III.

DEMOGRAPHIC DATA
a. Demographic Details
Code Name: Anne
Sex: Female
Civil Status: Single
Age: 12 years old
Birthplace: Benguet General Hospital
Birthday: une !"# 2""$
Address: 2% &ld Forestry Compound 'o(er )ngineers Hill# Baguio City
*eligion: *oman Catholic
+ate and ,ime Admitted: Fe-ruary "1# 2"1"# $:2" pm
b. Admission Details
.nitial /ital signs: ,emperature: !$01
"
C
: **: !$ -pm# shallo( regular
:C*: 122 cpm
Chie3 complaint: /omiting and mouth ulcers
4ard and room: 5edia (ard# room 2%%
.nitial diagnosis: Hand# 3oot and mouth disease
: rule out 6,.
Final +iagnosis: Hand# Foot and 7outh disease
Admitting 5hysician: +r0 A-rati8ue
Attending physician: +r0 Baguilat
S9in: :;< vesicular lesions on hand# 3eet# (arm to touch (ith good s9in turgor
H))N,: :;< mouth lesions# no gross de3ormities# normal hair distri-ution#
eyes are non=icteric# slightly sun9en (ith pin9is9 con>unctiva# no tearing or
a-normal discharges0 'ips and -ucccal mucosa are moist# nec9 is not (e--ed
(ithout supraclavicular retractions# (ith no palpa-le lymphdenopaties0
Chest?'ung: no lagging# no retractions# clear -reath sounds
Heart: noramal rate# regular rythym
A-domen: hypercactive -o(el sounds# so3t masses palpated# symmetrical
)xtremities: no gross de3ormities# pin9ish nail-eds# good capillary re3ill
V. COR!E O" CO#"I#EME#T
,his is the case o3 patient Anne# 12 years old# 3emale# *oman Catholic# Filipino#
(as -orn on une !"#2""$ in BGH and presently residing at 'o(er )ngineers Hill#
Baguio City0 Admitted in the institution 3or the 3irst time# Fe-ruary "1# 2"1" due to
vomiting and mouth ulcers0 ,he 3ollo(ing events are the se8uence o3 events during the
con3inement o3 patient Anne0
$. HEA%TH PERCEPTIO#&HEA%TH MA#AGEME#T PATTER#
,he child is admitted due to vomiting and lesions on mouth# 3eet and hand0 Be3ore
admission# the child@s general health is healthy0 She (as ta9ing vitamins namely celine
and gro(ee0 Gro(ee (as ta9en every other month and celine is continuous0 /itamins are
given a3ter dinner and (ith a spoon -ecause they are in li8uid 3orm0 .n ta9ing
medications# the child (ant to do it -y hersel3# she@s not encouraging the help o3 a nurse
nor her mother in ta9ing such0 No 9no(n allergies to medications0 ,he child does not
9no( a-out her 3inal diagnosis# she >ust 9no( a-out her mouth ulcers# no more no less0
,he child had -een to hospital -e3ore -ut not admitted0 She (as at the Notre +am 3or her
chec9 up on her lesions and given unrecalled medications -ut her condition (orsen so
they see9 3or another consultation0 Be3ore admission# the child is very lively -ut upon the
eruption o3 the lesions# the child -ecome irrita-le0 ,he parents and the child comply to all
medications and treatments0
'. #TRITIO#A%& META(O%IC PATTER#
,he child is a healthy eater (ho eats !x a day (ith snac9s in -et(een0 ,he child@s
usual time to eat is 1"am=12pm=$pm0 ,he child@s eat alone or (ith companion o3 her
yaya during the -rea93ast and lunch# -ut during dinner they eat together0 ,he child@s
3avourite 3oods are vegeta-les# cheesecurls# coo9ies and -reads0 She seldom eat meat and
other 9ind o3 >un9 3oods0 ,he child eat through a spoon and 3or90 ,he child pre3ers (arm
3ood to eta0 Feeding pro-lems occur (hen the child is distur-ed in her play >ust to eat
3ood0 ,he mother usually do is to le3t the child alone and (ait till she voluntarily go to
the dining area to eat0 ,he child@s -irth (eight is 2029g# and her present (eight is 1%02 9g0
,he s9in has good turgor# it is moist# nails are (ell trimmed and there are presence o3
oral lesions#2mm=Amm in diameter at the mucous mem-rane# hard palate and ventral part
o3 -oth o3 the upper and lo(er lips# vesicular lesions on the palmar are and 3eet# 2mm=
Amm in diameter and unevenly distri-uted0
). E%IMI#ATIO# PATTER#
,he child urinate 3re8uently# the urine as descri-ed -y the mother is color yello(#
no secretions and no 3oul smelly0 ,he child de3ecate 1=2 times a day# characteristics o3
the stool are semi=solid# -ro(n in color and there is no undigested 3ood0 A3ter admission#
the child@s elimination is the same as usual0 ,he child is toilet trained# don@t have any
concerns a-out elimination li9e -ed (etting0 ,he child@s s(eat a lot only in her head a3ter
a long play and hot days0 ,hey consult 3or a private 3or the said condition and the result
are not yet given0 6rinalysis (as per3orm due to poor inta9e o3 the child# the test reveals
that there are occasional -acteria# amorphous urate on the child@s urine0 ,he child can
a-le to control it@s -o(el movement# :Autonomy vs shame and dou-t: )ric9 )ric9son
Sociocultural Stage<
*. !%EEP A#D RE!T PATTER#
,he child@s usual hour o3 sleep and a(a9ening is 1"pm=1"am (ith a3ternoon
naps0 ,he child@s sleeps 12 hours all in all (ith no distur-ances0 ,he child can@t sleep
(ithout her 3avourite toy (hich is 7oymoy0 ,he child@s usual routine -e3ore sleeping is
urinating to prevent -ed (etting0 ,he child sleep on a 3oam -ed (ith her mother or her
yaya on side0 ,he child@s 3avourite sleeping position is right side lying0 ,here are no
pro-lems in a(a9ening ans getting ready in the morning0 a3ter admission# the child@s is
not the same as usual -ecause there are sleep distur-ances already li9e giving
medications and hospital setting0
+. ACTIVIT,&E-ERCI!E PATTER#
,he child is a elementary student She go to scholl at 11=12noon0 ,he child@s
3avourite activities are to play (ith her playmates# (atch ,/ and play (ith her toys0 ,he
child@s usual television vie(ing schedule is anytime0 ,here@s no ,/ restrictions0 ,he
child@s 3avourite program are +ora# ,om and erry and Barney0 She ta9e a -ath (ith
assistance and grooms# -rush (ith assistance# -ut she can a-le to choose the dress she
(ant to (ear to0 ,he child has a good motor a-ility# coordination# sensory s9ills are
slightly developed# there are -asic 3eelings already# emotions# a sense o3 sel3 and
independent -ecome important0:Stages# Age ranges and characteristics o3 human
development related to pediatric nursing<0 7uscular coordination improves# she can (al9#
rum# >ump#:Autonomy vs shame and dou-t: )ric9 )ric9son Sociocultural Stage<
.. COG#ITIVE&PERCEPTA% PATTER#
,he child can easily adopt to a ne( environment and companion0 She does not
have any hearing# visual pro-lems0 She does not cry (hen le3t alone0 She is an average
pupil in their class# as ver-aliBed -y the mother0 ,he child learns to clari3y
communication# recogniBes approval or disapproval:Sullivan@s .nterpersonal theory<0 ,he
chid is at the stage o3 preoperational thought0 ,he child has no concrete thin9ing -ut
generaliBes# she needs independent learning0:5iaget: Cognitive stage<
/.!E%" PERCEPTIO#&!E%" PATTER#
7other noticed that she -ecome irrita-le# did not tal9 and have limited activities
upon the eruption o3 the lesions0 Be3ore the admission# she i3 3riendly# tal9ative and easy
going0 She is a3raid o3 her 3ather# -ecause he is strict and also to the policeman -ecause
they had gun on their poc9et0 4hen the child is upset# she (ill >ust ver-aliBe this
(ordsC-ad 9a# -a9it mo a9o inaa(ay# no crying episodes and tantrums0
0. RO%E RE%ATIO#!HIP PATTER#
,he chid (ish to -e called Dani or Eitang0 She is more attached to her mother
rather than to her 3ather# due to (or90 ,he child@s hospitaliBation does not a33ect the
3inancial status o3 the 3amily since she is the only child o3 the 3amily0 ,he mother (orries
too much to condition o3 the child -ecause it@s their 3irst time to have li9e this and the
mother can@t identi3y the cause o3 the disease0
1. !E-A%IT, A#D REPRODCTIVE PATTER#
,he child is 3emale# ! years old0
$2.COPI#G !TRE!! TO%ERA#CE PATTER#
.3 the child is upset# she (ill go to her mother and ver-aliBe her pro-lem or the
things she (ish to have# she does not have any tantrums0 ,he child is very understanding
the 3act that i3 the mother said no# or that thing is not 3or you# she (ill not insist anymore0
But i3 the child had pro-lems regarding to her 3eeling or illness# she (ill cry and her
activities o3 her daily living lessens0 ,he child is not ac accident prone0 She has a lot o3
energy and assert independence -y saying N&0 shame developed i3 parental punishment
arises0:Autonomy vs shame and dou-t: )ric9 )ric9son Sociocultural Stage<
$$.VA%E&(E%IE" PATTER#
,he 3amily is a devotee o3 *oman Catholic church0 ,hey do -elieve that prayer is
the most po(er3ul (eapon in all their pro-lems0

"ebr3ar4 2$5 '2$26 .6+2 pm
.nto )0*0 cuddled -y mother# a !y?o complaints o3 oral lesions# vesicular lesions
on 3eet and hand0
!F 5resent condition started 2 days 5,A as appearance o3 lesions on oral mucosa0 &ne
day 5,A condition (orsened (ith lesions on mouth# hands and 3eet # no medications
(ere given0 ,here (as no onset o3 3ever# consultation (as done at Nutre +am0 1 day
5,A# the patient (as given +altarin gel0 Condition persisted so they (ent -ac9 3or
another consultation (ith +r0 Baguilat (here they (ere advised 3or admission0
FC Napansin 9o na -igla siyang tumahimi9 at na9ita 9o na may lesions sa -unganga niya
at sa 9anyang 9amay at paaC as ver-aliBed -y the mother0
OF/?S C*: 122 cpm **: !$ cpm temp: !G
"
C
F(ith lesions on mouth# 3eet and hand evenly distri-uted (ith no discharges noted
F (ith vesicular lesions on mouth# hand and 3eet
F scratching episode noted
Fpale in appearance
AF .mpaired s9in integrity: /esicular lesions related to in3ectious process
F to ver-aliBe needs and concern
F report any onset o3 lesions o3 the -ody
F .nstruct the mother to cut nails
F.nstruct mother to place mitten on hands to prevent drying o3 the s9in0
"ebr3ar4 2' '2$26 $$6'+ am
A"=A1Hgtts?min at !A" cc in3using (ell at le3t arm0
!FC7a9ati po at masa9itC as ver-aliBed -y the patient
OF vital signs as 3ollo(s: ,
"
: !$0"
"
C **: 2%cpm C*:11"-pm
F vesicular lesion on right 3oot# ventral aspect# popular lesions on ventral aspect o3 the
palmsI
:;< ulcerations on the -uccal cavity
F :;< loss o3 appetite
Floo9s pale
Fcries at times
F irrita-le
AF *is9 3or im-alanced nutrition: less than the -ody re8uirement related to oral cavity
lesions
"ebr3ar4 2' '2$26 )&$$
5F s9in lesion
!F Jhindi masa9it# hindi rin 7a9ati as ver-aliBed -y the patient
FCaya( 9o ng gamot# aya( 9o ding 9umainC as ver-aliBed -y the patient
OF (ith reddish# -lister=li9e# unevenly distri-uted and approximately 1mm=Gmm in
diameter
siBe o3 lesion on hand and 3eet
Fmouth lesions are unevenly distri-uted# reddish and papule li9e lesions
F(ith smooth and good s9in turgor
Firrita-le and cries at time
AF .mpaired s9in integrity: vesicular lesions on 3eet# hand and mouth related to
in3lammatory process
"ebr3ar4 2' '2$26 $$&/
F*eceived patient sitting in -ed (ith ongoing ./F o3 +
A
.7B A"=A1Hgtts?min at A2Acc
level in3using (ell at le3t hand0
!F JShe can a-le to ingests 3ood pero in small amount# 9asi masa9it pa rin da(C as
ver-aliBed -y the mother
OFdi33iculty in s(allo(ing
Fpresence o3 oral lesions# vesicular lesions at the palm and 3oot
Fre>ects solid 3oods
F irrita-le most o3 the time
AF .mpaired oral mucous mem-rane related to in3lammation on oral cavity as mani3ested
-y lesions on -oth sides o3 the mouth

SUBJECTIVE AND OBJECTIVE DATA ARE DISCUSSED ABOVE
GOALS NURSING INTERVENTIONS RATIONALE for all interventions EVALUATION
After 2 weeks of
nursing interaction,
ro!ote in"een"ence,
#iew se$f ositi#e$%
t&roug& rea$i'ation of
strengt&s an" $i!its as
a erson, interacting
wit& ot&er eo$e an"
t&e a(i$it% to e)ress
se$f an" so$#e concerns
roer$%*
Intro"uce se$f an" intention "uring t&e first &ase of
interaction*
Interact wit& t&e c$ient in a s$ow ace, using a $ow
fir! tone*
Assesse" $esions in ter!s of aearance, co$or,
"istri(ution an" si'e of t&e $esion* Encourage
fre+uent a!(u$ation as to$erate"*
,ro#i"e !eticu$ous skincare (% a$%ing $otion an"
!oisturi'er to t&e c$ient-s skin*
,ro#i"e" war!t& an" co!fort*
,ro#i"e fa#ourite foo"s in !as&e" for! suc& as
cookies an" (rea"s* A#oi" "istractions "uring !ea$
ti!e*
Increase rotein on "iet for tissue reair
a#oi" sic% foo"s an" foo"s t&at wou$" irritate t&e
ora$ ca#it%
increase f$ui" intake
E!&asi'e &an" &%giene
,ro#i"e ora$ &%giene care regu$ar$%* .ar! sa$ine
so$ution /)0"a%* Use cotton $e"gets*
Assist "uring "efecation an" urination* ,ro#i"e
1&e$ c$ient (ui$" &is trust wit& t&e
nurse2 ensuring t&at it is a
rofessiona$ t%e of interaction an"
t&at wi$$ ensure t&e confi"entia$it% of
interaction*
1ro!ote a ositi#e an" trusting
en#iron!ent wit& t&e c$ient
consi"ering t&at "eresse" c$ients
so!eti!es co!!unicate wit& so!e
gas or !a% (e unresonsi#e for
so!e reasons*
1So!eti!es c$ients w&o are
"eresse" !a% &a#e so!e e!otiona$
out(ursts, cr%ing se$$s or &esitanc%
in s&aring t&eir t&oug&ts* Be war% of
t&ese non#er(a$ cues an" ro#i"e
so!e co!forting gestures or a$$ow
c$ient cr% as it wou$" $essen &is
e)aggerate" e!otions*
1T&ese wi$$ &e$ in knowing w&ic&
asects %ou s&ou$" reinforce wit&
"uring t&e $an of care* It !a% a$so
&e$ c$ient un"erstan" of &is $i!its as
erson*
13nowing t&ese wi$$ &e$ %ou inoint
wit& t&e c$ient if &ow &e coe wit& &is
After 2 weeks of nursing
interaction, c$ient wi$$ (e
a($e to !anifest
i!ro#e" &%sica$
con"ition, i!ro#e"
status on ongoing
"isease rocess,
#er(a$i'e ositi#e
concet of se$f,
!anifest i!ro#e!ent
in &%sio$ogica$
con"ition, i!ro#e
current &ea$t& care
status, know &is
strengt&s an" $i!its as
a erson*

ri#ac% "uring toi$eting* ,reare toi$etr% !ateria$s
(efore&an"*
$u(ricate $is an" ro#i"e co!!ercia$$% reare"
ora$ $u(ricants
Arrange for a c&urc& #isit
Refer to astora$ care ser#ices
Resect cu$tura$ nee"s
1&er(a$ !e"ications
1 arrange for a fe!a$e nurse to assist in
s&owering an" toi$et nee"s
1A$$ow atient to kee a $itt$e statue of t&e go""ess
4$uck% c&ar!5on &er (e"si"e ta($e
1ro#i"e t&e fa!i$% ri#ac% at 6 ! for t&eir "ai$%
rosar%*
Arrange for an in"oor acti#it% $ike (oar" ga!es of
c&ess, snake an" $a""ers, wor" ga!es
,ro#i"e socia$i'ation wit& ot&er atients of t&e sa!e
age
Do not &urr% c$ient into an interaction, instea"
!aintain a t&eraeutic an" reassuring at!os&ere
t&at %ou are a#ai$a($e if &e is a$rea"% rea"% to ta$k
or s&are &is t&oug&ts wit& %ou*
Concetua$i'e goa$s for reco#er% toget&er wit& t&e
c$ient an" in#o$#e c$ient in si!$e "ecision !aking*
ro($e!s effecti#e$% or not2 t&ese wi$$
gui"e &i! to a#oi" negati#e coing
!easures
1T&is wi$$ &e$ c$ient know &is
strengt&s as a erson an" wou$" &e$
&i! resu!e &is autono!% an"
integrit%*
1T&is wi$$ not on$% ro!ote c$ient-s
ositi#e concet of se$f (ut wou$" a$so
en&ance &is a(i$it% to resu!e
functioning $ike &is "ai$% se$f1 care*
1T&ese negati#e t&inking state!ents
are often uti$i'e" (% "eresse"
in"i#i"ua$s an" correcting t&is wi$$
&e$ c$ient coe aroriate$%*
17aintaining a ositi#e i!age of se$f
&e$s a erson fee$ goo" a(out se$f*
In#o$#e c$ient in acti#ities t&at !eets &is a(i$ities an"
raise &i! &onest$% for ac&ie#e!ents "one*
Encourage c$ient care a(out se$f t&roug& groo!ing
an" eating roer$%*
8et &i! e)ress se$f t&roug& non sti!u$ating
acti#ities $ike "ancing, "rawing, or assu!ing ro$e
$a%ing*
Encourage re1 esta($is&!ent of re$ations&is wit&
significant ones an" e!&asi'e t&at roer contro$
of anger an" gui$t cou$" assist &i! interact
aroriate$%*