INTRODUCTION
Gastroenteritis or infectious diarrhea is a medical condition characterized by inflammation inflammation ("-itis") of the gastrointestinal the gastrointestinal tract that involves both the stomach the stomach ("gastro"-) and the small the small intestine ("entero"-), resulting in some combination of diarrhea, vomiting, diarrhea, vomiting, and and abdominal abdominal pain and cramping. Dehydration may occur as a result. Gastroenteritis has been referred to as gastro, stomach bug, and stomach virus. Although unrelated to influenza, it influenza, it has also been called stomach flu and gastric flu. Signs and symptoms
Gastroenteritis typically involves both diarrhea and vomiting, and vomiting, or or less commonly, presents with only one or the other. Abdominal cramping may also be present. Signs and symptoms usually begin 12 – 12 –72 72 hours after contracting the infectious agent. If due to a viral agent, the condition usually resolves within one week. Some viral causes may also be associated with fever, with fever, fatigue, fatigue, headache, and muscle and muscle pain. If pain. If the stool the stool is bloody, the cause is less likely to be viral and more likely to be bacterial. Some bacterial infections may be associated with severe abdominal pain and may persist for several weeks. Children infected with rotavirus usually make a full recovery within three to eight days. However, in poor countries treatment for severe infections is often out of reach and persistent diarrhea is common. Dehydration is a common complication of diarrhea, and diarrhea, and a child with a significant degree of dehydration may have a prolonged capillary prolonged capillary refill, poor refill, poor skin skin turgor, and turgor, and abnormal breathing. Repeat infections are typically seen in areas with poor sanitation, and malnutrition, malnutrition, stunted stunted growth, and long-term cognitive delays can result. Cause
Viral Rotavirus, norovirus, Rotavirus, norovirus, adenovirus, adenovirus, and and astrovirus astrovirus are known to cause viral cause viral gastroenteritis. Rotavirus is the most common cause of gastroenteritis in children, and produces similar incidence rates in both the developed anddeveloping anddeveloping world. Viruses world. Viruses cause about 70% of episodes of infectious diarrhea in the pediatric age group. Rotavirus is a less common cause in adults due to acquired immunity. Norovirus is the leading cause of gastroenteritis among adults in America, causing greater than 90% of outbreaks. These localized epidemics typically occur when groups of people spend time in close physical proximity to each other, such as on cruise
ships, in hospitals, or in restaurants. People may remain infectious even after their diarrhea has ended. Norovirus is the cause of about 10% of cases in children. Bacterial In the developed world Campylobacter jejuni is the primary cause of bacterial gastroenteritis, with half of these cases associated with exposure to poultry. In children, bacteria are the cause in about 15% of cases, with the most common types being Escherichia coli, Salmonella, Shigella, and Campylobacterspecies. If food becomes contaminated with bacteria and remains at room temperature for a period of several hours, the bacteria multiply and increase the risk of infection in those who consume the food. Some foods commonly associated with illness include raw or undercooked meat, poultry, seafood, and eggs; raw sprouts; unpasteurized milk and soft cheeses; and fruit and vegetable juices. In the developing world, especially subSaharan Africa and Asia,cholera is a common cause of gastroenteritis. This infection is usually transmitted by contaminated water or food. Toxigenic Clostridium difficile is an important cause of diarrhea that occurs more often in the elderly. Infants can carry these bacteria without developing symptoms. It is a common cause of diarrhea in those who are hospitalized and is frequently associated with antibiotic use. Staphylococcus aureusinfectious diarrhea may also occur in those who have used antibiotics. "Traveler's diarrhea" is usually a type of bacterial gastroenteritis. Acid-suppressing medication appears to increase the risk of significant infection after exposure to a number of organisms, including Clostridium difficile, Salmonella, and Campylobacter species. The risk is greater in those taking proton pump inhibitors than with H2 antagonists. Parasitic A number of protozoans can cause gastroenteritis – most commonly Giardia lamblia – but Entamoeba histolytica andCryptosporidium species have also been implicated. As a group, these agents comprise about 10% of cases in children. Giardia occurs more commonly in the developing world, but this etiologic agent causes this type of illness to some degree nearly everywhere. It occurs more commonly in persons who have traveled to areas with high prevalence, children who attend day care, men who have sex with men, and following disasters. Transmission Transmission may occur via consumption of contaminated water, or when people share personal objects. In places with wet and dry seasons, water quality typically worsens during the wet season, and this correlates with the time of outbreaks. In areas of the world with four seasons, infections are more common in the winter. Bottle-feeding of
babies with improperly sanitized bottles is a significant cause on a global scale. Transmission rates are also related to poor hygiene, especially among children, in crowded households, and in those with pre-existing poor nutritional status. After developing tolerance, adults may carry certain organisms without exhibiting signs or symptoms, and thus act as natural reservoirs of contagion. While some agents (such as Shigella) only occur in primates, others may occur in a wide variety of animals (such as Giardia). Pathophysiology
Gastroenteritis is defined as vomiting or diarrhea due to infection of the small or large bowel. The changes in the small bowel are typically noninflammatory, while the ones in the large bowel are inflammatory. The number of pathogens required to cause an infection varies from as few as one (for Cryptosporidium) to as many as 10 8 (for Vibrio cholerae). Diagnosis
Gastroenteritis is typically diagnosed clinically, based on a person's signs and symptoms. Determining the exact cause is usually not needed as it does not alter management of the condition. However, stool cultures should be performed in those with blood in the stool, those who might have been exposed to food poisoning, and those who have recently traveled to the developing world. Diagnostic testing may also be done for surveillance. As hypoglycemia occurs in approximately 10% of infants and young children, measuring serum glucose in this population is recommended. Electrolytes and kidney function should also be checked when there is a concern about severe dehydration. Dehydration A determination of whether or not the person has dehydration is an important part of the assessment, with dehydration typically divided into mild (3 –5%), moderate (6 –9%), and severe (≥10%) cases. In children, the most accurate signs of moderate or severe dehydration are a prolonged capillary refill, poor skin turgor, and abnormal breathing. Other useful findings (when used in combination) include sunken eyes, decreased activity, a lack of tears, and a dry mouth. A normal urinary output and oral fluid intake is reassuring. Laboratory testing is of little clinical benefit in determining the degree of dehydration.
Prevention
Lifestyle A supply of easily accessible uncontaminated water and good sanitation practices are important for reducing rates of infection and clinically significant gastroenteritis. Personal measures (such as hand washing) have been found to decrease incidence and prevalence rates of gastroenteritis in both the developing and developed world by as much as 30%. Alcohol-based gels may also be effective. Breastfeeding is important, especially in places with poor hygiene, as is improvement of hygiene generally. Breast milk reduces both the frequency of infections and their duration. Avoiding contaminated food or drink should also be effective. Management
The key treatment is enough fluids. For mild or moderate cases, this can typically be achieved via oral rehydration solution (a combination of water, salts, and sugar). In those who are breast fed, continued breast feeding is recommended. For more severe cases, intravenous fluids from a healthcare centre may be needed. Antibiotics are generally not recommended. Gastroenteritis primarily affects children and those in the developing world. It results in about three to five billion cases and causes 1.4 million deaths a year. Gastroenteritis is usually an acute and self-limiting disease that does not require medication. The preferred treatment in those with mild to moderate dehydration is oral rehydration therapy (ORT). Metoclopramide and/or ondansetron, however, may be helpful in some children, and butylscopolamine is useful in treating abdominal pain. Rehydration The primary treatment of gastroenteritis in both children and adults is rehydration. This is preferably achieved by oral rehydration therapy, although intravenous delivery may be required if there is a decreased level of consciousness or if dehydration is severe. Oral replacement therapy products made with complex carbohydrates (i.e. those made from wheat or rice) may be superior to those based on simple sugars. Drinks especially high in simple sugars, such as soft drinks and fruit juices, are not recommended in children under 5 years of age as they may increase diarrhea. Plain water may be used if more specific and effective ORT preparations are unavailable or are not palatable. Anasogastric tube can be used in young children to administer fluids if warranted. Dietary
It is recommended that breast-fed infants continue to be nursed in the usual fashion, and that formula-fed infants continue their formula immediately after rehydration with ORT. Lactose-free or lactose-reduced formulas usually are not necessary .[42] Children should continue their usual diet during episodes of diarrhea with the exception that foods high in simple sugars should be avoided. The BRAT diet (bananas, rice, applesauce, toast and tea) is no longer recommended, as it contains insufficient nutrients and has no benefit over normal feeding. Some probiotics have been shown to be beneficial in reducing both the duration of illness and the frequency of stools. They may also be useful in preventing and treating antibiotic associated diarrhea. Fermented milk products (such as yogurt) are similarly beneficial. Zinc supplementation appears to be effective in both treating and preventing diarrhea among children in the developing world. Antibiotics Antibiotics are not usually used for gastroenteritis, although they are sometimes recommended if symptoms are particularly severe or if a susceptible bacterial cause is isolated or suspected. If antibiotics are to be employed, a macrolide (such as azithromycin) is preferred over a fluoroquinolone due to higher rates of resistance to the latter. Pseudomembranous colitis, usually caused by antibiotic use, is managed by discontinuing the causative agent and treating it with either metronidazole or vancomycin Bacteria and protozoans that are amenable to treatment includeShigella Salmonella typhi and Giardia species. In those with Giardia species or Entamoeba histolytica ,tinidazole treatment is recommended and superior to metronidazole. The World Health Organization (WHO) recommends the use of antibiotics in young children who have both bloody diarrhea and fever. (http://en.wikipedia.org/wiki/Gastroenteritis)
Meningitis Meningitis is an acute inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs. Meningitis can be life-threatening because of the inflammation's proximity to the brain and spinal cord; therefore, the condition is classified as a medical emergency. Signs and symptoms
In adults, the most common symptom of meningitis is a severe headache, occurring in almost 90% of cases of bacterial meningitis, followed by nuchal rigidity (the inability to
flex the neck forward passively due to increased nec kmuscle tone and stiffness). The classic triad of diagnostic signs consists of nuchal rigidity, sudden high fever, and altered mental status; however, all three features are present in only 44 –46% of bacterial meningitis cases. If none of the three signs are present, acute meningitis is extremely unlikely. Other signs commonly associated with meningitis include photophobia (intolerance to bright light) and phonophobia (intolerance to loud noises). Small children often do not exhibit the aforementioned symptoms, and may only be irritable and look unwell. The fontanelle (the soft spot on the top of a baby's head) can bulge in infants aged up to 6 months. Other features that distinguish meningitis from less severe illnesses in young children are leg pain, cold extremities, and an abnormal skin color. Nuchal rigidity occurs in 70% of bacterial meningitis in adults. Other signs of meningism include the presence of positive Kernig's sign or Brudziński sign. Kernig's sign is assessed with the person lying supine, with the hip and knee flexed to 90 degrees. In a person with a positive Kernig's sign, pain limits passive extension of the knee. A positive Brudzinski's sign occurs when flexion of the neck causes involuntary flexion of the knee and hip. Although Kernig's sign and Brudzinski's sign are both commonly used to screen for meningitis, the sensitivity of these tests is limited. They do, however, have very good specificity for meningitis: the signs rarely occur in other diseases. Another test, known as the "jolt accentuation maneuver" helps determine whether meningitis is present in those reporting fever and headache. A person is asked to rapidly rotate the head horizontally; if this does not make the headache worse, meningitis is unlikely. Causes Bacterial
The types of bacteria that cause bacterial meningitis vary according to the infected individual's age group. In premature babies and newborns up to three months old, common causes are group B streptococci (subtypes III which normally inhabit the vagina and are mainly a cause during the first week of life) and bacteria that normally inhabit the digestive tract such as Escherichia coli (carrying the K1 antigen). Listeria monocytogenes (serotype IVb) may affect the newborn and occurs in epidemics. Older children are more commonly affected by Neisseria meningitidis (meningococcus) and Streptococcus pneumoniae (serotypes 6, 9, 14, 18 and 23) and those under five by Haemophilus influenzae type B (in countries that do not offer vaccination).
In adults, Neisseria meningitidis and Streptococcus pneumoniae together cause 80% of bacterial meningitis cases. Risk of infection with Listeria monocytogenes is increased in persons over 50 years old. The introduction of pneumococcal vaccine has lowered rates of pneumococcal meningitis in both children and adults. Recent skull trauma potentially allows nasal cavity bacteria to enter the meningeal space. Similarly, devices in the brain and meninges, such as cerebral shunts, extraventricular drains or Ommaya reservoirs, carry an increased risk of meningitis. In these cases, the persons are more likely to be infected with Staphylococci, Pseudomonas, and otherGram-negative bacteria.[4] These pathogens are also associated with meningitis in people with an impaired immune system. An infection in the head and neck area, such as otitis media or mastoiditis, can lead to meningitis in a small proportion of people. Recipients of cochlear implants for hearing loss risk more a pneumococcal meningitis. Tuberculous meningitis, which is meningitis caused by Mycobacterium tuberculosis, is more common in people from countries where tuberculosis is endemic, but is also encountered in persons with immune problems, such as AIDS. Recurrent bacterial meningitis may be caused by persisting anatomical defects, either congenital or acquired, or by disorders of the immune system. Anatomical defects allow continuity between the external environment and the nervous system. The most common cause of recurrent meningitis is a skull fracture, particularly fractures that affect the base of the skull or extend towards the sinuses and petrous pyramids. Approximately 59% of recurrent meningitis cases are due to such anatomical abnormalities, 36% are due to immune deficiencies (such as complement deficiency, which predisposes especially to recurrent meningococcal meningitis), and 5% are due to ongoing infections in areas adjacent to the meninges. Viral
Viruses that cause meningitis include enteroviruses, herpes simplex virus type 2 (and less commonly type 1), varicella zoster virus (known for causing chickenpox and shingles), mumps virus, HIV, and LCMV. Fungal
There are a number of risk factors for fungal meningitis, including the use of immunosuppressants (such as after organ transplantation), HIV/AIDS, and the loss of immunity associated with aging. It is uncommon in those with a normal immune system [19] but has occurred with medication contamination. Symptom onset is typically more gradual, with headaches and fever being present for at least a couple of weeks before diagnosis. The most common fungal meningitis is cryptococcal meningitis due
to Cryptococcus neoformans In Africa, cryptococcal meningitis is estimated to be the most common cause of meningitis and it accounts for 20 –25% of AIDS-related deaths in Africa. Other common fungal agents include Histoplasma capsulatum, Coccidioides immitis, Blastomyces dermatitidis , and Candidaspecies. Parasitic
A parasitic cause is often assumed when there is a predominance of eosinophils (a type of white blood cell) in the CSF. The most common parasites implicated are Angiostrongylus cantonensis , Gnathostoma spinigerum, Schistosoma, as well as the conditions cysticercosis, toxocariasis, baylisascariasis, paragonimiasis, and a number of rarer infections and noninfective conditions. Non-infectious
Meningitis may occur as the result of several non-infectious causes: spread of cancer to the meninges (malignant or neoplastic meningitis ) and certain drugs (mainly nonsteroidal anti-inflammatory drugs, antibiotics and intravenous immunoglobulins). It may also be caused by several inflammatory conditions, such as sarcoidosis (which is then calledneurosarcoidosis), connective tissue disorders such as systemic lupus erythematosus, and certain forms of vasculitis(inflammatory conditions of the blood vessel wall), such as Behçet's disease. Epidermoid cysts and dermoid cysts may cause meningitis by releasing irritant matter into the subarachnoid space. Mollaret's meningitis is a syndrome of recurring episodes of aseptic meningitis; it is thought to be caused by herpes simplex virus type 2. Rarely, migraine may cause meningitis, but this diagnosis is usually only made when other causes have been eliminated Diagnosis CSF findings in different forms of meningitis Type of meningitis Glucose Protein low high Acute bacterial Acute viral
normal
normal or high
Tuberculous
low
high
Fungal Malignant
low low
high high
Blood tests and imaging
Cells PMNs, often > 300/mm³ mononuclear, < 300/mm³ mononuclear and PMNs, < 300/mm³ < 300/mm³ usually mononuclear
In someone suspected of having meningitis, blood tests are performed for markers of inflammation (e.g. C-reactive protein, complete blood count), as well as blood cultures. The most important test in identifying or ruling out meningitis is analysis of the cerebrospinal fluid through lumbar puncture (LP, spinal tap). However, lumbar puncture is contraindicated if there is a mass in the brain (tumor or abscess) or the intracranial pressure (ICP) is elevated, as it may lead to brain herniation. If someone is at risk for either a mass or raised ICP (recent head injury, a known immune system problem, localizing neurological signs, or evidence on examination of a raised ICP), a CT or MRI scan is recommended prior to the lumbar puncture. This applies in 45% of all adult cases. If a CT or MRI is required before LP, or if LP proves difficult, professional guidelines suggest that antibiotics should be administered first to prevent delay in treatment especially if this may be longer than 30 minutes. Often, CT or MRI scans are performed at a later stage to assess for complications of meningitis. In severe forms of meningitis, monitoring of blood electrolytes may be important; for example, hyponatremia is common in bacterial meningitis, due to a combination of factors, including dehydration, the inappropriate excretion of the antidiuretic hormone (SIADH), or overly aggressive intravenous fluid administration. Bacterial meningitis Antibiotics
Empiric antibiotics (treatment without exact diagnosis) should be started immediately, even before the results of the lumbar puncture and CSF analysis are known. The choice of initial treatment depends largely on the kind of bacteria that cause meningitis in a particular place and population. For instance, in the United Kingdom empirical treatment consists of a third-generation cefalosporinsuch as cefotaxime or ceftriaxone In the USA, where resistance to cefalosporins is increasingly found in streptococci, addition of vancomycin to the initial treatment is recommended. Chloramphenicol, either alone or in combination with ampicillin, however, appears to work equally well. Empirical therapy may be chosen on the basis of the person's age, whether the infection was preceded by a head injury, whether the person has undergone recent neurosurgery and whether or not a cerebral shunt is present. In young children and those over 50 years of age, as well as those who are immunocompromised, the addition of ampicillin is recommended to cover Listeria monocytogenes. Once the Gram stain results become available, and the broad type of bacterial cause is known, it may be possible to change the antibiotics to those likely to deal with the presumed group of pathogens. The results of the CSF culture generally take longer to become available (24 –48 hours). Once they do, empiric therapy may be switched to specific antibiotic
therapy targeted to the specific causative organism and its sensitivities to antibiotics. For an antibiotic to be effective in meningitis it must not only be active against the pathogenic bacterium but also reach the meninges in adequate quantities; some antibiotics have inadequate penetrance and therefore have little use in meningitis. Most of the antibiotics used in meningitis have not been tested directly on people with meningitis in clinical trials. Rather, the relevant knowledge has mostly derived from laboratory studies in rabbits. Tuberculous meningitis requires prolonged treatment with antibiotics. While tuberculosis of the lungs is typically treated for six months, those with tuberculous meningitis are typically treated for a year or longer. Steroids
Adjuvant treatment with corticosteroids (usually dexamethasone) has shown some benefits, such as a reduction ofhearing loss, and better short term neurological outcomes in adolescents and adults from high-income countrieswith low rates of HIV.] Some research has found reduced rates of death while other research has not. They also appear to be beneficial in those with tuberculosis meningitis, at least in those who are HIV negative. Professional guidelines therefore recommend the commencement of dexamethasone or a similar corticosteroid just before the first dose of antibiotics is given, and continued for four days. Given that most of the benefit of the treatment is confined to those with pneumococcal meningitis, some guidelines suggest that dexamethasone be discontinued if another cause for meningitis is identified. The likely mechanism is suppression of overactive inflammation .[ Early complications
Additional problems may occur in the early stage of the illness. These may require specific treatment, and sometimes indicate severe illness or worse prognosis. The infection may trigger sepsis, a systemic inflammatory response syndrome of fallingblood pressure, fast heart rate, high or abnormally low temperature, and rapid breathing. Very low blood pressure may occur at an early stage, especially but not exclusively in meningococcal meningitis; this may lead to insufficient blood supply to other organs. Disseminated intravascular coagulation, the excessive activation ofblood clotting, may obstruct blood flow to organs and paradoxically increase the bleeding risk. Gangrene of limbs can occur in meningococcal disease. Severe meningococcal and pneumococcal infections may result in hemorrhaging of the adrenal glands, leading to Waterhouse-Friderichsen syndrome, which is often fatal The brain tissue may swell, pressure inside the skull may increase and the swollen brain may herniate through the skull base. This may be noticed by a decreasing level of consciousness, loss of the pupillary light reflex, and abnormal posturing. The
inflammation of the brain tissue may also obstruct the normal flow of CSF around the brain (hydrocephalus). Seizures may occur for various reasons; in children, seizures are common in the early stages of meningitis (in 30% of cases) and do not necessarily indicate an underlying cause. Seizures may result from increased pressure and from areas of inflammation in the brain tissue. Focal seizures (seizures that involve one limb or part of the body), persistent seizures, late-onset seizures and those that are difficult to control with medication indicate a poorer long-term outcome. Inflammation of the meninges may lead to abnormalities of the cranial nerves, a group of nerves arising from the brain stem that supply the head and neck area and which control, among other functions, eye movement, facial muscles, and hearing. Visual symptoms and hearing loss may persist after an episode of meningitis. Inflammation of the brain (encephalitis) or its blood vessels (cerebral vasculitis), as well as the formation of blood clots in the veins (cerebral venous thrombosis) , may all lead to weakness, loss of sensation, or abnormal movement or function of the part of the body supplied by the affected area of the brain. (http://en.wikipedia.org/wiki/Meningitis)
BACKGROUND OF THE STUDY
1. Incidence, Race, gender, age, ratio and proportion Globally, most cases in children are caused by rotavirus. In adults,norovirus and Campylobacter are more common. Less common causes include other bacteria (or their toxins) and parasites. Transmission may occur due to consumption of improperly prepared foods or contaminated water or via close contact with individuals who are infectious. Prevention includes the use of fresh water, regular hand washing, and breast feeding especially in areas where sanitation is less good. The rotavirus vaccine is recommended for all children. It is estimated that three to five billion cases of gastroenteritis resulting in 1.4 million deaths occur globally on an annual basis, with children and those in the developing world being primarily affected. As of 2011, in those less than five, there were about 1.7 billion cases resulting in 0.7 million deaths with most of these occurring in the world's poorest nations. More than 450,000 of these fatalities are due to rotavirus in children under 5 years of age Cholera causes about three to five million cases of disease and kills approximately 100,000 people yearly. In the developing world children less than two years of age frequently get six or more infections a year that result in clinically significant gastroenteritis.
(Webber, Roger (2009). Communicable disease epidemiology and control : a global perspective (3rd ed.). Wallingford, Oxfordshire: Cabi. p. 79. .)
Gastroenteritis is associated with many colloquial names, including "Montezuma's revenge", "Delhi belly", "la turista", and "back door sprint", among others. It has played a role in many military campaigns and is believed to be the origin of the term "no guts no glory". Locally, In July 22, 2004, the Department of Health (DOH), Philippines declared an epidemic (outbreak) of a water/food-borne disease called acute gastroenteritis in 45 towns in Central Pangasinan. Acute gastroenteritis is a human enteric (intestinal) disease primarily caused by ingestion of spoiled www.scribd.com/doc/143216255/Introduction or bacterial contaminated water or food.
2. OBJECTIVES General:
To improve the knowledge and skills that the nursing students have learned on their Related Learning Experience in approaching to the client’s condition, also to apply the attitude that they should have in rendering care to the patient To gather important and pertinent information regarding the client’s data Specific:
a) To understand the disease process, the nature, the signs
and symptoms, and the treatment for the problem of to consider bacterial meningitis age with moderate sign of dehydration ruled out electrolyte imbalance the patient.
b) To determine pharmacologic interventions including their therapeutic effect and the adverse effects. c) To enhance skills in doing independent and defective nursing interventions to the clients 3. Rationale for Choosing the case
The group decided to make this case as their chosen one, for this case is one of the unique cases that they have encountered in our duty within the hospital not just because of the predisposing factors but also by its precipitating factors affecting it. Also, since the client is a pre-school, his mother can give relevant information which may support the study. 4. Significance of the studies The importance of the study is that, it will enhance the skills of the student nurses in assessing the patient and also it will be added to their knowledge according to the case of the chosen case of the client. The study will also teach the students to learn how to interconnect with other health care providers and to be more familiar with those documents that the hospital has with their clients 5. Scope of limitation of the study The study will only focus about the case of the client which is t/c bacterial meningitis AGE with moderate sings of dehydration R/O electrolyte imbalance which is the condition of the chosen client and to the other relevant information about the case of the client.
Conceptual and Nursing Theory
DOROTHEA ELIZABETH OREM (“SELF-CARE DEFICIT NURSING THEORY”)
Since that Orem’s theory, defines self -care as the practice of activities that individuals initiate and perform independently on their behalf in maintaining life, health, and wellbeing. (Udan, 2011) According to Orem, you can say that a person is having a self-deficit when he is unable to carry out his own self-care. (Udan, 2011) In our case, the patient lacks care to himself. Even though he is a child the patient should be able to do basic self care like going to the bathroom and taking a bath and eating by himself , he is very active and was always on the move the mother doesn’t seem to have any control of her child when it comes to eating , that’s why it’s maybe he reason of his hospitalization For our client, Orem stated 5 methods of helping him to conquer self-care deficit. First, is acting for and doing for others, as his student nurse, we should help him in things he can’t do while he’s confined. Doing dependent activities wherein we can help h im. Also by providing an environment to promote patient’s ability and teaching h im the proper things to do for his situation.
