hypersensitivity.........allergy

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					          Unciano Colleges Inc.

   Circumferential Road, Antipolo City

             A Case Study on

  HYPERSENSITIVITY REACTION

In partial fulfillment of the requirements in

NURSING CARE MANAGEMENT 103

                (NCM 103)

              Submitted by:

           Group 3 Section III-C

            Sabado, Dante Jr. N.

          Salazar, John Fritz M.

           Samindao, Marianne

           San Luis, Katrina F.

           Sarsona, Adelaida A.

         Sevilla, Kenneth John M.

            Sibayan, Shirley D.

              Suva, Pepito S.

           Verastigue, Allan G.

             Yim, Roxanne V.

              Submitted to:

            Ms. Ruby Mendez RN

               May 14, 2010

                                                Pneumonia Case Study | 1
II. TABLE OF CONTENTS


Acknowledgement            3


Table of Contents          4


Introduction               5


Background of the Study    6


Objectives                 7


Patient‟s Profile          8


Nursing History            9


Assessment                 11


Anatomy & Physiology       21


Pathophysiology            25


Laboratory & Diagnostics   27


Drug Study                 29


Nursing Care Plan          31


Evaluation                 35


Bibliography               37




                                Pneumonia Case Study | 2
ACKNOWLEDGEMENT

We, the Bachelor of Science in Nursing 3rd year students, group C-3 of Unciano Colleges,

Antipolo City, would like to extend our deepest gratitude to the following people and the

institution. The completion of the case study was made possible through our invaluable

contribution of the following to whom we convex our sincerest gratitude:

To Angono General Hospital for giving us the opportunity to have our related learning

experience in hospitals.

To the doctors and staff nurses of Angono General Hospital for accommodating and

permitting us to see our client‟s chart and to assess our patients.

To our clinical instructor Ms. Mendez, RN, who professionally and obligingly performed her

responsibilities as our guide through the nursing related experience based on hospital setting.

And above all, to God Almighty, who saw all the sacrifices we‟ve made and He who gave us

intellect. He continues to inspire and guide us in everything we do, whatever we have

accomplished could not have been possible without Him.




                                                                      Pneumonia Case Study | 3
INTRODUCTION

Nursing in general is the process of caring or nurturing for another individual who needs

health care services. This function is expected or should be carried as a science, profession,

and service. Exposing to a hospital area will let nursing students learn and practice more than

lecture can do.

Nursing case studies are conducted because of three aspects, learning, familiarizing with the

case of the patient and involvement. These aspects will help nursing students to practice the

nursing process efficiently and effectively. And it would also help the patient to promote

their health and wellness.

We chose to take the case of baby M.F., who has been diagnosed with Pneumonia because of

the following criteria: cooperativeness, uniqueness of his condition, status of admission, and

the significant others‟ willingness and learning contents of the case.

       The client‟s family are also willing to have him as our case study. Prior to that, his

       significant others were very accommodating and cooperative during our interaction.

       And it is very challenging for us to take this case.




                                                                         Pneumonia Case Study | 4
Background of the study

Hypersensitivity is a term that is used to identify situations in which some type of substance

or medication triggers an unusually strong and adverse reaction from the immune system. In

some instances, hypersensitivity reactions can be extremely uncomfortable, cause permanent

damage, or even result in death. There are four commonly accepted types of this condition,

with variations of these four supported by different schools of medical thought.

Allergies are normally classified as Type 1 hypersensitivity. These involve allergic reactions

that produce an almost immediate effect. The individual may begin to have difficulty

breathing, experiencing what amounts to an asthma attack. In more extreme situations,

anaphylaxis may occur.

An antibody-dependent or cytotoxic reaction defines define Type 2 situations. Within this

category, the hypersensitive reaction manifests with the development of particular conditions

such as Goodpasture‟s Syndrome, Myasthenia Gravis, or Graves disease. A Type

2 hypersensitivity type has more long range implications.

Type 3 hypersensitivity is classified as an immune complex disease. Within this category,

conditions such as Arthus reaction or Serum sickness occur. Along with Type 2, patients

diagnosed with Type 3 often require ongoing monitoring in order to keep the triggered

condition under control.

DTH, or delayed type hypersensitivity, is known as Type 4. Within this category, patients

may develop various dermatological issues that are extremely uncomfortable, experience

fluctuation in T-cell levels, and possibly develop conditions such as multiple sclerosis. As




                                                                      Pneumonia Case Study | 5
With other hypersensitivity types, it is important to identify the substance or medication

causing the hypersensitive reaction and prevent any further ingestion of that substance.

One of the best ways to get an idea of how painful hypersensitivity can be is to consider the

momentary sharp pain that is often experienced when extremely cold beverages come in

contact with a tooth filling. The sudden and intense wave of pain created can often seem

unbearable for a brief moment before leveling off. For people with hypersensitive reactions

to medicine, food, or some factor in their environment, that level of pain does not subside

within a moment, but can last for an extended period of time.




                                                                      Pneumonia Case Study | 6
IV. Objectives




General Objectives:

Food allergies are more common in children than adults. About 7 out of 100 kids have them.
Only about 3 to 4 out of 100 adults do.1 Children often outgrow their food allergies. But if you
have a food allergy as an adult, you will most likely have it for life.

Specific Objectives:

To be able to:

-Establish rapport with the client and his significant others.

-Apply and improve our assessment skills using the 13 areas of assessments

-Review the anatomy and physiology of digestive system.

-Identify the actual potential and health problem of the client.

-Study the pathophysiology of Typhoid fever.

-Formulate appropriate nursing interventions.

-Review medications prescribed to our client and know the nursing considerations when
administering them.

- Evaluate the effectiveness of the Nursing Care Plan‟s and impart appropriate health teachings
on promoting client‟s health recovery.




                                                                          Pneumonia Case Study | 7
PATIENT’S PROFILE


HOSPITAL CASE NO.:     116- 64974

NAME:                  M.F

AGE:                   8 years old

SEX:                   Male

DATE OF BIRTH:         November 23, 2001

STATUS:                Child

RELIGION:              Roman Catholic

ETHNIC GROUP:          Filipino

RESIDENCE:             , Binangonan, Rizal

ROOM:                  Pediatric Ward

CHIEF COMPLAINT:       Rashes all over his body

DATE & TIME OF         May 10, 2010; 12:53pm

ADMISSION:

ADMITTING DIAGNOSIS:   Hypersensitivity Reaction

ATTENDING PHYSICIAN:   Dr. Cerda

DATE & TIME OF         May 11,2010; 11:00am

ASSESSMENT:




                                                   Pneumonia Case Study | 8
NURSING HISTORY


CHIEF COMPLAINT


“May mga pantal siya sa katawan at nilalagnat ” as verbalized by the client‟s father.


History of Present Illness


Five days before confinement, M.F‟s family had a Chicken Adobo for their dinner. M.F ate a

lot of it and few hours M.F suffered from intermittent fever and rashes all over his body.

According to according to his father M.F also complained itchiness that time. To relieve the

fever his father decided to gave him 5ml of biogesic syrup. After that his father rushed him

to Angono General Hospital for an initial check up. When check up is done, the residence on

duty prescribed Perphenhydramine for his allergy and Paracetamol syrup for fever. The

symptoms are still present to M.F. After 2 days the rashes all over his body get worst and his

fever doesn‟t subside so his father brought him again to Angono General Hospital via

jeepney dated May 10, 2010 at around 11am. They arrived at the Emergency Room and was

seen and examined by the Resident on Duty of the Hospital who is Dr. Cerda. Vital signs are

taken as follows: Body Temperature of 37.8 oC, Pulse Rate of 143 bpm and Respiratory Rate

of 46 cpm. The doctor request for confinement together with his order of IVF D5 0.3 NaCl

500cc x 12o at his right metacarpal vein, Hypersensitive 25mg TIV q 8o, and

Perphenhydramine ½ ampule TIV q 8o. Was then requested for some laboratory

examinations such as; Hematology and. He was admitted at the Pediatric Ward bed #1.




                                                                      Pneumonia Case Study | 9
History of Past Illness


According to his father, M.F‟s usual illness was fever, cough and colds. It was only his first

time of confinement.


Heredo-Familial History


During our assessment his father told us that their family has a history of hypertension and

diabetes while his wife has a history of Asthma.


Socio-Economic


M.F‟s father is a barber shop in their place. He earns almost P12, 000.00 every month. On the

other hand his mother is presently living in Singapore for work. She is a factory worker and

earns P15, 000.00 a month but only half of it was given to them due to her personal expenses.

His father will be the one to pay all his bills in the hospital.




                                                                     Pneumonia Case Study | 10
13 AREAS OF ASSESSMENT


 I.      SOCIAL STATUS

The patient is 8 years old. He was baptized as a Roman Catholic but he is not an active

participant to any religious or social organization. He is currently studying at his 2nd grade. They

live in Binangonan Rizal. There are 3 siblings and he is a second sibling of his parent. He was

born on November 23 2001. According to him he loves to stay at their house and he seldom go

out with friends. His favorite pastime is playing with his friend and watching TV.

       He belongs in the stage of Industry vs. Inferiority. Industry here refers to purposeful or

meaningful activity. It's the development of competence and skills, and a confidence to use a

'method', and is a crucial aspect of school years experience. Erikson described this stage as a sort

of 'entrance to life'. A child who experiences the satisfaction of achievement - of anything

positive - will move towards successful negotiation of this crisis stage. A child who experiences

failure at school tasks and work, or worse still who is denied the opportunity to discover and

develop their own capabilities and strengths and unique potential, quite naturally is prone to

feeling inferior and useless. Engaging with others and using tools or technology are also

important aspects of this stage. It is like a rehearsal for being productive and being valued at

work in later life. Inferiority is feeling useless; unable to contribute, unable to cooperate or work

in a team to create something, with the low self-esteem that accompanies such feelings.




                                                                          Pneumonia Case Study | 11
   II. MENTAL STATUS


        We asked our patient if he is aware where he is, he replied to us that he is in Hospital.

We asked him if he is still studying, he replied “Yes”. We asked him what is the full name of his

mother, which is currently with him to assess his awareness to person, he answered correctly. His

mother told us that he is now in his 2nd grade. He speaks and answers our questions but when he

answers our questions, he uses „Tagalog‟ dialect fluently. Also during the interview, he doesn‟t

maintain eye contact and seems to be very shy. We also asked the last event that he participated

in his school, and he said “Christmas party”. We also asked him what his favorite song is, he

replied “Nobody”. Our findings are confirmed by his mother.


 III.    EMOTIONAL DEVELOPMENT

   Our client was calm but he is a shy person, when we are talking to him there is a time that we

   need to repeat our question twice or thrice before he answer this sometimes he remain silent,

   He felt sad because of his condition, because he experiences failure to play with his friend.


   IV. SENSORY PERCEPTION

   Vision


   We asked M.F. to sit on the side of the bed before starting our assessment. We started our

   assessment by inspecting his external eye structures. Eyebrows were thick, black and evenly

   distributed. It was symmetrically aligned and equal in movement. Eye lashes were equally

   distributed and straight. Eyelids close symmetrically. Our client had 18 involuntary blinks

   per minute. His eyes were symmetrical in size. There were no discharges noted in the inner

   and outer cantus of both eyes. His pupils were black in color and equal in size about 5-6mm

   with the use of pattern in G&A notes and observable flat and round iris.
                                                                        Pneumonia Case Study | 12
We assessed his papillary reflex with the use of the penlight. We passed the light

approximately 3-4 mm on the level of his eyes from the outer cantus to the inner cantus of his

right eye. His pupils constricted about 1mm when the light passes then return to normal after

the light had passed. We did the same test on his left eye and it had the same reaction. We

notice that our client has a dark circle under his eyes.


Auditory


While the client was still in sitting position, we continued our assessment. Auricles were

symmetrical in size, uniform in color and aligned with outer cantus of his eyes. We can

notice some dirt both in his left and right external auditory opening. We palpate the auricles


for the texture, elasticity and areas of tenderness. We gently pulled the auricle upward,

downward and backward. And it was mobile, firm and not tender.


We asked the client that we would perform some hearing test to determine the function of

CN VIII (auditory). We performed the Weber‟s Test. By using the tuning fork, we activated

it by pinching the tuning fork on the end corner and placed it on the top of his head. We

asked him on which ear he could hear the vibration and he stated he could hear the vibration

on both ears. (WEBER NEGATIVE)


Lastly, we performed the Rinne‟s Test. We instructed the client to listen on the ringing sound

and tell us if he can no longer hear the ringing sound. We tested first his right ear. By using

the tuning fork, we activated it by pinching the tuning fork on the end corner. We held the

handle of the activated tuning fork on the mastoid process of his right ear until he can no

longer hear the sound. When he stated that he can no longer hear the sound, we immediately

                                                                      Pneumonia Case Study | 13
placed the still vibrating tuning fork in front of his right ear canal approximately 2-3 cm

away. We asked him if he can now hear the sound and he said yes. We also tested his left ear.

We activated the tuning fork and hold the handle of the activated tuning fork on the mastoid

process of his left ear until he stated that he can no longer hear the sound. Then we

immediately placed the still vibrating tuning fork in front of his left ear canal and he said that

he could now hear the sound. The tuning fork vibrations conducted by air are normally heard

longer. Air-conducted (AC) hearing was greater than bone-conducted (BC) hearing. AC>BC

(POSITIVE RINNE)


Olfactory


Client‟s external nose was assessed to check for any deviations in shape, size and color. Nose

was symmetrical and uniform in color. No discharges seen on his nose. We also assessed the

patency of both nasal cavities. We asked the client to close the mouth, exert pressure on the

nares and breathe through the opposite nares. Air moves freely as the client breathe through

the nares. Smelling taste was preformed, we prepared perfume and calamansi and instructed

the client to identify the different kind of odor by having his eyes blindfolded and smell it

while the other nostril is occluded. We first let his smell the perfume 1-2 inches away from

the nostril and he recognized it as pleasant smell and able to distinguish it was perfume. The

same thing with the calamansi, the client was able to tell us that it was calamansi with an

unpleasant smell. We did those things bilaterally.




                                                                       Pneumonia Case Study | 14
Gustatory


M.F.s tongue is pinkish in color and also his gums, when we asked him to open his mouth.

Upon inspection there is no a lesion or discharge seen inside his mouth. Upon assessing the

client we prepared taste test using sugar (for sweet), salt (salty), calamansi (for sour) and

coffee (for bitter). We instructed the client to have his eyes blindfolded. We let him taste

these by giving him a pinch of it, using a tongue depressor and put it on his tongue. The

client was able to distinguish and differentiate the sour from salty and sweet from bitter. We

did the test by giving first the less offending to the most offending taste. We let the client to

drink water to prevent after taste right after each procedure.


Tactile: We assessed his sense of touch with his eyes blindfolded and he was still in sitting

position. We performed our assessment on both upper and lower extremities and anterior and

posterior part of his body. We let our client identify between sharp and dull.


First, we let him feel the pointed part of the percussion hammer on his right palm, right arm,

left leg (gastrocnemius), right foot (sole) and chest. He felt the pointed object and said that it

was sharp. Then we let him feel the blunt end of the percussion hammer on its handle. We

put it on his left palm, left arm, right leg (gastrocnemius), left foot (sole) and back. He felt it

and identified it as dull. We repeated the procedure bilaterally and alternately on his upper

and lower limbs, anterior and posterior portion of his body and it had the same result.


Next, we let our client identify between soft and hard. We let him feel a cotton ball on his

right arm. We rubbed the cotton ball smoothly on his right arm and he identified it as soft.

Then, we let him feel the handle of the percussion hammer on his left arm. We pressed the

handle of the percussion hammer on his left arm and he identified it as hard. The procedure

was done on both arms and both legs alternately and had the same result.
                                                                         Pneumonia Case Study | 15
   We let our client identify between smooth and rough. We let our patient touch the head of

   percussion hammer over her left hand and he identified it as smooth. Then we let him touch

   the handle of percussion hammer over his right hand and he identified it as rough. The

   procedure was done alternately both on upper and lower limb and it had the same result.


   We also let our client identify between cold and warm. We rubbed ours hands (hand friction)

   to make it warm then we touch the left arm of our client and he identified it as warm. After

   that, we placed a cold bottle of mineral water on his right arm and he identified it as cold. We


   repeated the procedure again but on alternate arms and had the same result. Same procedure

   was done on his lower limbs and had the same result.


 V.      BODY TEMPERATURE STATUS

The body temperature was 38.2°C, febrile, taken via right axilla for 3minutes at around 11am .


      MOTOR ABILITY

   M.F. can ambulate without assistance when we asked him to take few steps (5 steps) and we

   also saw him going to the rest room by himself. We asked the client to walk across the room

   (5 steps) to assess his gait; we observed that he has upright posture and steady gait with

   opposing arm swing and walks unaided. Range of motion was tested by flexion, extension,

   abduction, adduction and rotation on client‟s upper and lower extremities. Active range of

   motion was noted both on his right and left upper and lower extremities.


           To test his muscle grading, we asked the client to resist the gravity that we are

           making with the use of our hand pushing against his upper and lower extremities. His

           right and left arms resisted the gravity made by hands while he is on sitting position.

                                                                         Pneumonia Case Study | 16
We noted that his right and left arm has a muscle grading of 5/5. On his lower extremities, we

 asked him to lie down on his bed. Lower right and left thigh resisted the gravity made by

 hands. Grading muscle strength was 5/5 movements against gravity and against full

 resistance both on his lower right and left extremities since both right and left lower

 extremities resisted the gravity made by hand. Then we asked him to sit on the side of his

 bed.


 We also tested his patellar reflex by asking the client to relax his lower extremities and

 deliver a gentle blow using a percussion hammer on his right kneecap (patella) and it moved

 freely and we observed the normal extension or kicking out of the leg. Same procedure was


 done on his left knee and had the same result. The functional level noted in the reflex is +2 or

 normal response.


 His functional level is 5 since he doesn‟t need assistance from his significant others and

 assistive devices in performing his activities of daily living.


 NUTRITIONAL STATUS:


 As we assess MF‟s nutritional status, we observed the external portion of the mouth using a

 penlight. We asked the client to open his mouth and we observed that the client‟s gums,

 tongue and mucous membrane are pinkish in color and intact. He has no dental carries, but he

 has 1 missing tooth on his upper and 2 missing on his lower teeth. According to him he

 seldom brushes his teeth. He eats 3x a day with a snack between meals. Their daily menu

 usually includes fish, meat, rice and vegetables.




                                                                       Pneumonia Case Study | 17
He has no allergies on any kind of food or even experience difficulty in swallowing. He has

an IV Fluid of D5 0.03 NaCl 500cc x 12o ,41-42 mgtts/min. He was 66 inches in height and

66 kilograms in weight.


ELIMINATION STATUS:


We asked MF how often he voids per day. He said that before his confinement, he defecates

once and urinates 5 times daily. According to him, his urine is approximately ¼ of a drinking

glass or equivalent to 63 ml per void. With that data, we estimated that our client voids at

about 315 ml/day before his confinement. On the day of our assessment, MF had never been

defecated since the start of his confinement, urinated 10 times, the color was light yellow and


has a faint odor. We asked the amount per void and he told us that it is approximately ¼ of a

drinking glass or 63 ml/void.


REPRODUCTIVE STATUS:


MF was not yet been circumcise.


STATE OF PHYSICAL REST AND COMFORT:


At home, he usually sleeps at 10 pm to 7 am with a total of 9 hours of sleep. He does not

experience any difficulty in sleeping. He takes a nap every afternoon. During hospitalization,

he doesn‟t experience any difficulty in falling asleep. He was able to sleep for a total of 8

hours but not in consecutive hours, he was disturbed by the noise and taking his vital signs as

ordered.




                                                                      Pneumonia Case Study | 18
STATE OF SKIN AND APPENDAGES


MF has a trimmed hair and black in color. His hair is evenly distributed. There is no infection

or infestation presence in the hairline or even in his scalp. The hairs of his eyebrows, ears and

nostrils are thin.


The client‟s skin has brown in color. But his skin losses its elasticity. Moisten skin is more

prominent over his extremities. We also check his skin turgor by pinching his skin over his

sternum, the skin springs back to its previous state within 1 second.


        MF‟s nails grow thin with a smooth texture. We noticed the presence of dirt in his

        nails both hands and feet. As we inspect the tissue surrounding nails there is an intact

        epidermis




                                                                        Pneumonia Case Study | 19
ANATOMY AND PHYSIOLOGY




Hair shafts grow from hair follicles situated in the dermis and hypodermis. Every hair

consists of a root, the part that lies under the skin, and a shaft, the part that extends from the

follicle above the skin.




                                                                        Pneumonia Case Study | 20
Sweat pore The funtion of a sweat pore is when you hot your body has to find a way tto cool

you off.So when your sweating your cooling off.


Dermal papilla Any of the superficial projections of the corium or dermis that interlock with

recesses in the overlying epidermis, contain vascular loops and specialized nerve endings,

and are arranged in ridgelike lines most prominent in the hand and foot. Also called papilla

of corium.


-The dermal papillae nourishes all hair follicles and bring food and oxygen to the lower

layers of epidermal cells.


Epidermis The upper or outer layer of the two main layers of cells that make up the skin.

The epidermis is mostly made up of flat, scale-like cells called squamous cells.


-acting as the body's major barrier against an inhospitable environment.


Dermis The dermis is the middle layer of your skin. It holds most of the glands and nerve

endings. For example, your sweat gland and your oil glands are located on this level. You

feel hot, cold, touch and several others through your dermis.


Hypodermis The outermost cell layer of the cortex, also called the exodermis, of plants. The

hypodermis may produce substances that act as a barrier to the entry of pathogens, and in

some plants it may function in the absorption of water and the selection of ions that enter the

plant.




                                                                     Pneumonia Case Study | 21
Pacinian corpuscles detect gross pressure changes and vibrations and are rapidly adapting

(phasic) receptors. Any deformation in the corpuscle causes action potentials to be generated,

by opening pressure-sensitive sodium ion channels in the axon membrane.


Sweat glands also referred to as sudoriferous glands are exocrine glands, found under the

skin of all mammal species, that are used for body temperature regulation. In humans a

system of apocrine - and merocrine sweat glands is the main method of cooling.


Blood and lymph vessels in vertebrates is a network of conduits that carry a clear fluid

called lymph ( Latin for clear water). It also includes the lymphoid tissue and lymphatic

vessels through which the lymph travels in a one-way system in which lymph flows only

toward the heart.


The retinal nerve fiber layer (nerve fiber layer, stratum opticum, RNFL) is formed by the

expansion of the fibers of the optic nerve; it is thickest near the porus opticus, gradually

diminishing toward the ora serrata.


As the nerve fibers pass through the lamina cribrosa sclerae they lose their medullary sheaths

and are continued onward through the choroid and retina as simple axis-cylinders.


Papilla of hair The papilla is the very bottom portion of the hair follicle that contains the

blood supply and the matrix. The matrix consists of cells that actually form the hair shaft.


A hair follicle is a part of the skin that grows hair by packing old cells together. Attached to

the follicle is a sebaceous gland, a tiny sebum-producing gland found everywhere except on



                                                                      Pneumonia Case Study | 22
the palms, lips and soles of the feet. The thicker the density of the hair, the more the number

of sebaceous glands that are found.


The sebaceous glands are microscopic glands in the skin which secrete an oily/waxy matter,

called sebum, to lubricate the skin and hair of mammals.Sebum acts to protect and

waterproof hair and skin,


Arrector pili: A microscopic band of muscle tissue which connects a hair follicle to the

dermis. When stimulated, the arrector pili will contract and cause the hair to become more

perpendicular to the skin surface


The Stratum germinativum (or basal layer, stratum basale) is the deepest layer of the 5

layers of the epidermis, which is the outer covering of skin in mammals. The stratum

germinativum is a continuous layer of cells. It is often described as one cell thick, though it

may in fact be two to three cells thick in glabrous (hairless) skin and hyperproliferative

epidermis (from a skin disease).


The pigmented layer of retina or retinal pigment epithelium (RPE) is the pigmented cell

layer just outside the neurosensory retina that nourishes retinal visual cells, and is firmly

attached to the underlying choroid and overlying retinal visual cells.The retinal pigment

epithelium is involved in the phagocytosis of the outer segment of photoreceptor cells and it

is also involved in the vitamin A cycle where it isomerizes all trans retinol to 11-cis retinal.




                                                                       Pneumonia Case Study | 23
The stratum corneum is the outermost layer of the epidermis, composed of large, flat,

polyhedral, plate-like envelopes filled with keratin, which is made up of dead cells that have

migrated up from the stratum granulosum.




                                                                    Pneumonia Case Study | 24
        PATHOPHYSIOLOGY:


Precipitating Factors:                                   Predisposing Factors:
    o       Food                                             o    Underlying gastrointestinal pathology.


    o       Food

                                                          o
                            Non-immunologic food intolerance Underlying gastrointestinal pathology.




                                Response to exclusion diet



                          Reactions may be immediate (1-2 hours)
                                 or delayed (several days)


                         Multiple food allergies are more common
        \
                         in gastrointestinal disease




                                  Type I hypersensitivity.



                         Anaphylactoid reaction due to presence of
                                        histamine


                                    Antigenic exposure



                            Immunological activity threshold is
                             breached, allergic breakthrough.


                           Removal of exposure to one of inciting
                           allergens may be sufficient to produce
                                   clinical improvement.


                                                                            Pneumonia Case Study | 25
Textual explanation


   An uncommon disease. True food allergy does exist but is clinically indistinguishable from

   non-immunologic food intolerance. Diagnosis of adverse response to food usually confirmed

   through response to exclusion diet. Reactions may be immediate (1-2 hours) or delayed

   (several days).Food allergies affecting skin are often caused by a single food whereas

   multiple food allergies are more common in gastrointestinal disease (Guilford 1994).Very

   little known about pathophysiology of food allergy. Most commonly accepted theory is Type

   I hypersensitivity. Anaphylactoid reaction due to presence of histamine may be one

   mechanism. Food allergy response in dogs is typically delayed (Rosser 1993). Antigenic

   exposure gives rise to histamine-releasing factors which remain active some time after

   antigen is removed. This may explain the lag between introduction of a hypoallergenic diet

   and clinical improvement. Allergic response may only become apparent when

   immunological activity threshold is breached, allergic breakthrough. This is when a small

   increase in allergen load may provoke an allergic response, similarly removal of exposure to

   one of inciting allergens may be sufficient to produce clinical




                                                                       Pneumonia Case Study | 26
LABORATORY AND DIAGNOSTIC FINDINGS


Hematology                                                May 4, 2010

Test                Result         Normal Values           Clinical Significance
Hemoglobin          9.9            M=4-18g/dL              Within the normal values
Hematocrit          30             M=40-54%                Due to infection
WBC Count           4.4            5.0-10.0                Due to infection
Neutrophil          66             50-70                   Within the normal values
Lymphocyte          34             25-40                   Within the normal values
Monocyte            0.03           0.00-0.06               Within the normal values
Platelet Count      262            150-450                 Within the normal values
                                            Pathologist: Demetric L. Valle Jr.MD.FPSP



Urinalysis                                                       May 4, 2010

test                result               NORMAL VALUES           Clinical significance

color               Light yellow                Yellow                     Normal

transparency        clear                        Clear                     Normal

Ph(reaction)        5.0                         Acidic               A pH below 7
                                                                 indicates acidity and a
                                                                    pH in excess of 7
                                                                   indicates alkalinity

Specific gravity    1.010                     1.015-1.025                  Normal

glucose             negative                   Negative                    Normal

Protein (albumin)   negative                   Negative                    Normal

                                    Pathologist: Bernadette Espiritu, MD




                                                              Pneumonia Case Study | 27
XIV. Evaluation




        After 32 hours of exposure in Angono General Hospital, ward, we, the 3rd year students

of Bachelor of Science in Nursing, section C, group 3 of Unciano Colleges - Antipolo, City

acquired proper attitude in communicating with the patients and the staffs in the hospital, we

gained much knowledge and competencies in our clinical area, and we applied our classroom

acquired skills in actual hospital setting.


        We established rapport with the client and its significant others. We learn more about the

anatomy and physiology of the patient‟s digestive system and we were able to gain more

knowledge about the medications given to our patient. We were able to enhance our assessment

skills using the 13 Areas of Assessment. We were able to formulate an effective nursing care

plan about the patient‟s condition.


     We were able to establish rapport with our client as well as his family and helped them

        recognize and gave importance on their health and personal development.

     We were able to identify and analyze present health problems of our client that might

        place him at risk and we were able to use our nursing skills to help him.

     We were able to review our knowledge about anatomy and physiology of the Digestive

        system as well as the pathophysiology of Typhoid Fever.

     We were able to formulate and plan appropriate nursing interventions that lessen the

        health problems of our client, by involving him as well as the members of our group.




                                                                         Pneumonia Case Study | 28
    We were able to impart necessary knowledge regarding health maintenance to our client

       that guided him to achieve a healthy life.

    We were able to evaluate the effectiveness of our nursing care plan.




XV. PROGNOSIS, DISCHARGE PLANNING & HEALTH TEACHING


PROGNOSIS


       The infant shows good prognosis towards full recovery and resumption of activities of

daily living, as manifested by being able to eat and sleep better, as well as in resuming his play

and his attempt to walk around. Our client's family, especially the mother, was open-minded and

accepted our health teachings and nursing interventions.


XVIII. DISCHARGE PLAN\


Guidelines from reputable health agencies suggest some steps parents can take to reduce their

child's chances of having food and other allergies, although there are no guarantees of success. If

either or both parents have a personal or family history of allergy, for example, asthma, eczema,




                                                                         Pneumonia Case Study | 29
hay fever, perennial allergic rhinitis (allergy to animals, dust mites, or molds) the following is

recommended:


      Avoid common allergenic foods, in particular peanuts and tree nuts, during pregnancy

       and while nursing -- peanut protein, as well as components of cow's milk, eggs, and

       wheat, are secreted into breast milk

      Breast-feed exclusively -- give your baby only breast milk for the first 6 months of life

       using hypoallergenic formulas to supplement breastfeeding if necessary.


Not all studies agree on exclusive breast-feeding. The latest and largest study investigating the

relationship between breast-feeding and allergies, particularly asthma, suggests that breast-

feeding in the early months of life can prevent allergies until your child is 2 years old.


Since delaying foods allows the child's gastrointestinal tract to mature, the following strategies

may be helpful:


      Delay giving your infant solid food until 6 months of age.

      Delay giving your child common allergenic foods as follows: dairy until age 1 year; eggs

       until age 2 years; peanuts, nuts, and fish until 3 years.

      If an allergy develops, carefully avoid the offending food.




                                                                           Pneumonia Case Study | 30
BIBLIOGRAPHY




Smelter, Suzanne C., EdD, RN, FAAN, Bare Brenda G., RN, MSN, Hinkle, Janice L., PhD, RN,

CNRN, Cheever, Kerry H., PhD, RN, 2008. Brunner & Suddarth’s Textbook of Medical-

Surgical Nursing, 11th ed. PA: Lippincott Williams & Wilkins.


Kozier, Barbara, MN, RN, Erb, Glenora, BSN, RN, Berman Audrey, PhD, RN, AOCN, Syder,

Shirlee, EdD, RN, 2004. Fundamentals of Nursing: Concepts, Process and Practice, 7th ed.

NJ: Pearson Education.


Marilyn E. Doenges, Mary Frances Moorhouse and Alice C. Geissier-Murr, 2006. Nurse’s

Pocket Guide: Diagnoses,Interventions, and Rationales, 11th ed. PA: F.A. Davis Company.


Doyle, Rita M., ed., 2008. Nursing 2008 Drug handbook, 28th ed. PA: Lippincott Williams &

Wilkins.


Karch, Amy, 2006. Focus on Nursing Pharmacology, 3rd ed. PA: Lippincott Williams &

Wilkins.


Catagnus, Julia M. and Hager, Linda, 2008. Nursing The Series for Clinical Excellence:

Deciphering Diagnostic Tests. PA: Lippincott Williams & Wilkins.


FIFTH EDITION. Basic Nutrition for Filipinos. PA: Virginia Serraon-Claudio, Ofelia V.

Dirige, Adela Jamorabo-Ruiz.




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