool.
Analysis:
There is a slight change in the bowel pattern oI our client during hospitalization because he cannot eat
well and because oI weakness.
E. Bathing Pattern
BeIore illness
During illness
BeIore Hospitalization During Hospitalization
He takes a Iull bath twice a day in the
morning and late in the
aIternoon.Materials Ior bathing are
silka, cream silk, 1 pail, and 1 tabo.
He takes a Iull bath early morning
assisted by his wiIe. Materials Ior
bathing are silka, cream silk, 1 pail,
and 1 tabo.
He do not take regular
bath. Usually head and
tail bath only.
Analysis:
There were no changes in the bathing pattern oI our client beIore illness but beIore hospitalization and
during hospitalization, there is an evident change due to the discomIorts, pain, weakness and easy
Iatigability.
F. Sleeping Pattern
BeIore illness
During illness
BeIore Hospitalization During Hospitalization
He takes naps at daytime (8-11am and 1-4pm). He
sleeps at 7pm and will wake up at 4am to go in his
work.
He takes naps at
daytime (8-11am and 1-
4pm). He sleeps at 7pm
and will wake up late at
7pm. He can`t go in his
work anymore.
He has a disturbed
sleeping pattern at night.
He usually sleeps at 8pm
and wakes up at 7am. He
takes a lot oI sleep in the
aIternoon.
Analysis:
The client is having interrupted sleep pattern during hospitalization because oI environmental conditions
like the noise, hot temperature and hospital routines such as giving oI medications and vital signs taking.
'I. PHYSICAL ASSESSMENT
General Appearance:
Peri To was seen lying on bed asleep. He was weak in appearance. He has an oxygen
inhalation via nasal cannula at 2L per minute and an intact IVF hooked at the leIt metacarpal
vein. He was wearing red shirt and gray shorts.
Vital Signs:
BP: 130/80mmhg
PR: 86bpm
RR: 21bpm
TEMP: 37.1C
Head to toe assessment:
HEAD
Normocephalic
Congruent to body size
HAIR
With a black, dry and evenly distributed hair
FACE
Heart shape
EYES
With pale conjunctiva
Icteric
Rounded
EYELASHES
Thin, short and evenly distributed
EYEBROWS
Symmetrical in shape and evenly distributed

EARS
Symmetrical in shape and size
With good hearing acquity
NOSE
Symmetrical nares
MOUTH
Brownish gums
Yellowish teeth
With Ireely movable tongue
Dry lips with cracks in edges
CHEST
Symmetrical chest expansion
RR oI 23 breath per minute
HEART
With cardiac rate oI 76 bpm
ABDOMEN
Distended
With intact dressing at the epigastrium extending to the hygastrium
with scar at the right iliac region
(-) bowel sound
UPPER EXTRIMITIES
Asymmetrical in size
With presence oI deltoid scar in the right and leIt arm
Able to do range oI motion
With dirty Iingernails
With good Capillary reIill
LOWER EXTRIMITIES
Bipedal pitting edema () 1
Able to do range oI motion
With dirty nails
With capillary reIill oI 2-3 sec
'II. ON GOING APPRAISAL

Mr Peri To, a 32 year old patient was admitted on August 28, 2011 at 12:55pm at the
Gov. Roque B. Ablan Sr. Memorial Hospital with a chieI complaint oI abdominal pain (RLQ).
He was admitted by Dr. Stone with an admitting diagnosis oI Intestinal Obstruction perIorated
secondary to post op edema. DiIIerent diagnostic procedures were ordered such as CBC,
Urinalysis, Abdominal X-ray and Sodium/Potassium. He was ordered to be on NPO and I and O
monitoring. A D5LRS 1 Liter IVF was inserted as venoclysis regulated at 21 gtts/min. She was
prescribed to take medicines like CeIuroxime every 8hrs ANST (-), Ranitidine 50mg IV every
8hrs, Metronidazole. In the evening a exactly 6:30 pm Dr. Stone ordered minimal Iood and liquid
Ior 3 day diet.

Initial Vital Signs:
Temp: 37.4 PR: 82 beats/min
BP: 130/90 mmHg RR: 17 breaths/min

On September 7, 2011, He was still week and still with bloated abdomen with an IVF oI
D5LRS 1 liter regulated to KVO. His operative dressing was intact and dry supported with
abdominal binder and had edematous Ioot. He was seen and examined by Dr. Stone and Dr.
Colon and ordered PNSS x 12 hours, D5NM 1 liter x 24 hours, soIt diet and DAT Ior tomorrow.
Peri To nebulize every 15 mins x 3 doses and has Oxygen Inhalation regulated to 2-3l /min. his
medication are CeproIloxacin 400mg/iv every 12hours, Paracetamol IV every 8 hours Ior temp.
~ 38C, Ranitidine 50 mg 75mg IV every 8 hours, Ketorolac 30 g IV every 8 hours,
Metronidazole 500 mg IV every 8 hours, Furosemide 40 mg IV stat, Salbutamol/nebu stat then
every 15 mins x 3 doses Peri To consumed 3 bottles oI IVF.

T: 36.6 - 38.2
BP: 100-120/70-80 mmHg
PR: 82 85 beats/min
RR: 19 21 breaths/min

On September 8, 2011, He was still week and still with bloated abdomen with an IVF oI
D5LRS 1 liter regulated to KVO. His operative dressing was intact and dry supported with
abdominal binder and had edematous Ioot. He was seen and examined by Dr. Colon and ordered
D5NM 1 liter x 24 hours and position abdominal upright and Ior repeat serum electrolyte. He
was reIIered to Dr. Domingo because oI the positive Typhi Dot test and ordered NGT and IFC
insertion, Ior repeat CBC, Na K Cl, and BUN, Crea, TPAG, CXR (PA-upright), IVF oI D5LRS x
8 hours Ior 3 cycle, continue meds, monitor NGT output every 4 hours and record, modiIu high
back rest, oxygen support with 2-3L/min via nasal cannula and vital sign and I and O every 1
hour. Peri To nebulize every 15 mins x 3 doses and has Oxygen Inhalation regulated to 2-3
L/min. His medication are CeproIloxacin 400mg/iv every 12hours, Paracetamol 300mg IV every
4 hours Ior RTC, Ranitidine 50 mg 75mg IV every 8 hours, Ketorolac 30 g IV every 8 hours,
Metronidazole 500 mg IV every 8 hours, Furosemide 40 mg IV stat, Salbutamol/nebu stat then
every 15 mins x 3 doses Peri To consumed 2 bottles oI IVF.

T: 36.7 - 37.4
BP: 100-130/70-80 mmHg
PR: 79 85 beats/min
RR: 19 24 breaths/min

'III. DIAGNOSTIC PROCEDURES
A. Urinalysis
The urinalysis is used as a screening and/or diagnostic tool because it can help detect
substances or cellular material in the urine associated with diIIerent metabolic and kidney
disorders
Purpose: This test is perIormed to our patient to assess the eIIects oI the disease on renal
Iunction and the existence oI concurrent renal or systemic diseases,e.g glomerulonephritis,
hypertension or diabetes.

Specimen: Urine

Color/Clarity: It is an indication how concentrated the urine is. Normally, the urine is
straw to amber due to urochrome, small amount oI urobilin and uroerythrin.
Specific Gravity: Determines the concentration oI urine.
Urine pH: It is deIined as the hydrogen ion concentration oI the urine; it is a
measurement/parameter oI the acid and alkaline. States oI urine is one oI the mechanism by
which the normal acid base balance oI the body is maintained.
P Pr ro ot te ei in n: : Normally a healthy individual excretes small amount oI protein in the urine up to
150/mg per day consisting mainly oI Albumin and Tamm-HorsIall Protein. Proteinuria in
amounts greater than 150mg/day is considered pathologic.Normally no protein is Iound
during qualitative analysis in the urine. In quantitative analysis, 10-100 mg/24L is normal. 1
indicates 30 mg/100 ml oI protein in the urine.
G Gl lu uc co os se e: : In the normal adult, an average oI 130 mg oI glucose is excreted during a 24-hour
period or an amount oI 0.01 to 0.03 gram per 100 cc oI urine.
H He em mo og gl lo ob bi in n: : H He em mo og gl lo ob bi in n i is s a a c co om mp po on ne en nt t o oI I r re ed d c ce el ll ls s a an nd d i is s I Io ou un nd d i in n t th he e b bo on ne e m ma ar rr ro ow w a an nd d
w wi it th hi in n t th he e c ce el ll ls s. . I It t t tr ra an ns sp po or rt ts s o ox xy yg ge en n I Ir ro om m t th he e l lu un ng gs s t to o t th he e b bo od dy y c ce el ll ls s. . W Wh he en n t th he e r re ed d c ce el ll ls s
b br re ea ak k d do ow wn n, , h he em mo og gl lo ob bi in n i is s c co ol ll le ec ct te ed d b by y t th he e l li iv ve er r a an nd d e el li im mi in na at te ed d t th hr ro ou ug gh h t th he e g ga as st tr ro oi in nt te es st ti in na al l
t tr ra ac ct t. .
K Ke et to on ne e: : I It t i is s c co om mp po os se ed d o oI I a ac ce et to on ne e, , k ke et to o, , h hy yd dr ro ox xy yb bu ut ty yr ri ic c a ac ci id d a an nd d a ac ce et to oa ac ce et ti ic c a ac ci id d. . T Th he es se e
p pr ro od du uc ct ts s r re es su ul lt t I Ir ro om m a ab bn no or rm ma al l I Ia at tt ty y a an nd d p pr ro ot te ei in n m me et ta ab bo ol li is sm m a an nd d a ar re e n no or rm ma al ll ly y c co om mp pl le et te el ly y
m me et ta ab bo ol li iz ze ed d b by y t th he e l li iv ve er r. .
N Ni it tr ri it te e: : I It t i is s a an ny y s sa al lt t o oI I n ni it tr ro on ns s a ac ci id d. . N No or rm ma al ll ly y i it t i is s n no ot t I Io ou un nd d i in n t th he e u ur ri in ne e s si in nc ce e i it t i in nd di ic ca at te es s
t th he e p pr re es se en nc ce e o oI I b ba ac ct te er ri ia a t th ha at t i is s a ab bl le e t to o r re ed du uc ce e u ur ri in na ar ry y n ni it tr ra at te es s t to o n ni it tr ri it te es s. .
B Bi il li ir ru ub bi in n: : I It t i is s a a p pi ig gm me en nt t d de er ri iv ve ed d I Ir ro om m t th he e b br re ea ak kd do ow wn n o oI I h he em mo og gl lo ob bi in n b by y c ce el ll ls s o oI I t th he e
r re et ti ic cu ul lo oe en nd do ot th he el li ia al l s sy ys st te em m i in nc cl lu ud di in ng g k ku up pI Ie er r c ce el ll ls s o oI I t th he e l li iv ve er r. . H He ep pa at to oc cy yt te es s r re em mo ov ve e b bi il li ir ru ub bi in n
I Ir ro om m t th he e b bl lo oo od d a an nd d c ch he em mi ic ca al ll ly y m mo od di iI Iy y i it t t th hr ro ou ug gh h c co on nj ju ug ga at ti io on n a an nd d g gl lu uc co or ro on ni ic c a ac ci id d t th ha at t m ma ak ke es s
t th he e b bi il li ir ru ub bi in n m mo or re e s so ol lu ub bl le e i in n a aq qu ue eo ou us s s so ol lu ut ti io on n. . T Th he e c co on nj ju ug ga at te ed d b bi il li ir ru ub bi in n i is s s se ec cr re et te ed d b by y t th he e
h he ep pa at to oc cy yt te es s i in n t to o t th he e a ad dj ja ac ce en nt t b bi il le e c ca an na al li ic cu ul li i a an nd d i in nt to o t th he e s sm ma al ll l i in nt te es st ti in ne es s w wh he er re e i it t i is s
c co on nv ve er rt te ed d t to o u ur ro ob bi il li in no og ge en n. .
U Ur ro ob bi il li in no og ge en n: : T Th he e u ur ro ob bi il li in no og ge en n w wh hi ic ch h i is s a a p pa ar rt t e ex xc cr re et te ed d i in n t th he e I Ie ec ce es s a an nd d i in n p pa ar rt t a ab bs so or rb be ed d
t th hr ro ou ug gh h t th he e i in nt te es st ti in na al l m mu uc co os sa a i in nt to o t th he e p po or rt ta al l b bl lo oo od d. . M Mu uc ch h o oI I t th hi is s r re ea ab bs so or rb be ed d u ur ro ob bi il li in no og ge en n i is s
r re em mo ov ve ed d b by y t th he e h he ep pa at to oc cy yt te es s a an nd d i is s s se ec cr re et te ed d i in nt to o t th he e b bi il le e o on nc ce e a ag ga ai in n. . S So om me e o oI I t th he e
u ur ro ob bi il li in no og ge en n e en nt te er rs s t th he e s sy ys st te em mi ic c c ci ir rc cu ul la at ti io on n a an nd d i is s e ex xc cr re et te ed d b by y t th he e k ki id dn ne ey y i in n t th he e u ur ri in ne e. .
L Le eu uk ko oc cy yt te es s E Es st te er ra as se e: : I It t i is s r re el le ea as se ed d I Ir ro om m t th he e W Wh hi it te e B Bl lo oo od d C Ce el ll l s se ec co on nd da ar ry y t to o b ba ac ct te er ri ia al l
i in nv va as si io on n w wh hi ic ch h c ca au us se es s t th he e r re el le ea as se ed d o oI I e es st te er ra as se e. .
B BC C: : I It t c co on ns st ti it tu ut te es s o on nl ly y o on ne e o oI I t th he e t to ot ta al l b bl lo oo od d v vo ol lu um me es s. . T Th he ey y o or ri ig gi in na at te e i in n t th he e b bo on ne e m ma ar rr ro ow w
a an nd d c ci ir rc cu ul la at te e t th hr ro ou ug gh h t th he e l ly ym mp ph ho oi id d t ti is ss su ue es s o oI I t th he e b bo od dy y. . T Th he er re e t th he ey y I Iu un nc ct ti io on n a ag ga ai in ns st t
i in nI Il la am mm ma at ti io on n. .
RBC: Normal microscopic Iindings in routine urinalysis ranges Irom 0-3.
E Ep pi it th he el li ia al l C Ce el ll ls s: : N No or rm ma al ll ly y t th hi is s s sh ho ou ul ld dn n` `t t b be e I Io ou un nd d i in n t th he e u ur ri in ne e. .
Bacteria: ConIirms the presence oI inIection
Amorphous Urates: Common crystal that can be present in a healthy person with acidic or
neutral urine
Ketone bodies: These are products oI Iaulty metabolism (catabolism) oI Iats whereby Iatty
acids are not completely oxidized. Such situation leads to the accumulation oI ketones in the
blood (ketonemia), which are excreted in urine (ketonuria) and bring about the general
condition called ketosis or acidosis.
M Mu uc cu us s T Th hr re ea ad ds s: : N No or rm ma al ll ly y i it t i is s n no ot t p pr re es se en nt t i in n t th he e u ur ri in ne e. .
C Cr ry ys st ta al ls s: : N No or rm ma al ll ly y i it t i is s n no ot t p pr re es se en nt t i in n t th he e u ur ri in ne e. .

Requesting Physician:
Date Requested: May 5, 2006
Date Processed: May 5, 2006

Components Result Normal 'alue Significance
Physical
Examination

Color Yellow Colorless-deep yellow Normal
Clarity Clear Clear Normal
SpeciIic Gravity 1.020 1.005-1.035 Normal
PH Acidic 4.6-8.0 Normal
Clinical
Microscopy

P Pr ro ot te ei in n - - n no or rm ma al l
G Gl lu uc co os se e - - N No or rm ma al l
H He em mo og gl lo ob bi in n - - N No or rm ma al l
K Ke et to on ne e - - N No or rm ma al l
N Ni it tr ri it te e - - N No or rm ma al l
B Bi il li ir ru ub bi in n - - N No or rm ma al l
U Ur ro ob bi il li in no og ge en n - - N No or rm ma al l

L Le eu uk ko oc cy yt te e e es st te er ra as se e - - N No or rm ma al l
C Ce el ll ls s
WBC/HPF 0-2 0-5 Normal
RBC/HPF 3-5 0-5 Normal
Epithelial Cells Few M-Occasional
F Few-many
Normal
Bacteria Few Few Normal
M Mu uc cu us s t th hr re ea ad ds s - - n no or rm ma al l
Amorphous Urates Few --------------------------- Normal

Analysis:
The result oI the urinalysis is normal; thereIore the patient`s renal Iunction is still in good
condition and is not aIIected by the disease process.

Nursing Responsibilities Rationale
1. Check doctor`s order.

2. InIorm & explain to the patient &
signiIicant other/s the reason why
the specimen was ordered, how it is
to be collected.
3. Provide a specimen bottle with
proper instructions.


4. Fill up laboratory request properly
and completely.
To determine the procedure to be done to
the patient.
To gain cooperation.



So that the patient and the signiIicant other
will know what to do and to be able to
obtain a proper specimen Ior the laboratory
procedure.
So that the medical technologist will know
the speciIic test to be done to the specimen

5. When the specimen is available,
send it immediately to the
laboratory.
6. ReIer the result to the physician
once available and attach it to the
patient`s chart aIterwards. So that
the physician Monitor I & O every
hour to assess the patient`s renal
ability to Iunction.
7. Teach the patient on proper perineal
hygiene.
once Iorwarded.
To avoid delay in transport that may alter
results.

To be able to determine the problems
occurring in the patient and determine the
appropriate management to be applied to
the patient.


To prevent ascending inIection.


B. Hematology
Date Requested: May 5, 2006
Date Processed: May 5, 2006
This encompasses the study oI blood cells and coagulation. It consists oI several tests that
allow Ior the evaluation oI diIIerent cellular components oI the blood on a broad spectrum oI
clients. The Iindings give valuable diagnostic inIormation about the hematologic and other body
system, prognosis, response to treatment and recovery.
Purpose: This laboratory procedure is done to our patient to determine any abnormal blood
levels occurring to the patient.

Specimen: Blood
O Hemoglobin is a main component oI erythrocytes (RBC), made up oI CHON (globin)
and pigment, which gives the RBC its red color. Its Iunction is to transport molecules
and carries oxygen Irom the lungs to the body tissues and transport carbon dioxide as a
product oI cellular metabolism back to the lungs.
O Hematocrit measures the volume oI RBC in whole blood, expressed as a percentage.
This blood test evaluates blood loss, anemia, blood replacement therapy, and Iluid
balance and screens red blood cell status. The hematocrit is a measure oI the
concentration oI red blood cells within the blood volume. Normal values depend on the
ratio oI two components, the number oI red cells present and the plasma volume, so the
hematocrit is also a useIul tool in evaluating dehydration and hypervolemia.
O The erythrocyte is an elastic biconcave disk about 7 um in diameter that contains
hemoglobin conIined within a lipoid membrane. The principal Iunction oI the RBC is to
the transportation oI oxygen and carbon dioxide between the tissue cells and the lungs.
The average length oI liIe oI the RBC is 120 days. Erythrocyte originates in the marrow
oI the long bones. Maturation proceeds Irom a stem cell through the pormoblast stage to
the normoblast the last stage beIore the mature adult cell develops.
O Mean Corpuscular 'olume (MC' is an evaluation oI the average volume oI each red
cell, derived Irom the ratio oI the volume oI packed red cells (hematocrit) to the total
number oI red blood cells
O Mean Corpuscular Hemoglobin gives the amount oI hemoglobin by weight in the
average RBC.
O Mean Corpuscular Hemoglobin Concentration (MCHC is an estimate oI the amount
oI hemoglobin in an average erythrocyte, derived Irom the ratio between the amount oI
hemoglobin and the number oI erythrocytes present.
O hite Blood Cell or leukocytes are less numerous and larger than the erythrocyte and
the nuclei. These serve as an important body deIense. They destroy many injurious
Iactors such as microorganism and the products oI degenerating tissues. This is made
possibly by certain special properties the cell possess namely diapedesis, mobility,
chemotaxis and phagocytosis.
O Neutrophils are the circulating white blood cells essential Ior phagocytosis and
proteolysis by which bacteria, cellular debris and solid particles are destroyed.
O Lymphocytes are small agranulocytic leukocytes originating Irom Ietal cells and
developing in the bone marrow.
O Platelets are the third and smallest oI the Iormed elements oI the blood. They are oval,
non-nucleated granular structures. They are produced in the bone marrow cells.The
platelets initiate the blood clotting process through the disintegration and release oI
thromboplastin which activates prothrombin. On disintegration, they also liberates
serotonin and epinephrine which causes vasoconstriction that in turn contributes to
reducing the loss oI blood when a vessel is interrupted. With any slight damage to the
inner surIace oI the blood vessel the platelets clump and stick together at the site helping
to plug leaks and prevent loss oI blood.
O ESR Laboratory test that measures the rate oI setting oI RBC`s; elevation is
indicative oI inIlammation also called the 'sed rate.

Components Result Normal 'alue Significance
Hgb 99 110-160 g/L DECREASED
Hct 0.32 0.38-0.54 DECREASED
RBC 3.57 4.5-5.5x10
12
/L DECREASED
MCV 89.6 8-100 IL Normal
MCH 27.7 27-32 pg Normal
MCHC 30.9 31-35 DECREASED
WBC 11.0 5.0-10.0x10 g/L INCREASED
Differential Count
Neutrophils 0.77 0.50-0.70 INCREASED
Lymphocytes 0.23 0.20-0.40 Normal
Platelet Count 185 150-450x10 g/L Normal
ESR 6mm/hr F 0-20
M 0-10
Normal

Analysis:
The decreased Hgb & Hct is related to the decrease RBC in the blood. The decreased
RBC is brought about by the decreased cardiac output as a result oI the disease process. RBC
count decreased due to increase cellular catabolism brought about by the presence oI
microorganisms or pathogens, which competes or demands aerobic metabolism to survive.
The increase in Neutrophils as well as increased WBC count is an indication that the
patient is suIIering Irom bacterial inIection and that the body`s resistance is lowered.
The slight decrease in MCHC (Mean Cell Hemoglobin Concentration) is due to the
decrease in hemoglobin level since its value depends upon the concentration oI this component.

Nursing Responsibilities Rationale
1. Check doctor`s order.

2. InIorm & explain to the patient &
signiIicant other/s the reasons why the
specimen was ordered, how it is to be
collected and the stinging sensation that
may be Ielt.
3. Fill up laboratory request properly &
Iorward it to the laboratory.
4. Upon the arrival oI the result, reIer it to
the physician & then attach it to the
patient`s chart.
5. Administer antibiotics prescribed by the
Doctor.
6. Advice patient to eat Ioods rich in
vitamin C.
To determine the procedure to be done to
the patient
To gain cooperation.




To notiIy the medical technologist.

For the physician to determine the
appropriate management to be applied to the
patient.
To treat inIection.

To increase the client`s resistance Irom
diseases.


IX. MEDICAL MANAGEMENT
Nothing per Orem
Nothing per orem which means nothing by mouth. Doctors use this on order when they do not
want the patient to take in any type oI Iood or liquid by mouth because when a patient is getting
ready Ior a surgery, they are ordered Ior NPO.
Responsibilities:
1. VeriIy the doctor`s order.
2. Instruct the patient not to take any Iood or liquid by mouth at least 6-8 hours beIore
surgery.
3. Instruct the patient the purpose oI not taking any Iood or liquid by mouth.
Intake and Output Monitoring
Input and output monitoring is a simple procedure that does not require doctor`s order.
Responsibilities:
1. Observe the patient iI there is Iluid imbalance or sign oI dehydration.

Indwelling Foley Catheter
Any catheter which is inserted into the bladder and allowed to remain in the bladder is called an
indwelling catheter. A common type oI indwelling catheter is a Foley catheter. A Foley catheter
has a balloon attachment at one end. AIter the Foley catheter is inserted, the balloon is Iilled with
sterile water. The Iilled balloon prevents the catheter Irom leaving the bladder.
Responsibilities:
1. Check urine daily Ior color, odor, amount and others.
2. Use only sterilized equipment Ior irrigation and drainage.
3. Use sterile technique Ior urinary procedures.
4. Report signs oI inIection to the doctor.
Nasogastric Tube
A nasogastric tube is used Ior Ieeding and administering drugs and other oral agents such as
activated charcoal.NGT is placed through the nose and moved into the stomach.
Responsibilities:
1. Position the patient in high Fowler` position.
2. Land marking is Irom the nose to the earlobe then to the xyphoid process.
3. Lubricate the tube with KY jelly at least 2-4 inches.
4. Insert the tube, hyperextend the neck Iirst and second Ilex the neck closer to the chest.
5. Instruct the patient to swallow as the tube is being advanced.
6. Checking the placement oI the tube is by aspirating the gastric content with green or oII
white color.
7. Auscultate Ior a whoosing sound aIter introducing 20cc oI air using asepto syringe.
8. Secure the tube at the bridge oI the nose.
9. Provide daily tube and nose care to promote comIort.



Intravenous Therapy
Intravenous therapy is used to correct electrolyte imbalances, to deliver medications, Ior blood
transIusion or as Iluid replacement.
*D5LRS
Lactated Ringer`s Solution and 5 Dextrose Injection is a non pyrogenic solution Ior Iluid and
electrolyte replenishment and caloric supply in a single dose container Ior intravenous
administration.
*D5NM
Normosol-M and 5 Dextrose Injection, hypertonic, is a non pyrogenic parenteral, Iluid,
electrolyte replenisher. It provides water and electrolytes (wit h dextrose and readily
source oI available carbohydrates) Ior maintenance oI daily Iluid and electrolyte
requirements.
Responsibilities:
1. Check IVF ordered by the doctor together with the available IV bottle in bedside.
2. Regulate the IVF well to deliver Iluid according to doctor`s order.
3. Assess the patient iI there is any redness, swelling or inIiltration on the catheter site to
prevent swelling in the inIusion site.
4. Avoid kinks on the IV line and don`t allow it to go through the line in order to prevent
air embolism.
5. Check Ior leaks by squeezing container Iirmly. II leaks are Iound, discard unit as sterility
may be impaired.
'ital Signs every 4 hours
Vital signs or signs oI liIe, include the Iollowing objective measures Ior a person: temperature,
respiratory rate, pulse rate, and blood pressure. When these values are not zero, this indicate that
a person is alive. All oI these vital signs can be observed, measured, and monitored. This will
enable the assessment oI the level at which an individual is Iunctioning.
Purpose:
1. A vital signs monitor is essential to help doctors monitor a patient's body temperature,
pulse, respiration rate, blood pressure and blood oxygen saturation. Because these make
the patient's health better.
2. A vital signs monitor gives the most important inIormation about the health oI a patient.
Clear Liquids
A clear liquid diet consists oI clear liquids, such as water, broth and plain gelatin, that are easily
digested and leave no undigested residue in the intestinal tract. The doctor may prescribe a clear
liquid diet beIore certain medical procedures or iI the patient have certain digestive problems.
Purpose
1. A clear liquid diet is ordered to our patient because he was undergone surgery that
require no Iood in the stomach or intestines.
2. A clear liquid diet is helps maintain the adequate hydration oI our patient, provides some
important electrolytes and gives some energy at a time when a Iull diet isn't possible or
recommended.
Soft Diet
The soIt diet serves as a transition Irom liquids to a regular diet Ior individuals who are
recovering Irom surgery or a long illness. The soIt diet limits or eliminates Ioods that are hard to
chew and swallow.
Oxygen Therapy
Oxygen therapy is the administration oI oxygen as a medical intervention, which can be Ior a
variety oI purposes in both chronic and acute patient care. Oxygen is essential Ior cell
metabolism, and in turn, tissue oxygenation is essential Ior all normal physiological Iunctions.
Responsibilities:
Position patient on high-Iowler`s position
SaIety measures (no smoking)
Avoid anything with sparks or static like-battery operated toys or gadgets.
Oral care is a must.

X. DRUG STUDY
Brand Name: Clindamycin
Generic name:
Classification: Antibiotic
Mechanism of Action: Anti- inIective, hinders or kill susceptible bacteria
Indication: InIections caused by sensitive staphylococci, streptococci, pneumococci,
bacteroides, Iusibacterium, clostridium perIringens, and other sensitive aerobic and anaerobic
organisms- endocaerditis prophylaxis Ior dental procedures in patients allergic to penicillin
Contraindication: Contraindicated in patients hypersensitive to drug or lincomycin- use
cautiously in patients with renal or hepatic disease, asthma, history oI GI disease, or signiIicant
allergies.
Adverse effect:
CNS: headache
CV: thrombophlebitis
EENT: pharyngitis
GI: abdominal pain, anorexia, bloody or tarry stools, constipation, diarrhea, dysphagia,
esophagitis, Ilatulence, nausea, pseudomembranuscolitis, unpleasant bitter taste, vomiting
Nursing Responsibility:
1. Assess patient inIection beIore and regularly throughout therapy.
2. BeIore giving the Iirst dose, obtain specimen Ior culture and sensitivity test, begin
therapy pending results.
3. Monitor renal, hepatic, and hematopoetic Iunctions during prolonged therapy.
4. Be alert oI adverse reactions and drug interactions
5. II adverse GI reactions occur, monitor patients hydration
6. Tell patient receiving IV to report discomIort at inIusion site.

Brand Name: Tranexamic acid
Generic name:
Classification: Anti- Iibrinolytic, antihemorrhage
Mechanism of Action: It is a synthetic derivative oI the amino acid lysine. It exerts its
antiIibrinolytic eIIect trough the reversible blockage oI lysine- binding sites on plasminogen.
AntiIibrinolytic drug inhibits endometrial plasminogen activator and thus prevent Iibrinolysis
and the breakdown oI blood clots.
Indication: Used Ior prompt and eIIective control oI hemorrhage in various surgical procedures.
Contraindication: Allergic reaction to the drug or hypersensitivity, presence oI blood clots,
current administration oI Iactor IX complex concentrates or anti- inhibitor coagulant
concentrates
Adverse Effect:
1. Severe allergic reactions such as rash, hives, itching, dyspnea, tightness in the chest,
swelling oI the mouth, Iace, lips or tongue.
2. CalI pain, chest pain, conIusion, coughing up blood, decreased urination, severe or
persistent headache, body malaise, shortness oI breath, vision changes.
Nursing Responsibility:
1. Unusual change in bleeding pattern should be immediately reported to the physician
2. Tranexamic acid should be used with extreme caution in children younger than 18 years
old.
3. InIorm client to inIorm the physician iI the side eIIects occur




Brand Name: Metronidazole
Generic name: Anerobizol
Classification: Anti- protozoals
Mechanism of Action: Disrupts DNA and protein synthesis n susceptible organisms,
bactericidal, or amebicidal action.
Indication:Amebicide in he management oI amebic dysentery
Contraindication: hypersensitivity
Adverse Effect:
CNS: seizures, dizziness, headache
GI: abdominal pain, anorexia nausea, diarrhea, dry mouth, Iurry tongue, glositis,
unpleasant taste, vomiting
Hematologic: leucopenia
Skin: rahes, urticaria
Nursing Responsibility:
1. II used IV, drug should not be given by IV bolus.
2. Administer each single dose over a period oI 1 hour.
3. Syringes with aluminum needles or hubs should not be used.
4. II a primary UV Iluid set- up is used, discontinue the primary solution during inIusion oI
metronidazole.




Brand Name: CiproIloxacin
Generic name:
Classification: Anti- inIective
Mechanism of Action: Inhibits DNA enzyme in susceptible microorganisms. It interIeres with
bacterial DNA replication. It is also bactericidal.
Indication:used in the treatment oI chronic bacterial prostatitis. It is also used in the treatment oI
skin or skin structure.GI tarct, bone or joint; lower respiratory tract, and urinary tract inIections.
Side Effect:
O Nausea
O Diarrhea
O Dyspepsia
O Vomiting
O Constipation
O Flatulence
O ConIusion
O Burning
O Abdominal pain
O Headache
O Rash
O Hypersensitivity
reaction
O Dry mouth
Adverse Effect:
O SuperinIection
O Neuropathy
O Cardiopulmonary arrest
O Cerebral thrombosis may occur
Nursing Responsibility:
1. Question Ior history oI hypersensitivity to the drug
2. Do not administer antacid within 2 hours oI ciproIloxacin
3. Determine pattern oI bowel activity
4. Check Ior dizziness, hradache, visual diIIiculties and tremors.
5. Observe therapeutic response.

Brand Name: Ranitidine
Generic name: Zantac
Classification: H2 receptor antagonist
Mechanism of Action: Inhibits gastric acid secretion by blocking the eIIect oI histamine on
histamine H2 receptors.
Indication: Use cautiously during lactation and in clients with decreased hepatic or renal
Iunction.
Contraindication: liver cirrhosis, impaired renal or hepatic Iunction.
Adverse Effect:
O Headache. Less common side eIIects are diarrhea, dizziness, anemia, hair loss, joint or
muscle pain, skin rash, rapid or slow heartbeat, and drowsiness.
Nursing Responsibility:
1. Document indications Ior therapy.
2. Avoid alcohol, aspirin containing products, and beverages that contain coIIee.
3. Instruct patient not to smoke because it may interIere or decrease the drugs eIIectiveness.
4. Report any evidence oI diarrhea and maintain adequate nutrition.

XI. NCP
Nursing Diagnosis
Hyperthermia related to generalized inIlammatory process

Nursing Inference
The invasion oI microorganisms in the body causes inIlammatory response as a
compensatory mechanism. In inIlammation, there is temporary vasoconstriction and rapidly
Iollowed by vasodilation and the release oI chemical mediators. These causes redness and heat
resulting to increased body temperature, thus hyperthermia occurs.

Nursing Goal
AIter 1-2 days oI rendering appropriate nursing interventions, the client will be able to
have lowered body temperature, normal skin color and normal respiratory rate.

Nursing Interventions
1. Provide a tepid sponge bath.
O To increase heat loss through conduction, decreasing body temperature
2. Remove excess blankets when the client Ieels warm, but provide extra warmth when the
client Ieels chilled.
O To limit heat production, decreasing body temperature
3. Reduce physical activity.
O To limit heat production, decreasing body temperature
4. Provide adequate nutrition and Iluids.
O To meet the increased metabolic demand and prevent dehydration.
5. Administer replacement Iluids and electrolytes as ordered.
O To support circulating volume and prevent tissue perIusion
6. Administer antipyretic (paracetamol) as ordered.
O To reduce body temperature


Nursing Diagnosis
Imbalanced nutrition: less than body requirements related to decreased Iood intake
secondary to loss oI appetite

Nursing Inference
Due to loss oI appetite, there is a decrease intake oI Iood causing to the decreased supply
oI nutrients to the diIIerent parts oI the body, thus imbalance nutrition occurs.

Nursing Goal
AIter 5-7 days oI rendering appropriate nursing interventions the client nutritional level
would be increased as would be maniIested by increased weight oI at least 4 lbs, good muscle
tone and absence oI weakness.

Nursing Interventions
1. Encourage client to choose Ioods that are appealing.
O To stimulate appetite, increasing Iood intake
2. Instruct client to avoid unpleasant odors/sight.
O To avoid negative eIIect on appetite
3. Encourage client to limit Iiber/bulk.
O This may lead to early satiety
4. Encourage client to have enough rest and sleep.
O To conserve energy decreasing metabolic needs
5. Consult dietician or nutritional team as indicated.
To implement interdisciplinary team management.