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I. INTRODUCTION
Overview of the Case
Chronic Kidney Disease is the failure of the kidneys to perform the function of
cleansing the blood of waste products. The primary method of cleansing the body of
waste involves the liver forming urea and the kidneys filtering this product out of the
blood to be excreted in the urine. Blood urea nitrogen and creatinine are nitrogenous
wastes, end products of protein metabolism. The amount of urea in the blood can be
measured with a blood test called blood urea nitrogen (BUN). Creatinine levels also can
be measured in the blood. BUN and creatinine levels are utilized to measure kidney

2. function. A high level in the blood is called uremia, literally meaning urine in the blood.
Urea is eventually converted to ammonia, leading to toxicity and related symptoms in all
systems of the body.
End Stage Renal Disease is already the 7th leading cause of death among
Filipinos? It is said that a Filipino is having the disease hourly or 120 Filipinos per million
populations per year. This shows that about 10, 000 Filipinos need to replace their
kidney function. Unfortunately though only 73% or about 7, 267 patients received
treatment. An estimate of about a quarter of the whole population probably just died
without receiving any treatment.
The kidneys play key roles in body function, not only by filtering the blood and
getting rid of waste products, but also by balancing levels of electrolyte levels in the
body, controlling blood pressure, and stimulating the production of red blood cells.
Treatment for chronic kidney failure, also called chronic kidney disease, focuses
on slowing the progression of the kidney damage, usually by controlling the underlying
cause. Chronic kidney failure can progress to end-stage kidney disease, which is fatal
without artificial filtering (dialysis) or a kidney transplant.
Objective of the Study
As a third year (N104) nursing student of Liceo de Cagayan University, within two
days of nursing intervention on a client with Chronic Kidney Disease of Northern
Mindanao Medical Centre, I will be able to conduct a thorough and comprehensive
study of the assigned patient according to the data that was gathered by conducting a
series of interviews. The condition of the aforementioned will augment and free of
possible complications from the disorder.
The completion of this case study enables the proponent to do the following:

3. 1. To organize my patient’s data for the establishment of good background
information
2. To show the family history as well as the history of past and present illness for
the knowledge of what could be the predisposing factors that might contribute to
the patient’s illness
3. To trace the psychological development of the patient through the analysis of
different developmental theories with comparison of the patient’s data
4. To review Patient’s Chart and carry out Medical Orders; thus, relate these
interventions to the alleviation of the Patient’s health condition
5. To present the different results of the patient’s diagnostic exams together with
the comparison of normal values for the understanding of what changes during
the disease
6. To discuss the Anatomy, Physiology and Pathophysiology of the Patient’s health
condition
7. To present the data from the nursing assessment performed on the patient using
the cephalocaudal approach for the good overview of her over-all health
8. To identify Patient’s Clinical Manifestations as basis for a specific, measurable,
attainable, realistic and time-bounded Actual and Ideal Nursing Care Plans.
9. To impart appropriate health teachings specifically for the patient to promote
wellness and appropriate discharge plan
10. To have an over-all conclusion and recommendation about the care study
Scope and limitation
The case presentation merely covers data that have been gathered through
interview per assessment tool and chart referral on the day of the assessment phase in
loading assigned patients and in the succeeding days of the rotation, in the care
formulated and intervened to its progress as the week’s rotation ended. Thus, it is
limited to the days in the rotation the student nurse interacted with the client in the hope

4. to gather the necessary data to support the presentation which is not enough to acquire
a bulk of specific details.
II. HEALTH HISTORY
Patient’s Profile
Client’s Name: Patient EBG
Age: 80 years old
Address: Kalinaw Dampias, Binuangan, Misamis Oriental
Civil Status: Married
Spouse: Mrs. CRG

5. Sex: Male
Job: Farmer
Nationality: Filipino
Religion: Roman Catholic
Birthday: May 7, 1931
Height: 167.74 cm (5’5’’)
Weight: 82 Kilogram
Allergy: No Known Food and Drug Allergies
Educational Attainment: High School Graduate
Admitting Physician: Melissa Suzanne Y. Abamongan, M.D.
Date of Admission: July 30, 2011
Time of Admission: 7:30 in the morning
Chief Complaint: Prior to admission, patient EBG from Binuangan Misamis
Oriental complains of shortness of breath. Patient then
sought consult and was admitted for the first time in Northern
Mindanao Medical Centre
Admitting Diagnosis: Chronic Kidney Disease secondary to Diabetes Mellitus
Nephropathy
Family Health History
During the interview, there were no traced of underlying condition of her family.
Most common illness experienced by the members of the family is only mild cough and
fever, and a medication bought on a near Botika ng Bayan was their primary source to
medicate their illness. On both maternal and paternal sides of Patient EBG, his parents
are both diabetic and hypertension. So genetically, it comes on their blood line that they
are diabetic and hypertensive.

6. Personal Health History
Patient EBG is married with Mrs. CRG with 2 children, a professional teacher
from an elementary school and a government employee at Binuangan.. He smokes
occasionally and can consume 3-4 sticks of cigarettes, while he is a hard drinker of
liquor and can consume 1 case of beer every 24 hours. According to patient EBG, he
drinks a lot together with his friends and there were no days that they skip from drinking.
With no known food and drug allergies. Patient EBG had tried all the skilled works, from
driving a very huge truck, go farming and working in an auto-repair shop. Because of his
stressful work and due to the influence of friends, he then became a hard liquor drinker.
He’s a diabetic for almost 15 year and did not seek medical admission and no
maintenance of medication.
Past Medical History
Patient EBG has not yet experienced any admission at the hospital since birth.
During my interview he said that it’s his first time to be admitted in a hospital.
History of present health illness
5 months prior to admission, patient EBG noticed to have a decrease in urine
output and it is below 500mL/day. No consult was done and no medications given.
Aging Pallor
The condition has tolerated until 3 days prior to admission, patient EBG
complains in loss of appetite.

7. Fever, still with decrease urine output
Until the night prior to admission, patient complains of difficulty in breathing and
unable to sleep man
Until morning prior to admission, the patient then brought to the hospital and then
admitted to have a better condition
Chief complains
Prior to admission, patient EBG an 80 years old from Binuangan Mis. Or.,
admitted for the first time in Northern Mindanao Medical Centre, complains of shortness
of breathing.
III. DEVELOPMENTAL DATA
Robert Havighurst’s Developmental Tasks
Developmental
Tasks
Description Passed or
Failed
Justification
1. Adjusting to
decreasing physical
strength and health
Older adults also have
to adjust to decreasing
physical strength and
health. The prevalence
of chronic and acute
diseases increase in
Passed Our patient is aware about his
health and is very cooperative
on the student nurses who
provide care to him. He is
cooperative in a way that he
follows the student nurses in

8. old age. Thus, older
adults may be
confronted with life
situations that are
characterized by not
being in perfect
health,serious illness
and dependency on
people.
procedures like removing the
catheter. Also, when giving
meds, he does not refuse in
taking the due meds given to
him.
2. Adjusting to
retirement and
reduced income
A central
developmental task
that characterized the
transition into old age
is adjustment to
retirement. The period
after retirement has to
be filled with new
projects, but is
characterized by few
valid cultural
guidelines. The
achievement of this
task may be
obstructed by the
management of
another task, living in
a reduced income
after retirement.
Passed Our patient is not receiving
pension but gets his income
from his farm (banana
plantation) and his photo
studio. He is a photographer
by experience according to
his grandchildren. His annual
income at his photo studio is
200,000 pesos.
3. Adjusting to death of
a spouse
Older adults may
become caregivers to
their spouses. Some
older adults have to
adjust to the death of
their spouses. After
they have lived with a
spouse for many
decades, widowhood
may force older people
to adjust to loneliness,
moving to a smaller
place,and learning
about business
matters.
Passed When asked, the patient
stated that his wife is already
dead. He accepts that he is
now a widow. His deceased
wife's name is Susanna. She
died on November 7, 2005
due to cancer (not specified).
They had 9 children.
4. Establishing an
explicit affiliation with
one's aged group
The development of a
large part of the
population into old age
is historically recent
phenomenon to
modern cities. Thus,
Passed Our patient is a member of
PHIC and a congregation of
Jehovah's witnesses in
Panabo City. According to
him, they have 7
congregations in Panabo and

9. advancements
understanding of the
aging process may
lead to identifying
further developmental
tasks associated with
gains and purposeful
lives for adults.
it is composed of 100
members per congregation.
In their congregation, their
focus is on teaching the good
news of Jehovah. He also
mentioned that he has friends
of the same age group
namely Helson Daclan who
delivers meds and Oscar
Emier.
5. Meeting social and
civil obligations
Older people might
accumulate knowledge
about life, and thus
may contribute to the
development of
younger people and
the society.
Passed Our patient tells stories about
his childhood life to his
grandchildren. He shares
experiences to them which
served as a guide and
lesson.
6. Establishing
satisfactory physical
living arrangements
Oder adults are
generally challenged
to create positive
sense of their lives as
a whole. The feeling
that life has order and
meaning results in
happiness.
Passed Our patient lives in a
subdivision in a Panabo City
together with his daughter.
According to him, his
daughter is the only one who
is not married among his
children. All eight had their
own families nonetheless he
sometimes would visit them.
Psychosocial theory (Erick Erikson)
Middle Adulthood: 65 and above
Ego Development Outcome: Integrity vs. Despair
Basic Strengths: Production and Care
Erikson felt that much of life is preparing for the middle adulthood stage and the
last stage recovering from it. Perhaps that is because as older adults we can often look

10. back on our lives with happiness and are contented, feeling fulfilled with a deep sense
that life has meaning and we've made contribution to life, a feeling Erikson called
integrity. On the other hand, some adults may reach this stage and despair at their
experiences and perceived failure.
This phase occurs during old age and is focused on reflecting back on life. Those
who are unsuccessful during this phase will feel that their life has been wasted and will
experience many regrets. The individual will be left with feelings of bitterness and
despair. Those who feel proud of their accomplishments will feel a sense of integrity.
Successfully completing this phase means looking back with few regrets and a general
feeling of satisfaction. These individuals will attain wisdom, even when confronting
death.
Justification:
My patient achieved happiness and contentment in his life based on his actions
and speeches. He is faithful and devoted to his religion. When asked what his principle
in life he said is, “Mamatay man kun buhi, mapabilin kay Jehovah”. He is ready to
accept death completely and he has shared his experiences to his beloved
grandchildren. Even though he accepted death fully but his faith and love for his
worshipped God never changed.
.
Cognitive development theory (Jean Piaget)
Formal operational stage
The formal operational period is the fourth and final of the periods of cognitive
development in Piaget's theory. This stage, which follows the Concrete Operational
stage, commences at around 11 years of age (puberty) and continues into adulthood. In
this stage, individuals move beyond concrete experiences and begin to think abstractly,
reason logically and draw conclusions from the information available, as well as apply

11. all these processes to hypothetical situations. The abstract quality of the adolescent's
thought at the formal operational level is evident in the adolescent's verbal problem
solving ability. The logical quality of the adolescent's thought is when children are more
likely to solve problems in a trial-and-error fashion. Adolescents begin to think more as
a scientist thinks, devising plans to solve problems and systematically testing solutions.
They use hypothetical-deductive reasoning, which means that they develop hypotheses
or best guesses, and systematically deduce, or conclude, which is the best path to
follow in solving the problem. During this stage the adolescent is able to understand
such things as love, "shades of gray", logical proofs and values. During this stage the
young person begins to entertain possibilities for the future and is fascinated with what
they can be. Adolescents are changing cognitively also by the way that they think about
social matters. Adolescent Egocentrism governs the way that adolescents think about
social matters and is the heightened self-consciousness in them as they are which is
reflected in their sense of personal uniqueness and invincibility. Adolescent egocentrism
can be dissected into two types of social thinking, imaginary audience that involves
attention getting behavior, and personal fable which involves an adolescent's sense of
personal uniqueness and invincibility.
IV. MEDICAL MANAGEMENT
Medical orders
July 30, 2011 (7:30AM) Rationale
► Please admit patient at P1F3-MRI
► Secured consent to care
► For confinement and in need for
medical attention
► For legal purposes and to ensure that

12. ►DAT with aspiration precaution
► IVF – PNSS iL + 2amp D50 Glucose at
10gtts/minute
► Diagnostics
 CBC with platelet count
 Blood typing
 U/A
 Na+, K+, BUN and Creatinine
 Ca, Mg, Phosphorus and Albumin
 Chest X-ray – PA refer
the client understands the nature of
treatment and procedures done are in
accordance to patient’s will
► Able to take foods as wished with
aspiration precaution to prevent from
choking
► NSS is a solution of common salt in
distilled water, of strength of 0.9%. It is
called normal saline because the
percentage of salt resembles that of the
crystalloids in the blood plasma. It is an
isotonic solution. It is less irritating for the
body cells. With addition of D50 glucose,
this is to prevent hypoglycemia and
maintain glucose level.
 To test for loss of blood,
abnormalities in the production or
destruction of cells, acute and
chronic infections, allergies, and
problems in blood clotting and
bleeding
 Done to determine persons blood
type for blood transfusion or
transplant purposes, because not all
blood types are compatible with each
other
 A screening to detect renal and
metabolic diseases
 To screen for an electrolyte
imbalances
 To determine if there is presence of
infection and electrolyte imbalances
 Use to help find problems with the
organs and structure inside the chest

13.  ECG 12 leads
 CBG every 2H
 SGPT, SPT, Total billirubin
► Therapeutics
 D50 water i vial IV push
 Furosemide 40g IVTT every 8 hours
with blood pressure precaution
 CaCO3 i tab TID PO
 To record electrical changes in the
heart and also used to evaluate
symptoms such as chest pain,
shortness of breath and palpitations
 Done in a regular basis for diabetic
patients to determine the glucose
level in the blood
 A test used to measure the amount
of the enzyme glutamate pyruvate
transaminase (GPT) in blood.
Most commonly ordered to check for
problems of the liver
 Given as an intravenous bolus to
patients who have hypoglycemia and
increases blood serum glucose level
 Used to eliminate water and salt
from the body. works by blocking the
absorption of sodium, chloride, and
water from the filtered fluid in the
kidney tubules, causing a profound
increase in the output of urine
 Antacid. Act as an activator in the
transmission of nerve impulses and
contraction of cardiac, skeletal
and smooth muscles. It is essential
for bone formation and blood
coagulation. It is also used a
replacement of calcium in deficiency
states. It controls of
hyperphosphatemia in end-stage
renal disease without promoting

14.  NaHCO3 i tab TID PO
 Ketolog 2 tabs TID PO
 NaHCO3 100meq IV push
 NaHCO3 side drip with D50 water
500cc + NaHCO3 100meq at
20cc/hour (to consume in 24 hours)
 Monitor vital signs q4H and refer
 Strict I&O q shift
 MHBR
aluminum absorption.
 Alkalinizing agent. Acts as an
alkalinizing agent by releasing
bicarbonate ions. It is used to
alkalinize urine and promote
excretion of certain drugs in
overdosage situations.
 Essential Amino Acid. Normalizes
metabolic process, promotes
recycling product exchange and
reduces ion concentration of
potassium, magnesium and
phosphate.
 Alkalinizing agent. Acts as an
alkalinizing agent by releasing
bicarbonate ions. It is used to
alkalinize urine and promote
excretion of certain drugs in
overdosage situations.
 Acts as an alkalinizing agent by
releasing bicarbonate ions. It is used
to alkalinize urine and promote
excretion of certain drugs in
overdosage situations in addition to
D50 water it prevents hypoglycemia
 To monitor and identify abnormalities
from the patient’s normal state, and
to establish basis for the effect of the
treatment and medications
 Evaluate client’s fluid and electrolyte
balance., also influence the choice of
the fluid therapy; document client’s
ability to tolerate oral fluids and
recognize significant fluid losses
 Promote proper ventilation

15.  To secure 2 “u” PRBC of patient’s
blood type to transfuse blood once
available in 6H with 8H apart
 The most commonly transfused
blood component which can restore
the blood’s oxygen-carrying capacity,
specially for patient’s with bleeding
problem and anemia
July 30, 2011 (10:25AM) Rationale
► Human Albumin 20% IVTT every 12
hours
► Insert FBC attached to urobag
► Give D50 water 1amp IV bolus NOW
► Titrate prevent in IVF at 20gtts/minute
► Give NaHCO3 drip (NaHCO3 100meq +
D50 water 200cc) to run at 10cc/hr
► Infuse Furosemide 40g IVTT every 6
hours
►Repeat ABG once NaHCO3 amp is
consumed
► Repeat CBG determination after 1 hour
► 10:45PM
 Give D50 water 1amp IV bolus NOW
 Repeat CBG 1 hour after
JULY 31, 2011 (2:30AM) Rationale
► Give 2 amp D50 water NOW
► Repeat CBG 1 hour after
► Diagnostics
 For UTZ of the whole abdomen
 For 24 hour urine evaluation
► Electrolytes. Treatment for hypokalemia,
prophylaxis during treatment with diuretics

16. ► Therapeutics:
 Give NaHCO3 100cc bolus NOW
 Continua NaHCO3 drip with D50 water
at 20gtts/minute
 Continue present meds
 Vital signs every 4 hours
 Strict I and O every shift
 Transfuse blood once available with
congestion precaution
 Refer accordingly
► 7:50PM
 Give para 300mg IVTT NOW
 Give Diphenhydramine i amp IVTT
NOW
 To establish a diagnosis of hepatitis B
infection and to assess immune status
in naturally infected and experimentally
vaccinated individuals
 Used for immunization in the prevention
of tetanus
 To prevent the bacteria from producing
toxins and to remove anaerobic
conditions
► For maximum therapeutic effects, and
prevention of complications
► It is indicated as a source of water and
electrolytes. In general, used for fluid
replenishment or medication administration
Laboratory results
HEMATOLOGY REPORT
TEST RESULT REFERENCE
RANGE7-10-11
11:44 AM
7-12-11
12:18PM
WBC
 High WBC count often means that an
infection is present in the body, while a low
number can mean that a specific disease
or drug has impaired the bone marrow’s
ability to produce new cells.
19.4 20.0 10^3/uL (5.0-10.0)
RBC
 Decreased RBC is usually in anemia of
any cause with the possible exception of
thalassemia minor, where a mild or
borderline anemia is seen with a high or
borderline-high RBC. Increased RBC is
seen in erythrocytotoxic state.
2.78 2.76 10^6/uL (4.2-5.4)
Hgb
 Decreased in various anemias, pregnancy,
severe or prolonged hemorrhage with
excessive fluid intake. Increased in
polycythemia, chronic obstructive 7.6 7.5 g/dL(12.0-16.0)

17. pulmonary disease failure of oxygenation
because of CHF and normally in people
living at high altitudes.
Hct
 Decreased in sever anemias, anemia in
pregnancy, acute massive loss. Increased
in erythrocytosis of any cause and in
dehydration or hemoconcentration
associated with shock.
22.1 21.8 % (37.0-47.0)
Mean corpuscular volume
 Decreased in ion deficiency, thalassemia,
anemia of chronic diseas and lead
poisoning. Increased in folate deficiency,
B12 deficiency and hypothyroidism
79.5 79.0 fL (82.0-98.0)
Mean corpuscular hemoglobin
 Levels below 27pg suggest conditions
such as anemia and iron deficiency.
Levels above 33pg suggest possible
thyroid issues.
27.3 27.2 pg (27.0-31.0)
Mean corpuscular Hgb concentration
 Decreased MCHC values are seen in
conditions where the hemoglobin is
abnormally diluted inside the red cells
such as in iron deficiency anemia and in
thalassemia. Increased MCHC calues
are seen in conditions where the Hgb
is abnormally concentrated inside the
red cells, such as in burn patients and
hereditary spherocytosis, a relative
rare congenital disorder.
34.4 34.4 g/dL (31.5-35.0)
Red cell distribution width
 In some anemias, such as pernicious
anemia, the amount of variation in RBC
size causes an increase in the RDW
14.3 13.8 % (12.0-17.0)
Mean platelet volume
 New platelets are larger and an increase
in MPV occurs when increased numbers
of platelets are being produced
9.8 9.9 fL (8.0-12.0)
Differential count 7-10-11
11:44 AM
7-12-11
12:18PM
Lymphocytes
 Increased with infections mononucleosis,
viral and some bacterial infections and
hepatitis. Decreased in aplastic anemia,
SLE and immunodeficiency—AIDs
6.4 6.7 (17.4-48.2)

18. Neutrophils
 Increased with acute infections, trauma, or
surgery, leukemia, malignant disease and
necrosis. Decreased with viral infections,
bone marrow suspension and primary
bone marrow disease.
89.3 85.3 (43.4-76.2)
Monocytes
 Increased with viral infections, parasitic
disease, collagen and hemolytic
disorders. Decreased with use of
corticosteroids, RA and HIV infection
3.8 6.6 (4.5-10.5)
Eosinophils
 Increased in allergies, parasitic disease,
collagen disease, and subacute infections.
Decreased with stress and use of meds.
0.4 1.4 (1.0-3.0)
Basophils
 Increase in acute leukemia and following
surgery or trauma. Decreased with allergic
reactions, stress, parasitic disease and
use of corticosteroids
0.1 0.0 (0.0-2.0)
Platelet
 Both increases and decreases can point
to abnormal conditions of excess bleeding
or clotting.
303,000 280,000 (150,000-
400,000)
BLOOD CHEMISTRY RESULT (7-10-11)
TEST RESULT REFERENCE
RANGE
Blood sugar (Fbs, Rbs, 2HPP)
 Increased in DM, nephritis,
hypothyroidism and infections.
Decreased in hyperinsulinism,
hyperthyroidism and hepatic damage.
309.0 mgs% (60-110)
Blood urea nitrogen
 Increased: renal failure, pre-renal
azotemia, shock, volume depletion,
post-renal (obstruction), GI bleeding,
stress, drugs (aminoglycosides, vanco
etc). Decreased: starvation, liver
failure, pregnancy, infancy, nephrotic
syndrome, overhydration.
37.76 mgs% (4.6-23.4)
Creatinine
 Increased: renal failure including pre-
renal, drug-induced (aminoglycosides,
vancomycin, others),
acromegaly. Decreased: loss of
muscle mass, pregnancy.
3.70 mgs% (0.6-1.2)
Potassium
 Increased in renal failure, acidosis, cell

19. lysis and hemolysis. Decreased in
hyperparathyroidism, vit. D deficiency,
GI losses and diuretic administration.
3.32 mmol/L (3.5-5.3)
Sodium
 Increased in hemoconcentration,
nephritis and pyloric obstruction.
Decreased in alkali deficit, Addison’s
disease and myxedema.
127.30 mmol/L (135-145)
Note: no UA result was attached in the chart.
V. HUMAN ANATOMY and PHYSIOLOGY with PATHOPHYSIOLOGY
Anatomy and Physiology of Liver
The liver is the largest organ of the human body, weighs approximately 1500 g,
and is located in the upper right corner of the abdomen. The organ is closely associated
with the small intestine, processing the nutrient-enriched venous blood that leaves the
digestive tract. The liver performs over 500 metabolic functions, resulting in synthesis of
products that are released into the blood stream (e.g. glucose derived from
glycogenesis, plasma proteins, clotting factors and urea), or that are excreted to the
intestinal tract (bile). Also, several products are stored in liver parenchyma (e.g.
glycogen, fat and fat soluble vitamins).
Almost all blood that enters the liver via the portal tract originates from the
gastrointestinal tract as well as from the spleen, pancreas and gallbladder. A second
blood supply to the liver comes from the hepatic artery, branching directly from the
celiac trunk and descending aorta. The portal vein supplies venous blood under low
pressure conditions to the liver, while the hepatic artery supplies high-pressured arterial
blood. Since the capillary bed of the gastrointestinal tract already extracts most O2,
portal venous blood has a low O2 content. Blood from the hepatic artery on the other
hand, originates directly from the aorta and is, therefore, saturated with O2. Blood from
both vessels joins in the capillary bed of the liver and leaves via central veins to the
inferior caval vein.

20. Basic liver architecture
The major blood vessels, portal vein and hepatic artery, lymphatics, nerves and
hepatic bile duct communicate with the liver at a common site, the hilus. From the hilus,
they branch and re-branch within the liver to form a system that travels together in a
conduit structure, the portal canal. From this portal canal, after numerous branching, the
portal vein finally drains into the sinusoids, which is the capillary system of the liver.
Here, in the sinusoids, blood from the portal vein joins with blood flow from end-arterial
branches of the hepatic artery. Once passed through the sinusoids, blood enters the
collecting branch of the central vein, and finally leaves the liver via the hepatic vein. The
hexagonal structure with, in most cases, three portal canals in its corners draining into
one central vein, is defined as a lobule. The lobule largely consists of hepatocytes (liver
cells) which are arranged as interconnected plates, usually one or two hepatocytes
thick. The space between the plates forms the sinusoid. A more functional unit of the
liver forms the acinus. In the acinus, the portal canal forms the center and the central
veins the corners. The functional acinus can be divided into three zones: 1) the
periportal zone, which is the circular zone directly around the portal canal, 2) the central
zone, the circular area around the central vein, and 3) a mid-zonal area, which is the
zone between the periportal and pericentral zone.

21. Sinusoids
Sinusoids are the canals formed by the plates of hepatocytes. They are
approximately 8-10 µm in diameter and comparable with the diameter of normal
capillaries. They are orientated in a radial direction in the lobule. Sinusoids are lined
with endothelial cells and Kupffer cells, which have a phagocytic function. Plasma and
proteins migrate through these lining cells via so-called fenestrations (100-150 nm) into
the Space of Disse, where direct contact with the hepatocytes occurs and uptake of
nutrients and oxygen by the hepatocytes takes place. On the opposite side of the
hepatocyte plates are the bile canaliculi situated (1 µm diameter). Bile produced by the
hepatocytes empties in these bile canaliculi and is transported back towards the portal
canal into bile ductiles and bile ducts, and finally to the main bile duct and gallbladder to
become available for digestive processes in the intestine. The direction of bile flow is
opposite to the direction of the blood flow through the sinusoids.
Network of branching and re-branching blood vessels in the liver

22. The liver lobule with portal canals (hepatic artery, portal vein and bile duct), sinusoids
and collecting central veins.
Pressure distribution
Blood pressure in afferent vessels and pressure distribution inside the liver is
essentially similar for most species. Pressure in the hepatic artery, originating from the
descending aorta and the celiac trunk, is considered to be the same as aortic pressure.
This includes a high pulsatile pressure between 120 and 80 mmHg with a frequency
equal to the heart rate. Vessel compliance causes a gradual decrease in pulsation as
the hepatic artery branches and re-branches inside the liver. Once at the sinusoidal
level, pulsation amplitude decreases to virtually zero and pressure drops to
approximately 2-5 mmHg. On the other hand, pressure in the portal vein, originating
from capillaries of the digestive tract, has no pulsation and a pressure of 10-12 mmHg.
In the sinusoids, both portal venous and hepatic arterial pressure is 3-5 mmHg.
Consequently, the pressure drop inside the liver is much less in the portal venous
system than in the arterial system. The pressure drop from the collecting central veins
to the vena cava is then approximately 1-3 mmHg, fluctuating slightly with respiration.

23. Detailed view of liver sinusoidal structure.
Flow distribution
Total human liver blood flow represents approximately 25% of the cardiac output;
up to 1500 ml/min. Hepatic flow is subdivided in 25-30% for the hepatic artery (500
ml/min) and the major part for the portal vein (1000 ml/min). Assuming a human liver
weighs 1500 g, total liver flow is 100 ml/min per 100 g liver. Comparing this normalized
flow rate to other species, it can be concluded that total liver blood flow is 100 130
ml/min per 100 g liver, independent of the species. The ratio of arterial: portal blood
flow, however, is species-dependent. The hepatic artery originates directly from the
descending aorta, and is therefore saturated with oxygen. It accounts for 65% of total
oxygen supply to the liver. The hepatic artery also plays an important role in liver blood
vessel wall and connective tissue perfusion. It also secures bile duct integrity. The blood
from the portal vein is full of nutrients derived from the intestine and allows the
hepatocytes to perform their tasks. Blood from the hepatic artery and the portal vein
joins in the sinusoids. However, recent studies by others as well as our own
observations have revealed that there are both common and separate channels for
arterial and portal blood. The hepatic artery perfuses the liver vascular bed in a 'spotty'
pattern, while the portal vein perfuses the liver uniformly. The liver is able to regulate
mainly arterial flow by means of so-called sphincters, situated at the in- and outlets of
the sinusoids. One of the most important triggers for sphincter function is the need for

24. constant oxygen supply. If the rate of oxygen delivery to the liver varies, the sphincters
will react and the ratio of arterial: portal blood flow alters.
VI. ASSESSMENT (Nursing Review Chart II)
Vital signs:
Temp.: 38.7°c Pulse: 74 bpm Respi:28 cpm BP:160/90 mmHg Height: 5’ 5” Weight: 82 kgs.
EENT:
[ ] impaired vision [ ] blind [ ] pain
[ ] reddened [ ] drainage [ ] gums
[ ] Hard of hearing [ ] deaf [ ] burning
[x] edema [ ] lesion [ ] teeth
Assess eyes, ears, nose,
throat for abnormalities.
[ ] no problem
RESPIRATORY:
[ ] asymmetric [ ] tachypnea
[ ] apnea [ ] rales [x] cough
[ ] barrel chest [ ] bradypnea
[ ] shallow [ ] rhonchi
[ ] sputum [ ] diminished [x] dyspnea
[ ] orthopnea [ ] labored [ ] wheezing
[ ] pain [ ] cyanotic
Facial edema
particularlyonthe
eyes;non-pitting
Dyspnea(SOB)
Withoccasional
cough
#2 venoclysisof
PNSSiL @ 20
gtts/min
Oliguria

25. Assess resp. rate, rhythm,
pulse blood breath sounds,
Comfort [ ] no problem
CARDIOVASCULAR:
[ ] arrhythmia [ ] tachycardia
[ ] numbness [ ] diminished pulses
[ ] edema [ ] fatigue [ ] irregular
[ ] bradycardia [ ] murmur
[ ] tingling [ ] absent pulses [ ] pain
Assess heart sound, rate, rhythm,
pulse, blood pressure, circulation,
fluid retention, comfort
[x]no problem
GASTROINTESTINAL TRACT:
[ ] obese [ ] distention [ ] mass
[ ] dysphagia [ ] rigidity [ ] pain
Assess abdomen, bowel habits,
swallowing bowel sounds,
Comfort [x] no problem
GENITO-URINARY AND GYNE:
[ ] pain [ ] urine color
[ ] vaginal bleeding
[ ] hematuria [ ] discharge
[ ] nocturia
Assess urine frequency,
control, color,odor, Comfort,
gyne bleeding, discharge
[x] no problem
NEURO:
[ ] paralysis [ ] stuporous
[ ] unsteady [ ] seizures [x] lethargic
[ ] comatose [ ] vertigo [ ] tremors
[ ] confused [ ] vision [ ] grip
Warm to touch
Sweating
T = 38.7°c
P = 74bpm
R = 28 cpm
BP = 160/90
mmHg
Edemaon upper
extremities;
pittingedema
grade:3
Cellulitis;warm
to touch;skin
tightness
Painful;pain
scale of:7/10

26. Assess motor, function,
sensation, LOC,
Strength, grip, gait, coordination,
Speech [x] No problem
MUSCULOSKELETAL AND SKIN:
[ ] appliance [ ] stiffness [x] itching
[ ] petechiae [x] hot [ ] drainage
[ ] prosthesis [x] swelling [ ] lesion
[ ] poor turgor [ ] cool [ ] deformity
[ ] wound [ ] rash [ ] skin color
[ ] flushed [ ] atrophy [x] pain
[ ] ecchymosis [ ] diaphoretic [ ] moist
Assess mobility, motion, gait, alignment,
joint function, skin color, texture, turgor,
integrity [ ] no problem
SUBJECTIVE OBJECTIVE
Communication:
[ ] hearing loss Comments: Hearing is good. Client
[ ] visual changes is responsive and hears
[x] denied clearly when talked to.
[ ] glasses [ ] languages
[ ] contact lens [ ] hearing aide
R L
Pupil size: 2-3mm [ ] speech difficulties
Reaction: Pupil Equally Round and Reactive to Light
and Accommodation
Oxygenation:
[x] dyspnea Comments : “Mejo galisud lage ko
[ ] smoking history ug ginhawa. Naa pud
[x] cough koy ubo karon gamay”
[ ] denied
As verbalized by
the client.
Resp. [ ] regular [x] irregular
Describe: Patient has difficulty in breathing
R: R lung is not symmetrical to left lung
L: L lung is not symmetrical to right lung.

27. Circulation:
[ ] chest pain Comments: Patient did not
[ ] leg pain experience any of
[ ] numbness of such.
extremities
[x]denied
Heart Rhythm [x] regular [] irregular
Ankle Edema: Edema noted; pitting grade: 4
Pulse Car. Rad. DP. FEM*
R : + 74 bpm + not obtain
L : + 74 bpm + not obtain
Comments: All pulse sites are palpable.
*If applicable
Nutrition:
Diet : Diet as tolerated –Aspiration precaution.
[ ] N [ ] V Comments: “Wala kayo ko gana
Character: mukaon. Gagmay ra kaayo
[x] recent change in akong kinan-an.”.
weight, appetite As verbalized by the client.
[ ] swallowing
difficulty
[ ] denied
[ ] dentures [x] none
Full Partial W/ Patient
Upper [ ] [ ] [ ]
Lower [ ] [ ] [ ]
Elimination:
Usual bowel pattern [ ] urinary frequency
1 times a day once a day
[ ] constipation [ ] urgency
remedy [ ] dysuria
none [ ] hematuria
Date of Last BM [ ] incontinence
07/12/11 [ ] polyuria
[ ] Diarrhea [ ] foley in place
character : [ ] denied
Comments: Bowel sounds: normo-
Bowel sounds are active bowel sounds
normoractive per Abdominal distention
auscultation. Present [ ] yes [x] no
Urine:(consistency, odor)
Slightly hazy and dark
yellow with aromatic odor.
MGT. of Health & Illness:
[ ]alcohol ___________ [ ]smoking :_____________
[ ] denied (amount, frequency)
[ ] SBE: N/A Last Pap Smear: Not obtained LMP: N/A
Briefly describe the patient’s ability to follow treatments
(diet, meds, etc.) for chronic health problems (if
present). Patient was irritable but able to follow
compliance to medication and follows the right diet to
be eaten.
SUBJECTIVE OBJECTIVE
Skin Integrity:
[x] dry Comments: “Sige lage ko ug panga-.
[x] itching tol, ambot lang pud ug
[ ] other ngano ni.”
[ ] denied
As verbalized by the client
[ ] dry [ ] cold [ ] pale
[ ] flushed [ ] warm
[ ] moist [ ] cyanotic
*rashes, ulcers, decubitus (describe size, location,
drainage)
Edema was noted on the lower extremities; pitting
grade 4 and a blister formation on the right calf.
.
Activity/Safety:
[ ] convulsion Comments: “Nang hupong akong tiil.
[ ] dizziness dili ko kalakaw tungod
[ ] limited motion of joints tungod aning buhag sa
[ ] LOC and orientation The patient is oriented to
place, time and date.

28. sa akong ti-ilan, sakit
itunob.”
Limitation in ability to
[x] ambulate As verbalized by the client
[x]bathe self
[ ]other
[ ] denied
Gait: [ ] walker [ ] cane [ ] other
[ ] steady [ ] unsteady
[ ] sensory and motor losses in face or extremities:
No sensory and motor losses in face or extremities.
[ ] ROM limitations: The patient has normal range of
motion.
Comfort/Sleep/Awake:
[x] pain Comment: “Sakit ang hubag sa akong
(Location paa.”
frequency) As verbalized by the client
[ ] nocturia
[ ] sleep difficulties
[x] denied
[x] facial grimaces
[x] guarding
[ ]No other signs of pain:
[ ] side rail release from signed (60 + years)
N/A
Coping:
Occupation: Housewife
Member of household: Husband, children and grand-
children
Most supportive person: Aileen Gabato (Daugther)
Observed non-verbal behavior: The patient is very
active and alert during the interview
Person(Phone number): kept confidential
VII. NURSING MANAGEMENT
Ideal Nursing Management
Nursing Diagnosis: Activity intolerance related to fatigue and body malaise
INTERVENTIONS RATIONALE
 Assess level of activity intolerance
and degree of fatigue and malaise
when performing routine activity of
daily living
 Assist with activities and hygiene
when fatigued
 Provides baseline for further
assessment and criteria for
assessment of effectiveness of
interventions.
 Promotes exercise and hygiene
within patients level of tolerance

29.  Encourage rest when fatigued or
when abdominal pain or discomfort
occurs.
 Assist with selection and pacing of
desired activities and exercise
 Provide diet high in carbohydrates
with protein intake consistent with
liver function
 Encourage supplemental vitamins A
B-complex, C and K
 Conserves energy and protects the
liver
 Stimulates patients interest in
selected activities.
 Provides calories for energy and
protein for healing
 Provides additional nutrients
Nursing Diagnosis: Imbalance nutrition; less than body requirements related to
abdominal discomfort and anorexia
INTERVENTIONS RATIONALE

30.  Assess dietary intake and nutritional
status through diet history and diary,
daily weight measurements and
laboratory data.
 Assist patient in identifying low
sodium foods.
 Elevate the head of bed during
meals
 Provide oral hygiene before meals
and pleasant environment for meals
at mealtime
 Offer smaller, more frequent meals
 Identifies deficits in nutritional intake
and adequacy of nutritional state
 Reduces edema and ascites
formation
 Reduces discomfort from abdominal
distention and decreases sense of
fullness produced by pressure of
abdominal contents and ascites on
the stomach
 Promotes positive environment and
increased appetite; reduces
unpleasant taste.
 Decreases feeling of fullness and
bloating
Nursing Diagnosis: Fluid volume excess related to decrease renal function and
inability to excrete fluids and electrolytes

31. INTERVENTIONS RATIONALE
 Restrict sodium and fluid intake if
prescribed
 Record intake and output regularly
depending on response to
interventions and on patient acuity
 Measure and record abdominal girth
and weight daily
 Explain rationale for sodium and fluid
restriction
 Elevate edematous extremities
 Minimizes formation of ascites and
edema
 Indicates effectiveness of treatment
and adequacy of fluid intake
 Monitors changes in ascites
formation and fluid accumulation
 Promotes patients understanding of
restriction and cooperation with it
 To reduce edema and promote
venous return
S O A P I E
S “Sakit kau akong hubag sa paa.” as verbalized by the client

32. O  redness,
 pain scale 7/10
 pallor
 guarding
 Temp 38.7°c
 irritable
 warm to touch
 restless
A Acute pain related to inflammation of the dermal and subcutaneous layer
of the skin
P Long term: Within eight hours of clinical rotation client will be alleviated
from discomforts brought about by pain
Short term: At the end of fifteen minutes client will verbalize reduction
and or controlled pain
I 1. Asses level of pain through pain scale
To obtain baseline data and measure amount of pain.
2. Assist client to a comfortable position and provide a non irritating
environment
Helps reduce pain and provides conducive environment
3. Assist into non pharmacological pain management
Diverts attention to pain causing relief
4. Monitor vital signs-usually altered during pain assist into relaxation
exercises
To reduce aggravation of pain.
5. assist into relaxation exercises
To reduce aggravation of pain.
E Long term: At the end of eight hours client experienced relief of
discomforts thus long term goal is met
Short term: At the end of fifteen minutes client verbalized reduction of
pain per cooperation and participation during the implementation phase
S O A P I E
S “Mejo galisod lage ko ug ginhawa” as verbalized by the client
O  Respiratory Rate 28

33.  shallow breathing
 lip pallor
 gasps for air
 nasal flaring
 weak
 lethargic
A Ineffective breathing pattern related to abdominal distention and
compression of lungs.
P Long term: Within fifteen minutes client will obtain an o2 sat of 99-100%
Short term: At the end of five minutes client will manifest normal breathing
cycle 12-20 cpm
I 1. Assess v/s especially RR
To obtain baseline data and determine the nursing action to
implement
2. Raise the head of bed or place in high fowlers position
To increase lung expansion
3. Monitor Abg levels
To determine level of o2 saturation
4. Encourage breathing techniques, purse lip breathing
To facilitate breathing and allows sufficient flow of oxygen to lungs
5. Encourage adequate rest
To limit fatigue
E Long term: At the end of fifteen minutes client obtained an o2 sat of
99%, therefore goal is met.
Short term: At the end of five minutes, client obtained and showed
normal breathing pattern, with an RR of 17cpm, therefore goal is met
S O A P I E
S “Naghupong ang ako mga tiil.” as verbalized by the client
O  pitting edema on lower extremities; grade four

34.  increase in size of the gastrocnemeus region
 increase in weight
 skin warm to touch
 tightness of skin
A Fluid volume excess related to localized retention of fluids at the
extremities
P Long term: Within two days of clinical rotation client will display reduced
edema on site
Short term: At the end of eight hours clinical rotation client will
demonstrate understanding of the necessary interventions.
I 1. Restrict sodium and fluid intake if prescribed
Minimizes formation of edema and reduce fluid retention
2. Record intake and output regularly depending on response to
interventions and on patient acuity
Indicates effectiveness of treatment and adequacy of fluid intake
3. Measure and record abdominal girth and weight daily
Monitors changes in ascites formation and fluid accumulation
4. Explain rationale for sodium and fluid restriction.
Promotes patients understanding of restriction and cooperation with
it
5. Provided with adequate activity, positive changes as able and assist
with repositioning every 2H
To prevent accumulation in dependent areas
E Long term: At the end of two days clinical rotation client displayed
decrease in size of edema.
Short term: At the end of eight hours intervention client demonstrated
understanding and significance to adherence to instructions.

35. Drug Study
Name of Drug
Generic/
Brand
Date
Ordered
Classification Dose/
Frequency/
Route
Mechanism of
Action
Specific
Indication
Contraindication Side Effects Nursing Precaution
Essentiale
forte
7-10-11 Hepatic
protectors
Icap TID
PO
Normalizes
the metabolism
of lipids and
proteins,
improves
the detoxificati
on function of
the liver,
restores the
cellular
structure of the
liver and
retards the
producing of
conjunctive
tissue.
Indicated for
the treatment
of fatty
degeneration
of the
liver, hepatitis
(including toxic
hepatitis, liver
damage
caused by
medicines or
alcohol
abuse), cirrhos
is of the liver,
disturbances
in liver function
associated
with different
illnesses.
Do not use
Essentiale
in hypersensitivi-
ty or allergy to
any ingredients
of the
preparation. The
application of
Essentiale in
newborn children
is not safe.
During
pregnancy
women are
recommended to
consult their
health care
provider prior to
taking Essentiale
In very rare
cases it can
cause:
abdominal
pain, nausea,
diarrhea and
allergic
reaction (skin
rash).
Do not use
Essentiale forte in
hypersensitivity or
allergy to any
ingredients of the
preparation.
The application of
Essentiale to new
born is not safe.
During pregnancy,
woman are
advised to consult
their health care
provider prior to
taking Essentiale

36. Drug Study
Name of Drug
Generic/
Brand
Date
Ordered
Classification Dose/
Frequency/
Route
Mechanism of
Action
Specific
Indication
Contraindication Side Effects Nursing Precaution
Spironolacto
ne
(Aldactone)
7-10-11 Potassium-
sparing diuretic
25mg itab
BID PO
Spironolactone
inhibits the
action of
aldosterone
thereby causing
the kidneys to
excrete salt and
fluid in the urine
while retaining
potassium.
Therefore,
spironolactone
is classified as
a potassium-
sparing diuretic,
a drug that
promotes the
output of urine
(diuretic) while
allowing the
kidneys to hold
onto potassium.
Removes
excess fluid
from the body
in congestive
heart failure,
cirrhosis of the
liver,
and kidney
disease and to
treat elevated
blood pressure
and for treating
diuretic-
induced low
potassium
(hypokalemia)
Anuria, acute
renal
insufficiency;
progressing
impairment of
kidney function,
hyperkalemia;
pregnancy and
lactation.
Side effects of
spironolactone
include
headache,
diarrhea,
cramps,
drowsiness,
rash, nausea,
vomiting,
impotence,
irregular
menstrual
periods, and
irregular hair
growth.
Check blood
pressure before
initiation of
therapy and at
regular intervals
throughout
therapy
Assess for signs
of fluid and
electrolyte
imbalance, and
signs of digoxin
toxicity.
Monitor daily I&O
and check for
edema. Report
lack of diuretic
response or
development of
edema; both may
indicate
tolerance to
drugs

37. VIII. Referrals and Follow-up
Referral and Follow-up Rationale
Medication  Instruct the patient and the family to follow
the home medications as prescribed by the
physician
 Explain each purpose of the medication
 Instruct the client not to take over-the-counter
drugs without doctor’s knowledge
 Explain the side effects or adverse reaction
on each medication. Report immediately as
soon as there is an occurrence or such
 Inculcate to the mind of the patient to comply
all the medications prescribed at the ordered
dosage, route and at the ordered time
 Let the patient complete the whole course of
drug therapy
 Treatment regimen is important to have fast recovery
 Knowledge about the medication will make the client
become aware of what he is taking and for the family
to participate in patient’s treatment
 Non-prescribed drug may have antagonistic or
synergistic effect in any drug therapy
 Explaining the side effects will make the patient and
the family identify what harmful effects to expect
 Taking the drugs at the ordered dose, route and time
limits the chance of toxicity and ensure it’s
effectiveness
 This can help the patient alleviate the problem and be
able to experience the full therapeutic effect of the
medication
Exercise  Encourage early ambulation
 Promote exercise to the patient especially
ROM
 Instruct client to avoid strenuous activities for
at least a week or month until fully recovered
 Advise patient to have adequate rest and
sleep
 Practice deep breathing exercise
 Walking is a good exercise and could promote
circulation, hence, proper healing
 This will promote good physical health
 Activities that required great muscle strength should
be avoided to prevent injury and muscle strain
 To gain back the lost strength and able to return to it’s
normal state thus allow ample time for healing
 This will help alleviate any pain or discomfort that
patient will encounter

38. Treatment  Explain the need of treatment after discharge
and must take it seriously to prevent such
complication to the patient
 Explain to the family the condition of the
patient and give them factual information
about the illness
 To make the client and family aware that the
treatment does not only end up in hospital but needs
to be continued at home to make he client
responsible towards medication
 To have better understanding of the patient’s
condition and to be able to know what intervention
should they give and could not alter the effect of the
therapy
Hygiene  Encourage having proper hygiene like taking
a bath, meticulous hand washing, and
brushing of teeth every after meal
 Encourage patient to continue hygienic
measures practiced at present such as
changing of clothes everyday and changing
of underwear as often as necessary, keeping
the nails neatly trimmed, maintaining own
supplies/items for personal necessities
 Provide a calm and accepting
 Hygiene provides comfort and cleanliness to the
patient. It also increases the patient’s sense of well-
being, which is very much needed in the therapy
process
 Keeping all practiced measures is necessary in
consistent maintenance of proper hygiene
 Calm, clean and non threatening may lessen the
occurrence of possible infection and would be a good
place for healing
Out Patient  Inform the patient that follow-up check-up is
important to have a continuous monitoring
and care even after attainment of the course
medical therapy
 Advice the patient and the family to carry out
follow-up diagnostic examinations
 Instruct the family to report any unusual signs
and symptoms experienced by the patient
 Through constant visit as out patient, the physician
would still monitor the progress of the therapeutic
intervention availed by the patient
 This is to evaluate the therapeutic response of the
patient to the treatment
 This will help detect early signs and symptoms of the
recurrence of disease

39. Diet  Encourage the client to eat variety of
nutritious foods like fruits and vegetables
once instructed by the physician
 Instruct client to take vitamins as ordered
 Advise client not to skip meals and have a
regular eating pattern/schedule
 Tell the patient not to take foods
contraindicated by the client
 To maintain and promote healthy body
 To boost the body’s immune system
 Regular interval of meals is the basic principle of a
good dietary plan
 To prevent the occurrence of complication

40. IX. Evaluation and Implication
Category Poor
(1)
Fair
(2)
Good
(3)
Justification
1. Duration of illness
x
It has been six months since he
has been having lower extremity
edema
2. Onset of illness
x
Having edema could have been
avoided by having good hygiene
3. Predisposing factor
x
Race and location predispose
Patient R to getting cirrhosis
4. Precipitating factor
x
Economic status and lifestyle
precipitates Patient R in getting
cirrhosis, these could have been
prevented by simple hygiene and
prevention methods
5. Willingness to take
the medications or
compliance to
treatment
x
Patient R is very willing to take her
medications. She knows the good
effects of drug and intravenous
therapy
6. Environment
x
Patient R was admitted at P1F3
female reverse isolation ward
7. Family support
x
There were only 2 members of the
family were present in the ward.
Her sister and her daughter were
the only supportive persons that
time
Calculations 3x1
=3
3x2
=6
3x1
=3
3 + 6 + 3 = 12
12/7 = 1.7
Ranges:
1.0 - 1.5 = Poor
1.5 – 2.5 = Fair
2.5 – 3.0 = Good

41. Patient R condition has been with her for 6 months before she choose to seek
treatment. She took for granted the worsening of her condition. She could have been
prevented the complications brought about by her condition if she had consulted a
health care professional immediately. Also simple observance of good hygiene could
have been to prevent him from contracting the infection of Liver Cirrhosis. On the other
hand, patient and other members of the family seek medical care; family support and
good compliance of medication were observed. Through this, the prognosis has come
up to the fair category.
The entire two days exposure at pediatric ward assigned to a client with Pediatric
Community Acquired Pneumonia has thought me a lot of things. That is, understanding
the entire pathogenesis of the disorder its affectation and what approach are to be
implemented. Thus, consequently an improvement of client’s condition is achieved with
the help and assistance of the team of caregivers implementing effective plan of care
including active participation of the client and significant other. Therapeutic relationship
and communication between the caregivers and the client with the significant others
contributed to the achievement of the set goal. Personally my nursing skills and
interpersonal relationship with the people I’ve worked with has improved accordingly in
the experience of the exposure.